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Daily Dose

Measles Exposure on an Airplane

Public health officials are warning passengers of possible exposure to measles on an airplane. Dr. Sue talks about how infectious diseases are just a plane ride away. I know you have read previous blogs on immunizations.  I have re-iterated many times, that despite the perception of some, many vaccine preventable diseases have not been eradicated from the United States and some may just be a “plane ride away”.

This is now the issue with a recent case of measles that occurred  in an unimmunized woman from New Mexico who was returning from a trip. The woman developed an illness, later confirmed to be measles, as she returned from London and subsequently travelled through no less than 4 different airports in the United States. The issue is that this one traveler, exposed many individuals on multiple airplane flights, as well as in 4 different airports.  As Dr. William Schaffner, an infectious disease specialist at Vanderbilt University stated, “the potential exposure of so many travelers in airport terminals is a cause for concern”. While most Americans have been immunized against measles (with the MMR vaccine), there are still those who remain unimmunized either due to the fact that they are too young, or because they choose not to be vaccinated (as had this woman who developed the “index case” of measles). Children do not receive their MMR vaccine until after their first birthday, and then receive a booster dose of MMR between the ages of 4–6 years. Therefore, a child who is less than 12 months of age, who may be up-to-date on all of their immunizations but is too young for MMR, may have been exposed to measles if they had been sitting within 5 airline rows of the woman who had undiagnosed measles. The same holds true for infants who might have been next to the woman in a security line, or at a Starbucks, or in the newsstand as she passed through these 4 various airports. It is also possibly an exposure for anyone of any age, who has never been immunized against measles, or who has not had the disease (older individuals). All of these exposures would have been accidental and never even noticed unless an exposed person subsequently develops measles. The incubation period for developing measles after an exposure is between 8-12 days, and measles will present with symptoms of fever, cough, runny nose, red eyes, and a body rash. So….here is just another example of the spread of an infectious disease.  This case involves travelers in airports from London, England, to Washington D.C., to Baltimore, to Denver, and ultimately to Albuquerque.  Now we need be alert for any further cases of measles in next several days and weeks.  Remember, measles is a respiratory virus, and it is spread via coughs and sneezes, and the virus may last in the air for up to 2 hours, without any one suspecting they are being exposed. If your child has not been immunized, this is a good reminder, run don’t walk, and get that MMR. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Plane Travel With Your Child

The best way to travel with a baby on a planeI had a question from a parent via our iPhone App about traveling overseas with a 4 month old.  I think it is actually quite an easy time to travel with an infant. 

By this age a baby not only is having a more regular sleep and wake schedule, they are also at the cutest age and are typically fairly easily entertained. They are so sweet and happy that it is also an good time for others to help you.  What person doesn’t want to come to your aid when you have a fussy infant.  You will see as your child gets older, there are less “helpers” for a crying toddler.

I also think that this is a good time to travel as your child has presumably already received their 2 and 4 month immunization series and have mounted and antibody response to some serious illnesses.  With that being said, an infant is not immune to viruses like RSV and flu, so if possible I would schedule travel in early fall, spring and summer and avoid the winter.  I realize that that may not be do-able, but for a vacation I like travelling with babies during “non-sick” season. It is also easier to fly long distances with an infant (lap child) when the flights might be less crowded and you can get a bulk-head seat which has “bassinets” or maybe an extra seat next to you that your infant car seat will fit in for traveling.  It can be expensive to buy a seat for an infant, and holding a baby while you are trying to sleep too just doesn’t work.  Hopefully you will be traveling with two parents to share the duty during an overnight flight. Lastly, I get a lot of questions about needing to have a baby “sucking” for take-off and landing.  I really don’t think that is necessary, especially if your infant is sleeping.  When I am travelling I often see parents awakening a sleeping baby once the pilot announces  “we are preparing to land”.  The baby wakes up, and starts to scream,  and then the parents are convinced that the baby’s ears hurt.  I really think the baby is tired and unhappy due to  being awakened. If they are awake and want to nurse , take a bottle or a pacifier that is fine but remember, “never wake a sleeping baby”.  I realized with my own children,  If I was “lucky” while they were all infants, we could fly  for 3 -4 hours while they slept and never peeped, either  for take-off or landing. On other trips we were not quite as fortunate and had a fussy baby mid flight, with presumably no ear problems. I think the “ear issue” is highly overrated. Their ears are no different than ours! Best time to fly with babies is really between 4 months and 12 months of age.  Once they are walkers it gets a lot harder!!  I would not attempt an overseas flight with a 1–2 year old, but that is me. I would wait till they were 3! That's your daily dose.  We'll chat again tomorrow! Send Dr. Sue your question!

Daily Dose

Family Road Trip with the Dog!

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Over the weekend, I had flashbacks of traveling with my children.  Why you ask? Because I am riding in our car with the family dog as the passenger! Now that the kids are out of the house, we find ourselves with a yellow labrador (as our boys say, “we are a BIG DOG family”), and she doesn’t like to be left behind. 

You know how your young children can sense that you are leaving?  If you are a working mother, you know that at a very early age your child seems to know the difference between your stay at home clothes and your work clothes.  If you have teens they also sense that you are preparing to leave and that text message trail  of “parent’s not home” most likely starts.   

At any rate, our dog is just like that. She knows when it is time for a walk, (she sees me putting on my tennis shoes), She gets confused on a day that I choose the gym over her! She also knows when the suitcases come out that something is up. She will head toward the garage almost as if she knows that there is a car trip ahead. 

So...just like young parents packing for a road trip, I am once again having to remember to pack but for the dog!  Dog food, treats (mum-mums for dogs?), chew sticks for distractions and of course her leash. Oh, can’t forget the favorite pillow either.   

We coax her (just like a 4 year old) to “potty” one last time before we load her into the car.  She gets the whole back seat (folded down for her of course). No car seats!  Too bad they don’t make iPad for dogs. I recently saw an ad for a cable TV station for dogs which will keep them entertained while their owners are out. It can’t be long before I can load a movie for her in the car.  (I may be on to something) 

Now, once in the car all is well for about 30 minutes as she gets used to the ride and then she starts to WHINE!  Do you need to potty? Are you car sick? Are you bored? I swear it is just like a flashback of 25 years ago when I was trying to figure out why my child was crying while strapped in their carseat.   Should we stop?  So, we pull over, but it is also now starting to rain.  We jump out and of course she looks around, doesn’t like the rain and heads straight back to the car without “going potty”! Years ago we had a very similar trip where after 4 different stops our child finally just gave up and threw up the minute we got him back in the car! That is still a vivid memory. 

After another “pit stop” our dog finally went to sleep, but of course we are approaching our destination! I wonder if I can carry her to bed without waking her up. Doubtful.  But I do love a family road trip with kids and/or the dog. It just feels like summer to me. 

Parenting

Family Road Trip!

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With gasoline prices at a reasonable level, many families may choose to skip the hassles of flying and opt for a road trip this summer.

While it may be true, “The best made plans of mice and men often go awry”, it’s still necessary to prepare as best you can for a family road trip; whether it’s to the Grand Canyon, the beach, the grandparents or all of the above.

Before the trip, make sure that the car is in good condition. Have it checked out by a mechanic and any trouble spots fixed. The tires should have plenty of tread and the recommended amount of air for highway travel.

Once you’re ready for the big trip, here are some suggestions to help make it a little less stressful and more fun.

Packing the car:

·      Pack an easily accessible small bag that contains clothes for the next day, an extra change of clothes (for spills), PJs, a toothbrush, and anything else you need for that day and night. It will be much easier to grab than trying to rummage through the big suitcase.

·      Take your toddler or young child’s blanket and pillow. This is extra important if your road trip includes an overnight stay. Kids like their own stuff, particularly at bedtime in a strange place.

·      Babies and toddlers drop, spill, and spit up. Keep a roll of paper towels and a box of wipes in the front seat for easy cleanups. Keep a garbage bag handy too.

The Ride:

Boredom is probably the biggest instigator of trouble for kids packed into a tight space. Prepare to fight boredom with a few tricks of your own.

·      Snacks. Although it only provides a short respite, any quiet time is appreciated. Go light on the sugar – too much can backfire. Choose fresh or dried fruit, whole grain muffins, popcorn, cheese sticks, milk etc. In other words, something healthy and age appropriate.

·      Portable DVD players. These can be a lifesaver. Load up on your children’s favorite movies and don’t forget the headsets if you have different aged kids. Eleven year-olds and three year-olds don’t typically share the same taste in movies and video games. New DVDs they haven’t already seen are a bonus. Let the kids pick out what they want to watch ahead of time. And, make sure you have an extra set of headsets; you know someone is either going to lose a pair or break a pair. That’s a given.

·      If there is more than one adult traveling – one of you can get in the backseat for a while. A little face-to-face contact, some patty-cake, and a few tickling games go a long way toward distracting a cranky baby or a bored toddler.

·      Make sure some favorite toys are within easy reach. You might add a new toy or two your little one hasn’t seen before. Remember etch-a-sketch? Tech savvy youngsters are coming up with some amazing etchings these days!

·      Don’t forget to plan for stops. You'll have to stop for feedings, diaper changes, and stretching breaks. You'll be much less stressed if you accept that it may take twice as long to get there as it did in your pre-kid days and plan accordingly. Pre-teens and teens are going to need to move around too. Besides, sitting for an extended length of time isn’t good for anyone.

Oh, and someone is going to need a potty break soon after the pre-arranged stop has happened. Be patient and pull over, it’s really a lot easier and less taxing than a yelling match about “why didn’t you go when we stopped 30 minutes ago?”

·      If your trip requires an overnight stay somewhere, think about booking a motel that has an indoor pool. It may cost a little more, but it's something to look forward to, and it will help your children sleep better. If they sleep better, you’ll probably sleep better too.

·      Don’t forget about books (or e-books) for the kids that like to read. Coloring books for the younger ones, and brush up on some travel games the whole family can join in on. Here are a few tried and true suggestions. I Spy (I spy with my little eye, something red.) The License Plate Game. Keep a list of all the different state license plates you see. The goal is to list as many states as possible- although Hawaii might be a real challenge anywhere but in Hawaii. The Memory Game. Start a story with one sentence. The next person has to say that sentence then add his or her own sentence to the story. The story can change pretty quickly as everyone tries to remember all the previous sentences and then come up with a new one.

While road trips can be a challenge, they are always an adventure and often become fond memories, as kids grow older.

Have fun this summer and don’t forget to take lots of pictures!

Story source: http://www.parents.com/fun/vacation/ideas/traveling-with-kids-ultimite-guide/

 

Daily Dose

Treating Kids Who Suffer with Motion Sickness

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If you’re planning the perfect getaway this summer with your family, don’t let motion sickness spoil your plans. Did you know 58% of children between the ages of four and 10 experience the symptoms of motion sickness? 

Motion sickness occurs when the inner ear, eyes and other areas of the body that detects motion, sends a mixed signal to the brain. 

Your child may begin to feel queasy with the initial nausea followed by a cold sweat, fatigue and loss of appetite. A younger non-verbal child may become restless, pale, sweaty and cries. At some point these symptoms are usually followed by vomiting. By then you have figured it out!

The best treatment for motion sickness is prevention! If you have already experienced motion sickness with your child then plan ahead.

If your child is over the age of two, place them in their car seat in the middle of the backseat and face them forward. Provide a small nutritious snack prior to the trip rather than a big meal, and avoid dairy.

Open the windows and do not let your child play video games or read while the car is in motion. Try to distract them by singing or talking. Sleeping may also be helpful, so at times you may plan your trip around naps and bedtime.

Frequent stops for a child who is feeling sick are a necessity. Letting them lay flat for a few minutes while the car is stopped and even applying a cool rag may make them feel better. Try small sips of carbonated beverages or crackers to help the nausea.

Expect the unexpected and be prepared.  Bring along zip lock bags and hand wipes in case of emergency. This will make everyone in the car a little happier.

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Traveling with Children

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I just returned from some summer travel and I must say it can be challenging to travel with children, especially the young 1-4 year old crowd. But some parents seem to be more prepared than others. 

On a recent flight, my husband and I were seated behind a family with 2 young children, 1 of whom looked to be about 4 and the other a toddler around 15 months. The father and the 4 year old had 2 seats together, and the mother and toddler were seated across the aisle from them.  Thankfully the flights were on time that day so we took off without much delay.  It was a 3 hour flight late in the evening so I thought that the parents had planned well as the children would probably play for a bit, watch a movie and fall asleep. 

Well, that’s not what happened.  Immediately after take off, the parents leaned back their seats and put on head phones. The dad had an iPad and started to watch a movie, (it wasn’t Dora), while the mother was playing a game on her iPhone , (it looked like a game with multiple apples or something that she was shooting?)   

The children (of course) were not thrilled that they were not being engaged and the youngest started to cry and fidget. At that point, the mother, who never took off her head phones handed the toddler across to the dad, who put the child on his lap while he kept watching the movie. This went on for the first hour or so with the child crying every few minutes and both parents handing the toddler back and forth. Luckily the 4 year old was sitting nicely and watching something on her electronic gadget. 

As it got later into the flight, (about 9:00pm), the toddler was getting more irritable. About the same time the other child’s movie ended and she started crying as well.  Fortunately, the dad took off his headphones and put down the iPad and took her (screaming and yelling) to the bathroom.  

In the meantime, the toddler continued to cry and kick (who can blame him)? Can you picture the mother with the toddler on her left arm while holding that iPhone and still playing a game! I mean REALLY?  I couldn’t make this up!  When the father came back the parents starting arguing about who had spent more time taking care of the kids, and even used some inappropriate language with one another. 

It took everything I had not to interfere with the whole situation! Where were the toys, coloring books and crayons, stuffed animals and blankets? How about some snacks, even “forbidden foods” like cookies and a fruit roll up (real ones).  Did they not bring anything to entertain a child while traveling?  How can they be entertained (and fed) and ignore their children? I felt more sorry for the kids than for the rest of us around them. 

Of course, once off the plane they were the “talk” at the baggage claim area.  I think they even went on to another flight!  I wish I had taped the whole thing on my iPhone, but I am not smart enough to have thought about that at the time.  Would have been a hit on YouTube!

Daily Dose

Travelling With Your Kids

It's not easy organizing your kids when travelling. I have new found respect for those who stay calm and are organized!I have a new respect for parents travelling with young children. I just spent an hour in the security line at a major airport and had the opportunity of watching parents with their children of various ages, snaking through security.  It could be a reality show on parenting!

There are some blessings to being an “older parent” and this new “normal” of going through security is one of the times I am happy to have self sufficient children. I remember just trying to get my young children on the plane (pre-security days) with all of their stuff, including blankies, toys, juice boxes, and snacks. Even then, everyone had their own backpack and we were always trying to make sure that the correct backpack was with the correct child, which would help limit any fighting as we headed to the board the plane. I always tried to dress the boys in matching clothes for trips (much to their chagrin) so that I could “find my 3 children” a little more easily as one was always trying to scurry away despite admonitions to hold their brother’s hand. (Zone defense with 3). Today, I watched a family in front of me navigate the security line with a stroller, 2 car seats, a huge bag of all sorts of stuff, as well as their two children, both of whom were under the age of 4. The parent’s did a beautiful job of getting through the first security checkpoint with everyone’s passport, and holding up said child when requested to match their passport. But by that time the children were growing restless, as were many adults, as this line length was quite similar to those at Disneyland, but with no promise of Space Mountain ahead. As we snaked our way towards the scanners the children began to “lose it”. Most impressively, the parents did a great job controlling the chaos. Some of the funniest moments (easy for me to say) came when the little girl, probably aged 18 months, was holding her dad’s passport and looking at his picture saying, “Daddy, Daddy”, and I am sure the dad thought,” give her anything that will entertain her.” But after she became bored with the picture she started to tear out a page of the passport!! Hysterical to watch the parent’s trying to negotiate getting back the passport with all pages intact, it was like “Let’s Make a Deal”. In the meantime the older brother, noticing that the parents were otherwise occupied, decided it was a great time to start “bugging” his little sister by grabbing her legs as she dangled from her Mom’s hip.  About that time we were finally reaching the scanner and the poor parent’s were trying to unload everything into the bins. Just as the Mom was trying to get the little girl’s shoes off I heard, “if you touch your sister one more time you are……..”, as the little boy ran ahead to go through the metal detector, only to be returned because he had escaped without taking off his shoes! The next meltdown came in the line next to ours as another child had to relinquish her stuffed bear to go through the scanner. This child, who was attached at the hip to the bear, appropriately started screaming, only to be whisked through the metal detector in the mother’s arms with a hand over her little mouth. Somehow this family, as well as many others around me, navigated all of that stuff through the security line, scanners and metal detectors while managing to emerge on the other side with the not only the correct children but with their shoes, car seats, strollers, stuffed animals, and bags of provisions to get through a flight. I have a new respect for all of those families who are travelling this summer.  I think that in order to travel with children it might be wise to have a new play activity at home prior to your trip. Instead of the play kitchen, get the play “security scanner center” where you can practice disrobing and filling bins with stuff. I know Fischer Price is listening. What’s your family strategy for smooth travel?  Let me know! I would love to share them with everyone!

Daily Dose

Fever & Your New Baby

Summer is here and many families are heading on vacation. I often get asked "can you trvael with a baby?"I have recently seen many babies coming in to the office for their first post hospital newborn check. The lovely thing about summer is that the office is not quite as busy as there just aren’t as many sick children.

Despite the decrease in sickness throughout the country during the summer, I still explain to new parents that it is important to try and limit their newborn’s exposure to illness. This is best accomplished by avoiding crowds.  This is especially important for the first 6–8 weeks of a baby’s life. We pediatricians get especially concerned if a newborn develops a fever during these first weeks. One of the first precepts of pediatrics is,” an infant under 8 weeks of age with a fever, is admitted to the hospital for a presumed bacterial infection until proven otherwise”.  This means a spinal tap, urine culture, and blood culture are performed and IV antibiotics are routinely started. In most cases the fever is secondary to a viral infection, but until all tests are negative, the baby spends 2-3 days in the hospital. Traumatic for everyone. But with the summer months here, many families are planning on travelling to the beach or mountains, or to go visit the grandparents etc. The travel issue came up as I had a patient that just had her 3rd baby (via C-section no less), and she came in with her precious newborn. While I was examining the baby, the mother casually mentioned that she was planning on going to Washington, DC in the next few weeks (baby would be about 3 ½ weeks old), for a family trip and sightseeing.  Her husband wanted the older children to see DC and they then planned to drive up to the battlefields in PA. UGH! I grew up in DC and there really is not a better place to take children for a combination of fun and learning.  But, the thought of travelling with a newborn, standing in lines to get through security at the airport (another post), and flying for over 3 hours only to stand in more lines to enjoy the sights of Washington with the older children, made me cringe.  Not just for the huge undertaking of travel, but because of this newborn’s possible exposure to infection.  Think of all of the germs that this newborn might come in contact with!! Now, you know I am not a “germaphobe” but I am wary of a newborn being exposed to this many people. Every time you stand next to someone who coughs or sneezes, they may unknowingly pass a virus on to you.  Many of the viral infections we so often discuss are airborne and enter our own eyes or noses via aerosolized droplets. Mother’s and father’s hands also touch many surfaces, and even with hand sanitizers there is no way to be sure that those travelling hands have not come into contact with germs that then may be spread to the newborn. No one wants to get a tiny baby sick, but there are a gazillion people out at airport check in counters, or in security lines, or sitting next to you on a plane that may be ill.  You don’t get to pick who you are with. Same thing goes for standing in a museum or shopping mall or hotel lobby.  So, that precious newborn may develop a fever from all of this exposure and they will end up in the hospital, wherever you are. So, if possible (I realize there are emergencies) stick close to home and plan that trip with your baby after they are 8 weeks of age. It will make it much easier on parent, infant and the pediatrician who hates to have to hospitalize a newborn. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Summer Vacation & Measles

If you are planning a summer vacation outside the U.S. there are new recommendations to protect your family against measles. It is the time of year when many families start planning for summer travel.  While trying to decide when and where to go, some families may choose international travel.  If you are planning on travelling outside of the United States, and have infants or toddlers, it is important to be aware of some recommendation just published by the CDC.

The CDC has just reported an increase in the number of “imported” measles cases seen in U.S. children 6-23 months of age after having returned from international travel. There were 13 cases of  “imported” measles  (7 cases among children in the 6–23 month age range) reported in the first 2 months of 2011, as compared to a typical 12 month period when there are 3-8 children who acquire measles. Although measles is a rare occurrence in the United States, measles is still endemic in much of the world (don’t just think third world countries, Europe currently has big outbreaks, including popular travel destinations such as France, Germany and England). With that being said, there are also measles cases being reported in different areas of the U.S  (unrelated to international travel. Texas is one of the states that has recently reported 3 cases of measles, which are thought to have been acquired while visiting Orlando, Fla. My colleagues in Texas are “on the lookout” for more new measles cases, as the incubation is up to 21 days post exposure.  These data just reinforce the need to continue to vaccinate all children against MMR (measles, mumps, rubella) as recommended between 12-15 months of age. But, the ACIP (Advisory Committee on Immunization Practices) does recommend earlier MMR vaccination for young children who are travelling outside of the United States. So if you are planning on taking “baby Jack” to see the Eifel Tower, you need to talk with your doctor about MMR vaccine.. In cases of international travel, a MMR vaccine is recommended for all children who are at least 6 months of age. If your child is over 12 months of age and has received their 1st dose of MMR, they should also receive a second MMR separated by at least 28 days from their first vaccine prior to travel if possible. For children who are not traveling outside of the U.S. the recommended schedule for MMR vaccine remains at 12-15 months and then again between 4 -6 years of age. Measles is a highly contagious disease and typically causes fever, a diffuse red rash, cough, and may cause pneumonia and encephalitis and even death.  Of the 7 cases in children between 6 – 23 months reported from Jan. and Feb of this year, 4 required hospitalization for several days, but luckily there were no deaths. As we approach the travelling months, stay tuned for more immunization updates and news.  Always go to www.cdc.gov to get the latest information as it relates to international travel, as recommendations are updated and change. That’s your daily dose for today.  We’ll chat again tomorrow.

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