It has been my pleasure to serve as a pediatrician at Cherry Creek Pediatrics for the past six years. I have enjoyed watching your children grow and thrive, and I have learned so much from you over the years. It is with great sadness that I have decided to take a break from the practice of pediatrics. My last day at Cherry Creek Pediatrics will be November 2. Once I am home, I am hoping to post more regular updates on this blog. Check back for new pediatric pearls soon!
As I recently watched my kids gathering items for show and tell at school, I found it bringing back memories of show and tell when I was a child. Perhaps my most vivid memory of show and tell from my childhood is of a girl named Ingrid. I can see her at the front of the classroom, her hands moving almost too fast to follow as she described the pictures pinned to a board behind her. The interpreter struggled to keep up with Ingrid, and we the students were captivated and horrified by the pictures of a young child lying in a hospital bed with all kinds of tubes coming from her body. Ingrid was that little girl, and she spoke to us through an interpreter because the meningitis that had ravaged her body when she was 18 months had also left her profoundly deaf.
Before vaccinations were developed for Strep pneumo and H. flu, two of the most common bacterial causes of meningitis, stories like Ingrid’s were all too common. Because vaccination again H. flu started well before I began my medical career, I have never seen an active case of H. flu. Sadly, though, I have taken care of children with extensive brain damage after their bout with H. flu. Vaccination against Strep pneumo, however, did not start until 2000—too late for one beautiful little five year old girl who came into urgent care when I was an intern. She was so sick with her meningitis that she could not walk or talk, and her parents had put her back in diapers because she no longer could use the toilet. When I performed her spinal tap, pure pus came out. She died the next day.
As parents today, we are fortunate that our children are protected from meningitis, whooping cough, polio, and epiglottitis. We aren’t afraid that a trip to the swimming pool will result in life-long paralysis for our children. Nor do we fear that every little fever could be the beginning of a fatal case of meningitis. I grew up hearing about my great-aunt’s baby who died as a toddler in the hospital of another manifestation of H. flu, something called epiglottitis. My grandmother and his mother brought his little body home in a taxi cab, and they cried the whole way. No longer do we worry that a croupy cough could actually be the beginning of epiglottitis. Our infant and childhood mortality rates have declined dramatically—and we have vaccines to thank.
I know that many parents are afraid of vaccinations. I am afraid of the diseases that vaccines prevent. These diseases can kill or create permanent, severe disabilities in children. A once vibrant, active child can become wheel-chair bound, feeding-tube dependent. No parent wants that to happen to his child.
As you consider the immunization schedule for your child, I urge you to talk to your provider about the vaccinations. Learn what the diseases are, and discuss the risks of the diseases and vaccines. Think about the children who have suffered from vaccine-preventable illness—children like Ingrid. Although I will not turn you away for choosing an alternative vaccination schedule, I do want you to make an informed decision about protecting your child and other children within the community.
Making the decision to breastfeed is a wonderful choice, both for the health of your baby as well as for your health as a mom. Infants who are breastfed get fewer colds and ear infections; have lower rates of obesity, asthma, and allergies; and bond better with their mother. Moms who breastfeed also experience better bonding with their babies, have lower rates of depression, and can sometimes even lose some of that “baby fat” faster! But what if you are a working mom? How do you juggle the stress of your job with the demands of pumping?
As a working mom myself, I can attest to the fact that the reality of going back to work presents new challenges for mothers. With a little planning and persistence, however, you can continue to provide breast milk for your baby even in your absence.
Before your baby is even born, you can buy a good, high-quality electric breast pump. You will make up the price of your pump with your savings in formula! Hand pumps just will not be able to provide enough stimulation or empty your breasts enough to maintain your breast milk supply while working. You can also purchase a hands-free pumping bra that will allow you to multi-task while pumping.
Talk with your employer about providing an appropriate space for pumping as well as finding time in your daily schedule for pumping. Remember that you most likely will be pumping every 2-4 hours at work when you initially return, especially if your baby is young (ie, 6-8 weeks).
Practice pumping at home, and try to build up an extra supply of breast milk in your freezer. Depending on what kind of freezer you own, you may be able to store your breast milk for 6 to 12 months. Pumping immediately after your infant has nursed helps to provide extra stimulation and thus can help to increase your supply. Don’t be discouraged if you are unable to pump extra milk immediately—it takes time for your body to start producing more!
Most of all, try not to stress over your return to work. Anxiety and stress can negatively affect your breast milk supply. It may seem overwhelming, but remember that any amount of breast milk your baby receives is beneficial. You may also find the following article from the Le Leche League helpful:
Happy New Year’s to all! If you are like most adults, you made some resolutions for the New Year—maybe to lose weight, to get into shape, to drink less. Whatever your personal resolutions are for 2012, you might consider some resolutions for the family. Here are a few ideas to help you focus on your kids and their health!
1) Create a “technology free zone” within your home. It’s great for kids to have a place where Mom and Dad aren’t distracted by e-mails, phone calls, text messages, and the like.
2) Go on family runs, walks, bike rides, or hikes. Play soccer together. Physical fitness for children begins at home, and it can be turned into fun family time together! My son loves to ride his bike 6 miles while my husband and I run along with him.
3) Get your child a library card. One of the best ways to encourage early literacy is to read to your child, but how many board books do you want around the house? For older children, a variety of books will help to build vocabulary and confidence with reading.
4) Renew your dedication to the “family dinner.” Family dinners promote family togetherness as well as healthy eating. Oh, and make sure that the dinner table is one of your technology free zones!
5) Create a “family night.” Play games together, read books together, or find some other fun activity that you can do as a family.
6) Make snack time healthy and fun. Get rid of the crackers and other processed foods and replace them with fresh fruits and vegetables. Remember “ants on a log”? It’s a fun, healthy snack that you can make with your kids. Get creative!
7) Kick your children out of the house!!! Have them play in the backyard rather than watching TV. Make it fun by having them do things like create obstacle courses or build forts out of chairs and blankets.
8) Take your children to the grocery store and get them into the kitchen. Having children involved in selecting and preparing food encourages wider varieties. And it’s a great opportunity for you to teach healthy eating habits!
9) Be the example for your child. Eat your five serving of fruits and vegetables a day, and eat a variety of colors in those fruits and vegetables. Show your child what healthy eating is!
Think of some family resolutions of your own. It’s a great opportunity to promote healthy eating and living for your child!
“Mommy, I have to throw up!” If you are at all like me, those words make a cold hand of fear clench your heart. I dread vomiting, both for my children as well as for me. Unfortunately, vomiting illnesses are something most children will have at some point. But generally a little pedialyte and time is all that is needed to cure most vomiting.
Vomiting may accompany many different illnesses from “the stomach flu” to urinary tract infections to pneumonia to strep throat. “The stomach flu,” one of the more common causes of vomiting, is actually a misnomer. “The stomach flu” is not related to your winter influenza, or “flu”. It is more properly termed “gastroenteritis” and is caused by a number of different viruses. Unfortunately, your flu shot will not protect you from gastroenteritis. Getting your child vaccinated with the rotavirus vaccine, however, can protect against some forms of gastroenteritis.
The term “gastroenteritis” encompasses illnesses characterized by vomiting and diarrhea. Fever may also accompany these symptoms. Vomiting often is the first symptom, may be violent and frequent, but usually resolves within the first 24-48 hours of illness. Diarrhea may begin with the vomiting or may develop later. Unlike vomiting, diarrhea may persist for even 2 weeks after the onset of illness.
While vomiting is a dramatic manifestation of illness, it is unusual for a child to become severely dehydrated from vomiting alone unless it persists for a prolonged period (more than 24 hours). I can remember a wonderful (said with sarcasm) trip to the mountains with my family when Liam, Lydia, and I all became sick with gastroenteritis. The kids were vomiting every 5 minutes at one point—they would sit up long enough to throw up and then immediately closed their eyes and lay back down. As sick as they were, we made it through without needing to go to the emergency room.
So how do you treat vomiting and diarrhea at home? Gut rest is one key. When my kids were in the worst of their vomiting, I didn’t even try to give them anything by mouth. After the vomiting had slowed down (in our situation, that took several hours), I slowly started giving them some Pedialyte. I started with a teaspoon every 5 minutes and doubled the amount I was giving them if they went an hour without vomiting. About 18 hours after it all started, they were both finally tolerating fluids.
But what if your child is begging for something to drink? If your child is exceedingly thirsty, you can dry a damp wash cloth for him to suck on—just wet enough for the mouth to feel some moisture but not wet enough to get fluid into the stomach. But don’t just give him a cup or bottle of liquids. Your child will likely guzzle the drink and end up vomiting again.
Once your child is tolerating fluids and has gone a good 6-8 hours without vomiting, you may let her start eating some bland solids. We typically talk about the BRAT diet—bread, rice, applesauce, toast. Think of things that are gentle on the stomach. I wouldn’t recommend steak and eggs as the first thing to eat!
A word about medications to stop vomiting or diarrhea: we do not generally recommend using them. For instance, medications like Imodium can prolong the amount of time that your child has diarrhea. Your child can, however, have Tylenol or Motrin as needed for fever. The most important thing you can do for diarrhea is to encourage your child to drink clear fluids.
While most of these illnesses can be treated at home, your child may need to be seen for the following reasons:
1. Your child is getting dehydrated. Signs of dehydration include not peeing at least every 6-8 hours for infants or 8-10 hours for older children or being listless and/or lethargic.
2. Your child has vomiting and fever WITHOUT diarrhea. Vomiting and fever without diarrhea may be a sign of another illness.
3. Your child has vomiting alone for more than 24 hours.
4. Your child vomits blood or has blood in her stool.
5. Your child has severe, constant abdominal pain.
6. You child has cough or difficulty breathing.
Please call our office if any of the above symptoms develop. In the meantime, please wash your hands well if you child has gastroenteritis. It is highly contagious, and nothing is worse than trying to take care of your child while you, too, are vomiting! It is definitely an experience I hope never to have again! As for school or daycare, your child should remain home until he is no longer vomiting. Diarrhea that is contained within the diaper is okay as long as your child is not overly fussy or uncomfortable.
While I have discussed gastroenteritis in this blog, do remember that there are other causes of vomiting. I remember seeing a little eight year old boy once who was vomiting after consuming 3 double cheese burgers, a large order of fries, and a large cola. Just the thought of it makes me feel queasy!!!
The horrific story from Penn State serves as a good reminder that we as parents need to arm our children with the tools to prevent sexual abuse. Please see my prior post on “Protecting Our Children” for tips on what you can do to protect your children.
Cough, runny nose, congestion, fevers, nausea, vomiting—ugh, who wants to deal with the flu, especially when it is your child! I know the calendar says September, and I know that we are still having warm, summer-like days. But believe it or not, flu season is right around the corner, and NOW is the time to protect your family with a flu shot.
Many people are hesitant to get the flu shot. The American Academy of Pediatrics recommends that all children get a yearly flu shot starting at 6 months. Children are more likely to suffer from complications from influenza including pneumonia and dehydration that can lead to hospitalization or even death. I’m not trying to be dramatic by using the “death” word—there were 282 pediatric influenza deaths during the 2009-2010 flu season and 114 pediatric influenza deaths during the 2010-2011 flu season. Here are some answers to some common questions about influenza:
Q. Isn’t it too early to get the flu shot now? Won’t it wear off before the end of flu season?
A. Flu vaccine will last for 9-12 months after vaccination, so getting your vaccine now will last you through flu season. Also, you do not get immunity immediately when you receive your flu shot, so you should give your body time to produce antibodies and give you protection.
Q. Isn’t flu season in the winter?
A. While influenza is typically at its peak during the winter months, it varies from year to year as well as from region to region. For instance, several years ago Denver had a spike in influenza activity in November. Additionally, Denver may be seeing sporadic activity while New York or Chicago may have widespread activity. Hence travel can put you at higher risk for influenza exposure. And even now we may start to see pockets of influenza activity that are unpredictable before influenza becomes wide-spread.
Q. Can’t I get influenza from the vaccine itself?
A. You CANNOT get influenza from the flu shot; the same is true of the flu mist, which is our live virus vaccine. Unfortunately, we give influenza vaccine at a time of year when regular colds are becoming more common. If you get sick after receiving your flu vaccine, it is because you were exposed to another virus in the community—maybe even in the doctor’s waiting room before getting your vaccine!
Q. What is the difference between the flu shot and the flu mist?
A. The flu shot is a killed virus vaccine that is injected; the flu mist is a live virus vaccine that is sprayed in your nose. Flu mist is only approved for individuals aged 2-49 and cannot be used in children 5 and under who have severe asthma (talk to your provider about the severity of your child’s asthma). The flu mist does not seem to provoke as good of an immune response in older individuals but is excellent (maybe even better than the shot) in children.
Q. Why doesn’t the flu vaccine provide 100% protection?
A. There are lots of different strains of the influenza virus, but we are unable to put all of those strains into a vaccine—it wouldn’t work then! Each year, scientists try to predict which strains of the influenza virus will be prevalent during a season; sometimes they are right, sometimes they are not completely correct. Each year’s vaccine has 3 different strains; this year’s vaccine is the same as last year’s and does include the H1N1 strain. Even if the vaccine is not completely correct, though, it will provide at least SOME protection against the flu—even for the strains not in the vaccine.
Q. Why does my child need two doses of the flu vaccine?
A. In order for a child’s body to produce adequate immune response to the flu vaccine, he needs a booster dose of the flu shot (or mist) one month after his initial dose the first year he receives the vaccine ONLY. This also applies only to children under 9 years of age. Once a child has had two flu vaccines in one season, he will only need one per season in future years.
Bottom line: influenza vaccine is safe, prevents illness, and can prevent death. Protect your child and yourself, and schedule your whole family for flu vaccination today!
Welcome back to school! For many of you, it has been a big year—time to send your child to prekindergarten. If you live in Denver County, please remember that you should apply to get money towards your child’s prekindergarten tuition. The Denver Preschool Program provides money to all Denver county residents for the prekindergarten year (the year immediately before kindergarten ONLY). It is based on a sliding scale depending on factors such as number of individuals in your household and your household income. If your child isn’t in preschool yet, the Denver Preschool Program is a great resourcec for finding a good preschool in your area. And it isn’t too early to start looking for next fall since many programs fill up quickly or have waitlists. For more information, visit www.dpp.org.
We recently returned from the traditional summer family road trip—a 4000 mile, 18 day, multi-state trip that included 7 nights of tent camping. When I tell people that we embarked upon such an adventure with our young children, many respond that we must be crazy. Well, yes, probably we are. We were also crazy to take Liam to Costa Rica at 8 months and Italy at 20 months. We’ve not only survived our trips, though—we’ve managed to have fun along the way, too!
Traveling with children requires some careful planning as well as some adjusted expectations. Remember that some things are out of your control (like the time Liam came down with strep on the road halfway between Denver and Ohio!). Try to look at traveling from your child’s perspective—while you might love to sit around reading books all day, your child may need a bit more activity. For successful travel with your child, think about these tips:
1. Make your trip an adventure. Create “treasure hunts” along hikes or at a museum.
2. Plan stops around your child’s interests. Our kids LOVE trains, so we try to include visits at various train-themed places (for instance, the Big Boy engine in Cheyenne, the model train layout in Colfax, Iowa, and the Golden Spike in Promontory, Utah). Even small things like watching trains work in a train yard can be the highlight of their day!
3. Remember that you may need to travel at a “kid’s pace.” You may need to stop more often, and you may not drive as many miles as you would on your own. Try to plan in some buffer days in case you need a little extra time.
4. It is okay to have travel rules! For instance, our kids really do not sit around watching DVD’s all the time, but they do see a lot of DVD’s while driving 600 plus miles in a day. Also, bedtime while traveling may not be the same, but they do settle back into a routine once we return home.
5. Have a special “treat bag.” Nothing cures boredom like a new toy or activity. I stock up on some simple things from Target or the dollar store before departing on the road or a plane. When the kids get restless, I pull out a surprise for them.
6. Take balls, Frisbees, or other games to play at rest stops. It’s good to get in a little exercise!
7. If you are flying, allow extra time for security. Be prepared with activities for the plane and the ground as well in case you are stuck in the airport!
8. Avoid the “junk food trap” by packing healthy snacks like carrot sticks or raisins. If you are driving, pack a cooler with sandwiches, fruit, etc.
9. Don’t stress about having the “perfect trip.” Remember that if you are having fun and have a positive attitude, your child probably will, too.
We’ve had our share of bumpy trips. In addition to the infamous strep episode, we’ve endured such things as Liam screaming for three-quarters of the way on the plane from home to Europe (and I do mean SCREAMING!). As stressful as it was at the time, we can laugh about it now. But most importantly, we are already planning and counting down to our next family vacation!
This article highlights the importance of touch supervision, discussed in my last blog, for young children around water. Remember that young children can drown in just 2 inches of water! Keep your children within an arms reach around any amount of water.
Our daughter Lydia proudly marched down the stairs the other day in her bathing suit and sunglasses and announced, “I’m ready to play in the wading pool!” Never mind the fact that it was 48 degrees and rainy outside. Our kids LOVE the water, and they both jump at any opportunity to play in it.
Once the weather is warmer, playing in the water becomes more appealing to everyone. But we mustn’t forget the very real dangers that even small amounts of water represent, especially to infants and toddlers. Compared to adults, infants and toddlers proportionally have much larger heads yet are still relatively weak in the neck and upper body. As a result, if they were to fall head first into water, they may not be able to push themselves up and hence can drown in even just a few inches of water. So before your children go splish-splashing, here are a few tips:
- Practice “touch supervision” with infants and toddlers: when around water, make sure that your child is within one arm’s reach.
- Make sure that your children are always supervised by an adult when around water. Even older children and expert swimmers should not swim alone!
- While swimming classes provide your children with important water skills, they do not “drown-proof” your child.
- Likewise, remember that inflatable rings, water wings, and the like are not personal floatation devices (i.e. life jackets). Many experts recommend avoiding such products because they provide a false sense of security to both parents and children.
- Make sure pools and spas have drains that are covered and working properly to avoid entrapment dangers.
- Don’t forget that the bathtub also represents a drowning hazard for infants and toddlers. Follow these same rules in the tub!
Remember that kids move fast, and an accident can occur around water in an instant. A scare has even happened to us. My husband and I had Liam and Lydia at the pool, and Lydia was having a great time jumping into my arms from the side of the pool. I turned my head to say something to my husband when Lydia decided to plunge in without her usual countdown of “1-2-3 jump!” Thankfully, we were practicing “touch supervision”, so when I heard her splash I was able to turn around and grab her ankles as she sank to the bottom because she was within one arm’s reach. It was a scary moment, but thankfully Lydia was okay. As easy as it is to be distracted by cell phones, e-mail, or even your friends, try not to take your eyes off your child!
Lydia was quite disappointed that we wouldn’t let her play in the wading pool on that cold, rainy day. But by following these rules, we will have lots of water fun on our hot, sunny summer days!
I have a confession to make. I deserve another “bad mother of the year” award. Recently, I forgot to put sunscreen on my children, and they burned. Oops! In my defense, it was a mostly cloudy day in the mountains with intermittent snow showers. We were swimming (yep, we swim when it snows!), and I just didn’t even think about that all-important sunscreen. And the kids weren’t alone—my husband and I burned, too.
As summer approaches, it seems like a good time remind everyone of the importance of sun protection. Here are some “fun in the sun” tips:
- Try to apply sunscreen 20-30 minutes prior to going outside.
- Use sunscreens with at least an SPF 30.
- Remember to reapply often, especially if your child is in water!
- If your child has sensitive skin, consider a sun block (i.e. titanium dioxide or zinc oxide). Sun blocks create a physical barrier from the sun rather than causing a chemical reaction in the skin. As such, sun blocks are gentler for the skin especially for children with conditions such as eczema. Sun blocks are considered as good or even better than sun screens. And these are not the zinc oxides of our youth—your child will not look like she has on war paint! Sun blocks have SPF ratings just like sunscreens, and you should use at least an SPF 30.
- Encourage your child to wear hat and sunglasses.
- Consider a swim shirt or other SPF clothing as another form of protection for your child.
Remember that protecting our skin from the sun is the key for preventing skin cancer. Make a habit of putting sun block on your child first thing in the morning before he even ventures outside, and set an example for your child by putting sun block on yourself. And don’t stop using the sunscreen in the winter—though it may be cold, the sun can still burn especially if it is reflected off snow!
As parents, one of our most important jobs is to protect our children. We make them hold our hands to cross the street. We give them helmets to wear when riding bikes or scooters or skiing. We buckle them into car seats or booster seats. We even do simple things like putting hats and gloves on them to protect them from the cold. But parents often feel ill-equip to protect their children from the unthinkable: sexual predators. Even many pediatricians often find the topic a difficult one to broach with their families.
From my perspective as a pediatrician, I encourage my families to do two things. First, please teach your children the appropriate anatomical names for their genitals. By doing so, you empower your children but you also protect them by giving them the appropriate vocabulary. Not everyone is open to little children knowing the terms “penis” and “vagina.” My own mother was horrified when my daughter announced loudly one day, “I have a vagina!” But Lydia knows what it is and knows that it is for her only.
Secondly, I encourage parents to start teaching children about “private areas” at a young age. In general, “private areas” are any part of the body covered by a bathing suit (an easy concept for young children) and are meant for them and them alone.
Feather Berkower co-authored Off Limits: A Parent’s Guide to Keeping Kids Safe from Sexual Abuse and leads Parenting Safe Children seminars in the Denver metro area. She has crafted some fantastic “Body Safe Rules” for children (Copyright Parenting Safe Children (2010). Used with permission from Parenting Safe Children. www.parentingsafechildren.com):
1) No one is allowed to touch your private body parts, except to help you clean them or if the doctor or nurse needs to examine them. (This includes siblings.)
2) You are not allowed to touch someone else’s private body parts.
3) It is OK to touch your own private body parts as long as you do it in private.
4) You and all of your family members are allowed to have privacy when bathing, dressing, and using the toilet. (Model privacy for your children.)
5) No one (adult or teenager) is allowed to take pictures of your private body parts or show you pictures of naked people.
6) When playing with friends, play with your clothes on.
7) No one is allowed to make you kiss or touch them if you don’t want to. No one is allowed to kiss or touch you if you don’t want them to, including relatives. You are allowed to choose who you kiss and touch and when you kiss and touch people.
8) You have permission to say NO and get away if anyone tries to touch your private body parts or tries to break any of your body safety rules. You never have to do what an adult or anyone tells you to do if the person is breaking a body safety rule or making you unsafe (e.g. touching private parts or keeping secrets).
9) If someone tries to or does touch your private body parts, try to get away and then go tell a trusted adult!
10) If someone tells you to keep a secret about touching private body parts, tell an adult.
A word about secrets: they may seem innocent, but encouraging your child to keep “secrets” creates a vulnerable child. Rather than saying, “Let’s keep Daddy’s birthday gift a secret!” try the phrase, “Let’s keep Daddy’s birthday gift a surprise!” By encouraging an open family that doesn’t have secrets, your child is much more likely to follow the last body safety rule. Your child will also understand that someone who cares about him would not want him to keep a secret from his parents.
Remember that your job as a parent is to educate and empower your children. Don’t be afraid to discuss sexual topics with your children because the more you talk about body safety with children, the safer they are. Also use resources such as Feather’s book, website (www.parentingsafechildren.com), and seminars to help guide you if needed. And as always, feel free to discuss any questions or concerns you have with your provider at the office.
I mentioned in a recent post that Lydia has been sick. So has Liam. It’s been a long winter—it seems like one or the other has been sick for the past two months. And invariably, these illnesses have involved the dreaded five letter word: FEVER. For parent, few things seem to cause such worry as fever. And certainly, I have my degree (no pun intended) of concern as I watch the thermometer tick up: “102, 103, wow, 103.7—you’ve got a pretty good fever today!”
But as scary as a fever may seem, remember that it is a sign that the body’s immune system is doing what it is supposed to be doing: fighting an infection. For the most part, a fever is not dangerous, but it can make you feel pretty crummy. Personally, I feel awful if my temperature hits 100.5—quite honestly, I don’t understand how kids tolerate the high fevers that they get!
As a parent, here are a few things that you should remember about fever:
1) PLEASE call our office IMMEDIATELY if your child is less than 2 months and has a rectal temperature over 100.4. This fever in an infant of that age needs to be evaluated right away; if it is the middle of the night, our doctor on call will advise you as to where you need to have your child seen.
2) Most fevers are due to viruses, and most viral fevers will last in the range of 24-72 hours (1-3 days). If a fever lasts longer than 3 days, we would recommend that you contact our office.
3) A truly DANGEROUS fever (ie, that brain damage concern that we all have) is in the 107-108 range. Hard to believe, I know, but fevers CAN get very high in kids.
4) Do call, however, if your child’s temperature is over 105. They have a higher chance of having a bacterial (treatable) cause of fever if the temperature is that high, although most fevers in that range are still caused by viruses.
5) We give medications like acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) to make a child comfortable with fever. Your child’s fever may or may not come down when given these medications, but she should feel more comfortable. Fever also often will wax and wane over the course of the day, so don’t be surprised if your child’s fever returns in the evening.
6) Always call if you think your child is laboring to breathe (look at his naked chest and watch for pulling in between the ribs or using his tummy to breath), listless or lethargic even after Tylenol or Motrin, seems to have a stiff neck, or in general you feel uncomfortable with your child’s fever.
I myself only treat my kids’ fevers if they seem uncomfortable. If it is the middle of the night and they feel hot, I wait to see if they wake up. During the day, I see how crabby or inactive they seem. So the next time your child has a fever, don’t panic! But do watch them closely during their illness, and don’t hesitate to call with questions or concerns. I will post a blog on Tylenol/Motrin dosing and usage soon.
You may have heard the news last week: the American Academy of Pediatrics officially recommended that children remain backwards facing in their car seats regardless of weight until age 2. Safety experts had previously made this same recommendation, citing data that children are 5 times safter in the backwards facing position between ages 1 and 2 for preventing head and neck injuries without an increased risk of injury to the legs. For more information, please see my prior blog on car seat recommendations. And don’t forget to keep your child in a booster seat until he is 57” tall—usually between ages 10 and 12!
Children at younger and younger ages are being exposed to social media. Smart phones and computers permeate our lives, and we often forget the influence they have on children. Please follow this link to a good article about children and social media:
Our daughter decided not to sleep last week. Granted, she was sick when she first made this decision. So Mommy, feeling badly for her, went to her room to comfort her when she started to scream. But five nights later, I was completely exhausted—and Lydia was no longer screaming because she was sick. She was now screaming out of habit. After all, why go back to sleep on your own at night when you can have Mommy come hold you for a little bit? Her soft, warm arms are a MUCH better place to sleep.
But a Mommy who hasn’t slept in several nights is not a happy Mommy, and Mommy will function much better if she is happy. So after ensuring that Lydia was not in pain, it was time for her to “cry it out.” I gently explained to her as I put her in bed that night that Mommy was not going to come up to her room if she started crying. I turned off the monitor, closed our bedroom door, and went to sleep. To my knowledge, she did not cry that night. At least, she didn’t wake me up! But she was the same smiling, happy Lydia in the morning—and I was smiling and happy, too, having gotten my first good night of sleep in several nights.
I’m sure many of you are thinking, “Wow, that sounds cruel! That poor child!” But I cannot emphasize enough how important good sleep is for both you and your child. Everyone feels better after a good night’s sleep! And sometimes getting that good night’s sleep involves some “sleep training” for your child. Letting your child “cry it out” can be one of the more efficient ways of convincing your child to sleep through the night. It can also be one of the hardest ways—as a parent, I completely understand that at times it is torture to lay in bed listening to your child scream. And yes, sometimes your child may even get herself so upset that she makes herself throw up! But I can reassure you that “cry it out” may be temporarily painful, but if you are consistent and persistent it WILL work. And your child will love you just the same in the morning.
I’ll write more in another blog about recommended “cry it out” techniques. In the meantime, if you about to embark on this process, get yourself a pair of earplugs and stay strong!
I always told myself before having children that I’d never have one of “those” children—you know, the ones who refuse to try new foods, who won’t eat fruits or vegetables, and who have a rather limited palate. I’ve discovered that parenthood is one big lesson in humility, and I must admit now that I do have one of “those” children—a picky eater.
Liam started out as a fantastic eater. Anything and everything we put on his plate, he would eat—everything from salmon to green beans to eggplant to hot salsa. Yep, even salsa. And I couldn’t give him pieces of grilled eggplant fast enough. But something happened shortly after he turned 2. Suddenly, Liam refused to eat pretty much anything and everything. We were reduced to about 3 vegetables he would eat and maybe 4-5 fruits (home canned peaches being one, but not fresh peaches!). Protein was maybe a bit easier, but not much. And if we put something new on his plate, it was met by an immediate, “I don’t like that.” Never mind the fact that he hadn’t even tried it!!!
So it was time to get creative as well as to establish some mealtime rules. First, we discovered that Liam still loved mustard. In fact, he told his grandparents once, “I like mustard with my mustard!” So mustard became our friend. Mustard on peas. Mustard on bananas. Mustard on anything and everything, no matter what we thought of the taste combination. Sometimes it worked, and sometimes it didn’t. Also, like most toddlers, Liam was a big fan of pasta. So we would have mushroom ravioli, and I would disguise veggies into the pasta sauce. But most importantly, we didn’t fix him special meals. Liam was given the same food as everyone else at the table. If he didn’t like it and didn’t eat it, fine—he would eat when he was hungry. We also established a “no seconds until you have at least tried everything” rule. He skipped a lot of seconds before finally agreeing to start trying new things.
Now that Liam is 5, his eating habits have greatly improved. He still doesn’t have the variety that his younger sister has, and he is still hesitant to try new things. But by establishing rules and being creative, we have coaxed him into a wider variety of foods. In fact, Liam now loves foods such as corn, broccoli, and tuna—even without mustard! We had a few gagging episodes at the table to get to this point, but we have survived. He is outgrowing his pickiness, and I now truly understand that picky children are born, not created. Remember that your job is to provide a wide variety of healthy, nutritious food. Your child’s job is to decide what he is going to eat—and you can’t force feed him! If you have concerns about your child’s nutrition, please talk to your provider.
“My child is such a picky eater!” I hear this phrase very commonly from parents at well visits. My next question: “Describe what you mean by picky.” Often, parents respond that their child has a good variety of food but “just doesn’t eat very much.” And most of the time, this scenario is completely normal and nothing about which parents should worry.
Children are good at regulating what they need in order to grow. Adults will eat for any number of reasons—it tastes good, they are bored or stressed, they are being social. Kids, especially toddlers, eat when they are hungry. It is not unusual for toddlers to have days where they may only take a bite or two of food. On other days, they may each more food than it seems like their tummies can hold. Your job as a parent is to offer a good variety of healthy food at each meal and let your child judge how much he needs to eat. Have set meal and snack times where your child is sitting at the table and is offered appropriate serving sizes. If she eats everything and asks for more, she may have more. If she doesn’t eat at all, that is fine. But don’t fall into the habit of letting your child “graze” through the day. If he chooses not to eat at a particular meal, he should be done until the next set mealtime.
As for kinds of food, look at your child’s variety over the course of a week. On any given day, a child may only want applesauce and macaroni and cheese or hot dogs and yogurt. Over the course of a week, however, your child should have an assortment of fruits and vegetables, even if it is just a few bites. Also try to average 20-24 ounces of milk per day for good calcium and vitamin D in the diet. And try not to make special meals for your kids—they will eat when they are hungry! My children are quite used to being told, “Sorry, that’s what we are having for dinner tonight. You can choose to eat it if you want.”
As long as your child is gaining weight appropriately, don’t worry about how much she eats each day. Also don’t worry what specific weight percentile your child is growing at on the growth curve. As long as your child is following a percentile (ie, growing at the 3rd, 50th, or 90th percentile), he will be fine. Our growth curves are
meant to ensure appropriate growth for an individual child. If you have specific nutritional or growth questions, please speak with your provider.
The car seat laws recently changed in Colorado, and trying to sort through the laws and recommendations for car seats can be confusing. Coupled with the fact that the NTSB estimates that 80% of all car seats are installed improperly, parents may feel overwhelmed when trying to protect their children. So what are the laws and recommendations?
1) LAW: All infants must be in a BACKWARDS FACING position until at least one year AND 20 pounds. RECOMMENDATION: Keep your infant BACKWARDS FACING until 2 years of age.
Many parents make the mistake of moving an infant to the forwards facing position once she is 20 pounds even if that weight is achieved at less than a year. Developmentally, however, an infant is not ready to be forwards facing under a year. In fact, toddlers should remain backwards facing until their second birthday. Studies have shown that toddlers are five times safer facing backwards until age2 for preventing head and neck injuries without an increased risk of injury to the legs. A toddler still has a relatively large head and weak neck compared to the rest of his body. As a result, in the forwards facing position the neck bears the brunt of crash forces. As a toddler grows, she will position her legs in a comfortable position. If you can imagine, some places in Europe keep kids backwards until age 4!
2) LAW: Children must remain in a 5 point restraint until at least 4 years and 40 pounds. RECOMMENDATION: Keep your child in a 5 point restraint for as long as he or she fits in it. If your car seat will hold a child over 40 pounds, keep your child there—it is safer!
3) LAW: Children must remain in a booster seat until age 8. RECOMMENDATION: Keep your child in a booster seat until he/she is at least 57” (4’9”). The goal of a booster seat is to ensure that the seat belt fits your child properly. How can you tell if the seat belt fits your child properly? Try answering these 5 questions:
1. Does your child sit all the way back again the seat?
2. Do your child’s knees bend comfortably at the edge of the seat?
3. Does the belt cross the shoulder between the neck and the arm?
4. Is the lap belt as low as possible, touching the thighs?
5. Can your child stay seated like this for the whole trip?
If you answered “no” to any of these questions, your child should stay in a booster seat to make sure the shoulder belt and lap belt fit properly for the best crash protection. Remember that your child MUST have a head rest while in a booster seat. If your car does not have head rests, you should use a high-back booster. If your car has head rests, you may use a booster without a back.
4) LAW: Once your child has moved out of a booster seat, he/she must remain restrained by a seat belt. Children under 13 should stay in the back seat. The back seat is twice as safe as the front seat!
A few other tips: if your car is equipped with LATCH, check to see with which seats you can use the LATCH system. Most cars are designed for LATCH in the outboard seats but not the middle seat, meaning you will need to use the seatbelt for a car seat in the middle position. If you are using an infant seat, check the owner’s manual to see if you need to have the carrier handle in the down position while in the car. It may seem inconvenient, but for most seats it is required for proper use. What about all those great car seat toys and attachments? Well, most of them have not been crash tested and are also not recommended for use by the experts. Finally, I would highly recommend having a car seat check. Hospitals are a great resource for these. We had our car seats checked with both of our children and learned something new each time! It may seem daunting, but make sure your most precious cargo rides safely.
Okay, so I don’t want to be a Scrooge and ruin anyone’s holidays. I do, however, want all parents to think about the gifts they are giving their children to ensure safety. Here are a few tips:
1) Think about choking hazards. Most toys are labeled with “not for children under 3” if they have parts that may be a choking hazard. If you aren’t sure, remember the “toilet paper roll” rule. If you can put a toy through the cardboard part of a toilet paper roll, it represents a choking hazard to a child under 3.
2) Avoid strangulation risks. Those necklaces, bells, and the like look really cute around your toddler’s neck. But your toddler could get them caught on something and strangulate, especially at bedtime.
3) Beware of button batteries! Button batteries can be deadly if ingested. If a toy has a button battery, make sure it is hidden within a compartment with a screw close. Always check to make sure batteries aren’t loose.
4) Buy the safety equipment now. What better gift to come with a bike or scooter than a matching helmet? Provide your child with all the appropriate safety equipment and require that he uses it every time.
Most of all, don’t stress over toys for your children. Simple in many ways is best. Those of you who are first-time parents will probably discover that the best gifts are the boxes and wrapping paper anyway!
As parents, we are all concerned about potential food allergies in our children. Food allergies can range from mild rashes to hives to severe anaphylactic reactions (difficulty breathing, wheezing, violent vomiting, or other symptoms). Common “allergenic foods” (foods causing allergies) include peanut, tree nuts, eggs, shellfish, and cow’s milk.
At one time, pediatricians counseled parents to avoid introduction of these highly allergenic food prior to a year of age to prevent allergies from developing. Recent research, however, has shown that delayed introduction most likely does not avert food allergies. In fact, some studies even suggest that these foods should be introduced early to avoid food allergies. For instance, one new study showed that introduction of eggs by 10.5 months of age helped to prevent food allergies.
I like to tell parents the story of one of my friends. She’s trained as a pediatrician, and her husband is a practicing allergist in Chicago. They have a family history of food allergies, so my friend avoided nuts and peanuts during her pregnancy and while nursing. She also delayed introducing these allergenic foods to her children. She has four children, including a set of identical twin boys. These boys not only share the same DNA but also were exposed to the same things in utero, while breastfeeding, and during food introduction. One of the boys has a life-long deadly peanut allergy; the other is not allergic to peanuts at all. I use this story to illustrate the point that we just don’t fully understand food allergies yet.
I no longer recommend that parents delay the introduction of allergenic foods until a year of age. Now, I will ask that you not give honey (a risk of botulism) or bottles of whole milk (a risk of iron deficiency anemia, although milk products like yogurt and cheese are okay) until your child has turned one. If you have an older child with food allergies, discuss the risks and benefits of not introducing those foods to your younger child with your pediatrician.
I’m sure many people think that I’m a bit obsessive with my children and their food, but choking on food represents a real and potential deadly hazard for children. In fact, a recent study in Archives of Otolaryngology—Head and Neck Surgery estimated the death rate from choking after swallowing a foreign object (including food and other objects) to be 3%, which translates into about 300 pediatric deaths per year. The American Academy of Pediatrics recently called on food manufacturers to change the shape of choking hazard foods like hot dogs. While that may seem overly dramatic, just one death from choking on a hot dog is one too many; and, as parents, it is our responsibility to minimize risk of choking for our children.
Think of potential choking hazard foods as a ball and valve. Generally, they are in a shape that can easily get lodged in a child’s airway—grapes, cherry tomatoes, peanuts, and cylindrical-shapes like hot dogs. Other choking hazards are foods that can conform to the shape of a child’s airway and “stick” there—peanut butter, gum. And remember that while children get premolars around age 1 and molars around age 2, they lack the “grinding” motion for things like crunchy raw fruits and vegetables until age 4.
I recommend cutting hot dogs lengthwise twice and then into small pieces. Likewise, I would at least quarter grapes. You may give your child a thin layer of peanut butter on a cracker, but I wouldn’t give a spoonful of peanut butter. Carrots, red pepper, apples, and the like should be cut into thin slices (length-wise for carrots). Avoid hard candies, gum, and actual nuts. In fact, peanuts are not recommended until age 7 because of the risk of choking (but not because of allergy concern). You can’t be too cautious with the choking hazard foods! For more information, see http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Choking-Prevention.aspx.