The Flipped Check-Up

17 Apr


When we moved to Irving and I decided to join a practice in Lewisville, I realized I wanted to know more about the schools in the area and get a feel for the culture of the teachers that would be teaching my patients and kids.  I searched online and found great and encouraging information about Carrollton-Farmers Branch, Irving and Lewisville school districts.  I also looked up several teachers and administrators.

While I expected to get good information, I never expected to learn a concept that I hope to incorporate into my medical practice, but that is exactly what happened.  I followed an educator on Twitter (@LaurenBibby) who is the Technology Integration Specialist for Lewisville ISD (@LewisvilleISD) and she has since “introduced” me to a concept known as the flipped classroom (even though she doesn’t know it yet).

Wikipedia describes flipped learning as “a form of blended learning in which students learn new content online by watching video lectures, usually at home, and what used to be homework (assigned problems) is now done in class with teachers offering more personalized guidance and interaction with students, instead of lecturing.”

So, students watch lectures at home in the afternoon then come to school the next day to do homework and other projects during class time.  This gives the teacher time and opportunity to address what the student doesn’t understand from the lectures rather than have students turn to their parents for their Calculus homework (when dad had trouble passing Algebra).

So, how does this apply to me and my practice?

I’d like to have more patients to do “flipped check-ups.”

In the flipped classroom, student listen to lectures at home and come prepared to do work and application related to the material.  In a flipped check-up, parents would read and learn about the upcoming checkup (check out this page on my blog: Check-Ups for an example), develop specific questions and then allow me to get into deeper, higher-level education when they come in for their check-up.

Yes, contrary to the stereotype, you did just hear a doctor advocate that his patients do on-line research prior to their visit (but I want it to be good information).  In fact, it’s the reason I started my blog in the first place.  I wanted my patients to be able to access my advice (in effect, access me) when I wasn’t there beside them to answer their questions.  I wanted them to have a place to go that had accurate recommendations that fit with my philosophy (so, why not have them actually be my recommendations, right?).

Here’s an example of how it could go:

Family has 4 months check-up scheduled.

They review the 4 Month Check-Up Blog Post.

Family comes in for a 4 month check-up.

They say, “We read your blog 4 month check-up blog post and are ready to start solids and he seems to be developmentally ok but we did have some more questions about helping him sleep through the night.”

This allows me to touch on the other areas for clarity and completeness but spend the majority of the rest of the visit discussing in depth about sleeping and some options for sleep training (or not, depending on the family’s preference).

When the child is older we could cover the topics located in my Masters in Parenting Series to cover some topics of development more deeply.

So, this leads me to some questions for you…

1)     Is this something you’d be interested in?

2)     If you wanted to do it, how could I make it easier for you?

Some Essential Questions to Ponder

11 Apr



I know just by seeing the picture above I’ve peaked a significant amount of interest…

I get asked a lot about essential oils.  I answer very little. Why?

The answer is simply that we don’t know much about how or if they work.  Except for anecdotal stories about how they have helped certain people in certain situations, no one has done a large studies to truly evaluate their effectiveness or safety.

The main explanation for why they are used is that people (parents) are simply looking for something that’s an alternative to using what I’m going to call from now on “conventional” medicines.

Going forward, I’m not going to rely much on my knowledge as a doctor, I’m just going to be using common sense and asking a series of questions that I hope will get you all thinking.

What is medicine?


This is the definition: any substance or substances used in treating disease or illness.

Doctors prescribe conventional medicines that enter the body from many different avenues.  I have patients that take Zyrtec (cetirizine) by mouth, inhale albuterol, sniff steroid nasal sprays.  There are conventional medicines that are delivered topically but they aren’t as commonly used (especially in kids).  The most common example was the Daytrana patch for ADHD but I haven’t seen it used in years (I’ve never prescribed it.) because topical medications can have unpredictable rates of absorption which makes determining how much medication actually gets into the system difficult to estimate.  I only really use topical creams for things that need to be treated topically (rashes).

I see friends recommending essential oils on all my social media accounts for many different ailments and it’s not always clear to me what they are recommending-topical application, diffusion or ingestion.  But, if medicine is “any substance or substances used in treating disease or illness” and medicine can be inhaled, applied topically or ingested, then why aren’t essential oils considered just another type of medicine?

What does it mean that they are more natural?

Another discussion that is centered around essential oils is that they are more natural.  I get this concern.  In a world where everything is processed (down to a lot of our food), why wouldn’t you want something that is more natural for your family?  However, just because something is natural, doesn’t mean it’s a good thing…

Let’s take formaldehyde.  Parents cite this preservative as a reason they don’t want to use conventional medicine. I’m not particularly concerned about formaldehyde because it is a by-product of metabolism inside our own bodies.  It is formed during metabolic processes and can then be converted into CO2 and exhaled or urinated out.  Keep in mind that it is a known carcinogen when the dose gets to high but we know (from history) that it requires a very high level of exposure to get to the point where it causes cancer.  Ultimately, the concern I have with formaldehyde is this…it is commonly used as a reason by families who don’t vaccinate even thought it’s made in the body (Is there anything more natural than that?).

A more simple argument against using essential oils based on the reason that they are more natural is this: “Oh, it’s more natural? Well, so is marijuana.”-@mrsdocsmitty.

Do doctors prescribe medicine for every little thing?

I commonly hear this: Doctors just want to prescribe a drug for everything.  I want something different for my family.

The whole thing that motivated me to write this post was a posting I saw on a social media account last week: It is a picture of a line of essential oils across a bathroom counter (about 10 bottles-not sure if they were all used this morning or not) and part of the caption below: “He uses oils for allergies, eczema, acid reflux and stress.”  I’m not attacking this person at all and I’m not actually sure who it belongs to (so don’t take it personally).  But, does trading a “conventional” medicine for an essential oil make any difference?  Are essential oils becoming the new “take one for everything”?

I personally have occasional struggles with allergies, acid reflux and stress but I might take medicine allergies or reflux every few months. I do modify my diet, sleep habits and exercise to help with reflux and stress.  Therefore, taking essential oils would not be an alternative to taking a medicine for me at all because I’d rather take nothing.  I think people assume that because I’m a doctor, my wife and I shove medicine down ours and our kids throats for just about any and every symptom imaginable. This is simply not true.  Our kids occasionally get cetirizine for allergies (on average less than once a month), acetaminophen or ibuprofen (on average less than once a month) and my asthmatic gets inhalers (1-2 days per year).  They take antibiotics only when absolutely necessary. Other than that, our kids take vitamins every day.

So, be wary of using the reasoning that doctors use medicine for everything.  Some may, but this doctor doesn’t and I don’t consider it any different to be using an essential oil for every little thing.

Do doctors stand to benefit when they prescribe a medication?

Fortunately and unfortunately, I don’t practice medicine in a time where I can get flown to Hawaii for a long vacation with my family for prescribing a certain medication.  I’m very glad I didn’t because working in that environment would have been very difficult.  When I first started practice, drug reps could bring lunch and some pens but even these two practices have stopped.  At this point, I have no incentive to prescribe a medication except the desire to see my patient improve.  In fact, soon I will be incentivized to not write for medications as insurance plans become more focused on cutting expenses by decreasing their cost of prescription drugs (I will be encouraged to use cheaper alternative when available but nothing is cheaper than not writing for anything.).  So, the argument that doctors are pushing drugs in an effort to profit is simply not true for most doctors.  There are doctors who are paid consultants and speakers for drug companies, but most are not.

Now, think for a second about your Young Living or doTERRA rep. How do they stand to benefit when they recommend a treatment for you?

Finally, for my distributors and reps out there: Are you practicing medicine without a license?

This is the definition of practicing medicine without a license from Michigan (I’m sorry I couldn’t find the one from Texas for my Texas people):

An individual who practices or holds himself out as practicing a health profession subject to regulation without a license or registration or under a suspended, revoked, lapsed, void, or fraudulently obtained license or registration, or outside the provisions of a limited license or registration, or who uses as his own the license or registration of another person, is guilty of a felony. For the purpose of the offense of practicing medicine without a license, the “practice of medicine” means the diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts. (emphasis mine)

The last part is the interesting part: the practice of medicine means the diagnosis, treatment, prevention, cure or relieving of human disease…by attendance, advice…or holding oneself out as able to do, any of these acts.  You’ll have to read it closely for yourself to see what you think.  Think about what would happen is something did go wrong with one of the oils you recommended or sold. Would your company back you?  Maybe you should ask them and see what they say.  Many people feel that the reason that the most profitable essential oils companies are structured as direct marketing is because the company can hide behind their individual representatives’ claims.

Now that I’ve kicked the ant pile, I will now sit back and see what happens.  People who know me personally know that I am one of the most open-minded pediatricians they know about calmly weighing evidence on either side of a discussion or debate.  I try very hard not to bring my preconceived ideas into consideration when I make a decision.  I have extensively studied essential oils personally and am confident that, at this time, I cannot recommend them for my patients until further studies come out regarding efficacy and safety in children.  I just pray now that you will consider my questions in the same way I have considered yours over the years.  Regarding comments on this post, based on the way I have structured this blog to provide relevant and scientifically accurate information, I cannot allow the comments to become a marketing ploy for essential oils.  If you want to debate some of the logic or concepts that I have presented or cite real scientific evidence, that is fine, but I will not allow comments that tout anecdotal evidence of how essential oils have helped you or your family.

It’s Just Preschool-Right? Right?

9 Apr



If you have preschoolers, think back to 10 years ago…there were many things you were worried about:

  1. Your career
  2. Your spouse (or future spouse)
  3. Your hobbies
  4. The Cowboys (still worried here) or your fantasy football team

You could probably look forward to 10 years from now and predict some things you would be worried about:

  1. Your career
  2. Your spouse (or future spouse)
  3. Your hobbies
  4. The Cowboys (still worried here) or your fantasy football team

Where you’ll send your child to preschool probably didn’t crack your top-4 list, but fast forward to today and… guess what?  For many people this time of year with school enrollment going, it’s #1, #2 and #3 on the list.

Here are some tips in helping you find the best preschool:

1) Prioritize what is important to you by asking yourself questions.

Do you want a particular curriculum or teaching style (some examples Montessori, classical or something else)?

Do you want certain extra activities such as music, art or dance?

Do you want a certain set of values taught (Christian school vs not)?

2) Research schools in your area.

Search the internet for schools in your area (remembering that the coolest website is not always the best place).

Ask your (wise) friends.  Don’t get advice from any and everyone, or you’ll just end up confused.  Find 2 or 3 friends who you trust that have walked through this process recently and see what they know.

3) Visit a few schools.

Keep your eyes peeled the whole time you are there.  Are the kids and teachers smiling and having fun?

Pay attention to the teachers other than the one you are scheduled to meet with. It’s easy to fake it for a minute if you know you have a parent visiting.  How are other teachers interacting with their students as you walk past their rooms or across the playground?

Finally, you can basically throw everything I have said out the window and focus on the real criteria that we used to choose schools for our children:

Will they love my child well?

We’ve picked 4 schools in our time as parents and couldn’t be happier with what each one provided all based upon using this criteria.


Young Children’s World (Highland Church of Christ)

All of our children went to YCW when we were in Abilene.  With 2 young children and our crazy schedules, we had very specific timing issues regarding when we could drop them off and when we could pick them up.  They were always very supportive.  Noah and Caden both love to look at their year in review books and can name all their class mates (even from multiple years).  We always felt our children were safe and loved.

St John’s Episcopal School

Noah did pre-K at St John’s.  We agonized over where to put him for his pre-K year (one of the hardest decisions we have made as parents).  When we met Mrs. Rebecca McMillon we were full of angst and fear about the upcoming year.  She immediately put our minds at ease when we realized that she really cared for Noah (nearly as much as us- which is a tall order!).  The school mission statement reads:  St. John’s Episcopal School shall provide an enriched academic program that emphasizes the development of each child’s potential within a caring and Christian environment.  Noah was placed Ms. Westervelt’s (ahem, Mrs. Sitzes) class PK4 class.  Mrs. Sitzes and the rest of the SJES staff nurtured Noah’s mind but, more importantly, she ministered to his little soul.  We couldn’t have asked for anything more.


Lakeland Christian Academy

Since we were new to the area, we chose Lakeland based on recommendations from friends, Trey and Stephanie Suire (@foodfit4real).  Because we were only looking for a place for our 1 yr old daughter, there were a couple of things we were looking for…fun and safety.  We have been very pleased with Lakeland and they have exceeded our expectations.  Hannah had some initial separation anxiety but has since blossomed into a little girl who can be put down and runs into the room to Mrs. Sharon and her friends.  We were very impressed on orientation day to hear that Lakeland has made some parents or caregivers really mad (who were not the normal pick-up parent) by making them prove who they were before letting them leave with the child.  My babies safety chosen over making some grumpy dad mad…ummm, yes please.

Montessori Episcopal School

This was another situation where we had to rely heavily on the recommendation of friends.  Several different people mentioned MES as a great place so we had to check it out.  Rachel was struck as she toured the school by how much joy there was all around.  From the headmaster to the front office staff but, especially after we met our child’s teacher, we could tell that MES was a place where children where enjoyed, not simply tolerated.  He is missed when he does not make it there and celebrated when he is.  They provide a unique blend of Montessori education with some structure that we think serves our children well in preparing them for their future transition to Kindergarten.

Dr. Justin Smith’s daughter currently attends Lakeland Christian Academy and his son attends Montessori Episcopal School.  Look forward to seeing the Newborn Baskets that he and @mrsdocsmitty have created for the upcoming silent auctions.  He will be seeing patients in the Cook Children’s Lewisville office every Tuesday afternoon until June, when he will transition to be working there full time, 5 days a week.

You can find out more about him through this blog, or through his Facebook and Twitter accounts (click links for details).

Wear Blue Today! -Child Abuse Prevention Month

4 Apr


Photo credit: (Almost) 5 year old

April is National Child Abuse Prevention and Awareness Month!

April 4 is wear blue today to bring awareness to the cause.

Remember that there are 4 different kinds of child abuse: Physical, Sexual, Emotional Maltreatment and Neglect

If you have any concerns about a child there are 2 main ways to report:

1)     Call 1-800-252-5400 (or 911 if imminent danger)

2)     Online at

There are lots of different things I could write about child abuse.  I served on the Child Advocacy Center board for Abilene for 3 years while I lived there.  I have heard countless stories of children who were abused.  It is both heartbreaking and devastating. 

I usually don’t like to give wrote statistics and lists because I feel that the power of storytelling is much more compelling.  However, this is a case where, if you take your time and ponder, you can feel the gravity of the situation by see what effects are caused when a child is abused.  As you read each consequence think about how each one would affect the child’s long-term future:

Effects of Abuse and Neglect (from

Child abuse and neglect extorts an enormous toll on society and greatly impacts the victims in numerous ways. The stress, trauma and persistent fear that occur at an early age from the result of child abuse causes children to have lifelong health, psychological, and behavioral consequences.

Physical Health Consequences:

  • Impaired brain development 
  • Poor overall physical health 

Psychological Consequences:

  • Poor mental and emotional health 
    • Depression, attachment disorders, anxiety, PTSD, panic disorder, anger, ADHD, dissociative disorders as well as many others. 
  • Cognitive and learning difficulties 
  • Language delays 

Behavioral Consequences:

  • Delinquent behavior 
  • Adult criminality 
  • Drug and alcohol abuse 
  • Teen pregnancy 
  • Abuse behavior 
  • Inappropriate behavior in relationships 
  • Difficulty with social interactions 

Abused children are:

  • 6 Times more likely to commit suicide 
  • 24 Times more likely to commit sexual assaults 
  • 6 Times more likely to abuse their own children, perpetuating the cycle of violence 
  • 25% more likely to experience teen pregnancy 
  • 25% more likely to abuse drugs or alcohol 
  • 59% more likely to be arrested as a juvenile 
  • 28% more likely to be arrested as an adult 
  • 30% more like to commit violent crime 

Persons who experienced childhood abuse and neglect have:

  • 4 to 12-fold increased risk for the leading causes of death in adults such as cancer, heart disease, stroke and diabetes due to high risk coping behaviors such as alcohol, drug abuse, smoking and over-eating.

So, what can you do?

  • Volunteer or donate a local Child Advocacy Center (click the link to find the one near you)-CACs need many things.  They have a local board that serves to educate the community about child abuse and provide awareness through local media and marketing campaigns.  CACs often provide toys and other items to children who have come into the center for an interview.  Contact your local CAC to see what items they may need.
  • Be aware of signs and symptoms of child abuse and pay attention to children you come into contact with.  Child abuse is not limited to any type of child: race, financial status and level of parent education do not make any child immune to abuse.  If you see something that concerns you, please make a report.
  • Become a foster or adoptive parent.  Identifying abuse is one thing.  The goal is always re-unification with their parent or another family member but this often takes time.  The children have to be placed somewhere while CPS works with the family to develop a safe plan for the child to return home.  Here is an online resource where you can find out more about the program.

“Just” Suvir and Jack-Saving US Government $400 Million and Helping to Detect Pancreatic Cancer

3 Apr



Photo credit: and

Another addition to the Masters in Parenting Series: Critical Thinking

Oh yeah, they were only 14 and 15.

Suvir Mirchandani could have been you 14 year old neighbor.  He could’ve been the kid who entered his 6th grade science fair project that took pictures of a plant roots and put them up on a poster board.  He could have been, but he wasn’t.  Instead, he was interested in finding ways to use computer science and technology to help with environmental sustainability.  He made 2 “simple” realizations: he was getting more handouts and printer ink is expensive.  He set out to discover if he could use these two facts to save the use of ink (and his school some money in the interim).  Comparing fonts, he discovered that simply by changing the font he could decrease his school ink consumption by 24% (which would save his school $21K).  He then went on to extrapolate his data to the US government and estimates that they could save upwards of $400 million.

Jack Andraka could have been your other 15 year old neighbor.  He could’ve been the kid who was sitting in biology class, barely paying attention and focusing only on what he needed to pass (or make an A).  He could’ve been, but he wasn’t.  Instead, he was connecting the dots and went on to design a “design a cheaper, more sensitive cancer detector.”  You can watch him talk about his discovery at his TEDx video.

It’s hard to know what sets a child on a path to becoming like these 2 remarkable young men.  I don’t know them but I’m sure there are some qualities in them that make them different from other teenagers their age: IQ points and high internal motivation are certainly likely.  But one thing seems certain; they both think and make deep observations about what is going on around them.

What is Critical Thinking?

Wikipedia lists 10 different definitions of critical thinking.  I think the best one for our purposes is: “the process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion (from”

The main takeaway is that it’s not just about taking information and regurgitating it back onto a page and getting an A on the test.  It requires taking in information, dwelling on it, combining it with other information you already know and coming up with an answer that goes beyond the information that was presented to you in the first place.

Many of the important skills for critical thinking are described with a set of learning objectives in education known as Bloom’s taxonomy.  The Duke TIP website has this amazing table of the learning objectives:

As you move your way down the list, you get to higher and higher levels of thinking.  If you want your child to think critically, you need to ask questions and help them travel down towards analysis, synthesis and evaluation.  If you start to do this when your child is 14, they won’t hear you because they’ll have headphones in or be distracted by their text messages.  If they do hear you they’re likely to think that you’re acting really weird.  You have to start thinking about this early.

4 Tips to Help Your Elementary Age Child Think Critically

Think critically yourself.  If all you ever do is watch reality TV and talk about your work like it’s boring and brainless, you can’t expect much more of your children.  Read a book and actually think about and apply what’s in it (comprehension).  Make observations about the world around you with your kids (analysis).  Talk through how you got from thought A to thought B or, better yet, make them guess how you arrived there (synthesis).

Ask them about their school day.  Don’t accept, “Fine.”  Ask, “What did you learn in math class?  How can you apply that to your life or to a real world situation (application)?”  Help them connect subjects together and draw observations relative to both (synthesis).  Ask what their favorite subject of the day was and why (evaluation)-and don’t always accept the same answer.

Read with them.  But don’t sit there and read in a monotone “let’s get this over with” tone.  Add inflection and excitement to the words.  Stop and ask, “What do you think this character is thinking/feeling right now (comprehension)?  What do you think the solution to their problem is (analysis, evaluation)?”

Encourage them to ask questions.  But more than just the theory that you encourage them to ask questions.  You can’t just let them ask you something while you stare at the phone and say “Uh-huh…hummm…uh-huh.”  You have to engage.  Sometimes you have to say, “That’s a great question.  I don’t know the answer but let’s look it up together.”  When they’ve asked the 1000th question and you’re at the end of your rope, you have to say, “I love the way you are so curious.”

Let’s help our kids be critical thinkers.  Maybe your child will be the next Suvir or Jack.

Head Lice-My Head Will Itch All Day Just From Writing this Post

27 Mar


Pic from A.D.A.M.

Since I went after school attendance policies on the blog, I thought it was time to discuss another school attendance issue.

It’s that dreaded phone call that no parent wants…or that dreaded sign on the door/letter in the backpack that gets everyone wondering…who’s the one in the class that should be pointed out and mocked: “Unclean, unclean!”?

“You’re child has lice and they need to be picked up and treated before they come back.”

“This letter is to inform you that an individual in our childcare center/school has head lice.”

A recent article on got me thinking about my experiences treating head lice in the clinic and my exposure to lice policies in schools.

Top 7 Myths About Head Lice

  1. Head lice are a problem of people with poor hygiene-Simply not true, anyone can get them…even your child-Mom who washes their kids hair twice a day.
  2. Head lice can carry other diseases and spread them person to person-Body lice can but head lice do not.
  3. Head lice are very contagious-Head lice can’t jump or crawl so it actually takes pretty extensive contact to spread them from person to person.
  4. Head lice are easy to diagnose-The little guys move away from light and do it pretty quickly.  If you see a bunch
  5. There is a test for diagnosing lice-You just have to find one alive on the scalp.
  6. Head lice can be spread to and from the family pet-Good news, Rufus doesn’t have to go to the pound.3
  7. Everything the school nurse or parent or grandparent calls head lice needs to be treated as head lice-I often can’t find anything but dandruff in kids that have been in and out of school for months with head lice.

So, what do you do when your child has lice?

Treat them and don’t freak out…

The most common, easiest and cheapest treatment is over-the-counter permethrin.


  1. Wash hair with non-conditioning shampoo.
  2. Apply product to damp hair.
  3. Leave on 10 minutes and then rinse off (in a sink to prevent exposure to other skin).
  4. Repeat process in 7-10 days.Image

Combing nits out of the hair is not necessary but you can if you want because they gross you out.  You can buy one of the cheap-fine tooth combs when you get your shampoo or you can buy the MagiComb (I guess the equivalent of the battery powered snot sucker and not available right now, sorry.)  Wow!  This one is even better…an electronic bug zapping comb, the RobiComb Electric Lice Zapping Comb (I do not actually endorse this product so please don’t waste your money).

Other Tips:

  • Check everyone in the house for lice or nits and treat anyone who is affected.
  • Change pillowcases and sheets (risk or transmission is fairly low (4%) but why not?
  • Vacuum floors, couches and other fabrics.

Shout Out and Advice for my School Nurses:

The AAP is very clear on what school policy about lice treatment should be.

  1. Children should not be sent home on the day of diagnosis (They have probably already had it for months and a few more hours won’t hurt-They should go back to class and avoid head eskimo kissing other children).
  2. Children should be allowed to return to school, even if nits are present.  In the AAP policy it states, “No child should be allowed to miss valuable school time because of head lice.”
  3. You can be the voice of calm when everyone else (parents, teachers and administrators) is freaking out.  Remind everyone involved that it’s not an indictment of poor parenting for a child to have lice.

So, keep calm and try not to itch your scalp the rest of the day after seeing this…



Sneezing-Help in a Flash

24 Mar

Image    Image    Image

It’s so annoying walking outside on a sunny day and being attacked by a fit of sneezing or when your 2 yo is watching Thomas the Train and has a complete meltdown “I got BLESS YOU all over my Kindle.”

Why do children sneeze?

  1. To clear irritants out of the nose (stimulation of hairs in nose)
  2. Allergies (as a result of histamine)
  3. Sunlight (a genetic reflex in ~20% of people)
  4. Just because (sneezing in newborns is common for no apparent reason)

People commonly list sneezing as a concern for their children during visits.  Unfortunately, it’s not a very helpful symptom in getting to the bottom of what is going on.  Sneezing by itself is not an illness and when there is an underlying cause you can usually tell by all the other things that are going on…

If you want to treat sneezing each of the causes does have a cure:

  1. Help the child learn to blow their nose
  2. Give your child an antihistamine (we use Zyrtec or Claritin)
  3. Never go outside
  4. Don’t have a baby

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