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Potty Training

Potty Training

Your Child

Checking Out Your Kid’s Apps

2:30

Apps are today’s equivalent to yesterday’s skates, cabbage patch dolls, transformers, NERF balls and video games.   Every kid wants one and there are plenty to go around.

A recent article on CNN.com looked at the dilemma many parents face when their little one wants a popular app downloaded onto their phone. A couple’s 9-year-old daughter wanted the app, Musical.ly. Her classmates were using it and sharing content and she wanted to be able to join in on the fun. It basically enables you to share your own music videos to popular songs. 

While dad, David G. Allan, didn’t say yes or no right away, he did tell her he would do some research and let her know his and his wife’s decision.

It’s a good thing he decided to check it out.

His online research provided commentary and articles about the app plus an opportunity to sign up and give it a try.

After downloading the app and examining the content, he and his wife chose to veto the request.

In a Facebook post, he laid out his 3 reasons why.

“I found sexual content in user profiles and videos, without trying very hard. There was easy, direct exposure to strangers. Adult strangers. And I found no way to filter out those first two items, even with privacy settings on. The privacy settings seemed to only reduce other risks.”

The app’s terms and conditions says signup requires users to be age 13 and older, but user age is self-reported and something parents can restrict only for app downloads at the device level.

When a website says that a child must be 13 years or older to use an app, that’s just a legal way to protect themselves; it is not necessarily because they want to protect your child.

A 1998 law titled the Children's Online Privacy Protection Act details the responsibilities of developers to protect online privacy and safety of kids under age 13. Website operators reduce their legal culpability by putting that age cutoff in their terms and conditions.

Over breakfast the next morning, Allan told his daughter that she would not be allowed to download the app and the reasons why. “I explained to her that an important part of my job as a parent is to do everything I can to keep her safe. And because she trusts that I've got her back in all things, my permission to use social media brings with it the assumption that it is a safe thing for her to do.”

Turns out that some of his daughter’s friends’ parents read his post and deleted the app from their child’s phone. It wasn’t long before his 9-year-old and her classmates were on to the next app. He checked that one out as well and allowed her to get it.

A good point made in the article is, “We will all have different ideas of what's appropriate, but it's the conversation and deliberation that's important. And the flipside of social media is that it gives us a great forum with which to engage in it.”

It’s not easy being a parent. There are times when you have to say no and stick to it, but giving the no a reason, puts it in context for a child. They may not like it, but at least they no why you’ve made that choice.

Apps are not going away and younger and younger children are finding them and sharing them. It’s imperative that parents not only know what apps their child is using, but that they do the research on these products. It’s one way to help keep your child a little safer when the digital world offers something that is simply not appropriate.

Story source: David G. Allan, http://www.cnn.com/2017/11/10/health/screen-decisions-go-ask-your-dad/index.html

 

Your Baby

Toxic Chemicals Found in Baby Foods

2:00

Most parents naturally assume that store-bought baby foods and formulas are well regulated and safe for their babies to consume. That may not be the case says a recent study released by the Clean Label Project. In fact, many of these products may contain high-levels of toxins, researchers said.

For the study, Clean Label Project, a non-profit which advocates for transparent labeling of products, looked at the top-selling formulas and baby food as well as emerging national brands based on Nielsen data. Of about 530 products that the researchers tested, 65 percent were found positive for arsenic, 58 percent for cadmium, 36 percent for lead, and 10 percent for acrylamide.

The highest toxin level found was arsenic. It is associated with cardiovascular conditions, developmental defects, diabetes, neurotoxicity, skin lesions, and even cancer, was present in nearly 80 percent of infant formulas. Rice-based baby food such as snack puffs, tend to have the highest levels of arsenic.

In 2016, the U.S. Food and Drug Administration proposed a limit of 100 parts per billion of arsenic in infant rice cereal, but isn't enforcing that limit. Rice often absorbs arsenic from contaminated soil as it grows in the environment.

"It is important for consumers to understand that some contaminants, such as heavy metals like lead or arsenic, are in the environment and cannot simply be removed from food," said Peter Cassell, a FDA spokesperson.

BPA was also found, although many companies now advertise as PBA free. Sixty-percent were found positive for the industrial chemical bisphenol A.

Lead, known for its’ devastating impact on children’s health, was found in 36 percent of the products. Low levels of lead in children's blood have been connected to lower IQs, slowed growth, behavioral problems, hearing issues and anemia, according to the Environmental Protection Agency.

Gerber, Mead Johnson (Enfamil), Plum Organics all released statements following the study assuring customers their products adhere to strict safety standards. Gerber said its foods "meet or exceed U.S. government standards for quality and safety." Mead Johnson said it specifically monitors the presence of many materials, including arsenic, cadmium, lead, BPA and acrylamide to ensure "safety and high quality." Plum, who also stressed products are "completely safe," said over the past year, it's created "new, more robust guidelines for contaminants in our products" and is in the process of implementing those rules.

Jaclyn Bowen, executive director of Clean Label Project, said, "The baby industry needs to do a better job in protecting America’s most vulnerable population,"

The researchers found that mainstream brands, which include Enfamil, Gerber, Plum Organics, and Sprout, were among the worst offenders that scored two out of five in the report on toxic metals.

A more in-depth review of the study can be found on http://www.cleanlabelproject.org/product-ratings/infant-formula-baby-food/

Story sources: Ashley May, https://www.usatoday.com/story/news/nation-now/2017/10/25/these-baby-foods-and-formulas-tested-positive-arsenic-lead-and-bpa-new-study/794291001/

Allan Adamson, http://www.techtimes.com/articles/214847/20171025/baby-food-and-infant-formulas-tested-positive-for-arsenic-lead-and-other-toxic-chemicals.htm

Parenting

Happy Halloween!

2:00

It’s that time of year as goblins, ghouls, super-heroes, pirates and princesses make their way through neighborhoods with outstretched hands and shy giggles.  Yep, Halloween is here!

While little ones concentrate on having fun, parents can help make this traditional holiday safer.

Candy check:

·      Children shouldn’t snack on treats from their goody bags while they’re out trick-or-treating. Give them a light meal or snack before they head out – don’t send them out on an empty stomach. Urge them to wait until they get home and let you inspect their loot before they eat any of it.

·      Tell children not to accept – and especially not to eat – anything that isn’t commercially wrapped. Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

·      If your child has a food allergy, check the label to ensure the allergen isn’t present. Do not allow the child to eat any home-baked goods he or she may have received.

·      If you have very young children, be sure to remove any choking hazards such as gum, peanuts, hard candies, or small toys.

Preventing fires and burns:

·      Select flame retardant materials when buying or making costumes.

·      Choose battery-operated candles and lights instead of open-flame candles.

Good visibility:

·      Make sure your child can see clearly where they are going and can be seen.

·      Trim costumes or clothing with reflective tape. Many costumes are dark in color and can’t easily be seen by car drivers.

·      Give your child a small flashlight or glow stick to carry with them if they are trick- or- treating after dusk.

Pumpkin Carving: Carving pumpkins is traditional in many families and while the results can be stunning, great care needs to be taken when children are involved. 

·      Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.

·      Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.

·      Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and should never be left unattended.

Costumes: Store bought costumes rarely fit properly, so you may need to make some adjustments.

·      Adjust costumes to ensure a good fit. Long skirts or capes can drag on the ground and cause falls.

·      Secure hats, scarves and masks to ensure that your child can see everything that is going on around them. Also, check to see that nothing is keeping your child from breathing properly. Masks and some super-hero helmets can fir too tightly, making it hard to breathe.

·      Make sure that swords, canes or sticks are not sharp.

Home safety:

·      To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations.

·      Parents should check outdoor lights and replace burned-out bulbs.

·      Wet leaves or snow should be swept from sidewalks and steps.

·      Restrain pets so they do not inadvertently jump on or bite a trick-or-treater.

An adult should always accompany young children. When your child is about ten, they may start asking to go with their friends. There are some questions to think about before you decide to let them go out on their own:

·      What is your child’s maturity level? Do they normally act pretty responsible and make good choices?

·      Who are the friends they want to go with and what is their maturity level?

·      What area are they going to be trick-or-treating in?  Will it be local or in an area your child may not be familiar with?

·      What time to they plan to start and be back home? Give your child a definite time.

Colored contacts have become popular with some older children. Often the packets these contacts come in have advertising on the package claiming that, “One size fits all.” They don’t.  These lenses are illegal in some states, but can be found online. They may cause pain, inflammation, and serious eye infections. Avoid these at all costs.

Whether your child is with you - or out with friends - make sure someone has a charged cell phone with them.  You want be prepared in case of an emergency.

Halloween has changed over the years and lots of parents now take their children to specific places that host Halloween parties and activities, but whether it’s in a controlled environment or out on the streets, it’s still smart to keep safety first.

Sources: https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Halloween-Safety-Tips.aspx

 Dr. Karen Sherman, http://www.hitchedmag.com/article.php?id=365

https://www.fda.gov/food/resourcesforyou/consumers/ucm187021.htm

 

 

 

Parenting

Cradle and Bassinet Safety Tips

1:45

Cradles and bassinets can be convenient for parents and comfortable for babies. You can move them easily from room to room, letting you keep an eye on baby during the day. At night, you can keep your baby in your own bedroom during the first few weeks of life as you and baby adjust to a new sleeping schedule.

In recent years, cradles and bassinets have gained new features: You can buy ones that vibrate, are on wheels, swivel from side to side, or nestle next to your bed for co-sleeping without bed-sharing. They’re also great for trips to see the grandparents.

While they are handy, cradles and bassinets are not substitutes for a crib. Babies outgrow them, so you’ll need a crib sooner or later, but they can be useful.

Just like cribs, there are important safety tips to be aware of when using cradles and bassinets:

  • Avoid bassinets and cradles with a motion or rocking feature, as these have caused suffocation when babies rolled against the edge. If you use an heirloom-rocking cradle, supervise your infant while in use.
  • As with a crib, a bassinet, cradle, sleeper or play yard should have a firm mattress that fits snugly without any space around the edges so a baby’s head can’t get wedged in and lead to suffocation. The American Academy of Pediatrics has not yet weighed in on the safety of these products; some pediatricians have warned parents that they are not safe for overnight sleeping. Parents should err on the side of caution and use only products that comply with safe-sleep recommendations.
  • If you have pets or other young children in the house – for instance, a dog who might knock over a bassinet, a cat who might climb in, or a toddler who might try to lift your baby from a bassinet – stick with a crib.
  • Moses baskets - a woven basket with handles - are often lined with puffy fabric, which raises a baby's risk for suffocation or sudden infant death syndrome (SIDS) and are best avoided.

Bassinets and cradles are designed for babies under 5 months old, and who cannot push up on hands and knees.

These temporary products can be helpful for keeping an eye on your baby while they are napping, if you need to move from room to room or stay overnight in another home. Parents and caregivers need to make sure any cradle or bassinet used meets current CPSIA safety standards.

Story sources: https://www.babycenter.com/bassinets-baskets

 

Daily Dose

Ear Infections

1:30 to read

Musings from the very busy pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button.

   

Parenting

Helping Kids Cope With Tragic Events

2:00

Another all too common tragedy has saddened the hearts of Americans this week. Just 35 days after a man opened fire on a crowd of concertgoers in Las Vegas, killing 58 people and wounding nearly 500 others, another mass killing has taken place. This time in the small community of Sutherland Springs, Texas, leaving 26 people dead and 10 critically injured.  About half of the victims were children, according to news reports. This follows a terrorist attack in New York City on Halloween that killed 8 people. The heartbreak and numbers are gut wrenching to think about.

These kinds of horrific events can make the world seem like a terrifying place, particularly for kids.

How can you help your child cope with such frightening news? As a parent or a caregiver, how you react can have a strong impact on how your child views his or her own safety.

Dr. Jennifer Caudle, an associate professor at Rowan University School of Osteopathic Medicine in Stratford, suggests that parents shield their children from news reports.

"Children may become upset by news coverage," Caudle said. So monitor and limit what they see, hear or read. This may reduce their anxiety and help them deal with these unsettling events, she explained.

Other suggestions include:

  • Ask your child what they have already heard about the event. 
  • Provide the facts but try not to make judgments about the situation. 
  • Avoid upsetting details, and reassure children that people are working hard to make things better for everyone. 
  • Don't pressure kids to talk about the events, but encourage them to share their feelings by talking, drawing or writing. 
  • Let children know they can come to you for information and that they are free to ask questions. 
  • Remind children that their home is a safe place. 
  • Let children know that people may react differently to hard-to-understand events.

If your child or adolescent seems to be obsessing over the events and is having a hard time putting things in perspective, they may need professional help. 

"Problems with sleeping, changes in appetite or behavior, mood changes and new physical complaints, such as stomach aches and headaches, could -- in some children -- be a sign that they are having a difficult time coping," she said. "If this is the case, make sure your child sees a health care professional."

The National Institute of Mental Health (NIMH) says that it is important to let your child know that you will do your best to take care of him or her, that you love them and it’s okay for them to feel upset or sad.

NIMH also offers these tips:

  • If your child is having trouble sleeping give them extra attention, let them sleep with a light on, or let them sleep in your room (for a short time).
  • Try to keep normal routines, for example, reading bedtime stories, eating dinner together, watching TV together, reading books, exercising, or playing games.

Unfortunately, these types of tragedies don’t appear to being going away anytime soon. But, you can help your child (and yourself) by reminding them that although there are some people that might want to inflict harm on others, most people are loving and kind. They want a safe place for children to grow up in and they are doing their best to make this world a better place.

Story sources: Mary Elizabeth Dallas, https://consumer.healthday.com/mental-health-information-25/child-psychology-news-125/helping-children-cope-when-a-mass-tragedy-strikes-728263.html

https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-parents/index.shtml

Daily Dose

Constipation

1:30 to read

Constipation is a topic that every pediatrician discusses….at least weekly and sometimes daily. It is estimated that up to 3% of all visits to the pediatrician may be due to constipation. Constipation is most common in children between the ages of 2 and 6 years. I have been reading an article on updated recommendations for diagnosing and treating common constipation. The most important take home message is “ most children with constipation do not have an underlying organic disorder. Diagnosis should be based on a good history and physical exam for most cases of functional constipation”.

 

Like many things in medicine….the evaluation and treatment of constipation has also changed a bit since the last guidelines were published in 2006. It is now appropriate to define constipation with a shorter duration of symptoms (one month vs two) and some of the most common diagnostic criteria (Rome IV Diagnostic Criteria) include the child having less than 2 stools/week, painful or hard bowel movements, history of large diameter stools (parents will tell me their 3 year olds “poops” clog the toilet), and some may have a history of soiling their underpants. 

 

By taking a good history you can avoid unnecessary tests..including X-rays which are not routinely recommended when evaluating a child with possible constipation.  In most cases physical findings on the abdominal exam will confirm the diagnosis in combination with the history. I often can feel hard stool in a child’s left lower quadrant and when asked the last time they “pooped”, no one can really recall. 

 

The preferred treatment is now polyethylene glycol (PEG) therapy. PEG is now used to help “disimpact a child” as well as to maintenance therapy.  Where as enemas were often previously prescribed, PEG therapy has been shown to be equally effective in most cases, is given orally and is much less traumatic (for parent and child!). PEG works by drawing more water into the stool, causing more stool frequency. There are many brands of PEG including Miralax and GoLytely among others. Miralax works well for children as it is tasteless and odorless and can easily be mixed in many liquids without your child knowing it is there. 

 

The guidelines now state that for children with functional constipation maintenance therapy with PEG should continue for as least 2 months with a gradual tapering of treatment only after a full month after the constipation symptoms have been resolved. I usually tell parents that this is equivalent to about how long it takes for them to forget that they have been dealing with constipation….and then begin tapering.

 

Lastly, there is no evidence that adding additional fluid or fiber to a child’s diet is of benefit to alleviate constipation….although it may “just be good for them in general”.

 

 

Daily Dose

Medicine Dosing Errors

1:30 to read

How do you give your baby/toddler/child their medications? In a recent article in Pediatrics it was found that up to 80 percent of parents have made a dosing error when administering liquid medicine to their children.  The study looked at children eight years old or younger. 

 

In the study both English and Spanish speaking parents were asked to measure different amounts of liquid medicines using different “tools”, including a dosing cup, and different sized syringes. They also were given different instructions with either text only or text with pictures. The different dosing tools were labeled with either milliliters/teaspoon or milliliters only.  Lots of variables! 

 

Not surprising to me, the parents who used the texts/picture combination instructions and who also used the milliliter only labeled dosing tools had the lowest incidence of dosing errors.  When parents had to use any math skills to calculate the correct dosage there were more dosing errors.  Most dosing errors were also overdosing rather than under-dosing the liquid medications.

 

This was an important article not only for parents to realize that it is not uncommon to make an error when giving their child medication, but also for doctors who write the prescriptions.  Before electronic medical records and “e-prescribing” I would typically write medication instructions in milliliters and teaspoons…in other words “take 5ml/1 tsp by mouth once daily”.  With electronic record you can only make one dosing choice which I now do in milliliters. But, with that being said, I still get phone calls from parents asking “how many teaspoons is 7.5 ml?”.

 

Previous studies have also shown numerous dosing errors when parents use kitchen teaspoons and tablespoons to try and measure their child’s medication. 

 

Some over the counter drug makers have tried to cut down on dosing errors with their liquid medications by making all of their products, whether for infants or children, the same strength. The only difference is the dosing tool that accompanies the medicine (syringe vs cup).  Interestingly, these medications may have a price difference when they are actually the same thing.  

 

This study may help to find strategies for comprehensive labeling/dosing for pediatric liquid medications, which will ultimately reduce errors.  Stay tuned for more!

 

 

 

 

 

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