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by Susan R. Johnson, M.D.

© Susan R. Johnson, M.D., 1999. Duplication and redistribution of unbound paper copies permitted.

an excerpt from Charlie and the Chocolate Factory, by Roald Dahl, 1964

As a mother and a pediatrician who completed both a three-year residency in Pediatrics and a three-year subspecialty fellowship in Behavioral and Developmental Pediatrics, I started to wonder: "What are we doing to our children's growth and learning potential by allowing them to watch television and videos as well as spend endless hours playing computer games?"

I practiced seven years as the Physician Consultant at the School Health Center in San Francisco, performing comprehensive assessments on children, ages 4-12, who were having learning and behavioral difficulties in school. I saw hundreds of children who were having difficulties paying attention, focusing on their work, and performing fine and gross motor tasks. Many of these children had a poor self-image and problems relating to adults and peers. As a pediatrician, I had always discouraged television viewing, because of the often violent nature of its content (especially cartoons) and because of all the commercials aimed at children. However, it wasn't until the birth of my own child, 6 years ago, that I came face to face with the real impact of television. It wasn't just the content, for I had carefully screened the programs my child watched. It was the change in my child's behavior (his mood, his motor movements, his play) before, during and after watching TV that truly frightened me.

Before watching TV, he would be outside in nature, content to look at bugs, make things with sticks and rocks, and play in the water and sand. He seemed at peace with himself, his body, and his environment. When watching TV, he was so unresponsive to me and to what was happening around him, that he seemed glued to the television set. When I turned off the TV he became anxious, nervous, and irritable and usually cried (or screamed) for the TV to be turned back on. His play was erratic, his movements impulsive and uncoordinated. His play lacked his own imaginative input. Instead of creating his own play themes, he was simply re-enacting what he had just seen on TV in a very repetitive, uncreative and stilted way.
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by Susan R. Johnson MD and Jeff Smith RN, Raphael House

There were not many courses dealing with nutrition in medical school or during my pediatric residency. I did learn that sailors on prolonged voyages at sea could get scurvy if they didn't have enought vitamin C, and I also was taught the importance of a low-fat diet. For literally decades, I did not eat butter and I drank only non-fat milk. Last year I spent two months at the Lukas Klinik in Arlesheim, Switzerland, learning about nutrition and the importance of providing high quality fats in our diet as well as in our children's diet. Infants and children especially need fats and their accompanying vitamins and minerals to myelinate their nervous systems.

Here are a few nutritional tips I recently have learned :

1) Reduce sugar consumption (especially sugar sweetened fruit drinks and sodas) and limit use of refined white flour and white flour products. These substances require minerals and enzymes to be processed. Because these substances contain little to no minerals, vitamins or enzymes, they continually deplete our own bodies' supplies. Our digestive organs do not function well without a good supply of vitamins, enzymes, and minerals, and therefore our digestion is weakened.

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by Susan R. Johnson MD, FAAP, Raphael House

As a pediatrician, I actually was taught that you could tell if a baby or child was warm enough by touching their skin. If they felt warm then they were wearing enough clothes, and if they felt cool or their skin was mottled (bluish-pink), then they needed more clothes. It was simple. I was also a parent that had her 2 year-old child outside in the rain wearing only a diaper while playing in the puddles. I actually thought he was okay because he felt warm!

Warmth is probably one of the greatest gifts we can give our children. Not only the warmth as love but the physical warmth of their body. Children are developing their bodies especially during the first 7 years of their lives. An infant and a young child will always feel warm unless they are on the verge of hypothermia because they have an accelerated metabolic rate. If we don't provide them with the layers of cotton and wool to insulate their bodies, then they must use some of their potential "growth" energy to heat their bodies. This same energy would be better utilized in further developing their brain, heart, liver, lungs etc. In addition, being cold decreases our immunity. We are all more susceptible to the germs and viruses that are always around us when we are wet and cold. When our body has to expend extra energy to keep warm then less energy is available to "fight" off infections.
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by Susan R. Johnson MD, FAAP, Raphael House

I still struggle getting my almost 7-year-old son asleep by 8:00. It seems there is a magic window. If we eat by 5:00 and I start slowing down his activities by 6:00, then there is a good chance that he will fall to sleep soon after reading stories at 7:30. If I don't have dinner ready until 6:00 or 7:00 and slow down doesn't begin until 8:00 or 8:30 then my son seems to get a second wind that keeps him awake and active until 10:00 or 10:30 at night.The next day is difficult for him. It is hard for him to get up, eat breakfast, and get to school on time. He is tired and more irritable the entire day. What is happening?

If you go to see an anthroposophical physician with these complaints, then chances are your child will end up with a remedy for the liver. Often Hepatodoron (made from the leaves of the vine, Vitus vinifera, and the wild strawberry, Fragaria vesca) is given. It seems that the liver is involved in our ability to have a good night’s sleep. It regulates our energy level for the next day and relates to our overall feelings of contentment or depression. The liver follows the cycle of the sun. Around 6:00 in the evening it wants to go to sleep and starts to store up the sugars (glycogen) to be used for the next day. It doesn't want to process any big meals (especially ones high in protein or fat after 3 pm).
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by Susan R. Johnson MD, FAAP, Raphael House

I knew that drinking lots of apple juice wasn't good for toddlers because they often filled up on juice, and they wouldn't be hungry for meals, thereby missing vital food substances (proteins, fats, vitamins, minerals, etc). What I didn't realize was that drinking juice was like drinking concentrated sugar and could potentially deplete the body of valuable vitamins and minerals in a manner similar to eating lots of candy or drinking lots of soda.

For example, when a child eats an orange, it does so slowly, and receives minerals and vitamins within the orange itself that help it process the sugar. The body requires B vitamins (thiamine, folic acid, B12) and trace elements like zinc, chromium, and magnesium as well as several enzymes to process and store the sugar we eat. When a child consumes a large glass of orange juice, it is like eating five or six oranges in 30 seconds, and because most juices are pasteurized, vitamins and other nutrients are inactivated by the high temperatures. In addition, the large amount of sugar presented quickly to the body causes too much insulin to be released from the pancreas. This over-release of insulin causes the blood sugar to drop. The brain, now faced with an unstable supply of sugar, preferentially closes down the higher learning centers (memory, thoughts, social behaviors etc.), and instead stimulates the more primitive emotional and motor centers of the brain to deal with this perceived "crisis" (resulting in an overactive child that is emotionally "out of control").

by Susan R. Johnson MD, FAAP, Raphael House

I lost a very special friend 3 years ago. He was my medical school roomate's father. I spent many holidays with my roomate and her family for the 7 years that I trained in Chicago, since I often wasn't given the time to travel home to be with my own family. That special friend was a human being that knew how to listen and in his listening I felt loved, so I called him Chicago Grandad. When Chicago Grandad listened to you, for those moments, you became the most important person in his life. He paid complete attention to every word that was said, and he did not interrupt or immediately bring the conversation back to himself. He didn't try to immediately solve the problem or give his advice. He just listened with understanding. You could laugh, you could cry, you could tell him anything and he listened.
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by Susan R. Johnson MD, FAAP, Raphael House

Parenting is one of the most awe-inspiring, noble, and challenging professions. Yet, being a parent gets so little support and appreciation from our culture. It was much easier for me to go through medical school, a pediatric residency, a fellowship, and work as a pediatrician, than be a parent. I can't remember ever being so depleted and exhausted as I have been these past 7-1/2 years parenting a child. I think some of the exhaustion comes from the developmental work that I needed to do (and am still doing) on myself, when faced with this bright-eyed, intuitive, energetic, developing boy. Raising a child provided me with the opportunity to re-live my own childhood. I am discovering that all my unresolved feelings and thoughts, that were long ago repressed, now have come bursting forth to the surface.
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by Susan R. Johnson MD, FAAP and Patricia McPhee RN, BSN, Raphael House

I have always heard from my own parents that breakfast was the most important meal of the day. Yet as a teenager, I often skipped breakfast or had the infamous "chocolate instant breakfast" or "pop-tarts". I thought I was doing just fine. I really didn't learn the importance of eating breakfast until my 12-week surgery rotation in medical school. It was 7 am and I was assisting in surgery and literally passed out while holding a retractor. After I had partially recovered in the corner of the operating room, the chief resident in surgery came over to me and whispered an invaluable piece of "survival" advice – eat a good, nutritious breakfast every morning! Needless to say, I have been eating a good, nutritious breakfast ever since that day.
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