Dr. Sandy: Mom First, Pediatrician Second

Ear Infections – What Are They and How to Prevent Them?

2012-01-25T20:47:00.000-05:00

“For the last two nights, he keeps waking up at night. He used to be a wonderful sleeper... I don’t know what’s wrong with him,” reported a tired mom holding an cute infant on her lap. She wiped his runny nose with a tissue.

Another dad tells me about his toddler daughter, “She’s been congested for over a week, and woke up last night with a fever to 101. She seems a little better during the day when I give her ibuprofen, but she’s miserable at night.”

"My son woke up this morning and told me that his ear hurt," said another mom about her four-year old.

All of these children have signs of a possible ear infection.

What is an Ear Infection?

When doctors refer to an “ear infection,” we are talking about a viral or bacterial infection in the middle ear. This is a space behind your ear drum that is connected to your nose via your Eustachian tube. See illustration below.

Fluid is produced in the middle ear space all day long and normally it is not a problem. However, when our noses get congested, then our Eustachian tubes can become blocked. Then the tubes do not function to drain the middle ear. This is especially true with young children and infants because their tubes are much smaller and are more horizontally oriented.

When fluid builds up in the middle ear, then bacteria and viruses can replicate in the fluid and cause an infection. If it is a bacterial infection, then antibiotics are needed to treat the infection. More than 50% of ear infections are caused by viruses and do not require antibiotic treatment. Your child’s doctor can assess for the possibility of a bacterial infection. If your child is having significant pain, fever, ear drainage, or other signs of bacterial infection, then your child’s doctor may prescribe antibiotics.

How do you know if your child has an ear infection?

Well, unfortunately, the answer is that you may not know. The good news is that if your child is not acting sick, has no symptoms other than a cold lasting less than two weeks, then he is unlikely to need antibiotics, so do not worry about missing an ear infection. Some symptoms of an ear infection that need to be treated are described below.

Pain: Generally, children experience pain and pressure from the fluid accumulation – so they do not sleep well or complain of pain when they are old enough to talk. Pulling on the ears is not a good indicator of an ear infection since some infants pull on their ears when they are just tired or when they are teething.

Fever: Many children have fevers with their ear infections. If your child has a fever after having a cold for several days, then he may have developed a secondary infection, such as an ear infection. Take your child to the doctor to be checked.

Congestion/Cold: Since the fluid builds up because the drainage system or Eustachian tube is not functioning, then your child is more at risk for an ear infection when she has been congested for several days. If your baby is fussy or has a fever after having a cold for several days to weeks, it may be an ear infection.

Ear Drainage: If you see drainage of fluid from your child’s ear, then the eardrum may have ruptured from the pressure. While this sounds horrible, your child will probably experience relief since there is less pain. In general, small ruptures of the eardrum heal well. However, the infection still needs to be treated, so see your child’s doctor.

How can I prevent my child from getting an ear infection?

Focusing on the nasal congestion is one of the best ways to prevent the fluid from building up and getting infected. Nasal saline works well for all ages. For younger children, help to clear their noses by putting a few drops of nasal saline in each nostril and then cleaning the nose using a bulb suction device. For older children, spray or drop the nasal saline into their nostrils and then have them blow their noses. Running a humidifier (cool or warm) in your child’s room will also help with the congestion. If the congestion is from allergies, treating the allergies with antihistamines may be appropriate depending on your child’s age.

Some children are more prone to ear infections due to their anatomy. Unfortunately, these children will get ear infections despite their parents’ best efforts to keep their noses clear. If your child has multiple ear infections in a year (usually 5 or 6 episodes), then your child’s doctor may recommend myringotomy or PE tubes to prevent recurrent infections.

Stay healthy, and thanks for reading!

“My tummy hurts!” - How to Tell When a Stomachache Is Real

2011-12-02T10:47:00.002-05:00

“Mommeeee… my tummy hurts!” my three-year old complained as he came out of his room for the second time that night.

“Show me where it hurts,” I said to him.

He pointed to an area around his belly button (where most children will point when asked this question). My son was normally a great sleeper, so I was a little concerned that maybe he really was coming down with something.

I looked at him and went through my checklist. Dressed in his dinosaur fuzzy footy pajamas, he had walked over to my room to report his distress (no signs of pain with walking). He wasn’t bent over or crying (not severe pain). He had come up with this reason after a previous unrelated reason for leaving his bed (not repeated or consistent pain). He had eaten dinner well earlier today and went to the bathroom normally (no loss of appetite and no vomiting, diarrhea or constipation). I put his hand on his forehead and he did not feel feverish (yes, we will always tell you to take your child’s temperature with a thermometer – but I’ll admit to using the mommy forehead test).

“What do you need to make it better?” I asked. I almost always ask my kids this question when they have a complaint. They usually have a fix in mind and the “boo-boo” disappears magically. My favorite was when my daughter told me that “chocolate candy” would fix her stomach pain. (I didn’t give in on that one!)

“I need boo-boo penguin,” he answered promptly. He was referring to our penguin-shaped ice pack that seems to cure almost all ailments.

So, I said okay. And within five second of boo-boo penguin’s magic, he was ready to sleep.

I wouldn’t recommend giving in to demands on repeated nights, but since this was a first request, I let it slide. Sometimes it isn’t worth the battle! (ummm - perhaps “do as I say, don’t do as I do” applies here also)

How do you know when a stomachache is the sign of real illness or when it’s just a behavioral ploy for attention or to get out of doing something (like eating vegetables or going to school)?

It can be difficult to tell sometimes. However, there are certain signs that are red flags for illness. Some of these require immediate medical attention. Others can be treated first at home and then your child should be brought to your pediatrician if there isn’t any improvement.

When you call your doctor, think about the following so that you can have these answers ready.

Timing - How long has the pain been going on? How often does your child have the pain? How long does it last? When does it happen? Most simple pains only last a few minutes and happen only once or twice. If the pain lasts for several days or several hours, call your child’s doctor. Some pains only occur during school mornings. Others happen only at bedtime. These can all be clues as to the underlying cause (or motive as the case may be!)

Severity – Is your child running around and playing? Or is she rolled up in a little ball crying about her pain? This will help you to determine the seriousness of the pain. Asking young children if their stomach hurts does not always help since they will usually give the answer that they think you want (not how they actually feel).

Location – Where does your child point to when you ask where it hurts? Tell them to point with one finger to where it hurts the most – otherwise, they’ll usually rub their entire belly button area and say “It hurts all over!” Pain located in the lower right side of the belly is possible appendicitis and is an emergency.

Triggers – Does it occur after eating certain foods or drinking certain liquids? Lactose-intolerance is fairly common and can be helped by eliminating lactose from the diet (your child can drink soy milk or Lactaid milk to get the needed calcium). Also, food allergies can cause stomach pain or vomiting or diarrhea. Celiac disease (or gluten intolerance) is a common food allergy that can cause ongoing stomach pain. Bloating and gassiness can be associated with food-related allergies or intolerance.

Vomiting or Diarrhea – Stomach bugs can cause short-term belly pain along with vomiting or diarrhea. However, if the vomiting/diarrhea is severe, lasts more than 24-48 hrs, contains blood, or your child is unable to keep fluids down, call your doctor.

Constipation – If your child’s pain is much better after having a bowel movement, then the pain may be related to constipation. Increase water, fiber and vegetables in your child’s diet to see if your child’s pain improves with softer stools. See my previous blog post on constipation for more information.

Urinary problems or groin pain – these can be signs of other medical problems like a urinary tract infection or testicular torsion. Call your doctor immediately.

Rash – stomachache and rash can be signs of other types of illnesses, such as a Strep infection, call your doctor for guidance. If your child has hives, then it may be an allergic reaction, seek help immediately.

Fever – fever usually means infection. If the fever is low grade (102 or less), has been less than 3 days, and the stomach pain is minimal, you can likely treat your child’s symptoms at home. However, if the pain is severe, your child is in distress, the fever is high, or any of the warning symptoms described above are present, then you should call your child’s doctor.

Weight changes or poor growth – if your child is not growing well or is losing weight, these can be signs of more serious diseases and your child needs to be seen.

What to do if you suspect the complaint is behavioral?

If your child is running around happily and is not ill-appearing, then the complaint of a tummyache may be a way of getting attention or a ploy to get out of an activity. If you think this is the case, the best thing you can do is to ignore it. The more you acknowledge it, then the more he will repeat the behavior (i.e. getting boo-boo penguin in the middle of the night – oops!)

Instead, provide a distraction and move on to the next activity. If there are no further complaints, then you know it’s just a clever way to get some attention. Or if he insists on a cure, then give a placebo, like a medicine syringe full of colored water or juice and see if the pain improves. If so, you know that there is nothing serious causing the pain.

Shower your child with love and attention when he is not complaining of tummy aches and gradually the behavior will stop. It may take a few weeks, but if you stick to it, then the imaginary tummy aches will be cured. (and then they’ll move on to “Mommeeee… my leg hurts!!!”) (more on that later!)

Happy Holidays, and thanks for reading!

Keeping Our Kids Happy and Healthy Through The Holidays

2011-10-22T22:12:00.000-04:00

“Can I wear my gloves today?” asks my daughter holding up her new pink gloves decorated with snowflakes. It’s the end of October and sixty degrees outside. It’s been unseasonably warm this season, and we’re only just starting see some colder weather announcing the arrival of autumn.

So I tell her, “Not yet, but soon. It’s cold, but not cold enough for snow yet.” She nods and puts them in her backpack for safekeeping. “Maybe it will be cold enough tomorrow!”

The she zips up her backpack, thinks for a second, and then asks, “Can I wear my boots?”

And so it goes… in the end, we’ve compromised. She can wear her boots this weekend, her hat now, and her gloves when she goes to the playground today if she wants.

Cold weather is here, and we are spending more time indoors sharing viruses and germs. Kids and adults alike tend to get sicker in the winter months because of this. Parents can take help prevent illness in their children by teaching them valuable skills that will prevent illness.

Regardless of age, one of the most important methods of prevention is good hand washing. My kids are notorious for running their hands under the water for three seconds (maybe getting a little bit of soap if we’re feeling extra good today) and then quickly wiping their hands on a towel as they run out to get back to playing.

To wash our hands properly, we should rinse our hands with water and soap for at least twenty seconds, or the time it takes to sing the alphabet song. For children who are old enough, teach them how to wash correctly. Show them how to clean the tips of the fingers especially well since children tend to put their fingers in their mouths often.

One of the most common ways that we pick up germs or viruses is by touching surfaces that someone else who has been sick coughed on, sneezed on, or touched. Then we end up infecting ourselves or our children.

Many parents also notice how younger siblings seem to get sicker at a younger age or perhaps more often than an older sibling did. This is because the older child brings germs or viruses home from school or daycare and infects the younger child.

Colds, flu, and vomiting/diarrhea diseases are some of the most common illnesses that children get from others. If your child ends up with any of these illnesses, here are some tips to help you and your child get through them.

For colds and flu, it is important to give your child plenty of fluids. Food is not as important while they are ill, and your child may lose her appetite while sick. Hydrating your child with age-appropriate fluids is important. Running a humidifier in the child’s bedroom and having her sleep in a more upright position will ease nighttime congestion and cough. For children older than 1 year, giving 1 teaspoon of dark honey can quiet coughing episodes.   In general, over-the-counter cold medications are not recommended for children under the age of 6 years. If your child has fever greater than 104, has prolonged fevers for more than 3days, has a severe cough, chest pain, wheezing, or seems lethargic, call your doctor immediately.

In the past, we were all told “cover your mouth when you cough”… and we did this with our hands. However, when a child coughs and covers his mouth with his hand, the virus particles get all over that hand, spreading the virus to others as he touches various surfaces.    To help keep from spreading germs, teach your child to cough into the crook of his or her elbow. And again, good hand-washing is key to prevention of spread.

Use antibacterial hand sanitizers when soap and water are not available. These are effective for killing many of the germs that can cause illnesses.

For vomiting and diarrhea illnesses at all ages, it is very important to prevent dehydration. This can be done by giving small frequent sips of an electrolyte solution, such as Pedialyte. If your child refuses to drink or cannot keep large amounts down, then give 5 mL every 5 minutes using a medicine syringe. This can hydrate a child successfully and will be less likely to trigger more vomiting.

You should avoid giving juice or sports drinks because the excessive sugar in these liquids can result in worsening diarrhea. Giving water alone does not provide enough of the salts and sugars that the body needs to function. Probiotics can also be very helpful with diarrhea illnesses. These can be found in yogurt (if your child isn't vomiting) and in powder or chewable tablet forms in most drug stores and several grocery stores.

If your child shows signs of dehydration, call your doctor immediately. Signs of dehydration include increased thirst, dry mouth, sunken fontanelle (for infants), doughy-feeling skin, decreased urine production, and lethargy or tiredness.

Regardless of the type of illness, do not send your child to school if he or she has a fever. Viral illnesses are the most contagious when the person has a fever. Most viruses are spread by respiratory droplets or contact with fluids that contain virus, so even though the fever is gone, your child may still be contagious to others. Use your best judgment when deciding when your child should go back to school.

Teach your child not to share food or drinks with other kids since someone else might be ill or be contagious and not realize it.

Help your child stay healthy and ready to learn by taking precautions and use prevention methods. Teach your child to wash his or her hands often and avoid direct contact with other sick children when possible. By doing this, everyone can stay healthy and have a happy holiday season!

Happy Fall and thanks for reading!

Hyperactive - Or Just Being a Kid?

2011-09-30T13:39:00.000-04:00

“Sit down! Why can’t you sit still?”

“Don’t touch that!”

“I told you that it’s time to go? Why aren’t you ready yet?”

“How could you forget your homework again?”

“Get off that ____!” (sharp thing, dangerous high thing, major machinery that children shouldn’t be on, museum object with sign that says ‘Don’t Touch’, etc, etc)

Do you ever feel like a broken record? Or think that your child is ignoring you? Or perhaps that there is something wrong with your child, or your skills as a parent?

Well… I have. As I watch one of my sons, yet again, be unable to keep his hands off of the items around him, or sit still for longer than a second, I wonder if there is more to him than meets the eye.

Now, my oldest is the calm, rule-following, responsible one who tends to obey and follow most of my requests. While he’s not a robot, he seems to get what my husband and I are trying to say.

My second, however, is totally different (as he should be). I love him to pieces, but he can drive me crazy at times. Now, don’t get me wrong, he’s not a bad kid. He’s actually very bright, very creative, and downright funny. He will be the first one to help his younger siblings if they are in need. He’s a pretty decent athlete and shines in many ways.

However, he just can’t stop moving! He gets frustrated easily and is very easily distracted. He doesn’t appear to know when it’s inappropriate to grab things from other people, and has a very hard time waiting for his turn.

Part of me wonders if he is just so different from my first son, that I’m making comparisons that just aren’t realistic or fair. But then, when I’m talking to parents and evaluating their children for ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder), I know in my heart that he may very well have it.

The good news is that ADD/ADHD is a treatable condition and that are many resources now available for parents and their children. ADD/ADHD may affect as many as 10% of the population. That means that in the average classroom of 24 kids, at least two children may suffer from the disorder. But how do you know if your child has a disorder or if he is just being a kid… and since it’s more common in boys (five times more common in boys than girls) – how do you know if he isn’t just “being a boy”?

ADD/ADHD tends to run in families (hmmm, so maybe it is my fault!) and at least two genes have been associated with the disease. Studies have shown the disease to be associated with brain chemical (neurotransmitter) changes, structural brain changes and is frequently found in children with other health conditions. It is felt that ADD/ADHD may be partly due to developmental delay of the part of the brain that is responsible for executive functioning (which is the part that manages control and judgment).

As children get older, many of them are able to learn to manage their symptoms as they gain the maturity and develop the higher brain function needed to govern attention, planning and judgment. Many adults who have ADD/ADHD do quite well and are able to multitask successfully. Some may still require medications as adults, but that is not very common.

There are several standardized tests and tools that medical doctors and psychologists use to help to determine if a child has ADD/ADHD. For the most part, it is recommended that you wait until your child is in school before testing is done. Often, the very active preschooler does fine when he reaches the age of 5-6 years and starts attending elementary school.

Treating the disease is important to ensure maximum success at school. Treatment may involve behavior modification therapy, working closely with teachers, getting special services for extra time for classwork and homework, accommodations such as having an extra copy of textbooks at home, and sometimes taking medications.

The criteria for the diagnosis of ADD/ADHD include the following:

Inattention:

a. often fails to give close attention to details or makes careless mistakes

b. often has difficulty sustaining attention in tasks or play activities.

c. often does not seem to listen when spoken to directly.

d. often does not follow through on instructions and fails to finish tasks

e. often has difficulty organizing tasks and activities

f. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort

g. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

h. is often easily distracted by extraneous stimuli

i. is often forgetful in daily activities

Hyperactivity

a. often fidgets with hands or feet or squirms in seat

b. often leaves seat in classroom or in other situations in which remaining seated is expected

c. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings or restlessness).

d. often has difficulty playing or engaging in leisure activities quietly

e. is often "on the go" or often acts as if "driven by a motor."

f. often talks excessively

g. Impulsivity – has difficulty awaiting turns, interrupts or intrudes on others

If you suspect that your child may have attention or hyperactivity issues, take your child to your pediatrician for further evaluation and advice.

(Okay, so it’s taken me five tries to sit down and finish writing this as I got distracted by the phone, my emails, searching for food, putting away dishes, doing the laundry… so guess where my son got it from? Oh well... hopefully he got enough good genes from my husband's side to balance him out!)

Take care and thanks for reading!

Back to School – Where did the summer go?!

2011-08-14T20:11:00.000-04:00

As I sit in my kitchen sipping my morning coffee, I glance over at my kids. Two are glued to Nintendo DS players. One is stuck to our iPad. And the fourth is still in bed. It’s eight in the morning and this is how they are starting the day. If they aren’t in camp, the default activity is something with a backlit screen (computer, video game, TV). This drives me crazy.

I think about going to back to school in two weeks (we go back before Labor Day). This is not going to be an easy transition!

Now, don’t get me wrong. I’ve tried throughout the summer to stimulate their brain cells. “Let’s do five pages of workbooks!” Grumbles and groans, while I hear, “Mom, I have to save!” Then there are about ten-fifteen minutes of focused library-like quiet after they settle down with age-appropriate workbooks. Then… they’re done. “Can I play now?”

We’ve read books, gone outside (when it’s not 120 degrees and a wall of humidity out there), been to summer camps, played sports, visited museums, vacationed at the beach, and so on.

But, now it’s time for school again. Hurray! Summer can be exhausting (for the parents!).

So, starting next week, it’s back to normal bedtime and wake up times. This will make the actual week of school a much easier transition. I highly recommend requiring this for your kids the week before school starts, especially your teenagers who would much prefer to go to bed at 2 a.m. and wake up around noon.

You may have heard of the motto – “9-5-2-1-0” as a way to remember what is healthy for kids every day.

9 - hours of sleep

5 - servings of fruits and vegetables

2 - hours of screen time (max)

1 - hour of exercise, and

0 - sugary beverages (like juice or soda)

So, take a look at what your child is getting and see if there is any room for improvement. This applies to kids who are in preschool, elementary, middle or high school.

Buying school supplies is always a treat for my kids. They love their new backpacks and cool lunchboxes. If your child is new to school, or isn’t a big fan of school, this is a positive way to bring up the idea of heading back.

Starting school is also when germ-sharing begins in earnest. Proper hand washing is the best way to prevent picking up viruses and bacteria that can make us sick. Teach your kids how to wash their hands well while at school and when they come home from school.

To wash hands properly, your child should wash with water and soap for at least twenty seconds, or the time it takes to sing the alphabet song. Try to clean the tips of the fingers especially well since children tend to put their fingers in their mouths or touch their faces.

Getting plenty of rest, eating a health breakfast and washing hands properly will help to make your child’s beginning of the school year a great one. Best of luck with the back-to-school preparations, and pat yourself on the back for a job well done as you send your little one off to school for another amazing year!

Thanks for reading!

Pooping on the Potty - Don't Make Me Go!

2011-07-02T11:20:00.000-04:00

“Currently, our toddler is practicing willful control of her bowels - in a bad way. Potty training was going well for awhile, but suddenly she's refusing to let herself have a BM. (We made no changes to routine, diet, etc.) She's just flat out clenching and fighting for all she's worth to not have a BM, even when we add high fiber foods. After 3-4 days of a grumpy, constipated child, we finally pull out some PediaLax products, which then seems to *make* her go 1-2 days later. Then she'll be regular for 2-3 days, but after that, the cycle starts all over again. Any advice for me and/or your blog readers?”

Going poop in the potty is a common issue for toddlers.... something about pooping into that bowl really bothers some kids. So they end up holding it in and get constipated. Then it hurts to go because they are constipated, and they are even more afraid to go next time... so they hold it in. Then they get more constipated... and so on. It’s a painful cycle for your toddler and can throw a monkey wrench in what had been successful potty training efforts.

So... here's what to try if it happens to your toddler or child. Buy some Miralax (an over the counter stool softener - very safe for kids, can use up to a year if you had to). Other stool softeners can work, but often result in more cramping and cannot be used for long periods of time. Give 1 capful a day (17g) of Miralax mixed in liquid (if the stools are too soft, cut back a little). But do this for at least two months - even if the stools are normal. Stop pushing potty training temporarily while you do this. She needs to forget that pooping hurts.

Her colon needs to get used to normal-sized, soft stools for several months. When constipation occurs, the colon gets stretched out of shape (think of how a woman’s belly gets all stretched after being pregnant – it takes time to get back to normal) (although I think mine will never get back to normal!). The stretch of the colon sends a signal to our brain to tell us that we need to go. If your colon is stretched out already, it takes even more stool to send that signal to your brain. So, it’s important to give your child's colon time to shrink back to normal size before you stop the Miralax.

It is very important to change your child's diet. Avoid constipating foods (bananas, rice, applesauce, toast (white bread), cheese). Give more fiber (oatmeal, bran, fresh fruits, vegetables), prune juice (if she'll drink it), prunes, and water. For some children, too much milk or dairy can be constipating. Toddlers need around 16-20 oz of milk to get enough calcium, but more than that can result in constipation and anemia (too much calcium can interfere with iron absorption which then leads to anemia or low red blood cells).

Then in about two months, start trying to potty train again. Don't remind her that she used to do it... just start from scratch... stickers, rewards, etc.

Don't worry – there are very few kindergarteners still wearing diapers to poop or pee... so everyone gets it eventually! Refusing to poop in the potty is very common and very normal toddler behavior.

If she hasn't poop in five days, has vomiting, has blood with stools, or severe stomach pain, call your doctor for help. Do not use Miralax in infants. If your baby is constipated, consult your child's doctor.

Hope this helps! Thanks for reading and Happy 4^th of July!

Fun in the Sun!

2011-05-26T21:21:00.001-04:00

“Can we play in the sprinkler, Mommy?” asked my 4-year old daughter. I looked up from my computer to see sweet puppy-eyes on a cute little face asking me to grant her this one simple request. It was hot outside and the pools weren’t open yet. It sounded like a perfectly fun and reasonable thing to do today.

Then I thought about what I had to do to set this up. Herd four excited kids into bathing suits, sunblock each squirmy kid (perhaps one of their least favorite activities of all time), find the sprinkler toy thing (I bought it last summer on sale... where did I put it?), turn on the water feed to our backyard hose faucet (still off from the winter), and then all the cleanup that would be involved afterwards (from the wet toys to the wet kids). So… being the slightly distracted mom that I was (focusing on something for work on the computer), I paused to figure out how I could get out of this one.

“The neighbors are playing in theirs,” she quickly added, noticing my hesitation. “We NEVER get to play in our sprinkler… PLEEEEEEEEEEEE-ASE?!?!” (puppy eyes again)

So I gave in.

And they had a blast! Even I had fun as I sprayed my screaming, laughing kids (and myself) with our hose as I tried to figure out how the new sprinkler contraption worked. All in all, it was a good couple of hours in the near-summer heat. The kids were wonderfully exhausted afterwards, ate dinner without complaint, and went to bed early. Happiness and contentment all around.

Summer is a great time to be outside, to be at the pool and play in the water. It’s the time most of us go on vacations – often to the beach or other sunny places. So, being safe in the sun is incredibly important to ensure that we are just having fun and that no harm will come from it.

With skin cancer being the most common form of cancer in the United States, it is vital to protect your kids (and yourself) from too much sun exposure. Each year there are more new cases of skin cancer than the combined cancers of the breast, prostate, lung and colon. One in five Americans will be diagnosed with skin cancer in their lifetime. Depending on the study you read, anywhere from 23-80% of a person’s lifetime exposure to the sun occurs before age 18, so it's important to limit the ultraviolet (UV) radiation exposure to your child's skin. Prolonged exposure to UV rays from the sun is thought to contribute to skin cancer and precancerous skin conditions.

To protect your child, here are some things you can do:

1. 1. Use sunblock (starting at any age – including your one-month old!). Use a waterproof sunscreen of SPF 45 or higher. Make sure that it’s rated to protect against UVA and UVB rays. Reapply frequently, especially if your child is getting into the water. Even on cloudy days, apply sunblock because ultraviolet rays penetrate the clouds and are still being absorbed by our skin.

2. 2. Wear long sleeve sunshirts and pants that protect against UV rays.

3. 3. Wide-brimmed sunhats are useful, especially the kind that extends down to cover the back of the neck.

4. 4. Choose sunglasses that block 99-100% of UVA and UVB rays.

5. 5. Avoid being outside during peak sun hours between 10 a.m. and 4 p.m. if possible. If your child’s shadow is shorter than your child, then the sun is very strong and it’s time to find shade or be indoors.

6. 6. Give extra water and fluids to prevent dehydration. Avoid caffeinated fluids which can actually cause dehydration because caffeine is a diuretic and makes your body need to urinate more.

Kids with fair skin, freckles, have light colored eyes (blue or green), or have red or blond hair are all at higher risk for developing skin cancer. Boys are at higher risk than girls. Your child is also at higher risk for melanoma if you have a family history of skin cancer.

What to Do for a Sunburn?

Despite your best efforts to protect your child from the sun, he/she may end up with a sunburn. Unfortunately, there is not a quick fix for this. Sunburns can take several days to heal and the full extent of the burn is sometimes not visible until 12-24 hours after the sun exposure.

Here are some things to try:

1. 1. Cool it down – a cool bath, placing cool towels or cool compresses to the sunburned area

2. 2. Aloe or moisturizing creams – put the cream on a on small area of skin first to make sure that your child is not allergic to aloe or the ingredients in the cream. Do not use benzocaine numbing sprays, especially on children under two years of age. Rarely, benzocaine can cause a disease that prevents oxygen from being carried on red blood cells in the body correctly.

3. 3. Do not pop blisters open – the skin on the blister protects the immature skin underneath from infection.

4. 4. Taking Tylenol or Motrin for pain can be helpful.

5. 5. Do not pick at the peeling skin – use a moisturizing cream.

Call your child’s doctor if there is severe sunburn that covers a large portion of the body with blisters, or if your child also has one of the following symptoms:

Fever

Headache

Confusion, paleness

Nausea or vomiting

Muscle cramps or pains

Fainting

These can be signs of heat exhaustion which is more serious than just a sunburn.

Luckily, with good care, you can prevent sunburns and keep your child’s skin safe. Pools open this weekend, so hopefully the weather will be good and everyone will have a great start to the summer swim season. Happy Memorial Day, and thanks for reading!

What Do You Mean I Have to Share? – Teaching fairness

2011-05-01T10:01:00.000-04:00

“Waaaahh!” came a cry from the basement.

Uh-oh, I thought… what is it now? I was sitting in our living room, the door to the basement nearby.

Stomp, stomp, stomp up the stairs. The wails increased in volume as the victim got closer. The crier was trying hard to maintain the ferocity of cry so that mommy would be dutifully impressed by the audacity of the crime. The cry was definitely the “I’m insulted” or “I’m mad” cry, as opposed to the “I’m hurt” cry.

“Mommy, he took my toy!” cried my four-year old daughter. She buried her head in my lap, sobbing pitifully.

“I had it first!” proclaimed her six-year old brother, holding the prized item high above his head, trailing close behind her. “It’s mine. I got it for my birthday!”

“You need to share,” I said to them (for I think the thousandth time in their lives).

“You’ve had it for a long time now,” I said to my son. “You can play with it for five more minutes, and then it’s her turn.”

Then I said to both children. “I’m going to set the kitchen timer. When it beeps you need to switch.”

They both nodded, problem solved, and ran off happily together back to the basement as if nothing had just happened.

All was quiet on homefront for about fifteen more minutes. Then… “waaaahh!” It was another child. I waited for the report of the horrible crime this time. Stomp, stomp, stomp… “Mommy!”

Learning to share is a normal developmental process and can be a challenging concept to teach.

It is important to realize that the sense of fairness or empathy for others changes as a child develops. A toddler to three-year old is only aware of his/her own personal feelings. They have not yet developed the ability to understand that what they do may hurt or negatively affect other people. “The world revolves around ME” is the motto of a two-year old.

As children get to age four and five, they start to realize that other people have feelings, too. This is when sharing and fairness becomes easier for them to understand. When you are teaching, you can explain why he/she should be kind and share. At this age, they can remember what it feels like when someone doesn’t share with them. They can start to understand that what they do can make others feel badly.

So how can you deal with arguments over sharing?

Prevention – If you know that both kids are going to want something that you are going to give them, you can prevent the fight by setting guidelines early on. Such as, “I have something fun for both of you. John will get to use it for five minutes, and then Susie can have it for the next five minutes.” Get them to agree on the rules of sharing beforehand.

If your young child is having a playdate, put your child’s prized possessions away so that the visiting child won’t be tempted to play with them. Talk about sharing toys before the playdate so that your child understands that someone else will be playing with her toys.

Intervene early – When you hear arguments beginning, distract them if you can. Steer them to another activity that is less contentious.

Give age-appropriate guidance – spending time giving a two-year old a lecture about how sharing/hitting/biting hurts others and would they like it if someone did that to them, and don’t they understand that it isn’t fair to hog a toy the whole time, and so on… It’s a little bit like Charlie Brown’s teachers saying “wah wah wah wah wah” to the children. Your preschooler is not capable of understanding all of the nuances of being nice.

Time them – A kitchen timer is a great way to help little ones to share and avoid fights. By saying that they can each play with a popular toy for five minutes, until the beeper goes off, is a concrete idea that they can understand.

Be short and sweet in your teachings – “You need to share. Give Jason the red one and you can have the blue one.” If your child cannot manage to do that, then take away the offending items and move on to another activity.

Praise sharing behavior – It is important to give praise when your child shares (either on his own or with your prompting). This will reinforce the “good” behavior that you want. If you focus too much on the less desirable or “bad” behavior, it will reinforce the “bad” behavior. Children want naturally crave attention from their parents. Even it is negative attention, it is still attention. (Think of the game that toddlers love of throwing something on the floor and you picking it up over and over again… they’ll keep doing it because you are paying attention to their behavior.)

When your child spontaneously shares or goes out of their way to help another child, it’s a great moment for any parent. Some children are natural helpers and learn early that it feels good to make others happy. Others need more coaching, but do not despair, for they will learn this, too.

Happy Mother’s Day next week to all the moms reading this blog! Hope you have a wonderful, relaxing, peaceful day! Thanks for reading!

Aaahh-choo! Spring is here!

2011-04-04T10:18:00.000-04:00

As I listen to my kids happily playing basketball in the driveway, digging dirt in the front yard (my daughter is planting an orange tree apparently), and throwing sand anywhere but inside the sand table on the deck, I’m sitting in the kitchen enjoying the sunshine and cool breeze that wafts through my backdoor. All the windows are open, and I can feel the stuffiness of the house being gently blown outdoors. I inhale and take a deep breath of the wonderful fresh spring air… and then, I sneeze.

And then I sneeze again. And again.

Sniff... sniff... sniff... (clear throat)… (blink-blink)… I love spring... really… I do… (cough)… but boy, do I suffer from allergies!

My kids do, too. At least three of them have seasonal allergies. I’m waiting to see if the youngest one is going to also. Kids generally do not develop allergies to the environment (pollen, mold, etc) until they are around three years old or older. The immune system is not usually ready to start recognizing that allergens, such as pollen, are something to be allergic to until then. It is possible for younger children to have seasonal allergies, but it is less common. Younger children tend to have food-related allergies if they have any.

If there is a strong family history of allergies, asthma or eczema, or if your child has asthma/wheezing or eczema, then the chances of your child having seasonal or environmental allergies are higher.

Testing for allergies can be performed by an allergist through skin testing. Your pediatrician may be able to do blood testing for allergies called RAST testing. While there are differing opinions, it is generally thought that skin testing is more accurate when diagnosing environmental allergies. This includes allergies to trees, grasses, molds, dust mites, molds, cockroach dander, cats, and dogs.

Skin testing is performed by putting small drops of diluted allergen (such as extracts from grasses) on the skin and then pricking the skin under the drop. If you are allergic, you will develop a red, itchy bump (called a wheal). The size of the wheal can indicate how allergic you are to the substance. The testing is briefly uncomfortable, but many children tolerate it without difficulty.

Testing is useful so that you can identify what your child is allergic to and make adjustments as needed. For example, if your child is allergic to dust mites, there are special coverings that you can put on your child’s pillow and bed mattress to reduce the number of dust mites that your child is exposed to at night. If your child is allergic to pollen, you can avoid too many outdoor activities when the pollen count is high.

Allergies can be managed usually with over-the-counter medications. These include Claritin, Zyrtec, and now Allegra. These come in liquid, dissolvable tablet and swallow tablet forms. Benadryl can be useful for short-term treatment, but can sometimes make children very drowsy. If your child has many allergies or has significant other problems triggered by allergies, such as wheezing, then allergy shots may be useful. Allergy shots help your child’s body get “used to” the substance that he/she is allergic to by introducing it to the body in very small amounts and gradually increasing the amounts over time.

Common symptoms of allergies include runny nose, sneezing, itchy eyes and/or mild sore throat without fever. If your child has fever, severe cough, eye discharge, or persistent thick nasal discharge or cough (especially if more than two weeks), then it's not just allergies, and you should call your child’s doctor.

Enjoy the spring weather, and (aah-choo!) thanks for reading!

Ouch! Head Injuries... When to Worry

2011-03-04T08:30:00.001-05:00

“Sandy, we have a situation,” my nanny said in a panicky voice over the phone. I was at work when I received this call and felt instant fear when I heard her dreaded words.

“What’s wrong?” I asked, trying to remain calm. My mind was racing through many horrific scenarios. What could have happened to my kids? Were they okay? Why was she calling?

As it turned out, my oldest son had been climbing up on a structure in our basement and had fallen off of it landing headfirst onto a toy with a sharp edge. He had cut his head on top pretty badly. The cut had been bleeding a lot and was scaring him and my nanny. The good news was that he was alert, could talk and remembered what had happened.

My nanny had done the right thing. She applied pressure to the wound with a clean towel. But it took a long time to stop bleeding. She didn’t know that the scalp is rich with blood vessels. A cut on the scalp can really bleed impressively.

Because he was alert, acting normally, wasn’t vomiting, and wasn’t bleeding anymore, I asked her to bring him to my office. He ended up needing seven staples (like metal stitches) for a good-sized laceration on his scalp. As a kid with a high pain tolerance, he was very calm through the whole procedure. He was even reading a book when Dr. Dakin was putting the staples in!

Even I was impressed with his tolerance and patience with the whole procedure. Nonetheless, I think (hope) he learned that climbing up on things in the basement and hanging over the top of them headfirst is generally a bad idea.

Head injuries can be very frightening. With active children, they are extremely common though. The horrible sound of your child’s head hitting a surface from a fall is one of the worst in the world. Most parents can remember those moments quite clearly.

So, what do you do and when should you worry?

At any age, if your child loses consciousness, is having seizures, or has significant injury/bleeding, call 911 immediately.

If your child seems very drowsy, has multiple episodes of vomiting, or is acting strangely, go to your nearest emergency room.

If your child appears alert, cried immediately at the time of injury, is not vomiting, and is behaving normally, it is reasonable to watch your child closely. If your child is under age two, call your doctor for guidance. If you are worried or there is a change in your child’s behavior, you should call your child’s doctor.

For most minor head injuries without open wounds, you should put ice on the area that was hurt to help reduce swelling. Watch your child closely for the first 24-48 hrs after the head injury. Avoid giving Tylenol or Motrin so that you don’t mask any symptoms. You should wake your child at least once that night to make sure that he/she is okay. Avoid contact sports or any activities that could result in another head injury until your child is completely symptom-free. If the head injury occurred while playing sports, consult your team doctor or your child’s doctor for when it is safe to return to play.

Symptoms to call your child’s doctor about:

1. Any behavioral changes or changes in alertness

2. More than one episode of vomiting

3. Persistent or severe headache

4. Weakness or loss of strength

Bleeding inside the head is the main worry after a head injury. Bleeding or swelling inside the head usually takes place during the first 24-48 hours after an injury and can cause life-threatening pressure on the brain. This pressure results in headaches, irritability, recurrent vomiting, vision/pupil changes, and changes in alertness.

Most people will check their child’s pupils to see if they are the same size. While it is fine to do this, unequal pupils usually show up only after there is quite a bit of pressure from an internal brain bleed. Just because the pupils are the same size early on, it does not mean that all is well.

Watch for other signs such as the ones mentioned above. While internal bleeding is rare from mild head injuries, you should watch your child carefully for signs and symptoms.

My son’s cut has almost completely healed. He has impressed many of his friends with his staples. His 3-year old brother has already asked for staples for his boo-boo’s. Hopefully, I have convinced him that staples are not for all boo-boo’s. (Not to mention that I have put all household staplers high out of reach just in case anyone gets any ideas!) Kids... always an adventure...

Stay safe and thanks for reading!

Valentine’s Day – Cards, Candy and Love

2011-02-13T15:40:00.003-05:00

“Mom, I’m tired of writing my name,” whines my six-year old. “Can you do it?”

I’m sitting at my kitchen table with my four kids, surrounded by a hundred Valentine's cards. Literally – 100. That’s twenty-five for each child’s class. My youngest child, who is in preschool, has no idea what Valentine’s Day is for… but he understands that the pencils that we are giving to his classmates has Toy Story characters on them… and he wants them all.

“Mine!” he proclaims while stuffing them into a grocery bag. “My pencils!”

So, I explain patiently that they are for his friends at school for Valentine’s Day. He pauses, looks up at me while I speak to him, and then promptly goes back to stashing away his precious pencil collection. After some negotiation, he is satisfied with two pencils for himself and giving the rest to his friends.

Then I look over to my four-year old who is trying very hard to write her name on all the cards. She has managed to fit the first three letters of her name in the blank spot next to the “From:” line, but has consistently run out of space for the last two letters of her name. So… she just writes them in wherever she has space on the card. Oh well, at least she’s writing! Hopefully, her classmates can figure out that it’s from her.

I don’t know about your kids, but mine don’t actually notice who the cards are from. They just dig through their Valentines’ bags for the goodies and then toss the rest aside.

Valentine’s Day is the holiday to celebrate love. Some believe that the origin of the holiday dates back to the Middle Ages.

I have memories of excitedly opening my decorated bag to find the cards inside. Back when I was in school, it was mostly cards. Treats were just an occasional thing. My favorite one was the little box of chalky sugar hearts with phrases like “BE MINE” stamped on them. They are still a classic today. Pure sugar… wow.

Elementary and preschools are usually good about making sure that every child gets something on Valentine’s Day. If you are creative, it’s a great time to get your child involved with making cards for their friends. They can learn important skills such as coloring, cutting, gluing, taping, and writing. Plus it helps them to feel good about giving their classmates something that they’ve created.

As your child gets older and Valentine’s celebrations no longer involve making crafts and decorating bags and boxes, you may want to consider making Valentine’s Day a special day for the family.

Pre-teens and adolescents may find Valentine’s Day somewhat stressful if their friends have started dating. In order to prevent your child from feeling lonely, left out or pressured about Valentine’s Day, try to make it a celebration about love in general. Valentine’s parties and decorations, special family meals, and love notes from you can make any child feel special and create a fun atmosphere for this special day.

As with Halloween and Easter, the candy quota from this holiday can be pretty intense. Try to limit the amount of sugar your kids eat on a single day and set a date after which you toss the rest or take it somewhere else were other people can enjoy it. (But of course, the good chocolate gets put in a special hiding place for parents only.)

Have a Happy Valentine’s Day! Thanks for reading!

Sledding, Snowmen, and Snow Ball Fights – Avoiding Frostbite

2011-01-29T00:15:00.001-05:00

Four little snowpeople stomped up to my front door this morning. Bundled in coats, gloves, and neckwarmers , they could barely see as adorable fuzzy hats with pom-poms slid down over their eyes.

“Mommy! We’re co-o-o-ld! Can we come inside?” they pleaded. Their teeth chattered and they shivered.

I think they had been outside for about five minutes… maybe six.

That was after one hour of begging to go outside as soon as they saw the new snowfall on the ground, twenty minutes of breakfast while still asking to go outside, and another twenty minutes of going potty and getting dressed while I tried frantically to find four matching set of gloves. (I think that gloves and socks have conspired to hang out together somewhere – where do they go?)

I remember playing outside for hours as a kid in the snow – with no care about the potential frostbite starting on my fingers and ears and nose. What’s wrong with my kids? Maybe they are just smarter than I was. It's cold out there!

Keep your kids warm in the snow. It’s fun – but can be dangerous. Children are at higher risk for frostbite compared to adults. They lose heat more easily than adults and are not as willing to give up having fun even if they are cold.

Frostbite is the result of prolonged cold exposure to our bodies. This causes damage to the tissues. Our fingers, toes, noses and ears are the most susceptible.

There are different degrees of severity of frostbite.   First degree, or frostnip, is when the surface of the skin is frozen. The skin has white, red, and yellow patches and often there is itching and pain and numbness. Usually the injury is not permanent.

Second degree frostbite is more severe. The skin is actually frozen and hard. This can result in blisters a few days after the injury and can take weeks to months to heal . Call your doctor or take your child to the nearest emergency room if this occurs.

Third and fourth degrees are much more severe and involve freezing of the muscles and deep tissues. Your child should not be at risk for this unless they are trapped in the cold for a very long period of time.

If your child is complaining of pain, itching or numbness of fingers, toes, ears or nose after playing in the cold, remove all wet clothing. Rewarm the area as quickly as possible without burning the skin. Soak the body part in warm (not hot) water for 20-30 minutes. The water temperature should be around 104 degrees F.    If the pain does not improve and the color does not return to normal within a few minutes, call your doctor immediately.

Dehydration is also an issue because in the cold, children do not realize that they are sweating and losing fluids. Give your child fluids to drink (non-caffeinated). A good rule of thumb is to have your child come in every one to two hours for a break to drink, eat a snack and warm up.

Every year, over 20,000 kids are injured in sledding accidents. Children between the ages of 10-14 years old are the most commonly injured.   Next most commonly injured are children ages 5-9 years. Fractures and head injuries are the most common type of injury. Running into trees, poles, stationary obstacles are the usual sources of injury. Wearing a helmet is recommended. At the very least, scope out where your children are sledding to make sure that it is free of dangerous obstacles. Make sure that they are not sledding into streets where cars may hit them. Do not allow your children to be pulled on sleds by ATVs, snowmobiles, or other motorized vehicles.

Keep safe, stay warm, and enjoy the snow (preferably indoors with a nice warm cup of cocoa)! Thanks for reading!

Vomiting and Diarrhea - the Dreaded Stomach Bug

2011-01-19T14:18:00.001-05:00

“I need to spit up!” declares my three-year old.

Hearing these words (which are code for I’m about to vomit right now), I launch myself off the couch, leap across dangerous obstacles composed of toys and books to get across the living room to scoop him up off our off-white carpet. Then running like mad cupping my hand strategically below his mouth, I repeat over and over, “Wait wait wait! Throw up in the potty, not on the floor! You’re okay, you’re okay!”

And then, a few inches from our target destination of the bathroom toilet, he throws up. Oh well… at least it’s easier to clean here.

The holiday season this year brought my family many presents… including a stomach virus. I got it and my kids got it (my husband kept thinking he was getting it –but managed to avoid it). Many people have unfortunately fallen prey to stomach viruses this year. You or your family members may have been through it, too. If so, I’m so sorry – I know how horrible it can be. Luckily, it tends to go away in a few days leaving most of us wiped out, but okay.

Children are smaller and have less ability to tolerate vomiting and diarrhea compared to adults. Therefore, they get dehydrated much quicker than grownups do.

If your child is vomiting or having diarrhea, it is of utmost importance that your child stays hydrated. Food or solids are not important while your child is vomiting.

Sometimes vomiting or diarrhea can be a symptom of a more serious illness.

If you see any of the following, you should call your doctor:

Projectile or forceful vomiting
Blood in the vomit or diarrhea
Severe stomach pain
Fevers>104 F
No improvement in vomiting in 24 hrs
Persistent diarrhea more than 10 days
Prolonged diarrhea after finishing antibiotic use.
Your baby is less than four months old and is having vomiting or diarrhea
Pain with urination or more frequent urination
Severe headaches
Drinking frequently
Symptoms other than just vomiting or diarrhea

To help your child get through it, try the following:

For vomiting, give your child small sips of clear fluids that have electrolytes (such as Pedialyte). If your child refuses to drink or is unable to keep fluids down, use a medicine syringe and squirt small amounts into his/her mouth every five minutes. Your child needs to urinate at least three times a day. If your child has not urinated for more than eight hours or is lethargic or can’t keep anything down, call your doctor immediately.

Do not give milk or heavy foods, such as dairy or fried foods. These are likely to come back up. If your child wants to eat, give small amounts of bland foods such as crackers, toast or plain cereal. Foods with lots of liquid are also good – such as popsicles, soup, and jello.

If your child has not thrown up for at least 12 hours, it is reasonable to try slowly advancing his/her diet. Again, avoid heavy foods for the best chance of success.

For diarrhea (and no vomiting), give your child the BRAT diet (bananas, rice, applesauce and toast) to help firm up stools. Lactose can be difficult to digest with diarrhea, so using a lactose-free milk or soy milk/formula temporarily may help with symptoms.

Probiotics are also useful for combating diarrhea. Probiotics are the healthy bacteria that help to keep our digestive system healthy. If your child is not vomiting, then eating yogurt is one way to get probiotics. Many pharmacies and grocery stores carry probiotics in various forms that kids can eat – granules for infants and toddlers, chewable tablets for young children, and capsules for older children and adults.

To prevent spreading the virus to others, wash your hands frequently! The viral particles are in the vomit and the stool. Wash your hands frequently and use antibacterial soaps and surface cleaners. Make sure that other children do not share utensils, cups and food with the sick child.

Oh wait, I think I hear something.

“Mommy! I need to spit up!” Uh oh, gotta run… here we go again!

Stay healthy, and thanks for reading!

Coughs, stuffy noses, and fevers – Welcome to Winter!

2010-12-12T12:57:00.000-05:00

“How can I help with the cough?” is one of the most common questions I get in the office during the winter cold season.

When cold weather arrives, we all stay indoors and we share our germs. Viruses love the winter season because it’s the best time to travel from one person to another and then to another. Kids who are around many other people tend to catch more colds and viruses than ones who are not. Common exposures come from daycare, school, and their brothers and sisters.

Children build immunity by fighting illnesses from viruses. Their immune systems learn how to fight these bugs, and then hopefully, will be more protected in the future as they encounter new viruses. Any pediatrician will tell you that they’ve never been sicker than their first few years in training or in practice due to the large number of viruses that we’re exposed to. If you’ve never been exposed to a virus, then your chances of catching it is much higher. However, once you’ve battled the illness, then your immune system has a memory that will help it to fight future similar viruses.

So, when a baby is born, EVERY virus is new to his system. It’s no wonder that babies will catch colds. When a baby or toddler starts childcare, very often they have a new cold or illness every two weeks for a while. Then when they reach elementary school, they are less likely to get sick because they’ve already had many of the viruses.

When a new virus emerges, like the H1N1 flu virus, we are all susceptible since none of our immune systems are prepped to fight it off.

Most cold viruses can last up to two weeks. Many people get concerned if their child is still congested or coughing a little after one week. However, two weeks is still reasonable. Fevers should be less than 103-104 F and should only occur during the first three days of illness. If your child has a fever later, has a high fever, is breathing fast, or working hard to breathe, you should call your doctor immediately for guidance.

Most coughs are protective. The cough reflex is designed to protect your lungs from drainage that is trying to go down into them. However, occasionally coughs can be more ominous and can be a sign of infection (bronchitis, pneumonia) or wheezing/asthma. If your child seems to have a bad cough, has a fever with the cough or has difficulty catching his/her breath, call your doctor.

So, what to do when your child has a cold? Well… it depends on the age of your child.

Young Infants (under 6 months of age): At this age, colds can be especially miserable because they can’t clear their own noses. If congested, it is hard for your baby to feed since your child has to breathe through his/her nose when drinking or eating. Putting a few drops of nasal saline in each nostril and then suctioning the nose will help. Sleeping upright in car seat or elevating your baby’s mattress may be helpful (do not use a pillow). A humidifier (cool or warm) next to where your baby sleeps will also help. Hydration is important, so small frequent feeds are good if your baby can’t eat his/her usual amount. While fevers may be part of a viral illness, young babies need to be checked if they have a fever to rule out other illnesses (especially babies under 3 months of age). Call your doctor if your baby has ANY fever>100.4 (rectally), has trouble feeding, is breathing fast, has coughing fits, is vomiting or is not improving. No over-the-counter cough medications are recommended at this age.

Older Infants and Toddlers: Children this age also have difficulty when their noses are stuffy and they are coughing. Sleeping is a challenge and often they will lose their appetites and drink less. While eating less is okay, it is important that your child drink enough fluids and stay hydrated. Clear fluids, like Pedialyte, will help to hydrate without increasing the mucous production like milk-products can. Nasal saline is also useful to clear stuffy noses. Suctioning your child’s nose will help him/her to breathe easier. A humidifier (cool or warm) will help to quiet coughs and make nighttime easier to manage. Sometimes, babies tend to collect mucous in their throats or upper airway and then vomit the mucous after coughing. While messy, this can be normal and is their way of getting rid of the drainage. However, if your baby has a high fever (>103-104), has difficulty drinking, is working hard to breathe, is vomiting other than with cough, or has a fever after the first three days of illness, call your doctor. No over-the-counter cough medications are recommended at this age.

Preschool-aged children: Kids aged 2-5 often have colds in the winter, especially if they are in preschool. The sharing of viruses is inevitable when every child seems to have a runny nose in class! For this age, you can help by taking care of the symptoms. Again, nasal saline is useful and teaching your child to blow his/her nose is important to prevent secondary infections such as sinusitis or ear infections. To help with sleeping, use a humidifier and have your child sleep upright on pillows. A teaspoon of dark honey has been shown to be as effective as cough suppressants. Over-the-counter cold medications are not recommended at this age. If your child has high fever (>103-104), has difficulty breathing, or has a fever after the first three days of illness, call your child’s doctor.

School-aged children: For older children, it’s primarily night time that is difficult. Run a humidifier, keep your child hydrated, and use nasal saline sprays to help. A teaspoon of dark honey can be effective for quieting coughs at this age. Over-the-counter cold medications can be used sparingly. It is important to pick a medicine that specifically treats your child’s symptoms. Multi-symptom cold medicines have active ingredients for each symptom – fever, cough, congestion, runny nose, and so on. Do not give your child medication for symptoms that your child doesn’t have. Also, while cough suppressant might make it easier to sleep, try not to use it during the day. Cough has a purpose (to protect your lungs from drainage), so suppressing it may lead to further complications. High fevers (>104), fever after the 1^st three days of the cold, or difficulty breathing are all symptoms for which you should call your child’s doctor.

Hope you and your family have a safe and healthy holiday season! Thanks for reading!

Flying With Kids

2010-11-22T22:50:00.001-05:00

I awkwardly pulled my laptop out from under the seat in front of me while trying not to spill the little plastic cup of soda and bag of pretzels precariously balanced on my airplane tray table. My son across the aisle from me whined, “Mommy, I’m hungry!” Then his brother said, “I need to go potty!”

Meanwhile, my two youngest children sitting next to me were impatiently waiting for me to start the Dora movie on the laptop. “We want Dora!” they chanted. They had not yet comprehended how computers are not instant satisfaction on startup. At the same time, my husband (who was sitting next to the two older children across the aisle) had his eyes closed, resolutely ignoring the boys as they tried to get someone’s attention to feed them and take them to the bathroom.

Hmmm… Are we there yet?

Thank goodness it was only a two hour flight. The last flight we took as a family was over four hours and that was easily the maximum capacity for my two-year old for flying on a plane. After that, I vowed no more long flights until he was older.

Flying with kids can be a challenge or it can be smooth-sailing. Very much it depends on the age of your child, the length of your flight, and the time of day of your flight.

I love to travel, and I really enjoy taking my kids places so that they can experience sights and adventures that I never had the opportunity to see and do as a child. I even actually enjoy flying with my kids (usually). However, I enjoy it more when they are older than three years of age and when I have enough adults around to help me. Let’s just say it’s a little less stressful and a whole lot less to pack.

It’s amazing how much STUFF a baby needs. I remember taking my oldest on a flight when he was five-months old. He was a tiny little baby, and he had an entire full-size suitcase dedicated to him and his STUFF. You know what I’m talking about – the diapers, the wipes, the bottles, the warmer, the clothes, and the backup clothes, the baby soaps and shampoos, the bibs, and the backup bibs, the blankets, etc. Not mention the car seat, portable high chair, toys, and so on.

So, how to survive a flight with your little one? Here are some ideas (based on age):

Young Infant – the nice part of this age is that entertainment is not necessary. Most of the times they are content to eat, sleep and poop as they normally do when not in an airplane. The biggest issue will be helping them to “pop” their ears and equalize the pressure in them during the flight. Generally, if your ears are popping, their little ears are trying to do the same. To help your baby with this, make sure that he/she is swallowing during takeoff and landing. You can do this by feeding your baby during these time periods. Just make sure to pack extra clothes and diapers, including extra clothes for you in case of unexpected spit-up or diaper accidents.

Check the TSA website listed later in this blog post to familiarize yourself with rules regarding bringing formula or breastmilk onto the airplane.

Older Infant/Toddler – This is a challenging age for flying. You can certainly fly successfully with a toddler, but timing is of utmost importance in this age group. Choose your flight time by avoiding anything near naptime or bedtime. Tired toddlers make lousy travel companions. Pack plenty of snacks, favorite toys and distractions. If at all possible, try to book nonstop flights to minimize the total travel time. For really long flights, a break in the middle at a connecting city for a few hours may be ideal – however leave enough time so that you won’t be running for a connecting flight with a toddler in tow.

Bring your stroller all the way to the gate and check it in at the gate just before you board. It will make getting all your belongings and your baby to the plane easier. Also, bring an empty sippy cup and then buy something in the airport to fill it, or ask them to fill it on the airplane with water or juice.

Some pediatricians recommend bringing along an weight-appropriate dose of Benedryl along in case your toddler is really having a difficult time with the trip. Benedryl is an allergy medication that generally causes drowsiness as a side effect. However, be aware that a small percentage of children actually get hyper on Benedryl. Therefore, it is wise to test this at home before you discover that your toddler is wild after taking Benedryl on the airplane!

Children Ages 2-4 Years Old – This age group generally loves airplanes… at least they love looking at them. Flying in them may be a different issue. Reading about flying or going on an airplane is a good idea if this is your child’s first trip.

I usually try to buy a surprise activity for each child to do on the airplane – a new coloring book or new activity that travels well. The fun of trying out a new coloring book and new markers will entertain most children for at least a portion of the trip. Don’t give it to them until you are actually on the plane to enhance the surprise (and distraction) factor.

Also, while I don’t normally advocate video watching – a portable DVD player or laptop or ipod can work wonders to keep little minds occupied for a good portion of longer trips. Taking a few walks up and down the aisle midflight helps to break the monotony of sitting in the seat. Feeding children in this age group just before you fly, or bringing food on the plane, is also a great way to pass the time.

School-Aged Children and Older – Luckily, this age group tends to be able to entertain themselves. Favorite activities include books, handheld games, and MP3’s make flying a more enjoyable and less boring experience for this group. Let them pack their own backpack and have them each carry their own carry-on. It makes traveling much easier (especially if you can pack things for a younger sibling in their bag also!).

Again, food is an excellent way to pass the time, so bring a meal onboard and give them something to do. This will also ensure that they will not be hungry during the flight.

With the many travel rules these days from TSA, it’s a good idea to check out their website for rules about traveling with children. They have a useful website at: http://www.tsa.gov/travelers/airtravel/children

So, I hope this helps if you have little ones traveling by plane this holiday season! If you tried some tricks for successful flying that have worked for your children, please share them by posting a comment!

Thanks for reading and Happy Thanksgiving!

Time to Sleep – I wish!

2010-11-10T13:35:00.000-05:00

“Mommy… can you cook my oatmeal?” said a soft voice. I felt a small but insistent tug on my arm.

Groggily, I opened my eyes and looked blearily at the little face peering up at me. I looked at the clock, and it glowed, “5:45 A.M.” I looked down at my almost-three year old son who was bright-eyed and alert, holding up a half-opened packet of instant oatmeal. “I’m hungry… you cook my oatmeal?” he demanded much more loudly.

Ughhh... I hate daylight saving time.

Daylight savings time was first conceived by Benjamin Franklin in 1784 and was designed to help us make the most of the natural sunlight variations of the seasons. If we use natural sunlight most optimally, then overall we save on energy and electricity costs for lighting and appliances. While this idea may make sense, it can be difficult to make that transition twice a year, especially for children.

So, how can you help your child adjust quicker?

Light-blocking curtains. This is especially useful in the spring when bedtime is suddenly at a time when the sun is still bright and shining. Every spring, we change the clocks forward. Without fail at bedtime, one of my kids will say, “It’s not nighttime!” and show me how bright it is outside our windows. So, I then show them the clock, reassure that it is indeed nighttime and then usher them rapidly into their bedrooms where they can’t see the sunlight because the curtains have light-blocking liners. It also works for the fall time change so that the ones who wake up with sunlight, don’t wake up so early. These types of curtains can be purchased at many home goods stores.
Change the clocks earlier in day. Technically, we are supposed to switch at 2 a.m… but I don’t suppose that anyone actually stays awake to change the clocks. Therefore, change it before your kids go to bed and keep bedtime at the “new” time. For example, my children go to bed at 8 p.m. So, I changed the clocks around 5 p.m. to reflect the new time (turned it back to 4 p.m.) Then they slept at the new 8 p.m. (which was 9 p.m.) and then they were supposed to sleep the full ten hours (apparently my youngest son did not get the memo). It just gives your family the chance to adjust on Saturday and Sunday, instead of just on Sunday.
Adjust nap times gradually. For little children, adjusting naps by 15-30 minutes a few days ahead of the scheduled clock change helps to make the 1 hour switch less painful.
Shut off technology. While it’s tempting to use that extra hour to watch TV, play video games, text, or surf the Web, it has been shown that all of these stimulate our brains, and interfere with our bodies to “shut down” easily. Turn off all electronic devices at least one hour before you go to sleep. This is true any time of the year.
Calming rituals before bed. Stretching, massage, lavender baths, stories, soothing songs, and so on. Look for ways to relax your child so that sleep will come easily.
Eat healthy and exercise the next day. One of the best ways to combat fatigue is to eat a good breakfast that is high in protein and fiber. Then exercise sometime during the day to get the natural endorphins that fight fatigue. Do this as a family and you’ll all feel better.

So, if you are still adjusting the time change, try some of the above to get back on track.

Of note, when it gets dark so early, it can be very hard in the evenings to stay energized and alert. Studies have shown an increased number of car accidents and pedestrian accidents just after the autumn clock change because it is so dark and we are more tired as we drive in the evenings. So, please be extra careful as you are driving or walking around after dark these next few weeks.

Thanks for reading!

Trick or Treat – I LOVE sweets!

2010-10-23T12:20:00.000-04:00

“Can I please have candy?” My daughter asks with an innocent big-eyed look with the most angelic smile. She asks me just as I walk into our house after a long day at work.

With my mind still transitioning from my work thoughts to how-to-be-a-mommy thoughts, I stammer, “Uhhh….. sure!”

Then my heart is briefly happy when she cheers and jumps up and down. She proclaims to her three brothers, “Yay! Mommy says I can have candy!”

And then, my responsible parent brain kicks in when my sons start to clamor loudly (and less politely) for candy. Ooops, what I have I done? I didn’t have any idea how much sugar they had already eaten that day, and we all know candy just isn’t healthy.

Candy - it’s been around since ancient history. The first candy confections were made from fruits and nuts rolled in honey. Then around the middle ages, sugar was manufactured. Initially it was very expensive so that only the rich could enjoy it. However, by the 17th century, sugar was cheaper and hard candy became a popular treat. In the mid-1800’s, there were over 400 candy factories in the US.

When you add up our total sugar consumption, the average American consumes around 135 lbs of sugar PER PERSON in a year! That’s about 2-3 pounds of sugar a week. It’s not all straight sugar of course. This amount includes dextrose and high fructose corn syrup which is found in many of our foods. In the mid-1800’s, the average consumption per person was only 5 pounds a year. It’s really quite sad how addicted we are to the stuff.

So, how to control the candy craving with Halloween just around the corner? Here are few tips and tricks.

1. Use a smaller bag/bucket. If you allow your child to carry a pillowcase-sized bag, it not only allows unlimited amount of candy collection, but it encourages people to throw handfuls of candy into it, instead of just giving 1 or 2 pieces. Older kids tend to go out later in the evening and tend to carry bigger bags. At that time of night, people are trying to get rid of excess candy. So, having the jumbo-sized bag just encourages people to give your child more candy.

2. Limit the trick-or-treating time. If you trick-or-treat for hours, your children will get more and more candy. Then you’ll have to deal with the ten gallons of candy that they’ve acquired. Set a time limit and set expectations ahead of time. Find other ways to celebrate Halloween that don’t involve candy. Have some friends over for party or play Halloween games or watch a Halloween-themed movie. You can make trick-or-treating just a small part of a fun day.

3. Allow them to eat it (at first). Sometimes you create the craving by limiting it. Imagine if I made you live in a room full of money and told you that you could only have one dollar each day. Most people would really look forward to the moment when they got the chance to have a little more of the stash – at least at first. And even if you didn’t care, it would likely be a part of your thoughts throughout the day since you could see it, but you couldn’t have it. Halloween trick-or-treating is all about the candy. So, let them have a chance to enjoy it.

4. After the binge, set a limit. No one NEEDS candy. So, consider it a treat. Just like all sweets, you should limit it to once a day at the most. If they want something sweet to eat, give them a piece of piece of fruit. As your children learn to get their sugar fix from healthier options, then you will give teach them a lifetime skill that will pay off in the future.

5. Set a date for when you are going to throw the leftover candy away. Very often Halloween would roll around and I would realize that I still had candy from LAST Halloween. While some candy doesn’t ever seem to expire, it can go bad eventually. Plus, if you don’t have it in the house, no one can eat it. So, just toss it.

6. Consider a barter. Let them “buy” fun things with their candy. This way you don’t squelch their fun, but they don’t risk their health and their teeth. Try five candy bars for a trip to the movies, or eight Tootsie Rolls for a pizza dinner. Be creative.

7. Take it to work or to other events. Get the excess candy out of the house. If it’s in your house, your kids will find it. Either give it away or throw it out.

Have other ideas for how to limit the candy craziness? Please share them! For now, I need to find an apple or something – all this talk about candy makes me hungry!

Thanks for reading!

Tantrums – Can I Throw One?

2010-10-16T09:47:00.000-04:00

“No!”

(pleading adult voice)

“NO!”

(more pleading from the tired grownup)

“NOOOOO!”

This is my two-year old son in his gymnastics class today. I can hear them as I am sitting in the waiting area for the parents. I feel bad for the coach. I knew it was going to one of those mornings.

You know how you just know on some days that your child just woke up on the wrong side of the bed? Everything is a battle. From changing clothes (“I can’t dooooo it!”) and then to brushing teeth (“I don’t waaaant to!). Eating breakfast is a mini-Congressional debate. “Eat your oatmeal, you said you wanted oatmeal.” “I want pancakes!” “You told me you wanted oatmeal, now you have to eat it.” “I want pancakes!”…. and so on.

The “terrible twos” start somewhere around fifteen months and end around age 4. This is a normal part of development and can be very trying for most parents. Your cute, adorable sweet baby has turned into a seemingly stubborn little monster. Tantrums are a normal part of this. It’s caused by your child’s need for independence and inability to harness feelings that they are having.

Approximately 20% of toddlers have at least two tantrums a day. And most will have at least one a week. They are emotional outbursts that help children express the feelings that they are having. For young children, they revert to primitive behaviors that express their feelings – yelling, crying, hitting, kicking, and even biting. Luckily, most are short-lived and children recover quickly from them once they are distracted.

How to handle tantrums?

1.) Ignore them. Tantrums require an audience. Has your child ever thrown a tantrum when no one was around to watch? Children naturally want attention, especially from their parents. So, when you are paying attention to them because they are screaming and throwing themselves to the floor, you are just reinforcing to them that “Hey, this is a great way to get mommy to put that computer down (or that baby , or that book, or those dishes, etc) and, by the way, I should remember to do this again in the future.”

2.) Be sure your child is safe. If the tantrum is happening somewhere unsafe (as you are crossing the parking lot), pick your child up and move to a location where they can flail and cry and dramatize the end of the world because you wouldn’t buy the toy that they suddenly need.

3.) Avoid the tantrum. If at all possible, avoid your child’s triggers. Hunger, tiredness, overstimulation are common triggers for kids. Make sure they are well fed, that you are avoiding activities during naptime or late afternoon, and that your child is prepped for the activities to come. Every child has a different temperament. If your child gets a little crazy every time you go into a crowd, it may be too much stimulation for him/her. Go to the festival or the museum when there aren’t so many people around. It will be better for all of you.

4.) Take deep breaths and count to ten in your head. It’s easy to throw the adult version of a tantrum when you are frustrated with your child or embarrassed by your child’s behavior. Losing your own temper in front of your child just teaches them that yelling is okay. Spanking is a grownup temper tantrum , hurts your child, and teaches him/her that hitting is fine. Don’t be surprised if your child hits or “spanks” other kids when they think the other child has done something wrong. Child abuse happens commonly when adults lose their patience. If you need it, make sure that your child is safe and give yourself a time-out.

Well, apparently, this coach knows how to handle cranky frustrated two-year olds, because my son is now happily working his way through the mini-obstacle course in the gym. Thank goodness. Perhaps today will be a good day after all!

Thanks for reading!

Birthday Party Madness

2010-10-09T09:36:00.001-04:00

“When’s my party?” asked my daughter. She’s turning four next month. Ooops. Guess I'd better start calling places!

I used to be really great at planning parties for my kids. Now, I’m on the 20^th birthday party (if I add up all the birthday parties for my four kids) and my enthusiasm has waned drastically.

Once I had a party at my home, and it was soooo much work that I vowed never to do it again. Hours of cleaning and prep beforehand, then hours of cleaning afterward. The kids loved it, the parents and adults had a nice time hanging out together, but I was exhausted. I’m much too lazy to repeat the experience.

But the alternative is really pricey. One can easily shell out $300 for a 90-minute playdate for your child and 14 of his/her closest friends. It’s really nice to just show up with a cake and walk out an hour and half later lugging leftovers and presents. The kids are sugared-up, worn out, and a good time is had by all.

I don’t know about you, but I don’t remember these kinds of parties when I was a kid. I seem to remember small gathering of a few neighbor friends or school friends, a grocery store birthday cake (loved the frosting flowers!), and some simple games.

Now it’s an event. Bouncing, dancing, climbing, exercising, arts and crafts, petting zoos, swimming, cooking, video games, and so on. I know… because we’ve done them all. As my oldest is getting out of the mega-party phase, we’ve moved on to sleepovers and movies and smaller (but longer) affairs.

The birthday party social calendar is equally nuts. Any of you who have young kids know what I’m talking about. If you figure an average of 20 kids in a preschool class, it’s a lot of birthdays and parties. My children have more parties and events in one year than I’ve had in the last ten years! I’m glad they’re having fun – but it’s crazy! I remember shopping on Black Friday one year and buying over twenty potential birthday gifts. It’s so much easier to have a stash of pre-bought presents to choose from as opposed to remembering last minute and having to run out to the store before the party.

Our county recently banned food for birthdays at school – no more cupcakes, donuts, cookies, or other treats. In an attempt to curb the obesity epidemic, they want to reduce the junk food that kids are getting at school. At first, I was a little upset because I thought of how disappointed the kids would be. But then, they allow other goodies – pencils, books, and so on – just not food. As I thought about it, I was really impressed by this decision. It sends a great message that you can celebrate without eating junk. Also for the kids who are trying hard to maintain a good weight, it reduces the temptation of that yummy cupcake with frosting and sprinkles. (Plus now I don’t have make them! Don’t get me wrong, I love to bake – but not at 8 p.m. at night after work!)

So, birthdays – a great time to celebrate, but how to make it less materialistic? One parent I know asked for donations to charity instead of presents. What a great idea! For that party, my kids learned how to donate money, what it was for, and how it helped others. It was a valuable life lesson. Others I know said no presents, just come and play. That was also great fun. Perhaps a memorable event (like a circus outing or laser tag with a few friends) instead of a party of 15 kids from school. And don’t even get me started on goodie bags (talk about kids feeling entitled to things… it’s so embarrassing when your kid demands a bag at the end of a party… what is that about?)

Oh well, time to get planning – yikes, I only have three weeks left! Got any birthday ideas? I’d love to hear them! Thanks for reading!

Video Games – The Brain Drain

2010-10-03T14:17:00.000-04:00

The other day I was sitting with my four kids at a restaurant with some friends and their children. One of our kids was playing Pokemon on a handheld Nintendo DS. Surrounding this child were a total of six other kids, varying from ages 2 to 9, who were staring intently at this tiny 3 x 4 inch screen. They all had the same look and I'm guess that you know the look… slack-jawed, eyes glazed, brain off and ears closed to everything except the high-pitched music coming from the little machine. They were completely quiet, mesmerized by the moving little creatures on the tiny screen. The adults wondered at the absence of the normal chaos and stress that comes with taking seven children to a restaurant together.

It’s confusing to know what to do. The relief that comes with having the children entertained is so wonderful.   The adults could actually TALK to each other… instead of scarfing down bites of food, trying to yell bits of conversation to each other while pulling little Johnny off the table and pleading with little Meagan to eat another bite of broccoli.

But we know that this cannot be healthy. They don’t appear to be using any higher brain function. They are completely zoned-out while watching video and computer games, movies, television.   There is minimal physical movement. It’s no wonder that there is an obesity epidemic in our country!

The American Academy of Pediatrics recommends that children be limited to one to two hours of screen time TOTAL. This includes television, computers, and handhelds. While this is achievable with very young kids, it becomes much harder to do this as your kids get older. So much school work now requires the use of the computer, and much of today’s social life exists on Facebook, MySpace, YouTube, and texting.

So, how to counter the couch potato syndrome and video game brain drain? The evolution of game systems that make kids (and adults) move their bodies when they play is a nice compromise. One of the most popular systems out now is the Nintendo Wii. They have several sports and exercise games that combine exercise while having fun. Microsoft will soon have an Xbox add-on called Kinect that will allow you to play video games just moving your body – no controller needed! Even adventure and driving and simulation games using Kinect will require you to move your body. Sony will also have a device that adds to the Playstation 3 to add functionality similar to the Wii Remote.

Of course, if you played video games as a kid (or now), you know this stuff is addictive. Much of my young life was spent in front of Pac-Man, Space Invaders, and Tetris. Try to limit it now for your kids – they have a lifetime of computers and cell phones and who knows what else in the future. Get them to read books, use their imagination with playdough, coloring or crafts, run around outside (or inside), play board games, or whatever else you can come up with so that the rest of their brains can develop. Teach them to entertain themselves without needing a battery or a plug! It’s hard I know (as I sit here in front of a computer on my second cup of coffee)… but we should at least try!

Thanks for reading!

Constipation – The Pain of Strain

2010-09-18T09:50:00.001-04:00

Poop – a necessary part of life. It’s amazing how traumatic it can be for kids and parents alike. So, if your child has a problem with constipation. Then here are some things that you can do to make it a little easier.

Some of what you can do depends on the age of the child.

Young Infants – Babies tend to strain when the poop, especially newborns. This is normal as long as the poop is soft. As doctors, we don’t consider it true constipation unless the stools are hard. It really does not matter too much how often they poop, or how much they grunt and groan and turn purple when trying to go. Parents often assume that it’s hard for the baby to poop (if we did what they did, we would feel constipated!). Not true. However, if they haven’t pooped for 5 days or more, or if they are having hard stools, then it’s constipation. (If you have a brand new baby, your baby should poop at least once in the first two days of life.)

So, if you think your baby is constipated, you can try giving 1-2 oz of water. or take your baby’s rectal temperature to see if you can stimulate a bowel movement. If this fails to produce a prize, then some doctors recommend giving a teaspoon of karo syrup. If your baby still cannot go, or seems like he is in pain, or has blood in the stool, call your child’s doctor.

Older Infants/Toddlers – Again, it’s the consistency of the poop (how hard it is) as opposed to the frequency (how often) of the poop that determines constipation. For older infants and toddlers who are now eating foods, there are certain foods to avoid if your baby is having hard stools. Bananas, Rice, Applesauce, and Toast (the infamous BRAT diet) are foods that cause constipation. So, avoid giving your grunting groaning toddler these foods when they are having trouble. Also, too much cheese or milk can sometimes constipate. Your baby needs at least 16-20 oz of milk (formula, breastmilk or whole milk if older than age 1). More than that may be adding to the hard poop problem.

What can help? More water, fresh fruits and vegetables (other than bananas). More fiber – in the form of oats (oatmeal), bran, whole wheat, will help. I like to say that white foods constipate (rice, white flour), and brown foods help (whole wheat, bran, etc). Check the labels of your whole wheat products. Sometimes the wheat is so processed, that the bread appears brown, but has almost no fiber content. Prune, raisins and prune juice can also help.

Potty-trainers – This group is notorious for holding poop. Something about pooping into the freedom of a potty terrifies those who are learning. Often, a child will hold his poop until someone puts him back into a diaper. By holding it in, more water is absorbed from the poop… and voila, constipated, hard stools that hurt. Then, they are not only worried about the potty, but they are afraid of the next painful poop. So, they hold it in… and the vicious cycle continues.

Give your potty-trainer the best chance to succeed. People tend to poop about 20-30 minutes after eating. So, if you can, try to put your child on the potty around that time. Read a book, color, listen to music, watch a portable DVD… do something to help your child to relax and forget about the fact that they are sitting on a potty. Then, if they happen to go – CELEBRATE! If they don’t, no reason to make a fuss. Just wait until the next time.

Some children need Miralax, an over-the-counter stool softener. This is a flavorless powder that you mix into your child’s drink. It helps to keep the stools soft and can help children get back into a regular pattern with soft, painless stools. It is safe to use for a period of time. Ask your doctor for guidance. And don’t forget the diet changes (it’s the same as what I’ve written for toddlers above).

Big Kids (and Grownups) – it’s hard to tell sometimes that an older child or teenager has constipation since you no longer are involved in that process anymore (thank goodness). However, if your child complains of intermittent mild stomachaches, it may be related to constipation. Avoiding the BRAT diet (Bananas, Rice, Applesauce and Toast) and too much cheese and milk (make sure they get calcium from other sources) might help. Increasing fiber and using fiber supplements such as Metamucil or Benefiber will help. Drinking plenty of water makes a difference. Prunes, raisins, prune juice will help a lot of people. If your child has not had a bowel movement in 3-4 days, call your doctor to see other medications are needed. If the stomach pain is severe, there is blood in the stool, or your child is vomiting, call your doctor immediately.

For a cute video on constipation by DadLabs, see the link below:

http://www.dadlabs.com/videos.html?view=dvideo&sid=1

Hope this helps those who are dealing with the pain of strain! Thanks for reading!

Silly Bandz and Being Cool

2010-09-12T14:26:00.000-04:00

Silly Bandz… now why didn’t I invent those? Who would have thought that rubber bands could become so popular? What’s next … paper clips?

If your child isn’t collecting them, chances are you know a child who is. And certainly, you can see them all over the stores. Placed strategically at a child’s eye level at the checkout aisle – shiny packages of what look like a child’s dream come true worth of colorful Silly Bandz.

For those of you who don’t know what they are. They are essentially rubber bands shaped as various objects, such as animals, instruments, and so on. You wear them on your wrists and you can trade them, collect them, and just leave them all over the house (which is what my kids do with them). It’s the latest craze and amazingly appeals to preschoolers to teenagers. I’ve seen many adults walking around with them on their arms. The “cool” factor is high, the price is low, and they are something wearable. This is the ultimate combination of factors that makes a fad a success.

But then, add in the media… suddenly Silly Bandz were banned from several schools. It was on the news, on TV, and in papers. They were the topic of mommy-discussions everywhere. Children were getting injured from bands that were too tight and too small for their wrists. Suddenly, there was a danger factor or “badness” factor. That made it even cooler for the adolescent group as parents of preschoolers toned it down a notch.

I tried resisting the Silly Bandz craze. I knew that my kids would just toss them aside when they were bored with them. Just more clutter in my house. But, boy, was it difficult! The looks on their faces when they told me that so-and-so had MORE than twenty bands, and that their best friends had ones shaped as dinosaurs and cool sea creatures. The pleading “why nots?” from my five-year-old almost put me over the edge as I tried desperately to get him interested in buying a book at the bookstore as we stood next to the giant kiosk of Silly Bandz at the checkout line. And finally, it happened. Silly Bands were given out as goodies and they entered my home.

Now my kids were cool. They didn’t need many. Just one or two satisfied my oldest son. He was content that now he had some. And, of course, the little ones just pulled them until they broke. (My youngest even resorted to scissors.) Oh well. Four dollars down the drain. But they were happy.

If only all fads were so inexpensive. Those of you with teenagers know how pricey big kid fads can be. The best shoes, the coolest clothes, the right makeup or hairstyle, the best video game system, and of course… the car.

I guess I should be happy that few rubber bands are all that I need to buy for now!

Being popular is a high priority in children’s lives – especially as they reach their middle school and high school years, it’s important to teach them how to cope with the pressure of needing to be liked and popular.
As a parent, it is important not to minimize their need to be cool or to tell that those things are unimportant.

They are very important… to them and their sense of place in their world. The following link has some good advice on how to teach your child to cope and how you can help to give them skills that will last a lifetime. It provides a nice outline how to help your child if they struggling with trying to fit in or if they are feeling left out.

http://www.justmommies.com/articles/popularity-game.shtml

Thanks for reading! If you like this blog, please forward to those who you think might enjoy it. You can subscribe to the blog on the main page, sign up for the RSS feed, or become a follower.

"Be A Sport" When Your Kid Plays Sports

2010-09-08T23:01:00.000-04:00

Standing on the sidelines watching my son play football, I was chatting with some of the other parents. One mom was talking about how the coaches had been fighting over her son when they picked kids for our teams last week. Lots of heated arguments ensued and angry, hurtful comments were made during the discussions. Her son was big, built, had experience, and was a natural for football. It was no wonder that he was the ideal candidate. The drama involved in building “super teams” and competing to get the best players is seen every year in sports – from college to professional teams. Coaches are always trying to get the best players. It makes sense. So, why was this mom upset that there was drama over her son? He was only seven years old! This was the local flag football team for kindergartners and first graders.

Another dad at the game shared that they had just left a league because of the politics involved as travel soccer team candidates were identified. A friend told me recently how stressed she was because she had to tell her daughter’s field hockey coach that they were leaving because they wanted someone who was better and more driven. She worried about how angry he'd be. Stories have been published about parents have been banned from games because they were too abusive to the coaches and were overly zealous about referee calls. And everyone who has been to competitive sports games has seen “that dad” or “that mom” who is a little crazy when their child doesn’t shine that day.

Organized sports are great for kids. It teaches them how to work on a team, how to follow instructions, follow through on commitments, as well as learn the skills for that sport in an controlled, safe environment. The physical activity is great exercise, and can teach a lifetime love of exercise and staying in shape.

What we don’t want our kids to learn is how to be a poor sport, or how to yell when you don’t get your way, or that winning is the only goal. Adults need to remember that the goals for children may be different than adult-oriented goals. Kids are observant and many of our own behaviors come from what we learned from our parents. I know that I’ve said things and thought with horror to myself, “Oh no! That sounded like my dad!” You can hear it from your own children when they say things back to you, and you realize that it sounded just like you. (And, of course, it’s usually behaviors that you aren’t proud of!)

So, teach your kids that putting their best foot forward and trying their best is the key. They may never play professional sports, or be a star athlete, but they will learn to love being on a team with their friends, be proud of achieving small personal goals (“You did a great job kicking the ball towards the goal today!”), and feel good about completing a season.

If your child happens to have a talent, support them, and make sure that they are participating in a healthy way and not overdoing it. Take them for regular check-ups with their doctor to make sure they are cleared to play. If they have an injury, have it checked by a physician before they do any further damage by “playing through the pain.” Children heal quickly, yes, but they have looser ligaments and tendons, and are still building their bones and muscle mass. They can injure themselves more easily and can do more permanent damage if not treated early.

That being said, organized sports are much more common and can be great fun. Keep your kids healthy and safe. Make sure that they have the proper equipment and protective gear, and they will have a great time.

Happy playing! (well, actually, happy driving and watching - you know what I mean!)

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Flu.... So soon? Time to vaccinate!

2010-09-03T21:26:00.002-04:00

Flu is here! We've seen several cases of flu in our office over the last few weeks. Already! While it's too soon to say if it's going to be significant and spread, it has caused us to start offering vaccinations for children now in our practice.

The flu vaccine is available at many places around the country at this time, and you should consider calling your child's doctor to see if you can get it soon. This year, the H1N1 vaccine is included as a strain in the seasonal flu vaccine. So, no need for two different types of vaccines this year. (Thank goodness, last year was a nighttime trying to get all those shots!)

How many flu vaccines does your child need this year? It's kind of confusing, so I'll try to outline it below for you.

If your child is over 9 years old, he/she only needs ONE flu vaccine this year.

If your child is under 9 years old, has had the seasonal (regular) flu vaccine before AND got the H1N1 vaccine last year, then your child only needs one flu vaccine this year. Even if your child only got 1 H1N1 vaccine last year, then he/she only needs ONE flu vaccine this year.

If your child is under 9 years old, has had the seasonal (regular) flu vaccine before, but did NOT get any H1N1 vaccine last year, then your child needs TWO flu vaccines this year. The vaccines need to be at least 1 month apart.

If your child is under 9 years old but has never had the seasonal (regular) flu vaccine, then your child needs TWO flu vaccines this year. The two vaccines need to be at least 1 month apart. Even if your child got the H1N1 vaccine last year, if he/she has NEVER had the seasonal (regular) flu vaccine, then your child needs two flu vaccines this year.

If your child is under 9 years old and has never had any kind of flu vaccine, then your child needs TWO flu vaccines this year. The two vaccines need to be at least 1 month apart.

Babies under 6 months of age cannot receive the vaccine. However, it is highly recommend that everyone else in the house (parents, caregivers, siblings) get the vaccine if they can. This way, hopefully they won't get the flu and bring it home to your baby.

Children who are allergic to eggs may or may not be able to receive the vaccine. They may need to be tested before they are given the vaccine. Check with your child's doctor.

The nasal spray version of the flu vaccine (FluMist) is very effective as well. Children over age 2 may be eligible for the nasal flu vaccine. If your child has asthma or significant wheezing or immune problems, he/she should not receive the nasal spray vaccine. Check with your child's doctor to see which form of the vaccine your child should receive.

It's hard to believe that flu is here already. But H1N1 was here all last summer, too... so I guess we shouldn't be surprised! Take care, and stay healthy!

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Chronic cough? Sore throat? Sneezing? It might be allergies...

2010-09-01T15:42:00.001-04:00

Over the last few weeks, my kids all sound like they are sick. Coughing and sniffling from one. Hoarseness and sneezing from another. Another one keeps rubbing his eyes. My own face and nose feel like someone has decided to fill my sinuses with wet tissues. That's how I know that the Fall season must be on its way!

Hay fever or allergic rhinitis is very common and can develop at any time. Most children do not develop allergies to environmental such as pollen, grasses, molds, and trees, until around 3-4 years of age. Right now at the end of August/beginning of September, ragweed is abundant in our area as well as grasses. Anyone who is allergic to these is likely to be feeling the effects of their allergies now.

Common symptoms of allergies include sneezing, itchy eyes, runny nose, occasional cough or sore throat. If you suspect that your child may have allergies, you could try some over-the-counter allergy remedies for children. Children's Zyrtec and Children's Claritin are readily available at stores. Recently there were some recalls of name brand versions of these, so you may have to get store-brand or generic versions.

If your child has frequent cough, trouble breathing, fevers, or appears sick, then it is less likely to be allergies and you should call your child's doctor immediately. Also, if your child is very young (under age 2), it is less likely to be related to allergies and you should call your doctor.

A good place to check to see what the pollen and allergen levels are in your area is at the website: www.pollen.com. On the "red zone" days, it's a good idea to avoid outdoor activities if your child is allergic to outdoor pollens. Reducing exposure to whatever your child is allergic to is the best way to avoid feeling bad from allergies.