children’s health

What To Do if Your Child Can’t Poop

Posted by

0

Today’s blog was written by Dr. Prakar Poudel, MB.BS, Medical Graduate, Future Pediatrician!

Is your child not passing stool ?

Many parents just like you visit the doctor when their child doesn’t pass stool for many days. But how many days are too many? How hard is too hard? How large too large? Should it hurt? Bleed?

You should suspect constipation if your child does not pass stool for about 5 days (unless they are a breast fed infant – they can average 2 weeks!). Constipated stool should be large and hard, sometimes painful, and sometimes have a little bright red blood from splitting the skin at the anus.

Around 30% of children below 5 years of age will experience constipation at some point, especially during their pre-school years. The causes of constipation in children can be confusing, but you can rule out a few common causes before a doctor’s visit.

Common Causes:

If your child drinks little fluid or a lot of milk, eats a lot of cheese or loads of highly processed foods, or eats few fiber rich foods, they can have difficulty passing stool daily.

Sometimes, they may also be hesitant to pass stool in a public toilet. Because of this nervousness, they also may not want to go at day-care or school. He or she may need patience and encouragement to ease their hesitancy in public toilets.

What is constipation?

So, how do you know if your child is constipated? The list below can help parents like you identify the problem. If:

  • they pass stool less than 2 times in a week
  • the stool is hard and thick.
  • they cry while passing stool
  • they take a long time in toilet
  • the passed stool has bright red blood on it
  • their belly hurts and is relieved by passing stool
  • their belly is distended
  • they pass foul-smelling gas

What to do?

All these signs are concerning, but can usually be resolved at home by giving your child an adequate amount of fluids and fiber-rich foods. Highly processed food should be minimized at this time, and limit dairy products. This is the only time your pediatrician will recommend sugary drinks, because sugar will draw water into the bowel. (White grape juice will match most carpets.)

As a parent, you should also be aware that children (and puppies!) will generally pass stool soon after they eat due to the gastrocolic reflex. This is very helpful in toilet training or with mild constipation. It is suggested that you keep your child for 5-10 minutes on the toilet after meals, even without any urge to pass stool. Keep special toys or books nearby that can only be played with while on the potty. We want this to be fun!

When to worry

Besides these common causes, medical causes like hypothyroidism, cystic fibrosis, celiac disease will always need a pediatrician visit. So, when should you visit a pediatrician with your child? Below are of some signs to guide that decision:

  • If your baby does not pass stool within 48 hours after birth.
  • If the baby is less than 1 month old
  • If the stool is ribbon-shaped
  • If a child is not gaining weight and height as per the growth chart
  • If your child is also vomiting
  • If a hair tuft or dimple is seen on the back of your child
  • If your family history has Hirschprung disease or cystic fibrosis
  • If the belly of your child is grossly distended
  • if he or she is leaking liquid stool
  • if they pass stools so large they clog the toilet

As always, if you have any questions, call your pediatrician. They love this stuff.

Pediatricians are weird.

What Does that Growth Chart Mean?

Posted by

0

Today’s post is brought to you by Prakar Poudel, International Medical Graduate, Future Pediatrician!

Growth is what makes children unique.

Everyone from Grandma to your neighbor watches the growth and development process from the moment your child is born until they become a fully mature adult. Natural laws dictate that the growth of each child is a unique, continuous and orderly process, although the different parts of a child can grow at different rates!

It is essential for your pediatrician to monitor the growth of your child until they are through adolescence, because changes in growth could be a sign of medical illness.

The most common measures to track are weight and height. However, the eruption of teeth and measurement of head circumference, chest circumference, mid-upper arm circumference and body mass index are other measures for tracking growth.

In general, a child:

  • doubles birth weight by age 6 months
  • triples birth weight by 12 months
  • quadruples birth weight by 2 years

Similarly, a child’s height:

  • will be around 50 cm (~20 in) at birth
  • will gain an additional 25cm (~10 in) by 1 year
  • 12.5 cm (~5 in) by 2 years, and
  • 10 cm (~4 in) by 3 years of age

One important note is that if growth in height is less than 4 cm (~1.6 in) per year after the age of 4 years, this suggests the child has a poor growth rate and needs a pediatrician’s visit.

The head circumference of a baby also increases at the rate of 2 cm (~.8 in) per month until 3 months of age and 2 cm per 3 months until 12 months of age.

If the measurement of the mid part of the biceps (upper arm) is below 12.5 cm in a newborn, the child also needs immediate medical attention. Average biceps size is in the graph below:

Lastly, teeth can also be considered a vital measure to track the child’s growth. As the child grows, primary (temporary) teeth erupt and fall in synchrony with the eruption of permanent teeth. All the temporary teeth fall and get replaced by permanent teeth by the age of 12 years.

Each child’s growth rate and velocity will be different and unique, so the Center for Disease Control (CDC) has created growth charts for weight, height and head circumference for each sex and age to monitor the overall growth of your child. The charts shown below are an example of growth charts of weight for age in boys and girls. All other kinds of growth charts can be found in your nearby children’s doctor.

A single appropriate growth chart is used for each child. The important part of plotting in these charts is that your child should be following a consistent percentile for it to be considered adequate growth. If your child’s weight crosses at least 2 percentiles – say falls from 75th percentile to the 25th – your child may need to see a pediatrician.

Any worries? Pediatricians love this stuff – call yours!

The Weird and Interesting Life of a Flu Virus

Posted by

13

sick-kid-01The first description we have of the influenza virus was from Hippocrates (my hero!) 2400 years ago. He dealt with it every winter, endlessly, just as we do now. Nowadays it makes between 3 and 5 million people sick each year, and kills 250 to 500 thousand people annually. In the US we average 200 thousand hospitalizations and 36 thousand deaths yearly. Persistent, nasty little bugger.

Influenza gets its name from the Italian word for influence, because we initially thought it was caused by the influence of the stars, and later by the influence of the cold. Now we know better.

The influenza  virus is a tiny spherical particle, only 80-120 nanometers in size. It would take a million of them standing in a row to make a 1 centimeter line. Its core is made of 8 separate segments of RNA (we humans have DNA). This core is surrounded by protective proteins and an envelop with 2 types of “glycoproteins”–the famous Hs and Ns you hear about when people talk about which type of flu is causing problems each year: Hemagglutinins and Neuraminidases. NPR has a very cool video of the flu virus invading a cell. The “key” in the video is the hemagglutinin.

The Hemagglutinins (Hs) bind to target cells in your body and inject the virus particle into your cells. How contagious the flu is, what symptoms it gives you, and how sick it can make you depends on the Hs. An H that can bind to cells in your eyes, nose, and mouth is more contagious than one that can only bind to your throat. An H that can bind to a cell deep in your lung is much more serious than one that can only bind to a cell in your throat.

The Neuraminidases (Ns) release the progeny of that prolific particle from that cell so that the little critters can spread further through your body.

The Hs and Ns are the molecules our immune systems build antibodies against, whether we catch the flu or just get exposed to the dead virus in the annual vaccine. The Hs and Ns are also the targets for antiviral drugs. There are 16 different Hs and 9 different Ns. Humans are usually infected with H 1,2, or 3 and N 1 and 2.

There are three groups (genera) of flu viruses in the family Orthomyxoviridae. (I am a nerd–I love that word. Ortho-myxo-vir-i-dae. It would make a killer rap song.) The three groups are simply labeled A, B, and C. Nerds have no creativity. A, B, and C. Sad.

  • Flu A has the most serogroups (Hs and Ns), infects the most different animals, and is the most virulent. It also mutates 2-3 times faster than B. The critters it infects are mostly aquatic birds, but it can infect many other species. We frequently call the flu by which animal is its main host. Human, bird, and swine are the most common strains we humans catch.
  • Flu B has only one serogroup and is almost exclusive to humans. It tends to be less severe and less common. Since it only has one serogroup and mutates slowly, many people develop a degree of immunity to it.
  • Flu C is even less common and less severe.

Flu viruses enter cells so that they can make copies of themselves and spread. As they make those copies they sometimes make mistakes, creating mutations. They average one mistake per copy, so mutation is constant– what we call antigenic drift. That’s why we never get immune to Flu A–it changes every year.

What makes Flu unique: There is one really cool thing about the flu virus that makes it different from most viruses: its RNA is split into 8 segments. Most viruses have one long piece of RNA. This means that if your local pig catches 2 different strains of flu at the same time, these strains can trade segments. When that happens we get antigenic shifts– much larger changes for which people have no immunity. These larger shifts can create a pandemic, like the Spanish flu in 1918 that killed an estimated 21 million people. We average 3 pandemics each century. We worry a lot about pandemics.

So, those are the ABCs of the flu virus. If you crave something more useful, like what you can do about it, check out my post on colds and flu or info on fever.

Now wash those little hands with soap, keep them away from noses and mouths, break out the alcohol (not the drinkable kind) and bleach, and go get those flu shots! This year’s shot covers Flu A H1N1 and H3N2, and two strains of B.

DomesticatedMomster
The Blogger's Pit Stop

Zika Virus: An Update

Posted by

6

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. Evidence shows that these babies may also have eye abnormalities that will  effect their vision. There have been links to serious deformities in the joints in the arms and legs of affected babies. A report published August 30, 2016 noted that 6% of the babies affected by Zika also have hearing loss. According to the AAP as of November 4, 2016, their are five main birth defects: severe microcephaly with partially collapsed skull, decreased brain tissue with subcortical calcifications, extreme muscle tone, eye damage with macular scarring and increased pigment, and limited joint motion range.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 0 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Injuries: Preventing the Scary Stuff

Posted by

8

safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

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. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

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.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

Domesticated Momster
The Blogger's Pit Stop

Top Ten Tips for Summer Vacation Success

Posted by

4

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

Posted by

0

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.

Children in the Aftermath of Trauma

Posted by

0

Sad child on black background. Portrait depression girlWe try to protect our children from as much as we can, but sometimes life has other plans.

The murders in Orlando have taken over our thoughts, our conversations at home and with friends, the internet, and the television waves. Our children are being bombarded by the nightmare in front of the TV at home, in conversations with friends, and with questions asked by their peers. It can be too much for a child to deal with.

Your child’s experience of an event will vary depending on their age,  personal style,  life experience, and  closeness to the disaster. A toddler will only care that his or her parents seem to be upset. Older children will hurt for the people involved, worry about friends and relatives that are not within their sight, and worry that it could happen to them sometime, at some other event. What seemed exciting to discuss with friends during the day becomes frightening after the lights go off.

Listen to them talk, and be patient when they ask you the same questions over and over. Reassure them, let them know that such things are extremely rare. Answer questions truthfully, at their own developmental level. Never lie.

Monitor what your child sees and hears – adult conversation and the media can magnify fear and confusion and increase their trauma. Repetition can intensify anxiety; pictures can get locked in their heads.

After the event symptoms of post-traumatic stress may appear, even in children not directly involved. They may be sad or moody, easily angered or irritable. They may be afraid to go to public venues. They may have trouble sleeping or sleep too much. Appetites may suffer. Your child may be anxious when his or her people are not all nearby, and wake from nightmares.

Children frequently have concentration problems after a trauma, and their grades will suffer. They may regress developmentally: your independent youngsters may become clingy, or need help doing things they had been able to do on their own. They may avoid activities they previously enjoyed, and withdraw into themselves. They may become anxious at the thought of going to school, or of being separated from mom or dad.

They can also develop physical symptoms like headaches and stomachaches. They may try to exercise more control on their environment, setting up their toys in a particular way, wanting their schedule to be predictable, or demanding activities they find reassuring. Teens may act out or try alcohol or drugs in an attempt to feel better.

Helping them may be as simple as listening. Be available and receptive but don’t push. A younger child may open up and tell you his story when you break out toys or art supplies; an older one may talk if you tell her a similar story about yourself, when you were scared or worried. Schedule time for just the two of you, and wait.

Children may try to hide their symptoms: they think they should be stronger, they don’t want to be a burden, or they think they are abnormal for having the problem. They may even feel that the disaster was their fault; children are not always logical. Allowing them to bury their symptoms will only erode their spirit from the inside.

Also, be a good example. Take care of yourself, eat healthy food, sleep, and discuss events calmly. Turn off the TV and stay off the web. Exercise. Take breaks to play, read a book, and do something unrelated to it.

Keep to recognizable routines– routine is reassuring and safe. Require reasonable behavior: if they still get in trouble for using that bad word, then everything must be OK. They may test you with bad behavior just to get that reassurance. Don’t spoil them with extra treats, because it will frighten them. Things must be really bad if The Parent gives me toys or lets me eat candy.

Lend a hand to other people. It will help to know that you have the power to help and comfort.

The traumatic symptoms may last quite a while. Triggers like parents going out at night or a security guard at a local festival may bring everything back. Fear of it happening again may linger. An anniversary will renew their anxiety.

If time passes and stress is affecting their lives, think about having them see a counselor or getting them into a peer group with similar concerns. We all need a little help sometimes.

My mom also used to say, “Time heals all wounds.” And with a little help from their guardians it always will.

Top 10 Tips for Successful Summer Vacations

Posted by

0

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?

Posted by

10

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