Faculty Bibliography

Before I enter the exam room, I flip open the child's chart. I turn back a page or two to find out when she was last seen in our clinic and read, embedded in my notes from the previous year: 'Child very resistant to exam.' What I dread when I see a note like this is a child who's terrified of me and of being examined. With a 5-year-old, I want a cheerful, sociable interview - not the tears that start to overflow as I ask my friendly questions or the quivering lower lip, sobbing or sometimes screaming when I actually touch her. Certainly babies might cry when I examine them - especially those who are 8 or 9 months old, when stranger anxiety typically begins. It's absolutely normal that a 15-month-old objects loudly to being made to stay in one place, and even that a 2-year-old may shriek whenever anyone does anything to him that he doesn't want done

MY daughter will tell you, if you ask, that she is named after Jo March, the strong-willed heroine of Louisa May Alcott's ''Little Women.'' She will say it with a tinge of apologizing for a parent's folly, and if I am nearby I will often interject some lighthearted comment about other famous Josephines -- Baker or Beauharnais, for example. But the truth is, she was named after Jo March and she knows it. Almost every year on her birthday, we somehow end up at Orchard House, the wooden house in Concord, Mass., where Alcott lived with her parents and her sisters, and where she wrote ''Little Women'' more than a century ago. At Orchard House, in 1858, the peripatetic Alcott family settled down. They had already been through the adventure of the failed Utopian community at Fruitlands in Harvard, Mass. (another entertaining day trip), had lived in many houses and boardinghouses and had stayed with generous friends. In Concord, not far from such good friends and neighbors as Ralph Waldo Emerson, they found a little brown house that fit them well. And I pay my respects to Emerson and to Hawthorne and to all the other luminaries of 19th-century letters who have passed through Concord, and to the great thinkers of transcendentalism. But internally, like every serious Orchard House pilgrim, I also suppress a quiet smile, knowing it is ''Little Women'' that attracts busloads of women, all of whom feel they are on close personal terms with characters described in an 1868 children's book. In our minds, most of us have long inhabited Orchard House, identifying with one sister or another (you don't have to ask whom I identify with; I named my daughter to show my devotion). We know these people, or we think we do; we've been at the table for their meals, sat up nights crying over their tragedies, helped with the scrimping and saving to get by

Klass offers tips on how to deal with young children's fears of a doctor. Sometimes he demonstrates on stuffed animals before examining a child in order to calm him or her down

`Christmas won't be Christmas without any presents,' grumbles Jo March on the first page of 'Little Women,' her family facing the prospect of a grim holiday season. Christmas season is a time of giving -- to our friends, relatives, and organizations that make sure poor children get presents. Now think about a needy child unwrapping a package. Then think about the best presents you ever got -- not necessarily the ones you nagged for or even greeted with the wildest whoop, but the ones you remember, the ones you may still own and honor. For most of us, the most remarkable gifts include books, books that were somehow the right book at the right time, books that thrilled us, shook us, changed our notions of the world, or introduced us to characters and places we never forgot. We saved them, reread them secretly during adolescence, maybe took a couple off to college. The giver who gives the right book to the right child at the right moment can kindle joy, create memories, even change a life. A book may be the present a child enjoys the most. It may be loved, read, and reread when all batteries have expired and all new toys been dismembered. But it also has important implications for a child's future. Before children learn the alphabet -- in fact, before children really start talking -- they can start learning to love books, because the books come with parental love and attention (or because parental love and attention comes with the books)

Sage advice is my business, my true stock in trade. Sure, I give shots, look into ears and listen to chests, but by far the largest part of my job involves listening to people talk about their children and then responding with guidance, recommendations--what I hope I can call expertise. As a pediatrician, I start from the assumption that my job is to avert danger and promote my patients' healthy growth and development. I believe that healthy children are more than the sum of immunizations and safety precautions, and that parents want more for their children (and from their pediatricians) than the absence of disease and injury. So conversations in the exam room veer easily from medications and child-proofing to emotions and discipline and on to behavior and bonding, and even to books and reading--a topic that has become my special obsession even though it seems remote from the medical realm. Regularly and faithfully, I counsel parents about the importance of reading aloud to their children, about beginning early with books and helping their toddlers grow up to love the printed page. Of course, when it comes to giving strictly medical advice, the answer is relatively easy. It's all part of my professional duty. I know it's my responsibility to teach parents how to take a baby's temperature, or explain the difference between a cold and a serious bacterial infection. And I feel I have a right and responsibility to cover areas that the pediatric profession has increasingly taken on: sleep position, say, or car seats, speech and language. I have the wisdom of pediatric textbooks and a weight of experience in the office and on the hospital wards on my side

Klass discusses the different ways children behave when they're sick: Some are stoic, denying pain or suffering, while others seem to revel in it. She recalls an incident involving her own daughter, who seems unaffected by illness

As a parent, I have noticed that certain conversations go with different stages of children's lives. When they're babies, we exclaim over the vagaries of temperament, over how children are different right from the beginning. In fact, as a pediatrician, I find myself asking at the two-month or the four-month visit, `What kind of a baby is he?' No parent ever has trouble coming up with an answer. Then there is the larger debate about child rearing that our culture engages in at fairly regular intervals. Perhaps it is unfair to call it a debate; perhaps it is more an epiphenomenon of marketing, book and magazine hype, and that peculiar combination of breast beating and navel gazing that marks our rather childish preoccupation with our jobs as parents and adults. We always seem to be ready to engage in yet another round of astonished debate about children and parents, and cause and effect. Yet when most adults look at their own lives, they place heavy emphasis on the combination of two factors that seem largely forgotten in this conversation: choice and chance. We do not tell our life stories as examples of determinism of any kind. What is the last memoir you read whose author sees himself as a hapless actor playing out the lines and stage directions encoded in his DNA? Or as a blank slate on which his parents drew the road map?

''Do parents matter?'' ask the magazine covers, as controversy swirls around the new book ''The Nurture Assumption: Why Children Turn Out the Way They Do'' by Judith Rich Harris. The book apparently comes down heavily on the side of heredity and peers over parents as the major influences on children. As our children grow, parents talk about the joys and sorrows of trying to civilize them. Parents like me who have 14-year-olds tend to sidle up to one another at parties and express the opinion that maybe we've already given our children as much as we can give -- or as much as we can hope they'll take. And always, in all of these conversations, there's a rueful acceptance that right from the start, not everything is under our control. But then there is the larger debate about child rearing that our culture engages in at fairly regular intervals. Perhaps it is unfair to call it a debate; perhaps it is more an epiphenomenon of marketing, book and magazine hype, and that peculiar combination of breast beating and navel gazing that marks our rather childish preoccupation with our jobs as parents and adults. We always seem to be ready to engage in yet another round of astonished debate about children and parents, and cause and effect