Month: November 2022

Want your child to grow up healthy, happy, smart, capable, and resilient? Play with them. Infants and toddlers thrive on playful games that change as they grow.

Why does play matter during the first few years of life?

More than a million new nerve connections are made in the brain in the first few years of life. And pruning of these neural connections makes them more efficient. These processes literally build the brain and help guide how it functions for the rest of that child’s life. While biology — particularly genetics — affects this, so does a child’s environment and experiences.

Babies and children thrive with responsive caregiving. Serve and return, a term used by the Harvard Center on the Developing Child, describes this well: back-and-forth interactions, in which the child and caregiver react to and interact with each other in a loving, nurturing way, are the building blocks of a healthy brain and a happy child, who will have a better chance of growing into a healthy, happy, competent, and successful adult.

Play is one of the best ways to do responsive caregiving. To maximize the benefits of play:

• Bring your full attention. Put the phone down, don’t multitask.
• Be reciprocal. That’s the “serve and return” part. Even little babies can interact with their caregivers, and that’s what you want to encourage. It doesn’t have to be reciprocal in an equal way — you might be talking in sentences while your baby is just smiling or cooing — but the idea is to build responsiveness into the play.
• Be attuned to developmental stages. That way your child can fully engage — and you can encourage their development as well.

Great games to play with infants: 6 to 9 months

The Center for the Developing Child has some great ideas and handouts for parents about specific games to play with their children at different ages.

6-month-olds and 9-month-olds are learning imitation and other building blocks of language. They are also starting to learn movement and explore the world around them.

Here are some play ideas for this age group:

• Play peek-a-boo or patty-cake.
• Play games of hiding toys under a blanket or another toy, and then “find” them, or let the baby find them.
• Have back-and-forth conversations. The baby’s contribution might just be a “ma” or “ba” sound. You can make the same sound back, or pretend that your baby is saying something (“You don’t say! Really? Tell me more!”).
• Play imitation games: if your baby sticks out their tongue, you do it too, for example. Older babies will start to be able to imitate things like clapping or banging, and love when grownups do that with them.
• Sing songs that involve movement, like “Itsy Bitsy Spider” or “Trot, Trot to Boston” with words and motions.
• Play simple games with objects, like putting toys into a bucket and taking them out, or dropping them and saying “boom!”

Great games to play with toddlers

Between 12 months and 18 months, young toddlers are gaining more language and movement skills, and love to imitate. You can:

• Play with blocks, building simple things and knocking them down together.
• Do imaginative play with dolls or stuffed animals, or pretend phone calls.
• Use pillows and blankets to build little forts and places to climb and play.
• Play some rudimentary hide-and-seek, like hiding yourself under a blanket next to the baby.
• Continue singing songs that involve movement and interaction, like “If You’re Happy And You Know It.”
• Go on outings and explore the world together. Even just going to the grocery store can be an adventure for a baby. Narrate everything. Don’t worry about using words your baby doesn’t understand; eventually they will, and hearing lots of different words is good for them.

Older toddlers, who are 2 or 3 years old, are able to do more complicated versions of these games. They can do matching, sorting, and counting games, as well as imitation and movement games like “follow the leader” (you can get quite creative and silly with that one).

As much as you can, give yourself over to play and have fun. Work and chores can wait, or you can actually involve young children in chores, making that more fun for both of you. Checking social media can definitely wait.

Playing with your child is an investment in your child’s future — and a great way to build your relationship and make both of you happy.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Proton-pump inhibitors (PPIs) are a common type of anti-acid medication, and are available both by prescription and over the counter. Omeprazole and pantoprazole are examples of PPIs. They are the treatment of choice for several gastrointestinal disorders, such as peptic ulcer disease, esophagitis, gastroesophageal reflux disease, and H. pylori infection.

New guidelines by the American Gastroenterological Association have highlighted the need to address appropriate PPI usage, and they recommend that PPIs should be taken at the lowest dose and shortest duration for the condition being treated. However, PPIs are frequently overused, and may be taken for longer than necessary. This can happen unintentionally; for example, if the medication was started while the patient was hospitalized, or it was started as a trial to see if a patient’s symptoms would improve and then is continued beyond the needed timeframe.

Who should use PPIs in the short term?

There are a variety of reasons for short-term PPI usage. For instance, PPIs are prescribed typically for one to two weeks to treat H. pylori infection, in addition to antibiotics. A PPI course of four to 12 weeks may be prescribed for people with ulcers in their stomach or small intestine, or for inflammation in the esophagus.

People may also be prescribed a short course of PPIs for acid reflux or abdominal pain symptoms (dyspepsia), and for symptom relief while physicians perform tests to determine the cause of abdominal pain. People may be able to move to a lower dose of PPIs, or discontinue their medication altogether, if their symptoms get better or they have completed their treatment course.

Who should be on PPIs long-term?

Some patients with specific conditions may need to be on PPIs for the long term, and they should discuss their condition and unique treatment plan with their doctor. Some conditions that may require longer-term use of PPIs include:

• severe esophagitis, eosinophilic esophagitis, Barrett’s esophagus, esophageal strictures, or idiopathic pulmonary fibrosis
• acid reflux
• dyspepsia or upper airway symptoms that improve with PPI usage but worsen when stopping PPIs
• people with a history of upper gastrointestinal bleeding from gastric and duodenal peptic ulcers may need to be on PPIs long-term to prevent recurrence.

What are some side effects of PPIs?

Any medication can cause side effects. Fortunately, adverse effects from PPIs are generally rare. However, these medications have been associated with increased risk of certain infections (such as pneumonia and C. difficile). Previously, there had been concerns that PPI usage was linked to dementia, but newer studies have contradicted this association.

Additionally, while rare, PPIs may also cause drug interactions with other medications. For example, PPIs may affect the levels and potency of certain medications, such as clopidogrel (Plavix), warfarin (Coumadin), and some seizure and HIV medications, sometimes necessitating dosage adjustments of these drugs. Therefore, it is important to let the team of healthcare providers who manage your medications know when a new medication has been added to your list or if a medication has been discontinued.

How do I work with my doctor to step down from taking PPIs?

Some patients are prescribed PPIs twice a day in an acute situation, such as to prevent rebleeding from stomach ulcers or if a patient has severe acid reflux symptoms. If there no longer remains a reason to take PPIs twice a day, you may be stepped down to once a day. To discontinue a PPI, your doctor may decide to taper the medication — for example, by decreasing the dose by 50% each week until discontinued.

What might I experience if my doctor suggests I stop taking a PPI?

Studies have shown that for patients with long-term PPI use, there can be rebound secretion of stomach acid and an increase in upper gastrointestinal symptoms when discontinuing PPIs. However, a different type of anti-acid medication (such as an H2 antagonist like famotidine or a contact antacid medication containing calcium carbonate like TUMS) can be used for relief temporarily. If a patient experiences more than two months of severe persistent symptoms after discontinuing a PPI, this may be a reason to resume PPI therapy.

What steps should I take next?

It is important to routinely discuss your medication list and concerns with your primary care doctor. The decision to step down or discontinue a PPI is complex, and for your safety you should verify with your doctor before adjusting your PPI dosing. Ultimately, the goal is to make sure you are only taking medications that are necessary in order to maximize the benefit and minimize side effects.

About the Authors

Nisa Desai, MD, Contributor

Dr. Nisa Desai is a practicing hospitalist physician at Beth Israel Deaconess Medical Center, and an instructor in medicine at Harvard Medical School. She completed undergraduate education at Northwestern University, followed by medical school at the … See Full Bio View all posts by Nisa Desai, MD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD

A visit with a surgeon can be overwhelming. You may feel anxious about your planned surgery. Many questions could be swirling in your head during a rushed visit. While surgeons have a reputation as technical specialists, bedside manner may be lacking at times.

It sounds simple, but setting the right expectations — on both sides — can ease your anxiety and help you feel more comfortable during a visit with your surgeon. So what exactly does this mean? And how can you accomplish it?

Tell your story

Tell your story to help set clear goals. Beyond simply stating what hurts or what is not working, be sure to include details such as

• how your current condition limits what you enjoy doing
• your daily activities
• how your condition affects your relationship with your social circle and family
• upcoming plans or goals such as travel, or life events like vacations or weddings.

Sharing details like these helps you collaborate to define a successful outcome for surgery.

Listen with your goals in mind

When explaining surgical options, surgeons are obligated to discuss key information, including risks, potential complications, and likely outcomes. Encourage your surgeon to put these facts into context based on what is important to you.

• Ask questions about how surgery will affect things you enjoy doing, such as playing pickleball, taking walks, cooking, reading, or listening to music.
• Ask what you should realistically expect during recovery and once you have recovered. For example, if you have a vacation or travel planned, be sure to discuss how surgery will affect your plans.

Define success before your surgery

Once you are confident that you have told your story and feel like you and your surgeon have set appropriate expectations, take the next step. Ask whether this discussion affects your surgeon’s approach to surgery, and explore how you each define surgical success.

Often, both surgeon and patient agree on a definition of success: for example, remove the entire tumor. But this simple definition may leave room for misalignment. Let’s say a surgeon is able to entirely remove a thyroid tumor, but now the patient speaks in a hoarse voice. While technically successful, this surgery may feel like a failure unless the person understood and accepted the risk that it could affect how they speak.

This highlights the importance of setting expectations. In this example, clear speech after surgery might be your expectation as a patient. Your surgeon must balance explaining how surgical risks might affect that expectation with the reality of treating the condition. Surgery is more likely to feel successful if both sides discuss and align their expectations.

Give yourself time when possible

Processing information about surgery can take time. A surgeon may have to provide realistic expectations that do not align with your initial expectations and hopes.

Some surgeries are urgent, others are not. If you do not need to make an immediate decision, be open with your surgeon. Let them know that you need time to consider the surgeon’s definition of success and your own. Reflecting on the discussion can reduce the stress and anxiety you’re likely to feel during an initial visit.

The bottom line: Making the most of your appointment

Communication goes two ways during a good pre-surgery visit. Do your best to tell your story and emphasize details of your life that are important. When listening, ensure that your surgeon acknowledges these details and describes how surgery may affect your life, as opposed to simply stating technical facts about the surgery. Setting expectations together will help you achieve a common goal and establish a strong surgeon-patient relationship that is essential for a positive surgical outcome.

About the Author

James Naples, MD,

Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. James Naples is a physician at Beth Israel Deaconess Medical Center, and a clinical instructor at Harvard Medical School in Boston, MA. He earned his medical degree from the University of Connecticut School of Medicine, … See Full Bio View all posts by James Naples, MD