Travelling with little children

Alright, so who likes to go on vacation? I love it! I need breaks from routine and while away I'm always sad to go back home. Has having kids changed my love for vacations? Well... no... but it sure is more stressful. Sometimes, I even wonder if it is worth it. But that is usually just a fleeting thought because at least for me, the positive outweighs the negative.

So I'm writing this blog right now in a dark hotel room trying to be as quiet as possible. Both kids are asleep... at least they are for now. Boy, last night when we arrived here it was past their usual bedtime by almost 2 hrs and it took another hour or so to get everyone down! While my husband was rocking the little one in the carseat I was trying to get the older one to calm down and lay down. I suppose she was just too excited, plus the entire environment was foreign. Break of routine is hard enough on any toddler's sleep hygiene but for my sensitive two year old, it completely messes her up. Oh well... so we'll be sleep deprived. I'm learning to just accept and go with the flow. At least when we were walking around outside and playing in the pool today, she kept telling me she was having fun.


Now the younger one slept in the carseat last night for the first half of her night. Initial transfer to crib effort by dad was not successful so we just kept her in the carseat and she slept until close to 3am. I pretty much jumped up and got her as soon as I heard a difference in breathing pattern because I was so afraid of waking up my older daughter. Baby went down again with no problems but everybody was pretty much up and awake by 630 this morning. That is only about 7 hrs of sleep for my toddler who normally gets 11 or 12 hrs at home. So it's no wonder she was completely melting down by 7pm tonight.


Sleeping... eating... and even potty training kinda all goes out the window when travelling. I still think it is worth it to get away...

Supermom

This morning the little one woke up to feed at around 5am-ish. I was hoping she'd fall right back asleep and I could sneak another 2 hrs of sleep in before having to get up to start my work day. However, her diaper felt giganormous! So I debated whether I should just ignore it and put her down to sleep as usual or whether she would sleep better if she had clean diapers on. Well, I ended up changing her diaper which woke her up completely. In fact, she was pretty unhappy that I woke her up and didn't even want to finish nursing. She cried and cried. I really didn't want to wake up the older one (there is only a thin wall separating the two baby rooms) so I headed back to my room.

So now, I've woken up my husband (which actually doesn't always happen... sometimes I believe he can sleep through anything!). Since trying to nurse my little one only made her more angry, I stopped trying. At this point, my husband became fully awake and decided to take over trying to calm down screaming baby. I took this as my cue to try to get some zzz's since it doesn't make practical sense for both of us to be up so early at the crack of dawn. At least one of us should get some sleep if the other is going to be up, right?


However, no matter how I tried.. I just laid there listening to the cries. I also kept opening my eyes to offer my two cents of wisdom... "did you try putting her down to see if she will just fall asleep?" "did you try the pacifier?" Ohh.. why can't I just relax.. chill... fall asleep and let hubby do the calming down since he took over? There are countless times when I'm the one up doing the walking back and forth, rocking, bouncing etc trying to calm hysterical baby while hubby is snoring away. Why can't I be snoring away? I don't know... maybe it is a mom thing. When baby fiii-nally fell asleep at around 7ish and I saw my husband emerge from the babyroom, I felt guilty and apologized. For what? I guess I felt guilty for trying to get some sleep while he was awake. I suppose I feel like it is ok if I'm sleep deprived because it is my job and my responsibility to care for the kids when they cry at night. Or maybe it is just me because I am somewhat of a control freak and feel like I have to be the one doing it all. I want to be supermom! Sigh.. but I'm just too tired sometimes...

On vaccines and such

It's National Infant Immunization Week!

So I had another patient today who is on a "delayed vaccine schedule". It seems like we are getting all the folks who do not want to follow the traditional vaccination schedule that is recommended by CDC (Center of Disease Control). Maybe we are just seeing a population that surfs the internet a lot and likes to do their own "research" on things. But we are also getting folks who come to us because their respective pediatric offices are either giving them a hard time about it or are refusing them as patients all together.

I understand this is a hot and controversial subject and there are probably millions of web pages out there dedicated to just this topic alone. Not wanting to go into all the nitty gritty, here are a few of my thoughts as a physician and a mom...


As a physician...
So you got to look at this from a public health point of view. The stats are that certain diseases used to be prevalent and used to cause a lot of hospitalizations leading even to death. Vaccines changed all that and a lot of the diseases are prevented now. Here in the US, I think we take a lot of things for granted. Visit a third world nation and there you will see a lot of the sicknesses/complications that arise from diseases that we hardly see here anymore because of our immunization program.


As a mom...
I definitely understand the fear of harmful side effects. It is especially hard if one knows people who are strong opponents to vaccination... plus it doesn't help to have such opposition from famous actors and such. At the same time, I'd feel bad if my child came down with some disease which I could have prevented with a shot. So as a mom, I'd have to weigh the pros and cons and make my decision based on which is the greater good... or lesser evil... however you like to look at it.

Birth order

I'd like to dedicate a blog just to my little one. I think it is hard to be #2 because #1 is always around to share attention and had been center of attention for two full years! I read a very interesting Time article about birth order and I can see why it is true.  Bottom line:


Eldest siblings are also disproportionately represented in high-paying professions. Younger siblings, by contrast, are looser cannons, less educated and less strapping, perhaps, but statistically likelier to live the exhilarating life of an artist or a comedian, an adventurer, entrepreneur, GI or firefighter. And middle children? Well, they can be a puzzle—even to researchers.

Why?  Probably because older siblings have the advantage of having their parents (and grandparents for that matter) all to themselves for a period of time.  Then more responsibility is placed in them later on and they are expected to take care of the younger siblings.  Even at two years old, my older daughter wants to help take care of the little one.  She is eager to throw away diapers and loves helping with bath time!  But this blog is supposed to be about #2...


So A is now almost 5 months old. She has a lot more fat folds than her sister and is so cuddly to hold. She will totally crack up if you jiggle her cheeks and tickle her chest. This is the age where she is exploring more and becoming more interactive by the minute. It is actually really fun to watch the two sisters interact together.


Today we had another blow-out poop! It is always tricky to change the diaper without getting poop all over the clothes... often I'd have to strip her naked and change her clothes completely. Thank goodness for oxy! So I'm finding that she has these blow ups after really hard cries. I sometimes wonder if she is crying so hard because she had a blow out or if her crying so hard produces the blow out poop.


But that is the thing... (back to birth order)... blow out diapers was a big deal when we had our first.  Now that we've been through it before, it hardly phases me.   I just throw her clothes in a tub of oxy to soak and find new ones to put on her.   Her poop is still yellow and not truly stinky.  Now when the older child poops in her underwear and requires cleaning up... that is another story!  And when they both do it at the same time (like today), I end up with two naked kids and me running around with poopey clothes looking for my tub of oxy.


I'm sure by the time my A is pooping in underwear it will all be less dramatic...  haha... maybe older sister will be the one potty training the younger...

Having uninterrupted adult conversations... or not...

Today was my long day at work. One of my patients was a 9 month old boy coming in for a routine well check. Mom also brought along her two year old daughter and four year old son. It is always challenging trying to speak to moms about baby's sleeping, eating, developmental milestones in the midst of a somewhat chaotic environment. Mom's attention was split between trying to calm down a fussy, sleepy 9 month old on her lap and her other two children who were all over the exam tables and patient equipment. She was trying to make sure they didn't hurt themselves physically and didn't get into any escalated arguments or fights. At one point in the visit, we were almost shouting to one another above all the raucous. Hearing one another was one thing but keeping sense and not losing our train of thought was another! Being a mom myself, I feel I now look at this situation with new perspective and empathy. I laughed and told the mom that I'll probably be in the same boat as her in 2 years... well, that is if we go for #3...

The joys of potty training

My older daughter who is almost 2 1/2 years old is almost completely potty trained. I say almost because so far she has only pooped in the toilet a total of about 5 times in the last month. Two factors I've observed that is playing a role here are:

1) Inconsistency: So the other downside of working part of the time is that we have different caregivers taking care of my children while I am working. Therefore, any sort of potty training is usually reserved for when I am around or when my mom is around. The other times, we keep her in the pull-up because we are sparing my dad from having to wash poopy underwear! So I believe that this process of training is taking longer because we're giving the message that sometimes it is 'ok' to poop in the pull-up. Now, despite wearing the pull-up my daughter will urinate in the toilet and not have any "peeing accidents". I think that is because of reason #2...

2) Patience/Timing: When training her to pee in the toilet, you pretty much know that if she is loaded up with fluids and about 2 hours have gone by and she has not peed, plop her on the toilet and she will have to pee. The problem with training for pooping is that you never really know when she has to poop. Plus there are other factors like she may be a little more constipated than usual so would need to strain more. Bottom line is that she will have to sit on the toilet longer if we want her to poop on the toilet. So far she has pooped about 5 times for us in the toilet in the last month. Now, I have witnessed the popping only twice and all the other times are with my mom. I think my problem is I don't feel I have the time to just sit with her indefinitely until she poops. After what feels like 5 min to me, I would ask her "Do you really need to go now or do you want to go later?" The first time she pooped in the toilet for me, she told me "now" and I waited longer. Sure enough she pooped! Now, sometimes she will say 'later' and I let her go so that I can attend to other things (like my 4 mos old who I am still breastfeeding every 3 hrs) The other day, she said "now" and did poop a little bit. But then I let her off the toilet (because I couldn't wait any longer) and then she pooped the rest of it in the underwear! Haha.. the joys of having a toddler around!

Sigh. So I think I just need to somehow block the time out and just wait with her if she tells me she has to go. At the same time... I can not let the other child starve so the trick as usual is to find the balance.

Ok... I hear the older one calling me.. maybe it is toilet time...

Toddlers protective of their mommies

Today I went to the dentist and had to bring along both kids. My older daughter started whimpering when she saw me laying on the dental chair getting ready to get my teeth cleaned. I saw the look on her face and warned the hygienist that my daughter might get upset. I've been on the other side where I'd have a mom on my exam table and her toddler would get very upset when all I was doing was listening to her heart and lungs. Well, I was right and my daughter started crying the minute the cleaning tools turned on. She stood there by my side, holding my hand and crying unconsolably. Soon my four month old, who was in her carseat joined her sister in a symphony of screams. I felt bad for the entire dental office!

There must be something about seeing one's mom being in a patient role that upset toddlers. I suppose they sense something may not be right and become fearful and protective of their mom. I remember trying to comfort other moms' kids as I strain to hear the heart and lung sounds in between loud whimpering sobs. Now, being on the other end and having my own daughter cry defensively for me was somewhat bittersweet. I must say though that a stethoscope is far less scary than those dental cleaning tools!

More about sleep disturbances

Oh man... I think the little one is teething! No wonder she has been waking up every hour after 3am for two nights in a row. I am sooo tired... This is harder than q3 call during residency!

Well, it is either that or she is getting sick again. So one disadvantage of being in healthcare is that I am exposed to so many germs. Plus, being so sleep deprived, my immunity is down and I am getting sick more easily. Then of course, I pass it on to my kids. I even caught the swine flu during my third trimester of pregnancy!

So here I'm adding two other categories to my previous post about factors that affect sleep:
1) Routine - need a consistent one
2) Sleep Associations - consistency is also key and try to avoid bad associations
3) Teething - may disrupt whatever good routine you get down
4) Sickness - definitely disrupts sleep... and sometimes requires changing bedsheets plus bathing the child a second time because of throw up from too much coughing! (sometimes you have to change your own clothing if you happen to be holding the child while he/she is throwing up in the middle of the night...)

My two full-time jobs

As I'm sitting here trying to update my personal CV, there is a part of me that wonders if I should be doing more from a career point of view. I think I am so used to so much schooling and thinking about the next step that it is strange to not really have a "next step" to go to. Life had been about getting further education... elementary school, middle school, high school, college, med school, residency! Now that I am working in private practice, I sometimes wonder if there is a "next step"? Perhaps for me the next step right now is motherhood...


Becoming a mom has been a tremendously wonderful experience overall. Sure there are moments of craziness and frustration... but they pale in comparison to the indescribable love that overwhelms me at times when I look at my two girls. Everyone tells me that time flies so fast and I can see it already slipping by. I want to remember and treasure every moment!


Now, I love my current job. I love my staff, I love the relationships I'm building with my patients, and I love the intellectual stimulation that different cases bring. I also love the fact that there is some sense of order, predictability, and control when I'm at work. In fact, I get such a sense of satisfaction when I can clear a large pile of papers on my desk or I sign off and close charts at the end of the day. There is a sense of "mission accomplished" that I feel. Haha... it is everything that being a mom of a 2 year old and 4 month old is not. Therefore, I'm extremely grateful for the opportunity to be a part of two somewhat contrasting worlds. Right now, I'm only working 5 half days a week and for me, it is just right. If I worked any more hours, I would feel that I'm missing out on my kids. I believe if I worked any less hours, I'd be pulling my hair out. Life right now is about finding that delicate balance between mothering and doctoring...

Getting babies to sleep

Tonight, both kids went down with no fussing! Husband was away at band practice so it's always a bit of a challenge to tackle the bedtime routine of bathing/reading/putting down alone. Some nights, it goes smoothly... (like tonight!) but other nights not so much.

When we had our first child, I spent hours reading different sleep books as well as different blogs on the internet. She was not an easy child and at times took extensive bouncing/rocking/shooshing to get her to fall asleep. Then getting her to stay asleep was another story! From Ferber (cry it out methods) to No Cry Sleep Solution... you name it, I read it. At the end of the day, my conclusion was that both nature and nurture plays a role. I think the "cry it out method" works for the most part but it works much better in some kids than others. And in a few kids, it may not work at all. I believe the key to good sleep (in adults as well as babies) lies in routine and healthy sleep associations.

Welcome to PhysicianMom.com

PhysicianMom.com is a blog founded by me, Dr. Ellen Kim. I'm a family physicain currently working at Wrightstown Family Medicine and I'm a mom. My husband is an avid blogger and I finally decided that it was time for me to start my own blog (and he's helping me, so that helps).

Let me start with a brief bio:

• I grew up in New Jersey.
• I went to MIT (where I met my husband) and studied biology (course 7).
• I attended Drexel University College of Medicine (at the time, it was MCP Hahnemann).
• I completed a family medicine residency at U Penn and I was a chief resident (that's me on the far left - the short one)
• After residency, I started working as a family physician at Wrightstown Family Medicine.

As for being a mom, I became a mom a few years ago and I figure I'd use blogging as a way to keep track of all the funny, frustrating, and challenging things that come my way...