WELLNESS Archives - Page 3 of 3 - Happy Healthy Kids

Bathing 201: Beyond the Baby Years

January 14, 2015 by Kelley 1 Comment

Bathing serves multiple functions in our house. Depending on the day and the kid, it can serve as a wind down tool or a wake-up call; sibling bonding time or much-needed alone time; a skin soother or grime remover. Our children take a bath or shower nearly every day, for these and other reasons. But when one of my sons scratched some dry skin on his hip so aggressively the other day that it started to bleed a bit, I started wondered if maybe we needed to cool it on his daily hot shower, at least during the winter. At the same time, doesn’t his current sport of ice hockey, perhaps the smelliest sport on the planet, call for it?

When our babies are first born, we’re given detailed information about how—and how often—to cleanse their hair, skin, and teeny tiny belly buttons. But when the newborn period is over, so is the annual well-visit spiel about bath time. And yet bathing is something our kids do nearly everyday, with major repercussions on hygiene, body awareness, dermatologic health, and even mood. Clearly, I needed someone to walk me through bathing 201. So I turned to pediatricians Julie Kardos, M.D. and Naline Lai, M.D., HHK advisory board members and creators of the Two Peds in a Pod blog, for age-by-age guidance. Here’s the nitty-gritty on getting kids clean, along with some product recs (based on my own research).

BABIES AND TODDLERS

How often to bathe? Three times a week or less. Be sure to wash their hands after diaper changes and potty time and before meals, however. If they really like bath time, you can do it everyday, but don’t soap areas other than their hands, face, and diaper area, and keep sessions short. The exception is children with eczema; daily bathing can be too drying. For these kids who love the bath, set up a basin of warm water and toys at the sink for them to play with.

What products to use? Mild, fragrance-free soaps or just plain water is best. “Generally, the less scented, the better,” says Dr. Kardos. Research shows that using a thick moisturizer on a young child’s skin everyday can cut their risk of eczema by half. Lotion can feel cold right out of a warm bath; try filling the bathroom sink halfway with hot water and let the bottle warm in there during bath time.

Keep in mind…This never goes without saying: Keep within arm’s reach of babies and toddlers while they’re bathing. Older siblings are fun tub companions, but terrible lifeguards. This is not time to catch up on Facebook, either, as tempting as our iPhones are. Digital distractions around the bath are a hazard for your child and your device.

ELEMENTARY SCHOOLERS

How often to bathe? Every other day works for most kids in the early grades. During the summer, though, you might want to make sure they have a quick shower or bath nearly everyday, in order to rinse off chlorine, sunscreen, and possible ticks, and clean any cuts or microabrasions. Make sure they lather up their hands, face, and genital area.

What products to use? Colorfully packaged soaps can motivate school-age kids to bathe, but try to choose brands with minimal fragrance, dyes, and chemicals. Highly-rated ones to try: Kiss My Face Kids’ Bubble Wash ($10, Amazon) Jason’s Kids Only! Tropical Twist Wash Bath Gel ($7, Amazon) and Tru Kids’ Bubbly Body Wash (Amazon, $9), all of which come in fun, gender-neutral designs. Avoid bubble baths, which seem like fun but can really dry out skin and irritate private parts (especially girls). If itchy, dry skin is a problem, fill the toe of a sock with skin-soothing oatmeal, tie or cinch the top, and let it float in the water.

Keep in mind…Kids this age love to lounge, splash, and test their breath-holding capacity underwater, so even if they’re swimmers, make sure you can hear them at all times if bathing takes place in the tub. One idea: Bring a laundry basket into the bathroom or a room adjacent to the bathroom and get some folding done during bath time.

‘TWEENS AND ‘TEENS

How often to bathe? Once kids are around 9 or 10, they really should bathe everyday to stay fresh and clean. Make sure they wash their hands, faces, genital areas, feet, and underarms, as well as the back and chest (which can become acne-prone). As early as possible, teach them to wash their faces at the sink after waking and before bedtime, too, so that if and when complexion issues arise, they will have already developed good habits. Place a mild face soap, like Cetaphil (they make an oily skin version,$10, Amazon ) on the edge of their sink to help remind them.

What products to use? Again, nothing fancy: low-fragrance, mild soaps are best. Bar soaps that contain lotion, like Dove ($7 for eight bars, Amazon), will keep skin from getting dry and itchy. If your ‘tween or ‘teen likes to use a bath poof or sponge, replace them regularly (they are bacteria magnets).

Keep in mind…Big kids need bathing instruction too, especially as they hit puberty. Speak frankly with them about how to clean themselves, including using their pads of their fingers to scrub their scalps and avoid flaking, washing their faces from the top down as opposed to center-out (as not to spread any secretions from their noses into eyes and mouths), and carefully but completely cleaning the groin area. Awkward? Sure! Helicopter-ish? I don’t think so. These are life skills that will boost hygiene, comfort, and even confidence during the trickiest time of childhood.

Be Wary of Supplements for Kids

December 16, 2014 by Kelley Leave a Comment

Immune boosting. Brain healthy. Tummy soothing. Whole aisles in Whole Foods and other stores are filled with rainbow-colored bottles bearing these promises and others, and they are marketed to parents like you and me, who want nothing more than to have healthy, bright, gastrointestinally secure children—particularly this time of year, when bugs, moods, and too-rich foods can run roughshod over our carefully laid holiday plans.

Many parents “swear by” some sort of vitamin, mineral, or herbal blend, which is why 1 in 9 kids take some sort of supplement. But real research about the benefits—and more important, safety—of kid-targeted supplements just isn’t there. Dietary supplements aren’t tightly regulated by the FDA the way medications are, which means that companies aren’t required to meet a strict criteria of certain safety standards or prove certain health claims before their products land on a shelf near you. This truth was magnified recently, when a premature baby in Connecticut died after being given a probiotic powder that was contaminated with a fungus. Manufactured by the popular supplement brand Solgar, ABC Dophilus powder was marketed as a supplement for babies and children specifically before the contamination was discovered and it was pulled from the shelves.

This news shouldn’t incriminate probiotics on the whole: They are prescribed by many doctors to help replace the good bacteria in kids’ guts when they are taking antibiotics, and research has supported their use in premature babies with certain conditions. But it is a reminder that supplements are not without risk; and because regulation is so weak, it’s often unclear what those risks actually are in the first place. It reminds me of something a dietary researcher told me when I was editing a story about supplements for children as an editor at Child magazine: “Natural doesn’t mean neutral.” Many supplements sell themselves on being derived from nature or eschewing chemicals, but that shouldn’t lead us to believe they are necessarily harmless as a result. Moreover, while supplements suffer from a lack of testing in people generally, research on their effects in children is especially scant.

Cases like the one in Connecticut and many others will hopefully serve as a wakeup call that the government needs to rethink its position on supplement regulation in the U.S. In the meantime, it’s essential that when we choose over-the-counter supplements for our families, we do so caution and in close concert with a physician who knows your child’s medical history well. Some supplements may interfere with medications your child is taking—for instance, vitamin C interferes with the absorption of acetaminophen (Tylenol). Meanwhile, according to a 2012 report, children who take multivitamins are at greater risk than those who don’t of getting too much iron, zinc, copper, selenium, folic acid, and vitamins A and C, which is why the AAP does not recommend the use of multivitamins in kids with a reasonably varied diet. From time to time, a reputable, well-tested supplement may be just thing to help a child thrive. But in most cases, your pediatrician will probably tell you that supplement is unnecessary, in which case you’ll cut back on your grocery bill as well as unclear potential risks to your kids’ health.

photo credit: KitAy via Photo Pin, cc

Prepping for a Doc Visit

December 15, 2014 by Kelley Leave a Comment

This is a guest post by Michelle Friedman, a mom, freelance writer, and marketer at Medical Scrubs Collection.

I walk into the bright glare of the waiting room, hanging onto coats and mittens, while handing out snacks and chasing after my toddler. I catch a whiff of hand sanitizer—and the sounds of wailing babies.

We’ve all been there. Well visits at the pediatrician are crucial for checking on your kids’ progress and getting them up-to-date on their shots, but not so great on the nerves. After a few disastrous experiences, I was forced to do a little research on how to make sure future well visits were more educational and less exasperating. Here’s what I’ve learned.

1. Come prepared with your own entertainment.

Different pediatricians have varying policies about the forms of entertainment they keep in their waiting rooms, due to a concern about spreading germs. Some doctors only have books or movies, while others have full entertainment stations. Regardless of what’s offered, bring along age-appropriate entertainment for your children to keep them busy during the inevitable wait. Books, small card games, and coloring books are all great ways to keep the kids busy. Educational apps that are kept as a treat just for the doctor’s office can keep their minds busy rather than their legs—because, let’s face it, an office full of sick kids are one of the last places we want our kids to “explore.”

2. Write down questions in advance.

In the days leading up to my kids’ well visits I remember all the little things I want to ask the doctor, but once he’s in the room and I’m trying to keep them from jumping off the exam table, my mind goes blank. And before I know it the nurse is on her way with the shots, and the doctor is gone. The American Academy of Pediatrics recommends keeping a notepad dedicated for doctor’s office visits where you jot down questions as they come to you—seeing them in print really helps. You can bring up your questions at the beginning of the visit, or after the doctor is done examining your child. Check your list to make sure that all your questions were answered, and write down any instructions given.

3. Prepare the patient.

Kids, like adults, are afraid of the unknown. Before the well visit prepare your child by explaining the order of events and what will happen at the visit. (It might be tempting to “not worry” them with details beforehand, but that can lead to even more fear and distrust the next go-round.) Emphasize that the doctor and nurses care about them, and want them to feel well. KidsHealth.org offers a great resource that gives an in-depth look at the psychology behind children’s fears when visiting the doctor, and how to allay them. I have found that teaching my young son his doctors’ names helps alleviate the anxiety, by giving more of a personal feel to their caretakers. I also don’t cover up the truth: If he will be getting shots, I let him know. We discuss how the shot will only feel like a pinch for a moment. With a child who is really anxious, you can teach coping skills with a stress ball, which you can bring with you on the big day. You can also prepare young patients by playing doctor at home with dress up clothes and toy instruments. The role play will help familiarize your child with the concept, and might even make the whole process a little more fun.

4. Keep your cool.

I’ve learned that perhaps the most important thing that you can do for your child at a doctors visit is to be a calming force. Children are great at picking up vibes from their caregivers, and the slightest hint of tension will translate into anxiety and tantrums. Be prepared for the inevitable tears, and enjoy the opportunity to mark your children’s milestones.

Now that I’ve committed to some advance planning, my children’s well visits have become mostly pleasant experiences where they get a chance to form relationships with their doctor. And when they’re not? I’m learning to deal a little better with the chaos myself.

How to Care for a Cough

December 1, 2014 by Kelley Leave a Comment

Does someone in your family have a cough right now? Better question: Who doesn’t? This time of year, classrooms resound with choruses of coughing children, whose parents likely wrestled, hours earlier, about whether or not to send them to school that day.

Trying to figure out the source and severity of a cough can be one of parenting’s great mysteries. I have three big coughers here at our house: When a cold comes on, they never seem much afflicted by sore throats or even stuffy noses, but rather a constant, nagging, occasionally gag-inducing cough which makes it sound as if they are much sicker than they actually are. I’ve tried just about every cough medicine on the market to combat it, with little success (and a whole lot of middle-of-the-night crying, usually more about “wild cherry flavor”—is there a more vile substance known to man?—than the cough itself).

Our favorite pediatricians and site advisory board members, Julie Kardos, M.D. and Naline Lai, M.D., verified that they get as many questions about coughing as just about anything else. So the other day, they provided straight, no nonsense answers to the five big questions we all seem to have about coughs. Give it a read; it just might save you a trip to the doctor’s office. (Or, more likely, the drug store…read on.)

Q. When is a cough “normal,” and when does it warrant a trip to the doctor’s office?

A. Kids get, on average, 10 viruses a year, mostly in the winter. And most get coughs with those colds viruses. It’s normal for a cough to last two weeks, even after a child is feeling better.
If a cough progressively worsens, or comes with a fever after your child has had other cold symptoms, that could be a sign of a bacterial infection, and you should definitely see the doctor. Ditto if there’s any sign of breathing trouble with a cough. (Do the “lift the shirt test”: lift up your child’s shirt, and if his stomach is moving a lot, or his ribs are sticking out as he breathes, that’s a red flag.) If a cough last more than two weeks, call his doctor, since he could have other issues such as a sinus infection, acid reflux or something anatomic pressing on his lungs.

Q. What if my child seems to cough like crazy every time they have a cold?

A. Some kids have a type of asthma that’s triggered by upper respiratory infections, and they cough a ton just when they’re sick. For these kids, doctors can prescribe specific asthma medications, which can help control the cough caused by a cold.

Q. Does cough medicine work?

A. Cough suppressants don’t work. There are no convincing studies in children to suggest otherwise. If the cough is due to allergies—this is often diagnosed when a child coughs only in certain places, like just at home or school or around certain animals—Benadryl (diphenhydramine) can be helpful. If the cough is caused by a bacterial infection, treating that infection with antibiotics will help cure the cough.

Q. Is there any harm to trying to suppress a cough?

A. Cough by itself isn’t evil at all. It’s the body’s way of getting rid of mucous. When people come to our office and they have nice clear lungs and are coughing up a storm, we say, “great!” A productive cough can make a child less likely to get pneumonia. Babies tend to get more complications from flu and other respiratory infections because they don’t have the strength to cough and mucous settles into the lungs and causes a bacterial infection.

Q. Still, coughs can keep kids up at night. Are there ways to make a child more comfortable?

A. If a child is over a year, you can try a teaspoon or two of honey every few hours and before bed. A humidifier and drinking a lot of fluids during the day keeps the throat moist too, which can help. If they’re elementary school age, you can give them cough drops during the day for the same effect. If the cough sounds like a barking seal, it could be croup, which is just an inflammation of the vocal cords due to a cold (the grown-up equivalent is laryngitis). Opening a window and letting your child breathe fresh, cold air can help control a “croupy” cough. (For more on croup, tune in to this Two Peds in a Pod podcast.)
But the biggest thing to remember is that a cough often bothers parents more than kids. If your child is coughing but sleeping through it, there may not be anything more you need to do than wait patiently for the cold to run its course.

How Safe is Sanitizer?

November 12, 2014 by Kelley 2 Comments

Our children will probably never remember a time when hand sanitizer, which hit the market in 1996, wasn’t everywhere they looked. Plastic gel bottles bedeck just about every desk, bathroom, and car cup holder they come across, and holding out their hands for a squirt before snack time has become as routine as raising their hand in class. One of my son’s first multisyllabic utterings was “han-i-tizer.” (At six, he still calls it that.)

At the same time, we’ve been hearing a lot about how cleanliness may not be all that it’s cracked up to be. Turns out that babies who are exposed to an array of dirt and bacteria—through farm settings or pets, for instance—are less likely to develop allergies and asthma than children raised in spotless surroundings. Antibacterial soaps, which seem like such an excellent idea, have likely contributed to the growth of antibiotic-resistant bacterial infections in recent years, and may affect kids’ hormonal development, according to the FDA, which advises against them.

And yet, even as we start to go easier on the Lysol and chuck the Triclosan, hand sanitizer is still ubiquitous. Which got my friend Stacey and I wondering at school pickup the other day: Just how effective—and safe—is the habitual slathering of alcohol on our kids’ skin? Luckily, Thomas Sandora, MD, MPH, a pediatric infectious disease specialist at Boston Children’s Hospital, just down the road from us, is one of the world’s experts when it comes to hand hygiene. Dr. Sandora took time out of his busy schedule yesterday to gave me the scoop on sanitizer.

1. Sanitizers that include at least 60 percent alcohol reduce the risk of GI bugs, in particular. Dr. Sandora led two studies—one in which families with children in child care received hand sanitizer to use at home, and one in which sanitizer was used in elementary school classrooms. The groups who received and regularly used the sanitizer had fewer gastrointestinal illnesses. Alcohol can also fight many other forms of bacteria and some viruses (including the seasonal flu, and interestingly, Ebola).

2. …But it doesn’t defend against everything. Some viruses aren’t affected by alcohol—like norovirus, a particularly nasty and common GI illness. Cleansing thoroughly with ordinary soap and water does seem to be effective in killing norovirus and most other germs from skin surfaces, however, so if you’re able, wash your kids’ hands well before—or in lieu of—using sanitizer.

3. Alcohol-based sanitizers aren’t contributing to the superbug problem. Because alcohol essentially obliterates bacteria on contact, these bugs don’t have an opportunity to mutate into more resistant forms. Overused antibiotics and “antibacterial” products, on the other hand, seem to promote these adaptations, leading to hard-to-treat “superbugs” like MRSA and C. difficile.

4. The amount of sanitizer you apply counts. A couple drops on the center of your palm isn’t necessarily going to get the job done. Use about a dime size amount, and be sure to rub it all over your child’s hands, including the backs and fingertips. In Dr. Sandora’s research, he found that families who used sanitizer liberally were less likely to pass around respiratory illnesses than families who used just a little. But be sure to use it only on kids 24 months and older, and no more than about 5 to 10 times a day, to reduce the chance that excess alcohol is absorbed by the skin.

5. Keep the pumps out of kids’ reach. Between 2005 and 2009, the National Poison Data System received nearly 69,000 reports of potential sanitizer ingestion. Young kids may be drawn to the jelly-like fluid, so make sure to keep your sanitizer bottles in places little children can’t access. While a lick or a suck on a sanitized thumb shouldn’t cause a problem, a toddler who’s ingested the equivalent of a couple teaspoons or more should receive medical attention. (Skin irritation, notes Dr. Sandora, is mild and not common.)

6. Think of sanitizer as a team player rather than solo act. Hand hygiene is perhaps our key defense against a variety of illnesses, says Dr. Sandora. But it’s also helpful to remember to cough or sneeze into your elbow instead of your hand, use (and promptly toss) tissues, and avoid close contact with people who are sick. And don’t forget to get your flu vaccine—everyone 6 months and older should get it every year.

Photo credits: Niquimerret via Photo Pin, cc; Valerie Everett via Photo Pin, cc

Pediatric Dentists’ Wish List

October 20, 2014 by Kelley Leave a Comment

This post is part of 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. Interested in hearing from a certain type of expert? Please make a suggestion here.

THE PEDIATRIC DENTISTS

This week, I consulted the pediatric dental team at Chestnut Dental Associates in Needham, MA about what they wish parents knew about taking care of kids’ teeth. At home, Dr. Keri Peterman, Dr. Jon Shusterman, Dr. Anne Hertzberg, Dr. Crissy Beard, Dr. Amy Regen, and Dr. Shelley McBride have eight children (ranging in age from 1 to 12) between them. Thanks, guys!

1. Young children might cry when you’re brushing or flossing their teeth. Don’t take that as license to rush the job. Lots of kids cry when their diapers are getting changed, too, but you aren’t likely to leave that task half-done as a result. Remember, you’re not hurting them; you’re helping them.

2. Children will need a hand with brushing well into grade school. Reaching the back teeth and the inside gum line properly requires a level of manual dexterity that a lot of kids simply don’t have. Monitor older children’s brushing and step in often to help them reach the tricky spots.

3. Cavities aren’t always just the result of lazy dental care at home. Some 60 percent of children have a cavity by age 5, making dental decay the most common chronic disease of childhood. A lot factors go in to the development of cavities (including genetics and water quality), so even model brushers need to keep regular appointments to see a pediatric dentist, who can help determine a child’s risk factors for cavities and help with their management.

4. Fluoride is your friend. Fluoride is an inorganic ion of fluorine which is in our periodic table of elements; it exists all over the earth. When used in moderation—recommended amounts when brushing with a fluoridated toothpaste, periodic dental treatments, fluoridated water— it’s very safe and effective at reducing the risk of tooth decay. Be sure to talk to your pediatric dentist to make sure you’re child is getting the right amounts.

5. A child is exposed to less radiation in today’s dental x-rays than in a cross country flight. Dental x-rays have changed over time, and digital technology reduces radiation exposure by 40-60%. When taken at appropriate time intervals they are essential to diagnosing and treating dental disease.

6. Sugar is everywhere. Yogurt, raisins, packaged snacks, and juice—even “organic” and “all-natural” kinds—are all very high in sugar. The best way to reduce overall sugar consumption is to limit snacks and cut out juice entirely between meals. The AAP recommends no more than 4-6 ounces of juice per day with meals, which reduces the possibility that a child will sip juice over a long period of time. When it comes to dental health, reducing the frequency your kids’ teeth are exposed to sugar is key.

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.

Breathing Trouble in Kids: 9 Sneaky Signs

September 11, 2014 by Kelley Leave a Comment

When it comes to symptoms of sickness in my kids, the one that confuses and scares me most is breathing trouble. If you suspect a fever, you can consult a thermometer. Runny noses and coughs make themselves known, noisily. Stomach upset? There are (all-too) many tip-offs that, too. But respiratory distress can be sneaky. Labored breathing is often inaudible, invisible, and difficult for children, especially very little ones, to recognize and articulate. The problem is, it can potentially signal some of the most serious childhood emergencies, including pneumonia, asthma, and life-threatening allergies.

photo credit: Hey Paul Studios via photopin cc

Case in point: One winter’s day five years ago, when my friend’s son was five months old, he seemed to be having trouble breathing. As a nurse, she knew to bring him to her son’s pediatrician’s office to get him checked out. A new pediatrician at the practice told her that the baby looked fine, that his difficulty breathing was probably just due to congestion, and that she could return in a couple of days “if (she) was nervous.” My friend, indeed, was still concerned, but went home, and undressed her son to bring him into the shower to try to clear his nasal passages. She saw that his ribs were protruding with the effort to breathe. “Screw the follow-up visit—I headed straight for the E.R.,” she says. Doctors there diagnosed the baby with pneumonia, and he spent five days in the hospital receiving supplemental oxygen and I.V. antibiotics.

You’ve probably read about the outbreak of Enterovirus D68, a serious respiratory infection that’s sending kids to the hospital in more than 10 states. With officials warning that the Enterovirus outbreak will likely continue to spread, and cold and flu season looming, it’s important to know what respiratory distress looks like in your child. Drs. Julie Kardos, M.D. and Naline Lai, M.D., HHK’s resident pediatrician advisers, recently wrote a post about this very subject on their blog, Two Peds in a Pod. Here, I share their nine telltale signs of breathing trouble, all of which warrant a visit to the doctor. (When in doubt, or if your doctor is inaccessible or your gut instinct is telling you to get a second opinion, always seek emergency help.)

Signs Of Breathing Trouble Call A Doctor, Head to the E.R. or Call 911 ASAP
Breathing faster than normal
Flaring his nostrils with each breath
Chest or belly moves upward dramatically with each breath (lift up her shirt to look for this)
Ribs are sticking out with each breath (lift up his shirt to look for this)
Making grunting or wheezing sounds at the end of each exhalation
Refusal to breastfeed or bottle-feed (if an infant)
Difficulty talking (an older child)
Seems anxious or tired as he becomes "air hungry" (struggles to breathe)
Pale or blue at the lips

Surprising Cause of Skipped Vaccines

August 21, 2014 by Kelley Leave a Comment

You’ve probably read that certain vaccine-preventable diseases like measles and whooping cough are making a comeback. (The first four months of 2014 saw more measles cases than in any year since 1996.) Breakouts tend to be focused in communities where there are large pockets of parents who choose against immunizing or delay it, out of religious or personal beliefs (like that shots trigger autism, despite rigorous research showing otherwise). This “opt out” trend has gotten a lot of press lately, but there’s another, less newsworthy reason why many parents aren’t getting their kids vaccinated on time: They just haven’t gotten around to it.

Last year, a study sponsored by the Centers for Disease Control (CDC) revealed that 49% of some 300,000 toddlers in managed care programs were late on certain immunizations by their second birthday. But only about 1 in 8 of those kids were undervaccinated due to “parent choice.” Most were likely behind due to logistical issues, such as missed well visits and sickness at the time of a scheduled appointment, said researchers in a Reuters report on the study. HHK advisory board member Julie Kardos, M.D., who runs a pediatric clinic outside of Philadelphia, has seen this phenomenon—and its possible repercussions—up close. One of her patients was a four-year-old boy who was behind on his vaccines, and was hospitalized for pneumonia. Before measles was identified as the cause, he exposed an entire E.R. to the illness, which is one of the most contagious diseases there is. (As Dr. Kardos and Naline Lai, M.D. write in their Two Peds in a Pod blog, nine out of 10 unvaccinated people get sick from exposure to measles, and are contagious before symptoms begin.)

Photo by: Dawn Huczek

What scares me is that this type of scenario seems pretty plausible. There are an incredible number of vaccines to keep track of now—the CDC now recommends immunizations against 16 preventable diseases, and a child could realistically have had 24 vaccines administered by age 2. Plus, many days, our family’s collective schedule seems like a deck of cards, and one false move—misplaced car keys, say—can cause everything else to topple. I can see how many parents could believe fully in the importance of vaccines, but feel they can put them off—and off, and off some more—until work slows down or Billy gets over his cold (and do toddlers ever really get over their colds before another one starts?). Even more convincing are the moms and dads who, due to multiple jobs or a lack of easy transportation, feel like they literally can’t get their child to the doctor’s office, despite their best intentions.

The thing is, every single person in the community is responsible for keeping vaccine-preventable diseases at bay. When even just around 10% of kids miss a vaccine against certain illnesses, so-called “herd immunity” against that bug is compromised, and something as minor as one undervaccinated child’s exposure to an infected person in an airplane, mall or doctor’s office can cause an illness to seep into a community. (I wrote more extensively on this topic in a Parents magazine article a couple years ago.) And these vaccine-preventable illnesses are no joke: Measles, for instance, can not only cause pneumonia, but encephalitis, which can lead to permanent brain damage. Keeping on track with vaccines is key, and especially when your child is young, says Dr. Kardos. For toddlers and preschoolers, shots are numerous and frequent not because doctor’s want to torture them (or us), but because their growing immune systems are more vulnerable to illness.

Dr. Kardos suggests printing out the CDC immunization schedule (filter by your child’s age and your favorite format—even tri-fold!— here) and keeping it on your ‘fridge or bulletin board or in your wallet. There are also some new apps for your phone that can help you keep track. (I like Vaccines on the Go, an app put by the Vaccine Education Center at Children’s Hospital of Philadelphia). In most cases, doctors will remind you what vaccines your child needs once you show up to a well visit, but knowing the schedule in advance can help remind you just how important those regular visits are. It can also prompt you to pack a favorite book, lovey, or my personal savior, lollipop, in your diaper or tote bag when you know it’s going to be a “special” day at the doc’s office. Vaccines can be a pain—literally and otherwise—but few things you can do for your kid and community are more important.

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.