July 10, 2009


Let's be completely clear on this: we don't learn to like sugar. We are born with chemical receptors on our taste buds that, when they are contacted by sugar, send a signal directly to our brains. That signal does many things, including giving us a sense of well-being and relief from discomfort.

As an aside, the lab where I used to work has helped to figure out the truth about our taste buds. A brilliant scientist I worked with explains on her website that what we were taught about certain tastes having specific locations on the tongue (like sweet in front and bitter in the back) is bunk. Part of the most recent research on taste shows that there is a large genetic component to what we can and can't taste. Though our taste sensitivities can change during our lifetime, it seems that we are all born with a basic toolbox.

In the hospital, we have been using sugar water to help sick babies get through painful procedures. It really seems to help. While giving kids sugar water in the office isn't standard procedure, I think there is a medical benefit to some of the lollipops I give out.

I have posted before about 'concrete thinking' and the inability of children at certain developmental stages to predict the future and prepare for it. So an empathic approach to a child who has just had an immunization or had a splinter removed required us to see that the procedure came as an unpleasant surprise to them. They have a normal physiologic response to a sudden and unexpected painful event: shock. (It's not as bad as the shock we go into when we have an overwhelming infection, or some other really serious medical problem.) Our blood pressure drops, we feel weak, our hearts race, and our blood sugar goes haywire. In the intensive care unit, careful management of a shock victim's blood sugar can be very helpful.

After an unfortunate surprise, the lollipop causes a brief little rise in blood sugar. From a lollipop, the sugar is absorbed directly into the bloodstream through the tongue and mouth, and doesn't have to get through the digestive system, which would be much slower. So I think they get some quick pain relief like the babies as well as a rise in their blood sugar that really seems to make them feel better.

This is why I don't give out sugar-free lollipops. They just can't work the same way. (In fact, I do have some that are sugar-free for my diabetic patients. I keep them in a cabinet.)

Each Dum-Dum lollipop has less than 25 calories. Even for a kid, this isn't a significant risk for weight gain. To gain a pound, we'd have to eat about 150 of them. One lollipop will not cause tooth decay.

And, of course, there are behavioral aspects of giving out the lollipops. They are an incentive to clean up the toys at the end of a visit and something nice about going to the doctor.

(A lot of parents are concerned that the lollipop will worsen their child's hyperactivity. I have a post coming up that deals with this issue specifically.)

Most of the children in my office are not getting any kind of painful procedure. It's for them that I think the lollipops are most important. It's a reward for good behavior, a way of noticing that they did everything right (or even mostly). It is one of the great failures of parenting that we don't catch our children being good. We point out, sometimes angrily, when they don't do what we want. But somehow we have the irrational expectation that when they're doing what they should, they are somehow rewarded for it. In fact, the child can often feel that you're not noticing them being good, but their misbehavior really gets your attention. In my office, I notice their good behavior, explicitly point out one or two things they did that were good, and reward them for it. Since I can't give them the most treasured reward—a parent's attention—I have to get by with candy on a stick. Besides, they taste really good.

The photograph at the top is from my collection and is by Weegee.


  1. What about parents who are behaving well? Can they get lollipops, too? And maybe chocolate for those who are really behaving themselves?

  2. Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts.


Please let me know what you think. Do you know a child or situation like this?