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Daily Dose

Family Time is Important!

1.30 to read

I loved Thanksgiving and all of the multigenerational family time that we had. Not only did we have the blessing of having all 3 of our sons and our daughter in law for Thanksgiving, we had their 90 year old grandmother with us as well. What a treat.  

My office is typically busy right before holidays, especially with the onslaught of coughs and colds (thankfully no flu yet) and I have found myself talking to all of my patients and their families about their Thanksgiving. It is fun to hear what everyone had done and a good way to get kids to talk.  (Did they travel, what did they eat, what is their favorite Thanksgiving food).  It is also really interesting to talk about family traditions.  I was seeing a family this week, with their 3 children ages 9, 7,  and 4.  If you can believe it, their mother was a patient of mine when I first started into practice and she was a teenager.  She is a super mother, very hands on, common sense and grounded. Her kids are all adorable. They make being their pediatrician pretty darn easy. So, when I started asking about their Thanksgiving she brought up blessings. She said that this subject had just come up at their house because one of her elementary aged children had asked her if they “were rich?”. She said she answered by saying, “yes, we are rich in blessings”.  When they asked her what this meant she told them that they were “rich with family, friends, food and health”  and because of that they were “blessed”. When I asked the children about blessings they could all recite why they were blessed. They also added a few more blessings like their pets and teachers.  The conversation kept everyone engaged and talking.

 What a great way to start off December and the busy holiday season. Let’s all remember our blessings.  

Daily Dose

A Little TLC Goes A Long Way

Just what is TLC and how can it help your child feel better quicker?I can tell that I am aging!!  Not by the new “character lines” I see popping up (hate that), but rather by the way that language and jargon continues to change. I really have tried to stay up with new acronyms such as LOL, or POS, or even “keep it on the DL”.

But while we “mature” adults feel the need to keep up with the younger generation’s “language”, some of the older acronyms seem to be fading away.  I realized this today when I was seeing a young patient and his mother. The cute little 5 year old boy had one of those nasty winter time viruses with a fever and a cough. After finishing his exam and doing an influenza test on him (it was negative) I told the mom that the best way to treat his virus was with fever control and a little TLC.  She gave me this blank look and said, “is that a brand of cough syrup?”  I didn’t know whether to laugh or to cry. I thought that TLC was a universal acronym for all mothers (or maybe better put for parents) as even my own parents and grandparents would say, “you just need a little TLC”. For those of you who have read this far and still don’t know what I am talking about, TLC is the acronym for “tender loving care”.  What better way to treat your feverish, coughing, uncomfortable child, than with a little TLC. When my own children are sick, even now that they don’t all live at home, they still all want some TLC.  As much of a rule follower that I am, when your child is sick, the rules get broken for a while. That means that children get to sleep in their parent’s beds (I often moved after a few wild kicks and thrashing), but one parent remained with the feverish child sleeping next to mom or dad. There were all sorts of “forbidden fruits” given to a child who was sick, such as “slurpees”, ice cream and popsicles in bed, favorite foods all day long and even television without a  time limit. The homework might not get finished due to a fever and general “feel bads”, and the list of things to do just went away for a few days while a child was sick.  It was one of those lovely parenting moments when you could just “turn off the time” and snuggle with a sick child. In other words, lots of TLC. TLC has nursed many a child through numerous illnesses over the years.  I don’t think the directions for TLC have changed.  Just do anything that makes your child feel better. Games in bed, making cookies and jello to eat after an afternoon nap, and even getting to have a special TV tray to use while eating chicken noodle soup.  These “comfort foods” and pampering do make anyone who is sick feel a little bit better.  There are even studies to confirm this. So, remember TLC is not a new fancy cough syrup. It is the “tender loving care” a parent gives to a sick child. Some things never change with time and TLC is one of them.  Best of all, no need for a prescription or a copay! That’s your daily dose for today.  What’s your favorite TLC remedy for your kids? Comment below to share with all of us!

Parenting

When Are Kids Ready For Chores?

2:30

The Merriam-Webster definition of the word “chore” is: A small job done regularly, or a dull, unpleasant, or difficult job or experience. I’d have to agree that household chores are oftentimes both. Whether we like them or not – someone has to do them.

Many parents end up doing all the chores around the house because it’s easier than trying to get their children to pitch in and help. By the time you explain to a child what needs to be done and how to do it- you could be finished with all the chores instead of just one.

While that may be appealing from a time management perspective, it doesn’t prepare children to be responsible adults. Self-reliance becomes more of a realistic goal for children when parents are willing to put the work into teaching them simple chores when they are young and expecting more when they are older.

Speaking of realistic, let’s not get all dreamy-eyed with visions of our little ones cheerfully picking up their toys and putting them away or making their beds before rushing off to school (at first.) But don’t despair; there are a few “tricks” that can make this experience a little easier.

Parenting expert Jim Fay, co-founder of the Love and Logic website, says we all need to feel needed and to know that we're making a contribution -- even kids. "But they can't feel that way if they don't have chores and make contributions to the family," Fay says.

Roger W. McIntire, University of Maryland psychology professor and author of Raising Good Kids in Tough Times, says, "A child has to have some responsibilities."

That’s all well and good – but how do you get your kids onboard?

Let’s start at the beginning with traps that can sabotage your progress:

Perfection: It’s not attainable – don’t expect it. Perfection is in the eye of the beholder. What looks perfect to me may look like a mess to you.  If you want your children committed to doing their chores, a much more relaxed attitude will win them over. Parents that expect perfection typically give up on the teaching aspect, jump in and do the chore themselves. It’s really more of a reflection of the parent than the child’s ability to learn. So breathe, relax and know that it’s going to take time.

Criticism: Criticizing your child’s accomplishment goes hand in hand with expecting perfection. Too often parents focus on what wasn’t done instead of what was done. Don’t be stingy with praise for trying. Encourage your child while the chore is in progress. You want to build positive momentum, especially with young kids.

Inconsistency: You can’t expect your child to learn and want to participate if you’re not dedicated to and enthusiastic about the outcome. Being consistent in what you expect and when you expect it completed helps your child understand their responsibilities in the household. When parents give up, so do their kids. And guess who ends up doing all the chores?

So, we’ve established some pitfalls to avoid… what next?

The “Chores Chart” makes organization easier and tasks clear. 

"Create a list of every job it takes to keep a family going," Fay says. Have kids pick out the chores they'd most like to do. Then create a chart.

First, check that everyone has an age-appropriate chore. Then divide the chart into three columns. One is for the list of chores and whose chore it is; another is for deadlines; the last one is for making a check mark when the chore is done. Put the chart where everyone can see it and let everyone follow through on their own assignments.

Weekends may provide a bit more time to get some of the extra chores done such as laundry, mowing the grass, cleaning the car etc. You can create a “Weekend” chart separate from the daily chores. It may change from weekend to weekend depending on what needs to be done and who is available.

Should you pay your kids to do their chores? Ah, the age old question. There are lots of opinions on this one. You’ll have to decide whether a financial incentive pays off in your family. Some things to consider are, do you believe chores should be more about responsibility and learning household tasks without a monetary reward? Or is learning how to manage money considered a “household task” that needs to be accomplished?

Small children may be less motivated by an allowance and more motivated by positive attention. Older kids may like the idea of earning money that they can spend however they want. You might want to have a list of “extras” that are offered for an allowance.

At what age are children ready to start doing chores? It’s probably younger than you think.

In general, Pantley says, preschoolers can handle one or two simple one-step or two-step jobs. Older children can manage more. Here are her pointers on kids' chores by age:

Chores for children ages 2 to 3:

·      Put toys away

·      Fill pet's food dish

·      Put clothes in hamper

·      Wipe up spills

·      Dust

·      Pile books and magazines

Chores for children ages 4 to 5:

Any of the above chores, plus:

·      Make their bed

·      Empty wastebaskets

·      Bring in mail or newspaper

·      Clear table

·      Pull weeds, if you have a garden

·      Use hand-held vacuum to pick up crumbs

·      Water flowers

·      Unload utensils from dishwasher

·      Wash plastic dishes at sink

·      Fix bowl of cereal

Chores for children ages 6 to 7:

Any of the above chores, plus:

·      Sort laundry

·      Sweep floors

·      Set and clear table

·      Help make and pack lunch

·      Weed and rake leaves

·      Keep bedroom tidy

Chores for children ages 8 to 9:

Any of the above chores, plus:

·      Load dishwasher

·      Put away groceries

·      Vacuum

·      Help make dinner

·      Make own snacks

·      Wash table after meals

·      Put away own laundry

·      Sew buttons

·      Make own breakfast

·      Peel vegetables

·      Cook simple foods, such as toast

·      Mop floor

·      Take pet for a walk

Chores for children ages 10 and older:

Any of the above chores, plus:

·      Unload dishwasher

·      Fold laundry

·      Clean bathroom

·      Wash windows

·      Wash car

·      Cook simple meal with supervision

·      Iron clothes

·      Do laundry

·      Baby-sit younger siblings (with adult in the home)

·      Clean kitchen

·      Change their bed sheets

From this list, you can see there are a variety of chores that a child can help with or learn to do.  As I go through each one, I think about how many of these tasks I could do when I was ready to head off into the world as a young adult. Who knew you could actually do your own laundry?

Source: Annie Stuart, Roy Benaroch, MD, http://www.webmd.com/parenting/guest-expert-10/chores-for-children?print=true

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Teens and Alcohol

Teens & Alcohol: A Deadly Mix

Your Baby

Acetaminophen Ranks Highest in Infants’ Accidental Poisonings

2:00

Infants are just as susceptible to accidental poisonings as toddlers and older children, according to a new study. Acetaminophen (such as Tylenol) was the most common medication error for infants. Some of the other products associated with accidental poisonings may surprise you.

The researchers look at data from all poison control center calls in a national database from 2004 to 2013 that related to babies younger than 6 months old.

Acetaminophen was the most reported medication mistake followed by H2-blockers (for acid reflux), gastrointestinal medications, combination cough / cold products, antibiotics and ibuprofen (such as Motrin or Advil).

The most common non-medication exposures were diaper care and rash products, plants and creams, lotions and make-up, the investigators found.

"I was surprised with the large number of exposures even in this young age group," said lead author Dr. A. Min Kang, a medical toxicology fellow at Banner-University Medical Center Phoenix in Arizona.

"Pediatricians typically do not begin poison prevention education until about 6 months of age, since the traditional hazard we think about is the exploratory ingestion -- that is when kids begin to explore their environment and get into things they are not supposed to," Kang added.

The research team found that there were more than 270,000 exposures reported during the decade of data, 97 percent of which were unintentional. However, over 37 percent were related to medication mistakes.

Acetaminophen was involved in more than 22,000 medication exposures and nearly 5,000 general exposures. This high rate reflects its frequent use because it's recommended instead of ibuprofen for infants, Kang pointed out.

"The concern with too much acetaminophen is liver failure although, luckily, young children are considered to be somewhat less likely to experience this than an adult because the metabolism is a little different," Kang said.

The current rate of acetaminophen mistakes may actually be lower notes Dr. Michael Cater, a pediatrician with St. Joseph Hospital in Orange, California, because infant drops are now standardized across manufacturers.

The number of ibuprofen exposures, however, surprised Cater since ibuprofen isn't recommended for those under 6 months old.

"Also surprising was the number of ethanol poisonings," likely from parents leaving empty glasses or bottles of alcohol around, he said. "Low-lying plants, some of which are toxic, are a source of concern, and this was a bit of a surprise to me."

Diaper creams and lotions likely top the list because they're easily reachable by infants when left on the diaper-changing areas, Cater added.

The AAP has a policy statement recommending that all liquid medications use metric units for dosing and that they include administration devices, such as syringes, to reduce the chance of an overdose.

Perhaps doctors should offer poison prevention education to caregivers earlier, even starting when a baby leaves the hospital, Kang suggested.

The poison control hotline phone number- 1-800-222-1222 – should also be posted in the home and programmed into parents and caregiver’s cell phones Kang said.

The findings were published online in the January edition of the journal Pediatrics, and in the February print edition.

Source: Tara Haelle, http://www.webmd.com/children/news/20160113/acetaminophen-tops-list-of-accidental-infant-poisonings

Your Child

Gluten-Free Diet Not Recommended for Healthy Children

2:00

A “gluten-free “ label on a food product is one sure way to increase sales as the popularity of such items continues to rise.

For people with Celiac disease or gluten sensitivity, eating gluten can cause diarrhea, abdominal pain, upset stomach and bloating. However, for healthy adults and particularly children, there are many reasons to avoid going gluten-free according to a commentary recently published in the Journal of Pediatrics, by Norelle Reilly.

Dr. Norelle Reilly is Assistant Professor of Pediatrics at Columbia University Medical Center and the director of pediatric celiac disease in the Division of Pediatric Gastroenterology and the Celiac Disease Center at Columbia University.

In a recent Time Magazine article, Reilly lays out four reasons why healthy children should not be on a gluten-free diet.

1. Gluten is not naturally toxic except for people with celiac disease, however, in almost all children, gluten travels through the intestine without causing disease and will never lead to problems. To date, science has not shown that there is a toxin in gluten that makes it bad for our bodies. A balanced diet containing fresh fruits and vegetables, lean proteins, and a variety of carbohydrate sources is the best way for healthy children to stay healthy, Reilly notes.

2. A gluten-free diet may not provide balanced nutrition for children. Some people assume that gluten-free food and healthy food as the same thing. Not necessarily so, says Reilly.

Many gluten-free substitutes for items such as breads and cookies are actually higher in fat and calories than gluten-containing varieties. Gluten-free items such as some cereals and breads may also not be nutrient fortified to the same degree as those with gluten. Folate and B-vitamins are often added to our usual starch staples, silently protecting people whose diets may not be very balanced from deficiency. Without these quiet sources of nutrition, vitamin deficiencies could develop, she writes.

Gluten-free foods are often fiber deficient, which is important for gastrointestinal health, including maintaining regular bowel movements. Quite commonly, children who initiate a gluten-free diet become constipated. Increased consumption of rice, a common gluten substitute, may also expose children to more arsenic in their diets, as arsenic is frequently present in the earth where rice is grown.

Reilly says that growing bodies and brains require balanced nutrition. For those children who need a gluten-free diet, balance can be implemented safely and healthfully with the guidance of an experienced registered dietitian to help avoid all of these and other nutritional pitfalls.

3. Have your child tested for celiac disease before putting them on a gluten-free diet. You can’t know for sure whether your child is gluten sensitive or has celiac disease until a physician has tested them. Symptoms alone are not enough to determine whether your child has celiac disease. Being on a gluten-free diet before having your child tested can make it more difficult to determine whether he or she actually does or does not have the disease.

Reilly suggests that if you are concerned that your child may have a problem with gluten, speak to your child’s doctor before banning it from your child’s diet. A child with celiac disease needs special monitoring over time and their family members may need to be tested. Even if you plan to give the diet a try regardless of the test result, it is extremely important for your child and family’s health to know why the diet is necessary.

4. A gluten-free diet is hard to maintain and expensive. For children who require this limited diet for long-term health, parents, schools, and the medical teamwork to make the child’s experience in school and at home as easy as possible.

Reilly notes that the children she has treated for celiac disease would trade in their gluten-free diet in an instant if they knew gluten would not make them sick.

In addition she adds, gluten-free foods are incredibly expensive and for many families the diet can be challenging to financially sustain in the long run.

Many adults prefer a gluten-free diet, but Reilly cautions that parents should check with their pediatrician or family doctor before putting their healthy children on the same eating plan.

Story source: Norelle Reilly, http://time.com/4329517/4-reasons-why-your-kids-should-not-be-gluten-free/

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

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”.

 

 

Your Child

Pre-teen Cholesterol Check-Up

1.45 to read

Do you know your child’s cholesterol level? Unless you have a family history of high cholesterol, getting your child’s checked probably hasn’t been high on your list of medical exams.

A panel of experts appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, are recommending that children be tested for high cholesterol by age eleven. They also recommend that children who are overweight, be screened every 2 years for diabetes.

Major medical groups already suggest children, with a family history of high cholesterol or diabetes, be screened early. Children without a family history of heart disease or diabetes have traditionally not been screened until their later years. Times have changed though and because of the childhood obesity epidemic many kids are developing heart disease and Type 2 diabetes at a much younger age.

Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.

"If we screen at age 20, it may be already too late," she said. "To me it's not controversial at all. We should have been doing this for years."

An alarming statistic shows how destructive childhood obesity has become. Autopsy studies show that children already have signs of heart disease, long before they show symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.

According to the National Cholesterol Education Program's Expert Panel on Blood Cholesterol in Children and Adolescents, the acceptable level for total cholesterol in kids 2 to 19 years old is less than 170 mg/dL. Their LDL cholesterol should be less than 110 mg/dL, HDL levels should be 35 mg/dL or greater, but preferably over 60, and triglycerides should be 150 mg/dL or less.

Doctors recommend screening between ages 9 and 11 because cholesterol dips during puberty and rises later. They also advise testing again later, between ages 17 and 21.

The rise in Type 2 diabetes, in children, has also increased in the last decade. It is hard to detect type 2 diabetes in children, because it can go undiagnosed for a long time; children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. That’s why early screening is so important.

The guidelines also say doctors should:

  • Take yearly blood pressure measurements for children starting at age 3.
  • Start routine anti-smoking advice when kids are ages 5 to 9, and counsel parents of infants not to smoke in the home.
  • Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.

There has been some controversy over doctors using terms like overweight and obese when talking with parents and children about their weight. The panel suggests that these are medically correct terms and should be used so that parents and children understand the importance of the problem.

Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight; even kids as young as age 2, the panel said.

"Some might feel that 'obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.

They were released online by the journal Pediatrics.

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