Top Ten Tips for Summer Vacation Success

skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten tips:

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

4th of July Safety: Tips from the Doc

safety signSunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket.

All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.

Top 10 Tips for Successful Summer Vacations

little cute girl near the pool with a circle for swimming

School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have a top ten from the Doc:

10. Pack a simple medicine kit: don’t waste a day of vacation at my office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

Why Did My Kid React to That Food?

Little chief-cook tasting the carrotKids can have reactions to food for many different reasons. They can be allergic, sensitive, intolerant, or have problems because the food contains poisons or has drug effects.

Food allergies are caused by a child’s immune system reacting to a food, similar to the way they can react to pollen or bug bites. Allergic reactions are usually to the protein in the food rather than the sugar or fat, and are usually immediate. The most common severe reactions are to tree nuts, peanuts, and shellfish. Less severe reactions are most common with cow’s milk, eggs, soy, wheat, and fish.

Celiac disease is in this category. People with celiac are allergic to the gluten protein in wheat and react with their immune system if they are exposed to even a tiny amount. Gluten allergy was worth a whole blog all by itself: A Gluten Free Blog.

80-90% of the time, kids will outgrow allergies to eggs, wheat, milk, and soy by 5 years of age. They outgrow peanut allergies only 20% of the time. (Do NOT experiment with this!) Fewer will outgrow allergies to tree nuts and seafood.

Symptoms of an allergic reaction include:

  • Skin rashes. Hives, or whelps–itchy raised patches with pale centers and red rims. Hives move around, fading in one area to reappear in another. Antihistamines like Benadryl (diphenhydramine) help the symptoms.
  • Breathing problems. Food reactions can make kids wheeze, make their throats feel tight, and give them sneezing fits.
  • Gastrointestinal symptoms like nausea, vomiting, and  diarrhea.
  • Circulatory symptoms like paleness, lightheadedness, and loss of consciousness.
  • Severe reactions can involve several of these areas, and are called anaphylaxis.

Food sensitivities and intolerances are not allergies. Some children can be sensitive to the common effects of a food and react strongly. For example:

  • Apples, pears and bananas contain pectin and can be constipating (useful if your child has diarrhea). Some children can get stopped up if they eat too many.
  • Dairy products can also constipate–some kids will never poop again if they eat a lot of cheese. (This may be a slight exaggeration.)
  • Sugar can cause diarrhea, so children may have problems if they drink a lot of juice. (Interestingly, we have never been able to prove that sugar makes kids hyper.)
  • Kids can react to dyes and preservatives in foods–they will feel nauseated or tired, and we have proven that red dye can make them hyper.
  • Lactose intolerance is an reaction to the sugar in milk. People who are lactose intolerant are missing the enzyme (lactase) that breaks down the sugar in milk (lactose). They get bloating, gas, and diarrhea.

There are certainly plants that contain toxins (poisons) in themselves–poisonous mushrooms, apple seeds, and belladonna are examples–but most poisonings are accidental, usually from foods that have spoiled:

  • C. Botulinium bacteria grows in improperly canned food and in cans that have rusted through.When we used to give Karo syrup for constipation, the bacteria would grow in Karo left on a cupboard shelf and children would die, paralyzed by the neurotoxin (nerve poison) that the bacteria produced.
  • Staph Aureus can grow in spoiled food and produce a toxin that is usually self limited in its effect, giving kids cramping, diarrhea, and vomiting.
  • Clostridium perfringens produces a similar toxin, and is frequently the villain in cafeteria incidents and contaminations in soil and sewage.
  • Salmonella can grow in spoiled meat, eggs, and milk and give your child diarrhea, vomiting and fever.
  • E. coli is more likely to grow in beef, but can be found in mishandled produce. Same unpleasant symptoms.
  • Shigella is common in daycare outbreaks. It causes the same nausea, vomiting, diarrhea, and fever, but has the added risk of seizures from the toxin it produces.

Foods can also have drug effects. The best examples of this are drinks (coffee, tea, energy drinks) and food (chocolate) that contain caffeine. Caffeine makes kids restless, shaky, and interferes with their sleep. In large doses, as with energy drinks, it can produce a rapid heartbeat, muscle tremors and seizures. There were 20,783 emergency room visits from energy drinks in 2011; 5 people died after consuming them. The youngest was a 14 year old girl.

Foods can also be irritants. For example, babies can get rashes around their mouths or diaper rashes from acidic foods.

People do not react to a food solely because it is a GMO (genetically modified organism)–GMOs are not something you need to avoid unless you have a reaction to the particular item. GMO wheat produces the same allergens as non-GMO wheat; if you are allergic to one, you will be allergic to the other. Also the subject of an entire blog: What’s the Deal with GMOs?

In conclusion, not every food reaction is a food allergy. Avoidance or treatment of the food reaction varies with the actual cause. If a child has an anaphylactic allergic reaction to peanuts, he or she never needs to be around peanuts again. They may outgrow other allergies. If they get gassy from a lactose intolerance, they can take lactase tablets when they eat dairy. Kids who become constipated with apples or cheese need to limit the number they eat. It is always important for every child to not be fed spoiled food or energy drinks.

Knowing in what way your child reacted to a food determines what you do about it in the future. Knowledge rules.

Domesticated Momster
Rhyming with Wine
Rhyming with Wine

Nutrition Facts: What to Grow in a Kid’s Garden

girl with plantIn Anna Karenina, Leo Tolstoy wrote “Spring is the time of plans and projects.” Plans and projects keep children out of trouble–or at least involve them in safer, more manageable trouble.

What could be better than digging in the dirt and playing in a spray of water on a hot summer day? What more creative than an adventure in the wilds of your back yard? Add in sunshine, fresh air and exercise, and planting a garden becomes the springtime activity of choice.

One of the best ways to coax kids into eating what is good for them is to involve them in its preparation. They are far more likely to eat the lunch they prepared with their own two hands than one you slaved over. If they help you peel and cut up carrots for dinner they will try them, and brag about their contribution while chewing.

Extend this a bit and you reap the miracle of children eating their vegetables because they grew them in their very own garden. They planted the seeds, watched over them, watered them, and cared for them. They will proudly eat the fruits of their labor and proclaim their tastiness.

Children need a variety of vitamins and minerals in order to function and grow, and the best place to get those nutrients, along with carbs for energy and fiber for bowel function, is in fruits and vegetables. Some, like beans and peas, are even excellent sources of protein. Many of them can be grown in small plots or in containers on a porch.

Carrots can be grown easily from seeds bought in your local garden store, and are very high in Vitamin A. Vitamin A helps with eyesight–especially night vision–which is why your mom always told you to eat lots. Watermelon, peas, peppers, beans, and tomatoes also have bunches of Vitamin A.

Tomatoes, peppers, and beans are high in B complex vitamins. B vitamins like riboflavin, niacin, thiamine and folic acid are tiny machines that allow your body to function. They help with everything from making blood cells, to generating energy from carbohydrates, to scavenging free radicles and protecting you from cancer.

Strawberries, raspberries, and blackberries are high in Vitamin C, which is necessary for collagen synthesis and wound healing and is an effective antioxidant. Without Vitamin C, people get scurvy.

Minerals are also easily come by on the plant side of your plate.

Calcium to build strong bones can be found in beans.

Potatoes, beans, corn, and mushrooms are high in iron, which helps carry oxygen around your body.

Potassium, necessary for muscle contraction and to maintain your heart rhythm, is present in potatoes, berries, peas, beans, and peppers.

Essential minerals like magnesium, phosphorus, copper, and zinc are all available in fruits and vegetables.

I’ve never seen a child turn down a pea fresh from the pod, or a strawberry plucked from the plant. Find a plant catalogue, pour through it with your child, pay attention to what will grow in your area and how much room the plants need to grow, and choose. Consider what you have room for: will these be container plants on the porch, or can you spare a patch of yard? Do you have space for a tree, or are we looking at a mushroom kit in the closet?

Some of my favorite kid friendly plants are peas, beans, peppers, tomatoes, and the ever popular carrot. Melons, pumpkins, and cucumbers are great if you have a little more room. Berries come in all sizes, from tiny strawberry plants fit for containers with pockets down the side, to raspberry vines best grown on trellises, to fat thorny blackberry bushes. Tires can be stacked up and filled with dirt in a tower as potato plants grow, then harvested by taking off one tire at a time.

Growing a few plants allows you to spend time with your children, get some exercise, and build some vitamin D of your own from all that sunshine. Have a conversation about science and nutrition while you are digging in the dirt. Money can be earned and financial lessons taught by naming the watering and weeding of those plants “chores.” Other lessons can be taught without any conversation: responsibility for life, the fruitfulness of hard work, and pride of accomplishment. Don’t miss this opportunity for spring plans and projects!

Domesticated Momster

Stuffy Noses Suck: What To Do About Allergies?

sneezing boy-01Allergies happen when a body’s immune defenses overreact to something in the environment. They decide that a molecule of pollen or mold is a dangerous invader and it needs to be killed. Queue the mucus, swelling and itching.

If your child has the tendency to wheeze, queue the airway spasm as well.

If he or she has sensitive skin, also expect an outbreak of dry itchy patches.

If they keep the mucus, swelling and wheezing for a while, they can develop secondary infections like earaches, sinusitis and pneumonia.

Allergies suck.

What triggers allergies? Kids can be allergic to a multitude of things. They can react seasonally to flowers in the spring, to grasses in the summer and fall, or to wood fires and Christmas trees in the winter. Year round allergens include molds, mildews and dust mites (tiny bugs that live in dust and upholstery and feed on flakes of skin). Many children are allergic to pets–especially cats and birds–and react to the pet’s feathers, fur, saliva or skin scale. The poisons in cigarettes are common triggers, as are fumes like perfume and air pollution. Scents and dyes in soaps and detergents can cause allergic reactions.Some kids react to contact with latex or metals like nickel.

Food allergies are different–a whole blog in themselves. Hmmm… maybe next week?

How do we prevent or treat an allergy attack? We can’t cure allergies–all we can do is try to keep them under control. If possible, avoid the allergen:

  • If your child is allergic to cats, don’t buy him or her a kitten. Ditto for birds, dogs, hamsters…
  • Never smoke in your house or car.
  • If the allergy is to pollens, keep your air conditioner on seasonally and buy filters that catch allergens.
  • Dust mites? Cover your child’s mattress and pillow with zip up covers designed to contain them.
  • Don’t use curtains in his or her room, or wash them weekly.
  • Limit stuffed animals to those you can wash in hot water with their bed linens once a week.
  • Vacuum daily (sorry).
  • Dust with a damp cloth (also sorry).
  • Molds? Fix any damp areas in your home. Use that bathroom vent – timers work great, and are easy to install.
  • Clear out vegetation close to the house, and discard any dead plant bits.

Medicines can help prevent allergic reactions. If avoidance is not enough, your munchkin can take an antihistamine as needed to block the allergic reaction. Try to stick with the newer, non-sedating antihistamines: claritin, zyrtec or allegra and their generics.

If an exposure is inevitable (“We have to go to Grandma’s and you know she has that cat!”) you can give them an antihistamine about an hour before.

If they are going to be exposed to their allergy trigger every day for a while (springtime pollen?), they can take the antihistamine every day, if you buy the non-sedating type. If their allergies are chronic, a daily steroid nose spray or a preventative medicine called Singulair (montelukast sodium) can also help prevent the symptoms.

Offer them lots of water to wash the allergens out of their system.

If they still have symptoms, allergy testing can help to pinpoint exactly what they are allergic to, so you know what to avoid or clean up. Knowledge is power. It does no good to find a new home for the cat if the child is only allergic to mold. Poor kitten.

Last, if avoidance and medication are not enough, your physician will bring up the subject of allergy shots to desensitize your munchkin to the allergen. He or she will not be thrilled.

Allergies are miserable, but there are things you can do to make your child more comfortable. Prevent the exposure if you can, and give medication if you can’t–either a short term antihistamine or longer term preventative nasal sprays or montelukast sodium.  Consider allergy testing and shots when those simpler therapies don’t work. And hydrate. Soon, the season will change.

How to Have a Stress Free Spring Break

little cute girl near the pool with a circle for swimming

Spring Break! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten!

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. A full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

Fever is Good. Really.

sick kid-01In about 400 BC, Hippocrates said “Give me the power to create a fever, and I shall cure any disease.” Hippocrates knew that fever was a symptom of disease, not the disease itself. It is the body’s response to illness-its defense against infection.

It’s 2400 years later, and I still spend my days telling people that fever is good, we want fever, fever means that our child’s immune system is working… Fever rules!

A normal human oral temperature is between 97.6 and 99.6 degrees Fahrenheit (37.5 – 38.3 Centigrade). Rectal temps are about a degree higher, axillary and ear temps about a degree lower. Temperatures vary by about a degree through the day, increase when you exercise, and vary from person to person.

The most common cause of fever is infection, but there are other causes: illicit drug use (amphetamines and cocaine), medicine side effects, brain trauma, heat stroke, cancer, vaccine reactions, hyperthyroidism, and inflammatory diseases like lupus, rheumatoid arthritis, and irritable bowel disease. Most of the non-infectious causes give a persistent fever, while fever from infection generally gets better after 3-5 days.

Note that teething was not on that list. Teething can increase a baby’s body temp a little, but not to the point of fever.

Pediatricians define fever as a rectal temp above 100.4 F. Random, but it works as a general rule of thumb.

We get fever when a part of the brain called the hypothalamus is triggered by “pyrogens,” which cause release of prostaglandin E2. Prostaglandin E2 resets the hypothalamus to a higher temperature, like the thermostat in a house. This causes peripheral blood vessels to constrict (thus your munchkins cold hands), generation of more heat, and shivering (small muscle constriction to generate even more heat).

Fever works to fight infection in a variety of ways. High temperatures:

  • Limit the spread of a virus (like the common cold),  by blocking that virus’s ability to explode the cells in which it has been multiplying to spread further throughout your body.
  • Hinder a bacteria (like strep throat)’s ability to divide and make more bacteria.
  • White blood cells, the cells that fight infection, move around better with a fever.
  • White blood cells also chomp on bacteria better with that high temp (phagocytosis).
  • Toxins produced by bacteria don’t work as effectively with a fever.
  • T-cells, which also fight infection, proliferate better.

Fever is good.

There are doctors who will tell people that they should never treat a fever. I, however, am in the “treat for comfort” camp. Fever generally makes kids feel tired (not always a bad thing), fussy, and can make them feel cold. It is uncomfortable and can burn off a lot of fluid at a time when we want our children to stay hydrated. A rapid change in temperature in a young child (6 months to about 5 years) can cause a febrile seizure. If your child is miserable, not drinking as much as you would like, or in pain from a sore throat or headache, acetaminophen or ibuprofen will help him or her to feel better.

Brain damage occurs with temperatures above 108 F (42 C), with things like anesthesia reactions and heat stroke. Only in Hollywood do you get brain damage from a common illness with a 104 F  temperature.

Normal childhood viral infections like colds and gastroenteritis generally trigger fevers in the 99 F to 104 F range. Fevers tend to go up a little in the morning, improve during the day, and spike higher at night. That 103 temperature that improves during the day but then spikes at 10 PM is actually pretty reassuring, because that is the classic viral fever curve. Kids generally get better on their own with rest, fluids, and time.

Bacterial infections, like strep throat, pneumonia, or sepsis, are more serious and sometimes need treatment with antibiotics. They classically give fever all day long, rather than in that morning and evening viral pattern. They are accompanied by symptoms specific to the source of the infection, like lethargy, breathing problems, sore throat, earache, or pain with urination.

So, when to worry? Your doc will want to see any baby under 3 months with a fever, because their immune systems are inexperienced at that age. We like to see kids with 104 F temperatures or fevers that persist longer than 3 nights, just to make sure there isn’t anything bad going on. Call us if your munchkin has trouble breathing, lethargy, inconsolable irritability, an earache, or pain with urination. We like to see kids with fever if they have compromised immune systems or serious medical problems. We like to see kids with fever caused by heat stroke rather than infection.

Never throw them into a cool bath or rub them down with alcohol, because fever seizures are caused by a rapid change in temperature, not by the actual height of the temperature. It is safe to give a child a tepid bath about an hour after they have a dose of acetaminophen or ibuprofen, because the medicine will keep the temperature from bouncing back up.

Never give aspirin to kids because it has been linked to Reye’s syndrome.

And if you’re worried, call your pediatrician. It’s what we’re here for.

Domesticated Momster

8 Easy Ways to Prevent Childhood Cancer

Cute girl of school age in superhero costume

More than 9000 kids get cancer in the US every year (about 1 in 450). The most common are leukemias, lymphomas, and brain tumors, but there are many different kinds. If you would like up to date numbers, the  AAP has them here.

Cancer is a group of more than 100 diseases caused by the cells in a person’s body multiplying out of control. Cancer is separated into different types depending on what sort of cell it originated from (blood, brain, lung…) and if it invaded nearby body parts (a tumor) or spread to other organs (metastasis). That might be a smidge simplified, but you get the idea.

Your children’s genes, the DNA they inherit from you, influence their risk of cancer–not something you can change. But lifestyle and environment also influence their risk, and there you can have an impact.

That impact includes not only your kid’s exposures in childhood, but also the example they see in your behavior and the habits you establish that will carry forward into their adult lives. What you teach them in childhood can protect them throughout their lives.

What to do to lower your child’s risk of getting cancer:

  1. First, the obvious one: don’t use tobacco, and don’t allow anyone else to smoke around your kids. I know, easier said than done, but an estimated four out of five cancers are caused by tobacco. The poisons in tobacco damage DNA, increasing the incidence of 14 different cancers including lung, some leukemias, voice box, throat, liver, kidney… Secondhand smoke alone increases cancer risk by 25%. The sidestream smoke off the burning end of a cigarette has 3 times the carbon monoxide, 10 times the nitrosamines and hundreds of times the ammonia of exhaled smoke. Add to this that if you smoke, your child’s chances of becoming a daily addicted smoker increase by 25 times, boosting their risk even more. Just don’t. No excuse is good enough.
  2. Also well known: protect them from sunburns to prevent skin cancer. Use at least SPF15 and reapply through the day. Seek shade during peak hours. Stick a hat on their head that shades their face, and a pair of sunglasses on their nose.
  3. Feed them a healthy diet with lots of fiber, fruits and vegetables. Avoid processed meats and an overabundance of red meat and salt. A healthy diet helps your body remove harmful chemicals, prevent and repair damage to DNA, and block the formation of cancer causing chemicals. A less healthy diet has been linked to breast, mouth, esophagus and GI cancers.
  4. Encourage exercise. Exercise stabilizes levels of hormones like estrogen and insulin that have been linked to cancer. An active lifestyle decreases the incidence of breast, bowel, and uterine cancers.
  5. Keep them at a healthy body weight. Fatty tissue produces hormones that influence the way cells grow. Cell overgrowth is at the root of cancers. Obesity has been linked to breast cancer, esophageal and bowel cancers, and liver, kidney, pancreas and uterine cancers.
  6. Limit their exposure to chemicals. Indoor pesticides have recently been shown to  increase children’s risk of leukemia by 47%. Be aware of the chemicals you might be exposed to at your job, wear appropriate safety gear, and don’t bring poisons home on your clothes–cancer causing chemicals such as arsenic, benzene, and asbestos are still used in industry. Check the use instructions (do they need to be used in a well ventilated area?) and ingredients in the products you do use at home. You can check for harmful ingredients in household products at nih.gov. Store household chemicals such as cleaners, paints, degreasers, and strippers safely high up and locked away.
  7. In the “be a good example” category: limit your alcohol consumption. Alcohol increases the amount of cancer causing chemicals in your body, and affects hormone levels. It also amplifies the toxic effects of tobacco. Drinking alcohol increases your risk of breast, mouth, throat and bowel cancers.
  8. Avoid certain kinds of infections. Infection can increase cancer risk by causing chronic inflammation and suppressing the immune system. Hep B increases your kid’s risk, so get them the vaccine, and teach them to avoid iv drugs and indiscriminate sex. Be careful with tattoos: Hep C also increases risk, and 41% of it comes from tattoos. Helicobactor pylori  increases cancer risk–doctors look for it with reflux disease, gastritis and ulcers.  Human Papillomavirus  works by causing cells to divide rapidly (hence the appearance of a wart). We lose 4000 women to preventable cervical cancer yearly, and the incidence of oral cancers due to HPV is increasing dramatically. The CDC recently announced that the vaccine has decreased the incidence of HPV in teens by 2/3. Get your child the HPV vaccine when he or she hits 11 or 12.

Cancer risk factors seem to hit the hardest when a baby is still in the womb, and in adolescence when their bodies are rapidly growing and changing, so these are the times when a parent can absolutely have an effect in preventing cancer.

A healthy lifestyle stacks the deck in your child’s favor, dramatically decreasing their odds of getting cancer. Protect them from cancer causing sunburns and poisons, get those vaccines, establish good habits, and be a good example. There is no down side to a healthy diet, regular exercise, and limiting their exposure to toxins, and it may increase their chances of hanging around for a while.

Domesticated Momster

Lead, and the Children of Flint

Toddler-Playing-With-A-Chair-01In April of 2014 politicians in Flint, Michigan changed the city’s water supply from Lake Huron and the Detroit River to the Flint River, in order to save money. The water from the Flint River was more acidic and had more salt and chlorine in it, and it corroded the aging lead pipes through which it flowed, allowing lead into the water and poisoning the inhabitants of Flint.

The EPA allows 15 ppm (parts per million) of lead in drinking water. Water from homes in Flint tested as high as 13.2 thousand ppm. Lead levels in children’s blood doubled, then doubled again.

Nontombi Naomi Tutu said we “needed the people of Flint to remind the people of this country what happens when political expediency, when financial concerns, overshadow justice and humanity.”

Why do we worry about Lead?

Lead is a soft gray heavy metal that functions in our bodies as a neurotoxin–it poisons nerves. Acute lead poisoning causes headaches, stomach pain, clumsiness, agitation or drowsiness, convulsions and death.

Chronic lead poisoning is more insidious. Lead is most harmful to infants, children and pregnant woman, because it damages developing nerves. Kids who are poorly nourished will be more affected because deficiencies in iron, calcium and zinc increase their body’s absorption of lead. Babies are more at risk because they live closer to floors and surfaces and everything goes into their mouths. Exposed children:

  • can lose cognitive function and develop speech and reading problems.
  • can be unable to focus and organize their thoughts, and exhibit behavior problems.
  • have a higher school dropout rate, problems with aggression, and a higher rate of delinquency.
  • can have damage to their hearing.
  • will have problems growing because lead messes with their ability to use Vitamin D and iron.
  • become anemic, which leaves them less able to transport oxygen around their bodies.
  • can cause damage to their kidneys, giving them lifelong problems with hypertension and cardiovascular disease.

Where is lead found?

When I was a kid we wrote with lead pencils and had lead in our gasoline!

Nowadays, lead is used in some industries, found in deteriorating lead paint in old houses, and leached out of old lead water pipes and pipes with lead solder. We also occasionally run into it in old toys, old Christmas decorations, and jewelry, and in toys, ceramics and cans imported from other countries. Cosmetics such as surma and kohl can have lead, as can some home remedies and dietary supplements. A few years ago there were crayons with lead in them. The manufacturer said, “Kids weren’t supposed to eat them!”

Ideally, we prevent lead poisoning.

  • If you work in an industry that uses lead, take off your shoes when you enter your home.
  • Don’t give your kids old toys and jewelry to chew on.
  • If you have lead pipes in your home, run the water for 30 seconds before you use any of it to drink or cook, because lead will gradually leach from the pipes it is sitting in. Never drink or cook with water run hot from the tap–hot water leaches out more lead.
  • If you live in an old house, clean up peeling paint and household dust with a wet mop.
  • Check for lead paint before any home renovations.
  • If you have well water, test it for lead. Most well filters do remove lead.
  • Give your child a nutritious diet to avoid deficiencies in iron, calcium, and zinc.

Treatment for Lead Poisoning:

Pediatricians generally check children’s lead levels at 12 months and sometimes 2 years, and any time there is concern.

Treatment of lead poisoning varies with how high the level is.

Between 5 and 45 mcg/dl, treatment involves finding and eliminating the source and optimizing the child’s nutrition. Levels as low as 5 mcg/dl have been shown to have lasting effects on children, but chelation therapy at these levels has not been proven to have any effect on kids’ cognitive ability or behavior.

Kids with levels over 45 mcg/dl need to be treated with chelating agents, which can be quite dangerous. Chelators bind the metal in the blood and improve its excretion into urine and stool. Unfortunately chelators also bind minerals that your child’s body needs for normal growth and development. Also, kids can be allergic to the chelators, and the medicine can damage their liver or kidneys.

Far better to prevent the exposure.

I do not have words for how horribly the people of Flint were betrayed by their elected officials.

Some resources if you have concerns:

  • EPA Safe Drinking Water Hotline  800-426-4791
  • Poison Control 800-222-1222
  • Pediatric Environmental Health Specialty Unit Network (PEHSU) 888-347-2632

 

Domesticated Momster