Many teens want their jobs to be exciting, glamorous and be the envy of their friends.  But those jobs only exist on MTV.  Or, at least they don’t exist unless you have experience.  You can’t get a job as Fashion Editor at Vogue or Executive Chef at The Ivy in Beverly Hills without proof that you are employable.  You would be surprised at the applicable skills and people that you meet in the most unlikely jobs.  Climbing the career ladder starts by avoiding these traps:

Trap #3: Getting a job at McDonalds or Walmart is not constructive for my future.

Many teens make the mistake and think that a job flipping burgers or stocking shelves is beneath them or won’t help them in their future career.  That is totally incorrect.  Firstly, there is no shame in working – at any job.  Even if you plan to be a doctor or a movie director, these types of jobs teach you communication skills, networking, managing relationships and customer service.  All key skills needed regardless of your career.

Secondly, a lot of these jobs also teach business skills such as money management, inventory tracking and working in teams.  It is these types of skills that will be highlighted on your résumé that you will use to get your career launching job in the future.  You can’t get these skills watching Jersey Shore reruns.

Plus, you may actually have fun at these places.

Trap #4:  Volunteer work is useless because I won’t earn money.

Not true.  You can get the best work experiences through volunteering.  Many charitable organizations such as animal shelters are desperate for volunteers.  This means that you may be able to do tasks that a paying job would never let you. For example, you may start working at an animal shelter scooping litter boxes but, once there, you may offer to help with fundraising or event planning or marketing or graphic design.  These organizations can’t afford professionals and don’t require someone to have experience to do these tasks.  Sure you won’t get paid, but you will get an opportunity to try out your graphic design skills and be able to put that on your résumé.  Besides, charities are the best places to network and meet really great people.

Sometimes I hear my 5-year-old son say things, or watch him do things, that I’ve been meaning to teach him but haven’t.  I was totally planning on doing it, it’s just that I hadn’t had time yet, or the teachable moment hadn’t happened.  And yet, he knew it already.

His brother and sisters taught him.

I was 42 years old when Liam was born.  He was a surprise baby.  A wonderful surprise, absolutely, one that I am eternally grateful for.  But when he was born, I worried about parenting him.  I am busier than I was when my eldest was born 20 years ago; I now work full-time at a very challenging job.  I don’t have the time that I used to.

Also, I’m a little worn out.  My older children are 20, 19, 14, and 10.  I’ve done so many Halloweens and first days of school and played so many games of Checkers and dress-up and Legos, taken a million (well, okay, maybe not a million, but it feels that way) trips to the pool and the park.  I’ve spent hours and hours teaching safety, manners, safety, potty usage, study habits, and all those other important lessons we parents are supposed to teach.  Would I be able to generate the energy to be enthusiastic about doing it all over again?

I shouldn’t have worried.  Turns out, I have helpers.

“Say please, Liam”, his siblings tell him when he asks for the salt.   “Clear your plate.  No, you have to scrape it before you put it in the dishwasher.”   “Liam, you need to share your toys with our guests.”  “No, you can’t cross the street.  Hold my hand and we‘ll look both ways together.”  It’s everything my husband and I have said, coming out of our children’s mouths.

The other day Liam pointed to a commercial for a TV show.  “I can’t watch that, “ he said.  “Elsa says it’s inappropriate for me.” I almost spit out the water I was drinking.  Elsa was absolutely right about the show, but I couldn’t believe the word “inappropriate” was coming out of a 5-year-old.

It’s not just correcting that they do with him. They taught him to play Checkers and how to boogie board on waves at the beach. They get down on the floor with him and play with his little cars. They celebrate his successes, from potty training to the first day of school to his memorization of Green Day songs (I’m a little less excited about the last, but at least it’s not gangster rap). Liam gets loved and celebrated not just by me and my husband, but by four other people who are just as devoted to him and invested in him as we are.

When you start a family, you don’t really think about it as something that could have a life of its own.  But that really is what happens.  The years of love and lessons and shared experience, mixed with growing unique individuals, build something that is bigger and richer than you could ever predict at the beginning.

Liam isn’t getting the short end of the stick by being the last one.  On the contrary: he is the luckiest of them all.

When people have asked me what it takes to be a physician, I usually tell them that there are three things that every doctor must have. And no, being scared of blood is not a deal breaker. Three out of the six people who did their surgery rotation with me in medical school fainted at one point or another. They’re all physicians today! One turned out to be a surgeon himself!

The first thing you have to have to become a great physician is a love of learning. If I go back and count all of my years of formal education it comes to a total of twenty-three. But that number is deceiving because when you decide to become a physician, your education never stops. This may sound trite, but it’s actually required by all the specialties of medicine under Continuing Medical Education (CME). So nearly every day as a doctor is spent learning new things. If that’s something you don’t love, it won’t come easy.

The second thing a doctor must have is a love of science. Medicine today is not based nearly as much on personal experience as it once was. Health care revolves around evidence-based practices that have been developed from scientific studies. This is a good thing because the outcomes for patients have dramatically improved by using scientific reasoning. Not only this, but much of the understanding of how the human body works is based in anatomy and physiology which is of course one of the disciplines of hard core science. Most of a student’s time is spent in these and other scientific courses such as physics, math and chemistry so if you don’t have a grasp and enjoyment of science from the outset, imagine how hard it will be to force yourself into something that doesn’t come naturally.

The third and probably most important thing that you should ask yourself prior to going down the path towards an MD degree is “Can I commit my life to caring about others?” This sounds like an easy yes or no question, but behind it are issues that will shape your life forever. To become a physician is to put other’s interests before yours. That means that you might end up working long, strenuous hours sacrificing parts of life that others take for granted. You will be put into situations where you have to choose: Am I going to be lazy, scared, intolerant or distant from my patient or am I going to do everything in my power to help them live the life they want. Obviously, putting the patient first means putting your life second. Before you start down this path, you should ask yourself honestly: “Am I capable of giving up what I want for what others need?”

Nothing I could have read could have prepared me for what I saw in the memorials and on the streets of Rwanda this summer during our visit. In 1994 Rwanda went through one of the most horrible genocides in recent history. Rwanda is about the size of Maryland, but almost twice as populated and during the genocide a third of their population were killed. In the memorials we saw the raw evidence and it was terrifying. We saw bodies upon bodies preserved and stacked into piles, and rows of skulls displayed on shelves. I was glad I went to the memorials, because it helped me understand what the country had been through. But you don’t need to go to a memorial to see the evidence: almost everyone over the age of 14 has scars on their faces and arms.

Have you ever visited a memorial?  Maybe the Vietnam Memorial or Ground Zero?  How did the experience impact you?

Related concepts:

Gilles de la Tourette syndrome, tics, PANDA

Introduction to tourette syndrome:

The great English poet, author, and conversationalist, Dr. Samuel Johnson, is believed to have had Tourette syndrome, complete with both facial and vocal tics. His towering success in his day — before useful medicines had been developed – can be an inspiration and encouragement to today’s families living with Tourette.

What is tourette syndrome?

Tourette syndrome is named for Georges Gilles de la Tourette who first described the condition in 1885. Tics (involuntary, non-rhythmic movements) are the hallmark of the disease.
Brain scans and EEGs show differences in the brains of children with Tourette’s. These changes are influenced by genetics, neurobiology, and by what is going on in the child’s life.

Who gets tourette syndrome?

Gilles de la Tourette syndrome affects about one out of every 2,000 people. Tourette syndrome occurs worldwide, in all ethnic groups – though it is most common among whites. The condition usually runs in families. It is three to four times more common in boys than in girls, and usually begins before the age of seven.

What are the symptoms of tourette syndrome?

Tics are the classic symptom of this condition. In many children, these are so mild as to hardly be noticed. In others, the tics are severe and intrusive.
Motor tics are most people’s first symptoms. These may be simple, sudden, involuntary movements such as eye blinking, facial grimacing, lip licking, or fist clenching. They may also be more complex tasks such as chewing a shirt, hopping, or clapping. Whatever the movement, it is outside the child’s control – although this is often followed by a voluntary movement in an attempt to disguise the tic.
Vocal tics can also be a symptom of Tourette. They are also outside of a child’s control. Grunting, throat clearing, sniffling, hissing, clicking, whistling, and barking are simple vocal tics. Coprolalia, the involuntary speaking of obscenities, is a complex vocal tic, and the most famous symptom of Tourette syndrome. Echolalia (the compulsion to repeat words that are heard), and palilalia (the compulsion to repeat one’s own words) can also be Tourette’s symptoms.
Physical exertion, intense concentration, and sleep all suppress the symptoms of Tourette syndrome. I know a delightful man with Tourette who is very successful as a professional drummer (without medication).
Emotional stress, on the other hand, brings out the symptoms.
Children with Tourette also have a higher risk of other problems, such as obsessive-compulsive disorder.

Is tourette syndrome contagious?

Tourette can be triggered by some infectious diseases, such as Lyme disease or strep. PANDA (Pediatric Autoimmune Neuropsychiatric Disorder) is the name given when antibodies to streptococcal infections trigger the symptoms.

How long does tourette syndrome last?

For most, Tourette is a lifelong condition. Thankfully, most have a significant decrease in their symptoms over time.

How is tourette syndrome diagnosed?

Tourette is often suspected based on the history and physical examination. Sometimes brain scans, EEGs, or neurotransmitter levels are used to clarify the diagnosis.
If there is any possibility of recent strep or Lyme disease, tests for them should be run, because specific treatment may be necessary both now and in the future.

How is tourette syndrome treated?

A number of medicines have been very successful in controlling the symptoms of Tourette.
These each have some side effects, and may not be used if the Tourette isn’t interfering much in everyday life. However, when the Tourette is very troublesome the medicines can be wonderful.
If strep or Lyme disease are identified, they must be treated aggressively.
Other types of support may also be important for the child with Tourette.

How can tourette syndrome be prevented?

Usually, Tourette syndrome is difficult to prevent. Lyme disease is generally preventable. Measures to prevent Lyme disease or strep may be helpful to reduce the risk of Tourette syndrome.
In the last few years, researchers have discovered some clues about the genetics of Tourette syndrome. In 2005, researchers from Yale University identified a genetic mutation present in some patients with Tourette syndrome. Clearly, more research is needed to determine the genetics of this condition and the potential for gene therapy.

Related A-to-Z Information:

Attention Deficit Hyperactivity Disorder (ADHD), Breath Holding, Encephalitis, Epilepsy, Head Banging, Hiccups, Lyme Disease, Night Terrors, Rabies, Scarlet Fever, Strep Throat, Streptococcus (Strep), Ticks

Related concepts:

Strep pharyngitis, Acute pharyngitis, Exudative pharyngitis

Introduction to strep throat:

Some children fool their parents, with just a fever and a headache or stomachache. Others have the worst sore throat they can remember. Either way, strep throat should be treated with antibiotics.

What is strep throat?

Strep throat is a bacterial infection of the throat. It is the most common infection caused by Streptococcus bacteria. Most sore throats, though, are caused by viral infections that are not improved by antibiotics. There are many strains of strep; some of them produce toxins that can lead to a scarlet fever rash. This rash is thought to be an allergic reaction to these toxins. Untreated, strep throat can sometimes lead to rheumatic fever. Kidney complications are among the other possibilities.

Who gets strep throat?

Strep throat is most common in children between the ages of 5 and 15. It is unusual in children before the third birthday. Children younger than 3 can get strep infections, but usually not primarily of the throat. Strep throat is most common in the late fall, winter, and early spring, perhaps because children are in closer contact with each other during those months.

What are the symptoms of strep throat?

People with strep throat get sick an average of 3 days after they are exposed (range, 2–5 days). Illness usually begins suddenly, with a fever that peaks on the second day. Many children also have sore throat, headache, stomachache, nausea, or chills.
The throat and tonsils are often swollen and beefy red, covered in a gray/white/yellow coat. Red or purple spots may develop on the roof of the mouth. Lymph nodes in the neck may be tender.
In some people, strep throat is very mild, with only a few of these symptoms. In others, strep throat is severe.

How is strep throat diagnosed?

A strep test, along with the appropriate history and physical findings, can assist in the diagnosis. In the absence of the test, strep throat is often confused with other throat infections, including those caused by adenovirus, Mycoplasma bacteria, or Epstein–Barr virus (mononucleosis).

How is strep throat treated?

Antibiotics are used to treat strep throat and to prevent many of its complications, including rheumatic fever. Ibuprofen can help children feel much better while the antibiotic is taking effect. The Centers for Disease Control and Prevention (CDC) recommends against treating sore throats with antibiotics unless the strep test is positive.

How can strep throat be prevented?

Treatment involves avoiding close contact with those who are contagious. Children should be kept out of school or daycare until they have been on antibiotics for 24 hours. Most people are no longer contagious 24 hours after starting the antibiotic. I also recommend getting a new toothbrush for children after they are no longer contagious but before they finish the antibiotics, to prevent re-infection.

Related A-to-Z Information:

Adenovirus, Airborne Transmission, Contact Transmission, Droplet Transmission, Epstein–Bar virus (Mononucleosis, Mono), FomitesScarlet Fever, Streptococcus (Strep)

Related concepts:

Child molestation, Rape

Introduction to sexual abuse:

Some of the most poignant episodes of my pediatric training were long visits with children victimized by sexual abuse. I vividly remember sitting with tears streaming down my face after hearing how children had been scarred by those they trusted.
How sad that this is such an important subject to discuss.

What is sexual abuse?

Sexual abuse includes any activity with a child for the sexual gratification of an adult or significantly older child (generally more than 4 years older). Children’s intense need for affection and nurturance from older figures makes them vulnerable. Adults and older children hold a position of tremendous power in their lives. It is the abuse of this power (and the abuse of children’s trust) that is so damaging to children.
Sexual abuse falls into three different categories:

1. Molestation — Defined as the touching or fondling of the genitals of a child, or asking a child to touch or fondle an adult’s genitals, or using a child to enhance pleasure from sexual acts or pornography
2. Sexual intercourse — Includes vaginal, oral, or rectal penetration
3. Rape

Who gets sexual abused?

The most common perpetrator of sexual abuse is either a family member or a close friend of the family. Sexual abuse by a stranger is quite uncommon.
Unfortunately no age is exempt from sexual abuse. About one third of cases occur in kids younger than six years of age, about one third in children ages six to twelve, and one third in children ages twelve to eighteen.

What are the symptoms of sexual abuse?

The most common way that sexual abuse comes to light is through the child’s disclosing sexual contact to a trusted adult. Historically, a child’s word was not taken seriously. During the last twenty years the pendulum swung to the opposite extreme — if a child described sexual contact it was considered a fact, and the volunteering of such information was considered very strong legal evidence. Recently, the pendulum has returned to a more balanced position: Take it very seriously whenever a child mentions sexual contact, but understand that not everything said necessarily mirrors physical reality.
Children who have actually been abused will often recant their initial statement because they are afraid of their abuser or because their abuser convinces them that this is “their little secret.” Several clues are associated with sexual abuse (but many children give no clues except what they say):

• Genital infections, redness, or discharge
• Burning with urination
• Urinary tract infection
• New onset of either bedwetting or stool problems
• Suddenly increased sexuality with peers, animals, or objects
• Seductive behavior
• Age-inappropriate sexual knowledge
• Regression
• Other dramatic behavior changes

Is sexual abuse contagious?

No

How long does sexual abuse last?

Most abuse begins with innocent physical contact. A needy adult then makes this a routine. Once a routine, it is not uncommon to progress to intercourse.

How is sexual abuse diagnosed?

The best way to clarify a situation is to have your child examined by a specialist in the area of sexual abuse. Most children’s hospitals have a sexual abuse team, or will be able to refer you to a specialist in the area.
A sexual abuse examination is comprised of two basic elements. First, and perhaps most important, a child would be interviewed by an expert who very gently elicits information about what might have happened. The interviewer will let the child set the pace and will use pictures or dolls to draw him or her out, without suggesting what might have occurred. This is generally followed by a physical examination of the external genitals, checking for any sign of trauma, laxity, or discharge. Sometimes this will be done with magnification, using an instrument called a colposcope. In at least half of the cases of child abuse that are confessed by the abuser, there are no findings on physical exam.

How is sexual abuse treated?

Abuse should be treated by a supportive team of experts.

How can sexual abuse be prevented?

Parents need to be careful about who spends time alone with their children – where and when.
We must prepare our children to prevent sexual abuse. Begin by teaching them the proper names and significance of their private parts as soon as they are able to understand (about age 3). Then they will be ready to understand the three key messages:

1. Say no if somebody tries to touch your nipples, rectum, or genitals.
2. Tell a trusted adult if someone tries to touch you.
3. Don’t keep secrets — If somebody tells you to keep a secret, let your parents know right away.

Related A-to-Z Information:

Anorectal Malformations (Imperforate anus), Attention Deficit Hyperactivity Disorder (ADHD), CMV (Cytomegalovirus), Constipation, Depression, Diaper Rash, Early Puberty, Enuresis (Bedwetting), Fractures, Head Banging, Headache, Hematuria, HIV, Human Herpesvirus, Inconspicuous Penis, Labial Adhesions, Meatal Stenosis, Night Terrors, Nightmares, Obesity, Pinworms, Sexual Curiosity in Young Children, Urinary Tract Infection (Cystitis), Warts

Related concepts:

Infectious mononucleosis, Mono, Epstein-Barr virus infections, EBV, glandular fever. Alice-in-Wonderland Syndrome

Introduction to mononucleosis:

Nicknamed the “kissing disease,” many parents think of mono as a disease of teens and young adults. They don’t know that young children are also commonly affected.
One form of mono is seen almost only in young children: a few children with mono display the Alice-in-Wonderland syndrome – sizes, shapes, and distances appear distorted during the infection.

What is mononucleosis?

Mono is an illness that classically includes a sore throat, fever, swollen glands, and noticeable tiredness.
It is the most well known infection caused by the Epstein-Barr virus (EBV). EBV causes more than 90 percent of mono cases. Other organisms occasionally cause mono, including CMV, adenovirus, HIV, toxoplasma, rubella, and the hepatitis viruses.
Like the virus that causes chickenpox, EBV is a herpesvirus.

Who gets mononucleosis?

EBV infects more than 95 percent of the people around the world. The average age of infection varies from place to place (in Africa, most are infected by age 3 to 6). In most developed nations, the average age is 10 or above. But EBV infection can occur at any age.
When the first EBV infection occurs after age 4, the mono constellation of symptoms is likely.

What are the symptoms of mononucleosis?

Classic mono usually begins with 2 to 5 days of feeling tired and under the weather, sometimes with a fever. This may even last a week or two. Then a sore throat develops with swollen glands in the neck and elsewhere. Fever and tiredness increase. Rashes and abdominal pain are common, especially in children. The rash is even more common if the child is treated with ampicillin. Some children also have a cough or runny nose.
Many people with EBV infection have only vague symptoms of a viral illness, or even no symptoms at all. The younger a child, the less likely classic mono is to be diagnosed.

Is mononucleosis contagious?

EBV is contagious. The virus lives in the saliva, and can live for several hours outside the body. Kissing gets the notoriety as a means of infection, but sharing eating utensils, foods, drinks, and toys (in day care) are significant ways to transmit mono.
Live EBV is in the saliva for 6 months or more immediately after mono. But EBV remains in the body for the rest of the life. It reappears in the saliva periodically throughout life. On any given day, about 1 in 4 people who once had mono will have EBV in their saliva.
EBV can also be spread through sexual contact and through blood transfusions.

How long does mononucleosis last?

The virus usually multiplies silently in the body for 30 to 50 days after infection. Once the fever appears, it often lasts for a week or two. If there are no complications, the major symptoms usually last for 2 to 4 weeks, and then gradually resolve. Some continue to have fatigue for months or even years after the infection.
A long list of possible complications can lengthen mono. These include meningitis, encephalitis, anemia, hepatitis, pneumonia, Reye syndrome, parotitis, or the painful testicular swelling found in mumps.

How is mononucleosis diagnosed?

Mono is suspected based on the history and physical examination. The liver and spleen are often enlarged, in addition to the swollen glands the family may have noticed.
Mono is most often diagnosed with a blood test. Parents should know that the most common blood test for mono is usually negative in children under 4, even if they are actively infected. Also, the test is often negative during the first week of symptoms, at any age.
About 1 in 20 children with mono also have strep throat at the same time. Mono should be suspected if proven strep throat does not improve quickly with antibiotics.

How is mononucleosis treated?

The most feared complication of mono is rupture of the spleen. This usually follows a blunt blow to the belly. For this reason contact sports should be avoided for at least 2 to 3 weeks, and until the spleen is no longer swollen. (No riding motorcycles or skydiving either!)
Rest, fluids, and medicines to relieve symptoms are the mainstay of treatment. Aspirin should be avoided in children (Reye syndrome can follow mono).
Sometimes steroids are used to quickly relieve symptoms, but they should be used with caution because they also suppress the immune system.

How can mononucleosis be prevented?

Teaching your children to avoid sharing saliva (shared drinks, foods, utensils, or toys) is the best preventive measure. Still, almost all of us have been, or will be, infected with EBV.

Related A-to-Z Information:

Adenovirus, Anemia (Low hemoglobin), Body-Fluid Transmission, Chickenpox (Varicella) , CMV (Cytomegalovirus) , Contact Transmission, Cough, Coxsackievirus, Diphtheria, Encephalitis, Exanthems (Childhood rash), Hepatitis A, Hepatitis B, Herpangina, Human Herpesvirus, HIV, Meningitis, Mumps, Pneumonia, Reye Syndrome, Rubella (German measles), Strep Throat, Tonsillitis, Toxoplasmosis

Dr. Greene’s Answer:

If you look at a classroom of 4th grade children or 8th grade children, you will quickly notice that children develop at very different rates. The differences depend partly on genetics and partly on the environment (obesity, for instance, sometimes triggers earlier puberty).

Girls typically begin to have underarm odor and perspiration anytime after the 8th birthday and boys anytime after they turn 9. If these changes happen earlier, or haven’t happened by 13 in girls or 14 in boys, it’s wise to check-in with their pediatrician to be sure that everything is on track.

Dr. Greene’s Answer:

Rob, one of the adolescent boys in my practice, loved to compete in track and field. His running times in his sophomore year of high school were excellent, but try as he might, his times began to fall off during his junior year. The harder he trained, the poorer his times got. A blood test during his physical showed him to be anemic–not enough oxygen-carrying red blood cells. The anemia came from iron deficiency.

Anemia is common among adolescents, regardless of their level of physical activity. Iron deficiency is the most common cause. An inadequate diet is the chief reason for this problem. Junk food diets can easily lead to iron deficiency. Teens on a weight-loss diet are especially at risk, as are girls with heavy periods. Iron deficiency is sometimes made worse by intense and lengthy physical training and by the use of pain medications, which irritate the lining of the stomach.

Iron supplementation significantly improves learning, memory, and cognitive test performance in iron-deficient adolescents (even if they are not deficient enough to become anemic) (Pediatric News, January 1997). Iron supplementation also measurably improves the performance of iron-deficient, anemic athletes (American Journal of Diseases of Children, October 1992).

Rob made changes in his diet and also took an iron supplement for a while. His performance improved steadily. (By the way, iron supplements do not improve the performance of nonanemic athletes).