Letters from Maine

In May 2015, the American Academy of Pediatrics convened an invitation-only symposium titled Growing Up Digital. Its goal was to reconsider the Academy’s advice on “screen time” and make sure that its policies were “science-driven, not based merely on the precautionary principle.” (“Beyond ‘turn it off’: How to advice families on media use,” Brown et al. AAP News, October 2015). Driven by the concern that the current AAP advice was becoming obsolete and as a result likely to be ignored by parents faced with the realities of our digital culture, the participants investigated the available data on “early learning, game-based learning, social/emotional and developmental concerns, and strategies to foster digital citizenship.”

Their findings have been distilled into a collection of “key messages” for parents published in the October, 2015 AAP News. It’s hard to argue with most of the common sense advice that includes “Role modeling is critical; playtime is important; co-engagement counts; set limits; and create tech-free zones.” A set of formal recommendations is in the works and will be published at a later date.

It is comforting to learn of the academy’s concern to keep its advice current and evidence-based. It is frustrating for those of us expected to deliver the party line when we suspect that parents are muttering to themselves, “Really?” I assume that most pediatricians at the parent/doctor interface will join me in welcoming much of the more nuanced advice in the final recommendations, particularly those for older children and adolescents.

However, if the new document is not carefully worded and promoted, I fear that the potent message of “no screen time under age 2” will be lost or diluted. While the symposium participants may have uncovered some evidence of benefit or at least no serious harm from some digital platforms, does this warrant softening the catchy and clear advice of “no screen time under 2?” I have to ask myself when would a child under the age of 2 being raised in a healthy environment have time for electronic distraction?

As Dr. Ari Brown, Dr. Donald L. Shifrin, and Dr. David L. Hill ask parents in their AAP News piece, “Does your child’s technology use help or hinder participation in other activities?” Just doing a little quick math: Wake up at 7 a.m., breakfast, playground time, maybe a midmorning nap, snack, lunch, afternoon nap, afternoon playground time, maybe another snack, dinner, bedtime story and lights out at 7 p.m. I don’t see a spot to shoehorn in some screen time without eliminating a developmentally and socially important activity. You could replace the hard cover book at bedtime with an electronic one on a tablet, but in my experience that runs the risk of replacing a soporific activity with one that is too visually stimulating.

One could argue that depriving a young child of screen time is going to put him behind his peers who have become masterful web navigators by the time they are 18 months. Rubbish. The learning curve for most electronic devices is so short that the “deprived” child will catch up in a couple of dozen clicks. However, screens require little more than a moving and tapping index finger. What about those other manipulative skills and the strength and coordination of the muscles sitting unused during screen time?

Unfortunately, the crafters of these new guidelines have repeated the same mistake the academy has made before when they observe, “The quality of the content is more important than the platform or time spent with media.” In my opinion, if the time spent on a screen is kept sufficiently short, children won’t squander it on bad stuff for very long nor will what they see be that harmful. Burdening parents with the task of determining quality is unrealistic. However, setting a time limit is far more workable and enforceable.

Finally, when it comes to parents enforcing no screen time under 2, everyone knows that Skyping with Grandma and Grandpa gets a free pass.

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 May 2015, the American Academy of Pediatrics convened an invitation-only symposium titled Growing Up Digital. Its goal was to reconsider the Academy’s advice on “screen time” and make sure that its policies were “science-driven, not based merely on the precautionary principle.” (“Beyond ‘turn it off’: How to advice families on media use,” Brown et al. AAP News, October 2015). Driven by the concern that the current AAP advice was becoming obsolete and as a result likely to be ignored by parents faced with the realities of our digital culture, the participants investigated the available data on “early learning, game-based learning, social/emotional and developmental concerns, and strategies to foster digital citizenship.”

Their findings have been distilled into a collection of “key messages” for parents published in the October, 2015 AAP News. It’s hard to argue with most of the common sense advice that includes “Role modeling is critical; playtime is important; co-engagement counts; set limits; and create tech-free zones.” A set of formal recommendations is in the works and will be published at a later date.

It is comforting to learn of the academy’s concern to keep its advice current and evidence-based. It is frustrating for those of us expected to deliver the party line when we suspect that parents are muttering to themselves, “Really?” I assume that most pediatricians at the parent/doctor interface will join me in welcoming much of the more nuanced advice in the final recommendations, particularly those for older children and adolescents.

However, if the new document is not carefully worded and promoted, I fear that the potent message of “no screen time under age 2” will be lost or diluted. While the symposium participants may have uncovered some evidence of benefit or at least no serious harm from some digital platforms, does this warrant softening the catchy and clear advice of “no screen time under 2?” I have to ask myself when would a child under the age of 2 being raised in a healthy environment have time for electronic distraction?

As Dr. Ari Brown, Dr. Donald L. Shifrin, and Dr. David L. Hill ask parents in their AAP News piece, “Does your child’s technology use help or hinder participation in other activities?” Just doing a little quick math: Wake up at 7 a.m., breakfast, playground time, maybe a midmorning nap, snack, lunch, afternoon nap, afternoon playground time, maybe another snack, dinner, bedtime story and lights out at 7 p.m. I don’t see a spot to shoehorn in some screen time without eliminating a developmentally and socially important activity. You could replace the hard cover book at bedtime with an electronic one on a tablet, but in my experience that runs the risk of replacing a soporific activity with one that is too visually stimulating.

One could argue that depriving a young child of screen time is going to put him behind his peers who have become masterful web navigators by the time they are 18 months. Rubbish. The learning curve for most electronic devices is so short that the “deprived” child will catch up in a couple of dozen clicks. However, screens require little more than a moving and tapping index finger. What about those other manipulative skills and the strength and coordination of the muscles sitting unused during screen time?

Unfortunately, the crafters of these new guidelines have repeated the same mistake the academy has made before when they observe, “The quality of the content is more important than the platform or time spent with media.” In my opinion, if the time spent on a screen is kept sufficiently short, children won’t squander it on bad stuff for very long nor will what they see be that harmful. Burdening parents with the task of determining quality is unrealistic. However, setting a time limit is far more workable and enforceable.

Finally, when it comes to parents enforcing no screen time under 2, everyone knows that Skyping with Grandma and Grandpa gets a free pass.

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 May 2015, the American Academy of Pediatrics convened an invitation-only symposium titled Growing Up Digital. Its goal was to reconsider the Academy’s advice on “screen time” and make sure that its policies were “science-driven, not based merely on the precautionary principle.” (“Beyond ‘turn it off’: How to advice families on media use,” Brown et al. AAP News, October 2015). Driven by the concern that the current AAP advice was becoming obsolete and as a result likely to be ignored by parents faced with the realities of our digital culture, the participants investigated the available data on “early learning, game-based learning, social/emotional and developmental concerns, and strategies to foster digital citizenship.”

Their findings have been distilled into a collection of “key messages” for parents published in the October, 2015 AAP News. It’s hard to argue with most of the common sense advice that includes “Role modeling is critical; playtime is important; co-engagement counts; set limits; and create tech-free zones.” A set of formal recommendations is in the works and will be published at a later date.

It is comforting to learn of the academy’s concern to keep its advice current and evidence-based. It is frustrating for those of us expected to deliver the party line when we suspect that parents are muttering to themselves, “Really?” I assume that most pediatricians at the parent/doctor interface will join me in welcoming much of the more nuanced advice in the final recommendations, particularly those for older children and adolescents.

However, if the new document is not carefully worded and promoted, I fear that the potent message of “no screen time under age 2” will be lost or diluted. While the symposium participants may have uncovered some evidence of benefit or at least no serious harm from some digital platforms, does this warrant softening the catchy and clear advice of “no screen time under 2?” I have to ask myself when would a child under the age of 2 being raised in a healthy environment have time for electronic distraction?

As Dr. Ari Brown, Dr. Donald L. Shifrin, and Dr. David L. Hill ask parents in their AAP News piece, “Does your child’s technology use help or hinder participation in other activities?” Just doing a little quick math: Wake up at 7 a.m., breakfast, playground time, maybe a midmorning nap, snack, lunch, afternoon nap, afternoon playground time, maybe another snack, dinner, bedtime story and lights out at 7 p.m. I don’t see a spot to shoehorn in some screen time without eliminating a developmentally and socially important activity. You could replace the hard cover book at bedtime with an electronic one on a tablet, but in my experience that runs the risk of replacing a soporific activity with one that is too visually stimulating.

One could argue that depriving a young child of screen time is going to put him behind his peers who have become masterful web navigators by the time they are 18 months. Rubbish. The learning curve for most electronic devices is so short that the “deprived” child will catch up in a couple of dozen clicks. However, screens require little more than a moving and tapping index finger. What about those other manipulative skills and the strength and coordination of the muscles sitting unused during screen time?

Unfortunately, the crafters of these new guidelines have repeated the same mistake the academy has made before when they observe, “The quality of the content is more important than the platform or time spent with media.” In my opinion, if the time spent on a screen is kept sufficiently short, children won’t squander it on bad stuff for very long nor will what they see be that harmful. Burdening parents with the task of determining quality is unrealistic. However, setting a time limit is far more workable and enforceable.

Finally, when it comes to parents enforcing no screen time under 2, everyone knows that Skyping with Grandma and Grandpa gets a free pass.

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].

You probably first heard the acronym EDC in medical school, and it replaced what you had been referring to as a “due date.” Of course, you remember the “C” is the first letter of “confinement.” Or is it? You would be forgiven if you thought EDC stood for Estimated Date of Cesarean.

While the practice of keeping new mothers cooped up in their homes for month and placed on dietary, activity, and even hygienic restrictions has all but disappeared in this country, the tradition persists in China. Believing that the process of even a normal delivery renders a woman vulnerable to all sorts of maladies, for 2,000 years Chinese grandmothers have been confining their daughters at home for the first month post partum.

In a recent article in the New York Times, I learned that while confinement continues post partum in China, it has changed among some affluent families so that it is more like spending a month in a high-end spa (“A Tradition for New Mothers in China, Now $27,000 a month” By Dan Levin, Oct. 1, 2015). The new confinement includes breastfeeding instruction, and dietary and activity choices that purport to be more scientifically based than the traditional restrictions. It has become popular with women who can afford it, while in the past confinement could be a month filled with tension between grandmothers and their daughters taking care of their new babies.

I can’t see the new Chinese version of confinement catching on here in North America, but the New York Times article did get me thinking about how we could do a better job helping mothers navigate the choppy waters of those first 30 days post partum. The Chinese are correct that a delivery is an assault on the body of even a previously healthy young woman. Even as one who hasn’t had the experience, I can only imagine it is like pulling an all-nighter (or two) and then running a marathon. Oh, and along the way losing a pint or two of blood.

There are a few families in North America who can afford to hire trained personnel (doulas), but for the most part we aren’t doing a very good job of helping women transition into motherhood. Of course, universal and more liberal family leave policies could make things easier. But simply lessening some of the tension associated with the inevitable return to the workplace isn’t enough. It is unlikely that we have the political will to make the changes to see those policies enacted.

However, there are things that we as pediatricians can do to make the postpartum period safer, healthier, and more comfortable for struggling families. First, we can encourage expectant mothers to make prenatal visits in our offices. While these visits are often little more than doctor shopping, we can ask the families who have committed to our practices to make a second appointment with more educational content. Would we get paid for it? Maybe not, but these second visits could pay for themselves in fewer after-hours calls.

We should do a better job of getting to know a new mother before she goes home from the hospital. What is her discharge hemoglobin? Does she have a history of depression and/or anxiety? Anemia and psychiatric issues can dramatically increase the risk that breastfeeding won’t go well and that post partum depression is more likely to ensue.

Are our offices and lactation consultants really available 24/7? Are we all on the same page when it comes to post partum advice? Do we return calls promptly and make follow-up calls? Are our offices and schedules truly new-mother friendly? Have we made use of all the available home health services that might be required?

The first postpartum month is critical, and new mothers need to be treated as our highest priority, but not confined.

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].

You probably first heard the acronym EDC in medical school, and it replaced what you had been referring to as a “due date.” Of course, you remember the “C” is the first letter of “confinement.” Or is it? You would be forgiven if you thought EDC stood for Estimated Date of Cesarean.

While the practice of keeping new mothers cooped up in their homes for month and placed on dietary, activity, and even hygienic restrictions has all but disappeared in this country, the tradition persists in China. Believing that the process of even a normal delivery renders a woman vulnerable to all sorts of maladies, for 2,000 years Chinese grandmothers have been confining their daughters at home for the first month post partum.

In a recent article in the New York Times, I learned that while confinement continues post partum in China, it has changed among some affluent families so that it is more like spending a month in a high-end spa (“A Tradition for New Mothers in China, Now $27,000 a month” By Dan Levin, Oct. 1, 2015). The new confinement includes breastfeeding instruction, and dietary and activity choices that purport to be more scientifically based than the traditional restrictions. It has become popular with women who can afford it, while in the past confinement could be a month filled with tension between grandmothers and their daughters taking care of their new babies.

I can’t see the new Chinese version of confinement catching on here in North America, but the New York Times article did get me thinking about how we could do a better job helping mothers navigate the choppy waters of those first 30 days post partum. The Chinese are correct that a delivery is an assault on the body of even a previously healthy young woman. Even as one who hasn’t had the experience, I can only imagine it is like pulling an all-nighter (or two) and then running a marathon. Oh, and along the way losing a pint or two of blood.

There are a few families in North America who can afford to hire trained personnel (doulas), but for the most part we aren’t doing a very good job of helping women transition into motherhood. Of course, universal and more liberal family leave policies could make things easier. But simply lessening some of the tension associated with the inevitable return to the workplace isn’t enough. It is unlikely that we have the political will to make the changes to see those policies enacted.

However, there are things that we as pediatricians can do to make the postpartum period safer, healthier, and more comfortable for struggling families. First, we can encourage expectant mothers to make prenatal visits in our offices. While these visits are often little more than doctor shopping, we can ask the families who have committed to our practices to make a second appointment with more educational content. Would we get paid for it? Maybe not, but these second visits could pay for themselves in fewer after-hours calls.

We should do a better job of getting to know a new mother before she goes home from the hospital. What is her discharge hemoglobin? Does she have a history of depression and/or anxiety? Anemia and psychiatric issues can dramatically increase the risk that breastfeeding won’t go well and that post partum depression is more likely to ensue.

Are our offices and lactation consultants really available 24/7? Are we all on the same page when it comes to post partum advice? Do we return calls promptly and make follow-up calls? Are our offices and schedules truly new-mother friendly? Have we made use of all the available home health services that might be required?

The first postpartum month is critical, and new mothers need to be treated as our highest priority, but not confined.

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].

You probably first heard the acronym EDC in medical school, and it replaced what you had been referring to as a “due date.” Of course, you remember the “C” is the first letter of “confinement.” Or is it? You would be forgiven if you thought EDC stood for Estimated Date of Cesarean.

While the practice of keeping new mothers cooped up in their homes for month and placed on dietary, activity, and even hygienic restrictions has all but disappeared in this country, the tradition persists in China. Believing that the process of even a normal delivery renders a woman vulnerable to all sorts of maladies, for 2,000 years Chinese grandmothers have been confining their daughters at home for the first month post partum.

In a recent article in the New York Times, I learned that while confinement continues post partum in China, it has changed among some affluent families so that it is more like spending a month in a high-end spa (“A Tradition for New Mothers in China, Now $27,000 a month” By Dan Levin, Oct. 1, 2015). The new confinement includes breastfeeding instruction, and dietary and activity choices that purport to be more scientifically based than the traditional restrictions. It has become popular with women who can afford it, while in the past confinement could be a month filled with tension between grandmothers and their daughters taking care of their new babies.

I can’t see the new Chinese version of confinement catching on here in North America, but the New York Times article did get me thinking about how we could do a better job helping mothers navigate the choppy waters of those first 30 days post partum. The Chinese are correct that a delivery is an assault on the body of even a previously healthy young woman. Even as one who hasn’t had the experience, I can only imagine it is like pulling an all-nighter (or two) and then running a marathon. Oh, and along the way losing a pint or two of blood.

There are a few families in North America who can afford to hire trained personnel (doulas), but for the most part we aren’t doing a very good job of helping women transition into motherhood. Of course, universal and more liberal family leave policies could make things easier. But simply lessening some of the tension associated with the inevitable return to the workplace isn’t enough. It is unlikely that we have the political will to make the changes to see those policies enacted.

However, there are things that we as pediatricians can do to make the postpartum period safer, healthier, and more comfortable for struggling families. First, we can encourage expectant mothers to make prenatal visits in our offices. While these visits are often little more than doctor shopping, we can ask the families who have committed to our practices to make a second appointment with more educational content. Would we get paid for it? Maybe not, but these second visits could pay for themselves in fewer after-hours calls.

We should do a better job of getting to know a new mother before she goes home from the hospital. What is her discharge hemoglobin? Does she have a history of depression and/or anxiety? Anemia and psychiatric issues can dramatically increase the risk that breastfeeding won’t go well and that post partum depression is more likely to ensue.

Are our offices and lactation consultants really available 24/7? Are we all on the same page when it comes to post partum advice? Do we return calls promptly and make follow-up calls? Are our offices and schedules truly new-mother friendly? Have we made use of all the available home health services that might be required?

The first postpartum month is critical, and new mothers need to be treated as our highest priority, but not confined.

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].

Apparently, it is well known among canine behavior specialists that under similar situations dogs will look at human faces while wolves continue about their business – usually eating (“Why Is That Dog Looking at Me?” by James Gorman, New York Times, Sept. 15, 2015).

It also has been shown that when presented with the challenge of opening a food container that has been sealed shut, dogs will give up quickly and look to a nearby human, presumably for help. On the other hand, wolves raised by humans don’t look for help, suggesting that this looking to humans for help behavior may have a genetic component.

If the container of food has been altered so that it can be opened, but only with significant effort, the wolves will persist until they succeed. The adult dogs give up too quickly to succeed and instead look to humans. But, it is very interesting that in some preexperiment trials, at least one 8-month-old puppy kept at it until he was able to open the container, suggesting that in addition to some genetic influence, hanging around humans may foster what we might consider learned helplessness.

This observation wouldn’t surprise the product engineers tasked with developing child-resistant closures that can be easily opened by an adult. And I’m sure this evidence of learned helplessness in an animal wouldn’t surprise those who believe that welfare in any form is an abomination. As a card-carrying centrist, I will leave that argument to the polarizers on both ends of the political spectrum.

But I think this observation is most interesting because it raises the question of how often today’s parents are contributing to their children’s sense of helplessness. You only have to watch a child or grandchild tackle and construct a Lego project to realize that children are natural problem solvers. They get the trial-and-error thing. The problem is that too often we adults intervene at the first hint of failure, and in doing so, screw up the beautiful simplicity of the trial-and-error method of learning.

Watching someone struggle with a challenge for which you know the solution is difficult, particularly difficult if the struggler is your child or spouse. It is tempting to step forward and offer, “Here, let me show you how to do it.” Or, even worse, “Let me do it for you.”

To return to the canine world, consider the dog that brings a ball or stick to his/her master and then sits patiently waiting for the object to be tossed. If nothing is thrown, the dog will eventually give up and curl up for a nap. Puppies, on the other hand, don’t expect someone to initiate the game. They will paw at the ball until it moves or chase some unsuspecting insect playmate.

While offering children the chance to participate in organized sports is preferable to having them sit inside watching television or glued to a computer screen, the pendulum has swung a little too far toward the “organized” side of things. Too many parents seem unaware that if children are placed in an environment with room to run, a ball or two, and a few older children from whom they can model behavior, the children will organize themselves. They will figure out how to choose teams, make rules, and settle disputes.

The sad thing is that too many children have been offered so few opportunities to exercise their own powers of invention that they believe they are helpless to organize themselves. To them a sport is just a miniature version of what they see on television and comes complete with full uniforms, organized teams, sidelines lined with adoring fans ... and – of course – team pictures and trophies for everyone at the end of the season.

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].

Apparently, it is well known among canine behavior specialists that under similar situations dogs will look at human faces while wolves continue about their business – usually eating (“Why Is That Dog Looking at Me?” by James Gorman, New York Times, Sept. 15, 2015).

It also has been shown that when presented with the challenge of opening a food container that has been sealed shut, dogs will give up quickly and look to a nearby human, presumably for help. On the other hand, wolves raised by humans don’t look for help, suggesting that this looking to humans for help behavior may have a genetic component.

If the container of food has been altered so that it can be opened, but only with significant effort, the wolves will persist until they succeed. The adult dogs give up too quickly to succeed and instead look to humans. But, it is very interesting that in some preexperiment trials, at least one 8-month-old puppy kept at it until he was able to open the container, suggesting that in addition to some genetic influence, hanging around humans may foster what we might consider learned helplessness.

This observation wouldn’t surprise the product engineers tasked with developing child-resistant closures that can be easily opened by an adult. And I’m sure this evidence of learned helplessness in an animal wouldn’t surprise those who believe that welfare in any form is an abomination. As a card-carrying centrist, I will leave that argument to the polarizers on both ends of the political spectrum.

But I think this observation is most interesting because it raises the question of how often today’s parents are contributing to their children’s sense of helplessness. You only have to watch a child or grandchild tackle and construct a Lego project to realize that children are natural problem solvers. They get the trial-and-error thing. The problem is that too often we adults intervene at the first hint of failure, and in doing so, screw up the beautiful simplicity of the trial-and-error method of learning.

Watching someone struggle with a challenge for which you know the solution is difficult, particularly difficult if the struggler is your child or spouse. It is tempting to step forward and offer, “Here, let me show you how to do it.” Or, even worse, “Let me do it for you.”

To return to the canine world, consider the dog that brings a ball or stick to his/her master and then sits patiently waiting for the object to be tossed. If nothing is thrown, the dog will eventually give up and curl up for a nap. Puppies, on the other hand, don’t expect someone to initiate the game. They will paw at the ball until it moves or chase some unsuspecting insect playmate.

While offering children the chance to participate in organized sports is preferable to having them sit inside watching television or glued to a computer screen, the pendulum has swung a little too far toward the “organized” side of things. Too many parents seem unaware that if children are placed in an environment with room to run, a ball or two, and a few older children from whom they can model behavior, the children will organize themselves. They will figure out how to choose teams, make rules, and settle disputes.

The sad thing is that too many children have been offered so few opportunities to exercise their own powers of invention that they believe they are helpless to organize themselves. To them a sport is just a miniature version of what they see on television and comes complete with full uniforms, organized teams, sidelines lined with adoring fans ... and – of course – team pictures and trophies for everyone at the end of the season.

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].

Apparently, it is well known among canine behavior specialists that under similar situations dogs will look at human faces while wolves continue about their business – usually eating (“Why Is That Dog Looking at Me?” by James Gorman, New York Times, Sept. 15, 2015).

It also has been shown that when presented with the challenge of opening a food container that has been sealed shut, dogs will give up quickly and look to a nearby human, presumably for help. On the other hand, wolves raised by humans don’t look for help, suggesting that this looking to humans for help behavior may have a genetic component.

If the container of food has been altered so that it can be opened, but only with significant effort, the wolves will persist until they succeed. The adult dogs give up too quickly to succeed and instead look to humans. But, it is very interesting that in some preexperiment trials, at least one 8-month-old puppy kept at it until he was able to open the container, suggesting that in addition to some genetic influence, hanging around humans may foster what we might consider learned helplessness.

This observation wouldn’t surprise the product engineers tasked with developing child-resistant closures that can be easily opened by an adult. And I’m sure this evidence of learned helplessness in an animal wouldn’t surprise those who believe that welfare in any form is an abomination. As a card-carrying centrist, I will leave that argument to the polarizers on both ends of the political spectrum.

But I think this observation is most interesting because it raises the question of how often today’s parents are contributing to their children’s sense of helplessness. You only have to watch a child or grandchild tackle and construct a Lego project to realize that children are natural problem solvers. They get the trial-and-error thing. The problem is that too often we adults intervene at the first hint of failure, and in doing so, screw up the beautiful simplicity of the trial-and-error method of learning.

Watching someone struggle with a challenge for which you know the solution is difficult, particularly difficult if the struggler is your child or spouse. It is tempting to step forward and offer, “Here, let me show you how to do it.” Or, even worse, “Let me do it for you.”

To return to the canine world, consider the dog that brings a ball or stick to his/her master and then sits patiently waiting for the object to be tossed. If nothing is thrown, the dog will eventually give up and curl up for a nap. Puppies, on the other hand, don’t expect someone to initiate the game. They will paw at the ball until it moves or chase some unsuspecting insect playmate.

While offering children the chance to participate in organized sports is preferable to having them sit inside watching television or glued to a computer screen, the pendulum has swung a little too far toward the “organized” side of things. Too many parents seem unaware that if children are placed in an environment with room to run, a ball or two, and a few older children from whom they can model behavior, the children will organize themselves. They will figure out how to choose teams, make rules, and settle disputes.

The sad thing is that too many children have been offered so few opportunities to exercise their own powers of invention that they believe they are helpless to organize themselves. To them a sport is just a miniature version of what they see on television and comes complete with full uniforms, organized teams, sidelines lined with adoring fans ... and – of course – team pictures and trophies for everyone at the end of the season.

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].

A recent study released by the Association of State Correctional Administrators and researchers from Yale Law School has found that federal and state prisons are holding as many as 100,000 inmates in solitary confinement or isolated housing (“Large Number of Inmates in Solitary Poses Problem for Justice System, Study Says,” by Jess Bravin, Wall Street Journal, Sept. 2, 2015). This new data has turned up the volume of voices calling for abolishment of solitary confinement on the grounds that not only is it inhumane but also counterproductive.

Do you agree with abolitionists or are you sympathetic to some prison workers and administrators who say that there are situations in which social isolation is the best and maybe the only solution when a prisoner is a serious threat to the safety of his fellow inmates and staff?

While you are mulling over your answer, here is a related question more relevant to your own situation. How do you feel about solitary confinement (a.k.a., time-out) as a consequence for a misbehaving preschooler?

Do you think it is cruel and inhumane? Do you recommend it to parents as part of a comprehensive behavior-management strategy? Will many parents try it? Or, do they recoil and wonder why you would suggest that they become prison wardens in their own homes? If parents try it, is it effective?

In my experience, if done correctly in the right circumstances, time-out for a young child in his room – even if it requires latching the door – can be a safe, humane, and effective consequence for misbehavior. Sometimes, it is the only thing that works. But the devil is in the “ifs.”

First, time-out should be the last step in a comprehensive behavior-management strategy that begins with prevention – by assuring that the child is getting enough sleep and the right kind of attention from his parents who have expectations for their child that are appropriate for his age and temperament. The child’s environment and schedule should be structured to minimize the temptation to misbehave. Other less-drastic-sounding consequences must have been tried unsuccessfully. And ... both parent and child must be psychologically and developmentally normal.

Will brief episodes of solitary confinement make a young child feel insecure or unloved? Not if his parents make it clear by their behavior that she is loved and living in a stable environment, regardless of whether she is in time-out or not. Will time-out make a child hate her room? I’ve never seen it happen. If the child plays happily in her room during her sentence, does this render time-out ineffective? No, that’s a win-win situation. The misbehavior has stopped and the child is happy. Does this mean that time-out may not be a good deterrent? It might. But I have found that the only effective deterrent is consistent follow-up of every threat with the promised consequence – regardless of the consequence.

What if the child “destroys” his room during time-out? And is it safe to leave a child alone in his room? The solutions to these challenges can be found in Lowes or Home Depot.

I’m not going to take up any more of your recreational reading time describing the details of how time-out can be made more effective and palatable for parents. But it can be done and may require purchasing a latch or some kind of child-resistant door closure device. It will most likely be used briefly – if at all – but it can remain as a tangible reminder to the child that his parent follows up on his threats.

I won’t be surprised if some of you are shocked that I would advocate solitary confinement for young children. I am interested to hear what you recommend to parents who are struggling to keep their child’s behavior in bounds.

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.”

A recent study released by the Association of State Correctional Administrators and researchers from Yale Law School has found that federal and state prisons are holding as many as 100,000 inmates in solitary confinement or isolated housing (“Large Number of Inmates in Solitary Poses Problem for Justice System, Study Says,” by Jess Bravin, Wall Street Journal, Sept. 2, 2015). This new data has turned up the volume of voices calling for abolishment of solitary confinement on the grounds that not only is it inhumane but also counterproductive.

Do you agree with abolitionists or are you sympathetic to some prison workers and administrators who say that there are situations in which social isolation is the best and maybe the only solution when a prisoner is a serious threat to the safety of his fellow inmates and staff?

While you are mulling over your answer, here is a related question more relevant to your own situation. How do you feel about solitary confinement (a.k.a., time-out) as a consequence for a misbehaving preschooler?

Do you think it is cruel and inhumane? Do you recommend it to parents as part of a comprehensive behavior-management strategy? Will many parents try it? Or, do they recoil and wonder why you would suggest that they become prison wardens in their own homes? If parents try it, is it effective?

In my experience, if done correctly in the right circumstances, time-out for a young child in his room – even if it requires latching the door – can be a safe, humane, and effective consequence for misbehavior. Sometimes, it is the only thing that works. But the devil is in the “ifs.”

First, time-out should be the last step in a comprehensive behavior-management strategy that begins with prevention – by assuring that the child is getting enough sleep and the right kind of attention from his parents who have expectations for their child that are appropriate for his age and temperament. The child’s environment and schedule should be structured to minimize the temptation to misbehave. Other less-drastic-sounding consequences must have been tried unsuccessfully. And ... both parent and child must be psychologically and developmentally normal.

Will brief episodes of solitary confinement make a young child feel insecure or unloved? Not if his parents make it clear by their behavior that she is loved and living in a stable environment, regardless of whether she is in time-out or not. Will time-out make a child hate her room? I’ve never seen it happen. If the child plays happily in her room during her sentence, does this render time-out ineffective? No, that’s a win-win situation. The misbehavior has stopped and the child is happy. Does this mean that time-out may not be a good deterrent? It might. But I have found that the only effective deterrent is consistent follow-up of every threat with the promised consequence – regardless of the consequence.

What if the child “destroys” his room during time-out? And is it safe to leave a child alone in his room? The solutions to these challenges can be found in Lowes or Home Depot.

I’m not going to take up any more of your recreational reading time describing the details of how time-out can be made more effective and palatable for parents. But it can be done and may require purchasing a latch or some kind of child-resistant door closure device. It will most likely be used briefly – if at all – but it can remain as a tangible reminder to the child that his parent follows up on his threats.

I won’t be surprised if some of you are shocked that I would advocate solitary confinement for young children. I am interested to hear what you recommend to parents who are struggling to keep their child’s behavior in bounds.

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.”

A recent study released by the Association of State Correctional Administrators and researchers from Yale Law School has found that federal and state prisons are holding as many as 100,000 inmates in solitary confinement or isolated housing (“Large Number of Inmates in Solitary Poses Problem for Justice System, Study Says,” by Jess Bravin, Wall Street Journal, Sept. 2, 2015). This new data has turned up the volume of voices calling for abolishment of solitary confinement on the grounds that not only is it inhumane but also counterproductive.

Do you agree with abolitionists or are you sympathetic to some prison workers and administrators who say that there are situations in which social isolation is the best and maybe the only solution when a prisoner is a serious threat to the safety of his fellow inmates and staff?

While you are mulling over your answer, here is a related question more relevant to your own situation. How do you feel about solitary confinement (a.k.a., time-out) as a consequence for a misbehaving preschooler?

Do you think it is cruel and inhumane? Do you recommend it to parents as part of a comprehensive behavior-management strategy? Will many parents try it? Or, do they recoil and wonder why you would suggest that they become prison wardens in their own homes? If parents try it, is it effective?

In my experience, if done correctly in the right circumstances, time-out for a young child in his room – even if it requires latching the door – can be a safe, humane, and effective consequence for misbehavior. Sometimes, it is the only thing that works. But the devil is in the “ifs.”

First, time-out should be the last step in a comprehensive behavior-management strategy that begins with prevention – by assuring that the child is getting enough sleep and the right kind of attention from his parents who have expectations for their child that are appropriate for his age and temperament. The child’s environment and schedule should be structured to minimize the temptation to misbehave. Other less-drastic-sounding consequences must have been tried unsuccessfully. And ... both parent and child must be psychologically and developmentally normal.

Will brief episodes of solitary confinement make a young child feel insecure or unloved? Not if his parents make it clear by their behavior that she is loved and living in a stable environment, regardless of whether she is in time-out or not. Will time-out make a child hate her room? I’ve never seen it happen. If the child plays happily in her room during her sentence, does this render time-out ineffective? No, that’s a win-win situation. The misbehavior has stopped and the child is happy. Does this mean that time-out may not be a good deterrent? It might. But I have found that the only effective deterrent is consistent follow-up of every threat with the promised consequence – regardless of the consequence.

What if the child “destroys” his room during time-out? And is it safe to leave a child alone in his room? The solutions to these challenges can be found in Lowes or Home Depot.

I’m not going to take up any more of your recreational reading time describing the details of how time-out can be made more effective and palatable for parents. But it can be done and may require purchasing a latch or some kind of child-resistant door closure device. It will most likely be used briefly – if at all – but it can remain as a tangible reminder to the child that his parent follows up on his threats.

I won’t be surprised if some of you are shocked that I would advocate solitary confinement for young children. I am interested to hear what you recommend to parents who are struggling to keep their child’s behavior in bounds.

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.”

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].

Okay, I admit that from time to time I have embellished the anecdotes that I include in these letters. Sometimes, I feel I need to make sure that you are paying attention. But this time, I am relating this story in its true, unvarnished state.

Two mature women with whom I am acquainted (No, one was not my wife!) had just finished their habitual Saturday morning walk through a wooded upper middle class neighborhood here in town. It was nine o’clock in the morning and the sun was shining. Suddenly, a mangy-looking fox trotted out of the woods and down the road toward them. Aware that from time to time local raccoons, skunks, and foxes have tested positive for rabies, these women began to run and flagged down the first car they saw, and without a word hopped in the back seat.

The surprised occupants of the vehicle were two mature men. You might call them strangers, but here in Maine, we don’t have any strangers. We have tourists. If a fellow Mainer doesn’t know you, he probably knows two people with whom you are acquainted.

As the women began to breathlessly explain their actions, one of the women felt a searing pain in her right thigh and assumed she had torn a muscle as she sprinted away from the fox. Within a few hundred yards, the car began to fill with smoke. Believing that the vehicle was on fire, all four occupants tumbled out into the street like four carnival clowns.

It quickly became clear that the cause of the smoke and the searing pain was that the woman’s pants were on fire. Throwing all caution and modesty to the wind, she quickly shed her pants in the middle of the road and in full view of these men, with whom it turns out she does share several acquaintances.

The source of the fire was the woman’s cell phone. The resulting injury was a palm-size, painful, deep, second-degree burn of her anterior thigh. In a quick Internet search, you will discover several very similar stories – minus the fox and the strangers. Some of the victims were children.

It turns out some cell phones have a tendency to spontaneously explode and/or catch fire. There seems to be no common factor in the events, although some of the ultrathin and flexible cell phones may be more prone to conflagration. However, the victim in our scenario has a storied past with cell phones. She has dropped them in the toilet at least once (history is a little unclear here on the exact number). On another occasion, she placed one in the sink of a public restroom, we can assume to prevent a second or third toilet submersion. As she approached the sink to retrieve it, the clever water-saving faucet – sensing her presence – turned itself on. But in the fox and fire incident, she denies any previous submersions or unusual events with this particular phone. A lawyer is now involved.

So while you and I as pediatricians may be concerned about the relationship between cell phones and health of our patients primarily because cell phones can be a dangerous distraction for young drivers, cyclists, and pedestrians, I share this anecdote to make you aware of another of their health hazards. You also may want to reconsider where you carry your cell phone.

I am not worried myself. I have a little flip phone for which I pay $100 for 500 minutes of usage a year, way more than I need or use. It couldn’t be considered a smartphone as its only noteworthy skill is taking pictures of the inside of my pants pocket. I suspect that its battery must be so small and impotent that even if it decides to self-immolate, I doubt I will notice. However, I do worry about scraggly-looking foxes meandering through my neighborhood.

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].

Okay, I admit that from time to time I have embellished the anecdotes that I include in these letters. Sometimes, I feel I need to make sure that you are paying attention. But this time, I am relating this story in its true, unvarnished state.

Two mature women with whom I am acquainted (No, one was not my wife!) had just finished their habitual Saturday morning walk through a wooded upper middle class neighborhood here in town. It was nine o’clock in the morning and the sun was shining. Suddenly, a mangy-looking fox trotted out of the woods and down the road toward them. Aware that from time to time local raccoons, skunks, and foxes have tested positive for rabies, these women began to run and flagged down the first car they saw, and without a word hopped in the back seat.

The surprised occupants of the vehicle were two mature men. You might call them strangers, but here in Maine, we don’t have any strangers. We have tourists. If a fellow Mainer doesn’t know you, he probably knows two people with whom you are acquainted.

As the women began to breathlessly explain their actions, one of the women felt a searing pain in her right thigh and assumed she had torn a muscle as she sprinted away from the fox. Within a few hundred yards, the car began to fill with smoke. Believing that the vehicle was on fire, all four occupants tumbled out into the street like four carnival clowns.

It quickly became clear that the cause of the smoke and the searing pain was that the woman’s pants were on fire. Throwing all caution and modesty to the wind, she quickly shed her pants in the middle of the road and in full view of these men, with whom it turns out she does share several acquaintances.

The source of the fire was the woman’s cell phone. The resulting injury was a palm-size, painful, deep, second-degree burn of her anterior thigh. In a quick Internet search, you will discover several very similar stories – minus the fox and the strangers. Some of the victims were children.

It turns out some cell phones have a tendency to spontaneously explode and/or catch fire. There seems to be no common factor in the events, although some of the ultrathin and flexible cell phones may be more prone to conflagration. However, the victim in our scenario has a storied past with cell phones. She has dropped them in the toilet at least once (history is a little unclear here on the exact number). On another occasion, she placed one in the sink of a public restroom, we can assume to prevent a second or third toilet submersion. As she approached the sink to retrieve it, the clever water-saving faucet – sensing her presence – turned itself on. But in the fox and fire incident, she denies any previous submersions or unusual events with this particular phone. A lawyer is now involved.

So while you and I as pediatricians may be concerned about the relationship between cell phones and health of our patients primarily because cell phones can be a dangerous distraction for young drivers, cyclists, and pedestrians, I share this anecdote to make you aware of another of their health hazards. You also may want to reconsider where you carry your cell phone.

I am not worried myself. I have a little flip phone for which I pay $100 for 500 minutes of usage a year, way more than I need or use. It couldn’t be considered a smartphone as its only noteworthy skill is taking pictures of the inside of my pants pocket. I suspect that its battery must be so small and impotent that even if it decides to self-immolate, I doubt I will notice. However, I do worry about scraggly-looking foxes meandering through my neighborhood.

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].

Okay, I admit that from time to time I have embellished the anecdotes that I include in these letters. Sometimes, I feel I need to make sure that you are paying attention. But this time, I am relating this story in its true, unvarnished state.

Two mature women with whom I am acquainted (No, one was not my wife!) had just finished their habitual Saturday morning walk through a wooded upper middle class neighborhood here in town. It was nine o’clock in the morning and the sun was shining. Suddenly, a mangy-looking fox trotted out of the woods and down the road toward them. Aware that from time to time local raccoons, skunks, and foxes have tested positive for rabies, these women began to run and flagged down the first car they saw, and without a word hopped in the back seat.

The surprised occupants of the vehicle were two mature men. You might call them strangers, but here in Maine, we don’t have any strangers. We have tourists. If a fellow Mainer doesn’t know you, he probably knows two people with whom you are acquainted.

As the women began to breathlessly explain their actions, one of the women felt a searing pain in her right thigh and assumed she had torn a muscle as she sprinted away from the fox. Within a few hundred yards, the car began to fill with smoke. Believing that the vehicle was on fire, all four occupants tumbled out into the street like four carnival clowns.

It quickly became clear that the cause of the smoke and the searing pain was that the woman’s pants were on fire. Throwing all caution and modesty to the wind, she quickly shed her pants in the middle of the road and in full view of these men, with whom it turns out she does share several acquaintances.

The source of the fire was the woman’s cell phone. The resulting injury was a palm-size, painful, deep, second-degree burn of her anterior thigh. In a quick Internet search, you will discover several very similar stories – minus the fox and the strangers. Some of the victims were children.

It turns out some cell phones have a tendency to spontaneously explode and/or catch fire. There seems to be no common factor in the events, although some of the ultrathin and flexible cell phones may be more prone to conflagration. However, the victim in our scenario has a storied past with cell phones. She has dropped them in the toilet at least once (history is a little unclear here on the exact number). On another occasion, she placed one in the sink of a public restroom, we can assume to prevent a second or third toilet submersion. As she approached the sink to retrieve it, the clever water-saving faucet – sensing her presence – turned itself on. But in the fox and fire incident, she denies any previous submersions or unusual events with this particular phone. A lawyer is now involved.

So while you and I as pediatricians may be concerned about the relationship between cell phones and health of our patients primarily because cell phones can be a dangerous distraction for young drivers, cyclists, and pedestrians, I share this anecdote to make you aware of another of their health hazards. You also may want to reconsider where you carry your cell phone.

I am not worried myself. I have a little flip phone for which I pay $100 for 500 minutes of usage a year, way more than I need or use. It couldn’t be considered a smartphone as its only noteworthy skill is taking pictures of the inside of my pants pocket. I suspect that its battery must be so small and impotent that even if it decides to self-immolate, I doubt I will notice. However, I do worry about scraggly-looking foxes meandering through my neighborhood.

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].

You may not have read the much ballyhooed article about selective eating in preschoolers that was distributed to the media prior to publication because it was buried online, but I bet that you have heard or read something about it (“Psychological and Psychosocial Impairment in Preschoolers with Selective Eating” by Zucker et al., [Pediatrics. 2015 Aug 3. doi: 10.1542/peds.2014-2386]). In fact, there were so many news stories, both print and electronic, and the headlines were so divergent that my wife asked me if there were actually two studies released simultaneously.

Some news reports emphasized the reassuring observation by the authors that most picky eating preschoolers will mature into older children with less selective eating habits. However, others highlighted the authors’ primary message that young children with severe selective eating behavior often have significant psychopathology (anxiety, depression, attention-deficit/hyperactivity disorder), and those with even moderate picky eating may be manifesting the effects of living in a dysfunctional family.

The authors recommend that we pediatricians rethink our traditional party line on selective eating. Instead of simply administering frequent doses of reassurance to the parents of “picky eaters,” we should begin to view even moderate selective eating as a red flag that the child and his or her family need help.

This shift in emphasis is long overdue. I always have felt that problem picky eating is an example of normal infant behavior that has been mismanaged by the child’s family. And in some cases physicians also must share in the blame for not having given the most appropriate advice in a timely fashion to parents who have complained about their child’s selective eating.

It would help if we all took a deep breath, stepped back a few steps, and looked at the bigger picture. We are talking about eating, one of the critical life-sustaining activities. One can understand why most infants are wired to initially reject new tastes and textures. Neophobia – fear of anything new – has probably saved millions of infants from the serious consequences of unsupervised foraging. But don’t you think that these aversions are for the most part weak enough to be easily overridden by every child’s innate drive for self-preservation? “I don’t like how this smells, tastes, looks, or feels, but darn it, I’m getting hungry, and I have to eat to survive. So I will eat it.”

The problem is that while some parents can agree with that line of reasoning, many parents, including those who buy the rationale, can’t bring themselves to quietly accept their new role as merely being providers of a healthy diet. For 9 or 10 months, it was their job to get food into their child because the poor little thing lacked the skill to do it himself. But once a child can chew solids and put things in his mouth, he can not only survive but thrive if someone will simply present him a balanced diet of appropriate consistency and volume … and then step back and shut up.

Obviously, this transition is difficult to a significant number of parents. In many cases, it is because no one has told them that toddlers will appear to eat less than they did as infants or that allowing children unlimited access to energy-containing fluid will blunt their appetites. Or that it is okay that a child only eats one-and-a-half meals on some days. Or that it if you wait long enough without resorting to coaxing, bribing, or begging, a child will eat what his body needs. And failing to be patient and instead making an issue of eating (or not eating), what began as a normal infant aversion to new tastes and textures can spiral into a divisive family catastrophe.

Are there some infants who are so hypersensitive to new tastes and textures that waiting will endanger their health? If they exist, in my experience they are very rare. However, there are certainly toddlers who have become hypersensitive. In my opinion, they were always vulnerable and would have been much less of a problem had they been properly managed early on when they were just a little neophobic.

Are there clues during the child’s infancy that his family is more likely to have significant difficulty making the transition from “feeding” to “presenting” food? This new study observed that high maternal anxiety was frequently observed in both moderate and severe selective-eating children. This is another example of how we need to be aware from a very early stage when a parent is anxious or depressed. The failure to identify and see that those issues are addressed can seriously impair the whole family’s wellness.

Finally, on the other end of the spectrum, is usual garden variety selective eating outgrown? Have you tried to host a dinner party lately? I don’t mean a pot luck supper – I’m talking about a sit-down meal with a single menu. My wife and I have almost given up trying. “Martha is gluten free (without a diagnosis), Bob is watching his cholesterol, Rachel is pretty sure she is lactose intolerant, and you know Charlie hates vegetables. The Wilsons only do organic and are vegetarians.”

Next time we are considering mailing them gift certificates for their favorite restaurants along with an invitation to come over to our place for an after dinner drink. BYOB.

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.”

You may not have read the much ballyhooed article about selective eating in preschoolers that was distributed to the media prior to publication because it was buried online, but I bet that you have heard or read something about it (“Psychological and Psychosocial Impairment in Preschoolers with Selective Eating” by Zucker et al., [Pediatrics. 2015 Aug 3. doi: 10.1542/peds.2014-2386]). In fact, there were so many news stories, both print and electronic, and the headlines were so divergent that my wife asked me if there were actually two studies released simultaneously.

Some news reports emphasized the reassuring observation by the authors that most picky eating preschoolers will mature into older children with less selective eating habits. However, others highlighted the authors’ primary message that young children with severe selective eating behavior often have significant psychopathology (anxiety, depression, attention-deficit/hyperactivity disorder), and those with even moderate picky eating may be manifesting the effects of living in a dysfunctional family.

The authors recommend that we pediatricians rethink our traditional party line on selective eating. Instead of simply administering frequent doses of reassurance to the parents of “picky eaters,” we should begin to view even moderate selective eating as a red flag that the child and his or her family need help.

This shift in emphasis is long overdue. I always have felt that problem picky eating is an example of normal infant behavior that has been mismanaged by the child’s family. And in some cases physicians also must share in the blame for not having given the most appropriate advice in a timely fashion to parents who have complained about their child’s selective eating.

It would help if we all took a deep breath, stepped back a few steps, and looked at the bigger picture. We are talking about eating, one of the critical life-sustaining activities. One can understand why most infants are wired to initially reject new tastes and textures. Neophobia – fear of anything new – has probably saved millions of infants from the serious consequences of unsupervised foraging. But don’t you think that these aversions are for the most part weak enough to be easily overridden by every child’s innate drive for self-preservation? “I don’t like how this smells, tastes, looks, or feels, but darn it, I’m getting hungry, and I have to eat to survive. So I will eat it.”

The problem is that while some parents can agree with that line of reasoning, many parents, including those who buy the rationale, can’t bring themselves to quietly accept their new role as merely being providers of a healthy diet. For 9 or 10 months, it was their job to get food into their child because the poor little thing lacked the skill to do it himself. But once a child can chew solids and put things in his mouth, he can not only survive but thrive if someone will simply present him a balanced diet of appropriate consistency and volume … and then step back and shut up.

Obviously, this transition is difficult to a significant number of parents. In many cases, it is because no one has told them that toddlers will appear to eat less than they did as infants or that allowing children unlimited access to energy-containing fluid will blunt their appetites. Or that it is okay that a child only eats one-and-a-half meals on some days. Or that it if you wait long enough without resorting to coaxing, bribing, or begging, a child will eat what his body needs. And failing to be patient and instead making an issue of eating (or not eating), what began as a normal infant aversion to new tastes and textures can spiral into a divisive family catastrophe.

Are there some infants who are so hypersensitive to new tastes and textures that waiting will endanger their health? If they exist, in my experience they are very rare. However, there are certainly toddlers who have become hypersensitive. In my opinion, they were always vulnerable and would have been much less of a problem had they been properly managed early on when they were just a little neophobic.

Are there clues during the child’s infancy that his family is more likely to have significant difficulty making the transition from “feeding” to “presenting” food? This new study observed that high maternal anxiety was frequently observed in both moderate and severe selective-eating children. This is another example of how we need to be aware from a very early stage when a parent is anxious or depressed. The failure to identify and see that those issues are addressed can seriously impair the whole family’s wellness.

Finally, on the other end of the spectrum, is usual garden variety selective eating outgrown? Have you tried to host a dinner party lately? I don’t mean a pot luck supper – I’m talking about a sit-down meal with a single menu. My wife and I have almost given up trying. “Martha is gluten free (without a diagnosis), Bob is watching his cholesterol, Rachel is pretty sure she is lactose intolerant, and you know Charlie hates vegetables. The Wilsons only do organic and are vegetarians.”

Next time we are considering mailing them gift certificates for their favorite restaurants along with an invitation to come over to our place for an after dinner drink. BYOB.

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.”

You may not have read the much ballyhooed article about selective eating in preschoolers that was distributed to the media prior to publication because it was buried online, but I bet that you have heard or read something about it (“Psychological and Psychosocial Impairment in Preschoolers with Selective Eating” by Zucker et al., [Pediatrics. 2015 Aug 3. doi: 10.1542/peds.2014-2386]). In fact, there were so many news stories, both print and electronic, and the headlines were so divergent that my wife asked me if there were actually two studies released simultaneously.

Some news reports emphasized the reassuring observation by the authors that most picky eating preschoolers will mature into older children with less selective eating habits. However, others highlighted the authors’ primary message that young children with severe selective eating behavior often have significant psychopathology (anxiety, depression, attention-deficit/hyperactivity disorder), and those with even moderate picky eating may be manifesting the effects of living in a dysfunctional family.

The authors recommend that we pediatricians rethink our traditional party line on selective eating. Instead of simply administering frequent doses of reassurance to the parents of “picky eaters,” we should begin to view even moderate selective eating as a red flag that the child and his or her family need help.

This shift in emphasis is long overdue. I always have felt that problem picky eating is an example of normal infant behavior that has been mismanaged by the child’s family. And in some cases physicians also must share in the blame for not having given the most appropriate advice in a timely fashion to parents who have complained about their child’s selective eating.

It would help if we all took a deep breath, stepped back a few steps, and looked at the bigger picture. We are talking about eating, one of the critical life-sustaining activities. One can understand why most infants are wired to initially reject new tastes and textures. Neophobia – fear of anything new – has probably saved millions of infants from the serious consequences of unsupervised foraging. But don’t you think that these aversions are for the most part weak enough to be easily overridden by every child’s innate drive for self-preservation? “I don’t like how this smells, tastes, looks, or feels, but darn it, I’m getting hungry, and I have to eat to survive. So I will eat it.”

The problem is that while some parents can agree with that line of reasoning, many parents, including those who buy the rationale, can’t bring themselves to quietly accept their new role as merely being providers of a healthy diet. For 9 or 10 months, it was their job to get food into their child because the poor little thing lacked the skill to do it himself. But once a child can chew solids and put things in his mouth, he can not only survive but thrive if someone will simply present him a balanced diet of appropriate consistency and volume … and then step back and shut up.

Obviously, this transition is difficult to a significant number of parents. In many cases, it is because no one has told them that toddlers will appear to eat less than they did as infants or that allowing children unlimited access to energy-containing fluid will blunt their appetites. Or that it is okay that a child only eats one-and-a-half meals on some days. Or that it if you wait long enough without resorting to coaxing, bribing, or begging, a child will eat what his body needs. And failing to be patient and instead making an issue of eating (or not eating), what began as a normal infant aversion to new tastes and textures can spiral into a divisive family catastrophe.

Are there some infants who are so hypersensitive to new tastes and textures that waiting will endanger their health? If they exist, in my experience they are very rare. However, there are certainly toddlers who have become hypersensitive. In my opinion, they were always vulnerable and would have been much less of a problem had they been properly managed early on when they were just a little neophobic.

Are there clues during the child’s infancy that his family is more likely to have significant difficulty making the transition from “feeding” to “presenting” food? This new study observed that high maternal anxiety was frequently observed in both moderate and severe selective-eating children. This is another example of how we need to be aware from a very early stage when a parent is anxious or depressed. The failure to identify and see that those issues are addressed can seriously impair the whole family’s wellness.

Finally, on the other end of the spectrum, is usual garden variety selective eating outgrown? Have you tried to host a dinner party lately? I don’t mean a pot luck supper – I’m talking about a sit-down meal with a single menu. My wife and I have almost given up trying. “Martha is gluten free (without a diagnosis), Bob is watching his cholesterol, Rachel is pretty sure she is lactose intolerant, and you know Charlie hates vegetables. The Wilsons only do organic and are vegetarians.”

Next time we are considering mailing them gift certificates for their favorite restaurants along with an invitation to come over to our place for an after dinner drink. BYOB.

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’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?