Thursday, December 27, 2012

Top 10 Posts

photo source: Shutterstock
There are many Top 10 lists at the end of the year. Since I've been running low on blog ideas and short on time with the holidays, I thought I'd do my Top 10 blog posts.

What started as a quick project has sent me down memory lane, since most posts are triggered by an event (or series of events) that make me want to write about the topic. I'm adding a bonus #11 because it is one of my favorites and I am feeling nostalgic.

11. Potty Training is one of my most personal blogs, describing my own potty training parent moments. Sorry kids!

10. Walk In Clinic Etiquette was written in part because of my frustration of the many options of urgent cares, some with good treatment, others with less than ideal treatment. It also highlights some of the issues our walk in clinic providers deal with regularly.

9. Fever is... one of the biggest worries of parents. There are so many real fears but also a lot of exaggerated fear. My attempt to set the record straight.

8. Cut the cord... Give them the World! My thoughts on parenting to allow kids to grow to be independent and productive adults.

7. Parenting when you're angry: Keep Cool We've all been there.

6. Oh, what a (sick) season! This is one of my newest posts. Tips on what to do if your family gets what's going around are still pertinent.

5. Itchy Bottom? Is it Pinworms? What to do? We had a number of pinworm calls from worried parents and I wanted to help our phone nurses out since the treatment options are confusing to parents.

4. Got Milk? Cow, Coconut, Soy, or Almond? Questions on milk alternatives are common for kids with dairy allergy or family preference.

3. Ear Wax: Both Good and Bad Ear wax is another common frustration to parents. When to leave it and when (and how) it should be removed are discussed.

2. Car Seat Confusion and Booster Boo Boos I love that this has been so widely read. It is such an important topic. Please share this one!

1. New Guidelines for Treatment of Strep Throat This surprised me as the most read post. I'm glad people are interested in reading things like this. I hope it decreases the demand for unnecessary antibiotics and educates people about why we do some of what we do in medicine.

One final "bonus" blog update. Pediatric Partners joined Team Mighty Maxwell (March for Babies) in support of Dr. Ratliff's son. Max remains at Children's Mercy. He continues to require help breathing with a ventilator but his doctors are trying to slowly decrease the amount of help he needs. He has had surgeries to help reduce pressure in his eyes and is seeming to be happier overall. For more updates, check out his CaringBridge page.

Tuesday, December 18, 2012

Oh, what a (sick) season!

photo source: Shutterstock
This cold and flu season has started early and hit hard! The number of kids we are seeing with severe illness, such as prolonged fevers (over 5 days over 101.5F) and difficulty breathing, are not typical for this time of year. On more than one occasion we have tried to admit a sick child, only to be told there are no available beds. While we are familiar with this in January, this started in November and is more common this month. I feel the need to review a few helpful tips.

What are we seeing right now? A bit of everything. Fever. Vomiting. Diarrhea. Strep throat. Influenza (fever, cough, sore throat, body aches). Bronchiolitis (from RSV and other viruses). Pneumonias. Asthma flare ups. Sore throats from viruses. Whooping cough. Mild colds and coughs. Basically, if you ask if it's going around, chances are the answer right now is "yes".

Wash hands and surfaces! First and foremost is control of spreading infection. You never know when someone is shedding a virus before they feel sick. If you are taking care of sick kids, you are at risk of getting sick along with them. Wash hands and surfaces often. Don't share food and drinks, even with your family! Avoid touching the eyes, nose, and mouth. These are where germs enter to make you sick! When's the last time you cleaned your phones and keyboards?

Fever can be a good thing. We worry in infants under 3 months, those who are immune compromised, or those that are not up to date on vaccines ~ they should always have a medical exam with fevers. If a fever lasts longer than 3-5 days kids should also be seen. For everyone else, we treat symptoms, not the thermometer. If a child is playful at 101F, no need to treat other than pushing fluids and watching carefully. Usually by 102F kids start feeling body aches and feel better with treatment. Watch your child's symptoms, don't worry about the actual degree on the thermometer. Use either acetaminophen or ibuprofen, but most pediatricians don't recommend alternating. Follow dosing charts for weight, and if weight is not known, use age. For dosing charts, see our Medication Dosing page.

Stay home if sick. Again, this is paramount for controlling the spread of all the germs. Don't try to mask symptoms with a fever reducer so you can send kids to school or you can go to work. Stay home and rest!

Never underestimate the power of water. If there is vomiting, an electrolyte drink in small volumes frequently is best. For most colds and coughs, simply drink more water. If there is congestion, runny nose, or cough, add water to the air with a vaporizer or humidifier while you sleep. Even if you have a home humidifier, using an additional one in the bedroom helps. Use saline in the nose. Drops are okay for infants. Older children and adults can learn to flush the nose with saline. Check out Nasopure for tips on learning how to do this and videos to see that it's not as bad as it sounds. (I am not associated with or paid by Nasopure. I just like their product.)

Antibiotics don't make viruses go away any faster. Please don't ask for a prescription if cold and cough symptoms just started within the past 10 days. Unless there is an identified infection requiring antibiotics, they won't help. Even some things we often treat with antibiotics don't need them. Many ear infections and sinus infections are viral and will resolve without antibiotics. At your office visit ask about the need for antibiotics if your child has one of these infections.

We cannot make any diagnosis over the phone. As descriptive as you are on the phone, there is no substitute for examining a child. I encourage people to go to their medical home as often as possible and use other urgent care centers or emergency rooms for true urgent/emergent needs. Going to the same office for sick visits helps to track infection rates to identify kids who might need another treatment, such as ear tubes for frequent ear infections. Even if you get good care elsewhere, it is hard to keep track of dates they were sick and which medicines were used. With most pediatricians open extended hours these days, it is usually possible to be seen by someone you know and trust in a familiar setting.

Some illnesses need multiple visits. I know this is time consuming (and expensive with many insurance plans) but illnesses progress, symptoms change, and exams change. Just because your child was seen a day or two ago and it was "just a cold" doesn't mean it won't progress into an ear infection, pneumonia, or dehydration over time. Unless your child is really sick, you don't need to bring them in at the first sign of a runny nose or fever. Try home therapies first. Coming in early doesn't stop the progression of illness. Preventative antibiotics are not recommended, even if your child has a history of frequent ear infections.

We are in the middle of a whooping cough epidemic. Unfortunately whooping cough can mimic mild colds at the beginning, but the cough can last for several months if not treated in the first couple weeks. A small percentage of people who have been vaccinated still develop whooping cough, though it may be milder it is still contagious. If you child has been exposed to whooping cough and develops any cough, visit your doctor for evaluation and treatment. If your child develops a cough that is followed by a whoop or a cough followed by vomiting, he or she should be evaluated for whooping cough. Be sure kids and all care givers are up to date on vaccine. Typical pertussis vaccine is given at 2, 4, 6, and 12-18 months, 4-6 years, and 11 years. If not given at 11-12 years of age, the Tdap should be given to all teens/adults once. Get vaccinated!

Our influenza season has started earlier than usual and is predicted to be a bad season. Flu vaccines are the best prevention against influenza, so yearly vaccination for all over 6 months of age is recommended. We gave more influenza vaccine than ever in our office this season, but we are out of stock. If your family has not been vaccinated, check with your health department and other locations offering flu vaccines.

If you need information on treating specific illnesses, use our tips on Illnesses and Symptoms, but please see someone at your usual physician's office as well if you are concerned. 

Sunday, December 16, 2012

Violence... I think parents can help prevent from home

Source: Shutterstock
I, like most of you, am horrified by the event's of last week's shooting. I have read countless articles in the aftermath about talking with kids, safety in schools, gun control, and even mental health services needing to improve.

I keep wondering if there is something each parent can do at home to help the future.

Violence in the media is constant. It is becoming more graphic and violent. Children do not have the ability to separate fantasy and reality, which makes them more vulnerable to altering behaviors depending on what they are exposed to. Until the last part of our brain matures during adulthood, we have not fully developed self control, emotional regulation, and judgement. So for those of you who think your children or teens are mature, they are still developing important parts of their brain!

If we limit exposure to violence, would it help prevent violence? If children are exposed to less violence at home and in the media, can we cultivate a society of people who can work through conflict in a civil manner?  It's been shown in study after study that violence exposure leads to violent behaviors. What about the opposite? Model positive behaviors and limit negative exposures to encourage healthy development of behaviors.

Research shows that the more violent video games kids play, the more violent they become. Very young children exposed to aggressive acts on television will be more aggressive with their play. There is even long term effects from early exposures. A study showed that men who were high TV violence viewers as children were significantly more likely to be physically aggressive with their spouse and to be convicted of a crime at three times the risk of other men. Women with high TV violence exposures as children were four times as likely as other women to be physically violent.

Parents: you can't "take back" early exposures. Don't wait until you are worried about your child/teen's behavior. Prevent it!

Some limits to violence are more difficult to enforce than others.

If kids live in violent homes, they are vulnerable on many levels. Recognizing these at risk kids and helping their situation improve or remove them from the situation is very difficult. There are free online resources to help (use a safe computer if you are at risk!) Even if you are not in an abusive situation, learn to recognize signs that someone is. You could save a life! SafeHome provides education and assistance for those in need in the Kansas City area.  The Hotline is a nationwide hotline that also has educational information on its website. 
When our children are at other homes, we don't always know the parenting styles or supervision as we do at home. Get to know the parents of your children's friends. Let them know your expectations of what your child can/cannot watch or play. Talk to your children and teens about what they do elsewhere. 

Easier fixes involve the media. (Note: I didn't say easy. I said easier.)

Remove the televisions and other electronics from bedrooms. They cut down on sleep (sleep deprivation adds to poor decision making and behaviors) and allow private, unsupervised viewing. 
Parents should screen what their children watch and play for age appropriateness. I have heard many parents say something to the effect of "He's always been around shows like this, and is not scared. He loves to watch them." Why is he not scared, if his age would typically be scared? Is he already desensitized? That scares me. Check out free on-line reviews from a reputable site, such as Common Sense Media, before deciding if something is appropriate for your child. Choose appropriate times that do not allow younger children to be exposed.
Listen to the music your children and teens enjoy and check out their reviews on Common Sense Media. Many songs promote partner violence, fighting, and sexual violence. Songs have a way of getting into our head. Fill their brains with healthy lyrics, not brainwashing songs that promote any form of dangerous behaviors!
Set maximum times children and teens may have screen time. The American Academy of Pediatrics suggests no more than 10 hours per week for children over 2 years of age. No screen time is recommended for children under 2 years. Remember that screen time includes television, movies, video games, social media, and all other things on a screen. 
Learn the technologies your children are using. If your child or teen is playing online, you need to learn how to set parental controls and monitor what has happened on line.

I am not advocating that families should never enjoy an age- appropriate movie or video game. We actually went to see The Hobbit last night. Although it is PG-13, I read reviews and decided that it was appropriate for my 11 year old. She has a strong sense of reality vs fantasy and was able to sit through the show without being scared at all. (She felt it was "boring" and too long.) It wouldn't be good for all 11 year olds though, and I don't think I would have taken her much younger. Point: parents must know their child, have the facts, and make educated decisions. Don't just say "yes" because it's easy!

And finally, the best parent is an active parent. Participate in activities with your children. Build up their self confidence. Talk to them about what's on their mind. Show them you care. Set limits and stick to them. Give healthy physical contact (hugs, high five, back pat, tickles) often, no matter how old they are, unless it makes them uncomfortable. Tell them you love them. Be their rock.  


"Impact of Media Violence Tips." Reviews and Ratings for Family Movies, TV Shows, Websites, Video Games, Books and Music. N.p., n.d. Web. 16 Dec. 2012.

"The Teenage Brain-- Why Do Teenagers Think Differently than Adults?" The Teenage Brain-- Why Do Teenagers Think Differently than Adults? N.p., n.d. Web. 16 Dec. 2012.

"Childhood Exposure To Media Violence Predicts Young Adult Aggressive Behavior, According To A New 15-Year Study." Childhood Exposure To Media Violence Predicts Young Adult Aggressive Behavior, According To A New 15-Year Study. N.p., n.d. Web. 16 Dec. 2012.

"The Impact of Media Violence on Children and Adolescents: Opportunities for Clinical Interventions | American Academy of Child & Adolescent Psychiatry." The Impact of Media Violence on Children and Adolescents: Opportunities for Clinical Interventions | American Academy of Child & Adolescent Psychiatry. N.p., n.d. Web. 16 Dec. 2012.

"Media Violence." Media Violence. N.p., n.d. Web. 16 Dec. 2012.

Tuesday, December 4, 2012

Stepping outside my comfort zone

Getting ready to start in our party scene!
This past week I was on vacation from my day job to be an active parent.

Sometimes we need that.

I really had to step outside of my comfort zone for this parenting act -- being in the cast of Clara's Dream (a version of The Nutcracker).  Parents often do things we never thought we would for our kids.  We intentionally put our nose to a probably dirty diaper to be sure it needs to be changed. We forego sleep to take care of kids. We take care of their needs before our own routinely.  They change us in many ways for the better.

For years my daughter has loved to perform on stage for theater and dance. She has asked on several occasions for me to audition for "family shows" where they allow parents of students to be in the cast. Each time she has asked, I answered with a firm "No".  I have never acted or danced. I prefer one-on-one conversations, not large groups - and definitely not the stage!

Several months ago she asked and I actually considered it. I had already requested vacation for that week due to show week always getting crazy with time constraints. Rehearsals were later in the evenings, so they wouldn't interfere with work. As I thought about it, I considered the joy of being an active part of her favorite activity and put away my fears of being on stage.  (Of course the fear returned each time we were called backstage to line up for the scene- but it was too late to turn back then!) It was an act of faith because I had never seen the show and knew little about what I was signing up to do.  I figured parents would mostly be "background" people and didn't realize we would learn dance steps and actually be a part of the scene. No, I didn't have to do ballet - just a Victorian ballroom style dance.

It was fun to be a part of my daughter's life in a way that will always have a special memory. Call it working mom guilt, but I want to make special memories in addition to daily quality time.  Quality time is not spent watching tv with kids, but doing things together.  Some things are small, like taking a walk or playing a game. Some things are more memorable because they are unique.

Not only did I get some great times with my daughter, I also met a number of fun people in the process.  Spending so much time with other parents of dancers was a great bonding experience in itself. And I got to know some of the students and teachers my daughter works with on a regular basis at dance classes.  It is always a good idea to know the people that hang out with the kids!

So when your kids ask you to do something and your first thought is "no way", take a moment to think about it. You might just change your mind and grow with your child!

Bow time... my "German son" is blocking me.
To be in your children’s memories tomorrow, you have to be in their lives today.  – Anonymous