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Daily Dose

How to Swallow a Pill

1:15 to read

I have always been a proponent of teaching children to swallow a pill.  In fact, I think I taught my boys to swallow a pill before they were 5 years old, mainly because I was tired of trying to find the measuring cup or syringe for the liquid medicine, which often didn’t go down “like spoon full of sugar”, even though we would sing the song during dosing. 

By the time one child had learned to swallow a pill the other two boys, as competitive as they were, decided that they too could do it, even the 2 year old.  So, based on that experience I have been encouraging young patients to swallow pills, and even teaching them in the office with my stash of mini M&M’s and Tic Tacs!  I also know that if you wait too long it becomes a huge ISSUE.

Well, who knew that someone would actually study “pediatric pill swallowing”?  In an article just published in the May issue of Pediatrics the authors looked at different pill swallowing interventions.  They found that up to 50 % of children were unable to swallow a pill.   Problems swallowing pills included a variety of reasons including fear, anxiety and intolerance to unpleasant flavors. 

The authors reviewed 5 articles published since 1987 which found that behavioral therapy, flavored throat sprays, specialized pill cups and verbal instruction with correct head and tongue positioning all helped children to swallow pills. They also found that pill swallowing training as “young as 2 years helped increase the likelihood of ease of pill swallowing”.

So, like many things....jump in with your young child and master the art of pill swallowing sooner than later. It will make everyone’s life easier.

Last caveat, I always tell my patients who are older “non-pill” swallowers, “you cannot possibly operate a motor vehicle if you can’t swallow a pill”! This is usually a huge motivator for the “late swallower” and they conquer the challenge. 

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Managing Your Child's Asthma

Daily Dose

Your Teen's Eating Habits

1:30 to read

While seeing patients one evening, I saw a 15 year old boy who had come in complaining of feeling dizzy and tired. It was the end of school as well, so he was busy with studying and finals.  This is the kind of patient that is typically given a 15 minute appointment.....but needs a lot more than that to figure out what is going on.

He was with his father who said that his son had not had a fever, had not otherwise been ill with cough or cold symptoms. Upon further questioning the teen said he was just tired and thought he might faint....although he had not.  He had gone to school that day. He was not involved in athletics and had no history of previous syncope (fainting). There was not a history of sudden cardiac death in the family. He also had a fraternal twin who was healthy. He usually tried to get about 6-8 hours of sleep a night. He denied drug or alcohol use. He had not had weight loss. HIs exam was entirely normal with normal vital signs.

But, when questioned about his eating habits he informed me that he was a vegan.  His father sat there quietly while I discussed his son’s choices.  He said that he had decided to be a vegan about a year prior, and that he rarely ate with his family. When I asked him to give me an idea of a typical breakfast, lunch and dinner I was amazed at what I heard. He really only ate “junk food”. He ate sugary cereal for breakfast, he might eat a veggie burrito for lunch, and he would often eat another fast food burrito or taco for dinner. He did not eat fruit at all. His Dad said that everyone else in the family ate “normal” meals, and that they were offered to his son as well.

I am writing this to illustrate one of the problems I see with teens who decide to become vegetarians or vegans etc, but really are just what his Dad so correctly stated are “junk food vegans or vegetarians”.

After a lengthy discussion and some lab work,  he was sent home with instructions to research ways to improve his diet even as a vegan, which in turn would probably help his fatigue. He was also stressed about the end of school.... which was another discussion as well!

Both eating issues and stress cause teens to have a lot of complaints of fatigue and feeling blah...I see them all day long. This adolescent agreed to   come back in a month with his diary of meals and he is going to see our nutritionist over the summer.

He was a delightful young man....and I was only an hour behind...but at least we got to the bottom of the problem.

Daily Dose


1:30 to read

Seeing your child faint is always scary for a parent. But in reality, fainting (syncope) is more common than one realizes. Fainting is defined as a transient loss of consciousness and occurs in 15-20% of children.  It is very reassuring to a parent to hear that in most cases fainting is not serious and is only due to cardiac causes (a parental fear) 2-6% of the time.

When parents bring their child in “because they fainted”, the most important part of the evaluation is a good history.  I ask both the parent and child questions.  If there were witnesses other than a parent it is important to question them as well.

I always want to know when the event occurred? Was it when they first had gotten up in the morning, had they eaten before the event?  Do they remember how they felt before they fainted, and did they feel “funny or dizzy” beforehand?  Were they actively exercising when it occurred?  Do they remember “waking up” and how they felt? Did they “wet their pants”?  Most importantly is there any family history of a sudden cardiac event or death (ask about drowning or seizures).

Parents often want to “have a lot of tests run” to rule out “everything”…but after a good history the most important next step is a thorough physical exam.  Just good old fashioned medicine, prior to anything else.  

The most common reason for fainting is often an association with “emotional stress - like seeing blood”, but there are other causes such as hunger and low blood sugar, heat, anxiety, or dehydration. This type of fainting is called vaso-vagal sycope or neurocardiogenic syncope.  Thankfully this type of fainting can be managed by teaching the patient to recognize their symptoms  and protecting them from falling and hurting themselves, not from fainting but from a possible secondary head injury. I tell every one of my patients that has fainted….if you feel funny, dizzy, see spots or whatever and “think” you are fainting, SIT DOWN!!! Fainting will not kill you but cracking your skull might.

I usually do a baseline EKG on children who have a “first fainting episode”, as it is an easy test and I have an EKG machine in my office.  ( not all doctors will even do an EKG).  This will rule out some abnormal rhythms or cardiac enlargement.  Although each case is different, there are “red flags” that should prompt a more extensive evaluation. Fainting that occurs during exercise should always have a more detailed work-up. Having a family history of certain cardiac diseases should also necessitate further work up. In these cases I typically refer patients to a pediatric cardiologist for further evaluation which might include an echocardiogram, a stress test or even cardiac monitoring. 

Actually, all 3 of my own children fainted during their teen weird, but I did know it was more common than people think. Interestingly, they all seemed to “outgrow” fainting.  Anecdotally, In my own experience fainting seems to be so much more common during adolescence, while those hormones are raging…which is very stressful.

Daily Dose

Celebrate Earth Day

1.30 to read

Last week was a really hard week for our entire country.  Thankfully we are starting off this week on an entirely different note, with Earth Day celebrations.  Today is the day that over one billion people around the world unite to “voice concerns for the planet, and to take action to protect it.”

The global theme for Earth Day 2013 is “The Face of Climate Change”, which is highlighting the impact of climate change on every person around the world. Not only are we seeing issues with global warming (the United States experienced the hottest year ever in 2012), but news stories continue to report massive weather events around the world. From super storms, to droughts in some parts of the world to flooding in others, international climate changes impact all of us.....and our children.

Earth Day activities are taking place in approximately 192 countries, making it “the largest civic observance in the world”.  What a great lesson to begin teaching our children!  While the challenge to save our environment is global, simple actions that we can take on a daily basis will be the start of initiating individual changes to save the planet for the next generations.

So, think of one thing you and your family can do today to impact environmental change.  Whether that is turning off lights and electronics when you leave home, walking to school rather than driving, beginning a recycling program in your larger projects within your community, every small contribution will lead to the greater good.

I know I have watched our country come together over the last week due to tragic events in both Boston, MA and West, TX. While we face many differences in beliefs within the United States, and worldwide, protecting the Earth is one challenge that knows no boundaries.  

Spend some time today discussing earth day, and model some “green” behavior for your child. The future of our children depends on this.

Your Child

Pre-teen Football Linked to Brain Changes in NFL Players


The start of a new school year also brings after-school sports programs. Late summer and fall is prime football season for many middle and high schools. In some states, it’s a hallowed tradition that boys and girls look forward to participating in whether it’s running down the field or cheering on the team.

While school football doesn’t typically offer the same ferocious body beating and brain –rattling that are seen in the National Football League (NFL), a new study shows that brain development can still be affected by playing football at a young age.

The study looked at the possible connection between a greater risk of altered brain development in NFL players who started playing football before the age of twelve as opposed to those players who began playing later in life.  The study is the first to show a link between early repetitive head trauma and future structural brain variations.

The study was small but interesting. It included a review of 40 former NFL players between the ages of 40 and 65 who played over 12 years of structured football with a minimum of 2 years at the NFL level.

One half of the players took up football prior to the age of 12 and half started at age 12 or later. The number of concussions suffered was very similar between the two groups. All of these players had a minimum of six months of memory and cognitive issues.

"To examine brain development in these players, we used an advanced technique called diffusor tensor imaging (DTI), a type of magnetic resonance imaging that specifically looks at the movement of water molecules along white matter tracts, which are the super-highways within the brain for relaying commands and information," study author Dr. Inga Koerte, professor of neurobiological research at the University of Munich and visiting professor at Harvard University, said in a press release.

The researches believe their findings add to the growing amount of scientific evidence that shows the brain may be especially vulnerable to injury between the ages of 10 and 12.

"Therefore, this development process may be disrupted by repeated head impacts in childhood possibly leading to lasting changes in brain structure," said study author Julie Stamm, currently a post-doctoral fellow at the University of Wisconsin School of Medicine and Public Health.

Despite finding a link to the brain development window where kids are more likely to suffer brain injury by repeated head impacts, the small size of the study means the results may not necessarily apply to non-professionals.

"The results of this study do not confirm a cause and effect relationship, only that there is an association between younger age of first exposure to tackle football and abnormal brain imaging patterns later in life," said study author Martha Shenton, a professor of psychiatry at Harvard Medical School.

Because of the intense publicity about and the findings of many studies on the short and long-term dangers of concussions, many school sports programs are looking at changing how they allow students to play in games associated with head injuries.  Where it was once common for coaches to let players continue playing after a particularly rough tackle or head butting, they are more likely now to insist that a field medical professional examine the child. Some schools are also implementing no tackle policies to protect very young players.

While traditional football isn’t likely to become extinct, parents and coaches can educate themselves about brain injuries and learn how to best protect young players from the chances of long and short-term disabilities.

Source: Brett Smith,



Your Teen

Parents Need to Have the “Sex Talk” With Their Kids


Let’s face it, talking to your child about sex isn’t something a parent looks forward to, but a new study says teens who have had a serious conversation about sex with one or both parents are more likely to use condoms or birth control is they are or become sexually active.

“The take home message is that parents do matter, and these conversations do matter,” said Laura Widman, lead author of the new paper and an assistant professor of psychology at North Carolina State University in Raleigh.

While the more information you can present to your child in a way that addresses the health aspects of sexual activity is good, parents don’t have to be experts says Widman, “Just having the conversation is important,” she said. “That’s the good news.”

According to the Centers for Disease Control and Prevention (CDC), nearly half of high school students have had sexual intercourse. Almost 60 percent of high school students surveyed who have had sex said they used a condom when they last had sex, but 14 percent of sexually active teens said they did not use any birth control the last time they had intercourse.

Young people, aged 15 to 24, make up only a fraction of the sexually active population, but they bear a disproportionate burden of sexually transmitted diseases. And while teen pregnancy rates have dropped significantly, there were still 625,000 teen pregnancies in 2010, and nearly half of them –273,000 — gave birth.

Widman noted that results from the study showed that teens who communicated with their parents about were more likely to communicate with their sexual partners and to use condoms.

“We know that being able to communicate with a partner about condom use is one of the best predictors of whether teens use condoms or not,” Dr. Widman said. “So providing kids with the language they need and getting the message across that the subject is not off-limits or taboo can make a difference in their behavior.”

Some parents worry that talking about sex with their child somehow sends a message that they are approving of that behavior. However, studies have found that children who are comfortable talking about sex are actually more likely to delay sexual activity and be older when they first have intercourse.

“Parents fear that if they bring these issues up, they’re signaling that it’s okay to have sex, but that’s completely untrue – we know that parents who bring it up, and bring it up regularly, their kids are least likely to have sex,” said Vincent Guilamo-Ramos, a professor of social work at the Center for Latino Adolescent and Family Health at New York University’s Silver School of Social Work and author of an article about that topic that was published recently in JAMA Pediatrics.

Parents aren’t the only ones uncomfortable talking about sex, so are their kids.  In a 2012, half of the kids surveyed said they were uncomfortable talking to their parents about sex. Only 19 percent of the parents said they were uncomfortable having the “sex talk” with their child.

Children often think that if they ask questions, their parents “will overreact or assume they’re having sex,” said Dr. Guilamo-Ramos, who has developed some pointers on talking with your children.

If you’re wondering how to start that conversation with your child, the Office of Adolescent Health, part of the U.S. Department of Health and Human Services, has these tips:

·      Use current events, pop culture or developments in your social circle to start conversations about sex, healthy relationships and contraception. It’s not a one-time chat, Dr. Guilamo-Ramos said. “Talk to your child on a regular basis.”

·      Take on the tough topics, like birth control and sexual orientation.

·      Pay attention to a teen’s romantic relationships. Teens in intense romantic relationships are more likely to have sex, especially if the partner is a couple of years older than your child.

·      Address your child’s concerns, not just your own. “They want help with the real life pressures they’re experiencing in social situations,” said Dr. Guilamo-Ramos. “Talk with them about what a healthy relationship looks like, and help them come up with strategies and short one-liners that will help them get out of tough situations.”

·      Make sure to talk to your sons, not just your daughters. “Parents’ messages are often more directed to girls than boys,” he said. “And boys aren’t getting the information they need.”

The findings from the North Carolina State University research stem from a large analysis of adolescent health data, based on more than 50 studies involving 25,314 teens over the course of 30 years. The link between parental communication and safer sex practices, while modest overall, is strongest for girls and for teens that talked with their mothers, according to the research, published online in JAMA Pediatrics

As with most studies, the results do not prove a conclusion, only an association. 

Source: Roni Caryn Rabin,


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Heart Healthy Kids

Heart Health

Your Child

Getting Into the Swing of Summer Safety


As we wave goodbye to another school year, we say hello to summer.

Today marks the first official day of summer with a special event that hasn’t occurred for nearly 70 years. Tonight there will be a rare summer solstice full moon.

What a unique opportunity to round up the kids and do a little stargazing and moon watching this evening!

Getting into the swing of summer often includes fun activities like swimming, boating, biking, camping and other outdoor activities, but it also requires more attentiveness from parents and caregivers.

The more laissez-faire days give kids a chance to relax from school routines, but can also put them at a higher risk for accidents and injuries. It’s always a good idea to brush up on your summer safety tips.

Summer means high temperatures. In certain parts of the country, temperatures can be well over a hundred degrees. That’s not likely to keep kids indoors all day, and they really shouldn’t be if they are generally healthy.

Outdoor play is good for kids, but you may need to get them out in the mornings and later in the evening when temps aren’t quite so high. Before sending kids out to play, make sure they always wear shoes to protect feet from cuts, scrapes and splinters, and wear sunscreen to protect from sunburns and harmful ultra-violet rays.

While playing poolside may be a blast, Safe Kids Worldwide reports that drowning is the leading cause of injury-related death for children ages 1 to 4 and it is the third leading cause of injury-related death among children 19 and under. Prevent accidents and injuries with these tips to ensure your family’s safety:

Pool Safety:

•       Teach children to never swim alone or go near water without an adult present.

•       Always jump in feet first to check the depth before diving into any body of water.

•       Never dive in the shallow end of the pool or into above ground pools.

•       Never leave a child unattended in or near water.

•       Make sure your child knows how to swim, starting at a young age.

•       Teach children to stay away from drains.

•       Make sure any pool or spa you’re child gets in has a safety compliant drain cover. Powerful suction from a pool or spa drain can even trap an adult.

•       Know how to perform CPR on a child and an adult. Often, bystanders are the first to aid a drowning victim, so learning CPR can help save a life.  CPR classes are available through many hospitals, community centers, or by contacting the American Red Cross.

•       Keep a cell phone nearby in case of an emergency, but don’t let it distract you from overseeing the children.

•       Know your child’s limits. Watch out for the "too's" — too tired, too cold, too far from safety, too much sun, too much hard activity.

•       Watch for kids diving above other kids. Make sure the area is clear when a child dives from a diving board.

•       Keep an eye on the weather. Make sure kids are out of the pool or lake if bad weather approaches. Take the fun inside till it’s clear.

•       Make sure that the water is clean – polluted water can make a child very sick.

Boating and water skiing safety:

Boating and water skiing can be great fun, but requires a lot of supervision.

According to the U.S. Coast Guard, nearly 71 percent of all boating fatalities are caused from drowning, 85 percent of which are a result of not wearing a life jacket. Here is what you can do to enjoy the water safely:

•       Always have children wear a Coast Guard-approved, properly fitted life jacket while on a boat, around an open body of water or when participating in water sports.

•       Educate yourself. According to the U.S. Coast Guard, 86 percent of boating accident deaths involve boaters who have not completed a safety course.

•       Always check water conditions and forecasts before going out on the water.

•       Never consume alcohol when out on the waters with your child. Impaired judgment is often the cause of the most critical accidents and injuries.

Lawn Mower safety:

While not considered a typical summer “fun” activity, many severe accidents occur to small children riding on lawn mowers with a parent or grandparent.

According to the American Academy of Orthopaedic Surgeons, lawn mower injuries account for a large percentage of accidental amputations. The Academy cautions that the speed of a typical lawn mower blade can send dirt and bacteria deep into a wound, creating a high risk for severe infection. To avoid accidents involving lawn mowers, keep these tips in mind:

•       Teach children to never play on or around a lawn mower, even when it is not in use. They should never be permitted to walk beside, in front of or behind a moving mower.

•       Children under 6 years of age should be kept inside the home while mowing.

•       Children should be at least 12 years of age before operating a push lawn mower and at least 16 years of age before operating a riding lawn mower.

Fire and fireworks safety:

Summer often involves grilling, campfires and fireworks. All of these activities are standard fair for a lot of families. A few simple safety tips can help prevent injuries.

•       Teach kids to never play with matches, gasoline, lighter fluid or lighters. Make a habit of placing these items up and away from young children.

•       Do not leave children unattended near grills, campfires, fire pits or bonfires. Always have a bucket of water or fire extinguisher nearby whenever there is a burning fire.

•       Take your child to a doctor or hospital immediately if he or she is injured in a fire or by fireworks.

•       Never let children ignite fireworks or play alone with them. Fireworks that are often thought to be safe, such as sparklers, can reach temperatures above 1000 degrees Fahrenheit, and can burn users and bystanders.

•       Attend community fireworks displays run by professionals rather than using fireworks at home.

These tips cover a few of the most common summer activities. We’ll continue with more summer safety tips in future articles. Welcome to summer fun and don’t forget to catch that awesome full moon tonight!

Story sources:





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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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