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Daily Dose

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Your Child

Time for Back-To-School Routines

1:30

It’s almost THAT time.

Many school districts will begin filling up the classrooms with new and returning students on or about the fourth week of this month.

There’s plenty to do in preparation, including immunizations, loading up on school supplies, new clothes and getting back to regular bedtime hours.

Four weeks may seem like plenty of time to get all these things done, but as you know, deadlines have a way of slipping up on us.

One way to help the family avoid sudden school-morning-shock is to start implementing bedtime hours and routines before classes begin.

Experts agree that two weeks before school begins is a good time to start easing back into the new hours.  Find out what time your child needs to be at school and work backwards to come up with a bedtime that will give them plenty of sleep.  If your child has been staying up later during the summer, you might want to adjust their bedtime by 15 minutes, then a half hour until you get to the bedtime they will use during the school year.

The Sleep Foundation recommends that kids between 6-13 years old get 9 to 11 hours of sleep at night. Teenagers can do well with a little less sleep; between 8 to 10 hours. Preschoolers need the most sleep with about 10 to 13 hours.

Mealtimes are also important. With longer daylight hours during the summer, meals often get pushed back to accompany evening activities. Shifting family mealtimes to an earlier hour can help train everyone’s biological clock to start expecting school schedules instead of the lazy-hazy days of summer.

As parents, you can expect some resistance. It happens every year as a new school year begins. Stick with the changes and your child will adapt. Kids aren’t the only ones that find it difficult to let go of summer; know that you also may have a difficult time adjusting to earlier mealtimes and setting new routines. Patience is going to be the key word for everyone as summer break transitions into school semesters.

Experts often note that routines help everyone function better together. While kids may not like them, they do need them. Kids are more likely to feel safer and know what is expected of them when there are guidelines.

One thing you can count on is that your kids will be watching you to see how you handle change. Be a good role model.

One simple way to help get everything done before school starts is to make a list of what needs to be done and create a calendar for achieving those goals. Check with your school and find out which immunizations and school supplies are needed, clothing or uniform regulations and pre-registration dates. Most schools will have all the information you need online.

There’s still time to enjoy the summer break and slip in a family vacation – August is a popular month for getaways. But, right now is a good time to create a plan for the remainder of August, and to prepare for that first school bell ring!

Your Child

Your Child’s First Day at School

1:45

While I may have forgotten a lot of things in my life, I remember my first day of school. I was so excited because I actually recognized someone. Her name was Donna. We’d met in a department store a week earlier. We had both picked out the same umbrella, but there was only one – she said I could have it. We’ve been friends for life.

When my daughter began school, she experienced all the same emotions I had those many years ago; scared, excited and uncertain where to go and what to do next. She found a friend also and they wandered the halls together.

Some school districts have already begun their new school year, but for many kids - the bell will ring in the next couple of weeks.

Children aren’t the only ones that are anxious as the first day rolls around – parents can get quite nervous and have that feeling that their little one is growing up so fast- trust me I know. It’s a normal “things are about to change” emotion.

One tip I’d like to suggest before your little one starts school is to share your own first day memories with your child as well as pictures. It’s amazing how comforting it is for a child to know that their parents did the same thing at their age and lived to tell about it!

To help make the first day of school a little less scary for your child, here are some other tips from https://www.healthychildren.org:

•       Point out the positive aspects of starting school: It will be fun. She will see old friends. She will meet new friends. Refresh her memory about previous years, when she may have returned home after the first day with high spirits because she had a good time.

•       Remind your child that he is not the only student who is a bit uneasy about the first day of school. Teachers know that students are anxious and will be making an extra effort to make sure everyone feels as comfortable as possible.

•       Talk about the kinds of interesting things he will learn in the months ahead.

•       Buy him or her something (perhaps a pen or pencil) that will remind her you are thinking of them while they are at school, or put a note in their lunch-box.

•       Reassure your child that if any problems arise at school, you will help re­solve them. (If problems do occur, get involved as soon as possible.)

•       Find another child in the neighborhood with whom your youngster can walk to school or ride with on the bus. If your child is not going to ride a school bus and you feel it is appropriate, drive your child (or walk with her) to school and pick her up the first day.

•       Encourage him to look for new students in his classroom or in the play­ground, invite them to join the group for a game, and ask them about their interests.

•       After school, show your child some special attention and affection. Give him or her a hug and ask what happened at school. Did she have fun? Did he make any new friends? Does she need any additional school supplies (notebooks, rulers, erasers) that you can shop for together?

In addition to the suggestions listed above, your child may need some extra support if he or she is starting school in a new location. Here are some suggestions to make the transition easier.

•       Talk with your child about his or her feelings, both their excitement and their con­cerns, about the new school.

•       Visit the school with your child in advance of the first day. Teachers and staff are usually at school a few days before the children start. Peek into your child's classroom, and if possible, meet the teacher and principal. You might be able to address some of your child's concerns at that time. She may have no questions until she actually sees the building and can vi­sualize what it will be like. (When you formally register your child in the new school, bring her immunization record and birth certificate; usually school records can be sent directly from school to school once you sign a "release of information" form.)

•       Try to have your child meet a classmate before the first day so they can get acquainted and play together, and so your child will have a friendly face to look for when school begins.

•       Do not build up unrealistic expectations about how wonderful the new school will be, but convey a general sense of optimism about how things will go for your child at the new school. Remind him that teachers and other students will be making an extra effort to make him feel welcome.

•       If your child sees another student or a group engaged in an activity she is interested in, encourage her to ask if she can participate.

•       As soon as you can, find out what activities are available for your child in addition to those that occur during school itself. Is there a back-to-school picnic or party planned? Can he or she join a soccer team? (For community sports programs, sign-ups often begin weeks or even months before the start of the season.)

It’s been many years since my first day at school but I remember it well. Your child’s life is about to change forever, but that’s a good thing-another milestone in life’s progression. Give him or her a hug, wipe away the tears and smile a big smile. Let them know you trust them and are proud of them. Then go ahead and shed a few tears of your own when you’re back in the car. Yes, they are growing up fast. 

Story source: https://www.healthychildren.org/English/ages-stages/gradeschool/school/Pages/Making-the-First-Day-of-School-Easier.aspx

 

Daily Dose

Tummy Aches

1:30 to read

I am getting a lot of phone calls and texts with concerns about  tummy aches. I have even started seeing patients in the office with complaints of “my tummy hurts”, and we are just in the first week of school. I know that school nurses are dealing with this common complaint as well.   Amazingly, I don’t see very many complaints of tummy aches during the “lazy days of summer”…but once school starts they seem to become more prevalent.

Don’t get me wrong…while the tummy aches are real and painful, they are usually not due to anything serious.  In many cases I see,  the abdominal discomfort may be due to a bit of anxiety and stress that often comes as children get back into the classroom.  While the child may not be aware of “stress”,  their body does sense it and the gut responds with abdominal pain. 

The children that I am already seeing are all healthy and growing well. They do not appear to be “ill” when I see them, but will complain that their tummy hurts. When I have them point to where the pain is, they typically point right around their belly button (periumbilical).  If asked to point to the one place where it “hurts the most”  they typically still cannot localize it…it’s just all over! Having generalized pain is typically a good sign, rather than having point tenderness in one area.  Upon further questioning they do not have a fever, have not had vomiting or diarrhea, DO NOT wake up in the middle of the night with abdominal pain and often cannot remember if they “pooped“ today or yesterday but usually swear that their “poop” is “normal” . (I am not always sure about that - stool history in kids is quite hit and miss!) 

A few of the children say that eating makes their tummy ache worse while others report it feels better if they eat. They typically are not having issues with a specific food.  (It also depends what they are given to eat - often they will eat their favorite food if given the opportunity).  

For some of the children the pain is “bad enough” that they come home from school, but once home their parents report that after an hour or so they seem better.  Other children stay in school, but the minute a parent picks them up they start saying “my tummy hurt all day at school”!  

I remember that one of my sons often had tummy aches during the school year and we were talking about it the other night (he is now an adult).  He says he remembers being worried about school and “hiding” in the morning when it was time to go to school (I would be looking all over for him as his older brother was already out the door, and anxious that he would not get to school on time,  while I had the younger brother on my hip as I searched the house).   Talk about getting a stomach ache…mine was in knots by the time I would get to work.  It would only be several hours later when I would get the phone call from the school nurse that he was there with a tummy ache.  He now says that he remembers that by the time he was 8 years old it all just changed and it went away. 

Many times all it takes is a little reassurance that the tummy ache is not serious. I tell the children that everything on their exam is normal which is a good thing. Sometimes it seems to help a tummy ache if I prescribe the child some extra fiber and maybe a Tums  a good source of calcium too). Who knows if it is placebo effect… but just by doing something they feel a bit of relief. The one thing I do know…they need to keep going to school and it usually gets better once they are settled back into a school routine.  

 

Daily Dose

School & Infectious Disease

1:30 to read

I received an email this week from a patient…subject line: “potential exposure to Herpangina”.  In the body of the email was the following:

Dear Parents,

We want  to inform you that a case of Herpangina disease has been reported for a child at ….. room #112.  This is a contagious disease that  is spread by direct contact with another person or contaminated objects.  Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness. We have attached further information about this common childhood illness published by Children’s Hospital in Boston. Our teachers are carefully disinfecting their room to help prevent further spread of the disease.

The mother of the child that sent me the email was “freaked” out and “worried” about  sending her child back to pre-school.  

My question is this, when did it become a “rule” to notify parents in a pre-school or day care setting that there were viral illnesses circulating?  It certainly seems unnecessary to me to send notification of EVERY childhood illness that occurs and for most of my families only serves to cause anxiety.  Some of the schools in our area post a sign on the entry that says something to the effect:  “there are cases of diarrhea, RSV, hand foot and mouth and fevers being reported in children that attend this school.”  Really, is it that surprising or necessary? Seeing that many of the numerous viral illnesses that children get these days are spread via respiratory droplets and contact with surfaces, such as toys and tables that everyone touches (computers too), children are exposed to things all of the time.  Do you go to work and ask your co-workers in a conference room..have you had diarrhea, a cough or a sore throat in the last day?

I understand notifying parents of illnesses, such as meningitis, measles, mumps…even chickenpox that are infectious and may be serious or life threatening. Thankfully, there are very few cases of these illnesses to report, now that the MAJORITY of children receive vaccines to these diseases. 

By putting these emails, texts and notices out for every parent to become alarmed about…and then to come to the doctor out of concern that their child  “may get sick….even before they have a symptom”,  serves no purpose. Herpangina and Hand Foot and Mouth are very similar viral illnesses, and both are caused by enteroviruses. It is at times hard to distinguish one illness from the other. But, with that being said, the treatment is solely symptomatic. In other words, treat the fever, make your child comfortable and don’t let them go back to school until they are fever free for 24 hours.  

Lastly, your child is going to catch a lot of these viruses, no matter what you do when they go out to play, shop or go to school. Each time they catch a viral illness it actually helps them to build antibody in order that their immune system may get stronger and stronger. I think the better note is….as winter comes children will get more coughs, colds and viral infections…if you think you child is not feeling well or running a fever, please keep them home from school for the day.  It is just a normal part of childhood…we don’t need any more anxiety in this world.   

 

Your Child

School Kids Benefit From Mindfulness Programs

2:00

Mindfulness is purposely paying attention to the present moment in a nonjudgmental way. A new study says that adding a mindfulness based stress reduction program to middle schools may help reduce kid’s stress and trauma.  

"High-quality structured mindfulness programs have the potential to really improve students' lives in ways that I think can be really meaningful over the life course," said lead author Dr. Erica Sibinga of the Johns Hopkins School of Medicine in Baltimore.

Children in many U.S. cities are at an increased risk of stresses and traumas due to the effects of community drug use, violence, multigenerational poverty, limited education and economic opportunities, Sibinga and her colleagues write in the journal Pediatrics.

 The study involved 300 students, in grades five through eight, at two Baltimore public schools. Children were randomly selected for either a twelve - week mindfulness based stress reduction program or health classes to take during the school day.

Nearly all the students were from low-income families and African-American.

The mindfulness program contained material about meditation, yoga and the mind, body connection; practice of those techniques; and group discussion.

The program helped the children be aware of their response to what was happening to them at the time.

"It allows them to not only know what is happening, but to stop and take three breaths and figure out how they want to respond to what is happening the present moment," Sibinga told Reuters Health.

By the end of the program, children in the mindfulness program had lower levels of general health problems, depression, recurrent thoughts about negative experiences and other symptoms of stress and trauma compared to the children enrolled in the health classes only.

Sibinga said the differences would be enough for the students to notice in their day-to-day lives.

The researchers acknowledge some limitations to the research, like children missing some classes and possibly being exposed to mindfulness practices outside the sessions.

While Sibinga acknowledged that she couldn’t say if the program would have the same results in other student populations, she suspected there would be benefits.

The next step is to look at how to spread the program to other schools, and look at how the program may work, she said.

"It doesn’t get us off the hook of trying to reduce the sources of trauma in our urban life," she said. But the study suggests adding structured mindfulness programs in urban settings would be beneficial, she added.

Some private schools in the U.S. have already implemented mindfulness classes in their school programs and have reported positive effects such as fewer behavioral problems and an increased ability to focus during class on school work.

Sources: Andrew M. Seaman, http://www.reuters.com/article/us-health-mindfulness-stress-school-idUSKBN0U12MY20151218

 

Daily Dose

Start the Back-to-School Sleep Routine Now

2.00 to read

Getting back into the routine of school days also means getting back to good bedtime routines.How can it be that school is just around the corner? Getting back into the routine of school days also means getting back to good bedtime routines. With that being said, you have to start the process now to ensure plenty of time to slowly get bedtimes re-adjusted. By starting early you can avoid the battles that some parent’s talk about when discussing bedtimes.

Children need a good night’s sleep to wake up happy, rested and ready to learn. Numerous studies have shown that elementary age kids need about 10 hours of sleep a night while tweens and teens still need a good 8 – 9 hours of sleep. I wonder how many children really get the recommended amount of sleep? I think too few. Unfortunately, I know from my own experience that teens seem to operate on a different sleep schedule and rarely are in bed as early as they should be. Most of us have relaxed bedtime a little during the summer and children are staying up later and sleeping longer in the mornings. This is great during the lazy summer months, when schedules are also different. But within a few weeks the morning alarms will ring forcing everyone to get up earlier to get to school. In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening. Why is it that pre-school children want to get up early, no matter what, while school-aged children are happy to sleep through alarms?  Such is life. Also, make sure that you are not only ensuring that you children get a good night’s sleep during the school year, but they also awaken in time for breakfast! Just like my mother used to say, “breakfast is the most important meal of the day’” and that adage is still true. A good night’s sleep followed by a healthy breakfast has been shown to improve mood, attention, focus and over all school performance, as well as even helping to prevent obesity. Start off the school year on the right foot. It is easier to begin with good habits than to try and break bad ones. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Homework Battle

1:15 to read

Homework is one of the least favorite exercises for both parent and child.

Homework is one of the least favorite exercises for both parent and child. I was reminded of this while helping my five and seven-year-old nephew and niece with their homework recently. It seems like yesterday since I was helping our own sons with homework, when in actuality it was many years ago. It is easy to forget the complaining, cajoling and pleading to get homework finished. But it is also an important exercise in helping your children get an organized workplace at home, to having family rules about computer and TV time before homework is finished and to teach independent study skills as a child matures.

So... trying to get my niece and nephew to settle down for homework with out getting up, trying to "sneak" back to the computer andto focus on the letter ‘N’, was a real test of forgotten parenting skills. I am not sure I was a total success. They did not want to do their homework, gave me 10 reasons it wasn’t necessary and told me "Aunt Sue you are the meanest aunt we have", which I am sure was not a compliment.

After much stalling, begging and promising "we" finished one worksheet for first grade and a Pre-K sheet glued with picture of ‘N’ words cut from catalogs (while he searched for Christmas presents for me to buy him). It was organized chaos to say the least, but it was finished! The short story is, have a set time for homework and a place for your young children to work, where they are within your sight, but also without a lot of distraction.

Try to get homework done earlier than later; it’s always harder when both parents and children are tired. Make their homework their responsibility, even from early elementary years, as it sets the stage for the rest of their years of homework. Lastly, don't ask Aunt Sue the pediatrician to help; she has "way too many rules".

That's your daily dose, we'll chat tomorrow.

Daily Dose

How To Soothe Back-To-School Jitters

1.45 to read

It is not uncommon for children to be both excited as well as apprehensive about the start to a new school year.Where has the summer gone?  Do you feel like I do and think, I blinked and POW it's back to school!  There's a lot of excitement for the new school year but some are feeling a bit nervous and anxious.

It is common for children to be both excited as well as apprehensive about the start to a new school year. Being a little worried about heading back to school is normal. Whether your child is going to the same school, but concerned about their new teacher, or starting a new school, the underlying uncertainty is normal. I can remember lying in bed the night before the first day of school and being so excited that I couldn’t sleep. I was always most excited about what “new outfit” I was going to wear. My mother had of course taken me shopping weeks before for the “back-to-school” skirt and sweater, and I just couldn’t wait to get to wear my new clothes. Back-to-school jitters are normal and should be discussed several days before school begins. It is very common for a child to have anxiety and stress related to a new school. But it is also not uncommon for children to worry about little changes related to such things as new lockers, cafeteria changes, a new teacher, or new friends. Some children will complain of tummy aches and headaches with the beginning of school. I am always reminded that I rarely hear children complain of a headache or tummy ache during summer vacations. These “aches and pains” are often a manifestation of a little underlying anxiety, and seem to be a September – June phenomena. A little parental reassurance will often help relieve those aches. The best plan for dealing with back-to-school jitters is to acknowledge the anxiety and plan on how to deal with it. Make sure that your child is rested for the first day of school and they have a good breakfast to start off the day. On the way to school discuss all of the positives for the new school year. Make your goodbyes short and sweet. Let your child know you will be there at the end of the day. Do not let your child see you upset, as sometimes parents too are anxious about the first days of kindergarten, high school or even college. Those back to school pictures are memorable and you will always like looking at the pictures with everyone smiling, even if your parental heart is a little sad at letting go. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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