William G. Wilkoff, MD

In my struggle to keep abreast of all things pediatric, I sample a variety of sources.

Of course each month I scan almost all of the abstracts in the journal Pediatrics. But to get a sense of what the nonmedical community is reading, I begin each morning with a cruise through the electronic versions of the New York Times and the Portland (Maine) Press Herald.

By lunch time I usually have hopscotched my way through the Wall Street Journal. And during our evening adult beverage quiet time, I amuse myself with our local daily. If a news story includes a link to an original article, I usually bore down deep enough to at least read the abstract. Keep in mind that this whole process of keeping current takes little more than a half an hour, 45 minutes tops.

It seems that psychology-related topics dominate the science and medicine stories that I encounter. This shouldn’t surprise you because most of us want to know more about why humans behave the way we do. We also wonder if animal behavior may provide some clues.

It may be because I was trained by careful and skeptical “hard” scientists that I have always read psychosocial and behavioral studies with several grains of salt. Despite my skepticism, I am not beneath embracing the odd study that seems to support one of my biases. The studies that don’t sync with my world view I quickly cast on the rubbish heap because the “sample group was too small,” or the “variables were not adequately controlled for,” or simply because I thought the study was poorly done.

It turns out that my skepticism has not only been well founded, but should have been broader in scope. In a recent study published in the journal Science, three young psychologists undertook a heroic and courageous effort to reproduce 100 studies from three leading psychology journals (Science 2015 Aug 28. doi:10.1126/science.aac4716). Chosen from a larger group, these studies were thought to reflect the core knowledge from which psychologists develop their understanding of such basics as learning, memory, and relationships.

The investigators found that in more than half the studies, they were unable to reproduce the results reported in the original studies despite the fact that in many cases, they were assisted by the original investigators in their attempts to replicate the conditions of the initial studies.

The authors quickly assert that their findings do not suggest that the original investigators were attempting to deceive. Nor does the failure to reproduce results necessarily mean that other future studies might confirm the original findings. Their primary point is that evaluating reproducibility is difficult.

However, this new study is troubling for two reasons. First, it casts even more doubt on the decision to expand the MCAT (Medical College Admission Test) by adding several hours of questions based on psychosocial topics in hopes of creating physicians who are more in tune with the emotional needs and social challenges of their future patients. If the results of more than half of the studies that might be considered the underpinnings of modern psychology can’t be reproduced, are we just asking aspiring medical students to learn a larger collection of half truths? And thus have medical students spend less time learning basic science and developing better critical thinking skills? There are better ways to sort for more empathetic and sensitive physicians than by building an unevenly weighted exam.

Second, although this study highlights the core of what makes science such a powerful and effective tool for discovering the truth, the anti-science folks will point to it as just another example of how we shouldn’t trust anything science tells us.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

In my struggle to keep abreast of all things pediatric, I sample a variety of sources.

Of course each month I scan almost all of the abstracts in the journal Pediatrics. But to get a sense of what the nonmedical community is reading, I begin each morning with a cruise through the electronic versions of the New York Times and the Portland (Maine) Press Herald.

By lunch time I usually have hopscotched my way through the Wall Street Journal. And during our evening adult beverage quiet time, I amuse myself with our local daily. If a news story includes a link to an original article, I usually bore down deep enough to at least read the abstract. Keep in mind that this whole process of keeping current takes little more than a half an hour, 45 minutes tops.

It seems that psychology-related topics dominate the science and medicine stories that I encounter. This shouldn’t surprise you because most of us want to know more about why humans behave the way we do. We also wonder if animal behavior may provide some clues.

It may be because I was trained by careful and skeptical “hard” scientists that I have always read psychosocial and behavioral studies with several grains of salt. Despite my skepticism, I am not beneath embracing the odd study that seems to support one of my biases. The studies that don’t sync with my world view I quickly cast on the rubbish heap because the “sample group was too small,” or the “variables were not adequately controlled for,” or simply because I thought the study was poorly done.

It turns out that my skepticism has not only been well founded, but should have been broader in scope. In a recent study published in the journal Science, three young psychologists undertook a heroic and courageous effort to reproduce 100 studies from three leading psychology journals (Science 2015 Aug 28. doi:10.1126/science.aac4716). Chosen from a larger group, these studies were thought to reflect the core knowledge from which psychologists develop their understanding of such basics as learning, memory, and relationships.

The investigators found that in more than half the studies, they were unable to reproduce the results reported in the original studies despite the fact that in many cases, they were assisted by the original investigators in their attempts to replicate the conditions of the initial studies.

The authors quickly assert that their findings do not suggest that the original investigators were attempting to deceive. Nor does the failure to reproduce results necessarily mean that other future studies might confirm the original findings. Their primary point is that evaluating reproducibility is difficult.

However, this new study is troubling for two reasons. First, it casts even more doubt on the decision to expand the MCAT (Medical College Admission Test) by adding several hours of questions based on psychosocial topics in hopes of creating physicians who are more in tune with the emotional needs and social challenges of their future patients. If the results of more than half of the studies that might be considered the underpinnings of modern psychology can’t be reproduced, are we just asking aspiring medical students to learn a larger collection of half truths? And thus have medical students spend less time learning basic science and developing better critical thinking skills? There are better ways to sort for more empathetic and sensitive physicians than by building an unevenly weighted exam.

Second, although this study highlights the core of what makes science such a powerful and effective tool for discovering the truth, the anti-science folks will point to it as just another example of how we shouldn’t trust anything science tells us.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

In my struggle to keep abreast of all things pediatric, I sample a variety of sources.

Of course each month I scan almost all of the abstracts in the journal Pediatrics. But to get a sense of what the nonmedical community is reading, I begin each morning with a cruise through the electronic versions of the New York Times and the Portland (Maine) Press Herald.

By lunch time I usually have hopscotched my way through the Wall Street Journal. And during our evening adult beverage quiet time, I amuse myself with our local daily. If a news story includes a link to an original article, I usually bore down deep enough to at least read the abstract. Keep in mind that this whole process of keeping current takes little more than a half an hour, 45 minutes tops.

It seems that psychology-related topics dominate the science and medicine stories that I encounter. This shouldn’t surprise you because most of us want to know more about why humans behave the way we do. We also wonder if animal behavior may provide some clues.

It may be because I was trained by careful and skeptical “hard” scientists that I have always read psychosocial and behavioral studies with several grains of salt. Despite my skepticism, I am not beneath embracing the odd study that seems to support one of my biases. The studies that don’t sync with my world view I quickly cast on the rubbish heap because the “sample group was too small,” or the “variables were not adequately controlled for,” or simply because I thought the study was poorly done.

It turns out that my skepticism has not only been well founded, but should have been broader in scope. In a recent study published in the journal Science, three young psychologists undertook a heroic and courageous effort to reproduce 100 studies from three leading psychology journals (Science 2015 Aug 28. doi:10.1126/science.aac4716). Chosen from a larger group, these studies were thought to reflect the core knowledge from which psychologists develop their understanding of such basics as learning, memory, and relationships.

The investigators found that in more than half the studies, they were unable to reproduce the results reported in the original studies despite the fact that in many cases, they were assisted by the original investigators in their attempts to replicate the conditions of the initial studies.

The authors quickly assert that their findings do not suggest that the original investigators were attempting to deceive. Nor does the failure to reproduce results necessarily mean that other future studies might confirm the original findings. Their primary point is that evaluating reproducibility is difficult.

However, this new study is troubling for two reasons. First, it casts even more doubt on the decision to expand the MCAT (Medical College Admission Test) by adding several hours of questions based on psychosocial topics in hopes of creating physicians who are more in tune with the emotional needs and social challenges of their future patients. If the results of more than half of the studies that might be considered the underpinnings of modern psychology can’t be reproduced, are we just asking aspiring medical students to learn a larger collection of half truths? And thus have medical students spend less time learning basic science and developing better critical thinking skills? There are better ways to sort for more empathetic and sensitive physicians than by building an unevenly weighted exam.

Second, although this study highlights the core of what makes science such a powerful and effective tool for discovering the truth, the anti-science folks will point to it as just another example of how we shouldn’t trust anything science tells us.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

I’m not much of a reader. In fact, there was a 10-year period during which I wrote more books (four) than I read. In high school and college, I can’t recall ever finishing an assigned novel or play. I would read just enough to create the desired illusion. Even now that I have more time, I’m good for about 20 minutes before I have to put a book down and do something … anything. If my feet are level with my waist, four pages is my max before sleep overtakes me.

But I could be the poster boy for the value of reading to young children. My father was a great reader. At heart he was an actor, and I could listen to his theatrical voice read for hours. I was still being read to regularly until I was 8 or 9 years old. I am convinced that it was his gift for reading aloud when I was young that helped me develop a facility with language that was crucial to my academic successes. It certainly wasn’t my own reading.

Two recent studies have added to the growing body of evidence that reading to young children is critical to their later language development and success in school (“Home Reading Environment and Brain Activation in Preschool Children Listening to Stories,” by Hutton et al. [Pediatrics. 2015 Aug 10. pii: peds.2015-0359. Epub ahead of print] and “The Words Children Hear: Picture Books and the Statistics for Language Learning,” by Montag, Jones, and Smith [Psychol Sci. Aug 4, 2015. doi: 10.1177/0956797615594361. E-pub ahead of print]). Parents in your practice have probably not read either of these peer-reviewed studies, but they may have read the New York Times and an op-ed by pediatrician Perri Klass, in which she emphasizes the importance of reading (Bed Time Stories for Young Brains, August 17, 2015). They have received free books at your office and know that you recommend they read to their children every day.

Many of those parents who have bought into the value of reading also understand the importance of a good night’s sleep. But for some of those families, those two priorities can collide when it comes time for the warm and fuzzy tradition of reading a bedtime story.

Work schedules and other family obligations may have pushed their young child’s bedtime to the brink of and beyond a healthy hour. Adding a bedtime story – and we all know there is seldom just one story – will only compound the problem. Which is more important … a bedtime story or a healthy bedtime?

Of course if we are talking about a single isolated night, the answer is obvious … do both. But I’m talking about the family that is overbooked and always running late. On a “good” night, bedtime ritual for the 2-year-old may start at 7:30 p.m. Adding a story will push start time to a clearly unhealthy 8:00. As a physician long obsessed with the underappreciated and at times catastrophic effects of sleep deprivation, my answer would clearly be forget the bedtime story and turn off the light.

But families need not allow themselves to fall into situations that force such a binary decision of reading or not reading a bedtime story. In some cases, it is an adult-centered decision by one parent who selfishly expects his or her child to be kept up until the parent can be home to participate in the bedtime ritual. In other cases, instead of building the day’s schedule around a healthy bedtime, some families treat bedtime as an afterthought, something they will get to when they can get around to it.

In addition to enhancing a child’s language development, reading stories at bedtime can be a bonding and family-building activity. Reading also can be a calming ingredient and a sleep-enhancing component in an effective bedtime ritual. And for the child who resists bedtime, reading can be used a reward that can be withheld or increased as the situation requires.

While I sense that the practice of saying one’s prayers at bedtime has fallen out of fashion for many families, the bedtime story is alive and well. We must help remind parents that the bedtime is at least as important as the story.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater” and “Is My Child Overtired?: The Sleep Solution for Raising Happier, Healthier Children.” Email him at [email protected].

I’m not much of a reader. In fact, there was a 10-year period during which I wrote more books (four) than I read. In high school and college, I can’t recall ever finishing an assigned novel or play. I would read just enough to create the desired illusion. Even now that I have more time, I’m good for about 20 minutes before I have to put a book down and do something … anything. If my feet are level with my waist, four pages is my max before sleep overtakes me.

But I could be the poster boy for the value of reading to young children. My father was a great reader. At heart he was an actor, and I could listen to his theatrical voice read for hours. I was still being read to regularly until I was 8 or 9 years old. I am convinced that it was his gift for reading aloud when I was young that helped me develop a facility with language that was crucial to my academic successes. It certainly wasn’t my own reading.

Two recent studies have added to the growing body of evidence that reading to young children is critical to their later language development and success in school (“Home Reading Environment and Brain Activation in Preschool Children Listening to Stories,” by Hutton et al. [Pediatrics. 2015 Aug 10. pii: peds.2015-0359. Epub ahead of print] and “The Words Children Hear: Picture Books and the Statistics for Language Learning,” by Montag, Jones, and Smith [Psychol Sci. Aug 4, 2015. doi: 10.1177/0956797615594361. E-pub ahead of print]). Parents in your practice have probably not read either of these peer-reviewed studies, but they may have read the New York Times and an op-ed by pediatrician Perri Klass, in which she emphasizes the importance of reading (Bed Time Stories for Young Brains, August 17, 2015). They have received free books at your office and know that you recommend they read to their children every day.

Many of those parents who have bought into the value of reading also understand the importance of a good night’s sleep. But for some of those families, those two priorities can collide when it comes time for the warm and fuzzy tradition of reading a bedtime story.

Work schedules and other family obligations may have pushed their young child’s bedtime to the brink of and beyond a healthy hour. Adding a bedtime story – and we all know there is seldom just one story – will only compound the problem. Which is more important … a bedtime story or a healthy bedtime?

Of course if we are talking about a single isolated night, the answer is obvious … do both. But I’m talking about the family that is overbooked and always running late. On a “good” night, bedtime ritual for the 2-year-old may start at 7:30 p.m. Adding a story will push start time to a clearly unhealthy 8:00. As a physician long obsessed with the underappreciated and at times catastrophic effects of sleep deprivation, my answer would clearly be forget the bedtime story and turn off the light.

But families need not allow themselves to fall into situations that force such a binary decision of reading or not reading a bedtime story. In some cases, it is an adult-centered decision by one parent who selfishly expects his or her child to be kept up until the parent can be home to participate in the bedtime ritual. In other cases, instead of building the day’s schedule around a healthy bedtime, some families treat bedtime as an afterthought, something they will get to when they can get around to it.

In addition to enhancing a child’s language development, reading stories at bedtime can be a bonding and family-building activity. Reading also can be a calming ingredient and a sleep-enhancing component in an effective bedtime ritual. And for the child who resists bedtime, reading can be used a reward that can be withheld or increased as the situation requires.

While I sense that the practice of saying one’s prayers at bedtime has fallen out of fashion for many families, the bedtime story is alive and well. We must help remind parents that the bedtime is at least as important as the story.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater” and “Is My Child Overtired?: The Sleep Solution for Raising Happier, Healthier Children.” Email him at [email protected].

I’m not much of a reader. In fact, there was a 10-year period during which I wrote more books (four) than I read. In high school and college, I can’t recall ever finishing an assigned novel or play. I would read just enough to create the desired illusion. Even now that I have more time, I’m good for about 20 minutes before I have to put a book down and do something … anything. If my feet are level with my waist, four pages is my max before sleep overtakes me.

But I could be the poster boy for the value of reading to young children. My father was a great reader. At heart he was an actor, and I could listen to his theatrical voice read for hours. I was still being read to regularly until I was 8 or 9 years old. I am convinced that it was his gift for reading aloud when I was young that helped me develop a facility with language that was crucial to my academic successes. It certainly wasn’t my own reading.

Two recent studies have added to the growing body of evidence that reading to young children is critical to their later language development and success in school (“Home Reading Environment and Brain Activation in Preschool Children Listening to Stories,” by Hutton et al. [Pediatrics. 2015 Aug 10. pii: peds.2015-0359. Epub ahead of print] and “The Words Children Hear: Picture Books and the Statistics for Language Learning,” by Montag, Jones, and Smith [Psychol Sci. Aug 4, 2015. doi: 10.1177/0956797615594361. E-pub ahead of print]). Parents in your practice have probably not read either of these peer-reviewed studies, but they may have read the New York Times and an op-ed by pediatrician Perri Klass, in which she emphasizes the importance of reading (Bed Time Stories for Young Brains, August 17, 2015). They have received free books at your office and know that you recommend they read to their children every day.

Many of those parents who have bought into the value of reading also understand the importance of a good night’s sleep. But for some of those families, those two priorities can collide when it comes time for the warm and fuzzy tradition of reading a bedtime story.

Work schedules and other family obligations may have pushed their young child’s bedtime to the brink of and beyond a healthy hour. Adding a bedtime story – and we all know there is seldom just one story – will only compound the problem. Which is more important … a bedtime story or a healthy bedtime?

Of course if we are talking about a single isolated night, the answer is obvious … do both. But I’m talking about the family that is overbooked and always running late. On a “good” night, bedtime ritual for the 2-year-old may start at 7:30 p.m. Adding a story will push start time to a clearly unhealthy 8:00. As a physician long obsessed with the underappreciated and at times catastrophic effects of sleep deprivation, my answer would clearly be forget the bedtime story and turn off the light.

But families need not allow themselves to fall into situations that force such a binary decision of reading or not reading a bedtime story. In some cases, it is an adult-centered decision by one parent who selfishly expects his or her child to be kept up until the parent can be home to participate in the bedtime ritual. In other cases, instead of building the day’s schedule around a healthy bedtime, some families treat bedtime as an afterthought, something they will get to when they can get around to it.

In addition to enhancing a child’s language development, reading stories at bedtime can be a bonding and family-building activity. Reading also can be a calming ingredient and a sleep-enhancing component in an effective bedtime ritual. And for the child who resists bedtime, reading can be used a reward that can be withheld or increased as the situation requires.

While I sense that the practice of saying one’s prayers at bedtime has fallen out of fashion for many families, the bedtime story is alive and well. We must help remind parents that the bedtime is at least as important as the story.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater” and “Is My Child Overtired?: The Sleep Solution for Raising Happier, Healthier Children.” Email him at [email protected].

My first bicycle was a hand-me-down with 10-inch wheels, a fan belt instead of a chain, and no brakes.

Training wheels? Surely you jest. I must have been less than 3 when I learned to ride. I bought my fourth bike on a cost-sharing plan with my folks for $50 when I was 11. It was a three-speed “English” bike and was my ticket to the rest of the world. My hometown rests in a bowl surrounded by hills, and so without a bike with gears, my parents knew I wasn’t going outside a 5-mile perimeter. But with my racing green Phillips, I became a two-wheeled explorer without limits as long as I was home by dark and unaccompanied by a police officer.

At 13 a friend and I were allowed to cycle unaccompanied for 300 miles. The 3-day journey included spending one night in a boarding house and another sleeping under picnic tables on the side of the road. I still can’t believe my folks allowed us to go in that era before cell phones and GPS. I think it was a simple miscalculation. They were sure we would be back home before dark the first night.

As an adult I have been a committed bike commuter, and my wife and I prefer to do our European sightseeing from the saddles of our folding bikes. My children all learned to ride bicycles before they were 4. But to them, their bikes were never more than a toy. Ride to school? “Dad, no one does that!” Luckily, we lived close enough for them to walk.

Even so, after a 25-year hiatus during which their bicycles hung from the rafters in our garage, all three of our children have incorporated two-wheel travel into their adult lives. One has become a competitive road racer. One commutes 20 miles round trip in Boston. And one has added cycling to her fitness routine on a regular basis.

Their rediscovery of bicycling is not unique. Here in Brunswick, Maine, biking to school, at least up until junior high, has become “cool.” A bike rack that was once just a rusting reminder outside our K-1 school is now filled, and the second- to fifth-graders’ three racks overflow on the first warm day of spring. In Boston, where I pretty much had a nodding acquaintance with all my fellow bike commuters 45 years ago, the road can be three deep in cyclists at some intersections during rush hours.

Surprisingly, not all young adults learned to ride a bicycle when they were children. It’s not unusual to encounter an adult who can’t swim. But not learning to ride a bicycle? How can that happen? There may be financial constraints. For example, my Dad never learned, but his family lived in a city and couldn’t afford a bicycle. But it is likely that many 30-year-olds found video games, cable television, and other indoor diversions more appealing when they could have been learning to ride. And for many it just wasn’t cool.

I learned in a recent Wall Street Journal article(“ ‘It’s Like Riding a Bike’ Means Nothing to These Adults Trying to Learn,” by Miriam Jordan, July 14, 2015) that while 5% of the population can’t ride a bicycle, 13% in the 18- to 34-year-old age bracket lack the skill. Enough of these young adults are discovering that bicycling could offer them ecologically friendly and cheap transportation as well as a low-impact recreational option that bicycling schools for adults are springing up in cities across the country from Los Angeles to New York to meet the demand.

I worry that the current surge in the coolness of bicycling that we are observing here in Brunswick is a strictly local phenomenon, and the number of children who reach adulthood not knowing how to bicycle will continue to grow. I wonder if our national health might be improved if bicycle instruction for those who don’t know how to ride were included in grade school physical education classes. It might make a lot more sense than teaching archery or badminton.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

My first bicycle was a hand-me-down with 10-inch wheels, a fan belt instead of a chain, and no brakes.

Training wheels? Surely you jest. I must have been less than 3 when I learned to ride. I bought my fourth bike on a cost-sharing plan with my folks for $50 when I was 11. It was a three-speed “English” bike and was my ticket to the rest of the world. My hometown rests in a bowl surrounded by hills, and so without a bike with gears, my parents knew I wasn’t going outside a 5-mile perimeter. But with my racing green Phillips, I became a two-wheeled explorer without limits as long as I was home by dark and unaccompanied by a police officer.

At 13 a friend and I were allowed to cycle unaccompanied for 300 miles. The 3-day journey included spending one night in a boarding house and another sleeping under picnic tables on the side of the road. I still can’t believe my folks allowed us to go in that era before cell phones and GPS. I think it was a simple miscalculation. They were sure we would be back home before dark the first night.

As an adult I have been a committed bike commuter, and my wife and I prefer to do our European sightseeing from the saddles of our folding bikes. My children all learned to ride bicycles before they were 4. But to them, their bikes were never more than a toy. Ride to school? “Dad, no one does that!” Luckily, we lived close enough for them to walk.

Even so, after a 25-year hiatus during which their bicycles hung from the rafters in our garage, all three of our children have incorporated two-wheel travel into their adult lives. One has become a competitive road racer. One commutes 20 miles round trip in Boston. And one has added cycling to her fitness routine on a regular basis.

Their rediscovery of bicycling is not unique. Here in Brunswick, Maine, biking to school, at least up until junior high, has become “cool.” A bike rack that was once just a rusting reminder outside our K-1 school is now filled, and the second- to fifth-graders’ three racks overflow on the first warm day of spring. In Boston, where I pretty much had a nodding acquaintance with all my fellow bike commuters 45 years ago, the road can be three deep in cyclists at some intersections during rush hours.

Surprisingly, not all young adults learned to ride a bicycle when they were children. It’s not unusual to encounter an adult who can’t swim. But not learning to ride a bicycle? How can that happen? There may be financial constraints. For example, my Dad never learned, but his family lived in a city and couldn’t afford a bicycle. But it is likely that many 30-year-olds found video games, cable television, and other indoor diversions more appealing when they could have been learning to ride. And for many it just wasn’t cool.

I learned in a recent Wall Street Journal article(“ ‘It’s Like Riding a Bike’ Means Nothing to These Adults Trying to Learn,” by Miriam Jordan, July 14, 2015) that while 5% of the population can’t ride a bicycle, 13% in the 18- to 34-year-old age bracket lack the skill. Enough of these young adults are discovering that bicycling could offer them ecologically friendly and cheap transportation as well as a low-impact recreational option that bicycling schools for adults are springing up in cities across the country from Los Angeles to New York to meet the demand.

I worry that the current surge in the coolness of bicycling that we are observing here in Brunswick is a strictly local phenomenon, and the number of children who reach adulthood not knowing how to bicycle will continue to grow. I wonder if our national health might be improved if bicycle instruction for those who don’t know how to ride were included in grade school physical education classes. It might make a lot more sense than teaching archery or badminton.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

My first bicycle was a hand-me-down with 10-inch wheels, a fan belt instead of a chain, and no brakes.

Training wheels? Surely you jest. I must have been less than 3 when I learned to ride. I bought my fourth bike on a cost-sharing plan with my folks for $50 when I was 11. It was a three-speed “English” bike and was my ticket to the rest of the world. My hometown rests in a bowl surrounded by hills, and so without a bike with gears, my parents knew I wasn’t going outside a 5-mile perimeter. But with my racing green Phillips, I became a two-wheeled explorer without limits as long as I was home by dark and unaccompanied by a police officer.

At 13 a friend and I were allowed to cycle unaccompanied for 300 miles. The 3-day journey included spending one night in a boarding house and another sleeping under picnic tables on the side of the road. I still can’t believe my folks allowed us to go in that era before cell phones and GPS. I think it was a simple miscalculation. They were sure we would be back home before dark the first night.

As an adult I have been a committed bike commuter, and my wife and I prefer to do our European sightseeing from the saddles of our folding bikes. My children all learned to ride bicycles before they were 4. But to them, their bikes were never more than a toy. Ride to school? “Dad, no one does that!” Luckily, we lived close enough for them to walk.

Even so, after a 25-year hiatus during which their bicycles hung from the rafters in our garage, all three of our children have incorporated two-wheel travel into their adult lives. One has become a competitive road racer. One commutes 20 miles round trip in Boston. And one has added cycling to her fitness routine on a regular basis.

Their rediscovery of bicycling is not unique. Here in Brunswick, Maine, biking to school, at least up until junior high, has become “cool.” A bike rack that was once just a rusting reminder outside our K-1 school is now filled, and the second- to fifth-graders’ three racks overflow on the first warm day of spring. In Boston, where I pretty much had a nodding acquaintance with all my fellow bike commuters 45 years ago, the road can be three deep in cyclists at some intersections during rush hours.

Surprisingly, not all young adults learned to ride a bicycle when they were children. It’s not unusual to encounter an adult who can’t swim. But not learning to ride a bicycle? How can that happen? There may be financial constraints. For example, my Dad never learned, but his family lived in a city and couldn’t afford a bicycle. But it is likely that many 30-year-olds found video games, cable television, and other indoor diversions more appealing when they could have been learning to ride. And for many it just wasn’t cool.

I learned in a recent Wall Street Journal article(“ ‘It’s Like Riding a Bike’ Means Nothing to These Adults Trying to Learn,” by Miriam Jordan, July 14, 2015) that while 5% of the population can’t ride a bicycle, 13% in the 18- to 34-year-old age bracket lack the skill. Enough of these young adults are discovering that bicycling could offer them ecologically friendly and cheap transportation as well as a low-impact recreational option that bicycling schools for adults are springing up in cities across the country from Los Angeles to New York to meet the demand.

I worry that the current surge in the coolness of bicycling that we are observing here in Brunswick is a strictly local phenomenon, and the number of children who reach adulthood not knowing how to bicycle will continue to grow. I wonder if our national health might be improved if bicycle instruction for those who don’t know how to ride were included in grade school physical education classes. It might make a lot more sense than teaching archery or badminton.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

“Dad, Jason said that you saw him in the office today.”

“Gee, Nick, it was very busy. I don’t remember anything about his visit.”

My response to my son was a lie, but I have always been willing to feign ignorance to protect my patients’ privacy. When our kids were home and within earshot I never mentioned that I had seen one of their friends or schoolmates in the office. In fact, I pretty much never talked about my professional life when they were around. They knew my work took a big chunk of my time and, in the remaining few hours, we had other things to talk about. Unfortunately, all three of my children may have mistaken my silence as an indicator that I didn’t like my job, which was far from the truth.

After hearing enough evasive answers, they realized that I had no intention of sharing anything about their peers’ medical history, regardless of how trivial the incident may have been. Even before HIPAA, I knew that my children shouldn’t be trusted to keep even the most innocent-sounding tidbit within the boundaries of our home. After all they were just children.

I suspect that most of you are equally cautious about sharing patient information with your children, even your adult children. But what about your spouse? Let’s be honest here: How HIPAA-compliant is your home? Does pillow talk sometimes drift over the line and compromise doctor-patient confidentiality? I suspect that we all share stories about interesting cases with our spouses hoping that we haven’t revealed enough information for them to figure out who were are talking about.

Of course, “interesting” is a relative term. If your spouse’s postgraduate degree is in computer science and not in medicine, he or she may not find your story about “the highest creatinine I have ever seen” very titillating. But, the story that begins, “You won’t believe what this mother was feeding her 6-month-old” might get his or her attention.

Although you may have known it wasn’t professional, I suspect that there may have been a few times when you have thrown caution to the wind and made no attempt to disguise the identity of the patient even though it was someone with whom your spouse was familiar. It may not have happened to you, but I can’t believe it never happens. Marriages are, or at least should be, very intimate and trusting relationships.

I think that many, maybe most, of the patients and parents in your practice assume that you have shared their stories with your spouse. My wife has often encountered a patient in the grocery store who launches into a story about their child’s illness and is surprised that Marilyn had no idea that the child had even been sick.

I also think that those people who believe the doctors share patient information with their spouses also believe that one of the marriage vows includes a clause in which spouses of physicians swear to keep those shared stories within the confines of the marriage.

Mind you, I’m not advocating that physicians should feel free to share any and all patient information with their spouses. In fact, I think as a rule, it shouldn’t happen, if for no other reason than it puts pressure on a spouse, who may fear that he or she might spread the tidbit inadvertently. But I think we have to be honest, human nature being what it is. Intramarital information sharing happens. Do you agree?

“Dad, Jason said that you saw him in the office today.”

“Gee, Nick, it was very busy. I don’t remember anything about his visit.”

My response to my son was a lie, but I have always been willing to feign ignorance to protect my patients’ privacy. When our kids were home and within earshot I never mentioned that I had seen one of their friends or schoolmates in the office. In fact, I pretty much never talked about my professional life when they were around. They knew my work took a big chunk of my time and, in the remaining few hours, we had other things to talk about. Unfortunately, all three of my children may have mistaken my silence as an indicator that I didn’t like my job, which was far from the truth.

After hearing enough evasive answers, they realized that I had no intention of sharing anything about their peers’ medical history, regardless of how trivial the incident may have been. Even before HIPAA, I knew that my children shouldn’t be trusted to keep even the most innocent-sounding tidbit within the boundaries of our home. After all they were just children.

I suspect that most of you are equally cautious about sharing patient information with your children, even your adult children. But what about your spouse? Let’s be honest here: How HIPAA-compliant is your home? Does pillow talk sometimes drift over the line and compromise doctor-patient confidentiality? I suspect that we all share stories about interesting cases with our spouses hoping that we haven’t revealed enough information for them to figure out who were are talking about.

Of course, “interesting” is a relative term. If your spouse’s postgraduate degree is in computer science and not in medicine, he or she may not find your story about “the highest creatinine I have ever seen” very titillating. But, the story that begins, “You won’t believe what this mother was feeding her 6-month-old” might get his or her attention.

Although you may have known it wasn’t professional, I suspect that there may have been a few times when you have thrown caution to the wind and made no attempt to disguise the identity of the patient even though it was someone with whom your spouse was familiar. It may not have happened to you, but I can’t believe it never happens. Marriages are, or at least should be, very intimate and trusting relationships.

I think that many, maybe most, of the patients and parents in your practice assume that you have shared their stories with your spouse. My wife has often encountered a patient in the grocery store who launches into a story about their child’s illness and is surprised that Marilyn had no idea that the child had even been sick.

I also think that those people who believe the doctors share patient information with their spouses also believe that one of the marriage vows includes a clause in which spouses of physicians swear to keep those shared stories within the confines of the marriage.

Mind you, I’m not advocating that physicians should feel free to share any and all patient information with their spouses. In fact, I think as a rule, it shouldn’t happen, if for no other reason than it puts pressure on a spouse, who may fear that he or she might spread the tidbit inadvertently. But I think we have to be honest, human nature being what it is. Intramarital information sharing happens. Do you agree?

“Dad, Jason said that you saw him in the office today.”

“Gee, Nick, it was very busy. I don’t remember anything about his visit.”

My response to my son was a lie, but I have always been willing to feign ignorance to protect my patients’ privacy. When our kids were home and within earshot I never mentioned that I had seen one of their friends or schoolmates in the office. In fact, I pretty much never talked about my professional life when they were around. They knew my work took a big chunk of my time and, in the remaining few hours, we had other things to talk about. Unfortunately, all three of my children may have mistaken my silence as an indicator that I didn’t like my job, which was far from the truth.

After hearing enough evasive answers, they realized that I had no intention of sharing anything about their peers’ medical history, regardless of how trivial the incident may have been. Even before HIPAA, I knew that my children shouldn’t be trusted to keep even the most innocent-sounding tidbit within the boundaries of our home. After all they were just children.

I suspect that most of you are equally cautious about sharing patient information with your children, even your adult children. But what about your spouse? Let’s be honest here: How HIPAA-compliant is your home? Does pillow talk sometimes drift over the line and compromise doctor-patient confidentiality? I suspect that we all share stories about interesting cases with our spouses hoping that we haven’t revealed enough information for them to figure out who were are talking about.

Of course, “interesting” is a relative term. If your spouse’s postgraduate degree is in computer science and not in medicine, he or she may not find your story about “the highest creatinine I have ever seen” very titillating. But, the story that begins, “You won’t believe what this mother was feeding her 6-month-old” might get his or her attention.

Although you may have known it wasn’t professional, I suspect that there may have been a few times when you have thrown caution to the wind and made no attempt to disguise the identity of the patient even though it was someone with whom your spouse was familiar. It may not have happened to you, but I can’t believe it never happens. Marriages are, or at least should be, very intimate and trusting relationships.

I think that many, maybe most, of the patients and parents in your practice assume that you have shared their stories with your spouse. My wife has often encountered a patient in the grocery store who launches into a story about their child’s illness and is surprised that Marilyn had no idea that the child had even been sick.

I also think that those people who believe the doctors share patient information with their spouses also believe that one of the marriage vows includes a clause in which spouses of physicians swear to keep those shared stories within the confines of the marriage.

Mind you, I’m not advocating that physicians should feel free to share any and all patient information with their spouses. In fact, I think as a rule, it shouldn’t happen, if for no other reason than it puts pressure on a spouse, who may fear that he or she might spread the tidbit inadvertently. But I think we have to be honest, human nature being what it is. Intramarital information sharing happens. Do you agree?

In January, I purchased the newly published second edition of “The Anthropology of Childhood: Cherubs, Chattel, Changelings,” by David F. Lancy (New York: Cambridge University Press, 2015), hoping it would provide me with some food for thought on the cold, dark winter nights. When the crocuses sprouted in April, I had slogged only halfway through its 533 pages (of which 104 are a list of references) and set it aside.

It has the heft of college text, but it is really more of a heavily referenced opinion piece. The author is an emeritus professor of anthropology at Utah State University, Logan, and his primary message is that how we value our children and how we choose to raise them here in North America should not be considered a benchmark against which to judge the way other societies treat their children. To emphasize his contention that we should not consider ourselves the norm, he refers to us as part of the WEIRD world (Western, Educated, Industrialized, Rich, Democracies).

Nearly every page includes at least one observation by an anthropologist that illustrates how different we are from many other societies. Not everyone values young children as cherubs the way we do. In some cultures, children are barely tolerated until they are old enough to contribute to the group. In some cultures, they are treated as no more than chattel.

While we believe that parents, certainly mothers, should play a critical role in the raising of children, there are many societies in which mothers are considered essential only for birthing and providing nutrition until the child is weaned. Children are left to be raised by other members of the society. Often, it is older siblings or cousins who assume the role we associate with parenthood.

The diversity of attitudes and child-rearing practices that Professor Lancy lays out in his tome is fascinating, even shocking at times, but after a few hundred pages one gets the message. But what I and every other parent want to know is if there is a common thread in these diverse cultures that can help us define the “natural” or the “best” or the “correct” way to parent our children. This question is particularly vexing for us in the WEIRD as we have become more heterogeneous, diverse, and multicultural. Most new millennium parents have no cultural tradition to fall back on, or if they have one it is likely to be very different from their partner in parenting. The result is that many parents find themselves on a constant, anxiety-driven search for the proper way to raise their child.

It’s not entirely clear to me how he arrives at it, but Professor Lancy offers his opinion on how we WEIRDs should raise our children. He feels we are taking the job of parenting far too seriously, and as a result, are meddling in a process that is best left to play out on its own. He observes, as do I, that children learn best by doing and imitating, not by being taught. Parents, specifically “involved” parents, are not a necessary requirement of successful child rearing. This message may come as an ego-busting shock to some parents. On the other hand, it should be liberating and guilt assuaging for parents whose careers and lifestyles limit the time they can spend with their children.

While I agree with Professor Lancy’s observation that much of the parenting that is done our society is unnecessary, and even at times counterproductive, the problem is that our society doesn’t offer many alternatives that provide the children an environment in which they can learn by doing and imitating. For example, grouping child care and preschool by age isolates young children from older children who can provide powerful role models for skill development. Unrealistic parental and provider fears about injury build barriers that rob children of opportunities to learn and grow.

The fact that here in the WEIRD families tend to have low birth rates makes it unlikely that parents will back off from overfocusing on their children. However, with help from knowledgeable and experienced experts in child health and behavior – pediatricians – there may be hope that some parents can learn to step back and let their children learn and develop in a more natural way.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

In January, I purchased the newly published second edition of “The Anthropology of Childhood: Cherubs, Chattel, Changelings,” by David F. Lancy (New York: Cambridge University Press, 2015), hoping it would provide me with some food for thought on the cold, dark winter nights. When the crocuses sprouted in April, I had slogged only halfway through its 533 pages (of which 104 are a list of references) and set it aside.

It has the heft of college text, but it is really more of a heavily referenced opinion piece. The author is an emeritus professor of anthropology at Utah State University, Logan, and his primary message is that how we value our children and how we choose to raise them here in North America should not be considered a benchmark against which to judge the way other societies treat their children. To emphasize his contention that we should not consider ourselves the norm, he refers to us as part of the WEIRD world (Western, Educated, Industrialized, Rich, Democracies).

Nearly every page includes at least one observation by an anthropologist that illustrates how different we are from many other societies. Not everyone values young children as cherubs the way we do. In some cultures, children are barely tolerated until they are old enough to contribute to the group. In some cultures, they are treated as no more than chattel.

While we believe that parents, certainly mothers, should play a critical role in the raising of children, there are many societies in which mothers are considered essential only for birthing and providing nutrition until the child is weaned. Children are left to be raised by other members of the society. Often, it is older siblings or cousins who assume the role we associate with parenthood.

The diversity of attitudes and child-rearing practices that Professor Lancy lays out in his tome is fascinating, even shocking at times, but after a few hundred pages one gets the message. But what I and every other parent want to know is if there is a common thread in these diverse cultures that can help us define the “natural” or the “best” or the “correct” way to parent our children. This question is particularly vexing for us in the WEIRD as we have become more heterogeneous, diverse, and multicultural. Most new millennium parents have no cultural tradition to fall back on, or if they have one it is likely to be very different from their partner in parenting. The result is that many parents find themselves on a constant, anxiety-driven search for the proper way to raise their child.

It’s not entirely clear to me how he arrives at it, but Professor Lancy offers his opinion on how we WEIRDs should raise our children. He feels we are taking the job of parenting far too seriously, and as a result, are meddling in a process that is best left to play out on its own. He observes, as do I, that children learn best by doing and imitating, not by being taught. Parents, specifically “involved” parents, are not a necessary requirement of successful child rearing. This message may come as an ego-busting shock to some parents. On the other hand, it should be liberating and guilt assuaging for parents whose careers and lifestyles limit the time they can spend with their children.

While I agree with Professor Lancy’s observation that much of the parenting that is done our society is unnecessary, and even at times counterproductive, the problem is that our society doesn’t offer many alternatives that provide the children an environment in which they can learn by doing and imitating. For example, grouping child care and preschool by age isolates young children from older children who can provide powerful role models for skill development. Unrealistic parental and provider fears about injury build barriers that rob children of opportunities to learn and grow.

The fact that here in the WEIRD families tend to have low birth rates makes it unlikely that parents will back off from overfocusing on their children. However, with help from knowledgeable and experienced experts in child health and behavior – pediatricians – there may be hope that some parents can learn to step back and let their children learn and develop in a more natural way.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

In January, I purchased the newly published second edition of “The Anthropology of Childhood: Cherubs, Chattel, Changelings,” by David F. Lancy (New York: Cambridge University Press, 2015), hoping it would provide me with some food for thought on the cold, dark winter nights. When the crocuses sprouted in April, I had slogged only halfway through its 533 pages (of which 104 are a list of references) and set it aside.

It has the heft of college text, but it is really more of a heavily referenced opinion piece. The author is an emeritus professor of anthropology at Utah State University, Logan, and his primary message is that how we value our children and how we choose to raise them here in North America should not be considered a benchmark against which to judge the way other societies treat their children. To emphasize his contention that we should not consider ourselves the norm, he refers to us as part of the WEIRD world (Western, Educated, Industrialized, Rich, Democracies).

Nearly every page includes at least one observation by an anthropologist that illustrates how different we are from many other societies. Not everyone values young children as cherubs the way we do. In some cultures, children are barely tolerated until they are old enough to contribute to the group. In some cultures, they are treated as no more than chattel.

While we believe that parents, certainly mothers, should play a critical role in the raising of children, there are many societies in which mothers are considered essential only for birthing and providing nutrition until the child is weaned. Children are left to be raised by other members of the society. Often, it is older siblings or cousins who assume the role we associate with parenthood.

The diversity of attitudes and child-rearing practices that Professor Lancy lays out in his tome is fascinating, even shocking at times, but after a few hundred pages one gets the message. But what I and every other parent want to know is if there is a common thread in these diverse cultures that can help us define the “natural” or the “best” or the “correct” way to parent our children. This question is particularly vexing for us in the WEIRD as we have become more heterogeneous, diverse, and multicultural. Most new millennium parents have no cultural tradition to fall back on, or if they have one it is likely to be very different from their partner in parenting. The result is that many parents find themselves on a constant, anxiety-driven search for the proper way to raise their child.

It’s not entirely clear to me how he arrives at it, but Professor Lancy offers his opinion on how we WEIRDs should raise our children. He feels we are taking the job of parenting far too seriously, and as a result, are meddling in a process that is best left to play out on its own. He observes, as do I, that children learn best by doing and imitating, not by being taught. Parents, specifically “involved” parents, are not a necessary requirement of successful child rearing. This message may come as an ego-busting shock to some parents. On the other hand, it should be liberating and guilt assuaging for parents whose careers and lifestyles limit the time they can spend with their children.

While I agree with Professor Lancy’s observation that much of the parenting that is done our society is unnecessary, and even at times counterproductive, the problem is that our society doesn’t offer many alternatives that provide the children an environment in which they can learn by doing and imitating. For example, grouping child care and preschool by age isolates young children from older children who can provide powerful role models for skill development. Unrealistic parental and provider fears about injury build barriers that rob children of opportunities to learn and grow.

The fact that here in the WEIRD families tend to have low birth rates makes it unlikely that parents will back off from overfocusing on their children. However, with help from knowledgeable and experienced experts in child health and behavior – pediatricians – there may be hope that some parents can learn to step back and let their children learn and develop in a more natural way.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” Email him at [email protected].

One of the perks that comes with being a grandparent is that you may get the chance to watch your grandchildren practice, play, and perform in a variety of organized activities. If you are retired and are fortunate enough to live in the same town, the opportunities are limitless and change with the season.

Each event is a kaleidoscope of interpersonal and developmental tableaux. First, of course, you are interested to see how your grandchild is doing. Are her skills improving? How do they compare with her peers’? Is she having fun? But then, what is the goal of the activity? Are the coaches/instructors/organizers doing a good job of reaching that goal?

Last week, I was watching my 8-year-old grandson play the last baseball game of his career (“Grampy, baseball is boring. I’m only playing lacrosse next spring.”) Between innings, I thumbed through the June 2015 Pediatrics. I encountered an article that confirmed my suspicions about some of the organized youth activities I had been watching for the last decade, “Physical Activity in Youth Dance Classes” (Pediatrics 2015;135:1067-73). Using accelerometers, researchers from San Diego State University recorded the activity of more than 250 girls, both children and adolescents, in 21 dance studios, both private and community based.

They discovered that the young dancers were, on average, engaged in moderate to vigorous activity 17.2 minutes (plus or minus 8.9 minutes), which amounted to about 36% of the usual class session. Only 8% of the children and 6% of the adolescents met the Centers for Disease Control and Prevention 30-minute guideline for after-school physical activity during dance.

I’ve watched a fair share of dance classes, and these findings come as no surprise. Typically, there is a lot of sitting around cross-legged in a circle, “listening” to “instruction.” There is even more lining up and waiting, and, then of course, adjusting the line, and an abundance of relining up, followed by a 6-second burst of activity. There is considerable poking and/or hugging fellow line mates, that I suspect wouldn’t have budged an accelerometer.

Unfortunately, this degree of inactivity is not unique to little girls’ dance classes. I have observed the same phenomenon during soccer, baseball, lacrosse, and swim classes – in which the ratio of inactivity to activity often exceeds 4:1. Although it may be slightly more prevalent when the instructors are parent/volunteers, professional physical educators also are guilty of injecting too little physical activity into the activities they are managing. Remember gym class. How much time was spent having your attendance taken, being instructed on how to do the activity, and then standing in line waiting your turn?

There are simple solutions, but they require thinking outside the box. Why have two lines of participants? Wouldn’t six lines mean three times as many children would be active at one time? For example, it has taken a while for soccer and hockey programs to catch on, but now both have games on smaller surfaces with less than the usual number of team members, in hopes that more children will be involved and active. Most great coaches have a knack for creating drills that keep the maximum number of participants active, foster the necessary skills, and at the same time are fun for the participants. The bottom line is that most children, particularly the younger ones, learn by imitating, not by being lectured to. They learn even more quickly if they have older children from which to model their behavior.

You could ask, “What’s the big deal?” Am I just venting the frustrations of an efficiency-obsessed former athlete? Does every minute of a child’s organized activity need to be packed with physical activity? No, not if children were allowed more opportunities for free play at other times during the day. No, not if parents were more diligent in restricting screen time. But if parents are going to count on dance classes and organized sports as physically active time for their children, they need to look more carefully at how that time is being used. An hour of dance class or soccer practice may be better than an hour in front of the tube, but it may fall far short of what the child needs.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

One of the perks that comes with being a grandparent is that you may get the chance to watch your grandchildren practice, play, and perform in a variety of organized activities. If you are retired and are fortunate enough to live in the same town, the opportunities are limitless and change with the season.

Each event is a kaleidoscope of interpersonal and developmental tableaux. First, of course, you are interested to see how your grandchild is doing. Are her skills improving? How do they compare with her peers’? Is she having fun? But then, what is the goal of the activity? Are the coaches/instructors/organizers doing a good job of reaching that goal?

Last week, I was watching my 8-year-old grandson play the last baseball game of his career (“Grampy, baseball is boring. I’m only playing lacrosse next spring.”) Between innings, I thumbed through the June 2015 Pediatrics. I encountered an article that confirmed my suspicions about some of the organized youth activities I had been watching for the last decade, “Physical Activity in Youth Dance Classes” (Pediatrics 2015;135:1067-73). Using accelerometers, researchers from San Diego State University recorded the activity of more than 250 girls, both children and adolescents, in 21 dance studios, both private and community based.

They discovered that the young dancers were, on average, engaged in moderate to vigorous activity 17.2 minutes (plus or minus 8.9 minutes), which amounted to about 36% of the usual class session. Only 8% of the children and 6% of the adolescents met the Centers for Disease Control and Prevention 30-minute guideline for after-school physical activity during dance.

I’ve watched a fair share of dance classes, and these findings come as no surprise. Typically, there is a lot of sitting around cross-legged in a circle, “listening” to “instruction.” There is even more lining up and waiting, and, then of course, adjusting the line, and an abundance of relining up, followed by a 6-second burst of activity. There is considerable poking and/or hugging fellow line mates, that I suspect wouldn’t have budged an accelerometer.

Unfortunately, this degree of inactivity is not unique to little girls’ dance classes. I have observed the same phenomenon during soccer, baseball, lacrosse, and swim classes – in which the ratio of inactivity to activity often exceeds 4:1. Although it may be slightly more prevalent when the instructors are parent/volunteers, professional physical educators also are guilty of injecting too little physical activity into the activities they are managing. Remember gym class. How much time was spent having your attendance taken, being instructed on how to do the activity, and then standing in line waiting your turn?

There are simple solutions, but they require thinking outside the box. Why have two lines of participants? Wouldn’t six lines mean three times as many children would be active at one time? For example, it has taken a while for soccer and hockey programs to catch on, but now both have games on smaller surfaces with less than the usual number of team members, in hopes that more children will be involved and active. Most great coaches have a knack for creating drills that keep the maximum number of participants active, foster the necessary skills, and at the same time are fun for the participants. The bottom line is that most children, particularly the younger ones, learn by imitating, not by being lectured to. They learn even more quickly if they have older children from which to model their behavior.

You could ask, “What’s the big deal?” Am I just venting the frustrations of an efficiency-obsessed former athlete? Does every minute of a child’s organized activity need to be packed with physical activity? No, not if children were allowed more opportunities for free play at other times during the day. No, not if parents were more diligent in restricting screen time. But if parents are going to count on dance classes and organized sports as physically active time for their children, they need to look more carefully at how that time is being used. An hour of dance class or soccer practice may be better than an hour in front of the tube, but it may fall far short of what the child needs.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

One of the perks that comes with being a grandparent is that you may get the chance to watch your grandchildren practice, play, and perform in a variety of organized activities. If you are retired and are fortunate enough to live in the same town, the opportunities are limitless and change with the season.

Each event is a kaleidoscope of interpersonal and developmental tableaux. First, of course, you are interested to see how your grandchild is doing. Are her skills improving? How do they compare with her peers’? Is she having fun? But then, what is the goal of the activity? Are the coaches/instructors/organizers doing a good job of reaching that goal?

Last week, I was watching my 8-year-old grandson play the last baseball game of his career (“Grampy, baseball is boring. I’m only playing lacrosse next spring.”) Between innings, I thumbed through the June 2015 Pediatrics. I encountered an article that confirmed my suspicions about some of the organized youth activities I had been watching for the last decade, “Physical Activity in Youth Dance Classes” (Pediatrics 2015;135:1067-73). Using accelerometers, researchers from San Diego State University recorded the activity of more than 250 girls, both children and adolescents, in 21 dance studios, both private and community based.

They discovered that the young dancers were, on average, engaged in moderate to vigorous activity 17.2 minutes (plus or minus 8.9 minutes), which amounted to about 36% of the usual class session. Only 8% of the children and 6% of the adolescents met the Centers for Disease Control and Prevention 30-minute guideline for after-school physical activity during dance.

I’ve watched a fair share of dance classes, and these findings come as no surprise. Typically, there is a lot of sitting around cross-legged in a circle, “listening” to “instruction.” There is even more lining up and waiting, and, then of course, adjusting the line, and an abundance of relining up, followed by a 6-second burst of activity. There is considerable poking and/or hugging fellow line mates, that I suspect wouldn’t have budged an accelerometer.

Unfortunately, this degree of inactivity is not unique to little girls’ dance classes. I have observed the same phenomenon during soccer, baseball, lacrosse, and swim classes – in which the ratio of inactivity to activity often exceeds 4:1. Although it may be slightly more prevalent when the instructors are parent/volunteers, professional physical educators also are guilty of injecting too little physical activity into the activities they are managing. Remember gym class. How much time was spent having your attendance taken, being instructed on how to do the activity, and then standing in line waiting your turn?

There are simple solutions, but they require thinking outside the box. Why have two lines of participants? Wouldn’t six lines mean three times as many children would be active at one time? For example, it has taken a while for soccer and hockey programs to catch on, but now both have games on smaller surfaces with less than the usual number of team members, in hopes that more children will be involved and active. Most great coaches have a knack for creating drills that keep the maximum number of participants active, foster the necessary skills, and at the same time are fun for the participants. The bottom line is that most children, particularly the younger ones, learn by imitating, not by being lectured to. They learn even more quickly if they have older children from which to model their behavior.

You could ask, “What’s the big deal?” Am I just venting the frustrations of an efficiency-obsessed former athlete? Does every minute of a child’s organized activity need to be packed with physical activity? No, not if children were allowed more opportunities for free play at other times during the day. No, not if parents were more diligent in restricting screen time. But if parents are going to count on dance classes and organized sports as physically active time for their children, they need to look more carefully at how that time is being used. An hour of dance class or soccer practice may be better than an hour in front of the tube, but it may fall far short of what the child needs.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

For those of us who appreciate the value of science and accept its limitations, it is sometimes difficult to understand how parents can choose to not immunize their children against serious and life-threatening diseases. To some extent, the explanation may be that immunizations simply have become victims of their own success.

How many adults have a relative, friend, or neighbor whose child has died as the result of bacterial meningitis or epiglottitis? They might have had a friend whose month-long cough was eventually diagnosed as whooping cough, but how many parents know of an infant who succumbed to pertussis? If you were trained in the last decade, you may not have had first-hand experience with most of the diseases for which we now have immunizations.

Reading a recent review of a new biography of Jonas Salk triggered a stream of memories of what it was like when polio descended on the landscape of North America – unchecked by an effective immunization. Moving through communities, choosing victims seemingly at random, it was every parent’s nightmare.

I grew up in a small town in New York State, so small that its inhabitants refer to it as a “village.” Everyone in Pleasantville knew at least one family that had been touched by polio. I don’t recall being aware of anyone in my family’s extended network of acquaintances who had died of the disease, but I suspect there may have been some fatalities that my parents avoided discussing in my presence. But I knew it was a disease with a significant mortality rate, and I knew of children and adults who had luckily survived several weeks or months in an iron lung. One of my parents’ closest friends walked with a limp as a result of polio.

There was rumor in town that all five members in one family had contracted polio and incredibly survived. Their cat had allegedly died of the disease. Our community was said to be particularly vulnerable because we had a public pool. This gift from the federal government’s Works Progress Administration provided a multi-lane superhighway for the virus to spread from child to child.

Even as a young child, I could sense that a blanket of fear hung over our little village during the summer when the disease was at its most prevalent. Now, as a parent, I am surprised how well my own parents disguised the fears that they and their peers must have harbored. My sister and I were still allowed to go swimming at the pool on the hottest days, but we knew that there were other families who stayed away.

When a vaccine trial began at our school, there was no question that we would participate. In fact, I don’t recall bringing home any permission slips to be signed. Nor do I remember hearing of any families who had opted out. We always wondered whether we had received the real vaccine or the placebo. But when the trials were over and the real vaccine was available, what parent in his or her right mind would even consider depriving his or her child from protection against this scourge that had taken up residence among us? I’m sure that Dr. Blum, my pediatrician, never needed to spend more than 30 seconds trying to convince my parents or any other parents, for that matter, of the need to vaccinate against polio.

My childhood ended before the development of the vaccines against the other common viral illnesses, and as a result I contracted and survived measles, mumps, rubella, and varicella. Of course, there must have been a few children who died of the diseases that had left me unscathed, but the number of fatalities was so small that I’m sure my parents would have wondered why we would need vaccines for these “usual diseases of childhood.”

But polio was different, and while it pales in comparison to Ebola, polio and its successful eradication created a generation of parents with a respect for science and the value of immunization. However, that generation has passed, and with it the stories they could have told the parents of today. Unfortunately, vaccine refusers seem to be immune to education and deaf to the lessons history can teach. I suspect that they would have foolishly ignored my parents’ stories about polio as just so much when-I-was-your-age mumbling.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

For those of us who appreciate the value of science and accept its limitations, it is sometimes difficult to understand how parents can choose to not immunize their children against serious and life-threatening diseases. To some extent, the explanation may be that immunizations simply have become victims of their own success.

How many adults have a relative, friend, or neighbor whose child has died as the result of bacterial meningitis or epiglottitis? They might have had a friend whose month-long cough was eventually diagnosed as whooping cough, but how many parents know of an infant who succumbed to pertussis? If you were trained in the last decade, you may not have had first-hand experience with most of the diseases for which we now have immunizations.

Reading a recent review of a new biography of Jonas Salk triggered a stream of memories of what it was like when polio descended on the landscape of North America – unchecked by an effective immunization. Moving through communities, choosing victims seemingly at random, it was every parent’s nightmare.

I grew up in a small town in New York State, so small that its inhabitants refer to it as a “village.” Everyone in Pleasantville knew at least one family that had been touched by polio. I don’t recall being aware of anyone in my family’s extended network of acquaintances who had died of the disease, but I suspect there may have been some fatalities that my parents avoided discussing in my presence. But I knew it was a disease with a significant mortality rate, and I knew of children and adults who had luckily survived several weeks or months in an iron lung. One of my parents’ closest friends walked with a limp as a result of polio.

There was rumor in town that all five members in one family had contracted polio and incredibly survived. Their cat had allegedly died of the disease. Our community was said to be particularly vulnerable because we had a public pool. This gift from the federal government’s Works Progress Administration provided a multi-lane superhighway for the virus to spread from child to child.

Even as a young child, I could sense that a blanket of fear hung over our little village during the summer when the disease was at its most prevalent. Now, as a parent, I am surprised how well my own parents disguised the fears that they and their peers must have harbored. My sister and I were still allowed to go swimming at the pool on the hottest days, but we knew that there were other families who stayed away.

When a vaccine trial began at our school, there was no question that we would participate. In fact, I don’t recall bringing home any permission slips to be signed. Nor do I remember hearing of any families who had opted out. We always wondered whether we had received the real vaccine or the placebo. But when the trials were over and the real vaccine was available, what parent in his or her right mind would even consider depriving his or her child from protection against this scourge that had taken up residence among us? I’m sure that Dr. Blum, my pediatrician, never needed to spend more than 30 seconds trying to convince my parents or any other parents, for that matter, of the need to vaccinate against polio.

My childhood ended before the development of the vaccines against the other common viral illnesses, and as a result I contracted and survived measles, mumps, rubella, and varicella. Of course, there must have been a few children who died of the diseases that had left me unscathed, but the number of fatalities was so small that I’m sure my parents would have wondered why we would need vaccines for these “usual diseases of childhood.”

But polio was different, and while it pales in comparison to Ebola, polio and its successful eradication created a generation of parents with a respect for science and the value of immunization. However, that generation has passed, and with it the stories they could have told the parents of today. Unfortunately, vaccine refusers seem to be immune to education and deaf to the lessons history can teach. I suspect that they would have foolishly ignored my parents’ stories about polio as just so much when-I-was-your-age mumbling.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

For those of us who appreciate the value of science and accept its limitations, it is sometimes difficult to understand how parents can choose to not immunize their children against serious and life-threatening diseases. To some extent, the explanation may be that immunizations simply have become victims of their own success.

How many adults have a relative, friend, or neighbor whose child has died as the result of bacterial meningitis or epiglottitis? They might have had a friend whose month-long cough was eventually diagnosed as whooping cough, but how many parents know of an infant who succumbed to pertussis? If you were trained in the last decade, you may not have had first-hand experience with most of the diseases for which we now have immunizations.

Reading a recent review of a new biography of Jonas Salk triggered a stream of memories of what it was like when polio descended on the landscape of North America – unchecked by an effective immunization. Moving through communities, choosing victims seemingly at random, it was every parent’s nightmare.

I grew up in a small town in New York State, so small that its inhabitants refer to it as a “village.” Everyone in Pleasantville knew at least one family that had been touched by polio. I don’t recall being aware of anyone in my family’s extended network of acquaintances who had died of the disease, but I suspect there may have been some fatalities that my parents avoided discussing in my presence. But I knew it was a disease with a significant mortality rate, and I knew of children and adults who had luckily survived several weeks or months in an iron lung. One of my parents’ closest friends walked with a limp as a result of polio.

There was rumor in town that all five members in one family had contracted polio and incredibly survived. Their cat had allegedly died of the disease. Our community was said to be particularly vulnerable because we had a public pool. This gift from the federal government’s Works Progress Administration provided a multi-lane superhighway for the virus to spread from child to child.

Even as a young child, I could sense that a blanket of fear hung over our little village during the summer when the disease was at its most prevalent. Now, as a parent, I am surprised how well my own parents disguised the fears that they and their peers must have harbored. My sister and I were still allowed to go swimming at the pool on the hottest days, but we knew that there were other families who stayed away.

When a vaccine trial began at our school, there was no question that we would participate. In fact, I don’t recall bringing home any permission slips to be signed. Nor do I remember hearing of any families who had opted out. We always wondered whether we had received the real vaccine or the placebo. But when the trials were over and the real vaccine was available, what parent in his or her right mind would even consider depriving his or her child from protection against this scourge that had taken up residence among us? I’m sure that Dr. Blum, my pediatrician, never needed to spend more than 30 seconds trying to convince my parents or any other parents, for that matter, of the need to vaccinate against polio.

My childhood ended before the development of the vaccines against the other common viral illnesses, and as a result I contracted and survived measles, mumps, rubella, and varicella. Of course, there must have been a few children who died of the diseases that had left me unscathed, but the number of fatalities was so small that I’m sure my parents would have wondered why we would need vaccines for these “usual diseases of childhood.”

But polio was different, and while it pales in comparison to Ebola, polio and its successful eradication created a generation of parents with a respect for science and the value of immunization. However, that generation has passed, and with it the stories they could have told the parents of today. Unfortunately, vaccine refusers seem to be immune to education and deaf to the lessons history can teach. I suspect that they would have foolishly ignored my parents’ stories about polio as just so much when-I-was-your-age mumbling.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

I was 7 years old when my family got its first television. I can’t recall the year, but I know that we were one of the last houses in our neighborhood to have a color TV. As parents, my wife and I kept our children on a moderate viewing diet, mostly “Captain Kangaroo” and “Sesame Street” when they were young. Until they were teenagers, they believed that only televisions in motel rooms received cartoons. Now, as parents, they are more restrictive with their children than we were with them. One family doesn’t even own a television.

A few years ago, my wife and I cut back our cable service to “basic” and, other than a few sporting events and a rare show on PBS, our TV sits unused in our living room. Five months out of the year, we have no television at all – when we’re in our cottage by the ocean.

Our trajectory from being enthusiastic viewers to television abstainers seems to be not that unusual among our peers. At dinner parties, I often hear, “There is nothing worth watching on television. It’s all junk and commercials.” Could the same condemnation be voiced about television for young children? Could there be some benefit for preschoolers in watching an “educational” show such as “Sesame Street”? Or is it all garbage, even for the very young?

A recently and much ballyhooed study by two economists suggests that, at least as “Sesame Street” is concerned, television can have a positive effect on young children. You may have read the headline: “Study: Kids can learn as much from ‘Sesame Street’ as from preschool” (Washington Post, June 7, 2015).

The researchers exploited a quirk of the precable landscape when some markets could not tune into some shows, including “Sesame Street,” because they were receiving only a UHF signal. Analyzing the data over several years, the economists found that, in communities where children had the opportunity to watch “Sesame Street,” those children had a “14% drop in the likelihood of being behind in school.” That association appeared to fade by the time the children reached high school. To claim that “Sesame Street” is at least as good as preschool based on these numbers seems to me to be a bit of a stretch. It may be that UHF-watching kids watched more professional wrestling, and this encouraged them to be more disruptive in school.

We must remember that these researchers are economists, and we should take anything they conclude with a grain of salt. But let’s say that there may be something to their conclusion that there is an association between “Sesame Street” viewing and school readiness. Does this mean that we should be developing more shows on the “Sesame Street” model, and that young children should be watching educational television several hours a day? Is there a dose effect? Or does this apparent association simply suggest that we should be improving preschools?

For decades, pediatricians and the American Academy of Pediatrics were focused on content and giving too little attention to the amount of screen time. This has improved slightly in the last few years, but the fact remains that television is a passive and sedentary activity that is threatening the health of our nation. It is robbing millions of Americans of precious hours of restorative sleep. It is giving even more millions an easy and addictive way to avoid doing something else. Instead, the addicts spend hours each day watching other people doing something. I always have suspected that the introduction of color to television is the culprit. Black-and-white TV was interesting to a point, but I don’t recall it being addictive. Most of us will watch for hours anything that is colorful and moves.

“Sesame Street” is and has been a wonderful show, and I suspect it has helped millions of children learn things they may not have been exposed to at home. But in one sense, educational programming could be considered a gateway drug. Once the set goes on, many parents don’t have the fortitude to shut it off. We should think twice before claiming that it is on a par with preschool.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

I was 7 years old when my family got its first television. I can’t recall the year, but I know that we were one of the last houses in our neighborhood to have a color TV. As parents, my wife and I kept our children on a moderate viewing diet, mostly “Captain Kangaroo” and “Sesame Street” when they were young. Until they were teenagers, they believed that only televisions in motel rooms received cartoons. Now, as parents, they are more restrictive with their children than we were with them. One family doesn’t even own a television.

A few years ago, my wife and I cut back our cable service to “basic” and, other than a few sporting events and a rare show on PBS, our TV sits unused in our living room. Five months out of the year, we have no television at all – when we’re in our cottage by the ocean.

Our trajectory from being enthusiastic viewers to television abstainers seems to be not that unusual among our peers. At dinner parties, I often hear, “There is nothing worth watching on television. It’s all junk and commercials.” Could the same condemnation be voiced about television for young children? Could there be some benefit for preschoolers in watching an “educational” show such as “Sesame Street”? Or is it all garbage, even for the very young?

A recently and much ballyhooed study by two economists suggests that, at least as “Sesame Street” is concerned, television can have a positive effect on young children. You may have read the headline: “Study: Kids can learn as much from ‘Sesame Street’ as from preschool” (Washington Post, June 7, 2015).

The researchers exploited a quirk of the precable landscape when some markets could not tune into some shows, including “Sesame Street,” because they were receiving only a UHF signal. Analyzing the data over several years, the economists found that, in communities where children had the opportunity to watch “Sesame Street,” those children had a “14% drop in the likelihood of being behind in school.” That association appeared to fade by the time the children reached high school. To claim that “Sesame Street” is at least as good as preschool based on these numbers seems to me to be a bit of a stretch. It may be that UHF-watching kids watched more professional wrestling, and this encouraged them to be more disruptive in school.

We must remember that these researchers are economists, and we should take anything they conclude with a grain of salt. But let’s say that there may be something to their conclusion that there is an association between “Sesame Street” viewing and school readiness. Does this mean that we should be developing more shows on the “Sesame Street” model, and that young children should be watching educational television several hours a day? Is there a dose effect? Or does this apparent association simply suggest that we should be improving preschools?

For decades, pediatricians and the American Academy of Pediatrics were focused on content and giving too little attention to the amount of screen time. This has improved slightly in the last few years, but the fact remains that television is a passive and sedentary activity that is threatening the health of our nation. It is robbing millions of Americans of precious hours of restorative sleep. It is giving even more millions an easy and addictive way to avoid doing something else. Instead, the addicts spend hours each day watching other people doing something. I always have suspected that the introduction of color to television is the culprit. Black-and-white TV was interesting to a point, but I don’t recall it being addictive. Most of us will watch for hours anything that is colorful and moves.

“Sesame Street” is and has been a wonderful show, and I suspect it has helped millions of children learn things they may not have been exposed to at home. But in one sense, educational programming could be considered a gateway drug. Once the set goes on, many parents don’t have the fortitude to shut it off. We should think twice before claiming that it is on a par with preschool.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

I was 7 years old when my family got its first television. I can’t recall the year, but I know that we were one of the last houses in our neighborhood to have a color TV. As parents, my wife and I kept our children on a moderate viewing diet, mostly “Captain Kangaroo” and “Sesame Street” when they were young. Until they were teenagers, they believed that only televisions in motel rooms received cartoons. Now, as parents, they are more restrictive with their children than we were with them. One family doesn’t even own a television.

A few years ago, my wife and I cut back our cable service to “basic” and, other than a few sporting events and a rare show on PBS, our TV sits unused in our living room. Five months out of the year, we have no television at all – when we’re in our cottage by the ocean.

Our trajectory from being enthusiastic viewers to television abstainers seems to be not that unusual among our peers. At dinner parties, I often hear, “There is nothing worth watching on television. It’s all junk and commercials.” Could the same condemnation be voiced about television for young children? Could there be some benefit for preschoolers in watching an “educational” show such as “Sesame Street”? Or is it all garbage, even for the very young?

A recently and much ballyhooed study by two economists suggests that, at least as “Sesame Street” is concerned, television can have a positive effect on young children. You may have read the headline: “Study: Kids can learn as much from ‘Sesame Street’ as from preschool” (Washington Post, June 7, 2015).

The researchers exploited a quirk of the precable landscape when some markets could not tune into some shows, including “Sesame Street,” because they were receiving only a UHF signal. Analyzing the data over several years, the economists found that, in communities where children had the opportunity to watch “Sesame Street,” those children had a “14% drop in the likelihood of being behind in school.” That association appeared to fade by the time the children reached high school. To claim that “Sesame Street” is at least as good as preschool based on these numbers seems to me to be a bit of a stretch. It may be that UHF-watching kids watched more professional wrestling, and this encouraged them to be more disruptive in school.

We must remember that these researchers are economists, and we should take anything they conclude with a grain of salt. But let’s say that there may be something to their conclusion that there is an association between “Sesame Street” viewing and school readiness. Does this mean that we should be developing more shows on the “Sesame Street” model, and that young children should be watching educational television several hours a day? Is there a dose effect? Or does this apparent association simply suggest that we should be improving preschools?

For decades, pediatricians and the American Academy of Pediatrics were focused on content and giving too little attention to the amount of screen time. This has improved slightly in the last few years, but the fact remains that television is a passive and sedentary activity that is threatening the health of our nation. It is robbing millions of Americans of precious hours of restorative sleep. It is giving even more millions an easy and addictive way to avoid doing something else. Instead, the addicts spend hours each day watching other people doing something. I always have suspected that the introduction of color to television is the culprit. Black-and-white TV was interesting to a point, but I don’t recall it being addictive. Most of us will watch for hours anything that is colorful and moves.

“Sesame Street” is and has been a wonderful show, and I suspect it has helped millions of children learn things they may not have been exposed to at home. But in one sense, educational programming could be considered a gateway drug. Once the set goes on, many parents don’t have the fortitude to shut it off. We should think twice before claiming that it is on a par with preschool.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

Our local daily paper, like most other print newspapers, is on its last legs. But I read it faithfully for the obituaries, and to see how my former patients are doing on their school sports teams. Of course, there is always the smattering of motor vehicle accident reports to keep me reading.

One doesn’t have to be an insurance adjuster or an actuary to realize that motor vehicle accident fatalities cluster into two groups: teenagers and older folks (70 plus). One group falls victim to inexperience and a delusional sense of immortality. Those in the other group are losing their ability to sense their environment and respond with sufficient speed. One group makes poor decisions. The other makes them too slowly.

Because my mother died in her early 60s and my father never had a driver’s license, I never faced the difficult task of telling my aging parents that they were too old to drive. But I have heard from some of my friends of how difficult it was to ask Mom and Dad to give up their car keys.

The American Medical Association announced recently that they have to decided to take on a similar challenge by agreeing to “spearhead an effort to create competency guidelines for assessing whether older physicians remain able to provide safe and effective care for patients” (“Aging MDs Prompt Call for Competency Tests at AMA Meeting,” Associated Press, June 8, 2015). Prompted by the reality that one in four physicians in this country is over the age of 65 years, the AMA is beginning to talk about the issue and formulate plans to convene a variety of councils and work groups.

I’m sure there are some older physicians whose clinical skills have eroded with age to a point that they pose a significant threat to the safety of their patients, but I don’t think the situation warrants a full-court press by the AMA or anyone else for that matter.

First, I suspect that most physicians who continue to practice after they turn 70 years are not doing so because they need the money. That might be true 10-15 years from now when today’s young physicians are facing retirement while they are still recovering from the monstrous educational debts they incurred in their 20s. At present, though, I suspect that most physicians continue to practice because they enjoy what they do. I have to believe that a physician whose primary motivation is the joy of seeing patients is, in general, going to be doing a good job of it – and his or her patients probably know it and appreciate it.

Second, we already have in place (or should have) systems for identifying and dealing with physicians who are practicing substandard care for variety of reasons, such as substance abuse, financial malfeasance, inadequate training, or outright incompetence. Do we really need another layer of screening for older physicians? It feels like just another example of profiling. For example, does the Transportation Security Administration need to strip search every male with a dark complexion named Hassan?

The problem is that in many situations our safety nets for identifying and addressing incompetent physicians have too many holes in them. One of the reasons for this inadequacy is the unofficial code of silence that physicians have followed for years. Unless a fellow physician’s behavior is three orders of magnitude beyond the pale, many of us feel uncomfortable about approaching him or her or even lodging an anonymous report to the state board of licensure.

Of course, as physicians age some will lose critical clinical skills. On the other hand, with age many older physicians have gained perspectives on health, life, and death that their younger colleagues need to hear. We don’t need to single out older physicians for closer scrutiny. We simply have to improve our current surveillance systems and attitudes for physicians of all ages. If anyone wants to look more closely at how older physicians practice, the first question to ask should not be “What are they doing wrong?” but “What are these folks doing right that allows them to continue to enjoy practicing medicine at age 75?”

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

Our local daily paper, like most other print newspapers, is on its last legs. But I read it faithfully for the obituaries, and to see how my former patients are doing on their school sports teams. Of course, there is always the smattering of motor vehicle accident reports to keep me reading.

One doesn’t have to be an insurance adjuster or an actuary to realize that motor vehicle accident fatalities cluster into two groups: teenagers and older folks (70 plus). One group falls victim to inexperience and a delusional sense of immortality. Those in the other group are losing their ability to sense their environment and respond with sufficient speed. One group makes poor decisions. The other makes them too slowly.

Because my mother died in her early 60s and my father never had a driver’s license, I never faced the difficult task of telling my aging parents that they were too old to drive. But I have heard from some of my friends of how difficult it was to ask Mom and Dad to give up their car keys.

The American Medical Association announced recently that they have to decided to take on a similar challenge by agreeing to “spearhead an effort to create competency guidelines for assessing whether older physicians remain able to provide safe and effective care for patients” (“Aging MDs Prompt Call for Competency Tests at AMA Meeting,” Associated Press, June 8, 2015). Prompted by the reality that one in four physicians in this country is over the age of 65 years, the AMA is beginning to talk about the issue and formulate plans to convene a variety of councils and work groups.

I’m sure there are some older physicians whose clinical skills have eroded with age to a point that they pose a significant threat to the safety of their patients, but I don’t think the situation warrants a full-court press by the AMA or anyone else for that matter.

First, I suspect that most physicians who continue to practice after they turn 70 years are not doing so because they need the money. That might be true 10-15 years from now when today’s young physicians are facing retirement while they are still recovering from the monstrous educational debts they incurred in their 20s. At present, though, I suspect that most physicians continue to practice because they enjoy what they do. I have to believe that a physician whose primary motivation is the joy of seeing patients is, in general, going to be doing a good job of it – and his or her patients probably know it and appreciate it.

Second, we already have in place (or should have) systems for identifying and dealing with physicians who are practicing substandard care for variety of reasons, such as substance abuse, financial malfeasance, inadequate training, or outright incompetence. Do we really need another layer of screening for older physicians? It feels like just another example of profiling. For example, does the Transportation Security Administration need to strip search every male with a dark complexion named Hassan?

The problem is that in many situations our safety nets for identifying and addressing incompetent physicians have too many holes in them. One of the reasons for this inadequacy is the unofficial code of silence that physicians have followed for years. Unless a fellow physician’s behavior is three orders of magnitude beyond the pale, many of us feel uncomfortable about approaching him or her or even lodging an anonymous report to the state board of licensure.

Of course, as physicians age some will lose critical clinical skills. On the other hand, with age many older physicians have gained perspectives on health, life, and death that their younger colleagues need to hear. We don’t need to single out older physicians for closer scrutiny. We simply have to improve our current surveillance systems and attitudes for physicians of all ages. If anyone wants to look more closely at how older physicians practice, the first question to ask should not be “What are they doing wrong?” but “What are these folks doing right that allows them to continue to enjoy practicing medicine at age 75?”

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

Our local daily paper, like most other print newspapers, is on its last legs. But I read it faithfully for the obituaries, and to see how my former patients are doing on their school sports teams. Of course, there is always the smattering of motor vehicle accident reports to keep me reading.

One doesn’t have to be an insurance adjuster or an actuary to realize that motor vehicle accident fatalities cluster into two groups: teenagers and older folks (70 plus). One group falls victim to inexperience and a delusional sense of immortality. Those in the other group are losing their ability to sense their environment and respond with sufficient speed. One group makes poor decisions. The other makes them too slowly.

Because my mother died in her early 60s and my father never had a driver’s license, I never faced the difficult task of telling my aging parents that they were too old to drive. But I have heard from some of my friends of how difficult it was to ask Mom and Dad to give up their car keys.

The American Medical Association announced recently that they have to decided to take on a similar challenge by agreeing to “spearhead an effort to create competency guidelines for assessing whether older physicians remain able to provide safe and effective care for patients” (“Aging MDs Prompt Call for Competency Tests at AMA Meeting,” Associated Press, June 8, 2015). Prompted by the reality that one in four physicians in this country is over the age of 65 years, the AMA is beginning to talk about the issue and formulate plans to convene a variety of councils and work groups.

I’m sure there are some older physicians whose clinical skills have eroded with age to a point that they pose a significant threat to the safety of their patients, but I don’t think the situation warrants a full-court press by the AMA or anyone else for that matter.

First, I suspect that most physicians who continue to practice after they turn 70 years are not doing so because they need the money. That might be true 10-15 years from now when today’s young physicians are facing retirement while they are still recovering from the monstrous educational debts they incurred in their 20s. At present, though, I suspect that most physicians continue to practice because they enjoy what they do. I have to believe that a physician whose primary motivation is the joy of seeing patients is, in general, going to be doing a good job of it – and his or her patients probably know it and appreciate it.

Second, we already have in place (or should have) systems for identifying and dealing with physicians who are practicing substandard care for variety of reasons, such as substance abuse, financial malfeasance, inadequate training, or outright incompetence. Do we really need another layer of screening for older physicians? It feels like just another example of profiling. For example, does the Transportation Security Administration need to strip search every male with a dark complexion named Hassan?

The problem is that in many situations our safety nets for identifying and addressing incompetent physicians have too many holes in them. One of the reasons for this inadequacy is the unofficial code of silence that physicians have followed for years. Unless a fellow physician’s behavior is three orders of magnitude beyond the pale, many of us feel uncomfortable about approaching him or her or even lodging an anonymous report to the state board of licensure.

Of course, as physicians age some will lose critical clinical skills. On the other hand, with age many older physicians have gained perspectives on health, life, and death that their younger colleagues need to hear. We don’t need to single out older physicians for closer scrutiny. We simply have to improve our current surveillance systems and attitudes for physicians of all ages. If anyone wants to look more closely at how older physicians practice, the first question to ask should not be “What are they doing wrong?” but “What are these folks doing right that allows them to continue to enjoy practicing medicine at age 75?”

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.”

When you decided to go to medical school, did you expect that you would be seeing as many patients with mental health complaints as you are seeing now? If you have been practicing pediatrics for more than 15 years, has your patient mix significantly taken on a more behavioral flavor? Do you think that more of your patients are experiencing serious mental health issues?

If you answered yes to any or all of those questions, your perception of the mental health status of this country’s children agrees with mine and probably that of most other Americans. However, a recent study suggests that not all of our perceptions are reality based (N. Engl. J. Med. 2015;372:2029-38). The authors used a parent-scored scale of the children’s impairment and found that the rate of severe mental illness has fallen significantly over the last generation. Despite the decline in severe cases that they observed, the percentage of children receiving outpatient mental health services (including psychotherapy and psychotropic drugs) has increased. In other words, while we and other providers are indeed seeing more children and adolescents with mental health and behavioral complaints, the tip of the iceberg is shrinking.

Does that divergence make any sense? As the chief of the National Institute of Mental Health’s in-house genetic epidemiological research program observes, it is hard to make any sense of the results of this new study, or any study, because there is a plethora of agencies doing surveys often using different methodologies. In Kathleen Merikangas’ words, “It’s a nightmare” (“Severe Mental Illness Found to Drop in Young, Defying Perceptions” by Benedict Carey in the New York Times on May 20, 2015).

The situation seems to be a classic case of comparing apples and oranges. It is probably even worse because different agencies can’t even agree on whether McIntoshes and Granny Smiths should both be counted as apples. With this degree of uncertainty, the officials charged with making decisions about funding and allocating mental health services are flying blind much of the time.

When it comes to divining the trends in the prevalence of mental illness in children and adolescents, your guess is as good as mine. So ... because I happen to have the time, I’m going to give you mine.

From my lofty perch here on the rocky coast of Maine, it appears to me that the recent study in the New England Journal of Medicine is accurate in its observation that serious mental illness is not increasing and may in be decreasing. But why does it feel that our office schedules are bulging with the patients presenting with less serious behavioral problems? One answer is that many of the cases of serious physical illness that we once saw never make it to the waiting room. For example, most children with congenital heart disease are now diagnosed in utero and delivered and treated in tertiary centers. Serious infectious diseases such as meningitis and epiglottitis have been damped down by successful immunizations. The abundance of subspecialists, the tendency of some physicians to issue knee-jerk referrals, and the awareness by parents that they can self-refer has left a void in our schedules that in the blink of an eye has filled with the walking worried.

It is worry and anxiety that in my estimation is on the rise and generating a large percentage of visits. Whether this is a post 9-11 phenomenon or simply a reflection of too-much-news-too-quickly is unclear. But the bottom line is that parents are worried and as a result so are many of their children. I am less sure on whether there has been a true increase in depression. It may be that people are more willing to talk about their unhappiness or it may be a ripple effect from our national sleep deprivation.

Finally, there has been a tendency to narrow the definition of normal that goes hand in hand with the notion that if it isn’t “normal,” there must be some medication to fix the problem. Attention-deficit/hyperactivity disorder is the poster child for this schedule-filling duo.

So that’s what I think. I suspect you feel you are seeing more behavior-related problems. But is this because of a true increase in the level of mental health problems in this country? How do you explain it?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

When you decided to go to medical school, did you expect that you would be seeing as many patients with mental health complaints as you are seeing now? If you have been practicing pediatrics for more than 15 years, has your patient mix significantly taken on a more behavioral flavor? Do you think that more of your patients are experiencing serious mental health issues?

If you answered yes to any or all of those questions, your perception of the mental health status of this country’s children agrees with mine and probably that of most other Americans. However, a recent study suggests that not all of our perceptions are reality based (N. Engl. J. Med. 2015;372:2029-38). The authors used a parent-scored scale of the children’s impairment and found that the rate of severe mental illness has fallen significantly over the last generation. Despite the decline in severe cases that they observed, the percentage of children receiving outpatient mental health services (including psychotherapy and psychotropic drugs) has increased. In other words, while we and other providers are indeed seeing more children and adolescents with mental health and behavioral complaints, the tip of the iceberg is shrinking.

Does that divergence make any sense? As the chief of the National Institute of Mental Health’s in-house genetic epidemiological research program observes, it is hard to make any sense of the results of this new study, or any study, because there is a plethora of agencies doing surveys often using different methodologies. In Kathleen Merikangas’ words, “It’s a nightmare” (“Severe Mental Illness Found to Drop in Young, Defying Perceptions” by Benedict Carey in the New York Times on May 20, 2015).

The situation seems to be a classic case of comparing apples and oranges. It is probably even worse because different agencies can’t even agree on whether McIntoshes and Granny Smiths should both be counted as apples. With this degree of uncertainty, the officials charged with making decisions about funding and allocating mental health services are flying blind much of the time.

When it comes to divining the trends in the prevalence of mental illness in children and adolescents, your guess is as good as mine. So ... because I happen to have the time, I’m going to give you mine.

From my lofty perch here on the rocky coast of Maine, it appears to me that the recent study in the New England Journal of Medicine is accurate in its observation that serious mental illness is not increasing and may in be decreasing. But why does it feel that our office schedules are bulging with the patients presenting with less serious behavioral problems? One answer is that many of the cases of serious physical illness that we once saw never make it to the waiting room. For example, most children with congenital heart disease are now diagnosed in utero and delivered and treated in tertiary centers. Serious infectious diseases such as meningitis and epiglottitis have been damped down by successful immunizations. The abundance of subspecialists, the tendency of some physicians to issue knee-jerk referrals, and the awareness by parents that they can self-refer has left a void in our schedules that in the blink of an eye has filled with the walking worried.

It is worry and anxiety that in my estimation is on the rise and generating a large percentage of visits. Whether this is a post 9-11 phenomenon or simply a reflection of too-much-news-too-quickly is unclear. But the bottom line is that parents are worried and as a result so are many of their children. I am less sure on whether there has been a true increase in depression. It may be that people are more willing to talk about their unhappiness or it may be a ripple effect from our national sleep deprivation.

Finally, there has been a tendency to narrow the definition of normal that goes hand in hand with the notion that if it isn’t “normal,” there must be some medication to fix the problem. Attention-deficit/hyperactivity disorder is the poster child for this schedule-filling duo.

So that’s what I think. I suspect you feel you are seeing more behavior-related problems. But is this because of a true increase in the level of mental health problems in this country? How do you explain it?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].

When you decided to go to medical school, did you expect that you would be seeing as many patients with mental health complaints as you are seeing now? If you have been practicing pediatrics for more than 15 years, has your patient mix significantly taken on a more behavioral flavor? Do you think that more of your patients are experiencing serious mental health issues?

If you answered yes to any or all of those questions, your perception of the mental health status of this country’s children agrees with mine and probably that of most other Americans. However, a recent study suggests that not all of our perceptions are reality based (N. Engl. J. Med. 2015;372:2029-38). The authors used a parent-scored scale of the children’s impairment and found that the rate of severe mental illness has fallen significantly over the last generation. Despite the decline in severe cases that they observed, the percentage of children receiving outpatient mental health services (including psychotherapy and psychotropic drugs) has increased. In other words, while we and other providers are indeed seeing more children and adolescents with mental health and behavioral complaints, the tip of the iceberg is shrinking.

Does that divergence make any sense? As the chief of the National Institute of Mental Health’s in-house genetic epidemiological research program observes, it is hard to make any sense of the results of this new study, or any study, because there is a plethora of agencies doing surveys often using different methodologies. In Kathleen Merikangas’ words, “It’s a nightmare” (“Severe Mental Illness Found to Drop in Young, Defying Perceptions” by Benedict Carey in the New York Times on May 20, 2015).

The situation seems to be a classic case of comparing apples and oranges. It is probably even worse because different agencies can’t even agree on whether McIntoshes and Granny Smiths should both be counted as apples. With this degree of uncertainty, the officials charged with making decisions about funding and allocating mental health services are flying blind much of the time.

When it comes to divining the trends in the prevalence of mental illness in children and adolescents, your guess is as good as mine. So ... because I happen to have the time, I’m going to give you mine.

From my lofty perch here on the rocky coast of Maine, it appears to me that the recent study in the New England Journal of Medicine is accurate in its observation that serious mental illness is not increasing and may in be decreasing. But why does it feel that our office schedules are bulging with the patients presenting with less serious behavioral problems? One answer is that many of the cases of serious physical illness that we once saw never make it to the waiting room. For example, most children with congenital heart disease are now diagnosed in utero and delivered and treated in tertiary centers. Serious infectious diseases such as meningitis and epiglottitis have been damped down by successful immunizations. The abundance of subspecialists, the tendency of some physicians to issue knee-jerk referrals, and the awareness by parents that they can self-refer has left a void in our schedules that in the blink of an eye has filled with the walking worried.

It is worry and anxiety that in my estimation is on the rise and generating a large percentage of visits. Whether this is a post 9-11 phenomenon or simply a reflection of too-much-news-too-quickly is unclear. But the bottom line is that parents are worried and as a result so are many of their children. I am less sure on whether there has been a true increase in depression. It may be that people are more willing to talk about their unhappiness or it may be a ripple effect from our national sleep deprivation.

Finally, there has been a tendency to narrow the definition of normal that goes hand in hand with the notion that if it isn’t “normal,” there must be some medication to fix the problem. Attention-deficit/hyperactivity disorder is the poster child for this schedule-filling duo.

So that’s what I think. I suspect you feel you are seeing more behavior-related problems. But is this because of a true increase in the level of mental health problems in this country? How do you explain it?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected].