medicine Archives - Happy Healthy Kids

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.

How to Comfort Kids with Colds

November 24, 2015 by Kelley Leave a Comment

If you have a child older than 9 or 10, you might remember a day when drugstore shelves were lined not only with cold medicines for kids, but formulas for babies—teeny little dropper bottles packing decongestants, cough suppressants and other ingredients. That changed in 2008, when the FDA issued an advisory against giving cold medicine to kids under 2. The AAP followed with an even stauncher stance: “Over-the-counter cough and cold medicines do not work for children younger than 6 years and in some cases may pose a health risk.”

These days, you’ll be hard-pressed to find a pediatrician who advocates medicating garden-variety viral colds in kids of any age. It’s nice to be advised against wasting any more money than I usually do at CVS, but at the same time, I’m left with a helpless feeling as the boys sneeze, sniffle, and cough their way to sleep. So I reached out to Drs. Julie Kardos and Naline Lai, the Philadelphia-based pediatricians behind Two Peds in a Pod and advisory board members for Happy Healthy Kids. With kids of their own at home and an office full of congested kids at work, they know what works, and what’s a waste of time. Here’s their advice for what really helps children with colds feel better.

DURING THE DAY…

Encourage rest and naps. “Parents are often worried that kids will feel as miserable as we do with a cold,” say Drs. Kardos and Lai. “But, unlike adults, it’s not a big deal to let them sleep during the day.” And that’s what they should do. Rather than push kids who have more than a little sniffle, let them stay home and rest for a day or two. Waking up several times during the night because of annoying cold symptoms causes sleep deprivation which can make for a crankier kid. Naps help restore sleep and mood.

Hydrate well. Give kids with colds a bit more than they normally drink. Fluids help the body flush out germs, thin out mucus, and replace fluids lost from cough and fever. For sore throats, acidic fruit juices can be irritating, “but frozen Slurpies actually taste great,” say the docs (for more sore throat advice, see this Two Peds in the Pod post).

HHK note: My kids love these watermelon slushies when they are sick. To make: Place 1 cup of seeded watermelon chunks in the freezer for at least 30 minutes. Place in a blender with cold water and a tablespoon of honey. Blitz and serve.

Ease up on screen rules. “Distraction helps discomfort, and it’s (really!) okay to let kids watch some movies during the day. Relaxing on the couch takes a kid’s mind off of annoying cold symptoms.”

AT BEDTIME…

Start a warm bath or shower. A nice, steamy bath or shower always helps clear the head and may even help drain the nose.

Use saline or suction. A quick mist of saline spray into kids’ noses before bed—and maybe an extra pillow or two and a box of tissues—can be just the thing to clear congestion before they fall asleep. For infants, help them blow their noses by using a bulb suction. However, be careful: Over-zealous suctioning can lead to a torn-up nose and an overlying bacterial infection. Use a bulb suction only a few times a day.

HHK note: Not all children are fans of feeling the spray tickle their noses, but for some reason, the colorful bottle and fun grape and orange scents of Boogie Mist helps sweeten the deal.

Run a cool-most humidifier in their bedrooms.

Moist airs helps unclog stuffy noses and soothe dry-throat coughs. Cool is safer than warm: In case anyone falls on the humidifier while stumbling to your bed or the bathroom in the middle of the night, there’s no risk of a scalding injury.

HHK note: My boys loved picking out their favorite “pet” among Crane’s cute animal-themed humidifiers (choose from a frog, duck, owl, dog, elephant (here) or many others), and they are easy to clean.

5 Common Summer Ailments in Kids

July 16, 2015 by Kelley Leave a Comment

Most of us associate sick days with wintertime. That’s when storefronts and commercials are dominated by cough syrup and Kleenex; not now, when sunscreen and beach balls take center stage. So when our kids spike a fever or complain of a sore throat on vacation, it may take us a bit longer to catch on—and, frankly, accept—that they’re under the weather.

As much of a drag as summer ailments are, it’s important they’re on every parents’ radar. Some health problems that go along with warm weather are as, if not more, serious to kids’ health than the coughs, colds, and flu that circulate during the school year. To get the scoop on what pediatricians are seeing in the office right now, I talked to my friend Laura Scharf, M.D., a pediatrician at Quincy (Ma.) Pediatric Associates who also serves as a physician at Camp Becket in the Berkshires, as well as HHK’s advisors Naline Lai, M.D. and Julie Kardos, M.D. of Two Peds in a Pod. Here, they weigh in on how to recognize and treat some of kids’ most common summer ailments. (In each case, be sure to consult with your child’s own healthcare provider for individualized treatment.)

Coxsackie (Hand, Foot, and Mouth Disease)
Common in kids, Coxsackie often spreads around pools, sprinkler parks, public bathrooms, and other “wet” places. Part of the large family of enteroviruses that live in our gut, different Coxsackie strains cause different symptoms, but hallmarks are a high fever and small, sometimes painful blisters around the mouth, hands, feet, and sometimes buttocks. “A new strain we’re seeing can also cause a more extensive rash, often on the lower legs,” says Dr. Scharf. Kids can also get runny noses and pinkeye.
How to treat: Ibuprofen or acetaminophen (administered as directed on the label) can control fever and pain. Soft, cool foods and drinks like yogurt and milkshakes can help soothe blisters in the mouth and throat. Symptoms usually go away in 3-7 days.

Summer Colds
Believe it or not, we’re seeing a lot of colds in the office, says Dr. Lai. Often caused by different enterovirus strains than the ones that cause Coxsackie, these colds may bring on a fever and cough. They circulate where a lot of kids congregate, like camps and daycare. “So it’s not surprising we saw a spike after the July 4th holiday,” Dr. Lai says.
Prevent and treat: Viral colds can’t be eradicated with an antibiotic. Rest and lots of fluids is the best prescription. Your child should feel better within a week; if not, see a doc.

Lyme Disease
Prevalent in the northeast, Pacific northwest, and midwest, particularly in woodsy areas (but not always), Lyme disease is the most common illness spread by infected ticks. (Other tick-borne illnesses include babesiosis, ehrlichiosis, and Rocky Mountain Spotted Fever. For a complete rundown, with geographic trends, check out the CDC’s page, here.) Kids who end up testing positive for Lyme come to the doctor’s office with a nagging fever, aches and pains, and sometimes a bulls-eye-shaped rash. Read more about diagnosing and treating Lyme in this previous HHK post I did with Lyme expert Nevena Zubcevik, D.O.).
Prevent and treat: Apply sprays with 20% picaridin or 30% DEET on your child before he or she goes outside for long periods, especially around wooded or grassy areas. See a doctor right away if he or she has a strange, circular rash or unexplained, recurring fevers or achiness (without other symptoms). Lyme can be diagnosed through blood tests (though false negatives are common, so be sure to follow up if symptoms persist), and treated successfully with antibiotics, especially if caught early.

Rashes
“Summer is rash season,” says Dr. Scharf. Some skin flare-ups are associated with illnesses, such as Coxsackie or Lyme, above. But our peds are also seeing a lot of bumps and welts due to photosensitivity (a reaction to excessive sunlight), contact dermatitis (sensitivity to a material or a product, often a new sunscreen), heat rash (when sweat gets trapped under clogged pores), poison ivy, and bug bites.
Prevent and treat: Limit sun exposure, especially if you have a sun-sensitive kid, and do a patch test to make sure a new sunscreen or product agrees with your child before sending him or her out for the day (sensitive kids often do best with mineral-based sunscreens with titanium dioxide or zinc oxide.) Teach your kids to avoid overgrown wooded areas and keep to paths to avoid poisinous plants. Dressing your child in loose, lightweight clothes can help ward off heat rash. If rashes develop, consult your pediatrician or dermatologist; treatments range from calamine lotion to topical steroids in more extreme cases, to temper welts and stave off itching. It’s important to keep sores clean with soap and water, and to teach kids try to avoid scratching too much, especially with unclean hands. “We see a lot of infected bug bites from this, “says Dr. Lai.

Stomach Bugs
Foodborne illnesses peak in summer months. Bacteria on food grows fastest in warm, moist conditions, and people are often cooking and eating far away from refrigerators and trusted heat sources that can regulate storage and cooking temperatures (think of picnics and beach barbecues). Illnesses usually strike within minutes or hours of eating a contaminated food, and can be mild or severe, causing abdominal pain, diarrhea, vomiting, and sometimes fever. Kids can also pick up bugs from swimming in—and often swallowing—contaminated water. Between 1978 and 2010, norovirus was the second-leading cause of illness outbreaks associated with untreated recreational water, such as lakes, according to the CDC.
Prevent and treat: Clean hands frequently when preparing food, and be sure to keep food that’s susceptible to bacteria (like raw meats) packaged tightly and separated from other edibles. Keep raw produce and meats cold with frequently changed ice packs if outdoors, and cook foods to recommended temperatures (145 for beef steaks, 160 for ground meats, and 165 for pork). The USDA recommends bringing a meat thermometer to picnics and cookouts. If a queasy stomach strikes, keep a child hydrated with plenty of non-acidic, non-dairy fluids. When kids are swimming, especially in untreated lakes or ponds, make sure they avoid swallowing water, and wash up afterwards.You can also replenish them gradually with small sips of oral rehydration solutions made with electrolytes.

Photo credit: Dave Jacquin via Flickr, cc license 2.0

Pediatricians’ Wish List

September 23, 2014 by Kelley Leave a Comment

photo credit: byLorena.com via photopin cc

This is the first in a “Wish List” series in which I ask experts in different kid-related fields—medicine, education, etc.—what they really want parents to know and do better. I’d love to hear suggestions for our next Wish List expert…Kindergarten teacher? Day care worker? Dentist? Environmentalist? The possibilities are endless. Please make a suggestion here.

THE PEDIATRICIANS

Julie Kardos, M.D. and Naline Lai, M.D. are pediatricians in a busy clinic affiliated with the Children’s Hospital of Philadelphia. As fall and winter approach, and their offices fill up with sick and sniffling tykes, they share their top five wishes for patients and their families.

THEIR WISH LIST

1. Vaccinate fully, and on time. As more and more parents opt out of vaccinating or delay immunization appointments in certain pockets of the country, diseases like measles and whooping cough are cropping up again. Do your part for your kid and community by scheduling immunizations, including the flu shot or mist, on schedule. See and print out a complete schedule here.

2. Enforce bedtimes—for little kids and big kids. Too-little sleep leads to depressed kids, hyper kids, and weepy and emotional kids—regardless of their age and stage. Keep tabs and limits on media and even homework, and monitor bedtime, to make sure children get the daily sleep they need: 16-18 hours for babies, 11-12 hours for preschoolers, 10 hours for school-age children, and 9-10 hours for teens. For sleep guidelines and tips from the CDC, see here.

3. Trust yourself. Teachers, day care workers, and even doctors are all capable of “over-calling” or “under-calling” conditions in kids. You know your child best: If you think he is sick, push your physicians for answers; if she seems fine even though someone—the school, a grandparent—insists something is “wrong,” listen to your gut.

4. Teach your children to seek you for comfort. It’s tempting to shove an iPad or a lollipop in front of children when they are scared or uncomfortable, at a doctor’s office or elsewhere. Distraction when necessary—like pulling out a splinter—is okay, but after the deed is done, shower your child with the kisses, hugs, and words that only human interaction can provide.

5. Be careful about sending mixed messages. If you want your child to eat better, make sure you’re eating well. Same goes for exercise, fighting fair, hand washing, and any number of things. Kids notice more than you think; make sure you are role modeling the behavior you want to see in them.

What’s in Your Medicine Cabinet, Dr. Tello?

September 12, 2014 by Kelley 2 Comments

It recently dawned on me that since having kids, I’ve spent more money on medications and toiletries for them than myself. Their bathrooms are stocked with a variety of fever relievers, potions, lotions, and de-grimers: A quick peek revealed, for instance, five bottles of liquid ibuprofen, some sticky, honey-based homeopathic remedy for coughing, four boxes of Band-Aids in an evolving array of favorite characters, and a “soothing vapors” bubble bath for stuffy noses. I’ve even taken the time, recently, to painstakingly organize their medicine cabinet to make middle-of-the-night dispensing easier.

My “medicine cabinet” (the upper shelf of my closet, actually) is a comparative wasteland of expired or rejected products. There’s Sudafed with a 2008 expiration date, prenatal vitamins from my third pregnancy three years ago, and lots of lotion and creams that were purchased, tried, and left to languish. What did this say about my investment in my own health and wellness?, I wondered. It was time for an overhaul.

After chucking the expired medications, I asked HHK adviser Monique Tello, M.D., what she keeps in her own medicine cabinet. As a primary care physician who specializes in women’s health issues at Massachusetts General Hospital, and a busy, practical mom, she knows what products are essential, and which just hog precious bathroom space. Here’s her list and comments, with links in case you too are in a stocking-up sort of mood.

Dr. Tello's Must-Haves (for Adults, Not Kids)

Naproxen (i.e. Aleve)	"For headaches, muscle aches. Not for those with a history of ulcers, and not for taking every day."	<br />
Acetaminophen (i.e. Tylenol)	"When you’ve already taken Aleve. To be used sparingly, to spare the liver."	<br />
Diphenhydramine (i.e. Benadryl)	"For nighttime post-nasal drip cough."	<br />
Nighttime cough syrup (i.e. Nyquil)	"When Benadryl is not enough."	<br />
Neti pot with non-iodized salt packets	"Best sinus infection prevention ever."	<br />
Docusate (i.e. Colace, a stool softener)	"Because two pregnancies left me with a condition that demands regularity."	<br />
Magnesium hydroxide/ Simethicone (i.e. Maalox Anti-Gas)	"My go-to after a poor food choice, or a too- large dinner out."	<br />
Bismuth subsalicylate (i.e. Pepto-Bismol)	"Because the kids bring home GI bugs every winter." (Note: Pepto has a children's version that doesn't contain subsalicylate, which may be harmful for kids.)	<br />
Hydrocortisone cream (i.e. Cortaid)	"For itchy bug bites that are keeping you up at night."	<br />
Diphenhydramine cream (i.e. Benadryl topical)	"When Cortaid is not enough."	<br />
Triple antibiotic ointment (Polysporin)	"For hangnails and cat scratches, so they don’t progress to something requiring a doctor’s visit."	<br />
Hypoallergenic facial moisturizer cream (i.e. Eucerin)	"For daily use, wonderful for the skin."	<br />
Lip balm with SPF	"A swipe on the lips and nose on sunny or cold days goes miles in prevention."	<br />
Epsom salts	"Not only for sore muscle tub soaks, also a soothing tub soak for painful conditions in hard-to-reach areas."	<br />

How to Measure Medicine

August 7, 2014 by Kelley Leave a Comment

The AAP has long warned against using kitchen spoons to measure out medicine, finding that parents who do so are likelier to overestimate the amount of medicine their kids need. So, why, then, I’ve wondered, are so many pediatric liquid medicine manufacturers still offering directions in teaspoons? What’s more, why do they include two different units of measurement on those little cups that come with the bottles—“tsp” on one, “ml” on the other? When you stumble out of bed to tend to a child who’s crying with fever for the third night in a row, those tiny acronyms are barely distinguishable—and that’s if you’re lucky enough to be dealing with a cup that has black writing, rather than clear raised letters, which you try to make out with your fingers, Braille-like, when holding the thing up to the bathroom nightlight proves fruitless. Nothing at 3 a.m. should be that hard.

Turns out, the AAP has the same concerns. In a recent report, they’re advising that medicine companies ditch the teaspoon directives, and stick just to milliliters in their labels and measuring cups. In the meantime, think about designating a medicine syringe or cup per child per medicine bottle, and marking them up with a Sharpie. Put the child’s initials, the name of the medicine, and a line for correct dosage on the measuring device. Change them out as your child moves up the weight charts. Arrange possible needed meds in Tupperware bins, out of reach in a bathroom or bedroom closet. The next time you hear that telltale midnight wail, you’ll thank yourself.