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
Tuesday, June 28, 2011
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
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