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Your Toddler

Recall Reminder: 8th Child Dies From Fallen IKEA Dresser

2:00

IKEA has voluntarily issued a reminder about its recall of MALM and other models of chests and dressers due to a serious tip-over hazard. An 8th child has reportedly died after being trapped under a fallen IKEA dresser.

CEO Lars Petersson said Ikea wants to increase awareness of the recall campaign for several types of chest and dressers that can easily tip over if not properly anchored to a wall.

The initial recall was issued in June 2016, for 17.3 million chests and drawers. The Swedish retailer and the federal safety regulators are reminding customers to take immediate action to secure the dressers, or to return them.

This recall re-announcement involves MALM and other IKEA chests and dressers that do not comply with the requirements of the U.S. voluntary industry standard (ASTM F2057-14).  The recalled children’s and adult chests and dressers include the MALM 3-drawer, 4-drawer, 5-drawer and three 6-drawer models and other non-MALM models.  The recalled children’s chests and dressers are taller than 23.5 inches; recalled adult chests and dressers are taller than 29.5 inches. 

The MALM chests and dressers are constructed of particleboard or fiberboard and are white, birch (veneer), medium brown, black-brown, white stained oak (veneer), oak (veneer), pink, turquoise, grey, grey-turquoise, lilac, green, brown stained ash (veneer), and black.  A 5-digit supplier number, 4-digit date stamp, IKEA logo, country of origin and “MALM” are printed on the underside of the top panel or inside the side panel.  

To see a complete list of other non-MALM chests and dressers included in this recall, click on this link www.IKEA-USA.com or http://www.ikea.com/ms/en_US/ikea-chest-and-dresser-recall/index.htmlon IKEA’s website.

Dangerous tip-over incidents often occur when curious kids climb on furniture in an attempt to access TVs, toys, remotes or other desired items.  While the threat is serious, the solution is simple. Anchor TVs, furniture and appliances in the home. And when product recalls are announced, act on them immediately. Visit AnchorIt.gov to see how TV and furniture tip-over incidents occur and the simple steps to prevent them.

Story Source: https://www.cpsc.gov/Recalls/2018/IKEA-Reannounces-Recall-of-MALM-and-Other-Models-of-Chests-and-Dressers-Due-to-Serious-Tip-over-Hazard

Daily Dose

Lead Testing

1:30 to read

Lead exposure is young children may lead to long term consequences. Therefore, blood lead level testing has been recommended for all children at their 1 and 2 year check ups. Most doctors offices either prick a child’s finger or heel to draw the blood for testing, and many use an in office machine to perform the test.  

 

Some of the blood testing is performed by Magellan Diagnostics and the F.D.A. just announced that the 3 minute test run in many doctor’s offices could “yield inaccurate results when used on blood drawn from a vein”.  The F.D.A. went on to say “that there was no evidence at this point that the finger and heel prick methods have provided inaccurate results, and for some reason only venous blood has been associated with inaccurate readings”. 

 

I have already been getting some calls and emails from concerned parents wondering if their child needs to have repeat testing performed.  Fortunately, in our office we have routinely used capillary blood from a finger stick. We test that specimen for both lead and also a hemoglobin test to look for anemia.  You would probably remember a “venous blood draw” as it requires finding a vein (usually in the crook of the arm) and actually using a needle and syringe to draw the blood sample…a lot more difficult than a finger stick, especially in a squirming toddler.

 

We are all exposed to some lead in our environment, and lead levels under 5 mcg/dl as being “safe”.  If a child’s screening lead level is higher than 5, then most doctors will draw a venous sample to confirm the elevated levels and to then try to determine if the lead exposure is coming from the home, school, or environment. Infants and young children are especially vulnerable to the effects of long term lead exposure and lead poisoning, especially during periods of rapid brain growth and development. High lead levels may lead to long term effects on IQ and performance as well as affecting other body systems.

 

If your child is under the age of 6 years and you are concerned about the accuracy of their lead testing, you should call your doctor’s office and inquire if they had testing done on venous or capillary blood.  If there are concerns it would be appropriate to draw another sample from capillary blood or sent to an outside lab.  It is estimated that most of the testing performed in a doctor’s office was done on Magellan equipment which is used by about 10,000 pediatricians throughout the country.

 

Daily Dose

Pink Eye

1:30 to read

This is another time of the year that I see a lot “pink eye”.  Any time the eye is pink..you have “pink eye”, which mothers seem to be quite confused by!!   They often comment…”this is pink eye?” , to which I respond, “well, the child’s eye (conjunctiva) is pink (red), so yes…this is pink eye”.  The term is just a description of the eye….but then you need to determine why the eye is “pink”.

 

Conjunctivitis is one of the most common causes of a pink eye….and there are many different types of conjunctivitis.  As with any condition the history is really important in helping to determine why a child’s eye is inflamed.  Several of the most common causes of the “pink eye” are bacterial, viral and allergic conjunctivitis.

 

Bacterial conjunctivitis often shows up in younger children and they have lots of matting of the eye lids and lashes and a mucopurulent discharge (gooey eyes). Some moms say that the “goo of gunk” comes as quickly as they can wipe it.  The child often has a lot of tearing and will rub the eyes as they feel that something is in their eye and it is irritated.  Bacterial conjunctivitis will typically resolve in 8 -10 days on its own, but antibiotic eye drops are used to shorten the course  of the pink eye and also reduce the contagiousness.  It seems as if every child in a day care class room will get conjunctivitis as they constantly rub their eyes and touch toys!!  Hand washing helps….but you can’t wash a child’s hands every time they touch their eyes.

 

Viral conjunctivitis usually occurs in combination of with systemic viral illness. Sore throat, fever and bright red eye are often seen in older children and teens and is due to adenovirus.  While the eye is red, the discharge is typically watery and matting is much less common. These patients are contagious for up to 12 days so it is important to practice good eye/hand hygiene, especially in the household. Artificial tears may help the feeling of eye irritation, but antibacterial eye drops rarely help except in cases of a secondary infection.  I get many phone calls from parents saying, “we tried prescription eye drops and they are not working”. I make sure to tell my older patients to take out their contacts and wear glasses for 7-10 days.

 

At this time of year I am also seeing a lot of seasonal allergic conjunctivitis.  These children have intensely itchy and watery eyes, as well as swelling of the eyelids and area surrounding the eyes. They look like they have been crying for days as they are so swollen and miserable. Many also have a very watery nasal discharge. They do not have fever. Using over the counter medications for allergy control, such as nasal steroids and anti-histamines will help some of the allergic symptoms. There are also over the counter eye drops (Zaditor, Patanol) that help when used daily.  During the worst of the season I make sure that the child has daily hair wash and eyelash and eyebrow wash with dilute soapy water to make sure the pollen is removed after they have been playing outside. It is nearly impossible to keep a child indoors for the 6 or more weeks of allergy season!

 

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!

 

 

Daily Dose

Parenting is Tiring

1:15 to read

If there is one thing I hear over and over again from parents it is the common complaint, “ I am so tired”.  I hear this most often from mothers, who also wonder why their own children “never get tired”!   

It is ironic that children balk at taking naps, and often push their parents to let them stay up later at bedtime.  On the other end of the spectrum is a parent who would love to take a nap!

As a new parent with an infant you quickly learn what sleep deprivation is all about.  If it is your first baby you will learn to sleep when the baby sleeps....as you never know when you will get to sleep at night!  The word babies and circadian rhythm should not even be used in the same sentence. 

Then as babies get older, parental sleep does come again,  but suddenly you have a toddler who is up at night with dreams or night terrors or who know’s what!!  Anything that gets a toddler “off schedule” or “out of sync” really does mess up their sleep cycles, so that means parents have disrupted sleep as well. 

During the “middle years” of parenting, it seems that everyone does get a bit more sleep, although parents have to stay up late to get ready for the following day and often wake up much earlier than their children....just to have time to get themselves organized and ready for the day before getting everyone else up and out the door. 

Finally, the teenage years!!! While teens are more self-sufficient, they still need parents to “gently remind them” that they need to go to bed. Most teens would like to stay up all night, and sleep all day. Only problem with this schedule is SCHOOL and they need to be alert. We all know teens don’t get enough sleep, which means that their parents don’t as well.  

What about when your teenagers are out for the evening, what parent can sleep until their child is home and tucked into bed?  As a mom that meant “re-checking” that they stayed in that bed!! More sleepless nights....those teenage years feel somewhat similar to having infants -  totally crazy sleep cycles. 

So....now you know why most moms (and dads) complain of being tired all of the time. They are!

Daily Dose

Jaundice in Newborns

1:30 to read

It is not at all uncommon for a healthy newborn to develop jaundice in the first several days of life. Bilirubin is produced when red blood cells are broken down. It is a yellow pigment that we all metabolize in the liver and then it is excreted in urine and stools. In an newborn, the body produces almost 2-3 times the bilirubin that an adult does. Because newborns are also “immature” their liver cannot keep up with the bilirubin production and therefore bilirubin levels rise. In some cases the bilirubin is high enough to cause a yellowing of the skin (jaundice), and this is termed physiologic jaundice of the newborn. 

 

Your infant will have their bilirubin level checked while they are in the hospital and your pediatrician will follow any bilirubin levels that seem to be rising. In most hospitals the bilirubin is tested transcutaneously (through the skin), and you may never know that you baby has been tested. If bilirubin levels seem to be high, a blood test will be performed to more accurately assess the bilirubin level. If bilirubin levels continue to rise a baby may then be put under phototherapy (special blue lights that breaks down bilirubin in the skin and help it to be eliminated). Phototherapy prevents extremely high levels of bilirubin which may get into the brain and could be toxic to the baby and cause brain damage.

 

When a baby is put under phototherapy they may be in a basinette or wrapped in a “bili-blanket”  and they will wear sunglasses to prevent any damage to their eyes from light. They are usually naked or only in a diaper so that as much skin is exposed as possible. In most cases the bilirubin levels have peaked by day of life 3 or 4 and the baby will no longer need phototherapy. While the baby is under the “bili-lights” they will continue to have blood tests (from their heels) to follow the bilirubin levels.

 

As babies are now being discharged in 24-48 hours after delivery some babies will develop jaundice after they have already gone home…so you your doctor will plan on seeing you 1 to 2 days after your are discharged. But, should you notice that your baby seems to be getting more jaundiced you should call you doctor and be seen sooner.  

 

Just this week I saw a baby who continued to become more jaundiced after he went home. At times I see this when a mother is breast feeding and her milk has not yet “come in”.  If a baby is not getting a lot of milk then they cannot poop and pee out bilirubin…somethings just take time to get going with feeding, peeing, pooping and liver maturation. So…this baby boy was started o home phototherapy. Rather than re-admitting him to the hospital, a pediatric home health care company sent out a nurse with a bill blanket who instructed the parents on the use of it. The baby was then able to feed at home every 2-3 hours, and the bili-blanket was used throughout the day and night. The parents lived so close to the office that they would bring the baby in for bilirubin tests, while in other cases the nurse will go to the home to do the testing.  Home phototherapy in an otherwise healthy infant does not disrupt the new family and really helps the mother establish her breast feeding and lets “everyone” sleep in their own beds!

 

This baby only required phototherapy for 24 hours…in some babies it may be longer. Once the bilirubin was back in a “safe range” the lights were discontinued and he will continue to process the bilirubin on his own. His little yellow face and eyes will be the last evidence of his newborn jaundice and “one for the baby books” as it should never be a problem again.

 

Daily Dose

Tattoos

1:30 to read

Some of my adolescent patients (who are over 18 years) have come in for check ups and shown me their latest “fashion statement”, a tattoo or an occasional tongue piercing.  While years ago it was teenage girls with pierced belly buttons, that fad has declined (at least in my patient population), and societal acceptance of tattoos and other body piercings is more common. While I do see tattoos, tongue piercings and eyebrow piercings within my practice… it seems that I also notice them far more frequently on the parents of the new babies I am seeing.

 

While tattoos and body piercings may be a form of self-expression for a teen, it is also important to remember that there may be risks involved.  A recent article in Pediatrics reviewed risks and consequences of the ever growing “body modification” trend.

 

In several surveys somewhere between 20%-38% of youths 18-24 years old have a tattoo or body piercing (other than ear lobe) and the perception of the association between having a tattoo or body piercing and engaging in high risk behavior is changing.  

 

But, when a teen asks me about tattoos or body piercings I do remind them that there are risks involved, including infection. While most teens worry about a skin infection I also remind them of the risks of HIV, hepatitis B and C and even tetanus…so you want to make sure you have an up to date tetanus vaccine before thinking about a tattoo or piercing. You also want to make sure that there are good antiseptic processes and sanitary practices in place when choosing a tattoo parlor and always use a professional tattoo artist.  

 

I also tell them that tattoos should be viewed as being “permanent”, and I would consider where I had the tattoo placed, and would it be possible to cover it if necessary for employment opportunities?  In the not too distant past I remember our office requiring any employee with a visible tattoo to have it covered with long sleeves but while those days are over, at least in my  office, other employers may have rules about tattoos or body piercings. Because tattoos are supposed to be permanent I also remind teens that trying to remove an ill placed or “out of style” tattoo is difficult, expensive and may only be partially effective. 

 

If any piercing or tattoo begins to look infected or has skin changes the adolescent should definitely seek treatment with a physician. Better still….maybe use a henna “non-permanent tattoo” and limit piercings to the ear.

 

 

 

 

 

 

 

 

Parenting

Bedwetting Accidents

1:45

I’ll admit it; I was a bed-wetter on and off until I was about 6 years of age. The biggest hurdle I faced in getting past leaving a little puddle of urine in the bed during the night, was visually realistic dreams. I would actually see myself get out of bed, walk to the bathroom and sit on the toilet. Unfortunately, I was only dreaming and would awaken after feeling a wet spot in the bed. It was quite embarrassing.

An accident in a friend’s bed during a sleepover was the last straw.

It took several pre-bedtime experiments to finally help me make it through the night dry; but eventually I was able to tell reality from dreams.

How common is bedwetting? Nocturnal enuresis (the medical name for bedwetting) is involuntary urination that happens at night during sleep after the age when a child should be able to control his or her bladder.

About 13 percent of 6 year olds wet the bed, while about 5 percent of 10 year olds.

Bedwetting sometimes runs in families – if one or both parents wet the bed when they were children, odds are that their children will too.

Most of the time, bedwetting goes away on its’ own. Until that time, it can test a parent’s patience and cause a child plenty of anxiety.

To help a child cope with this uncomfortable time, reassure your child that bedwetting is a normal part of growing up for many kids, and that it will not last forever. If you have stories of your own experiences, this would be the time to share them with your little one.

My child also wet the bed and one sure way to stop her tears of embarrassment was to tell her one of my own personal experiences.  It didn’t take long to switch from sobbing to laughing over our shared nighttime horror.

Kidhealth.org offers these tips for breaking the bedwetting spell:

- Try to have your child drink more fluids during the daytime hours and less at night (and avoid caffeine-containing drinks). Then remind your child to go to the bathroom one final time before bedtime. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful.

- When your child wakes with wet sheets, don't yell or punish. Have your child help you change the sheets. Explain that this isn't punishment, but it is part of the process. It may even help your child feel better knowing that he or she helped out. Offer praise when your child has a dry night.

Sometimes, bedwetting can be a signal that there is a medical condition that should be checked out. If it begins suddenly or is accompanied by other symptoms, talk to your pediatrician.

The doctor may check for signs of a urinary tract infection (UTI), constipation, bladder problems, diabetes, or severe stress.

Call the doctor if your child:

•       Suddenly starts wetting the bed after being consistently dry for at least 6 months

•       Begins to wet his or her pants during the day

•       Snores at night

•       Complains of a burning sensation or pain when urinating

•       Has to pee frequently

•       Is drinking or eating much more than usual

•       Has swelling of the feet or ankles

•       Is 7 years of age or older and still wetting the bed

Bedwetting can be a sign that a child is under a lot of stress. Often, when a child loses a family member or pet, is doing poorly in school or is frightened about something, they will suddenly start wetting the bed – even if they’ve never done it before or have mastered the art of getting through the night dry.

Your support and patience can go a long way in helping your child feel better about and overcome the bedwetting.

Remember, the long-term outlook is excellent and in almost all cases, dry days are just ahead.

As for me, I had to find a touchstone to let me know the difference between dreaming and actually getting up to go the bathroom. It was the bathroom light switch. If I actually touched the light switch and turned it on, then counted to five before moving, I was really awake. If the light was already on and I walked to the toilet and sat down- I was dreaming.

Story source: http://kidshealth.org/en/parents/enuresis.html#

 

 

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