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Daily Dose

Helping A Child Deal With Death

1.15 to read

I had an e-mail today from a friend who has an elementary school aged daughter. She had just found out that the father of one of her daughter’s classmates had died, and she was concerned about talking to her own daughter about the death.I had an e-mail today from a friend who has an elementary school aged daughter. She had just found out that the father of one of her daughter’s classmates had died, and she was concerned about talking to her own daughter about the death.

They have been fortunate that no one in their own immediate family had died, and therefore she had never really discussed death with her daughter. I could sense that she was dreading the discussion, just as much as some parents dread discussing sexuality with their children. Interestingly, both of these issues are “facts of life”. Death is a reality for everyone, but children come to understand death in different stages, which are appropriate for their age and development. There are often occasions to discuss death with children even before the death of a relative, or friend, such as “the plant died”, “ the bug got smashed and died” or the squirrel was hit by a car and died”. You may not even realize it but young children have some concept about death from hearing those simple facts. Over time the discussion about death becomes more detailed. Whenever you have to have a discussion with a child about death it is sad. Even very young children feel sad and grieve, but in different ways than adults. When beginning the discussion about death it is appropriate for a parent to start off with a statement such as “Mommy has some sad news.” or “daddy and mommy have been talking about your Uncle Bill being seriously ill and we are worried that he might die”. Do not avoid discussing illness and death, as children are more fearful of the unknown than having the truth told to them, in an age appropriate manner. It is also important that you do not use terms like “went to sleep” or “went away” or “passed on” as you do not want your child to fear going to bed to sleep or be concerned that you will “go away” and not return. Just like discussions about sexuality and the body, use appropriate terms related to dying. Younger children may not understand the finality of death and have “magical thinking” that the person will “wake up” or come back later on. It is not until children are about six to nine years old that they comprehend death and the permanence of death. Be truthful and honest with your child and try to explain death in concrete terms that a child may understand, by telling them “that your heart no longer beats” or “a person doesn’t breathe anymore”.  At the same time, it is important to keep the conversation brief and simple in order that children may listen and then ask questions. Answer their questions to the best of your ability, and if you don’t know an answer you can say, “I just don’t know”.  Some of this may be related to your own religious beliefs. It is a balance between avoiding giving too much information and also encouraging your child to express their feelings and to reassure them of their fears. Unfortunately, most parents will have to have discussions about death on more than one occasion. The discussion will change a bit each time, as children get older and the circumstances surrounding a death may be more complicated. There are also many great books to read with your child. My favorite for a younger child is “Heaven Has a Floor”, by Evelyn Roberts.  I still read this and am comforted by the story. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Sudden Cardiac Death In Young Athletes

1.30 to read

I received a question via iPhone App from a mother who was concerned about the recent discussions in both the media and in the medical community surrounding sudden cardiac death (SCD) in young athletes.

Each year between 10–12 million kids in the U.S. participate in sports.  The tragedy of a sudden death in an otherwise  “presumably healthy” child causes not only sadness, but concern as to how the death might have been prevented. Doctors are often asked, “isn’t there a test or something to prevent this? “.

Depending on the studies I have read, the sudden cardiac death of a child or adolescent accounts for about 100 deaths a year in the U.S.  The prevalence rate for sudden cardiac death is 1:100,000- 200,000 and is higher among males than females.  Statistics show that 90% of these sudden deaths occur immediately post training or competition with football and basketball having the highest incidence.

In 2007 the American Heart Association came out with guidelines to evaluate athletes who may be at risk for sudden cardiac death. The most important screening mechanism has been found to be the “gold standard” in medicine, a thorough history and physical exam. The history that should be taken on any athlete who is being screened for sports participation should include a history of any unexplained or sudden death in a family member. Are there any family members with unexplained fainting episodes or seizures? Are there family members who had unexplained deaths (drowning or single car accidents)?   Are there any family members with a known genetic disorder that predisposes to sudden cardiac death?  The history should also ask about any fainting (syncope) in the athlete.

After a good history is taken (which should be updated yearly), the child/adolescent needs a complete and thorough physical exam. This exam should include blood pressure measurements, and a careful cardiac exam looking for new murmurs.  Symptoms such as palpitations during exercise, visual changes, fainting while exercising or immediately after exercise, and chest pain should all warrant further evaluation. Studies show that about half of pediatric patients who succumb to sudden cardiac death had experienced a warning sign. 

There are about 20 causes for SCD, with the most common causes being hypertrophic cardiomyopathy, anomalous coronary artery, and myocarditis. While some may advocate routine EKG screening and echocardiograms on athletes (this is done in Italy), many studies have been done which show that it would take the screening of 200,000 student athletes to prevent 1 death.   At the same time you will certainly identify some children with clear risk factors for SCD, but for every positive finding there may be 10–20 athletes who have “borderline” or questionable findings that would require even more expensive follow up. These pediatric patients might also be told they cannot participate in sports during the evaluation time and some might be told that they cannot participate even if they were not found to have disease, but were excluded just due to liability concerns. 

There does not seem to be one right answer to this issue. If your child is going to begin competitive sports make sure to see your pediatrician for a complete physical exam including a good family history.  Also advocate that your school have automatic external defibrillators viable at all times and personnel that know how to use them. That's your daily dose for today.  We'll chat again tomorrow.

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Daily Dose

Binge Drinking Numbers Rising!

Binge drinking and alcohol use among teens continues to rise. A college freshman as already died from alcohol poisoning What parents and teens need to know. Colleges are gearing up for finals, high school prom and graduation season is underway and the incidences of binge drinking continues to climb.  Why put these topics in the same sentence?

Underage and excessive drinking by high school and college students has been recognized as a problem for a long time, but recent studies only confirm that binge drinking continues to rise.  One report from a 2002 task force on drinking stated “abusive drinking by college students is widespread, dangerous and disruptive.”  Drinking excessively is associated with date rape, unintentional sex (is that an oxymoron), violence and poor academic performance. What is binge drinking? By definition it is drinking “five or more drinks in a row for men, and four or more drinks in a row for women.”  But this definition does not take into account length of time in which the alcohol is consumed or a person’s body weight. A better definition now defines binge drinking as “a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent or above.“ This typically occurs within a two hour window of excessive drinking. Underage drinkers typically tend to drink on fewer occasions than their older peers but have more alcohol related problems than students of legal drinking age.  Sadly, more than 1,700 college students age 18-24 die each year from unintentional alcohol related injuries and more than 5,000 underage youth die from alcohol misuse. Another alarming statistic is that an underage youth dies in an alcohol related incident every two hours! So with these sobering statistics at hand , it is incumbent that parents begin educating their children, even at early ages, about alcohol use and misuse. Our children need to know that alcohol is a legal psychoactive drug that changes brain chemistry and may have long term effects on the still maturing teenage brain. Alcohol effects both the pre-frontal cortex (the brain’s chief decision maker) and the limbic system.  MRI studies on youth from 14-21 years of age who are frequent (that is scary) alcohol drinkers show definitive changes in both of these areas. Due to the fact that a teen’s brain is still developing, it is surmised that there might be permanent physiologic and psychological damage to an adolescent brain from early alcohol abuse.  There are ongoing studies looking at whether this damage is reversible. Teens also need to know that while alcohol is a “drug” it too may cause over-dosage and death similar to other drugs. Many teens do not realize that you can die from binge drinking. No, not in a car accident or from falling out of a window, but due to the central nervous system depression from high blood alcohol levels, that then “turn off “ vital areas in the brain resulting in coma and death. Talk to your teens about the signs of “alcohol over-dosage”, which may include vomiting, cold and clammy skin,  shallow breathing and unresponsiveness.  Letting a friend “sleep it off” after a night of heavy drinking is never the right idea. A good resource for parents to help educate their teens and college students about binge drinking is www.gordie.org. They have recently released an app The Gordie Check that reviews the signs of alcohol poisoning, stores emergency contacts and can help locate nearby medical facilities or call 911.  Pass this on to your college students (and high school students for that matter). Lastly, as binge drinking continues to rise among high school and college students, and more youth are reporting drinking in their early teens,  it is incumbent that parents discuss their views on underage drinking and also model the behavior they want to see in their children. In other words,  teach your children about responsible drinking when they become of age. When talking to my teenage patients about alcohol they often comment to  me “ Dr. Sue why don’t you talk to my parents about coming home drunk” and then they can talk to me!  Truer words could not be spoken. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Saying Goodbye to a Beloved Family Pet

I had been dreading writing this daily dose. Our beloved golden retriever, Maddie, died this week.

We are a “dog family” and throughout our marriage and raising our children we have been blessed to own two very special dogs. I really believe that children need pets, and we had one of everything (gerbils, snakes, hamsters, cats) while raising our children. The first dog, a precious mutt named “Mrs. Brown”, was given to us by my brother who is a vet. While I was finishing my pediatric residency and pregnant with our first son, my brother treated a stray dog that had been hit by a car, and was brought into his animal hospital. The woman who found the dog was named Mrs. Brown, and she insisted to my brother that she wanted to pay to have the dog treated, but was unable to take yet another dog home. Over the course of the dog’s treatment my brother became attached to the sweet mutt, but he was a bachelor living in a small apartment, and really had nowhere to put a dog. So…. after calling us about the dog, and insisting that we would love her, despite our protestations, my brother drove the dog from his Houston clinic to our small home in Dallas. He really only called us because we had a fenced in yard!! I came home from the hospital after being on overnight call, to find my brother and a very “ugly” skinny, black and white dog ensconced on my sofa. The dog, who was now named, Mrs. Brown, moved in and as they say, the rest is history. She was the best dog, smart, never chewed, had accidents and adored our newborn son. They grew up together and she later welcomed the next two boys. She was like Lassie throughout their childhood. She followed them when they went to play, walked with them to school and as they got older she was “just one of the boys”. She was good until the day she died when we estimated her to be about 14 years old. We were all grief stricken and that is one of the first times that our children really had to deal with death. We swore we could never have another dog like “MB”. It took us about a year, and then we all knew we were ready for another dog. This time the boys decided that they wanted a BIG DOG. After much research and numerous “fights” among the boys, we decided on a golden retriever. Being the only female in the family, I insisted that we get another female dog. On the first trip out to “look at puppies”, as my husband reiterated to all of the boys that we were “not buying the first puppy we saw”, of course we returned home with Madrid (named for a son’s recent trip to Spain), a eight-week-old golden retriever. She too became the love of their lives; although I remember a lot of puppy training, house training and chewed chairs and shoes (always the most expensive) during her first several years. But with age and a lot of “school” she grew into yet another perfect family dog. As each son left home, Maddie seemed to know that she became even more special, as we had more time to take her on walks and pay attention to her. After our youngest went off to college last year, she even moved from sleeping downstairs with the boys, to climbing the stairs each night to sleep beside our bed. She was loved by the neighbors and their children and was part of the family. In the last several months she developed health problems and I kept praying that she would live until the boys were home in mid October to tell her good bye. But sadly she died before that and we had to call each son to tell them about Maddie. It was not an easy phone call to make. Somehow, even though much older this time, I knew it would be difficult for each of them. But I remembered a book that we had read to the boys when they were younger, “Dog Heaven” by Cynthia Rylant. It is such a beautiful book with sweet text and bright illustrations. It made our boys feel so much better about Mrs. Brown’s place in heaven, where she could run forever, eat biscuits whenever she wanted and was walked by angels before the dogs fell asleep on a cloud. It is the perfect book to read to a child who is saddened by the loss of their dog (or substitute any pet). So we all read it again, and felt better just knowing that our Maddie was now asleep on a cloud, next to Mrs. Brown, and probably talking about their favorite escapades while “raising” our sons. That’s your daily dose, we’ll chat again tomorrow.

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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