Pediatric Advice – Dr. Plastic Picker

Category: Pediatric Advice

My son not having sex for the first time I’m sure, because he had COVID and was quarantined in his triple.

August 27, 2023

by Dr. Plastic Picker

This has been a topic I’ve been thinking of for the last year. It’s natural for me since we got our son off to college at UC Berkeley successfully and we are still navigating with our 15-year-old daughter the joys and pangs of being a teenage girl in our modern society. I’m also a pediatrician for now almost 20 years, and I’ve given “the talk” to more teens than I can imagine that come in and out of my clinic exam rooms. But when your own children are around the same age and going through the same, it hits differently. And honestly I counsel my children and my patients completely differently than when I was a younger pediatrician with just infants in my own house. Sex, consent, intimate partner violence, gender issues – all of it isn’t as pressing when you are changing diapers at your own home. But when you have two awesome teenagers yourself and a pretty 15-year-old girl at home – sex very much is in the back of our minds as parents.

For the first time ever, I had a teenager just having entered high school ask me after hemming and hawing for a bit “When do you think I should have sex? Beginning of high school? End of high school?” I was very proud of this said teenager for having asked me this question. We connected because this teenager had begun watching Kdramas and we just chatted about popular titles. Kdramas are so popular now beyond the Asian-American community, and I think a good thing mostly for representation of a more diverse cast of heroes and heroines. So with that connection, this teenager was brave to ask me this question and I am not the primary pediatrician. This was a chance visit with a doctor that said teenager will never see again.

I usually ask the teens what they know from school and reading themselves. I ask them if they know about birth control and different forms, so I don’t have to repeat myself. I ask them if they know how common chlamydia. I go over the numbers and how it’s easier to test now, just urine and blood for all the STDs. We used to do cervical swabs and urethral swabs, and I assure them it’s so much easier now whenever they need us to test them. I talk about planned parenthood, and confidentiality and that I’m here to not judge and be a resource for them. I give them all the information and I’m so comfortable doing it. I use funny stories from my own life, to make it more relatable to them. I’m honest with my own patients about my own life and decisions, to hope to be an example to keep them safe in loving relationships. I tell them I met my boyfriend when I was a freshman in college, and we were friends and dated after a year of being friends. So between 19 and 24 (when we were married during medical school), we had lived in the same dorm buildings and at some point “things happened.” I told them I got on birth control for acne initially and to regulate my period because I was so stressed as a Harvard freshman that I didn’t have my period, but at some point the birth control was there for birth control because I wanted to have children at the time I decided. I emphasize that as young teens for the girls that they are very fertile, and I joke around that “a boy will walk by you and you’ll become pregnant!” which is not true. But that I do have several cases where I’m not sure if there was actual vaginal penetration and I think I may have had 2 cases in my career, where the young boy ejaculated somewhere very close to the girl and the young teen girl got pregnant. In both cases, the two young teens actually did love each other and the families decided to keep the babies. Those children are healthy, but I tell them – gosh that was really hard for those kids and one was an AP Chemistry student too. So be careful, it can happen to you!

From the CDC

But what I told this patient and what I’ve told my own children and all the children that are thinking about sex or may have sex or are hanging out in the teenage social media mileau that have oversexualized everything is this:

You deserve to be loved. Whether that be after you are married or before, you 100% deserve to be loved. That you want to be close with someone you care for sexually is very natural. And whenever you make that decision, I am here for you as a pediatrician not to judge but to make sure you are safe. But sex is not just sex, it’s such a beautiful thing that should be shared with someone who cares for you. It’s like anything you do for the first time, if you kind of do it “right” initially – like brushing your teeth or flossing – you do it better forever after and there won’t be as many issues later on. It’s such a private thing, that try to have some privacy and comfort. My own children I hope they will wait, but I told my son who is in college, use a credit card and get a hotel room or call your uncle for advice if you are embarrassed to talk to us. And that’s it. You deserve to be loved in every way, and isn’t love such a beautiful thing?

For my own daughter, I’ve told her the same. Her own pediatrician actually gave her a very different talk in the privacy of a confidential visit. But my daughter is very open with me, and told me afterwards the broad strokes of that talk. I so appreciate the different pediatric perspective but that talk was very different.

But for my own daughter and the patients I’ve had since they were young, I add a wistful little ending. The beauty is in the waiting. The perfect boy, he becomes your husband (Mr. Plastic Picker) and a wonderful partner. But enjoy today however old you are. 14, 15, 16, 17, and maybe even 18. 19. The beauty is in the anticipation, the waiting, the yearning.

And again for my own daughter, I told her honestly you are so busy right now. You have to continue develop your sense of self – emotionally, professionally and physically. And having a boy (or girl or whatever gender of the person that you love) there with his opinions , no matter how wonderful he is, complicates things. It’s about you now. And girl, you got so much awesome stuff going on!

But the summer she goes off to college and I’m not there to keep an eagle eye on things? 100% she’s getting a nexplanon placed (long term implantable birth control). I’m a romantic, but I’m not stupid. LOL. And that’s my story and I’m sticking with it! Have a wonderful rest of your weekend from your local litter picking pediatrician. I’m going to the beach to pick up trash this morning, and I’ll be with my teenager this afternoon getting curtain bangs so she can look cute for herself. She’s super excited about the curtain bangs!

Maybe something like this?

Succulents that are at an undisclosed location at the HMO.

April 20, 2021

by drplasticpicker

This is my final word on Vitamin D deficiency. This is meant for my pediatric patients and their parents. If you are not my patient, than please read for entertainment and kindly go to your own doctor. I realize that I was spending a lot of yesterday following up on lab values yesterday and all my labs are almost down to one screen, but there were a lot of low vitamin D levels. Its important for me to check, but my advice is standard and the same now. Also I was overdue to put something in the Pediatric Advice column.

Did you know that Dr. Plastic Picker did two years of pediatric endocrine training? Yes I did! I did it at Man’s Greatest Hospital. I DID NOT GET KICKED OUT OF TRAINING. I left fellowship in good standing and with high marks on my inservice exams and good reviews. I left because we were trying to figure out life and Mr. Plastic Picker who is a doctor too found a job that he wanted as a specialist specialist in my home town. I had the option of finishing training here in San Diego and actually did talk to the program director, but also had a job offer at HMO San Diego. I had enjoyed endocrine training but it was mostly type 1 diabetics, and honestly being a general pediatrician paid more, I could start right away, no call, and it was easier. I was done taking super long exams after over 20 years of taking exams. I didn’t have a huge urge to memorize the synthetic pathway of cholesterol. I wanted to take care of kids, raise my own kids and I needed money. So $60K to be an endocrine fellow versus $160K to start a real job that was less hours and spend time with my children, seemed back them a no-brainer. And now looking back, not finishing fellowship was probably one of the best decisions I ever made. This is why I admire pediatric specialist so much (the ones that finished) because I promise you, they are not making the big big bucks relative to generalist at least in pediatrics. Maybe pediatric GI, pediatric allergy and intensivist but certainly NOT pediatric endocrinologists. Anytime we have an issue in our pediatric endocrinology department, I do feel guilty that I didn’t finish – but only for a second. Not finishing fellowship and starting work resulting in at least me being able to maximize my retirement contributions an extra 38K even one year earlier over the lifetime of my career until 65, is at least $378K in retirement savings accounting for compounding growth in a regular stock market. So if you ask me now do I regret not finishing pediatric endocrine fellowship, HECK NO! Remember Dr. Plastic Picker is all about the bottom line and the bottom line is that I had to make the decision that was right for my children and marriage at that point, and the higher paying easier job where I was still practicing medicine with more flexibility is the one I chose. After a few years in general practice, I realized I loved the variety of general pediatrics and the time came for me to decide to forgo the credit of the two years of endocrine training – and I without hesitation and I waved bye-bye!


This sight at Costco is scary. Life cannot be reduced to a gummy.

November 29, 2020

by drplasticpicker

I’ve been asked this question many times in clinic. I have relented at times and given parents the correct doses and timing for melatonin. I think I know more about melatonin than most pediatricians just because I’ve read two articles on it, and I used to work in a sleep research group. Being an endocrine research fellow in a sleep research group gave me more confidence to give advice on sleep.

Here are two articles I recommend you read on melatonin before you even consider giving it to your child. One, is from and the American Academy of Pediatrics and one is from Dr. Craig Canapari, my old friend from residency and a Nationally Recognized Pediatric Sleep Expert and Pediatric Pulmonologist Here is the scientist that I worked with on sleep research, he is currently the chief medical officer at the FDA Office Division of Metabolism and Endocrine Products . That’s actually a really important position.


I actually recommend kids garden and not be on social media.

September 28, 2020

by drplasticpicker

Life is full of contradictions. As a pediatrician I worry about children being exposed to too much screen time, as this has been shown to disrupt sleep and has replaced some of the time children are interacting with real people or moving their bodies. Social Media has been a conduit for child exploitation as well, as adults who are evil-doers have made contact with children through the different platforms. Yet at the same time, Dr. Plastic Picker is a social media Instagram creature. I exist because of social media, Facebook and Instgram, although I think my heart belongs on this blog and in clinic. How can your social media semi-savy pediatrician advise you to limit your social media?


My few qualifications for giving advice is that my kids are happy. I found these post-its in our daughter’s room. She drew them for herself.

July 23, 2020

by drplasticpicker

I saw a set of siblings 4 and 5 years of age yesterday for their physicals and one set of vaccines, and mother expressed the same frustration that many parents are having. “How do I keep the kids brain developing?” Many parents are in the same position. School is moving on-line, and on-line school is supoptimal for the development of a 4-6 year olds. Many parents ask me for advice, and I am a doctor and not a teacher. I always direct parents to teachers and educators. But I understand, they trust me. I have made a lot of mistakes raising and still raising my children. But our teen and tween children are healthy, inquisitive people and generally considered good students. Most importantly they are happy and they have what I think most of my patients consider really good brains. So here are some suggestions from your pediatrician who is NOT A TEACHER. Are your children 3-6 years of age? How do you keep them stimulated?


Beans that were in our pantry.

June 12, 2020

by drplasticpicker

One of the proudest professional moments of my life was during the year I was chief resident, the pediatric senior class at Man’s Greatest Hospital had a 100% pass rate on the pediatric boards. It never made sense to me that the hallowed institution that I trained at did not have 100% pass rate. Indeed the occupants of the chief residency position were known to make markedly less than 100%. But the year I was Chief Resident, the senior class had a 100% pass rate and I passed well over a few standard deviations as well. This was in large part because I had to delay my boards because I had a baby during Junior Year and made up some rotations. I took my exam with the senior class which was below me. So I studied with them. While I had more time and was studying and completed four years worth of PREP questions sitting in the the chief residency office, I created Pediatric Board Review power points from my notes. When there was any empty lecture time during Morning or Noon conference when the lecturing attending showed up late or the admitting team was stuck on the floor, I had multiple power points ready to go. I am proud of the legacy of that 100% pass rate.

But can you believe that in the entire 2015-2019 AAP Prep Questions there is only 1 question about iron deficiency anemia? This is the most common issue we encounter as general outpatient pediatricians and there is one question! Well this former Chief Resident and current Assistant Boss and now eco-warrior Dr. Plastic Picker is going will rectify this situation.


Chia Seed/Oatmeal Pudding. Low sugar and can be a breakfast! Cooking and photo credit by Daughter Plastic Picker (age 12).

May 21, 2020

by drplasticpicker (with daughter Plastic Picker’s help)

Parents are cooking more meals for their children during COVID-19 quarantine. We have continued to do well child visits for kids that require vaccines, and several parents in my practice asked me for breakfast ideas. I think the combination of more inactivity due to quarantine and more screen time, has worsened the pediatric constipation crisis and widenened the pediatric fiber deficit. In addition, when we are scared to browse through the grocery store – I think parents are falling back on more processed foods and that as you know leads to Taste-Bud Dysfunction


Screenshot of a slide for a Pediatric Hypertension Lecture I attended at the AAP NCE 2019.

May 3, 2020

by drplasticpicker

Back in October, I attended the American Academy of Pediatric National Conference in New Orleans with Dr. Dear Friend. We were there with a group of pediatricians from our health-care system, and it was a high-yield conference. Part of it was because we actually traveled to the conference and it was a fun destination. We had too much fun attending the lectures during the day, exploring new Orleans at night and also trying to reduce our plastic use! One of the talks we attended was on Pediatric Hypertension.


Snorlax makes another blog appearance!

April 14, 2020

by drplasticpicker

This is definitely one of those topics that Dr. Plastic Picker is a much better pediatrician now than I was at the beginning of my career. It helps that I myself have gone through puberty, completed a clinical year of pediatric endocrinology, and am semi-successfully guiding my own two children through this process.

This can be both a stressful and wonderful time in life. There is a sense of loss for the littleness of your children. I had this profound sense of loss because I worked so much when they were little. I miss the warmth of those young bodies snuggling up to me at night. The promise of that time would often get me through the long overnight calls or urgent care shifts. Our daughter had a profound sense of loss as well. When her body began changing she said that she did not want to grow up. Our son was very nonchalant about the whole thing, which is true to his easy going personality.

But as I tell my children and my patients, puberty is a wonderful thing because it means the body is working! It means that your hypothalamic-pituitary-gonadal axis is functioning as it should and you’ve reached this milestone. If you didn’t go through puberty by a certain time, it would be a medical problem. I would have to start getting blood work, radiographs and maybe MRI your brain. As a pediatrician, I am aware of the dangers of being little as well. You are more susceptible to diseases which is why there are more vaccines when you are young. Little children can’t physically protect themselves as well. So I look at puberty, as a wonderful time that children are gaining bodily strength. They are developing themselves to be adult people. Because in the end the purpose of raising children and protected them while they are young is to get adults, and then they can protect and fend for themselves. And now my own teenagers can get things I need from the upper shelves that I can’t reach! Score!


This is a picture of Mylar baloons in the desert from one of our Dr. Plastic Picker friends. Does the heat aleve or exacerbate eczema? How should you bathe your atopic child when the weather changes?

March 29, 2020

by drplasticpicker

Today the politicians are again arguing about who is to blame for the skyrocketing COVID-19 cases. But in California, there is a glimmer of hope. We began mandatory quaratining relatively early, and in our community our local leaders have been working together across the aisle to help our homeless communities and provide rent relief to our population. Beaches are closed and our local friends the Police were driving calmly up and down the beach telling our relaxed San Diegans to disperse. I was born and raised in San Diego, and I have a great love for my homeworld (Star Trek reference). In this increasingly polarized world, there is still a sense of civic responsibility and engagement in my hometown. I am hoping this helps us #flattenthecurve. Looking at the prediction models, it looks like we will likely have enough ICU beds for our county. So I am still vigilant but hopeful. I wrote yestserday that the best way I can help, is by doing the job I am qualified to do – a general outpatient pediatrician who middle-manages a department and is responsible for a few actual outpatient clinics

So in that vein, I will be an outpatient pediatrician and give general advice about eczema! This is such a common problem and I hope this gives you some relief since we are trying to keep these “minor” issues at home. But minor issues are important to deal with as well.