Mocha Moms: What's on the Table?

For many students, the first day of school is just around the corner. In addition to getting notebooks, clothes and other supplies, children also need to get their annual health check-ups. This week's Mocha Moms are joined by pediatrician Michael Darden.

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MICHEL MARTIN, host:

I'm Michel Martin, and you're listening to TELL ME MORE from NPR News.

Normally on Tuesday, we bring you our Money Coach, Alvin Hall. This week, he's talking with a listener about buying a first home, and we decided we needed more time for that conversation. So we're going to bring it to you tomorrow.

So now, as usual, it's time for the Mocha Moms. We talk with members of this mother support group each week for their common sense and savvy parenting advice.

This week, summer's drawing to an end. Where did the time go? And that means it's time for a new book bag, new shoes, and probably a health checkup. So we thought it would be a good time to ask parents and doctors what they should be talking about together as your kids get ready for school.

So I'm joined by Mocha Moms regulars Jolene Ivey, Cheli English-Figaro and new Mocha member, Asra Nomani. I'm also joined by a special guest - Dr. Michael Darden, who is a pediatrician with his own practice. He joined us from his office in Takoma Park, Maryland. Welcome. Dr. Darden, welcome all.

Ms. JOLENE IVEY (Co-Founder, Mocha Moms): Hey, Michel.

MARTIN: Hi there.

Ms. ASRA NOMANI (High School English Teacher, Jones College Prep): Hi, Michel.

Dr. MICHAEL DARDEN (Pediatrics, Howard University College of Medicine): Hello.

MARTIN: So, Jolene, I think - well, you know Dr. Darden because he was a pediatrician for some of your five? Five - all of your five?

Ms. IVEY: Yeah, all of my five. And I have to tell a story on Dr. Darden. When my last three babies were born, they were born at home. And Dr. Darden came for their one-day checkup to the house. Well, when the one who is now almost 10 was born, we were in the middle of a big construction project.

And anyway, he came to the house, he checked the baby, he looked around and said, oh, my God. And he went home and he got his wife and a casserole, and he came back to my house that afternoon and said, I thought maybe you needed a little bit of help today. So I was just so impressed. He's such a sweetheart. So thank you, Dr. Darden.

Dr. DARDEN: You're welcome.

MARTIN: Now, of course, we're all filled with rage and envy because none of our pediatricians brought us any casseroles. But hey, we're not hating. We're not hating. So I think this leads me to the first question, which is, what should parents - presumably, most parents are picking a pediatrician before their kids are born. But Jolene, if you just start by telling me what - when you were picking a pediatrician, what were you looking for?

Ms. IVEY: Well, I was looking for a doctor who, number one, would support my philosophy as far as how I raise my children and what's important with their health. And me having my babies at home, obviously, I've already made a statement about, to some extent, of how I want my children raised. And he's very good about talking not just to me, but directly to the children about what he's doing, why he's doing it. He doesn't just give a shot without talking to you about it. You talk about, you know, all the history of the shot, why you're getting the shot, why some people don't want the shot. So those kinds of things - I like to have these things discussed intelligently.

MARTIN: And what do you mean by your philosophy? What do you mean? You mean you want what?

Ms. IVEY: Well, I don't just do things just because that's what you do. I do things because that's what I think is the best thing to do. And I, you know, I give my child bearing thought. I give the breastfeeding thought. I give their inoculations thought. I just don't do things or not do them just because that's what everybody else does.

MARTIN: Well, we need to talk a little bit more about vaccination because, obviously, those are the law for - there are certain vaccinations that are required for your kid to attend school.

But before you do that, Dr. Darden, I want to ask you: What can parents do to be most effective when they come to you? What kind of parent do you most like to work with?

Dr. DARDEN: The answer to that question is all of them. I think that what my goal is, is to try to have parents basically understand child development. I think that if you can understand why your newborn is constantly crying, if you can understand why your teenagers is driving you up the wall, it doesn't really solve the problem, but it makes it a lot better on the parents to really understand why their kids are going through those types of issues.

MARTIN: Asra, what are you looking for in a pediatrician?

Ms. NOMANI: Well, as Dr. Darden was talking, I thought I saw the image of this developmental chart that my pediatrician has up in her office. And my pediatrician is Dr. Endera Mijendar(ph), a woman who is my neighbor. I saw her when I was growing up. I babysat for her children. So I've seen an entire generation of kids that she's raised in my hometown.

And she's tough, and I appreciated that. And she is also tough with my son, even at his age. Now he's four, but she's very clear with him that, you know, you don't walk on the little waiting room stuff that they've got. And what I like about her is that she is very clear about what she's doing and why she's doing it, and she's the one who gave me that term that it's age appropriate, you know, that what he's doing at this point is exactly what he's supposed to be doing.

MARTIN: And, Cheli, what about you? Before we move into the sort of the meat of what we need to be doing for our health checkups before we go back to school, what about you? What are you looking for in a pediatrician?

Ms. CHELI ENGLISH-FIGARO (President, Mocha Moms): I'm looking for someone who's going to listen to me and to recognize that parents really know their children. And I think sometimes - I have a wonderful pediatrician. Her name is Marilyn Porter. And I have a special needs child. And sometimes the parent will know that something is not quite right before anyone else does. And so I think it's really important for pediatricians and doctors in general just to respect the parent and respect the parent's instinct, because sometimes the parent will know before the doctor knows.

MARTIN: Dr. Darden, is that hard sometimes? I mean, when you see - what -seventeen ear infections in a course of a week, and, you know, it seems like a normal thing to you. But then a parent comes in, says, look, I'm really worried just because my child doesn't normally cry this much, or something of that sort. How do you sort that out for yourself as a doctor?

Dr. DARDEN: In pediatrics, especially in the age group before children are able to talk, it is of extreme importance. The most important thing that we can do when we assess anybody is to get the history. All of the special stuff that we do laboratory-wise, scan-wise, all of the technological things that we have available, those mean nothing unless they are very adamantly connected to your history. So when a parent tells me that they're detecting something that's kind of unusual, that has to be really ringing bells in our brain when we make our assessment. That's the first and foremost thing that we look at.

MARTIN: So the parent should feel that he or she is being listened to.

Dr. DARDEN: Absolutely.

MARTIN: Okay. Let's talk about history for a minute. What records should parents keep at home? Are there - should they keep copies of everything at home? Should they have certain copies of health records with the school nurse? And what if your child's school doesn't have a school nurse?

Dr. DARDEN: Yeah. I think two documents in your file that are going to be very important for parents to keep, and parents may want to collect them, let's say, at the end of the first year and then when they're ready to go to kindergarten at five years of age and then, you know, throughout their middle and adolescent years. And one is their growth curve. And all pediatricians and all family practitioners who take care of kids are going to have that. The other is the list that includes all of the vaccines, which we generally call the vaccine sheet. Those are key. So if any parent moves to a different locale, for example, the doctor that's receiving the patient on the new end may not be so interested in all of the details of this visit, that visit, but the key thing will be the vaccine sheet and the growth record.

Generally, charts will contain a, what we call a patient profile list that just includes all the major illnesses or major concerns that a person has had. So those three things are really the ones that you'd really want to keep in the event that there's a fire in the doctor's office, doctor has to suddenly shut down doors, et cetera, et cetera.

MARTIN: What should - should every child have a pre-school health checkup, and up to what age? And what should parents be doing to prepare their children for that back-to-school checkup?

Dr. DARDEN: Well, this is dictated by the state. The states dictate to various counties and therefore to the various schools that certain times of a child's life, there has to be a formal checkup with documentation of that evaluation. And that includes vaccinations as well. Certainly, those parent who are getting their kids ready for kindergarten, that's an important year. Pre-K - or what some parents will call pre-K4 - is an important year because, generally, those institutions are going to require the copy of the recent physical within that last 12-month period, as well as the vaccines.

The other time where forms and documents are needed would be when a child transfers from one school to another, whether it be they're moving to a different area or whether they're going from middle school to high school, or whether they're going from elementary school to middle school. Those are key times. Generally, though, children should get a physical exam every year.

MARTIN: Okay. You're listening to the Mocha Moms. I'm Michel Martin. This is TELL ME MORE from NPR News. And we're talking about health checkups for kids with pediatrician Dr. Michael Darden.

Jolene talked earlier about vaccinations. And she said that, you know, she likes to be very mindful of what her children are getting. I think, you know, all parents do. But want to mindful of what their children are being vaccinated for and - but do parents really have that much choice in the matter? I mean, most - aren't most vaccinations mandated by the law for children who attend public school?

Ms. IVEY: You know, my memory of it is there are some vaccines that they recommend at a certain point, and perhaps later it becomes mandatory. There were a few like that over the course of time with my kids. And the ones that weren't mandated, I did not give them. I waited. And when it became mandatory, obviously, you know, the kid would get it. But - and I'm not one of those parents who signs the form and says, you know, we have objections to vaccines and we're not going to get them done. I know that you can do that. I don't do that. I go ahead and get the vaccine. But I wasn't getting every vaccine that came down the pike. And fortunately, my kids have had the chicken pox, and so you could skip that one if you've had the disease.

MARTIN: Okay. Dr. Darden, what about that? I mean, do parents have a lot of wiggle room in that regard?

Dr. DARDEN: Well, I'll say this. If you were confused yesterday, tomorrow you're going to be even more confused. And I know Jolene and the rest of the panel is going to start to say, whoa, what's happening here?

We've got a whole new slew of new vaccines coming the pike that are currently under the status of a recommendation. They're presently not required by the school. And that includes hepatitis A - hepatitis B is what is now mandated. We have the new vaccine for meningitis, which was previously restricted just for college-bound kids. But now, it's being recommended for kids down to age 12. There is the HPV vaccine for the girls which…

MARTIN: Human papillomavirus.

Dr. DARDEN: The human papillomavirus vaccine. A lot of people are confused about that. So, you know, when you ask is there wiggle room, yes, there is wiggle room until those certain vaccines are required. On the forms that we have to fill out, they do require the DT or the DTaP, the polio, the hepatitis, the Prevnar for the kids under five, which is the one that people would call the pneumonia vaccine. They do require the chicken pox vaccine if the child has never received the disease.

MARTIN: Yeah.

Dr. DARDEN: But all of these other ones are still currently under recommendation status. And what's going to happen down the road, I don't know. There was a committee as a part of the American Academy of Pediatrics, which is the committee for immunization practices. Generally, they meet in the fall, I believe. And that's when they decide what vaccines need to be required, which ones need to be…

MARTIN: But that raises a question. How are you supposed to keep up with all this? I mean, you know, I mean, you got groceries, dry cleaning…

Dr. DARDEN: It is…

MARTIN: School - I mean, I'm not trying to minimize the importance of this, but I mean, my goodness.

Dr. DARDEN: I would say this. What we pediatricians have done is that most of us have allotted times where people can come in just for vaccine catch-ups without a visit. And so, we're - you know, everyone has a sheet that has all of their history of the vaccines. And usually the schools do a pretty good job of flagging those individuals. I think parents…

MARTIN: I wasn't talking about from a time management perspective. I was talking about from an information perspective, keeping track of all the decisions that - being mindful of Jolene's point of view on this - that you want, as a parent, it's something to have an opinion about whether you want your child to have one of these vaccines or not. When, actually, my question is, you know, how do you keep on top of this? Shelly, you had something to say on this?

Ms. ENGLISH-FIGARO: Just relating to the vaccine issue, I wanted to ask the doctor what is his opinion in terms of vaccines - certain vaccines, particularly the cocktails, causing autism? Because that's really big in the news these days. Because, physically, the MMR cocktail, that's the vaccine, I believe, for measles, mumps and rubella.

MARTIN: Mumps and rubella.

Ms. ENGLISH-FIGARO: They - at least I've heard - that they have connected that particular cocktail with autism.

Dr. DARDEN: Well, in my mind, because I've been in practice 26 years, I have seen vaccines do very, very well. I have seen people get chicken pox when they get the chicken pox vaccine. So it does pose valid concerns from parents. Now, we talk about that. We say the pros and con. And specifically, if it's recommended, we say look, you make the choice. I'm just a provider. I'm not going to force you to do anything as far as vaccines.

MARTIN: What about that MMR link to autism? I know this is something that's hotly debated on the some of the parenting blogs and things of that sort. What's your take on that, Dr. Darden?

Dr. DARDEN: The reason why that came in to vogue is because of a coincidence in time. We generally give the measles, mumps, rubella, or what we call the MMR vaccine between 12 and 15 months. The diagnosis of autism generally appears, clinically, at about that same time. The FDA looked at that issue, as well as the American Academy of Pediatrics, and looked purely at the statistics saying that, generally, if you have a 75 to - now I think it's up to like 92 percent immunization compliance in the entire continent of the United States - in other words, most kids have received MMR vaccine - then, even though the incidence of autism has increased, it certainly would seem to be a lot higher than what we're seeing right now. I think the MMR-autism issue just does not stand the test of statistics.

MARTIN: Okay.

Dr. DARDEN: And I think that that's why they have not recalled that vaccine and have, instead, advised us as providers to go full steam ahead with giving the MMR.

MARTIN: Okay. Asra, we're down to our last minute. Do you have a question for Dr. Darden?

Ms. IVEY: Well, I'm concerned that we're sort of raising a guinea pig generation, quite honestly, where our kids are guinea pigs for this intersection of the drug industry and the medical industry because we've got this - stresses on parents. And we've got an industry that's pushing a lot of these brochures. And that's my concern. I mean, that's my worry in terms of what we can do to educate ourselves so that our kids don't just end up as guinea pigs for a multi-billion dollar industry out there.

MARTIN: But I have to say on the other side of that question that some of these therapies for kids have really made a big difference in improving the quality of their lives and, you know, the family's lives. I mean, and kids who have allergies.

Ms. IVEY: And kids...

MARTIN: Kids who have asthma and things of that sort. I mean, I think you have to be…

Ms. IVEY: That's a balance. Right.

MARTIN: Both perspectives on this. So Dr. Darden, any thoughts about that?

Dr. DARDEN: I think that the decision of, you know, is my child being a guinea pig here really rests in the trust that you have in the doctor. There are certainly issues that you're not going to be able get because of the big industry. But I think that many things we do have a risk. When we get into our automobiles every day, even with a seat belt, we may not survive the day. So it's along that line, and I think that I would not criticize any parent for refusing a vaccine. I think that as long as they are educated and they have time to think about it, I think that's what this it's all about.

MARTIN: All right. That was Dr. Michael Darden. He joined us from his office in Takoma Park, Maryland, where he's a pediatrician with his own practice. And our Mocha Moms regulars, Jolene Ivey, Cheli English-Figaro and new Mocha, Asra Nomani, joined us here from our studios in Washington. You can find links to the Mocha Moms at our Web site, npr.org/tellmemore.

Thanks for joining us.

Ms. IVEY: Thanks, Michel.

Ms. NOMANI: Thank you.

Ms. ENGLISH-FIGURE: Thank you, Michel.

Dr. DARDEN: Thank you so much.

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