Friday, February 27, 2015

Parenting 101

Our son has come to that stage in early childhood development where defiance and mischief have gone from a casual hobby to a passionate career. For that reason we, like many parents before us, have turned to the experts for advice. Over the past few months, we have read books and watched videos created by those claiming to be the most qualified to assist novices in navigating the treacherous waters of toddlerhood.  

The marketing strategy of each of these programs was eerily similar (Stop Tantrums and Enjoy Your Child Again!) and they all had glowing endorsements from other experts who had authored their own books. I could not help but wonder how many of these authors' children are now serving time in a federal penitentiary. Even more frightening, I could have a shared a resume with a few of the writers (authored a blog for years, parent to multiple children, owns a dog, etc.)

The first book I read was penned by a disciple of the R.I.E. (Resources for Infant Educarers) philosophy. Created by Hungarian immigrant Magda Gerber, the movement focuses around respect for the autonomy of even the youngest child. The movement’s goal is to foster an “authentic child” who “feels secure, autonomous, and competent.” In a nutshell, it asks the parent to view their toddler as fully aware human and to communicate accordingly. A general rule of thumb would be: If you would not interact with another adult that way you shouldn’t interact with your child that way. Time outs? There are no time outs in life! Counting out loud? That crap doesn’t fly at a shareholder’s meeting!

“Educarers” are enlightened enough to recognize that their child’s misbehaviors are the result of the parent’s inability to effectively communicate their expectations. Following this path involves looking the child in the eye and explaining to them in a calm, unwavering voice that you do not wish for them to continue or repeat an action. It may take repetition and simplified sentences, but it will be well worth the effort once you and your offspring develop a reciprocal understanding of each other’s wishes and expectations. Gerber’s disciples vehemently reject the idea that a toddler is simply an underdeveloped human being helpless in the face of their desires and emotions. They dismiss this line of reasoning as the “caveman theory.”

Naturally, the very next book I read was by a child psychologist who was a staunch disciple of the very caveman philosophy denounced by the first book I had read. Not only did he disagree with the Gerber philosophy (which he called the “young adult assumption”), his book spent an entire chapter convincing the reader that the R.I.E. approach was not only ineffective; it was likely to lead to literal child abuse. The book was light on actual statistics, and I thought the RIE = felony inference was a tad heavy-handed. I understand passionately-held philosophical differences, but we might be getting carried away when one child-rearing book accuses another of perpetuating child abuse. It isn’t as if the first book came with a sock full of pennies and a list of plausible excuses to use on nosy daycare workers.

This book, called 1,2,3 Magic, instituted a system of counting to deter what it deemed “stop behaviors.” These would include insubordination, fits, arson, etc.. and when they occurred the parent was simply to address the child in a calm voice and announce “that’s one.” If the child were to continue the behavior they would say “that’s two.” At the count of three, an age-appropriate punishment would be applied. If they are younger, it could be a timeout. If they are older, perhaps they could be forced to open a MySpace account. He stresses there will be no discussion or explanation because any attempt by the caregiver to rationalize their actions would undermine their authority. Over a period of time, the child will learn to stop the behavior before the count of three.

I then watched a DVD from the Happiest Toddler on the Block series. This philosophy relies heavily on speaking “toddlerese”, a trademarked manner of communicating with a child. It involves the caregiver attempting to match the inflection and energy of an upset toddler to convey empathy and understanding. If the toddler is throwing themselves on the floor and yelling “BUT I WANT TO PLAY WITH THE CIRCULAR SAW!!!!” you would position yourself in a similar position and, with a slightly diluted level of energy, repeat “YOU WANT TO PLAY WITH THE CIRCULAR SAW!” until they stop.

Here the idea is that by using “toddlerese” you convey that you understand your child’s wishes and emotional response. Once the child realizes this and settles down, you would then be able to explain that although you understand their wish to fiddle with power tools, it might not be the best idea. There was also a section of positive reinforcement that seemed rather reasonable but contained a chapter called “playing the boob” which could lead to some unnecessary confusion among consumers.

Interestingly enough, the one of the few things that all the philosophies and authors agreed upon was the ineffectiveness of spankings. None of them recommended it and some went so as far as to suggest that they could irreparably harm the emotional health of the child. I found this especially interesting since I was spanked by both my parents and, on occasion, public school teachers throughout my formative years. I would say that I turned out just fine, but one could utilize the content of this blog to make a strong counter-argument.

Aside from the moratorium on spankings, all three alluded to something far more important: consistency. If you tell them that you are going to take away their iPad, take away their iPad. Don’t make empty threats or cave at the first signs of a fit. Otherwise your precious little offspring may find themselves staring at the business end of a Celebrity Big Brother 38 contract. Kids need guidance and boundaries. A wise friend of our family once observed that there is nothing more frightening for an impressionable young child than to wake up one day and realize that they are in charge of their own lives simply because their parents no longer wish to be.

Wednesday, February 11, 2015

Stranger Danger

It can be difficult as a parent to foster childhood optimism in your offspring while also instilling a healthy level of wariness concerning those that may wish to do them harm. Some might show their child a video or take them to a class; but these tactics are for parents that are simply phoning it in. Missouri resident Elizabeth Hupp wasn’t about to outsource the safety of her 6 year-old son. So, along with the boy’s grandmother and aunt, she hatched a scheme to make sure that her son didn’t become a statistic.
First, they recruited the assistance of the aunt’s 23 year-old coworker Nathan Firoved who agreed to kidnap and terrorize his colleague’s nephew. As the young man exited the school bus one day, Nathan lured him into his pickup. Once inside the vehicle, he bound the young man’s hands and feet with plastic bags, threatened him with a gun, and informed him that he would “never see his mommy again” and would be “nailed to the wall of a shed.” He then covered the boy’s face with a jacket and drove the traumatized child to his mother’s basement.

Once there, and still unable to see, his pants were removed by his aunt who informed him that he would then be sold into sexual slavery. After what is believed to be several hours, the blindfold was removed and the young man was taken upstairs where his family revealed the ruse and “lectured him about stranger danger.” The child subsequently revealed the events to school officials who reported the matter to law enforcement. The mother has been charged with felony kidnapping and abuse of a child. The grandmother, aunt, and aunt’s co-worker have been charged with felonious restraint. The family members involved told investigators “their primary intent was to educate the victim and felt they did nothing wrong.”
Clockwise from top left: Mom, Nathan, Aunt Rose, Grandma

There were two crucial moments of human interaction that occurred in this case. The first was the moment that the mother shared her idea with the boy’s grandmother and aunt. Was there any discussion? Did the mother invite feedback? Should we give these two other women the benefit of the doubt and assume that they talked the boy’s mother out of a worse idea? It is plausible that such a terrible idea can grow and fester within the confines of a solitary, troubled mind but the fact that it survived a family conference should give all of us pause. Perhaps the exchange proceeded this way:

Mom, you know how you, me, and Aunt Rose were talking about how junior was too nice to people….


Well, I was thinking we could get that registered sex offender down the street to take him camping over the holiday weekend.

Honey, I think that your heart is in the right place but camping seems a little extreme. Why don’t we hire some random dude to kidnap him while brandishing a firearm?

You’re right mom. I was just getting carried away. Thanks for being my voice of reason.

The second crucial moment of interaction was when the aunt approached Mr. Firoved at work and asked if he could spare an afternoon to abduct her nephew. Was he paid for this? Did he feel obligated because she had covered one of his shifts the week before? When did it become awkward to decline the opportunity to kidnap a minor? I wonder if he was even the first person the aunt approached about this. Can you imagine some guy in the break room telling Rose, “that’s not really my cup of tea but why don’t you ask Nathan; his Redbox code didn’t work and he is free tonight?”

Regardless of how you feel about Missouri’s Amateur Scared Straight program, you have to admire the participants’ unshakeable faith in the legitimacy of their actions. Even after being apprehended they are still willing to project the “I don’t know what all the fuss is about” attitude to the media. I shudder to think that these people are registered voters.

I hope this young man is adopted by a kind family who encourage and nurture him. And wouldn’t it be a bitter irony when he finally finds happiness in the arms of the very people his family tried to warn him about: strangers.

Wednesday, February 4, 2015


I have written about the unnecessarily labyrinthine health insurance system before, but the recent birth of my second child presented me with two rather vivid examples of the institutionalized inefficiency I have come to loathe.

As a part of my health insurance policy, my wife is entitled to a single consultation with a certified lactation consultant per pregnancy. She conducted diligent research and finally located an in-network facility that employed a lactation consultant accredited by everyone except the American Dairy Association.
The session was informative and we congratulated ourselves on taking advantage of this benefit with no out-of-pocket cost. So imagine my consternation when I received a bill for the appointment because insurance had declined to cover it. With my coverage book in hand, I called the nationally-known provider that administers my insurance in order to bring this error to their attention.

Once on the phone with an associate, they explained to me that while I had gone to an in-network facility and been seen by a properly accredited lactation consultant; the clinic had coded the bill incorrectly. I responded that I have a copy of the bill and it clearly states “lactation consultation services” were rendered. From there the conversation continued thusly:

Her – Yes, but they did not code it as a preventative services visit and all lactation consultations must be billed in this manner. You will have to call the clinic back and have them submit a corrected claim.

Me – That seems rather illogical since the purpose of the visit was to facilitate lactation not prevent its occurrence.

Her – I am sorry sir, but we cannot pay it unless it is coded correctly.

Me – This was not a colonoscopy or mammogram. The only condition this visit could have prevented is inefficient lactation. Can you honestly tell me that lactation consulting is a preventative service?

Her – Let me place you on a brief hold

*** 10 minutes pass******

Her – I spoke to my supervisor and it appears to have been a billing glitch. It will be paid within two weeks.

I fully understand the need to guard against fraudulent claims, but this bordered on obstructionism. The insurance provider could clearly see that my wife was pregnant and that we were billed by an in-network provider for the very service my policy covered. If the claim was submitted under the name of a 75 year-old man and the service was rendered by an accountant, I could understand the scrutiny.

Unfortunately, this was only the beginning of “lactategate” since my next task was to obtain reimbursement for a manual breast-pump. My health insurance policy will not cover an electric breast-pump unless my newborn is placed in the NICU. Otherwise, they will only cover a manual model. Thankfully my child was born without complications, so I ordered a manual breast pump from Amazon and logged into my provider’s website to locate the reimbursement forms.

Still unable to find the form, I called and spoke to an associate. After asking me if the breast-pump in question was for me or someone else on the policy, they informed me that the only way to obtain reimbursement would be to take a blank sheet of paper, attach the receipt, and write my Subscriber ID, Wife’s full legal name, and her birthday. I was then to place this piece of paper in an envelope and send it to a P.O. Box at the other end of the state. I would hear something back in six weeks.

Uncomfortable dropping an identity-theft starter kit into a mailbox, I asked again if there was a more efficient way to complete this process and was told no. I hung up and called back the next day in order to get a second opinion. Our conversation went something like this:

Me – Are you telling me, that in the year 2015 a company with a website that allows me to see the processing of E.O.B. claims in real-time and has a corresponding smartphone app cannot allow me to submit a claim form on their website?

Her – I am sorry sir, I do not know what to tell you.

Me – How is that even possible?

Her – Well, it is a security and privacy issue….

Me – Wait, so you are telling me that your website is not secure but you are uploading my HIPAA sensitive records to it?

Her – Let me place you on a brief hold…..

**5 minutes pass**

Her – Why don’t you just fax the info to this number and it should be scanned into the system by the close of next business day. Is there anything else I can help you with?

Our system becomes more and more complicated with each passing year. In 2013, the not-for-profit organization that administers my health benefits plan was left with a $256.2 million surplus despite spending almost $1 billion in “Administrative expenses and broker commissions.” This roughly equates to $83 extra for every human they cover. Undoubtedly, they would argue that this money was re-invested into the community or retained as a legally-required surplus; and that is a reasonable counterpoint since medical costs are so unpredictable.

Why are they so unpredictable? The birth of my child will generate at least 5 separate events at no fewer than 4 private medical billing organizations (all of which will take a cut). The hospital will generate two separate bills for the child and the mother, while the anesthesiologist, OBGYN, and pediatrician will all file claims for the same event. That is why an amused chuckle is the only answer you are going to get if you ask someone in the medical community how much a textbook vaginal delivery costs.

No single entity can really see all the moving parts and even the ones that come closest (like my insurance carrier that often benefits from pre-negotiated contracts with providers) are still forced to pad their coffers with obscene surpluses. At the close of 2013, my provider’s surplus was over $740 per covered individual and growing. Perhaps this is a microcosm of why an average of 30% of the money American’s spend on healthcare is absorbed by administrative fees and bureaucracy.