Saturday, May 24, 2014

Summertime = School Physical Time!

Summertime is the time many school aged kids get their annual check ups. In Kansas it is important that high school aged kids do their physicals after May 1st if they want to participate in a school sport. Other kids simply don't need to miss school on their birthday to do a physical. It's also good to avoid our office during sick season if possible. For all these reasons, summer time is a great time to have a well check. So if you haven't scheduled your physical exam yet, it's time to call! Appointments do fill in fast.

Why do healthy kids need to come in? It's recommended that kids have annual screenings for growth, development, injury prevention, and more. Actually there's so much that we are supposed to discuss and do at a well visit that it is impossible to do it all in a standard 20 minute exam. (See Drowning in a Sea of Advice for more.)

To help with this enormous volume of information, we use handouts and our website to share a lot so we can spend time at the visit discussing your other questions. Please take the time to register each of your children on our website so you will get a pre-visit e-mail. This is becoming even more important as we are trying to be your true medical home and provide the best care to every patient with their unique needs.

To register, simply go to and click on the "Create an Account" tab at the top of the page and fill in the information. (Note: Firefox seems to be the best browser for our website. If you are using Explorer or Safari and cannot get the site to load properly, try Firefox.)

Once you've registered the first child, it's easy to add family members. See our How To page for details!
By registering each child you will be able to not only receive these informational pre-visit e-mails, but also ask questions to our front office staff or your favorite providers in a confidential password-protected manner, and pay bills online. Everything is confidential and we will never sell your personal information. 

Our pre visit e-mails have age-specific information to consider before your visit. Please take the time to read through it. Each e-mail has a homework section that is especially important. If you do your homework before the visit, you will find the visit to run more smoothly and you will get more out of it.

This summer I am doing a test of sorts. We are including several printables on the pre-visit e-mail to make your office time easier. You can print your patient information sheet if needed (due once/year, usually at the annual checkup, so young children who come more often don't always need these). We are starting a pre-visit questionnaire that will help identify any concerns to address at the visit. I am hopeful that we will be able to cover more of your specific questions if we know you have read the information on the e-mail, so we don't have to repeat all of the standard things. This should allow much better use of time at your visit to address your concerns.

Watch for your pre-visit email and take the time to read it! I hope to see your kids for their well checks soon!

Saturday, May 17, 2014

My child swallowed....

It happens all the time. Kids put things in their mouth that aren't supposed to be eaten. Parents often call about what to do when their toddlers or children swallow things. Most of the time things will just pass -- though I'm not a fan of watching the stools for the swallowed object because it just worries parents if they miss it.
choking, swallow, cpr, safety

The biggest risk group is children between the ages of 6 months and 6 years, but anyone can be at risk. I have seen an older school aged child swallow a magnet after putting 2 small strong magnets on either side of their tongue to look like a tongue piercing. Adults have been known to swallow things such as needles (many sewers put the needle in their mouth if you think about it).

If you are around kids it is a good idea to know child CPR and refresh your skills every couple years. Classes are often held at local Red Cross stations, hospitals, or fire departments. You can also find classes by searching "CPR" and your zip code. For great information on signs and symptoms of choking and general treatment of choking, visit this KidsHealth Choking link.

If your child seems to put more non-food items in his mouth than other kids, he is at risk of pica. Pica is when a person compulsively puts non-foods in his mouth. For more see the KidsHealth Pica link.

Always keep the poison control number (1-800-222-1222) stored in all your phones! You will see below that I refer to them often. If you call your doctor about a potentially toxic substance, chances are we will refer to poison control. They have the best database of substance risks and their treatments. Don't delay treatment by calling the doctor!
For more information:
Here's a list of common things and what to do.
  • Balloons: Balloons are statistically some of the most inhaled or ingested foreign bodies. One reason is they are so popular with kids, and often are found at parties or other large crowds, where toddlers and young children are often less directly supervised. They can suffocate a child quickly if they are inhaled. Call 911 if there is any difficulty breathing, drooling, or other signs of distress. If swallowed, they will pass on their own.
  • Batteries: If you think your child has swallowed a battery, whether or not he appears distressed, immediately take him to an emergency room. If there is distress, call 911. Batteries can cause voltage burns or leak, causing acidic burns as soon as four hours after being swallowed. X-rays will confirm if the battery is in the chest or abdomen. They usually need to be removed to prevent serious injury. Be sure to keep all of your batteries, especially the small button batteries, safely stored away from children.
  • Bugs: Most of us has swallowed a bug some time in our life. You might not even know if a small one hides in your soda can and you take a big gulp. A little extra protein, right? Unless your child chokes, or if it has a stinger (bee, wasp) there is nothing to worry about. If he's choking, follow choking instructions (link at top). If you suspect a bee or wasp was swallowed, especially if your child seems to be reacting to a sting in the mouth, or there's sudden difficulty breathing, drooling, or choking, call 911. Serious reactions to stings in the mouth can occur.
  • Buttons: Buttons, much like coins, are generally harmless unless they get stuck. See the information on coins. Unlike coins, they are not easily seen on X-ray, which can make identification of a stuck coin a little trickier, but if you suspect an issue, talk to your doctor.
  • Cleaning products, laundry detergent, and other chemicals: These are highly dangerous and you should call poison control with any suspicion of ingestion or 911 if there are signs of distress. These should always be stored away from children to prevent the possibility of swallowing in the first place. Even the "green" products are usually not safe with ingestion.
  • Coins: Coins are some of the most frequently swallowed objects. These usually pass through the body without any problems. Unfortunately many parents never see it come out the other end. Since it is so common you would think there would be a consensus as to how to manage it. There isn't. Of course if there is any distress, drooling, breathing difficulty or coughing, your child should be seen immediately, ideally in an ER so that an immediate surgical consult can be made if necessary. If it was inhaled into the windpipe instead of swallowed into the esophagus or stuck high in the esophagus causing compression on the wind pipe, it may need to be removed. As for kids who swallow coins and have no symptoms, it isn't as clear cut. Some doctors get X-rays for all children who swallow a coin to be sure it isn't stuck in the esophagus (about a third of those stuck eventually end up passing, but most need to be removed). Others only X-ray if there are symptoms. Some remove the ones in the esophagus immediately, others will wait up to 48 hours if there is no distress. Generally once it reaches the stomach it will pass.
  • Crayons or play doh: I used to wonder why so many things were labeled "non-toxic" -- at least until I had a child of my own. They put everything in their mouth! These are generally safe (again, unless they choke), although it is possible that these things contain lead or other contaminants. If your child frequently puts them in the mouth, it is probably a good idea to not allow them near your child and talk to your doctor about pica (see link above for more information). 
  • Dirt or rocks: Unless your baby chokes or bites down on a rock and breaks a tooth, dirt and rocks are generally harmless. If your child seems to crave these and eats dirt compulsively, see the pica link above.
  • Energy drink: Energy drinks are a popular choice for many, but they contain caffeine and other stimulants that can make them dangerous for children. Call poison control for instructions.
  • Grass or plants: Unless the grass was recently chemically treated or if the plant is poisonous, there is little to worry about here. If you're unsure about a plant being poisonous, contact poison control. If there is choking, do CPR or call 911.
  • Gum: Contrary to popular belief, the occasional swallowed gum does not stay in your gut for years. It isn't digested like other foods, but unless it gets stuck along the way, it finds its way out just like all your other food. 
  • Hand sanitizer: Hand sanitizer in small amounts, such as putting fingers in the mouth after rubbing sanitizer on the hands, is generally safe. Larger amounts can be dangerous and you should call poison control if you suspect ingestion.
  • Magnets: A single magnet is not a worrisome as multiple magnets, but since it often is not known exactly what a child swallows, it is always recommended to take your child to be evaluated if there is a suspicion of swallowed magnets. They will need X-rays and if there are multiple magnets, they must be removed to prevent perforation of the gut.
  • Medicines, vitamins, supplements: If your child swallowed (or potentially swallowed) a medication or supplement, call the poison control number ASAP. Have the bottle with you so you can answer their questions.
  • Nicotine: Sadly ingested nicotine has been an increasing problem since e-cigarrettes have been on the market, but even regular cigarettes, cigars, and their ashes pose problems. Effects of nicotine poisoning include vomiting, sweating, lethargy and tremors in mild poisoning and confusion, paralysis, and seizures in severe poisoning. If you even think your child has eaten a nicotine product, call poison control (or 911 if significant symptoms).
  • Pet food: As disgusting as it smells to me, kids love to eat pet food. The biggest risk here is choking. If they choke, use your CPR skills. If you're not confident with CPR, call 911 and they will walk you through it.
  • Pop-top from a can: The flip top that opens a soft drink can is usually not a concern unless a child chokes on it. It generally will pass through the intestines if swallowed, but if there are signs that it was inhaled or is stuck in the intestine, a child should be seen. These do not show up on X-ray because they are made of aluminum. 
  • Poop: This one is gross, but happens more than any parent wants to know. Many babies stick their hand down their diaper and then the hand goes to his mouth. While this is really gross, it does not cause any danger to the child. If it is his own poop, he will not be exposed to any new germs. If your child finds someone else's poop, usually animal poop, there is a little more concern for infection but still pretty low risk. Symptoms of nausea, vomiting, diarrhea, and low grade fever usually happen within 30 minutes to 4 hours after the ingestion if they are affected. In this case, treat symptoms as you would any other stomach bug and call your doctor. For specific information of various types of poop (even raccoon!) check out the Illinois Poison Control blog on poop. 
  • Salt and baking soda: These common kitchen items do not raise fear in many people, but if either is taken in large amounts, they can cause serious problems. One tablespoon of salt in a toddler can cause seizures due to electrolyte imbalances. More can be deadly. One tablespoon of baking soda changes a body's pH and can cause serious injury. If your child swallows either of these, call poison control immediately. 
  • Sharp objects: Any pointed object such as toothpicks, wire, chicken bones, open safety pins and hair pins can pierce the gut. If you think or know your child has swallowed one of these, get the child to the emergency room immediately. 

Thursday, May 1, 2014

Screen Free Challenge

Are you up for a challenge?

Join thousands of other families who want to reconnect by going screen free for the week of May 5 – 11, 2014.

What does screen free mean? To put it simply: do not use anything with a screen unless it is directly related to work or school. Televisions, computers, smart phones and other screens are all a part of our world, but they can overtake our lives. By consciously avoiding non-essential screen time, we can reconnect with our family and friends and even ourselves.

Does going screen free for a week sound impossible?

For many people screens are an essential part of our lives. We use online calendars so we can remember our daily schedule and share it with family. We use online resources to make purchases, or research a topic. Computers help us conduct business and more. Texting allows quick communication. Less essentially we use screens to keep up with friends or to share what we’re up to. We play games. We watch movies and television shows. We use screens as a cheap babysitter. It is a huge recreational pastime. It’s easy and inexpensive.

But there are many costs.

  • Do your kids complain that you’re always on your phone or computer? Maybe they don’t verbalize it but they might show it with disruptive behaviors. And remember you’re their role model. They will do as you do. But they’d rather spend time with you. Even the teens who deny it. 
  • Do your children throw a fit when you tell them to turn the screen off? This can be a sign of addiction, or at least poor self-control. Aggressive tendencies are often exacerbated by screen time.
  • Children lose time outdoors and in other active and creative play because they’d prefer to watch television or play a video game. Screen time is directly correlated with obesity, behavior issues, and sleep problems. Active play and social interactions can help with each of these problems.
  • Infants and children learn best through human interactions and exploration, yet a screen sometimes mesmerizes them for hours at a time. Some of us feel comforted that our kids are learning by playing some of these games or watching certain “educational” programs, but this is often not the case. Studies do not show beneficial learning, especially in young children, with screen interactions. In many cases time spent on these games and programs is detrimental to their development.
  • The typical school aged child has more screen time than ANY other activity except sleep!

Just think of all the free time you will make by turning off the screens. Have every member of your family make the commitment and help each other find new ways to connect.

Because most of spend over 2 hours a day with recreational screen time, we can capture that time to play a game with our kids, take a walk, read a book, write poetry, do a craft project, clean out the garage, garden… the list goes on. Let your kids do things and experience life instead of letting them watch or play with something someone else created for them. And it’s okay to just spend time together talking. Sometimes it’s those simple times that become our most special memories.

Unplug. Start with just one week. See where it takes you!

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Screen Free Week is Just around the Corner!