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
Wednesday, May 25, 2011
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
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