I can always tell when a parent of a child I'm treating is a smoker. The examination room is just filled with smoke - not too different from the experience you'd have if you walked into a bar or restaurant that still allows smoking. My style is to ignore it until the very end of the visit - sneaky, I know! I just forge ahead trying to not inhale too much air. I have to admit, there have been times I've had to find excuses to leave the room to get a few smoke-free breathes of air!! I talk to the child and parents about whatever sick or injury issue brings them in that day and give advice on that issue and then casually ask "By the way, any one at home smoke?" There's always a shocked look followed a pause before someone gives one of the following response:
1. Yes.
2. Not in the house.
3. No.
4. Not around the child.
5. We had relatives over who smoke.
6. His/her father/mother smokes but I don't.
Regardless of the answer, my reply is always the same. "I hope you are not offended by what I'm about to say but I could smell the smoke on you when I walked into the room. The level of smoke is the same level as an actual cigarette. That means that whoever is smoking is exposing me, your child and whoever else comes in contact with the smoke on your clothing with the same harmful effects of smoke as if the person smoking were actually smoking in this room. It turns out, second hand smoke is as bad for all of us as first hand smoke. Smoke is smoke - all of it is bad."
That seems to diffuse any defensiveness and even if the person I'm talking to still can't admit to being the smoker, we often, I'd say at least 90% of the time, get to a discussion of how to help the smoker quit. I talk about how it isn't easy and support groups help. I talk about the supports we have at our multi-specialty practice. I talk about the impact of smoking on the child's health for overall health, for recovery from sickness, for recovery from sports injuries, for sports performance, for school performance, for performance in the arts, for feeling good in general, and the list goes on. I have this down to about 3-5 minutes and if I run a bit behind to get this discussion in, I don't mind. It's an important one to have.
Apparently, I'm on to something for talking to parents about the need to make their child's entire environments smoke free. I learned this today on White Coat Notes that there's an actual movement here in Massachusetts for pediatricians to talk about smoking and the need to quit during a child's check-up. That's an awesome plan! I'd argue, though, we can go a step further and incorporate this important message into any health encounter a family has. I've actually made it a mission to do this for years and know many pediatric colleagues who have done the same, and most of the people I know are either in urgent care, caring for sick and injured kids, or specialists. My view is people do best when teachable moments are part of a context, such as someone pointing out they can smell the smoke on their shirt. In the context of a sick or injured child, a parent honestly "gets" that smoke will impede that child's ability to heal. Similarly, in the context of a well child visit, parents will "get" how smoke will impede an overall child's growth and development. Hopefully, over time, these multiple messages will sink in.
But, in addition to messages, we have to give people resources and support to fight the battle we are encouraging them to fight. It would be irresponsible and unfair to not encourage them to be healthy without leading them to the path that will do just that.
The most compelling reason to stop smoking that seems to help motivate parents: kids who have parents who don't smoke tend to not smoke. While many parents admit to having trouble quitting, those same parents also admit they'd hate for their kids to start.
So, as parents, if you smoke, the time is now to be brave and stop - and there is help a phone call away at your pediatrician's office. And, as pediatricians, the time is now to have more healthy living conversations with your small patient's parents.
BIO:
I’m a pediatrician, health journalist, mother, wife, musician, Starbucks frequenter, and lover of popular culture. With so many hats, no wonder my head is flattening! If all goes well, we’ll share a virtual cup o’jo from time to time and learn something new about the world. Thanks for stopping by and giving me a few minutes of the time I know you have precious little of these days!
VISIT DR. GWENN:
http://pediatricsnow.blogspot.com/
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