Have you ever wondered how ads that seem to be made just for you pop up on Facebook, Google and just about every other site you go to?

It’s called “behavioral advertising” and it’s rather cleaver and sneaky at the same time.

Check out a recent sidebar of Ads I noticed on my Facebook Home page:

Interestingly, the day before I was online hunting for information about photography, travel writing and an online program I was interested in. Coincidence? Not at all.

Behavioral ads emerge because of our online behavior. Our search history is actually food for the the code of the ads. We leave digital breadcrumbs in cyberspace that leads these ads to our site. CDT explains it this way:

So, we leave a trail of our digital cookies all over the web that lead the ad network right back to our computer. It’s no wonder that when I did my hunt for “shoes” after my hunt for photos, travel and writing, up came this ad:

Now that you know the reality, you can be a step ahead of these groups and not let them use your desires for their  financial gain. As adults, this shouldn’t be too challenging to do. However, helping our kids and teens understand this may not be so easy. That’s one of the reasons it’s so important we be involved with our kids online lives and make sure they are not involved with social media until they are teenagers. It takes some wherewithal and maturity to truly negotiate this world smartly.

When you do talk to your kids about the financial reality of the online world, use the pictures in this post and remind them of what Will Rogers once said:

 “Advertising is the art of convincing people to spend money they don’t have for something they don’t need.”

If that doesn’t work, pull out the Borg analogy.

In the world of Star Trek, run ins with the Borg were not easy. In fact, they were down right futile.

Many people today describe the same futility with online ads. They just cave because they find them too alluring – too powerful.

Luckily, we’re not Borg. And, most of us have the power to say “resistance is not futile – I’m not going to click that ad today.” That’s what I do and what I teach my kids to do. I know you can do the same.

If you feel yourself feeling weak, just ask yourself this: where would you rather have your money housed…in your bank account of the bank account of Facebook and the Ad Networks they partner with??

(Borg Image)

By now you’ve heard the news. Like it or not, the new Facebook Timeline is coming to a Facebook profile near you. In otherwords, yours, mine and all of our closest, and not so closest, friends.

Not wanting the change to completely catch me off guard, I decided to take the leap today.

At a first glance, the Timeline looks sort of cool. It’s a true timeline of our Facebook life with pertinent information upfront.

However, my joy ride was quickly interrupted by some hidden speed bumps that boil down to one concept: the temptation to over share.

Unlike the former profile which asked for basic facts about our lives, education, likes, employment, this new Timeline goes a step further into the core of our lives from issues of health to details of travel. And, it does so by offering cleverly placed drop down menus that tempt you to offer up information that most of us wouldn’t have even considered putting on a resume, or on Facebook…before the introduction of the Timeline.

Tricky, I know.

The subtle massaging our our desire to share begins as soon as we transition to the Timeline with these categories:

 

The first true new category is “Map” which is really an expansion of Facebook Places. When you click on “Map” a big map page opens that allows you to enter a place you’ve visited. I decided to enter “Boston” since that’s the nearest major city to my current home. Here’s what came up:

Posting location information online is still controversial. Many people are not sure it’s safe and wonder how much location information we should be providing about ourselves online, past or present. It’s one thing to say casually “I visited Boston once” but do we want to provide a visual trail complete with dates? I’m not so sure we want that much information about ourselves online, that complete of a personal record, with people we are not true friends with offline.

I had my next Timeline head scratching moment with the Status Bar. At a quick glance, the Timeline’s status bar looked just like the familiar status bar of the old profile page…except it now has a new item called “Life Event”.

If you click “Life Event” you get a variety of options prompting you to enter all sorts of data, data that you may not have considered staring before these drop down menus emerged. That’s the issue I have with these screens. Many people, like most, will look at these drop down screens and move on, uninterested to post more information than they were going to before these screens were created. But, what about the emotional vulnerable among us or teenagers? Those are the folks I worry about when I see the following screens.

First up, “Family & Relationships”:

It’s not unusual to share expanding a family or getting married. But, we have to be careful about encouraging sharing loss. That has to be done in a healthy way and to people who are true friends. I’m not sure I like the idea of someone posting that as a status…that’s not as healthy as posting “I’m sad…someone died today”. People will notice the latter much more than a change in status and reach out more effectively.

Next up, “Health and Wellness”. Check these out:

We know from studies that sharing information online and online support groups can be beneficial. However, it has to be done correctly and actively. Changing a status won’t yield the same result as posting on one’s wall “I’m really upset – had a tough doctor’s appointment” or “Guess what – I’m cured!” In all cases, the success of posting health information will boil down to whether a person has a health group of friends online and how active those friends are online. A person can have 500 Facebook Friends but if those people are not active online, no post will matter.

Finally, “Travel & Experiences”. Some of these categories may be fun while others definitely TMI. Take a look:

The success of sharing this type of information boils down to why you are sharing the information, who is receiving the information, and the risk of sharing the information, if any. For example, telling the world you have decided to marry your new love for photography with your love for dogs to help your local dog pound find homes for abandoned puppies would be an outstanding piece of information to share. On the other hand, while visiting a friend in Thailand, living out your dream to get a tattoo may not be so wise, especially since you are in your late 30s or 40s, have kids, a job…all those fun life issues where a tattoo may be so well received.

As if the above issues are not enough to contemplate, the changes in Privacy settings that came with the new Timeline are equally mind boggling. Like the Timeline itself, they, too, look and feel very different. So, spend a few minutes playing around and making sure your settings are what you want them to be for everything on your site, including the 3rd party applications. Then, sit down with your teenagers who have Facebook pages and help them understand the new Timeline.

Information online can be like water in a sink with a slow leak…one way or another, some will escape. So, post with care and hope for the best.

Reading the tweets and news stories condemning Paula for not disclosing her diabetes sooner, and accusing her of doing so for personal gain, I’m reminded of the old American Indian Proverb:

Never criticize a man until you’ve walked a mile in his moccasins.

She was incredibly honest with Al Roker on TODAY for her reasons to stay quiet initially: “I came home, I told my children, I told my husband, I said, ‘I’m gonna keep this close to my chest for the time being’ because I had to figure out things in my own head.”

And, in the same interview, she noted changes she’s made since her diagnoses in her diet and in exercise and in what her show does and doesn’t promote:

“I have always eaten in moderation….You know, people see me on TV two or three times a day and they see me cooking all these wonderfully Southern, fattening dishes. That’s only 30 days out of 365….And it’s for entertainment. And people have to be responsible.”

Did you know that when a person gets diagnosed with a chronic condition, the person experiences the same 5 stages of grief as when a loved one dies? Noted by famed physician Dr. Elisabeth Kubler-Ross, they are:

1. Denial
2. Anger
3. Depression
4. Bargaining
5. Acceptance

As with all grief, moving through these stages takes time. There are many starts and stops and it’s easy to get stuck along the way. Having experienced first hand all of these stages when I was diagnosed with Rheumatoid Arthritis 2 1/2 years ago, I can tell you the process is incredibly intense, not at all easy and slow. So, 3 years may seem like a long time to you, a person without a chronic condition, but to someone learning to adjust to a new normal, it’s actually not that long at all. Remember, this process becomes the start of the rest of someone’s life.

The reality of chronic diseases is they are much less like the American Indian Proverb I quoted initially and much more like this Dutch Proverb:

Sickness comes on horseback but departs on foot.

One reason I’m stepping forward to support Paula is because I’ve seen how powerful celebrity and expert spokespeople can be in the world of chronic conditions. In the arthritis world, pro golfer Phil Mickelson has had a very well received campaign sponsored by Pfizer for psoriatic arthritis and Enbrel. His campaign and ads helped me enormously even though I have a different form of arthritis.  They came on TV when I was facing a particularly though time with my RA and gave me just what I needed to feel more hopeful and positive about the future , the medications I found myself on, and the activities I put on hold. Incidentally, no one questioned why Phil waited over a year to come forward with his story or why he was partnering with Pfizer to help others with arthritis. If Paula can do that for diabetes, more power to her!

We live in a media world where the glass is always half empty and reported that way. How about we start looking at the glass as half full and start giving people trying to help others the benefit of the doubt for a change.

Last year, the Florida State legislature attempted to gag pediatricians from discussing gun safety with families. That law, referred to as the docs n’ Glocks Law, was overturned by a Federal Judge this past September after strong rallying by the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence.

Judge Marcia Cooke’s ruling was a huge victory for gun safety education and for pediatricians. Her ruling validated what pediatricians in Florida, and every other state in our Nation, have been attempting to explain for a very long time: this issue isn’t about gun ownership but about gun safety.

The recent  tragic death of a Texas 8th grader, Jaime Gonzalez, is a grim and very real reminder of how serious events can become when any type of gun is involved.  According to reports, police could not discern that the gun was a pellet gun and the events unfolded in a way that forced them to act so that the school student body and staff would be safe. That’s their job. Playing Monday morning quarterback isn’t going to change the event. However, we can prevent future events by recognizing that we need to do better in providing gun safety educations in our schools, for parents in their homes and for pediatricians in their offices.

For some reason, gun safety education is one of those topics that everyone agrees is important, including pediatricians, yet no one takes enough time to truly do justice to when they have a family, or group of students, in front of them. With kids still bringing guns to school, we have to stop assuming that someone else is providing that important talk and step up.

Parents need to have the talk with their kids, whether they own a gun or not.

Schools need to have gun safety education in their health and safety courses and in their Open Circle times.

And, pediatricians need to fit it into their busy office visits.

We should be having it at home with our kids.

Communities and schools can think outside the box and post information and links to resource on websites and in newsletters. Drama classes could organize skits. Art classes could make posters. Both of these avenues have been very successful with other hard to discuss topics such as drug and alcohol use and abuse and high tech issues.

As long as you do more today than you did yesterday, the students in your community will more safe tomorrow and the likelihood of another school gun incident will go dramatically down.

This is a New Year’s Resolution we can do something about – and we owe it to the Jaime Gonzalez’s family to do just that.

There are times in life I’m reminded of the 1980’s Billy Crystal parody, “You Look Marvelous”. The skit was a paroday of Fernando Lamas and gave birth to the phrase “You look marvelous…it’s not how you feel, it’s how you look!!”

If you want a great pick me up, take the next 4 minutes and listen to the song:

What’s astonishing is that a song that was meant to be tongue and cheek has become a theme song for a generation of people who were infants and small children when the song was first aired. These folks are the folks who wear makeup to pick there kids up from school, wear designer clothes at the supermarket, and would never, ever think of admitting to illness when an appearance at an event is at steak, whether it be a playdate, a family event or a social gathering.

I’ve thought about this song a great deal lately as it seems we’re constantly finding ourselves in social gatherings where one of the children ends up being sick. Recently we were at on such gathering and a parent of a child casually told us that his son had been up all night vomiting. “But, he’s fine now – a real trooper. He’s not eating much but I can’t blame him for that.”  Given that many of the folks who had contact with this child came down with crud awfully similar to what he had, I’d beg to differ.

The reality is this scenario is frighteningly common. Parents are blinded to how contagious their children are to other people and how much time it takes to truly recover from these infections. The thought of not attending a social event is simply not an option more times than not and often met with comments such as:

“What if I give acetaminophen or ibuprofen?”

“What if she just doesn’t eat?”

“We’ll only stay a few minutes – he won’t even talk to anyone.”

“I promise she won’t cough or sneeze on anyone but me.”

The majority of illnesses we all get are viruses. They tend to come on very quickly and last a good 1-2 weeks. When any of us have a virus, a flu or stomach virus, or even a cold, we’re contagious right before we develop our symptoms and then for a few days after our symptoms go away.

So, take a stomach flu. Even if your child has one of those fast and furious ones that seems to come on out of no where and then goes away in a few hours, your child is still contagious for at least another day. Heading to a party a few hours after the last time your child threw up still exposes everyone at the party to the stomach bug.

When considering attending a party, or sending your child to school, the other issue, of course, is considering the other kids and adults at the event. Not knowing their health histories or those in their households, we could be placing them in enormous risk should they catch whatever our kids have. For example, someone could have an immune issue or be on a medication that suppresses the immune system. They could have someone at home who is under treatment for a cancer or other immune disorder that puts them at risk for battling even the most mild of infections. In other words, the decision to attend a part impacts not just our family but every family at the event.

So, as your child recovers from his next illness, just remember that looking marvelous is fantastic and a great sign your child is on the path to good health again. But, before you put your child back in the social spotlight again, make sure enough time has passed for your child to truly feel as marvelous as your child looks.

For more information:

When to keep kids home from school and daycare

The Stomach Flu

Looking for information on the digital world of texting, gaming and social media of your kids and teens? Wondering where that article was on texting or cyberbullying you know you saw recently on Pediatrics Now?

Don’t worry! They haven’t disappeared…just moved.

You can find all the articles on the digital world of kids and teens that you’ve come to rely on, plus new resources and materials, on the sister site to Pediatrics Now, CyberSafe.

On CyberSafe is you’ll find all things high tech and digital that you wonder about with your growing digital and very plugged in family from articles to resources to information on new products.  In addition, you’ll find excepts from Dr. Gwenn’s book, CyberSafe, and related information.

So, for peace of mind with your digital family, there’s only one word, and site, you need to know: CyberSafe.

Do you follow your blood pressure at home, perhaps with a home monitoring device like the one shown in the picture? Does your blood pressure go up and down a bit?

What happens at the doctor’s office? Is it typically a bit higher than at home…or a lot higher.

Well, the reality is that all of us get a bit amped up heading to a doctor’s appointment – even us doctors. So, our blood pressures typically are about 5 mmHG higher at an appointment than at home. The trouble is, though, I’m finding that many times my blood pressure and many of my friends and relatives are ending up with blood pressure readings much higher than that at physician’s offices. Anxiety, sickness, medications all taken into account, there is one constant that’s at play in all these aberrant readings: improper blood pressure taking technique.

When I was in medical school, we had a few classes on how to properly take blood pressures. Taking a blood pressure isn’t very difficult but getting an accurate reading can be some simple steps are not followed, namely:
1. Ensuring proper cuff size for the arm. A cuff to large or too small will throw off the reading.
2. Making sure the cuff is placed on a bare arm and not over clothing as the reading will not be accurate over clothing.
3. Giving the patient a few minutes to rest before taking the reading.
4. Using the left arm, when possible.

Without fail, though, over the last year, few of these steps have been followed when I’ve had my blood pressure taken at amy of my doctor’s visits. The other day, in fact, I was at an appointment and I asked the nurse if I should take my arm out of the sleeve of my sweater and she said “no”. The reading for my blood pressure came back sky high at 150/100.  I wasn’t too worried because I know my baseline from taking it at home – but was surprised the nurse wasn’t more concerned and didn’t insist on rechecking it, perhaps with my arm out of the sleeve, because according to the Mayo Clinic, a number that high could have indicated stage 2 hypertension:

That night, at home, I did a little experiment. I took my blood pressure after I had been zipping about the house doing some housework, with the cuff over my sleeve. The initial reading was 140/88. After sitting for 10 minutes relaxing, the reading came back at 124/81, this time with the cuff on my bare arm.

I get that the health care groups are busy but are they so busy they can’t give us a few minutes to site and take our arms out of our sleeves so our blood pressures can be accurate??

Few issues get people’s blood boiling the way sex does. It’s no surprise that we come to blows over issues concerning teen sex and sexuality – we nearly come to blows when adults issues on the same topics come to the table. Differences aside, the true issue to consider is who truly knows best how to guide teens through these challenging waters: health experts such as pediatricians and OB/GYNs, or politicians, including those who work on their behalf in the Department of Health and Human Services??

We live in a complex time. But, imagine if we lived in a less complex age, a time where teenagers listened to advice of their mentors, parents and physicians. Imagine if that time was one where teens understood that some actions were not meant for teen bodies and that deferring certain activities, such as sex, until young adult life, was the best and most mature decision for a teen to take. In this idealized world, the images teens would see of their peer group on all forms of media would be positive – showing teens reaching for the stars and saying “no” to risky behaviors.

If only that idealized world were anything close to our reality in 2011. In today’s world, the teen culture is very immediate and often doesn’t consider the consequences of actions. Today’s teen culture, at least in the United States, is also significantly lacking in the health information they need to make sound decisions around sex and to know what to do if something goes awry – such as an unwanted pregnancy or sexually transmitted disease.

Today’s world is also loaded with sexualized images of teens. From advertisements to popular shows such as Glee and Twilight, teens are inundated with images of teens having sexual relationships with each other. Given their already out of control hormones, this doesn’t help them stay focused on the other aspects of their lives.

It is true that we are making progress in the United States with teen pregnancy rates declining. But, can we really call this a victory when the rate of decline is more akin to a plateau over the last few years?

And, can we truly feel confident we are helping our teens as much as we can when our teen pregnancy rate is actually higher than most other developing countries?

In these countries, according to a very compelling report, teens are treated with more respect and given more information and resources to make healthier decisions and stay safe. As a result, these countries have much lower teen pregancy rates, teen sexually transmitted disease rates and teen abortion rates:

It would be great if teens didn’t have sex but we now that won’t occur. They are immediate creatures by design. That’s the way their brains are hardwired at this state in their development. So, from time to time they’ll act out of impulse and not out of reason. This is why it’s so crucial for us to give them the tools and resources to manage situations when they occur. This is the only way for them to stay healthy and not compound one problem that occurred due to being a teen with another problem that resulted from adults preventing them from trying to responsible, and economically, handle the situation before it became worse.

Compared to the other developed countries the United States is compared with, we have it wrong. We, for some reason I have never been able to comprehend, feel if we give our kids information they will act. We never stop and consider that if we given them information they will not act and will make a good and sound decision. I’ve talked with and worked with enough teens to know that the majority are good kids who do not want to ruin their lives. I firmly believe that if we give our kids and teens the time and attention they deserve to have their questions answered on the tough topics such as sex…and sexuality and drugs and teen dating and teen dating violence, to name a few, they will make better and more healthy decisions. We have to, we must, start giving them more of the benefit of the doubt. There was a time when someone, some adult, in our lives did that for us, isn’t it time we did that for them?

The true experts in teen health are unified for teen health and feel strongly that this week’s decision by Secretary Sebelius was wrong. I couldn’t agree more and hope that Secretary Sebelius will not just look at the data more objectively but listen to the true experts on teen sexuality and overall health. If the politicians want us, the people, to trust in them as the experts in policy and politics, perhaps they should start trusting us experts in health from time to time.  This has to be a two way street for our society to thrive and remain healthy.

Have you noticed how just about everything is occurring earlier in the lives of kids than it did when we were kids? Today’s kids are expected to achieve milestones earlier than the past and fine-tune their preferences for the future without having any life experience to base those preferences on.

Nowadays, this trend is including very young developmental tasks such as potty training. I’m hearing from parents concerns and questions about how to potty train some incredibly young kids. We’re not just talking about young toddlers between the age of 1-2. Some parents are starting to ask if an infant a few months old can be potty trained.

Potty training is as much biological as it is emotional and social. When you think about potty training in terms of biological processes that need to occur and then get executed and mastered by very young kids, it’s easy to see why there is not only a great deal of confusion but a mis-match between what we hope will occur for our kids and what they can actually occur. The frank reality is that most kids simply are not ready to potty train until they are ready – and that may be around 2 years of age, or 3, or even 4 for some kids.

Pushing, pleading, begging, bribing didn’t help our kids achieve potty training any quicker than it was meant to be. In the end, success occurred when we followed their lead and didn’t expect them to do something they truly could’t.

Talking to parents about this issue since I became a pediatrician, I can vouch to the variability of when kids achive potty training success as well as one truism: a parent’s desire for a child to be potty trained is meaningless if the child isn’t truly ready. As a parent, this was my experience, too.

Parenting a toddler is challenging enough. Why add more chaos to the mix by pushing something that the child is not ready for? Instead, we collectively need to learn more patients and to truly get to know where our kids are with their ability to tackle a new task, whether potty training, starting school or any new milestone, actually.

A child’s days of diapers and Pull Ups are numbered but how many that child needs before becoming fully potty trained will be unique for that child. So, avoid the pressure to push the process earlier than it’s meant to occur. Your child will be better off by taking this approach – and so will you.

Disclosure:

I have partnered with Pull-Ups® to serve as a Pull-Ups® Potty Training Partner. I have been compensated for my time commitment to the program, which includes writing articles for Pull-Ups.com, and offering tips and advice on the Pull-Ups®  Facebook page. However, my opinions are entirely my own and I have not been paid to publish positive comments or endorse the product.

Child abuse is one of the most difficult issues we face as pediatricians and in society. A new study out this month by Boston University School of Medicine sheds some light on one of the most important issues in helping children who have been abused: a pediatrician’s ability to report.

Bob Sege, MD, the study’s lead author, and I talked appeared on Fox 25′s Morning Show yesterday to make sense of not just the study but the bigger issue:

New study says child abuse is underreported by primary care providers: MyFoxBOSTON.com