When to Have a Baby in Pediatrics

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One of the questions that I get emailed most is, “when should I have children?” This comes from pediatricians in varying stages of training, and even those in college thinking about a future career in pediatrics. It’s a great question with no answer! The answers to this depend on so many personalized factors and there are pros and cons to each. To oversimplify, there are few suggestions I can offer that may help you in your decision, but they are unapologetically biased by my personal experiences.

During medical school, I saw two women choose to have their first child between the second and third years, taking one year off. This allowed them to take a break between the didactic and clinical years of medical school. At the time, I thought this seemed like an unnecessary delay in training. Later on though, I thought this idea seemed brilliant. The pros include: a long maternity leave and younger age at childbearing. Their children were then three years old when they entered residency, which could certainly have its own pros and cons. For one, they were done breastfeeding and waking overnight. Their children were more independent and in preschool. However, they are also old enough to know when you are missing for 80 hours/week and remember it. Also, unless you are then willing to have a second child during residency, there will be a large age gap between children.

I saw many co-residents have children during residency. This is much harder to generalize as the experiences are very variable. In general, it’s hard to be pregnant during the first two years of residency, which include many more inpatient months and overnight calls. Maternity leaves tend to be shorter too, depending on your delivery and residency program, you typically only have 6-8 weeks off. Due to the long hours of residency, you will likely need a very flexible partner and/or nanny or au pair to have enough childcare coverage. Raising a child and affording high-quality childcare can be expensive on a resident salary as well.

Many colleagues chose to have their first child during fellowship, which similarly to residency is often more challenging in the first year. Later on in fellowship though, there are more research months, which gives you more flexibility and more time for sleep! Depending on your fellowship program, you may be able to extend your maternity leave.

For those not doing fellowship, having a baby as a junior attending is the sweet spot. Longer maternity leave, better hours, higher salary. The only real con is older maternal age.

For me, I had my first child during 3rd year of residency and if you have read this blog before, you know that he came at 34-weeks gestation. Nothing about it was easy. We had an eleven day NICU stay and 6 week maternity leave. My second was born during my second year as an attending and things were much smoother. My pregnancy was easier, my maternity leave was 12 weeks, my hours were shorter, and my salary was higher.

The real answer though is that you have to have your children when YOU are ready. You have to make the choice that feels right for your growing family. Consider your own health, time, family support, financial situation, housing, etc. and then follow your heart. In some ways, there is never a perfect time to start your family. Even if there were, you never know how your pregnancy will go, how healthy you and your baby will be, or what effect having a baby will have on you. I have friends who have a post-partum stroke, miscarriages, and infertility. Every day I take care of families who have children with complex congenital conditions and life-changing diagnoses. Having children is hard in so many ways.

And yet it is also the greatest. Of course having had a preemie I have regrets and wonder what if, but in holding my sweet six-year-old, I can’t imagine changing a thing. I love being a working mom and know that although my career has made me miss a lot of time with my children, my work is worth it. I know that being a pediatrician makes me a better mother and in many ways, being a mother makes me a better pediatrician.

 

I would love to hear reader thoughts on this! Share your stories in the comments.

Mommy Call Book Club

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After reinvigorating my passion for reading with my neighborhood book club, I decided to start a Mommy Call Book Club on Instagram. Inherent to the success of my return as a reader is the fact that my children are now older and play nicely with each other. I reached a critical milestone recently: reading while my children played independently in public. It felt like a dream. So, I figured I could take on another book club, one where I would curate some of my favorite parenting books for you. I’ll do the heavy reading, or in some cases, skimming, so that you have some ideas before making a purchase. This also helps me in clinic, so I know what books my patients’ parents are reading and what to recommend to them when they present with particular issues. If you want to follow along, search for #mommycallbookclub. In the meantime, here are some of the books I already covered and links to purchase!

How Toddlers Thrive by Tovah Klein, PhD. I have raved about Tovah’s book before, as she was my college mentor and taught me most of what I know about toddlers. This book is a great resource for anyone trying to understand the toddler years: parents, teachers, babysitters. I channeled Tovah’s toddler whispering abilities so many times in the past 5 years. One of the lessons that stuck with me most is not ascribing my own thoughts onto my children’s artwork. Instead of asking them what they are drawing, I comment on their use of color or space. Perhaps the scribble is meant to be an elephant or perhaps it is just a scribble, but it is up to them to decide what they want it to be and what they want to share.

The Explosive Child by Edward M. Hallowell, MD. I learned about this book from a psychologist when I asked for advice on an ADHD patient. I think this is a great read for anyone living with or caring for a child with challenging behaviors that are on the extreme end of the spectrum. There are great tips for how to stop punishing kids for things that are not malicious and instead partner with kids to find preventative strategies. I found this book very practical.

The Sensory Child Gets Organized by Carolyn Dalgliesh. As we enter a new school year, you may want to keep this book nearby for your sensory kid struggling with new routines and demands. There were some parts that I didn’t like as an MD, but overall if you are looking for practical organizational tips to make the day-to-day easier, this was good.

Taking Charge of ADHD by Russell A. Barkley, PhD. One of the things I like about this book is that it looks at raising a child with ADHD from a research perspective, but also gives realistic parenting advice, a developmental approach, and treatment options. The author also addresses the effect that ADHD children have on their parents and siblings.

Sensational Kids by Lucy Jane Miller, PhD, OTR. Unlike the Dagliesh book mentioned earlier, this one has a heavier focus on diagnostics, comorbidities, and interventions. Like the others, it also uses cases to illustrate the definitions and demonstrate scenarios.

There are so many other great books that I want to share with you, but I would also love to hear from you about what you are reading! This list is ADHD and sensory heavy, but there are so many more great parenting books to come, so stay tuned.

 

[I am an Amazon Affiliate and I do profit from purchases made from my links. So please do use them! The opinions expressed above do not necessarily reflect those of my employer.]

National Coffee Day: pay it forward with coffee

image001There is no coffee in my house. But when I heard that Dunkin’ Donuts and its Greater Philadelphia franchisees were celebrating National Coffee Day (today, Friday, September 29th!) with a buy one get one coffee deal, I wanted to share this with Mommy Call readers in need of a little caffeine to make it to the weekend. Even this tea drinker can get behind coffee if it supports Dunkin’ Donuts donating 500 pounds of coffee to the American Red Cross to  support those who volunteer in disaster relief efforts and biomedical services.

So head over to Dunkin’ Donuts (participating stores only) today and purchase a medium, large, or extra-large cup of the brand’s signature hot coffee to get an additional medium-sized hot coffee for free to give to a friend or neighbor. I love random acts of kindness!

 

[I have no affiliation with Dunkin’ Donuts and was not compensated for this post.]

City Happenings: A September Guide for Families in Philadelphia

Little Moon + ArrowNow that the children are back-to-school and you aren’t going to the beach this weekend, there are many things happening in the city to keep you busy. A few in particular recently came across my radar that I wanted to share with Mommy Call readers. Some of these are happening this weekend, so don’t procrastinate (like I did in writing this blog post).

Lume Creative Learning Studios

Lume not only offers art classes for kids and adults but is a community gathering and event space for Passyunk Avenue and offers birthday parties. Where else could you find a Drag Queen Storytime?

Evelyn’s Corner: Grand Opening September 16, 2017

You may not think the city needs another kids art studio, but Evelyn’s Corner is bringing a new perspective to the kids’ art class scene. The website alone inspires creativity. In addition, they offer private classes and in-home birthday parties.

Momo’s Treehouse: Grand Opening September 16, 2017

If you loved their Old City location, the new Fitler Square space promises to exceed your expectations. Their Grand Opening celebration will be joined by Baby Wordplay and the Igloo and includes a petting zoo at the Grays Ferry Triangle from 10:30-12:30.

Penn Museum Family Game Night: September 15th, 2017, 6-9 PM

The Penn Museum is creating an adventure-packed evening for children 6 and up, including ancient board games, artifact guessing, hieroglyph decoding and more. Admission is $15pp or $50 per family of 4.

MOM’s Organic Market: Grand Opening September 8-10th

This new organic market in Center City not only aims to bring high quality, organic produce, but also sustainable insect proteins, a beekeeping section, car charging stations, sustainable seafood, growler-filling stations, liquid bulk products, and a recycling center. The grand opening celebration will include meet and greets with local green leaders, tastings, henna art, and kids activities.  5% of Grand Opening sales will be donated to the Philadelphia Orchard Project and Pennsylvania Environmental Council.

Play Arts: One Year Anniversary Party September 10th

I’ve written before about my love of Fishtown’s uber-cool Play Arts. They have been celebrating their one year anniversary all week, but the festivities culminate on Sunday, September 10th, with a party from 10AM-12PM. As if you need additional reasons to attend, they will be serving Cake Life cupcakes, dishing out door prizes, and offering discounts! RSVP is required!

Rock to the Future

This is a nonprofit that provides free and low-cost music education programs for Philadelphia youth. Their MusiCore program is where students learn their choice of instrument, form bands, write and record original music, play cover songs, participate in vocal ensemble, attend creative workshops, work with real musicians, and perform live. This program is open to grades 6-12 and operates Monday-Friday 3-6PM.

Little Moon + Arrow (photo above)

If you have been to the parent store, Moon + Arrow, you can imagine how adorable and crafty their version for the littles is. Their new space is drenched in sunlight and with all the pillows in the windows you will wish you could stay all afternoon.

Mister John’s Music

Queen Village cult favorite, Mister John, has upgraded to his own space in the Italian Market. He’s transformed a spice shop into a cozy studio with beautiful old world charm. With new teachers on staff and all their new square footage, there are new class options as well.

Franklin Ice Cream Bar

Sometime this Fall, Franklin Fountain is opening an Old City sister store where you can build-your-own ice cream pop shaped like the Keystone that is the symbol of Pennsylvania. There are even vegan options. I’ll see you there.

Bartram’s Garden: Philadelphia Honey Festival, September 10, 2017

Nothing is cuter than a bunch of children parading around in bee costumes. As the Honey Fest wraps up at Bartram’s Garden (10AM-4PM on 9/10/17), expect this as well as beekeeping demos, honey extractions, a marketplace and garden tours.

A Mainlander’s Beach Homecoming

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Growing up a mainlander, I always felt like an islander outsider. Once living away though, I described Long Beach Island as my hometown, as no one could recognize Manahawkin by name, and I claimed a bit of islander identity. I have spent years recounting my beach town upbringing to jealous urbanites, who dream of their beach house rentals while accruing vacation in a concrete jungle. I always try to describe the paradox of having your small town beach sanctuary invaded by tourists, who create longer lines and traffic jams, but simultaneously sustain the businesses for the long, quiet winter ahead. My parents were among these business owners, with a marina in Brant Beach, where they would need to sell enough boats in three months to last us the next nine. As vibrant as the tourists make the island, we all know how as the crowds trickle out, the speed limits raise, and the lights go off, the locals enjoy the island as much as the tourists did all summer from those early fall weeks through Memorial Day.

When your hometown culture has always had a local versus tourist divide, it feels uncomfortable to return on the tourist team. However, as a former mainlander, my Ship Bottom rental made me an islander of sorts. With my newly minted, albeit temporary, islander status, I quickly fell into character. I bemoaned having to drive “all the way to the mainland” as I had heard so many islanders say in my youth. My children collected clams and snails from the bay and we snuck sand into every item we own. We exclusively showered outdoors. Evenings were for sunset bike rides and glasses of wine on the deck. There was no need for fancy. Being an islander meant enjoying the idle moments.

Yet, knowing the island’s history made me feel more connected to it. I wanted to tell others that I wasn’t really a tourist, I belonged here. It felt empowering to show guests my local knowledge of the landscape and see so many familiar faces and businesses still thriving. High school classmates are now local entrepreneurs. We drove up and down the boulevard admiring its beauty, with childhood memories flashing by with each passing storefront. We ate dinner in the restaurant housed within my dad’s old marina; the new may obscure the old, but with the memories of locals the history is never gone.

Since I left the area eighteen years ago, the way I experience the island is now much different. I remember sitting at the counter at Just Bead It in Surf City, my summer job for most of my adolescence, watching mothers toting toddlers and dragging wagons full of shovels and chairs. Now, I am her. Instead of waiting for the lifeguards to leave to sneak onto the dunes of Barnegat Light for a bonfire with friends, I am hoisting children onto abandoned lifeguard stands. My children, rather than myself, are scooping clams from the bay and collecting shells from the beach. I can only imagine what my adult life on the island would look like through the examples set by my classmates who remained.

Standing in line at The Local, a spot that in name gives the illusion of insider status yet with outsider prices, there was a small disagreement about which way the line should go. In confronting a tourist, the woman in front of me said, “those of us who are locals know that the line always goes this way.” Then, she turned to me and said, “you know, right?” Nearly two decades later and I was mistaken for a local islander while renting a beach house, making this former mainlander’s week on LBI feel complete. Although I have chosen not to make LBI my permanent home, each time I return I regain my fondness for it and know it will always be home.

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