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
Wednesday, June 15, 2011
Telemedicine Visits
I am a concierge pediatrician. That means I do house calls. I also give phone advice, communicate with clients via email, and I do telemedicine visits. What's that, you say? What's a telemedicine visit? You are not alone in asking. It is one of the more common questions I am asked.
Telemedicine is the use of a computer screen to do a patient visit. This is similar to Skype, but through a secure portal. It is most commonly used in Intensive Care units and for rural medicine. It is a way to link patients with doctors who are geographically distant. (The wonderful thing is, no one is really distant in the age of the internet). Information from an ICU monitor can be transmitted around the world to the physician who is the best in that field. In rural areas, it is used to link patients with a chronic illnesses to their specialists. They also use it for monitoring chronic conditions. It follows HIPAA and AMA rules and regulations, so it is completely legal.
That's cool and all, you say. Then you point out that I don't practice in an ICU or in a rural area. You want to know how this is going to help a typical urban mom with a sick child. That is an excellent point. Sometimes, you need to call the doctor in the middle of the night. You might reach a physician, but you are more likely to reach an Advise Nurse or an answering service. If you get a physician, she may tell you that she cannot fix your problem over the phone. It needs a higher level of service. She gives you the option of waiting until morning to call for an appointment, or going to the emergency department.
This is where I swoop in and save the day! Or night, as the case may be. Often, that higher level of care can be managed through a telemedicine visit. With the magic of the digital age, I can get a much better idea of how sick your child really is. Sometimes. all I need to do is see the child through the computer screen. Other times, I am looking for something specific, such as pink eye or a rash. Once this is done, I can give you more specific information. I can tell you if that visit the next day is necessary. Often, I can tell you that ER visit is not necessary. Occasionally, I can send out a prescription.
You're looking at me as if that example isn't enough information. Okay, try this one. You wake your child for school, and he has a fever and a sore throat. He was fine last night. Now what? Do you send him to school? Do you take him to the doctor's office? No. You call me and we do a telemedicine visit. I am able to determine that he needs a rapid strep test. A requisition is electronically sent to the lab in your neighborhood. You run by the lab, and results are sent to me within the hour. I can then tell you whether or not it is safe or advisable to send him to school.
It takes much less time to manage an illness via telemedicine than through a traditional office visit. Yes, the office physician may have a lab in his building. He may even be able to perform the strep test in his office. However, you still have to sit in a waiting room with other people who are ill. You may only have to wait a few minutes for your appointment. You may have to wait an hour. If it is flu season, you may not be able to get a same-day appointment with your provider. Your child may have to be seen by someone they've never met. Telemedicine is quick, convenient and offers continuity of care.
Not everything can, or should be handled via telemedicine. Please let your provider help in that decision as to when to do a telemedicine visit versus an onsite visit. You wouldn't want her to miss an important diagnosis.
I hope this has given you a more concrete idea of telemedicine and what it can do. It is more than phone advice, yet less than a face to face visit. It has different uses in different settings. It can sometimes, but not always, replace an office visit. It is quick, convenient and safe.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
See this post as a video:
http://www.youtube.com/user/personalmedicinetv#p/a/u/0/xZZ0psXHpdQ
http://firesidepediatrics.com
http://personalmedicine.com
Telemedicine is the use of a computer screen to do a patient visit. This is similar to Skype, but through a secure portal. It is most commonly used in Intensive Care units and for rural medicine. It is a way to link patients with doctors who are geographically distant. (The wonderful thing is, no one is really distant in the age of the internet). Information from an ICU monitor can be transmitted around the world to the physician who is the best in that field. In rural areas, it is used to link patients with a chronic illnesses to their specialists. They also use it for monitoring chronic conditions. It follows HIPAA and AMA rules and regulations, so it is completely legal.
That's cool and all, you say. Then you point out that I don't practice in an ICU or in a rural area. You want to know how this is going to help a typical urban mom with a sick child. That is an excellent point. Sometimes, you need to call the doctor in the middle of the night. You might reach a physician, but you are more likely to reach an Advise Nurse or an answering service. If you get a physician, she may tell you that she cannot fix your problem over the phone. It needs a higher level of service. She gives you the option of waiting until morning to call for an appointment, or going to the emergency department.
This is where I swoop in and save the day! Or night, as the case may be. Often, that higher level of care can be managed through a telemedicine visit. With the magic of the digital age, I can get a much better idea of how sick your child really is. Sometimes. all I need to do is see the child through the computer screen. Other times, I am looking for something specific, such as pink eye or a rash. Once this is done, I can give you more specific information. I can tell you if that visit the next day is necessary. Often, I can tell you that ER visit is not necessary. Occasionally, I can send out a prescription.
You're looking at me as if that example isn't enough information. Okay, try this one. You wake your child for school, and he has a fever and a sore throat. He was fine last night. Now what? Do you send him to school? Do you take him to the doctor's office? No. You call me and we do a telemedicine visit. I am able to determine that he needs a rapid strep test. A requisition is electronically sent to the lab in your neighborhood. You run by the lab, and results are sent to me within the hour. I can then tell you whether or not it is safe or advisable to send him to school.
It takes much less time to manage an illness via telemedicine than through a traditional office visit. Yes, the office physician may have a lab in his building. He may even be able to perform the strep test in his office. However, you still have to sit in a waiting room with other people who are ill. You may only have to wait a few minutes for your appointment. You may have to wait an hour. If it is flu season, you may not be able to get a same-day appointment with your provider. Your child may have to be seen by someone they've never met. Telemedicine is quick, convenient and offers continuity of care.
Not everything can, or should be handled via telemedicine. Please let your provider help in that decision as to when to do a telemedicine visit versus an onsite visit. You wouldn't want her to miss an important diagnosis.
I hope this has given you a more concrete idea of telemedicine and what it can do. It is more than phone advice, yet less than a face to face visit. It has different uses in different settings. It can sometimes, but not always, replace an office visit. It is quick, convenient and safe.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
See this post as a video:
http://www.youtube.com/user/personalmedicinetv#p/a/u/0/xZZ0psXHpdQ
http://firesidepediatrics.com
http://personalmedicine.com
Thursday, June 9, 2011
Why Get an Annual Physical?
Have you had a physical examination in the past year? Have each of your children? Pediatricians and Family Practitioners recommend each child be seen for well care once a year (more frequently for children under 2 years of age). Yet, many parents see little reason for this. They only want to bring the children in to see a physician when the school requires a physical, or when the child is sick. This is a gamble you may not want to take.
The annual physical is a tool used by clinicians to monitor your health. Please, do not think it unnecessary just because you or your children are healthy, today. In children, the visit is key in watching growth and development, and updating immunizations. When you are around your child every day, you may not notice subtle changes in their growth, such as a slowing of height velocity or excessive weight gain. Without measuring your child on a regular basis, short stature problems may not be diagnosed in time for treatment to be administered. Also, thirty percent of adults in America are overweight. This number is rapidly climbing in children and teens, as well. If obesity is diagnosed early it is much easier to treat, and the chronic illnesses associated with it can be avoided. Similarly, these visits are an excellent opportunity for the doctor to check your child's development.
Let's talk for a moment about immunizations. These should be updated at every physical examination. Immunization recommendations change every year. If your child or teen was up to date last summer, they may not be in accordance with the new guidelines this summer. If your provider sees your children every year, this gives him or her an opportunity to offer your child the best protection against a wide variety of diseases.
I hope your children are all healthy. However, what if they are not? Many subtle diseases and disorders cannot be diagnosed at their initial presentation. That would be the first visit for which you bring that child to the doctor for that problem. If your clinician does not know your children very well, this can delay the correct diagnosis. These delays can be financially costly, or even life-threatening. Your doctor should know your children, and they should know their doctor. This type of knowledge comes from continuity of care, or seeing the same doctor regularly.
If your child is unfortunate enough to have a chronic illness, then they may already be seeing their primary care physician regularly. However, many chronic illnesses require the input of a specialist. This specialist should work with your primary care doctor. This not only improves outcomes, but can actually reduce the overall number of office visits. For example, if your child has a disorder that needs to be followed every 6 months, the specialist may want to see your child at month 1, and your primary can see that same child at month 7, etc.This way both physicians are familiar with what is happening to your child and have continuity of care.
Many parents want to take their children to a convenience clinic for annual visits. Here, your children are not going to see their own physician. They may not see a physician at all. They may see someone with little or no recent experience treating children. This is important, because these providers may not be trained in how to pick up "silent" cardiac problems in your teen athlete. They may not have all, or any, of your child's immunization records. They frequently do not have the necessary time to do a complete family history, which is indicated in a teen athlete they have not seen previously. Please, make it a priority to have such examinations done by your child's primary care provider.
So, you see, there are many advantages to having an annual physical. We monitor your children's growth and development. Immunization statuses are updated. We also look for new illnesses as well as monitoring chronic ones. Continuity of care is provided. We call it "routine healthcare maintenance." It's like getting the oil changed in your car on a routine basis.
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
The annual physical is a tool used by clinicians to monitor your health. Please, do not think it unnecessary just because you or your children are healthy, today. In children, the visit is key in watching growth and development, and updating immunizations. When you are around your child every day, you may not notice subtle changes in their growth, such as a slowing of height velocity or excessive weight gain. Without measuring your child on a regular basis, short stature problems may not be diagnosed in time for treatment to be administered. Also, thirty percent of adults in America are overweight. This number is rapidly climbing in children and teens, as well. If obesity is diagnosed early it is much easier to treat, and the chronic illnesses associated with it can be avoided. Similarly, these visits are an excellent opportunity for the doctor to check your child's development.
Let's talk for a moment about immunizations. These should be updated at every physical examination. Immunization recommendations change every year. If your child or teen was up to date last summer, they may not be in accordance with the new guidelines this summer. If your provider sees your children every year, this gives him or her an opportunity to offer your child the best protection against a wide variety of diseases.
I hope your children are all healthy. However, what if they are not? Many subtle diseases and disorders cannot be diagnosed at their initial presentation. That would be the first visit for which you bring that child to the doctor for that problem. If your clinician does not know your children very well, this can delay the correct diagnosis. These delays can be financially costly, or even life-threatening. Your doctor should know your children, and they should know their doctor. This type of knowledge comes from continuity of care, or seeing the same doctor regularly.
If your child is unfortunate enough to have a chronic illness, then they may already be seeing their primary care physician regularly. However, many chronic illnesses require the input of a specialist. This specialist should work with your primary care doctor. This not only improves outcomes, but can actually reduce the overall number of office visits. For example, if your child has a disorder that needs to be followed every 6 months, the specialist may want to see your child at month 1, and your primary can see that same child at month 7, etc.This way both physicians are familiar with what is happening to your child and have continuity of care.
Many parents want to take their children to a convenience clinic for annual visits. Here, your children are not going to see their own physician. They may not see a physician at all. They may see someone with little or no recent experience treating children. This is important, because these providers may not be trained in how to pick up "silent" cardiac problems in your teen athlete. They may not have all, or any, of your child's immunization records. They frequently do not have the necessary time to do a complete family history, which is indicated in a teen athlete they have not seen previously. Please, make it a priority to have such examinations done by your child's primary care provider.
So, you see, there are many advantages to having an annual physical. We monitor your children's growth and development. Immunization statuses are updated. We also look for new illnesses as well as monitoring chronic ones. Continuity of care is provided. We call it "routine healthcare maintenance." It's like getting the oil changed in your car on a routine basis.
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
Wednesday, June 1, 2011
Swimmer's Ear
This past weekend, all across this great nation, something wonderful happened. The pools opened! Memorial Day Weekend is the official start of pool season. That makes this a great time to talk about swimmer's ear.
Swimmer's ear, also known as acute otitis externa, is an infection of the outer ear and ear canal that is usually caused by a combination of bacteria and fungi. Accumulation of water in the ear canal is a major trigger in the development of infection. This infection is associated with a lot of inflammation which, in turn, causes pain and itching. If there is a large amount of wax in the ear, this will increase the pain. (A normal amount of wax actually coats the external ear canal and can prevent infection). The inflammation also causes a purulent discharge (pus) from the ear which can be quite striking in some cases. Some children have a small amount of pain and little or no discharge. Others will have copious amounts of discharge and pain that radiates to the angle of the jaw and down the neck. Wikipedia has a lovely picture, but diagnosis usually requires looking inside the ear canal. For those of you in our concierge medicine practice, this would mean a house call not a telemedicine visit.
Swimmer's ear accounts for a number of outpatient visits every summer and a lot of discomfort. It affects roughly 10% of the population at some point in time. The good news is that it is both treatable and preventable.
Water plays a huge role in the development of swimmer's ear. If your ears never get wet, you will probably never get otitis externa. However, if you never bathe, you won't have many friends. Swimming in pools means spending much more time in the water. This increases your risk of developing this infection. I recommend all swimmers purchase preventative drops to use after swimming. These drops are to be placed in the ears at the end of swimming each day, or at the end of each trip to the pool, lake or ocean. They are heavier than water. They descend to the base of the ear canal, pushing out any water that is present. Then, they evaporate at body temperature, leaving the ear canal dry and clean. There are several companies that make such drops. Ask your physician or pharmacist to assist you in picking one.
Preventative drops are only that, preventative. Once an infection has started, they are no longer helpful. If your child complains of ear pain, with or without itching, that lasts more than a day or so, see a physician. If there is a purulent discharge, that gives you even more reason to see someone and consider starting medication. The medications used are usually drops in the ear. Antibiotics by mouth are seldom needed.
However, many of you who are swimming are also camping and a physician isn't readily available. In such cases, you may want to administer a vinegar solution until you can see a doctor. You can use distilled white vinegar diluted half and half with water. Keep in mind, this is not a substitute for medical care. If your child has fever or blood from their ear, do not use diluted vinegar: see your provider as soon as possible. If you use the diluted vinegar, the dose is 3-4 drops in the ear twice daily. You can use an eye dropper or drip this off your fingertip. If your child has fever, severe ear pain, swelling of the outer ear, blood from the ear canal, or pain radiating to the jaw or neck do not give vinegar. See your provider.
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
Swimmer's ear, also known as acute otitis externa, is an infection of the outer ear and ear canal that is usually caused by a combination of bacteria and fungi. Accumulation of water in the ear canal is a major trigger in the development of infection. This infection is associated with a lot of inflammation which, in turn, causes pain and itching. If there is a large amount of wax in the ear, this will increase the pain. (A normal amount of wax actually coats the external ear canal and can prevent infection). The inflammation also causes a purulent discharge (pus) from the ear which can be quite striking in some cases. Some children have a small amount of pain and little or no discharge. Others will have copious amounts of discharge and pain that radiates to the angle of the jaw and down the neck. Wikipedia has a lovely picture, but diagnosis usually requires looking inside the ear canal. For those of you in our concierge medicine practice, this would mean a house call not a telemedicine visit.
Swimmer's ear accounts for a number of outpatient visits every summer and a lot of discomfort. It affects roughly 10% of the population at some point in time. The good news is that it is both treatable and preventable.
Water plays a huge role in the development of swimmer's ear. If your ears never get wet, you will probably never get otitis externa. However, if you never bathe, you won't have many friends. Swimming in pools means spending much more time in the water. This increases your risk of developing this infection. I recommend all swimmers purchase preventative drops to use after swimming. These drops are to be placed in the ears at the end of swimming each day, or at the end of each trip to the pool, lake or ocean. They are heavier than water. They descend to the base of the ear canal, pushing out any water that is present. Then, they evaporate at body temperature, leaving the ear canal dry and clean. There are several companies that make such drops. Ask your physician or pharmacist to assist you in picking one.
Preventative drops are only that, preventative. Once an infection has started, they are no longer helpful. If your child complains of ear pain, with or without itching, that lasts more than a day or so, see a physician. If there is a purulent discharge, that gives you even more reason to see someone and consider starting medication. The medications used are usually drops in the ear. Antibiotics by mouth are seldom needed.
However, many of you who are swimming are also camping and a physician isn't readily available. In such cases, you may want to administer a vinegar solution until you can see a doctor. You can use distilled white vinegar diluted half and half with water. Keep in mind, this is not a substitute for medical care. If your child has fever or blood from their ear, do not use diluted vinegar: see your provider as soon as possible. If you use the diluted vinegar, the dose is 3-4 drops in the ear twice daily. You can use an eye dropper or drip this off your fingertip. If your child has fever, severe ear pain, swelling of the outer ear, blood from the ear canal, or pain radiating to the jaw or neck do not give vinegar. See your provider.
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
Wednesday, May 25, 2011
Emergency Preparednes
In case you hadn't noticed when I write, I write from the heart. This week, my heart is with the recent tornado victims. I'm sure you feel the same.
I'd like to talk about emergency preparedness. We all need to address this issue. We need to take personal responsibility for our homes and our families. We need to make sure we have the necessary supplies in the appropriate place or places.
The first question that arises is what constitutes an emergency preparedness kit? The best information I found was at www.ready.gov/america/getakit/index.html. This website gives a ton of information in list form, and is very readable. The ready.gov list is easy for all of us to accomplish. The thing that is striking about the ready.gov list is that it talks about having 3 days worth of food and water. The American Red Cross website says that, also. Emergency crews may get to you in a couple of hours, or it may take 2-3 days. The second question is do you have a specific place in your house that is your "emergency area?" You need a place to store these things in advance. This place should be close to where you take cover.
I'm not going to go through the list on ready.gov. Instead, let me talk about your children. Preschool and school aged children can help by making their own emergency box. All it takes is a shoe box and a little forethought. Let them help. They should each have their own box. It should contain a couple of favorite photos of the family. These are fun to look at while waiting for an "all clear," and can be helpful to emergency crews if family members get seperated. Let them each have their own flashlight. Yes, they will play with them and annoy you. However, if you live through a major disaster, you'll get over it! Pack extra batteries. Let them add some favorite non-perishable foods. The quantity of these is not meant to last 3 days. It is meant to get you through a 2-3 hour tornado warning. After all, it's just a shoe box. These boxes need to be packed and repacked once a year. This means photos should be updated annually and the food really does need to be non-perishable. At the same time you pack the shoe boxes, pick out a spare change of clothing to pack in your emergency area.
Teens and preteens will be happy with the same kind of box with some minor changes. Allow them to pack some old cartridges from a favorite handheld game. Consider headphones and iPods. They can contribute greatly to family harmony in a small space.
I have some miscellaneous items I would like to add to the list. Remember, that you have to stay calm and informed. Make sure your emergency area has extra batteries, playing cards, books and board games. I recommend a television as a way to monitor the emergency, over radio. Some people disagree, others use both. I also suggest packing plastic baggies with zipper closures. They come in handy if everything starts to get wet. Keep several sizes handy. Kansas City suggests shoes and whistles for when it is over, http://sms.mx/CPd6y0.
If you are like most families, you have multiple cell phones. In an emergency situation, turn all but one phone off to conserve battery power. Keep the other(s) on chargers as long as power is available. As power goes out in one phone, turn on the next phone. This improves your chances of having phone power until emergency crews can reach you.
Emergencies happen. While we can't be prepared for each and every one, let us plan for the ones we can anticipate. Involve your children. This will make it more like a game and reduce their anxiety. Have a specific emergency area in your house with supplies there all the time. All you will have to do is add loved ones. Talk about this as a family and consider having drills. Then, when an emergency happens, I hope this will make it easier on everyone.
Dr Nan N
House Call Pediatrician
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
I'd like to talk about emergency preparedness. We all need to address this issue. We need to take personal responsibility for our homes and our families. We need to make sure we have the necessary supplies in the appropriate place or places.
The first question that arises is what constitutes an emergency preparedness kit? The best information I found was at www.ready.gov/america/getakit/index.html. This website gives a ton of information in list form, and is very readable. The ready.gov list is easy for all of us to accomplish. The thing that is striking about the ready.gov list is that it talks about having 3 days worth of food and water. The American Red Cross website says that, also. Emergency crews may get to you in a couple of hours, or it may take 2-3 days. The second question is do you have a specific place in your house that is your "emergency area?" You need a place to store these things in advance. This place should be close to where you take cover.
I'm not going to go through the list on ready.gov. Instead, let me talk about your children. Preschool and school aged children can help by making their own emergency box. All it takes is a shoe box and a little forethought. Let them help. They should each have their own box. It should contain a couple of favorite photos of the family. These are fun to look at while waiting for an "all clear," and can be helpful to emergency crews if family members get seperated. Let them each have their own flashlight. Yes, they will play with them and annoy you. However, if you live through a major disaster, you'll get over it! Pack extra batteries. Let them add some favorite non-perishable foods. The quantity of these is not meant to last 3 days. It is meant to get you through a 2-3 hour tornado warning. After all, it's just a shoe box. These boxes need to be packed and repacked once a year. This means photos should be updated annually and the food really does need to be non-perishable. At the same time you pack the shoe boxes, pick out a spare change of clothing to pack in your emergency area.
Teens and preteens will be happy with the same kind of box with some minor changes. Allow them to pack some old cartridges from a favorite handheld game. Consider headphones and iPods. They can contribute greatly to family harmony in a small space.
I have some miscellaneous items I would like to add to the list. Remember, that you have to stay calm and informed. Make sure your emergency area has extra batteries, playing cards, books and board games. I recommend a television as a way to monitor the emergency, over radio. Some people disagree, others use both. I also suggest packing plastic baggies with zipper closures. They come in handy if everything starts to get wet. Keep several sizes handy. Kansas City suggests shoes and whistles for when it is over, http://sms.mx/CPd6y0.
If you are like most families, you have multiple cell phones. In an emergency situation, turn all but one phone off to conserve battery power. Keep the other(s) on chargers as long as power is available. As power goes out in one phone, turn on the next phone. This improves your chances of having phone power until emergency crews can reach you.
Emergencies happen. While we can't be prepared for each and every one, let us plan for the ones we can anticipate. Involve your children. This will make it more like a game and reduce their anxiety. Have a specific emergency area in your house with supplies there all the time. All you will have to do is add loved ones. Talk about this as a family and consider having drills. Then, when an emergency happens, I hope this will make it easier on everyone.
Dr Nan N
House Call Pediatrician
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://PersonalMedicine.com
Wednesday, May 18, 2011
New Acetaminophen Dosing
New Acetaminophen Dosing, One Physician's Response
In the past few weeks, many changes have burst onto the front page concerning acetaminophen, the most commonly used over the counter medication for children. Infant drops are going bye-bye, yet dosing information for children under age 2 will be made more available for combination medications containing acetaminophen. Isn't this a mixed message? What are we to make of all this?
I think it is only fair for me to tell you what I make of all this. I cannot comment on what others are making it. I come to you as a physician and a mother.
Acetaminophen is one of the most useful and widely used medications in the US, and possibly worldwide. It is used for fever, pain and even for prevention of both. It is also the most common medication found in accidental ingestions. That's the medical term for poisoning. That's when your toddler, child or teen gets into the medication without your knowledge or permission. It also includes those times when a parent or grandparent accidentally or unknowingly gives a higher dose than what is indicated. If these overdoses are suspected immediately, they can be diagnosed by a series of timed blood tests and treated with medication. Unfortunately, this is not always the case. I will spare you the details, but this can result in a painful death by liver failure that can take several days. It's heartbreaking.
Acetaminophen is marketed in several different strengths. Tablets come in different strengths, as do liquid preparations. Dosing information for children under 2 years of age has not been available on the packaging. For Pediatricians and Family Practicioners, this has meant a lot of after hours phone calls for dosing information. The proactive physician will make this kind of dosing information available to parents before they need it. I have always given this to parents at the 2 month visit, and geared it toward the child's weight. I also discussed this in one of my first blogs. However, multiple preparations in multiple strengths definately causes confusion. Getting rid of the most concentrated strength will certainly increase safety. Even with this move, doses will need to be based on a child's weight, not on their age.
This means parents will need to know their child's weight at all times. Many of us don't do that. We don't weigh our children on a regular basis. We certainly don't weigh them when they are sick and miserable. Some of us don't have scales in our homes. I recommend two things. The first is that you check with your provider to see if they have a patient portal to your child's medical record. This is a way to access parts of the electronic medical record over the internet. The part that includes your child's weight, height and other vital signs is universally accessible in participating hospitals and clinics. Unfortunately, it is only as accurate as your child's most recent visit. Therefore, you should also consider getting a good set of home scales so that you can weigh your child at home when they are sick.
I am not a fan of over the counter cold medications. They don't work well in children, and they are fraught with side effects. This leads me to the combination medications with acetaminophen. Most of them are "cold" medications. Having dosing information available for children under age 2 years is convenient, because that means fewer phone calls to the physician in the middle of the night. However, it also means that more parents will be giving their children and toddlers medications that I don't think they should have. I think it is going to be difficult for the FDA to do this without sending a mixed message. It is just as unwise for the FDA to be giving mixed messages to parents and grandparents as it is for us, as parents, to give mixed messages to our teenagers. We need to push them to make a completely responsible decision.
Furthermore, if we are going to talk about the safety of acetaminophen, let us not forget the teens. This is still a favorite medication to use in suicide and suicide attempts. While I admit that legislature can to little to address this, all this media attention could be a springboard for conversations. Let's start talking about teens and their use of acetaminophen. Let's talk about their use of over the counter medications in general.
There is a lot of new information out there. A spotlight has been thrown on acetaminophen. I think that is a good thing. I'm not sure it is enough. I have mixed feelings about the withdrawal of acetaminophen infant drops from the market, but I think it is the right thing to do. I am not certain that it is right to post dosing information for children under age 2 for combination medications containing acetaminophen. I also think the conversation needs to move forward concerning the different strengths of tablets. Finally, keep this, and all medications, out of the reach of children and teens. Perhaps that should be the topic of my next blog.
Secure your health. Start at home.
twitter: @DrNanN
personalmedicine.com
youtube: personalmedicineTV
In the past few weeks, many changes have burst onto the front page concerning acetaminophen, the most commonly used over the counter medication for children. Infant drops are going bye-bye, yet dosing information for children under age 2 will be made more available for combination medications containing acetaminophen. Isn't this a mixed message? What are we to make of all this?
I think it is only fair for me to tell you what I make of all this. I cannot comment on what others are making it. I come to you as a physician and a mother.
Acetaminophen is one of the most useful and widely used medications in the US, and possibly worldwide. It is used for fever, pain and even for prevention of both. It is also the most common medication found in accidental ingestions. That's the medical term for poisoning. That's when your toddler, child or teen gets into the medication without your knowledge or permission. It also includes those times when a parent or grandparent accidentally or unknowingly gives a higher dose than what is indicated. If these overdoses are suspected immediately, they can be diagnosed by a series of timed blood tests and treated with medication. Unfortunately, this is not always the case. I will spare you the details, but this can result in a painful death by liver failure that can take several days. It's heartbreaking.
Acetaminophen is marketed in several different strengths. Tablets come in different strengths, as do liquid preparations. Dosing information for children under 2 years of age has not been available on the packaging. For Pediatricians and Family Practicioners, this has meant a lot of after hours phone calls for dosing information. The proactive physician will make this kind of dosing information available to parents before they need it. I have always given this to parents at the 2 month visit, and geared it toward the child's weight. I also discussed this in one of my first blogs. However, multiple preparations in multiple strengths definately causes confusion. Getting rid of the most concentrated strength will certainly increase safety. Even with this move, doses will need to be based on a child's weight, not on their age.
This means parents will need to know their child's weight at all times. Many of us don't do that. We don't weigh our children on a regular basis. We certainly don't weigh them when they are sick and miserable. Some of us don't have scales in our homes. I recommend two things. The first is that you check with your provider to see if they have a patient portal to your child's medical record. This is a way to access parts of the electronic medical record over the internet. The part that includes your child's weight, height and other vital signs is universally accessible in participating hospitals and clinics. Unfortunately, it is only as accurate as your child's most recent visit. Therefore, you should also consider getting a good set of home scales so that you can weigh your child at home when they are sick.
I am not a fan of over the counter cold medications. They don't work well in children, and they are fraught with side effects. This leads me to the combination medications with acetaminophen. Most of them are "cold" medications. Having dosing information available for children under age 2 years is convenient, because that means fewer phone calls to the physician in the middle of the night. However, it also means that more parents will be giving their children and toddlers medications that I don't think they should have. I think it is going to be difficult for the FDA to do this without sending a mixed message. It is just as unwise for the FDA to be giving mixed messages to parents and grandparents as it is for us, as parents, to give mixed messages to our teenagers. We need to push them to make a completely responsible decision.
Furthermore, if we are going to talk about the safety of acetaminophen, let us not forget the teens. This is still a favorite medication to use in suicide and suicide attempts. While I admit that legislature can to little to address this, all this media attention could be a springboard for conversations. Let's start talking about teens and their use of acetaminophen. Let's talk about their use of over the counter medications in general.
There is a lot of new information out there. A spotlight has been thrown on acetaminophen. I think that is a good thing. I'm not sure it is enough. I have mixed feelings about the withdrawal of acetaminophen infant drops from the market, but I think it is the right thing to do. I am not certain that it is right to post dosing information for children under age 2 for combination medications containing acetaminophen. I also think the conversation needs to move forward concerning the different strengths of tablets. Finally, keep this, and all medications, out of the reach of children and teens. Perhaps that should be the topic of my next blog.
Secure your health. Start at home.
twitter: @DrNanN
personalmedicine.com
youtube: personalmedicineTV
Tuesday, May 10, 2011
Staying Hydrated
Hey, it's hot out there!
It's gone from high temperatures in the low 70's to highs in the low 90's overnight, pretty much skipping the 80's altogether. It may be different where you are, but this is life in the midwest. We have three and one half seasons a year. (We only get half a spring).
Now that it has suddenly become hot, let's talk about staying hydrated and keeping our kids hydrated. Adults need eight to ten 8-oz glasses of water a day. They need more if they are very active (strenuous exercise for more than 30 minutes). I know this has been contested in the lay literature, but I still stand by this. Your intestinal tract will work better, your skin will stay more hydrated and you hair will shine. More importantly, you will feel better.
In addition to water, you may want other fluids. I recommend 100% juice, not juice drink or juice mix, even for adults. I would avoid beverages with added sugar-it simply isn't needed. This includes sucrose, fructose, and high fructose corn syrup. Green tea and coffee are said to have health advantages. However, for every caffeinated beverage you drink, you need another 8 oz of water! For a 3-cup a day coffee drinker, like myself, who works out hard an hour a day (5-6 days a week) that's a lot of water.
This same advice about additional fluids applies to your children. They need adequate amounts of water, which I will discuss in a moment. They should get juice that is always 100% juice. Four ounces a day is plenty. More than that blunts their appetite for solid foods. Avoid giving them beverages with added sugar, fructose or high fructose corn syrup.
The hard part of this blog is talking about how much water to give your children. There are very few published guidelines. The ones I could find all deal with children who are already dehydrated. This is what we are trying to avoid. Furthermore, the amount has to change as they grow. Therefore, you should know that much of the following information is my opinion, based on my experience and expertise.
Let's start with infants. Breastfed infants do not need additional water. However, mother needs to make sure she stays well hydrated. Bottlefed infants should start getting water at 1-2 months of age. Start with 2-4 oz a day and work up to 4-6 oz a day. Constipated infants may benefit from 8 oz a day. There is seldom any need to go above that amount in children less than 6 months old. In hot weather, it is better to shelter these children from the heat, than to increase their water intake. This is because their kidneys may not handle the increase in water the same as an adult, and their electrolytes may become unbalanced. This can result in hospitalization.
As they get older, things start to change. At 6-12 months of age, 8-16 oz of water a day seems to work for most children. If your infant is constipated, try increasing their water intake more toward 16 oz a day and see if that doesn't help. At 12-24 months of age, 16-24 oz a day works well for most children. By age 4, I start talking directly to the children about their water intake. I teach them that they need 1 (8 oz) glass of water for every year they are old. That means 4 glasses for a 4 year old, 5 glasses for a 5 year old, etc, all the way up to 8-10 years of age. This makes it very simple and easy to remember. It also works extremely well to maintain good health.
In those wonderful preteen and teen years we discuss the transition to adult recommendations. This includes a discussion of caffeine and increasing water intake to compensate for that. I will allow teens to drink 8 oz of juice a day, simply because many of them are drinking 3-4 8 oz glasses of juice drink already. Cutting back to a single glass of 100% juice is a much healthier choice.
Despite all this, it may be difficult to keep up with the hot weather. How do you know if you child needs more fluids? The early signs of mild dehydration are subtle. They are fatigue and irritability. Older children may exhibit confusion. If you see these things, get your child to a cool environment and get them to drink some fluids. Water is preferable. Most of us get plenty of electrolytes in our diet. However, if they have been extremely active, such as participating in competitive sports for more than 30 minutes without a break, consider an electrolyte drink. If your child does not improve in 15-30 minutes, contact your healthcare provider.
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
It's gone from high temperatures in the low 70's to highs in the low 90's overnight, pretty much skipping the 80's altogether. It may be different where you are, but this is life in the midwest. We have three and one half seasons a year. (We only get half a spring).
Now that it has suddenly become hot, let's talk about staying hydrated and keeping our kids hydrated. Adults need eight to ten 8-oz glasses of water a day. They need more if they are very active (strenuous exercise for more than 30 minutes). I know this has been contested in the lay literature, but I still stand by this. Your intestinal tract will work better, your skin will stay more hydrated and you hair will shine. More importantly, you will feel better.
In addition to water, you may want other fluids. I recommend 100% juice, not juice drink or juice mix, even for adults. I would avoid beverages with added sugar-it simply isn't needed. This includes sucrose, fructose, and high fructose corn syrup. Green tea and coffee are said to have health advantages. However, for every caffeinated beverage you drink, you need another 8 oz of water! For a 3-cup a day coffee drinker, like myself, who works out hard an hour a day (5-6 days a week) that's a lot of water.
This same advice about additional fluids applies to your children. They need adequate amounts of water, which I will discuss in a moment. They should get juice that is always 100% juice. Four ounces a day is plenty. More than that blunts their appetite for solid foods. Avoid giving them beverages with added sugar, fructose or high fructose corn syrup.
The hard part of this blog is talking about how much water to give your children. There are very few published guidelines. The ones I could find all deal with children who are already dehydrated. This is what we are trying to avoid. Furthermore, the amount has to change as they grow. Therefore, you should know that much of the following information is my opinion, based on my experience and expertise.
Let's start with infants. Breastfed infants do not need additional water. However, mother needs to make sure she stays well hydrated. Bottlefed infants should start getting water at 1-2 months of age. Start with 2-4 oz a day and work up to 4-6 oz a day. Constipated infants may benefit from 8 oz a day. There is seldom any need to go above that amount in children less than 6 months old. In hot weather, it is better to shelter these children from the heat, than to increase their water intake. This is because their kidneys may not handle the increase in water the same as an adult, and their electrolytes may become unbalanced. This can result in hospitalization.
As they get older, things start to change. At 6-12 months of age, 8-16 oz of water a day seems to work for most children. If your infant is constipated, try increasing their water intake more toward 16 oz a day and see if that doesn't help. At 12-24 months of age, 16-24 oz a day works well for most children. By age 4, I start talking directly to the children about their water intake. I teach them that they need 1 (8 oz) glass of water for every year they are old. That means 4 glasses for a 4 year old, 5 glasses for a 5 year old, etc, all the way up to 8-10 years of age. This makes it very simple and easy to remember. It also works extremely well to maintain good health.
In those wonderful preteen and teen years we discuss the transition to adult recommendations. This includes a discussion of caffeine and increasing water intake to compensate for that. I will allow teens to drink 8 oz of juice a day, simply because many of them are drinking 3-4 8 oz glasses of juice drink already. Cutting back to a single glass of 100% juice is a much healthier choice.
Despite all this, it may be difficult to keep up with the hot weather. How do you know if you child needs more fluids? The early signs of mild dehydration are subtle. They are fatigue and irritability. Older children may exhibit confusion. If you see these things, get your child to a cool environment and get them to drink some fluids. Water is preferable. Most of us get plenty of electrolytes in our diet. However, if they have been extremely active, such as participating in competitive sports for more than 30 minutes without a break, consider an electrolyte drink. If your child does not improve in 15-30 minutes, contact your healthcare provider.
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
Wednesday, May 4, 2011
Bicycle Safety
May is National Bicycle Safety month. It's time to get those bikes out of the garage, clean them up and get ready to ride!
It's also time to review bicycle safety with the entire family. Bicycle safety, like so many things, starts at home. It is an ideal family activity-the safety as much as the riding. It is an excellent way to grow together.
As you clean your bicycles, teach your children to check them for damage. Damaged parts should be repaired or replaced before you start riding. If your children or teens will be riding at night, be sure the lights work. Check horns and bells as well.
Check your helmets at the same time. Helmets that get worn frequently, will get worn out. Check the straps and the fit. The helmet should fit snugly. If it moves on your child's head without moving their scalp, it is too loose. Also, it should sit perfectly horizontally on the head, and not at a jaunty angle. Remember, it's purpose is safety, not looks. Most importantly of all, if a helmet has been in an accident, it should be replaced. I encourage all of my clients to wear helmets. If parents wear a helmet as well, they set an excellent example.
Dress appropriately when you ride. This means avoid clothing that is loose enough to get caught in the spokes or chain, such as skirts or wide pants. To protect your toes, wear close-toed shoes or boots, not flip-flops. (I've seen some ugly toe injuries in the last couple of years). If your shoes have laces, make sure they are tied. Also, teach your children to wear reflective clothing if they ride at night or near dusk.
Review the Rules of the Road with the entire family. Remind everyone that cyclists have to ride on the same side of the road as cars, and in the same direction. Stay in bike lanes whenever possible. If driving beside parked cars, be aware that someone may open a car door into your cycle. Stop at all stop signs (always) and at traffic lights (when it is appropriate). Obey speed limits. Watch for cars, because they will not be watching for you.
Then, of course, my best advice is this: go out and enjoy yourself!
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
It's also time to review bicycle safety with the entire family. Bicycle safety, like so many things, starts at home. It is an ideal family activity-the safety as much as the riding. It is an excellent way to grow together.
As you clean your bicycles, teach your children to check them for damage. Damaged parts should be repaired or replaced before you start riding. If your children or teens will be riding at night, be sure the lights work. Check horns and bells as well.
Check your helmets at the same time. Helmets that get worn frequently, will get worn out. Check the straps and the fit. The helmet should fit snugly. If it moves on your child's head without moving their scalp, it is too loose. Also, it should sit perfectly horizontally on the head, and not at a jaunty angle. Remember, it's purpose is safety, not looks. Most importantly of all, if a helmet has been in an accident, it should be replaced. I encourage all of my clients to wear helmets. If parents wear a helmet as well, they set an excellent example.
Dress appropriately when you ride. This means avoid clothing that is loose enough to get caught in the spokes or chain, such as skirts or wide pants. To protect your toes, wear close-toed shoes or boots, not flip-flops. (I've seen some ugly toe injuries in the last couple of years). If your shoes have laces, make sure they are tied. Also, teach your children to wear reflective clothing if they ride at night or near dusk.
Review the Rules of the Road with the entire family. Remind everyone that cyclists have to ride on the same side of the road as cars, and in the same direction. Stay in bike lanes whenever possible. If driving beside parked cars, be aware that someone may open a car door into your cycle. Stop at all stop signs (always) and at traffic lights (when it is appropriate). Obey speed limits. Watch for cars, because they will not be watching for you.
Then, of course, my best advice is this: go out and enjoy yourself!
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, April 26, 2011
Your Medical Records
They're Your Medical Records-Why Can't You Have Them?
This past week, I got a reminder that I am always a consumer of healthcare, and only sometimes a physician. I needed a copy of my immunization records. That sounds easy enough. As a provider, I know that this is the simplest part of the record to copy and forward. I also knew that I would have to jump through the same hoops as anyone else.
I called and was directed to the website to download the correct form. I did that. Fifteen minutes later, I was calling back, because I couldn't find the number to fax back the signed form. During that call, I pointed out that some of my immunization information might be in my employee file in Occupational Health, rather than my patient file. They assured me that they would check both. In less than 30 minutes, I was receiving my records back by fax.
I will admit that this is where it differs from most people. I only got my records by fax, because I was in a physician's office. A clinic or hospital will not fax records to an individual. Some will not fax them to a school. Some will fax them to an employer, others will only do so under special circumstances. Everyone else has to wait for snail mail. Okay, you say. That should only take 7-10 business days. Right. It should. Usually, though, it takes 2 months. It doesn't matter if you are having records sent across the country or 2 blocks down the street. It still takes 2 months. If you are asking for your complete medical record, it can take much longer.
What if I didn't have a fax machine, or a personal computer? Then, I would have to find the time to drive in to the office and fill out the release form. If you have moved out of the area, they can mail you the form. That is a 7-10 day delay each direction. This is very frustrating, especially if you are dealing with a deadline. People have asked me if this is an intentional stall technique designed to keep people from asking for their medical records. I don't think so. If it is, it isn't very effective.
As a pediatrician, most of my dealings with forwarding records are quite simple. Parents want immunization records, school physical forms and camp forms. Most of the time these are handed to the family at the child's well visit. Sometimes, however, forms get lost after that. Some parents have to have 3 physical forms completed for each child, each year. Yes, they lose them. Other times, I have seen schools or daycares lose forms for an entire class. It happens. We deal with it. However, there is no denying that such things put stress on the physicians and office staff involved.
I asked a few other people about difficulties getting medical records. I was overwhelmed with the horror stories that were forwarded to me. Stories of people whose records were delayed because of concerns about litigation. Stories of prolonged waits to get records transferred after a move. Stories of physicians not knowing where to look in the charts for outside records(http://chilmarkresearch.com/2011/03/04/a-tale-of-two-medical-records/). Stories of charts being "wrecked," or someone tampering with them, to hide information (http://www.usatoday.com/news/health/2008-04-29-medical-records_N.htm#). Exhorbitant fees charged by the page for copying and forwarding of records.
You have a right to your medical records. Hospitals and clinics have the right to charge a fee to offset the costs of copying and forwarding these records, but there is currently no industry standard for those fees. Hospitals can delay giving you the records under a few select circumstances. However, they should make every effort to get the records to you as quickly as possible. Especially, if it involves the transfer of care of a patient.
Shouldn't electronic medical records (EMRs) be making this easier? I've been using EMRs for almost 10 years. They have done some wonderful things. If a clinic has multiple locations, the same chart is available in all of those locations on the same day. Providers can now type (or use voice-to-text) a note into the chart and have it available the same day the patient is seen. Allergy information is available from the moment a client checks in until they fill their prescription at the pharmacy. Prescriptions are sent digitally, with no misinterpretation due to handwriting.
So, why can't you get your records? Well, a lot of people are working on this. The first part is to make sure the chart is up to date. You may have heard of a government initiative called Meaningful Use. One part of Meaningful Use wants to see providers complete patient notes within 72 hours of a visit. (I work with physicians who complete most of their notes the same day). The second part is accessibility. Some places allow the client (read patient) to access their EMR through a secure portal and view their information. However, most of these are "read only." At Personal Medicine, the patient owns the record and can access it at any time and print or download whatever they need, through their secure portal. Other places are looking at CCRs, Continuity of Care Records or CCDs, Continuity of Care Documents. These can be used to download your entire record to a SIM card or a MicroSD drive.
Talk to your healthcare provider. Let him or her know that you want more. You want accessibility and portability. You want a portal where you can view your records at any time. Better yet, you want to be able to print your records through that portal. Talk loud and talk often. Your voice can and will make a difference.
Oh, yeah. My immunization records are missing several pieces of information that should be there. Like my last 2 doses of influenza, and proof that I had measles, mumps, rubeola and varicella as a child.
I have emailed my Primary Care Physician and asked for a CCD. I'm still waiting to hear back. Next, I'll try visiting him in person.
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
This past week, I got a reminder that I am always a consumer of healthcare, and only sometimes a physician. I needed a copy of my immunization records. That sounds easy enough. As a provider, I know that this is the simplest part of the record to copy and forward. I also knew that I would have to jump through the same hoops as anyone else.
I called and was directed to the website to download the correct form. I did that. Fifteen minutes later, I was calling back, because I couldn't find the number to fax back the signed form. During that call, I pointed out that some of my immunization information might be in my employee file in Occupational Health, rather than my patient file. They assured me that they would check both. In less than 30 minutes, I was receiving my records back by fax.
I will admit that this is where it differs from most people. I only got my records by fax, because I was in a physician's office. A clinic or hospital will not fax records to an individual. Some will not fax them to a school. Some will fax them to an employer, others will only do so under special circumstances. Everyone else has to wait for snail mail. Okay, you say. That should only take 7-10 business days. Right. It should. Usually, though, it takes 2 months. It doesn't matter if you are having records sent across the country or 2 blocks down the street. It still takes 2 months. If you are asking for your complete medical record, it can take much longer.
What if I didn't have a fax machine, or a personal computer? Then, I would have to find the time to drive in to the office and fill out the release form. If you have moved out of the area, they can mail you the form. That is a 7-10 day delay each direction. This is very frustrating, especially if you are dealing with a deadline. People have asked me if this is an intentional stall technique designed to keep people from asking for their medical records. I don't think so. If it is, it isn't very effective.
As a pediatrician, most of my dealings with forwarding records are quite simple. Parents want immunization records, school physical forms and camp forms. Most of the time these are handed to the family at the child's well visit. Sometimes, however, forms get lost after that. Some parents have to have 3 physical forms completed for each child, each year. Yes, they lose them. Other times, I have seen schools or daycares lose forms for an entire class. It happens. We deal with it. However, there is no denying that such things put stress on the physicians and office staff involved.
I asked a few other people about difficulties getting medical records. I was overwhelmed with the horror stories that were forwarded to me. Stories of people whose records were delayed because of concerns about litigation. Stories of prolonged waits to get records transferred after a move. Stories of physicians not knowing where to look in the charts for outside records(http://chilmarkresearch.com/2011/03/04/a-tale-of-two-medical-records/). Stories of charts being "wrecked," or someone tampering with them, to hide information (http://www.usatoday.com/news/health/2008-04-29-medical-records_N.htm#). Exhorbitant fees charged by the page for copying and forwarding of records.
You have a right to your medical records. Hospitals and clinics have the right to charge a fee to offset the costs of copying and forwarding these records, but there is currently no industry standard for those fees. Hospitals can delay giving you the records under a few select circumstances. However, they should make every effort to get the records to you as quickly as possible. Especially, if it involves the transfer of care of a patient.
Shouldn't electronic medical records (EMRs) be making this easier? I've been using EMRs for almost 10 years. They have done some wonderful things. If a clinic has multiple locations, the same chart is available in all of those locations on the same day. Providers can now type (or use voice-to-text) a note into the chart and have it available the same day the patient is seen. Allergy information is available from the moment a client checks in until they fill their prescription at the pharmacy. Prescriptions are sent digitally, with no misinterpretation due to handwriting.
So, why can't you get your records? Well, a lot of people are working on this. The first part is to make sure the chart is up to date. You may have heard of a government initiative called Meaningful Use. One part of Meaningful Use wants to see providers complete patient notes within 72 hours of a visit. (I work with physicians who complete most of their notes the same day). The second part is accessibility. Some places allow the client (read patient) to access their EMR through a secure portal and view their information. However, most of these are "read only." At Personal Medicine, the patient owns the record and can access it at any time and print or download whatever they need, through their secure portal. Other places are looking at CCRs, Continuity of Care Records or CCDs, Continuity of Care Documents. These can be used to download your entire record to a SIM card or a MicroSD drive.
Talk to your healthcare provider. Let him or her know that you want more. You want accessibility and portability. You want a portal where you can view your records at any time. Better yet, you want to be able to print your records through that portal. Talk loud and talk often. Your voice can and will make a difference.
Oh, yeah. My immunization records are missing several pieces of information that should be there. Like my last 2 doses of influenza, and proof that I had measles, mumps, rubeola and varicella as a child.
I have emailed my Primary Care Physician and asked for a CCD. I'm still waiting to hear back. Next, I'll try visiting him in person.
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, April 19, 2011
Getting More Fruits and Vegetables in Your Diet
For years, I have been telling people to get 5-9 servings of fruits and vegetables in their diet every day. This past week, I saw someone post a new recommendation that stated we should get 10 servings of fruits and veggies a day. I haven't been able to confirm that. It doesn't make much difference, if most of us are only getting 3-4 servings a day. Many studies have shown that most Americans get only 3-4 servings of fruits and vegetables a day, with most of those being fruits. The recommendation I can find is that we should be getting 5-9 servings a day, with at least 3 servings being vegetables.
I'm not writing today to argue about the details of the recommendation. So, why am I writing? Because most of us aren't getting enough of the healthy cancer-fighting, heart disease-preventing vitamins and antioxidants that are found in fruits and vegetables. If you have family members in this situation, I would like to help. I am going to suggest several things that have worked for a number of people I know. Choose a couple and work them into your daily routine. Once you have done them for several weeks and they become habits, add a couple more.
First, let us talk about what constitutes a serving. A serving of fruit is either a piece, or 1/2 cup for fresh fruit, or 1/4 cup for dried fruit. Let me explain that. An orange is a serving. A medium apple is a serving. A watermelon is not a serving, but 1/2 cup of watermelon is. A grape is not a serving, but 1/2 cup of grapes is. For some reason, a banana is 2 servings. For vegetables, 1/2 cup is a serving for most vegetables with the exception of leafy green ones. It takes 1 cup of leafy greens to make a serving. They should be measured before any cooking, and do not press them down into the measuring cup.
I can already hear someone asking, "Do I really have to measure all this?" Um, yeah. I really don't know any way around that. Until you can accurately eyeball 1 cup and 1/2 cup as well as my great-grandmother, then yes. I suggest you buy several sets of measuring cups. Use them as serving spoons. Keep them handy when preparing food. For my little family of 2, we have 3 sets. It's not quite enough.
Now that you're prepared and have all the right tools, let's get started. It starts with breakfast. Try to get 2 servings of fruits and veggies worked into breakfast. Vegetables are easily added to omelets. Onions, tomatoes and mushrooms can also be put on breakfast sandwiches, English muffins and bagels. I can see getting 1-2 servings of vegetables in an omelet, but getting an entire serving of vegetables on a single breakfast sandwich may be more difficult. You may have to put half the serving on the sandwich and serve the other half as a side dish.
For many people, fruit is easier to eat at breakfast than vegetables. I recommend you use juice for only one serving of fruit (or vegetable) a day, as it is low in fiber. The exception to this is if you are using a juicer, as this retains much more of the fiber. Of course, whole, fresh fruit has all of the fiber and never any added sugar. Use whole, fresh fruit liberally throughout the day. Fruit smoothies are simple and quick and can be a complete breakfast. I suggest you use fresh or frozen fruit whenever possible. Smoothies need a little bit of liquid. Add milk or yogurt, rather than ice cream. For those who cannot have dairy, you can use soy milk, rice milk or almond milk. Smoothies are low in protein. You can add protein powder, or have 1/4 cup dry roasted nuts along with the smoothie (not in it) for a complete meal. Smoothies can be prepared in advance and kept in a thermos for an afternoon snack. Fruit can also be added to hot or cold cereals. For me, a typical breakfast is steel cut oatmeal with 1-2 cups of fresh berries and a little artificial sweetener.
Then there is snack time. For those of you who are home schooling, you have a bit more control over your children's snacks than children in the public or private school systems. However, parents can group together and put pressure on schools to change what is available at snack times. It is already working across the nation to get carbonated beverages out of schools. Snacks should be a fruit or vegetable paired with a source of protein. Simple things are a 1/4 cup of dried fruit mixed with 1/4 cup of nuts. My favorite is 1/4 cup of craisins with 1/4 cup of lightly salted, dry roasted peanuts. (I make several in advance and put them in sandwich-sized baggies). Another example would be an apple or pear and an ounce of cheese in cubes or slices. For those with dairy allergies, try substituting peanut or almond butter. For children allergic to both, apple with deli slices of ham is delicious. Pairing a protein source with your carbohydrate will keep hunger away longer and limits swings in blood sugar.
Lunchtime comes around and we haven't had much in the way of vegetables. This is an opportunity to change that. Swing the balance back with vegetable sticks. Carrots, celery, bell peppers, jicama, sugar peas, even raw sweet potatoes are good choices. Use your imagination. Try to avoid dipping vegetables in cheese or salad dressing, as these are high-fat choices. Choose instead hummus, nut butters, or go without dip. However, if ranch dressing is the only way you can keep your child from trading away his veggies at lunchtime, then measure out one serving. Serving sizes are on the bottle.
After school is another snack time and another opportunity to get a fruit or vegetable into everyone. Don't miss out on this. You can look at what they have already eaten during the day, as well as looking ahead to dinner plans and choose accordingly. Okay. Face it. Most of us aren't that organized. Make sure you have choices available for afterschool that include fruits and vegetables. Build on what we've already discussed.
Dinner comes along and most of us have not yet had 3 servings of vegetables for the day. We might have had 3-4 fruits and 1 vegetable, if we have been working at it. This means that most of the time, dinner plans need to include 2 servings of vegetables. If you opt for a large dinner salad, you can easily get 2-3 servings of vegetables into a single meal. If you only fix one vegetable at dinner, place 1 cup on everyone's plate. It's an easy fix. Of course, if you do that with 2 vegetables and they only eat one, you still win.
Have you reached your totals? Are we at 5-9 fruits and vegetables for the day? We should have had our 3 servings of vegetables. If you aren't sure about the total count, then go ahead and add a fruit to dessert. This takes the focus off of sugar in your dessert.
I hear it. Someone is grumbling about the cost. "All these fruits and vegetables are more expensive." More expensive than what? I could go on for hours about how you will be saving on healthcare costs in the long run, but I won't. I will say that it helps to buy what is in season. More importantly, studies have been done that show diets rich in fruits and vegetables are less expensive than diets rich in junk food. Those studies show that if you Change your buying power from junk food to fresh produce, you actually save money. The problem is that you cannot buy both. You have to decide what is important. I can't do it for you.
One word of caution: this is a lot of fiber. If this is a big change in someone's diet, it can cause some gastrointestinal discomfort. It needs to be paired with an appropriate intake of water! You need to be getting 64-80 ounces of water a day. If not, the fiber can sit in the gastrointestinal tract and cause pain. In rare cases, it can cause obstruction. Please, do not use this as an excuse to avoid fruits and vegetables, just drink the water. You can do it.
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
I'm not writing today to argue about the details of the recommendation. So, why am I writing? Because most of us aren't getting enough of the healthy cancer-fighting, heart disease-preventing vitamins and antioxidants that are found in fruits and vegetables. If you have family members in this situation, I would like to help. I am going to suggest several things that have worked for a number of people I know. Choose a couple and work them into your daily routine. Once you have done them for several weeks and they become habits, add a couple more.
First, let us talk about what constitutes a serving. A serving of fruit is either a piece, or 1/2 cup for fresh fruit, or 1/4 cup for dried fruit. Let me explain that. An orange is a serving. A medium apple is a serving. A watermelon is not a serving, but 1/2 cup of watermelon is. A grape is not a serving, but 1/2 cup of grapes is. For some reason, a banana is 2 servings. For vegetables, 1/2 cup is a serving for most vegetables with the exception of leafy green ones. It takes 1 cup of leafy greens to make a serving. They should be measured before any cooking, and do not press them down into the measuring cup.
I can already hear someone asking, "Do I really have to measure all this?" Um, yeah. I really don't know any way around that. Until you can accurately eyeball 1 cup and 1/2 cup as well as my great-grandmother, then yes. I suggest you buy several sets of measuring cups. Use them as serving spoons. Keep them handy when preparing food. For my little family of 2, we have 3 sets. It's not quite enough.
Now that you're prepared and have all the right tools, let's get started. It starts with breakfast. Try to get 2 servings of fruits and veggies worked into breakfast. Vegetables are easily added to omelets. Onions, tomatoes and mushrooms can also be put on breakfast sandwiches, English muffins and bagels. I can see getting 1-2 servings of vegetables in an omelet, but getting an entire serving of vegetables on a single breakfast sandwich may be more difficult. You may have to put half the serving on the sandwich and serve the other half as a side dish.
For many people, fruit is easier to eat at breakfast than vegetables. I recommend you use juice for only one serving of fruit (or vegetable) a day, as it is low in fiber. The exception to this is if you are using a juicer, as this retains much more of the fiber. Of course, whole, fresh fruit has all of the fiber and never any added sugar. Use whole, fresh fruit liberally throughout the day. Fruit smoothies are simple and quick and can be a complete breakfast. I suggest you use fresh or frozen fruit whenever possible. Smoothies need a little bit of liquid. Add milk or yogurt, rather than ice cream. For those who cannot have dairy, you can use soy milk, rice milk or almond milk. Smoothies are low in protein. You can add protein powder, or have 1/4 cup dry roasted nuts along with the smoothie (not in it) for a complete meal. Smoothies can be prepared in advance and kept in a thermos for an afternoon snack. Fruit can also be added to hot or cold cereals. For me, a typical breakfast is steel cut oatmeal with 1-2 cups of fresh berries and a little artificial sweetener.
Then there is snack time. For those of you who are home schooling, you have a bit more control over your children's snacks than children in the public or private school systems. However, parents can group together and put pressure on schools to change what is available at snack times. It is already working across the nation to get carbonated beverages out of schools. Snacks should be a fruit or vegetable paired with a source of protein. Simple things are a 1/4 cup of dried fruit mixed with 1/4 cup of nuts. My favorite is 1/4 cup of craisins with 1/4 cup of lightly salted, dry roasted peanuts. (I make several in advance and put them in sandwich-sized baggies). Another example would be an apple or pear and an ounce of cheese in cubes or slices. For those with dairy allergies, try substituting peanut or almond butter. For children allergic to both, apple with deli slices of ham is delicious. Pairing a protein source with your carbohydrate will keep hunger away longer and limits swings in blood sugar.
Lunchtime comes around and we haven't had much in the way of vegetables. This is an opportunity to change that. Swing the balance back with vegetable sticks. Carrots, celery, bell peppers, jicama, sugar peas, even raw sweet potatoes are good choices. Use your imagination. Try to avoid dipping vegetables in cheese or salad dressing, as these are high-fat choices. Choose instead hummus, nut butters, or go without dip. However, if ranch dressing is the only way you can keep your child from trading away his veggies at lunchtime, then measure out one serving. Serving sizes are on the bottle.
After school is another snack time and another opportunity to get a fruit or vegetable into everyone. Don't miss out on this. You can look at what they have already eaten during the day, as well as looking ahead to dinner plans and choose accordingly. Okay. Face it. Most of us aren't that organized. Make sure you have choices available for afterschool that include fruits and vegetables. Build on what we've already discussed.
Dinner comes along and most of us have not yet had 3 servings of vegetables for the day. We might have had 3-4 fruits and 1 vegetable, if we have been working at it. This means that most of the time, dinner plans need to include 2 servings of vegetables. If you opt for a large dinner salad, you can easily get 2-3 servings of vegetables into a single meal. If you only fix one vegetable at dinner, place 1 cup on everyone's plate. It's an easy fix. Of course, if you do that with 2 vegetables and they only eat one, you still win.
Have you reached your totals? Are we at 5-9 fruits and vegetables for the day? We should have had our 3 servings of vegetables. If you aren't sure about the total count, then go ahead and add a fruit to dessert. This takes the focus off of sugar in your dessert.
I hear it. Someone is grumbling about the cost. "All these fruits and vegetables are more expensive." More expensive than what? I could go on for hours about how you will be saving on healthcare costs in the long run, but I won't. I will say that it helps to buy what is in season. More importantly, studies have been done that show diets rich in fruits and vegetables are less expensive than diets rich in junk food. Those studies show that if you Change your buying power from junk food to fresh produce, you actually save money. The problem is that you cannot buy both. You have to decide what is important. I can't do it for you.
One word of caution: this is a lot of fiber. If this is a big change in someone's diet, it can cause some gastrointestinal discomfort. It needs to be paired with an appropriate intake of water! You need to be getting 64-80 ounces of water a day. If not, the fiber can sit in the gastrointestinal tract and cause pain. In rare cases, it can cause obstruction. Please, do not use this as an excuse to avoid fruits and vegetables, just drink the water. You can do it.
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, April 12, 2011
Ceruminosis
Ceruminosis is an interesting word. I like the way it rolls off my tongue. I don't like the way it blocks my ears. Ceruminosis is excessive wax blocking the ears. In some children it comes out of their ears in chunks. In others, it sets up in the ear canal like concrete. Parents sometimes feel it is an arch enemy that must be battled relentlessly until it is completely banished.
That might be a bit harsh.
Ear wax, or cerumen, is present for a purpose. It protects the inside of the ear canal from dryness, dust and other airborne particles. It is important that some ear wax be present at all times. Without wax our ears would itch all the time and even the tiniest dust particle would cause intense pain.
Small, young children seem to have more ear wax than older children. I don't know if that is really true, or if it is just that their ear canals are smaller. This would make the same amount of ear wax appear larger. Either way, parents of small children notice ear wax coming out of their children's ears more so than parents of older children. Please, resist the urge to remove this wax with paper clips, bobby pins or pen caps. These objects may damage the inside of the ear canal, and can even cause permanent hearing loss.
Cotton swabs, such as Q-tips, can actually push wax further back into the ear canal. Yes, a certain amount of wax will be visible on the head of the cotton swab. However, a larger amount tends to be pushed down into the ear canal, creating a firm, large "rock" of wax. These can be very difficult to remove.
So, what's a parent to do? First of all, don't panic. Remember that the wax is supposed to be present. Don't try to remove it. Don't consider it a problem, unless a healthcare provider comments that it is a large amount, or your child complains of pain or decreased hearing. If these things occur, there are several over the counter drops designed to dissolve the wax. These drops melt or dissolve the excess wax, allowing the hairs in the ear to move it out of the ear. Usually, you don't even see the wax leave, as it is moved out in a very thin film. This is a painless procedure, and does not require the ears to be rinsed afterward.
People who have very dry skin will also have dry ear wax. Their ear wax is flaky. These individuals can benefit from oil being placed in the ears on a regular basis, such as once a week. Good choices are Sweet oil or Baby oil. Some people like to warm the oil. If you choose to do this, then I recommend you drip the oil into the ear directly off your fingertip, so that you can be certain it isn't too warm. For small children with excessive amounts of wax, Sweet oil or Baby oil can be used nightly for a week (not warmed, for safety reasons). Have your healthcare provider check the amount of wax in the ears at the beginning and the end of this week. Sometimes, you will need to repeat for another week.
Of course before putting any oil, or anything else, in anyone's ears, it is best to have a healthcare provider check the ears to make sure there isn't some other problem, such as an infection.
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
That might be a bit harsh.
Ear wax, or cerumen, is present for a purpose. It protects the inside of the ear canal from dryness, dust and other airborne particles. It is important that some ear wax be present at all times. Without wax our ears would itch all the time and even the tiniest dust particle would cause intense pain.
Small, young children seem to have more ear wax than older children. I don't know if that is really true, or if it is just that their ear canals are smaller. This would make the same amount of ear wax appear larger. Either way, parents of small children notice ear wax coming out of their children's ears more so than parents of older children. Please, resist the urge to remove this wax with paper clips, bobby pins or pen caps. These objects may damage the inside of the ear canal, and can even cause permanent hearing loss.
Cotton swabs, such as Q-tips, can actually push wax further back into the ear canal. Yes, a certain amount of wax will be visible on the head of the cotton swab. However, a larger amount tends to be pushed down into the ear canal, creating a firm, large "rock" of wax. These can be very difficult to remove.
So, what's a parent to do? First of all, don't panic. Remember that the wax is supposed to be present. Don't try to remove it. Don't consider it a problem, unless a healthcare provider comments that it is a large amount, or your child complains of pain or decreased hearing. If these things occur, there are several over the counter drops designed to dissolve the wax. These drops melt or dissolve the excess wax, allowing the hairs in the ear to move it out of the ear. Usually, you don't even see the wax leave, as it is moved out in a very thin film. This is a painless procedure, and does not require the ears to be rinsed afterward.
People who have very dry skin will also have dry ear wax. Their ear wax is flaky. These individuals can benefit from oil being placed in the ears on a regular basis, such as once a week. Good choices are Sweet oil or Baby oil. Some people like to warm the oil. If you choose to do this, then I recommend you drip the oil into the ear directly off your fingertip, so that you can be certain it isn't too warm. For small children with excessive amounts of wax, Sweet oil or Baby oil can be used nightly for a week (not warmed, for safety reasons). Have your healthcare provider check the amount of wax in the ears at the beginning and the end of this week. Sometimes, you will need to repeat for another week.
Of course before putting any oil, or anything else, in anyone's ears, it is best to have a healthcare provider check the ears to make sure there isn't some other problem, such as an infection.
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
Monday, April 4, 2011
Social Media and Your Family
Recently, the American Academy of Pediatrics (AAP) published a report on social media and it's effects on children and teenagers. Since that time, there has been much talk in the media about "facebook depression." I would like to talk about the entire report, about social media and your children and teenagers, and how to digest this topic. It's a biggie.
The article is titled Clinical Report-The Impact of Social Media on Children, Adolescents and Families by GS O'Keefe and KC Pearson, Ped 2011; 127: 800-804. I will have to plagiarize from it liberally to give it justice. I will try to use quotation marks when I do so.
In the abstract (first paragraph), it states that "any web site that allows social interaction is considered a social media site, including social networking sites such as facebook, My Space, and Twitter; gaming sites and virtual worlds such as Club Penguins, Second Life and the Sims; video sites such as You Tube; and blogs." If it makes you feel any better, I had not heard of some of these sites until I read the article. Also, I immediately flashed back to when my son and his friends taught me how to use You Tube...the second and third time. I felt out of my league just reading that first paragraph.
The second paragraph went a little bit better. The authors reminded me that our children's online lives are an extension of their offline lives.
The article does a nice job of clarifying some of the dangers of social media: "bullying, clique-forming and sexual experimentation," which are also seen offline. It also mentions those dangers specific to the online world: "cyberbullying, privacy issues, sexting, internet addiction and sleep deprivation." It also points out the positives of social media for children and adolescents. It gives a lot of attention to privacy issues, including use of your child's information by ad agencies! There isn't a lot of time spent on facebook depression, considering the media attention it has received. Suffice to say, for children and teens who are prone to depression, spending many hours on facebook may make this worse.
They had some interesting statistics to share. Like, 22% of all kids go to their favorite site 10 times a day, and >50% go to a social media site at least once a day.
They had some nice caveats:
a) "Their online lives are an extension of their offline lives."
b) Know where they go. The site discusses the importance of checking your child's internet history, and if you don't know how to do this, learn.
c) "Don't falsify age to get around restrictions." This refers to age restrictions for signing up your child or teen. Those restrictions are there for a reason. If you falsify this information, you are sending a mixed message about lying. It is very hard to backpedal once you do this.
d) "What is happening online is an extension of underlying issues." This is pretty much a restatement of (a), but geared toward when you find a problem. If you find problem behavior, please bring it to the attention of your pediatrician, so that it can be addressed.
I was a little disappointed that the article didn't say anything about limiting screen time. Perhaps, they felt that the AAP has covered this elsewhere. The AAP Guidelines recommend no more than 2 hours of nonacademic screen time for anyone under 18 years of age. This includes television, all of those social media sites listed above, AND texting. (This news about texting makes my neices very unhappy).
When I was a kid (yes, I'm going to go there) I had a bicycle and a curfew. Now, we have to worry about Nature Deficit Disorder. If you don't know what that is, Google it. Kids don't have curfews anymore. They don't need them, because they are all on social media. We need to break that cycle and get them back outside. If your neighborhood is unsafe, then get them to the Boys and Girls Club or the YMCA. Find a church with an active Youth organization. If you can't find what you want, work with other parents and create something. Your kids are worth it!
Overall, it is a very good article. I would recommend you ask your physician about it.
It concluded with 2 statements of advice:
1. "Talk to them (your children and teens) about their online use."
2. "Become better educated about their online use."
To that, I would add:
3. Limit their nonacademic screen time to 2 hours a day.
4. Help them become more active.
DrNanN
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
The article is titled Clinical Report-The Impact of Social Media on Children, Adolescents and Families by GS O'Keefe and KC Pearson, Ped 2011; 127: 800-804. I will have to plagiarize from it liberally to give it justice. I will try to use quotation marks when I do so.
In the abstract (first paragraph), it states that "any web site that allows social interaction is considered a social media site, including social networking sites such as facebook, My Space, and Twitter; gaming sites and virtual worlds such as Club Penguins, Second Life and the Sims; video sites such as You Tube; and blogs." If it makes you feel any better, I had not heard of some of these sites until I read the article. Also, I immediately flashed back to when my son and his friends taught me how to use You Tube...the second and third time. I felt out of my league just reading that first paragraph.
The second paragraph went a little bit better. The authors reminded me that our children's online lives are an extension of their offline lives.
The article does a nice job of clarifying some of the dangers of social media: "bullying, clique-forming and sexual experimentation," which are also seen offline. It also mentions those dangers specific to the online world: "cyberbullying, privacy issues, sexting, internet addiction and sleep deprivation." It also points out the positives of social media for children and adolescents. It gives a lot of attention to privacy issues, including use of your child's information by ad agencies! There isn't a lot of time spent on facebook depression, considering the media attention it has received. Suffice to say, for children and teens who are prone to depression, spending many hours on facebook may make this worse.
They had some interesting statistics to share. Like, 22% of all kids go to their favorite site 10 times a day, and >50% go to a social media site at least once a day.
They had some nice caveats:
a) "Their online lives are an extension of their offline lives."
b) Know where they go. The site discusses the importance of checking your child's internet history, and if you don't know how to do this, learn.
c) "Don't falsify age to get around restrictions." This refers to age restrictions for signing up your child or teen. Those restrictions are there for a reason. If you falsify this information, you are sending a mixed message about lying. It is very hard to backpedal once you do this.
d) "What is happening online is an extension of underlying issues." This is pretty much a restatement of (a), but geared toward when you find a problem. If you find problem behavior, please bring it to the attention of your pediatrician, so that it can be addressed.
I was a little disappointed that the article didn't say anything about limiting screen time. Perhaps, they felt that the AAP has covered this elsewhere. The AAP Guidelines recommend no more than 2 hours of nonacademic screen time for anyone under 18 years of age. This includes television, all of those social media sites listed above, AND texting. (This news about texting makes my neices very unhappy).
When I was a kid (yes, I'm going to go there) I had a bicycle and a curfew. Now, we have to worry about Nature Deficit Disorder. If you don't know what that is, Google it. Kids don't have curfews anymore. They don't need them, because they are all on social media. We need to break that cycle and get them back outside. If your neighborhood is unsafe, then get them to the Boys and Girls Club or the YMCA. Find a church with an active Youth organization. If you can't find what you want, work with other parents and create something. Your kids are worth it!
Overall, it is a very good article. I would recommend you ask your physician about it.
It concluded with 2 statements of advice:
1. "Talk to them (your children and teens) about their online use."
2. "Become better educated about their online use."
To that, I would add:
3. Limit their nonacademic screen time to 2 hours a day.
4. Help them become more active.
DrNanN
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
http://PersonalMedicine.com
Thursday, March 24, 2011
Vomiting and Diarrhea
It's flu season. When people talk about flu, they can be talking about either stomach flu or respiratory flu. Today, I'd like to discuss stomach flu. This is also known as gastroenteritis, or sometimes just enteritis. It is characterized by vomiting, diarrhea or both. It can sometimes be associated with fever, abdominal pain or cramping, but not always. Stomach flu in adults typically lasts 1-2 days. However, in children and teens, it frequently lasts 5-7 days. For this reason, I'd like to talk about what you can do to make your child more comfortable when this occurs.
Usually, the vomiting starts first. As parents, our natural tendency is to withold food and drink from a child who is vomiting. Nothing in, nothing out, right? Unfortunately, that's just not the case. Children can continue to vomit and have diarrhea for several days, even if they are not eating or drinking. Therefore, experts currently say to go ahead and try to feed your child through this phase, if possible. However, sometimes they just won't keep anything down. Or, whatever they take in comes right out the other end. When that happens, we have to try other measures.
I tell parents to give clear liquids for 24 hours, then a BRAT diet (which will be explained in detail) for the next 24 hours, then a bland diet for the next 4-5 days. Theses children should have no fried foods, no spicy foods and no dairy, except for yogurt with active cultures, for 1 week. This is the overview. The devil is in the details.
The first 24-48 hours is the hardest part. The clear liquids need to be given frequently and in small amounts. It is labor intensive and thankless. Not all clear liquids are good choices. For example, water doesn't seem to stay down well in most children. Clear soda or ginger ale works much better. Dark soda can also be given (but is not a first choice, it doesn't stay down as well), and the soda does not need to be flat or room temperature for most children. However, any child can be an exception. Soda provides sugar, which these children need, as they are not eating. Soup broth is another good choice. It provides potassium, an important electrolyte. Clear juices, such as white grape juice can also be given. Avoid apple and pear juice. The sugar in these juices is not well absorbed and can cause increased diarrhea. Gelatin that has not solidified is used by many people, and that's fine. Just keep in mind that it may change the color of your child's stools. Also, remember that if you cannot read through the liquid, it is not a clear liquid.
When you start your child on clear liquids, the amount and timing can be very important. I recommend 1 tablespoon (T) every 15 minutes for the first hour; 2T (1 oz) every 15 minutes for the second hour; 3T every 15-20 minutes the third hour, and 4T (2 oz) every 30 minutes the fourth hour. I don't recommend going over 2 oz at a time the first day. Keep in mind that this is not likely to go smoothly. Your child will most likely vomit long before you get to the fourth hour. When this happens, stop, wait 1-2 hours and start over at 1 tablespoon.
Your child is not going to be happy when you are restricting their fluids. They are probably going to throw temper tantrums and push your buttons. Try to remember that they would be much less happy if they were vomiting constantly. The second day, you can start them on a BRAT diet. You can do this even if the vomiting hasn't stopped completely. BRAT isn't a reflection on your child. It stands for Bananas, Rice, Applesauce, Toast and crackers. These are bland foods that are unlikely to trigger vomiting, but also bind up the stool and slow down diarrhea. Offer these foods in small amounts frequently throughout the day. If your child doesn't like all of these foods, then just offer the ones he or she likes. Hopefully, they will like some of them.
Over the next several days, add in more bland foods. Adding protein will help your child recover faster. As stated above, avoid fried foods, spicy foods and dairy for one week. The exception to that is yogurt with active cultures. Keep in mind that chicken nuggets are fried before they are frozen and placed in the freezer section.
If you are one of the lucky parents who is able to feed their child through the initial stages of stomach flu, start with the BRAT diet. Then add bland foods slowly over the next several days. You will still need to avoid fried foods, spicy foods and dairy, except for yogurt. Other comfort measures include comfortable clothing for the fever and warm baths for the abdominal pain and cramping.
Call your physician for vomiting that shoots 5' across the room, or for vomiting that is green or contains blood. If the vomit contains little particles that look like coffee grounds, that could be dried blood. That is another reason to contact your physician. Always call for abdominal pain that is limited to the right lower side of the abdomen, as this may be a sign of appendicitis. Consider talking to your healthcare provider in advance, as they may have specific guidelines for how soon to call based on your child's age, urine output and underlying conditions.
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
Usually, the vomiting starts first. As parents, our natural tendency is to withold food and drink from a child who is vomiting. Nothing in, nothing out, right? Unfortunately, that's just not the case. Children can continue to vomit and have diarrhea for several days, even if they are not eating or drinking. Therefore, experts currently say to go ahead and try to feed your child through this phase, if possible. However, sometimes they just won't keep anything down. Or, whatever they take in comes right out the other end. When that happens, we have to try other measures.
I tell parents to give clear liquids for 24 hours, then a BRAT diet (which will be explained in detail) for the next 24 hours, then a bland diet for the next 4-5 days. Theses children should have no fried foods, no spicy foods and no dairy, except for yogurt with active cultures, for 1 week. This is the overview. The devil is in the details.
The first 24-48 hours is the hardest part. The clear liquids need to be given frequently and in small amounts. It is labor intensive and thankless. Not all clear liquids are good choices. For example, water doesn't seem to stay down well in most children. Clear soda or ginger ale works much better. Dark soda can also be given (but is not a first choice, it doesn't stay down as well), and the soda does not need to be flat or room temperature for most children. However, any child can be an exception. Soda provides sugar, which these children need, as they are not eating. Soup broth is another good choice. It provides potassium, an important electrolyte. Clear juices, such as white grape juice can also be given. Avoid apple and pear juice. The sugar in these juices is not well absorbed and can cause increased diarrhea. Gelatin that has not solidified is used by many people, and that's fine. Just keep in mind that it may change the color of your child's stools. Also, remember that if you cannot read through the liquid, it is not a clear liquid.
When you start your child on clear liquids, the amount and timing can be very important. I recommend 1 tablespoon (T) every 15 minutes for the first hour; 2T (1 oz) every 15 minutes for the second hour; 3T every 15-20 minutes the third hour, and 4T (2 oz) every 30 minutes the fourth hour. I don't recommend going over 2 oz at a time the first day. Keep in mind that this is not likely to go smoothly. Your child will most likely vomit long before you get to the fourth hour. When this happens, stop, wait 1-2 hours and start over at 1 tablespoon.
Your child is not going to be happy when you are restricting their fluids. They are probably going to throw temper tantrums and push your buttons. Try to remember that they would be much less happy if they were vomiting constantly. The second day, you can start them on a BRAT diet. You can do this even if the vomiting hasn't stopped completely. BRAT isn't a reflection on your child. It stands for Bananas, Rice, Applesauce, Toast and crackers. These are bland foods that are unlikely to trigger vomiting, but also bind up the stool and slow down diarrhea. Offer these foods in small amounts frequently throughout the day. If your child doesn't like all of these foods, then just offer the ones he or she likes. Hopefully, they will like some of them.
Over the next several days, add in more bland foods. Adding protein will help your child recover faster. As stated above, avoid fried foods, spicy foods and dairy for one week. The exception to that is yogurt with active cultures. Keep in mind that chicken nuggets are fried before they are frozen and placed in the freezer section.
If you are one of the lucky parents who is able to feed their child through the initial stages of stomach flu, start with the BRAT diet. Then add bland foods slowly over the next several days. You will still need to avoid fried foods, spicy foods and dairy, except for yogurt. Other comfort measures include comfortable clothing for the fever and warm baths for the abdominal pain and cramping.
Call your physician for vomiting that shoots 5' across the room, or for vomiting that is green or contains blood. If the vomit contains little particles that look like coffee grounds, that could be dried blood. That is another reason to contact your physician. Always call for abdominal pain that is limited to the right lower side of the abdomen, as this may be a sign of appendicitis. Consider talking to your healthcare provider in advance, as they may have specific guidelines for how soon to call based on your child's age, urine output and underlying conditions.
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
Sunday, March 13, 2011
Fever
I hear a lot of concerns from families about fevers in children. Fortunately, most of these concerns are not based in fact and can easily be alleved with a little education. For example, fever does not make your child's brain melt and come out their ears. It does not cause deafness and rarely causes other neurologic problems. Children do not die from fever and fevers do not cause mental retardation. (However, infection can cause both death and mental retardation in exreme and rare cases. I don't want to dismiss these concerns, but I do want to try to put them in perspective).
Parents worry that certain infections are associated with high fevers. This is true. Fortunately, most high fevers are associated with harmless viral illnesses that are shortlived. Occasionally a high fever can be a sign of a more serious infection. Because of this, it is important to have your child see a physician for any fever lasting more than 3 days, or fever associated with other worrisome symptoms. So, what constitutes worrisome symptoms? How about a mucousy cough, shortness of breath, hallucinations, severe headache or unexplained pain. If your child has any other symptom that really worries you, contact your physician.
It is important to note that certain antibiotics, especially at high doses, can cause deafness. High fevers used to be routinely treated with high doses of antibiotics. These doses are no longer used, and some of these antibiotics are no longer even available. I mention this primarily for historical reasons. Some of you may have older relatives who know someone who experienced this during their childhood. Very young infants, such as those under 2 months of age, can still be susceptible to hearing loss. If you have a young infant under 2 months of age who is treated with several days of intravenous antibiotics, your physician may recommend testing for hearing loss.
Here are a few other things we know. Fever is one of your body's defense mechanisms. It helps fight infections. Therefore, when your child develops a fever, it is a sign that they have an infection or inflammation, usually infection. The fever is going to help fight infection, and should be allowed to do so. There is now evidence that shows that children get over an infection faster if we do not treat their fever. Therefore, as parents and health care providers, we should not be treating fevers with acetominophen or ibuprofen on a routine basis. We should reserve these medications for fevers that are over 103 degrees farenheit, or fevers that last more than a couple of days.
The exception to this is fever in a child with a history of febrile seizure. A febrile seizure is a specific type of seizure that is not part of a seizure disorder. It is not harmful. It is simply that child's way of bringing down their body temperature.
I receive many calls during the night about what dose of acetaminophen or ibuprofen to give a child. This is especially true for children under the age of 2. Why, you ask? Because the dose for older children is available on the bottle. Therefore, parents of children under 2 years of age have no guideline concerning dosage. A general rule of thumb is to give 1 tsp of children's strength ibuprofen or acetaminophen for every 10kg or 22lbs of body weight. (See below). Acetaminophen is to be given every 3-4 hours, while ibuprofen needs to be given only every 6-8 hours. Acetaminophen is still one of the leading causes of poisoning in children in this country. For that reason, I suggest that you not keep several types or concentrations around the house if you don't need them. Also, consider getting rid of the "Infant Concentrate" once your child can take medications from a spoon or medicine cup. When using an Infant Concentrate, always measure it with the dropper provided with that particular bottle and no other dropper.
If you are treating your child's fever, and it is not responding to either acetaminophen or ibuprofen, there are other measures you can take. Some people alternate the two medications. If you are going to do this, please speak with your physician first. You may also use a tepid, or lukewarm bath. Your child should be placed in this bath for 30-45 minutes. Placing the child in the bath for less than 30 minutes will bring down the temperature of the skin, but will not bring down their core temperature. Sponge baths are ineffective for the same reason.
If, despite these measures, your child continues to have a fever for 3 or more days, please contact your Personal Medicine provider. Call sooner if your child is having additional problems.
Dosing:
Never give any medication to children under 8 weeks of age without your doctor's permission.
0-6lbs: Contact your physician.
6-11lbs: 1/2 droppers of Acetaminophen Infant Drops or 1/3
dropper Ibuprofen Infant Drops.
11-17lbs: 1/2 tsp of Acetaminophen or Ibuprofen. 1 dropper Acetaminophen Infant Drops. 2/3 dropper
Ibuprofen Infant Drops.
17-22lbs: 3/4 tsp of Acetaminophen or Ibuprofen. 1 1/2 droppers of Acetaminophen Infant Drops. 1
dropper Ibuprofen Infant Drops.
22-33lbs: 1 tsp of either Acetaminophen or Ibuprofen. May also use 2 Acetaminophen 80mg tablet, one
160mg tablet, 2 Ibuprofen 50mg tablets or one 100mg tablet.
33-44lbs: 1 1/2 tsp of either Acetaminophen or Ibuprofen. May also use 3 80mg Acetaminophen or 3
50mg Ibuprofen.
44-55lbs: 2 tsp of Acetaminophen or Ibuprofen. May also use 4 Acetaminophen 80mg tablets, two 160mg
tablets, 4 Ibuprofen 50mg tablets or two 100mg tablets.
55-66lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 5 Acetaminophen 80mg tablets or
five 50mg Ibuprofen.
66-77lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 3 Acetaminophen 160mg tablets or 3
100mg tablets of Ibuprofen.
77-88lbs: 3 tsp of Acetaminophen or Ibuprofen. May also use 4 tablets of 100mg Ibuprofen, or two (adult)
200mg Ibuprofen.
88-100lbs: 3 1/2 tsp of Acetaminophen or Ibuprofen.
Over 100lbs: Use adult doses.
Please note these doses are only a guideline, and that your personal physician may recommend somewhat different doses. However, these guidelines should be helpful in those "middle of the night" instances when you may feel hesitant to call your physician.
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
Parents worry that certain infections are associated with high fevers. This is true. Fortunately, most high fevers are associated with harmless viral illnesses that are shortlived. Occasionally a high fever can be a sign of a more serious infection. Because of this, it is important to have your child see a physician for any fever lasting more than 3 days, or fever associated with other worrisome symptoms. So, what constitutes worrisome symptoms? How about a mucousy cough, shortness of breath, hallucinations, severe headache or unexplained pain. If your child has any other symptom that really worries you, contact your physician.
It is important to note that certain antibiotics, especially at high doses, can cause deafness. High fevers used to be routinely treated with high doses of antibiotics. These doses are no longer used, and some of these antibiotics are no longer even available. I mention this primarily for historical reasons. Some of you may have older relatives who know someone who experienced this during their childhood. Very young infants, such as those under 2 months of age, can still be susceptible to hearing loss. If you have a young infant under 2 months of age who is treated with several days of intravenous antibiotics, your physician may recommend testing for hearing loss.
Here are a few other things we know. Fever is one of your body's defense mechanisms. It helps fight infections. Therefore, when your child develops a fever, it is a sign that they have an infection or inflammation, usually infection. The fever is going to help fight infection, and should be allowed to do so. There is now evidence that shows that children get over an infection faster if we do not treat their fever. Therefore, as parents and health care providers, we should not be treating fevers with acetominophen or ibuprofen on a routine basis. We should reserve these medications for fevers that are over 103 degrees farenheit, or fevers that last more than a couple of days.
The exception to this is fever in a child with a history of febrile seizure. A febrile seizure is a specific type of seizure that is not part of a seizure disorder. It is not harmful. It is simply that child's way of bringing down their body temperature.
I receive many calls during the night about what dose of acetaminophen or ibuprofen to give a child. This is especially true for children under the age of 2. Why, you ask? Because the dose for older children is available on the bottle. Therefore, parents of children under 2 years of age have no guideline concerning dosage. A general rule of thumb is to give 1 tsp of children's strength ibuprofen or acetaminophen for every 10kg or 22lbs of body weight. (See below). Acetaminophen is to be given every 3-4 hours, while ibuprofen needs to be given only every 6-8 hours. Acetaminophen is still one of the leading causes of poisoning in children in this country. For that reason, I suggest that you not keep several types or concentrations around the house if you don't need them. Also, consider getting rid of the "Infant Concentrate" once your child can take medications from a spoon or medicine cup. When using an Infant Concentrate, always measure it with the dropper provided with that particular bottle and no other dropper.
If you are treating your child's fever, and it is not responding to either acetaminophen or ibuprofen, there are other measures you can take. Some people alternate the two medications. If you are going to do this, please speak with your physician first. You may also use a tepid, or lukewarm bath. Your child should be placed in this bath for 30-45 minutes. Placing the child in the bath for less than 30 minutes will bring down the temperature of the skin, but will not bring down their core temperature. Sponge baths are ineffective for the same reason.
If, despite these measures, your child continues to have a fever for 3 or more days, please contact your Personal Medicine provider. Call sooner if your child is having additional problems.
Dosing:
Never give any medication to children under 8 weeks of age without your doctor's permission.
0-6lbs: Contact your physician.
6-11lbs: 1/2 droppers of Acetaminophen Infant Drops or 1/3
dropper Ibuprofen Infant Drops.
11-17lbs: 1/2 tsp of Acetaminophen or Ibuprofen. 1 dropper Acetaminophen Infant Drops. 2/3 dropper
Ibuprofen Infant Drops.
17-22lbs: 3/4 tsp of Acetaminophen or Ibuprofen. 1 1/2 droppers of Acetaminophen Infant Drops. 1
dropper Ibuprofen Infant Drops.
22-33lbs: 1 tsp of either Acetaminophen or Ibuprofen. May also use 2 Acetaminophen 80mg tablet, one
160mg tablet, 2 Ibuprofen 50mg tablets or one 100mg tablet.
33-44lbs: 1 1/2 tsp of either Acetaminophen or Ibuprofen. May also use 3 80mg Acetaminophen or 3
50mg Ibuprofen.
44-55lbs: 2 tsp of Acetaminophen or Ibuprofen. May also use 4 Acetaminophen 80mg tablets, two 160mg
tablets, 4 Ibuprofen 50mg tablets or two 100mg tablets.
55-66lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 5 Acetaminophen 80mg tablets or
five 50mg Ibuprofen.
66-77lbs: 2 1/2 tsp of Acetaminophen or Ibuprofen. May also use 3 Acetaminophen 160mg tablets or 3
100mg tablets of Ibuprofen.
77-88lbs: 3 tsp of Acetaminophen or Ibuprofen. May also use 4 tablets of 100mg Ibuprofen, or two (adult)
200mg Ibuprofen.
88-100lbs: 3 1/2 tsp of Acetaminophen or Ibuprofen.
Over 100lbs: Use adult doses.
Please note these doses are only a guideline, and that your personal physician may recommend somewhat different doses. However, these guidelines should be helpful in those "middle of the night" instances when you may feel hesitant to call your physician.
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
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