illness Archives - Happy Healthy Kids

Handwashing without Tears

January 17, 2021 by Kelley Leave a Comment

This post was first published on a recent Global Handwashing Day in 2016—back in those simpler times when hand hygiene helped defend against garden-variety sniffles and barfing bugs, not a deadly pandemic.

Sure, kids these days are more attuned to the importance of handwashing, but on our homefront, at least, the simple task remains a chore. Despite my constant nagging that the boys suds up upon arrival home from school or sports, before eating, and after using the bathroom (every time!), compliance remains spotty, and initiative scant. It probably doesn’t help that our liquid soap is at the dregs level in two out of three bathrooms the children use. It’s clear we need to up our game.

Since we first covered hand hygiene on this blog, research has only grown to show that washing with good old soap and water beats just about any other germ-busting regimen out there, including sting-y sanitizers and pricey supplements. The trick is getting kids to wash without being reminded, and to do more than a quick rinse. Here’s a round-up of best expert advice I found; I’ll keep you posted as to which of these clicked for us.

Get the good soap. No, not that beautiful bottle you covet from Restoration Hardware. I mean the yummy-smelling stuff that’s in a bottle that’s easy to depress and won’t make a mess. Some faves: Method Mickey Mouse lemonade soap (Amazon, 2 for $10); these giant, inviting bottles of Every Soap for Every Kid, in scents like Tropical Coconut Twist (Amazon, 32 oz. for $13); Tru Kid Helping Hand Wash (Amazon, 8 oz. for $9); and, for potty trainers, the Sesame Street Bundle in varieties like Cookie Monster Crunch (Amazon, 3 for $15).

Buy stools to make washing up easier. Kids can’t wash well when they can’t reach the
faucet and soap comfortably. You can go colorful—Tundras makes a cute $9 stool in bright green, cobalt, and cranberry red—or fashionable, but make sure there’s one for every sink in the house. We love these Bee Stands from Ballard Designs, because they match our decor but still have a fun design.

Put some posters up around the bathroom. The Massachusetts state government made this eye-catching printout you can laminate for a few bucks at Staples; Etsy’s crafty artisans, as usual, up the ante with some cute printables (like this, for $5, from the Funky Art Shop) that actually serve as decor.

Check out the supplies in your school bathrooms, too. In a recent survey, kids who didn’t wash their hands at school cited lack of cleaning supplies (19%), not liking to use school bathrooms (21%), and bathrooms being “disgusting” (15%). Only 63 percent of kids say their school always has all the soap, water, paper towels and drying equipment needed to wash their hands. Some schools compensate by scattering sanitizers around, but bathrooms should be clean and fully equipped with hand washing materials as well. Poke around the bathrooms next time you visit the school, and talk to kids; if supplies are wanting, consider proposing a fundraiser to allow for better and more plentiful soap and towels for kids’ use.

Practice what you preach. The broken-record message: Model the behavior you want to see in your kids. According to Stanford’s division of public health, only two-thirds of grown-ups wash their hands after they use the restroom. Make a point of washing up together at the kitchen sink or bathroom before family dinner.

Ultimate Sick-Day Survival Kit

December 2, 2018 by Kelley 1 Comment

I’ll admit it: Even with a dozen years, three children, and countless sick days under my parenting belt, I still become a little unhinged when my kids are sick. At the first sign of glazed-over eyes, raspy cough, or the dreaded, telltale, 2 a.m. gag, my heart starts pounding, because I know my child and I are in for a few days of sleepless nights, home-from-school days, and round-the-clock cleaning. And that’s if it’s an illness is limited to one family member, which we all know is about as likely as a four-leaf clover in January.

I was a little cocky a few weeks ago, when it occurred to me that we’d gone three whole months without anything more than a sniffle. Of course, within, oh, minutes of that thought passing through my brain, my youngest refused his afternoon snack, just wanted to cuddle, and preceded to barf buckets on himself, his carseat and half of the minivan on the way to pick up my older sons at school. One week later, his older brother’s norovirus also presented itself in the car, this time on the way to a ski trip. After fishing around for plastic bags and coming up empty, the portable potty seat became a sick basin. Double ick. Granted, we were traveling, but it made me resolve to be better equipped for sudden sicknesses—which they all are, really—at home and on the go. For me, at least, having all the proper tools for keeping kids comfortable and the house disinfected at the ready goes a long way toward mitigating my anxiety over dealing with a tough bug.

After talking to some docs and veteran moms and thinking about what’s saved the day for us time and again in the past, I’ve come up with a list of must-have products for sick-day “success” (as it were). While good hand hygiene and a flu shot (find a nearby vaccination center here) may help keep illness at bay, these soothing products are worth stashing away in a closet or bathroom drawer for when sickness does strike. Note on chart, below: If viewing on a mobile devices, links in chart below might not direct you to correct products. Use links in descriptions below chart, instead.

1. Kid-Friendly Tissues. Puffs and other companies now have boxes with fun designs that appeal to kids, which just might make tykes more likely to reach for a tissue rather than their sibling’s shirt sleeve. Also, take this genius cue from Mommy Shorts (via Wide Awake) and use a rubber band to harness together a full square tissue box and an empty square tissue box. Voila—tissues and trash can in one.

2. Graco Battery Operated Nasal Aspirator. One of my babysitters is a nurse at Boston Children’s Hospital, and she says that this is what she and her colleagues use all the time on stuffed-up babies and toddlers who come through the E.R. It’s quick, simple, and painless.

3. Honey. Studies show it and doc-moms swear by it: A teaspoon or two of honey can help soothe a sore throat and quiet a cough, as good if not better than cough medicine.

4. Aquaphor. Smear a gob of this salve below runny noses to prevent drying and chafing, or on sore bottoms after a stomach bug.

5. Rectangular Wash Basin. Kids aren’t so skilled at aiming their puke in the right places. Stash a medium-sized—I find 8-quart to be perfect—plastic bin in a bathroom drawer, cabinet or shelf so it’s easy to grab when your child starts feeling queasy.

6. CareBags. What a terrific product: These bags, which fold-flat for easy storage in the car, have an absorbent bottom that eliminates odors, and an easy-tie top. Great to have on hand for car sickness of any type.

7. Gatorade. Research shows Gatorade is effective as Pedialyte at rehydrating kids after a stomach illness—and my guess is that 10 out of 10 kids would say it tastes better.

8. Pedialyte Pops. You can freeze these pops, which forces kids (little ones, especially) to rehydrate slowly after an illness.

9. Braun Ear Thermometer. While stick thermometers are considered the most accurate, it can be hard to get a good reading with a squirmy child. Braun’s ear thermometers are highly rated, easy to use, and, from my experience, can work without waking a sleeping child.

10. Acetaminophen suppositories. For the helpless-feeling times when a child has a fever but feels too ill to swallow (and keep down) medicine, these rectal suppositories are a lifesaver. Make sure you get a product formulated for your child’s age and weight.

11. Clorox Hydrogen Peroxide Wipes. This hospital-grade cleaner is now available for household use, and is one of the few products that can kill norovirus (the super-bad stomach illness) as well as most other germs. A little pricey, but totally worth it.

12. Large white hand towels. Get a stack of these soft towels and keep them in the laundry room for sick nights. They have multiple uses: a pillow-topper for kids with tummy bugs, a cool forehead compress for bringing down a fever, and a clean-up rag. Because they are white, you can easily bleach out germs and stains after use.

13. Disposable straw cups. Color-coded cups help you keep track of which drink is your sick child’s, and the straw makes it easier to sip while reclining on a bed or couch. Toss after your kid makes a full recovery.

14. Soft fleece blanket. Feverish kids have rapid temperature changes, and you probably don’t want them using your cashmere throw from the living room when they get the chills. Buy one of these fuzzy, inexpensive blankets in your child’s favorite color, and keep it on his shelf for sick days on the couch.

15. Nature DVD or streamed video. Sometimes, all your kid can handle is starting at a screen, but too much SpongeBob can make a headache worse. Many nature videos, with their soothing voices and sounds, set just the right mood. We like Disney’s Oceans and Earth series.

16. Maze books. For when your child starts to feel a little better and may be up for an activity, keep some maze books on hand. They re-engage the brain without taxing it, and some—like Kumon’s Around the World series—are really fun for kids and grown-ups to do together.

Keep Kids Safe from Ticks

June 3, 2017 by Kelley 1 Comment

You may not have appreciated the harsh winter, but there’s one species that did: ticks. According to scientists, the snow that covered much of the country acted like a cozy blanket for the critters, allowing them to survive and propagate in unusually high numbers. And they’re not just hanging out in the deep woods. “We’re finding plenty of infected ticks in built environments, places like city parks, playgrounds, work campuses, college campuses,” a Binghamton University researcher told CBS Boston last month.

What’s especially worrisome is that ticks’ favorite meal appears to be kids. Children between ages 5 to 14 are the most common carriers of Lyme disease, which can cause a wide range of serious medical problems, from joint pain and fatigue (in the early stages) as well as neurological, behavioral, and emotional disturbances (in more advanced cases). An early CDC study of 64 New Jersey grade schoolers with Lyme found that median duration of their illness was 363 days, and the mean number of school days missed because the child was too ill to attend was 103 days. 78% of the parents stated that their children experienced a fall in grade point average during the time of illness.

According to experts, it’s time that parents start thinking of tick prevention the way we do sun protection or hand washing. For those of us who grew up thinking that the little bugs were nothing more than an icky nuisance, taking daily measures against ticks is a hard new habit to start. But Nevena Zubcevik, D.O., an attending physician at Harvard Medical School and the Co-Director of The Dean Center for Tick Borne Illness at the Spaulding Rehabilitation Hospital, has generously shared these easy-to-follow guidelines for keeping kids safe from ticks this summer and beyond.

STARTING IN THE SPRING…make your home and yard an unhappy place for ticks.
Pruning excess bushes and making sure you keep the grass short in your yard is a good practice. So is spraying the yard for ticks—there are lawn-care companies who offer organic options to insecticides. If you have a dog, consider applying anti-tick medication monthly, even in winter months. Dogs and other pets frequently bring ticks into the house.

EVERY MORNING…Spray your kids with a research-proven tick repellent.
“Tick prevention, given the wide area of presence, should be a daily practice,” says Dr. Zubcevik. You don’t have to venture out to the woods to get a tick bite. Recent studies show that urban parks, yards and play areas have ticks that carry these diseases. The reason for the widespread presence of ticks is that they live on small rodents like mice, squirrels and rabbits. They are also found on migratory birds, so ticks carrying illnesses generally found in other parts of the country can now be detected most anywhere.
Long pants and socks are especially helpful for defending kids against ticks, which tend to attach to their hosts’ ankles and legs first. But it can be unreasonable to ask kids to wear long clothes on a hot summer’s day. A recent Consumer Report showed that sprays such as Repel with lemon eucalyptus or Sawyer with 20% picaridin have the capability of keeping mosquitoes and ticks away for up to 8 hours – and outperformed compounds with DEET in their testing. “Those compounds are also safer than DEET for repetitive use in children,” says Dr. Zubcevik.

IN THE EVENING…Check your kids’ bodies for ticks, and wash bodies and clothes.
Ticks mostly live on wood or bushes and tall grass. They’ll attach to your leg and can crawl up and enter the waist or hairline area. Since kids are short, they also often brush by a bush and end up with a tick in or around their earlobe, hair or armpit. A prompt shower with a full body tick check after being outdoors on daily basis can help find ticks that just attached and catch them before they have transmitted disease. Making sure you check between toes, in belly button and earlobes as well as the buttocks, groin and hair is key. Hair-drying in the summer can help kill small ticks that would otherwise be missed with a tick check – though time consuming, such practice can help long term prevention.

IF YOU FIND A TICK…Remove it, freeze it, and talk to a doctor.
If you find a tick you can use thin tweezers to catch the tick at the insert site, closest to the skin and gently jiggle the tick until it detaches. If the tick is embedded deep, then a visit to the doctor would be warranted, says Dr. Zubcevik. (Never burn or squeeze a tick. The tick carries most of the bacteria in the stomach and by squeezing it you run a risk of injecting the contents into the person. You should then keep the tick, and freeze it in a ziplock bag and then send it for testing.) The testing is done at UMass, and in five business days they will let you know whether the tick has any serious illnesses.
If the result is positive for a tick-borne illness, talk to your child’s pediatrician about options. There are some opposing views about prophylactic treatment. Some physicians say that because the diseases the ticks carry can be debilitating and in some cases life-threatening, it’s important to treat if there was evidence of a bite; while others disagree and prefer to wait for symptoms of illness. “The problem is that the longer you wait, the higher the chances the bacteria has had time to spread throughout the body, in which case it might be more difficult to treat,” Dr. Zubcevik says. Current studies at John’s Hopkins University show that up to 35% of people develop chronic symptoms despite treatment for Lyme. “We do not know what the exact reasons of these chronic symptoms are,” notes Dr. Zubcevik. “Scientists have postulated that it could be an autoimmune reaction that is triggered by the infection, chronic inflammation, or continued infection by the bacteria.”

ALWAYS BE ON THE LOOKOUT…for signs and symptoms of Lyme.
Red flags are flu like symptoms, joint pains or swollen joints, sudden change in behavior, sudden development of repetitive movements, lethargy, fatigue, and headaches. A classic “bulls-eye” shaped rash around the bite site may be present, but not always, and therefore should not be required for diagnosis of this illness.
One big reason kids are at high risk is that they generally do not communicate symptoms very well. Parents should know that in case their kids develop any symptoms that are new and concerning, they should be vigilant to find out whether or not their child needs treatment. “Currently we have very poor testing for Lyme disease,” says Dr. Zubcevik. “The current test misses 89% of Lyme disease cases in the first 8 weeks of infection.”
Since testing is so inadequate, Dr. Zubcevik warns, results should not be depended on exclusively for diagnosis. Symptoms and risk factors should also be strongly considered. “The treatment is actually quite benign,” she says. “We use antibiotics such as amoxicillin for children under the age of 8 and doxycycline for older kids. Both of these antibiotics have good safety records and are generally well tolerated. With these facts in mind, both parents and physicians should feel comfortable starting a patient on antibiotics if they clinically present as Lyme.”

Bottom line…As long as Lyme remains so tricky to diagnose and treat, taking precautions is key. “Parents should be vigilant with prevention,” says Dr. Zubcevik. “It’s what we have most control over.”

The Tick Toolkit
	Repel with lemon eucalyptus or Sawyer with 20% picaridin have been tested to keep mosquitoes and ticks at bay for up to 8 hours.
	Fine tip tweezers like these by TAMSCO will allow you to remove ticks more easily.
	When sprayed on a child's socks or clothes before heading out in grassy, wooded or overgrown areas, Permethrin helps repel ticks.
	Get kids jazzed for a nightly bath or shower with a fun soap, like Method's Mickey Mouse lemonade body and hair wash.

Top Kids’ Health Headlines of 2016

December 30, 2016 by Kelley Leave a Comment

I think we can all agree that 2016 was a news roller coaster —at turns nauseating, exciting, and just plain sobering. And the output of fascinating headlines included an unusual amount of news relevant to parents and kids. Here are five family-centric health topics that caught my attention last year, and are good to catch up on if you haven’t already. What am I missing? Be sure to comment here or on Facebook to let me know. Happy New Year to you and yours…and thanks so very much for reading.

Screen Time for Tots O.K.—As Long as Parents Get Involved. For the past decade, parents have struggled to heed American Academy of Pediatrics (AAP) recommendations banning any and all screen-time for kids under 2. But now, conceding the ubiquitousness of digital media in all our lives, the AAP have updated their guidelines to not include an age floor for screen use—but instead encourages parents to be more proactive in how, what, and for how long kids of all ages watch. They recommend printing out and sticking to a Family Media Use plan like this one that encourages careful vetting of games and shows, time for outdoor play and exercise, and putting phones and tablets “to bed” when kids do.

HPV Vaccination Works—But Not Enough Kids Are Getting It. The prevalence of the cancer-causing human papilloma virus (HPV) in teen girls has dropped impressively—by 64%—since the HPV vaccine was introduced a decade ago. And yet, just 42 percent of girls and 22 percent of boys between the ages of 13 and 17 are getting the recommended 3-dose vaccine series. A just-released study in Pediatrics suggests that pediatricians take a more formal approach to getting families on board—presenting it clearly as one of the recommended vaccines for kids rather than launching an open-ended conversation about it over the course of a well visit.

Dads are Crucial to Kids’ Healthy Development. Shifting family dynamics have gotten more fathers involved in childcare, but old stereotypes and gender norms still perpetuate the notion that moms are the emotional center of kids’ lives. New research and guidelines may change that perception: In a rigorous review of recent research on fatherhood, the AAP released a clinical report showing that dads’ involvement is a stronger predictor of kids’ health and success than many might assume. Among their findings: Healthy “horseplay” often initiated by dads may challenge children to be more confident in taking risks; the amount of father communicates with a child at age 3 may be one of the chief predictors of kids’ later verbal ability; and teens with involved dads are less likely to engage in risky behavior or suffer from depression. Michael Yogman, M.D., chair of the AAP Committee on Psychosocial Aspects of Child and Family Health and co-author of the report, goes so far as to suggest that pediatricians start giving dads, specifically, a prescription at infant well visits: “Play with your baby every day.”

Zika Hits Home—and the Impact Goes Beyond Microcephaly. A little more than a year after we started reading about the devastating effects of the mosquito-borne virus in South America, cases of Zika started popping up in Florida in July 2016. The spread, at least domestically, seems to have been contained by now, but public health officials warn that warm weather in 2017 could bring about more cases—and more dangers. A new study in the New England Journal of Medicine, suggests that damage during fetal development from the mosquito-borne virus can occur throughout pregnancy, and that other birth defects are even more common than microcephaly, when babies are born with very small heads. Given Zika and the increase in tick-borne illness diagnoses in kids, it’s more important than ever that parents get as serious about applying an effective insect repellent to kids—and themselves, especially if pregnant—as they’ve become about slathering on sunscreen. We’ve listed the most effective safe bug sprays, here.

U.S. Kids are Heating Healthier, But… Finally, some good news on the kid diet front: Brown University research on children’s eating patterns between 1999 and 2012 reveals that kids are eating more whole grains, whole fruits, dairy, and protein from seafood and plants. They’re also laying off sugary foods and drinks more than ever before. But: they continue to eat too much salt and not enough vegetables—even fewer veggies than previous, less health-conscious generations consumed, say Brown epidemiologists. Here are some HHK ideas for some simple, kid-friendly veggie side dishes, and 25 superfoods—including seven vitamin-packed vegetables—worth trying on your children.

Getting Kids Outside this Winter

December 8, 2016 by Kelley 1 Comment

On these cold, dark December days, it’s tempting to crank up the thermostat, “lose track” of kids’ screen time, and daydream of an existence where we could teleport from car to house with zero exposure to the elements. But some recent reading is convincing me that I need to toughen up and get myself—and the kids—outside as much as possible this winter.

For one thing, studies are showing what kindergarten teachers have always known: Fresh air, even and maybe especially during wintertime, boosts attention. It’s something that Finland, which typically gives students 15 minutes of outdoor recess for every 45 minutes of classroom time, year-round, credits for its top rankings in the Program for International Student Assessment survey of reading, math and science scores. What’s more, outdoor activity in the colder months, specifically, may give us an extra health boost. Muscles work harder in slick or snowy conditions, and we burn more calories as our bodies have to work harder to raise our body temperature. Also, people who spend a lot of time outside in the wintertime are less likely to encounter germs that proliferate indoors when it’s cold, which can help protect us against some nasty bugs.

And yet, weather is the thing most likely to keep kids from playing outside, cited even more often than safety concerns, homework, and busy schedules by parents in a 2012 survey by the National Wildlife Federation. So what can we do to successfully nudge ourselves and kids outdoors when artificial light and heat seem so much more inviting?

L.L. Bean Mad Bomber Hat

Pay less attention to jackets, and more to hats. Kids are notorious for balking at and shedding their coats. In reality, children do have an elevated metabolism and energy level that does cause them to feel hotter than us, so they are apt to get overwarm and annoyed if the are overly bundled. But they also lose body heat more rapidly. Get them a winter jacket that they, above all, will want to keep on, and don’t sweat too much the “temperature ranges” that fancy puffer coat companies market. Where to spend your money (and your nagging quota): Hats. “A hat can go a long way toward keeping your child warm,” pediatrician Lee Bears, M.D., recently told the Washington Post. “If you are going to fight over something, that might be the thing to fight over.” As goofy as they look, you can’t beat bomber hats with chin straps for warmth. L.L Bean makes them in boy- and girl-friendly styles, and if parent reviewers in places like northern Maine and Newfoundland are satisfied, you probably will be, too.

Fold and Stow Snow Scooter

Snow Fort Building Set

Nite Ize “Flashlight”

Counter empty-yard syndrome. There’s nothing that makes backyard play less appealing than an empty patch of dead grass or crusty snow. Kids are far more apt to engage in active play when given more toy choices, according to research, so don’t stash all of the toys away with the skateboards and sprinklers when the temperature drops. Certain playthings are meant for cold or snowy conditions. Some kid-tested crowd-pleasers:
Hearthsong’s Fold and Stow Snow Scooter: This nifty scooter “floats” on the snow thanks to a ridged bottom. Ages 4 and up.
Glow-in-the-dark frisbees: Frisbees are great because they’re easier to grab than balls when you have gloves on, and these Nite Ize “Flashlight” LED-illuminated discs come in four super-bright colors that will be easier to see in the darkening pre-dinnertime hours.
Snow Fort Building Set: Much more than some plastic molds, kids can really sculpt a fortress with this kit. Ages 5 and up.

Fix.com’s winter fun ideas

Lead them in some simple games. We love Fix.com’s great (and simple) list of cold- and kid-friendly games, like Snow Spray Paint Art. Find it here.

Keep it short and sweet. Keeping outdoor play intervals short are more appealing as well as safer when the temperatures drop below freezing. To help motivate, set a timer on your watch or phone for 15 minutes, Finland’s typical recess interval—even this short a stint can get the heart pumping and is totally doable, especially if you ensure that kids have a set place to find and deposit their outwear on the way in and out. And a promise of sweet incentives upon their return indoors, like a cup of Silly Cow’s pricey, but truly excellent marshmallow-swirl flavored cocoa, hurts very little.

E.R. Nurse’s Wish List

December 1, 2016 by Kelley Leave a Comment

This post is part of a “Wish List” series in which I ask experts in different pediatric fields—medicine, education, etc.—what they really want parents to know and do better. Interested in hearing from a certain type of expert? Please make a suggestion here.

If there’s one genuinely stressful experience common to pretty much any parent, it’s a trip to the emergency room. There are few circumstances when we feel less in control than headed into the E.R. with a sick child in arms, and yet, it ranks high among situations when we’d most like to have our wits about us. As we approach winter, when emergency department volume peaks, I asked Katie, a pediatric nurse who’s worked in a major children’s hospital E. R. and a neonatal intensive care unit, what she wishes every parent knew before heading to the hospital. Thanks for the tips, Katie!

1. Buy a thermometer—and use it. One of the most frequent statements parents make is, “he/she has a fever.” The nurse will always ask, “how high was the fever?” and the most frequent response is “well, I don’t know. He/she just felt warm.” You can save time and money by simply taking your child’s temperature before heading to the hospital. A fever below 101 typically does not merit a visit to your local E.R. on its own.

2. Before coming to the ER, call your pediatrician and give your child a proper dosage of Motrin or Tylenol.
Your pediatrician knows your child (hopefully) better than we do. Calling them and giving them a heads up, and explaining symptoms or injuries, will determine if you truly need to go to your local E.R. To be safe, they’ll often tell you to go to your E.R., but they will also give us a heads up that you are coming. This may expedite your process, and we’ll have a better idea of who you are when you come into the E.R. Also, give a dose of Tylenol or Motrin before coming in, if your child has a headache, fever, pain, or is uncomfortable. This will also expedite your visit and you’ll be one step ahead of the game once you arrive to the E.R.

3. If you have a child with a complicated medical history, write down their allergies, history and medications and bring it with you. Life is hectic. We get it. But, if your child has multiple conditions, medications, allergies, or any other specific medical concerns, write them down in a lucid moment and put it in a slip of paper in your wallet or save it on your phone. Parents who come to the E.R. even slightly organized will help nurses and doctors do their job better. There have been countless occasions where parents have failed to mention an important medication or symptoms that can be very key in the diagnostic or treatment process. We truly need all the information. You know your child best, so be prepared to share your knowledge.

4. Do not be afraid to ask questions, ask for help, or inquire about resources. One of the best parts of being in an E.R. is that we get a chance to educate patients about almost anything health-related. Don’t be afraid to ask your doctor or nurse questions even if it seems silly or you think it might be common sense. We have access to multiple resources, from child life specialists who can stop by during your visit to outside specialists we can refer you to. We’d rather take extra time with you than have you walk out confused.

5. Be prepared to wait. The busiest time to go to any E.R. is between 4pm-midnight. The reason: School and sports practices end, kids will admit around dinner time that they do not feel well, or they have been sick all day and it seems to get worse around bedtime. We wish this wasn’t the case, but it is. Patients receive treatment based on how sick they are, not in the order they arrive. Bring a book, iPad, games, coloring books or anything else that can help keep kids occupied for about an hour or more. We’ll do everything we can for your child, and if they seem to be doing worse as you’re waiting, tell us. We definitely do not want you waiting longer than you have to, and if your child needs more Tylenol, Motrin, an Ice Pack, Band-Aid, blanket or anything else, we are always happy to help.

Read more expert wish lists here.

Guide to Kids’ Belly Pain

September 13, 2016 by Kelley 2 Comments

If I crunched the numbers on how often my kids have uttered certain phrases, “my belly hurts,” ranks pretty darn high. So common is this refrain, and typically uneventful the outcome, that there’s a cry-wolf quality to it; I typically point my child towards the pantry or bathroom and go about my day. But sometimes, a stomachache persists, and then figuring out the cause can be like falling into a rabbit hole (and equally unpleasant). And we bumbling parents aren’t the only ones to feel this way. “Belly pain is a dreaded symptom around the office,” says pediatrician Naline Lai, M.D., co-founder of the Two Peds in a Pod blog and an HHK adviser. “It’s so complex, and there are so many different things it can be.”

This is particularly true during these back-to-school days, a perfect storm of abdominal pain risk factors. There’s the fresh viral soup that a closely congregated group of young children stirs up, leading to potential stomach bugs. There’s the suddenly tight schedule of socializing and learning, which cause some kids to drink less water and ignore signs of having to go to the bathroom, both of which can cause constipation. And then there’s stress, a not-well-understood and yet definite trigger of belly discomfort.

With the help of Dr. Lai, we came up with a list of five common belly ailments school-aged kids, and sneaky signs that can help point in the direction of a culprit. Please note that this is only a starting point of reference, and in just about every case of belly pain that doesn’t pass quickly or recurs regularly, you should consult your child’s doctor. Dr. Lai and her Two Peds colleague, Julie Kardos, M.D. ran a helpful post about when you should definitely talk to the pediatrician about your child’s belly pain, here.

Problem	Typical Symptoms	Keep in Mind...
GI Bug	Can come on fast; nausea or stomach cramps followed by vomiting and/or diarrhea; sometimes a fever but not often	Little kids, especially, have trouble explaining what nausea feels like, says Dr. Lai. They may talk about a boo-boo in their belly, but other red flags are refusing food, general fussiness and clinginess, and fatigue.
Constipation	Usually a dull ache, often around the belly button area; reduced number or size of bowel movements; can be bloating around the belly if advanced	Constipation can be very painful, but other things can mimic the severe discomfort sometimes associated with it, like a twist in an ovary or testicle, so call a doctor if concerned. "Also, if they're uncomfortable, be sure to keep track of their bowel movements--kids certainly won't," says Dr. Lai.
Non-gut-related infections (urinary tract infections, pneumonia, etc.)	Fevers are often apparent; kids with UTIs often complain of belly aches low and centered around bladder, and often have pain when urinating and/or an urge to urinate frequently; pneumonia that affects the lower part of the lungs can cause stomach pain or nausea, and typically is associated with a bad cough	"Organs not associated with the gut can cause belly pain," Dr. Lai says. If bacterial, infections often require antibiotics, so if your child has these symptoms, run them by the pediatrician.
Food sensitivity (i.e. lactose intolerance)	Crampy abdominal pain following the consumption of certain foods; loose stools	Lactose intolerance is the most common food sensitivity we see, and can develop as kids get older, says Dr. Lai.
Appendicitis	Pain often starts out in belly button area and moves to the right lower abdominal area; can become very severe	Appendicitis is one of the "great masqueraders of medicine, because it's tricky to tell the difference between this and something benign," says Dr. Lai. If there's any question, go to the doctor.
Stress	The key to anxiety-related stomach pain is that it's very situational, Dr. Lai says. "What often happens in kids who suffer from it is that they have belly pain every morning before school, but miraculously, not on weekends."	"The abdomen is a little known stress point," says Dr. Lai. "Some people get headaches when they're troubled, and others get stomachaches." If every other cause of persistent belly pain is ruled out, docs often look to what's going on at school, at home, and with friends to see if something might be stressing a child out.

Protecting Kids From Mosquitoes

July 19, 2016 by Kelley 1 Comment

Are you, or anyone in your family, a mosquito magnet like me? In a group of people, I am always the first swatting; and the next day, itching like mad. I’ve twice—once, on my Hawaiian honeymoon—had to go on a crash course of oral steroids to treat dozens of oversized welts caused by a single buggy encounter.

Medical literature suggests that some people are genetically predisposed to attracting these mosquitos—something about the amount of heat and carbon dioxide we produce—and that seems to play out in our family, given that my dad, and now my youngest son, seem predisposed to an inordinate amount of itchy, oversized bites this time of year. But it’s now apparent that, even here in the states, these flies are more than pesky, and we all need to take protection more seriously. While findings of bugs carrying the West Nile virus are on the rise, Zika has officially infiltrated the U.S.: as of mid-July CDC reports that more than 1,300 people have carried the virus into the country. As this fascinating chart by the Bill Gates Foundation illustrates, mosquitos are the deadliest creature on the planet, more dangerous than humans, snakes, and 12 other fearsome creatures combined.

Last summer, I did a round-up of expert tips for steering clear of ticks; as we roll into mosquito high season, I’m sharing takeaways from the most recent research for keeping kids safe from ‘skeeters.

DEET is safe and works—but make sure you choose the right concentration.
While it may feel fishy to spray your child down with a chemical that can (for real) melt plastic, a recent review by British public health researchers echoed many others to show that DEET products are safe for kids when used as directed, and are perhaps the most time-tested way to successfully repel insects. Studies show that a product should contain at least 10% to work much at all, but effectiveness seems to plateau at 50% concentrations. The higher the concentration, the longer it lasts; but as with most chemicals, the American Academy of Pediatrics (AAP) recommends choosing a product that contains the lowest DEET concentration that will be effective for the amount a time a child will be exposed to buggy conditions. For children over 2 months of age only (chemical use on newborns should be avoided), the AAP and CDC recommend choosing a DEET product between 10% and 30%—the former lasting about 2 hours, and the latter for around 5 hours—and reapplying as the product directs or when you feel the bugs starting bite again. Unfortunately, many sprays marketed to “families” have too-low concentrations of the protective chemical. So be sure to check the fine print on the bottom of the front label: Among the four DEET-based bug spray options at my local supermarket yesterday, three were 7% concentration.

Good DEET spray choice for day trip (for kids over 2 months): Cutter Backwoods Insect Repellent (25%)

Good DEET choice for travel (for kids over 2 months): OFF! Deep Woods Insect Repellent Wipes (25%)

Good (non oily!) DEET spray choice for backyard or playground (for kids over 2 months):

Two lesser known repellents work too, if you can find ’em.
Picaridin is another chemical repellent with a long safety track record, and a 2016 Consumer Reports study found that sprays with 20% concentration of Picaridin were even more widely effective than DEET. The problem is, it’s hard to find products with concentrations this high outside of Europe and the Internet (see below). Another winner: Oil of lemon eucalyptus. Though a more natural choice than DEET and Picaridin, it’s not recommended for use in kids under 3 (it can be a skin irritant).

Good picaridin choice (for kids over 2 months): Sawyer Premium Insect Repellent with Picaridin (20%)

Good Oil of lemon eucalyptus choice (for kids over 3 only): Repel Lemon Eucalyptus (30%)

Skip bands, bracelets, bath oils, and candles.
Those cute little rubber bracelets and pretty citronella lanterns aren’t going to do more than decorate wrists and picnic tables. Consumer Reports found they had little to no effect on shooing away mosquitoes, echoing a 2002 New England Journal of Medicine report that also found that Skin-So-Soft didn’t repel the bugs for longer than about 10 minutes.

Make your home unfriendly to mosquitoes.
While these bugs are wily opponents, there are things you can do to make your property less hospitable to them. Make sure window and door screens are tight fitting and don’t have holes. Eliminate sources of standing rainwater where mosquitoes like to breed (such a empty pots, buckets, and vinyl covers for pool and furniture), and try a product like mosquito dunks if you have a catchment basin (like we do). You can talk to a professional lawn care company about research-proven treatments for your lawn and trees to dissuade mosquitoes, but these tend to be expensive, and, according to the American Mosquito Control Association, widespread pesticide spraying may harm other, beneficial insects.

Be aware of time of day and weather.
Mosquitoes that carry different types of diseases like to emerge at different times of day. In most areas of the U.S., mosquitoes tend to be peskiest in the early evening hours, but if you’re in a place where these bugs tend to cause dengue, yellow fever, or chikungunya, you need to be vigilant about spraying and keeping doors and windows closed during daylight hours, too. Also, be sure to use repellent in humid conditions; think the woods just after a rainstorm. To see what types of mosquitoes are active in your area, check out this map by the CDC. And regardless of time or climate, experts urge us parents to start thinking about bug spray just as we would sunscreen: an essential, daily habit. Unfortunately, scratchy legs aren’t the only things we’re protecting kids against these days.

Photo credit: Quel maringouin! via Photo Pin, cc

It’s Time to Take the HPV Vaccine Seriously

February 23, 2016 by Kelley Leave a Comment

Since it became available in 2006, the vaccine against the Human Papilloma Virus (HPV) has had few passionate advocates outside medical circles, and no wonder: The vaccine was, after all, new, and therefore didn’t have an overwhelming volume of efficacy data behind it. Moreover, with so many parents still reluctant to immunize their children against diseases like measles, it would stand to reason that a good number might be skeptical of a vaccine that’s meant to protect 11 and 12-year-olds—some pre-pubescent, most sexually inactive— against an STD. “I realize it’s probably more about my squeamishness with the thought of (my daughter) becoming sexually active than the vaccination itself,” one mother told a reporter in a 2011 npr.org investigation. “It’s not the science. I think it’s my own issues around her developing sexually.”

And yet, some facts: Studies done before widespread HPV vaccination show that by the time they’re 15, nearly 10 percent of American girls are infected with HPV. By age 17, that has doubled to nearly 20 percent. And while not everyone who contracts HPV becomes very sick from it, 11,000 women in the U.S. do get HPV-related cervical cancer each year, and a growing number of men are developing head and throat cancers related to the virus. Anyone who has followed the heartbreaking story of country star Joey Feek, who’s battling end-stage cervical cancer, knows how devastating HPV-related cancer can be.

But for those who remain skeptical, some recent data shows that the HPV vaccine is not only safe, but working—and extremely well. Between 2011 and 2014, an array of large, controlled studies showed no association between the vaccine and serious side effects or adverse health problems. And just this week, data from a large, CDC-led study revealed that HPV infection rates among girls 14 to 19 years of age were 63% lower from 2009 to 2012 than before the vaccine was introduced in 2006; for women in their 20s, rates have dropped by a third.

So, even though none of us like to think about our kids becoming sexually active, much less contracting a terrible cancer, it’s time all of us with pre-teens start talking to pediatricians about the HPV vaccine. All boys and girls should get it, starting with a first dose at 11 or 12 years old, when they also get a meningitis shot and a Tdap booster. (They should get a second shot one month later, and then a third one after 6 months). Older teens who missed getting the vaccine earlier should try to get their shots by age 21 (men) and age 26 (women). According to the most recent U.S. statistics, four out of ten teen girls and six out of ten adolescent boys have not started the HPV vaccine series, and are vulnerable to cancers caused by HPV infections.

Think of it as not just an investment in the health of your own kids, but their future loved ones, too.

For more information, check out this HPV vaccine information page at the website for the Centers for Disease Control.

Photo credit: photo credit: HPV vaccine via Photo Pin, cc

What You Need to Know this Flu Season

January 26, 2016 by Kelley Leave a Comment

Ever since my oldest son got the flu twice in three years despite being vaccinated, I go on high alert for news about “flu activity” come late January, when the virus typically starts to ramp up in the northeast. The flu is no joke—kids with a history of asthma or other respiratory issues are at high risk for pneumonia with the virus. Even my healthy son was listless, coughing, and had an around-the-clock 103-degree fever for a straight week.

Vaccine scientists predict what flu strain will be most prevalent from year to year and design a formula accordingly, so even the experts don’t know until the virus peaks how effective each season’s shots have been. Here’s what we know so far—and how we can help keep our kids as protected as possible.

1. This flu season looks mild—so far. As of last week, overall flu cases are low compared to recent years. Just three states—Maryland, Massachusetts and North Carolina—reported “widespread” flu activity across the state, and cases were “minimal” or “low” in 47 states. This time last year, only 17 states had minimal flu activity. Last flu season, the estimated number of flu-associated hospitalizations of 970,000 people in the United States was the highest ever during a single season, according to the Centers for Disease Control and Prevention. Many epidemiologists point to this winter’s warmer temperatures thus far as a partial explanation: Flu tends to circulate fastest in cold, dry conditions.

2. This year’s vaccine seems like a good match. The flu could be suffering from an even more formidable opponent than warm, humid conditions: a well-matched vaccine. Last year’s formula didn’t include coverage against the flu strain that wound up predominating for the better part of 2014-15. The 2015-16 vaccine covers either three or four strains of the flu, including the influenza A virus that’s striking people in greatest numbers thus far.

3. It’s not too late to get vaccinated. It takes about two weeks for the vaccination to set in, and since flu tends to peak in February and last through May, getting immunized now will cover you through the heart of sick season. While the vaccine isn’t 100 percent effective, it’s definitely your bet shot at either preventing the virus or shortening its severity and duration. I continue to vaccinate my kids even though my one son—for reasons doctors can’t definitively explain—has had an unlucky track record. Barring certain medical conditions, everyone 6 months and older should be vaccinated. Want to find the most convenient place to get your shot (or mist)? Check out this handy, searchable map. Most insurance plans cover shots in full, but vaccines are less than $50 (and at places like Costco, quite a bit less than that) out of pocket.

4. Good hygiene is as important as immunization. Getting kids in the habit of washing their hands—with regular soap—when returning home and just before eating can provide great defense. Keep alcohol-based hand sanitizer in your bag and the car and use a squirt after you’ve been in a well-trafficked place like the mall, a museum, or the library. And if they are hacking or feverish, do others a solid and teach them to cough into their elbows, even after the worst of their symptoms subside. Just as vaccines are as much a public service as personal protection, so are good hygiene habits.

5. If you suspect the flu, see a doctor right away. If your child runs a persistent fever, has headaches, is coughing, and/or feeling generally achy and unwell, flu is a possible culprit (even if he or she has been vaccinated). Make an appointment with the doctor sooner than later, since they can test for the flu easily and quickly. Once the flu is diagnosed, you can take extra care to keep your sick child away from siblings and other kids until their fever and symptoms subside; and if he or she is high risk for pneumonia or other complications, the doctor can possibly start your child on an antiviral medication that can reduce the flu’s duration and severity. But in most cases, ibuprofen or other fever-reducing medications (as well as plenty of rest, liquids, patience, and fun movies) will see sick kids—and tired parents—through a bout. For more ideas for keeping children comfortable during illness, check out HHK’s Sick Day Survival Kit.

photo credit: Influenza via Photo Pin, cc