Dear Parents with Phil Boucher, M.D.

Ask Your QuestionA new JAMA Pediatrics study followed 747 kids from ages 5 to 7,/Then a study on nirsevimab showing that preventing RSV also prevents antibiotics. And finally, a parent question about croup: what actually helps at 9pm, and why the nebulizer isn't it.What you'll take awayA screen metric easier to move than "hours," and a 10% target for this weekWhy notifications, not willpower, are the first lever to pullRSV & RSV antibodies to prevent hospitalizations AND antibiotic exposureWhat to do when your child starts barking, and the two signs that mean go inBy the numbersEach additional hour of daily primary-parent smartphone use tracked with 0.42 fewer points of annual growth in a child's receptive vocabulary (JAMA Pediatrics, Aug 2026)RSV drives about 57,000 U.S. pediatric hospitalizations and 1.5 million pediatrician visits a yearNirsevimab is 80% to 90% effective at preventing RSV hospitalization. It cut antibiotic prescribing 14.4% for outpatient respiratory infections and 69.4% for RSV hospitalizations (Clinical Infectious Diseases, Aug 2026)Chapters(02:00) The screen time number that isn't your kid's (10:15) Nirsevimab, RSV, and fewer antibiotics (21:40) Parent question: croup at homeLinksThe screen study, JAMA Pediatrics, Aug 2026: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2852943The nirsevimab study, Clinical Infectious Diseases, Aug 2026: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciag406/8750980Ask Dr. B a question This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit dearparents.substack.com/subscribe

You Can’t Collaborate With an Anxious BrainAcid blockers and food allergy, SPACE with Robyn Isman, and a wild three-year-oldNew format this week: one study, one conversation, one listener question. Tell me in the comments if it works.Sponsor: Novaferrum. Use code NFIG10 for 10% offComment On This EpisodeIs my baby’s reflux medicine a problem? (01:20)* What acid suppression changes about the gut, and why the gut is where the immune system gets built* The numbers from a 2025 database study: PPIs in the first year linked to roughly five to six times the rate of food allergy diagnosis, with antibiotics showing a dose-dependent pattern* The stepwise approach I run before I write a prescription: feeding position, milk supply, dairy or soy removal, two weeks at a time* When antibiotics are non-negotiable, and when a one-sided ear infection can safely waitWhy isn’t my kid’s anxiety getting better? (09:35)Therapist Robyn Isman built her practice around SPACE, the Yale protocol that treats child anxiety by working only with parents.* What accommodation actually is* Unilateral parental action: you decide, then you tell your child... you don’t ask how they feel about it first* The announcement, and exactly what it sounds like when you change bedtime* Delaying, disengaging, distancing: three ways to hold the line when your kid escalates* Validation plus confidence, and the wording that keeps it from sliding into reassurance: not “I know you can do it,” but “I know you can do it while you’re scared”* Why reminding an anxious kid of past successes usually backfires* Where school avoidance, permissive parenting, and the phone in your kid’s pocket all collidedIs my wild three-year-old ADHD? (56:20)A mom asks about her impulsive, intense, transition-hating three-and-a-half-year-old.* Why I don’t diagnose ADHD at this age, and what I look for instead* The sensory-seeking behaviors that get read as defiance: crashing, jumping, oversized hugs, shutting down in noise* Sleep first. Snoring, mouth breathing, restless nights, wired but tired* The short list of labs I’d actually consider, and why I’d call an OT firstOur pediatric practice is open to those in Nebraska, Florida, Texas, Illinois, Kansas, and Iowa. We are now in-network with most insurance plans for these types of visits. If you’re looking for a whole-picture evaluation of your child (we obviously do these virtually if you’re not in our neck of the woods!), learn more and schedule at —> https://clinics.frontierpediatric.careLinks* Sponsor: Novaferrum. Use code NFIG10 for 10% off* The study: Chaaban MR, Tanzo JT, Thatte S, Kabalan M, Kaelber DC. “Association of Acid-Suppressive Medication and Antimicrobial Use in Infancy with Food Allergy and Anaphylaxis.” Journal of Clinical Medicine, 2025. Free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12155881/* Robyn Isman: https://www.theanxiouschild.com* Instagram: https://www.instagram.com/parentingtheanxiouschild/* Do Less Parenting podcast:* SPACE (Supportive Parenting for Anxious Childhood Emotions), developed by Dr. Eli Lebowitz at the Yale Child Study Center:* Sensory processing episode with Dr. Kristen Pfeil, OTD, OTR/L: https://dearparents.substack.com/p/dear-parents-episode-004-sensory* NovaFerrum: iron drops and chewables kids will actually take. Use code NFIG10 for 10% off using this link —> Novaferrum* Have a question for the show? https://drphilboucher.com/ask This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit dearparents.substack.com/subscribe

dear parents,Today I get to talk about the history of homeschooling and how it has exploded in the past decade…super interesting conversation around the history of homeschooling and what it looks like nowadays.Dixie Dillon Lane holds a PhD in history from Notre Dame, homeschools her own kids, and just wrote Skipping School: A History of American Homeschooling and How It Went Mainstream (I had to steal back this book from my wife’s nightstand so I could prep for this interview!)We talk about how homeschooling evolved from a counter-cultural, keep-it-under-the-radar movement in the ‘80s and ‘90s into a normal educational choice that families move in and out of year to year. We dig into what the research actually says about socialization and safety, why religious instruction is no longer the top reason families homeschool, and how parents can be deliberate about preparing homeschooled kids for adult life.And one stat that shocked me: there are now more homeschooled kids in America than kids in parochial schools.Links:Get Dixie’s book: https://amzn.to/4fRwrOgCheckout the WSJ review of Skipping SchoolHave a parenting question? Ask at https://drphilboucher.com/askThanks for reading dear parents! This post is public so feel free to share it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit dearparents.substack.com/subscribe

I love teaching authoritative parenting.Above is a very real response from a dad to my lesson on the handling window between getting home from school/work and dinnertime.Watch the lesson on after school meltdowns this question came from: https://apsg.drphilboucher.com/apsg-demo-22Authoritative parenting is both high in warmth and high in boundaries. It has by far the best research on short-term outcomes, such as getting through difficult day-to-day moments and seasons, as well as long-term outcomes related to our children’s development and our relationship with them as they grow.Authoritative parenting is not as easy as authoritarian and permissive parenting.Authoritarian and permissive parenting are really based on avoiding discomfort.In authoritarian parenting, you use your big voice and threats and coercion and guilt and shame to get compliance. In doing so, parents try to avoid the discomfort that we face when our children don’t do as they prefer immediately. It is high in demands and low in warmth/connection.In permissive parenting, warmth is present, but limits and boundaries are lacking. Permissive parenting is a response aimed at avoiding the discomfort the child might face if a parent sets a boundary or expectation. It is high in warmth but low in boundaries and limits.Authoritative parenting, by contrast, takes the good side of both…. it is high in warmth and connection and also high in boundaries and expectations.Read more about authoritative parenting:https://dearparents.substack.com/t/authoritative This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit dearparents.substack.com/subscribe

This is a free preview of a paid episode. To hear more, visit dearparents.substack.comYour Toddler’s Sleep Didn’t Break. She’s Just Missing You.Read/watch/listen to the full post https://dearparents.substack.comAsk your question: https://drphilboucher.com/askThis week’s episode is an Ask Me Anything from a mom named Emily, and it’s one so many of you are living right now:Hi, Phil. My name is Emily, and our daughter Remy turns three in about three weeks, and recently has really regressed with her sleeping over the last two weeks. Particularly at nighttime, she lays in her bed until we leave, and then immediately goes to the door and screams for about an hour, bangs on the door crying, hits her toys against the door, and it just really goes on from there.It’s also happening at nap time at home, even though she’s napping great at daycare. I think it’s some sort of separation anxiety. Not entirely sure what triggered it. We did start swim lessons a couple weeks ago that she had a lot of separation anxiety with, but she’s gotten a lot better. Her daycare class has also been a lot more chaotic than usual, and we notice that when things are a little up and down at school, she tends to regress.So just curious if this is a phase. We’ve been letting her cry it out. We did try laying in there till she fell asleep. Within the minute she woke up and realized we weren’t there, pattern starts all over again. Tried leaving the door open with a barrier to say, “Hey, stay in there.” But that didn’t work. She kept coming out and then wanted us to sleep in there with her. So right now we’re just kinda letting her scream. And we have an infant at home that can wake up when she does scream. So anyway, just curious what you think. It’s happening at night and at nap time when we’re at home. And really don’t wanna get into a co-sleeping situation, ‘cause the last time we brought her into our big bed when she regressed, it was really hard to break her of that.She usually loves her bed and sleeps really great. So curious what you think. Thanks.My response:First, the co-sleeping trap is real, and you can avoid itThis is one of the most common issues parents bring to me, and it very often leads to co-sleeping, because we’re all exhausted, there’s a new baby at home, and it’s so easy to fall into “just get in bed with me,” or to not even realize they climbed in because you were too tired to notice.Avoiding co-sleeping is possible. It just takes some intentionality. We have six kids and never fell into it Emily clearly wants a peaceful bedtime and an end to the nightly door battle, and we can get her both.This is not a melatonin problemBefore we go further: a lot of well-meaning friends will hear this and say, “Oh, just give her some melatonin.” Please don’t.This is not a melatonin deficiency. This is a habit, separation anxiety, and busyness-of-life situation that we fix with new practices, not with something that chemically knocks a kid out. Melatonin might work temporarily, but it won’t fix the real issue. And I don’t love putting young kids on it for any stretch of time. Remember, melatonin is a hormone, not a vitamin. It has effects all over the body, and when it isn’t indicated, I’d much rather skip it.The big picture: this is separation anxiety, not broken sleepI honestly don’t even think of this as a “sleep regression.” People talk about regressions like a child hits a magic age and their sleep just detonates. There are windows where it’s more common, sure. You’ve heard about the four-month one, the eight-month, the nine-month. It’s tough to keep them straight because you can find a blog post about the 6.4-month regression if you look hard enough. It just happens across babyhood and toddlerhood.Here’s what tells me this is typical separation anxiety specifically: