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Water in the air helps thin the mucus, so increase the humidity in the bedroom during the dry winter months. Use a humidifier or vaporizer in the bedroom during illnesses even if your home has a humidifier attached to the heater. Humidifiers with a cool mist are safest with young children. Be sure to follow package directions for cleaning and changing the filter. Vaporizers are generally less work to use, but the steam comes out very hot and can burn young children. Again, follow package directions for proper cleaning and use. Allow it to dry out a bit during the day to avoid build up of mold.
Water in the nose in the form of saline can really help. The salt in the saline draws the fluid out of the swollen nasal passageways, decreasing the swelling and opening the airway to allow more mucus to be blown (or sucked) out.
Increase fluids that kids drink. Really push water. And unless a child is allergic to milk, it is an old wive's tale that milk will make the mucus worse. If that's what they want, they can have milk with a cold.
I think what really needs to happen is to get the mucus out. Using saline along with a strong blowing (or suctioning) of the nose is important.
For infants and younger children it can be hard to blow forcefully to get the mucus out. I have been disappointed in the use of a bulb suction because it is very difficult to make a seal and to have enough air to really get a good suction. They tend to cause trauma to the nose because you need to stick it up so high to make a seal. I like nasal aspirators that seal outside the nose and have a continuous flow of air. Check out How to use the Nosefrida. A similar nasal cleaner is available from Nasopure. (Note: I am not tied to either of these companies and do not get any payment from either company.)
For kids over 2 years old, washing the nose is one of the best ways to treat (and prevent) nasal congestion. Check out this video from Nasopure for an easy how to use. (Note: I do not get payment from this company, I simply love the Nasopure company. Not only does the product work well, it is also an all American company. Bottles are made in Kansas City and assembled by disabled adults in Columbia, Missouri.)
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AsthmaAsthma Attack in a child starts with information on asthma, then at 1:50 video of what retractions look like.
Asthma attack shows the typical short breathing in phase with long exhale seen with an asthma attack. Also you can see the airway pulling in at the neck (retractions).
Bronchiolitis, often simply called RSV, but caused by many virusesBronchiolitis Cough, 3.5 months old shows a baby with a wet sounding cough, typical of bronchiolitis.
Bronchiolitis is a video from the ER physician Dr Oller. He reviews causes of bronchiolitis, how it's spread, and how it affects the body. At 1:40 he discusses the natural progression of the simple cold into bronchiolitis. At 3:04 there is a picture of how we collect a nasal swab to help with diagnose of any viral illness.
Sick with Bronchilitis shows an infant with suprasternal retractions (sucking in at the base of the neck) and the typical cough associated with bronchiolitis. The man erroneously says "croupy", see below for croup.
RSV and Infant Treatment shows the best treatment for babies with RSV (or any bronchitis): suctioning. Some babies need this deep suctioning in the doctor's office or hospital. Others can get by with nasal aspirating at home. (Note, the next blog will be about treatments, but I have to say here that the bulb syringe is fairly useless for this.)
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|see the "exit port"|
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|Wash hands to prevent illness!|
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And parents are happy. They "got something" for their visit.
And parents are happy because "something was done" at the visit.
And yes, this does cause less patient satisfaction sometimes because they didn't "get something" for their visit. What they got was an assessment, a diagnosis, a treatment plan of things to do at home to treat symptoms, and instructions on how to monitor for worsening of symptoms. Nothing tangible, but very worthwhile!
My concern is that higher patient satisfaction scores are NOT associated with better care. Conversely, they have been associated with higher healthcare costs, increased prescription drug costs, and even higher mortality. (The Cost of SatisfactionA National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality)Even my patients who have seen me for years might be uncomfortable the first time they leave with a diagnosis of ear infection and are told to NOT use an antibiotic right away. I don't get blood work just because a child started with a fever today. My patient families know me. We've developed a trusted relationship, so they listen to my advice. They learn that it is okay to not do labs or start antibiotics because I take the time to explain what is going on, what is to be expected as things progress, and what to look for if the child's condition worsens. They know how to contact me or the on call provider if needed.
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Send in a letter or secure electronic message with your concerns before the appointment. Be sure it's at least a few days before the appointment so the doctor has a chance to review it!
Schedule a consult appointment for just parents to come in without the child.
Call in advance to tell the phone nurse your concerns so she can pass it on to the physician.
Don't bring siblings to an appointment where you want to discuss a private matter about another child.
All of these means allow the physician (or other provider) to know your concerns without blatantly kicking a child out to talk about something privately.
|photo source: Wikipedia Commons|
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ANTIVIRALS CONTINUE TO BE IMPORTANT IN THE CONTROL OF INFLUENZA.
Treatment should be offered for:
- any child hospitalized with presumed influenza or with severe, complicated or progressive illness attributable to influenza, regardless of influenza immunization status; and
- influenza infection of any severity in children at high risk of complications of influenza.
Treatment should be considered for:
- any otherwise healthy child with influenza infection for whom a decrease in duration of clinical symptoms is felt to be warranted by his or her pediatrician; the greatest impact on outcome will occur if treatment can be initiated within 48 hours of illness onset.
For those of you unfamiliar with the Cochrane group, I need to take a quick sideline. They are a well respected group that reviews all the studies within certain parameters on one topic to evaluate the overall findings of several independent studies.
Results from this study include:
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You will never know exactly when your period will start, but good clues that it is getting close to time:
- It's been about 2 years since your breasts started growing. (Remember those first bumps?)
- There's clear, white, or yellow stuff in your underwear sometimes. It can look like dried boogers or just a little crusty stuff in your underwear, but it's not from being unclean or peeing in your pants. Your body is just getting ready for the full cycle of ovulation (when the egg is released) and the period. Your vagina is moistened with a clear fluid that can drain onto your underwear. Another thing you might notice is mucus is released once a month, about half way between your periods when the egg is released from your ovary once you're on a regular monthly cycle. It often begins before the period starts. As long as there is no pain or funny odor, this discharge is normal. Talk to your doctor if it does smell bad or if you hurt or itch in that area.
- Pimples. Pimples are common with puberty (and for years following). Many girls will notice that the pimples tend to worsen right before their period starts.
Puberty has such a wide range of normal ages so it is common for one girl to go things much sooner than her friends. Puberty is most common between 9 and 16 years of age (though some girls notice breast buds as early as 7 or 8 years old). The common age for a period to start is between 10-15 years old. If you are outside of this normal age range, talk to your doctor about it because there are many reasons. Some can be as simple as your family tree (when did your mom or sisters start?) but some can be a medical issue that can and should be treated.
And the opposite issue: All my friends have had their periods for a long time, but I barely have boobs. When will I start?
Again, there is a wide range of normal (see the question above). Some families have a later puberty than others, so it might just be in your genes. There are other reasons that deserve talking with your doctor about, such as being underweight-- which delays puberty, and other medical issues that need an investigation to uncover a cause that might need to be treated. (That sounds like a mystery book, but your doctor will know what to do!)
Bottom line for early or late puberty:
If you are outside the normal age range, please talk with your doctor. Don't be embarrassed to bring it up! They might either reassure you that things are still okay, or they might help find the reason and get your body the treatment it needs. Some of these can be serious problems, so don't be shy about going to the doctor. This is one reason that a yearly physical exam is especially important until growth is complete -- your doctor can help keep track of a normal growth progression.How much blood will there be, and what does it feel like?
The amount of bleeding varies from day to day, month to month, and person to person. It is common for the first 2 years to have irregular cycles, but many girls can begin to predict their blood flow volume pattern after a few cycles.
Many girls have some pain during their period. The blood flow does not hurt, but as the uterus contracts it can cramp. Like other muscle cramps, there can be pain from period cramps, but the amount of pain varies in different people. Some girls have cramping with every period while others never feel anything. It is easy to take over-the-counter pain relievers (like ibuprofen or naproxen) to relieve pain. Some girls find it helpful to take ibuprofen or naproxen 2-3 times/day (per package directions) starting 3 days before the period is supposed to start to prevent the cramps. Eating healthy foods, getting regular exercise, and sleeping well every night also seem to help. For severe period cramps that keep you from doing what you want (or need) to do, talk to your doctor.What do I do if I start my first period and I don't have any pads around or I'm not at home?
First, don't panic! Remember that ALL women have periods, so it is nothing weird to adult women (or men, for that matter, since they live in a world with women). Ask a teacher, school nurse, friend's mom, aunt, or whoever is around for help. She will not judge you or get freaked out. Really.How long should I wear a pad or tampon?
Pads should be changed if they are visibly full or after 4 hours, whichever is first. (Except overnight.) If left on longer, they start to have a foul odor, and you don't want that!
Tampons should be changed every 2-6 hours, depending on the amount of blood flow you have that day. Tampons come in different sizes for light days, regular days, and heavy days. Don't ever wear a tampon longer than 6 hours because it can allow germs to grow and cause a serious infection. For that reason I don't recommend wearing them overnight.
Once your cycle becomes more regular, you should be able to predict the flow by the day of the period (and time of day, since that often varies too). Use a calendar to track the amount of flow as well as the days of your period until you get it all straight. Either an old fashioned paper calendar or an app designed to track periods can help. (Search for "period calendar" or "menstrual calendar" in your app store if you have a smart phone or tablet.)What do I do with the pad or tampon after it's been used?
Most pads are disposable. You can roll it up, wrap it in a little toilet paper (or the wrap it originally came in) and throw it in the trash can. (Use a single layer, ladies! Don't be wasteful with a wad of TP!)
If you use re-usable pads, they will have to be washed before the next use. Talk to your parent about where to keep them between uses.
Many people flush tampons down the toilet, but that can lead to clogged toilets in many sewage systems. Never flush into a toilet that uses a septic tank. Tampons do not break up like toilet paper does and they will clog a septic tank system. If you aren't sure, you can wrap it in toilet paper and throw it in the trashcan.
Never flush a plastic applicator. You can either put it back in the wrapper or wrap in toilet paper and throw it in the trash.I leaked! Not only am I totally embarrassed that everyone will know, what do I do to clean up my underwear?
When a period first starts, it often comes without warning and underwear can get soiled. Heavy flow days can also cause leakage onto your underwear. If you expect a heavy flow day, you can wear old underwear, prepare with a product designed for heavier flow, and go to the bathroom more often to change the pad or tampon.
Despite the best techniques, all women sometimes soil their underwear and even their outer clothes. If you can change right away, fresh blood is easier to clean than dried blood. (This goes for just about any spill in the kitchen too, so clean up as soon as you spill!)
If you're at school, go to the nurse's office. She can help and it probably won't be the first time a girl has come to her for help-- really! If you're at a friend's house, see if she has something you can borrow if you don't have an emergency change of clothes.
In general, cold water to rinse out blood is better than hot. Because blood is made of proteins that change in heat, the heat can "cook" the blood into the clothing and make the stain permanent. If you have laundry detergent you can put a few drops on the stain and rub it in. If you have a spray or stick stain remover, you can use that. Allow that to soak overnight in some cold water before putting in the regular laundry.
- Carry a clean set of underwear (and pants if needed) in a plastic bag to use in case of emergency.
- Carry a stain stick (they sell these near the laundry detergent) if desired.
- Rinse in cold water as soon as you can.
- Rub stain remover or laundry detergent into the stain and let it soak. Put it in the plastic bag you carry if you aren't home.
- As soon as you get home put the soiled clothes in cold water (rub in more stain remover or laundry detergent as needed). Allow clothing to soak overnight.
- After soaking overnight, rinse in cold water. Repeat a scrub and soak in detergent if needed.
What about when a pad won't work, like swimming or ballet? Am I too young for a tampon?
- Once you don't see the stain any more, you can wash with the rest of your clothes like normal.
Tampons frighten a lot of girls, but they are safe to use as soon as you are comfortable using them. They do not affect your virginity. They simply are a product that will collect the blood inside you so you don't need to wear a pad on the outside. Many girls use one with their first period. Others don't use them at all. It is up to you!How exactly do you get the tampon in?
First, some general anatomy. You need to know what things look like down there. You can use a hand held mirror to look at yourself and compare to this picture. This is a drawing, so you will look a little different, but you should be able to see the basic parts.
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Tampons are inserted directly into the vagina. Much like an absorbent sponge, a tampon will gently swell as it becomes soaked with blood. A string allows for easy removal from the body. Tampons are convenient for swimming or exercising and can be paired with a panty liner - a type of thin pad or a regular pad for extra protection on heavy flow days. When using tampons, women should change them every 4-6 hours.It's time to change the tampon, but I can't find the string. Did it get lost up there somewhere?
First: Don't panic! Your tampon is not lost forever! Sometimes the string can stick to the skin between your labia (labeled labium magus and minus above). You might need to feel around a bit. If there's a mirror nearby, you can use it to look. Sometimes going pee can help the string fall down if it is stuck around the skin somewhere.
If the string really is up in the vagina, you can put your finger into the vagina to see if you can slip the string back out.
If you can't get the tampon out, tell an adult as soon as possible. If they can't help you get it out (or if you don't want them to try) you might have to go to the doctor to have it removed.
NEVER forget about a tampon that has been put in... you could get a serious infection if you leave one in too long.I seem to always get spotting on my underwear when I wear a tampon, but the tampon isn't full of blood yet. Why is that?
There are several reasons I can think of that blood can get on your underwear. The first, of course is the tampon overflows because it was left in too long for the amount of flow you have at that time. But you can tell that when there is no more white showing on the tampon. If it isn't full, there are other reasons to consider.
First, was the blood on your skin when you put the tampon in? If you wipe after putting the tampon in, that can help this issue. Actually, more than wiping, pushing the toilet paper (TP) up towards where the tampon is (with the string out of the way) can show if there's blood in the area. Repeat until the TP is clean. You can also wipe the folds of skin with a flushable wet wipe (sold near the other feminine hygiene products or near the diaper wipes -- same concept: wiping with a wet cloth works better than dry TP for many issues).
Another cause would be if the tampon is not inserted properly. Be sure it is completely in. Signs that it isn't in also include being able to feel it when you walk or sit. If it is in all the way, you should never feel it.
Did you pee or poop with the tampon in? This can move the tampon enough to let blood leak around it. Try changing the tampon (and wipe after placing it) each time you go to the bathroom.
Why do I need to pee so much when I'm on my period?
Many women gain water weight just before their period. (Have you heard women complaining of bloating? That's the water.) Your body's hormone changes cause this slow gain, and they also cause the release of the excess water back out of your body (called diruresis). This increases urine production. Look at it in a positive light: you have to go to the bathroom often, so it reminds you to change your pad or tampon frequently!Can you pee or poop with a tampon in?
Short answer: Yes. But if you do, it is possible to have the tampon shift and cause leakage, especially if you have a bowel movement (poop). If it is too soon to change the tampon and you need to go, you can hold the string to the side so it doesn't get as soiled while you go. Wipe carefully so you don't pull on the string-- you can keep holding it to the side while you wipe too for "safe keeping."My school uniform doesn't have pockets. How can I carry a pad or tampon to the bathroom?
If your uniform is a skirt, you can wear shorts with a pocket underneath. Some girls will be able to wear a tampon with a pad so that when they remove the pad mid-day, they leave the un-soiled pad on for the afternoon. If you're allowed to carry a purse, carry one every day for unexpected first period days and to get in the habit of always having it. You can also talk with your school nurse or a teacher about what other girls do.I track my periods on a calendar, but there doesn't seem to be any pattern. Why aren't they once a month like they should be?
Once a month is more of a phrase than a reality. A typical cycle is about 21 - 35 days from start to start. Bleeding can be as little as 2 days and up to 7 days. The first 2 years after starting a period, many girls are irregular. After those 2 years, it becomes more predictable. You might be different than your friend, but your cycle should be about the same each month after the first 2 years. It does help if you track your cycles on a calendar or online app.
If you are having very heavy bleeding, talk to your doctor because you can be at risk for anemia (too low of blood counts from blood loss). This can sometimes simply be your body adjusting to a period, but it can also be from a treatable condition. Your doctor can help you decide what needs to be done.
The amount of bleeding and how long it lasts varies from person to person. Some days there will be barely any blood (called spotting because it looks like just a spot of blood). Other days are heavier. Bleeding can last between 2-7 days normally. Again, charting it on a calendar or app can help you figure out your pattern.How do I keep from getting stinky?
First, be sure to regularly change your tampon or pad. If it goes without being changed, bacteria start to make a very foul odor. You should change pads or tampons at least every 6 hours (except overnight, when the pad can be left on as long as you sleep). This is important to avoid infections as well as bad smells!
You can use flushable wet wipes instead of toilet paper to help clean the area better. If you need them outside of your home you can carry some in a plastic zip lock bag and keep with your pads or tampons.
There are feminine hygiene products with deodorant available, but who wants to smell flowery? Seriously, I don't recommend these because too many girls have an allergic reaction to them and who wants to have an itchy rash in the place you can't publicly scratch?
Another thing that's important: Wash! Once you go through puberty, your body in general smells more, so it is important to bathe regularly. Don't forget to do a daily wash of all the skin folds between your legs. You can use any soap (avoid fragrances if your skin is sensitive), but be sure to rinse well! Soap that remains between the folds can cause rashes. You can rinse the area by splashing a cup of clean water between your legs a few times. If you have a hand-held shower head available, that makes it easy to rinse the area well. You can also lift a leg so the shower water can rinse between your legs -- but hold on so you don't fall!Do I need to wear protection between periods?
You might want to wear a panty liner when it is getting close to your next period, just in case you start, but it's not necessary.How do I know when the next one will be?
Over time it becomes easier to predict. Keep track of the dates of bleeding as well as how heavy it is and any other symptoms. These can include pimples, cramping, mood swings, tiredness, constipation or diarrhea, back pain, sore breasts, bloating, food cravings, or headaches. All of these symptoms can help predict your cycle. There are several apps available on the computer, smart phones, or tablets, many of which are free. I suggest going to your app store and reading reviews to pick your favorite.How much more will I grow since I started my period?
Growth speeds during the years before your period, then slows after your period. Some girls stop growing all together, but most still grow for the next 1-2 years. Ask adult family members how they grew (if they remember) because growth patterns tend to follow parents and other family members.What is PMS?
Common effects of PMS include: bloating, cramps, fatigue, moodiness, headaches, or pimples. There are over-the-counter medications that can ease these symptoms. Ibuprofen or naproxen tend to work well. If you have severe cramping and you are expecting your period, you can start the ibuprofen or naproxen three days before your symptoms start. This decreases the pain better than starting the medicine when the cramps start. Some girls prefer wearing loose clothing or using warm compresses on their stomach. Mothers can share with their daughters their own tricks for coping.My boobs hurt with my periods. Why is that?
Many girls notice breast tenderness during PMS (Pre Menstrual Syndrome). Your hormones are changing at this time and they can cause the breasts to swell. The swelling causes tenderness. You can help minimize this by eating right, exercising, and getting enough sleep (all month long). Caffeine can worsen it, so avoid things with caffeine.Where can I get more information?