How to Raise a Healthy Child by Robert Mendelsohn

1. How to Raise a Healthy Child by Robert Mendelsohn

How to Raise a Healthy Child by Robert Mendelsohn

Robert S. Mendelsohn

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ONE OF AMERICA’S LEADING PEDIATRICIANS PUTS

PARENTS BACK INCONTROL OF THEIRCHILDREN’S HEALTH

Howtoraise a

HEAKfflY

PL

Spite of

TOUR DOCTOR

Ballantine / Del Rey /Fawcett / Ivy /Presidio Press

CO> EAN

ROBERT S. MENDELSOHN, M.D., hasbeen practicing pediatrics for almostthirty years. He has been the nationaldirector of Project Head Start’s MedicalConsultation Service, chairman of theMedical Licensing Committee for theState of Illinois, and associate professor ofPreventive Medicine and CommunityHealth in the School of Medicine of theUniversity of Illinois. Dr. Mendelsohn hasreceived numerous awards for excellencein medicine and medical instruction.

Sale of this book without a front cover may be unauthorized.If this book is coverless, it may have been reported to thepublisher as “unsold and destroyed” and neither the authornor the publisher may have received payment for it.

A Ballantine Book

Published by The Random House Publishing GroupCopyright © 1984 by Robert S. Mendelsohn, M.D.

All rights reserved.

Published in the United States by Ballantine Books, animprint of The Random House Publishing Group, a divisionof Random House, Inc., New York, and simultaneously inCanada by Random House of Canada Limited, Toronto.

Ballantine and colophon are registered trademarks of RandomHouse, Inc.

ISBN 0-345-34276-3

www.ballantinebooks.com

This edition published by arrangement with ContemporaryBooks, Inc.

Manufactured in the United States of AmericaFirst Ballantine Books Edition: June 1987

OPM 39 38 37 36 35 34 33 32 31

Contents

Introduction id

1. Most Things Get Better by Morning 1

Why most childhood illnesses do not

require medical treatment, and needlesstreatment may do more harm than good

2. Parents and Grandparents Are Wiser than

Doctors 6

Why you are a better guardian of your

child’s health than your doctor is; how totell when your child is really sick; how toknow when to call a doctor

3. How Doctors Can Make Healthy Kids Sick 18Shortcomings of pediatricians; damage done

by unnecessary treatment; invalidity ofstandard growth charts; why you shouldavoid routine physical examinations andwell-baby checkups

4. Protecting Your Children before They Are

Born 30

Threats to your child’s health before he isconceived, during pregnancy, during labor,during delivery, and in the hospital nursery

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5. Proper Nutrition for Health and Growth 51

The importance of breastfeeding; when tointroduce solid foods; the pre-adolescentdiet; why you should choose natural foods,unprocessed and untainted by chemicaladditives

6. What You Should Expect of Your Child 63

Why comparisons of physical and

behavioral development don’t make sense;common parental concerns about physicaldevelopment and childhood behavior; whatyou have the right to expect and what youdon’t

7. Fever: Your Body’s Defense against Disease 73Exploring the myths about fever; what’s

“too high;” should fevers be controlled?;fever and convulsions; fever and brajndamage; the value of fever in fightingdisease

Quick Reference Guide to Fever 86

8. Headache: Usually Emotional, but the Pain

Is Real 89

Causes of headaches; headaches as asymptom of disease; what treatment togive; when a doctor is neededQuick Reference Guide to Headaches 99

9. Mother, My Tummy Hurts! 102

Causes of abdominal pain; when it requirestreatment; emotional causes; allergies;appendicitis; poison

Quick Reference Guide to Abdominal Pain

109

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10. Coughs, Sneezes, and Runny Noses III

Facts about the common cold andinfluenza; overtreatment of symptoms;misuse of antibiotics for viral infections;pneumonia; croup

Quick Reference Guide to Coughs, Colds,and Influenza 120

11. The Mythical Menace of Strep Throat 123

Causes of sore throat; misconceptionsabout strep, rheumatic fever, and rheumaticheart disease; beware of tonsillectomiesQuick Reference Guide to Sore Throats 136

12. Earaches: Painful, Yes; Dangerous, Rarely 140Treatment of ear infections; objects in the

ear; removing wax; use of antibiotics,tympanostomy; the once-feared mastoid;relieving pain; when to see a doctorQuick Reference Guide to Earaches 151

13. Protecting Your Child’s Vision 153

Value of periodic eye exams; glasses forchildren; crossed eyes; lazy eyes;conjunctivitis; styes; myths about eyes

Quick Reference Guide to EyeProblems 160

14. Skin Problems: The Curse of Adolescence 162Diaper rash; heat rash; acne and Accutane;impetigo; eczema; ringworm

Quick Reference Guide to SkinProblems 180

15. Skeletons in the Orthopedic Closet 183

Overtreatment of self-correcting conditions:

flat feet, bowed legs, knock-knees, pigeontoes, congenital hip dysplasia, scoliosis;myths about shoes

Quick Reference Guide to OrthopedicProblems 189

16. Accidental Injuries: Medicine at Its Best 191

What to do when your child has an

accident; cuts and abrasions; bums; headinjuries; poisoning; sprains, strains, andfractures; choking; animal bites; frostbite;automobile accidents; household safetyprecautions

Quick Reference Guide to AccidentalInjuries 210

Household Safety Precautions 211

17. Asthma and Allergies: Try Diet, Not Drugs 213Allergies as the cause of illness; types ofallergies; diagnosing allergic causes; use ofelimination diets; hazards of drugs used intreatment; controlling asthma

Quick Reference Guide to Allergies 218

18. The Child Who Never Sits Still 220

Overdiagnosis of hyperactivity; dangers of

drug treatment; dietary control ofoveractivity; sense and nonsense aboutlearning disabilities; the inadequacy ofpsychological and psychiatric counseling

19. Immunization against Disease: A Medical

Time Bomb? 230

The risks of immunization; is immunizationbeneficial and necessary?; when to seektreatment for childhood diseases; symptomsand home treatment of chicken pox,mumps, measles, rubella, whooping cough,

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diphtheria, scarlet fever, meningitis,tuberculosis, SIDS, poliomyelitis, infectiousmononucleosis

20. Hospitals: Where Patients Go to Get Sick! 254Why you should avoid hospitalization ofyour child if possible; the frequency ofhospital-caused illnesses; the emotionaltrauma of hospitalized children; how toprotect your child in the hospital; needlesssurgery

.21, How to Select the Right Doctor for Your

Child 260

The threat posed by an excess ofpediatricians; a doctor’s psychological andfinancial incentives to overtreat patients;the hallmarks of a competent, conscientiouspediatrician

Author’s References 264

Index

271

Introduction

This book reflects my belief that in pediatrics, as inother specialties, a great deal of bad medicine is prac-ticed in the United States. That does not imply, however,that doctors have less integrity or compassion than therest of mankind. The shortcomings lie within the philoso-phy and teaching of medicine, not in the character ofthose who are taught.

Doctors aren’t culprits. Like their patients, they arevictims of the system. They are the first to be impairedby medical education’s preoccupation with interventionrather than prevention, its infatuation with drugs andtechnology, and the indefensible rituals, mores, and ego-tistical attitudes that are burned into the brain of everystudent who survives the rigid and often irrelevant cur-riculum and training. They emerge with their heads sostuffed with institutionalized foolishness that there is noroom left for common sense.

I don’t exempt myself from this criticism of other pe-diatricians. I confess that I began my medical practicebelieving most of what I had been taught, and my pa-tients paid the price for many years. Fortunately, per-haps because I began teaching medical students myself, Ilearned to question many of the medical principles thathad been drilled into me and to suspect every new drug,surgical procedure, and medical “innovation” that came

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along. I soon discovered that most of them couldn’twithstand rigorous scientific evaluation and that an in-credible percentage of the “wonder drugs” and “revolu-tionary procedures” soon disappeared when it wasdiscovered that they did more harm than good.

In my two previous books. Confessions of a MedicalHeretic and Male Practice: How Doctors ManipulateWomen, I sought to caution my readers about the haz-ards of blind faith in the American medical profession. Itwas not my purpose then, nor is it now, to discourage myreaders from seeking needed medical attention. Despitethe shortcomings of their education and training, doctorsdo save lives, and they do make sick people well. Theyare at their best when challenged by medical emergen-cies and at their worst when they feel compelled—asthey were taught to do—to treat people who aren’treally sick.

I hoped, in those books and this one, to alert you tothe deficiencies of medical practice so that you would beprepared to defend yourself against dangerous and inap-propriate medical treatment. As a subsidiary objective, Ireasoned that if enough patients began to question theirdoctors about the treatments they prescribed, the doc-tors might begin to question them, too.

It may be coincidental, and much of the progress mustbe credited to other critics within and outside my profes-sion, but there is strong evidence that these objectivesare being achieved. Many doctors are being prompted bytheir patients and by the media to question their ownmedical beliefs. I know this is true, because my col-leagues frequently tell me so and because surveys ofdoctors indicate that a growing number of patients arerefusing to take their doctor’s opinions at face value.

Patients have become less in awe of their doctors, lessdocile and compliant. Doctors are no longer—in theminds of many patients—invested with scientific infalli-bility. Instead, they are being compelled to search forplausible answers to tough questions about the drugsthey prescribe, the tests they order, and the surgery they

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recommend. The impact is great when a doctor repeat-edly finds himself looking for defensive answers thataren’t there.

Many of the doctors I know welcome these changes,but others find them disconcerting when they are unableto explain or to defend many of the drugs and proceduresthat they have prescribed routinely in the past. In eithercase, however, the new awareness of the shortcomingsof conventional medical practice is yielding constructivechanges. When doctors are compelled to question theirown behavior, to reconsider objectively many of thethings that they have been taught, and to cast an eye onprevention rather than intervention, their patients inevi-tably enjoy beneficial results.

Many reforms have emerged in the last three or fouryears that constitute belated recognition by doctors thatthe side effects of many drugs are more dangerous thanthe ailments they seek to correct, that elective surgery isoften unnecessary and always dangerous, and that therisks of many routine tests, x-rays, and examinations aregreater than those of the diseases that they are employedto detect.

During the last few years many of medicine’s mostcherished procedures have come into disrepute becausethey could not withstand the public scrutiny to whichthey were being subjected. For example:

• The American Academy of Pediatrics has ad-vised against routine administration of chest x-rays when children are admitted to hospitals, atacit acknowledgment of the potential cumulativehazards of radiology.

• The Academy has also reversed its position onroutine use of the tuberculin test, except in areasof high incidence of the disease. Hopefully, thismay be the first step toward elimination of alldangerous and unnecessary screening tests andimmunizations that benefit the doctors who ad-minister them more than their patients.

The routine annual physical examination hasbeen scrapped by the American Medical Associ-ation.

The American Cancer Society (ACS) no longerrecommends routine annual Pap smears and, fora time, also stopped recommending routine peri-odic mammographies. Although no convincingnew evidence has emerged to support the deci-sion—other than the outcry of underemployedradiologists—the ACS has reversed its positionagain. It now maintains that a mammographyevery one or two years is a safe and highly rec-ommended practice for symptomless women,ages 40 to 50. This is in contradiction of theguidelines set by the National Cancer Institute in1977, which restrict X-rays screening in this agegroup to women with a personal or family historyof breast cancer. In my view, annual mammogra-phies for symptom-free women are a form ofself-fulfilling diagnosis. Perform enough of themand they may produce the breast cancer they areused to detect!

Routine chest X-rays, once considered so essen-tial that mobile units provided access to them,have gone by the boards.

Although the pharmaceutical companies keepchurning out new drugs, there is increasing pa-tient resistance to overmedication, and fewerdrugs are being prescribed. The number of pre-scriptions filled in 1980 was. 100 million fewerthan in 1974. Perhaps as a consequence, the drugindustry is putting enormous pressure on theFood and Drug Administration to permit it to ad-vertise prescription drugs to consumers, not justto doctors.

Tranquilizer prescriptions dropped from 104.5million in 1973 to 70.8 million in 1981. The use ofValium—a major source of drug overdose fatali-ties—has been cut in half from a peak of 62 mil-lion prescriptions in 1975.

• Sleeping pill prescriptions dropped from a high of40 million to 21 million in 1980.

• Increasing numbers of women are rejecting thePill and intrauterine birth control devices be-cause of the hazards they present.

• Breastfeeding is on the rise—a boon to bothmothers and babies—despite the continuing fail-ure of many obstetricians and pediatricians to en-courage it with vigor.

• Obstetrical procedures are being questioned andmodified, and there is a slow but gradual move-ment toward natural childbirth and even homebirth.

These remarkable alterations of cherished medicalpractices and procedures make it clear that the profes-sion is responding to a rising chorus of criticism. Not so,however, in my own specialty—pediatrics—which hasemerged relatively unscathed and unaltered until now. Inthe pages that follow I will expose pediatric practice tothe same critical scrutiny that I devoted to other seg-ments of the medical profession in earlier books. Butbecause pediatrics is my specialty, which I have prac-ticed and taught for more than a quarter-century, I feelcompetent to do more than point out its flaws. This bookwill offer appropriate advice to parents who want toavoid the risk and expense of needless intervention whileproviding the care that will assure the health of theirchildren. (For literary convenience—yours and mine—the pronoun he will be used throughout this book to referto both boys and girls.)

Without attempting to be encyclopedic, I will offerspecific advice on the medical problems that your childis likely to encounter from the moment of conception tothe day he leaves the nest. You will learn how to tellwhen he is seriously ill, how you can deal wifh problemsthat don’t require medical attention, how to determinewhen you should call your doctor, and hotf to assure

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that the treatments prescribed for your children are ap-propriate and safe.

With this basic information all parents can assume alarger role in maintaining the health of their children.However, this does not mean that you should assume thedoctor’s role, doing badly those things that a good doctorcan do well. Despite the deficiencies of medical schools,doctors do learn technical skills that parents should nottry to perform. This book will teach you what you needto know to care for most of the ills that may afflict yourchild, but also how to know when prudence demandsthat you employ a doctor’s skills.

If you read the chapters that follow carefully, they willresolve most of your doubts and fears about the health ofyour child and help you prepare him or her for a long,healthy, and happy life!

Robert S. Mendelsohn, M.D.

Evanston, Illinois

1

Most Things GetBetter by Morning

A'his book was written for parents who are seekingadvice on how to raise healthy children, parents who areeager to give their kids a good start in life without en-trusting all of the medical decisions to their pediatri-cians. My purpose is to help you determine when yourchild needs medical attention and when medical inter-vention should be avoided because it may do more harmthan good. I also intend to alert you to the hazards ofdrugs, tests. X-rays, and other treatments that your pedi-atrician may want to employ—forms of medical inter-vention that may actually inflict damage on your child.

Pediatricians er\joy one significant advantage overother medical specialists because they can exploit thewholesome tendency of most parents to be more con-cerned about the health of their children than about theirown health. Think about that for a moment. If youawaken at night with a splitting headache, what do youdo? If you are like most adults, you probably get up,take an aspirin, and go back to bed. Very likely you soonfall asleep and feel fine when you wake up in the morn-ing.

Now consider how you react when your childawakens in the middle of the night with the same symp-tom. Your first impulse may well be to talk to your pedi-atrician as soon as you can get him on the phone.

If you reach the doctor instead of his answering ser-

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vice, his response is predictable. Chances are he’ll ask,“Did you take his temperature?” Then, whatever yourresponse, “Well, I don’t think it is anything to worryabout. Give him an aspirin and bring him to the office inthe morning.” You hang up the phone, regretting thatyou made the call, give Jimmy the aspirin, and he soongoes back to sleep. So do you. You are relieved whenJimmy awakens in the morning, eagerly demanding hisbreakfast, and chipper as can be. After he’s been fed,you wonder whether to take him to the doctor or ignorethat request and spare yourself the effort and expense.

That’s the way that scene is usually played, and it’s abad scene that parents should avoid. With a simple head-ache as the only symptom, there was no need to call thedoctor, and even less reason to see him in the morning.Unless your child displays evidence of serious illness, avisit to his pediatrician will yield no benefit but may in-vite needless medical interventions that could make awell child sick!

If you have read other books on child health, you willappreciate that this is an unconventional view. Most ofthose books are written by doctors, and even those thathonestly acknowledge the self-limiting nature of mostchildhood ailments are consistent with all the others inone respect. Whatever the symptom or ailment, “Seeyour doctor” is the bottom line. The thesis of this book,predicated on nearly three decades of pediatric teachingand practice, is not “See your doctor.” That may sur-prise you, but what I have learned during those years isthat the vast majority of childhood illnesses do not re-quire medical attention and that, when they receive itneedlessly, the treatment given may do more harm thangood. Consequently, my advice to parents, based on longobservation of the behavior of other doctors, and myown experience in treating thousands of children, is“Avoid your doctor whenever you can.”

Let me share with you some other premises that formthe basis for that advice and the recommendations that Iwill make in the pages that follow:

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• At least 95 percent of the ailments that childrenare prey to will heal themselves and do not re-quire medical attention.

• Too often, the risk of careless or needless medi-cal intervention is greater than the dangers of theillness itself.

• Pediatricians spend most of their time treatingparental distress. The child rarely needs treat-ment but gets it anyway and is subjected to theconsequences, and it is the parent who gets therelief. That’s because most doctors believe thatparents demand, or at least expect, that they willdo something for the child. What concerned par-ents really need is reassurance, and what theirkids don’t need is treatment when they aren’treally sick. Most doctors won’t take the time toprovide meaningful parental reassurance; it isquicker and easier to write a prescription for thechild.

• Mother Nature, mothers, grandmothers—yes,even fathers and grandfathers—are the best doc-tors around, because they do not share the typi-cal doctor’s compulsion to interfere with thebody’s efforts and ability to heal itself.

• At least 90 percent of the drugs prescribed bypediatricians are unnecessary and a costly risk tothe child who takes them. All drugs are toxic andthus dangerous, per se. Beyond that, excessivechildhood use of prescription drugs may generatethe belief that there is “a pill for every ill.” Thismay lead the child to seek chemical solutions toemotional problems later in life.

• At least 90 percent. of children’s surgery isunnecessary, needlessly exposing the patient tothe risks of death from the surgery itself, fromanesthesia, or from infections contracted in thehospital, which is an inescapably germ-ridden environment.

• Most pediatricians have received little dr no edu-

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cation covering the fundamentals of nutrition andpharmacology, and no emphasis is placed onthese vital subjects in medical school. Their pa-tients suffer because of the pediatricians’ igno-rance of the impact of diet on health and of thehazards and side effects of the drugs he pre-scribes.

• Parents need to learn when to call a doctor, andwhat they can do, without a doctor’s interven-tion, to reinforce the body’s ability to heal itself.

I realize that I would be placing an unfair burden onyou, as a parent, if I simply described the shortcomingsof pediatric practice and urged you to avoid doctors andassume greater responsibility for your children’s health.It is one thing for you to accept that kind of advice whenyour own health is involved and quite another to acceptit when you are making medical decisions in behalf of abeloved child.

This understandable ambivalence places parents atthe mercy of their pediatricians. Most of the childrenseen by pediatricians require no treatment, but theyoften get it anyway. Your child’s doctor has strong in-centives to make you feel better by treating your child.That behavior does not square with my ethical precepts,but in practice the pediatrician who employs it is re-warded financially and psychologically for “curing” achild who wasn’t seriously ill.

The financial incentives derive from the fact that adwindling number of patients and an increasing over-supply of pediatricians are combining to curtail the in-come that pediatric practices generate. In order tostabilize his annual income, the doctor has an incentiveto intervene more aggressively, performing questionabletests and treatments, so that he can extract increasedfees from each patient he treats. This incentive will un-doubtedly grow in the years ahead, as the oversupply ofpediatricians becomes an even larger problem for thedoctors in this field.

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The psychological incentive stems from the pediatri-cian’s need to feel that he is doing something productive.That’s not easy for him to do when most of the patientshe sees don't really need his skills.

Surveys of pediatricians have shown that many do notfind their work rewarding; as many as one-third indicatethat they are seriously considering changing their careerdirection to obtain “greater challenge” or because theyfeel “burned out.” For some, the temptation to displaytheir knowledge and thus win the gratitude of parents,even when the treatment is superfluous and even poten-tially damaging, can be overwhelming.

This indefensible medical behavior is a real threat toyour child. You need to be constantly alert to the defi-ciencies of pediatric practice so that you can monitor thebehavior of your child's doctor and avoid hazardoustreatment that he doesn’t need. But simply knowingwhat's wrong with pediatricians isn’t much help whenyour child has a headache, or a pain in the belly, or aracking cough—and a fever, to boot. You need the abil-ity to identify the conditions that require medical atten-tion and distinguish them from those that will most likelycure themselves. Most parents also need to know moreabout the treatments to avoid or even reject becausethey are inappropriate and potentially harmful to theirchildren.

Because most childhood illnesses respond to norma]bodily defenses that may be impeded by medical treat-ment, use of your natural skills is usually preferable tothose of a doctor in giving your child the help he needs.Moreover you will play the principal role in helping yourchild avoid illnesses by providing the wholesome nutri-tion that he needs and by making certain that he avoidsthe foods he shouldn't have. This book is intended tohelp you by providing the information you need to shar-pen your skills and give you confidence as you raise yourhealthy child.

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Parents andGrandparents AreWiser than Doctors

arents often believe I’m joking when I tell them thatmothers, fathers, and grandparents are more capablethan doctors of managing the health of children. Yet Ifirmly believe it, for reasons that are at once simple andprofound.

Unless you have passed the half-century mark andwere brought up outside the major cities of our country,you can’t be expected to remember the classic “familydoctor,” for today there are scarcely any to be found.Those of us who can remember them are apt to do sowith feelings of warmth and affection, for we recall thefamily doctor as a friendly, sensitive, unpretentious,reassuring, compassionate figure in our lives.

The family doctor of that era often had been inti-mately involved with our families for two, three, andeven four generations. He knew each of us as individualpersonalities, was sensitive to our attitudes, moods, andidiosyncrasies. He viewed us as human beings in need ofhelp, not as clinical subjects for all of the technologicaland pharmacological interventions that doctors todayhave substituted for careful examination and commonsense.

Our family doctor knew our medical histories andoften those of our parents and grandparents as well.6

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Most of the time he listened to us without impatience,answered our questions thoughtfully, calmed our fears,and explained simply and clearly what was going on inour bodies and our minds. His office was warm, comfort-able, and nonthreatening, and he had a personality tomatch it. If we felt too sick to go there, he came to us,believing that it made more sense for a healthy doctor tovisit a sick patient than vice versa. He didn’t let his med-ical education and his ego get in the way of his humanityand his common sense. If we needed a pill, we got one,but more often he allayed our fears and anxieties withnothing more than calm reassurance and a friendly paton the head and let nature do its work without interfer-ence.

I’ll confess that in my mind’s eye this appealing ghostmay be somewhat romanticized, but even allowing forthat, what he was is what today’s doctors should be.Unfortunately, few of them are, so it falls to you, theparent, to assume that role in maintaining the health ofyour child.

How can I assert that parents, with no medical train-ing, are better able than pediatricians to meet most of thehealth needs of their children? Simply because you arewilling and able to give your children time and attention,and your doctor is not. The most important elements inthe diagnosis of illness are behavior change, appearance,and the medical history of the child. As the parent, youare extremely sensitive to your child’s behavior patterns,quick to note a change in his or her appearance, andtotally familiar with the child’s medical history, yourown, and probably those of your parents as well. Thetypical pediatrician, whose assembly line spews out 30,40, or even 50 patients a day, doesn’t know your child asyou do and has neither the time nor the inclination tolearn. All of his technology—his tests and shots and x-rays and drugs and theory—in most instances are nosubstitute for the commonsense care that you, as an in-formed parent, can provide.

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That’s why your pediatrician can never be the pri-mary authority on whether your child is sick and whyyou should never let him be. You are far better qualifiedto judge the physical condition of your child than yourdoctor is, simply because you know the child better. Youlive with your kids and observe their behavior and ap-pearance with interest and concern, day by day.

GUIDELINES FOR DIAGNOSIS

If your child doesn’t feel sick, look sick, and act sick,the odds are that he isn’t sick, or certainly not sickenough to require medical attention. How many timeshave you been tempted to call the doctor when yourchild complained of a stomachache or headache and thenwere glad that you didn’t when you found him rough-housing with his brothers and sisters within an hour ortwo?

I have just given you the first of three rules that youcan use to guide you in diagnosis, but I’ll repeat it be-cause it is the most important:

Rule No. 1: If your child doesn’t feel sick, look sick, andact sick, he probably isn’t sick.

Rule No. 2: Give Mother Nature ample time to work hermagic before you expose your child to the potentialphysical and emotional side effects of treatmentsthat your doctor may administer. The human bodyhas a remarkable capacity to heal itself—a capac-ity that in most cases surpasses anything that medi-cal science can do—and it doesn’t produceunwanted side effects.

Role No. 3: Common sense is the most useful tool indealing with illness. Your doctor is less likely toemploy it than you are, and certainly no more able,

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because that’s not what they taught him in medicalschool!

Granted, there are infrequent illnesses of critical na-ture for which competent medical treatment is essential,but in the case of children they are the exception ratherthan the rule. The obvious question is “How can parentstell which ones are serious and which are not?”

The answer is that you can’t always tell, and for thatmatter, neither can your doctor. However, when youhave finished reading this book you will be able to deter-mine the seriousness of most of your child’s ailments andwill need to consult a doctor only in the limited numberof instances when you are in doubt.

I have observed, in both the teaching and the practiceof medicine, that most doctors do a competent job oftreating patients who are very sick and a miserable job ofcaring for those who are well. This is the major flaw inmedical education. The medical student and the pediatricresident, for that matter, learn precious little about howto keep children well, because their education beginswith the premise that everyone who comes to their officewill require treatment.

In medical school the student gets about three monthsof pediatric instruction, devoted largely to the discussionof childhood diseases that had importance decades agowhen the curriculum was written but now have virtuallydisappeared. He absorbs a lot of biased informationabout immunizations but is taught very little about phar-macology, despite the fact that as a practicing physicianhe’ll hook more kids on drugs than the most diligentpusher in town.

Only about 60 hours are devoted specifically to phar-macology during four years in the typical medicalschool, and most of that time is spent absorbing irrele-vant information about abstract pharmacological theory.Ultimately, most of what doctors know about the drugsthey administer to their patients is taught them by an

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army of pharmaceutical salesmen/promoters euphemisti-cally known as “detail men.” If you were to equate thisrelationship to the distribution of street drugs, the detailman would be the supplier and the doctor the pusher.

DOCTORS AREN’T TAUGHT THEIMPORTANCE OF NUTRITION

Virtually nothing is done in medical school to teachstudents that nutrition may often be the most importantelement of diagnosis and treatment. Consequently, theybegin their practice unaware that food allergies are theprimary cause of many childhood ailments and that ade-quate nutrition is the basis of good health. This igno-rance compels them to use drugs in the treatment ofdiseases that could have been cured with a simplechange in diet.

If the medical student has the opportunity to get somebrief hands-on experience in a well-baby clinic, he won’tlearn very much about the real world of medicine he issoon to enter. Virtually all of his time will be spent ad-ministering immunizations, dispensing vitamins, andpassing out samples of infant formula supplied by themanufacturer’s detail man. The patients he sees havecome to the clinic for routine, periodic physical examina-tions, so he’ll rarely see a patient who is really sick andisn’t taught how to recognize one who is.

Fledgling doctors are taught to scoff at the holistichealth practitioners, at nutritional therapy, and at anyother form of health care that does not require an M.D.They learn to rail at “quackery,” yet no one points out tothem the abundance of quackery that exists within con-ventional medicine itself. How can any doctor rational-ize condemning those who treat patients with Laetrilewhen he has been guilty of feeding his own patients Ben-dectin, Oraflex, Zomax, or thalidomide, until they were

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removed from the market because of the damage attri-buted to them?

What little doctors learn about breastfeeding, themost effective long-term health protection a child canobtain, is usually taught by male doctors who, for obvi-ous reasons, have little interest or experience in this vitalfunction. Despite its enormous influence on the develop-ment and ultimate health of your baby, which I will dis-cuss later, I heard only one lecture on breastfeedingduring four years in medical school. But the formulamakers were wide awake while my instructors slept, andI was brainwashed by a deluge of literature that theysupplied.

What students do learn in medical school seems torelate as much to succeeding in business as to keepingtheir patients well. They are taught to behave like doc-tors, to project the appearance and demeanor of omnipo-tence, so their patients will hold them in awe.

You may assume that the inadequacies of medicalschool are overcome during the pediatric residency, butthey’re not. There the resident deals with hospitalizedpatients and learns to use cannon to fend off mosquitoesbecause of the emphasis on hazardous diagnostic tech-nology, surgery, and other drastic procedures that aretypical of the hospital routine. He still gets little or noexperience in dealing with the vast majority of childhoodillnesses that are brought to a pediatrician for care.

That translates, in private practice, to a compulsion tooverreact to simple illnesses with dramatic forms of in-tervention; it is a hazard that demands your constant vig-ilance. I’ll be more specific about that throughout thisbook.

When he completes his residency and opens his firstoffice, the typical pediatrician is poorly educated andlargely unskilled. He knows very little about the risks ofthe drastic treatments he administers, the side effects ofthe drugs he prescribes, the risks of the surgery heorders or performs, the possible inaccuracy of the tests

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on which he relies, or the shortcomings of the medicaltechnology he employs. He knows virtually nothingabout the most critical items in pediatric health care—the impact of nutritional, allergic, psychological, andemotional factors on the well-being of his patients.

Pediatricians actually spend most of their time treat-ing patients who don’t need treatment and refer to spe-cialists most of those who are injured or seriously ill. Infact, the referral of patients to other specialists is such anintergral part of their function that they are sometimesreferred to as “access managers” within the medical pro-fession.

Perhaps because I’ve been a pediatrician for so long, Ihave little remaining conviction that a specialist isneeded to perform this function. Most childhood ill-nesses can be treated competently within the home, byinformed and caring parents. When medical treatment isindicated it can be provided as well by general practi-tioners or family practitioners or by specialists to whomtheir patients are referred. In fact, given the opportunity,nurse-practitioners could perform most of these func-tions equally well. That is actually the practice in manyother countries that have only a relative handful of pedi-atricians yet produce medical outcomes that are betterthan ours.

It may seem anomalous, but those outcomes are bet-ter because there are fewer pediatricians. Children inthose countries are healthier because there is less medi-cal intervention and thus less exposure to potentiallydamaging drugs and medical technology. AlthoughAmerican medical schools teach their students very littleabout pharmacology, they do teach them to exploit all ofthe new drugs and medical technologies that are avail-able. New drugs and equipment appear almost daily,spawned by the laboratories of the pharmaceutical in-dustry and the medical equipment manufacturers. Moreoften than not, they are unproven and potentially unsafe.

Most parents assume, as they should have the right

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to, that they can rely on the federal Food and Drug Ad-ministration to keep drugs off the market until they havebeen proven safe for human use. Most doctors, whodon’t have the right to because they know better, operateon that premise, too. This confidence in the FDA is mis-placed, because virtually all drugs are released withoutappropriate or significant human trials. They may haveimmediate or short-term effects of some patients thathave not been discovered. Even more likely is the possi-bility of cumulative and long-term effects, which 1 willdiscuss more fully in a later chapter. These long-termeffects are never known at the time new drugs are intro-duced and perhaps not for decades after that, when un-told harm has already been done to unsuspectingvictims.

The history of medicine, here and abroad, is repletewith examples of drugs approved for human use thatwere removed from the market only after countless vic-tims bore evidence of the damage they caused. You mayrecall some of the more sensational examples—DES,MER 29, thalidomide. To compound the problem, al-though the FDA has the power to keep unproven drugsoff the market, it has virtually no authority to force theirremoval once they have been approved. It also lacks aneffective postmarketing surveillance mechanism thatwould alert it and the public to the appearance of de-structive effects from the drugs that have been released.That’s why the hazards of drugs are most often publiclyrevealed in European nations, which do exercise post-marketing, surveillance that brings their risks to light.

DOCTORS RARELY INVESTIGATETHE DRUGS THEY USE

It is a rare doctor, indeed, who investigates the teststo which a drug or a treatment has been subjected beforehe begins to use it on his patients. Even when doubts are

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raised about commonly prescribed drugs, most doctorspay no attention to them. The manufacturers of severalof the drugs doctors most frequently prescribe for chil-dren have been ordered by the FDA to offer proof thatthey are safe and effective or remove them from themarket. The manufacturers have been sparring with theFDA for years, while still selling these drugs. In mostinstances they have yet to come up with proof that thesedrugs are any good, yet doctors keep right on prescribingthem. I'm not talking about a handful of drugs but—lit-erally—hundreds of them.

It seems almost incredible, but American parentsspend millions of dollars every year on drugs that theirdoctors have prescribed without any evidence that thedrugs are effective or safe or, worse, in the face of re-sponsible allegations that they are not. Of the 30 drugslabeled ineffective by the FDA that were most frequentlyprescribed in 1979, more than half—including the topthree—are often prescribed for children. Those on thelist include Dimetapp, Actifed, Donnatal, Omade Span-sules, Phenergan Expectorant, T\iss-Ornade, PhenerganVC Expectorant with Codeine, Actifed C Expectorant,Bentyl, Phenergan Expectorant Plain, Benylin CoughSyrup, Mam and Marax DF, Dimetane Expectorant,Ambenyl Expectorant, Dimetane Expectorant DC, andTeldrin. Next time your doctor prescribes one of themfor your child, ask him why he is using a drug that themanufacturer has been unable to defend as doing anygood.

During the early years of my practice, when I was stillnaive enough to believe what they had taught me in med-ical school, I was guilty of the same sort of behavior.During my pediatric residency I was taught to use x-raysto treat the tonsils, acne, ringworm of the scalp, and en-larged lymph and thymus glands. No one told me that Ineed to have any concern about the long-term conse-quences of this treatment, nor did it occur to me to ques-tion whether I might be causing my patients future harm.

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In those days I took everything on faith and expected mypatients to do likewise. I’m ashamed of that now andsuspicious of every new medical fad, because thosex-ray treatments were responsible for a virtual epidemicof thyroid cancer among patients subjected to them. Thedamage that was done is still being discovered every day.Even more tragic is the fact that in the case of enlargedlymph and thymus glands, we were treating nonailments.Their size ultimately diminished without treatment, inthe natural order of things.

Who knows what the future consequences will be ofthe things pediatric residents are being taught today?They are learning to use bilirubin lights to treat infantjaundice, tympanostomy for ear infections, antibioticsfor almost everything, hormones to control growth, pow-erful drugs to modify child behavior, and other drugs,tests, immunizations, and procedures whose long-termeffects are unknown. The consequences have yet to befully revealed, but if you reexamine the previous disas-ters that litter the path of “medical progress” you can besure they will be many and tragic.

If there is a given about medical practice, it is thatdoctors don’t seem to learn anything from their mistakesand that most of them seem oblivious to the basic tenetof the Hippocratic oath, “First, do no harm.” Doctors doa lot of harm, but the very structure of their medicaleducation over time makes them insensitive to the harmthat they do.

“We want our doctors to be caring and sensitive,”Daniel Borenstein, of the UCLA School of Medicine,said recently, “but if they are overly caring, it’s difficultfor them to continue to function. Throughout medicalschool there’s a hardening of the spirit.”

The pediatric resident may become quite skilled incertain mechanical procedures frequently performed inhospitals, such as inserting needles into veins and arte-ries, performing spinal taps, and even inserting trachealand bronchial tubes. However, these skills diminish rap-

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idly after he leaves the hospital and stops using them.Within a year or two, you can’t depend on him to retainmany of the skills he learned. Fortunately for him, andfor his patients, it doesn’t make much difference becausehe rarely needs to use them. They were typically learnedwhile treating children in pediatric clinics who were thevictims of economic deprivation, inadequate hygiene,and poor nutrition and consequently suffered ailmentsrarely seen in middle-class or affluent pediatric prac-tices. Since most pediatricians go where the money is,there isn’t much chance that they’ll continue to treatpoor children when they enter private practice. In fact,most of the time they’ll be treating kids who don’t needtreatment because they aren’t seriously ill.

WHAT DOCTORS ARE TAUGHTTO DO ABOUT MISTAKES

As part of my preparation for entering private prac-tice I was taught during my pediatric residency what todo if I made a terrible mistake. I wasn’t told what to tellthe parents of the child so that they could handle theirgrief more adequately, nor was I given any ethical stan-dards to adhere to. Instead, I was admonished to call mymalpractice insurance carrier immediately and let himtell me how to proceed. If I had to say anything publiclyabout a grievous—perhaps fatal—error, the magicphrase was, “What happened to this poor child was onein a million.”

That’s why, when something goes wrong, you’ll oftenhear a doctor say, “It was one in a million.” In Torontothere was the famous case of Stephen Yuz, who enteredthe Hospital for Sick Children and was diagnosed ashaving psychological vomiting. He died some days laterfrom an intestinal obstruction. It was one in a million, ofcourse, as was the death of a Chicago child as the resultof an asthma test.

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I have attempted, in this chapter, to dissuade youfrom having blind faith in your pediatrician and to pointout that when you seek medical attention that your childdoesn’t really need you may expose him to greater risks.Medical attention should be your last resort—not yourfirst—when your child is sick. The vast majority ofchildhood illnesses will respond to natural bodily de-fenses, fortified by your own skills, loving attention, andcommon sense.

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How DoctorsCan MakeHealthy Kids Sick

If you think about the relationships you have had withdoctors, I suspect you’ll be surprised to discover thatthey’re unlike those you have with anyone else who pro-vides you with a service. The typical doctor-patient rela-tionship is revealed in a phrase that has become part ofthe language, doctor’s orders. Doctors do give giveorders to their patients; lawyers, accountants, and otherprofessionals give advice.

When you take your child to a pediatrician he con-ducts a physical examination that is too often cursoryrather than thorough; orders tests and x-rays; makes adiagnosis; decides on a course of treatment, often re-quiring drugs; and sometimes admits him to a hospitalfor an extended stay. He does all this with a minimum ofexplanation, without asking for your approval, usuallywithout warning you about the risks and potential sideeffects of the treatment he is giving, and without tellingyou what it is all going to cost. When it is all over he willexpect you to pay your bill, even if the diagnosis waswrong, or the treatment didn’t work, and your child isstill sick. Doctors, in short, have minimal accountabilityto their patients for anything they do.

Americans clearly are at the mercy of their doctors,and as a parent you are even more so because your con-cern for a child who can’t make his own decisions makes

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you particularly vulnerable. Your child, in turn, becomesvulnerable to treatment that is often painful and debilitat-ing. Because doctors are taught in medical school tosubmerge any emotional response to human suffering,they simply don’t pay enough attention to the pain theyinflict and the damage that their treatments may cause.

Among doctors as a group, I believe the pediatricianis the most dangerous because he appears to be the mostbenign. The image of a pediatrician is most often that ofa smiling, kindly, caring professional who, along with hisprescriptions, gives balloons and lollipops to your kids.He undeservedly escapes the opprobrium that is some-times" directed toward obstetricians and surgeons, whoare more likely to be viewed as callous and money-grubbing.

WHY PEDIATRICIANS AREDANGEROUS

The confidence inspired by the demeanor of pediatri-cians is, in my experience, undeserved. It tends to maskthe elements of pediatric practice that are threatening toyour child. Let me recite briefly some of the reasonswhy I believe pediatricians are dangerous and then getinto the most serious of them later, in greater detail.

1. The pediatrician serves as the recruiter for the med-ical profession. He indoctrinates your child from birthinto a lifelong dependence on medical intervention. Itbegins with a succession of needless “well-baby check-ups” and immunizations and then moves on to routineannual physical examinations and endless treatment ofminor ailments that would cure themselves if they wereleft alone.

2. Pediatricians are the least likely of all specialists totell parents about the potential side effects of the drugsand treatments they prescribe. What pediatrician evertold mothers of the evidence linking infant formula tohigh blood lead levels and Sudden Infant Death Syn-

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drome (SIDS)? What pediatrician, until pressured to doso by media revelations, ever told parents of the risk ofepilepsy and mental retardation associated with the im-munizations that he performs? What pediatrician tellsparents that antibiotics should be reserved for cases inwhich there is no acceptable option, that frequent andindiscriminate use may have adverse future conse-quences for the child?

3. The pediatrician’s wanton prescribing of powerfuldrugs indoctrinates children from birth with the philoso-phy of “a pill for every ill.” This may lead the child to thebelief that there is a drug to treat every condition andthat drugs are an appropriate response to normal feelingsof frustration, depression, anxiety, inadequacy, insecu-rity, etc. Doctors are directly responsible for hookingmillions of people on prescription drugs. They are alsoindirectly responsible for the plight of millions more whoturn to illegal drugs because they were taught at an earlyage that drugs can cure anything—including psychologi-cal and emotional conditions—that ails them.

4. Pediatrics is among the lowest-paid of the medicalspecialties. Consequently, because he has greater needfor the income they generate, the pediatrician is morelikely than other doctors to order unnecessary x-raysand tests. The risks to the patient are twofold: first, po-tentially harmful effects from the tests and the x-raysthemselves; second, the danger that inappropriate treat-ment may be given because the pediatrician discountedclinical evidence in making his diagnosis and relied ontest results that too often are unreliable.

5. Pediatricians are so accustomed to seeing patientswho aren't really sick that they often fail to recognize theones who are. I have been an expert witness in manymalpractice suits that bear this out. Board-certified pedi-atricians have overlooked important, life-threateningconditions because they had forgotten what to look for ina sick child and missed the symptoms that should havealerted them to a serious condition.

Meningitis is an outstanding example of this short-

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coining, because it is today one of the rarities in pediat-rics. It used to be 95-percent fatal and now is 95-percentcurable, but only if the pediatrician recognizes the symp-toms and identifies the disease in time. Every pediatri-cian, during his residency, is taught how to diagnosemeningitis. In fact, it is one of the few really usefulthings that he is taught. But that lesson is often blottedout after years of examining a procession of healthy chil-dren. To make matters worse, the pediatrician gets soaccustomed to treating nonailments that when he doesproperly diagnose a sick child he may no longer re-member the appropriate treatment.

6. Because they see more children in order to enjoy aprofitable practice, pediatricians don’t spend enoughtime with their patients to diagnose and treat them prop-erly. Every competent physician knows that 85 percentof an accurate diagnosis is based on the patient’s history,10 percent on a thorough physical examination, and theremainder on laboratory tests and x-rays. It takes at leasthalf an hour to an hour to take an adequate history andto conduct a thorough physical exam. Pediatricians typi-cally spend 10 minutes with a patient and thus fail todiscern much of what they need to know for a reliablediagnosis because they simply don’t spend the time thatis needed. The result is “knee jerk” or “cookie cutter”diagnosis, in which habit replaces sound judgment basedon careful examination.

7. Pediatricians are the most likely of all specialists toenhance their income by promoting and defending lawsthat force patients to use their services. It is pediatri-cians, not politicians, who are responsible for mandatoryuse of silver nitrate or antibiotic drops in a newborn’seyes, mandatory school physical examinations that pro-vide opportunities for “creative diagnosis” of nonail-ments, mandatory hospital births, and court-ordered useof controversial and unproven methods of treatment towhich the parents object. Increasingly, one of thedangers inherent in taking your child to the doctor is thepossibility that he may be taken from you and placed in

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state custody if you reject the treatment that his doctordemands. I have testified in behalf of the parents inmany such legal actions in recent years.

8. Pediatricians are the principal foes of breastfeed-ing, despite incontrovertible evidence that it is one of themost effective ways to assure the future health of yourchild. Although the LaLeche League is beginning tocounter the influence that the formula makers have longhad on pediatricians, many doctors either fail to encour-age or actively discourage breastfeeding. I won’t go intoall of the reasons for this, but it is worth noting that thegrowth of the pediatric specialty in the United States canbe attributed in large measure to the financial support ofthe manufacturers of infant formula, who have long usedpediatricians as unpaid salesmen.

9. Pediatricians give tacit support to the unconscion-able obstetrical intervention that is damaging children,physically and intellectually. They cover up the obstetri-cians’ role in producing much of the damage that theysee. When a parent has a child with a birth defect, andasks a pediatrician whether the obstetrician might be re-sponsible, he will get the reply that is taught during pedi-atric residency: “Don’t look back; just look ahead.”Dangerous obstetrical practices that produce retarda-tion, learning disabilities, and physical abnormalitieswould disappear in a few years if pediatricians had thecourage and compassion to place the blame on obstetri-cians, which is often where it belongs.

Despite all this evidence of negative effects from pedi-atric care, the myth persists that American childrenenjoy better health care because of our abundance ofpediatricians. That belief is wrong on two counts. First,infant mortality statistics reveal that American childrenare less healthy than those in many other developed na-tions that have few pediatricians. They’re even lesshealthy than children in some of the underdevelopedcountries. Second, the reason our children are lesshealthy may well be because of our abundance of pedia-tricians.

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Despite evidence to the contrary, public health policyin the United States is based on the premise that accessto care determines the health of a population. Doctorshave succeeded in convincing politicians of this, eventhough they can't prove it I believe that as long asemergency medical services are available, access to rou-tine medical care probably has a negative effect onhealth. We’ve seen it happen in California, Saskatche-wan, Israel, and elsewhere: call a doctor’s strike and thedeath rate goes down1.

KEY TO HEALTH: STAY AWAYFROM DOCTORS!

The best way to raise a healthy child is to keep himaway from doctors, except for emergency care in thecase of an accident or an obviously serious illness. Ifyour child displays symptoms of illness, monitor hiscondition closely, but don’t seek medical help until thereare clear indications that he is seriously ill. Most doctorsignore the fact that the human body is a wondrous ma-chine with an astonishing capacity to repair itself. If youtake your sick child to a doctor, he probably won’t allowit to do that. Instead, he will interfere with the body’snatural defenses by giving your child treatment that hedoesn’t need and shouldn’t get, with side effects that hisbody is not designed to handle.

If you become convinced that you should accept myadvice and avoid your doctor whenever it makes senseto do so, you will learn to avoid the traps that pediatricmedicine has laid for your child. The first of these is the“well-baby visit”—a cherished ritual of pediatricians thatenhances their income but does nothing constructive foryour child. The hazard of these examinations is the pro-clivity of doctors—a heritage of medical school—to dis-cover illness where none exists. The diagnosis leads to

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treatment, of course, with consequences that may makeyour child sick.

The time to see a doctor is when your child is reallysick, not when he’s well. If your pediatrician asks thatyou bring your baby in for routine, regular checkups on amonthly, bimonthly, or other regularly scheduled basis,ask him why he thinks this is necessary. Ask him if heknows of any objective studies that indicate it will haveany effect in improving your child’s health. I’ve neverseen one, and I don’t believe he will be able to point toone, either.

Although professional groups have recommended thatthe value of preventive child health care be validated byconducting controlled studies that follow patients overmany years, little research has been done. The threestudies that I have seen offered no support to pediatri-cians who demand that their patients visit them on a reg-ular basis. The studies focused individually on generalhealth, behavioral patterns and learning abilities, and de-velopmental status, as the end points of the research. Asreported in Pediatrics, “None of these studies providedevidence that the preventive services given affected theoutcomes measured positively.”

In the absence of any evidence that well-baby visitswill improve the health of your child, I suggest you avoidthem and the risks of needless treatment they presentand save your time and money. In all my years as a pedi-atrician I do not recall ever having discovered an illnessduring a well-baby examination that was not revealed ina timely manner by taking a careful history on the child’sinitial visit or by the subsequent development of observ-able symptoms. I’ll discuss that more fully later.

Well-baby visits are worthless because they are es-sentially superficial, and they are superficial because thedoctor knows deep in his heart, that they are a waste oftime. Another study conducted in metropolitan Pitts-burgh revealed that pediatricians conduct a well-babyvisit in an average of a little more than 10 minutes andthen provide advice on child development, potential

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problems, and similar matters in an average of 52 sec-onds. Similar findings were reported in New York City,Baltimore, Seattle, Los Angeles, and Rochester, NewYork.

No doctor can diagnose a symptom-free disease in 10minutes or give any constructive advice in 52 seconds. Ifmy child were the patient, I wouldn’t even give a doctorthe opportunity to try.

When your child enters a pediatric examining room heis almost invariably subjected to height and weight mea-surements, usually taken by a technician or a nurse. Thisis part of the ritual Modem Medicine has developed tomake you feel that you are getting your money’s worth.First-time parents wait nervously while the nurse placesthe squirming baby on the scale and may be asked tohelp hold the child’s legs down so that the height can bemeasured. Mom and Dad sigh with relief when their pe-diatrician finally appears, checks the measurementsagainst a chart, and announces that their child is devel-oping “normally.” Conversely, they are worried if theyare told that their baby is gaining too much or too littleweight.

What their doctor doesn’t tell them is that this ritualhas no medical significance whatsoever. They aren’t toldthat some formula manufacturer was probably the sourceof the growth chart that the doctor is using and that hegets them free. That leads to an obvious question: Whyare the formula makers so eager to have your doctorcheck your baby’s weight? Answer: Because the weightgain of breastfed babies may not match the averageweights shown on the formula maker’s chart. They hopethat the pediatrician, instead of reassuring the motherthat this is normal and nonthreatening, will tell her tostop breastfeeding and switch to their product, of.whichhe has a handy reminder in his hand. Too often, that isexactly what he does, and the baby is subsequently de-nied the immunity and other benefits that breastfeedingprovides.

For at least half a century doctors have been relying

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on various standard weight and height tables to measurethe health of patients of all ages. For older children andadults the most commonly used chart is one developedby the Metropolitan Life Insurance Company, last re-vised in 1959. The pediatrician compares your child’sheight and weight measurements to those on the averagegrowth curve. If the child is at either end of the spec-trum, he will be defined as “abnormal.” The doctor mis-leads the parent by evaluating a single patient on thebasis of a theoretical statistical value.

WHY WEIGHT CHARTSARE MISLEADING

This evaluation is misleading because the charts arebased on an average of a group of subjects that may notbe comparable—environmentally, racially, or geneti-cally—to your child. The doctor makes the assumptionthat, unless your child is near the 50th percentile, he iseither too skinny or too fat, too tall or too short. If themeasurements are well removed from the midpoint, thedoctor can then seize the opportunity to treat your child.

This indefensible practice reminds me of a definition Ionce heard of the role of lawyers, whose function, it wassaid, was “to raise doubts in the minds of their clients,which they can then resolve over a long period of time atgreat profit to themselves.” That's what is happeningwhen a pediatrician uses variations from “normal” heightand weight as an excuse to treat your child.

Comparison of individual children to charts of aver-age height and weight is unscientific, per se, and be-comes more so when you consider that the chartsthemselves are invalid. As this is written there is a ragingdebate over the Metropolitan Life charts, which manydoctors have challenged as defining ideal adult weights10-20 pounds too low. It appears that Metropolitan willrespond to this criticism by raising the weight standards,

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and another group of doctors is challenging that. What-ever the result, one thing is certain. Doctors will ignorethis history and continue to compare your child to what-ever standard is agreed to, as though the measurementshad been handed down from a Higher Power that in-scribed them on stone.

Studies have shown that the standard height andweight charts applied to children (several are in use) areeven less valid than those used for adults. For example,they are meaningless when applied to measure the devel-opment of black children. That’s because they are basedon the progress of groups of Caucasian children, andblack children exhibit different growth characteristicswhen studied as a group. Another deviation that thecharts fail to take into account are genetic factors inchild development. They make the assumption, ignoringthe genetic factors, that a child with parents shorter thanfive feet, six inches, should attain the same height as achild whose parents are both over six feet tall.

Comparisons with standard growth charts also troubleme because no valid norms have ever been developed forbreastfed babies, who often exhibit weight gains that arebelow those achieved by babies who are formula-fed.This is quite normal, and also beneficial, and there is noevidence that God made a mistake when he constructedbreasts that don’t yield Neo-Mull-Soy or Enfamil. Un-fortunately, many pediatricians don’t seem to believethat, so if you are breastfeeding your baby and hisweight gain does not match the charts, your doctor islikely to insist on switching him to formula. That’s badfor you and worse for your child. I’ll have more to sayon this later, but let me emphasize right now that I be-lieve breastfeeding is a vital element in the health of chil-dren, not only in infancy but later in life.

The use of standard growth charts is an example—and American medicine is filled with them—of quantita-tive nonsense superseding qualitative sense. Don’t letyour pediatrician influence you by attaching importanceto comparisons of your child’s growth with any standard

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norms. Remember, if he tries, that these norms are basedon tiny groups of children, were done many years ago,often compare apples and oranges, and don’t differen-tiate between breastfed and bottlefed babies.

Let me repeat: Your pediatrician literally does notknow the normal growth pattern of breastfed babies. Heis misleading you if be tells you that your breastfed babyisn’t growing fast enough. If your baby is otherwisehealthy, don’t switch to formula because of nonsenseyour pediatrician has extrapolated from his worthlesscharts!

I know it may be difficult for you to accept the factthat growth charts have no place in medical diagnosis,because doctors have been using them for so long. Letme assure you that I am not alone in the view that moreharm than good may come from using them to measurethe health and progress of an individual child. This posi-tion is shared by many other doctors who have beenmoved to look objectively at the results they have expe-rienced in their own practices rather than continue toaccept what they learned in medical school.

I have belabored this issue because I want it to serveas an advance warning of all the other offenses againstyour child that your pediatrician may commit. I’ll de-scribe many more as we move on to specific illnesses.The point is that, if a pediatrician will treat a child on the.,basis of information obtained from invalid charts, it isnot difficult to comprehend the interventions he willconceive if he has a more tangible symptom that he canuse to rationalize his behavior.

For the most part, the damage done by growth chartsis limited to their impact on your pocketbook and yourpeace of mind. However, in recent years they have led toa major abuse that I will mention briefly only to con-demn it. I refer to the growing use of estrogens and otherhormones to try to alter the height of children who areperceived as being too tall or too short. Little is knownabout the potential damage that may be inflicted by thehormones that are being used to stimulate or retard

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growth, and nothing is known about the long-term ef-fects of this treatment.

In recent years the medical journals have reported ex-tensively on the use of estrogen to keep girls from grow-ing “too tall." One headline, which assured readers thatsuch treatment was “safe,” noted the following risks andside effects, but they were buried deep in the text of thestory: morning sickness, night cramps, thrombophlebitis(blood clots in the .veins), hives, obesity, hypertension,abnormal menstrual bleeding, suppression of pituitaryhormones, migraine headaches, precipitation of diabetesmellitus, gallstones, atherosclerosis, breast and genitaltract cancer, and sterility. The article also noted that“relatively few girls have been treated long enough ago... to have outlived the latent period for neoplasia [theformation of malignant tumors].”

How many doctors who recommend this treatmenttell their patients about these side effects? How manyparents would permit their doctor to treat a child forheight control if they were made aware of the risks thetreatment entails?

The risks of exposure to significant damage in thecourse of routine medical care are neither remote norinconsequential. That’s why you should assume thedominant role in dealing with your child’s health.

4

Protecting YourChildren beforeThey Are Born

h^ost of us tend to believe that the awesome respon-sibility of parenting begins when we take our new babyhome from the hospital. Actually many decisions thatwill affect the health and vitality of your child are madelong before that. Your first opportunities to build ahealthy foundation for your child’s growth and develop-ment come before he or she is bom.

While it is too late to take advantage of these opportu-nities if you already have your child, you should knowabout them anyway, in the event you plan to have an-other. If, however, you are reading this book in anticipa-tion of the birth of your baby, this chapter will be ofimmediate importance to you.

The future well-being of your baby will be affected bychoices you can make throughout your pregnancy. It canbe affected by the attitudes of the obstetrician youchoose. Then, when the long wait is over and the firstpangs of labor appear, you may even choose to avoid thehospital and deliver your baby at home.

Please don’t dismiss that choice out of hand. At firstglance it may sound like radical advice, but I assure youthat it isn’t. A steadily increasing percentage of mothersare demanding home births for their babies, becausethey have examined both options and determined thathome birth is the sensibly conservative choice.

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What is radical—and dangerous for you and yourchild—is the arsenal of obstetrical intervention that liesin wait for you in the hospital, as well as the threatslurking in the hospital nursery that may damage yourbaby after he is bom. There is ample evidence that themedical technology, drugs, anesthetics, surgery, andother obstetrical slings and arrows employed in mosthospitals expose mothers and babies to needless risk.They have a frightening potential for inflicting severe,even life-threatening, damage on you and also on yourchild.

CHILDBIRTH SHOULD BEA NATURAL PROCESS

The classic family doctor of my own childhood “as-sisted” in the delivery of babies when, and to the extentthat, his services were required. To him, childbirth wasan uncomplicated natural process, and he did not inter-fere with it except in those rare instances when some-thing went terribly wrong. If labor was prolonged, hedidn’t give the mother a shot of Pitocin so he could get tothe golf course on time. He was content to give nature achance and would sit with a laboring mother for hoursuntil her body, not Parke-Davis Pharmaceutical Com-pany, decided it was time for her to deliver.

What a contrast with the often irrational obstetricalbehavior we see today! Contemporary obstetricians, forthe most part, no longer “assist.” They consistently in-terfere in a natural physiological process that they insiston treating as though it were a disease. In a shockingpercentage of cases this medical interference with a nor-mal bodily function adversely affects the physical or in-tellectual capacity of the child for the rest of his life.Sometimes it even ends that life before it really has achance to begin.

If you have your baby in a hospital, you will be ex-posed to an array of obstetrical hazards so broad that I

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can’t possibly describe them fully here. However, theywere thoroughly documented in my previous book, MalePractice: How Doctors Manipulate Women, so if youwant more information about the obstetrical risks tomothers, you will find it there. What I discuss in this andsucceeding chapters are the secondary effects of obstet-rical intervention on your child, and the primary damagethat your doctor and the hospital’s routine proceduresmay inflict on your baby after his birth.

Obstetricians, in defense of their own fouled nest, in-sist that a hospital is the only safe place for you to haveyour child. On occasion they even go to court to try toprevent mothers from using midwives and having theirbabies at home. There is no statistical or scientific evi-dence to defend their position; in fact, the available evi-dence proves them wrong. Meanwhile, observation ofthe iatrogenic (doctor-caused) damage to children, cou-pled with simple logic, is enough to demonstrate to anyimpartial judge that the safest place to have a baby is athome.

The reason is almost self-evident. Having your babyat home is less risky than going to the hospital becausemuch of the most dangerous technology employed inhospitals is not available to doctors or midwives whodeliver babies at home. This reduces the opportunity forneedless, hazardous intervention and virtually assuresthat you will be permitted to have your baby naturally, asGod intended that you should. Procedures such as ultra-sound diagnosis, internal fetal monitoring, excessive useof sedatives, pain relievers and anesthetics, Pitocin-induced labor, and the temptation to resort to delivery bycesarean section, are largely avoided when you play itsafe and have your baby in your very own bed!

Obstetricians who practice in hospitals decry homebirth as reckless, because hospital facilities are not avail-able in the event a complication arises. If those doctors,whose practice is limited to hospitals, were determiningwhich mothers were appropriate candidates for homebirth, and were then required to deal with any emergen-

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cies that arose, I would agree with them. They don’thave the skill and experience to select the appropriatehome birth candidates and to anticipate problems inother mothers. They also would be at a loss to cope withan occasional problem they did not cause and withoutthe assistance and technology available to them in thehospital.

Home birth doctors and midwives are experienced inidentifying mothers who can safely give birth at homeand rejecting home birth for those who are not. They canalso anticipate problems, but without the interventionthat occurs in the hospital setting, these problems arefew and far between, and home birth doctors know howto cope with those that do arise.

HOW BABIES ARE DAMAGEDDURING HOSPITAL BIRTHS

There are fi ve distinct stages during which you shouldbe alert to actions of your doctors that could result in thebirth of a deformed, brain-damaged, or mentally retardedchild. The first is the period prior to conception; second,the nine months of pregnancy; third, while you are inlabor; fourth, during the delivery of your baby; and, fi-nally, the period during which your child remains in thehospital for newborn care. Let’s examine them, and therisks they entail, one by one.

The Preconception Stage

The behavior of doctors can influence the health ofyour baby long before the thought of having one haseven crossed your mind. The fact that you are readingthis book suggests that it is too late for you to do any-thing about that, but it is not too late for you to take theprecautions in the future that will protect your nextchild.

Fetal deformities and mental retardation may occur as

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the result of excessive exposure to x-rays throughoutyour life, and these radiation effects are a threat to thehealth of both men and women and the children that areborn to them.

Among women, the consequences of excessive expo-sure to radiation are usually noted among those whohave their first babies in their later years. That's becausethe effects of X-rays are cumulative, so the older youare, the more opportunities there have been for radiationto accumulate and take its toll. This increases the possi-bility that Down’s syndrome, a form of mental retarda-tion, will afflict your child. Nor is this form of X-raydamage limited to women. Fathers may also be responsi-ble for offspring with fetal deformities and mental retar-dation if X-ray exposure has damaged their sperm.

This potential impact on fetal development is one ofmany reasons why you and your children should avoidX-ray exposure to the extent that you can, from the ear-liest age. You can expect your doctor and dentist todownplay the risks of X-ray diagnosis, which they willmaintain are minimal. Your dentist will also insist thathis X-rays are harmless because the dosage is very low.Don’t be misled by these assurances. It doesn’t makeany difference how low the dosage is during any singleexposure to x-rays if you accumulate enough during yourlifetime to damage you or your child.

I advise my patients to reject all X-rays unless theyare essential to the diagnosis of a potentially life-threatening disease. If you must submit your child to anX-ray, don’t hesitate to let your doctor know that youare concerned, even if you feel uncomfortable doing so.Your child’s health is more important than your doctor’sfeelings. Insist that X-ray examinations be conducted atthe lowest dosage possible. Ask your doctor whether histechnician has been specifically trained and whether theequipment has been inspected recently to assure that itdelivers the appropriate dose. Observe whether the tech-nician provides proper shielding for the reproductiveorgans of your child.

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Never let yourself forget that X-ray machines can belethal. Study after study has shown that a shockingnumber of X-rays are performed in the United Stateswith defective equipment, operated by untrained medicalpersonnel who don’t know how to use the machine prop-erly. To make matters worse, most of the time the x-raysweren’t essential in the first place.

You face another major risk if conception follows tooclosely a period of contraception with birth control pills.This, too, can result in a deformed or brain-damagedchild. Women who have used the Pill should allow sev-eral months to pass before they attempt to have a child.

What to Watch for during Pregnancy

The babies who are at greatest risk during the firstdays, weeks, or months of life are those bom premature-ly, before all of their organs are fully developed, andthose who lack physical stamina because of abnormallylow weight at birth. You can help assure that your childwill develop normally if you eat an adequate, nutritiousdiet from the moment of conception until the day he isbom.

When I was young, doctors were fond of encouragingmothers to do this by reminding them that they were“eating for two.” Today’s obstetricians are more likely tobe preoccupied with the insistence that you restrict yourweight. Not too long ago, the maximum weight gain thatmany obstetricians would tolerate was 10-15 pounds.More recently, the reins your doctor will try to place onyour appetite have been loosened a little, but most doc-tors will still try to limit your weight gain during preg-nancy to 20-25 pounds. That’s more rational, but thelimitation still doesn’t make any sense. On the contrary,maternal dietary and caloric restrictions may lower yourchild’s birth weight and threaten his development oreven his survival.

The possibility that your doctor may try to subjectyou to excessive weight restrictions is very real. A fed-

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eral agency reported that in 1975 one of every three preg-nant women in the United States suffered frommalnutrition—more than a million women a year. Ob-viously, some of them were malnourished because theycouldn’t afford proper food, or for cosmetic reasons oftheir own, but the overwhelming majority suffered frommalnutrition because their obstetricians wouldn’t letthem eat. Don’t let your doctor do this to you, because itis virtually inevitable that, if you are malnourished, yourbaby will be, too.

Your primary concern during pregnancy should not bewith how much weight you gain but with how adequatelyand well you eat. If your doctor tells you to hold yourweight gain to 15-20 pounds, he will probably insist thatthis is important because it will make your delivery eas-ier. He may also tell you that it will forestall the possibil-ity that you will develop toxemia, one of the mostdangerous and sometimes fatal complications of preg-nancy.

These sound like persuasive reasons to control yourweight, and you obviously would be wise to heed them ifthey were true. You needn’t, because all of the availableevidence indicates that in terms of ease of delivery andthe threat of toxemia the truth is the other way around.

If you are malnourished, your uterus may not func-tion properly and labor will be prolonged or even stop.The obstetrician who restricted your diet has now turnedthat lemon into lemonade for himself by creating the op-portunity to do a cesarean section. That’s a bonanza forhim but potential trouble for you and your child.

And so it also is with toxemia. Evidence has beenaccumulating for half a century that it is improper mater-nal nutrition, not excess weight, that causes toxemia inpregnancy. Because the proper nutritional elements arenot present in your diet, your liver malfunctions, andyour body’s responses produce the symptoms that areassociated with toxemia.

Many women find it difficult to adhere to the weightrestrictions imposed by their doctors and find them-

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selves nearing the outer limits during the final twomonths of pregnancy. If they take their doctors’ instruc-tions seriously, they go on near-starvation diets, cuttingdown their food intake at the worst possible time. This isthe period when their child needs maximum nourish-ment, because he should be gaining the most weight. It isalso the crucial period in the development of the brain. Ifyou starve yourself to hold to some arbitrary, medicallyimposed weight restriction, you also starve your baby,endangering his life and health as well as your own.

My advice to expectant mothers—no matter whattheir obstetricians are telling them—is to exercise com-mon sense about food intake and how much or how fastthey gain weight. But don’t lose any sleep over it if youfind yourself gaining more than your doctor would like.You’ll feel better about it if you remember that thechances that an underweight baby will die during the firstmonth after delivery are 30 times those of babies bom atnormal weight. Because they have been denied the nour-ishment they needed to develop properly, some degree ofmental retardation is found in half of the low-birth-weight babies, and their incidence of epilepsy, cerebralpalsy, and learning or behavioral problems is three timesthat of babies of normal weight. That’s a good reason foryou to eat a well-balanced, nourishing diet, avoid starv-ing yourself or your baby, and tell your obstetrician to gofly a kite if he fusses at you because you’ve gained 30pounds.

Be equally firm in your refusal if he tries to put you ondiuretics should your hands and feet begin to swell.Nearly all pregnant women display swelling due to waterretention at some time during pregnancy. This is almostalways a normal condition and a valuable one, becausethe stored fluid that produces the edema is needed tosupport the increased blood volume that you and yourbaby require.

Many doctors seize this condition as an indication oftoxemia and prescribe a diuretic to eliminate the storedfluids. In most cases that’s wrong, because it simply de-

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prives you and your baby of fluids you need. The resultcan be catastrophic. The death rate of babies bom tomothers without edema has been shown to be 50 percenthigher than that of babies bom to mothers who storedample fluid. You are also at risk if you take diuretics,because these drags can kill you by lowering your bloodpressure and pushing you into hypovolemic shock!

Your doctor will almost certainly warn you sternlyabout the hazards of cigarettes, alcohol, and othermood-altering drags during pregnancy. He should warnyou about them, and you should heed his warnings, be-cause there is strong evidence that even moderate use ofthese substances may have a negative impact on yourunborn child. For the same reason, he should also warnyou not to take any over-the-counter drugs during yourpregnancy—aspirin, cold remedies, and the like.

Unfortunately, he probably won’t warn you about theeven greater risks present in some of the treatments thathe may employ. Fetal damage can also be caused by pre-scription drags, x-rays taken during pregnancy, ultra-sound, and procedures such as amniocentesis, which isused to detect abnormal conditions of the fetus. I won’tgo into these hazards here, but you should inform your-self about them. Many books about the medical hazardsof pregnancy are available, including my own book,Male Practice: How Doctors Manipulate Women.

Intervention during Labor and Delivery

At the beginning of this chapter I urged you to con-sider home birth for your child in order to avoid thegreater opportunities for medical intervention that arepresent if you enter a hospital. Almost every form ofobstetrical intervention in what should be a natural proc-ess of birth has the potential for causing brain damageand mental retardation. The risks of such intervention,and thus the consequences, are substantially reduced ifyou have your baby at home.

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A few years ago Dr. Lewis E. Mehl, of the Universityof Wisconsin infant development center, studied 2,000births, nearly half of which had taken place at home. Thedifferences between the home and the hospital birthswere striking:

• There were 30 birth injuries among the hospital-bom children and none among those bom athome.

• Fifty-two of the babies bom in the hospital re-quired resuscitation, against only 14 of those

' bom at home.

• Six hospital babies suffered neurological dam-age, compared to one bom at home.

The extent of the intervention in the birth process thattypifies hospital deliveries is appalling. True, some of theprocedures that are used have merit when they are ap-propriately applied—situations in which the risks ofdoing the procedure are justified by the benefits it mayprovide. The menace to the mother arises from the syn-drome “What can be done will be done,” which pervadesAmerican medicine. Procedures developed specificallyto deal with critical situations are used routinely onevery patient who comes in the door.

The typical hospital delivery, in most hospitals, ischaracterized by one needless intervention after another.Again, because I have covered them in previous books, Iwill not go into the details here. Included, however, areinternal and external fetal monitoring, intravenous feed-ing, analgesics and anesthetics, Pitocin-induced labor,episiotomy, and cesarean sections.

I do want to take the opportunity here to share withyou emerging information about the risks of fetal moni-toring through the use of diagnostic ultrasound. I do soonly because it is not generally available to lay readers,nor is it information that is apt to be shared by your

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doctor. The use of ultrasound for fetal monitoring or anyother diagnostic purpose raises some alarming questionsthat can’t be answered by those who employ it. It isanother way in which modern obstetrics violates themedical imperative, passed down by Hippocrates,“First, do no harm.”

External fetal monitors consist of two bands that arestrapped around your abdomen and connected to a mon-itoring unit that records the device’s findings on tape.One band is pressure-sensitive and measures thestrength and frequency of your contractions. The otheremploys ultrasound to determine the condition of thefetus. In most hospitals doctors use fetal monitors rou-tinely, although one study of 70,000 pregnancies foundno difference in outcome between monitored and un-monitored patients, and other studies have shown thatmonitoring results in an increase in infant mortalityamong the patients monitored. This suggests that, atbest, monitoring does no good, and at worst it may doharm.

There is, at this writing, no conclusive evidence di-rectly linking ultrasound to fetal damage, nor is there anyhard evidence that it will not cause damage. Unlike X-rays, which impart an electrical charge to matter througha process called ionization, ultrasound rays are nonion-izing. Proponents of ultrasound seize this as proof that itis not dangerous, but there is no evidence that this de-fense is valid. In short, I can’t prove conclusively thatultrasound, may damage your baby, but the doctor whouses it on you can’t prove that it won’t.

Alice Stewart, a British epidemiologist who heads theOxford Survey of Childhood Cancers, commented inmid-1983 on “very suspicious hints” that children ex-posed to ultrasound in the womb may be developing leu-kemia and other cancers in higher numbers thanunexposed children. A World Health Organization reportcalling for extensive research on the hazards of ultra-sound, and restraint in its use, had this to say about ben-efits versus risks (all italics mine):

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Choosing end points for study [of ultrasound] isespecially difficult in human subjects. Latent pe-riods easily could be as long as 20 years in the caseof cancer development, or the effect may not be

seen for another generation Because the human

fetus is sensitive to other forms of radiation there isconsiderable concern that it may also be sensitiveto ultrasound Animal studies suggest neuro-

logic [sensory, cognitive, and developmental], im-munologic, and hematologic possibilities forstudies in humans. There is some evidence that ifthe exposure is within the period of organogenesis,congenital malformations may result from expo-sure to ultrasound in laboratory animals. In gen-eral, these end points in animal studies have beenunexplored in humans and should be followed upwherever possible

It is not clear at this time whether ultrasoundfetal monitoring is beneficial to the mother or fetusin terms of pregnancy outcome and this, above all,should be examined closely ; if there is no generallyacknowledged benefit to the monitoring, there isno reason to expose patients to increased costsand possible risk.

If, despite the concerns that have been raised aboutleukemia, suppression of the immune response, congeni-tal malformations of the fetus, and other possible effectsof ultrasound, your doctor still insists on using it on you,what can you do? I suggest that you tell him you willpermit it when he presents you with convincing scientificevidence that it is necessary, that you and your baby willbenefit from it, and that it won’t harm you or your babynow or 20 years down the road.

He can’t very well object to your desire for this reas-surance in your own behalf and that of your unbornchild. He will also be unable to provide it, because suchevidence doesn’t exist. Perhaps that will persuade him todo what he should have done in the first place: forget

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about ultrasound and use his stethoscope instead!

If you have already given birth to a healthy, normalchild, you need not be concerned with these prenatalrisks until you decide to have another. If you are await-ing the birth of a child, I urge you to study the potentialhazards that await you with great care. It is because ofrisks such as those I have described that I find homebirth so appealing. That is why I was oveijoyed whenboth of my own daughters opted to have their babies athome. My own beautiful, healthy grandchildren are nowtwo, three, and five years old, and each of my daughtersis due to present me with another. They, too, will bedelivered at home.

If you’re not ready to accept home birth as an option,and elect to have your child in a hospital, be on yourguard. Make good use of what you have learned in thischapter, and in the other books that you read, and youshould be able to avoid most of the risks to yourself andyour baby that I have described.

Hazards that Lurk in the Hospital Nursery

Although competitive pressures have brought im-provements in some hospitals, the probability remainsthat your baby will be whisked off to the nursery mo-ments after he is born. He will be subjected to a numberof procedures, some of them legally mandated in moststates, and then compelled to lie there—probablyscreaming his head off—for at least four hours. Onlythen, and only once every four hours after that, will yoube allowed to breastfeed your baby or give him his bot-tle, if that is the option you select.

Your obstetrician will waste no time in giving yournew baby his first exposure to the chemicals that domi-nate medical practice in the United States. He’ll squirt afew drops of silver nitrate into the baby’s eyes. Thistreatment is predicated on the ridiculous presumptionthat all mothers must be suspected of having gonorrhea,which may have been transmitted to the baby during de-

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livery. Doctors have, in fact, fostered legislation requir-ing this treatment in every state.

Doctors reject the argument that the mother could betested for gonorrhea jnstead of inflicting silver nitrate onher baby, claiming that this won’t do because the test isnot 100-percent accurate. That defense is pure nonsense,because the silver nitrate isn’t 100-percent effective, ei-ther. Whether one is more effective than the other ismoot, because if your baby were to develop gonorrhealophthalmia for either reason, the problem can and will besolved by using antibiotics to treat the disease.

' The use of silver nitrate made some sense before anti-biotics became available, but the price your baby paysbecause its use is continued today, when it is no longerneeded, is not insignificant. Silver nitrate causes chemi-cal conjunctivitis in 30 to 50 percent of the babies whoreceive it. Their eyes fill up with thick pus, making itimpossible for them to see during the first week or so oflife. No one knows what the long-term psychologicalconsequences of this temporary blindness may be. Thetreatment may also produce blocked tearducts, whichnecessitates difficult surgical intervention to correctdamage done by a senseless procedure. Finally, somedoctors—including me—believe that the high incidenceof myopia and astigmatism in the United States may berelated to the placing of this caustic agent into the deli-cate, tender membranes of your baby’s eyes.

In some states doctors may now substitute antibioticsfor the silver nitrate, although there is no evidence thatthis prophylactic use of antibiotics to prevent gonorrheais effective. This does eliminate the immediate damagethat may be done by silver nitrate, but it also providesthe first example of indiscriminate use of antibiotics,which probably will be oft-repeated by your pediatricianand may cause problems for your child later in life.

In many hospitals a second example of indiscriminateuse of antibiotics may follow on the heels of the firstone. In an effort to prevent the crossinfection thatthreatens babies in hospital nurseries, many doctors are

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now giving routine injections of penicillin. Becauseevery use of antibiotics contributes to the possibility ofsensitization in later life, it should be avoided unless thetreatment is appropriate and essential in dealing with adisease. There is also the risk, in some children, of anallergic shock reaction to antibiotics of all kinds.

When your baby reaches the nursery he will bebathed immediately, and there is a strong probability thatthe nurse will use hexachlorophene soap. It has beenknown for many years that hexachlorophene is absorbedthrough the skin and that it can cause neurologic damagein some children. Yet hospitals continue to use it, despitethe risk to your baby, to try to avoid the onus of a bacte-rial epidemic in their germ-laden nurseries.

What makes this ridiculous, and even reckless, is thefact that hexachlorophene soap and antiseptic prepara-tions afford no advantage over bathing with plain tapwater. In five carefully conducted trials involving 150newborns, 25 infants were bathed with each of four dif-ferent antiseptics and 50 were bathed with plain water.Bacteriologic samples taken from each group followingthe initial bath and on the third and fifth days showedthat all of the. baths were equally effective.

Don’t let the hospital expose your baby to a poten-tially dangerous chemical to reduce the danger of infec-tion when plain water will work just as well!

Another beloved procedure that your infant child willbe subjected to is the PKU (phenylketonuria) test. Le-gally mandated in most states, it is given to determinewhether an infant is a victim of a rare form of mentalretardation. The condition is caused by an enzyme defi-ciency, but it occurs in less than one out of 100,000babies.

The PKU blood test itself is not dangerous, exceptthat it does require insertion of a needle that will open apathway for the bacteria that abound in every hospitalnursery. The problem lies with the test results, which arenotoriously inaccurate and result in many false positivefindings. If your child is diagnosed as a victim of PKU,

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he will be placed on a restricted diet composed of proteinsubstitutes that have an offensive taste, tend to causeobesity, and become terribly monotonous. There is dis-agreement among doctors on how long the diet should becontinued. The range is from three years to life. Mostdoctors who diagnose PKU will not permit the mother tobreastfeed.

It is ridiculous, in my judgment, to condemn childrento an obnoxious special diet based on a test that may bewrong, for a disease that rarely occurs, when the pre-scribed diet itself raises serious questions. Seven yearsago treatment centers in the United States, Australia,England, and Germany revealed that some children withPKU showed progressive neurologic deterioration “eventhough their disorder had been diagnosed early and di-etary treatment had been promptly instituted.” All ofthese children labeled as having “variant forms of PKU,”which differed from the classic form, died.

Unless there is a history of PKU in your family, myadvice is to avoid the test and breastfeed your baby,which I believe to be the best treatment anyway, even ifhe has the disease. If you can't escape the test, and thefinding is positive, insist that it be repeated a couple ofweeks later to assure that the first result was accurate. Ifit is still positive, make sure that the doctor determineswhether the PKU is the classic or a variant form, andmake certain that the diet your child is given is appro-priate for its type. Finally, insist on continuing to breast-feed along with the diet, because that’s the best overallhealth protection your child can have.

If the second test is negative, don’t fret for yearswondering whether the first one might have been right.One of the unfortunate consequences of all forms of in-discriminate mass screening is the emotional trauma par-ents go through when a false positive reading is given. Ihave had more than one mother ask me years later, “Doyou think ‘it’ Gate talking, late toilet training, etc.) mightbe PKU?” The same thing happens when a pediatriciantells a parent that a child has “a slight heart murmur.”

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This sounds threatening, but unless there are othersymptoms, they are simply an innocuous finding thatdoes not signify disease.

The list of obscure diseases for which mass screeningof newborns is required is steadily expanding, althoughthe requirements vary widely from state to state. Doc-tors are the prime movers behind this legislation, and inmy judgment they are also the prime beneficiaries. It isridiculous to expose all children and their parents to thephysical and emotional risks of screening for diseasesthat aren’t seen more than once in a blue moon.

Also add to the dangers that await your child in thenewborn nursery the possible use of bilirubin lights totreat infant jaundice. This is a common condition innewborn babies, and the chances are somewhere be-tween 30 and 50 percent that your baby will be mildlyjaundiced. How great that chance is will be determinedto a large extent by the degree of obstetric interventionyou experience in the delivery process.

It seems that every generation of doctors creates anew set of interventions that create problems that canonly be resolved by further intervention. Most of thethings a mother goes through when her baby is deliveredin a hospital—the analgesia, the anesthesia, the induc-tion of labor, all of the drugs—increase the chance thather infant will develop jaundice, because it is one of theirside effects.

Many doctors routinely give vitamin K to newbornbabies because they have been taught that infants areborn with a deficiency of this vitamin, which influenceshow rapidly the baby’s blood will clot. That’s nonsense,unless the mother is severely malnourished; but mostdoctors do it anyway. Administration of vitamin K to thenewborn may produce jaundice, which prompts the pedi-atrician to treat it with bilirubin lights (phototherapy).These lights expose the baby to a dozen documentedhazards that may require still further treatment and pos-sibly affect him for the rest of his life.

Bilirubin is the bile pigment found in the bloodstream,

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which your doctor will probably describe as a potentialsource of brain damage through transfer of the pigmentfrom the bloodstream to the central nervous system. Ac-tually, bilirubin is a normal breakdown pattern of the redblood cells. This breakdown converts them into biliru-bin, which is what gives your infant the jaundiced, yel-low coloring. The condition is not threatening except inrare instances when it is very high or rapidly rising onthe first day of life. This is usually caused by Rh sensiti-zation and requires treatment with bilirubin lights or ex-change transfusions. The transfusion simply replacesyour infant’s blood with other blood that is not contami-nated with bilirubin, while the bilirubin lights hasten itsexcretion. Light in the blue part of the spectrum, whichcan be supplied artificially in the hospital nursery, or nat-urally by the ultraviolet rays in sunlight, oxidizes biliru-bin more rapidly so that it can be excreted through theliver.

If jaundice does not appear until after the first day oflife, the risks of treating it outweigh the benefits. Thebilirubin is normally excreted naturally, and the processof excretion can be hastened by exposing your child tonatural sunlight, but it may take a week or two to get ridof all of it.

Despite the normal and nonthreatening nature of mostcases of infant jaundice, doctors usually insist on treat-ing the condition with bilirubin lights, rather than per-mitting natural sunlight to do the job. Now your child’shealth is threatened by using phototherapy to treat anonthreatening condition! Responsible medical author-ities have reported that phototherapy for infant jaundicemay be responsible for increased mortality, particularlyin very small infants. The higher risk of death resultsfrom lung problems (respirator distress syndrome) andhemorrhage. Infant deaths have also been reported fromaspiration of pads placed over their eyes to protect themfrom the lights.

Although your doctor will probably assure you thattreatment with bilirubin lights is completely safe, no one

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actually knows what the long-term effects may be, andplenty of short-term effects have already been identified.They include irritability and sluggishness, diarrhea,lactase deficiency, intestinal irritation, dehydration, feed-ing problems, riboflavin deficiency, disturbance of thebilirubin-albumin relationship, poor visual orientationwith possible diminished responsiveness to parents, andDNA-modifying effects.

If, because of a misguided cesarean, excessive weightcontrol during pregnancy, or for other reasons, you havea low-birth-weight baby, you will have to contend withthe treatment he gets in the neonatal intensive care nur-sery. Doctors and hospitals take intense pride in thesefacilities and all of the technological wizardry they em-ploy—an attitude that mystifies me, because there is noevidence that they benefit the children who are isolatedin them.

They do, however, expose your child to additionalrisks. If your low-birth-weight child is sent to intensivecare, he will be separated from you immediately afterbirth and placed in a radiant warmer. This involves someelement of risk, because babies have been burned inthem. The risk that should cause the greatest concern,however, arises when your child is given oxygen whilehe is in this incubator.

Failure of your doctor to limit the flow rate of oxygenproperly can in premature babies result in a diseaseknown as retrolental fibroplasia, the leading cause ofblindness in children. To avoid this, the oxygen level inyour baby’s blood must be closely monitored, whichmeans drawing blood, and that in turn can produce acondition known as iatrogenic anemia. One interventioncontinues to lead to another, and the baby may need ablood transfusion, which exposes him to the risk of ac-quiring serum hepatitis or AIDS.

If your child is placed on oxygen in intensive care, letyour doctor know that you are aware of these risks andthat they are causing you great concern. That may fore-

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stall any carelessness on the part of the medical person-nel.

CIRCUMCISION AND OTHERSURGERY—UNNECESSARYPROCEDURES

The odds are high that if you have a male baby yourdoctor will recommend that he be circumcised. About1,500,000 circumcisions are performed each year. Thatrepresents about 80 percent of all the male babies thatare born in the United States. If performed for other thanreligious reasons, it is a useless, unnecessary, and poten-tially dangerous procedure.

Every generation of doctors has found a new excusefor circumcision, despite the fact that even the AmericanAcademy of Pediatrics has advised that “There is no ab-solute medical indication for circumcision of the new-born.” If your doctor suggests circumcision for yourbaby boy, ask him why he wants to expose the poor kidto the pain, the possibility of infection or hemorrhage,and the risk of death from surgery that has no medicaljustification.

Although it is not likely that they will be performedimmediately after birth, you should also beware of twoother surgical procedures for conditions that may exist atbirth. The first of these is the umbilical hernia, a smalldefect in the abdominal muscle that permits the abdomi-nal contents to protrude. The condition is quite commonand can usually be expected to correct itself before yourbaby’s first birthday. However, even if it doesn’t, sur-gery should not be considered until your child is three tofive years old, because there is still a good chance thatthe condition will correct itself.

Finally, there is the possibility that your baby may be

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bom with an undescended testicle, and your doctor willrecommend surgery to bring it down. The need to do sois dubious, at best. Some doctors maintain that it is es-sential because of the threat that cancer may develop inthe undescended testicle. That reasoning may seem per-suasive, but it shouldn’t be, because the mortality ratefrom the surgery is higher than the potential mortalityrate from testicular cancer. Consequently, it is safer foryour child to leave the undescended testicle alone. It isanother matter if your child has two undescended testi-cles. In that event surgery deserves serious considera-tion because sterility is almost inevitable if neither ofyour child’s testes is in its proper place.

I have tried to forewarn you in this chapter of all ofthe risks that you and your child will face if you arehospitalized when he is bom. Yet these are only the im-mediate dangers. In addition, there are psychologicaland nutritional risks that arise from your separation fromyour child and the interference of hospital procedureswith normal breastfeeding. I will cover these in subse-quent chapters.

5

Proper Nutrition forHealth and Growth

JLour most important contribution to the future healthof your child will be the attention you give to your owndiet during pregnancy and to proper nutrition for yourbaby after he is bom. Because your pediatrician has littleknowledge and even less interest in nutrition, you willhave to become your own expert where your child’s dietis concerned.

Your first and most important nutritional decision—whether you will breastfeed your baby or not—will af-fect his health and development in infancy and for therest of his life. Unfortunately, most obstetricians and pe-diatricians fail to emphasize the importance of breast-feeding strongly enough and to inform you fully, if at all,of the comparative shortcomings of bottlefeeding for-mula milk. It is essential, therefore, that you informyourself.

Breastfeeding lays the foundation for healthy physicaland emotional growth and provides your child and your-self with many additional benefits as well. Here are someof the benefits of breastfeeding that are stimulating apromising resurgence of this womanly art in the UnitedStates.

1. Mother’s milk, time-tested for millions of years, isthe best nutrient for babies because it is nature’s perfectfood. It provides your child with all of the nutrients he

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needs for healthy growth for at least the first six monthsof life, and all responsible nutritional and pediatric au-thorities acknowledge its superiority over both infantformulas and cow's milk.

Cow’s milk is deficient in iron and should not be givento babies for at least six months. Even then it should beintroduced with caution, because many babies—perhapsas many as 15 percent—are allergic to cow’s milk. Itshould be suspected as the potential cause of many ill-nesses.

Bottlefeeding with infant formula is also less than sat-isfactory from a nutritional standpoint, even though themanufacturers fortify their products with vitamins andminerals and maintain that their products are as nutri-tious as mother’s milk. If you breastfeed your baby thereis no danger that some essential nutrient will be omittedfrom your milk, but that can’t be said for manufacturedinfant formula. The manufacturers not only can fail buthave failed to include essential ingredients, with disas-trous consequences for the infants who were fed theirproducts. Classic examples were the lack of vitamin B6in SMA formula, which led to a pyroxidine deficiencyand convulsions in the infants who received it, and theproduction of Neo-Mull-Soy with an inadequate saltcontent, which resulted in failure to thrive.

Bottlefeeding with infant formulas also predisposesinfants to lifelong obesity because the products providethe wrong kind of nutrients. Human milk is 1.3 percentprotein: cow’s milk and infant formulas are 3.3 percentprotein or more. That’s why one study of 250 full-terminfants at six weeks of age found that 60 percent of thebottlefed babies were overweight, compared to 19 per-cent of those who were breastfed. Excess protein placesan unduly heavy load on the kidneys, and some childrengain weight faster because they retain more fluid.

Finally, breastfed babies are permitted to eat untilthey are satisfied, and you have no ability or need tomeasure the quantity of milk that your child takes.Formula-fed babies are usually placed on a fixed sched-

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ule, with a measured amount of milk given at each feed-ing. Too often, mothers feel a responsibility to encouragetheir baby to take the full scheduled feeding, making himdrink six or eight ounces when he was satisfied withfour. I'll have more to say about the relationship be-tween infant overfeeding and obesity later on.

2. A breastfed baby gains from kis mother’s milk anatural immunity to many allergies and infections that isdenied to babies who are bottlefed. Mother’s milk con-tains unique substances that inhibit the growth of bacte-ria and viruses, affording your baby critical protectionagainst disease during the most hazardous months of hislife.

3. The bonding of mother and child is regarded asessential to your baby’s emotional development, and itprovides emotional rewards for you, as well. The nurtur-ing that breastfeeding supplies is the ideal way to estab-lish this bond almost from the moment of birth. Unlessyou have received excessive drugs during delivery,which also affected your baby, his desire to begin nursingshould be at its peak within 20-30 minutes after birth.From that moment on he should be nursed when he givesevidence of the desire to do so. At the outset this may beas many as 20 times a day.

The emotional and psychological rewards of breast-feeding cannot be overstressed. You and your baby willsacrifice one of the most beneficial of human experi-ences if you fail to breastfeed. Dr. Grantly Dick-Read,regarded by many as the father of today’s natural birthmovement, said it well: “The newborn baby has onlythree demands. They are warmth in the arms of itsmother, food from her breasts, and security in the knowl-edge of her presence. Breastfeeding satisfies all three.”

Newborn babies should be fed when they are hungry,not on some arbitrary schedule. That’s one of the addi-tional shortcomings of postnatal procedure in most hos-pitals, which I alluded to earlier. Too often, mothers and

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babies are required to conform to a four-hour feedingschedule, simply because that is more convenient for thehospital staff. This is not good for your baby and it is notgood for you. Your baby’s hunger is regulated by hisneed for food, not by the nursery clock. He should befed when he wants to be fed, whether that’s once everyhour or once every four.

If your baby is born in a hospital, try to secure per-mission to keep him in your room so that you can feedhim as often as he desires and give him the nurturing thatwill help bonding take place. If this is not permitted, de-mand that he be brought to you when he is hungry, notevery four hours. Also caution your doctor to insist thatno supplementary feeding be given your baby in the nur-sery. Some nurses can’t resist the temptation to shove abottle of formula into a baby’s mouth when he cries,even when the baby is being breastfed. This may quellhis appetite when you are feeding him, and you don’twant him to have the formula, so it is appropriate toinsist that when your baby cries the nurses bring him toyou instead.

4. Not to be overlooked in deciding whether you willbreastfeed your baby are severed factors of specific im-portance to you. If you begin nursing your baby within afew minutes after delivery, it will help prevent hemor-rhage because his sucking will cause your uterus to con-tract, hastening its return to its normal condition whichreduces the flow of blood.

Mothers who breastfeed are able to return to theirnormal weight with greater ease than those who abandonthis phase of the reproductive cycle by resorting tobottlefeeding. Typically, about nine pounds of a mother’sweight gain during pregnancy is body fat, which is be-lieved to accumulate to enable you to produce milk forthe baby after his birth. If you breastfeed, this excess fatwill be consumed in the process. If you don’t, heroicmeasures may be required to restore your normalweight.

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5. If your baby is totally breastfed, it will provide youwith contraceptive protection, in most cases, for at leastsix months, and in some instances for as long as 2%years. The act of breastfeeding causes your reproductivecycle to move into a dormant stage, and you are unlikelyto have menstrual periods for seven months or moreafter the delivery of your baby or to become pregnantuntil after your periods resume. Sheila Kippley, authorof an excellent book on breastfeeding, examined data onAmerican women whose babies were totally breastfedand found an average of 14.6 months without menstrualperiods after their babies were bom.

While this means of contraception is not completelyreliable, it is probably as effective as any of the others,and no risks are involved. Remember, though, that occa-sional, haphazard breastfeeding won’t do the trick. Ifyou breastfeed your baby only occasionally, and givehim a bottle of formula at other times, you probablywon’t receive the contraceptive benefit that exclusivebreastfeeding will provide.

I get a lot of questions from new mothers about howoften their babies should be fed, how long they should befed, and how much they should eat. My answer—whether your baby is breastfed or bottlefed—is that thebaby is boss. Feed him when he seems irritable, let himnurse until he loses interest, and don’t be concernedabout whether he is eating too little or too much.

If you breastfeed, your baby will consume 80-90 per-cent of the available milk in about four minutes of feed-ing on each breast. However, a longer period of nursingis advisable for emotional reasons and to stimulate theproduction of milk. The act of nursing, even when it isonly minimally productive in providing additional food,stimulates lactation and increases the production of milk.If you limit the period of nursing unduly, or fail to nurseyour baby often enough, lactation may decrease to thepoint at which you are not producing as much milk asyour baby requires.

The emotional reasons for extending the nursing pe-

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riods are very important. My friends in the LaLecheLeague, to which I was medical advisor for many years,tell me that more mothers would breastfeed if they wereaware of the wondrous relationship it establishes be-tween mother and child. Some mothers, they say, arealso intimidated by the misconception that breastfeedingis inevitably a difficult, uncomfortable, unmanageablenuisance. There is no doubt that many mothers have thatconcern, but in my experience, once they experience thepleasures of breastfeeding, it is quickly dispelled. If youare undecided about whether to breastfeed your baby, Iurge you to read The Womanly Art of Breastfeeding,published by the LaLeche League International, Inc.,9616 Minneapolis Ave., Franklin Park, IL 60131, andBreast-feeding and Natural Child Spacing; The Ecologyof Natural Mothering, by Sheila Kippley, Harper andRow, 1974; Penguin, 1975.

It is not necessary to give supplementary water to abreastfed baby, nor are supplemental vitamins required.Babies who are fed infant formula don’t need supple-mentary vitamins, either, because these products arefortified with them. A healthy child does not benefit fromexcess vitamins and may be damaged by them.

DON’T START SOLID FOODSTOO EARLY

Breastfed babies do not require solid foods during thefirst year of life and should not be given any during atleast the first six months of life. Bottlefed babies shouldnot be given solid foods for at least four months. Untilthe infant is four months old, much of the solid food heeats passes through his body undigested. The intestinesare not yet well enough developed to process solid food,particularly protein. For example, the enzyme that isneeded to process rice cereal is not present, in quantitiesadequate to digest it, until your baby is four months old.Solid foods should also be avoided in the first months of

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life because the baby’s allergy defenses are not yet fullydeveloped, and there is also a higher incidence of chok-ing because the art of swallowing is still being mastered.

Solid foods should be introduced gradually into theinfant’s diet: fruit or cereal is usually given first, thenmeat. Avoid commercially prepared baby foods to theextent that you can, not only because they are more ex-pensive, but because they are less nutritious after beingprocessed to death.

Your baby will fare best if you prepare his food your-self. Use fresh fruits, vegetables, and meats, becausecanned and frozen foods contain varying levels of saltand other additives such as nitrites and monosodium glu-tamate. Wash the food carefully and make sure it is thor-oughly cooked. Then grind it, puree it, mash it, or put itin a blender, and spoon it in.

Many mothers have found that babies respond well tomashed fresh bananas or cooked yams as their first food.Babies seem to like the flavor, and they are easy to pre-pare. Cereals can be introduced by giving your baby bitsof natural, whole-grain bread. This will do as well ascooked cereal, although a lot of the bread will probablyland on the floor until your baby leams how to manageit. If you feed him cooked cereal, be sure it is the natu-ral, whole-grain variety, not the processed variety fromwhich nutritious ingredients have been removed and po-tentially harmful chemicals added.

Eggs, because they often cause allergic reactions,should be avoided until your baby is at least a year old.Introduce hard-boiled eggs first, feeding only themashed-up yolk. If there is no negative reaction after acouple of weeks, it is time to try feeding eggs scrambledwithout milk. Cow’s milk should also be avoided untilyour baby is at least a year old and then introduced grad-ually. Observe your baby closely to be sure that there isno allergic physical or behavioral reaction, such as ex-cessive crying or fussiness.

A hidden benefit of preparing your own baby foodmay be the influence it will have on the diet consumed

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by the others in the family. They will share in your ef-forts to provide your baby with a nutritious, natural,well-balanced diet. However, unless you want them toeat elsewhere, don’t expect them to enjoy their dinner ifit, too, is pureed.

Don’t allow your pediatrician or anyone else to try topersuade you to use commercial baby foods for reasonsof safety. The baby food manufacturers are not aboveattempting to frighten mothers who feed their childrentable food rather than their canned products. A pamphletthat did this. Dear Mother, put out by the manufacturersof Beech Nut baby foods, compelled even the staidAmerican Academy of Pediatrics committee on nutritionto protest. The committee said it deplored industry“scare” tactics and was concerned that some materialfrom scientific publications had been taken out of con-text.

“We are not in agreement with implied excessivedangers in home preparation of foods,” the committeedeclared. “Obviously care should be taken in the prepa-ration and storage of infant foods, but the likelihood ofhome-prepared fresh foods being toxic is remote.”

CHILDREN’S APPETITES VARY

Parents sometimes become overly preoccupied withhow much their child is eating. If the pediatrician hassaid that a bottlefed baby should be getting six ounces offormula at each feeding, mother will struggle to get himto consume the last half-ounce. As the child gets older,there may be repeated battles at the dinner table to gethim to join the clean-plate club. This is a mistake, andthe worries are unnecessary, because no child—unlesshe or she is suffering from anorexia nervosa—will everstarve to death if food is available.

The size of a child’s appetite will vary from day to dayand year to year for a variety of reasons. It can be af-fected by his level of activity, by his fondness for thefood he is served, and by the intake he requires if he is in

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the midst of a spurt in growth. The child, whether he is ababy or in his teens, will eat what he needs.

Children are often condemned to adult obesity be-cause they were overfed as children. Studies of infants atvarious ages up to 18 months show more than 70 percentgetting excess calories, some as much as 250 percent ofthe recommended daily allowance for normal nutritionaland energy needs. It is also estimated that 30 percent ofall school age children are overweight.

This becomes troublesome in later life because adultobesity results from excessive production of fat cells inthe early childhood years. The number of fat cells in-creases from birth to two years and again at puberty. Anoverfed child may have 75 trillion fat cells when he be-comes an adult, compared with 27 trillion for a child whowas fed an adequate but not excessive diet. This differ-ence is important because weight gain in adults is notdue to an increase in the number of fat cells but to anincrease in their size. If too many fat cells have beenproduced in childhood, they remain in the body for life,waiting to be filled up when the adult eats a high-caloriemeal or a chocolate eclair.

One basic rule should be your guide in your effort toprovide sound nutrition for your children and others inyour family: the more any food is processed, the lessnutritious it becomes. Virtually all foods are most nutri-tious when they are served in their raw, natural state. Ifthey must be cooked, the duration of cooking should beas short as possible. That’s one reason why the Chinesestir-frying method is so attractive. Fresh fruits and vege-tables are more nutritious than the same varieties afterthey have been cooked and canned.

At the opposite end of the spectrum are the “conve-nience” foods that have become so popular in the UnitedStates, and breads and cereals made from refined flourand loaded with refined sugar. The “empty calories” theyprovide, and the chemical additives used to color, flavor,stabilize, and preserve them, are the last thing your childneeds. Keep that in mind as you plan the meals you pre-

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pare for your family. Serve fresh, natural foods preparedfrom scratch and avoid processed commercial productssuch as packaged “TV dinners.”

If you stick with natural foods and cook them as littleas possible, little is required to assure your family of ahealthy diet other than the application of common sense.Don’t concern yourself with all of the unproven medicaltheories about the hazards of feeding your child eggs, ordairy products, or any other natural, unprocessed food.Provide a varied, balanced diet and your family will getall of the nutrients it needs. The basic guideline for adaily diet that most nutritionists would suggest for pre-adolescents is this: three servings of milk or milk prod-ucts, or an alternative source of protein; two servings ofmeat, cheese, eggs, peanut butter, beans, or other pro-tein source; four or more servings of fresh fruits and veg-etables; and four or more servings of breads made fromunrefined flour and cereal grains. However, it is worthnoting that a child’s entire nutritional need, includingprotein and calcium, can be met without milk or milkproducts.

Remember that breakfast is the most important mealof the day. If your child skips it, he will be more suscep-tible to infection and also to fatigue, which may affect hisgeneral health and hamper his work in school. Be surethat he eats wholesome food for breakfast, not sugar-laden junk. Don’t let him form the habit of putting sugaron his cereal, and don’t introduce him to the sugar-coated cereals that the breakfast food manufacturerspush so vigorously on TV.

Remember, too, that it is tradition, not nutrition, thatis responsible for the American habit of breakfasting oncereal, pancakes, bacon, and eggs. Your child’s nutri-tional needs will be as well served—perhaps betterserved—if you give him wholesome leftovers from thedinner you had the night before. I’ve often thought itironic that many Americans are appalled by the fact thatMexican children breakfast on a bowl of beans and theChinese on a bowl of brown rice. Both are healthy foods

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that contain a wealth of protein and vitamins. Mean-while, the typical American kid is eating an expensivecommercial cereal that has been processed to death andloaded with refined sugar, yielding empty calories thatdo him little good.

KIDS DON’T H/VE TOEAT EVERYTHING

Don’t be upset if your child takes an instant dislike tosome foods—particularly vegetables. As long as he isgetting a basic diet, with all of the food groups repre-sented, it isn’t imperative that he eat every vegetable inyour produce merchant’s bins. The classic source ofmealtime friction seems to be spinach, which most kidshate and most parents apparently believe to be an essen-tial source of iron and calcium. Actually, while spinach isrich in these minerals, they are present in a form that isdifficult to digest, and spinach is a poor energy source.So, don’t push spinach if your child doesn’t like it. If hehas an aversion to all vegetables, try concealing them instews, soups, or breads, and encourage him to try eatingthem raw.

Don’t get so locked into conventional mealtimes thatyou can’t be flexible if your child seems hungriest atsome other hour. His bodily clock may not be regulatedby Emily Post. If his appetite suddenly slacks off, bear inmind that it may simply be a natural reduction in his foodrequirements, but consider also the possibility that he iseating too many snacks. If it proves to be the snacks,make certain that those which are available to him arehealthful ones such as fresh fruit, raisins, nuts, seeds,yogurt, raw vegetables, and milk.

I’ll conclude this chapter with a warning about thepotential nutritional consequences if it becomes neces-sary for your child to be hospitalized. It is here, on theirown turf, that the nutritional indifference of doctors ismost clearly demonstrated. That’s why it is important foryou to observe closely how well he eats duringhis hospi-

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tal stay and what kind of diet he receives.

Studies have found that up to half of the patients con-fined to hospitals suffer from malnutrition within a fewdays. That’s not because hospital food is necessarilybad; much of it, in fact, is pretty good. It is becausedoctors are so enamored with medical technology—labtests and X-rays—that require their patients to fast oreat severely restricted diets. Some patients literallywaste away from malnutrition while their doctors subjectthem to an elaborate series of tests in an effort to deter-mine what is wrong with them. By the time the doctor isthrough with his tests, malnutrition may have becomethe patient's most serious problem.

One study of children’s nutrition in a New York hospi-tal found that two-thirds of 200 children had a nutritionproblem. Those who conducted the study said that thisdid not surprise them but that they “were somewhat cha-grined to find out what many physicians don’t knowconcerning the details of pediatric nutrition.” A majorityof the primary physicians caring for the children hadnever had a nutrition course of any kind!

I don’t know why they should have been surprised.Several years ago the chairman of the American MedicalAssociation committee on nutrition noted ”... the grow-ing suspicion that a great many people in the nation’shospitals are unwillingly becoming the victims ofphysician-induced malnutrition and outright star-vation. ... It is not due to wilful neglect on the physi-cian’s part; rather it is due to his lack of understanding ofthe whole new science of nutrition.”

This criticism did not pass unnoticed within theAMA. It solved the problem to its own. satisfaction, ifnot to mine or yours, by abandoning the committee onnutrition!

There is no more important action that you can taketo raise a healthy child, or one in which you can placeless reliance on the medical profession, than making surethat he eats the right kinds of food in the appropriatequantities, and avoids those that will do him harm.

6

What YouShould Expectof Your Child

A^ost baby books dwell at length on the developmen-tal landmarks of early childhood—sitting, standing,crawling, walking—and the host of behavioral concernsthat will surface as your child grows older. These mile-stones are of legitimate interest to proud parents, butonly rarely should they be a matter of concern, and Idon’t need a whole book to give you my advice aboutthem. I’ll do it in one sentence: unless there is somethingobviously wrong with your child, don’t worry about howsoon he sits, stands, crawls, or walks.

If this is your first child, you will be strongly temptedto compare his progress with that of other children hisage. I know that nothing I write will keep you from doingthat, but I hope I can convince you that such compari-sons are more apt to mislead than to inform. During thefirst few years of life the development of individual chil-dren varies so widely that comparisons are meaningless.However, if you want a rule of thumb, try this: mostchildren sit with support at 6-8 months, sit without sup-port at 8-10 months, walk at 12-18 months, talk at18-24 months, ride a tricycle at 3 years, and copy asquare at 4 years. Having said that, let me urge you toresist the temptation to boast if your child reaches any ofthese milestones at an earlier age or to worry if his devel-opment is delayed. At some point in their development

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all normal children arrive at the same place, and whetherit is early or late makes no difference.

Sooner or later your children will learn to do whatyou expect of them if your expectations are realistic. Allof us know, but we sometimes forget, that all children donot learn at the same rate, within the same time frame,with the same ease; nor can they be expected to reach auniform level of achievement by the time they becomeadults. That knowledge, unfortunately, does not preventus from having grand expectations of our own children,which begin while they are still in the crib. Nor does itkeep us from making behavioral comparisons with otherchildren that are both meaningless and dangerous.Today’s “early bloomer” may be the backward child oftomorrow, and vice versa.

Our rosy expectations of our kids are beneficial ifthey encourage us to give them the attention and supportthey need to achieve the potential they have. They canalso be devastating to our child’s development and self-image if our expectations exceed his potential, or if welack the patience to allow his skills and interests to de-velop naturally during the formative years.

It is sometimes difficult for parents with high expecta-tions, who may themselves be high achievers, to re-member that the occupation of children is to play and tolearn. We must learn to accept the fact that during theirdevelopmental years children cannot be expected to ex-hibit adult behavior. More likely, many of the things theydo will seem almost calculated to drive you up the wall.Nothing I have to say in this chapter will make yourchild’s annoying behavior any less worrisome or exas-perating, but it may be easier to live with if you under-stand what’s normal and where the child is coming from.

PHYSICAL BEHAVIOR THATCONCERNS PARENTS

First let’s separate physical behavior from emotionalbehavior. What are the physical things that parents most

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commonly worry about? All babies, often to the initialdistress of their parents, cough, grunt, belch, hiccup,sneeze, pass gas, spit up, and vomit. You may worryabout this at first and wonder whether it indicates somedeficiency in your child’s diet. You needn’t, because aslong as the baby is eating right and not losing weight youcan regard all of this behavior as normal.

While we’re on the subject of infantile sounds, let mecaution you also not to get hung up on burping. Some-where in the distant past some mother found that herbaby was less apt to spit up his lunch if she patted himon the back until excess air was released from his stom-ach. This procedure has become such a ritual that somenew mothers appear to believe that their child will notsurvive if he doesn’t burp loudly after every meal. Infact, there’s nothing carved in stone that says your babyhas to burp. Some babies swallow a lot of air and readilyproduce an earsplitting burp. Others swallow very littleand don’t need to burp at all. If you find that burpingafter a meal keeps your baby from spitting up, you maywant to encourage him a bit, but don’t make a produc-tion of it. There is no medical reason why he has to burpat all.

While we’re on the subject, let me say a word aboutcolic. This is the name mothers and doctors give to aphenomenon that usually occurs before three months ofage. A previously placid and contented baby suddenlybegins drawing up his legs and having paroxysms ofscreaming. It may surprise you, considering the eon thatbabies have been on earth, but there isn’t a shred ofscientific evidence indicating what causes it. However,the word colic is a convenient term for doctors, who useit to explain crying that they can’t explain.

Some medical textbooks refer to “gas” in the intes-tines, caused by excessive fermentation of carbohy-drates, as a possible cause. But then they note thatremoving the carbohydrates doesn’t relieve the condi-tion, which seems to cast grave doubts on this explana-tioa The simple truth is that many mothers and most

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doctors talk about “colic” as uncontrollable cryingcaused by “gas” in the baby’s stomach. Scientists saythat they don’t know what causes it. I’m with the scien-tists. I don’t know, either!

Crying is the second worrisome behavior that appearsat birth. The first cry you hear is reassuring, but fromthen on crying is something every parent could cheer-fully do without. Over the years doctors have given par-ents a lot of bad advice about what to do when their babycries, and a lot of kids have suffered because of it.

I was amused recently to come across a book pub-lished in 1894 by Dr. Luther Emmett Holt, who is gener-ally regarded as the father of pediatrics. The book. Careand Feeding of Children, went through more than 75printings and was published in three languages, and uponreading it, I was reminded of where pediatricians got alot of their bad advice. Here, in his question-answerstyle, is what he had to say about crying:

When is crying useful?

In the newly bom infant the cry expands the lungs,and it is necessary that it should be repeated for afew minutes every day to keep them well ex-panded.

How much crying is normal for a very young baby?

From 15 to 30 minutes a day.

What is the nature of this cry?

It is loud and strong. Infants get red in the facewith it; in fact, it is a scream. This is necessary forhealth. It is the baby’s exercise.

What is the cry of indulgence or from habit?

This is often heard even in very young infants, whocry to be rocked, to be carried about, sometimesfor a light in the room, for a bottle to suck, or forthe continuance of any other bad habit which hasbeen acquired.

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How can we be sure that a child is crying to be indulged?If it stops immediately when it gets what it wants,and cries when it is withdrawn or withheld.

How is an infant to be managed that cries from temperor to be indulged?

It should simply be allowed to cry it out. A secondstruggle is rarely necessary.

At what age may playing with babies be begun?

Never until four months, and better not until sixmonths. The less of it at any time, the better for theinfant.

What harm is done by playing with very young babies?They are made nervous and irritable, sleep badly,and suffer in other respects.

Dr. Holt also recommended feeding at regular inter-vals, putting children to bed at exactly the same timeevery day and evening, stopping night feedings at fivemonths, and not rocking a baby because it is “uselessand sometimes injurious.” He also maintained that underno circumstances should a child be allowed to sleep in itsmother’s bed.

CHILDREN CRY BECAUSE THEYHAVE PROBLEMS

Much of Dr. Holt’s advice is still accepted by manypediatricians. Study it, and then do the opposite. Chil-dren cry because they are hungry, or lonely, or tired, orwet, or in pain. Compassionate people do not withholdcomfort from adults who are crying, for whatever rea-son. Why in heaven’s name should a loving parent with-hold comfort from a little child? If your child cries, don’tlet it continue. Pick him up and find out why. If he cries

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at night because he is lonely or afraid, take him into yourbed.

Psychologists and psychiatrists always give me a badtime when I make that last recommendation. I recallbeing on the Phil Donahue show with Tine Thevenin,author of The Family Bed, and a psychiatrist who wasinvoking the Oedipus complex and other pet theories totry to put her down. Donahue turned to me for my opin-ion, and I told him I agreed with the psychiatrist. I saidthat psychiatrists should not take their children to bedwith them, but that it was quite all right for everyoneelse!

Bowel habits, diarrhea, constipation, and toilet train-ing are also parental concerns that begin at birth andcontinue through the years. Many first-time mothers areinordinately concerned with the appearance and condi-tion of their baby’s stools, particularly if the baby isbeing breastfed. The color and consistency of a baby’sstools vary considerably depending on his diet.Breastfed babies, for example, usually have stools thatresemble loose scrambled eggs. This is not diarrhea; it isperfectly normal and not a matter of concern. There is adanger, though, that your pediatrician may use this nor-mal condition as an excuse to switch your child frombreastfeeding to formula milk.

If that happens, pay no attention to him. The mostsensible rule to follow is this: if your child is thriving andgaining weight, don’t worry about the consistency of hisstools, whether they are extremely loose or as hard asmarbles. You need to be concerned only if he is notthriving, is losing weight, or if the stools are bloody. Inthat case, see a doctor. However, if this does becomenecessary, be wary of medications unless your doctor isable to diagnose a specific cause. Pediatricians are invet-erate stool-gazers, inclined to treat loose stools withopiates such as Lomotil. In the absence of a specific dis-ease, a more sensible course, which really doesn’t re-quire medical supervision, is to look for food allergies

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and then eliminate the offending foods. The most likelyfood is cow’s milk.

This is also true of constipation. There is no magicnumber of bowel movements your child should have andno reason to be concerned if he fails to have at least oneevery day. If your child seems to be constipated, look forthe cause in his diet and see a doctor only if the consti-pation is accompanied by pain or bleeding.

As for toilet training, pay no attention to medical ad-vice, because your pediatrician doesn’t know any moreabout it than you do. It’s a family affair. It doesn’t makeany difference, except in terms of your own conve-nience, whether you train your child early, late, or nei-ther of the above. Some children train readily. Othersdon’t, and I have no magic formula you can use if youhave one of those. My daughters have, though. Theyturned to their mother for advice on training their chil-dren!

The emotional behaviors of children that may pro-voke frustration and anger in parents are almost endless,from the “terrible twos” to the “turbulent teens.” Whatyou must remember, when your nerves get frayed, is thatthey all stem from developmental processes withoutwhich your child could never become a functioningadult. Moreover, physical punishment is rarely, if ever,the solution.

Your immediate reaction is likely to be anger whenyour toddling child jerks the cloth from a table andsmashes your most cherished vase. If it is, you mustlearn to control it, because at that age hasty physicalpunishment won’t solve the problem; it will merely con-fuse your child. A more appropriate response will be toremind yourself that the child isn’t being deliberatelynaughty. He’s simply exercising the normal curiosity thatwill enable him to learn and trying out his newfoundmotor skills. Then, begin firmly but not angrily to teachhim the word no, and put the rest of your cherished ob-jects out of reach.

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PUNISHMENT IS NOTTHE SOLUTION

Virtually all disturbing childhood behaviors stem fromsome emotional cause. Your response is not to punishthe child but to isolate the cause. Often, the child youhave finally toilet-trained after a long struggle will sud-denly begin to wet his pants again. This isn’t deliberate,because no child really enjoys wet pants or the negativematernal response they evoke. It is virtually certain,when this happens, that the child is responding to someenvironmental stress. Don’t spank your child; try toidentify and eliminate the stress.

Remember, if your child suddenly becomes violentwith his playmates, or becomes a discipline problem inschool, that he is probably reacting to some situation orproblem that is beyond his control. It could be illness,exhaustion, hunger, visual or hearing defects, or simplya reaction to turmoil at home. It may even be a responseto his deteriorating self-image because you have unreal-istic expectations of him. If so, he won’t respond posi-tively to punishment. Emotional support and constantdisplays of love and affection are more apt to be thecure.

Children must, of course, be guided toward responsi-ble adult behavior, but parents shouldn’t expect them toachieve it all at once. Nor is there any convincing evi-dence that it can be effectively achieved by employingthe old maxim “spare the rod and spoil the child.” Cor-poral punishment at any age confuses and traumatizesthe child, because he can’t understand why the motherand father he loves, and who are supposed to love him,are suddenly raging at him and causing physical pain. Heis made to feel insecure, resentful, and even worthless,and the consequence may be psychological harm.

The impact of physical punishment on child develop-ment has been studied extensively, and the consensus ofthis research is that violence damages both parent and

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child. It fails to teach children what to do and yields onlya temporary benefit, if that, in teaching them what not todo. I won’t deny that I’ve raised my hand in anger onoccasion, but for the most part I have tried to achievethe desired end with my own children through the use ofexample and the provision of tender, loving encourage-ment. I am more than satisfied with the results, I hopeand trust that my grandchildren, likewise, will rarely en-dure physical punishment of any kind.

SOME MAXIMS ABOUTCHILDHOOD BEHAVIOR

If you become so frustrated with any aspect of yourchild’s behavior that you are tempted to discipline himphysically, restrain yourself. Consider alternative meansof behavior modification that may be more effective.There are many alternatives to violence, but the subjectis too vast to be dealt with here. Your local bookstore iscertain to have a shelf full of sound advice, so all I’llprovide here is a handful of maxims about child behaviorthat I have developed for my patients over the years.

• Children aren’t adults, so don’t expect them tobehave as though they were.

• Children learn by doing, so don’t expect to ap-prove of everything they do.

• It is a rare child whose behavior equals his par-ents’ expectations.

• Children are more likely to do as you do than todo as you say.

• Adolescence is a time when children learn to beadults by trying their wings. They may need aleash, but never a cage.

• It is often less important for parents to controltheir children’s behavior than it is for them tocontrol their own.

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• Children react to anger; they respond to love andaffection.

• The pain you inflict on your children will proba-bly be inflicted on theirs.

A secure and loving home environment and emotionalstability within the family appear to be the major ele-ments in overcoming some of the specific behaviors thatconcern or displease parents. These include thumb suck-ing, nail biting, nose picking, rocking and head banging,bed wetting, and erratic sleep habits. There are a host offolk treatments for these common annoyances, some ofwhich seem to work for some children, but there is nospecific medical “cure” for any of them.

You can deal most successfully with these problems ifyou refrain from making an issue of them, pay close at-tention to the emotional needs of your child, make surethat he knows you love him, whatever he does, and exertyourself to make him feel secure. If you develop thatkind of warm relationship with him, you’ll do more thaneliminate annoying habits. You’ll be rewarded with ahappy, confident, emotionally stable child!

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Fever: YourBody’s Defenseagainst Disease

Do you worry when your child has a fever and reachfor the telephone to let your doctor know right away?Many parents do, because medical professionals—doc-tors and nurses—have led them to believe that all feversare dangerous. Doctors have also reinforced the mis-taken notion that the height of a child’s temperature is ameasure of how sick he is. That’s why fever is the symp-tom that produces about 30 percent of the patients a pe-diatrician sees.

When you telephone your pediatrician to tell him yourchild is sick his first question, almost invariably, is“Have you taken his temperature?” Whether you tellhim 101 or 104, he’ll probably tell you to give the kid anaspirin and bring him to the office. This ritual is almostuniversal among pediatricians. I suspect that some ofthem perform it by rote and would offer the same adviceif you told him your child’s temperature was 110! Whattroubles me is that they ask the wrong question and givethe wrong advice. The very fact that fever is their firstconcern implies that there is something implicitly dan-gerous about fever itself. Then, when they prescribeaspirin, you are led to the inevitable conclusion that it isnecessary and desirable to treat your child with drugs tobring the fever down.

This charade continues when you take your child to

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the doctor’s office. In most practices the first thing thenurse does is to take his temperature and write it on hischart. There’s nothing wrong with that. An elevated tem-perature does offer a diagnostic clue that can be impor-tant in the context of everything else the doctor learnsduring his subsequent examination. The problem is thatthe presence of fever is too often given more importancethan that When the doctor finally aiTives in the examin-ing room he is apt to look at the chart, assume an ex-pression of benign concern, and say gravely, “Hmmm,102 degrees. Well, now, we’d better do something aboutthat!”

That’s nonsense—misleading nonsense—because thepresence of fever, by itself, does not mean that he mustor should do anything at all. Unless there are additionalsymptoms such as extreme listlessness, abnormal behav-ior, respiratory difficulty, and others that could indicatethe presence of serious diseases such as diphtheria andmeningitis, your doctor should tell you there is nothingto worry about and send you and your child home.

It is not surprising, in view of this misleading preoc-cupation of doctors with fever, that the vast majority ofparents questioned in surveys fear it greatly and thattheir degree of concern increases with each degree oftemperature registered on the thermometer. Rarely isthis concern justified. You’ll be spared a lot of parentalanguish, and your child will avoid needless and poten-tially harmful tests. X-rays, and medication, if you keepin mind some basic facts about fever. These are truthsthat every doctor should know, that many seem to ig-nore, and that most of them won’t tell you.

Fact No. 1: A temperature of 98.6 degrees Fahrenheit isnot the "normal” temperature for everyone.

That’s what most of us have been told all of our lives,but it simply isn’t true. The 98.6-degree standard forbody temperature is merely a statistical average, and“normal” for most people is either higher or lower thanthat. This is particularly true of children. Their “normal”

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temperatures, measured in carefully controlled studies,ranged from a low of 96.6 degrees to a high of 99.4. Veryfew of these healthy children registered temperatures ofprecisely 98.6 degrees.

Your child’s temperature may also fluctuate signifi-cantly throughout the day. You can expect his tempera-ture to be about a degree higher in the late afternoonthan it is in the early morning. Thus, an elevated readingtaken at dinnertime may be a perfectly normal readingthat occurs at that hour almost every day.

Fact No. 2: Your child’s temperature may rise for a vari-ety of reasons that do not signify illness.

Children’s temperatures may be elevated while theyare digesting a heavy meal. They may increase becauseof ovulation in pubertal teenagers. Sometimes they are aside effect of medications prescribed by your doctor—antihistamines and others.

Fact No. 3: The fevers you should be concerned aboutusually stem from an obvious cause.

Most of the fevers that spell serious trouble are theresult of poisoning, or exposure to toxic substances inthe environment, and to causes that lead to “heat-stroke.” You’ve probably witnessed the latter in personor on TV—the soldier collapsing on the parade ground,or the marathon runner falling by the wayside, becauseof excessive physical exertion in the hot sun. Tempera-tures of 107 degrees or above, resulting from thesecauses, can result in lasting bodily harm, as can thosethat occur when someone becomes overheated fromspending too much time in a sauna or Jacuzzi.

If you suspect that your child has swallowed a poison-ous substance, call the poison center immediately. If youcan’t reach a poison center, don’t wait to see if there areadverse reactions. Rush him to a hospital emergencyroom right away and, if possible, take the poison con-tainer with you. That will help determine the appropriateantidote. Most of the time the swallowed substance willbe relatively innocuous, but you’ll be glad you soughthelp promptly on the occasion when it isn’t.

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Immediate treatment is also essential if your childcollapses and lapses into unconsciousness—even briefly—after strenuous activity in the hot sun or overexposurein a sauna or a Jacuzzi. Don’t just call your doctor. Takethe child to a hospital emergency room at once. Theseexternal influences are potentially dangerous becausethey may overwhelm the bodily defenses that normallyprevent temperatures from soaring to dangerous levels.

Temperature elevations caused by events of this sortare very rare, of course. They can be identified by yourknowledge of the circumstances and the associatedsymptoms such as loss of consciousness that leave nodoubt that your child is in real trouble.

Fact No. 4: Temperature readings will vary depending onhow they are taken.

Rectal temperatures in older children are usuallyabout a degree higher than those taken orally, and axil-lary (underarm) temperatures may be about a degreelower. However, in babies rectal temperatures usuallyvary only slightly from oral or axillary temperatures.Consequently, an axillary reading is quite adequate todetermine the temperature of an infant, and the use of arectal thermometer is unnecessary. Avoid using one andspare your child the hazard of a rectal perforation—arare accident that sometimes occurs when a rectal ther-mometer is inserted. I mention this risk only becauserectal perforations are fatal in about half the instances inwhich they occur. That’s why I advise parents not totake rectal temperatures. There’s no need to do it, sowhy risk damaging your child?

Finally, don’t assume that you can determine theheight of fever by placing your hand on your child’schest or forehead. It has been demonstrated that skilledhealth professionals can’t do that with any degree of reli-ability, and neither can parents.

Fact No. 5: In advising against the treatment of fever,per se, I make an exception of newborn babies.

Newborn babies may suffer from infections related toobstetrical intervention during the delivery process, pre-

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natal or hereditary conditions, or events that occurshortly after birth. They may develop scalp abscesses asa result of fetal monitoring prior to.delivery or aspirationpneumonia from amniotic fluid forced into the lungs be-cause of ovennedication of the mother during labor.They may contact an infection from circumcision per-formed by the obstetrician before they left the hospital.Finally, they may develop infections from the legion ofgerms that abound in the hospital itself. (That’s one ofthe reasons all of my grandchildren have been bom athome!) Prudence demands that you take your newbornbaby to the doctor if he runs a fever of any level duringthe first few months of life.

Fact No. 6: If your baby has a fever, don’t overlookoverdressing as a possible cause.

Parents, particularly those who are caring for theirfirst child are often overly concerned about keeping thebaby warm. They bundle the child up in layer upon layerof clothing and blankets, forgetting that babies are inca-pable of casting off excess clothing and blankets if theheat becomes oppressive. An elevated temperature mayresult. If your baby already has a temperature, perhapsaccompanied by chills, and you respond by wrappinghim tightly in heavy blankets, you will simply force histemperature to rise even more. A simple rule to follow,which I suggest to my patients, is to dress your baby inas many layers of clothing as you find comfortable foryourself.

Fact No. 7: Most fevers are caused by viral and bacterialinfections that the body’s own defense mechanisms willovercome without medical help.

The common cold and influenza are the most commonsources of elevated body temperatures in children of allages. They can generate fevers that range all the way upto 105 degrees, but even at that level they are not a legiti-mate cause for alarm. The only potential risk is dehydra-tion, which may result from accompanying conditionssuch as excessive perspiration, rapid respiration, cough-ing, runny nose, vomiting, and diarrhea. You" can help

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avert the threat of dehydration by making sure that yourchild receives plenty of fluids. A good rule of thumb is totry to get the patient to drink eight ounces of fluid everyhour, preferably liquids that have some nutritional value.However, that’s a lot of fluid, and it doesn’t make anydifference what kind it is, so give your child fruit juice,soda, tea, or anything else he’s willing to take.

In most cases you will be able to identify a fever asthe product of a viral or bacterial infection, because theaccompanying symptoms are those that are typical ofthese ailments—a mild cough, a stuffy or runny nose,watery eyes, etc. There is no need to call the doctor or togive any form of medication if no other symptoms arepresent, because there is nothing he or you can prescribethat will cure a viral infection or dispose of a bacterialinfection any more effectively than the body’s own de-fenses will. Medications given to relieve discomfort mayinterfere with the body's efforts to cure itself, for reasonsthat I’ll explore more fully in a later chapter. Antibioticsmay shorten the course of a bacterial infection, but therisks outweight the benefit.

Fact No. 8: There is no consistent relationship betweenthe height of a child’s temperature and the severity of adisease.

There is a common misconception that the height ofbody temperature is an indication of the severity of anillness, but no consensus exists among parents or evenamong doctors about what “high” is. I’ve found amongmy patients an astonishing range of beliefs on this matterand also about the level a fever must reach before it is“too high.” Research has shown that more than half ofall parents consider a fever “high” at levels between 100and 102, and almost all believe it is “high” if it reaches103 degrees. These parents are also convinced that theheight of a fever indicates how sick their child is.

This is emphatically not the case. Knowing the pre-cise level of your child’s fever will tell you nothing abouthow sick he is if the fever is produced by a viral or bacte-ria] infection. Once you have determined that your child

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has a fever caused by infection, it is useless to hoverover him, taking his temperature every hour or so, todetermine how high it goes. There is nothing to be gainedby measuring its climb, and doing so will probably mag-nify your fears and upset the child.

Some common, nonthreatening diseases such as ro-seola (one-day measles) produce extremely high temper-atures in some children, while other more seriousdiseases may not produce any temperature elevation atall. Unless your child's fever is accompanied by addi-tional symptoms, such as vomiting or respiratory diffi-culties, it need not be a cause of concern, even if itreaches 105.

More important in determining whether a fever is theresult of a mild infection like the common cold, or amore serious one such as meningitis, is the overall ap-pearance, behavior, and attitude of your child. These areall factors that you can judge more accurately and skill-fully than your doctor, because you are the leading au-thority on the appearance and behavior of your child. Ifhe is listless or confused, or displays other disturbinglyabnormal behavior, a call to your doctor may be war-ranted if the symptoms persist for a day or two. How-ever, if he’s active and playing and behaving normally,you needn’t fear that his ailment is a matter of seriousconcern.

Every now and then I see an article in one of thepediatric journals about “fever phobia.” That’s a termused by doctors to describe the “unreasonable” fear thatsome parents have of fever. This is typical of the “blamethe victim” attitude that prevails in my profession. Doc-tors don’t make mistakes; when they occur they arealways the patient’s fault. As far as I’m concerned,“fever phobia” is a disease of pediatricians, not parents,and to the extent that parents are victimized by it, doc-tors are at fault.

Fact No. 9: Untreated fevers caused by viral and bacte-rial infections do not rise inexorably and will not exceed105 degrees.

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Doctors do a great disservice to you and your childwhen they prescribe drugs to reduce his fever. The effectof this advice is to validate the common fear of manyparents that their child's temperature will continue torise unless measures are taken to control it and bring itdown. They don’t tell you that reducing his temperaturewill do nothing to make the patient well or that ourbodies have a built-in mechanism, not fully explained,that will prevent an infection-induced temperature fromreaching 106 degrees.

Only in the case of heatstroke, poisoning, or otherexternally caused fevers is this bodily mechanism over-whelmed and inoperative. It is in those cases that tem-peratures reach and exceed 106 degrees. Doctors knowthis, but most of them behave as though they didn't. Ibelieve that they are motivated by a simple desire tomake you, the parent, believe they have done somethingto help your child. In addition, they are exhibiting theircompulsion to intervene whenever they are provided theopportunity and their reluctance to admit that there arediseases that they can’t effectively treat.

Apart from terminal illness, did any doctor ever tell apatient, ‘There’s nothing I can do”?

Fact No. 10: Measures to reduce temperature, such asdrugs or sponging, are worse than unnecessary; they areactually counterproductive.

If your child contracts an infection, the fever that ac-companies it is a blessing, not a curse. It occurs becauseof the spontaneous release of pyrogens that cause thebody temperature to rise. This is a natural defense mech-anism that our bodies employ to fight disease. The pres-ence of fever tells you that the repair mechanisms of thebody have gone into high gear.

The process works like this: When an infection de-velops, your child’s body responds by manufacturing ad-ditional white blood cells, called leucocytes. Theydestroy bacteria and viruses and remove damaged tissueand irritating materials from the body. The activity of thewhite cells is also increased, and they move more rapidly

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to the site of the infection. This part of the process,called leucotaxis, is stimulated by the release of the pyr-ogens that raise body temperature. Hence the fever. Arising body temperature simply indicates that the processof healing is speeding up. It is something to rejoice over,not to fear.

But that isn’t all that’s happening. Iron, which manygerms need in order to thrive, is being removed from theblood and stored in the liver. This reduces the rate atwhich the bacteria multiply. The action of interferon, adisease-fighting substance produced naturally in thebody, also becomes more effective.

Artificially induced fevers have been used in labora-tory experiments with animals to demonstrate this proc-ess. Elevated temperatures decrease the death rateamong animals infected with disease, but if their bodytemperatures are lowered, more of them die. Artificiallyinduced temperatures have actually been used for manyyears to treat diseases in humans that do not normallyproduce fevers themselves.

If your child has a fever resulting from infection, re-sist the temptation to use drugs or sponging to bring itdown. Let the fever run its course. If parental sympathyimpels you to do something to relieve your child’s dis-comfort, sponge him off with tepid water or give him onetablet of acetaminophen of the strength recommendedfor his age. Do nothing beyond that unless the fever per-sists for more than three days, or other symptoms de-velop, or your child looks and acts really sick. In thatevent, see your doctor.

I want to emphasize that, while reducing his fevermay make your child more comfortable, you may inter-fere with the natural healing process if you do it. Myonly reason for discussing methods of temperature re-duction is the probability that some parents won’t beable to resist doing it. If you are going to do it, spongingis preferable to drugs because of the risks associatedwith aspirin and acetaminophen. Despite the frequencyof their use, these are far from innocuous drugs. Aspirin

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probably poisons more children every year than anyother toxic substance. It is a form of salicylic acid, whichis also the basis for an anticoagulant used in a commer-cial rat poisons that causes rats to die of internal hemor-rhage.

Aspirin can produce a variety of side effects in chil-dren and adults, not the least of which is intestinalbleeding. It also has been associated with Reye’s syn-drome when given to children with influenza or chickenpox. This is an often fatal disease of children primarilyaffecting the brain and liver. That’s one reason so manydoctors have switched to prescribing acetaminophen(Tylenol, etc.). That doesn’t really solve the problem,because evidence is emerging that large doses of thisdrug may be toxic to the liver and kidneys. It is alsoworth noting that babies bom to mothers who takeaspirin near the end of labor or during delivery some-times are victims of cephalhematoma, a condition inwhich fluid-filled bumps appear on the scalp.

If you can’t resist sponging your child to bring downhis fever, use tepid water, not cold water or alcohol. Thereduction of fever by sponging is caused by evaporation,not by the temperature of the water. There is no addedbenefit in sponging your child with water that is uncom-fortably cold. Don’t use alcohol, because it is no moreeffective than tepid water, and the fumes released onevaporation may be toxic to a small child.

Fact No. II: Fevers produced by viral or bacterial infec-tions will not cause brain damage or permanent physicalharm.

The fear of fevers in the higher ranges stems primarilyfrom the widespread belief that permanent physical orbrain damage may result if you permit your child’s feverto get “too high.’’ If that were true, it would justify anylevel of panic a parent might display, and because manyparents believe it is true, it often does.

If you have harbored this fear, put aside everythingyou have been led to believe about fever by your doctor,your parents, your grandparents, your spouse, or even

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the friendly medical expert who lives next door andoffers her advice over your morning cup of coffee. Evengrandmothers are not always right! Your child’s cold, in-fluenza, or any other infection will not produce a feverthat exceeds 106 degrees, and below that level the feverwill not cause any lasting harm.

Because your child’s bodily defenses won’t allow in-fections to produce fevers of 106 degrees, you need notlive in fear of mental or physical damage when his tem-perature begins to rise. I doubt that many pediatricians,including those who have practiced for decades, haveseen more than one or two cases of fever above 106 de-grees during their entire careers. Those they did seewere the result of causes other than infection, such aspoisoning or heatstroke. I have treated tens of thousandsof children, and I’ve seen only one case of fever higherthan 106. That’s not surprising, because it is estimatedthat 95 percent of childhood fevers don’t even reach 105.Fact No. 12: High fevers do not cause convulsions. Theyresult when the temperature rises at an extremely rapidrate.

Many parents are fearful of fevers because they havewitnessed a convulsive seizure and believe that theirchild may experience one if his temperature is allowed torise “top high.” I empathize with those who have thisconcern, for a child in the throes of a convulsion is afrightening spectacle. If you have seen one occur, youmay find it hard to believe that this condition is rarelyserious. It is also relatively uncommon; it is estimatedthat only 4 percent of children with high fever experiencefever-related convulsions. There is no evidence thatthose who do have them suffer any serious aftereffectsas a result. One study of 1,706 children who had sufferedfebrile convulsions failed to disclose a single death ormotor defect. There is also no convincing evidence thatfebrile seizures in childhood increase susceptibility toepilepsy later in life.

More to the point, however, is the fact that treatmentto prevent febrile convulsions is almost always'given too

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late to do any good. Medication and sponging are a use-less exercise because, by the time you become awarethat your child has a temperature, the probability is thatany resulting convulsion would already have occurred.That’s because the convulsion is not related to the heightof your child’s temperature but to how rapidly the tem-perature rose to whatever level it reached. By the timeyou become aware of the child’s temperature, the proba-bility is that this rapid rise has already occurred, andunless the child has already convulsed, the danger periodhas passed.

The possibility of febrile convulsions is limited pri-marily to children under live years of age, and eventhose children who experience them prior to that agerarely have them after the age of live. When a child ex-periences a convulsion, many doctors will prescribelong-term therapy with phenobarbital or other anticon-vulsants to prevent a recurrence of seizures when an-other fever occurs.

If your doctor suggests this treatment for your child, Iurge you to question him about the risks of long-termanticonvulsant therapy. Also ask him about the behav-ioral changes it may produce in your child. There is noconsensus among doctors on the long-term managementof febrile seizures. The drugs commonly used can causeliver damage, and animal studies suggest that they mayhave a negative impact on the development of the brain.One authority on the subject has argued that “Some pa-tients may be better off leading a more normal life be-tween occasional seizures than they would if they livedseizure-free in a perpetual state of drug-induced drowsi-ness and confusion ”

I was trained to prescribe phenobarbital for childrenwho had febrile convulsions, in order to prevent recur-rences. The same treatment strategy is still being taughtto students in medical school. I began to develop doubtsabout this procedure when I saw that some patients hadrepeat convulsions even when they were taking pheno-barbital. That obviously raised a question about whether

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those who were taking phenobarbital and were seizure-free were benefiting from the drug or would haveescaped another convulsion even if they hadn’t used it.My doubts were enhanced when some mothers began toreport that phenobarbital overstimulated their childreninstead of quieting them or quieted them so much thatnormally active, outgoing kids became, by comparison,semizombies. Because convulsions are so infrequent,and cause no lasting damage, I no longer prescribe thistherapy for the children who are entrusted to my care.

If your child suffers a febrile convulsion and your pe-diatrician prescribes long-term anticonvulsant therapy,you will have to determine whether you want to acceptit. I know it may be difficult for you to question thetreatments prescribed by your pediatrician and thatwhen you do you may get a brusque and unresponsivereply. If this is what happens when you question yourpediatrician about a medication, there’s not much pointin arguing with him. Accept the prescription and then geta second opinion from another doctor before you decidewhether to have it filled.

If your son or daughter does experience a fever-induced convulsion, try not to panic. That’s advice thatis far easier for me to give than it may be for you tofollow, because the sight of your child in the midst of aconvulsion may be so unnerving. Calm yourself by re-membering that the convulsions are not life-threateningand will not result in physical damage and then take afew simple steps to protect your child from injury.

First, place the child on his side so that he will notchoke on his own saliva. Next, keep him from strikinghis head against any hard or sharp object while he isthrashing about. Make sure that he does not have abreathing obstruction during the seizure and place somesoft but firm object such as a folded leather glove orbillfold (not your finger) between his teeth to keep himfrom biting his tongue. Then, for your own peace ofmind, call your doctor and tell him what happened.

Most seizures last no more than a few minutes. If one

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is prolonged, call your doctor and ask for his advice. Youmay expect the child to sleep after the seizure haspassed, but even if he doesn’t, don’t give him anythingto eat or drink for an hour or so. He may be so drowsythat he aspirates the food and chokes on it.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO FEVER

Fevers are a common symptom in children and arenot an indication of serious illness unless associated withmajor changes in appearance and behavior or othermajor symptoms such as respiratory difficulty or loss ofconsciousness. The height of fever is not a measure ofthe severity of an illness. Infection-induced fevers willnot reach levels that can cause permanent damage toyour child. Fevers do not usually require medical atten-tion, except as recommended below. They are the body’snatural defense against infection and should be allowedto run their course without medication or other treat-ment intended to bring them down.

1. If your child is less than two months of age, andhis temperature exceeds 100 degrees, call yourdoctor. The fever may be the symptom of aninfection that is prenatal in origin or related tothe delivery of the baby. Fevers in newborn in-fants are so uncommon that simple prudenceand your peace of mind make a visit to the doc-tor worthwhile, even though it may prove to beunnecessary.

2. For older children it is unnecessary to call thedoctor unless the fever fails to abate withinthree days or is accompanied by other majorsymptoms such as vomiting, respiratory dis-tress, persistent cough lasting several days, andother major symptoms not normally associated

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with the common cold. Also see your doctor ifyour child displays continued listlessness, irrita-bility, inattentiveness, or otherwise acts andlooks seriously ill.

3. Call your doctor, regardless of the temperaturelevel, if your child is experiencing difficulty inbreathing, is vomiting repeatedly, or has a feverthat is accompanied by twitching or otherstrange movements, or you are concerned aboutany other alarming element of the child’s behav-ior or appearance.

4. If your child experiences chills along with hisfever, don’t try to counteract it by piling onmore blankets. This will simply cause the tem-perature to increase more rapidly, and the chillsare not to be feared, because they are a normalbodily response. The chills do not mean that thechild is cold but are part of the mechanismthrough which the body adjusts to a higher tem-perature level.

5. Encourage your feverish child to rest, but don’tmake too big a production of it. There is nomedical need to confine him to bed or even tokeep him indoors if the weather is reasonablydecent. The fresh air and moderate activity mayimprove his disposition and make him easier tolive with, and it won’t make him any sicker. Youshould try to discourage him from engaging inintense competitive sports, however.

6. If you have reason to believe that the fever isthe result of a cause other than infection, suchas heatstroke or poisoning, take your child to ahospital emergency room at once. If there is noemergency room in your area, seek medical at-tention wherever it is available.

7. Ignore the old wives’ tale “Feed a cold andstarve a fever.” Nourishment is an'important

part of recovery from any illness. To the extent,your child will tolerate it, you should feed bothcolds and fevers. Both conditions bum up thebody’s supply of protein, fats, and carbohy-drates, and they should be replaced. If the childwon’t eat, give him fluids such as fruit juice thathave some caloric value. And don’t forget, youdon’t have to be Jewish to benefit from chickensoup!

8. Fevers and the other symptoms commonly as-sociated with it may cause your child to lose asignificant volume of fluids. This could lead todehydration, but you can help avert it by mak-ing sure that he drinks plenty of fluids. Fruitjuices are fine, but if he resists them, almost anyother fluid will do. The trick is to try to get himto consume eight ounces an hour.

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Headache: UsuallyEmotional, but the

Pain Is Real

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^ lmost every abnormal condition of the body—or-ganic, psychological, or emotional—can cause a head-ache. The most common organic cause in children isviral or bacterial infection anywhere in the body, but al-lergies, metabolic disturbances, or trauma may also beresponsible. The next most frequent cause is psychologi-cal or emotional stress.

Headaches rarely require medical treatment, andwhen they do it is treatment of the disease or injury thatis causing the headache, not treatment of the headacheitself. The immediate need, when your child says his“head hurts,” is to identify the cause. In most instancesyou can do this as readily, and perhaps more effectively,than your doctor.

Doctors take a statistical approach in their search forthe cause of a headache. They attempt, by questioningthe child and his parents, to determine whether any othersymptoms are present or whether any unusual eventshave occurred prior to its onset that may be an emotionalsource of the headache. If this is unproductive, and noclinical findings emerge from a physical examination, thedoctor will perform a series of inclusionary and exclu-sionary tests, searching for some possible causes and ex-cluding others. Based on the statistical frequency of thepossible causes, he will begin a process of elimination. If

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this fails to yield a positive finding, he will probably as-sume that the headache is the result of some form ofemotional or psychological stress. He will then probablyprescribe an analgesic preparation, such as acetamino-phen (Tylenol) or aspirin. He will also caution the par-ents to observe the child closely in order to detect thepossible emergence of additional symptoms.

My experience has taught me that 85-90 percent ofchildhood headaches can be diagnosed on the basis ofhistory alone. It doesn’t require a visit to the doctor todetermine whether your child has a cold or the flu orsuffered an emotional upset prior to the onset of theheadache. Most of the time you are far more capable ofidentifying the cause than your doctor is. You alone havethe opportunity to monitor your child’s behavior and re-actions around the clock in a search for the conditions orevents that may be provoking the psychological or emo-tional trauma. You are familiar with the child’s normalbehavior patterns, and in most cases you ultimately willsense what is bothering him. In short, you have theknowledge and the experience to isolate a psychologicalor emotional cause, and your doctor doesn’t. All he hasto go on is the minimal amount of information he canextract from you or your child during a brief office visit.

That’s why, if your child has a headache, it is prema-ture to rush him to a doctor immediately. Before you doyou should begin a structured program of observationand questioning to attempt to identify the cause. Also, ifyour child is very young, be sure that when he says his“head hurts” he really means a headache. You wouldn’tbelieve the number of children who have been brought tome for treatment of headaches who were really com-plaining about external pain they felt because their sisteror a playmate socked him with a toy!

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HOW TO DISCOVER THECAUSE OF HEADACHES

Begin your investigation by exploring the basic areasthat are most often the source of childhood headachepain. Determine the answers to these questions:

1. Does your child also have the symptoms of acommon cold or influenza that are described inChapter 10? If so, you can safely assume thatthe headache is an additional symptom of one ofthose ailments and requires no medical treat-ment.

2. Did the child experience a fall or blow on thehead prior to the onset of the headache? Wasthis traumatic event accompanied by loss ofconsciousness? If so, or if there are other dis-turbing symptoms such as disorientation or diz-ziness, call your doctor or, better still, take thechild to a hospital emergency room. If the injuryoccurred outside your presence, and you areunable to determine whether there was loss ofconsciousness, play it safe and call your doctor.

3. Has there been a recent change in your child’sdiet that might signify an allergy to foods he hasnot eaten before? Has your family moved to anew location where there are types of vegeta-tion that your child has not been exposed to be-fore?

4. When did you first notice the headaches? Wasthe initial one preceded by some unpleasant,frightening, or otherwise emotionally traumaticevent?

5. Do the headaches typically recur at the sametime each day? Does this indicate association

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with anticipation of some specific event or ac-tivity—school, piano lessons, etc.?

6. Is the child closely associated with another per-son who routinely uses headaches to get atten-tion or sympathy or to evade responsibility?

7. What unpleasant or tiresome work, or threaten-ing events or activities, has the child avoidedbecause of previous headaches?

8. What rewards has the child obtained from pre-vious headaches? Don’t overlook increased at-tention and sympathy.

Within these broad categories some specific potentialcauses of the headaches may emerge in response to theseadditional questions:

• Has your child had a recent emotional upset be-cause of some circumstance involving family orfriends? (Examples: the death of a loved one; aparental dispute that may have raised concernabout the possibility of a divorce or separation.)

• Could the headache be prompted by an unpleas-ant or frightening situation? (Examples: fear of aphysical encounter with a schoolmate; fear of areprimand at school for undone homework; con-cern about a scheduled test.)

• Could the headache be the result of some recentchange in normal life patterns? (Examples: sepa-ration from friends or relatives; a move to a newhome and the need to make new friends; an ail-ment contracted on a vacation trip; the onset ofthe heating season.)

• Could the headache be prompted by a desire toescape responsibility? Did the child “borrow” thesymptom from a relative or other close associatewho routinely uses headaches as a means of

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avoiding work or responsibility? (Example: ifyour child is compelled to do the dishes alonebecause Aunt Mabel always gets a headache justbefore it’s time to do them, he may get the mes-sage!)

• What events are immediately associated with theonset of the headaches and with their disappear-ance? (Example: suspect problems with friendsor teachers at school if the child complains of aheadache while at the breakfast table, but it dis-appears soon after you agree to let him stayhome from school.)

EVEN EMOTIONAL HEADACHESARE REAL

Always bear in mind that, although your child’s head-ache may be emotional rather than organic in origin, it isnonetheless real. The common adult protest, “You giveme a headache,” is often more than an expression ofannoyance. The behavior of others, worry, fear, anger—the whole range of human emotions—can, at one time oranother, literally give you, and your child as well, anhonest-to-goodness headache that really hurts.

If you identify a cause of this nature, the treatmentshould not be medical. It requires the practice of sound,sympathetic parenting. The child needs your help, dis-played through love, affection, understanding, moralsupport, and a demonstration of genuine parental con-cern. Giving the child an analgesic such as aspirin orTylenol is not a substitute for the emotional support thathe needs.

In most cases patient observation and a review of re-cent events and conditions will identify the cause of theheadache. If those measures fail, continue to observe thechild closely to detect any additional symptoms that maydevelop. These might include fever, vomiting, coughing.

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skin rashes, visual disturbances, weight loss, chronic fa-tigue and lassitude, and any other physical variationsfrom the child's normal condition.

The location of the headache may also be helpful indetermining the cause. If the pain is in the front of thehead, suspect the sinuses as the source of the trouble.An additional indication would be a greenish or yellowdischarge from the nose. This condition will usually cureitself, and limited amounts of Tylenol can be used appro-priately to relieve the pain if it becomes unbearable.Meanwhile, use a vaporizer to help relieve the conditionby opening up the nasal passages to permit drainage andgive your child ample fluids to prevent dehydration. Ifthese measures fail, and the headache pain becomes un-bearable, you may be compelled to take your child to adoctor to obtain a prescription for a more effective painreliever—codeine. I don’t like to prescribe this drug, orany other narcotic, because it is addictive and has manypossible side effects, some of them serious. However,limited use of codeine for the relief of acute pain is ac-ceptable.

If sinus attacks recur, it is time to look to preventionrather than repeated treatment. Consider the possibilityof food or environmental allergies as the cause and beginan attempt to identify the offending substance or sub-stances yourself or obtain the help of a competent spe-cialist. Dr. Theron Randolph, of Chicago, author of theexcellent book, Alternative Approaches to Allergy, headsa group called the Human Ecology Action League,which maintains a register of specialists in this field. Youcan write him at P.O. Box 1369, Evanston, IL 60204, ortelephone him at (312) 864-0995, for the name of a practi-tioner in your area.

Note that the frontal sinuses do not develop until theage of six, so if your child is younger than that, a sinusinfection is not apt to be the problem. Another word ofcaution: Sinus problems can be magnified by changes inair pressure, so do not take your child in an airplanewhen he is suffering from this condition.

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HEADACHES RESULTINGFROM TENSION

Pain in the back of the head is more likely to be aproduct of tension that is of emotional origin. If the painis on the side of the head, there is the possibility that itmay be migraine, although this is rare in children andvirtually unknown prior to the age of 10. Migraine head-aches are usually familial or hereditary, but allergiccauses should also be sought. They are frequently asso-ciated with vomiting and disappear after the victim hasvomited and goes to sleep. There is no specific treat-ment, other than the use of analgesics to relieve the pain.

If all of your careful probing fails to reveal the sourceof the headaches, and they continue to plague your child,it is appropriate to seek the help of a doctor. Your timeand effort have not been wasted, however, because youwill be able to provide detailed information that willassist him in making an accurate diagnosis. It is alsoappropriate to see a doctor, of course, if associatedsymptoms develop that cannot be related to the onset ofa cold, influenza, or some other common ailment.

When you see your doctor, share with him fully whatyou have learned in your own search for a possible causebecause all of this information is an essential part of thecareful history he should take. If he seems uninterested,and unwilling to spend the time required, you may havethe wrong doctor.

Your doctor should also do a careful and thoroughphysical examination, which usually proceeds from headto toe. It should include these elements:

• Examination of the back of the eye with anophthalmoscope, which reveals the condition ofthe retina. By looking at the nerves and bloodvessels at the back of the eye the doctor can dis-cover abnormalities that may indicate,vasculardisorders or increased intracranial pressure.

which might be caused by a brain tumor. Suchtumors are extremely rare in children and, ifpresent, are also revealed by vomiting and nau-sea, which is often more noticeable in the earlymorning; fainting spells; dizziness; vision prob-lems; and other neurological abnormalities.Brain tumors in children are so uncommon thatthey rank far down on the list of probable head-ache causes.

Examination of the eardrums and external aircanal with an otoscope, which enables the doc-tor to observe eardrum perforations, infection,or the presence of a foreign body. Small childrenmay put crayons, beans, beads, and other ob-jects in their ears, which may become infectedand cause a headache.

Measurement of blood pressure with a small cuffthat is appropriate for the size of the child. Highblood pressure can indicate kidney problems,certain tumors, and vascular malfunctions.

A careful neurological examination, duringwhich the doctors tests your child’s reflexes witha reflex hammer and his sensory functions withpins, brushes, and a tuning fork. The doctor islooking for the presence of tendon and other re-flexes that normally are equal in both extremi-ties. The absence of uniform reflexes in botharms and legs may indicate an abnormality of thecentral or peripheral nervous system, spinal corddiseases, the possibility of a brain tumor, andother neurologic malfunctions.

A stethoscopic examination of the heart andchest and—equally important—the pulses invarious parts of the body. This will detect heartailments, lung problems, and vascular disorders.

A completely stripped physical examinationshould be performed during which the doctor vi-sually inspects every part of your child’s body,although not necessarily all at once. He should

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check the abdomen to determine abnormalities ofthe liver, the thyroid gland, and the lymph nodes.

The sort of examination I have just described is whatyour sick child deserves but doesn’t always get. Pediatri-cians typically schedule so many patients that they tendto rush through everything, including history taking andphysical examinations. In fact, many doctors are care-less in the conduct of physical examinations. I first ob-served this while I was an intern at Cook CountyHospital in Chicago. Examinations were given there forprospective board specialists, and as part of the examthe candidate was presented with a patient who was inbed, under the covers. Not infrequently, the candidatewho conducted the examination failed to discover thatthe patient had a wooden leg! While working in theemergency room in the same hospital I received a patientfrom the Michael Reese emergency room who broughtwith him a note containing the diagnosis—a coronaryheart attack. When I removed his jacket I found a stabwound!

DON’T BE AFRAID TO QUESTIONYOUR DOCTOR

So, don’t assume that your doctor will do a thoroughphysical examination, and if he fails to do one, questionhim about it. If your question makes him angry, or hebrushes you off with an evasive answer, consider findinganother doctor. If you feel the need to give him a reasonfor your question, tell him what you read in this book.That will make him angry!

If the doctor fails to elicit a cause for the headachesfrom the history and the physical findings—and maybeeven if he does—he will probably tell you he is going toperform some tests. These should include a blood testand a urinalysis, to reveal hidden infections and meta-bolic disorders such as diabetes. I approve of both of

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these tests, if another cause for the headache has notbeen found, because—unlike many of the tests that doc-tors routinely use—they provide a high degree of validanswers. However, I have some strong reservationsabout how far beyond these two tests a doctor should go.

For example, taking an X-ray of the skull, or a CATscan, or performing an electroencephalogram (EEG), israrely productive, but many doctors are fond of orderingthem. That’s because too many doctors seem to believethat anything they can do they must do. In my judgment,skull X-rays and CAT scans are rarely indicated andusually should be avoided, as should all needless expo-sure to radiation. Even a history of a traumatic head in-jury is not an indication for skull X-ray, unless the injurywas accompanied by a period of unconsciousness follow-ing the injury, persistent vomiting, or other symptomssuch as inability to focus the eyes or loss of memory.

The same warning applies to the EEG, a procedurethat is valuable in detecting the presence of brain tumorsand blood clots and diagnosing epilepsy but is unreliablefor most other purposes. As a diagnostic tool, in general,the answers that it provides are as likely to be wrong asthey are to be right. Studies have shown that 20 percentof the patients with serious and life-threatening neurolog-ical problems show normal EEGs, and 20 percent of thepatients with no neurologic problems have “abnormal”readings. In one of my earlier books I reported the expe-rience of one researcher who connected an EEG ma-chine to a mannequin that had a head stuffed with limegelatin. The machine pronounced the mannequin to bealive and well!

When he has completed his examination, your doctormay recommend the use of drugs. Limited use of an an-algesic is appropriate for the relief of pain tf the cause ofthe headache has been determined but to be avoided if ithas not, because of the risks associated with both aspirinand acetaminophen. Reject the use of antihistamines andpsychotropic drugs unless a firm diagnosis has beenmade and the doctor can defend their use. You have

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every right, although he may not like it, to question yourdoctor about the potential benefits of any drug he pre-scribes and about how those benefits stack up against thepotential risks and side effects of the drug.

My objection to the use of drugs for the relief of head-ache pain if no cause of the headache has been founddeserves further explanation. Pain is nature’s way of sig-naling that something is wrong. The use of analgesicsmay end the pain, but it doesn’t solve the underlyingproblem. Your child is still sick, but if the pain is gone,there is less incentive to continue to search for the con-dition that caused it. It is important that you and yourdoctor be alert for the emergence of additional symp-toms until the headaches disappear without the use ofdrugs or their cause is identified.

Here is my advice to parents whose child has recur-rent headaches:

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO HEADACHES

1. Avoid emotionally triggered childhood head-aches by providing a warm, sensitive, caring,loving environment for your child. Try to es-tablish a confiding relationship with him, sothat you can provide moral support and com-fort when there are events or situations in hislife that are disturbing to hint. Never forget, fora moment, that this is the parents’ primary roleand the one that will have the greatest impacton the health and development of your child.

2. Be careful not to impose excessive demandson your child that will cause him to becomeemotionally ill because of his fear that he can-not live up to your expectations. Children can-not and should not be expected to assume theburdens of adults for, as someone' else has

said, “the business of a child is to play and tolearn.”

3. If your child complains of recurrent headachesand no other symptoms are present, attempt todetermine the cause yourself. Eliminate emo-tional causes and the onset of a common coldor influenza as possibilities before you turn toother potential causes.

4. Unless other symptoms are present, there is noimmediate need for concern that the headachemay indicate more serious physical problems.A call or visit to the doctor is premature.

5. If your anxiety level becomes too high, andyour child’s headache is giving you one, takehim to the doctor but monitor carefully whathe does to the child.

6. If the headache becomes incessant, or recursthroughout the day for several days, see yourdoctor even though there are no other symp-toms.

7. When you do visit a physician, be sure hetakes a careful history, in addition to conduct-ing a thorough physical and neurological exam-ination. Your child is deserving of the bestyour doctor has to offer, and if he doesn’t getit, consider finding another doctor.

8. Question any tests the doctor wants to con-duct, other than a blood count and a urinalysis.Resist other tests, such as skull x-rays andEEGs, unless associated symptoms are presentor abnormal findings were discovered duringthe physical and neurological exams. Demandan explanation of the need for any additionaltests the doctor wants to do. If this angers thedoctor, or he is evasive, consider finding an-other doctor.

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9. Reject all medication except mild analgesicsfor short-term relief of pain, unless it can bedefended as a specific for a known cause of theheadaches. Don't accept “just-in-case” medi-cation. Meanwhile, insist that the doctor con-tinue to monitor the physical and neurologicalcondition of your child while you remain alertfor the development of additional symptomsthat may help pinpoint the cause.

10. If you know that the headache was caused byan accidental injury, and there was loss of con-sciousness or your child is dizzy, disoriented,or confused, take him to a hospital emergencyroom. Do this also if the injury occurred out-side your presence and you cannot determinewhether he experienced a period of uncon-sciousness.

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Mother,

My TummyHurts!

A bdominal pain ranks with fever and the commoncold as a leading source of pointless visits to pediatri-cians. It is a common phenomenon in children, but thepain rarely stems from organic causes, so it usually doesnot indicate a serious illness. I estimate, in my ownpractice, that only one in 10 of the children brought tome because of “stomachaches” actually needs medicalattention.

Unless abdominal pain is accompanied by othersymptoms—notably vomiting, diarrhea, loss of appetite,and weight loss—it is usually nothing you need to worryabout. A bit of careful detective work on your part willprobably isolate a nonmedical cause for your child’s dis-comfort. In most cases you will discover that yourchild’s frequent belly pains are the result of indigestionfrom eating too much or too fast; are the by-product ofanother ailment; are the result of psychological or emo-tional causes; or are produced by allergies to food, medi-cations, or chemical additives to the food that he eats.

The psychological and emotional causes parallel thosealready described for headaches. Let’s-say, for example,that your child repeatedly develops abdominal pain inthe morning, just before it is time to go to school. Youare reluctant to have him miss his classes, but he appearsto be in such agony that you finally agree to let him stayhome from school. In all probability he will experience a

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miraculous recovery the moment the school bus disap-pears down the street!

After this scene has been repeated a few times youmay be tempted to reprimand or punish your child fordeceiving you. Don’t, because the pain was real, but itdisappeared promptly—as it should have—when thetrauma that caused it was relieved.

This reaction is so common that it even has a name—school phobia—and you can’t solve the problem by tak-ing your child to a doctor. Instead, his pain is your cue toundertake some patient and sympathetic interrogation todetermine the association between his school and hispain. Is he being bullied while waiting for the school busor after he gets to school? Is he having discipline prob-lems with his teachers? Is he ashamed and worried be-cause he hasn’t been completing his homework? Does hehave an incompetent teacher he simply can’t stand? Or,if he is very young, is he simply troubled over beingseparated from you and sent off to a strange and possiblyfrightening environment? If you can identify and elimi-nate the cause of his concern, it is likely that his painswill be eliminated, too.

As in the case of headaches, stomachaches mayevolve as a form of subconscious avoidance of unpleas-ant tasks or a desire to gain sympathetic attention fromparents who are not fully satisfying their child’s need tofeel loved. A lot of recurrent “tummy aches” would clearup if more parents heeded the advice on the bumperstickers, “Have you hugged your kid today?”

STOMACHACHES OFTENCAUSED BY ALLERGIES

Allergies to foods and chemicals are another frequentsource of belly pain. Lactose intolerance—allergy tocow’s milk—is far more common than most parents real-ize. In addition to milk, however, there is a broad rangeof foods to which children (and adults) may be allergic.

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You can determine whether a food allergy is causingyour child’s abdominal pain by developing a structuredprogram to determine whether one or more of the foodshe eats are consistently associated with his malady. Thisrequires time and effort and may elicit some childishcries of protest, but if food allergies are the problem, itworks. Withdraw specific food items from his diet, oneby one, and observe whether the recurrent pains disap-pear after a few days. If this yields a likely suspect, rein-state the food item and see whether the pains recur. Ifso, you’ve found the answer!

The process will be more difficult if your child hasmultiple food allergies, because eliminating one offendermay not eliminate the pain, which will still be producedby others. In that event you will have to reverse theprocess by eliminating all of the most probable allergensfrom his diet and then restoring them one by one. If thepains recur when a food is added, you will have identi-fied one of the culprits. Eliminate it permanently andthen continue to restore other food items, one at a time,until you have identified everything to which he is aller-gic.

If you use the first approach, you will expedite theprocess by beginning the elimination process with themost likely candidates. Foods with chemical additivesare major offenders, and eliminating them means thatyou will have to eliminate virtually all processed foodsand manufactured products and resort to natural foods,cooked from scratch. Don’t overlook breads, pastries,and even pastas. Buy natural foods, products labeled“100-percent natural,” and read the labels carefully. Nat-ural foods that are likely offenders include tomatoes, cu-cumbers, oranges, apricots, prunes, peaches, plums,raspberries, and grapes, but your child may be allergic toothers.

Let me warn you that you will be startled to discoverhow prevalent chemicals are in our daily diets when youbegin looking for foods that don’t contain them. The fineprint on many food packages would ruin the appetites of

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most consumers if their eyesight were good enough todecipher it. How would you like a nice bowl of soupmade from sodium carbonate, potassium carbonate, so-dium tripolyphosphate, sodium alginate, disodium phos-phate, disodium inosinate, and disodium guanylate? Ifyou were offered it, knowing what it contained, youprobably would be afraid to eat it, and you should be.Yet these are all ingredients in one popular brand of Chi-nese noodle soup mix!

All of the chemical colorings, preservatives, stabi-lizers, and taste enhancers are potential sources of aller-gic reactions, to say nothing of more hazardous effects.They are a prime cause of hyperactivity, which I’ll dis-cuss in detail later. They are not easy to avoid, but if youcan avoid them, the benefits will not be limited to curingyour child’s abdominal pain. The more you rely on natu-ral foods as the basis of your family fare, the healthieryou and everyone else in your household will be.

I urge you to become a food detective for two rea-sons. First, your doctor couldn’t do it if he wanted to,and he doesn’t want to. Second, if you are able to iden-tify and eliminate the source of your child’s discomfort,you will help him avoid the even greater discomfort andpotential risks that may result if you take him to a doc-tor. If your child has recurrent abdominal pain but isgrowing well, looks healthy, is gaining height and weight,and has no other symptoms, there is no appropriate med-ical treatment for the condition and no need to see adoctor. Provide moral support and look for an allergic oremotional cause.

DON’T USE MEDICINE TO“CURE” STOMACHACHES

I don’t recommend the use of any medication whenyour child complains of a “stomachache.” Some parentsrespond by giving their child sodium bicarbonate (bakingsoda) or one of the over-the-counter antacid-prepara-

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tions. This is unwise for two reasons. First, when yourchild complains of a “stomachache,” the pain he refers tomay not be in his stomach but elsewhere in the abdomen—in the intestines, kidneys, or some other organ. In thatevent the antacid won’t provide relief. Second, if hereally has pain produced by excess stomach acid, whichis unlikely in children, sodium bicarbonate may relieve ittemporarily, but because it neutralizes all of the acid inthe stomach, it will cause a rebound effect. The child’sstomach will work overtime replacing the acid, probablywith more acid than was there before. The only sensibleimmediate relief you can offer is a generous dose of love,comfort, sympathy, and distraction. If the symptom isemotional in origin, that may end the pain.

I do not mean to suggest that abdominal pain isalways innocuous. It is one symptom of well over 50diseases, some of them serious and even life-threatening.In every case, however, if it does indicate a seriousproblem, there are other symptoms as well. The risk, ifyou take your child to the doctor, is that he will ignorethe possibility of a nutritional or emotional cause andbegin an ill-advised diagnostic process based on the pres-ence of one symptom alone. Because abdominal pain isone symptom of so many diseases, he has an almost end-less array of tests that he may inflict on your child. Manyof these tests are only marginally accurate, which maylead to a false diagnosis. Many are painful and needlesslytraumatic for your child and, consequently, for you aswell. Virtually all of them are dangerous, and some evencarry a mortality rate. Yet, without any additional symp-toms, none of them is necessary.

A further risk is the possibility that the doctor mayhospitalize your child in order to perform these tests.Many of them require advance preparation, such ascleaning out the bowel, which is more readily and thor-oughly accomplished if your child is hospitalized. That’sa high price to pay, in more ways than money, for whatwill probably be a fruitless search. In addition to the

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risks inherent in the tests and X-rays themselves, there isthe emotional trauma most children experience whenhospitalized. There is also the very real danger that yourhealthy child will acquire an illness while he is in thehospital.

If your child does display a number of symptoms inaddition to pain, such as vomiting, diarrhea, or bloodystools, he should be taken to a doctor. As I have indi-cated previously, he could be the victim of any one ofseveral ailments, the most likely of which is appendicitis.

DIAGNOSIS OF APPENDICITIS

The incidence of appendicitis is highest among malesbetween the ages of 15 and 30 years, but it is found at allages, even among infants during their first weeks of life.It is perhaps most dangerous among very young childrenbecause it is difficult to diagnose, and in a majority ofcases the appendix ruptures before the diagnosis ismade.

Appendicitis is almost invariably accompanied byvomiting and fever, but the vomiting may not be persis-tent and the fever may be very mild. In its early stagesthe pain is usually general throughout the abdomen, butwithin a matter of hours it localizes in the lower rightquadrant, and pressure at that point will cause intensepain. If the appendix subsequently ruptures, the pain willagain become generalized throughout the abdominalarea. The attack is almost always preceded by a loss ofappetite.

When you take your child to the doctor he shouldtake a careful history, with particular attention paid toevents that preceded the onset of the pain. He shouldconduct a thorough physical examination, including ex-ercises that will help identify the site of the pain. Theseshould include asking your child to raise his legs whilelying on his back, which puts a strain on the abdominal

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muscles, and also observing him while he walks to deter-mine whether he is favoring the one side of the abdomenbecause of pain. A blood test should be taken to deter-mine whether there is an elevated white cell count, indi-cating infection, and a urinalysis, to reveal the presenceof white blood cells, indicating urinary tract infection.

If, as a result of his examination, the pediatrician sus-pects appendicitis, he will probably refer your child to asurgeon. If the surgeon recommends removal of the ap-pendix, insist that your pediatrician concur in the recom-mendation and share the responsibility. Surgeons are inthe business of doing surgery, and if there is a legitimatereason to suspect appendicitis, they will usually seize theopportunity to put their talents to work. As a conse-quence, thousands of perfectly healthy appendices areremoved every year. That’s not only painful and expen-sive, but there is substantial reason to believe that theappendix performs some useful functions, so it is unwiseto allow your child’s appendix to be removed unless he isat risk. In addition, while appendicitis can be fatal, par-ticularly if the organ ruptures, appendectomies have amortality rate of their own which is almost as high asthat of appendicitis itself. Be certain that your pediatri-cian and the surgeon agree on the diagnosis and thatthere is a significant possibility that the appendix mayrupture, before you permit your child to endure the riskof surgery.

If you do agree to surgery, insist that your pediatricianbe present in the operating room when the surgery isperformed. That’s simply insurance against somethinggoing wrong, and it also provides you with a witness incase something does. It isn’t generally known, but a lotof research takes place in the operating rooms of teach-ing hospitals, sometimes without the knowledge or con-sent of the patient or his parents. It is prudent to insistthat your pediatrician be present during the surgery tomake certain that your child does not become the unwit-ting subject of a research procedure.

Recurrent abdominal pain can be terribly frustrating.

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as can any chronic physical condition that makes yourchild miserable, because inevitably his misery rubs offon you. Fortunately, to employ a classic medical cop-out, you don’t have to “learn to live with it.” Follow theguidelines I’ve given you in this chapter and you shouldbe able to identify the cause of your child’s recurrentpain.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TOABDOMINAL PAIN

Most childhood abdominal pain does not require med-ical attention unless it is accompanied by additionalsymptoms. Consequently, you should make that distinc-tion when your child complains that his “tummy hurts.”Here are the guidelines that will enable you to determinewhether the cause may be appendicitis, an intestinal ob-struction, or another serious ailment that requires thehelp of a doctor or is a problem you can handle yourself.

1. If abdominal pain is the only symptom, you aremore able than your doctor to identify thecause. However, if it is accompanied by addi-tional symptoms such as fever, vomiting, painon urination, or bloody stools, your doctorshould be consulted.

2. If there is no additional symptom, carefully re-view the events and circumstances that pre-ceded the onset of the abdominal pain. Hadyour child eaten too much too fast? Had heeaten or drunk anything to which he was unac-customed? Could he have ingested a poisonoussubstance or swallowed an object such as a mar-ble or a safety pin? Had he been given somemedication he had never taken before? Had heexperienced some traumatic event—a fight or

argument with a playmate, a bad report card, asevere reprimand or'punishment? If stomach-aches have been a recurrent phenomenon, waseach of these preceded by a similar event? Havethey been associated with avoidance of an un-desirable experience (e.g., school) or unpleasanttasks (e.g., washing dishes)? A painstaking re-view of this kind should enable you to deter-mine whether the pain is of emotional origin.

3. If a visit to the doctor is indicated, monitor hisactions. Make certain that he takes a careful his-tory and conducts a thorough physical examina-tion. This should include a blood test todetermine whether there is an elevated whitecell count, indicating infection; a urinalysis todetermine whether white blood cells arepresent, indicating a urinary tract infection; andexamination to determine whether the pain islocalized in the lower right quadrant of the ab-domen, indicating appendicitis.

4. If the doctor concludes that your child's appen-dix is the culprit, he may refer you to a surgeon.If surgery is recommended, insist that your pe-diatrician concur and share responsibility forthat decision. Then, insist that he be present inthe operating room when the operation is per-formed.

5. Don’t leave your child alone in the hospital be-fore or after the surgery is performed. Remainwith him yourself or have a friend or relative doso until you are sure he is well on the road torecovery. Then get him released from the hospi-tal as soon as you possibly can.

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Coughs,

Sneezes, andRunny Noses

^ mericans spend more each year on over>the-counter remedies for coughs and colds than the com-bined costs of running the governments of Guatemala,Honduras, and El Salvador. If you added what’s spentfor antibiotics, antihistamines, and other medicationsprescribed by doctors, you could probably throw inCosta Rica and Ecuador, too. That’s an appropriate com-parison, because most of those governments don’t workvery well, and the cold medicines don’t work, either.

Coughs, colds, and influenza affect all of us, but chil-dren seem to be more susceptible to them than adultsand more likely to be treated for them when they occur.While the treatment may relieve cold symptoms, none ofthe drugs that are given will effect a cure. In fact, need-less and often counterproductive medication has givenrise to a private joke among doctors that is not sharedwith patients: without treatment a common cold usuallylasts about seven days; with treatment it will last about aweek.

The common cold is such a universal phenomenon,affecting almost everyone at least once during the year,that theories abound about its causes and how it shouldbe treated. These theories can be divided roughly intotwo categories—the moral theory and the viral theory.The moral theory, based on the higher incidence of colds

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in winter, holds that they are related to exposure to in-clement weather. This theory, a favorite of mothers andgrandmothers, argues that a child caught a cold becausehe didn’t put on his muffler, mittens, or galoshes. Theviral theory, espoused by doctors, says that colds arecaused by one of 100 or more viruses and that they occurmore frequently in winter because children are in schooland are exposed to infected children in the confinementof the classroom. The viral theorists maintain that thekid would have caught cold if he had worn two mufflersand three pairs of wool socks inside his boots.

My own suspicion is that each of these theories, orrather a combination of them, is correct. There’s littlequestion that colds are viral infections and that the virusis transmitted through the air by victims who cough andsneeze or by contact with viruses lodged on hard sur-faces. Yet, despite the lack of evidence that exposurecauses colds, I’m inclined to side with the mothers andgrandmothers who insist that children dress warmlywhen they go outdoors. This ambivalence arises partlybecause I think mothers and grandmothers know moreabout health than scientists and doctors and partly be-cause it is an open question—in my mind—whether ex-posure lowers resistance to the viruses that are the directcause of colds.

In any event, you have nothing to lose if you insistthat your child dress appropriately in cold weather. Youdo have something to lose, though, if the doctor whocorrectly insists that your child’s cold is viral proceeds totreat it with antibiotics, which are ineffective against vi-ruses. I’ll discuss that more fully later in this chapter.

SYMPTOMS OF COMMONCOLD, INFLUENZA

The symptoms of the common cold, which vary inintensity from one child to another, are malaise, fatigue,runny nose, coughing and sneezing, bleary eyes, and

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usually a low-grade fever. Influenza, also viral in origin,is characterized by most of the same symptoms, plusvomiting, diarrhea, body aches, and high fever in manycases.

If the nasal secretions are clear, gray, or white, yourchild is probably the victim of a viral infection such asthe common cold or influenza. If they are yellow orgreen, it indicates the presence of pus, which is indica-tive of bacterial sinusitis. Colds may also be complicatedby other bacterial infections such as bronchitis and otitismedia (middle ear infection).

Common colds and influenza do not require medicaltreatment, and the medications often used to treat them,as I have already suggested, will merely relieve symp-toms. The effects of doing this may be counterproduc-tive, because they interfere with the body’s efforts tocure itself.

This is also true of viral pneumonia, sometimesknown as “walking pneumonia,” an ailment that neitheryou nor your doctor can identify except by X-ray. Thesymptoms are usually mild, and your child is in nodanger from this form of pneumonia, except from theX-rays your doctor may order if you give him the oppor-tunity. That is not the case, however, with bacterialpneumonia. This disease usually can be detected byfever above 102 and severe shortness of breath, followedby blueness of the skin. If your child develops thesesymptoms, there’ll be no doubt in your mind that it is anemergency, and you should take him to a doctor or hos-pital emergency room at once.

Another respiratory ailment relatively common inchildren is croup. It is also viral in origin, and it can beidentified by the metallic gasping sound that is heardwhen the child takes a breath; a hoarse, metallic cough;and an unusual pulling in of the chest on inspiration. Ifyour child has croup, the symptoms will be relieved bytaking him into the bathroom turning the shower on“hot,” and allowing him to breathe the steamy air for 20minutes. If that doesn’t relieve the condition, suspect

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bacterial pneumonia and take him to the doctor.

Short of obviously severe respiratory difficulties,however, parents should avoid taking their child to thedoctor or giving him over-the-counter medications forthe treatment of symptoms. The drugs commonly used inthe treatment of cold and influenza symptoms, whetherprescribed by your doctor or purchased in the cornerdrugstore, fall into half a dozen classes. They includedecongestants, expectorants, antihistamines, cough sup-pressants, pain relievers, and antibiotics. They have sev-eral things in common: they are unnecessary; theysometimes have undesirable or dangerous side effects;they may interfere with the body’s own efforts to defeatthe disease; and they are a waste of money. Frequently,several of the drugs are given in combination, eventhough one or more of them may address symptoms thatyour child doesn’t have.

The decongestants, which are also known as vaso-constrictors, are prescribed to relieve difficulties withnasal breathing, which result from the swelling of themucous membranes in the nasal passages. The decon-gestant opens the nasal passages by shrinking the swol-len membranes. That gives temporary relief, but thereinlies the problem. It is only temporary, and when thebreathing difficulty recurs you are inclined to give yourchild more of the medication. Ultimately, there will be arebound effect, and the congestion will be more severethan it was before you began the medication. A moresensible and risk-free approach to the relief of nasal con-gestion is the use of a humidifier or frequent visits to asteamy bathroom, as described earlier.

Antihistamines, often prescribed individually, or in-cluded in combination drugs, are used for the treatmentof allergies. The body fights allergies by releasing naturalhistamine, which will produce watery eyes and a runnynose. Antihistamines stem the release of histamine, dry-ing out the nasal membranes and hampering the body’seffort to cure the cold. What the cold sufferer needs ismore hydration, not less.

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The expectorants are intended to liquefy mucus in thelungs so that it will be easier for your child to cough itup. Most of the preparations on the market that are al-leged by their manufacturers to do this have yet to winapproval from the Food and Drug Administration asbeing effective. It doesn’t make much sense to buy adrug when the manufacturer can't prove that it works.

Several cold preparations contain the cough suppres-sant dextromethorphan hydrobromide, in amounts rang-ing from 3 mg to 20 mg. The FDA regards it as effectivein suppressing coughs, but the question here is “Whywould you want to?” Granted that the coughs may beannoying, the fact is that they serve a purpose. Whywould you want to interfere with the body's mechanismfor getting rid of the mucus that is congesting yourchild’s lungs?

The principal pain relievers used in connection withcolds and influenza are aspirin and acetaminophen. Theyare commonly given for two reasons: the reduction offever, which I have already covered in detail; and therelief of the aches and pains often associated with influ-enza.

DANGER OF TREATINGINFLUENZA WITH ASPIRIN

It’s unlikely that you have ever heard this from yourpediatrician, but the use of aspirin in connection withinfluenza is a risky business, indeed. This is also true ofthe antivomiting agents such as Compazine, Thorazine,and Tigan. Compazine and Thorazine are particularlydangerous drugs, originally developed for treating psy-choses. They have been linked to Reye’s syndrome, anoften fatal disease of children. Its major manifestationsare encephalitis and hepatitis. It is currently recom-mended that aspirin and these other drugs not be givenduring the flu season, much less to a child diagnosed ashaving influenza, because of their combined effect as apossible cause of Reye’s syndrome.

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I reconimend against the use of any medication for therelief of symptoms associated with influenza and thecommon cold. If your child’s discomfort becomes morethan you can bear, use the appropriate medication for aday or two at most and limit the medications to thosethat are intended to relieve the symptom or symptomsthat are troubling your child the most. Don’t use thecombination drugs that treat four or five symptoms atonce.

Note also that many of the over-the-counter liquidcold remedies contain a high percentage of alcohol, andin some cases this may be the only ingredient that makesany sense. It may help the cold victim get some sleep,but even for children a shot of brandy will do it just aswell, and the brandy won’t be contaminated with a lot ofdrugs that your child doesn’t need!

If you take your child to the pediatrician because hehas influenza or the common cold, he is likely to pre-scribe drugs for the relief of one or more of the symp-toms and probably a combination drug that addressesseveral symptoms at once. Many of the preparations thattop the list of drugs most frequently prescribed are inthis category, and in many cases their manufacturers areunder orders from the FDA to prove that they are effec-tive or take them off the market. Doctors continue toprescribe them, however, despite their dubious valueand despite the fact that if all medication were avoidedthe patient would be better off.

Regrettably, that isn’t the worst thing that can happenif you seek medical treatment when your Child has acold. There is a real danger that he will be given an anti-biotic that is of no value in treating viral infections. Sincethe introduction of antibiotics a few decades ago, peoplethe world over have come to regard them as the ultimatein life-saving drugs. At the outset they were used appro-priately and, indeed, deserved the label miracle drugs.They conquered many of mankind’s most feared infec-tions, among them syphilis and gonorrhea, and some op-timistic futurists foresaw the day when all infectious

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bacterial diseases would disappear from the face of theearth.

Alas, that was not to be. As is usually the case withdoctors who are presented with a new form of treatment,the extreme soon became the mean, the antibiotics wereprescribed for a broadening range of diseases, whetherthe drugs were effective in those applications or not.Several of them, originally developed for use in treatinglife-threatening bacterial diseases, are now prescribedfor the treatment of colds and influenza.

Doctors could justifiably be condemned for prescrib-ing antibiotics to treat viral diseases such as these if theonly consequences were needless exposure to potentiallydangerous side effects and the unnecessary expense. Butthese are the lesser consequences of what can only bedescribed as medical idiocy. There are more threateningdual consequences of widespread, indiscriminate use ofantibiotics: first, the development of antibiotic-resistantorganisms in the community at large; second, if yourchild is needlessly and repeatedly exposed to antibiotics,he may ultimately be threatened by organisms that areresistant to all known forms of treatment.

WHY YOU SHOULD A^OIDEXCESSIVE USE OF ANTIBIOTICS

Indiscriminate use of antibiotics by doctors, and par-ticularly by pediatricians, is not at all uncommon. It may,in fact, be the rule rather than the exception. One hospi-tal study of antibiotic usage found that they are given toone-third of all patients, and in 64 percent of the casestheir use was not indicated or they were improperly ad-ministered in terms of drugs or dosage. The authors ofthe study observed that “A consequence of using largequantities of drugs capable of inhibiting the growth ofmicroorganisms may be a selection of microbial flora re-sistant to these drugs. The appropriate use of such medi-cation is of immediate importance to the patient and also

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of potential importance to patients who may be sub-jected to organisms resistant to available therapy. Anti-microbial drugs are unique in this regard, since theiradministration may thus affect their ultimate useful-ness.”

That’s a complicated way of saying that antibioticskill good germs as well as bad ones, permitting other badones that are resistant to antibiotics to take over andflourish. By improperly treating a disease that was treat-able by other means the doctor produces a new diseasethat known antibiotics cannot control. That’s a highprice to pay for medical carelessness and incompetence.

Growing microbial resistance to antibiotics may ulti-mately set medical treatment back to the position it heldbefore penicillin was introduced more than 40 years ago.In fact, the mortality rate for some infections such assepticemia (infection of the bloodstream) has already re-turned to the levels that prevailed before antibioticscame into use. Unless doctors change their behavior andbecome more rational and cautious in the use of antibi-otics, we may see the day against which one Nobelprizewinning scientist warned. Professor Walter Gilbert,a Harvard chemist, said, “There may be a time down theroad when 80 percent of infections will be resistant to allknown antibiotics.”

Why do so many doctors prescribe antibiotics forcolds, influenza, and other viral conditions that thesedrugs won’t cure? They tell each other that they do itbecause their patients want them to. That rationalizationwon’t wash, however, because parents take their chil-dren to doctors to get medical advice, not to give it. Amore likely probability is that doctors prescribe antibi-otics for viral infections such as colds and influenza be-cause nothing will cure them, but they’ve been taughtalways to give the patient something, lest their staturediminish in their patients’ eyes. I can understand that,because I went through that medical school brainwash-ing myself. But I can’t understand, if they still feel that

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compulsion, why they don’t give their patient a placebothat would serve the same purpose and do no harm.

If you can’t resist the temptation to take your coldafflicted child to the doctor, don’t fail to defend him fromantibiotics and other useless medications your doctormay prescribe. The odds are high that the doctor willprescribe them, because surveys have shown that asmany as 95 percent of physicians give patients one ormore prescriptions for the treatment of the commoncold, and about 60 percent of the drugs are antibiotics. Isay “defend him” because more is involved than simplypaying for a useless medication. The incidence of sideeffects from antibiotics is far from low. One formal studyrevealed that vomiting, loose stools, and skin rash wereexperienced by 4 percent of children treated with peni-cillin G plus sulfisoxazole, and 29 percent of those re-ceiving ampicillin. While most of the side effects wereminor, severe reactions occurred in roughly 2 percent ofthe treated children. Percentages like that don’t soundhigh to doctors, who are accustomed to prescribing somedrugs that produce unwanted side effects in virtuallyeveryone who takes them. However, they should soundhigh to parents who don’t want to risk finding their chil-dren among the 2 percent who suffer severe reactions todrugs that don’t do any good and shouldn’t have beengiven in the first place.

Be particularly wary if your pediatrician prescribestetracycline for your child. If your child is under eightyears of age, and your doctor prescribes tetracycline foranything other than a life-threatening disease, leave hisoffice at once. Find another pediatrician, because theone you have doesn’t know what he is doing or doesn’tcare what he does.

In 1975 the American Academy of Pediatrics recom-mended against the use of tetracycline in children underthe age of eight, because it can retard bone growth, dam-age the liver, and cause stomach upsets, nausea, diar-rhea, vomiting, and skin rash. With extended yse, it mayalso stain the child’s teeth permanently yellow.

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Always bear in mind, when considering whether totake your child to a doctor, or whether to use the drugsthat he prescribes, that “what can be done will be done”by many doctors, whether it makes any sense or not.Many of the studies of antibiotic usage bear this out. Onelarge city hospital used to require that the prescribingphysician secure approval from the infectious diseaseconsultant before antibiotics could be released from thepharmacy. When the restriction was removed the use ofampicillin increased eightfold. Similarly, when chloram-phenicol was placed on a restricted list its use droppedby a factor of 10.

If I seem to have belabored the issue of antibioticmisuse, it is only because of its significance to the futurehealth and well-being of your child. But I hope you willresist the use of other medications as well and quell theurge to give your pediatrician the chance to employ all ofthe worthless, opportunistic tricks he has in his bag.Where most respiratory illnesses are concerned, a pedia-trician’s training is a poor and potentially dangerous sub-stitute for your own common sense.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO COUGHS,COLDS, AND INFLUENZA

Common colds, influenza, and croup are caused byviruses and cannot be cured by any known medicaltreatment. They will usually respond to the body’s owndefense mechanisms within a few days and do not re-quire medical attention. However, there are things youcan do to relieve your child’s discomfort and hasten hisrecovery when be is afflicted with one of these illnesses.Here are some suggestions for the management of coldsand influenza.

1. Maintain a high level of humidity in the child’sroom or in your home. Be sure that the humidi-

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fier is cleaned frequently, or it will spread irri-tants. If your child is troubled by difficultieswith nasal breathing or a croupy cough, takehim into the bathroom, close the door, tum theshower on—using the hottest setting—andallow him to breathe the steamy air for 20 min-utes.

2. Make a determined effort to replace the fluidsthat your child loses from coughing, sneezing,and perspiring. Tty to get him to drink eightounces of fluid every hour. Fruit juices are best,because they have some nutritional value, butyour objective is to get him to drink something,so give him anything he will tolerate—water,tea, or even soft drinks as a last resort, if hewon’t drink anything else.

3. Encourage your child to get plenty of rest. Tryto keep him in bed during the early stages of hisillness, but don’t make a production of it. If heresists staying in bed, let him get up, but try tokeep him from exerting himself too much. Itwon’t even hurt to let him go outdoors, as longas he doesn’t exercise too violently.

4. Avoid all medications, even though they mayprovide some mild relief of symptoms. If thechild’s misery becomes more than you canstand, give medications that are specific to thesymptoms that trouble him most, not combina-tion drugs that treat four or five symptoms.Don’t give the medication for more than a dayor two. Avoid cough drops, because they mayproduce side effects if taken excessively. Theyare apt to be, because to a child they taste likecandy.

5. Try to remember, before you give in to thetemptation to give some over-the-counter drugfor the relief of symptoms, that you may be de-

feating your child's bodily efforts to cure him-self. Most of what you can do with medicationscan be accomplished through constant attentionto hydration and humidity.

6. Stay away from your doctor unless your childdevelops severe respiratory difficulties andblueness of the skin, which may indicate bacte-rial pneumonia. In that event, get him to a doc-tor or hospital emergency room at once.

7. Whether your child has a cold or not, try tomake certain that he receives a balanced diet,rich in the nutrients and vitamins that he needsand as free as possible of the chemical additivesthat are present in most of the prepared foodssold today.

8. Remember that patience, loving attention, andtender reassurance will do more to make yoursick child feel better than all the medicine on thepharmacy shelf!

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The MythicalMenace ofStrep Throat

It’s an unusual child who lives in the north temperatezone and makes it through the winter without at leastone sore throat Scratchy, irritated throats can be painfuland annoying—to parents, as well as to children. Theyoften interfere with eating, talking, swallowing, and evensleeping, so they inevitably produce a succession ofplaintive appeals for relief.

When your child is the victim, your instinctive re-sponse may well be to call your doctor. But if you yieldto that impulse, you simply set the stage for medical in-rtervention aimed at strep throat. Your doctor will almostcertainly take a throat culture, and if it reveals the pres-ence of strep, he’ll probably prescribe an antibiotic. Thatmay slightly shorten the course of the disease, but it willalso increase the chances that your child will experiencea succession of sore throats all winter long, for reasonsI’ll explain later.

Doctors aren’t directly responsible for most sorethroats, but they are responsible for the concern thatparents feel when this symptom appears. The concernstems from the belief, inspired by doctors, that the sore-ness may be due to a streptococcal infection and that thiscondition, left untreated, may have grave consequences.These include acute nephritis or rheumatic fever and life-

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long heart disease, both legitimate reasons for parentalanxiety, so it is not surprising that parents reach for thetelephone to call their doctor when a child’s discomfortbecomes acute.

As a parent, you need to know how you can relieveyour fears without resorting needlessly to costly and po-tentially harmful professional help. You need facts thatyour doctor may neglect to provide about strep infec-tions and sore throats.

First, you should be aware that sore throats, most ofthe time, are caused by viruses for which Modern Medi-cine has no cure. The only legitimate treatments a doctorcan prescribe will not cure the sore throat. They willsimply relieve the symptoms somewhat, and they are sosimple and obvious that parents can perform them with-out any prior exposure to medical school.

Second, you should know that taking a culture to de-termine the presence of “strep” is a waste of your moneyand the doctor’s time. It wiU not prove beyond doubtthat your child has, or does not have, a strep infection.However, that question can be answered quite satisfac-torily by clinical examination; an examination so simplethat informed parents can conduct it themselves.

Third, the chances that your child will experiencerheumatic fever, even if he has a strep infection, are ex-tremely remote. During a quarter of a century in a pedi-atric practice that had more than 10,000 patient contactsa year, 1 saw only one case of rheumatic fever. In reallife, the threat of rheumatic fever does not exist in mostpopulations. The disease is rarely seen except amongmalnourished children living in the crowded conditionsassociated with desperate poverty.

Now, let’s examine why 1 can confidently make thesestatements, which probably contradict most of what youhave been told by your doctor, if, in fact, he’s told youanything at all.

Because most sore throats are caused by viruses, theyare not legitimately treatable by your doctor since no

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valid cure exists. They will respond to normal bodily de-fenses, however, and the symptoms usually disappear inthree or four days.

A less frequent cause of sore throats is bacterial in-fection, almost invariably the streptococcus baccili.“Strep throat,” as it is commonly known, will respondwithin 24-48 hours to treatment with penicillin. Withouttreatment, strep will surrender to antibiotics produced inthe bloodstream and usually disappears in less than aweek; antibiotics merely hasten the process a bit.

A third source of sore throats is three diseases that,when they are present, are a legitimate cause for parentalconcern. The first, relatively common compared to theothers, is infectious mononucleosis. The second, diph-theria, was once a feared disease, but it has virtuallydisappeared. The third, leukemia, is relatively uncom-mon but is the most feared of all. All of these diseasesdemand attention by your physician, and you should seehim promptly if the diagnostic instructions that followlead you to suspect any of them. Mononucleosis anddiphtheria are discussed fully in Chapter 19.

SORE THROAT CAUSESYOU CAN CONTROL

Finally, a surprising number of sore throats arecaused by external conditions that you, as a parent, haveconsiderable ability to control. These conditions produceirritation of the throat membranes, and soreness results.The principal offenders are dryness resulting from lackof humidity in the winter air, antihistamines you haveadministered to your child—with or without your doc-tor’s advice—to relieve the symptoms of a cold; smok-ing or exposure to air filled with smoke; chemicalpollution of the ambient air in the environment in whichyou live; and even too much screaming and yelling,which may irritate the vocal cords.

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Sore throats caused by viruses are usually diagnosedby exclusion. If the symptoms associated with othercauses are not present, and your doctor can’t find an-other explanation for the condition, he attributes the ail-ment to a virus. In most cases that diagnosis will becorrect.

No treatment is available that wifi cure a viral throatinfection, and your doctor ought to tell you that Somedoctors, however, rather than admit they are helpless,may take a throat culture and begin an immediate courseof penicillin treatment “because it may be strep throat.”

The simplest way for you to forestall this possibility isto avoid your doctor unless there are clear indicationsthat your child needs his help. Here’s what you need toknow to make that determination:

Characteristically, the onset of a viral infection isgradual, occurring over a period of one or two days. Thefirst indication of an impending viral sore throat isusually a vague tingling sensation around the soft palate,which becomes evident upon swallowing. Within a dayor two an annoying sore throat develops, often accompa-nied by a ninny nose (usually a clear, watery fluid), mildfever, coughing, and swollen neck glands. If this is thesequence of events, you can reasonably assume thatyour child has a viral sore throat. Only if the symptomspersist for more than a week, or if respiratory difficultyemerges, is there any need to take your child to a doctor.

In contrast, bacterial infections emerge swiftly andwithin a few hours—rather than days—produce a highfever, swollen lymph glands in the area below the jaw,and extreme pain in the throat. They may not be accom-panied by ninny noses, coughs, and other common coldsymptoms.

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“STREP THROAT” NOT ASERIOUS CONDITION

Most cases of strep throat in children over age fourcan be diagnosed by looking for what doctors know as“the classic triad” of symptoms—pus on the tonsils andin the throat, swollen glands in the neck, and a tempera-ture above 103. Pus is present when a normally pinkthroat appears to be fiery red, with spots of white oryellow that often look much like cottage cheese. If yourchild is less than four years old, you can’t rely on a clini-cal examination to determine the presence of strep. Athroat culture may determine it, but there is no point intaking one because, for reasons related to the immuneresponse, children under four don’t get rheumatic feveranyway.

If your child’s sore throat symptoms persist for morethan a week, which is beyond the normal course of thecommon viral and bacterial infections, take him to yourdoctor. This is simply a precaution to assure that he isnot a victim of infectious mononucleosis or leukemia,which must be diagnosed by blood tests that you cannotperform. The delay in seeing your doctor will not in-crease the risk to your child, because in the early stagesof a sore throat your doctor wouldn’t and shouldn’t per-form these tests. That’s because the treatment of mono issimply rest, which your sick child should be getting any-way, so early detection has no special value. Leukemia isso uncommon that indiscriminate testing for it is inap-propriate, and the chances that your child has diphtheriaare even more remote. If it is present, you will know itbecause the sore throat will evolve into severe respira-tory difficulties, e.g., choking. Unless these symptomsappear, your doctor won’t suspect diphtheria, either, be-cause he probably has never seen a case.

Sore throats produced by environmental conditionswill yield to the application of your own good common

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sense. If your child’s sore throat is not accompanied byfever, glandular swelling, pus, or any other symptom,dry air is the first culprit you should suspect. During thewinter, in northern climates, the humidity in the averagehome ranges around 15 percent. That number becomesmore meaningful when you consider that the normal hu-midity in the Sahara desert is higher—18 percent! If dryair is your child’s problem, spend your money on a goodhumidifier, not on office calls. You can exercise the samekind of judgment on the other environmental causes aswell.

THROAT CULTURES, PENICILLIN,AND STREP THROAT

Parents, teachers, and other lay people have beeneducated by doctors to believe that, if a child with astrep infection is not treated, he is at grave risk of con-tracting rheumatic fever. This disease is a cause for con-cern primarily because it can produce rheumatic heartdisease. When presented with a child who has a sorethroat, the typical pediatrician will tell you, the parent,that he is going to take a throat culture to determinewhether the child has “strep.” He may also invoke thehazards of rheumatic fever as his rationale for doing so.What he won’t tell you are all the reasons why taking aculture rarely makes sense.

He won’t tell you, for example, that the sore throat ismost likely to be caused by a virus and that taking aculture is a wasteful exercise if the classic triad is notpresent and there are no clinical indications of strep.

He won’t tell you that, even if the culture is positive,it does not necessarily mean that your child has a strepinfection. An average of 20 percent of perfectly healthyschoolchildren cany strep bacteria in their throats allwinter long but do not develop the disease because of thenatural immunity their systems have developed.

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Your doctor probably won’t tell you that under thebest of circumstances only 85 percent of actual strep in-fections are identified by throat cultures and that whenthe lab work is done in the doctor’s own office, ratherthan in a competent laboratory, the average accuracymay drop to as low as 50 percent. That’s because thosewho perform lab work in doctor’s offices are often rela-tively untrained and inexperienced and have only spo-radic opportunities to run the tests.

Your doctor almost certainly won’t tell you that, al-though the use of penicillin may shorten the course ofthe strep symptoms by three or four days, it may alsocause recurrences of the infection all winter long. Antibi-otics, while knocking out the strep bacilli, also preventthe development of the antibodies that are the body’snatural defense against the disease. If the strep infectionis not treated, but allowed to run its course, the bodywill produce antibodies to fight it that can continue toprotect the child against reinfection during the remainderof the winter season. It is the penicillin’s action againstthe antibodies that makes it effective in preventing rheu-matic fever. The consequence of antibiotic treatment isthat, if a child is subjected to a throat culture and peni-cillin at the beginning of the winter season, his tonsilswill be the target of a cotton swab repeatedly, throughoutthe months to come. If one of your children has gonethrough a winter being treated for one sore throat afteranother, the treatment, rather than the bacilli, may bethe real culprit.

Your doctor may ask. you whether your child is aller-gic to penicillin; in fact, he’s so fearful of malpracticesuits that he almost certainly will. He probably won’t tell,you, however, about the potential consequences of anallergic reaction to the drug. Penicillin may produce diar-rhea and rashes and, in rare instances, anaphylacticshock and death. If your child is receiving penicillin forthe first time, be sure that your doctor is aware of thisand that he monitors the child closely for any reaction

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that could lead to fatal shock. Remember, also, thatwhile penicillin will not lose its effectiveness in the treat-ment of strep, indiscriminate and needless use ofthe drug may interfere with its efficiency in dealingwith other, more dangerous bacteria later in your child’slife. As I explained earlier, the patient may developpenicillin-resistant strains of bacteria, so that the drugwon’t work when it is really needed to save a life.

If your doctor gives you a prescription for oral peni-cillin, he may remember to warn you that it will be inef-fective as a preventive of rheumatic fever unless thechild takes it faithfully every four hours for 10 full days.However, the evidence is that, more often than not, thiscounsel goes unheeded, even if it is given. It is easy tounderstand why this is true. Typically, the antibiotic re-lieves the symptoms of a sore throat in a couple of days,as Mother Nature probably would have without thedrug, and the parent often assumes that the medicine hasdone its job. It has, as far as the strep infection is con-cerned, but it won’t be fully effective against the possi-bility of rheumatic fever unless it is taken for the fullcourse prescribed.

Even knowing this, it is a remarkably determined par-ent who will continue to insist that the child take hismedicine every four hours for eight days after hestopped feeling and acting sick. Repeated studies haveshown that when pencillin is prescribed the compliancerates are well below 50 percent. That simply means thatin more than half of the cases in which penicillin is giventhe patient doesn't continue taking it long enough for itto be effective against the disease—rheumatic fever, notstrep—that it is supposed to prevent.

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RHEUMATIC HEART DISEASE NOTHREAT FOR MOST CHILDREN

If children were in significant danger of contractingrheumatic heart disease, noncompliance with the doc-tor's instructions would be a cause for concern. In reallife it is a cause for concern only among the group athighest risk—the children in poverty-stricken house-holds who are least likely to receive medical attentionand, when they do, the least likely to take their medicineas long as they should.

However, despite overwhelming evidence that rheu-matic fever has all but disappeared, except in the lowersocioeconomic strata of society, doctors rarely tell theirpatients that it is a minimal risk. Parents are led, or atleast allowed, to believe that rheumatic fever and theaccompanying threat of lifelong heart disease is an immi-nent hazard for every child with a sore throat That con-clusion is contradicted by simple logic, as well as thestatistical facts.

First of all, virtually all studies of the incidence ofrheumatic fever among victims of strep throat have beendone on closed populations in military bases and orphan-ages. It is well known that the epidemiology of closedpopulations is not typical of open ones. Yet these find-ings have been applied to the population at large, andmillions have been treated for strep infections to preventa disease that scarcely exists. It is fair to questionwhether the damage done by that treatment exceeds therisk that the penicillin is used to treat. Doctors are quickto warn parents of the dangers of rheumatic fever, but Idon’t know many who warn patients of the risks of thetreatment they prescribe!

If rheumatic fever were a serious threat, one wouldassume that countless cases would emerge in a city aslarge and densely populated as New York, particularlysince so many of its residents live in conditions of pov-erty. Such an assumption could hardly be further from

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the truth. In fact, only 57 rheumatic fever cases wereseen at New York’s famed Bellevue hospital between1970 and 1977, and not a single case was identified in1978, the most recent year for which I have data.

If pressed, doctors will acknowledge that the inci-dence of rheumatic heart disease is waning, but they areprone to attribute the decline to the availability of peni-cillin to prevent the disease. That assertion doesn't holdwater, because the incidence of rheumatic fever began todrop long before penicillin came on the scene. Twenty-five years ago an attempt was made in the Chicago met-ropolitan area to establish a registry of rheumatic fevercases, and all doctors were asked to report those theytreated. The effort was abandoned because no casescould be found in the affluent neighborhoods and sub-urbs of Chicago. The only cases reported were in theimpoverished inner city, proving once again that it isonly the children in poor families who are seriously atrisk.

Studies have shown that the incidence of rheumaticfever is related to the density of children per room,which may also explain the results obtained in studiesdone in military installations and orphanages. Rheumaticfever is, indeed, a socioeconomic disease, and it is un-likely that the use of penicillin, even among the poor,will have much effect. The efficiency of penicillin varieswith the nutritional state of the patient, and good nutri-tion is not a feature of poverty.

While it is clear that the incidence of cases diagnosedas rheumatic fever is diminishing, it is less certainwhether this disease was ever a legitimate major threat.A study of cases diagnosed as rheumatic heart disease 40years before revealed that 90 percent of the cases hadbeen misdiagnosed because of misapplication of the clas-sic criteria. Nine out of ten of the presumed victims ofthe disease didn’t have it at all. Thus, it may be mislead-ing to say that rheumatic heart disease is no longer athreat because, in fact, it never really was. This has sig-

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nificance for those who were diagnosed as having thisdisease many years ago and have been worrying about itever since.

A final question for your doctor, if he still insists thatrheumatic fever is a cause for concern: given the factthat as many as 15-50 percent of strep cases are notdiagnosed and therefore not treated, and that half ofthose that are treated don’t benefit because of the lowcompliance rate, where are all the people who shouldhave contracted rheumatic fever because they had astrep throat?

THREE VIEWS OF THETREATMENT OF STREP

A majority of doctors are divided into two camps onthe appropriate treatment of strep throat. There is also athird camp, a lonely one, to which only a few of us be-long.

One group of doctors insists that penicillin should beadministered immediately in all cases of sore throat,without awaiting the results of the throat culture test.They note, correctly, that unless penicillin is givenwithin 48-72 hours of the onset of symptoms it may notavert the possibility of rheumatic fever when it is finallyused. Since the symptoms usually have been present fora period of time before the culture is taken, deferring theuse of penicillin during the 24- to 48-hour wait for testresults may render it ineffective.

The second group argues that penicillin should bewithheld until the results of the throat culture are ob-tained. They point to the risks of penicillin, the hazardsassociated with its indiscriminate use, and the fact thatpatients shouldn’t be told to waste their money on pre-scriptions they may not need.

The third camp, in which I place myself, holds thatboth throat cultures and antibiotics are to be avoided.

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because the hazards of treatment outweigh the remotepossibility that your child will suffer any lasting effectseven if he has a strep infection.

My position is simply the product of experience andobservation over a quarter of a century. When I com-pleted my medical education, I became associated with apediatric practice that served a clientele along the afflu-ent lakefront of Chicago. My senior partner was alearned and conscientious physician, Dr. Ralph Kun-stadter. I was soon surprised to discover that he rarelytook throat cultures, and when I asked him about it hesaid he considered them irrelevant and a waste of time.

Dr. Kunstadter had received his training 20 years ear-lier than I did, before the medical schools had totallyabandoned Mother Nature, but I was imbued with every-thing I had learned about intervention. This led me totake throat cultures for a time, despite his example. Ifinally abandoned them, too, when I discovered that theresults that I obtained after going to the trouble and put-ting my patients to the expense were no better than Dr.Kunstadter’s. As I noted earlier, although we must havehad 130,000 patient contacts during the 15 years wepracticed together, only one case of rheumatic fever ap-peared. Obviously, risking damage to all the other chil-dren who had sore throats by treating them withpenicillin, in order to prevent one case of rheumaticfever, would have been a poor trade-off.

WHY TONSILLECTOMIESSHOULD BE AVOIDED

Finally, a word about your child’s tonsils—the inter-ceptor of bacteria entering his throat, which may becomeinfected as his body fights bacterial disease. Be on yourguard if your child’s doctor tries to persuade you thatinfection in his tonsils is an indication for their removal,for that is rarely the case.

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For decades tonsillectomies were the bread-and-butter surgery of surgeons and pediatricians. During the1930s doctors were doing between 1.5 million and 2 mil-lion tonsillectomies a year. Few children reached theirteens with their tonsils intact, despite the fact that theirremoval could rarely be justified on legitimate medicalgrounds. For millions of children the consequences ofthis purposeless surgery were emotional trauma, loss ofa natural defense against disease, and, in some, cases,death.

The only absolute indications for tonsillectomy or forremoval of the adenoids are malignancy or airway ob-struction because the tonsils are so swollen that it be-comes virtually impossible for your child to breathe. Yet,for many decades doctors performed them routinely, de-fending this irrational behavior with the unproven con-tention that failure to remove infected tonsils wouldsubject the child to possible hearing loss or, at the veryleast, lead to recurrent sore throats.

The compulsion of pediatricians and surgeons to re-move tonsils without justification was demonstrated inan experimental study conducted in the mid-40s. Agroup of pediatricians was asked to examine 1,000 chil-dren, and it was recommended that 611 of the kids havetheir tonsils removed. The remaining 389 were thentaken to another group of pediatricians, who advised that174 of them have their tonsils taken out. That left only215 of the original 1,000, and a third group of pediatri-cians was asked to examine them. Although they hadalready been examined by two other doctors, tonsillec-tomies were recommended for 89 of them! If the charadehad been continued for another round or two, surgeryprobably would have been recommended for the remain-ing 126 kids as well.

The tonsils and adenoids are lymphoid tissues, whichare the primary site of the body’s immunologic activityagainst disease. Because they are the interceptors ofbacteria entering your child’s throat, it is inevitable that

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they become infected, swollen, and inflamed. If they areremoved, your child’s first line of defense against infec-tion is gone, and the responsibility is transferred to thelymph nodes in his neck. His body’s immunologic com-petence is reduced and there may be an increased riskthat your child will become a victim of Hodgkin’s dis-ease.

As a consequence of parental resistance resultingfrom media criticism of wanton removal of tonsils, thenumber of tonsillectomies now performed each year isonly a third of what it used to be. Nevertheless, far toomany are still being performed, and your child is a po-tential victim of one of them. I doubt that more than onechild in 10,000 requires this surgery, yet hundreds ofthousands of tonsillectomies are still performed everyyear. They result in 100-300 deaths, with a complicationrate of 16 per 1,000 procedures.

I have long since concluded that locating the tonsilswithin easy reach of the surgeon’s knife may have beenGod’s only mistake! Unless your child’s tonsils are soswollen that they interfere with his breathing, don’t per-mit your doctor to perform a tonsillectomy unless he canoffer convincing reasons for doing so. Even then I wouldrecommend that you get a second opinion.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO SORE THROATS

Sore throats, per se, although they may cause consid-erable discomfort, are not a serious condition, even ifthey are caused by a strep infection. They do not requiremedical treatment unless they persist in the presence ofadditional symptoms that may indicate a serious illness.Here is my advice to parents whose child develops asore throat:

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1. Don’t rush your child to the doctor simply be-cause he has a mild fever and a sore throat. Seea doctor only if the symptoms persist for morethan a week.

2. Replace the body fluids that are lost from per-spiring, coughing, sneezing, nasal discharge, di-arrhea, more rapid respiration, and loss ofappetite. Give eight ounces of fluid every hourthat the child is awake. That is a lot of fluid andperhaps more than he will want to take, so en-courage him by offering a variety of options.The fluids can be nonfluoridated water, tea (or-dinary or herbal), fruit and vegetable juices,soups, and even soft drinks as a last resort ifthat’s all you can persuade him to swallow.

3. Maintain proper humidity in the child’s roomand, if possible, throughout the house. Humidi-fiers that supply cool steam vapor are excellentand safe. Remember, though, that it is impor-tant to keep the humidifier clean lest it begincirculating irritants that will further inflame thethroat. You should try to raise the humidity inthe child’s room to at least 30 percent, althoughunder some conditions that may be difficult.

4. If your child is complaining vociferously, youmay want to do something to relieve his symp-toms. The recommended dose of a simple anal-gesic agent such as Tylenol is appropriate.There are risks associated with this drug, but fortemporary relief of pain I do not consider smallquantities to be dangerous. An alternative thatsome mothers prefer, which often works aswell, is a teaspoonful of liquor. For reasons thatescape me, white liquors—gin and vodka—seem to be favored by those who make this sub-stitution. Perhaps the parents don’t want towaste their Jack Daniels on a kid!

5. My views on the suppression of fever have al-ready been discussed, but let me remind youagain that the fever associated with a disease isa mechanism the body employs to cure itself. Itis unwise to interfere with it. Fevers below 105do not pose a significant risk, other than that ofconvulsions. Convulsions are frightening butrarely dangerous and probably can’t be avoidedbecause they are not related to the height offever but to the rate of ascent.

6. The penchant of doctors to prescribe aspirin orother drugs for the reduction of fever, whichmany of them do routinely, is one that I findappalling. Every doctor learns during the pre-clinical years of medical school that for everydegree of rise in temperature the rate of travelof the disease-fighting leukocytes in the blood-stream is doubled. This process known as leu-cotaxis. I can’t comprehend why a doctorwould want to put the brakes on a mechanismthat is striving to make his patient well.

7. Without treatment a sore throat—even if it isthe result of a strep infection—should improveand disappear within a week or less. If itdoesn’t, see your doctor, because it may indi-cate the presence of a disease other than strep—infectious mononucleosis or, .very rarely,diphtheria or leukemia.

Mono is easily identified by blood tests, andthe normal treatment is nothing more than goodnutrition and bed rest. More severe cases maybe treated with steroid hormones—usuallyprednisone—but this is radical and controver-sial treatment that should be used only in casesof extremely high risk. Diphtheria occurs sorarely that your doctor may not even suspect it,unless your child’s ailment has reached thepoint of extreme respiratory difficulty. If your

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child experiences choking and is unable tobreathe properly, rush him to the nearest hospi-tal emergency room.

8. Doctors justify the use of penicillin to treat strepthroat as a means of forestalling rheumatic heartdisease. This condition is so rarely a conse-quence of strep infections that it does not war-rant the treatment of the infection withantibiotics. However, if you do take your childto the doctor and he prescribes penicillin fortreatment of a strep infection, the symptomsshould begin to disappear within 24-48 hours. Ifthey aren’t gone in a week, inform your doctor.Your child’s sore throat may be the result of adisease other than strep, and he should conductthe appropriate tests to determine whether thisis the case.

9. Unless your child has chronic breathing diffi-culty because his throat is often obstructed byswollen tonsils, don’t let your doctor perform atonsillectomy without getting a second opinionindicating that one is really necessary. Yourchild’s tonsils indicating that one is really neces-sary. Your child’s tonsils are one of his body’snatural defenses against disease, and heshouldn’t part with them unless there is aclearly established need to do so.

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Earaches:

Painful, Yes;Dangerous, Rarely

£wcta can be the meet painful of chiKUtood 31-nesses. Your child may suffer greatly when he has one,and because you fed so helpless and so fearful that theinfection may bring hearing loss or other consequences,they can be agony for you, too.

Statistically otitis media (middle ear infection) is re-sponsible for about 8 percent of aO patient visits to pedi-atric practices and 17 percent of aO infections that arediagnosed. That does not mean, however, that 17 per-cent of aD infections are otitis media, for it is probablythe most oveniiagmrsed and overtreated of all childhoodillnesses.

Most parents hasten to call the doctor when theirchild complains of an earache. That’s tine even of par-ents who normally re^vd a call to the doctor as the lastresort when their child says he is sick. Their unusualconcern about earaches is prompted by the acute painthat their child is suffering or the fear that it soon willbecome acute. In addition, many parents hold the mis-taken belief that ear infections may cause their childrento suffer the loss of hearing or develop mastoiditis, afrightening relic of the mnikal past.

I am in no way critical of parents who hold these fearsbecause, for the most part, doctors reinforce them. Pedi-

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atricians also, more often than not, diagnose ear infec-tions where none exist. True, your child may experiencea temporary hearing deficit as a result of recurrent earinfections during the winter months. But if he does,relax, because his full hearing will reappear long with thetulips in the spring. During more than 25 years in pediat-ric medicine I have never seen a case of permanent hear-ing loss as a result of ear infection. As for mastoiditis,which was a major concern of parents during my child-hood years, I have yet to see a single case develop,whether the victims of the ear infection were treated ornot. It has mysteriously disappeared.

In most cases ear pain is caused by pressure that de-velops when something—usually infection—interfereswith the drainage of the ear through the eustachiantubes. Bacterial and viral infections can occur, however,in the ear canal (otitis externa), in the middle ear (otitismedia), and in the inner ear. The inner ear infectionsrarely occur in children but in adults may involve ver-tigo, dizziness, and tinnitus (ear noises).

EARACHES CAUSED BYFOREIGN BODIES

Foreign bodies in the ear are another relatively com-mon source of earches. They may cause pain themselvesor lead to infection that causes pain. Small children seemto delight in shoving small objects into their ears andsometimes their nostrils. Someone even wrote a songabout “beans in your ears.” I can assure you that theoffending objects are not limited to beans. Over theyears I have invaded ear canals to remove pieces ofpaper, cotton balls, BB shot, vitamin pills, M & M can-dies, jelly beans, pieces of cereal, and even paper clipsand safety pins.

If your child tells you he put something into his ear, oryou have reason to suspect that he did, take him to yourdoctor at once. These foreign objects will rarely emerge

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by themselves, and it is dangerous for you to try to re-move them. If you have no reason to suspect a foreignobject, there is no need to seek medical treatment for theearache unless it has persisted for 48 hours or more.

Allergies are also a frequent component in the produc-tion of ear infection. They may predispose your child tobacterial infection. The most common culprit is cow’smilk, in its natural form or as found in infant formula. Itcauses a swelling of the mucous membranes, which in-terferes with the dramas erf1 secretions through the eus-tachian tube. Eventually infection results because of theaccumulated secretions. MDk allergy is responsible forthe high inckkrce of ear infections in bottlefed babies.However, allergies to other foods, dust, pollen, etc., canproduce the same effects. So can allergy to chlorinatedwater in swimming pools.

Parents and doctors may also be responsible for in-jury to the ear canal and the eardrum because of theirefforts to remove wax from the ear. This is rarely a nec-essary procedure, and when it is necessary, there aresafe ways of doing it. If you want to avoid damagingyour child’s ear, I suggest you follow a simple rule that Ihave been giving to parents for years: “Never put any-thing into your child’s ear that is smaller than yourelbow!”

No one can provide a scientific explanation of whysome children produce more ear wax than others, butthey do. There are also racial differences in the quantity,consistency, and color of the wax found in ears. An ac-cumulation of wax can sometimes cause mild, temporaryhearing loss, but this rarely occurs in children.

The best way to remove ear wax is by inserting a fewdrops of hydrogen peroxide into the ear twice a day fortwo or three days. The child may complain about a bub-bling or roaring sound when it is inserted, but it won’thurt hfan Let the hydro^n peroxide remain in the earfor several minutes and then rinse the ear with gentlebursts of water from a syringe. You can also use a com-

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mercial preparation. Murine eardrops, but peroxide isless expensive and just as effective.

DANGERS OF REMOVINGWAX FROM EARS

It is inadvisable for you or your doctor to use anykind of instrument to remove wax forcibly from yourchild’s ears, even a cotton swab. Even though the pack-age cautions them not to do it (in very small print), someparents are fond of using Q-Tips to remove wax from theear canal. This is dangerous and unnecessary for severalreasons:

1. You are going into a blind passage with a deli-cate membrane at the end, and you don’t knowhow far to go.

2. The lining of the ear is a delicate structure withlots of glands and cilia that are there to keep theear free of debris. The glands secrete mucousand oils. This lining is so sensitive that invadingit, even with a soft cotton swab, is like driving atank across your lawn.

3. The ear has its own mechanisms for movingnoxious agents out of the ear canal. You inter-fere with these mechanisms when you attemptto clean the ear with a swab because you arelikely to push wax and dirt back in and compactit so that the natural removal process is less ef-fective. You may also cause physical damage tothe ear canal or the eardrum itself.

Your pediatrician should also be discouraged fromusing an instrument to remove wax from your child’sears. He’ll say he has to do it in order to see the eardrumand determine whether infection is present. That’s not a

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valid reason, because one slip of his metal instrument, orone sudden head movement by a squirming child, couldresult in a punctured eardrum. Although this will healitself, it may leave a scar, causing minor hearing loss.

Occasionally a child damages his eardrum by poking asharp object, such as a pencil, into the ear canal. Theeardrum virtually always heals itself without treatment.In all my years of practice I have never seen a case inwhich it didn’t. Nevertheless, it is a wise precaution tosee an ear specialist if this happens to your child. Inextremely rare instances the damage may be sufficient torequire surgical repair, but the doctor should be ques-tioned closely before you accept surgical treatment, oreven antibiotics, for an injury of this nature.

EARACHES CAUSED BYCHANGES IN PRESSURE

Another occasional source of earaches is the atmos-pheric pressure change that occurs when your child ridesin airplanes or elevators. These pressure changes some-times cause pain and temporary hearing loss, as youhave undoubtedly observed on your own airplane flights.The symptoms disappear when internal and externalpressure are equalized, but if they are not equalized,blockage of the eustachian tube can produce infection.Adults and older children can usually equalize the pres-sure by swallowing, yawning, chewing gum, or attempt-ing to expel air from the nose while holding it firmly withthe mouth closed. There is no evidence that this last pro-cedure is harmful. Babies, who can’t be instructed tofollow any of these procedures, will usually avoid thesymptoms if they are nursed during takeoff and landing.An alternative with infants is simply to give them some-thing to chew or swallow.

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HOW MOST DOCTORSTREAT EARACHES

Let’s turn now to what happens when your child hasan earache and you take him to the doctor. When I wasin medical school I was solemnly warned by my profes-sors that untreated ear infections would result in deaf-ness. For a long time, and just as'solemnly, I transmittedthis information to my patients and stuffed them with asuccession of antibiotics, decongestants, and antihista-mines. Later, when it began to become the vogue, I duti-fully punctured the eardrums of my patients and insertedplastic tubes to facilitate drainage.

As the years passed I learned that many of my pa-tients, perhaps the majority, failed to take their antibi-otics for the time period prescribed, and many of themnever got the prescription filled at all. In medical circlesthis kind of behavior is called “patient noncompliance,”and it is frowned upon by doctors and pharmaceuticalmanufacturers alike. But what disturbed me more thannoncompliance was the realization that my noncompliantpatients recovered from their infections as rapidly asthose who complied, and not one of them ever wentdeaf!

At first I consoled myself by invoking the standardline that all doctors are taught to recite when their pa-tients get well by ignoring their advice: “You’re lucky,that’s all.” Before long that rationalization no longer sat-isfied me, because so many untreated patients had re-covered without medication that there couldn’t be thatmuch luck to go around.

That destroyed my faith in antibiotics, and I quit pre-scribing them, with no apparent negative effect on mypatients. It wasn’t long before I also lost my faith intympanostomy—the plastic tubes. That happened be-cause many mothers refused to let me insert them, andmany others fell out shortly after I inserted them. In de-fiance of current medical opinion, those patients did just

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as well as those whose tubes remained in place for theprescribed period of time. My tympanostomy tubesjoined the antibiotics on the shelf I reserve for drugs andprocedures that are conceived for the benefit of doctorsand drug manufacturers, not for patients.

Today I don’t recommend antibiotics, decongestants,or antihistamines to any of my patients who have ear-aches. I actively oppose tympanostomies, and I teachmy students to do the same. Their patients aren’t losingtheir hearing because of ear infections, and neither aremine.

Unfortunately, we are among a minority of pediatri-cians, and the others are still going by the book. Whenyour child has an earache, and you take him to the doc-tor, the pattern is usually set. After the nurse has takenyour child’s temperature the doctor will rush into theexamining room, ask what the problem is, and then do acursory physical examination. He’ll check your child’sthroat, listen to his heart and lungs, and then peerthrough an otoscope to check the condition of his ear-drums.

What he will see in the light shining from the end ofthe otoscope is the ear canal, which may or may not beinflamed, and the eardrum itself. If there is an infectionbeyond the ear canal, it will probably be in the middleear. That’s behind the eardrum, so the doctor won’t beable to see the site of the actual infection, if there is any.He will make his diagnosis by observing the condition ofthe eardrum rather than the infected area itself.

Normally the eardrum is pearly white in color. Whensevere middle ear infection (otitis media) is present it willbe a violent shade of red. When the doctor looks at yourchild’s eardrum he may see one of these two colors or arange of shades of pink and red that lie in between. If heobserves an eardrum that is beet red, he’ll probably tellyou that your child has a severe infection of the middleear and give you a prescription for Amoxicillin, to betaken three times a day for 10 days. If he sees one of thelesser shades of pink or red, he’ll probably diagnose it as

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a mild middle ear infection and then proceed to treat itthe same way.

This doctor is treating your child improperly on twocounts. First, the fact that an eardrum is pink or evenmildly red does not mean that your child has a middleear infection. The change in color can occur when a childis upset and crying, or because of fever due to a causeother than ear infection, or even because of an allergicreaction. A single observation of an eardrum that isslightly pink or red does not warrant diagnosing theproblem of an ear infection, because the same eardrummay appear normally white if the doctor inspects it againan hour later.

The second mistake is treating the patient with antibi-otics, whether his eardrum is pink, beet red, or evenroyal blue! The only case in which the use of antibioticscan remotely be justified is if the ear is actually discharg-ing pus, which occurs in less than 1 percent of ear infec-tions, and I’m not convinced that it can be justified eventhen.

A series of controlled studies have revealed that theuse of antibiotics for treatment of ear infections makesno difference in terms of the important outcomes—hear-ing loss, spread of infection, or mastoiditis. Their usemay slightly shorten the duration of pain and infection,but the trade-off is that the antibiotics also reduce thebody’s natural immune response. Consequently, in orderto slightly reduce the duration of the infection, you in-crease the possibility that the child will have new infec-tions every four to six weeks.

The most recent study I have seen reported cites theresults of a double-blind experiment involving 171 chil-dren in the Netherlands. Half were treated with an anti-biotic, and the other half were not. There was nosignificant difference in the clinical course of the disease—pain, temperature, discharge from the ear, or changein the appearance of the eardrum or hearing levels—be-tween those treated without antibiotics and those whoreceived them.

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Some of my colleagues condemn me for the position Itake on the use of antibiotics for treatment of ear infec-tions. Sometimes they accuse me of endangering thelives of children by opposing their use. My response is, Ibelieve, irrefutable. At least it has never been refuted.Here it is:

A majority of the ear infections experienced by chil-dren are not treated by doctors. Among those treatedwith antibiotics, the compliance rate is incredibly low.Children’s Hospital, in Buffalo, New York, studied 300children who were given prescriptions for antibiotics be-cause of middle ear infections. Less than 50 percent ac-tually received the amount that was prescribed. Only 22of the 300 complied fully with the directions. In short, amajority of kids with ear infections aren’t treated, andmost of those who are treated with antibiotics don’t fol-low directions so the antibiotics are ineffective. If antibi-otics were really necessary to prevent hearing loss,hearing deficiencies would afflict most of the kids in thecountry.

I have discussed elsewhere the hazards of indiscrimi-nate use of antibiotics. Those hazards prevail in the caseof ear infections as well.

For years doctors have also prescribed oral deconges-tants and antihistamines in the treatment of ear infec-tions. The principal drugs used are pseudoephedrinehydrochloride and chlorpheniramine maleate. The tradenames of those most commonly prescribed are Actifedand Sudafed, and these drugs and others like them havebeen given to millions of children afflicted with ear in-fections or with the common cold. For years the Foodand Drug Administration has questioned the value ofthese drugs and demanded that the manufacturers provetheir worth or remove them from the market. Doctorskeep right on prescribing them for children, neverthe-less. In 1983, at the conclusion of a three-year study atthe University of Pittsburgh, it was revealed that neitherof these drugs was effective in the treatment of ear infec-tions. More than 500 children were included in an exper-

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iment in which half were given these drugs and the otherhalf a placebo. Both groups recovered at the same rate.

What I have tried to do in the preceding pages is reas-sure you that any fears you have had about the conse-quences of ear infections can be put aside and that theuse of drugs in their treatment is not only unnecessary inmost cases but may actually be counterproductive. Thesame advice goes for the surgical procedure alreadymentioned—tympanostomy—which today has becomethe surgery most commonly performed on children.

TYMPANOSTOMY RARELYIS JUSTIFIED

Pediatricians often use tympanostomy to treatchronic, recurrent middle ear infections where seriousfluid is present. That’s a clear fluid, not pus. Its purposeis to release the vacuum within the inner ear so that fluidwill escape through the eustachian tubes. It’s the sameprinciple as punching a second opening in the top of abeer can so that the beer will flow freely out of the firstone.

In doing the procedure, the doctor punctures a hole inthe eardrum and inserts a polyethylene tube. The tubemay be left in for weeks or even months. Sometimes it isremoved deliberately; sometimes it falls out of its ownaccord. The principal justification for the procedure isthe prevention of hearing loss, which is no justification atall.

Controlled studies have shown that when both eareare infected, and a tube is inserted in only one of them,the outcome for both ears is almost identical. Meanwhilethe procedure itself carries many risks and side effects.Justified as a means of preventing hearing loss, tympan-ostomy can cause scarring and hardening of the ear-drum, with resulting hearing loss. Incredibly, one of theside effects of this procedure, performed to cure recur-rent otitis media, is acute otitis media!

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WHAT TO DO IN THEMIDDLE OF THE NIGHT

What should you do when your child develops an ear-ache and wakes you up in the middle of the night? First,don’t seek medical attention immediately, even if he isexperiencing severe pain. There is no worthwhile imme-diate treatment your doctor can provide that you can’tprovide yourself. Use a heating pad; insert two drops ofheated (but not hot) olive oil in the child’s ear every twohours; give whiskey by mouth, which will help the childsleep (Give 10 drops of whiskey to a small baby and upto one-half teaspoon to a larger one. The dose can berepeated in one hour and once more in another hour, ifneeded.); and, if severe pain continues, use the appro-priate children’s dose of acetaminophen. The object is torelieve the symptoms while the body defends itself.

If the pain persists after 48 hours, see your doctor todetermine whether the cause of the pain might be a trau-matic injury or the presence of a foreign body in the ear.If neither of these proves to be the cause of the earache,and no pus is draining from the ear, take your child homewithout further treatment and let nature take its course.

Most of my colleagues will regard this as a radicaldeparture from accepted medical principles. I maintain—and I have given you the evidence that supports it—that it is the accepted medical principles that are radicaland that my approach is conservative. Scientifically con-trolled studies have established that the conventionaltreatment of ear infections doesn’t work and may dam-age the patient. While I can’t provide any scientific evi-dence that olive oil and whiskey will cure ear infections,my patients will tell you that they do relieve pain, and Iknow that they won’t do any harm.

Meanwhile, my colleagues’ patients aren’t losing theirhearing because of ear infections, and neither are mine.But some of their patients are suffering hearing deficitsas a direct result of the treatments they receive.

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DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO EARACHES

Ear infections will not cause permanent hearing defi-cits, and mastoiditis is so rare a condition that most con-temporary physicians have never seen a case.Conventional treatment with antibiotics, other drugs,and the surgical procedure known as tympanostomy isno more effective than the body’s own defenses in deal-ing with the disease. If your child complains of an ear-ache, follow these procedures:

1. Wait 48 hours before you call your pediatrician.

2. Relieve the pain with a heating pad, two dropsof heated olive oil (not hot) inserted in the earcanal, and the appropriate children’s dose of ac-etaminophen if the pain becomes unbearable.Don’t use aspirin because of the potential sideeffects. In 1955, as a young resident, I diag-nosed my first case of aspirin intoxication. Thechild died, and I have been leery of aspirin eversince.

3. If the pain persists after 48 hours, see a doctor—not to treat infection, if that’s what it provesto be, but to rule out the possibility of trauma orthe presence of a foreign body.

4. Don’t allow your doctor to use an instrument toremove wax from your child’s ear and don’t tryto do it yourself.

5. If your doctor examines your child and finds aviral or bacterial infection, question the need forits use if he prescribes an antibiotic. If he finds aforeign body, let him remove it, but again ques-tion the need if he prescribes an antibiotic. Ifyour child has a self-inflicted injury to the ear-drum, your pediatrician may refer you. to an ear

and throat specialist. Be suspicious and ques-tion the need if he recommends surgical treat-ment or antibiotics. In all my years ofexperience I have never seen a case in whicheither was necessary.

6. If your child has chronic, recurrent middle earinfection, it is probably because of allergies orthe antibiotics he was previously given. If yourdoctor recommends tympanostomy, don’t per-mit it without obtaining a second opinion. Thisprocedure has replaced tonsillectomy as the fa-vorite of pediatricians, but there is no reliablescientific evidence that it will do any good, andthere’s considerable evidence that it may causefurther harm.

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Protecting YourChild’s Vision

l^ike most of us, you probably consider vision themost priceless of your senses and are appalled by thevery thought that your child might lose his eyesight.That’s an appropriate concern, so it is important for youto see he has proper eye care. It is also important thatyou know how to avoid improper treatment.

Vision is measured as a ratio of an individual eye’scapacity related to what a normal eye should see. Thus,20/20 vision means that an eye sees at 20 feet what itshould see at that distance. If a child has 20/50 vision, hesees at 20 feet what he should be able to see from 50 feetaway.

At birth, babies have some gross visual capacity, buttheir ability to distinguish details is limited. Their visionimproves gradually until it reaches full capacity at aboutthe age of five. A child’s eyes are sufficiently developedto be capable of 20/20 vision at about six months, but theinteraction between the eye and the brain is not yet de-veloped well enough to provide vision of that quality. Atthe age of two a child’s eyesight is about 20/70; at three,20/30 or 20/40; at four, 20/25; it reaches 20/20 by the ageof five, barring some visual problem.

Because some parents are concerned when they aretold that their three-year-old has 20/40 vision, it is im-portant for you to understand that it is not essential that

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anyone have 20/20 vision. Children can function quitewell with 20/40 vision, and it is probable that the three-year-old with that level of visual capacity will have 20/20vision at the age of five. It is also important to under-stand this because some doctors will prescribe correctiveglasses for three-year-olds with 20/40 vision. That’s un-necessary unless a specific eye defect requires correc-tion or one eye sees better than the other so they don’tfocus properly. This should be corrected, or one eye maycease to function as it should.

The three common visual deficiences are nearsighted-ness (myopia), farsightedness (hyperopia), and astigma-tism. All of these conditions are due to the shape of theeye and do not indicate either weakness or disease. If thedistance between the cornea and the retina is too great,the eye focuses in front of the retina, not on it, causingnearsightedness. If the distance is too short, the eye fo-cuses behind the retina, and the person is farsighted.Astigmatism is caused by an irregularity of the cornea orthe lens. All of these conditions can be corrected withglasses or contact lenses, and none of them indicates agreater danger of eye disease in the future.

About 10 percent of children may need glasses for oneor another of these conditions, but failure to wear cor-rective lenses will not cause the condition to worsen.Farsightedness often diminishes by the time a child be-comes an adult at the age of 21; nearsightedness usuallyworsens but stabilizes at about the same age.

CROSS-EYES ARE USUALLYSELF-CORRECTING

During the first months of life a baby’s eyes mayfunction independently of each other, leading parents tofear that their child may be “cross-eyed” or “wall-eyed.”This random movement is neither unusual nor abnormal,and by the third month of life the eyes should begin tofunction in unison when following moving objects

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around the room. Some children, however, display acondition known as alternating strabismus, in which oneeye or the other sometimes wanders “out of synch.” Thiscondition is almost always self-correcting by the age offive, but if your child has it and you take him to thedoctor, he may receive treatment, perhaps including sur-gery, that he doesn’t need.

The condition can be serious if one of your child’seyes “sits in the corner” and is not functional at all. Ifthis condition is not corrected, the function of that eyemay be permanently impaired. This condition, known asamblyopia, is the absence of normal vision despite anormal eyeball and a normal optic nerve, because theeye does not transmit visual stimuli to the sensory por-tion of the brain that serves the eye. It can usually beaverted by patching the good eye, which forces the useof the “lazy” one; through eye exercises (orthoptics);with glasses; and, in extreme cases—when all othermeasures fail—with surgery.

It is essential that true strabismus, which may lead toamblyopia, be corrected by the time your child reachesschool age. If one of his eyes “sits in the corner,” youshould take him to a competent ophthalmologist for cor-rective measures. However, be certain that the doctordoes not resort to surgery until all the less heroic mea-sures have been tried and have failed.

Before you submit your child to treatment, however,be sure it is true strabismus you are dealing with, withone eye fixed in the corner, and not the relatively com-mon alternating variety. Why? Because I have seen toomany cases of alternating strabismus in two- and three-year-old children that doctors have insisted on correct-ing—even with surgery—despite the fact that thecondition was almost certain to correct itself before thechild reached the age of five.

Although the thrust of this book is to urge you toavoid unnecessary medical attention, I want to beequally firm in urging you to seek it when your child’scondition demands it. Eye injuries are a case of this

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kind. When your child suffers a severe eye injury youshould not attempt to treat it, and neither should yourpediatrician. Take him at once to a competent ophthal-mologist or a hospital emergency room that can summonone. Amateur treatment, whether by a parent or by adoctor who is not a specialist in the field, could result inpermanent damage to the eye.

The only immediate treatment you should give for aneye injury is to apply a warm, moist compress and tobathe the eye with pure, sterile water in the case ofchemical burns. Meanwhile, have someone phone theophthalmologist or the hospital emergency room and de-scribe the injury to determine whether there is anythingfurther you should do before you leave for the hospital.

If you know the problem is simply a speck in the eye,and your child’s tears don’t remove it, try to wash it out.Pull back the lids and squirt boiled but cooled water (notboiling water) into the eye from a sterile eyedropper. Payparticular attention to the upper eyelid, because that iswhere foreign objects are most likely to lodge. If thatdoesn’t work, try to keep your child from rubbing hiseye until you can get him to the doctor. He could damagethe eye if the offending object is sharp or abrasive.

MOST VISION PROBLEMSARE OVERTREATED

Apart from actual eye injuries, doctors tend to over-treat other vision problems just as they do everythingelse. Many children suffer the nuisance of wearingglasses, and the ridicule of their playmates, because theirdoctors fit them with corrective lenses that they reallydon’t need. One formal study of pediatric eye care in-volving 2,000 children and 300 pediatricians found that 7out of 10 children with glasses did not actually benefitfrom them, presumably because their vision was not suf-ficiently impaired to require correction. An appalling 40

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percent of those tested with their glasses on failed a vi-sual acuity test!

Parents are put to substantial needless effort and ex-pense by pediatricians who insist on routine eye exami-nations, sometimes demanding that they be given asoften as once a year. The only beneficiary of this non-sense is the doctor who performs the examination. Yourchild, unless he is having obvious problems with his vi-sion, does not need a routine eye examination, much lessone every year.

It is a sensible precaution to have your child’s eyesexamined at about the age of 4, when testing becomespossible, and again at the age of 9 or 10. Beyond that,unless a vision problem is suspected at home or inschool, no further examination should be necessary. Foradults a conservative approach is to have a vision testevery 10 years up to the age of 40 and every 5 years afterthat.

Doctors are also prone to overtreat eye illnesses,most of which are caused by allergies and irritation. Themost common eye ailment in children is conjunctivitis,or “pinkeye,” usually due to allergies, but sometimes toviral and bacterial infections as well. Children may alsodevelop chronic red eyes because of exposure to tobaccosmoke or other forms of air pollution, eyestrain, and in-adequate sleep.

Allergic conjunctivitis may be caused by pollen, dust,animal danders, medications, cosmetics, food, chemicaladditives, and many other allergens. This type is usuallycharacterized by itching and redness but not by a dis-charge from the eyes, other than tears. Another form ofallergic conjunctivitis has its own self-explanatory name,“swimming pool conjunctivitis.”

Vernal conjunctivitis, as the name implies, is sea-sonal. Typically, it appears in the spring, continuesthroughout the summer, and disappears during thewinter months. The symptoms are itching, tearing, lightsensitivity, and a mucous but not purulent discharge.

The final and most annoying category is-catarrhal

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conjunctivitis, which is contagious. The victim’s eyes arered and sensitive to light; they itch and bum; and theydischarge a thick mucus or pus that may collect on theedges of the eyelids. It is not unusual for children suffer-ing from this form of conjunctivitis to awaken in themorning unable to open their eyes because the lids arecemented together. This can be a frightening conditionfor your children, so they need reassurance that theirvision is not in danger. Obviously, because this conditionis contagious, hygienic measures—such as not sharingtowels—should be employed to avoid the spread of thedisease to other members of the family.

There is no need for you to be able to distinguish be-tween the types of conjunctivitis, but if your child is afrequent sufferer from this condition, you should suspectand look for an allergic cause. None of these conditionsrequires immediate medical attention, either, but if thepurulent discharge of catarrhal coqjunctivitis persists forseveral days, it may warrant a visit to the doctor fortreatment with a topical antibiotic. In most cases yourchild’s conjunctivitis will respond to gentle cleansing ofthe eyes with boiled (but not hot) water and a cleancloth.

If you suspect an allergic reaction, conduct a carefulreview of your child’s history to try to identify the al-lergy that is responsible for the problem. Look forchanges in activity, location, diet, medication, or otherunusual conditions or events that preceded the onset ofthe problem. Once again, this is something that you cando more effectively than your doctor.

Styes, which are infections of the sebaceous glands atthe edge of the eyelid, are another common affliction ofchildren. At the outset a stye yields a sensation compara-ble to the presence of a foreign body in the eye. Subse-quently there is tearing and a painful irritation andredness. Ultimately a pimplelike lesion appears at theedge of the eyelid. No medication is indicated, but theapplication of hot compresses for 10-15 minutes every

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few hours will usually localize the infection so that thestye drains and disappears. Boric acid or Epsom saltssolutions are sometimes used, but plain boiled water willdo just as well.

MYTHS ABOUT VISION

A lot of time and money is wasted because of mythsabout vision. Many of these beliefs are the source ofneedless friction between parents and children. Somepeople believe most of the following statements, andmost people believe some of them, but there is no scien-tific evidence that any of them is true:

1. Reading in poor light will damage your eyes.

2. Too much reading will damage your eyes.

3. Sitting too close to a television screen willdamage your eyes. (Avoid it anyway, becauseno objective research has been done on thelong-term potential damage from low-level ra-diation.)

4. Reading in a moving vehicle will damage youreyes.

5. Exposure to flashbulbs and strong artificiallight will damage your eyes.

6. Wearing another person's glasses will damage,your eyes.

7. Wearing “dime store” glassess will damageyour eyes.

8. Going without your glasses will damage youreyes.

9. Wearing glasses will progressively weakenyour eyes.

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10. If a foreign object isn’t removed promptly, itmay get lost behind your eye. (It can’t, be-cause the coryunctival membrane separates thevisible part of the eye from the back of thesocket. The only opening is the tiny lachrymalduct through which tears flow.)

11. Gating carrots will improve your vision. (If ithelps you persuade your child to eat his vege-tables, perpetuate the myth!)

So many situations arise in which parents must say,“Don’t!” to their children that it is counterproductive toincrease the friction by enforcing myths such as these.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO EYE PROBLEMS

1. Unless you have a venereal disease, try to per-suade your doctor not to place silver nitrate orantibiotic drops in your child’s eyes at birth.(See pages 42-43) The benefits do not justifythe risks.

2. If your child has no vision problems that be-come apparent at home or in school, there is noneed for routine physical examinations at regu-lar intervals. Schedule only two examinationsduring childhood—one at the age of four andthe other at the age of nine.

3. If your newborn baby’s eyes don’t move in uni-son, don’t be upset. The condition should cor-rect itself by the third month of life. If the childcontinues to have alternating strabismus, inwhich one eye or the other sometimes movesrandomly, do nothing. This condition is usuallyself-correcting by the age of four or five.

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4. If your child’s eye remains fixed in one comer,' it can lead to amblyopia, a permanent visual dis-ability, so see an ophthalmologist but resist sur-gery. Ask the doctor to try patching, orthoptics,and glasses first and resort to surgery only if allelse fails.

5. If your child develops conjunctivitis, keep theeye clean by sponging it with sterile water on aclean cloth. Then try to identify an allergiccause for the condition. Stay away from yourdoctor unless there is a purulent discharge thatpersists for several days despite your efforts.

6. Treat styes with hot compresses to localizethem so that the affected sebaceous gland willdrain and heal. Medication is unnecessary.

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Skin Problems:

The Curse ofAdolescence

Skin ailments are rarely life-threatening, but they rankhigh in any catalog of parental concerns because of theemotional and psychological impact they often have ontheir victims—particularly adolescents. The disfiguringeffects of acne, in particular, have made life miserablefor millions of adolescents and adults, and this diseaseremains one of the most baffling conditions in pediatricmedicine.

The first medical condition that troubles most newmothers is a skin problem—diaper rash. Stubborn cases,which make babies uncomfortable and irritable, can beextremely frustrating. Mothers, in despair, often respondby purchasing over-the-counter ointments or by consult-ing their pediatricians for treatment of this simple andcommon condition. Neither response is necessary, andboth of them, in fact, may be harmful to the child.

It is symbolic of the practice of pediatric medicinethat one of the first treatments an infant is likely to re-ceive after he leaves the hospital is a classic example ofpharmaceutical overkill. Virtually all doctors use somedmgs needlessly; most doctors use some drugs reck-lessly; and the result is that dangerous overmedicationhas become the rule rather than the exception in Ameri-can medical practice. Diaper rash is a simple conditionthat can and should be treated with simple measures, but

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that concept is unacceptable to the pharmaceutical man-ufacturers and to many pediatricians as well. Presentthem with a rosy, irritated backside and they’ll unveil apanoply of salves and ointments containing antibiotics,cortisone, and hydrocortisone, with potential damagingside effects that will really give you something to worryabout!

Prevention is the key to avoidance of diaper rash.Don’t use plastic or rubber pants or disposable diapers.Use cloth diapers and be sure that they have been rinsedfree of any irritating detergents. Wash the baby carefullywith mild soap and water after each bowel movementand expose his buttocks to the air as much as possible. Ifa rash begins to develop despite these precautions, con-tinue to follow the same procedures but dust his bottomwith ordinary cornstarch before rediapering. If that failsto solve the problem, substitute zinc oxide ointment orLassar’s paste, another zinc preparation, for the corn-starch. Finally, the obvious: monitor the condition ofyour baby’s diapers frequently, and if they are wet,change them promptly.

If you observe these precautions faithfully, and thediaper rash persists, there may be an underlying condi-tion that requires medical treatment, but these cases areunusual. An example is the rash caused by a yeast infec-tion (often from antibiotic medications) for which treat-ment with a prescription ointment may be necessary.Foods, such as cow’s milk or soybean-based infant for-mulas, are frequently responsible. That’s one of the al-most countless arguments in favor of breastfeeding yourchild. It greatly reduces the incidence of diaper rash andother conditions stemming from dietary allergies.

Acne is at the other end of the spectrum of skin ail-ments that afflict children and adolescents. This disfigur-ing disease is the plague of countless teenagers and someyounger children and adults as well. The physical effectsare quite well understood, but the medical profession re-mains baffled by the underlying causes. Little or noprogress has been made in relieving the symptoms of

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acne, much less curing it, without what are, to me, unac-ceptable risks.

WHY ACNE OCCURS

Acne is a disease of the sebaceous glands, which arelocated about Vk inch below the surface of the skin. Theirfunction is to secrete an oily substance called sebum,which lubricates the hair and skin and inhibits the evapo-ration of water on the skin, which helps to stabilize bodytemperature. The composition of sebum is about half tri-glyceride, or ordinary fat. This is food for Corynebacter-ium acnes, a bacterium found in the hair follicles. Thebacteria multiply, yielding by-products that produce irri-tation in the follicles. The process is complicated, but theresult is that the pores become blocked, sebum accumu-lates, and the disease progresses from whiteheads toblackheads, to pustules, and ultimately—in about 2 per-cent of cases—to cysts. It is these cysts that produceheavy facial scarring, particularly if they are picked orsqueezed, which triggers more infection.

There is a great deal of mythology about acne. Manypeople believe that blackheads are caused by an accu-mulation of dirt in the pores. They aren’t; the black coloris not caused by dirt but by an accumulation of the pig-ment melanin—the same substance that gives Cauca-sians a tan when they are exposed to sunlight. However,this belief leads many teenagers to scrub their faces untilthey are almost raw. Ordinary cleanliness is a virtue, butintense scrubbing with soap and water will not affect thecourse of acne, because it reaches only the surface of theskin and not the deeper area where the sebum is accu-mulating. Too much scrubbing may actually aggravatethe condition.

Misconceptions about the role of diet are widespreadamong acne sufferers and even among doctors, for thatmatter. Some of the dietary beliefs may be useful, be-cause they keep many kids from eating junk, but there is

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no scientific evidence that any category of food has aconsistent effect in triggering or intensifying acne.

Over the years the finger has been pointed at choco-late, at fatty foods such as French fries, at peanuts, andat foods containing iodine. There is empirical evidencethat some foods do aggravate the condition in some pa-tients, but controlled studies do not point to any foodallergy as a specific cause. Nevertheless, some individ-uals do appear to react to some foods, and when a spe-cific trigger is identified as a possible cause it certainlyshould be avoided, despite what the research shows.

Some nutritionists are having modest success in thedietary management of acne, despite the lack of scien-tific evidence that it should work. Medical doctors mayscoff at this, citing the studies that deny any dietary in-fluence in the incidence of acne. Some even label itquackery. Meanwhile, they continue to treat their pa-tients with their own forms of unscientific quackery,which won’t stand up to the test of controlled studies,either.

MOST ACNE TREATMENTSONLY MILDLY HELPFUL

More than 150 over-the-counter preparations areavailable for the treatment of acne. Most of the better-known ones contain benzoyl peroxide, which eliminatessome of the oil and may offer mild relief to some pa-tients. Even if it doesn’t, your teenage son or daughter isbetter off using one of these preparations than some ofthe more hazardous but no more effective treatmentsthat doctors prescribe. During the years that I havepracticed I have watched doctors treat acne victims withantibiotics such as tetracycline and erythromycin; vita-min A in massive (and harmful) doses; zinc sulfate tab-lets; cortisone; injections of triamcinolone acetonide todrain the lesions; hormone therapy; ultraviolet light; lo-tions containing sulfur, sodium thiosulfate, salicylic acid

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in various combinations with alcohol; dermabrasion;chemical face peels; x-ray treatments; and even, incredi-bly, gynecological surgery! And after all of that witch-doctoring, some of them still have the nerve to callnutritionists quacks!

I won’t get into the damage caused by all of thesetreatments, none of which really works, but let me illus-trate what can happen to patients when doctors use un-proven and untested treatments by discussing a few ofthem.

Twenty years ago tens of thousands of acne victimswere given x-ray treatments in an effort to control oreliminate the disease. In fact, I prescribed these treat-ments myself. The results of this dangerous and irratio-nal behavior are evident today in a virtual epidemic ofthyroid tumors, some of them malignant, among thoseexposed to catastrophic radiation for this and other con-ditions.

Although they have abandoned x-ray therapy foracne, pediatricians and dermatologists have substitutedother treatments that are largely ineffective and presenthazards of their own. Various tetracycline preparationsare being used, despite the risks. Prolonged use of thisantibiotic may render your child’s body susceptible toserious infection because its effects are not limited toharmful bacteria. It kills the protective bacteria in thebody as well, opening the way to serious infections thatwere rarely seen 30-40 years ago. Tetracycline, whenadministered to young children, may also permanentlyyellow their teeth and even invade their bones.

Acne victims whose complexions are profusely pittedand scarred are also being urged to improve their appear-ance by dermabrasion. This procedure involves the useof sandpaper, wire brushes, and other abrasive materialto remove a layer of skin containing the acne scars. Theeffectiveness of this procedure has never been estab-lished. A study reported in 1977 by a researcher atHouston’s Baylor College of Medicine found that “Treat-ment of acne pitting and scarring by classic dermabra-

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sion is, at best, somewhat disappointing; at worst it isunsuccessful and frequently accompanied by undesirablesequelae.”

WHAT ABOUT ACCUTANE?

The newest actor on the acne treatment scene is aderivative of vitamin A, Cis-retinoic acid, which hasbeen available in the United States by prescription sinceSeptember 1982. It is marketed by the Swiss pharmaceu-tical firm, HoSmann-LaRoche, under the trade nameAccutane. It was estimated that doctors wrote 60,000prescriptions for the drug during the first two months inwhich it was available.

Accutane differs from other drugs used in the treat-ment of acne in one major respect. It works, but no one,including the manufacturer and the FDA, knows how orwhy. In clinical trials it was effective in about 90 percentof the cases. That’s the good news. The bad news is thatit has such a frightening array of side effects that reputa-ble dermatologists are extremely wary about using it.Too many others, however, are prescribing it with thesame abandon that x-ray treatments were used 20 yearsago, without fully apprising their patients of the potentialconsequences.

The risks and side effects are considerable. The FDAdrug bulletin has pointed out that Accutane causes in-flammation of the lips in more than 90 percent of thepatients who use it. Up to 80 percent of the patients de-veloped dryness of the skin or mucous membranes, 40percent developed conjunctivitis, and almost 10 percentexperienced a rash or thinning of the hair. Five percentexperienced peeling of the palms of the hands and solesof the feet, skin infections, and increased susceptibilityto sunburn.

My heart goes out to teenagers who are afflicted withacne and to sensitive and caring parents who must sufferthe emotional and psychological consequences along

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with them. I can also understand why the teenage victimwould gladly endure almost any risk to be able to look inthe mirror and see a face that is blemish-free.

What you must consider, if it is your child who isaffected, are the additional potential short- and long-termconsequences of the drug. New ones emerge almostdaily. If your teenager has acne, you must weigh therisks and benefits of Accutane and decide whether thebenefits are worth the risks. In order to do that, how-ever, you should be made aware of all the risks, notmerely the obvious ones experienced by most of thosewho take the drug. It is doubtful that your child’s doctorwill give you this information in all of its troubling detail,so I will provide it here. My purpose is not to make yourdecision for you but to enable you to make an informedjudgment about the use of this drug and decide whetheryou and your child are prepared to trade a short-termmiracle for a potential long-term disaster.

The prescribing information on Accutane reveals notonly that it acts on the skin but that high concentrationsof the chemical reach many tissues other than those atwhich the treatment is directed. Experimental studiesshow that after seven days the presence of the drug canbe detected in the liver, ureter, adrenal gland, ovaries,and lachrymal (tear) glands. The drug also producesreactions in the blood. Twenty-five percent of patientsexperienced an elevation in plasma triglycerides, 15percent developed a decrease in high-density lipopro-teins (HDL), and 7 percent showed an increase in cho-lesterol levels. These three factors are of majorimportance in the development of vascular disease of theheart and blood vessels. This side effect is of such con-cent that the manufacturer of Accutane recommendsthat “Blood lipid (fats) determinations should be per-formed before Accutane is given and then at weekly orbiweekly intervals until the lipid response to Accutane isestablished.”

Not only can Accutane affect the fatty elements in thebloodstream, but 40 percent of patients who received the

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drug showed evidence of other abnormal blood condi-tions which indicated that something was wrong withoutidentifying precisely what the problem was. Thirteenpercent developed high platelet counts, a change thatcan lead to disturbances in blood clotting. Ten to 20 per-cent showed decreases in red blood cell counts and whiteblood cell counts, the presence of white cells in theurine, and abnormal levels of blood enzymes (SGOT).Other users of Accutane (less than 10 percent) showedprotein in the urine, red cells in the urine, or elevatedblood sugars.

In clinical trials five patients treated with Accutanefor more than two years showed skeletal abnormalities.Three adults had spine degeneration, and two childrendisplayed X-ray findings of premature closure of the epi-physes. The last finding is of particular importance toadolescents, because the epiphysis is that part of thebone that normally stays open until full growth isachieved. Premature closing of the epiphysis will preventa child from attaining normal stature. Another indicatorof bone growth, the blood alkaline phosphatase level, isabnormal in 14 percent of Accutane-treated patients.

In 72 human patients who had normal pretreatmenteye examinations, five developed comeal opacities (cata-racts) while on Accutane.

Of potential importance to adolescent boys are exper-imental results in dogs showing degeneration of thetestes after Accutane treatment, and also depression ofsperm production. Studies evaluating the effects of Ac-cutane on sperm production in humans are now beingconducted.

POTENTIAL RISKS TOADOLESCENT GIRLS

There is also potentially grave significance to adoles-cent girls and women in the propensity of the drug tocause fetal deformities in the offspring of experimental

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animals that receive it. In rabbits Accutane was toxic tothe embryo and resulted in induced abortion. No ade-quate studies of Accutane have been done on pregnantwomen, but it is clear that the manufacturer is sensitiveto the possibility that it could be another thalidomide.The prescribing information provided by the manufac-turer cautions that “... patients who are pregnant or in-tend to become pregnant while undergoing treatmentshould not receive Accutane. Women of child-bearingpotential should not be given Accutane unless an effec-tive form of contraception is used, and they should befully counseled on the potential risks to the fetus shouldthey become pregnant while undergoing treatment.Should pregnancy occur during treatment, the physicianand the patient should discuss the desirabilty of continu-ing the pregnancy." The manufacturer is concernedenough about fetal abnormalities to urge that “contra-ception be continued for one month or until a normalmenstrual period has occurred following discontinuationof Accutane therapy.”

There is no question that Accutane relieves or elimi-nates the symptoms of acne in most of those who use it,but the mechanism that produces this benefit, and causesthe abundance of side effects, is unexplained. Because ithas been in use for a relatively short time, the long-termconsequences, of course, are not known. Looking at themyriad threats to your child that it poses, it is fair to notethat its approval for human use is dubious, at best. If achemical with as many dangerous properties as Accu-tane were sold as a treatment to remove wax from yourkitchen floor, there would be a skull and crossbones onthe label and a vivid warning, “Not to be taken inter-nally." Yet doctors are apt to prescribe it with little or nowarning at all.

This places an enormous responsibility on parents toguide their children in deciding whether to use the drug.A child with severe acne has an almost irresistible incen-tive to ignore the risks of Accutane. Furthermore, ado-lescents are more prone than adults to view disaster as

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something that happens only to others and choose thecourse of immediate self-gratification rather than that ofcommon sense. Teenage automobile insurance rates, andadolescent use of street drugs, reflect those tendencies.Consequently, it is probably that a teenager with a badlymarred face will discount the potential adverse conse-quences of using Accutane because of his compulsion to“get rid of the zits.” He’ll view the side effects as some-thing that will be experienced by others and convincehimself that “it won’t happen to me.” This makes it im-perative that parents compel their child to consider thor-oughly the risks of Accutane and participate with him indeciding whether the drug will be used.

My own behavior may be influenced somewhat by re-morse over my ill-considered decision 30 years ago toprescribe X-ray treatment for acne, but I will not pre-scribe Accutane for my patients. The known risks arereason enough, and only the Lord knows the magnitudeof the long-term damage that has yet to be disclosed.

EXPERIMENT WITH SAFEAPPROACHES

The field of acne treatment is rich in theory and de-void of evidence of treatments that work, other than Ac-cutane. Every doctor and health expert who treats acnehas a catalog of treatments that he insists work for him.There is no scientific evidence that any of them do. Con-sequently, my strategy over the years has been to em-ploy only the treatments that are least likely to damagethe patient. Just like the more damaging ones, some ofthem work and some of them don’t, but I don’t knowwhy, and neither does anyone else. Moreover, none ofthem requires medical supervision, so you can experi-ment until you find the most successful treatment with-out risks to your child and without any cost.

I noted earlier that there is no scientific evidence thatthe presence of acne is related to diet, yet in many indi-

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vidual cases nutritional approaches to the problem seemto work. Dr. Jonathan Wright, who writes an excellentcolumn in Prevention magazine, offers one bit of evi-dence of a dietary relationship that, while not scientific,is convincing. He notes that acne was unknown amongnorthern Canadian Eskimos until they shifted from a“primitive” to a civilized diet. At that point the incidenceof acne among these Eskimos reached almost 100 per-cent. Dr. Wright is only one of many reputable physi-cians who believe that at the present low level of medicalknowledge a nutritional approach is the only sensibleway to deal with the disease.

“I have found only a few cases of acne (even badones),” Dr. Wright says, “which were resistant to treat-ment involving cleaning up the diet, avoiding food aller-gens, and adding such things as zinc, essential fattyacids, B-complex vitamins, and vitamin A. Even inmany of the resistant cases, attention to factors of nu-trient assimilation seems to help. In fact, I have hardlytreated anyone in the last four or five years whose acnedidn’t settle down to a dull roar or to nothing at all withnutrition-related treatment.”

I advise my patients who are victims of acne to payparticular attention to nutrition, not only to identifythrough elimination diets the foods that may aggravatethe condition but to find a diet that will improve it Don’tbother talking to your doctor about nutrition, because hedoesn’t know anything about it and consequently doesn’tbelieve in it. He believes in better living through chemis-try and will probably prescribe tetracycline, hydrocorti-sone, or Accutane. Instead of seeing a doctor, read somegood books on nutrition and try the procedures they rec-ommend. Look for books by nutritionists Adele Davis,Carlton Fredericks, Michio Kushi, Paavo Airola, DaleAlexander, and Rudolph Ballentine.

Try diets that avoid refined sugar, white flour, and allprocessed foods containing chemical additives or preser-vatives of any kind. Carefully monitor your child’s dietto determine whether his acne outbreaks coincide with

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the ingestion of any particular foods. Observe cleanli-ness but avoid excessive scrubbing of the affected areas,which may cause more harm than good. If you feel com-pelled to use some form of topical medication, see yourdruggist, not your doctor. The preparations that are soldover the counter probably won’t do much good, but theyare relatively safe compared to the medications a doctoror dermatologist may use.

OTHER SKIN CONDITIONS

I have devoted a lot of attention to acne because it isundoubtedly the single most troubling of childhood skindiseases, but there are a number of other common skinailments that may one day concern you. One of the mostinnocuous of these is heat rash, which has no real medi-cal consequences but upsets parents for cosmetic rea-sons. It can be so unsightly that it sends mothers to thepediatrician to get their beautiful babies back.

Heat rash is not a condition that requires the attentionof a doctor; in fact, the less medical treatment it re-ceives, the better. Heat rash in babies is usually theproduct of overdressing the child because of parentalconcern about “keeping the baby warm.” Babies don’thave to be kept any warmer than adults and will sufferno ill effects in normal room temperature if they wearnothing but a diaper or nothing at all.

If your baby develops heat rash, dress him lightly, ornot at all, to give his skin maximum exposure to the air.Apply calamine lotion to sooth the itching. Use plain ca-lamine lotion, not Caladryl, which contains an antihista-mine in addition to the calamine lotion. Your child maybe allergic to the antihistamine and suffer a variety ofside effects, including the possibility of a skin rash to addto the one he already has. It is pointless to subject him tothat possibility because there is no proof that the anithis-tamine will relieve itching any more effectively than thelotion used alone.

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Another rather common skin disease, which usuallydevelops in babies and very young children, is eczema.It appears as a rough, patchy, red rash; the skin becomesthick and scaly, and if it is scratched, a serum oozes fromit that forms an unsightly crust. The conventional medi-cal view is that eczema is hereditary, but I know of noscientific proof of that belief, and if it is correct, I believeit is an allergy that is inherited and not a tendency toeczema itself.

My own experience in treating eczema has demon-strated that the condition is of allergic origin and that itwill usually clear up without treatment if the allergen orallergens that are causing it can be identified. In mostcases the culprit is apt to be cow’s milk or soybean-based formulas, but other foods and even other sourcesof allergy can be responsible. Breastfed babies rarely de-velop eczema.

Rather than use ointments or other medication if yourchild develops eczema, experiment with eliminationdiets to try to identify a food allergen that is causing theproblem. Begin by withdrawing cow’s milk and infantformula, and if the eczema disappears, eliminate thempermanently from his diet. Even babies can survive quitenicely on meat-based formulas. If you are not breast-feeding your baby, any one of a number of books that areprobably available at your local library will provide al-ternative diets that do not include milk or infant for-mulas.

STEROID HORMONETREATMENT RISKY

If you take your child to the doctor because he haseczema, he is likely to give you a prescription for a topi-cal steroid hormone, Kenalog, or for another steroid,prednisone. In stubborn cases, when all else fails, I haveno objection to the use of Kenalog on small areas for alimited period of time—a few days at most. However,

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repeated and extended use on large areas of the skin maybe dangerous because the steroid hormones in Kenalogare absorbed directly into the body through the skin.

Remember that both Kenalog and prednisone weredeveloped to treat life-threatening conditions in whichthe benefits conceivably outweighed their severe poten-tial side effects. In fact, the manufacturer’s statementof the indications for the use of prednisone clearlystates that its use should be restricted to “serious or life-

threatening conditions ” The use of these drugs for

treatment of eczema, acne, and even sunburn is anotherexample of the pernicious tendency of American medi-cine to use extreme and dangerous measures to treat rel-atively innocuous conditions.

Impetigo is another childhood skin condition that isunsightly and annoying for children and their parents—the more so because it is of bacterial origin and conta-gious. It begins with a pimple that breaks and spreads,forming brown and yellowish scabs or crusts. The pim-ples usually appear on the face, making their presenceeven more annoying. Years ago doctors treated impetigowith gentian violet or potassium permanganate. It didnothing to cure the impetigo, but it covered up the infec-tion by dyeing it purple, which was as ugly as the scabs.Today, doctors are apt to use antibiotics such as erythro-mycin and tetracycline, topically or systemically, to treatimpetigo. There is no evidence that they are effective,either, but they are potentially harmful to your child forreasons that are explained elsewhere in this book.

Impetigo does not require medical treatment. Observescrupulous cleanliness, to make sure that your child doesnot spread it to other members of the family, eliminatesugar from the diet, and wait for the condition to cureitself.

Hives are another condition of the skin, usuallycaused by allergies, that produce an itching sensation an-noying to the victim. They appear in the form of welts,often all over the body, which may be white in the centerbecause the swelling squeezes the blood out of the welt.

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This affliction does not require medical attention; youcan relieve the itching by applying calamine lotion to thewelts or giving your child a cornstarch bath. The latter,although it is a folk remedy, not an accepted medicalprocedure, seems to work, but I don’t know why. Thentry to identify the allergy that is causing the problem,which you can do more effectively than your doctor. Al-lergens to suspect include medications, food, clothing,perfume and cosmetics, soap, chemical additives infood, and insect bites. If you take your child to a doctorfor this ailment, he may prescribe cortisone or antihista-mines, both of which are unnecessary and potentiallyharmful.

Fungal infections such as ringworm and athlete’s footmay also appear in children as well as adults. Ringwormappears in circular patches of rough skin that are usuallyabout the size of a nickel. When they are located on thescalp the hair within the circle may break off. Many doc-tors will treat this condition with antibiotics and antifun-gal agents such as griseofulvin. That’s an improvementover the days when they treated it with x-rays that led tothyroid cancer, but it is still medical overkill. My advice:stay away from the doctor, observe scrupulous cleanli-ness, and let the condition get better by itself. That ad-vice also applies to athlete’s foot, but stubborn cases ofthis fungal infection can also be treated with over-the-counter preparations such as Desenex.

Because they are usually so active and spend so muchtime out of doors, children are more prone than adults tobe exposed to poisonous plants and insect bites. They donot cause serious problems in most children, but in a fewthe allergic reaction may be severe and even potentiallyfatal.

If your child is exposed to poison ivy, poison, oak, orpoison sumac, clusters of small blisters will appear onthe areas of skin contacted by the poison, and a painfulitching sensation results. This can be treated with cala-mine lotion and with frequent showers or cornstarchbaths, in which a cup of two of cornstarch is added to a

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tub of water. If the exposed area is very extensive, andyour child's reaction is severe, consult a doctor. He willprobably treat the condition with topical or systemiccortisone or, if the reaction is dangerously severe, willhospitalize the child and give intravenous fluids. That’sacceptable treatment if the condition is life-threatening,but cortisone should not be used for mild cases of poi-soning because of the potential side effects and long-term consequences.

Stings and bites from bees, wasps, mosquitoes, andother insects produce a relatively mild, if painful, reac-tion in most victims. However, if your child is excep-tionally allergic to bites of this kind, they can—althoughrarely—lead to death. The usual treatment is simply towash the affected area with soap and water, apply cala-mine lotion, and use cold compresses to reduce theswelling. If the stinger is visible, it should be removedwith a tweezer.

If your child has a severe reaction to insect bites,such as difficulty in breathing or a shocklike state, see adoctor. Also, try to limit his risk by staying away fromareas in which he is likely to be exposed to insect bites. Ihave had patients whose reaction to insect bites was sosevere that it produced generalized shock. I supplied theadolescents with adrenaline and a syringe that they couldcarry with them when they were required to enter high-risk areas, for use to avoid shock if they were bitten.Your doctor can do the same for you. In the case ofyounger children I gave kits to their parents.

Warts are perhaps the most mystifying—or evenmystical—of disfiguring skin conditions. Many peoplestill believe that they can be caused by handling toads(they can’t), and old wives’ tales abound about supernat-ural methods of removing them. What’s mystical is thefact that almost any kind of supernatural treatment thatthe victim really believes in often seems to work. Thatmay be pure coincidence, because warts usually disap-pear by themselves, without treatment, in time. How-ever, the coincidences occur so frequently that one has

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to wonder whether the power of suggestion may not, in-deed, be a cure.

Warts can be removed surgically, chemically, andwith electrolysis, but no treatment is necessary for anybut cosmetic reasons. They are caused by viruses andwill usually stop growing and disappear if you give themtime. If they are disabling, or intolerably disfiguring, seea dermatologist.

THE FACTS ABOUT SUNBURN

Finally, a word about sunburn, which in this nation ofsun worshipers is probably the most common skin afflic-tion of all. On any pleasant summer day millions of peo-ple can be found relaxing on the beach or at poolside,including a fair proportion who never go near the water.They’re there to get a “healthy” tan, which they believemakes them more attractive. Howevet, it’s not all thathealthy and over the long term won’t make them attrac-tive at all.

There are three negative consequences to overexpo-sure to sunlight that should make you think twice aboutallowing your children to spend the summer baking inthe sun. The first of these is a short-term consequence—painful sunburn—and the other two are long-term. Oneis the premature drying, wrinkling, hardening, andcracking effect of excess exposure to sunlight that willeventually make skin appear old before its time. Theother is the possibility that excessive radiation, which iscumulative over time, will increase the possibility ofcancer of the skin.

Sunlight contains two kinds of ultraviolet rays. Onetype is known as UVAs, which produce a tan, and theother as UVBs, which cause the skin to bum by breakingdown the collagen and elastic fibers of the dermis, whichis the underlying layer of skin. Initially, the only effect ofthe latter is a painful sunburn, but ultimately many peo-

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pie suffer premature aging effects, and some contractcancer of the skin.

Acute sunburn usually occurs during the first twodays of a vacation among those who failed to limit theirinitial exposure and acquire a tan gradually by increasingtheir exposure on a daily basis. All it takes to ruin aFlorida vacation is to permit your children to spend sev-eral hours in the sun on the first day or play at the poolor on the beach. The most dangerous hours are thosebetween 10:00 a.m. and 2:00 p.m. and extremely hotdays are the most risky because the effects of ultravioletrays are increased by heat. Your child is more apt to geta severe sunburn if he is out in a boat, because of re-flected rays. Suntan oils that do not contain a sunscreenthat filters out the ultraviolet rays will not prevent sun-burn and may even provoke it because the oil magnifiesthe sun’s rays. Finally, don’t assume that your child issafe on a cloudy day, because the clouds do not screenout all of the ultraviolet rays, even though they may filterthem somewhat.

There are two ways to forestall the damaging effectsof the sun’s rays. The first, obviously, is to stay out ofthe sun or limit exposure to the periods of the year andthe hours of the day when the sun’s rays are less intense.The second is to protect your child’s skin with a sun-screen that has an adequate Sun Protection Factor(SPF). These products should be labeled with an SPFnumber, which increases with the degree of protectionoffered. Some are as low as SPF 2, which offers verylittle protection; the most effective ones are SPF 15 orabove. Pick one that matches the sensitivity of yourchild’s skin.

Because the effects of the sun’s radiation are cumula-tive, just as those from X-rays are, the risk of cancerincreases with each exposure to the sun. In my view,however, your child’s risk of developing cancer from ex-posure to sunlight is far less than his risk of developing itfrom X-rays, because sunlight does only surface damage

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and does not penetrate deeply into the body as X-raysdo. Doctors typically tend to exaggerate the cancer haz-ards of sunshine, for which they can blame the patient,and minimize those of X-rays, for which they must takethe blame. Be that as it may, the risk is there—from bothcauses—nonetheless. The link between skin cancer andexposure to sunlight is amply demonstrated by observa-tion of the locations where most skin cancers occur.More than 90 percent are found on areas of the bodysuch as the face, ears, backs of the hands, and back ofthe neck. People who spend a lot of time driving cars aremost apt to get skin cancer on the left side of their faces,which are most exposed to the sun. Finally, if there is ahistory of skin cancer in your family, you are at greaterrisk.

How great is the risk that your child may ultimatelyget skin cancer if he spends too much time in the sun?Not great enough so you should lose any sleep over it.Because the lesions are visible, skin cancer is easily de-tected and diagnosed with a simple biopsy. The over-whelming majority of skin cancers are readily curableonce they are detected. The case of melanoma, whichcan be dangerous because it may spread to other areas ofthe body, are relatively rare. They comprised only 2 per-cent of all the skin cancers diagnosed in the UnitedStates in 1982. You certainly don’t want your child todevelop skin cancer in later life, but the possibility thathe might be seriously threatened by sunshine is notsomething that should worry you sick!

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TOSKIN PROBLEMS

None of the common skin ailments experienced bychildren requires medical treatment. The exceptions arefound in children with critical allergies to poisonousplants and insect bites, who may be subject to severe

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and even fatal shock. These children should receivemedical attention at once. With this exception, the fol-lowing common skin problems can be safely treated athome.

1. Diaper rash: Observe scrupulous cleanliness.Change diapers promptly when they are soiledor wet, dust the baby’s skin with plain corn-starch, and expose the skin to the air as much aspossible. In stubborn cases, apply zinc oxideointment.

2. Heat rash: Dress the child loosely and lightly ornot at all. Apply calamine lotion or bathe him ina tub of water containing one or two cups ofcornstarch.

3. Eczema: Observe scrupulous cleanliness, avoidmedications, and try to identify a diet-relatedcause. The condition will cure itself.

4. Impetigo: Observe scrupulous cleanliness. Takecare to avoid spreading the infection to othermembers of the family. Eliminate sugar from thediet and wait for the condition to cure itself.

5. Hives: Relieve the itching with calamine lotionor cornstarch baths and try to identify a diet-related allergy or other allergy that is the cause.

6. Insect bites: Remove the stinger if it is visibleand treat the site with calamine lotion to relievethe itching. If your child is severely allergic toinsect bites, seek medical attention at once be-cause of the danger of life-threatening shock. Ifyour child has never been bitten before, monitorhis reaction closely to determine whether he hasa severe allergy to insect bites.

7. Poison ivy, poison oak, etc.: Wash the affectedarea with soap and water. Relieve itching withcalamine lotion or cornstarch baths. If it is your

child’s first exposure to poisonous plants, moni-tor his reaction and see a doctor at once if it issevere.

Acne: Closely review the history of your child’saffliction to determine whether there is anycause-and-effect relationship between outbreaksof acne and food allergies or any similar cause.Experiment with elimination diets to determinewhether food allergies may be the cause. Keepthe lesions clean to minimize secondary infec-tions, using mild, nonperfumed soap. Avoid ex-cessive scrubbing and do not squeeze pimples.Unless you want to risk using Accutane, stayaway from doctors, because they don’t knowany more about acne than you do and may pre-scribe risky, ineffective, expensive medications.

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Skeletons in theOrthopedic Closet

I ust as you are concerned about your child’s intellec-tual and behavioral development, you are no doubt sen-sitive to every aspect of his physical appearance anddevelopment as well. You will observe with keen interestthe age at which your baby first rolls over, stands up inhis crib, crawls, and walks. If your child displays anyunexpected physical characteristics, or lags in any areaof motor skills, you may be concerned that somethingserious is wrong.

Don’t mislead yourself by making developmentalcomparisons of your child with other children. If yourneighbors’ child is walking at an early age, and yoursisn’t, it doesn’t mean that their offspring is smarter orphysically superior to yours. The age span during whichthese developmental phenomena occur is quite broad,and variations rarely have any relationship to intellectualendowment or innate physical capacity.

Such comparisons are equally pointless when appliedto the physiological structure of your child. First-timemothers, particularly, are apt to be almost clinical in theattention they pay to their child’s physical appearance.They come to me expressing concern about their baby’sflat feet, bowed legs, or “pigeon” toes, fearing that oneor more of those conditions may be “abnormal” and re-quire correction.

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These presumed abnormalities create a bonanza foraggressive pediatricians and orthopedic specialists.Many doctors eagerly intervene with casts, braces,splints, corrective footwear, and even surgery, to “cor-rect” conditions that would, in time correct themselves.If your child is the potential victim of this orthopedicoverkill, protect him from it, because it is rarely neces-sary and may be psychologically traumatizing for thechild who is labeled as needing this type of intervention.

The fact that your baby is bowlegged at the age of onedoes not mean that he’ll resemble a “B movie” cowboywhen he grows up!

Some of the fears that parents have about child devel-opment stem from myths that have been passed down intheir families for generations. For example, there is acommon belief that a child may develop bowed legs if heis encouraged to walk too soon. There is no scientificevidence that this is true. On the contrary, such encour-agement probably will help the child develop a sense ofbalance at an earlier age. Equally false is the commonbelief that bulky diapers will cause a child’s legs to be-come bowed. They won’t, but they may keep the babyfrom having an accident in your lap!

At birth, virtually all babies have legs that are bowedand feet that toe in because of the fetal position that theyassumed during the months before birth. Fat pads com-monly present under their arches also give them the ap-pearance of having flat feet. If parents are not familiarwith the normal progression in the development of thelower limbs, it is not surprising that these seeming anom-alies arouse concern.

DEVELOPMENT OF CHILD’S LEGS

After a baby escapes the confinement of his mother’swomb his legs will pass through four stages of develop-ment. Up to the age of about one and one-half yearsthere is a preponderance of bowed legs, which will begin

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to straighten out as the leg muscles are developedthrough walking and other physical activity. Between theages of Wi and 2 years there is usually a switch frombowed legs to knock-knees, and this knock-kneed ap-pearance, persists between the ages of 2 and 12. Then, inadolescence, there is a balancing effect and the legs tendto straighten out.

Obviously, given this developmental progression,there are opportunities for doctors to intervene at anystage to treat conditions that will be self-correcting if thechild is simply left alone. Doctors have a further advan-tage over patients because of the enormous variations inthe development of one child and that of another. Thedevelopment of the lower limbs falls into what one en-lightened specialist has called “the borderland of ortho-pedics." There is no adequate definition of conditionsthat are normal and those that are abnormal, any morethan there is a legitimate definition of “normal” for achild’s nose or ears.

Unless your doctor can identify a specific physiologi-cal abnormality, and prove to your satisfaction that itrequires treatment, no corrective measures for eitherbowed legs or knock-knees should be undertaken untilyour child enters his teens. In virtually all cases the con-dition will have corrected itself before that time.

If knock-knees do persist into adolescence, the mostlikely probability is that they have not straightened natu-rally because your child is overweight. In that event thekid doesn’t need help from an orthopedist; he needs adietician—a role that mothers are well equipped to as-sume. The exceptions are rare cases of clubfoot, neuro-genic disease, or osteogenesis imperfecta, all of whichpresent specific symptoms that go beyond presumedvariations from the norm.

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SHOES AREN’T IMPORTANT

The attention that many parents devote to the devel-opment of their children’s feet is evident when you see atwo-month-old baby lying in his crib wearing a $20 pairof high-topped shoes. The kid isn’t going anywhereunaided, yet he is expensively equipped to run a four-minute mile! There’s an element of vanity in this, ofcourse, for baby shoes are cute. That’s why so many ofthem wind up encased in bronze. But most parents doseem to believe that their children will have foot prob-lems in later life if they aren’t provided from birth with“proper shoes.” Needless to say, the shoe manufacturersdo nothing to discourage this conviction. The shoe in-dustry benefits from the fact that a disproportionateshare of the 600 million pairs of shoes sold in the UnitedStates each year are fitted to children and that a millionor more are expensive, unnecessary correcti ve shoes.

Shoes, expensive or otherwise, are not essential tothe proper development of the foot. Barefooted aborig-ines have better feet than millionaires shod by Gucci.Other than appearance, the only purpose shoes serve isto protect the feet from iqjury or the elements. Conse-quently, it is unnecessary and wasteful for you to investin expensive shoes for your children for any reason otherthan appearance. A pair of inexpensive canvas sneakerswill serve equally well. Expensive high-topped shoes willnot help your child’s feet develop properly, nor will inex-pensive tennis shoes cause flat feet, fallen arches, orathlete’s foot, as many parents seem to believe.

One survey of 104 normal infants brought to a clinicfound that 87 percent were wearing shoes with high tops,74 percent had shoes with hard soles, and SO percentwore shoes with special arch supports. Seventy-three ofthe children wore shoes before they walked and 35 woreshoes before they could stand. None of the children de-rived any physical benefit from the shoes they wore. Infact, the high tops and stiff soles may have retarded the

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development of ankle strength and restricted their abilityto learn to walk properly.

Wearing corrective shoes, in most cases, makes evenless sense. There is no evidence that costly correctivefootgear will correct any variation from normal, to theextent that “normal” can be defined. Except in the casesof clubfoot or other true deformities, corrective shoesprovide no benefits to justify their cost. Meanwhile, achild who wears obviously corrective shoes that suggesta deformity may suffer emotional damage as a result.That goes for corrective casts and braces as well.

Although bowed legs, knock-knees, and pigeon toesare the most commonly treated orthopedic conditions inchildren, there are others that are grossly overtreatedand often misdiagnosed. One of these, congenital hipdysplasia, occurs in infancy when the femur (thigh bone)is not correctly attached to the pelvis. Genuine hip dys-plasia is most likely to occur in difficult breech deliver-ies, when the femur is dislocated from its socket. Thecondition should be corrected immediately by the obste-trician, who grasps the newborn child by its ankles sothat the dislocated joint will snap back into place.

In most cases that is the end of tire problem, if therewas one. Congenital hip dysplasia, in which the disloca-tion persists, is quite uncommon, although it is fre-quently diagnosed. Studies indicate that it probablyoccurs in no more than one in 1,000 children and morelikely in only one in 2,000. The condition is detected byplacing the child on his back with his knees raised andhis feet flat on the examining table. The knees are thenpressed outward, and if one or both resist, dysplasia maybe present. This can usually be corrected by placing apillow or extra diapers as a form of splint between thebaby’s legs. Aggressive pediatricians however, may bereluctant to settle for this simple treatment. Many areprone to follow the problem with many repeat X-rays—exposing the child to imprudent radiation—and to utilizesplints and casts to correct the problem. Beware ofthem, for this treatment is usually unnecessary, and the

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casts can cause muscle atrophy, circulatory distur-bances, and emotional problems.

OVERDIAGNOSIS OF SCOLIOSIS

Another current fad among pediatricians is the diag-nosis of scoliosis. The condition, found more often ingirls than in boys, is a lateral (sideways) curvature of thespine. It can be detected visually by inspecting yourchild’s posture from the rear to determine whether:

• one shoulder blade is higher than the other orone shoulder blade protrudes more than theother;

• the tilt of the child’s waistline is abnormal, with agreater indentation on one side;

• the hips are tilted, with one more prominent thanthe other;

• there is an obvious curve to the spine;

• one side of the back or one shoulder is abnor-mally elevated when the child bends over.

In my early years of practice scoliosis was rarelydiagnosed and even more rarely treated during the child-hood years. Today the disease is fast becoming epidemicbecause doctors are ordering so many routine X-raysbecause mass screening has been introduced in somestates. Doctors are diagnosing cases that never wouldhave been picked up during an ordinary physical exami-nation, and in many cases they are treating mild condi-tions for which no treatment is required.

I do not want to minimize the importance of treatingscoliosis in cases that are severe. Left untreated, thiscondition in children may produce significant deformityin later life. However, I’m convinced that needless treat-ment of mild cases of scoliosis is probably a greater

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threat to children than failure to treat the cases that aresevere.

If your child is diagnosed as having scoliosis, don’tsubmit him to treatment without first making certain thattreatment is justified by the degree of curvature that ispresent. Don’t accept any form of treatment withoutstudying the alternatives. In some cases it may be neces-sary to employ a “Milwaukee brace,” an uncomfortablemetal device that reaches from the chin to the hips andencircles the body, stretching and stabilizing the spine. Iwould not saddle a child with this contraption until allthe less drastic measures had been explored. These in-clude electronic biofeedback, exercises, deep muscletherapy, dance therapy, physiotherapy, and other lessradical alternatives. Surgery, in my judgment, should beregarded as a last resort, employed only after all othermethods of treatment have failed. Get a second opinionif surgery is recommended for your child.

My advice about the treatment of scoliosis echoesthat which I give with respect to any ailment in whichthe parameters of normalcy and abnormality are rela-tively undefined. Many don’t, but I believe doctorsshould observe the principle that “less is more.” Don’ttake your doctor’s recommendation of some draconiantreatment at face value. Thoroughly explore the conse-quences of the treatment and the alternatives that areavailable and demand that your doctor defend the treat-ment he proposes to employ. Then, if you are still indoubt, a second opinion will be well worth the effort andthe expense.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TOORTHOPEDIC PROBLEMS

There are few adequate definitions of the characteris-tics that are “normal" or “abnormal” in the physical con-formation of your child. Many seeming abnormalities of

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early childhood, such as bowed legs and pigeon toes, aremerely stages in normal physical development. Theyrarely require medical attention and almost never requiretreatment of any kind. You’ll avoid a lot of needlessmedical treatment and expense if you remember thesethings:

1. Infants almost always appear to have flat feetbecause they have a pad of fat beneath theirarches. Even if their feet are truly flat, it is aninherited characteristic that does not requiretreatment or warrant the use of correctiveshoes. Individuals with flat feet actually appearto have fewer foot problems than those whosearches are pronounced.

2. Virtually all babies are born with bowed legs,which straighten out naturally as the leg mus-cles develop. By the age of two, most childrenbecome knock-kneed, and this condition almostalways corrects itself by the time the childreaches adolescence. Treatment for these con-ditions is not warranted unless they persist intothe adolescent years.

3. Congenital hip dysplasia is extremely rare andseldom requires radical treatment with casts orsurgery. Mild conditions are often overtreated.Don’t permit your pediatrician to employ ex-treme measures without first assuring yourselfthat they are essential. In most cases no treat-ment is necessary, and in most others a simplepillow splint, or using extra diapers, will suffice.

4. Scoliosis is not serious unless the curvature ofthe spine is severe, but it is over treated almostas often as it is overdiagnosed. If your child isdiagnosed as a victim of scoliosis, don’t accept

• surgical procedures or even bracing withoutfirst exploring all of the less radical treatmentalternatives.

16

Accidental Injuries:Medicine at Its Best

It has always struck me as paradoxical that so manyparents worry unduly about common, nonthreatening ill-nesses and yet give scant attention to the childhood acci-dents that kill more children than all the major children’sdiseases combined. More than 8,000 children under theage of 15 will die accidentally in the United States thisyear. Many of those accidents could be prevented, andmany deaths avoided, if the proper measures were takenpromptly after the accidents occurred.

At the end of this chapter you will find a list of guide-lines that could help you save your child from accidentaldeath or injury. Within the chapter itself you will findspecific advice on how to deal with accidental emergen-cies, if your child has the misfortune to suffer one.

Most minor injuries do not require a doctor’s atten-tion, but emergency room treatment should be sought atonce if your child’s injury is severe. How do you tell thedifference? The most important rule, if your child sus-tains an injury, is to avoid panic. That may not always beeasy, because small cuts in some locations will bleed pro-fusely, and it doesn’t take much blood, spreading over awhite T-shirt, to scare any parent half to death.

Nevertheless, you must try to remain calm, becauseyour response to your child’s trauma will require the ex-ercise of immediate, sound judgment. You must decide

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whether the injury is severe enough to require medicaltreatment, whether to rush your child to the emergencyroom immediately or to call your doctor first, andwhether to call an ambulance or take the child to thehospital in your car. Even in cases that are obviously soserious that they will require hospitalization, you need todecide whether any life-saving measures should be takenwhile you are awaiting the ambulance or before you putyour child into the car.

On the following pages I will try to provide someguidelines that will help you determine the seriousness ofinjuries and the treatments you should use if a call orvisit to the doctor is not needed. As in the case with allof the other advice given in this book, err on the side ofcaution when you are in doubt.

I urge emergency room treatment for serious injuriesnot only in order to get prompt treatment, but because Ibelieve this is where you will find American medicine atits best. For the most part, emergency room doctors arebetter trained, more skilled, and more broadly experi-enced than other doctors. They are also accustomed toresponding quickly to emergency situations. When he isin serious trouble, there is no better place to take yourchild.

CUTS AND ABRASIONS

Every parent knows that cut fingers and skinnedknees are a common phenomenon among children, butI’m convinced that most parents don’t know what to doabout them. There is a common misconception that theuse of antiseptics and even antibiotics is necessary to“prevent infection” when the skin is broken. Conse-quently, when a child cuts his finger or scrapes his knee,parents are inclined to rush to the medicine cabinet forsome of the over-the-counter remedies that have beenlaid by for emergencies such as these. That’s an ill-advised reaction because these home remedies are not

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necessary and may add insult to the injury andmake it worse.

Most of the antiseptic preparations that are sold overthe counter at your local drugstore—iodine, Mercur-ochrome, peroxide, and ointments of various composi-tions—may irritate body tissue but will have nosignificant effect on germs. The body has its own sys-tems to fight infection, and they work quite effectively ifyou give them the chance.

What should you do when your child has a minor cutor scrape? Very little. Wash it gently with plain tap waterto remove any dirt that may be present. Cover thewound with a clean bandage if that is necessary to stopthe bleeding, but otherwise leave it exposed to the openair. No further treatment should be necessary for minorcuts and abrasions.

A doctor’s services may be required, of course, if thewound is bleeding uncontrollably or is so severe thatstitches may be required to facilitate healing or for cos-metic reasons. In that event your best bet is to head for ahospital emergency room.

Cases of severe bleeding constitute one type of emer-gency that you may have to handle quickly, without med-ical advice. If the blood is flowing from a vein, forgeteverything you have ever been told about applying tour-niquets and try to stop the bleeding by applying pressuredirectly to the wound. Cover the affected area with apiece of clean cloth or gauze and apply pressure until thebleeding stops or until you can get the victim to theemergency room. Only when blood is spurting from anartery should you resort to the use of a tourniquet thattotally cuts off the circulation to the limb. In those rareinstances in which one must be used, it should be left inplace for only a minute or two. If a tourniquet is left inplace too long, it can result in loss of the affected limb.

Many parents wonder whether a tetanus inoculation isnecessary every time their child suffers an abrasion orcut. Most children are inoculated against tetanus in earlychildhood (its the T in the DPT shot), but sonie doctors

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persist in giving tetanus booster shots when an injuryoccurs. In my youth I was told that tetanus was a threatif an injury occurred in a barnyard or from a rusty nail.Consequently, I gave tetanus booster shots whenever aninjury of this nature was presented to me. I also gavebooster shots, for preventive reasons, every 10 years.

Today I question whether booster shots are everneeded and even whether the administration of tetanusantitoxin makes any sense. There is no scientific evi-dence indicating how often tetanus boosters are requiredor whether they are required at all. Millions of Americanservicemen received tetanus inoculations when they en-tered service in World War II. Although four decadeshave passed, the evidence is that, with a few exceptions,their immunity has lasted until the present. That seemsto be a powerful argument against the need for routinetetanus boosters at any scheduled interval shorter than40 years!

BURNS

When I was a kid the standard home remedy forminor bums was the application of a coating of butter orlard. The theory was that this softened the affected skinand protected it from the air, which soothed the pain. Anumber of proprietary salves were also kept handy,which obviously had to be even better, because youcould smell the medicine they contained. Today we rec-ognize that there are several kinds of bums, categorizedby the extent of the damage, and specific methods mustbe employed to deal with each of these categories.

When your child is burned the treatment you provideshould have three objectives: the relief of pain, the pre-vention of infection, and avoidance or treatment ofshock. It is important to know how to achieve these ob-jectives in each of the three categories of bums.

First-degree burns affect only the outer layer of skin,which becomes red, sore, and tender but not blistered or

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charred. The immediate treatment is to immerse the af-fected area in cold water, which will lower the skin tem-perature and also help to relieve the pain. Subsequentlya water-soluble antiseptic ointment or baking soda pastecan be applied and covered with a gauze dressing. This isnot medically necessary, but it will help relieve pain byreducing the exposure of the burn to air.

Second-degree burns are much more serious. Theydestroy the top layers of skin and damage some tissue aswell. This can produce permanent scarring, and there isgreater danger of infection because leakage of fluid fromthe blood causes the formation of blisters that can be-come infected when they break. A second-degree burnon a very small area, such as a child might receive from acigarette, can be treated at home, but those involvinglarger areas of the body should receive prompt medicalattention.

Third-degree burns are those in which there is char-ring and destruction of all of the layers of skin and evenof some of the flesh beneath. The nerve endings are alsosometimes destroyed so that there may be little or nopain. When second- and third-degree burns cover morethan 10 percent of the skin area there is danger of deathfrom shock or from subsequent infection.

Emergency treatment of second- and third-degreeburns that cover large skin areas is difficult for parents toadminister because of their reluctance to cause theirchild further pain. However, it is essential, and if yourchild is the victim, it is imperative that you steel yourselfto do the things that should be done at once, before med-ical help arrives.

If professional medical attention cannot be obtainedquickly, the best treatment is to immerse the burned areain cool (not ice cold) water as quick as you can. Thisserves two purposes. It will lower the temperature of theburned area so that thermal damage does not continue toprogress, and it will provide some relief from pain byeliminating exposure to the air.

If it appears that the victim may go into shock, make

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him remain in a prone position, keep him warm, and ele-vate his feet and legs unless there are associated headand chest injuries. Do not administer stimulants or liq-uids of any kind. The symptoms of shock for which youshould be alert are a rapid pulse, facial pallor, cold,moist skin, trembling, and unusual thirst.

If the victim’s clothing has adhered to the burnedarea, don’t attempt to remove it. If blisters have formed,be careful not to break them, for that will multiply therisk of infection. Don’t touch the burned area with yourhands or any other object. Finally, don’t apply lard, but-ter, ointments, antiseptics, or any other type of medica-tion to the burned area. They will simply make it moredifficult for the doctor to do his job.

Children are often afflicted with chemical burns whenthey become attracted to cleaning materials that arecarelessly left within their reach. Many of these prepara-tions contain strong acids, detergents, lye, and otherharmful alkalies. If this happens to your child, the af-fected area should be flushed immediately with copiousamounts of water. Be sure you immediately remove anyclothing that may be saturated with the offending chemi-cal. Then seek medical attention as a precautionary mea-sure.

Another common source of severe bums to childrenis excessively hot tap water. There is no reason for thethermostat in a household hot water heater to be setabove 125 degrees, but there is good evidence that mostheaters are set above 130 degrees—a temperature thatwill produce severe skin bums in 30 seconds or less.Water heaters have been found in some households withthe thermostats set at 160 degrees, a temperature thatwill cause a severe third-degree bum almost instantly.

Not infrequently, children left unattended in the bath-tub turn on the hot water purposely or accidentally andthen panic when they are engulfed in water that is pain-fully hot. If the thermostat of the hot water heater is setabove 125 degrees, the results can be and often are fatal.It is estimated that more than 2,000 tap water scald bums

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require hospitalization every year and that as many as 15percent of these burns prove to be fatal.

Why not check the thermostat on your water heaterright now?

HEAD INJURIES

Head injuries sustained in falls, or when the head isstruck accidentally by objects such as stones or baseballbats, are rarely serious. They seldom require medicaltreatment or X-rays, but close observation of the vic-tim’s reaction following the accident is required to makecertain that no neurological damage has been done. Be-cause they fear the possibility of lasting brain damage,many parents will rush their child to the doctor or hospi-tal emergency room when he suffers an injury to thehead. Children are often brought to me who have no ob-servable symptoms, simply because they have fallen outof bed. These visits are seldom necessary and could beavoided if parents knew the symptoms to look for thatjustify medical attention for head injuries to a child.

If your child suffers a head injury, the first and mostimportant question should be: Did he experience loss ofconsciousness, even briefly, following the injury? If hedid, or if the accident occurred when he was alone andyou don’t know whether he did, take him to your doctoror hospital emergency room at once. An X-ray will prob-ably be ordered to determine whether your child’s skullwas fractured in the accident. If the X-ray reveals a sim-ple fracture, it is rarely serious, but if the fracture isdepressed and pressing on the brain, further treatment oreven surgery may be necessary.

If there was no period of unconsciousness, there is noneed to call your doctor immediately. Many doctors rou-tinely order X-rays when they are presented with a headinjury, but this is not justified in the absence of symp-toms other than the mere knowledge that there was anaccident. Some doctors also order an electrodncephalo-

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gram (EEG), despite the fact that the available evidenceindicates that this is not of significant value in diagnosis.

It is important, though, following a head injury inwhich no loss of consciousness occurred, to observeyour child carefully for at least 24 hours to determinewhether there are other factors that indicate the need formedical attention. Look for symptoms by asking thesequestions:

• What is your child’s level of consciousness? Ishe alert or lethargic and difficult to arouse?

• Is there any abnormality in the size of his pupils?Is the pupil of one eye dilated more than theother and unresponsive when it is exposed to abright light?

• Is your child experiencing double vision? (Do hiseyes move in unison, as they should?)

• Can your child move all of his extremities in anormal manner?

• Is he having respiratory problems, indicated byunnatural breathing?

• Is there evidence of loss of coordination, dizzi-ness, or difficulty maintaining balance?

• Is there any drainage of blood or clear fluid fromyour child’s ears or nose?

• Is he experiencing a severe headache that doesnot diminish or increases in intensity?

If any of these symptoms are present, play it safe andsee your doctor.

A final word to anxious mothers: don’t assume it is acrisis if your child under five topples from a high chair orfalls out of bed. Your child’s screams are more apt to befrom fright than from injury, for studies show that only 3 *percent of the children who have this misfortune sufferinjuries that warrant medical attention. Many of these

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were broken bones rather than injuries to the head. Beconcerned about a head injury only if the child experi-ences a loss of consciousness.

POISONING

Ingestion of poison by children and deaths from poi-soning have been reduced dramatically in the lastquarter-century. This is due in part to the development ofa network of poison control centers and to regulationsrequiring the use of childproof caps on many prescrip-tion and nonprescription drugs and household products.Despite this progress, however, more than 2 millioncases of poisoning are reported in the United Statesevery year, and a large percentage of them involve chil-dren. Most of them would not have occurred if theproper household precautions had been exercised.

At least three-fourths of the children who ingest poi-son will not require medical treatment if parents respondpromptly and appropriately to the emergency. Your firststep should be to try to identify the poisonous substancethat was ingested and, if an antidote is specified on thelabel, administer it at once. Then call your local poisoncontrol center to determine whether anything furtherneeds to be done.

If you identify the offending substance, but no anti-dote is suggested on the label, call your poison controlcenter for instructions. If you have the container, keep itat hand, because you will probably be asked to read thelabel information. If you are told to take your child to ahospital emergency room take the container with you.

Home treatment, guided by experts in the poison con-trol center, should be adequate in most cases. Most doc-tors are not expert in the treatment of poisoning cases.According to Dr. Richard Moriarity, director of the Na-tional Poison Center Network, “Most physicians have avery poor education [about poisoning] and very littletraining.” Dr. Moriarity believes that about 85 percent of

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all poisoning cases are not life-threatening and could behandled at home.

The management of poisoning cases varies dependingon the poison that was ingested, so it is important thatadvice be sought from a poison control center. If youhave not already done so, look up the telephone numberof your local center and add it to your list of emergencynumbers. As a general rule, the objective in the treat-ment of poisoning cases is to remove as much of thepoison from the system as possible and dilute or neutral-ize that which remains. In most cases this will requirethe use of a tablespoon of syrup of ipecac to induce vom-iting, so it is wise to keep a supply on hand at all times.Don’t administer it, however, until you have consultedthe poison control center, because there are situations(as when corrosives have been swallowed) when vomit-ing is not recommended.

Vomiting should not be induced when the offendingsubstance is a petroleum product, caustic, or strongacid. Petroleum products are likely to do more damageto the lungs than to the intestinal tract, so it is not advis-able to bring them back up. As for caustics and acids,they burned your child’s throat on the way down andyou don’t want to bum it further when they come backup.

Commonly ingested products for which vomitingshould not be induced include gasoline, kerosene,naphtha, petroleum-based paint removers, turpentine,various polishers for furniture and automobiles, bugkillers, drain and oven cleaners, ammonia and otherbleaches, and products that contain sulfuric, nitric, hy-drochloric, carbolic, and other strong acids. This list isnot intended to be all-inclusive, so check with a poisoncontrol center before you induce vomiting to eliminateany poisonous substance.

What should you do if you discover your two-year-oldwith an empty medicine bottle in his hand? First, try todetermine how many tablets or capsules the bottle mayhave contained. Then call the poison control center and

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give them the information you have. Don’t assume, be-cause the child exhibits no ill effects, that he is not indanger. The damage done by many drugs may not appearfor several hours, and if you fail to act until the symp-toms appear, you may be risking the life of your child.

The best way to protect your child is to keep him frombeing poisoned in the first place. This may involve someinconvenience in your household, but that is a smallprice to pay to assure that your child does not become apoisoning victim. Here are some suggestions that shouldbe followed in every household where small children arepresent.

• Assume that all drugs and household products,however innocuous they may seem, are poten-tially dangerous if they are swallowed by an in-quisitive child. Even children’s vitamin tabletscan be harmful if a child is tempted to eat awhole bottle of them. '

• Put childproof catches on cabinets used for stor-ing household products and lock up medicinesand other dangerous substances. It is not enoughto put them “out of reach.”

• Don’t leave dangerous substances unattendedwhile you answer the telephone or the doorbell.Children have a way of getting into things, evenif they have only a few seconds in which to do it.

• Keep medicines and household products in theiroriginal containers. This will prevent mistakesand assure that the label instructions are avail-able in the event that the substance is acciden-tally ingested.

• Promptly dispose of empty containers and un-used medications.

• When administering medications to your child,be sure the light is bright enough to read thelabel.

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• When you have guests, be sure purses are placedwhere your child can’t reach them. More thanone child has been poisoned by medicine hefound in a purse.

Occasionally a child is the victim of food poisoningthat will make him very ill for a short time but has noserious consequences. The symptoms are vomiting,usually accompanied by dianhea, that can’t be explainedby any prior evidence of an illness such as influenza.Unless there are obviously severe symptoms other thanthe two already mentioned, there is no need not seekmedical attention or to treat your child with anythingother than tender, loving care. You may relieve his thirstby allowing him to suck on ice chips, but don’t give himanything to eat or drink for six hours after the vomitinghas ceased. He may then have herbal teas, chickenbroth, and boiled water, but withhold solid food untilafter he has had a good night’s sleep. If the vomitingpersists, and the child has lost more than 10 percent ofhis original weight, see a doctor. He may find it neces-sary to treat your child for dehydration.

SPRAINS, STRAINS, ANDFRACTURES

The bone and muscle structure in children differs sig-nificantly from that of adults, and this affects the type ofiryury that occurs to arms and legs. Sprains, which in-volve the tearing or stretching of a ligament, are seldomseen in young children because the ligaments are not yetfirmly attached to the bone. Growing children are morelikely to suffer damage to the epiphysis, which is the softend of the bone where growth occurs. If your childtwists his wrist, knee, or ankle, and the swelling and painpersist for two days or more, see a doctor because, if it isa fracture of the epiphysis, it requires casting.

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In children the outer layer of bone—called perios-teum—is relatively thick compared to that of adults, andalso less brittle. Consequently, injuries that would pro-duce a sharp break in adults, with the broken ends of thebone displaced, often result in “green-stick” fractures in.children. The name is apt, because these breaks are com-parable to the splintering that occurs when you break agreen branch from a tree. Rather than snapping apart,the bone bends, producing many small longitudinalcracks at the point of fracture. This requires medicaltreatment.

If your child suffers a leg injury from twisting an ankleor a knee, there is no need to seek medical attentionimmediately. Delaying for a couple of days to see if thepain and swelling subside will not impede the treatment,if the injury proves to be a fracture and medical helpmust be sought. Encourage your child to keep his weightoff the injured member and apply ice packs to the injuredarea to reduce the swelling. This will cease to be of valueafter an hour or so, and many doctors recommend thatheat then be applied to improve the circulation in theinjured member.

I should note, in all candor, that this is one of themany situations in which the “science” of medicine isless than precise. There is vast disagreement overwhether the application of cold or the application of heatis the best treatment for a sprained ankle.

There is a classic story in medical circles about thedoctor who told a patient to apply ice packs to hissprained ankle. The patient followed this advice for twodays, with great inconvenience and discomfort, but thesprained ankle did not improve. He complained to hishousekeeper about this lack of progress, and she advisedhim to apply heat to the ankle. The patient did, and theankle began getting better almost immediately. The nexttime he saw his doctor, the following conversation en-sued:

Patient: “Doctor, the last time I saw you you told me

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to apply ice to my sprained ankle. I did, and it didn’t doany good. Then my housekeeper told me to apply heat,and it worked right away.”

Doctor: “Hmmm. That’s funny. My housekeeper toldme to use ice.”

The point, of course, is that no one really knowswhich works best for sprained ankles—heat or cold. Theimportant thing is to immobilize the ankle and wrap itwith an elastic bandage to prevent motion that will ag-gravate the injury. Just be sure that the bandage is notapplied so tightly that it cuts off circulation. Don’t listento anyone who tells you that the best treatment for asprain is to have your child walk on it at once. Pain isnature’s way of telling you that something is wrong, so ifyour child’s ankle hurts, the message is “Keep off!”

If any injured member—ankle, knee, wrist, elbow, orshoulder—has not improved in a couple of days, see adoctor. The two-day wait will reduce the possibility thatyour child will undergo a needless X-ray yet assure thathe does receive one if he really needs it It is estimatedthat about 98 percent of the X-rays ordered for arm andleg injuries do not reveal a fracture, so it is obvious thatmany are ordered frivolously.

Parents whose children are receiving steroid treat-ment for asthma or other conditions should be alert tothe possibility their child may suffer fractured ribs orvertebrae for no apparent reason. Extended use of ster-oids causes a reduction in bone density, and the asth-matic child who has been on steroid therapy for a year ormore may actually suffer a rib fracture during a coughingbout. The National Asthma Center studied 128 childrenwho had taken steroids for a year or more and found that14 of them had suffered a total of 58 broken ribs or ver-tebrae. No fractures of this nature occurred among acontrol group of 54 other asthmatic children who had notreceived long-term steroid treatment.

If your child suffers a really serious injury in a fallfrom a tree or is hit by a car, and it appears that theremay be a severe fracture or possible injury to his neck or

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spine, don’t attempt to move him or pick him up. Coverhim with a warm blanket to help avoid shock, and stembleeding by applying pressure to the wound. Then makesure that an ambulance has been called, and await thearrival of trained paramedics who will know how tomove your child safely and what emergency treatmentshould be given at the scene.

CHOKING

Infants and small children have a strong desire fororal gratification, which explains why they are so fond ofpopping small objects into their mouths. Sometimesthese objects become lodged in their throats or are aspir-ated into their lungs, creating an emergency situationthat demands action by anyone who is close at hand.

Cautious parents will avoid giving children toys thathave small, removable parts; peanuts; or lozenge-typehard candies on which they might choke. However, youcan’t watch your kids every moment of the day so thereis always the possibility, despite all your precautions,that a child will come upon something small enough to fitinto his mouth. Sometimes the object gets stuck in histhroat.

It is vital that you act promptly and properly whenthis occurs. The first step is to determine whether thechild is able to talk and breathe. If he is, the airway isonly partially obstructed. Rather than take any emer-gency measures that might jar the object into a moredangerous position, take the victim to a hospital emer-gency room and have it removed.

If the airway is totally obstructed so that the childcannot breathe, you don’t have time to seek outsidehelp. You must take emergency action yourself. First,inspect the child’s throat to see if the obstacle is visible.If it is, and you think you can remove it with yourfingers, try to do so, but don’t try it if you think there isany risk that you will push it farther in.

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If you can’t reach the object, place the child overyour lap or arm with his head and shoulders hangingdown and slap him sharply between the shoulder bladeswith the heel of your hand. Do this three or four times toinduce him to cough up the object. Remember, neverslap an upright person on the back in an effort to removean object, because it may force it farther into his airwayor throat.

If this measure fails, try the Heimlich maneuver.Stand behind the child and put your arms around him,grasping your fists just below the center of his rib cage.Hold the thumb of one hand against his abdomen, andgive a quick thrust inward and upward. The increase inair pressure in his lungs will often pop the object out ofhis throat.

Bear in mind that this maneuver was developed pri-marily for use with adults. If too much pressure is ex-erted on the abdomen of an infant or a small child, it cancause damage to internal organs—notably the liver. Analternative with infants is to place the child on his stom-ach in your lap and press sharply on his upper back toforce air out of his lungs.

Many hospitals, and organizations such as the RedCross, offer free instruction in cardiopulmonary resusci-tation. Because of the frequency with which foreign ob-jects are ingested by children, it would be prudent foryou to enroll in a course if you have the opportunity.

ANIMAL BITES

If your child is bitten by a dog or any other animal,the wound should be washed immediately with soap andwater and then held under running water for severalminutes. Medical attention should then be sought as aprecautionary measure or to close the wound withstitches, if that is required.

The most serious concern with animal bites is the pos-sibility that the offending animal may have been infected

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with rabies. Make an immediate effort, if a dog was theculprit, to identify the animal and determine whether ithas had rabies shots. If your child is bitten by a squirrelor some other wild animal, it is important to determinewhether there is any evidence, in your area, that the of-fending species has been infected with rabies.

Rabies is caused by a filterable virus that has an affin-ity for nervous tissue so that it affects the spinal cordand the brain. The incubation period on humans can ex-tend from 10 days to two years or more. The usualsymptoms are uncontrollable excitement, fever, spasm inthe muscles, larynx, and pharynx. As the disease pro-gresses, the victim will salivate copiously and displayunquenchable thirst but be unable to swallow water.That accounts for the term hydrophobia, a common layterm for the disease. Death often results from convul-sions, exhaustion, or paralysis. Once the disease ispresent the only treatment is rest and sedation to fore-stall convulsions.

The choice to be made, if your child suffers an animalbite, is between the consequences of rabies and the con-sequences of the rabies shots that can be given to fore-stall the possibility that your child may become a victimof the disease. Because the disease is so horrible to con-template, many parents accept rabies shots for theirchild even when there is no evidence that rabies waspresent in the animal that inflicted the bite.

If that decision is ever required of you, don’t fail toconsider the potential consequences of the shots. First,the side effects include extreme pain, which is not some-thing you would wish on your child if it can be avoided.But of greater concern is the fact that rabies vaccine mayproduce fatal anaphylactic shock and severe paralysisthat could incapacitate your child for life.

The possibility that the rabies vaccine will producethese dire consequences is remote, but so is the possib-lity that the victim of an animal bite will contract rabies,unless the offending animal is proven to be rabid. Tens ofthousands of Americans are bitten by aniiflals every

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year, but only a handful contract this dread disease.

Your choice is further complicated by the fact that,even if the offending animal is diagnosed as being rabid,there is a real possibility that the diagnosis may be inva-lid. A recent example of this occurred in Dlinois, wherethe state department of public health incorrectly diag-nosed rabies in 10 dogs and cats in the Chicago area. Asa result, more than 100 persons submitted to painful anddangerous rabies shots, and many valuable dogs wereneedlessly destroyed. In some cases, the false diagnosismade by the state was confirmed by the federal Centersfor Disease Control.

When a child is bitten by an unknown dog or by a wildanimal, parents and physicians are presented with afrightening dilemma, one to which there is no “right” so-lution. During my years of pediatric practice I havepassed through three stages in my response to the pos-siblity that the offending animal may be rabid. Today Igive rabies shots only when the bite was inflicted by ananimal known to be rabid; by a bat, a species likely tocarry rabies; or by a wild animal of a species known tobe rabid in the area in which the bite occurred.

So what are you, a parent, to do if your child is bittenby an animal? The only honest answer I can give, with-out playing God, is to tell you that it is a dilemma thatyou, with the help of your God, will have to resolveyourself. I can only tell you what I would do if one of myown beloved grandchildren were the victim: if the animalthat inflicted the injury was rabid, or if there was astrong probability that it might have been, I would givethe rabies vaccine. Unless those conditions prevailed, Iwould not.

Snakebites are also a threat in some areas of ourcountry. When I was a child, boy scouts were taught toprovide emergency treatment for snakebites by cuttingan X in the wound and squeezing or sucking out the poi-son. I recall thinking that this was a gruesome act tocontemplate. Today I know that there is no scientific evi-dence that this treatment will yield any benefits, nor is

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there any evidence that it will not. If the bite occurs in anisolated area where no medical help is available, nothingis lost by trying it. Otherwise, call your poison controlcenter for instructions or rush your child to a doctor orhospital emergency room at once. It is important to tryto identify the type of snake that bit your child and gethim to a place where he can receive the appropriate anti-venin serum as quickly as possible.

FROSTBITE

Children seem to be less sensitive to cold than adultsand, when they are enjoying themselves sledding or ski-ing, often stay out of doors longer than they should.Sometimes, when they come into the house, areas of theskin—particularly on their ears, nose, fingers, or toes—will appear totally white. When touched, this frostbittenarea will be without feeling.

When I was a child there was a common belief thatthe proper treatment of frostbite was to rub the affectedarea with snow. That’s one home remedy that makes ab-solutely no sense! The objective, when frostbite ispresent, is to warm the skin, not keep it cold. The ap-propriate treatment is to warm the injured member grad-ually by immersing it in water or soaking it with wetcompresses that are at approximate body temperature.Hot water should not be used, because your purpose isto thaw the area gradually, and the frozen skin you aretreating is not able to sense whether the water is too hot.

Cases of simple frostbite do not ordinarily requiremedical treatment, but extended overexposure to thecold, particularly when the victim fell asleep or becameunconscious, usually requires treatment and hospitaliza-tion.

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AUTOMOBILE ACCIDENTS

Although the types of iqjury that occur in automobileaccidents have already been covered in this chapter, itwould be inappropriate to end it without a word aboutauto safety. After the first few days of life, automobileaccidents are the leading cause of death for children.Babies under one year of age are the most vulnerable,followed by children in the 1 -6 year bracket, and thenby those aged 6 to 12.

These statistics indicate why children are more vul-nerable than adults in an auto accident. Because theyweigh less, they are thrown about more by the force ofthe impact. This makes the use of the car seats for in-fants under 45 pounds, and safety belts for older chil-dren, a matter of critical importance. Don’t make themistake of believing that a baby is safe if you hold him inyour lap. He should be in a car seat when you take himhome from the hospital.

Approved car seats are now required by law in manystates and should be in all of them. I say that as one whohas had to try to mend the appalling injuries that resultfrom auto accidents. All of us are inclined to think thataccidents are something that happens to others. Yet in1981 auto accidents caused 1,900,000 disabling injuries,1,750,000 temporary total disabilities, 150,000 permanentimpairments, and 50,800 fatalities. With a staggering in-cidence of death, injury, and disability such as that, it’sapparent that an auto accident might happen to any ofus, or to our children.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TOACCIDENTAL INJURES

The vast majority of accidental injuries do not requiremedical attention if parents are familiar with the treat-

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ment they can apply at home. However, judgment mustbe exercised to determine which injuries are extensiveand serious enough to demand medical care. Study theinformation provided in each of the headings in thischapter, and you will be able to apply the appropriatetreatment and exercise the considered judgment that willbe required if an accident befalls your child.

HOUSEHOLD SAFETYPRECAUTIONS

• Teach your children the fundamentals of safetyand set a good example for them yourself.

• Don’t leave babies and young children unsuper-vised.

• Check the thermostat on your water heater andmake certain it is not set above 125 degrees.

• Do not allow allow children to play with matchesor use the stove without permission. Make cer-tain that the handles on cooking pans are notwhere children can reach them. Keep hot fluidsout of the reach of children.

• Keep scissors and knives where small childrencan’t reach them.

• Keep power tools and sharp hand tools wherechildren cannot reach them.

• Unload all firearms, lock them up, and lock upthe ammunition in a separate location.

• Cover electrical outlets and don’t keep electricalappliances in the bathroom.

• Check all toys to be sure they don’t present haz-ards.

• Keep all medicines in locked cabinets and storehousehold cleaning products in cabinets that arelocked or have childproof latches.

Make certain that window screen and porch rail-ings are secure.

Don’t leave toys on the staircase or use looserugs on or near stairways.

Keep the sides up when your baby is in the crib,strap him into his high ch^ir, and place gates atthe top and bottom of each stairway when hebegins to crawl.

Fill holes that appear in your yard and repairbroken sidewalks immediately.

If you have a pool, don’t permit your children toswim unattended, be sure it is securely fenced,and don’t allow your children or their guests torun on the slippery deck.

Post a list of emergency numbers next to each ofyour telephones. It should include the telephonenumbers of your pediatrician, the local ambu-lance service, the hospital emergency room, thepoison control center, and the fire and police de-partments. This could save valuable time whenan accident occurs.

When traveling in an automobile, make sure thatyour child under 45 pounds is strapped into anapproved car seat and that every member of yourfamily has his or her seat belt securely fastened.

17

Asthmaand Allergies:

Try Diet, Not Drugs

ou won’t find the word allergy in Shakespeare oreven in the English literature of a century ago. The medi-cal concept that allergies are responsible for manyhuman ailments is a relatively new one. Yet it is not newenough to excuse the failure of most doctors to accord itan appropriate role in differential diagnosis. It is a sadfact that allergies and nutrition—two major forces inhuman health—receive little attention in medical schooland constitute an area of vast ignorance in contemporarymedical practice.

Although we often are not aware of it, most of us areallergic to things in the food we eat and the air webreathe. Because of medical ignorance, however, manydiseases that could be managed by identifying and avoid-ing the allergens that cause them are treated, instead,with dangerous drugs and even surgery. In many casesthis unnecessary treatment is worse than the diseasebeing treated.

The most common allergies are those that producestuffed-up, runny noses, sneezing, and coughing. Whenthese symptoms appear only in the fall of the year weassume that the culprit is pollen in the air and call theailment hay fever. However, some people suffer fromthese symptoms throughout the year, with chronic nasalobstructions that may lead to other infections (sinus.

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etc.) as well. In those cases allergens other than pollenare obviously responsible.

Some allergens are found in the environment in whichwe live and others in the food we eat. The environmentalallergies include pollen and molds; air pollution fromheating fuel, automobile exhausts, and tobacco smoke;animal dander (minute scales from hair, feathers, orskin); household dust; drinking water (chlorine); fabricsin clothing, blankets, quilts (particularly wool); cos-metics and soaps; chemical sprays; and insect bites, toname some of the most common offenders.

Food allergies cover a broad range, with cow’s milk atthe top of the list. Other foods that produce allergic reac-tions in some children include com products, wheatfractions, gluten, eggs, fish, tomatoes, garlic, citrusfruits, and the chemical additives, preservatives, stabi-lizers, coloring, and flavoring that are found in mostprocessed foods.

ALLERGIES PRODUCE MANYSYMPTOMS IN CHILDREN

Children are particularly susceptible to allergic reac-tions that may produce such diverse symptoms as head-ache, migraine, eye pain and blurred vision, vertigo,hearing loss, tachycardia (rapid heartbeat), nausea, vom-iting, heartburn, diarrhea, abdominal pain, allergic cys-titis (blood in urine), fatigue, muscle weakness,bed-wetting, learning disorders, insomnia, hyperactivity,and poor memory. Bottlefed babies are at least 20 timesas susceptible to allergies as children who are breastfed.

All doctors will assume that allergies are responsiblefor diseases such as asthma and hay fever, and most willsuspect allergies as the cause of some skin conditions,but many fail to consider the possibility of allergies whenyour child has the other symptoms cited above. Instead,they shoot at the wrong target and give him drags for therelief of symptoms rather than doing the medical detec-

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tive work that might have identified a food or environ-mental allergy as the culprit that was making your childsick.

While failure to consider allergies as the potentialcause of illness can lead to false diagnosis and inappro-priate treatment, recognition of the possibility may beequally dangerous. A pediatrician’s suspicion of allergyusually leads him to refer your child to an allergist whoseresponse may also be inappropriate. Many allergistsabuse skin testing by haphazardly performing dozens ofuncomfortable, costly, and potentially dangerous skintests. These tests, especially for food allergies, are no-toriously inaccurate and totally inappropriate whengiven—as they often are—for potential allergens towhich your child is not even exposed. They have legiti-macy and value in confirming suspected allergies thathave been identified by other means, but indiscriminatetesting is not to be condoned.

Testing, however, is only part of the problem. Thetreatments that follow may be worse than the symptomsthey are supposed to relieve. If scratch tests reveal thatyour child is allergic to household dust, it obviouslymakes sense to provide him with the most dust-free envi-ronment that can be contrived. Elimination of suspectfoods also makes sense if it is carried out as part of anelimination diet to validate or invalidate the tests. How-ever, it is pointless to eliminate nutritious foods perma-nently without testing your child’s reaction to them toconfirm the validity of the tests. That being the case,why give the tests? Why not use an elimination diet todetermine your child’s reaction to specific foods and skipthe scratch tests?

The real hazard, when you take your child to anallergist, is the probability that he will prescribe desen-sitization shots or treatment with drugs such asantihistamines, adrenal corticosteroid hormones such ascortisone or prednisone, or xanthine derivatives suchas theophylline.

The value of administering allergy desensitization

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shots is extremely controversial, and the long-term con-sequences are unknown. The few controlled studies thathave been made of their effectiveness are contradictory,at best. However, they seem to suggest that hay fevershots may be effective in reducing symptoms in manypatients, while shots for food allergies are probably not.The critical question, as yet unanswered, is what poten-tial consequences may affect your child in future years if. he receives allergy shots. Apparently, the specialists inthis field don’t want to know the answer, because thesedesensitization shots have been given for decades, yetthis question has never been adequately addressed.

The drugs commonly used in the treatment of allergicconditions, including asthma, have many potentiallyharmful and dangerous side effects. These antihista-mines, steroid hormones, or xanthine derivatives aresold under trade names such as Aminophyllin, Aarane,Marax, Slophylline, Theodur, and Theobid, some to betaken orally and others via inhalers. All of them haveside effects that may be merely annoying to your childbut in many instances are dangerous. For example, ster-oid treatment of asthmatic children has been demon-strated to retard lung maturation and physical growthand to cause a higher incidence of cataracts in childrenreceiving long-term steroid therapy.

I recommend that parents reject desensitization shotsand drug therapy for their children unless the conditionis life-threatening or until all of the alternatives havebeen explored. If you suspect that your child’s illness isallergic in origin, look carefully for the potential source.You don't need a doctor to do this. First, consider all ofthe potential causes that exist in the child’s environment,eliminate them one by one to the extent you can, andobserve whether the symptoms are ameliorated or disap-pear. Begin an elimination diet in which suspect foodsare eliminated from the diet one by one to determinewhether one or more of the things he eats are responsi-ble. The odds that you will discover the cause and solvethe problem are substantially in your favor.

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SEVERE ASTHMA REQUIRESMEDICAL HELP

While I am convinced that most allergic conditions donot required medical treatment, I don’t want to minimizethe need for medical attention for severe asthma and forimmediate action in the event of a severe asthmatic at-tack. This is a potentially life-threatening condition, andit should be treated as such.

Unlike hay fever, which primarily affects the nasalpassages, asthma is focused in the bronchial tubes. Theallergen causes the small bronchial tubes to swell, a thickmucus is secreted, and the air passages become soclogged that breathing becomes difficult. In severe asth-matic attacks the patient wheezes, coughs, and gasps forbreath, and the child’s life may be at risk unless the con-dition is treated immediately. If this happens to yourchild, rush him to your doctor or, better still, to a hospi-tal emergency room before the air passages become soclogged that he cannot get enough oxygen to survive. Aninjection of adrenaline will open up the airways, produc-ing what amounts to a temporary miracle cure. Adrena-line, when used for this purpose, is an excellent drug thatcan be used practically with impunity.

Although asthma is usually allergic in origin, it ismore baffling than the other allergic diseases because itsonset is inconsistent and sometimes unrelated to causesthat are specifically food or environmental allergens.Asthmatic attacks may be provoked by colds and otherinfections, by anxiety, by emotional upsets and otherpsychological conditions. Many parents are frustratedbecause their asthmatic child actually develops the abil-ity to trigger an asthmatic attack by becoming emotion-ally upset over some disappointment or other event inhis life. The frequency of attacks may also be related toexercise, climate, and even the season of the year.

As a parent who is in constant contact, with yourchild, you are fully aware of his diet and the environmen-

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tal conditions that surround him and are sensitive to hismoods. Consequently, before you seek medical attentionfor any other than a life-threatening allergic condition,make a determined effort of your own to identify thecause. You are better qualified to do that than your doc-tor is. Only if your own efforts fail, and the illness per-sists or becomes life-threatening, need you consult adoctor.

DR. MENDELSOHN’S QUICKREFERENCE GUIDE TO ALLERGIES

As explained throughout this book, allergies shouldbe suspect as the cause of a host of illnesses not typicallyassociated with them. The appropriate action, when adisease is allergic in origin, is not to treat the symptomswith potentially dangerous drugs and desensitizationshots but to identify and eliminate the allergen from thechild’s diet or environment. Parents are better qualifiedthan doctors to undertake this mission because theyknow their child well, and have him under constant sur-veillance. If you suspect that your child’s illness is aller-gic in origin, consider taking these steps:

1. Study every element of your child’s environ-ment, paying particular attention to the poten-tial allergenic conditions and substances that arelisted on page 214. If the symptoms of allergyare seasonal, occurring in the fall of the year,pollen should, of course, be the prime suspect.

2. If no environmental culprit is found, begin anelimination diet to determine whether your childis allergic to one or more specific foods. Elimi-nate food items that are most likely to be aller-genic from the diet (see list on page 214) andobserve whether the allergic symptoms disap-pear within 10 days or so. If they do, begin add-

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ing each of these foods to his diet, one by one.If the symptoms reappear, you have identifiedone of the food items to which he is allergic.The reaction should occur within a couple of. days. Repeat this process with the other fooditems until you have identified all of those thatyour child should avoid.

3. If you are unable to identify the allergen that istroubling your child, consult a human ecologyallergist who can guide you in more sophisti-cated techniques for making this determination(see address on page 94). Only if that fails do Irecommend consultation with a traditional aller-gist. If you do consult one, be extremely waryof scratch tests, desensitization injections, anddrug treatments.

4. If your child’s allergies produce a life-threateningcondition, such as severe chronic asthma, acompetent physician should be consulted in theevent of a severe attack. This should not deteryou from your efforts to identify the offend-ing allergens, but it is essential to avoid life-threatening situations. If your asthmatic childhas an attack so severe that breathing is dan-gerously inhibited, take him to your doctor or ahospital emergency room so that an injection ofadrenaline can be administered at once.

18

The ChildWho NeverSits Still

Vi/ hen your child reaches the toddler stage you maydiscover that he has more energy, is more active, and isless disciplined than most other kids of comparable age.At first you’ll be pleased that he is outgoing and alert,not lethargic and withdrawn. Then, after chasing himday after day from one exploratory mishap to another,you may find that your reservoir of patience and staminahas been exhausted. That’s when you’ll begin to wonderwhether his boundless energy is a blessing, after all. Youmay even worry that his behavior is abnormal; that he is“hyperactive” or a victim of “attention deficit disorder(ADD),” “learning disability (LD),” or “minimal braindamage (MBD),” all of which are so often diagnosedtoday.

My purpose in this chapter is to warn you of the haz-ards of making that diagnosis yourself, and of lettinganyone else—doctor, teacher, or friend—do it for you.Once your child is given one of these labels there is astrong probability that he may be subjected to some un-acceptable risks.

Professional counseling and drug treatment for chil-dren who exhibit exaggerated but perfectly normal de-velopmental behavior has become almost epidemic in theUnited States. Largely because of pressure from schoolauthorities, many American parents have lost faith in the

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legitimacy of their own decisions and in the accumulatedwisdom of their parents, relatives, and friends. They’vebeen led to believe that doctors and mental health pro-fessionals have the. only answers to questions that pre-vious generations answered quite effectively themselves.

If kids were made with cookie cutters, like the ginger-bread man, norms could be set for your child’s develop-mental behavior and the level of activity that he shoulddisplay. Happily, they’re not, with the result that no twochildren are precisely alike. That’s frustrating forteachers, doctors, and every other professional who be-lieves that everything in life should go by the book. It isnot uncommon today for a child who is so active andinattentive that he gives his teacher fits to be diagnosedas “hyperactive” or “brain-damaged,” treated with de-pressive chemicals, and isolated in the “learning lab” atschool.

The possibility that your exceptionally active but per-fectly normal child could be branded with one of thesederogatory labels—none of which has a valid scientificdefinition—is not remote. The number of children whohave suffered this fate has risen by 500,000 in the lastfive years. It could happen to your child if he displayssome of these behaviors, which are on the checklists thatpsychologists use: doesn’t always listen to directions;fidgets and won’t sit still; daydreams in class; butts intosituations that are none of his business; is slow gettingready for school; shows off when other children arearound; or is more physically active than the other chil-dren in his class.

Your reaction to that list is probably the same asmine. I would begin to worry if a child didn’t displaymost of those behaviors. Then I’d devote my attention totrying to diagnose why he is behaving like a vegetable!But when he does display them the mental health profes-sionals are likely to give him drugs that often do turn himinto something resembling a vegetable!

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AVOID DRUGS FORBEHAVIOR MODIFICATION

If some of your child’s behavior is more exaggeratedand thus more annoying than that of other children youknow, don’t endanger him by exposing him to therapy ordrugs. Instead, search for the environmental factors—athome, in school, or among his peers—that may be caus-ing emotional problems. What pressures on your childare producing the behavior patterns that are unaccept-able to his teachers and to you? Search also for dietaryallergies that may be at the heart of his problems. Mean-while, try to relieve some of the emotional pressure thathis behavior is causing, provide strong emotional sup-port at home, and let him know that he has you on hisside when he encounters trouble outside your home.

In my experience, if it is carried out objectively andthoroughly, this approach usually works. Certainly, if itdoes, it is a desirable alternative to professional counsel-ing that may cause your child to be labeled hyperactive,MBD, or ADD. If that happens, your child’s school willprobably place him in a special education program andassign him to a “learning laboratory,” which will brandhim as inferior among his peers. (In some schools thelearning lab is derisively labeled—by the kids who aren’tin it—as the “looney lab.”)

I don’t believe any child deserves that fate simply be-cause he is harder to manage or harder to teach than theothers in his class. This should concern you, but youshould be even more concerned if psychoactive drugs,such as Ritalin or Cylert, are prescribed for your child.

Educators and doctors who label a child hyperactiveor learning disabled, and then suggest treating him withchemicals, always defend their recommendations by as-serting that it will improve the child’s ability to learn.They know that you will respond to this more positivelythan to their true motivation, which is to drug your child

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into near-somnolence so he will be more manageable andless of a nuisance in the classroom.

No one has ever been able to demonstrate that drugssuch as Cylert and Ritalin improve the academic per-formance of the children who take them. The major ef-fect of Ritalin and similar drugs is on the short-termmanageability of hyperkinetic behavior. The pupil isdrugged to make life easier for his teacher, not to make itbetter and more productive for the child. If your child isthe victim, the potential risks of these drugs is a highprice to pay to make his teacher more comfortable.

DANGEROUS SIDE EFFECTSOF RITALIN

What are the risks to your child if he is put on Ritalinor a similar drug? First, there is ample evidence that theyare prescribed inappropriately and administered care-lessly and have side effects that are dangerous in them-selves. Add to that the fact that they obviate the needand the incentive to discover what is really troublingyour child, and you have a package that exemplifies con-temporary medical practice and educational policy attheir worst.

In the prescribing information for Ritalin that themanufacturer, Ciba-Geigy. supplied for the Physician'sDesk Reference, the company acknowledges that it doesnot know how Ritalin works or how its effects relate tothe condition of the central nervous system. It warnsagainst the use of the drug in children under the age ofsix and admits that its long-term safety is unknown. Italso notes that suppression of growth in those who takethe drug has been noted in some cases and that there issome clinical evidence that it may provoke convulsiveseizures in some patients.

The prescribing information then goes on to the po-tential side effects, which are so frightening that I will

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quote them directly from the book (the italicized phrasesare mine):

Nervousness and insomnia are the most com-mon adverse reactions but are usually controlledby reducing dosage and omitting the drug in theafternoon and the evening. Other reactions includehypersensitivity (including skin rash), urticaria[swollen, itching patches of skin], fever, arthralgia,exfoliative dermatitis [scaly patches of skin], er-ythema multiforme [an acute inflammatory skindisease], with histopathological findings of necro-tizing vasculitis [destruction of the blood vessels],and thrombocytopenic purpura [a serious bloodclotting disorder], anorexia; nausea; dizziness; pal-pitations; headache; dyskinesia [impairment of vol-untary muscle movement], drowsiness; bloodpressure and pulse changes, both up and down;tachycardia [rapid heartbeat], angina [spasmodicattacks of intense heart pain]; cardiac arrhythmia[irregular heartbeat]; abdominal pain, weight lossduring prolonged therapy.

There have been rare reports of Tourette’s syn-drome. Toxic psychosis has been reported in pa-tients taking this drug; leukopenia [reduction inwhite blood cells] and/or anemia; a few instances ofscalp hair loss. In children, loss of appetite, ab-dominal pain, weight loss during prolonged ther-apy, insomnia, and tachycardia may occur morefrequently; however, any of the other adverse reac-tions listed above may also occur.

This is the kind of information about a drug that themanufacturer is compelled by law to share with the doc-tors who wiD prescribe it. Unfortunately, there is no lawrequiring that the doctors who prescribe the drug sharethe information about its potentially damaging or fataleffects with you. That’s why I have provided so much

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information about Ritalin, which applies, as well, to itscounterparts.

If your child’s teacher, school principal, counselor, orpediatrician attempts to pressure you into acceptingchemical treatment for his behavior patterns, reject theadvice out of hand. There is no benefit to your child thatjustifies the risks, nor can they be justified in order tospare his teacher the annoyance of having him talk out ofturn or squirm in his seat.

LOOK FOR EMOTIONAL PRESSURESAS CAUSE

Don’t accept a teacher’s assessment of your child’sbehavioral shortcomings without investigating whetherthey may be the result of his or her interaction with him.Irreconcilable personality conflicts are not uncommon,and if one exists between your child and his teacher, theteacher may be the problem because he or she is notdealing equitably and sympathetically with your child. Inthat case the answer is to change teachers, not to usedrugs to try to alter the behavior of her pupil.

While you are endeavoring to correct any conditionsthat are causing problems for your child at school, lookfor others that may be troubling him at home. If he isinsecure because of stress among other family members,try to resolve those problems or at least avoid exposinghim to the tensions that exist. If there are difficultieswith his playmates or others outside your home, try toresolve those. Then turn your attention to the possibilitythat his hyperactive behavior may stem from allergies tofood or other substances. There is substantial evidencethat nutritional approaches may succeed in improving hisemotional condition and behavior.

I must caution you that your pediatrician may not besympathetic to this approach. The late Dr. BenjaminFeingold, the pioneer of dietary control of hyperactive

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behavior, encountered great skepticism from others inthe medical profession. That’s not surprising, becausedoctors chronically reject nonmedical solutions to prob-lems they believe belong to them. Don’t let that discour-age you. Nervous system symptoms related to foodhypersensitivity have been described by one observerafter another for at least half a century. More recently,there has been a mass of clinical evidence that demon-strates that the Feingold diet does work with many chil-dren.

Dr. Feingold, who was chief of the allergy clinics ofthe Kaiser Foundation in California, zeroed in on chemi-cal food additives—colorings, flavorings, preservatives,stabilizers, and others—as the principal contributors tohyperactive behavior. He recommended eliminatingthese chemicals from the diet by substituting naturalfoods for the highly processed items found in mostAmerican pantries and refrigerators. There is over-whelming clinical evidence that this approach is oftensuccessful.

Dr. Feingold’s results have been duplicated by manyothers. Dr. William G. Crook, a pediatrician and allergistat the Children’s Clinic in Jackson, Tennessee, reportedon another study at a food allergy symposium. He saidthat hyperactivity was related to food allergy in aboutthree-fourths of the cases in a study of more than 100children who were overactive.

Dr. Crook observed precisely what Dr. Feingold had,and what many parents have, experienced: children canbe helped by using elimination diets to identify offendingfoods. He identified milk and refined cane sugar as theleading culprits in a list that also included corn, wheat,eggs, soy, citrus, and other items.

If you have an overactive child with behavior prob-lems, don’t turn to drugs prescribed by your doctor untilyou have determined what success you have with foodyou can buy from your grocer!

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QUESTION DIAGNOSISOF BRAIN DAMAGE

You should also be extremely wary of any suggestionthat your child’s behavior patterns stem from some formof brain damage or disorder. These conditions do exist insome children, of course, but the number is far fewerthan the number of such cases that are diagnosed. Psy-chiatry is such an imprecise science, if it can be called ascience, that its practitioners rarely agree on a diagnosis.Experiments have been conducted which show that psy-chologists and psychiatrists' can be expected to agreewith each other on a diagnosis only about 54 percent ofthe time. That’s so close to the law of averages that youcould consult a cabdriver and a carpenter and get thesame result.

Nevertheless, on the basis of questionable diagnosis,your child may be recommended for psychotherapy if hisbehavior varies from what the mental health practitionerchooses to consider the “norm.” Children who are cor-rectly diagnosed as having brain or neurological damageor actual psychoses may benefit from treatment, ofcourse. But short of that there is little evidence that psy-chological counseling helps and considerable evidencethat it may actually aggravate a child’s psychological/emotional problems.

The inadequacies of psychotherapy have been re-vealed repeatedly in follow-up studies of populationsthat have been exposed to psychiatric treatment. Onewell-known study points out that the spontaneous remis-sion rate in patients with psychiatric conditions is 70percent for both adults and children. Another study, re-porting on a 20-year follow-up of patients at the Univer-sity of Wisconsin, compared patients who werecounseled with those who applied for but never receivedcounseling. The most positive conclusion the studycould reach was that counseling seemed to do no harm!

Another study of youths in Cambridge aqd Somer-

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ville, Massachusetts, was even less reassuring. It com-pared a group that had been counseled for five years, ona one-to-one basis, with a personal counselor, to anothergroup that received no therapy at all. Almost withoutexception, psychological therapy appeared to have anegative effect on these youngsters in later life. Begun in1939, this 30-year follow-up found a solid correlation be-tween therapy and criminal behavior. More of the menwho had received psychotherapy as youths were con-victed of serious crimes and multiple crimes than thosewho had no treatment at all. Those who had the longestand most frequent contact with counselors had the high-est incidence of antisocial and criminal behavior.

Finally, a 1980 review of 120 studies of psychotherapyfor juvenile delinquents found that those who receivedcounseling fared worse, in terms of subsequent behavior,than those who didn’t. A report on this research in theToronto Globe & Mail summed it up in this paragraph:

If you want to stop a juvenile delinquent fromrobbing, raping, and clubbing people, don’t sendhim to a social worker, a psychiatrist, a psycholo-gist, a group home, a therapeutic community anddon’t make any efforts to counsel his family either.They all fail and some may even make him moreviolent than when he began.

There are, to be sure, some specific childhood mentaland neurological disorders that stem from brain and neu-rological damage. Many of them are the consequence ofmedical interventions that I have discussed earlier in thisbook, e.g., cerebral palsy, Down’s syndrome, Tourette’ssyndrome, autism, etc.

If your child is the victim of one of these conditions,professional help is appropriate, if for no other reasonthan to explore innovative treatment that may appear,e.g., the nutritional supplementation methods in themanagement of mongolism and other causes of mentalretardation pioneered by Detroit’s Henry Thrkel, M.D.,

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and Ruth Harrell, M.D., of Old Dominion University.However, if your child is suffering from this kind of con-dition—rather than behavior manifestations that simplymake him more difficult to manage than other children—you’ll know the difference. Your best course is to seekprofessional help when it is clearly needed, but avoid it ifyou are told that your child is suffering from a “learningdisability,” an “attention deficit disorder,” or some othervaguely defined condition. The mental health profes-sionals have yet to prove that any of these alleged dis-'orders even exists!

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Immunizationagainst Disease:

A Medical Time Bomb?

The greatest threat of childhood diseases lies in thedangerous and ineffectual efforts made to prevent themthrough mass immunization.

I know, as I write that line, that this concept is onethat you may find difficult to accept. Immunizationshave been so artfully and aggressively marketed thatmost parents believe them to be the “miracle” that haseliminated many once-feared diseases. Consequently, foranyone to oppose them borders on the foolhardy. For apediatrician to attack what has become the “bread andbutter” of pediatric practice is equivalent to a priest’sdenying the infallibility of the pope.

Knowing that, I can only hope that you will keep anopen mind while I present my case. Much of what youhave been led to believe about immunizations simplyisn’t true. I not only have grave misgivings about them;if I were to follow my deep convictions in writing thischapter, I would urge you to reject all inoculations foryour child. I won’t do that, because parents in about halfthe states have lost the right to make that choice. Doc-tors, not politicians, have successfully lobbied for lawsthat force parents to immunize their children as a prereq-uisite for admission to school.

Even in those states, though, you may be able to per-suade your pediatrician to eliminate the pertussis(whooping cough) component from the DPT vaccine.

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This immunization, which appears to be the most threat-ening of them all, is the subject of so much controversythat many doctors are becoming nervous about giving it,fearing malpractice suits. They should be nervous, be-cause in a recent Chicago case a child damaged by apertussis inoculation received a $3.3 million settlementaward. If your doctor is in that state of mind, exploit hisfear, because your child’s health is at stake.

Although I administered them myself during my earlyyears of practice, I have become a steadfast opponent ofmass inoculations because of the myriad hazards theypresent. The subject is so vast and complex that it de-serves a book of its own. Consequently, I must be con-tent here with summarizing my objections to the fanaticzeal with which pediatricians blindly shoot foreign pro-teins into the body of your child without knowing whateventual damage they may cause.

Here is the core of my concern:

1. There is no convincing scientific evidence thatmass inoculations can be credited with eliminating anychildhood disease. While it is true that some once com-mon childhood diseases have diminished or disappearedsince inoculations were introduced. No one really knowswhy, although improved living conditions may be thereason. If immunizations were responsible for the disap-pearance of these diseases in the United States, onemust ask why they disappeared simultaneously in Eu-rope, where mass immunizations did not take place.

2. It is commonly believed that the Salk vaccine wasresponsible for halting the polio epidemics that plaguedAmerican children in the 1940s and 1950s. If so, why didthe epidemics also end in Europe, where polio vaccinewas not so extensively used? Of greater current rele-vance, why is the Sabin live virus vaccine still being ad-ministered tQ children when Dr. Jonas Salk, whopioneered the first vaccine, points out that Sabin vaccineis now causing most of the polio cases that appear. Con-

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tinuing to force this vaccine on children is irrational med-ical behavior that simply confirms my contention thatdoctors consistently repeat their mistakes. With thepolio vaccine we are witnessing a rerun of the medicalreluctance to abandon the smallpox vaccination, whichremained as the only source of smallpox-related deathsfor three decades after the disease had disappeared.

Think of it! For 30 years kids died from smallpox vac-cinations even though no longer threatened by the dis-ease.

3. There are significant risks associated with everyimmunization and numerous contraindications that maymake it dangerous for the shots to be given to your child.Yet doctors administer them routinely, usually withoutwarning parents of the hazards and without determiningwhether the immunization is contraindicated for thechild. No child should be immunized without makingthat determination, yet small armies of children are rou-tinely lined up in clinics to receive a shot in the arm withno questions asked!

4. While the myriad short-term hazards of most immu-nizations are known (but rarely explained), no one knowsthe long-term consequences of injecting foreign proteinsinto the body of your child. Even more shocking is thefact that no one is making any structured effort to findout.

5. There is a growing suspicion that immunizationagainst relatively harmless childhood diseases may beresponsible for the dramatic increase in autoimmunediseases since mass inoculations were introduced. Theseare fearful diseases such as cancer, leukemia, rheuma-toid arthritis, multiple sclerosis, Lou Gehrig’s disease,lupus erythematosus, and the Guillain-Barre syndrome.An autoimmune disease can be explained simply as onein which the body’s defense mechanisms cannot distin-guish between foreign invaders and ordinary body tis-sues, with the consequence that the body begins to

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destroy itself. Have we traded mumps and measles forcancer and leukemia?

I have emphasized these concerns because it is proba-ble that your pediatrician will not advise you about them.At the 1982 Forum of the American Academy of Pediat-rics (AAP), a resolution was proposed that would havehelped insure that parents would be informed about therisks and benefits of immunizations. The resolutionurged that the “AAP make available in clear, concise lan-guage information which a reasonable parent would wantto know about the benefits and risks of routine immuni-zations, the risks of vaccine preventable diseases and themanagement of common adverse reactions to immuniza-tions.” Apparently the doctors assembled did not believethat “reasonable parents” were entitled to this kind ofinformation because they rejected the resolution!

The bitter controversy over immunizations that isnow raging within the medical profession has notescaped the attention of the media. Increasing numbersof parents are rejecting immunizations for their childrenand facing the legal consequences of doing so. Parentswhose children have been permanently damaged by vac-cines are no longer accepting this as fate but are filingmalpractice suits against the manufacturers and the doc-tors who administered the vaccine. Some manufacturershave actually stopped making vaccines, and the lists ofcontraindications to their use are being expanded by theremaining manufacturers, year by year. Meanwhile, be-cause routine immunizations that bring patients back forrepeated office calls are the bread and butter of theirspecialty, pediatricians continue to defend them to thedeath.

The question parents should be asking is: Whosedeath?

As a parent, only you can decide whether to rejectimmunizations or risk accepting them for your child. Letme urge you, though—before your child is immunized—to arm yourself with the facts about the potential risks

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and benefits and demand that your pediatrician defendthe immunizations that he recommends.

I will deal more fully with each of the most commonlyadministered immunizations in subsequent discussionsof the diseases to which they are applied. If you decidethat you don’t want to have your child immunized, butyour state laws say you must, write to me, and I may beable to offer suggestions on how you can regain yourfreedom of choice.

I am not going to try to cover all of the more obscure,life-threatening diseases in this book. However, in theremaining pages of this chapter I will describe the mostcommon diseases, one or more of which may affect yourchild.

MUMPS

Mumps is a relatively innocuous viral disease, usuallyexperienced in childhood, which causes swelling of oneor both of the salivary glands (parotids), located justbelow and in front of the ears. Typical symptoms are atemperature of 100-104 degrees, appetite loss, head-ache, and back pain. The gland swelling usually begins todiminish after two or three days and is gone by the sixthor seventh day. However, one gland may become af-fected first, and the second as much as 10—12 dayslater. The infection of either side confers lifetime immu-nity.

Mumps does not require medical treatment. If yourchild contracts the disease, encourage him to stay in bedfor two or three days, feed him a soft diet and a lot offluids, and use ice packs to reduce the swelling. If hisheadache is severe, administer modest quantities ofwhiskey or acetaminophen. Give 10 drops of whiskey toa small baby and up to one-half teaspoon to a larger one.The dose can be repeated in one hour and once more inanother hour, if needed.

Most children are immunized against mumps along

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with measles and rubella in the MMR shot that is admin-istered at about 15 months of age. Pediatricians defendthis immunization with the argument that, althoughmumps is not a serious disease in children, if they do notgain immunity as children they may contract mumps asadults. In that event there is a possibility that adult malesmay contract orchitis, a condition in which the diseaseaffects the testicles. In rare instances this can producesterility.

If total sterility as a consequence of orchitis were asignificant threat, and if the mumps immunization as-sured adult males that they would not contract it, Iwould be among those doctors who urge immunization.I’m not, because their argument makes no sense. Or-chitis rarely causes sterility, and when it does, becauseonly one testicle is usually affected, the sperm produc-tion capacity of the unaffected testicle could repopulatethe world! And that's not all. No one knows whether themumps vaccination confers an immunity that lasts intothe adult years. Consequently, there is an open questionwhether, when your child is immunized against mumpsat 15 months and escapes this disease in childhood, hemay suffer more serious consequences when he con-tracts it as an adult.

If the mumps immunization is given to protect adultmales from orchitis, not to prevent children from gettingmumps, it would seem reasonable to administer it only tothose males who haven’t developed natural immunity bythe time they reach puberty. They would then be morecertain of protection as adults. All girls and countlessboys would thus avoid the potential consequences of ahazardous vaccine.

You won’t find pediatricians advertising them, but theside effects of the mumps vaccine can be severe. Insome children it causes allergic reactions such as rash,itching, and bruising. It may also expose them to theeffects of central nervous system involvement, includingfebrile seizures, unilateral nerve deafness, and encepha-litis. The risks are minimal, true, but why should your

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child endure them at all to avoid an innocuous disease inchildhood at the risk of contracting a more serious one asan adult?

MEASLES

Measles, also called rubeola or “English measles,” isa contagious viral disease that can be contracted bytouching an object used by an infected person. At theonset the victim feels tired, has a slight fever and painsin the head and back. His eyes redden and he may besensitive to light. The fever rises until about the third orfourth day, when it reaches 103-104 degrees. Sometimessmall white spots can be seen inside the mouth, and arash of small pink spots appears below the hairline andbehind the ears. This rash spreads downward to coverthe body in about 36 hours. The pink spots may run to-gether but fade away in about three or four days.Measles is contagious for seven or eight days, beginningthree or four days before the rash appears. Conse-quently, if one of your children contracts the disease, theothers probably will have been exposed to it before youknow the first child is sick.

No treatment is required for measles other than bedrest, .fluids to combat possible dehydration from fever,and calamine lotion or cornstarch baths to relieve theitching. If the child suffers from photophobia, the blindsin his bedroom should be lowered to darken the room.However, contrary to the popular myth, there is nodanger of permanent blindness from this disease.

A vaccine to prevent measles is another element ofthe MMR inoculation given in early childhood. Doctorsmaintain that the inoculation is necessary to preventmeasles encephalitis, which they say occurs about oncein 1,000 cases. After decades of experience withmeasles, I question this statistic, and so do many otherpediatricians. The incidence of 1/1000 may be accuratefor children who live in conditions of poverty and mal-

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nutrition, but in the middle- and upper-income brackets,if one excludes simple sleepiness from the measles itself,the incidence of true encephalitis is probably more like1/10,000 or 1/100,000.

After frightening you with the unlikely possibility ofmeasles encephalitis, your doctor can rarely be countedon to tell you of the dangers associated with the vaccinehe uses to prevent it. The measles vaccine is associatedwith encephalopathy and with a series of other compli-cations such as SSPE (subacute sclerosing panencepha-litis), which causes hardening of the brain and isinvariably fatal.

Other neurologic and sometimes fatal conditions as-sociated with the measles vaccine include ataxia (in-ability to coordinate muscle movements), mentalretardation, aseptic meningitis, seizure disorders, andhemiparesis (paralysis affecting one side of the body).Secondary complications associated with the vaccinemay be even more frightening. They include encephali-tis, subacute sclerosing panencephalitis, multiple sclero-sis, toxic epidermal necrolysis, anaphylactic shock,Reye’s syndrome, Guillain-Barre syndrome, blood clot-ting disorders, juvenile-onset diabetes, and even a rela-tionship with Hodgkin’s disease and cancer.

I would consider the risks associated with measlesvaccination unacceptable even if there were convincingevidence that the vaccine works. There isn’t. Whilethere has been a decline in the incidence of the disease,it began long before the vaccine was introduced. In 1958there were about 800,000 cases of measles in the UnitedStates, but by 1962—the year before a vaccine appeared—the number of cases had dropped by 300,000. Duringthe next four years, while children were being vaccin-ated with an ineffective and now abandoned “killervirus” vaccine, the number of cases dropped another300,000. In 1900 there were 13.3 measles deaths per100,000 population. By 1955, before the first measlesshot, the death rate had declined 97.7 percent to only0.03 deaths per 100,000.

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Those numbers alone are dramatic evidence thatmeasles was disappearing before the vaccine was intro-duced. If you fail to find them sufficiently convincing,consider this: in a 1978 survey of 30 states, more thanhalf of the children who contracted measles had beenadequately vaccinated. Moreover, according to theWorld Health Organization, the chances are about 15times greater that measles will be contracted by thosevaccinated for them than by those who are not.

“Why,” you may ask, “in the face of these facts, dodoctors continue to give the shots?” The answer may liein an episode that occurred in California 14 years afterthe measles vaccine was introduced. Los Angeles suf-fered a severe measles epidemic during that year, andparents were urged to vaccinate all children six months.of age and older—despite a Public Health warning thatvaccinating children below the age of one year was use-less and potentially harmful.

Although Los Angeles doctors responded by routinelyshooting measles vaccine into every kid they could gettheir hands on, several local physicians familiar with thesuspected problems of immunologic failure and “slowvirus” dangers chose not to vaccinate their own infantchildren. Unlike their patients, who weren’t told, theyrealized that “slow viruses” found in all live vaccines,and particularly in the measles vaccine, can hide inhuman tissue for years. They may emerge later in theform of encephalitis, multiple sclerosis, and as potentialseeds for the development and growth of cancer.

One Los Angeles physician who refused to vaccinatehis own 7-month-old-baby said: “I’m worried about whathappens when the vaccine virus may not only offer littleprotection against measles but may also stay around inthe body, working in a way we don’t know much about.”His concern about the possibility of these consequencesfor his own child, however, did not cause him to stopvaccinating his infant patients. He rationalized this con-tradictory behavior with the comment that “As a parent,

I have the luxury of making a choice for my child. As a

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physician... legally and professionally I have to acceptthe recommendations of the profession, which is whatwe also had to do with the whole Swine flu-business.”

Perhaps it is time that lay parents and their childrenare granted the same luxury that doctors and their chil-dren enjoy.

RUBELLA

Commonly known as “German measles,” rubella is anon-threatening disease in children that does not requiremedical treatment. The initial symptoms are fever and aslight cold, accompanied by a sore throat. You know it issomething more when a rash appears on the face andscalp and spreads to the arms and body. The spots do notrun together as they do with measles, and they usuallyfade away after two or three days. The victim should beencouraged to rest and be given adequate fluids, but noother treatment is needed.

The threat posed by rubella is the possibility that itmay cause damage to the fetus if a woman contracts thedisease during the first trimester of pregnancy. This fearis used to justify the immunization of all children, boysand girls, as part of the MMR inoculation. The merits ofthis vaccine are questionable for essentially the samereasons that apply to mumps inoculations. There is noneed to protect children from this harmless disease, sothe adverse reactions to the vaccine are unacceptable interms of benefit to the child. They can include arthritis,arthralgia (painful joints), and polyneuritis, which pro-duces pain, numbness, or tingling in the peripheralnerves. While these symptoms are usually temporary,they may last for several months and may not occur untilas long as two months after the vaccination. Because ofthat time lapse, parents may not identify the cause whenthese symptoms appear in their vaccinated child.

The greater danger of rubella vaccination is the possi-bility that it may deny expectant mothers the protection

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of natural immunity from the disease. By preventing ru-bella in childhood, immunization may actually increasethe threat that women will contract rubella during theirchildbearing years. My concern on this score is sharedby many other doctors. In Connecticut a group of doc-tors, led by two eminent epidemiologists, have actuallysucceeded in getting rubella stricken from the list of le-gally required immunizations.

Study after study has demonstrated that many womenimmunized against rubella as children lack evidence ofimmunity in blood tests given during their adolescentyears. Other tests have shown a high vaccine failure ratein children given rubella, measles, and mumps shots, ei-ther separately or in combined form. Finally, the crucialquestion yet to be answered is whether vaccine-inducedimmunity is as effective and long-lasting as immunityfrom the natural disease of rubella. A large proportion ofchildren show no evidence of immunity in blood testsgiven only four or five years after rubella vaccination.

The significance of this is both obvious and frighten-ing. Rubella is a nonthreatening disease in childhood,and it confers natural immunity to those who contract itso they will not get it again as adults. Prior to the timethat doctors began giving rubella vaccinations an esti-mated 85 percent of adults were naturally immune to thedisease.

Today, because of immunization, the vast majority ofwomen never acquire natural immunity. If their vaccine-induced immunity wears off, they may contract rubellawhile they are pregnant, with resulting damage to theirunborn children.

Being a skeptical soul, I have always believed that themost reliable way to determine what people really be-lieve is to observe what they do, not what they say. If thegreatest threat of rubella is not to children, but to thefetus yet unborn, pregnant women should be protectedagainst rubella by making certain that their obstetricianswon’t give them the disease. Yet, in a California surveyreported in the Journal of the American Medical

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Association, more than 90 percent of the obstetrician-gynecologists refused to be vaccinated. If doctors them-selves are afraid of the vaccine, why on earth should thelaw require that you and other parents allow them toadminister it to your kids?

WHOOPING COUGH

Whooping cough (pertussis) is an extremely conta-gious bacterial disease that is usually transmittedthrough the air by an infected person. The incubationperiod is 7-14 days. The initial symptoms are indistin-guishable from those of a common cold: a runny nose,sneezing, listlessness and loss of appetite, some tearingin the eyes, and sometimes a mild fever.

As the disease progresses, the victim develops a se-vere cough at night. Later it appears during the day, aswell. Within a week to 10 days after the first symptomsappear the cough will become paroxysmal. The childmay cough a dozen times with each breath, and his facemay darken to a bluish or purple hue. Each coughingbout ends with a whooping intake of breath, which ac-counts for the popular name for the disease. Vomiting isoften an additional symptom of the disease.

Whooping cough can strike within any age group, butmore than half of all victims are below two years of age.It can be serious and even life-threatening, particularlyin infants. Infected persons can transmit the disease toothers for about a month after the appearance of the ini-tial symptoms, so it is important that they be isolated,especially from other children.

If your child contracts whooping cough, there is nospecific treatment that your doctor can provide, nor isthere any you can apply at home, other than to encour-age your child to rest and to provide comfort and conso-lation. Cough suppressants are sometimes used, but theyrarely help very much and I don’t recommend them.However, if an infant contracts the disease, you should

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consult a doctor because hospital care may be required.The primary threats to babies are exhaustion fromcoughing and pneumonia. Very young infants have evenbeen known to suffer cracked ribs from the severecoughing bouts.

Immunization against pertussis is given along withvaccines for diphtheria and tetanus in the DPT inocula-tion. Although the vaccine has been used for decades, itis one of the most controversial of immunizations.Doubts persist about its effectiveness, and many doctorsshare my concern that the potentially damaging side ef-fects of the vaccine may outweigh the alleged benefits.

Dr. Gordon T. Stewart, head of the department ofcommunity medicine at the University of Glasgow, Scot-land, is one of the most vigorous critics of the pertussisvaccine. He says he supported the inoculation before1974 but then began to observe outbreaks of pertussis inchildren who had been vaccinated. “Now, in Glasgow,”he says, “30 percent of our whooping cough cases areoccurring in vaccinated patients. This leads me to be-lieve that the vaccine is not all that protective.”

As in the case with other infectious diseases, mortal-ity had begun to decline before the vaccine became avail-able. The vaccine was not introduced until about 1936,but mortality from the disease had already been declin-ing steadily since 1900 or earlier. According to Stewart,“the decline in pertussis mortality was 80 percent beforethe vaccine was ever used.” He shares my view that thekey factor in controlling whooping cough is probably notthe vaccine but improvement in the living conditions ofpotential victims.

Others in the profession do not deal kindly with doc-tors who raise questions about their cherished vaccines.In' 1982 I appeared in a one-hour NBC television docu-mentary devoted to the pertussis vaccine controversyand commented that “the danger [from the vaccine] is fargreater than any doctors here have ever been willing toadmit.” In July 1982, the Journal of the American Medi-cal Association, in a bitter attack on the program.

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charged that the network chose dubious ‘experts’ tobadmouth the vaccine and endowed them with false cre-dentials.” It then proceeded to attack my credentials.

I don’t feel any compulsion to defend myself from theAmerican Medical Association which, over the years,has had to spend an inordinate portion of its budget in itsown self-defense. It is instructive, however, to read whatthat same issue of the AMA Journal had to say about therisks of pertussis vaccine. I’ll cite what they had to sayand let you judge whether it is inappropriate for me toraise questions about its use. For starters, JAMA saidthis:

To health professionals, of course, the dangersof DPT are nothing new. The D and T components,which were given long before the P was added inthe late 1940s, are partially purified toxoids consid-ered to cany little risk. The whole-cell P compo-nent, consisting of 4 units of protective pertussisantigen per 0.5 ml of DPT is universally acknowl-edged to be relatively crude and toxic, and the ad-vent of a safer version is eagerly awaited (italicsmine).

Almost from the inception of widespread DPTimmunization, severe reactions have been re-ported, beginning with Byers’s and Moll’s study ofvaccine-associated encephalopathy in 1948. Theincidence of such reactions has not been firmly es-tablished. It does seem fairly certain that vaccine-associated seizures, unusual as they are, areconsiderably more common than brain damage orresidual impairment secondary to such seizures.

It is obvious from this statement that the AmericanMedical Association does not deny that pertussis vac-cine is hazardous, with the potential of frightening sideeffects. Their concern is over the fact that media atten-tion is making the recipients of the vaccine aware of therisks!

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If it is improper for a doctor to share with his patientshis knowledge of the risks of immunization, I pleadguilty to the charge. The common side effects of the per-tussis vaccine, acknowledged by JAMA, are fever, cry-ing bouts, a shocklike state, and local skin effects suchas swelling, redness, and pain. Less frequent but moreserious side effects include convulsions and permanentbrain damage resulting in mental retardation. The vac-cine has also been linked to Sudden Infant Death Syn-drome (SIDS). In 1978-79, during an expansion of theTennessee childhood immunization program, eight casesof SIDS were reported immediately following routineDPT immunization.

Estimates of the number of those vaccinated with thepertussis vaccine who are protected from the diseaserange from 50 percent to 80 percent. According toJAMA, reported cases of whooping cough in the UnitedStates total an average of 1,000-3,000 per year anddeaths 5-20 per year.

My question is: Does it make sense to expose millionsof children each year to the potential hazards of the vac-cine in order to provide them with dubious protectionagainst a disease that is so rarely seen?

DIPHTHERIA

Although it was one of the most feared of childhooddiseases in grandma’s day, diphtheria has now almostdisappeared. Only five cases were reported in the UnitedStates in 1980. Most doctors insist that the decline is dueto immunization with the DPT vaccine, but there isample evidence that the incidence of diphtheria was al-ready diminishing before a vaccine became available.

Diphtheria is a highly contagious bacterial diseasethat is spread by the coughing and sneezing of infectedpersons or by handling items that they have touched.The incubation period for the disease is two to fi ve days,and the first symptoms are a sore throat, headache, nau-

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sea, coughing, and a fever of 100-104 degrees. As thedisease progresses, dirty-white patches can be observedon the tonsils and in the throat. They cause swelling inthe throat and lamyx that makes swallowing difficultand, in severe cases, may obstruct breathing to the pointthat the victim chokes to death. The disease requiresmedical attention and can be treated with antibioticssuch as penicillin or erythromycin.

Today your child has about as much chance of con-tracting diphtheria as he does of being bitten by a cobra.Yet millions of children are immunized against it withrepeated injections at 2, 4, 6 and 18 months and thengiven a booster shot when they enter school. This de-spite evidence over more than a dozen years from rareoutbreaks of the disease that children who have beenimmunized fare no better than those who have not. Dur-ing a 1969 outbreak of diphtheria in Chicago the cityboard of health reported that 4 of the 16 victims had beenfully immunized against the disease and 5 others had re-ceived one or more doses of the vaccine. Two of thelatter showed evidence of full immunity. A report on an-other outbreak in which three people died revealed thatone of the fatal cases and 14 of 23 carriers had been fullyimmunized.

Episodes such as these shatter the argument that im-munization can be credited with eliminating diphtheria orany of the other once common childhood diseases. Ifimmunization deserved the credit, how do its defendersexplain this? Only about half the states have legalrequirements for immunization against infectious dis-eases, and the percentage of children immunized variesfrom state to state. As a consequence, tens of thousands—perhaps millions—of children in areas where medicalservices are limited and pediatricians almost nonexistentwere never immunized against infectious diseases andtherefore should be vulnerable to them. Yet the inci-dence of infectious diseases does not correlate in anyrespect with whether a state has legally mandated massimmunization or not.

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In view of the rarity of the disease, the effective anti-biotic treatment now available, the questionable effec-tiveness of the vaccine, the multimillion-dollar annualcost of administering it, and the ever-present potentialfor harmful, long-term effects from this or any other vac-cine, I consider continued mass immunization againstdiphtheria indefensible. I grant that no significant harm-ful effects from the vaccine have been identified, but thatdoesn’t mean they aren’t there. In the half-century thatthe vaccine has been used no research has ever beenundertaken to determine what the long-term effects ofthe vaccine may be!

CHICKEN POX

This is my favorite childhood disease, first because itis relatively innocuous and second because it is one ofthe few for which no pharmaceutical manufacturer hasyet marketed a vaccine. That second reason may beshort-lived, though, because as this is written there arereports that a chicken pox vaccine soon may appear.

Chicken pox is a communicable viral infection that isvery common in children. The first signs of the diseaseare usually a slight fever, headache, backache, and lossof appetite.

After a day or two, small red spots appear, and withina few hours they enlarge and become blisters. Ultimatelya scab forms that peels off, usually within a week or two.This process is accompanied by severe itching, and thechild should be encouraged not to scratch the sores. Ca-lamine lotion may be applied, or cornstarch baths given,to relieve the itching.

It is not necessary to seek medical treatment forchicken pox. The patient should be encouraged to restand to drink a lot of fluids to prevent dehydration fromthe fever.

The incubation period for chicken pox is from two tothree weeks, and the disease is contagious for about two

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weeks, beginning two days after the rash appears. Thechild should be isolated during this period to avoidspreading the disease to others.

SCARLET FEVER

Scarlet fever is another example of a once feared dis-ease that has virtually disappeared. If a vaccine had everbeen developed for it, doctors would undoubtedly creditthat with the elimination of the disease. Since there is novaccine, they give the credit to penicillin, despite the factthat the disease was already disappearing before the firstantibiotics appeared. In all probability, as with other dis-eases, the true reason for its waning incidence is im-proved living conditions and better nutrition.

The disease got its name from the red rash that coversthe body of victims. It is caused by a streptococcus in-fection, and the initial symptoms are vomiting, head-ache, a swelling of the lymph nodes in the neck, and afever of 101-105 degrees. The disease usually affectschildren between the ages of two and eight, and the rashthat accompanies it fades in about a week. If your childcontracts scarlet fever, which is most unlikely, you neednot be alarmed because it is no more dangerous than astrep throat infection. It will disappear by itself, but ifyou take your child to a doctor, he is likely to prescribean antibiotic that your child really doesn’t need.

MENINGITIS

One of the appalling inconsistencies of contemporarymedical practice is the tendency of doctors to overtreatthe diseases that don’t require treatment, and miss thediagnosis in diseases like meningitis that deserve all ofthe skill they have to offer. This disease is an inflamma-tion of the membranes that cover the brain and. the spinalcord, called the meninges. The symptoms may include a

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stiff neck (but not necessarily), a persistent headache,vomiting, fever, and convulsions in infants. Bacterial,viral, and fungal infections can cause the disease. One ofthe bacterial types is particularly contagious because thebacteria are found in the throat as well as in the cerebro-spinal fluid.

Meningitis is amenable to treatment, but early diag-nosis is essential. Doctors often miss the diagnosis be-cause they fail to take the mother seriously when shereports significant changes in her child’s behavior. Manyalso fail to give serious consideration to the possibility ofmeningitis unless the child has a stiff neck.

Potential consequences of failure to diagnose andtreat meningitis properly are mental retardation anddeath. If your child has an unexplained fever for three orfour days, accompanied by drowsiness, vomiting, a shrillcry, and possibly a stiff neck, it is time to suspect menin-gitis. Some of these symptoms are also present with in-fluenza. You can distinguish meningitis by the last two,particularly the shrill cry. If your child has this, insistthat your doctor perform the appropriate tests, whichmay include a spinal tap. In that event, if he doesn’t findthe spinal canal on the first or second attempt, tell him tostop trying and call another doctor.

Antibiotics have reduced mortality from this dreaddisease from 95 percent to 5 percent. That’s why correct,early diagnosis of the disease is a matter of life or death.

TUBERCULOSIS

Parents should have the right to assume, and most doassume, that the tests their doctor gives their child willproduce an accurate result. The tuberculin skin test isbut one example of a medical test procedure in whichthat is definitely not the case. Even the American Acad-emy of Pediatrics, which rarely has anything negative tosay about procedures that its members routinely employ,

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has issued a policy statement that is critical of this test.According to the statement.

Several recent studies have cast doubt on thesensitivity of some screening tests for tuberculosis.Indeed a panel assembled by the Bureau of Bio-logies has recommended to manufacturers thateach lot be tested in 50 known positive patients toassure that preparations that are marketed are po-tent enough to identify everyone with active tuber-culosis. However, since many of these studieshave not been conducted in a randomized, double-blind fashion and/or have included many simul-taneously administered skin tests (thus thepossibility of suppression of reactions), interpreta-tion of the tests is difficult.

The statement concludes, “Screening tests for tuber-culosis are not perfect, and physicians must be aware ofthe possibility that some false negative as well as posi-tive reactions may be obtained.”

In short, your child may have tuberculosis, eventhough there is a negative reading on his tuberculin test.Or he may not have it but display a positive skin test thatsays he does. With many doctors, this can lead to somedevastating consequences. Almost certainly, if this hap-pens to your child, he will be exposed to needless andhazardous radiation from one or more x-rays of hischest. The doctor may then place him on dangerousdrugs such as isoniazid for months or years “to preventthe development of tuberculosis.” Even the AMA hasrecognized that doctors have indiscriminately overpre-scribed isoniazid. That’s shameful, because of the drug’slong list of side effects on the nervous system, gastroin-testinal system, blood, bone marrow, skin, and endo-crine glands. Also not to be overlooked is the danger thatyour child may become a pariah in your neighborhoodbecause of the lingering fear of this infectious disease.

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I am convinced that the potential consequences of apositive tuberculin skin test are more dangerous than thethreat of the disease. I believe parents should reject thetest unless they have specific knowledge that their childhas been in contact with someone who has the disease.

SUDDEN INFANT DEATHSYNDROME (SIDS)

The dreadful possibility that they may awaken somemorning to find their baby dead in his crib is a fear thatlurks in the minds of many parents. Medical science hasyet to pinpoint the cause of SIDS, but the most popularexplanation among researchers appears to be that thecentral nervous system is somehow affected so that theinvoluntary act of breathing is suppressed.

That is a logical explanation, but it leaves unansweredthe question: What caused the malfunction in the centralnervous system? My suspicion, which is shared byothers in my profession, is that the nearly 10,000 SIDSdeaths that occur in the United States each year are re-lated to one or more of the vaccines that are routinelygiven children. The pertussis vaccine is the most likelyvillain, but it could also be one or more of the others.

Dr. William Torch, of the University of NevadaSchool of Medicine at Reno, has issued a report suggest-ing that the DPT shot may be responsible for SIDScases. He found that two-thirds of 103 children who diedof SIDS had been immunized with DPT vaccine in thethree weeks before their deaths, many dying within a dayafter getting the shot. He asserts that this was not merecoincidence, concluding that a “causal relationship issuggested” in at least some cases of DPT vaccine andcrib death. Also on record are the Tennessee deaths, re-ferred to earlier. In that case the manufacturer of thevaccine, following intervention by the U.S. surgeon gen-eral, recalled all unused doses of this batch of vaccine.

More recently, in 1983, the department of pediatrics

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of the UCLA School of Medicine and the Los AngelesCounty health department reported another disturbingstudy of 145 SIDS victims. Of this number, 53 had re-ceived DPT immunizations in close proximity to theirdeaths. Twenty-seven died within 28 days of being im-munized, 17 of those within a week after receiving theDPT shot, and six within 24 hours of receiving it. Theresearchers concluded that these findings “further sub-stantiate a possible association” between DPT shots andSIDS.

Expectant mothers who are concerned about SIDSshould bear in mind the importance of breastfeeding toavoid this and other serious ailments. There is evidencethat breastfed babies are less susceptible to allergies,respiratory disease, gastroenteritis, hypocalcemia,obesity, multiple sclerosis, and SIDS. One study of thescientific literature about SIDS concluded that “Breast-feeding can be seen as a common block to the myriad ofpathways to SIDS.”

POLIOMYELITIS

No one who lived through the 1940s and saw photosof children in iron lungs, saw a President of the UnitedStates confined to his wheelchair by this dread disease,and was forbidden to use public beaches for fear ofcatching polio can forget the fear that prevailed at thetime. Polio is virtually nonexistent today, but much ofthat fear persists, and there is a popular belief that immu-nization can be credited with eliminating the disease.That’s not surprising, considering the high-poweredcampaign that promoted the vaccine, but the fact is thatno credible scientific evidence exists that the vaccinecaused polio to disappear. As noted earlier, it also disap-peared in other parts of the world where the vaccine wasnot so extensively used.

What is important to parents of this generation is theevidence that points to mass inoculation against polio as

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the cause of most remaining cases of the disease. In Sep-tember 1977 Jonas Salk, the developer of the killed poliovirus vaccine, testified along with other scientists to thateffect. He said that most of the handful of polio caseswhich had occurred in the U.S. since the early 1970sprobably were the by-product of the live polio vaccinethat is in standard use in the United States. In Finlandand Sweden there have been no cases of polio in morethan a decade, but in those countries the killed virusvaccine is used almost exclusively.

Meanwhile, there is an ongoing debate among the im-munologists regarding the relative risks of killed virusvs. live virus vaccine. Supporters of the killed virus vac-cine maintain that it is the presence of live virus organ-isms in the other product that is responsible for the poliocases that occasionally appear. Supporters of the livevirus type argue that the killed virus vaccine offers inad-equate protection and actually increases the susceptibil-ity of those vaccinated to the disease.

This affords me a rare opportunity to be comfortablyneutral. I believe that both factions are right and that useof either of the vaccines will increase, not diminish, thepossibility that your child will contract the disease.

In short, it appears that the most effective way toprotect your child from polio is to make sure that hedoesn’t get the vaccine!

INFECTIOUS MONONUCLEOSIS

The symptoms of infectious mononucleosis resemblethose of the common cold or influenza, so in its earlystages it is not likely to be suspected or diagnosed. Itusually affects children and young adults, and if yourchild is the victim, he will display fever, swollen glands,a sore throat, weakness, and fatigue. As the disease pro-gresses, the symptoms may also include abdominal pain,nausea, headaches, chest pain, coughing, and severalother less common symptoms.

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If your child has these symptoms and they persistbeyond the normal course of a common cold, he shouldsee a doctor. If the doctor suspects mononucleosis, hewill probably order a blood test, which will usually, al-though not always, determine whether mononucleosis ispresent. The disease usually runs its course in one tothree weeks, but in extreme cases it may persist forweeks or even months.

The fact that mononucleosis, in its early stages, can-not be distinguished from other ailments such as thecommon cold need not concern you because there is nospecific drug treatment for the disease. The treatment iswhat you would be giving your child in any event—bedrest and liberal fluids. Some doctors prescribe adrenalsteroids such as prednisone for mononucleosis, but I be-lieve they should be avoided except in extreme cases ofthe disease. They have serious side effects, as describedin Chapter 17.

20

Hospitals:

Where Patients Goto Get Sick!

Througbout Ibis book I have tried to help you identifyillnesses that require medical treatment and to alert youto forms of treatment that may be more dangerous thanthe disease that is being treated. One final admonition isrequired: Don’t allow your child to be admitted to a hos-pital unless his condition is so serious that his life is indanger.

Relatively few childhood ailments require hospitaliza-tion, but many children are hospitalized needlessly sim-ply because it is more convenient (and more profitable)for their doctor. Most illnesses and accidental injuriescan be treated as effectively in the emergency room, adoctor’s office, or an outpatient clinic, without hospital-ization, and your child will usually receive better, safercare at home.

There are two major categories of disease that areunique to those who seek medical treatment and particu-larly to those who are hospitalized as a result. You maynever have heard of either of them, because their namesare rarely used by doctors in the presence of their pa-tients. Why? Because iatrogenic is the term applied toillnesses and injuries caused by doctors, and nosocomialis the term used to describe infections acquired by pa-tients after they enter a hospital Both constitute majorthreats to your child if you permit him to be hospitalized.

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About 2 million Americans are admitted to hospitalseach year for the treatment of one ailment and end upwith another. The illnesses they acquire in the hospitalprove to be fatal to as many as 20,000 of them. Thenumber who contract nosocomial illnesses equals about5 percent of hospital admissions. In other words, if yourchild enters the hospital with one disease, the chancesare 1 in 20 that he will contract another one before he isreleased. Moreover, there is a real possibility that beforehe is released the disease he acquired in the hospital maykill him. If his admission to the hospital was for a life-threatening condition, that may be an acceptable risk,but if his admission was not essential, it is certainly arisk your child should avoid.

These risks are rarely revealed in publications thatpatients read, but doctors are well aware of them fromreports published in their medical journals. One such re-port in the Journal of the American Medical Associationin 1978 had this to say about the mortality and cost ofnosocomial infections:

Hospital patients with nosocomial bacteremia[bacterial blood infections] and matched hospitalcontrol patients without this infection were used todetermine the excess hospital costs and mortalityattributed to nosocomial bacteremias. Mortalitywas 14 times greater in patients with nosocomialbacteremia than in matched numbers of the controlgroup with the same primary diagnoses. An item-ized cost analysis, based on 81 case-control pairs,showed an average excess of approximately $3,600in direct hospital costs for patients who had noso-comial bacteremias.

The hospital-acquired infections caused the averagepatient to remain in the hospital for 14 additional days.At today’s skyrocketing daily hospital rates, that $3,600figure would probably be doubled or tripled.

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RESPIRATORY ILLNESSESCONTRACTED IN HOSPITALS

A study done six years ago in a hospital pediatricward revealed that one-sixth of the children at risk ac-quired respiratory illnesses while in the hospital. Therehave also been countless instances of epidemic diseaseamong hospitalized children. In 1979, for example, twochildren died and three others suffered permanent paral-ysis or brain damage during an outbreak of meningitis ina Florida hospital nursery. In the Florida epidemic, andin most of the others, the outbreak was traced to thefailure of medical personnel to wash their handsl

It is well over a century since a Hungarian physician,Ignaz Semmelweis, discovered that deaths from “child-birth fever” resulted from the failure of medical studentsto wash their hands. His findings were generally rejectedby others in his profession, and he was driven into ob-scurity, finally to die in an asylum—presumably of ahospital-caused infection. Apparently medical personnelare slow learners, because many of them still haven’tgotten his message today.

In 1981 a study was conducted for more than twomonths in the intensive care units of a private hospitaland a university-affiliated teaching hospital. Researchersobserved the hand-washing habits of doctors, nurses,and other medical personnel. The medical personnelwashed up between patients only 41 percent of the timein the teaching hospital and only 28 percent of the time inthe private hospital. Doctors were the worst offenders.They washed their hands only 28 percent of the time inthe teaching hospital and 14 percent of the time in theprivate hospital.

I’m dwelling on this because I want to disabuse you ofthe notion—held by most people—that a hospital is ahygienic, virtually sterile sanctuary for your child. Infact, as the studies indicate, the sanitary practices of themedical personnel are often abominable, and the hospital

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itself is probably the most germ-laden facility in town. Ifyou can’t avoid it, you can at least be forewarned anddemand that appropriate sanitary precautions be takenfor your child.

The threat of iatrogenic illness also mounts in the hos-pital, because doctors are so strongly motivated by in-stinct, training, and unwarranted fear of malpracticesuits to employ all of the medical technology available tothem, even when it is of dubious value in diagnosis andtreatment. Everything your doctor does presents anadded risk for your child. Every needle he inserts makesa new pathway into the body for infectious organisms;every drug he administers yields the possibility of harm-ful side effects; every X-ray he orders holds the possibil-ity of causing radiation-induced damage to your child inhis later years.

Countless studies have shown that iatrogenic illnesscontracted in hospitals is not an isolated phenomenon. Inone such study 815 consecutive patients in the generalmedical service of a university hospital were evaluated.More than a third of them—36 percent—were found tohave a disease condition caused by something done tothem by a physician. A total of 165 patients had onephysician-caused condition, and 125 of them had fromtwo to seven iatrogenic conditions. These included heartand lung complications, infections or inflammation, gas-trointestinal problems, nerve damage, allergic reactions,bleeding, and metabolic complications.

For at least two decades other studies have reportedsimilar results. In 1963 a study of 1,000 patients admittedto a university hospital during an eight-month period re-vealed that 20 percent of them had acquired an iatrogenicdisease during their stay. Fifty-one percent of the victimshad complications due to the administration of drugs,and 24 percent were the aftermaths of diagnostic or ther-apeutic procedures. Illnesses related to preexisting com-plications, nursing errors, and the untoward effects ofsurgery were excluded from the study, or the numberswould have been even more shocking.

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EMOTIONAL IMPACT OFHOSPITALIZATION

The hazards of hospitalization for the young child arenot limited to the physical risks. There may be damagingpsychological and emotional consequences as well. For ayoungster, mere separation from his mother and familyfor any period of time can be a traumatic experience.When that separation is associated with the awesome at-mosphere of the hospital setting, the experience is al-most inevitably a frightening one for a child.

The emotional and psychological damage from suchan experience is not always transient. The possibility oflong-term effects is substantial, as was noted in Pediat-rics, the Journal of the American Academy of Pediatricsin November 1979:

When a young child must be hospitalized, theeffects of the experience can be very detrimental.Several studies have indicated that these effectsmay evidence themselves as behavior distur-bances, regressed development, retarded recovery,and the like. Two studies from Britain providestriking evidence that a hospital admission ofgreater than one week’s duration, or repeated shortadmissions before the age of five years, are asso-ciated with an increased incidence of behavior dis-turbances at age 10 years and into adolescence.

My intention in this chapter has been to alert you tothe risks your child will face if you permit him to beadmitted to a hospital. I also realize, though, that one ofthese days your pediatrician may insist on hospitalizingyour child, and you will need to know how to respond!What should you do if that day arrives?

First, demand that your doctor prove to your satisfac-tion that the things he plans to do in the hospital can’t bedone in his office, in an outpatient facility, or at home.

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Except in life-threatening situations, which may requiresophisticated medical monitoring around the clock, thereis virtually no diagnostic procedure that can’t be done onan outpatient basis and virtually no illness that can’t betreated by an informed parent at home.

Second, if the admission is for a surgical procedure,make certain that the surgery is really required and thatit can’t be provided on an outpatient basis, with theaftercare provided at home. As I have indicated in otherchapters, most of the surgery performed on children isunnecessary, and most of that which is indicated can beperformed safely and adequately without hospitalizingthe child. Why risk hospitalizing him for one ailment atthe risk of giving him another?

Third, if hospitalization is unavoidable, don’t permityour child to spend one hour there alone. When youcan’t be with him yourself, make certain that some otherfamiliar face and concerned observer is at hand. Famil-iarize yourself with the medications and treatments he issupposed to be given and watch the medical personnellike a hawk so they don’t make any mistakes. They’rehuman and fallible, and often harried, and it’s up to youto protect your child from the consequences of the pres-sure they're under. Don’t be intimidated by doctors ornurses. Demand information about the medications andtreatments your child is getting, ask about the risks andside effects, be alert to sanitation deficiencies, and per-sist in asking your doctor to release your child as soon aspossible.

Don’t worry about being regarded as a nuisance bythe hospital staff. That could be a useful reaction, be-cause it may make them eager to send your child home!

How to Selectthe Right Doctorfor Your Child

that you’re aware of the bazanis your childfaces if he receives unnecessary or inappropriate medicaltreatment, you may be wondering how you can find aconscientious pediatrician and thus minimize the risks.How can you identify one who will treat your child prop-erty when he needs treatment and tell you so candidlywhen he doesn’t?

That’s not an easy task, not so much because somedoctors may be unethical or incompetent, but because ofthe system within which they are educated and function.To summarize what I have said earlier, you must neverforget these points:

1. Doctors do what they have been trained to do. Al-though most childhood ailments will be cured by thebody’s own natural defenses, pediatricians are nottrained to allow nature to take its course. They aretrained to intervene, and all intervention is accompaniedby risks to your child.

2. Unlike conscientious mechanics, who “don’t fixwhat ain’t broke,” most doctors find it difficult to justifytheir fee for an office call if they tell you that your childdoesn’t need medical attention. They respond to per-ceived parental expectations by giving the child medicine

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that is not required or tests that are not indicated andthus expose him to the risks that accompany virtually alldrugs and many diagnostic procedures.

3. Although I’ve given it little attention in this book,doctors do have financial needs, particularly at the be-ginning of their careers, greater than those of almost anyother profession. Most of them embark on their medicalcareer heavily burdened with debt arising from theirenormous education expenses and the costs of outfittingan office and must carry heavy office overhead from thevery start. They have a strong, and in some cases irre-sistible, incentive to increase their income by providingservices that your child doesn’t need.

4. Increasingly, that incentive is compounded bygrowing competition within the medical profession. Doc-tors are emerging from the medical schools in recordnumbers, and in the areas in which most of them preferto practice the demand for physicians no longer equalsthe supply. Responsible medical authorities project asurplus of 7,500 pediatricians by 1990. In order to main-tain their incomes in the face of a dwindling supply ofpatients, doctors are impelled to increase the number ofservices provided to each of the patients who remains.This incentive will increase steadily in the years ahead.

This brings me back to the question I am most fre-quently asked: “How can I, as a concerned parent, selecta conscientious pediatrician who will provide effectivecare but not overtreat my child?”

That’s a perplexing question to which there is no patanswer. The standard advice given those seeking doctorsis to consult the local medical society. They will give youa list of conveniently located pediatricians, but it won’ttell you whether they are worth their salt, because theAMA does not measure the performance of its members.You will do as well by letting your fingers walk throughthe Yellow Pages.

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My suggestion is that you begin your search by askingseveral of your friends what pediatricians or group prac-tices they have used. Pick the one with whom a majorityof them have established a rapport. That won’t assureyou of getting a competent, caring pediatrician who isnot given to medical overkill, but it may improve theodds.

Once you have selected a doctor, observe closely hisbehavior during the time he spends with your child,keeping in mind what you have learned from this book.Here are the things you should watch for to determinewhether the pediatrician you have selected is the rightone for you.

1. Did he examine your child thoroughly and takea complete history during your first officevisit?

2. Does he elicit from you on this and succeedingvisits your observations about the physical andemotional condition of your child? That is avital part of the history that no competent pedi-atrician should overlook.

3. When he asks a question, does he listen towhat you have to say? Many doctors don’t.

4. Does he answer your questions willingly,thoughtfully, and thoroughly, or does he brushthem off and put you down?

5. Does he relate warmly to your child and winhis confidence and affection almost at once?

6. Does he always hand you a prescription, or ishe hon st enough to admit it when he knowsthat nothing needs to be done for your child?

7. Does he explain thoroughly the hazards andside effects of the medications and immuniza-tions that he prescribes?

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8. Are your visits treated as perfunctory pill-peddling exercises, or does he display a genuineinterest and counsel you on how to maintainthe health of your child?

9. When you ask a question does he ever havethe integrity to say, “I don’t know?”

10. Does he respond promptly when an emergencyrequires that you call him on the phone?

Consider yourself lucky if you find the right doctor onyour very first try. If the first pediatrician you visit fallsshort in any of the above respects, share your concernwith him. If you’ve found the right doctor, he’ll respectyour candor and try to respond to your needs. If youhaven’t, find another doctor and try again. Before youhave located the right one you may become as frustratedas Diogenes, but your child deserves any level of effortthat is necessary to secure the most competent medicalhelp that you can secure.

Don’t fad to bear in mind, though, that it is you, notyour doctor, who is the principal actor in. preserving thehealth of your child. The right doctor will be able to helphim when he is seriously ill, but you are the one with theopportunity and the responsibility to keep him well.

Author’s References

Chapter 3

The shortcomings of “well-baby visits” are discussedin a commentary by Robert A. Hoekelman, M.D., De-partment of Pediatrics, University of Rochester, and ref-erences he cites, in Pediatrics, December 1980.

Chapter 4

For further information on the hazards of malnutritionin pregnancy see What Every Pregnant Woman shouldKnow: The Truth About Diets and Pregnancy, by Gail S.Brewer and Tom Brewer, M.D., Random House, 1977.

Dr. Lewis Mehl’s study of the “Statistical Outcomesof Home Birth in the United States” will be found inSafe Alternatives in Childbirth, by David Stewart,Ph.D., NAPSAC, Marble Hill, MO, 1976.

Concerns about the safety and value of diagnostic ul-trasound are raised in Environmental Health Criteria Re-port No. 22, Ultrasound, published by the World HealthOrganization, Geneva, 1982. Also see the article, “SafeForm of Radiation Arouses New Worry,” by Philip M.Boflfey, The New York Times, August 2, 1983.

Chemical conjunctivitis in infants treated with silvernitrate is discussed in the Merck Manual, Nth edition,published by Merck, Sharp & Dohme.

The hazards and side effects of infant exposure to bili-rubin lights were reported in 1979 by James Sidbury,

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M.D., scientific director of the National Institute ofChild Health and Human Development, Bethesda, MD.They are also discussed in the Yearbook of Pediatrics,1977 and 1978, edited by Sydney S. Gellis, M.D.

The folly of exposing newborn babies to the risks ofhexachlorophene baths was revealed in an assessmentby N. M. Kanof, M.D., chairman of the American Medi-cal Association Committee on Cutaneous Health andCosmetics, in the Journal of the American Medical As-sociation (JAMA), 1972, Vol. 220, page 409: “There ap-pears to be no need to apply any antibacterial agent tothe cutaneous surface of the normal newborn infant.Contamination of nurseries can be controlled by the useof antibacterial agents on delivery room and equipmentand personnel—the sources of infection.” Another, rea-son to have your baby at home!

The value of routine administration of vitamin K tonewborn infants was discounted by Drs. J. M. VanDoorm, A. D. Muller, and H. C. Hemker in The Lancet,April 17, 1977: “We conclude that healthy babies, con-trary to current beliefs, are not likely to have vitamin Kdeficiency... the administration of vitamin K to thenewborn is not supported by our findings...”

The negative impact on breastfeeding of supplemen-tary feeding of formula in the hospital nursery is de-scribed by Waldo Nelson, M.D., in the Textbook ofPediatrics, 7th Edition, Page 117: “Too much emphasisis put on daily weight gains. If early supplemental milkfeedings are given to achieve this false goal, attempts atsuccessful breastfeeding are doomed to failure, since it isusually easier for the infant to get milk from a bottle thanfrom a breast.”

Many studies indicate that maternal skin contact im-mediately after birth is as effective or more effectivethan placing the newborn in a radiant warmer. They in-clude one by Hill and Shrank, Journal of Obstetrics,Sept./Oct. 1979, and another by J. Fardig, “A Compari-

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son of Skin to Skin Contact and Radiant Heaters inPromoting Neonatal Thermoregulation,” Journal ofNurse!Midwifery, Jan./Feb. 1980.

Chapter 5

Authorities who have noted the relationship betweeninfant obesity and bottle-feeding with infant formula in-clude Dr. Donald Naismith, a nutritionist at Queen Eliza-beth Hospital, London; Dr. David M. Paige, of the JohnsHopkins School of Medicine, and many others. The rela-tionship between infant and childhood obesity and adultobesity has also been extensively documented and wasdiscussed fully by Dr. Simeon Margolies at an “obesityupdate” presented by the Johns Hopkins faculty.

Data on optimal weight gain during pregnancy, and itsrole in maternal milk production, was discussed in theNew England Journal of Medicine, by Dr. George V.Mann, of Vanderbilt University, in 1974.

The incidence of malnutrition in hospitals has beenwidely reported in medical journals. Studies cited herewere reported by Dr. Mark Raifman, director of pediat-rics at Peninsula Hospital Center, Far Rockaway, N.Y.,and Mary Price-Moissand, assistant professor in medicaldietetics at the University of Illinois, at the annual meet-ing of the American Public Health Association.

Chapter 7

For further information on febrile convulsions see anarticle by Barton D. Schmitt, M.D., American Journal ofDiseases of Children, February 1980, and “Prognosis inChildren with Febrile Seizures,” by Karin B. Nelson andJonas H. Ellenberg, Pediatrics, May, 1978.

For a discussion of the consequences of long-termdrug therapy to avoid febrile seizures see “Maintenanceof Drug Therapy,” by* Dr. Samuel Livingston, et al, Pedi-atric Annals, April, 1979.

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Chapter 10

“Antibiotic Use at Duke University Medical Center,”a report on indiscriminate use of antibiotics in a hospital,by Mary Castle, RN, MPH, Catherine M. Wilfet, M.D.,Thomas R. Cate, M.D., and Suydan Osterhout, M.D.,was published in JAMA, June 27, 1977. It is but one ofmany similar studies at various hospitals throughout thecountry.

Further information on the “Misuse of Antibiotics forTreatment of Upper Respiratory Infections in Children”is contained in a report of the Clinical PharmacologyUnit, University of Vermont College of Medicine, pub-lished in Pediatrics for the Clinician, 1975. The inci-dence of side effects is also reported.

Chapter 11

The presence of streptococcal bacteria in the throatsof 20 percent of school children is documented on page246 of the 1982 report of the Committee on InfectiousDiseases of the American Academy of Pediatrics.

Chapter 12

A critical study of the use of antibiotics and tympan-ostomy for treatment of ear infections was published inThe Lancet, October 24, 1981. It reports on a double-blind study conducted by three Dutch physicians, F. L.Van Buchem, J. H. M. Dunk, and M. A. Van’t Hof.

A study of the hazards of indiscriminate use of tym-panostomy tubes for treatment of ear infection was re-ported in the British Medical Journal in 1981.

Chapter 13

The data on inappropriate prescribing of glasses forchildren and other deficiencies in pediatric care will befound in Assessment of Medical Care for Children: Con-trasts in Health Status, Vol. 3, by David M. Kessner,

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Carolyn Kalk Snow, and James Singer, Institute of Medi-cine, National Academy of Sciences, 1974.

Chapter 14

The disappointing results from dermabrasion treat-ment of acne scarring were reported by M. Spira, BaylorUniversity College of Medicine, in Plastic and Recon-struction Surgery, July, 1977.

The statistical incidence of side effects from Accutanewas reported in the FDA Drug Bulletin, July, 1983.

Chapter 15

The data on needless expenditures for shoes and theassertion that inexpensive canvas sneakers are adequateas basic shoes is from a report by Dr. Jeffrey Weiss, ofJefferson Medical College, Philadelphia, to the Ambula-tory Pediatrics Association.

Chapter 16

Ray E. Heifer and Thomas L. Slovis of MichiganState University reported in 1977 a study of injuries suf-fered by children five or under who fell out of bed. In 80percent of the cases there was no injury; 17 percent hadminor bruises and scratches; only 3 percent sustainedbroken bones or fractured skulls that warranted medicalattention, and there were no injuries that were life-threatening or permanently damaging to the child.

The high incidence of bone fractures among patientsreceiving steroid treatment for asthma was reported in astudy conducted by Allen D. Adinoff, M.D., and J.Roger Hollister, M.D., of the National Asthma Center,Denver, CO.

Chapter 18

The 30-year study of the effect of psychological coun-seling on youths in Cambridge and Somerville, Mass.,was reported at a meeting of the American Association

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of Psychiatric Services for Children in 1979. It was con-ducted by Joan McCord of Drexel University.

For further information on nutritional approaches tothe treatment of mongolism see Medical Treatment ofMongolism, by Henry Turkel, M.D., in the Proceedingsof the Second International Congress on Mental Retar-dation (Vienna, 1961), and Can nutritional supplementshelp mentally retarded children: An exploratory study,Proceedings of the National Academy of Sciences,USA, Vol. 70, January, 1981.

Chapter 19

Further documentation of the decline in incidence ofseveral diseases prior to the introduction of vaccines canbe found in ‘The Case Against Immunizations,” by Rich-ard Moskowitz, M.D., in the Journal of the AmericanInstitute of Homeopathy, March, 1983. Several signifi-cant studies are referenced.

The effects of vaccines on the immune response andother immunization issues are discussed in Vaccinationsand Immune Malfunctions, by Harold E. Buttram,M.D., and John Chriss Hoffman, Humanitarian Publish-ing Company, Quakertown, PA, 1982.

The Los Angeles study of the relationship betweenDPT immunization and Sudden Infant Death Syndromewas conducted by Larry Baraff, M.D., et al, and is re-ported in Pediatric Infectious Disease, January, 1983.

A critique of the pertussis vaccine is contained in“Vaccination Against Whooping Cough: Efficiency vs.Risks,” by Gordon T. Stewart, M.D., The Lancet, Jan-uary, 1977. Further discussion of the risks and benefits ofthe DPT vaccine will be found in th e paper. CurrentProblems in Pediatrics, issued by Vincent A. Fulginiti,M.D., University of Arizona College of Medicine, April,1976.

A review of the value of breastfeeding in disease pre-vention is presented in the article, “Breastfeeding andthe Prevention of Sudden Infant Death Syndrome,” by

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David A. Bimbaum, M.D., in the Medical Trial Tech-nique Quarterly, Spring, 1978.

Details on the reluctance of California medical per-sonnel to be vaccinated against rubella are reported inJAMA, February 20, 1981.

A report by Dr. Gordon T. Stewart on the TennesseeSIDS deaths following DPT immunization was publishedin The Lancet, August 18, 1979.

Chapter 20

Revealing studies of infections acquired in hospitalsare discussed in JAMA, November 24, 1978, and in thearticle, “Hospital-Acquired Viral Respiratory Illness in aPediatric Ward,” Pediatrics, September, 1977.

The careless hand-washing habits of hospital person-nel are the subject of a study, “Hand-Washing Patterns inMedical Intensive Care Units,” The New England Jour-nal of Medicine, June 11, 1981.

General References

Those interested in further information about theshortcomings of “medical science” are referred to theserecent books:

Betrayers of the Truth: Fraud and Deceit in the Hallsof Science, by William Broad and Nicholas Wade,Simon and Schuster, New York, 1982.

Health Shock: How to Avoid Ineffective and Hazard-ous Medical Treatment, by Martin Weitz, Prentice-Hall,New York, 1982.

Medicine Out of Control: The Anatomy of a Malig-nant Technology, by Richard Taylor, Sun Books, Mel-bourne, 1979.

INDEX

Aarane, 216

Abdominal pain, 102-110, 214Abrasions, 192-194Abscess, scalp, 77Access managers, 12Accidents, 191-212automobile, 210Accutane, 268Acetaminophen, 81,90, 93,94,98, 115, 137, 150, 151Aches, body, 113, 115Acne, 14, 162-173, 182causes of, 164-165Corynebacterium, 164medications for, 165-173treatment of, 165-173Acquired immune deficiencysyndrome (see AIDS)Actifed, 14

Actifed C Expectorant, 14Additives, food, 102, 104-105,172,226Adenoids, 135Adinoff, Dr. Allen D., 268Adrenaline, 217AIDS, 48Airola, Paavo, 172Alcohol, 38, 116, 137, 150Alexander, Dale, 172Allergies, 102,142, 157,175-177,180-181,

213-219,226detection of, 103-105drug, 129

environmental, 94, 142,213-214

food, 10,52,57,68-69,91,94, 103-105, 174, 214,222

MMR vaccine, 235symptoms of, 214-216treatment of, 114Allergists, 215, 219human ecology, 219Alternative Approaches toAllergy, 94

Ambenyl Expectorant, 14Amblyopia, 155, 161Ambulatory PediatricsAssociation, 268American Academy ofPediatrics, xiii, 49, 58,119, 233, 248-249, 258,267

American Association ofPsychiatric Services forChildren, 268-269American Cancer Society, xivAmerican Medical

Association, xiv, 62, 243American Public HealthAssociation, 266

271

272

Aminophyllin, 216Amniocentesis, 38Amoxicillin, 146Ampicillin, 119, 120Anemia, iatrogenic, 48Anesthesia, 3Antacids, 105-106Antibiotics, 15, 20, 21,43-44,78, 111, 113, 116-120,125, 129-130, 133-134,139, 145-146, 147,148,151, 152, 158, 163,165,176, 192, 245, 247, 248,267

Anticonvulsants, 84-85Antifungal agents, 176Antihistamines, 98, 111, 114,125, 145, 146, 148, 173,176, 215

Antiseptics, 192-193, 195Antivomiting agents, 115Appearance, change in, 7Appendectomy, 108Appendicitis, 107-109,110Appendix, ruptured, 107Appetite, 58-61Arthralgia, 239Arthritis, 239rheumatoid, 232Aspirin, 1,2, 38,73,90,93,98, 115, 138, 151side effects of, 81-82,115-116

Asthma, 204, 216-218, 268causes of, 217Astigmatism, 154cause of, 43Ataxia, 237Athlete’s foot, 176Attention deficit disorder, 220Avoiding doctors, 23-26

Ballentine, Rudolph, 172Banff, Larry, 269Baths, neonatal, 44,265Baylor University College of

Medicine, 268Bed-wetting, 214Beech Nut, 58Behavior

change in, 7, 79, 84emotional, 69hyperkinetic, 223modifying, 15, 222-223physical, 64-67Behavior problems, 35, 64-72,220-229

causes of, 225-229Bellevue Hospital, 132Bendectin, 10Bentyl, 14

Benylin Cough Syrup, 14Bilirubin lights, 15, 46-48side effects of, 47-48,264-265

Bimbaum, Dr. David A., 270Birth control pills, xv, 35Birth defects, 22, 33-35,37-38, 41Bites

animal, 206-209insect, 176-177, 180-181Blackheads, 164Bleeding, 198severe, 193Blindness, 236cause of, 48Blood clots, 98, 237Blood pressure, 96Blood tests, 97, 100, 108, 110,127, 253

Boffey, Philip M., 264Bonding, mother-child, 53,55-56, 265

Borenstein, Daniel, 15Bottlefeeding, 51-56, 214, 265Bowed legs, 183, 184-185,

190

Bowel habits, 68-69Brace, Milwaukee, 189Brain damage, 82-83, 197,227-229

273

minimal, 220Breads, 57Breakfast, 60-61Breastfeeding, xv, 11,22,25,27-28, 42, 45, 50, 51-56,68, 214, 251, 265, 269Breast-Feeding and NaturalChild Spacing: TheEcology of NaturalMothering, 56Brewer, Dr. Tom, 264British Medical Journal, 267Broad, William, 270Bronchitis, 113Bums, 194-197chemical, 196first-degree, 194-195scald, 196-197second-degree, 195third-degree, 195-196Burping, 65

Buttram, Harold E., 269

Caladryl, 173Calamine lotion, 173, 176,

177, 236,246

Calling pediatrician, 1-2,4,

8, 85, 86,95,151 (seealso emergencies)guidelines for, 24-25Cancer, 40, 41, 232, 237skin, 179-180thyroid, 15Canvas sneakers, 268Car seats, 210

Care and Feeding of Children,66-67

Castle, Mary, RN, MPH, 267Cate, Dr. Thomas R., 267CAT scans, 98Cephalhematoma, 82Cereals, 57

Cerebral palsy, 37, 228Cesarean section, 32, 36, 39,48Charts

height, 25-29Metropolitan Life, 26weight, 25-29

Checkups (see examinations,physical)

Chicken pox, 82, 246-247symptoms of, 246treatment of, 246Childbirth, xv, 30-50home, 30-31, 32-33, 38-39,42,264

hospital, 21, 31-32, 33-50intervention during, 38-42premature, 35Children’s Clinic (Jackson,TN), 226

Children’s Hospital (Buffalo),148

chloramphenicol, 120Chlorpheniramine maleate,

148

Choking, 127, 139, 205-206Ciba-Geigy, 223-224Cigarettes, 38Circumcision, 49, 77Clothing, 196winter, 112Clubfoot, 185, 187

Cndfinf

Colds, 77-78, 91,95, 100,111-122

causes of, 111-112medications for, 113,

117-121

symptoms of, 112-115,

241, 252-253Colic, 65

Common sense, 6, 7,8-9Compazine, 115Coi\junctivitis, 157-158,161allergic, 157catarrhal, 157-158chemical, 43,264vernal, 157

Consciousness, loss of, 91,

101, 197,198

274

Constipation, 68, 69Contraception, xv, 35,55Convulsions, febrile, 83-86,235,248,266

Cornstarch, 163,176, 236, 246Cortisone, 165, 176,215Cough drops, 121Cough suppressants, 114, 115Coughs, 111-122,213whooping, 230, 241-244,269

Crib death (see Sudden InfantDeath Syndrome)

Crook, Dr. William G., 226Cross-eyes, 154-156Croup,113Crying, 66-68Cultures, throat, 124, 127,128-129, 133-134Cuts, 192-194Cylert, 222,223Cystitis, allergic, 214Cysts, 164

Davis, Adele, 172Deafness, 145unilateral nerve, 235Dear Mother, 58Decongestants, 114, 145, 146,148

Dehydration, 77-78,88,94,202,236Dentists, 34

Dermabrasion, 166-167, 268Dermatologists, 178DES, 13Desenex, 176Desensitizalkm shots,

215-216

Devetopseni, child's, 63-72,183-190

Dextromethorphanhydrobromide, 115Diabetes, 97juvenile onset, 237Diagnosis, 7,20-21, 25,

227-229

guidelines for, 8-9ultrasound, 32Diapers, 162-163Diarrhea, 68,107,113,129,202,214

Dick-Read, Dr. Grantly, 53Diet (see also Nutrition)elimination, 103-105,216,218-219

hospital, 61-62,244neonatal, 44-45Dieticians (see Nutritionists)Dimetane Expectorant, 14Dimetane Expectorant DC, 14Dimetapp, 14

Diphtheria, 74,125,127, 138,244-246incidence of, 245symptoms of, 244-245Disease, 230-253autoimmune, 232incidence of, 269neurogenic, 185Distress, parental, 3Diuretics, 37-38Dizziness, 198Donahue, Phil, 68Doonatal, 14

Down's syndrome, 34, 228,269

Drexel University, 269Drugs, xi, xii, xiii, xiv, xv, 3,9-10, 12-16,20,38,39,80, 148,266 (see alsoindividual drug names)Duke University MedicalCenter, 267Dunk, Dr. J.H.M., 267

Ear infections, 15, 113,140-152

Earaches, 140-152causes of, 141-142,144treatment of, 145-150Eardrums, 145, 146-147,149

275

damaging, 143-144

Earn, 15,113, 140-152foreign bodies in, 141-142Eczema, 174, 181Edema, 37-38Education, medical, xi-xii,3-4, 7, 10-12, 145EEG (see

Electroencephalograms)Eggs, 57

Electroencephalograms, 98,100, 197-198Ellenberg, Jonas H., 266Emergencies, 75-76, 87, 113,138-139, 155-156,177,191,193,195-1%,199-201, 204-205, 206,209, 217, 219,263Encephalitis, 235, 236, 237Epilepsy, 20, 37,83,98Episiotomy, 39Erythromycin, 165, 245Estrogen, 29Eustachian tubes, 141Examinations, eye, 157,160Examinations, neurological,%, 100

Examinations, physical, xiii,18, 19, 21,95-97, 100,

107, 110, 124, 146,262school, 21

well-baby, 19,23-25Expectations, parental, 63-72,99-100, 183-184Expectorants, 114Eyeglasses, 154, 155,

156-157,159, 267Eyes, 153-161bleary, 112

foreign bodies in, 160painful, 214treatment of, 156-159

Face peels, chemical, 166Family Bed, The, 68

Family doctors, 6-7Fardig, J., 265Farsightedness (seeHyperopia)

Fatigue, 112, 214FDA (see Food and DrugAdministration)

FDA Drug Bulletin, 268Febrile seizures, 266Feet, Oat, 183, 190Feingold, Dr. Benjamin,225-226

Fever, 73-88, 107, 109, 236,239, 246, 247, 248childbirth, 256height of, 78-79, 82high, 78, 80, 82-83, 113low-grade, 113neonatal, 76-77reducing, 79-82, 115, 138rheumatic, 123, 124,128-133scarlet, 247Fever phobia, 79Flu (see Influenza)

Food and Drug

Administration, xiv, 13,14, 115, 116, 148, 167Food preferences, children’s,61Foods

commercially prepared, 57,58

processed, 57,59-60solid, 56-57Foreign bodiesswallowing, 109, 205-206in ear, 141-142in eye, 160

Formula, infant, 19, 51-56,163,265

manufacturers of, 25, 52SMA, 52

Fractures, 202-205Fredericks, Carlton, 172Frostbite, 209

276

Fruits, 57, 59, 60Fulginiti, Vincent A., 269

Gehrig’s disease, 232Gellis, Dr. Sydney S., 265Gilbert, Walter, 118Glandslymph, 14, 15salivary, 234sebaceous, 158, 164swollen, 126, 234thymus, 14, 15Gonorrhea, 43Gonorrheal ophthalmia, 43Griseofulvin, 176Growth, 15, 25-29charts for, 25-29racial factors in, 27Guillain-Barre syndrome, 232,237

Hand-washing habits, 270Harrell, Ruth, M.D., 229Hay fever, 213, 216Head injuries, 197-199Headaches, 1-2, 89-101,

214, 248

causes of, 91-93,99, 100emotional, 93-94medication for, 101migraine, 95, 214recurrent, 99-101severe, 198sinus, 94tension, 95-97Hearing loss, 214 (see alsoDeafness)

Heart disease, 124rheumatic, 128, 131-133,139

Heart murmurs, 45—46Heartburn, 214Heatstroke, 76,83,87Height charts, 25-29Heimlich maneuver, 206Heifer, Ray E„ 268

Hemiparesis, 237Hemker, Dr. H. C„ 265Hemorrhageintestinal, 82maternal, 54neonatal, 47, 49Hepatitis, infectious, 48Hernia, umbilical, 49Hexachlorophene soap, 44,265

Hip dysplasia, 187, 190Hippocratic Oath, 15, 40History, medical, 6, 7, 21,100, 110, 262Hives, 175-176, 181Hodgkin’s disease, 237Hoekelman, Dr. Robert A.,264

Hoffman, John Chris, 269Holistic health, 10Hollister, Dr. J. Roger, 268Holt, Dr. Luther Emmett,66-67

Hormones, 15, 28-29, 165side effects of, 28-29steroid, 138, 174-175, 215,216, 253, 268Hospital births, risks of,33-38

Hospital for Sick Children(Toronto), 16

Hospitalization, 3, 106-107,110,177, 242, 254-259,270

emotional impact of,258—259

Hospitals, 3,106-107,110,254-259, 270Human Ecology Action

Humidifiers’ 114, 120-121,137

Humidity, 114, 120, 128, 137lack of, 125

Hydration, 114,121,137Hydrophobia, 207-208

277

symptoms of, 207Hygiene, 256, 270Hyperactivity, 105,214,220-229Hyperopia, 154Hypovolemic shock, 38

Iatrogenic illness, 257Immunity, 135-136infant, 53

Immunization, 19,20,230-253,269,270risks of, 231-233Impetigo, 175, 181Incentives, pediatrician's 4-5financial, 4, 261psychological, 5Incubators, 48Indigestion, 102Infections, 81

bacterial, 78-79,82-83,89,113,125, 141ear,15, 113ear canal, 141fungal, 176inner ear, 141middle ear, 113, 140-152neonatal, 86nosocomial, 3, 44,49,76-77, 255, 270sinus, 94, 113streptococcal, 123, 124,125-130, 138urinary tract, 108viral, 78-79, 82-83,89,

113, 124, 126,141yeast, 163

Influenza, 77-78,82, 91, 95,100, 111-122medications for, 113,115-122

symptoms of, 112-115Injuries, 91,98, 101,150,155-156,191-212,268Inoculations (see

Immunization andVaccines)

Insomnia, 214Interferon, 81Interventionmedical, 1-5,19,270obstetrical, 22, 31, 38-42Intestinal obstruction, 109Intrauterine devices, xvIntravenous feeding, 39Iodine, 193Ipecac, syrup of, 200Isoniazid, 249

Jaundice, infant, 15, 46-47Jefferson Medical College,268

Johns Hopkins School ofMedicine, 266Journal of the American

Institute of Homeopathy,269

Journal of the AmericanMedical Association,240-241, 242-243, 255

Kaiser Foundation, 226Kanof, Dr. N.M., 265Kenalog, 174-175Kessner, David M., 267Kippley, Sheila, 55,56Knees, knock, 185, 190Kunstadter, Dr. Ralph, 134Kushi, Michio, 172

Labor, 31,32

intervention during, 38-42Lactation, 55 (see alsoBreastfeeding)

Lactose intolerance, 52, 69,103

Laetrile, 10

LaLeche League, 22, 56Lancet, The, 265,267,270Lassar’s paste, 163

278

Lead, 19Legs

bowed, 183-185development of, 184-185Learning disabilities, 37,220-229

Learning disorders, 214Leucocytes, 80-81Leucotaxis, 81,138Leukemia, 40,125,127,138,232

Liquor (see Alcohol)Livingston, Dr. Samuel, 266Lomotil, 68

Low-birtb-weight babies, 48Lupus erythematosus, 232

Malaise, 112

Male Practice: How DoctorsManipulate Women, 32,38

Malnutritionin hospitals, 266nosocomial, 62, 244Malpractice, .16, 231, 233Mammography, xivMann, Dr. George V., 266Marax, 14, 216Marax DF, 14

Maigolies, Dr. Simeon, 266Mastoiditis, 140McCord, Joan, 269Measles

English, 236-239German, 239-241one-day, 79symptoms of, 236treatment of, 236Measurements, 25-29Medical Trial TechniqueQuarterly, 270

Medication, storing, 201-202Mehl, Dr. Lewis E., 39,264Memory loss, 214Meningitis, 20-21, 74,247-248

aseptic, 237symptoms of, 247-248treatment of, 248MER 29, 13Merck Manual, 264Mercurochrome, 193Michigan State University,268

Midwives, 33

Migraine headaches, 95,214Milk, cow’s, 52,57, 163allergy to, 52, 69, 103, 142Milk, human (seeBreastfeeding)

Mistakes, pediatricians’,16-17, 18-29Mongolism (see Down’ssyndrome)

Monitors

external fetal, 39-40internal fetal, 32, 39, 76Mononucleosis, infectious,125, 127, 138, 252-53symptoms of, 252-53treatment of, 253Moriarty, Dr. Richard,199-200

Mortality, infant, 22, 37-38,47

Moskowitz, Dr. Richard, 269Muller, Dr. A D., 265Multiple sclerosis, 232, 237Mumps, 234-36symptoms of, 234treatment of, 234Muscle weakness, 214Myopia, 154cause of, 43

Naismith, Dr. Donald, 266NAPSAC, 264National Academy ofSciences, 268

National Asthma Center, 204,268

National Cancer Institute, xiv

279

National Poison CenterNetwork, 199Nausea, 214 (see alsoVomiting)

Nearsightedness (see Myopia)Nelson, Karin B., 266Nelson, Dr. Waldo, 263Neo-Mull-Soy formula, 32Nephritis, acute, 123Neurogenic disease, 183Nose, runny, 111-122, 213Nurse-practitioners, 12Nurseries, hospital, 42-49Nutrition, 3-4, 5, 10, 51-62,65,87-88, 122, 164-165,172-173

maternal, 35-37, 48Nutritionists, 172, 185

Obesity, cause of, 52-53, 59,266

Obstetrics, xv

Office visits, 2, 73-74, 77, 90,141, 150, 177, 198, 262,(see also Emergencies)well-baby, 264Ointmentsantiseptic, 193, 195zinc oxide, 163Ophthalmologists, 156, 161Ophthalmoscope, 95Oraflex, 10Orchitis, 235Orders, doctor’s, 18Oraade Spansules, 14Orthopedic problems,183-190

Orthopedists, 183-190Orthoptics, 155Osteogenesis imperfecta, 185Osterhout, Dr. Suydan, 267Otitis externa, 141Otitis media, 113, 140-152Otoscope, 96,146Overdressing, 77

Overfeeding, infant, 52-53,58-59

- Oxford Survey of ChildhoodCancers, 40

Paige, Dr. David M., 266-Pain relievers, 114, 115 (seealso individual drugnames)

Pap smears, xivParalysis, 207Parents, role of, 6-8Pediatrician, choosing,260-263

Pediatric Annals, 266Pediatrics, 24, 258, 264, 266,270

Pediatrics for the Clinician,267

Penicillin, 44, 119, 125, 126,129-130, 133, 134, 139,245, 247

Peninsula Hospital Center(Far Rockaway, N.Y.),266

Periosteum, 203Peroxide, 193

Pertussis, 230-231, 241-244,269

symptoms of, 241treatment of, 241Pharmacology, 9, 12, 304Phenergan Expectorant, 14Phenergan Expectorant Plain,14

Phenergan VC Expectorantwith Codeine, 14Phenobarbital, 84-85Phenylketonuria test, 44-46Phobiasphoto-, 236school, 103Photophobia, 236Phototherapy, 15, 46-48side effects of, 47

280

Physician’s Desk Reference,223

Pigeon toes, 183Pinkeye, (see Conjunctivitis)Pitocin, 31, 32, 39PKU test (see

Phenylketonuria test)Plastic and ReconstructiveSurgery, 268Pneumoniaaspiration, 77bacterial, 113, 122, 242viral, 113

Poison ivy, 176, 181-182Poison oak, 176, 181-182Poison sumac, 176, 181-182Poisoning, 75, 83, 87, 109,199-202food, 202Pollution, 125, 157Poliomyelitis, 231-232,251-252incidence of, 251Polyneuritis, 239Poverty, 131-132Preconception, 33-35Prednisone, 138, 174-175,215Pregnancy, 30-50, 170,239-241

nutrition during, 35-37,48,264, 266

Prenatal care, 30-50Prescriptions, xiv, 19, 20, 38,80, 111, 116, 117, 119,167-171,262 (see alsoindividual drug names)Pressure, atmospheric, 144Prevention, 5, 24Prevention, 172Price-Moissand, Mary, 266Protein, 52Pseudoephedrioe

hydrochloride, 148Psychiatry, 227-229, 268-269Psychotherapy, 227-229, 268Public health policy, 23

Public Health Service, 238Punishment, 70-71, 103corporal, 70Pupils, dilated, 198Pus, 127, 147Pyrogens, 80

Quackery, 10, 165Queen Elizabeth Hospital,London,266

Rabies, 206-209symptoms of, 207Rabies vaccine, 207-209Radiant warmer, 265Radiology, xiii, xivRaifman, Dr. Mark, 266Randolph, Dr. Theron, 94Rashes, 119, 129diaper, 162-163, 181heat, 173, 181Red Cross, 206Reflexes, testing, 96Relationshipsdoctor-patient, 18-19,262-263

mother-child, 53, 55-56,265-266

Residency, pediatric, 11-12,15

Respiratory ailments,

111-122,198nosocomial, 256-257Respiratory distresssyndrome, 47

Retardation, mental, 20, 33,34, 37,44, 228-229, 237,269

Retrolental fibroplasia, 48Reye’s syndrome, 82, 115, 237Rheumatic fever, 123, 128,

129, 130, 131-133incidence of, 131-132Rheumatic heart disease, 128,131-133, 139Ringworm, 176

281

scalp,14Ritalin, 222-225side effects of, 223-225Roseola, 79

Rubella, 235, 239-241, 270symptoms of, 239treatment of, 236Rubeola, 236-239Symptoms of, 236treatment of, 236

Safety, 211-212 (see alsoAccidents)

Scarlet fever, 247cause of, 247incidence of, 247symptoms of, 247Schedules, feeding, 52-53,55,61, 67

Schmitt, Dr. Barton D„ 266School phobia, 103Scoliosis, 188-189, 190diagnosing, 188-189Sebum, 164Secretions, nasal, 113Semmelweis, Ignaz, 256Septicemia, 118Shock, 177,195-1%anaphylactic, 129, 207, 237Shoes, 186-188corrective, 187infants’, 186, 268Sidbury, Dr. James, 264-265Side effects

drug, 13, 19-20, 75, 114,119,167-171, 175,216,223-224hormone, 29phototherapy, 47-48rabies vaccine, 207treatment, 8, 19-20x-ray, 14-15SIDS (see Sudden InfantDeath Syndrome)

Silver nitrate, 21,42-43,160,264

Singer, James, 268Sinusitis, bacterial, 94, 113Skin problems, 162-182Skin tests, allergy, 215Sleep habits, 67Sleeping pills, xvSlophylline, 216Slovis, Thomas L., 268SMA formula, 52Smallpox, 232Smoking, 125 (see alsoCigarettes)

Snakebites, 208-209Sneezing, 111-122,213Snow, Carolyn Kalk, 268Soap, hexachlorophene, 44,265

Sodium bicarbonate, 105-106Sore throats, 123-139Spanking, 70

Spine, curvature of, 188-189Spira, M., 268Sponging, 82alcohol, 82Sprains, 202-205SSPE, 237Sterility, 235Steroid hormones, 138,174-175, 204, 215, 216,253, 268Stethoscope, %

Stewart, Alice, 40-41Stewart, David, Ph.D., 264Stewart, Dr. Gordon T., 242,270

Stings, insect, 177, 181Stomachaches, 102-110causes of, 102-105, 109medication for, 105-107Stools, 68-69bloody, 107, 109loose, 119

Strabismus, alternating, 155Strains, 202-205Strep throat, 121, 123-125,127-130,139,267

282

treatment of, 133-134Stress, 89,225-226Styes, 158-159Subacute sclerosingpanencephalitis, 237Sudden Infant Death

Syndrome, 19-20, 244,250-251,269cause of, 250Sunburn, 178-180Sunscreens, 179Supplements, nutritional, 56Surgery, 3, 15,108,110,134-136, 144, 145-146,149, 152, 155, 166,166-167, 189,190,257,259

neonatal, 49-50Swabs, cotton, 143

Tachycardia, 214Taylor, Richard, 270Teldrin, 14

Temperature, body (see alsoFever)axillary, 76“normal,” 74-75oral, 76rectal, 76

Testacies, undescended, 50Tests, lab, 21, 106Tetanus inoculations, 193-194Tetracycline, 119,165,166Thalidomide, 10,13Theobid, 216Theodur, 216Theophylline, 215Thermometers, 76Thevenin, Tine, 68Thorazine, 115Tigan,115

Toilet training, 68,69,70Tonsillectomy, 134—136,139Tonsils, 14, 134-136, 139Torch, Dr. William, 250Toronto Globe A Mail, 228

Tourette’s syndrome, 228Toxemia, 36, 37Toxic epidermal necrolysis,237

Tranquilizers, xivTrauma

emotional, 91,92, 258-259physical, 91,150 (see alsoInjuries)

Triamcinolone acetonide, 165Tuberculin test, xiii, 248-249Tuberculosis, 248-250Tumors, brain, 96, 98Turkel, Henry, M.D., 228, 269TUss-Omade, 14Tympanostomy, 15,145-146,149, 152, 267

UCLA School of Medicine,15,251

Ultrasound, 32, 38,39-42,

264

Ultrasound, 264Ultraviolet light, 165, 178University of Glasgow, 242University of Illinois, 266University of Nevada, 250University of Pittsburgh,148-149

University of Rochester, 264University of Vermont Collegeof Medicine^ 267University of Wisconsin, 227University of Wisconsininfant developmentcenter, 39

Urinalysis, 97, 100,108,110Urination, painful, 109

Vaccines, 269DPT, 230-231,242-244,245-246,250-251,269MMR, 235,236-238,239-241, 270

pertussis, 230, 242-244,269Sabin, 231-232

283

Salk, 231-232,251-252tetanus, 193-194Valium, xiv

Van Buchem, Dr. F. L., 267Vanderbilt University, 266Van Doorm, Dr. J. M., 265Van’t Hof, Dr. M. A., 267Vaporizers, 94Vasoconstrictors, 114Vegetables, 59,60,61Vertigo, 214

Viruses, 112-122, 124, 126(see also Infections, viral)Vision, 153-161blurred, 214double, 198measurement of, 153myths about, 159-160Vitamin A, 165Vitamin B«, 52Vitamin K, 46,265Vomiting, 107, 109, 113,119,202, 214, 241, 248inducing, 200 '

Wade, Nicholas, 270Warts, 177-178Wax, ear, 142removing, 142-143

Weakness, muscle, 214Weight charts, 25-29Weiss, Dr. Jeffrey, 268Weitz, Martin, 270Well-baby clinics, 10Well-baby visits, 264Whooping cough, 230-231,241-244, 269symptoms of, 241treatment of, 241Wilfet, Dr. Catherine M„ 267Womanly Art of

Breastfeeding, The, 56World Health Organization,40, 238, 264

Wright, Dr. Jonathan, 172

X-rays, 14, 15, 20, 34-35, 38,40, 107, 166, 187, 197,204chest, xiii, xiv, 113dental, 34skull, 98, 100

Yuz, Stephen, 16

Zinc oxide ointment, 163Zinc sulfate tablets, 165Zomax, 10

About the Author

Robert S. Mendelsohn, M.D., has practiced pediatricsfor over thirty years. A leading critic of modern medicine,he has helped stimulate significant improvements in theway medicine is practiced in the U.S. Dr. Mendelsohn’sprevious books include CONFESSIONS OF A MEDI-CAL HERETIC and MALE PRACTICE: HOW DOC-TORS MANIPULATE WOMEN. This is his first bookaddressed to his own medical specialty.

MOTHERS,GRANDMOTHERS, AND MOTHERNATURE ARE THE BEST DOCTORS AROUND.’

Dr. Robert Mendelsohn has dedicated his life to demystifying the medicalprofession, both as a renowned pediatrician for nearly thirty years and asthe widely read author of Confessions of a Medical Heretic and other books.

In this practical and informative guide, he turns his expertise to his ownspecialty, maintaining that parents tend to rely too heavily on theirpediatricians and that they can take a more active role in determiningwhich ailments require an office visit and which can be dealt with at home.

Learn how to treat and diagnose athome: • everyday colds and flus •childhood illnesses • strep throat

• vision and hearing problems

• allergies • emotional problems

• skin ailments • and everything elseyou’ll need to know about majorsymptoms and illnesses

PLUS

• A complete section on picking therightdoctorforyour child

• Comprehensive guidelines for usingtime-honored, age-old remedies

• All the facts about immunization

• Step-by-step instructions for know-ing when you should call a doctor

• Detailed information for copingwith accidental injuries.

With Dr. Mendelsohn’s help, you cantrust your instincts.

www.ballantinebooks.comU.S.fl. $7.99 CANADA $10.99 CHILDCARE

ISBN 0-345-34276-350799

780345

342768

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