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Your Child

Preschoolers Should be Examined for Possible Vision Problems

2:00

For very young children, blurry vision may seem normal to them. There’s also a good chance that their parents won’t know their little ones are having difficulty seeing clearly.

That’s why the U.S. Preventive Services Task Force (USPSTF) is recommending that 3 to 5 year olds receive vision screening at least once to detect abnormal visual development or risk factors for it.

A couple of visions problems that first show symptoms at this age are Strabismuc (crossed eyes) and Amblyopia (lazy eye).)

Crossed eyes do not look in the same direction at the same time. Six muscles attach to each eye to control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down.

Infants and young children often develop this condition by the age of three, but older children and adults can also get crossed eyes. People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. An optometrist should examine any child older than 4 months whose eyes do not appear to be straight all the time.

Lazy eye is the loss or lack of development of central vision in one eye that is unrelated to any eye health problem and is not correctable with lenses.

Lazy eye often occurs in people who have crossed eyes (misalignment) or a large difference in the degree of nearsightedness or farsightedness between the two eyes. It usually develops before age 6 and it does not affect side (peripheral) vision.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. In vision therapy, patients learn how to use the two eyes together, which helps prevent lazy eye from reoccurring.

According to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this age generally will not voice complaints about their eyes.

Parents should watch for signs that may indicate a vision problem, including:

•       Sitting close to the TV or holding a book too close

•       Squinting

•       Tilting their head

•       Frequently rubbing their eyes

•       Short attention span for the child's age

•       Turning of an eye in or out 

•       Sensitivity to light

•       Difficulty with eye-hand-body coordination when playing ball or bike riding

•       Avoiding coloring activities, puzzles and other detailed activities

If you notice any of these signs in your preschooler, arrange for a visit to your doctor of optometry.

While the two may sound similar, there is a difference between a vision screening and an eye exam.

Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.

Sometimes, parents get a false sense that their child doesn’t have a vision problem if he or she passes a vision screening.

A doctor of optometry performs an eye exam. He or she will look for any developmental problems and evidence of disease. If needed, your doctor of optometry can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.

When considering an eye exam, parents should:

•       Make an appointment early in the day. Allow about one hour.

•       Talk about the examination in advance and encourage your child's questions.

•       Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.

The preschool years are a time for developing the visual abilities that a child will need in school and throughout his or her life. Steps taken during these years to help ensure vision is developing normally can provide a child with a good "head start" for school.

Story sources:

http://www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/preschool-vision-2-to-5-years-of-age?sso=y

Molly Walker, http://www.medpagetoday.com/ophthalmology/generalophthalmology/63476

 

Daily Dose

Should Children Lift Weights?

I am often asked by both young patients and their parents if children can participate in weight lifting and strengthening exercises.

I think the appropriate term is strength training and conditioning, rather than weight lifting, which connotes competition and the need for heavier and heavier weights. When done appropriately, strength training and conditioning is great for kids of all ages, and really encourages being physically fit. Weightlifting is not appropriate for a growing child as it can put too much strain on the tendons and cartilage. This is especially true when kids become competitive about lifting bigger and bigger weights at the risk of long-term injury. Allowing children to weight lift in hopes of “bulking up” or “building the biggest muscles” before pubertal development and their growth spurt is inappropriate. All of that can be deferred for the post pubertal athlete. On the other hand, an age appropriate strength training and conditioning program may actually be protective of a child’s joints by increasing their muscle strength and their endurance. By participating in supervised and structured strengthening programs, a child as young as eight may improve their endurance, body awareness and balance, all of which are beneficial. A strength-training program can be done without weights, as in resistance training, by simply using the child’s body weight. Examples of this would be abdominal crunches, push-ups and pull-ups. These are great ideas for the younger children. For older children free weights or resistance bands may be added. Parents or coaches who are familiar with the use of free weights should always supervise. Start out with lighter weights, and make sure that the child can do at least 10 repetitions with the weight, if not, drop to a lower free weight. Have the adult watch the child for form and technique and supervise any increase in weights or repetitions. There are also many programs through local gyms and YMCA’s tailored just for kids to participate in strength training. When beginning a conditioning program encourage your child to have a warm up period, with a little aerobic activity like walking or running as this his will help to warm the muscles and prevent injury. After the strength training it is equally important to have a cool down period with gentle stretching. Many children enjoy working out with their parents and this can become a family activity (we can all use the exercise) to promote coordination, healthy bones, joints, cholesterol and blood pressure. Most importantly make it fun! That’s your daily dose, we’ll chat again tomorrow.

Your Toddler

Anchor It!

1:45

The U.S. Consumer Product Safety Commission (CPSC) has launched “Anchor It”, a national public education campaign, to help make people aware of the dangers that free-standing furniture and TVs present, particularly to children.

The annual number of children injured or killed from furniture and TV tip-overs is astounding.

According to CPSC data, unstable and unsecured TVs and large pieces of furniture kill a child every two weeks, on average, in tip-over incidents that are easily preventable.  CPSC also reported that 38,000 Americans go to emergency rooms each year with injuries related to tip-overs of top-heavy furniture or televisions placed on furniture, instead of a TV stand.  Two-thirds of those injuries involved children younger than 5.  Additionally, between 2000 and 2013, 84 percent of the 430 deaths reported to CPSC involved children younger than 10.

A January 2015 CPSC report found that a television tipping over from an average size dresser falls with thousands of pounds of force. 

The impact of a falling TV is like being caught between two NFL linemen colliding at full-speed—10 times. 

“Every 24 minutes in the U.S. a child goes to the emergency room because of a tip-over incident involving furniture or a TV,” said CPSC Commissioners Marietta Robinson and Joseph Mohorovic. “We must take action now. CPSC’s new ‘Anchor It!’ campaign is a call to action for parents and caregivers to ‘get on top of it, before they do.’ If we can prevent one more death, it will be worth it.”

Cards and posters are being distributed parents and caregivers of toddlers at daycare centers and preschools. A list of safety steps parents and caregivers can take are printed on the handouts. They are:

·      Buy and install low-cost anchoring devices to prevent TVs, dressers, bookcases or other furniture from tipping.

·      Avoid leaving items, such as remote controls and toys, in places where kids might be tempted to climb up to reach for them.

·      Store heavier items on lower shelves or in lower drawers.

·      Place TVs on a sturdy, low base and push them as far back as possible, particularly if anchoring is not possible.

·      If purchasing a new TV, consider recycling older ones not currently used. If moving the older TV to another room, be sure it is anchored properly to the wall.

The “Anchor It” campaign’s website (www.Anchorit.gov) shows you how to anchor furniture and television sets properly, with easy to follow instructions. Keep your little one safe and Anchor It!

 

Your Baby

Could higher cigarette taxes save babies lives?

1:45

A new study says that when the cost of cigarettes increase, fewer babies die.  The study links rising cigarette taxes to a decline in infant deaths.

Specifically, researchers said that each $1 per pack increase in the overall tobacco tax rate over the years 1999-2010 may have contributed to two fewer infant deaths each day.

The dangers of smoking during pregnancy are well documented. Complications include infant nicotine addiction, lower oxygen for the growing baby, increased chances of miscarriage, an increase of a baby developing respiratory problems and sudden infant death syndrome to name just a few.

Fortunately, U.S. smoking rates have declined during the years examined in the study – 1999 to 2010.

The research doesn't directly prove that higher taxes translate into fewer infant deaths. Still, "we found that increases in cigarette taxes and prices were associated with decreases in infant mortality," said study author Dr. Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University in Nashville.

In the new study, researchers tracked infant death rates and tobacco taxes from 1999-2010, when inflation-adjusted tobacco taxes on the state and federal levels rose from 84 cents a pack to $2.37 per pack. During the same time period, the number of infant deaths per 1,000 live births fell from 7.3 to 6.2 overall, and from 14.3 to 11.3 among African-Americans.

Other factors were also considered that might influence infant mortality including family income and education. Researchers still found an association with the rising cigarette taxes.

Patrick acknowledged that it's possible that factors other than cigarette taxes contributed to the decline in the infant death rate. One possibility is that medical care improved over that time, leading to fewer deaths. But Patrick said that prospect is unlikely since such a change would presumably be seen in all states, and the study didn't reveal that kind of trend.

The researchers also examined the effect of tobacco prices, and found that increases appeared to have the same level of impact on infant mortality as tax hikes.

What about the prospect that pregnant women and new mothers might choose to spend money on tobacco -- including higher taxes -- instead of on their children? "That would only occur if smoking is a large share of the household expenditures," Levy said. And, he said, it's important to note that research has shown that higher taxes are especially likely to lead to less smoking among the poor.

While there may be other contributing factors that reduce the number of infant mortality during the research dates, researchers noted that the higher cost of cigarettes means more pregnant women will smoke either not at all or less and that’s a good thing for the babies they deliver.

The study was published online in the journal Pediatrics.

Sources: Randy Dotinga, http://www.kfvs12.com/story/30638397/higher-cigarette-taxes-tied-to-fewer-infant-deaths

http://www.webmd.com/baby/smoking-during-pregnancy

Your Child

Nicotine Poisoning in Young Children Skyrockets 1,500% in 3 years

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In the last 3 years, there has been an astonishing increase in calls to poison control centers from caregivers and parents of children who have or might have been exposed to liquid nicotine.

From 2012 -2014, accidental exposures to e-cigarettes by children under the age of 6 increased by about 1,500 % according to researchers analyzing nicotine and tobacco product poison control calls.

Children with accidental exposures to e-cigarette liquids were more than five times more likely to be admitted to a medical facility than those exposed to traditional cigarettes and more than twice as likely to have severe medical outcomes, wrote researcher Gary A. Smith, MD, of the Nationwide Children's Hospital Center for Injury Research and Policy in Columbus, Ohio, and colleagues. Their study was published online in the journal Pediatrics.

"These are not trivial exposures. There were comas, seizures, and even one death in the 40-month period we studied, and these exposures were predictable and preventable," Smith told MedPage Today. "E-cigarettes and vaping liquids are products that should never have entered the market without adequate consideration of the harms they could cause to young children."

Not only are children becoming seriously ill because of accidental nicotine poisoning, but children have died from it.

"One death to a 1-year-old child occurred associated with nicotine liquid accessed from an open refill container," the researchers wrote. "Children exposed to e-cigarettes or other tobacco products had higher odds of having a severe outcome than children exposed to cigarettes."

Nicotine is a toxic substance that can cause convulsions, coma, vomiting, irregular heart rhythms, weakness and even death. Before the availability of e-cigarettes and liquid nicotine, acute nicotine poisoning usually occurred in young children who accidentally chewed on nicotine gum or patches.

The study comes right after two new initiatives have been established to put the brakes on nicotine poisoning in children.

The Child Nicotine Poisoning Prevention Act will take effect this summer and will require child-resistant packaging on liquid nicotine containers.

Also, the Food and Drug Administration released long-awaited rules last week, requiring e-cigarette companies to undergo federal review to stay on the market and add health warnings to their products. The new regulations, which take effect in August, also ban the sale of e-cigarettes to anyone under the age of 18.

Many health officials are upset that the FDA has taken so long to address the dangers of nicotine poisoning in young children.

"Liquid nicotine is another example of a highly toxic product that was put into the marketplace without consideration for safety of children," Smith said. "It's as if we're treating our children as canaries in the coal mine. We wait until there's a dramatic event and then do something."

Smith also acknowledged that many parents might not know just how dangerous these products can be for children. "Even a relatively small dose, which may not cause many effects in adults, can cause major effects in kids."

If you suspect that your child has ingested nicotine, experts recommend that you NOT induce vomiting, but call poison control at 800-222-1222 or that you call 9-1-1.

Story sources: Naseem S. Miller, http://www.orlandosentinel.com/health/os-e-cig-kids-poisoning-rising-20160509-story.html

Salynn Boyles, http://www.medpagetoday.com/Pediatrics/Parenting/57795

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College Health

Your Toddler

Thumb Sucking

2.00 to read

I admit it – I was a thumb sucker for way too long. My thumb and mouth didn’t part company until I was in first grade. The fear of getting caught during a sleepover at a friend’s house was enough for me to finally call it quits.

It’s normal for babies and toddlers to suck their thumbs. Babies are born with the urge to suck as part of their survival. They also use it as a way to soothe themselves when they feel hungry, afraid, restless, sleepy or bored. Toddlers carry on that natural instinct as they find their way in the world.

By the time children are around four-years-old they’ve typically stopped sucking their thumb and found replacements for self-soothing. Occasionally, children (like myself) will continue to suck their thumb out of habit.

Some experts say that if a child is still sucking their thumb by the age of six, they may be doing so because of emotional distress such as anxiety.

Thumb sucking isn’t a problem under the age of four, but if a child continues- with great intensity- after five or six years old, they could be setting themselves up for dental or speech problems.

Prolonged thumb sucking may cause their teeth to become improperly aligned (malocclusion) or push their teeth outward. If the thumb sucking stops, the teeth most likely will align correctly, but the longer the sucking continues the more likely orthodontic treatment will be needed.

Extended thumb sucking may also cause speech issues such as lisping, inability to say Ts and Ds, and pushing the tongue out when talking. A speech therapist may be needed to help correct these problems.

How do you help your child stop sucking their thumb? It takes a lot of patience.

One place to begin is to pay attention to what triggers the thumb sucking. Does your little one start when they are bored, sleepy, or unsure about something? Redirecting can help. Busy hands help keep thumbs from going into the mouth. Give your child a large stuffed animal to wrap their arms around or have them help hold the book when you are reading to them. Offer a squeezable rubber ball or finger puppets to grasp when they are watching TV.  The key is to offer an alternative at the times you notice they are the most likely to want to suck their thumb.

Ask your child to not suck their thumb in public and gently remind them when you see them doing it. Let them suck their thumb at home, but start the process of being self-aware in public. Kids often unconsciously slip their thumb into their mouth. A reminder helps them notice what they are doing.

You can also start talking to your child about why it’s time to give some thought to stopping. In age-appropriate language explain how thumb sucking is okay for younger children, but as children get older they learn how to stop. Ask them questions like “Do you see (insert name of an older child or adult here) sucking his or her thumb?” They’ll think about it more and start to decide whether they want to continue. It’s a process that takes time.

Punishing or shaming your child is absolutely the wrong method to address thumb sucking. This approach not only doesn’t work, but also lowers a child self-value and can create an even stronger desire to thumb suck. It’s like quitting anything you’re doing that may not be good for you in the long run- the worse someone tries to make you feel about it- the more you want to do it (think overeating, smoking, drinking.)

You can also talk to your pediatrician or family doctor for his or her suggestions on how to help your child. For older children, behavioral therapy may be beneficial.

There are products that are nasty tasting that can be swabbed on your child’s thumb, but some experts think that approach is cruel and more like a punishment than a humane way to help a child outgrow a natural inclination.

Most kids will simply quit sucking their thumb when they are good and ready. Helping your child reach that point may require patience and creativity, but in time his or her thumb will cease to be a constant comfort companion.

Sources: http://children.webmd.com/tc/thumb-sucking-topic-overview

Parenting

“Live Long and Prosper”

2:00

Leonard Nimoy, the actor who played the iconic character Spock in the Star Trek television series and films, passed away last week from chronic pulmonary obstructive disease, also known as COPD.  He was 83.

Spock’s Vulcan salute, accompanied with the phrase “live long and prosper”(LLAP), was recognized around the world as a symbol of friendship and good wishes.

So what does the passing of an elderly movie star have to do with kid’s health?  Kids, teens and adults were fans of Nimoy’s beloved character, Mr. Spock. In his final months, he reached out to his fans with a farewell warning. 

Nimoy attributed his COPD to years of smoking, even though he quit three decades ago around the age of 50.  A few months ago he tweeted a simple but cautionary warning to young adults and teens, “Don’t smoke. I did. Wish I never had. LLAP.”

According to the Centers for Disease Control & Prevention, chronic lower respiratory disease, most of it COPD, killed 149,205 Americans in 2013, making it the third-leading cause of death after heart disease and cancer. Chronic respiratory disease killed more people than accidents, stroke, or Alzheimer’s disease. And that’s only the tip of the iceberg.

I personally know how COPD can slip into your life and kill you, even years after you’ve crushed out your last cigarette butt. My mother died of COPD 20 years after she quit smoking. She smoked from the time she was in her teens till her 60s. While she did live to be in her 80s, many of those years were spent gasping for air and hooked to an oxygen tank. She also warned her kids and grandkids not to smoke. Like so many other teens, they didn’t listen.  Now, they wish they had.

An online article by Forbes’ Matthew Herper, eloquently states the difference in the fictional character of Spock and the man, Leonard Nimoy, and how we can honor both.

“It’s ironic — bitterly so — that a man who became famous playing a character who was the epitome of logic and clear thinking died because of one of humanity’s most illogical flaws: our propensity toward addiction and for risking our health for momentary pleasure. It would be a fitting way to honor him if we could approach the problem of smoking with the kind of logic that Spock would have. As we deal with a whole lot of tobacco-related issues, including how to deal with e-cigarettes which are putatively safer than traditional cigarettes but whose manufacturers seem intent on proving no such thing, we could use some Vulcan clarity.”

As much as the phrase “ this is a teaching moment” has been misused and over used, I think it applies in this case. Many pre-teens, teens and young adults know and appreciate the Spock character and the man who played him all these years. What they probably don’t know much about is what killed him.

As they say, the door is open and this might be an excellent time to talk about smoking with your child. Whether it’s cigarettes, e-cigarettes or chewing tobacco. They are all highly addictive and each holds it’s own serious health issues.  E-cigarettes are still being studied for health complications. More in-depth research is beginning to expose the chemicals used to vaporize the nicotine that is inhaled into a user’s lungs.  The findings are not good.

It’s hard for many kids to care about the possible long-term health effects of something that feels so good at the moment. But irritating symptoms such as coughing, shortness of breath and loss of stamina will start adding up. If you smoke, you will experience all of these symptoms at some time.

COPD is incurable. There is nothing that can reverse it. Typically it occurs in people 65 and older, however, 2 percent of COPD cases involve men aged 18 to 24 and 3 percent involve women in the same age group. The numbers increase slightly for people aged 25 to 44 with 2 percent of cases in men and 4.1 percent of cases in women.

My niece-in-law died from COPD at the age of 48. She first showed symptoms at age 22 – she started smoking at age 12.

People who have never smoked can develop COPD from second-hand smoke, air pollution, chemicals or dust. However, smoking accounts for 9 out of 10 COPD –related deaths.

Now is a good time to use some of Spock’s clarity of details to talk with your child about smoking, whether it’s with cigarettes, e-cigarettes, paperless tobacco, hookahs or anything else that is inhaled into the lungs.

Nimoy’s last tweet reminds us that life is bittersweet, “"A life is like a garden," he wrote. "Perfect moments can be had, but not preserved, except in memory. LLAP"

Not smoking doesn’t guarantee a long life, but it certainly helps one live a healthier life and that’s a blessing every child deserves. 

Sources: Matthew Herper, http://www.forbes.com/sites/matthewherper/2015/02/27/want-to-live-long-and-prosper-dont-smoke/

Kristeen Cherney, http://www.healthline.com/health/copd/age-of-onset#Overview1

 

Your Child

Getting Ready for a New School Year!

2:00

As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her kidsdr.com Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto http://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!

Source: http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Back-to-School-Tips.aspx

 

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DR SUE'S DAILY DOSE

When parents head back into the dating scene.

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