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Daily Dose

It's the Sick Season

1:30 to read

Well, the New Year is starting off with a flood….of illness that is.  It is a typical winter in the pediatrician’s office with a bit of every virus you can name. RSV, flu, norovirus, just to start the list.  While so many parents want to name the virus, it is typically not necessary as you treat many viruses in the same manner, symptomatically.  

 

So, if your child is coughing and congested it may be due to any number of upper respiratory viruses, but the most important thing to remember…..how is your child breathing and is your child having any respiratory distress?? I sound like a broken record in my office as I remind our nurses to have parents take off ALL small children’s shirts, gowns, onesies and look at how they are breathing as you never want to miss a child who may be “working to breath”. In many cases, the visual of a child’s chest as they take breaths is more important than any cough they may have.  So remember this: “visual inspection and not just audible”.  Sending me a video of a child coughing is rarely helpful, but a video of their breathing is very important when trying to decide how to guide a parent.

 

Another tip: In most cases if your child is having respiratory distress they are quiet, as they are conserving their energy…which means they are not fighting with their sibling or running around the house, but are often sitting quietly. This also means that when they come to the doctor they are not screaming and yelling in anticipation of the doctor…again, they are usually sitting quietly in their parent’s lap. While a happy quiet child is a pleasure at my office, in a toddler it is not typical.

 

Lots of diarrhea and vomiting in our area as well. In this case, I am always trying to make sure that a child is not getting dehydrated. So, the things to look for include if your child has tears, saliva in their mouth and if they are urinating (having wet diapers).  If your child is vomiting you have to remember to wait about 30 minutes after they have vomited before giving them anything to drink….even if they are “begging for a drink”. Once they have not vomited you need to give them TINY sips of clear liquid and keep offering sips every 10 - 15 minutes. If you do this, in most cases you can keep the child from vomiting repeatedly.  Once they are keeping down sips you can go up in volume.  It is like the turtle and the hare….slow and steady wins!!  

 

With diarrhea alone it is more difficult for your child to become dehydrated, as you can have them keep drinking to keep up with the loss in their stool. Many parent “worry” as their child does not want to eat…and that is ok, the fluids are the most acute issue. You can go without food for quite some time…..don’t you ever skip a meal?

 

Keep washing those hands…and I hope you had your flu shot as I promise…it will come. 

 

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

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Parenting

New Year Family Resolutions!

1:45

It’s the start of a brand new year and many of us will be evaluating our physical and mental health, goals and habits to see where we can make improvements. New Year’s resolutions always start off hopeful, but for many of us, fade away as day to day activities send us back on the treadmill of life.

However, it doesn’t have to be that way and when you share resolutions with someone else, there’s always that personal reminder that goals were set for a reason.

That’s why making resolutions, not as individuals, but as a family can keep hope alive.  Begin by making family resolutions a tradition that starts at the beginning of the year and has checks and balances throughout the year.  At the end of the year, see how everyone did and what could be done to make the next year even better.

Resolution: a decision to do or not do something. That’s about the clearest definition I’ve seen. Decisions are important – one decision may not always be the complete journey, but it’s a beginning. Without beginnings, nothing changes.

The best way to teach your children the importance of New Year’s resolutions is by making it a family tradition.

Dr. Benjamin Siegel, professor of pediatrics and psychiatry at Boston University School of Medicine, suggests saying, “Each one of us is going to state a few things that we want to continue to do and things we’d like to change that would make us feel better about ourselves and how our family works.”

Each family member gets a chance to share something they are proud of and something they would like to change. Depending on the age of your children, it may help if one or both parents go first. If your child is old enough to write, have he or she write down their accomplishments and goals. If they cannot write yet, you can write for them. Copy down exactly what they are saying without trying to “improve” the grammar or goal.

Ideas for families can include group activities as well as individual undertakings. Resolutions for the entire family might include taking a monthly hike, playing board games twice a month or committing to more volunteering activities. Try to limit the number so they are more doable and more meaningful. “A list of 100 things is impossible,” Siegel says. “It should be based on things that are doable without economic hardship.”

Post your list in a place where the family will see it on an ongoing basis such as on the refrigerator or a bulletin board in the kitchen. Dr. Kathleen Clarke-Pearson, a clinical assistant professor of pediatrics at the University of North Carolina School of Medicine, suggests making a resolution box, in which each family member can drop in his or her resolutions, and then pull them out at a later date to review them.

What your child needs to work on depends on your child. If you are concerned about his diet, then encourage healthier eating habits for him as well as the whole family. If your daughter’s room is a mess, try to help her commit 10 minutes a day to cleaning it. As your child ages, he can be more active in coming up with goals, which will mean more to him when he achieves them.

For preschool-aged children, the American Academy of Pediatrics (AAP) recommends resolutions that focus on cleaning up toys, brushing teeth and washing hands and being kind to pets. However, parents who consider these behaviors part of their regular expectations may want to provide resolutions that focus on higher goals.

Older children can begin to understand the relationship between a resolution and an improved outcome. Younger kids may view the whole exercise as a game. It doesn’t matter; whatever helps each family member accomplish his or her goal is the more important issue.

When your child gets into adolescence, the AAP recommendations focus more on the child taking more responsibility for his actions, including taking care of his body, dealing with stress in a healthy way, talking through conflict, resisting drugs and alcohol and helping others through community service.

Parents are the role models in this dynamic. Just as with everything else you do, your child is watching. “Parents should be reflective about how they wish to be in the coming year,” Siegel says. “It’s a good opportunity to promote good mental and physical health.”

Just like adults, kids know the thrill of accomplishing something, especially when their parents acknowledge them. As you go over the family list of resolutions each month or quarter, take time to acknowledge the successes, along with reinforcing the resolutions that need more attention. “Children will benefit by having the parent praise them, which will improve their self-esteem,” Siegel says. “This will help them with self-regulatory behaviors that they can integrate into being a healthy adult.”

Review time is not punish time for unmet resolutions. That may seem obvious, but emotions can get the best of us when things don’t go the way we planned. It’s important to be flexible but also understanding. The resolution is a guide for betterment, not written in stone. Understanding, compassion and dealing with issues head-on can help keep everyone on track.  Learning to take responsibility for our decisions, being able to change our mind and find a better solution and discussing new options, all help in making resolutions a reality.

However your family arrives at resolutions, the best part is that you’re doing it together and learning how to manage your role not only in the family but also in the larger world.

Story source: Laura Lewis Brown, http://www.pbs.org/parents/holidays/making-new-years-resolutions-child/

 

Daily Dose

Happy New Year!

1:30 to read

Happy New Year!!  So here we go again with the New Years resolutions and the “to do” list.  I  try to figure out something each year that I am going to “resolve” to do….one of which continues to be to learn how to play bridge. Somehow I have had the same resolution for two years and yet I still cannot play…at least well. I start off with a bang and just as I can “kind of sort of” play a real game, I somehow get too busy to play and here we go again…back to beginner. I need a new plan!

 

I was having dinner with my “adult children” and they were talking about their New Yea'rs resolutions and it seems they have “categories” of resolutions. In other words they have several different resolutions…which they called personal, professional, social etc. Their thought is that they are more likely to succeed if they have more than one goal??  Maybe they are correct? New approach?

 

So…with that being said let’s think about several different areas that might be good for family resolutions. 

 

Family meals:  We all vowed to try to eat out less and cook at home more often. Not only is it less expensive, it is often healthier and an important time for families to come together to discuss their day. Whether your child is 2 ,10, or 20 yrs old,  just eating together as a family has been shown to improve moods, behavior, school performance and yes, reduces obesity.

 

Electronic media:  As I am on the computer typing I am reminded about how often we all have our faces engrossed in a screen. Some of my young patients know how to “Swipe” and “Refresh” before they can even walk!!  As the world becomes more electronic we are are becoming more isolated…and this is especially true of children. Making a family commitment to limit screen time for all ages may be difficult but is important for building language, social skills and even better sleep. Texting is not talking…who needs a study to confirm that?

 

Exercise: Who doesn’t vow to get more exercise every year…well maybe not young children who long to go outdoors regardless of the weather. But for everyone else, we are becoming more and more sedentary and that is probably somewhat related to the above issue (electronic media).  Make a family plan to exercise at least 3 -4 days a week, maybe after family dinner? Walking, bike riding  (helmet please), playing soccer in the yard, shooting hoops together, or even playing tag, make it easy. Getting our children to move continues to be important for overall health.   They will sleep better, snack less and exercise also gets those good endorphins flowing.  If you keep it up you actually do “feel better”. 

 

Smoking: If you are a parent that smokes…. resolve to “give it up for your children”.  Second hand smoke is REAL, and more and more data shows how it may contribute to SIDS, asthma and other lung problems in children. Model behavior you want to see in your children.  Teen smoking continues to be an issue and many teens are experimenting with electronic cigarettes which then often lead to smoking at a later age. Giving up smoking saves a lot of money towards a fun trip or night out!!

 

OK - let me know how your family does after a few months!! I am hopeful to stay on track for all of 2017. Happy Healthy New Year!!

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

Daily Dose

New Sleep Guidelines for Your Baby

1:30 to read

I am sure that many of you heard about the latest recommendations on infant sleep that the American Academy of Pediatrics has released. The latest policy statement from the AAP recommends that all infants sleep in their parents room, but not in the parents bed,  for at least the first 6 months of life and preferably for the first year!!  This is big news and quite a change from the previous sleep recommendations which were published in 2011.

 

All of the latest recommendations regarding sleep are intended to help to reduce the incidence of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for children under the age of 1 year. SIDS in one of the greatest fears of all parents. While “the back to sleep” campaign has reduced the incidence of SIDS, there are still over 3,500 babies in the U.S. who die suddenly and unexpectedly every year while sleeping. (this includes some from suffocation and strangulation and not SIDS).

 

In addition, the recommendations re-iterate that the baby should not co-sleep with their parents, but should be in a crib or bassinet with a firm sleep surface, in the parents’ room. These new recommendations, may be driven by the reality that breast feeding mothers are exhausted and often fall asleep while nursing their baby. If the mother is sitting in a chair or on the couch and falls asleep the baby may be at risk of suffocation if they roll into a cushion or fall down between pillows. If the mother is in bed breast feeding and accidentally falls asleep at least the baby is on a firm surface - make sure when you do breast feed your baby in bed to remove all loose blankets and pillows in the area around your baby prior to feeding - just in case.

 

Although it has been a long ago, I always put our infants in their own cribs to sleep -  you might say I was obsessed. One night, shortly after the birth of our 3rd child I found myself on my hands and knees looking under the bed. When my husband was awakened and asked me “what are you doing?” I replied…”looking for the baby!” He then reminded me that I had put the baby in his crib in the nursery right after I had finished breastfeeding him.  I truly had no memory and thought he had fallen under our bed!! This, from someone who had previously stayed up for 36 hours during residency working in the hospital and thought I could handle sleep deprivation- clearly not true!! I just remember the feeling of being frantic! 

 

The AAP continues to recommend that the crib be essentially bare - in other words, no bumpers, no blankets, no stuffed toys, just the fitted crib sheet. The baby should always be placed on their back to sleep…once your baby learns to roll from back to front ( which typically happens after they have learned to roll tummy to back), they may be left to sleep on their tummy. Even with a baby in your room you cannot get up all night to keep trying to keep them from rolling over!  

 

The AAP does recommend using a pacifier for sleep times ( I am a huge pacifier fan as you know). The only problem with a pacifier is convincing The Parents that it is time to “get rid of the paci” once their baby is over a year old….. sometimes hard to sell that concept.

 

Lastly, the APP reiterated that they do not support the use of any of the devices sold to new parents to help “prevent”  SIDS. In other words, all of the technology being marketed including  “anti-SIDS mattresses, home cardiorespiratory monitors, and even fancy video monitors.  While many a well intentioned parent will invest a lot of unnecessary money and time trying to make the baby safe during sleep, the mantra “less is more” is now the best way to ensure safe sleep for your baby. I remind parents that there will be plenty of ways to spend that money  - start the college savings!

 

 

 

 

Daily Dose

Elf on the Shelf

1:00 to read

“Tis the season”, and many of the families I care for have gotten out their “Elf on the Shelf” to help keep the season as merry and harmonious as possible. I think “TEOTS” is genius, as it is a fun way to use positive reinforcement during the holidays as behavior modification.  That elf needs to stay around a bit longer…but then it would lose the appeal.  The anticipation of the elf arriving plays a major role don’t you think?  

 

With the arrival of the elf I get to hear all of the cute family elf stories during the month of Dec. I also noticed that “TEOTS” has some new “gadgets” and outfits to add to the fun, such as a zip line to swing from and suctions boots so he/she can climb up walls. Ingenious right? Surely they will soon have an array of elf outfits so the elf can have some choices to wear during zip lining.

 

During the last year there was also a lot of discussion about what our children were hearing on the news and during presidential debates etc. It doesn’t matter your political affiliation, children were picking up on a lot of what was going on.  Even children whose parents were paying attention to all of the bullying during the debates and atrocious sound bites on the news by limiting TV and electronics told me that their children still overheard things. They were concerned about the messages that both candidates were sending…especially to children.  

 

So…when one of my families took out “TEOTS”  their son, who is almost 3, decided it was the year to name him. “Of course you can name your elf they said”.  The next day he announced that the was looking for the elf and asked his mother, “where is Donald Trump?”. She was a bit confused…until he returned holding the the elf and proudly announced, “ I found The Donald”!!

 

Out of the mouths of babes. More elf stories this month for sure!!

 

 

Daily Dose

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!

 

 

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DR SUE'S DAILY DOSE

Why you should never use a kitchen spoon to measure medicine.

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