Thursday, April 24, 2014

Screen time: Do you have a love - hate relationship with it?

Screen time. Parents often have a love - hate relationship with it. We've all heard the warnings that it is bad for our kids, but we've experienced the benefits of it keeping our kids occupied while we get things done. And some programs and games have an educational component -- do we group those in the same category as purely entertaining ones?

Most parents by now have heard the recommendations that kids under 2 years should have no screen time. At all. And older kids should have no more than 10 hours / week total.

Most parents are also fully aware that their kids exceed those guidelines. Some by a little. Others by a  lot. There are all kinds of reasons parents have for allowing this. Some are good reasons, others are not.

To be honest, there is still a lot we don't know about screen time. Research continues. When I was a child, television and movies were just passive watching. Thankfully there wasn't much offered, and with a limited number of channels, we usually stuck to watching tv only on Saturday mornings. Other times we played outside. Shows were not as action packed and overstimulating as those of today. Compare Mr. Rogers to pretty much any show designed for kids today with quick scene changes, music in the background and motion everywhere. Now there are interactive games, many of which are educational, or at least they seem to be teaching letters, counting, or other skills. There's even Wii and Kinect that use whole body movements to get kids off the couch. One can get a good workout with some of the games, but Wii bowling is nothing compared to real bowling.

So how do you count educational and active game time? Should it be included in that 10 hours/ week, or should you allow extra time for it? Are e-readers a form of screen? They often allow interaction like a computer and many can show videos and offer games.

Short answer about counting total screen time: We don't know.  Experts can give thoughtful opinions, but really at this point it's all educated guesses.

Some studies show that kids learn better when things are presented on a computer or video format. Maybe it keeps their attention better than a paper workbook. I love the ability to hold my finger on a word in an electronic e-reader and have the pronunciation and definition pop up. How many times as a young reader did I simply skip over words I didn't know? My daughter likes to increase the font size so only a sentence or two are on the screen. She feels like she reads faster because she "turns the page" more often. Does this build her confidence reading? Does it actually slow her down? I don't know. But she's happier to read and it seems to work for her. (This does drive me nuts if I pick up the Kindle after she's changed the settings... but I can change it back to my preferences easily.) Are kids losing the ability to find things in alphabetical order, such as using an encyclopedia to look something up, since they just hit "search" and find the answers? Does it matter?

Parents must really pay attention to what kids are watching and playing as well as how much time they are spending on a screen. For every minute they are on a screen they aren't interacting with people to work on social skills, they aren't outside playing games and getting exercise. If the games they are playing help develop thinking skills, strategy, math, reading, and more, then some screen time every day can benefit. If the content has violence or other age inappropriate material, it can be very detrimental. If they are online playing against other people, dangers multiply. While I can see kids who hate to read actually not notice how much they must read to play a game on a computer or tablet, are there better ways to get them pumped into reading a book?

There's a time and place for everything. The dinner table and bedroom are never a good place for online/screen time. Watch and play with your kids. They will love the time with you and you can better supervise what they're exposure is and modify it as needed.

More information:
Media Resolutions Every Family Should Make in 2014 has some tips to help monitor and limit screen time.
For information on internet safety, check out YourSphere for Parents.
American Academy of Pediatrics Media page.

Tuesday, April 15, 2014

Shorted at the pharmacy

Has this ever happened to you? Your baby has an ear infection, so you pick up the antibiotic and diligently give it as directed on the bottle. Every day you remember it because you want the infection to go away. But as the days pass, you notice there isn't enough in the bottle to give the full 10 days of medicine.

We get frequent calls from worried parents that they run out of medicine before the full course is completed.

Since pharmacists give exactly the amount calculated for the dose to be dispensed, it is understandable that it doesn't quite last that long.


A little medicine will stick to the insides of the bottle. A few drops can be lost on a syringe. If you're using a dosing cup, it can be over or under filled by a few milliliters (or more if you look at an angle) each time you use it. Add a few milliliters with each dose, often twice a day for 10 days, it is easy to see how you can be off by a couple teaspoons by the end of the 10 day course.

photo source: Shutterstock

When I was in training, I was taught to increase the dispense volume by 10- 20%. This means if a child would take 5ml twice a day for 10 days I would give 110 - 120 mls.

5ml x 2 x 10 days = 100 ml
10% x 100 ml = 10 ml "extra" or 20% x 100 ml = 20ml "extra" 
100ml + 10ml = 110 ml or  100ml + 20ml = 120 ml

Pharmacists no longer will give extra volume. If the dose is 5 ml twice a day for 10 days, they will only give 100ml. That means there is no wiggle room. Small drops of "waste" all add up by the end of the bottle and you will come up short.

What you can do to help:

Can you tell from the poor photo quality that this was taken by me with old dosing devices I found at home?
  • Only use a medicine dispensing container, such as a syringe, dosing spoon, or dosing cup. A cereal spoon varies in size and is not reliable.
  • Shake the bottle before dispensing liquid medicines.
  • Tighten the lid after use to decrease the risk of spills.
  • Store the medicine away from kids. 
  • Refrigerate medicines if needed - the label should state this.
  • Measure carefully. 
    • If the dosing device is labeled with a different measurement type (such as tsp vs ml) be sure you know the conversion-- if not, ask the pharmacist before you make the purchase.
    • Syringe: Use the smallest syringe that will fit the entire dose. For instance, if your child needs 0.6 ml, but you use a 10ml syringe, it will not be accurate. Be sure to hold the syringe straight up and down, not at an angle, or one part of the liquid will be higher than the other. Also be sure the syringe is marked for the dose you need to give-- don't guess where 3.75 is between 3 and 4. 
    • Medicine cup: I find it helps to put the medicine cup on the counter to level it out, then I get my eyes at the level of the cup to measure. Again, be sure it is marked for the volume you need.
    • Medicine spoon: Hold it at eye level straight up and down to align the medicine with the appropriate line.
  • If you use a syringe, see if the pharmacist has a syringe adapter for the bottle (as pictured above) to be able to hold the bottle upside down to avoid sticking the syringe into the bottle and losing medicine on the outside of the syringe.
  • Don't share medications. 
  • Don't save "leftover" medicines for another time. Liquid medicines tend to expire pretty quickly and no prescription medicine should be used without a professional evaluating the need for it.
Despite your best efforts, it is possible that you will run out of medicine before the full number of doses you were supposed to give. 
  • If it is an antibiotic: There is research supporting shorter courses of antibiotic work as well as the traditional 7-10 days for some infections, so you might just need to have your doctor check to be sure the infection cleared before filling another prescription. 
  • If it is a long term medicine that needs to be taken daily: Talk to your doctor to see if they can help get a little more medicine per bottle if you routinely are short at the end of the month.

Monday, April 7, 2014

Developing healthcare responsibility in your children

I am writing this fully knowing I am at risk of upsetting some parents. But this is the time of year we see more school aged kids for their annual physicals, so it is the time of year I think about how parents could help their kids grow into independent adults or hinder that growth by trying to be a good parent.

source: Shutterstock

I read an article recently (The Overprotected Kid) that really hit home with me about how parents try so hard to keep their kids safe that we sometimes prevent them from learning about real life. Although the article is based on allowing kids to roam and play with things that haven't been engineered to keep them safe, it did touch on the fact that parents hang around to answer for kids and speak up for them.

I find that parents often try to help their children during visits to my office by answering questions about their health, sometimes even what they are feeling. I'm sure they want to be sure I know their (parent) perspective. Maybe they are just trying to speed up the visit so they can leave and do the other things on their to do list. But it usually ends up taking longer, because I then spend more time trying to talk to the child.

When a question is directed at the child, let the child answer. If I need parental clarification, I'll ask for it. Obviously a pre-schooler needs more help than a high schooler, but if the teen has never had the opportunity to answer for himself, he might not have the skills and confidence to do it.

Sometimes a parent will start asking their child questions or tell them to tell me about .... I'm sure they are thinking that it is helping me, but it doesn't. (I'm not talking about the parent reminding the child to tell me something they previously discussed, I'm talking about the parent who in response to something I've asked tries to draw the child into conversation-- that's my job.) I have a set amount of time to assess a child's physical exam as well as other factors, and I have a process of evaluating all the points I must consider.

When I ask a child a question, I'm not only looking for the answer they are giving, but I'm also gaining valuable information about the child. Can they speak clearly? Do they understand a question that is age appropriate? Do they make eye contact? Are they developmentally mature for their age? Do they understand how their habits effect their health?

So often well intentioned parents pipe up and answer questions directed at the child. It doesn't matter if I'm looking directly at the child, the parent answers. Even if the child starts to answer. I will often redirect to the child for clarification and the parent still answers. Some of the kids roll their eyes. Others take it in stride without much of an expression at all, as if they're used to their parent taking care of everything. Some simply turn back to their hand held game and play, ignoring the grown ups in the room. Ugh! How does that help me get to know the kid?

Sometimes I wonder how the parent makes it through the day when the child is at school since they can't be there to speak up for the child all day there. It can be that bad.

I really worry about the older school aged kids, especially those in high school, who have parents answer for them. How will they be able to assume their healthcare responsibilties once they turn 18? If they don't know about their past medical history, allergies, and family medical history how can they eventually establish healthcare with a new physician without a parent? If they can't give a clear and concise summary of what their symptoms are for an illness, what will they do when you're not there?

And yes, I see parents piping up for their high schoolers.

I guess it's a learned behavior for all. Parents get used to answering the questions for pre-verbal kids, and they keep doing it.

Please stop.

Let kids in elementary school be prepared to order off the menu when the waitress comes to the table -- after discussing their choice before she gets there if they need help deciding on a healthy item. Have older elementary kids speak up at the store to ask for help when they need a dressing room or if they need a price check. Let them talk to their teachers first if they question a grade or need help learning a concept. Let them give their own health summaries at the doctor's office. You can be there for support along the way, but offer less and less as they get older and more experienced.

If your child has true inabilities to do these things there might be an underlying problem, such as anxiety or developmental delay. Those should be addressed. But by far and away most school aged kids can do these things. Let them.

They need to do these things to be able to one day live independently. Trust me, they will appreciate it some day! Too many college kids call home for parents to "fix" things that the young adult should be able to handle. But they can't jump into the deep end of the pool without learning to swim along the way.