This week there is a story making national headlines. It concerns women in their late seventies and early eighties having plastic surgery (http://bit.ly/qd5dDd). The article I chose to quote attributes this to "toxic social pressures." These same social pressures occur in teens, as manifest by the growing number of teens opting for bariatric surgery to assist with weight loss. Toxic social pressures can actually occur as early as first or second grade.
How do parents deal with the effects of all this negative pressure? How do we prevent it?
As with most things, prevention is the best policy. We prevent this with grass roots efforts. It starts at home. We all need to take responsibility for this. We need to teach our children to look beyond physical appearance. Picking on someone for how they look is bullying. They need to understand that bullying isn't just fighting or physical threats. Words can hurt just as badly as fists. We've all been hurt by the words of an acquaitance or coworker. As adults, we find it disturbing or even painful. As children, we simply aren't equipped to deal with this.
I would also talk to your children about their self-image. What do they feel good about, concerning themselves. What bothers or scares them about themselves. Then ask them the same things about their siblings and close friends. Then, ask them about classmates and other children in school. Ask about the children who stand out, both as favorites and as outcasts. Why are they favorites or outcasts? Is it because of their appearance or their personality? Children can pick out the favorites and outcasts by 3-4 years of age. These conversations are excellent opportunities to help them develop personal values. It can make them stronger individuals and help them develop integrity.
If you can, arrange play dates with classmates who are outcasts, as well as favorites. This will enrich your child's social experiences, as well as your own. The invited child may be an outcast due to his or her personality. Such a situation will require close monitoring by adults, but can be safely done. Keep in mind that "hurt people hurt people." The child may be lashing out due to unwitnessed abuse or lack of parenting at home. That child may need you more than you could possibly know.
As you educate your children in this manner, they will learn the joy of helping others. This is one of the greatest joys of being a person. They will become empowered, which will help their self-esteem. These simple things can greatly improve their happiness.
A much more difficult question is what to do once bullying has occurred. Schools in the US are being challenged to deal with this problem, and it has become massive. Few programs have proven their efficacy. The KiVa program (http://bit.ly/oeJICh) is one exception. Some Kansas schools will be rolling out this program soon. For those parents whose school is not in this program, get involved. Get involved with your school to battle bullying before you become aware of a problem. Help create in your childs' school(s) an atmosphere of nurturing. Children who are outcasts or victims of bullying have much more difficulty concentrating on schoolwork.
Let's stop teaching children to condemn one another or themselves. A healthy self-image in childhood will lead to greater self-confidence and a healthier self-image as an adult.
Just trying to change the world.
Nanette Nuessle, MD, FAAP
House Call Pediatrician
Overland Park, KS
http://FiresidePediatrics.com
www.PersonalMedicine.com
Tuesday, August 23, 2011
Tuesday, August 9, 2011
Cosleeping
Cosleeping is finally out in the open. For years, this has been a topic taboo for parents to discuss with their friends, coworkers or even, sometimes, their pediatrician. Last week there was an article published (http://bit.ly/nw955n) that stated cosleeping is not as dangerous as we previously thought. This statement got a lot of press and people are speaking out.
The most important thing that I can say is this: cosleeping is a decision that each family must address individually. The answer isn't the same for every family, or even for every child within a given family. You have to do what is right for you and your baby. Yes, I just said it. I spoke out against current recommendations. It is not the first time I have taken this stand on this issue. The bottom line is that you get to choose. Do what is right for you and your child.
Cosleeping is also called bedsharing. It is the norm in most parts of the world today. It was the norm in the US for over a century. I don't really know when it lost popularity here. The 21st (and late 20th) century imposes many difficulties on childrearing. (Another one is the daycare-driven idea that all children should be potty trained by age 2). To say that no child and no parent should cosleep is unrealistic and unproven by research.
There are many benefits to cosleeping. For mothers and infants who are breastfeeding, the advantages are pretty obvious. It makes breastfeeding easier and more efficient. Cosleeping babies breastfeed more often and longer. There are also studies that show moms sleep as deep as usual, but babies do not. This may make them less susceptible to SIDS. It is known that SIDS is less common in countries where cosleeping is the norm, but a causal effect has not been proven. Finally, there is a lot of interaction that occurs between mother and child during sleep (http://bit.ly/q6WaP8).
There are also disadvantages to cosleeping. The most obvious is that the parental bed is no longer the sanctity of a couple. When I talk about cosleeping with new or prospective parents, many fathers picture 2 or 3 children in their bed and no longer having private time with their wives. If this were the case, how did they get the 2nd and 3rd child? Seriously, though, having 3 children in your bed is seldom the case, and not something I am recommending. Having a baby is a huge change in your family dynamics. Talk to each other about this before, during and after your baby's birth. Start having a regular date night, if you aren't already doing that. Get help if you are struggling with the transition. Don't automatically blame cosleeping. However, cosleeping is a choice. It may not be for you, and that's okay.
The other disadvantages have to do with safety concerns. If your baby is cosleeping, make sure they sleep on their back or side. Discourage your child from sleeping on their tummy. Don't cover baby's face or head with bed linens. Avoid pillows, stuffed animals and other fluffy things. Some infants have gotten injured by having their head get caught in the headboard. Check your headboard and make sure this can't happen. Also, make sure baby can't get trapped between the mattress and the bedframe. Don't allow toddlers and older children in the same bed with an infant. They simply aren't mature enough to show awareness of the baby while they are sleeping. The same goes for parents who are under the influence of alcohol or drugs that cause drowsiness: they may be less aware of the baby's presence. This could lead to someone rolling onto baby and suffocating him or her. Infants exposed to cigarette smoke are more prone to SIDS. If you smoke, don't cosleep. In fact, if you smoke, please quit. It is unhealthy for parents and for children of all ages. If you cannot do it alone, help is available. Never leave your infant alone in the parental bed. Naps without mom or dad will need to be in a bassinet, play yard or crib.
What about transitioning infant to his or her own bed? Well, that is a lot like weaning your baby. It has to be a mutual decision between parents and child. Many children transition to their own crib quite well between 5 and 9 months of age. Others aren't ready for that transition until grade school. Most are somewhere in between. My oldest child coslept the first 3-4 months of her life, then went into a crib without any fuss. My youngest was the polar opposite of that. He was born while I was in training and on call (in the hospital) every third night. When I was home, he wanted me all to himself for the first hour, and in the middle of the night. By 5 months, he was sleeping in a play yard next to our bed. He would wake up around 2:00 and cry until placed in our bed. At 9 months, we put him in a crib. He would still wake up and cry to be put in our bed around 2:00 am. By 13 months, he was climbing out of the crib and coming to find us. This meant he didn't wait until 2:00. He would come to our bed as soon as he sensed we were asleep. The more we tried to put him back in the crib, the more he fought it. He needed to know we were available to him. At all times. Finally, we gave in and let him decide where he wanted to sleep. (As if we really had a choice. He could climb out of the crib!). He would start out in his crib or bed, and when he became lonely he would come to us. Once he realized he was in control, he started coming to our bed later and later each morning. Eventually, he was climbing into our bed 10 minutes before the alarm went off. The anxiety level in our home dropped considerably and everyone slept better.
Newer studies show there is no emotional or psychological damage cause by cosleeping. I am still waiting for someone to study the psychologic advantages of cosleeping. However, I am not holding my breath.
In summary, there are advantages and disadvantages to cosleeping. Some of the "disadvantages" have recently been debunked. Most importantly, cosleeping is a decision. It must be made individually by each family based upon the needs of their baby.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
The most important thing that I can say is this: cosleeping is a decision that each family must address individually. The answer isn't the same for every family, or even for every child within a given family. You have to do what is right for you and your baby. Yes, I just said it. I spoke out against current recommendations. It is not the first time I have taken this stand on this issue. The bottom line is that you get to choose. Do what is right for you and your child.
Cosleeping is also called bedsharing. It is the norm in most parts of the world today. It was the norm in the US for over a century. I don't really know when it lost popularity here. The 21st (and late 20th) century imposes many difficulties on childrearing. (Another one is the daycare-driven idea that all children should be potty trained by age 2). To say that no child and no parent should cosleep is unrealistic and unproven by research.
There are many benefits to cosleeping. For mothers and infants who are breastfeeding, the advantages are pretty obvious. It makes breastfeeding easier and more efficient. Cosleeping babies breastfeed more often and longer. There are also studies that show moms sleep as deep as usual, but babies do not. This may make them less susceptible to SIDS. It is known that SIDS is less common in countries where cosleeping is the norm, but a causal effect has not been proven. Finally, there is a lot of interaction that occurs between mother and child during sleep (http://bit.ly/q6WaP8).
There are also disadvantages to cosleeping. The most obvious is that the parental bed is no longer the sanctity of a couple. When I talk about cosleeping with new or prospective parents, many fathers picture 2 or 3 children in their bed and no longer having private time with their wives. If this were the case, how did they get the 2nd and 3rd child? Seriously, though, having 3 children in your bed is seldom the case, and not something I am recommending. Having a baby is a huge change in your family dynamics. Talk to each other about this before, during and after your baby's birth. Start having a regular date night, if you aren't already doing that. Get help if you are struggling with the transition. Don't automatically blame cosleeping. However, cosleeping is a choice. It may not be for you, and that's okay.
The other disadvantages have to do with safety concerns. If your baby is cosleeping, make sure they sleep on their back or side. Discourage your child from sleeping on their tummy. Don't cover baby's face or head with bed linens. Avoid pillows, stuffed animals and other fluffy things. Some infants have gotten injured by having their head get caught in the headboard. Check your headboard and make sure this can't happen. Also, make sure baby can't get trapped between the mattress and the bedframe. Don't allow toddlers and older children in the same bed with an infant. They simply aren't mature enough to show awareness of the baby while they are sleeping. The same goes for parents who are under the influence of alcohol or drugs that cause drowsiness: they may be less aware of the baby's presence. This could lead to someone rolling onto baby and suffocating him or her. Infants exposed to cigarette smoke are more prone to SIDS. If you smoke, don't cosleep. In fact, if you smoke, please quit. It is unhealthy for parents and for children of all ages. If you cannot do it alone, help is available. Never leave your infant alone in the parental bed. Naps without mom or dad will need to be in a bassinet, play yard or crib.
What about transitioning infant to his or her own bed? Well, that is a lot like weaning your baby. It has to be a mutual decision between parents and child. Many children transition to their own crib quite well between 5 and 9 months of age. Others aren't ready for that transition until grade school. Most are somewhere in between. My oldest child coslept the first 3-4 months of her life, then went into a crib without any fuss. My youngest was the polar opposite of that. He was born while I was in training and on call (in the hospital) every third night. When I was home, he wanted me all to himself for the first hour, and in the middle of the night. By 5 months, he was sleeping in a play yard next to our bed. He would wake up around 2:00 and cry until placed in our bed. At 9 months, we put him in a crib. He would still wake up and cry to be put in our bed around 2:00 am. By 13 months, he was climbing out of the crib and coming to find us. This meant he didn't wait until 2:00. He would come to our bed as soon as he sensed we were asleep. The more we tried to put him back in the crib, the more he fought it. He needed to know we were available to him. At all times. Finally, we gave in and let him decide where he wanted to sleep. (As if we really had a choice. He could climb out of the crib!). He would start out in his crib or bed, and when he became lonely he would come to us. Once he realized he was in control, he started coming to our bed later and later each morning. Eventually, he was climbing into our bed 10 minutes before the alarm went off. The anxiety level in our home dropped considerably and everyone slept better.
Newer studies show there is no emotional or psychological damage cause by cosleeping. I am still waiting for someone to study the psychologic advantages of cosleeping. However, I am not holding my breath.
In summary, there are advantages and disadvantages to cosleeping. Some of the "disadvantages" have recently been debunked. Most importantly, cosleeping is a decision. It must be made individually by each family based upon the needs of their baby.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Tuesday, August 2, 2011
Fall Allergies
It's time to talk about fall allergies. I know it seems early, with daytime temperatures over 100 degrees. However, fall allergy season starts in the last half of August. If you have family members with allergies, it is time to prepare.
The best way to deal with allergies is to prevent a reaction. This is done first by avoidance. Don't go out into fields, if you have a lot of fall allergies. That makes sense, but some people are not able to do that. These individuals can lower their risk of an allergic reaction by taking antihistamines and by keeping their homes as allergy free as possible.
Keeping your home allergy free is not easy if you have multiple allergies. For seasonal allergies, it is important to keep your house closed up. Resist the temptation to open the windows and turn off the air conditioning as temperatures drop. If you also have food allergies or indoor allergies, you may have to be more vigilant during this time. Exposure to multiple allergies can add up and make you really miserable.
Let's talk a little bit about antihistamines. I realize that much of this information may be review for some people. Antihistamines block histamine. Histamine is released by our immune systems in response to a trigger. Some people react to one trigger, and some to another. Some people's trigger setpoints are more sensitive than others. Since antihistamines work by blocking release of histamine, they work best when taken before the allergic reaction starts. For the fall allergy season, that means taking medication from August 15th until the first hard frost. (Where I live, the first hard frost happens sometime between Halloween and Thanksgiving). That seems like a lot of medication for a long period of time. I agree. Clearly, not everyone with fall allergies has severe enough symptoms to warrant this regimen. However, if you have allergies that trigger asthma or eczema, this can be life-changing. The newer nonsedating antihistamines (eg. fexofenadine, loratidine) allow us to treat you for extended periods of time without drowsiness. Diphenhydramine is more effective in many people, but is also associated with drowsiness in most people. Grade schoolers given diphenhydramine at bedtime showed an inability to concentrate that lasted until about 3:00 pm the following day. Many pediatricians are getting away from it's use for this reason.
For individuals with moderate to severe allergies, this may not be enough treatment. If you continue to have itchy eyes, stuffy nose and sneezing despite the above advice, there is more you can do. For itchy eyes, there are several over the counter (OTC) eye drops that are very effective. Follow all instructions on the label and do not use for more than 1 week without your physician's input. Nasal steroids can help with nasal congestion and sneezing. Like antihistamines, they work best if started prior to allergy season. They can be associated with headaches, nosebleeds and colds, so do not take them without first talking with your provider. However, they can be very helpful in individuals with asthma triggered by allergies. We know that if we control the upper airway (nose), it is easier to control the lower airway (lungs).
Some people take drugs called "mast cell" inhibitors, such as montelukast. There seems to be a lot of confusion about when and how to use these. To explain this, I would like to back up a bit. The allergy response (an allergic reaction) is called a cascade. This is because it is a series of chemical reactions that in turn cause more allergic reactions. A good visual is to think about playing pool. When you "break" in pool, the cue ball hits one or two balls, which each hit 2-3 balls, etc, scattering all the balls over the table. A cascade is similar in how one reaction causes several other reactions. Antihistamines work on 2/3 of that cascade, and mast cell inhibitors work well on the other third. Because of this, mast cell inhibitors should always be used with an antihistamine, and never instead of an antihistamine. Do you follow? I hope I made that clear. It's a difficult concept.
In summary, fall allergy season will be starting soon, and there is much you can do to relieve symptoms. Avoidance is the best treatment. Don't open up the house when the weather cools off, as this introduces allergens into your home. Antihistamines and other medications work best if taken before the allergic reaction starts. Medications may need to be taken from August 15th to the first hard frost. I hope that you have a better understanding of how and why certain medications are used. More importantly, I hope you have a happy and healthy fall season. For more questions, contact your Personal Medicine provider.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
The best way to deal with allergies is to prevent a reaction. This is done first by avoidance. Don't go out into fields, if you have a lot of fall allergies. That makes sense, but some people are not able to do that. These individuals can lower their risk of an allergic reaction by taking antihistamines and by keeping their homes as allergy free as possible.
Keeping your home allergy free is not easy if you have multiple allergies. For seasonal allergies, it is important to keep your house closed up. Resist the temptation to open the windows and turn off the air conditioning as temperatures drop. If you also have food allergies or indoor allergies, you may have to be more vigilant during this time. Exposure to multiple allergies can add up and make you really miserable.
Let's talk a little bit about antihistamines. I realize that much of this information may be review for some people. Antihistamines block histamine. Histamine is released by our immune systems in response to a trigger. Some people react to one trigger, and some to another. Some people's trigger setpoints are more sensitive than others. Since antihistamines work by blocking release of histamine, they work best when taken before the allergic reaction starts. For the fall allergy season, that means taking medication from August 15th until the first hard frost. (Where I live, the first hard frost happens sometime between Halloween and Thanksgiving). That seems like a lot of medication for a long period of time. I agree. Clearly, not everyone with fall allergies has severe enough symptoms to warrant this regimen. However, if you have allergies that trigger asthma or eczema, this can be life-changing. The newer nonsedating antihistamines (eg. fexofenadine, loratidine) allow us to treat you for extended periods of time without drowsiness. Diphenhydramine is more effective in many people, but is also associated with drowsiness in most people. Grade schoolers given diphenhydramine at bedtime showed an inability to concentrate that lasted until about 3:00 pm the following day. Many pediatricians are getting away from it's use for this reason.
For individuals with moderate to severe allergies, this may not be enough treatment. If you continue to have itchy eyes, stuffy nose and sneezing despite the above advice, there is more you can do. For itchy eyes, there are several over the counter (OTC) eye drops that are very effective. Follow all instructions on the label and do not use for more than 1 week without your physician's input. Nasal steroids can help with nasal congestion and sneezing. Like antihistamines, they work best if started prior to allergy season. They can be associated with headaches, nosebleeds and colds, so do not take them without first talking with your provider. However, they can be very helpful in individuals with asthma triggered by allergies. We know that if we control the upper airway (nose), it is easier to control the lower airway (lungs).
Some people take drugs called "mast cell" inhibitors, such as montelukast. There seems to be a lot of confusion about when and how to use these. To explain this, I would like to back up a bit. The allergy response (an allergic reaction) is called a cascade. This is because it is a series of chemical reactions that in turn cause more allergic reactions. A good visual is to think about playing pool. When you "break" in pool, the cue ball hits one or two balls, which each hit 2-3 balls, etc, scattering all the balls over the table. A cascade is similar in how one reaction causes several other reactions. Antihistamines work on 2/3 of that cascade, and mast cell inhibitors work well on the other third. Because of this, mast cell inhibitors should always be used with an antihistamine, and never instead of an antihistamine. Do you follow? I hope I made that clear. It's a difficult concept.
In summary, fall allergy season will be starting soon, and there is much you can do to relieve symptoms. Avoidance is the best treatment. Don't open up the house when the weather cools off, as this introduces allergens into your home. Antihistamines and other medications work best if taken before the allergic reaction starts. Medications may need to be taken from August 15th to the first hard frost. I hope that you have a better understanding of how and why certain medications are used. More importantly, I hope you have a happy and healthy fall season. For more questions, contact your Personal Medicine provider.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Tuesday, July 19, 2011
Head Injuries in Athletes
On July 18, an article was published (http://bloom.bg/olNHUS) that discussed the long term effects of brain injuries in football players. It's scary stuff. It is especially scary, because one of the men interviewed stated, "You don't play football without getting a concussion." I don't know if that statement refers only to professional players, or if it includes middle and high school athletes. So, I did some research on head injuries in athletes and children.
Statistics
I found that roughly 40% of all traumatic brain injuries in children occur during sports and recreational activities, and that 80-90% of these head injuries are concussions. A concussion is a mild form of brain injury. If your child is a football player, here is some good news: the majority of traumatic head injuries occur during bicycling, skating and skateboarding. Many of the head injuries sustained during these 3 sports are lethal. I also found that only 35% of cyclists wear a helmet every time they ride. This means that many of these injuries are preventable. I couldn't find statistics for how many skaters and skateboarders wear helmets, but from interviewing clients I know the percentage is much lower.
Cycling, skating or skateboarding injuries can be prevented by wearing a helmet. Football, on the other hand, isn't played without a helmet. (At least not organized full contact football). This results in less serious injuries, such as a concussion. In fact, football participation is the leading cause of concussions. There are over 40,000 concussions suffered every year among American high school football players. (Note to my son: yes, that is American high school players and American football). Multiple concussions can occur to the same player. Multiple head injuries in the same season can have serious consequences. These include, but are not limited to learning difficulties, memory problems and changes in personality.
Prevention and Diagnosis
What is a parent to do? Well if your child is a cyclist, skater or skateboarder, have them wear a helmet every time they participate in their sport. Make sure it is the right helmet (http://1.usa.gov/pwzRR3) and that it fits correctly. If your child plays football, it is not as simple as that. They're already wearing helmets. Fortunately, helmets are improving. There is a lot of research happening in this field right now. Talk with your coach and your school to see if their helmets are up to date. The next step is early detection of a concussion. Injured players are screened at the sidelines to see if they have a concussion. If so, the player does not return to play until symptoms have resolved. This means symptoms need to be completely gone, not just mostly better. Sometimes these symptoms are very subtle. This is why coaches and trainers have screening tests they can administer right after an injury. However, these screening tests are not always administered correctly. According to recent research (http://bit.ly/o2XM5Y), the key is for every athlete to have one of these screening tests at the beginning of the season, before they have an injury. This gives the coach a baseline for comparison. (I recommend this be done for all competitive middle school and high school atheletes).
What to Expect
As a parent, I would like to know what to expect if my child is said to have a concussion. First, let me say that this is a clinical diagnosis. This means that there is no test that will confirm the diagnosis. A CT scan or MRI will be normal. If these tests are done, they are done to make sure there isn't a worse injury. Symptoms of a concussion can be headache, dizziness, confusion, unsteadiness, difficulty concentrating, amnesia or drowsiness. Males are more likely to get amnesia, while females are more likely to have drowsiness. These can also be symptoms of a more serious injury. If your young athlete has any of these symptoms after a head injury, have them evaluated.
Many parents are not told how long these symptoms can or should last. Most parents expect their child to wake up perfectly normal the next morning. That's not always the case. The headache from a concussion usually lasts 24-48 hours, but can last 4-5 days. However, if your child has had a concussion and the headache lasts more than 48 hours, they need to be evaluated again. Also, athletes shouldn't return to athletic activity until all symptoms are gone.
Closing Thoughts
I know this hasn't been a very positive or uplifting post. However, I do hope that it has been empowering. My quest is to help you see how to prevent a serious head injury in your young athlete. I also hope that you will find ways to work with your child's coaches and trainers to detect concussions early and get appropriate treatment.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Statistics
I found that roughly 40% of all traumatic brain injuries in children occur during sports and recreational activities, and that 80-90% of these head injuries are concussions. A concussion is a mild form of brain injury. If your child is a football player, here is some good news: the majority of traumatic head injuries occur during bicycling, skating and skateboarding. Many of the head injuries sustained during these 3 sports are lethal. I also found that only 35% of cyclists wear a helmet every time they ride. This means that many of these injuries are preventable. I couldn't find statistics for how many skaters and skateboarders wear helmets, but from interviewing clients I know the percentage is much lower.
Cycling, skating or skateboarding injuries can be prevented by wearing a helmet. Football, on the other hand, isn't played without a helmet. (At least not organized full contact football). This results in less serious injuries, such as a concussion. In fact, football participation is the leading cause of concussions. There are over 40,000 concussions suffered every year among American high school football players. (Note to my son: yes, that is American high school players and American football). Multiple concussions can occur to the same player. Multiple head injuries in the same season can have serious consequences. These include, but are not limited to learning difficulties, memory problems and changes in personality.
Prevention and Diagnosis
What is a parent to do? Well if your child is a cyclist, skater or skateboarder, have them wear a helmet every time they participate in their sport. Make sure it is the right helmet (http://1.usa.gov/pwzRR3) and that it fits correctly. If your child plays football, it is not as simple as that. They're already wearing helmets. Fortunately, helmets are improving. There is a lot of research happening in this field right now. Talk with your coach and your school to see if their helmets are up to date. The next step is early detection of a concussion. Injured players are screened at the sidelines to see if they have a concussion. If so, the player does not return to play until symptoms have resolved. This means symptoms need to be completely gone, not just mostly better. Sometimes these symptoms are very subtle. This is why coaches and trainers have screening tests they can administer right after an injury. However, these screening tests are not always administered correctly. According to recent research (http://bit.ly/o2XM5Y), the key is for every athlete to have one of these screening tests at the beginning of the season, before they have an injury. This gives the coach a baseline for comparison. (I recommend this be done for all competitive middle school and high school atheletes).
What to Expect
As a parent, I would like to know what to expect if my child is said to have a concussion. First, let me say that this is a clinical diagnosis. This means that there is no test that will confirm the diagnosis. A CT scan or MRI will be normal. If these tests are done, they are done to make sure there isn't a worse injury. Symptoms of a concussion can be headache, dizziness, confusion, unsteadiness, difficulty concentrating, amnesia or drowsiness. Males are more likely to get amnesia, while females are more likely to have drowsiness. These can also be symptoms of a more serious injury. If your young athlete has any of these symptoms after a head injury, have them evaluated.
Many parents are not told how long these symptoms can or should last. Most parents expect their child to wake up perfectly normal the next morning. That's not always the case. The headache from a concussion usually lasts 24-48 hours, but can last 4-5 days. However, if your child has had a concussion and the headache lasts more than 48 hours, they need to be evaluated again. Also, athletes shouldn't return to athletic activity until all symptoms are gone.
Closing Thoughts
I know this hasn't been a very positive or uplifting post. However, I do hope that it has been empowering. My quest is to help you see how to prevent a serious head injury in your young athlete. I also hope that you will find ways to work with your child's coaches and trainers to detect concussions early and get appropriate treatment.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
Tuesday, July 12, 2011
Sports and Heat
This past weekend, we had "feels like" temperatures of 103 degrees. Rumor has it, temperatures were even warmer on Monday. It doesn't look like this is going to go away before the dog days of August.
I spent Sunday sitting outdoors at a local sporting event. A 21 year old young man who was a member of our party developed signs of heat exhaustion after 2 hours. He had headache, fatigue and muscle cramps. Even though I am much older, I didn't start feeling the effects of the heat until I had been out for 4-5 hours. I was tired, and starting to fall asleep in my chair. Okay, I was also starting to get irritable. However, I was drinking 12 oz of water (and other fluids) every hour, and I may be in better shape than the young man.
This weather can be particularly dangerous for athletes who are practicing outdoors. We need to keep this in mind as we send our youngsters off to sports camps. Heatstroke is dangerous and can kill. Heat exhaustion is the early stage of heatstroke. Risk factors for heatstroke are dehydration, fatigue, poor fitness and lack of acclimatization to the weather. Once the temperature is over 98 degrees (and humidity is over 55%), children should rest 5-10 minutes after every 25-30 minutes of activity. I strongly recommend encouraging them to drink water during these breaks.
Your children may not get heatstroke if they are swimming. However, they can still get dehydrated. This puts them at risk for developing heatstroke during later activities. It is easy to forget this risk, since they are wet and less hot while in the pool. They have less evaporative water loss through their skin, but their bodies still use more water than on a cool day. Also, they are exercising in that water, even when they are just playing. Have them stop hourly for something to drink.
Football seems to have the highest risk of heatstroke, with 27 deaths over the last 10 years. Much of that increase in risk is due to their need to wear protective equipment. If temperatures are over 98 degrees and the humidity is over 55%, these kids should be in only shorts and t-shirts with helmet and shoulder pads. As the humidity rises over 80%, they should remove all safety equipment to continue activity. This also means they have to alter their activity, as they are not wearing safety equipment. There are differing recommendations about when to stop activity, with some references saying you don't need to stop until humidity is 100%. I wouldn't wait that long.
If a child or teen is having headaches or muscle cramps, these could be signs of heatstroke. Move the individual to a cool place and give plenty of fluids. Water is best. Juice can also help, but avoid caffeinated beverages. This is one of the few times when I recommend a sports drink with electrolytes. (However, the majority of their fluid intake should be water). If their body temperature is 102 degrees or more, immerse them in cold water (and consider calling 911). A great way to do this is with a plastic wading pool, ice and lots of water. You want to immerse the person in cold water, except for their face. Nausea, vomiting and dizziness can also be signs of heatstroke. If the child is also dehydrated, they may have difficulty sweating. The skin will be red, hot and dry. If the person has rapid breathing, a rapid pulse, seems confused, disoriented or is hallucinating, call 911 while you are cooling them in the wading pool.
Let's keep our kids safe while they enjoy the activities they love. For additional information, contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
Fireside Pediatrics
State of the art care for your child in your home
http://FiresidePediatrics.com
www.PersonalMedicine.com
I spent Sunday sitting outdoors at a local sporting event. A 21 year old young man who was a member of our party developed signs of heat exhaustion after 2 hours. He had headache, fatigue and muscle cramps. Even though I am much older, I didn't start feeling the effects of the heat until I had been out for 4-5 hours. I was tired, and starting to fall asleep in my chair. Okay, I was also starting to get irritable. However, I was drinking 12 oz of water (and other fluids) every hour, and I may be in better shape than the young man.
This weather can be particularly dangerous for athletes who are practicing outdoors. We need to keep this in mind as we send our youngsters off to sports camps. Heatstroke is dangerous and can kill. Heat exhaustion is the early stage of heatstroke. Risk factors for heatstroke are dehydration, fatigue, poor fitness and lack of acclimatization to the weather. Once the temperature is over 98 degrees (and humidity is over 55%), children should rest 5-10 minutes after every 25-30 minutes of activity. I strongly recommend encouraging them to drink water during these breaks.
Your children may not get heatstroke if they are swimming. However, they can still get dehydrated. This puts them at risk for developing heatstroke during later activities. It is easy to forget this risk, since they are wet and less hot while in the pool. They have less evaporative water loss through their skin, but their bodies still use more water than on a cool day. Also, they are exercising in that water, even when they are just playing. Have them stop hourly for something to drink.
Football seems to have the highest risk of heatstroke, with 27 deaths over the last 10 years. Much of that increase in risk is due to their need to wear protective equipment. If temperatures are over 98 degrees and the humidity is over 55%, these kids should be in only shorts and t-shirts with helmet and shoulder pads. As the humidity rises over 80%, they should remove all safety equipment to continue activity. This also means they have to alter their activity, as they are not wearing safety equipment. There are differing recommendations about when to stop activity, with some references saying you don't need to stop until humidity is 100%. I wouldn't wait that long.
If a child or teen is having headaches or muscle cramps, these could be signs of heatstroke. Move the individual to a cool place and give plenty of fluids. Water is best. Juice can also help, but avoid caffeinated beverages. This is one of the few times when I recommend a sports drink with electrolytes. (However, the majority of their fluid intake should be water). If their body temperature is 102 degrees or more, immerse them in cold water (and consider calling 911). A great way to do this is with a plastic wading pool, ice and lots of water. You want to immerse the person in cold water, except for their face. Nausea, vomiting and dizziness can also be signs of heatstroke. If the child is also dehydrated, they may have difficulty sweating. The skin will be red, hot and dry. If the person has rapid breathing, a rapid pulse, seems confused, disoriented or is hallucinating, call 911 while you are cooling them in the wading pool.
Let's keep our kids safe while they enjoy the activities they love. For additional information, contact your Personal Medicine provider.
Dr Nan N
House Call Pediatrician, Overland Park, KS
Fireside Pediatrics
State of the art care for your child in your home
http://FiresidePediatrics.com
www.PersonalMedicine.com
Tuesday, June 28, 2011
Fireworks
Every summer, parents ask me what fireworks are safe to use around small children. The unfortunate truth is that none of them are safe for small children. Not even sparklers, they ask? My answer has to be: No, not even sparklers.
Sparklers are dangerous. They can burn at 1,100-1,800 degrees. They are a major cause of hand and finger injuries in children. Not only is the person holding the sparkler at risk, but also anyone standing nearby. In the past, they have also been a significant cause of foot burns, as children drop their sparkler or step on one that is still hot.
Don't get me wrong. I love the Fourth of July. It is one of my favorite holidays. It is celebrated with foods I can promote: grilled steaks or chicken, served with fruits and vegetables (corn on the cob, watermelon, berries). I just want everyone to be safe while they party. Yes, party! Have a good time. Just, please, do it without endangering yourself or others.
Start by dressing yourself and your children appropriately. I think we all know that a barefoot toddler in a tutu is a bad idea. I recommend against bare feet and against open-toed shoes. Loose fitting clothing is also not recommended. Girls, pass on the sundress, even if you are watching from afar. A cute pair of shorts and a lightweight shirt are much safer. It's hot outside, so tie your hair back. It's safer and cooler.
Secondly, think about the fireworks you are going to buy. To make this decision, you need to know who is coming to your shindig. Are all of your friends college age? Will there be small children in attendance? How about older children that will want to help light the fireworks? Depending upon the laws in your area, you may be responsible for the safety of all of them. Buy only consumer fireworks and not commercial grade. I've already discussed the concerns about sparklers. It is much harder to find information about smoke bombs, but let me say this. You are causing chemicals and smoke to be released into the air where they will get inhaled. I don't think there have been any long term studies on the safety of these inhalants. If you know otherwise, please contact me. Firecrackers and bottle rockets should never be held in the hand or aimed at another person. Always light fireworks with a punk, not a match or a cigarette lighter. Supervision is a must, sometimes even with college students. (Sometimes especially with college students).
There are other options for small children. There are plenty of activities that will make them happy, such as squirt gun fights and bicycle or tricycle parades. Older children, as well as adults, can participate in bean bag tosses and three-legged races. If that's not exciting enough, try aerosol string fights. These can be done with teams or as a free-for-all. For squirt gun fights and aerosol string fights, be sure participants don't run near a grill or firepit. You can also get faux fireworks that are filled with confetti. They're fun when you pop them and generally safe for little ones (with supervision). Cleanup is best handled as a contest for whomever picks up the most bits of paper.
Of course, the day isn't over without some really big fireworks display. I suggest attending a commercial display. You can attend in person, watch from a friend's house nearby, or watch on television. It doesn't matter to me. I just don't feel that the Fourth of July is complete without at least one such show.
Remember the following things: 1) dress appropriately, 2) choose your fireworks with your audience and participants in mind, 3) plan other activities, because no fireworks are safe around small children. Lastly, enjoy good food, family, friends and a commercial fireworks display.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Sparklers are dangerous. They can burn at 1,100-1,800 degrees. They are a major cause of hand and finger injuries in children. Not only is the person holding the sparkler at risk, but also anyone standing nearby. In the past, they have also been a significant cause of foot burns, as children drop their sparkler or step on one that is still hot.
Don't get me wrong. I love the Fourth of July. It is one of my favorite holidays. It is celebrated with foods I can promote: grilled steaks or chicken, served with fruits and vegetables (corn on the cob, watermelon, berries). I just want everyone to be safe while they party. Yes, party! Have a good time. Just, please, do it without endangering yourself or others.
Start by dressing yourself and your children appropriately. I think we all know that a barefoot toddler in a tutu is a bad idea. I recommend against bare feet and against open-toed shoes. Loose fitting clothing is also not recommended. Girls, pass on the sundress, even if you are watching from afar. A cute pair of shorts and a lightweight shirt are much safer. It's hot outside, so tie your hair back. It's safer and cooler.
Secondly, think about the fireworks you are going to buy. To make this decision, you need to know who is coming to your shindig. Are all of your friends college age? Will there be small children in attendance? How about older children that will want to help light the fireworks? Depending upon the laws in your area, you may be responsible for the safety of all of them. Buy only consumer fireworks and not commercial grade. I've already discussed the concerns about sparklers. It is much harder to find information about smoke bombs, but let me say this. You are causing chemicals and smoke to be released into the air where they will get inhaled. I don't think there have been any long term studies on the safety of these inhalants. If you know otherwise, please contact me. Firecrackers and bottle rockets should never be held in the hand or aimed at another person. Always light fireworks with a punk, not a match or a cigarette lighter. Supervision is a must, sometimes even with college students. (Sometimes especially with college students).
There are other options for small children. There are plenty of activities that will make them happy, such as squirt gun fights and bicycle or tricycle parades. Older children, as well as adults, can participate in bean bag tosses and three-legged races. If that's not exciting enough, try aerosol string fights. These can be done with teams or as a free-for-all. For squirt gun fights and aerosol string fights, be sure participants don't run near a grill or firepit. You can also get faux fireworks that are filled with confetti. They're fun when you pop them and generally safe for little ones (with supervision). Cleanup is best handled as a contest for whomever picks up the most bits of paper.
Of course, the day isn't over without some really big fireworks display. I suggest attending a commercial display. You can attend in person, watch from a friend's house nearby, or watch on television. It doesn't matter to me. I just don't feel that the Fourth of July is complete without at least one such show.
Remember the following things: 1) dress appropriately, 2) choose your fireworks with your audience and participants in mind, 3) plan other activities, because no fireworks are safe around small children. Lastly, enjoy good food, family, friends and a commercial fireworks display.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Tuesday, June 21, 2011
House Call Medicine
Last week I wrote about telemedicine. It was an attempt to help people understand what I do. From the feedback I received, it was clear that I needed to back up. I need to explain what a House Call Pediatrician does. By this I mean, what can we do and what are our limitations. Okay. I can do that.
When a physician says that he or she does house calls, I think we all know that means they see clients in their own home. In my case, I will also see children in their daycare or their parent's place of business. Everyone is eager to see a house call, or concierge, physician for acute illnesses such as colds and flu. I can do that. I also do complete physicals. These can be school physicals, sports physicals or your annual physical. I can update your child's immunizations at that time. I can also manage chronic illnesses, treat common sports injuries and suture simple lacerations. My goal is to be your child's primary care physician.
If your child has a chronic illness that requires treatment by subspecialists, I cannot do that in your home. However, I can refer your child to the appropriate specialists, and manage their overall care. I can be the physician those specialists call when they have questions. I can help guide you through that process.
If your child has a sprain or strain, I can splint that in your home and follow it's progress. If a fracture is suspected, I can refer you to a place where the radiology studies can be done. Those results are either faxed or sent to me digitally. I usually get these results in a matter of hours, not days. With that information, I can make appropriate treatment decisions. Results are entered into the medical record.
If your child needs labwork done, I choose not to draw blood on your child in their home. This is invasive, and many children feel it is a violation of their personal space. They should not be made to feel that way in their own home. Fortunately, bloodwork is seldom needed in pediatric clients. For labwork, I will send you and your child to a local lab or the nearby children's hospital. Results are, again, available within a few hours. They are usually sent to me digitally and entered into your child's record. Treatment options are made, based upon these results.
Many physicians ask how I manage all the charts. I don't carry charts, per se. All our charts are electronic and can be accessed via my computer. The information is encrypted and password protected. This electronic record contains growth charts, immunization records, past medical history, family history and information from specialists. I can send prescriptions electronically to the pharmacy of your choice.
While all of this is pretty nifty, you need to know what I cannot do in a house call. I cannot perform minor surgeries. I cannot suture complex lacerations. I cannot treat true emergent problems. Certain problems, such as dehydration or respiratory distress, will still need to be sent to an emergency department. Decisions are made on a case by case basis, with your child's safety as the key concern. I, also, cannot see every client at the time they want to be seen. This is why I have a schedule. While non-urgent appointments are made online, many parents wish to speak with me personally when scheduling urgent appointments.
I hope this has clarified things for you. As a house call, or concierge pediatrician, I would like to be your child's primary care physician. Just like any other primary care physician, I will sometimes need to refer you and your child elsewhere. I will do what is in the best interest of your child. Not every concierge physician offers these same services. Some will do less, and some more. If you have questions, please contact us online.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
View this blog as a video: http://www.youtube.com/user/personalmedicinetv#p/a/u/1/wT0tJSsXFgk
http://FiresidePediatrics.com
http://PersonalMedicine.com
When a physician says that he or she does house calls, I think we all know that means they see clients in their own home. In my case, I will also see children in their daycare or their parent's place of business. Everyone is eager to see a house call, or concierge, physician for acute illnesses such as colds and flu. I can do that. I also do complete physicals. These can be school physicals, sports physicals or your annual physical. I can update your child's immunizations at that time. I can also manage chronic illnesses, treat common sports injuries and suture simple lacerations. My goal is to be your child's primary care physician.
If your child has a chronic illness that requires treatment by subspecialists, I cannot do that in your home. However, I can refer your child to the appropriate specialists, and manage their overall care. I can be the physician those specialists call when they have questions. I can help guide you through that process.
If your child has a sprain or strain, I can splint that in your home and follow it's progress. If a fracture is suspected, I can refer you to a place where the radiology studies can be done. Those results are either faxed or sent to me digitally. I usually get these results in a matter of hours, not days. With that information, I can make appropriate treatment decisions. Results are entered into the medical record.
If your child needs labwork done, I choose not to draw blood on your child in their home. This is invasive, and many children feel it is a violation of their personal space. They should not be made to feel that way in their own home. Fortunately, bloodwork is seldom needed in pediatric clients. For labwork, I will send you and your child to a local lab or the nearby children's hospital. Results are, again, available within a few hours. They are usually sent to me digitally and entered into your child's record. Treatment options are made, based upon these results.
Many physicians ask how I manage all the charts. I don't carry charts, per se. All our charts are electronic and can be accessed via my computer. The information is encrypted and password protected. This electronic record contains growth charts, immunization records, past medical history, family history and information from specialists. I can send prescriptions electronically to the pharmacy of your choice.
While all of this is pretty nifty, you need to know what I cannot do in a house call. I cannot perform minor surgeries. I cannot suture complex lacerations. I cannot treat true emergent problems. Certain problems, such as dehydration or respiratory distress, will still need to be sent to an emergency department. Decisions are made on a case by case basis, with your child's safety as the key concern. I, also, cannot see every client at the time they want to be seen. This is why I have a schedule. While non-urgent appointments are made online, many parents wish to speak with me personally when scheduling urgent appointments.
I hope this has clarified things for you. As a house call, or concierge pediatrician, I would like to be your child's primary care physician. Just like any other primary care physician, I will sometimes need to refer you and your child elsewhere. I will do what is in the best interest of your child. Not every concierge physician offers these same services. Some will do less, and some more. If you have questions, please contact us online.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
View this blog as a video: http://www.youtube.com/user/personalmedicinetv#p/a/u/1/wT0tJSsXFgk
http://FiresidePediatrics.com
http://PersonalMedicine.com
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