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Haverhill MA Pediatricians

Health Forum

Dr. Carolyn Bornstein’s guest appearance on Slate’s new medical podcast called Checkup. This particular podcast is entitled Vaccination Facts and Fiction.

Dr. Bornstein appears at approximately minute 13:35 to discuss the importance of the HPV vaccine and address some potential parental concerns.

You can visit the podcast and this particular episode on Slate’s website:  Slate’s Checkup with Carolyn Bornstein, M.D.

     How much sleep children need at each stage of their lives has been a subject of great debate among parents and pediatricians alike. A study in the January 2013 issue of the journal JAMA Pediatrics hopes to put that question to bed.

Using time-diary data from a national sample of American families, researchers from UCLA and the University of Washington estimated percentiles of sleep for weekdays, weekends and overall in children from birth to age nineteen. The information is largely unsurprising. Babies nap. Older kids don’t. Teenagers sleep longer on the weekends. There were no significant differences found among various racial-ethnic groups or over the study’s ten-year period. The CDC’s recommendations for hours of sleep needed by children (12 to 14 hours for kids 1 to 3 years of age, 11 to 13 for 3 to 5-year-olds, 10 to 11 hours a night for the 5 to 10 year old set and 8.5 to 9.5 hours for teens) well mirrors the results of this latest study.

This new information is all well and good, but the specific needs of each individual child needs to be considered. Some kids just need more sleep than others and, unfortunately for their parents, others function very well on much less sleep than the norms presented here.

Parental questions and concerns about children’s sleep are an everyday occurrence in pediatric offices. Sleep issues range from problems falling asleep to difficulties staying asleep. The former is the most common by far, especially in toddlers and pre-schoolers. Typical is the 3-year-old who makes numerous “curtain calls” after being put to bed with requests for another drink of water, one more story, or a second or third trip to the bathroom. A predictable bedtime routine that involves quiet activities like reading and storytelling can prepare young children for sleep. But if the curtain calls continue, parents may consider giving the child one pass or ticket where they are granted one additional request. After that, all requests are met with a firm back-to-bed order.

It’s also important to make sure kids aren’t taking naps that are too long or too late in the afternoon so they’re just not tired at bedtime. And kids shouldn’t be drinking coffee of course, but there is also caffeine in sweet drinks and chocolate, so this is important to think about and minimize in the child with sleep difficulties.

Generally, once these children go to sleep, they tend to stay asleep. Frequent night wakenings is more common in infants and can be frustrating and exhausting for parents. While the total number of hours newborns sleep varies greatly, most babies generally establish a typical day/night sleep cycle and are ready to sleep through the night by 4-6 months of age. After this time, the problem I generally see in the office is the baby who falls asleep being nursed or rocked and placed into his crib sound asleep. These children associate sleep with the breast or their parents arms and simply do not know how to put themselves to sleep, which is problematic because we all normally have several periods of arousal a night. At these times, most of us simply roll over and go back to sleep. But if a baby is nursed or rocked to sleep, every time she rouses, guess what? She needs to be nursed or rocked back to sleep… or at least she thinks she does. What parents of these babies need to do is to teach them how to fall asleep independently. One excellent way to do this is by putting infants into their cribs when they are drowsy but not quite asleep. This gives them the experience of falling asleep in their own cribs and associating the crib with a place to fall asleep, not just a place from which to call for someone to come in and help them back to sleep.

In addressing both kinds of sleep issues—falling asleep and staying asleep—consistency is key. Giving in and rocking the baby or capitulating to that one more drink or book, even if it occurs only every fourth or fifth night,  only incentivizes kids to hold out for a parent to come nurse them or read to them.

When parents have tried multiple techniques to coax their children to sleep and nothing seems to work, I am invariably asked, “Should I just let her cry?” Well, there is no right or wrong answer to the “let them cry it out” dilemma. For some parents this just isn’t an option. They either cannot bear to listen to their children cry or one or both parents needs to get up in the morning and needs sleep. Some families live in close quarters with others and are concerned about keeping up other family members or the neighbors. But for those parents who want to give this so-called extinction method a try, an October 2012 study in the journal Pediatrics may give them reason to persevere with the approach. The Australian study acknowledged that the extinction intervention was effective in teaching infants to sleep through the night and reducing the incidence of associated maternal depression. The question the study sought to answer was: are children being harmed by this approach in the long run? Through questionnaires completed by the study’s families, they found that, at least in the first six years of life, the answer was a definite no.

So I will continue to discuss the cry-it-out option with families. I generally talk about a co-called modified extinction method where rather than let kids cry it out in their rooms alone, parents can opt to stay in the room with the crying child or check on them and reassure them at regular intervals until they fall asleep. But for families interested in going cold turkey, I now have good evidence that they, like us doctors, are following the cardinal rule of “first do no harm.”

physical punishment

The American Academy of Pediatrics has long recommended
against corporal punishment. Children who are hit can become hitters
themselves, bullying other children or eventually hitting their own kids. They may
never learn more appropriate forms of discipline or self-control if spanking is
all they experience. What is conveyed to them is that discipline is
reactionary, not thought-through or purposeful.

I’ve stated in a
previous column that we are always teaching our children, whether we are
intending to or not and what we teach children when we punish them physically
is that violence is an acceptable way to deal with anger, frustration or
disappointment in another person. If we hit instead of articulating to our kids
our expectations of them, we rob them of the opportunity to learn better
communication skills. Hitting also impedes the development of a sense of trust,
safety and security. Another obvious consequence might be actual physical harm
to the child, as our emotions can so easily get away from us.

Despite
recommendations to the contrary, many parents still use corporal punishment to
discipline their children. In a 2005 poll conducted in the United States, 72%
of adults reported that it was “OK to spank a child.”

Well, now,
pediatricians and other professionals have some new data to carry in their
armamentarium of advice against spanking. A new study in the journal Pediatrics out this summer concluded
that harsh physical punishment—defined as hitting, slapping, shoving or grabbing—is
associated with mood disorders, anxiety as well as substance abuse and dependence
in later life. These results came from face-to-face interviews by US census
workers of nearly 35,000 non-institutionalized adults over the age of 20.  The response to the survey was an impressive
86.7%.  All results were in the absence
of more severe child maltreatment. Socioeconomic variables and a family history
of dysfunction were adjusted for. One surprising result of this study (for me
as well as for the authors) was the finding that as education and household
income increased, the incidence of harsh physical punishment actually also
increased. The authors of the study concluded, importantly, that some mental
health disorders could be decreased by 2-7% if harsh physical punishment of
children were to stop tomorrow.

 

So how will this
study change my practice? I will certainly continue to advocate for
non-physical methods of discipline. But now I have something more to talk to
parents about than just the benefits of time-outs as the preferred method of
discipline, or the AAP’s positions. Now I can point to real down-the-line
consequences if corporal punishment is the go-to modus operandi in a family.

1. Caring for your
Baby and Young Child
(Copyright American Academy of Pediatrics 2005.)

2. “Physical Punishment and Mental Disorders: Results from a
Nationally Representative US Sample. Afifi,TO et al. Pediatrics Vol. 130 No.2 August 1, 2012.

Well, with the turkey gobbled up, the holiday lights being hauled down from the attic and (for
better or worse) snow on the way, at least in my neck of the woods, the time
seems about right to talk about winter sports safety. Whether your kids are
boarders or skiers, sledders or skaters, there are measures you can take to
ensure their sport stays fun and minimize the occurrence of injury. The U.S.
Consumer Product Safety Commission reported that a total of over 100,000 skiing
and snowboarding injuries were treated in emergency rooms around the country in
2010.

The most obvious and important recommendation for winter sport safety is that all children
should be wearing properly-fitting helmets. From my own casual observation, most
kids on the slopes today boarding or skiing are wearing helmets. And I must say
there are some pretty fashionable styles out there!

But other sports including sledding and
ice-skating are also fraught with the risk of head injury. Helmets should be
considered for these kids as well.

Head injuries may
be the most serious and obvious risk of winter sports, but it is by no means
the only one. Other common injuries sustained by downhill skiers include knee
injuries including sprains of the anterior cruciate ligament (ACL) of the knee,
wrist sprains, spiral fractures of the tibia, and hyperextension injuries to
the thumb. To minimize these injuries, equipment should be fitted and adjusted properly.
Ski shop personnel who are familiar with outfitting kids can be consulted. And
wearing wrist guards can help minimize sprains to the wrist.

Sledding also has its share of injuries: an average of 20,000 a year according to the American
Academy of Pediatrics. Boys aged 10 to 14 sustained the most injuries, with
broken bones being the most common finding. To minimize the danger, children
should be sitting upright in their sleds, feet first, not lying on their
bellies going head first down the hill. Safe sledding also means the hill
shouldn’t end in a body of water or a road of any kind, even a not-so-busy one.
Ideally parents should be available to supervise the sledding, watching for
over-crowding and recklessness. Sleds with runners and a steering mechanism are
safer than tubes or toboggans.

With any winter sport, injuries related to the cold weather and wind are a concern. Hypothermia
occurs faster in children than adults and occurs more frequently when children
get wet. It is important to dress children warmly in layers as well as to make
sure their outer layers are water-proof. Hats should be worn underneath helmets
and mitten keep hands warmer than gloves. And don’t forget the water bottles!
Winter sports use lots of energy and it’s important to keep children hydrated,
especially if they are skiing at higher elevations.

In recent years, more has been learned about the dangers of the sun on growing children’s eyes. The
lenses of children’s eyes are clearer than adults, allowing for greater
penetration of the sun’s rays and thus potentially more damage. In many winter
sports, the sun is further reflected off the snow, increasing the need for
protection. Too much sun exposure can cause cataracts, a clouding of the lens
of the eye.

In choosing sunglasses for children, go for those that protect against bother UVA and UVB
rays. Wraparound style glasses afford 5% more protection than glasses that only
sit in front of the eyes. And make sure the glasses aren’t just tinted. This
can be worse for the eyes than not wearing sunglasses at all because in the
tinted environment causes the pupils to dilate, letting in more damaging UV
rays.

Exercise is important to kids’ health and well-being. There are lots of fun family activities that
can keep kids active and healthy. With some extra planning and attention,
hopefully we can also keep them safe.

Dr. Carolyn Roy-Bornstein

 

I get asked a lot of questions about well water in the office. That’s not surprising since 15-20% of US
households get their water from private wells. Unlike municipal water supplies,
private wells are not bound by federal regulations. And aside from initial
inspections during drilling, state regulation of private wells is minimal. It
is up to the owners of the wells to have their water tested and it is up to us
as pediatricians to make specific recommendations. Let me give you an idea of
why.
Groundwater collects under the topsoil and above the bedrock forming what
is called an aquifer. The water table, or the depth at which the aquifer is
saturated with water, varies according to the seasons. Aquifers are replenished
with rain water and run-off and the water is filtered naturally on its journey
underground. Wells take advantage of this naturally-occurring water in the
earth by different methods. Old-fashioned dug wells were nothing more than
shallow, lined holes with a pump at the spigot. They were easily contaminated.
Drilled wells, on the other hand, reach the bedrock some 100 to 400 feet below
the earth’s surface. They have an electric pump at the bottom of the well. In
positioning wells, home-owners should strive to keep them as far as possible
from septic fields and from areas which house livestock or store fertilizers or
other chemicals.
Well water can be contaminated by both micro-organisms and by organic
and inorganic chemicals. These contaminants vary regionally (for example,
contamination from crop fertilizers in the mid-west vs. sea salt contamination
in coastal communities. Arsenic is a fairly common contaminant of well water. A
recent study from the US Geological Survey found that 13% of some 2000 wells tested in New England exceeded federal safety standards for public drinking water. While no arsenic poisonings from well
water have been reported from well water in this country, arsenic is a known
cause of bladder, skin and lung cancer.
Uranium contamination occurs mostly in the mountainous western US
although areas with much granite are also at risk. Radon, another naturally
occurring radioactive gas similar to uranium can also contaminate well water.
Radon can be consumed directly by drinking, but exposure can also occur
showering and cleaning with contaminated water. Perchlorate is a
naturally-occurring chemical used in rocket fuel and fireworks that can also
contaminate well water. Importantly, perchlorate can interfere with thyroid function.
Nitrates are one of the most common contaminants of well water. They can
come from either sewage or fertilizers. If well water testing detects nitrates,
further testing for coliform bacteria should be done. If no coliforms are
detected, the source of the contamination is likely fertilizer. Nitrates with
coliforms suggests contamination from either livestock or human sewage. Water
with > 10mg/L of nitrate should not be given to children younger than age
one.
Speaking of micro-organisms, not only bacteria but also parasites,
funguses and even viruses can contaminate well water. Testing for these
organisms can be confusing because not all organisms found necessarily cause
disease. Also, the absence of coliforms on a well water test does not necessarily
mean that fecal contamination is not present. Families can learn where to have
their well water tested by contacting their local Department of Public Health
or US Environmental Protection Agency. Testing can be expensive and the American Academy of Pediatrics encourages
states and municipalities to provide free or low-cost testing to families who
cannot afford it.
If contaminants are found in a family’s well water, there is plenty that
can be done to eliminate the contaminants or lessen their toxic effects. If
bacteria are found, the well should first be inspected to look for damage or
defects and any structural problems repaired. In consultation with local health
departments, water can be treated with high concentrations of chlorine then
flushed out of the system and re-tested. Carafe-style and faucet-mounted
filters can reduce lead, sediment, some organic materials as well as Giardia and Cryptosporidium cysts.

But they are designed for use with municipal
water and should not be counted on to filter contaminated well water.
Ultraviolet light, ozone or hydrogen peroxide can remove or kill many
micro-organisms. Reverse-osmosis filtration systems can remove many kinds of
contamination but are expensive.
Regardless of the kind of contamination—chemical or bacterial—the source
of the contaminant should be located and corrected. Homeowners can seek help in
testing and treating their water by contacting NSF International, a non-profit,
non-governmental agency that tests and certifies consumer products.

Well water can be safely consumed by families, but vigilance, regular
testing and, if needed, treating is necessary.

Dr. Roy-Bornstein

1. “Drinking Water from Private
Wells and Risks to Children.” Pediatrics. Vol 123, No. 6 June 2009.

2.
“Troubling Findings in Some N.E. Wells.” Boston Globe. June 28, 2012.

In a previous Pediatric Points column I wrote a few years ago, I made
the case for offering the (then new) HPV Vaccine against Human Papilloma Virus
(HPV) to girls. HPV is the most common sexually transmitted infection. Within two years of first having sex,
nearly 40% of young women are infected with one or more types of these viruses.
Younger women are more susceptible to infection with HPV for several reasons
including a lack of adequate cervical mucus production and incomplete immune
systems. The good news is that they will very often clear these viruses on
their own. But for those young women in whom infection persists, the risks of
eventually developing cervical cancer increases.
Cervical cancer is the second leading cause of cancer deaths among women
worldwide. Over 1/4 of a million women die from this disease each year. 70% of
all cases of these cancers are caused by two especially high risk types of HPV
numbered 16 and 18.  Gardasil is the name
of the shot that protects against these two HPV types as well as against types
6 and 11 which are responsible for 90% of genital warts. These kinds of warts
affect both men and women.
The Food and Drug Administration approved HPV vaccine for boys in 2009.
The Advisory Committee on Immunization Practices voted in October 2011 to
recommend the routine vaccination of boys between the ages of 11 and 21.
Although women are affected
in larger numbers by HPV-related cancer (approximately 15,000 HPV 16- and
18-associated cancers each year) men are also affected by this
sexually-transmitted virus. Approximately 7,000 cases of HPV-associated
cancers, including anal, penile and oropharyngeal, occur each year in men. The
HPV vaccine has been found to be very effective in males. In studies of men not
previously infected who received all three shots, efficacy for prevention of
HPV-related genital warts approached 90%.
HPV vaccine for girls, in my opinion, is essentially a vaccine against
cancer and I recommend it whole-heartedly to my patients. If I had girls of my
own, I would vaccinate them in a heartbeat. But currently fewer than 50% of
girls have completed the three-dose series. Many pediatricians I have spoken to
are reluctant to tackle this new recommendation for boys when we haven’t yet
been successful with the population many of us feel would benefit enormously
from vaccination. Some of us are skeptical that the vaccine for boys is truly cost-effective.
Some also point to the Australian experience where mandatory vaccination of
girls led to a decrease in genital warts in both men and women, suggesting successful
herd immunity.
Also, we pediatricians are spending increasingly more of our time
defending proven, effective, life-saving vaccines to nay-sayers, reluctant
parents, and media pressure. To quote Dr. Stacey Humphries from a recent issue
of Consultant for Pediatricians, “To add controversial vaccination of boys to the mix with limited data available
may only further taint vaccine acceptance.” So for now, while Dr. Moran and I
will certainly give the HPV vaccine to any boy whose family requests it, for
now, we’re now going to be pushing this one.

Dr. Roy-Bornstein

There’s always something to worry about as a parent. It begins the
moment we discover we’re pregnant. We start worrying about everything we put
into our bodies and how it will affect our unborn children. From that point on,
every developmental stage of childhood comes with a worry (or two, or three.)
Crib death looms in infancy. Drowning hovers over toddlerhood. Abduction fears
mark the school-age years. The teens usher in fears of drugs, drinking and
driving. Having children makes the world more joy-filled and more fear-filled
at the same time.
But it doesn’t end there. I wish I could tell you that once they’re out
of the house, college graduates, young adults with stable jobs and apartments
of their own, that everything’s fine and the worrying can end. It doesn’t. My
oldest just announced he’s taking up hang-gliding. See? It’s always something.
Just this morning as I cleaned lint from my clothes-dryer I wondered if I had
taught my boys to do this. And there it is: another worry. Dryer fires.
Nine years ago, my youngest son, then a teenager, was hit by a drunk
hit-and-run driver while walking his girlfriend home after a study date. She
did not survive her injuries. He carries his with him to this day in the form
of a traumatic brain injury. We helped our son during those early days in
intensive care, then through months of physical therapy. He took
anti-depressants for years and sees a therapist still. He worked hard at his recovery
and made impressive gains. He is currently in a graduate program for math
education in a nearby state.
But there’s always something to worry about. My husband and I mine our
conversations with our son for signs of depression or anxiety, residuals from
the accident. He recently told me that he went to the school’s Disabilities
Office seeking extra test-taking time and a distraction-free testing
environment. I immediately worried that he was overwhelmed and struggling. But
he assured me he was just trying to utilize available services and avoid a
stressful end to the semester.
And what more can a parent ask for? Seeing our children independent,
following their dreams, seeking the help they need to get there. It’s what
we’ve prepared them for since the day they were born. I guess I just thought
the days of worrying would someday come to an end. But as far as I can see,
worrying and parenting go hand-in-hand. Forever.

 

We’ve never met. You just had a baby named Angelese with my cousin’s son George. I guess that makes us family. You had your baby at home. I am glad things went well for you with no complications. She’s beautiful. I’ve seen pictures of her on my cousin Christina’s FB page. Christina says you’re going all-organic as far as the baby goes. That’s the way to go. She doesn’t need all those antibiotics and hormones in commercial meat and milk. She also says you’re not planning on vaccinating your baby. Ever. Against anything.  No vaccines.

And that’s where we have a problem. Or at least I have a problem. You see, I’m a pediatrician. I vaccinate for a living. I’ve been around a while and have seen children die of diseases that have largely been eradicated due to vaccines. Vaccines I believe in.

The truth is Angelese will probably be just fine. She is afforded a certain amount of protection—called herd immunity—because most parents do vaccinate their children. That may not always be true. In fact if enough parents en masse refuse all vaccinations, herd immunity will evaporate and we will all be at risk, not just Angelese.

And that’s the thing. You have only your daughter to take care of. I have to keep all the other children in mind. If Angelese gets chicken pox, besides a few pox scars, she will likely do just fine. She’s strong with a healthy immune system. She can fight viruses just fine. But some children are not strong or fine and do not have healthy immune systems. My niece Emma just underwent chemotherapy and a stem cell transplant for neuroblastoma. For her, varicella could be deadly. Those are the children I need to think about. For me, there is also this is the ethical reason to vaccinate.

In my community there are some pediatricians who won’t accept you into the practice if you don’t go along with the immunization schedule as recommended by the American Academy of Pediatrics. In my practice, you’re welcome. (In fact, one solo practitioner’s, to me, over-the-top response is to threaten you with a call to DCF. He believes with-holding vaccines from your child amounts to child abuse.) I don’t believe that. I do believe deep in my heart, that all parents loves their children and no matter what decision they make, they are making the decision that they truly believe is in the best interest of their kids. I don’t believe in cutting those parents off from health care just because they disagree with me. But I do believe it’s my job to continue to defend and recommend vaccines.

We have parents in our practice who, for whatever reason, want to space out their children’s vaccinations, give just one at a time, delay some and defer others altogether. I take care of all of them.

When pregnant women come to the office to interview me as a possible pediatrician for their babies, the most frequently asked questions involve the vaccine schedule. I make it clear that they should not interpret my willingness to give them their shots on an alternative schedule to mean that I agree with them that it isn’t safe to give three shots at once. I don’t agree with them. And it is. One of the most compelling pieces of evidence for this was a June 2010 study in the medical journal Pediatrics that found no adverse neuropsychological outcomes in children who received on-time vaccines in their first year of life. These parents also need to understand that their children are at risk for whatever disease they’ve not vaccinated them against for as long as they’ve put off that vaccine. I also tell them up front that I’ll be hawking them at every visit to pony up and get vaccinated. I even email my patients news stories about disease outbreaks and clinical studies on vaccine safety and efficacy.

It was easier to convince parents about the efficacy of vaccination when their biggest worry was autism. The relationships between the MMR vaccine, thimerisol and autism have been roundly debunked for some time now. Parents’ concerns nowadays seem more to have to do with the necessity of vaccines at all. The vaccine program is in some ways a victim of its own success. Parents who have never seen encephalitis from measles, amputations after meningococcal infection or a seizure during a case of pertussis may not fully appreciate how aggressive some vaccine-preventable diseases can be.

No decision is easy when it comes to our children. There is always something to worry about. (My 28-year-old son announced recently that he is taking up sky-diving. Believe me. There will always be things to worry about.) You’d feel terrible if something happened to Angelese because you vaccinated her. You’d never forgive yourself if something happened because you didn’t. As parents, we all just do the best we can with the information we have. I hope you’ll consider listening to the information regarding vaccines.

Dr. Roy-Bornstein

We were having a staff luncheon yesterday: me, Dr. Moran, Jennifer and Heather. This is Heather’s last week before her maternity leave. We were having a surprise shower for her. She thought it was just one of our usual monthly staff meetings until we started putting gift bags with onesies, hats and baby blankets in front of her.

“You guys ambushed me!” Heather stammered.

Over lunch, we discussed the newest member of our practice, a newborn baby whom Dr. Moran had rounded on at the hospital that morning.

“He’s from your side of the family,” he told me. Apparently I had been the baby’s father’s pediatrician since he was a little boy.

He smiled, then corrected himself. “I mean your side of the practice.”

But he wasn’t so far off the mark. We have been doctors in this community for almost twenty years now. Children we have known since birth are now having children of their own. In another reference to family, we refer to these children as our “grand-patients.”

So today, it was my turn to round on this new baby from “my side of the family.” I introduced myself to the mother, congratulating her on her beautiful new daughter.

“So, how are we related?” I asked her, as I examined the infant in her bassinette at the mother’s bedside.

She knew exactly what I meant. She didn’t miss a beat.

“Oh, Janice is my mother-in-law,” she told me.

There was no need for last names. I knew exactly who she meant. After all, we’re family.

Carolyn Roy-Bornstein MD

Earlier this month I spent a week at Disney World on a family vacation. It was a very special trip. My 5-year-old niece Emma, after a brutal year of chemotherapy and stem cell transplants for her neuroblastoma, was finally cancer-free. This was Emma’s big Make-a-Wish trip and since Auntie was there at her bedside in Minneapolis for the beginning of her chemo, I was darn sure I was going to be there at the end of it.

I was the early riser of the family so every morning, before the rest of the group awoke, I’d head to the lobby in the pre-dawn. There, I’d check my email, grab a cup of coffee and talk politics with the night staff of the hotel. It was a pleasant enough routine.

One morning, in the middle of our political discussion, a fierce riot scene played out on the lobby TV, muted in the background. My debate-mate immediately launched into his views of the Occupy Wall Street movement and the 99%. But we soon learned that it wasn’t an Occupy movement at all. Rather, it was some students from Penn State protesting the firing of their beloved football coach Joe Paterno, let go for not doing enough to help the alleged sexual abuse victims of former assistant coach, Jerry Sandusky. Now all these mornings in our political deliberations, my front-desk-man and I had not seen eye-to-eye on many things: Herman Cain’s alleged sexual dalliances, Mitt Romney’s waffliness, the future of Obama-care. But on this point we were aligned: where was the moral outrage at the predatory behavior of persons in positions of trust and authority in children’s lives? Why were these students placing the importance of college athletics over the care and protection of children? Did these students really understand the facts of the case or were they merely going along for the ride?

On the last night of Emma’s Make-a-Wish trip, we were standing in line at Santa’s village so Emma could have a turn on the big man’s lap. The line was snaking slowly but surely through the aisles of an auditorium. At one point two young children started swinging from the railings which were decorated with Christmas lights. The tiny white lights shook and clinked under their weight. I watched as a pair of brothers spied the burgeoning mayhem. With a gleam in their eyes, they, too, reached for the top railing, ready to swing with their friends. Their mother, who had been deep in conversation with me, turned toward her boys ever-so-slightly. With a roll of her eyes and a dismissive wave of her hands she said in her deep Southern accent, “You just followers. You know that? You nothin’ but a pair of followers.” The two boys looked at each other. They got a very sheepish look in their eyes. Finally they let go of the decorated railing and resumed their place in line with their mom.

Maybe those Penn State students could take a lesson.

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