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ADHD: Behavioral Therapy First Before Drugs

1:30

Researchers have been studying the possible benefits of using behavioral therapy as a first choice in treatment for children with attention-deficit hyperactivity disorder (ADHD).

One paper found that children’s ADHD problems improve quicker when behavioral therapy is started initially instead of medications, the New York Times reported. . Another paper noted that this treatment progression is less expensive over time.

If the effectiveness of the behavior therapy-first approach is confirmed in larger studies, experts say it could change standard medical practice for children with ADHD, which currently favors medications as first-line treatments.

Medications were most effective when used as supplemental, second-line treatment for children with ADHD who required the drugs. In many cases, the drugs were effective at doses lower than normally prescribed, according to the findings in the Journal of Child & Adolescent Psychology.

"We showed that the sequence in which you give treatments makes a big difference in outcomes," study co-leader William Pelham Florida International University, told The Times.

"The children who started with behavioral modification were doing significantly better than those who began with medication by the end, no matter what treatment combination they ended up with," he said.

Some experts noted that the research focused on behaviors and not some of the other complications associated with ADHD such as attention and learning problems.

"I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective, but the irony is that that option is seldom available to parents," Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, told The Times.

One resource for more information on finding a specialist in behavioral and cognitive therapies is, http://www.abct.org/Home. Click on the “Find a CBT Therapist” link.

Another online resource is, www.additudemag.com, which offers information on the program, COPE (Community Parent Education) and how to locate one in your community.

Story Source: WebMD News from HealthDay, http://www.webmd.com/add-adhd/childhood-adhd/news/20160218/behavioral-therapy-adhd

Parenting

The Dos and Don’ts of Cleaning Your Child’s Ears

2:00

True story. When I was a child, my mother was somewhat obsessed about earwax; specifically, she did not like to see earwax in my ears. Ever.

In order to make sure that my ears were clear of any nasty wax, she would use a bobby pin (remember those?) and gently insert it down into my ear and scape out any brownish gooey stuff. That would be followed up with a Q-Tip to make sure all substances were gone. It didn’t take many accidental pokes to get me to sit as still as possible.

I don’t know if there is any connection, but I have tinnitus and have had it for years.

Don’t ever stick anything into your child’s ear. That’s not just my opinion; it’s a warning from The American Academy of Otolaryngology-Head and Neck Surgery. The ear, nose and throat organization recently released new guidelines for the public.

It’s perfectly all right to wipe the outside of the ear with a washcloth. But it's important to not use a cotton swab, a finger, or anything else (such as a bobby pin!) to poke inside the ear because of the risk of damaging the delicate ear canal and eardrum, or packing the wax in even further, which could cause infection.

What is earwax and why do we have it? Earwax is made in the outer ear canal, the area between the fleshy part of the ear on the outside of the head and the middle ear. The medical term for earwax is Cerumen.

Earwax has many important functions. It helps protect the eardrum and ear canal by providing a waterproof lining for the ear canal, helping to keep it dry and preventing germs from causing infection. It also traps dirt, dust, and other particles, keeping them from injuring or irritating the eardrum.

In most cases, nothing needs to be done to remove earwax from kids' ears; regular bathing is enough to keep it at healthy levels.

If earwax ever does need to be removed, let a doctor do it. There are only a few reasons earwax should be removed; it’s causing pain or discomfort, or hearing loss. That’s about it.

The academy’s updated list consists of what to do and what to avoid when it comes to dealing with earwax:

DON’T over-clean your ears. It may irritate the ear canal, cause infection, and even increase impacted wax.

DON’T put anything smaller than your elbow in your ear. Cotton swabs, hair pins, car keys, toothpicks — all can cause injury to the delicate ear canal, including a cut, perforation of the eardrum, or a dislocation of the tiny bones in the ear that enable hearing. Injury can lead to hearing loss, dizziness, ringing in the ear and other problems.

DON’T use ear candles. “Candling” is an alternative health fad purported to help with everything from earwax to cancer, but doctors say there is no evidence to back up any of those claims. Candling does not remove impacted earwax, and it can cause serious damage to the ear canal and eardrum.

DO seek medical help if you have symptoms of hearing loss, ear fullness and ear pain.

DO ask your doctor about home remedies for treating earwax impaction. But first, be sure you don’t have a medical or ear condition that could make some options unsafe.

DO seek medical attention if you experience ear pain, drainage, bleeding, hearing changes, an odor coming from the ear or other noticeable change.

There are safe home remedies to use that will clean earwax out, but talk with your pediatrician first to make sure the remedy is appropriate for your little one.

When a physician removes earwax, it’s typically done in the exam room. There might be a little discomfort but it isn't painful, though some kids may be uncomfortable with the sensation of someone handling their ears.

In rare cases where a child can't sit still or cooperate with the doctor, the procedure will be done in an operating room with the child given general anesthesia.

Doctors use a variety of different tools to remove earwax, including a tiny device with a curve at the end (called a curette), graspers, and suction, as well as an otoscope (a handheld tool with a light, used in regular checkups to see far into the ear canal). Removal takes just a few minutes and usually doesn't require any further treatment.

If there's a sign of infection, the doctor may prescribe antibiotic eardrops. But further home treatment usually isn't needed after most removals.

Dr. Seth Schwartz, chair of the guideline update group, said the strangest thing he’s seen someone stick in a waxy ear: a Barbie doll shoe. That definitely tops my mother’s bobby pins.

Remember, kids watch everything you do. If they see a parent or guardian putting something in their ear, they are more likely to put something in theirs too. That something could cause permanent damage. 

Story sources: Mary Brophy Marcus, http://www.cbsnews.com/news/earwax-removal-dos-and-donts/

Patrick Barth, MD, http://kidshealth.org/en/parents/earwhttp://kidshealth.org/en/parents/earwax.html#

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