HEAVY METALS FOUND IN POPULAR FRUIT JUICES

Nearly half of 45 fruit juices tested had elevated levels of heavy metals, which can pose health risks for children and adults, Consumer Reports has found.

The report, released Wednesday, says that even small amounts of juice might hold risks.

"In some cases, drinking just 4 ounces a day — or half a cup — is enough to raise concern," James Dickerson, PhD, chief scientific officer for CR, says in the report.

If anything, the results simply reinforce existing concerns about fruit juices.

"I don't think we need to say you can't give your kids any juice," says Steven Abrams, MD, a professor of pediatrics at Dell Medical School, University of Texas at Austin. But, he says, "juice is not a product that is intrinsically healthy for children." He co-authored the American Academy of Pediatrics' guidelines on juice, which set limits by age.

Meanwhile, juice producers say the report needlessly alarms consumers.

How Was the Testing Done?

Consumer Reports experts tested 45 juices made by 24 brands, including well-known and lesser-known brands such as Gerber, Minute Maid, Mott's, Great Value from Walmart, Clover Valley from Dollar General, and Big Win from Rite Aid. Those tested included organic products, too, as well as store brands from Whole Foods and Trader Joe's.

In the report, 24 products are listed as ''better alternatives."

Still, all but one of the juices in the Consumer Reports tests had inorganic arsenic levels below the FDA’s proposed limit of 10 parts per billion, and 58% had levels below CR’s recommended cutoff of 3 ppb. Trader Joe's Fresh Pressed Apple Juice was the only product above the 10 ppb threshold. CR says its tests found three samples averaged 15.4 ppb.

There is no scientific evidence indicating that the presence of trace levels of heavy metals in juice has caused any negative health outcomes among individuals at any life stage.Patricia Faison, technical director of the Juice Products Association

What Are the Health Risks From Heavy Metals?

Depending on how much and how long the exposure is, heavy metals can pose risks to children and adults. Risks include a lower IQ, behavior problems such as attention deficit hyperactivity disorder, type 2 diabetes, and cancer, among many other health issues, CR says.

Experts worry about accumulated heavy metals not from only juice, but other sources. They are found not only in food and drink, but throughout the environment; plants absorb the heavy metals from contaminated soil and water, CR says.

What Does This Mean for Children and Adults?

The best advice about serving juice to children is to limit it, says Abrams, who is also director of the Dell Pediatric Research Institute. Broaden their choices, he adds. "Don't use only apple or orange."

Among the misconceptions among parents, he says, is that organic juices are lower in heavy metals. Not true, he says. "Families should not assume that choosing the organic label guarantees being free of toxins."

He also discourages serving children juice from juice boxes or pouches. "Kids will tend to sip on it, and they get a lot of juice sitting on their teeth [risking cavities]. It's convenient, I get that. But I think they tend to drink more."

What Do the Juice Manufacturers Say?

In a statement, Patricia Faison, technical director of the Juice Products Association, an industry group, accused Consumer Reports of raising unnecessary concern.

"There is no scientific evidence indicating that the presence of trace levels of heavy metals in juice has caused any negative health outcomes among individuals at any life stage," she says.

"The juice industry is committed to providing safe, high-quality nutritious juice that meets or exceeds regulations established by the U.S. Food and Drug Administration (FDA) for food safety."

Producers of juice also conduct their own testing, Faison says.

Gerber also responded, saying in part: "At Gerber, we always go the extra mile to provide high-quality and safe nutrition for little ones. When it comes to our juice, this means regular testing of our ingredients, water and finished juices, working closely with our farmers to reduce and limit contaminants, and using some of the most precise analytical equipment and test methods available."

Sources:

Consumer Reports: "Arsenic and Lead Are In Your Fruit Juice: What You Need to Know."

Patricia Faison, technical director, Juice Products Association.

Cathy Dunn, spokesperson, Nestle.

Steven Abrams, MD, professor of pediatrics, Dell Medical School, University of Texas at Austin; director, Dell Pediatric Research Institute.

American Academy of Pediatrics: "Fruit Juice in Infants, Children, and Adolescents: Current Recommendations."

They focused on levels of cadmium, lead, mercury, and inorganic arsenic, saying that these elements pose some of the greatest risks and that research has found they are common in food and drink. The juices tested were apple, fruit blends, grape, and pear.

The new testing was done as a follow-up to a study in 2011, when CR found elevated levels of inorganic arsenic and lead in apple and grape juices. The new evaluation was done to see if there's been improvement, to test other juices, and to test for other heavy metals.

What Are the Major Findings?

Overall, CR says, heavy metal levels in fruit juices have declined since their last testing. But in the new report, every juice contained at least one of the four metals tested, and 47%, or 21, had concerning levels of cadmium, inorganic arsenic, and/or lead. None had concerning levels of mercury. Other major conclusions:

• Seven of the 21 had enough heavy metals to potentially harm children who drink a half-cup or more a day, and nine of the 21 held risks for kids drinking a cup or more a day.
• Ten of the juices posed a risk to adults, too: Five were potentially hazardous at a half-cup or more a day, and five at a cup or more a day.
• The highest heavy metal levels were in grape juice and juice blends.
• Organic juices did not have lower heavy metal levels than non-organic.
• 
  
  In the report, 24 products are listed as ''better alternatives."

  Still, all but one of the juices in the Consumer Reports tests had inorganic arsenic levels below the FDA’s proposed limit of 10 parts per billion, and 58% had levels below CR’s recommended cutoff of 3 ppb. Trader Joe's Fresh Pressed Apple Juice was the only product above the 10 ppb threshold. CR says its tests found three samples averaged 15.4 ppb.

  There is no scientific evidence indicating that the presence of trace levels of heavy metals in juice has caused any negative health outcomes among individuals at any life stage.Patricia Faison, technical director of the Juice Products Association

  What Are the Health Risks From Heavy Metals?

  Depending on how much and how long the exposure is, heavy metals can pose risks to children and adults. Risks include a lower IQ, behavior problems such as attention deficit hyperactivity disorder, type 2 diabetes, and cancer, among many other health issues, CR says.

  Experts worry about accumulated heavy metals not from only juice, but other sources. They are found not only in food and drink, but throughout the environment; plants absorb the heavy metals from contaminated soil and water, CR says.

  What Does This Mean for Children and Adults?

  The best advice about serving juice to children is to limit it, says Abrams, who is also director of the Dell Pediatric Research Institute. Broaden their choices, he adds. "Don't use only apple or orange."

  Among the misconceptions among parents, he says, is that organic juices are lower in heavy metals. Not true, he says. "Families should not assume that choosing the organic label guarantees being free of toxins."

  He also discourages serving children juice from juice boxes or pouches. "Kids will tend to sip on it, and they get a lot of juice sitting on their teeth [risking cavities]. It's convenient, I get that. But I think they tend to drink more."

  What Do the Juice Manufacturers Say?

  In a statement, Patricia Faison, technical director of the Juice Products Association, an industry group, accused Consumer Reports of raising unnecessary concern.

  "There is no scientific evidence indicating that the presence of trace levels of heavy metals in juice has caused any negative health outcomes among individuals at any life stage," she says.

  "The juice industry is committed to providing safe, high-quality nutritious juice that meets or exceeds regulations established by the U.S. Food and Drug Administration (FDA) for food safety."

  Producers of juice also conduct their own testing, Faison says.

  Gerber also responded, saying in part: "At Gerber, we always go the extra mile to provide high-quality and safe nutrition for little ones. When it comes to our juice, this means regular testing of our ingredients, water and finished juices, working closely with our farmers to reduce and limit contaminants, and using some of the most precise analytical equipment and test methods available."

  Sources:

  Consumer Reports: "Arsenic and Lead Are In Your Fruit Juice: What You Need to Know."

  Patricia Faison, technical director, Juice Products Association.

  Cathy Dunn, spokesperson, Nestle.

  Steven Abrams, MD, professor of pediatrics, Dell Medical School, University of Texas at Austin; director, Dell Pediatric Research Institute.

  American Academy of Pediatrics: "Fruit Juice in Infants, Children, and Adolescents: Current Recommendations."

ORAL HYGIENE FOR BABIES AND TODDLERS

Training children to prioritize and practice good oral hygiene habits early can result in a healthy smile that lasts a lifetime. Even as the very first baby teeth begin to erupt through the gums around 6 to 8 months of age, the infant’s state of oral health has the potential to affect their future adult smile.

RISK OF DECAY STARTS EARLY.

The risk for decay increases as soon as the child’s first baby teeth appear. Some infants experience such severe tooth decay, that their teeth are unable to be repaired and must be extracted. This usually occurs when a baby is in the habit of being put to sleep with a bottle. Typically, the upper front teeth are most affected but decay can occur in other teeth as well.
When a baby tooth is lost prematurely due to accidents or oral decay, among other reasons, crowding and spatial problems can occur with the eventual eruption of the permanent teeth. The healthier the primary set of teeth stays, the less risk exists for the permanent teeth to “come in” incorrectly or experience decay. Consequently, prioritizing an infant’s oral health from the beginning can aid in preserving a healthy smile for decades.

TOOTH DECAY IS PREVENTABLE.MONTHS 

Tooth decay is preventable through practicing good oral hygiene and visiting the dentist regularly and as recommended! It is recommended that parents take their child to the Pediatric Dentist within 6 months of the eruption of their first tooth and no later than their first birthday. The Pediatric Dentist will advise the parents on how to care for their baby’s mouth, check for decay, and inform them of any possible problems.

CLEANING YOUR INFANT OR TODDLERS TEETH.

Oral hygiene practices change and increase with age so here are some tips to caring for your child’s dental heath from birth through toddlerhood.
BIRTH TO 6-MONTHS:
Dental hygiene begins at birth. Implementing healthy habits from the start can make all the difference in reducing and preventing tooth decay in infants and kids. Clean an infant’s gums lightly after every feeding with a moistened washcloth or damp clean gauze pad. Never put a baby to sleep with a bottle, prop a bottle in a baby’s mouth, or let a baby feed “at will.” As dental decay is a communicable and infectious disease, try not to ever test the temperature of a bottle with your mouth. Also keep from sharing utensils or washing a pacifier or bottle nipple by putting it in your mouth. Sticking to these practices helps stop the spreading of bacterium that generate tooth decay.
6 TO 12 MONTHS :
Usually the first tooth erupts through the gums between 6 and 8 months of age. Practicing increased healthy habits from the moment teeth begin to appear, once again, reduces and prevents the chance for tooth decay. After feeding, continue to clean the infant’s gums with a wet washcloth or clean damp gauze pad. As the infant begins to eat more solid foods and is able to drink from a cup, start weaning the baby from the bottle one step at a time. Usually by 12 to 14 months, babies can drink from a cup, so it is a good idea to start slowly offering them cups of water or juice instead of a bottle at that time. At this point, do not allow the baby to walk

 around carrying his/her bottle, and practice healthy habits by restricting the amount of sweet food and beverages the child consumes.
It is also important to know what the normal appearance of a child’s gums and teeth look like. Regularly check for new small white or brown spots on the child’s teeth, which may indicate tooth decay. If any questionable or strange looking spots of this sort appear, contact the Pediatric Dentist for an appointment immediately. Schedule the child’s first dental appointment at this stage, as it is recommended for a child to be examined by a Pediatric Dentist no later than the first birthday.
12 TO 18 MONTHS:
By one year of age, a child should undergo an oral examination by a Pediatric Dentist. At this stage, brush a child’s teeth for them twice a day with plain water. Keep checking regularly for suspiciou


s white or brown spots on the teeth, which can denote tooth decay, and make an appointment with the Pediatric Dentist immediately if any such spot are noticed. Also continue to avoid spreading decay causing germs to the child by refraining from any practices that might transmit saliva, such as drink sharing.

18- MONTHS TO 5-YEARS :

At 24 months, start brushing the child’s teeth twice a day with a pea-sized amount of fluoridated toothpaste. Make sure that the child does not swallow any of the toothpaste, and teach him/her to spit all of it out after brushing. Begin teaching the child how to brush his/her own teeth, but typically children need help until they possess the hand coordination to sufficiently brush their own teeth. Children should be capable of brushing without supervision around age 6 or 7. By 30 months, most of the primary (baby) teeth should be in, and by 3 years old toddlers should no longer be using their pacifiers and/or sucking their thumbs. If a child is over the age of 3 and regularly still uses a pacifier or sucks his/her thumb consult the Pediatric Dentist. At this point, the child should be visiting the Pediatric Dentist for regular checkups. Also remember to continue to check for suspicious white or brown spots on the teeth, which
may indicate tooth decay. Anytime uncharacteristic or suspicious spots appear in a child’s mouth, dentist should be contacted.white or brown spots on the teeth, which can denote tooth decay, and make an appointment with the Pediatric Dentist immediately if any such spot are noticed. Also continue to avoid spreading decay causing germs to the child by refraining from any practices that might transmit saliva, such as drink sharing.
18 months-5 years:
At 24 months, start brushing the child’s teeth twice a day with a pea-sized amount of fluoridated toothpaste. Make sure that the child does not swallow any of the toothpaste, and teach him/her to spit all of it out after brushing. Begin teaching the child how to brush his/her own teeth, but typically children need help until they possess the hand coordination to sufficiently brush their own teeth. Children should be capable of brushing without supervision around age 6 or 7. By 30 months, most of the primary (baby) teeth should be in, and by 3 years old toddlers should no longer be using their pacifiers and/or sucking their thumbs. If a child is over the age of 3 and regularly still uses a pacifier or sucks his/her thumb consult the Pediatric Dentist. At this point, the child should be visiting the Pediatric Dentist for regular checkups. Also remember to continue to check for suspicious white or brown spots on the teeth, which

 may indicate tooth decay. Anytime uncharacteristic or suspicious spots appear in a child’s mouth, the dentist should be contacted.

CHOLESTEROL --THE MYTH.

*Cholesterol* is finally officially removed from Naughty List
The US government has finally accepted that *cholesterol* is not a _nutrient of concern_. doing a U-turn on their warnings to us to stay away from high-cholesterol foods since the 1970s to avoid heart disease and clogged arteries.
This means eggs, butter, full-fat dairy products, nuts, coconut oil and meat have now been classified as *safe* and have been officially removed from the _nutrients of concern_ list.
The US Department of Agriculture, which is responsible for updating the guidelines every five years, stated in its findings for 2015: "Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day.
"The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology)
The Dietary Guidelines Advisory Committee will, in response, no longer warn people against eating high-cholesterol foods and will instead focus on sugar as the main substance of dietary concern.

US cardiologist Dr Steven Nissen said: _It's the right decision_. _We got the dietary guidelines wrong. They've been wrong for decades_."
"When we eat more foods rich in this compound, our bodies make less. If we deprive ourselves of foods high in cholesterol - such as eggs, butter, and liver - our body revs up .
The Real Truth about Cholesterol
The majority of the cholesterol in you is produced by your liver. Your brain is primarily made up from cholesterol. It is essential for nerve cells to function. Cholesterol is the basis for the creation of all the steroid hormones, including estrogen, testosterone, and corticosteroids. High cholesterol in the body is a clear indication
which shows the liver of the individual is in good health.
Dr. George V. Mann M.D. associate director of the Framingham study for the incidence and prevalence of cardiovascular disease (CVD) and its risk factors states: _Saturated fats and cholesterol in the diet are not the cause of coronary heart disease_. _That myth is the greatest deception of the century, perhaps of any century_
*Cholesterol is the biggest medical scam of all time*
There is no such thing as *bad Cholesterol*
So you can stop trying to change your Cholesterol level. Studies prove beyond a doubt, cholesterol doesn't cause heart disease and it won't stop a heart attack. The majority of people that have heart attacks have normal cholesterol levels.
OUR BODY NEEDS 950 mg OF CHOLESTEROL FOR DAILY METABOLISM AND THE LIVER IS THE MAIN PRODUCER.
ONLY 15% OF CHOLESTEROL IS BEING DONATED BY THE FOOD WE EAT. If the fat content is less in our food we eat, our liver
Got to work more to maintain the level at 950 mg. If the cholesterol level is high in our body, it shows the liver is working perfect.
Experts say that there is nothing like LDL or HDL.
…………..
….. *Cholesterol is not found to create block any where in human body*.
Please share the recent facts about CHOLESTEROL

NAMASTE,
DR PADAMJEET GULIA,
CONSULTANT PEDIATRICIAN.

THE LINK BETWEEN SCREEN TIME AND EYE SYMPTOMS IN KIDS.(GUIDELINES)

The guidelines from the American Academy of Pediatrics and the American Academy of Ophthalmology are based on consensus statements. We recommend that children under 18 months of age avoid all digital screen time, with the exception of video chatting with apps such as FaceTime, Skype, WhatsApp, and similar types of programs. This is to make sure that we are stimulating them with natural visual stimuli in order to support visual development.

For children aged 18-24 months of age, it is recommended that parents and families slowly introduce digital screen time to their children. Parents should be actively involved with what is being watched, monitoring what is being seen, and educating their children about the program and the content.
For children who are 2-5 years of age, we recommend limiting screen time to about an hour a day. It is important to remember that this includes TV, computer, iPad, tablets, iPhones, and other types of electronic programming, with the exception of video chatting. It is really important to try to make sure that parents are showing their children high-quality programming and are still actively involved in terms of what is being watched and teaching their children about what is being seen.

For kids age 6 years and over, the limits are a little less clear. We understand that it can be very difficult to limit screen time based on the amount of homework that is being prescribed and the time that children need to spend on the computer to successfully accomplish their schoolwork. With that being said, it is important to really encourage children to do other things with their time. We still recommend limiting screen time in general to 1-2 hours a day, if possible.
This is important because we know that adults develop symptoms associated with a computer vision syndrome when they spend excess time on the computer or screens of any kind. These symptoms include headaches, fatigue, and asthenopia. We would assume that children are at risk of developing these same symptoms. That is why these limits are in place.
Interestingly enough, these [recommended] limits and [expectation of types of symptoms that may occur] are not based on any hard and fast science. However, more and more research is being done that tells us there is probably a correlation between these symptoms and screen time. A paper published in 2017, found that children with more than 3 hours a day of total screen time are at a higher risk of developing asthenopia, headaches, motor tics, and potentially even refractive error.
This study was retrospective and observational, with a small cohort, and thus highlights the fact that we need more research in this area. We would really like to understand this a little better.
The flip side is that more work is being done examining the role of video games and dichoptic computer games to treat amblyopia which, for decades, has been treated with patching, eye drops, and glasses. I think this is an interesting area of research because children would much prefer to play a video game to having to wear a patch on their eye.
The research is showing us that all of these modalities used together potentially could treat amblyopia equally as effectively and improve compliance..

Namaste,

Dr Padamjeet Gulia,

Consultant Pediatrician,

www.thepaediatricin.blogspot.com

BLOOD PRESSURE; SIX SUMMER FOODS FOR MANAGING BLOOD PRESSURE.

HIGHLIGHTS,

 • Blood pressure is one of the most common conditions in India

 • All berries are loaded with heart-healthy compounds called flavonoids

 • Skimmed milk is rich in calcium and vitamin D helps reduce BP

Blood pressure is one of the most common conditions in India. It is said that one in every three Indians are suffering from hypertension and heart ailments. High blood pressure is a silent killer; in fact, according to the National Centre For Biotechnology Information (NCBI), blood pressure shows seasonal variation. It is the pressure exerted by the blood against the walls of the arteries. It tends to damage the body's blood vessels, thus causing kidney diseases, heart afflictions and other health problems. Blood pressure should be taken care of, especially during summers as it tends to fluctuate more often. We give you some expert tips on managing blood pressure with healthy summer foods.

"The hypertension diet should have foods with high magnesium, potassium and fibre content in it. They should be necessarily low in sodium."

Here are the summer foods for managing blood pressure;

1. Berries

All berries are loaded with heart-healthy compounds called flavonoids. The antioxidant rich fruit may help lower blood pressure, as per a study published in the Journal of the Academy of Nutrition and Dietetics. Add blueberries, strawberries, et al to your daily diet.

2. Skimmed milk

Skimmed milk is rich in calcium and vitamin D, two of which work as a team to help reduce blood pressure naturally. According to National Health Service, UK, drinking a glass of skimmed milk a day can cut blood pressure by upto a one third. So gulp down a glass of skimmed milk daily in order to reap maximum benefits.

3. Yogurt

According to a study presented at the American Heart Association (AHA), women who consumed five or more servings of yogurt a week had a lower risk of developing high blood pressure than similar women who hardly ever ate yogurt. So load up on chilled yogurt every day and enjoy a healthful life.

4. Watermelon

According to a study published in the American Journal of Hypertension, watermelon could significantly reduce blood pressure in overweight individuals both at rest and while under stress. The pressure on the aorta and on the heart reduced after the consumption of watermelon.

5. Bananas

This tropical fruit is super rich in potassium and even more easy to include in your daily diet. One banana provides one percent of calcium, eight percent of magnesium and 12 percent of potassium that you need every day.

6. Kiwi

According to a report presented in the American Heart Association (AHA), kiwis may naturally lower blood pressure. Three kiwis a day could keep high blood pressure at bay. So toss kiwis in your salads and stave off any risk of high blood pressure.

This summer, ensure that your blood pressure is regulated and well-maintained.

Namaste,

Dr Padamjeet Gulia,

Consultant Pediatrician,

www.thepaediatricin.blogspot.com

TOUCH SCREEN OF DEVICES AND CHILDREN

_*Use Of Touch Screen Of Devices By Children Hamper Their Growth Many Children Hamper Their Growth Many W_ays_ays**

.         Nowadays, Parents provide their toddlers and children to use mobile phones, tablets, computers and other gadgets where they use these touching their screen with their fingers, a new study has established that it leads to their holding capacity to hold a pen or pencil while writing by fingers as depicted in the attached picture. In fact, many parents use the tactic of giving their gadgets to their kids to them busy, while they go about their day without disturbance. Little do they know, that this habit is actually hampering their growth in a lot of ways. Confirming the same, UK doctors have explained how the excessive use of phones and tablets is preventing children's finger muscles from developing sufficiently, thereby making it increasingly hard for them to hold pens and pencils.
Children are not coming into school with the hand strength and dexterity they had 10 years ago," said Sally Payne, the head pediatric therapist at the Heart of England Foundation NHS Trust in the UK. "Children coming into school are being given a pencil but are increasingly not able to hold it because they do not have the fundamental movement skills," the researcher said. "To be able to grip a pencil and move it, you need strong control of the fine muscles in your fingers. Children need lots of opportunities to develop those skills," she said. "It's easier to give a child an iPad than encouraging them to do muscle-building play such as building blocks, cutting and sticking, or pulling toys and ropes," She quoted as saying by the 'Guardian'. The person, who runs a research clinic at Brunel University London investigating key skills in childhood, including handwriting, said that increasing numbers of children may be developing handwriting late because of an overuse of technology. "One problem is that handwriting is very individual in how it develops in each child," she said. "Without research, the risk is that we make too many assumptions about why a child isn't able to write at the expected age and don't intervene when there is a technology-related cause," she said. Although the early years' curriculum has handwriting targets for every year, different primary schools focus on handwriting in different ways – with some using tablets alongside pencils, she said.                             This becomes a problem when same the children also spend large periods of time on tablets outside the school.

ABUSIVE PATIENTS

Every clinic has their share of unhappy patients. Patients get upset for many reasons. They may not be getting better or the treatment is costing much more than they thought they would or they feel that the doctor's not paying enough attention to them; or that they have to wait too long; or that the staff is unfriendly. This is quite natural. After all, no one likes being sick, and no one enjoys spending money in a doctor's clinic. The outcome of any treatment is uncertain, and when you are sick, your head and your heart often don't work properly. Every little incident can upset you, and you often need to vent. While you may want to scream at the doctor, you are too scared to do this ; and in any case, the doctor is not easily accessible. This is why angry patients will often use the clinic staff as their punching bag . The staff is often at the receiving end of the patient's ire, no matter what the underlying reason for his anger may be. This can be hard for the poor clinic staff, because they have to put up with a lot of emotional abuse for no fault of theirs. Even worse, often the doctor will also take the patient's side because he doesn't want to upset his paying patients. It can be extremely hard to listen to a lot of rubbish from an angry patient when you are not at fault. We doctors need to learn to empathise with our clinic staff because they have an extremely difficult role to play. We need to support them and teach them that when a patient starts shouting at them, they need to keep their cool and not treat this as a personal insult. An angry patient needs to release his bile, and the clinic staff is the easiest target, which is why they often will be at the receiving end of verbal abuse. Yes, it's not fair on them, but they need to learn not to take any of these insults personally. It's hard to have to listen to the emotional tirade of an abusive patient, but just because a patient is throwing a temper tantrum, there's no need for them to lose their temper - this will just escalate the problem, and make matters worse. If the staff listens to them patiently, most patients will come to their senses, and will apologise when they realise how badly behaved they have been. When confronted by an irate patient, your staff need to behave in an extra mature fashion. They should feel sorry for the poor patient , who is unhappy and scared, and is expressing his emotions in an immature fashion. When a child throws a temper tantrum, a parent doesn't respond by having a temper tantrum himself. He understands his child's emotional distress, takes a deep breathe, cools down, and tries to get the child to see reason. This is exactly what the clinic staff needs to learn to do when a patient is angry. It's not easy, but it's a skill which can be learned, and the doctor can help them to do this. Your staff needs to have the confidence that you will back them up. If you learn to be a role model of patience and forbearance, your staff will also learn to behave in the same fashion.