New Search Trick!

This has little to do with pediatrics, unless you consider that I refer patient parents to our website all the time.

But I learned a really, really cool new trick recently from Amy S in our office. (We LOVE Amy! She is a behind the scenes person rarely noticed by patients, but an integral part of our office!)

So, what's the new trick?

You can search a word/topic in Google with a restriction of a particular website.

Search "eczema: pediatricpartnerskc.com" and you will get

That first page is our eczema page. The next several are other pages on our website that mention eczema.

Pretty cool, huh!

So if you're ever looking for a page and you know it is on a particular website, or you have a favorite website and you want to see if they cover a topic, you can limit your search.

Pretty cool, if I do say so myself!

Cell Phone and Social Media Etiquette

My family was recently on vacation, so I was in public areas more than normal. To say I was surprised by all the people enjoying their cell phones more than their company is not correct. "Saddened" is a better word. Why do people who are out together spend so much of their time avoiding their friends and family who are with them? It isn't uncommon any more to see a table of people all looking at their smart phones. What is our society coming to? How will our children learn to interact with others appropriately?

As a physician who must take phone calls for work, some of which might be true urgent calls (true emergencies should be called to 911), I still don't answer my phone most of the time. It is okay for people to leave messages. Returning a call after excusing myself from my family or friends within a short time is much more considerate for all involved. I find it beneficial too since I can listen to a message, get my thoughts in order before returning the call, and I have a record of the call to document later in a patient's chart. Most people simply answer a phone call or text because they can. Or they scan a social media site when they should be talking with others face to face.

A friend shared a blog today on her Facebook page that I found interesting and timely. It is from the American Academy of Pediatrics (AAP) Council on Communications and Media (COCM) and had a list of phone etiquette rules for kids. As I read it, I thought of some more rules that could (should, in my opinion) be used by all.

Here are my suggestions. In no particular order:

• It’s okay to let people leave a message. If the phone rings when you are in a conversation, ignore it unless you’re expecting an important call. For routine calls, use a conversation break to excuse yourself and state you need to return a call or text. 
• Important calls still deserve respect. If you are expecting an important call, alert those with you ahead of time that you might need to excuse yourself when your phone rings. This lets them know that you aren’t just taking a routine call when the phone rings and they are still important to you. 
• Go to a quiet place to return calls and texts. This is not only polite to the people in the room, but it also reminds you that there are people who are waiting for you to return. 
• Be with those with you. Make eye contact when you are talking to people. Don’t keep checking your phone ~ it makes it seem like those with you are less important than whatever you are seeing on your phone. Messages will be there later! 
• Limit bragging. Don’t upload and share pictures of everything you do with friends. This might unknowingly hurt another friend’s feelings if they weren’t invited to join. Or friends will get bored and tune you out. 
• No phones at the table. Leave your phone out of sight and on silent when eating. Unless everyone puts their phones in the center of the table with a “No touch” rule, all phones should be hidden and ignored during a meal. Talk to those at the table. Enjoy their company. Most calls can wait a few minutes for you to finish your meal. 
• Keep the noise down. Turn the ringer off when you are in any public place. If you are alone and on your phone, keep your voice to a normal talking level so you don’t disrupt others around you. Better yet – go outside to take a call. 
• Keep phones on silent and put away when at school, work, or in a professional setting (such as at a checkout line at the store or at a doctor's office). It is not only rude, but can get you in trouble with your teacher or boss. It limits the constructive time spent with you by the person you should be giving your full attention to.
• Incriminating or hurtful information doesn't belong. Don’t type, photograph or forward anything you wouldn’t want your parents, boss or principal to see. Remember that once you push send words and pictures will last forever on the web and could be seen by anyone if a friend saves or forwards it. It could come back to haunt you. If you would be embarrassed if your parent, grandparent, or neighbor sees it, don’t do it!
• Get help when needed. If you see something you think could hurt someone, or that indicates someone is hurting, tell a responsible trusted adult. You could save a life! Literally. 
• Don’t measure your value by how many “friends” you have, or all the cool things they seem to be doing. Your life is worth something, but you don’t have to broadcast it to everyone online. 
• Live life! Spend your time actually doing things, don’t waste it watching what others are doing or documenting every little thing you do. 
• Only “friend” people you know in person. Even if they know a friend of a friend, they are not your friend. Be safe and only friend real friends and family. Make your privacy settings private so others who you don't know can't see your posts.
• Never give personal information to people you don't know. Be careful that others might share your posts, so avoid using your team names, school name, and other identifying information. Turn off your camera's GPS if you take pictures that will allow a stranger to know where you are.
• Never share passwords with anyone but your parents. And always let your parents know your passwords. They have your best interests at heart and can help you stay safe online. 
• Never answer a text while driving (or even walking). This really doesn’t need any explanation. Texting distracts you from getting to where you need to be safely. 
• Avoid taking calls when driving. Any distraction to driving is a distraction. The really cool thing with cell phones is that they all have voice mail. That means people can leave messages. And you can call them back from a safe place. Brilliant! If you must take a call when driving, use a hands-free device for added safety. Be aware of state laws restricting some drivers of any phone use.
• Keep phones out of your bedroom. Use a public area of the home to charge phones overnight. This prevents your phone from waking you at all hours of the night. Sleep is important, and just because your friend has insomnia doesn’t mean you need to answer their call!    

Nutrition For the Picky Eater

I am frequently asked about how to get kids to eat. In general, there are a few quick "rules":

• Don't offer junk. Don't make it easily available at home... most kids can't drive to the store!
• Hungry kids will eat what's offered. Let them get hungry between meals. No grazing.
• Not every food group will be eaten at every meal, so use the day to space foods to incorporate a range of nutrition over time. Think of snacks as mini-meals.
• Keep meal time fun.
• Enforce "Taste a bite without a fight" after 3 years of age.
• It's okay to be tricky and fun: add pureed vegetables to things, use yogurt or hummus dips, put food on a stick, arrange food into fun shapes, be creative.
• Juice is not a food.

This is my first attempt at adding video to my blog. I apologize for the tilted view... it looked straight on my camera! YouTube limits the length to 10 minutes, and I ended up at 11 minutes, so it is broken into two shorter segments.

Part 1:



Part 2: 

Resources mentioned at the end:

My Pinterest page has several boards with recipes and nutritional information, in addition to other kid-friendly ideas! (Warning: if you don't use Pinterest, it can be addictive. Tons of great project ideas and recipes, educational sites, and other time wasters...)

Kids Eat Right: The Academy of Nutrition and Dietetics' page on scientifically-based health and nutrition information you can trust to help your child grow healthy.

Adenovirus Infections

photo source: Shutterstock

It's been a relatively sick winter season, and I keep hoping it is winding down.  But as one season winds down, another starts.

This week my eyes have been watering and burning and my nose is a little stuffy. (I think my nose would be worse if I didn't do twice daily nasal washes - I am a true believer in them!)

But my eyes are driving me nuts. I first thought it was due to allergies since earlier this week I knew that local pollen counts were up, but as I consider what I'm seeing in the office, I wonder if I have a mild adenovirus. (Yes, even doctors have a hard time determining what is going on. This is why I say to never trust someone when they say "it's just my allergies." Make them wash their hands!)

We start to see adenovirus this time of year. I don't test for it but when I start seeing certain trends, I suspect it's here.  It causes many types of symptoms, different in different people.

Red eyes without mucus discharge is one common finding. It is not "pink eye" or bacterial conjunctivitis, but we have many kids sent in from schools and daycares because they think it's "pink eye." I usually just write a note that eye drops are not needed and they can return to daycare since it is a virus.

I have seen quite a few red eyes this week...

Other symptoms are much like a common cold: fever, runny nose, cough, swollen glands, and sore throat. It can cause wheezing in infants and croup (yes, we're seeing those now too).

Sometimes vomiting and diarrhea are due to adenovirus - and right now we are blaming all the stomach problems on the new Sydney Norovirus, but it could be something more typical too.

Prevention is key with any illness. Continue to wash hands and surfaces well all year long, not just when the flu is in the news. Keep sick family members home if they are sick to avoid spreading germs to others.

Most children with adenovirus can be treated at home.

• Treat with a pain reliever/fever reducer as needed for comfort. Remember it is not how high a fever is, but how a child acts that is most important (as long as they are over 3 months and immunized). 
• Push fluids. 
• Use a humidifier or vaporizer if the air is dry to help the airway. 
• Use saline rinses or sprays in the nose as tolerated. 
• Kids over 1 year can use honey for cough. I don't recommend cough medicines since they haven't been shown to work, are expensive, and have side effects. 
• And for those red, burning, watery, itchy eyes: cool compresses. Since allergy season overlaps with adenovirus season and they symptoms are very similar, you can try age-appropriate allergy medicine to see if it helps the red, itchy, watery eyes. Watch for yellow mucus discharge of the eyes. Since kids rarely wash their hands before rubbing their eyes, they are more likely to secondarily infect their eyes with repeated rubbing of irritated eyes. 
• Wash hands frequently!

When to see your doctor:

• Sore throat and fever in children should be evaluated for Strep throat by a throat swab and test during business hours. Strep throat can look exactly like a sore throat from adenovirus or other viruses, so it needs to be tested before appropriate treatment can be determined.
• If there are breathing problems such as rapid breathing, ribs sucking in and out, child is not able to complete a sentence due to shortness of breath, or other concerns your child should be seen ASAP.
• If your child looks dehydrated (no tears, dry mouth, poor urine volume) he should be seen ASAP.
• If the eyes are red with discharge, your child should be seen during business hours to see if antibiotic eye drops are needed. 
• A child with symptoms of a urinary tract infection (symptoms may include fever, painful urination, frequent urination, blood in urine, or urinary accidents) should have their urine tested for infection. If symptoms are mild, you can wait until business hours, but if associated with high fever, vomiting, or other concerns, bring in for assessment ASAP.

For more reading:

KidsHealth Adenovirus

CDC - About Adenoviruses

Sick, Sick, and More Sick.

Photo source: Shutterstock

It isn't news that we are experiencing a rough winter as far as illnesses go. Flu is all over the news. Schools have high rates of absenteeism. You hear coughs wherever you are in public places.

A few nuggets of information that might help you treat your family this sick season:

Fever

Fever is a symptom of illness and makes us feel achey and miserable, but the number on the thermometer does not necessarily correlate with the diagnosis or treatment needed. Look at your child. If they are happy with a fever, over 3 months and immunized, let it run its course. If they complain of pain (or if your immunized infant over 2-3 months is fussy) give a pain reliever/fever reducer. Push fluids to avoid dehydration. Treat other symptoms as needed. Don't worry if the temperature on the thermometer goes up ~ worry if your child is in severe pain, having difficulty breathing, or looks dehydrated.

Cough

Coughs do not need medicine generally. Honey (for those over 1 year) has been shown to be safer and more effective than other cough suppressants. Adding humidification to the air does wonders to loosen mucus and ease breathing.

If the cough is accompanied by rapid breathing, sucking in of the ribs or abdomen, or followed by vomiting, your child should be seen by a medical practitioner for further evaluation and treatment.

If your child has a history of asthma or other wheezing, it is okay to see if the rescue medicine (albuterol or levalbuterol) helps the cough. If not, it either is really bad wheezing that needs further evaluation or a cough. And don't forget your prevention medicine if you use it!

If your child has been exposed to whooping cough and develops a cough, please see your medical provider for evaluation and treatment.

Water's Power

Water is good for most illnesses. Increase fluids to prevent dehydration and help the body repair itself. Sips of water can help a sore throat and ease a cough. Add humidification to the air when the weather is cold and dry. Use saline to clear the mucus from the nose and open nasal passageways. Never underestimate the power of water!

Tamiflu 

Tamiflu is recommended for certain high risk people who are exposed to or sick with influenza. Prophylaxis can be given to prevent illness in children over 1 year of age who have known exposure within the past 48 hours if they meet high risk indications. Treatment of illness can be given to those over 2 weeks of age if they meet high risk criteria. There are shortages beginning this season and resistance can easily develop, so its use should be limited to those who truly need it.

High risks include: less than 2 years, lung disorders, immunologic disorders (immune compromised), chronic metabolic disease, and neuromuscular disorders.

If influenza symptoms have been present for more than 48 hours, it is not indicated unless there are special circumstances.

Tamiflu shortens the symptoms of influenza by 26 hours, about a day. It can help prevent the spread of the virus. It can have side effects, most commonly nausea and vomiting, but also more serious rashes and neurologic symptoms (confusion, delirium, and hallucinations).

Flu Vaccine

Vaccination is the best prevention against influenza. It does not make people get the flu. It is safe and indicated for everyone over 6 months of age. Thank you to all my patients who were vaccinated this year!  Although it is not 100% effective, it should lessen the risk of influenza to you.

Please don't wait to see if it will be a bad season before deciding if it's worth it to get the vaccine. Once the season has started it is less effective because it takes your body about 2 weeks to build immunity. Waiting also puts you at risk for being left out if there are shortages. Our office gave more vaccine than ever this year, but we still ran out earlier than ever this year.

If your family still needs the vaccine, check your local health department and pharmacies.  When we start vaccinating again this summer for next season, be sure to get your family vaccinated! (We will publicize availability on our website, Facebook page, and by email to those registered on our website.)

Vomiting and/or diarrhea

Vomiting and diarrhea can result from many viruses, usually NOT influenza. Treat with an electrolyte solution (such as Pedialyte, Gatorade's G2 - less sugar than regular). Give small volumes frequently. When kids get thirsty, they might gulp and then vomit, so put only 1 teaspoon in a small cup or syringe, or give a popsicle made of the electrolyte solution. Juice, carbonated lemon/lime drinks, and other high sugar drinks should be avoided.

Dairy increases stomach upset, and I generally say to avoid all milk products (except human milk) for 48 hours after the last vomiting or diarrhea. Breast milk can sometimes be tolerated, but it must be given slowly too, so often breast feeding should be stopped. Pump and give the expressed milk by the teaspoon in a syringe.

Facebook Tips to Not Miss Page Posts

This is an off topic blog, but I use Facebook regularly to share great health and behavior tips to parents, and I find that only a small percentage of them are able to see the posts regularly. It makes sense that if you have hundreds of friends plus follow scores of pages, you won't see every post every day. But if you really like a page and want to be sure to see all of its posts, I have found the best way is to add it to an interest group. There are two ways to add pages to your interest group, both described below.

I have seen many posts about how to make things show in your News Feed by selecting "Get Notifications" and "Show in News Feed", but I find that those simply don't work. (I follow many pages since I administrate my office FB page, so maybe that affects it, but I still miss pages that way.)

You will be able to set up various interest lists if you want. (They STILL don't always show up in your news feed, see BIG TIP below.)

First, log into Facebook for either method of setting up interest groups or adding to your group. (Note: if you are a page administrator, you must be logged in as your personal account, not your Page.)

First method: This works well if you are on a page and want to add it to an interest group. Click on the little gear/arrow (in blue below) and then add to Interest Lists.

Second method:  This works well if you want to add several favorite pages all at once or if you want to follow an interest group that is public.

From the Home screen view: Along the left sidebar there are several categories: Favorites, Apps, Interests, and more.  Before you set up interests, it will just have "Add Interests..."  Once you have set them up, you can select the Interest Group you want to see.  My Interests are pictured here:

The blue Interest "Work help" is one I've made, and it consists of pages I often find interesting articles to repost. "Health Causes" and "Child Causes" (green) are standard public groups that I follow to see if I find new pages to "Like".  If you click on "Add Interests..." you will find many pages either similar to pages you already follow or ones your friends follow.  You can also make your own interest group(s), which is where you can put pages you don't want to miss:

BIG TIP: Once you have your interest groups set, you need to remember to actually look at them since they don't automatically pull into your news feed. The only pages that show up at that point are those from that group. (No friend updates or other pages.) You will then simply click on "Home" to return to your usual News Feed.

I hope this helps... at least until Facebook changes its settings again!

Evolution of Illness

When kids are sick, parents understandably want them to feel better quickly. They want a sound night's sleep. They want to be able to return to work/school. They want to see a happy, healthy child again. They come to our office hoping for answers and a cure.

Sometimes there is no quick fix, just treating symptoms and time.

This is the season we are seeing a lot of sickness. It's been about 11 years, but I remember the frustrations of having a sick baby when my daughter had bronchiolitis. Some of the details are muddy, but I remember the feelings of inadequacy because I couldn't help her feel any better any faster. I knew the illness tends to get worse before it gets better and there is little we can do to alter its course, but knowing this it didn't make me feel any better as the mom who was helpless.

I lost sleep for several nights as I watched her pant (not breathe, but pant). I resorted to giving asthma-type breathing treatments (because my son had wheezing so we had everything we needed to give a treatment at home) despite the fact that they didn't seem to help her much. It was probably the humidified air that helped more than anything. But the vaporizer in her room and the saline to suction her nose wasn't helping, so I wanted to at least try the asthma medicine. She kept wheezing. We brought her in to the office 3 days in a row to have someone else check her. I can't check oxygen levels at home and needed someone to objectively examiner her.  So three days in a row we went in for repeat exams. She was able to maintain her oxygen level and stay hydrated despite breathing 60-70 times/minute for days. I still don't know how. I remember wishing her oxygen level would drop enough that we could hospitalize her, not critically, just enough. Then she'd be on monitors, and maybe I could sleep a bit knowing someone else was watching her. Thankfully she never got that sick, and eventually we were all sleeping again, but it took a long time for that.

So I understand the frustration when we tell parents things to do at home and ask that they come back in  __ days or if ___, ____, ___ symptoms worsen. It really isn't that we are holding out on a treatment that will fix the illness, it's just that we don't have a quick fix for many illnesses. We need to be able to examine at different points in the evolution of the illness to get a full picture of what is going on.

The exam can tell us a lot, but it doesn't predict the future. One minute ears can look normal, the next they develop signs of an infection. I cannot say how many times I've heard a parent complain that someone else "missed" something on exam that I now see. Yes, sometimes things can be missed, but I suspect that most of the times the exam has simply changed.

I learned this phenomenon as a resident on the inpatient unit. I had a patient who had been admitted for an abdominal issue. I did a physical on the child in the morning before rounds, including looking at ears, which were normal. Late that afternoon the nurse called because a fever had started. New symptom, so another exam was done. This time the ears were red and full of pus. Within hours this child had developed a double ear infection. I examined the ears both times and they were definitely different.

I understand the frustration (and expense) to take kids back in to be seen if symptoms worsen, change, or simply just don't resolve at home. If symptoms change, we need to re-evaluate, which includes an exam. Medical providers cannot look into the future to see what will develop. It is not appropriate (or effective) to put kids on an antibiotic or iv fluids to prevent the illness from taking its natural progression. Sometimes we need time to see how the illness progresses to see what other treatments might be needed.

When parents call back and want something else done, they are often upset that we want to see the child again. I hear many types of complaints.

Money is probably the biggest issue. It is not because we want your co pay. The "we" I use here is not just my office and I am not speaking of any particular situation. With online doctor rating sites, social media sites, and knowing doctors around the country, I write with many examples in mind. I've seen online complaints that doctors are just money hungry, trying to get someone to come back in just so we can charge more money. It is true that we charge for every visit. We are not able to waive the co pay because we did "something wrong" or "missed a diagnosis" the first time. Each is a separate visit with updated information and a separate exam. Insurance contracts dictate that a separate co pay is charged. We must adhere to legal contracts or it would be considered insurance fraud.

Increasing our numbers for "production" is sometimes brought up. It is not because we want to fill our waiting room with more children to increase the waiting time for everyone else. We don't want to waste your time or ours. But we need to see a child to know what is happening at that moment to be able to give any valuable advice and treatment.

We want to see your child again because we need to see your child to know what to do. Maybe now the child's symptoms have changed.  Maybe not, but without the history and exam we do not know. The exam might now show wheezing, low oxygen levels, a new ear infection or sounds of pneumonia. Sometimes the exam still is overall normal, but the fever's been going on long enough without any identifiable cause, which requires lab and/or xray evaluation. 

Please remember that if you get a different answer at a different visit, it doesn't mean that the first assessment was wrong. Usually it is due to a progression of the illness, and things change. Human bodies are not static.