Parenting Advice for Kids

Raising Healthy Kids

A Harvard pediatrician replies to parents worried about day care, autism and vaccines.

Hands On :McCarthy, with daughter Natasha, is a parent as well as a doctor.

I recently put my kids in day care, and they have had constant cold symptoms and mild diarrhea.  I realize day care is an adjustment and exposes them to all sorts of new bacteria and viruses,  but it's been more than a month and I am having symptoms as well.   How long should this be expected to last ?

       DR. CLAIRE MCCARTHY  :   There are all sorts of studies  to show  that children who attend day care get sick more often  than those who don't.  The number of illnesses each year varies a lot from child to child, from about three times a year to as much as six or seven - which could feel like almost constant illness to a parent, especially if the parent is catching the illnesses, too!      As much as this may make you want to pull your kids out of day care, if isn't necessarily a bad thing.  It turns out that getting exposed to plenty of bacteria and viruses when you are young may be a really good thing - because it helps promote the healthy development of the immune system.  In fact, research has shown that early exposure to germs can decrease a child's risk of getting asthma and other allergic diseases.  It may even decrease the risk of certain cancers such as Hodgkin's disease.

      It would be a good idea, though, to talk to your day - care provider  about its procedures for preventing the spread of infection.  Hand washing alone can make a huge difference.   Toys should be wiped down at least once a day.  And clearly infectious children ( such as those with fevers, diarrhea or bad coughs ) should be excluded from day care until they are better.

With all the publicity about autism and immunizations,  I've chosen not to immunize my kids.  What are your thoughts ?

      There is a lot of publicity about autism and immunizations.  What there isn't a lot of, though, is scientific data to link them.  Children get lots of immunizations in the first two years of life - and that's when the signs of autism emerge.  So it's entirely possible, if not probable, that families or doctors will begin to notice autistic behaviors within a month or two of a child's getting a vaccine - but that doesn't mean the vaccine caused the autism.    It's not that the concern hasn't been taken seriously.   On the contrary, scientists have studied  it very closely.  There is a lot of talk about mercury in vaccines  ( in thimerosal, a preservative ) causing autism.  However, while exposure to large amounts of mercury  ( way more than is in thimerosal )  can cause brain damage, it is not a known cause of autism.   Thimerosal was removed from all routine vaccines given to children preschool age and younger.      The only vaccine currently given to young children that contains thimerosal is the influenza vaccine, and that is also available in a preservative - pre from.

        There  is also a lot of talk about the MMR ( measles, mumps and rubella )  vaccine's being a cause of autism, but that hasn't held up to close inspection, either.  Studies done in Britain that purported to show a correlation between the MMR vaccine and autism were seriously flawed and could be replicated by other researchers.  And several large population studies comparing children who did or didn't get the MMR vaccine showed the same rate of autism in both groups.      Vaccines are not without risks, of course - but in general, those risks are very small.  And vaccines protect children against many diseases, some of which can be disabling or even fatal.  A good  place to learn about the true risks and benefits of vaccines is the immunization section of the Web site of the Centers for Disease Control,cdc.gov/vaccines.

If my child eats only a little of his meal,  am I creating a fussy eater by offering a series of other foods until he eats more, or am I a good parent for making sure my child is full ?  

        You are absolutely a good parent for being concerned about you child's eating habits.   However, you may want to alter your approach.   Learning to listen to hunger  cues is important   for lifetime weight control.  Too often, we eat for social reasons, or out of boredom, or because it's a mealtime not because we are actually  hungry.    When people eat that way, the risk of  becoming overweight goes way up .     Instead of offering a series of foods, offer a variety at once  - always including some fruits and / or vegetables.  At dinnertime, give him what you're having .    Let him sample - even if the takes just one bite, that's fine.  Sometimes kids need to try things 10 times before they realize they like them ! When he says he's done, let him be done.

MCCARTHY is an attending physician at Children's Hospital in Boston and an instructor in pediatrics at Harvard Medical School.  For more information go to health.harvard.edu.  Readers should consult a medical professional for an accurate diagnosis.

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