Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

A mom, a pediatrician, and her insights about keeping your kids healthy.

How To Dose OTC Medicines In Babies

kyotcs_feverinfographic_weightageAbout 4 million sweet babies are born in the U.S. every year. And since September & October are two of the most popular months in the year for the birth of babies I’m taking a moment to share a couple of reminders for new families and those of you who support them.

1. Nursing Moms & Over The Counter (OTC) Medications: Every new parent feels a sense of overwhelm and exhaustion after welcoming a new baby. It can be especially exhausting when moms are breastfeeding and carry the new concerns about what they’re eating, how they’re both supporting themselves and their baby’s milk and when moms and dads have concerns about passing OTC medications (or Rx ones) through mom’s milk. Here are a few guidelines and reminders:

  • Don’t take aspirin if you’re breastfeeding.
  • It’s always best to avoid extra strength formulas of any medication, as they stay in the blood stream longer.
  • Always ask your doctor if you are worried or have questions about a medicine or supplement you’re taking if you’re breastfeeding. Always makes sense to ask.
  • Read the Drug Facts label as this will sometimes help you understand risks.
  • I like LactMed as a resource/search tool to help find information on medications. LactMed is updated monthly and is a database of over 1,000 drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant. All data are derived from the scientific literature and fully referenced.

2. When Your New Baby Gets A Cold Or Fever: Your baby’s first bout with a cold or fever can leave you feeling scared (and exhausted) as you watch your baby deal with the inconvenience of mucus and snot, coughs and/or sneezes. Infants are more susceptible to infections because they don’t have fully developed immune systems hence why we all work hard to avoid exposures for them early in life. But upper respiratory infections (“colds”) do happen even with the best of protections.

Oral cough and cold medicines (including cough suppressants, cough expectorants and multi-symptom cold medicines) are not safe for infants and young children under the age of 4 or 6 years of age.

However, if your baby has a fever and is OVER the age of 3 months, you can give them acetaminophen to help relieve symptoms. The label on OTC medicines for infants and children only includes dosing for children age 2 and older; so talk to your doctor for dosing for younger children.

Always dose medicine by your infant’s weight, not their age, so at every well child check-up as your baby grows, ask your pediatrician to provide the proper, current dose for OTC medicines.

You can also give your child ibuprofen for mild infections, fever, or teething. Dosing for children 6 months and older is on the label; talk to a doctor for dosing for younger children although it is not typically recommended.

Dosing acetaminophen and ibuprofen by weight in infants and toddlers

Non-Medicine Interventions for Colds

If your infant or toddler is too young to be given OTC medications or you’d prefer not to use them, there are other options to help relieve symptoms and keep your baby sleeping and comfortable.

  • Hydration: keeping their nose and sinus and airway humidified can help babies and children move mucus around and can sometimes help reduce cough. Use a cool-mist humidifier in the room. The mucus gets less sticky and dehydrated and they can mobilize it better. Another option is to use saline nose drops to loosen and thin nasal mucus and then suck it up with a nasal bulb syringe or “snot sucker.”
  • If your child is over 1 year of age you can use a small teaspoon of honey to help with cough.
  • Positioning may help: for toddlers over a year of age you can prop them up in the bed at night with a pillow as this sometimes can help them clear mucus easier and reduces likelihood to cough. NO PILLOWS in the cribs of infants!
  • This won’t last forever! Colds are part of babyhood for most infants. And the rule of 7’s: cold symptoms can often last 7 days and it’s not uncommon for a baby to get as many as 7 colds in one year!

3. Tackling Diaper Rash: Diaper rash causes your baby’s bottom to appear bright red and irritated. Sometimes the skin even appears raw. This inflammation of the skin can be caused by plain old bad luck (!!!), or sometimes from more infrequent diaper changes, diarrhea, uncomfortable diapers or from material used to cover diapers. Rarely, a recent course of antibiotics that can cause yeast to grow in the diaper area. Fortunately, diaper rash is usually easily treated and can improve within just a few days. Does make our hearts hurt when we see it, though… so here are a few remedies:

  • Use an ointment, such as petroleum ointment, petroleum jelly, non-petroleum jelly, lanolin products and zinc oxide to form a protective shield on your child’s skin after every diaper change. This can help prevent further irritation caused by stool and urine touching the skin.
  • Change your child’s diaper frequently to keep it clean and dry. When out of diapers you can even use a cool to warm hair-dryer to dry the skin and then let them crawl around without anything on!
  • Put your child’s diaper on loosely or try a different brand of disposable diapers to see if it makes a difference. For example, an extra-absorbent option or one made for sensitive skin might help relieve symptoms — although this isn’t always a sure bet. Letting your child go without a diaper for short periods of time is also a GREAT way to promote healing.
  • Do not use an OTC topical pain reliever containing hydrocortisone (a steroid) on a child with diaper rash unless instructed by your doctor. If used incorrectly, it can make your child’s symptoms worse or cause other side effects. This is especially true if your baby has a diaper rash caused by yeast (we have prescription medicines for these instead).

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs # KnowYourOTCs for more info on health and wellness.

Playing Multiple Sports Is Better For Most Children

New data out (that I happen to LOVE) seems to go against many parental instincts, including a few of my own. I think plenty of parents have been led to believe in the last few decades that specialization and mastery in a single sport early in life is GOOD for their children. Some of that instinct rises from our guts in the mis-appointed “10,000 hours rule.” The idea that once our children do something for 10,000 hours they will be an expert. The 10,000 hour rule (brought to masses in part via Malcolm Gladwell) suggests that with dedication and time (10,000 hours) a person will develop mastery over a sport or skill. A recent American Academy of Pediatrics clinical report states, “it has often been misquoted that to succeed, an athlete needs to have 10,000 hours of practice/competition over 10 years. The media have incorrectly extrapolated Ericsson and co-workers’ studies of chess players to a formula for sports success. Many examples exist of successful athletes who have <10,000 hours and others who have not succeeded despite having >10,000 hours of practice/competition.”

Children in sports have changed over the last 40 years.

There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. This increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout. ~Dr. Joel S. Brenner

And it’s just not true that grunt hours in a single sport will make champions of all of our children. Worse — focusing early and often on one single sport may lead to overuse injuries, burnout, isolation, and a less likely shot at succeeding at and loving sports for a lifetime.

overuse-injuries-1

I think in the time of the tech boom we can also be led astray by the “Zuckerberg effect”  — the idea that we can only really change the world by focusing on a single thing and becoming a global master in doing so.

Reality is, those children who specialize in a single sport early are at higher risk for overuse injuries, burnout, quitting sports altogether and even isolation and loneliness. Successful, even elite athletes, are more likely to develop when our children don’t specialize in a single sport until late puberty, around age 15 or 16 years. 

_______________________________________________

Basically it’s this: when children are young they should be playing sports to enjoy them and they should play a bunch of them. EVEN if you’re the parent to one of those kids who is super good at something consider mixing things up. Playing one sport only, year-round, may increase risks for injuries, isolation, and dropping out of sports early.

_______________________________________________

The Numbers On Children In US Sports

  • 60 million children between age 6 and 18 play US organized sports
  • More than 1/4 of children athletes (27%) only play one sport
  • Girls represent 34% of those in organized sports, boys are 66%
  • According to some reports, overuse injuries account for 46% to 50% of all athletic injuries
  • The data shows that up to 70% of children drop out of organized sports by their 13th birthday. So pushing them from a young age to participate in a single sport for the purpose of competition and mastery, will actually NOT lead to them playing in high school or college.
  • Only 3-11% of high school athletes play at college level
  • Hardly any athletes (0.03 – 0.5%) reach the professional level

Use these numbers to let your child (and YOU) off the hook from those early, elite, traveling, teams that don’t seem to come up for air.

A new clinical report published in Pediatrics states that children who specialize in a single sport and train intensively for it are at higher risk of experiencing overuse injuries, burnout and even anxiety. Overuse injuries include: stress fractures, tendinitis and shin splints. The report encourages parents to keep their children from specializing in a single sport until late adolescence, think age 15 or 16. Instead, we want our kids to play multiple sports and activities with an emphasis on having fun and learning fundamental movement and sports skills rather than on training for competition.

4 Easy Tips For Parents To Help Nurture Happy, Lifelong Athletes

  • Lots of different sports. Encourage your children to play a variety of sports. Don’t push for a single sport, even if they seem to be excelling at it at an early age. Or if it really feels right, work with your pediatrician and coaches on a plan to reduce risks of overuse injuries. Playing different sports may actually help them become better at their preferred sport and set them up for play during HS, college and beyond.
  • Wait until 10th grade! Delay sport specialization until after puberty at age 15 or 16.
  • Days off every week. Ensure that your athlete is taking 1-2 days off per week to decrease injury risk.
  • Month breaks. Take 1 month off from each single sport 3 times per year. Year-round ANYTHING sets your child up for injuries.

 

Community and A Conference

21091855984_fc2bb18bd0_kI feel so much gratitude every day. I feel it for near cliche reasons (my sweet babies, good health, shelter, opportunity to make change, perspective that seeing the world has afforded me, and the freedom we have living here in a democratic society). Sometimes gratitude overwhelms me. And unsurprisingly that’s typically true on the most challenging days of life; I don’t see and feel and smell my gratitude on the easy days as well as I do on the days when life taxes and feels uncertain. I sense the gratitude housed in me most when I’m leaning on those around me, when I cry or when I’m worried or lack control in a situation. And the reason is this: my gratitude is greatest for the people in my life and seems to swell when I feel a sense of belonging. For being alive, for being a part of something greater than myself, and for the luxury of being suspended, taught, and caught just in time by the net of those who have me. Who trust in me and in themselves that we have the courage to live with intention, compassion, and empathy and that we can dent the universe. Supportive communities change everything…

My work here at Seattle Children’s in building digital tools, partnering in the design of curriculum created by patients, and nurturing parent-to-parent support with digital technology is influenced wildly by my net of community, my witness to suffering, and of course, my own experiences of when communication fails in the health space.

Like a lot of people, I feel I have the most incredible friends and I do feel I have the most supportive community of co-workers, patients, colleagues, advisors, and entrepreneurs who nurture in me an ongoing will to keep trying out new things in the health space. Most of the people in my community and on “my team” are as passionate and desperate to see change as I am…

We all have a team. Most of us have multiple, of course. Sometimes we define team with our families, a group at work solving a unifying problem, or by the outlines of communities from childhood or other stages in life. Social networks have woven some of these teams into daily networks we historically couldn’t have had. Thank goodness that with networks, texts, social channels, cellular phones, and other intuitive technology we typically never have to be far from those who surround us.

My good friend Susannah Fox is the one who long ago said, “Community is Your Superpower.” She began to proclaim this after fastidious work to understand and describe some of early research in peer-to-peer health care while doing research at Pew Research Center and now works in government to serve patients around this country at large. But her point and her wisdom extends to every corner of of our lives. The wild power that comes from insight and expertise from those who are like us. Not just emotionally but with information, resource, and tactics to solve life’s vexing problems, together.

8041814374_5854441a11_k21739369995_a43c60d04b_k

I mention all this because tomorrow around 4am I’m leaving my family in the dark to head to the airport to attend the Medicine X conference in Palo Alto. I’m joining dear friends, expert patients, entrepreneurs, nurses, executives, physicians, and artists as we gather to examine the opportunity of emerging technology to enhance our lives, solve health problems, hone solutions, and inspire diligence to making health care better. At Medicine X the patient voice is louder than at any other medical conference I’ve attended around the world. But more than anything as I ready to attend, I think of my visit as a return to a web of people and ideas that pour fuel into the center of me to keep thinking of ways to make change faster.

Medicine X has, bar none, been the conference that has most influenced my career. I typically share with others the notion that each fall I return to Stanford University and get spiritual fueling to keep chipping away at health care and communication challenges at home. What I learn and what I feel while there stays with me all year — and changes what I do in work and how I support patients and families I care for. In years past I’ve been afforded the opportunity to speak at Med X, to lead master classes and to participate in panels. This year I’m joining a panel on “the human side of technology” but will be mainly listening and absorbing the lessons from others. I’m on the edge of my seat to finally meet a few colleagues and friends I’ve to the point only known online. Highlights include a panel I’ll arrive in time for about disparities, adversities and hope tomorrow morning (including Dr Lucy Kalanithi who wrote the stunning epilogue in When Breath Becomes Air), more than a dozen short “ignite talks” from patients solving their health problems in unique ways (including my anticipation in hearing Dilan Barmache on precision medicine, Liz Salmi on compassionate care, talks on parents and partnership & a “focus on what we have rather than what we need” with Erin Moore, redesign of maternity and early child health with Jody Lin and Victoria Woo and so many more), and keynote addresses and panels from global experts. There are masterclasses with renounced journalists and talks on patient technologists. I mean I can go on and on and on.

The schedule is impressive. But like most experiences in life my thrill for attending isn’t about the didactics, it’s about the people and relationships. The sense there are those who help us, have our back, but also that there are those equally fired up to make change that contribute to our understanding in ways previously unimaginable. I have so much to learn and have so far experienced Medicine X as some of the most concentrated. I’m so thankful for this packed time and also all the ongoing learning online between annual get-togethers at #MedX. The conference is live-streamed and uses the #medx hashtag on twitter. So akin to the umbrella philosophy, everyone can be included and you can peer in over the weekend whenever you’d like.

The list is too long to rattle off but from the top of my head just this moment let me say clearly: Joyce, Nick, Michael, Bryan, Claudia, Pam, Susannah, Margaret, Colleen, Roni, Larry, Emily, Alex, Jodi, John, Charles, Helen, Dana, Liz, Fred and all those I will get to listen to and ALL THOSE I WILL GET TO MEET I just cannot wait to see you. Thank you so much for including me and for showing up in California this weekend to share what you know and how you see the world.

No More Antibacterial Soap At Home or School

It’s a clear no-go on those “antibacterial” soaps you see on people’s counters and sometimes in our schools. They are soon to vanish from stores. No good evidence the (typically liquid) soaps actually protect our family from bacterial infections better than washing with regular soap and water and there are some concerns the ingredients used to make the soap may pose risk. Because of this, the Food and Drug Administration (FDA) recently announced a ban on chemicals/pesticides used in antibacterial soaps due to safety concerns, including two of the most commonly used ingredients: triclosan and triclocarban. Some of these antibacterial soaps will still be used in hospitals.

Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water.” ~ Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation & Research

Some history: Back in 2013 the FDA asked companies that produce antibacterial soaps to prove that their products were more effective than basic soap and water. Turns out, they couldn’t (or didn’t) provide data to show that these products were safe for long-term use nor that they are more effective. We know anytime we add antibiotics into our environment. water, food or agriculture, they kill bacteria off so that bugs that are less treatable with medicines have an easier time surviving. The end result are so-called, “superbugs” or bacteria in our environment and thankfully, rarely in our bodies, that are difficult or impossible to treat. That’s a LOSE-LOSE for humans (and animals). Hence the new ban on these soaps. Companies now must comply with removing the chemicals within 1 year’s time, or take the products off the market. There are 3 chemicals used in some soaps still allowed (not included in the 19 ingredients listed in the FDA ban) that rarely may still be found.

Why We Don’t Want To Use “Antibiotic” Soap

Some bacteria are good (the ones that live in our guts and the ones that live on our skin, for example) and contribute to our microbiome. We want to preserve those as these bacteria protect us, help us break down food, and even support vitamin production. There is also some data that every course of antibiotics we ever take changes this microbiome and may have lasting and long-term effects including susceptibility to chronic disease.

So as part of our wellness relies on these “good” bacteria, part of human wellness also relies on effective antibiotics against the bad ones (for serious infections, surgery, when an immune system is compromised). Clearly, we only want to use antibiotics when necessary; if we overuse them we create environments where resistant bacteria thrive. Once that happens, we won’t be able to cure infections they cause. Read full post »

For The Sake Of Privacy: Just Some Of The 20 Questions

img_9254This year, for the first time, I did the annual 20 questions (see below) with the boys at the start of school and realized that I couldn’t share all of the responses here. Just too personal, just too vulnerable, just too real. Sharing all of the answers they entrusted with me would somehow expose them. At some point, every “mommy blogger” censors and protects her children and I, of course, have been doing that since day one. But with these, even somewhat impersonal questions, I felt the exposure and raw responses more than ever. No way that I want to exhume vulnerability that the boys don’t need the world to hold…

Some moms cross over into the abyss of online oversharing with their children’s lives (I hope I won’t but life is clearly a work in progress). This mom wrote recently about over-sharing as a blogger and how it was her own father who stepped in to “Lion Grandpa” (I’m using that as a verb) for his grandson saying “enough is enough” when the mom discussed signs of his first pubertal change online. She pivoted and retreated from her raw content online and has decided to stop writing about rearing her children. Each year I write less and less about the boys and as time has unfolded I’ve taken to asking them before sharing.

There are about 200 bajillion blog posts about the challenges of “sharenting” online and blogging about children and/or the industry of moms who leverage their parenting experience in their work. No question that when it comes to sharing publicly, everybody has their own unique fingerprint of what lines exist and what lines we won’t cross. The decade (+) of blogging has clearly connected us; stories that detail intimate narratives about life and love and passion and failure and intent really do sew us together while being alive. This may be especially true in the isolation and rigors, doubts and overwhelm, and abundant joy that comes while raising children.

So to these 20 questions — the blog post has historically, around here, been a hoot for the boys. They do LOVE to be interviewed. We’ve used the interview as a benchmark into the annual unfurling of time. We have enjoyed the pool of reflection it’s given as the boys navigate concrete responses and loyalties of colors and airplanes to the progression in dreaming about the future. No question it’s fun to think about the 2012 responses and how they compare to today’s — I mean, these little boys really are growing up. Here’s the 2013 (includes 2012 responses) & the 2015 posts.

These boys are still just as sweet and innocent when they respond to the questions (developed when they were in preschool) but their reflections seem to swell now past the margins of the question and into the souls of who they are working to become. Lucky, lucky, lucky, lucky me. May you, too, have a series of questions you ask each year that you write down. Next year I’m editing them and adjusting for age and we’ll see just what renders into shareable — who knows! Until then, enjoy the silliness…

Most Of The 20 Questions At The Start Of School

Read full post »

Reducing Back To School Stress In 12 Minutes

I find the back-to-school time period to be a little bit stressful (hellowwww, understatement) and perhaps even anxiety inducing. Even good transitions rack up stress. As we brace for the holiday weekend and expect the onslaught of school in earnest while September unfolds, I suggest we can decrease the stress with a bit of info. Here’s my 12-minute podcast to support you as you send your kids back to school and set them up for an awesome start. We’re all hoping for a healthy, safe fall. Take a listen…it won’t take long and you may find yourself a little more relaxed and ready for the chaos. Immunizations, sleep, anxiety and tips for transitions!

Tips For Getting Sleep Schedules Ready For School:

  • Timing: Shift slowly and get started now. If bedtime has migrated to 10pm, for example, and you’re hoping to have your kids sleeping by 8pm for school, start now. Move bedtime forward about 30 minutes every 3 to 4 days.
  • Screens (this isn’t new, I know): Screens, using them and exposing ourselves to the light they emit, impairs our natural sleep hormone melatonin from rising and helping our brain drift off to sleep. Have all screens, tablets, phones, and laptops transition back to sleeping in the kitchen (not at the bedside). In minimum, turn off screens at least 1 hour before desired bedtime!
  • Sleep As Health: getting sufficient sleep contributes to improved attention, safer driving, less health risks, and a more steady mood. We’re nicer when we sleep! It also contributes to how we think on life and even how we remember events; when we don’t sleep we tend to remember things in more somber light. Getting enough sleep supports a healthier life and I would suggest an even happier one. Quick reminder: school-aged children need 9 to 11 hours of sleep and teens need 8 1/2 to 9 1/2 hours. Really!

 

Online Easy Access To Immunization Records

The digital health world recently took a step in the right direction when it comes to supporting access to your health care information. You can now be in charge of both your own and your family’s immunizations records in several states through a tool and online resource called MyIR (think “my immunization registry”). You can register yourself and your dependents and access to your official, consolidated immunization records on any device, any time. How great is that? No more calling your doctor’s office and asking them to fax your records over. Waiting for snail mail to deliver a copy is a thing of the past. For procrastinators with school paperwork, this is for YOU! With back to school rapidly approaching, now is the time to get your children up to date on their vaccines. And a great time for you to have unfettered access to the records.

New Immunization Record Access: MyIR

  • MyIR gives you access to your official, consolidated immunization records on any device, any time
  • Records get updated immediately after any new vaccine is given
  • Can be printed to give schools, athletic clubs and day cares
  • Available in: Alaska, Arizona, Louisiana, Washington & West Virginia

Here’s How To Get Your Immunization Record:

  • Visit: www.myir.net and register.
  • You can register yourself and any other family members
  • Verify: click Auto Match to have the site match your account with your state records
  • If Auto Match can’t find an exact match, click State Assisted Registration and follow steps (I had to do this and it was very efficient!).

myir auto matchmyir verify

2016 Vaccine Updates In Washington State

  • Last year, 85% of WA State kindergarteners had all required immunizations. Ideally we’ll get that up closer to 95%
  • Need 2 chicken pox shots documented this year. This year, schools are requiring documentation for all children in K-12 fro varicella vaccine. Parents need to make sure the school has the record to prove children have had both doses (given typically at 1 year and 4 year well child check-ups).
  • The flu vaccine is not required for school, but is safe and essential — flu vaccine is recommended for all children over 6 months of age.
  • Nasal flu vaccine not recommended this year — only option is the poke, but it’s the best bet at protecting your children from influenza!

HPV Vaccine Reminders

  • The HPV vaccine reduces the risk of cancer from HPV for boys and girls. It also reduces the likelihood of getting genital warts and lesions after teens or young women and men becomes sexually active.
  • All teens benefit: girls & boys receive 3 doses of the HPV vaccine starting at age 11. First dose at age 11 years, a second dose 2 months later, and a third dose at least 6 months after the first dose. If you wait a bit longer, the series doesn’t have to be restarted so get in to get the booster if you haven’t finished all three shots in the series!
  • No benefit in waiting!  The vaccine is proven more effective at younger ages (age 11 tends to give a more robust immune response than when giving the vaccine in later adolescence). There is no health benefit in waiting in immunize your teens — same pain with the poke but more time a teen could be exposed to HPV.

 

Read The Label And Know What Is In OTC Medicines

Quick reminders as we tidy our lives at the beginning of the school year. With little ones and children all heading back to school, we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the fall is upon us, it’s a great time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, and organize the cupboard! In some ways it’s combination medicines that make me worry the most — so this is a quick review on what you can do to feel confident when dosing and using OTC medications at home with your family.

Reading Over The Counter Labels & Dosing Liquid And Children’s Medicine:

1. Read the label.  Plain and simple get in the habit of always reading it as we don’t want to forget to make sure we really know what ingredients we’re giving and why. No question that sometimes we use medicines to “cure” children of illnesses, infections, or deficits (prescription antibiotics, anti-infectives, chemotherapy) but most OTC medicines only treat symptoms our children experience from infections or injuries. That makes them less necessary, although sometimes wildly helpful and soothing. Treating pain and discomfort is of course a priority for all parents when our children are uncomfortable! Consequently, we want to use OTC when they earnestly help and match the correct medicine with the symptom we’re targeting…the label can help.

reading labels 2

2. Know the ingredients — watch out for double dosing! So many products out there have combination medications. Many medicines for cough and cold will combine medicines for fever with medicines for mucus with medicines for cough. Some medicines combine medicines for allergy symptoms with medicine for fever. You might inadvertently be giving your child a second dose of acetaminophen (AKA “Tylenol”) when using a combination medicine without knowing it. Expert toxicology and pediatric emergency room friend, Dr. Suzan Mazor reminds, “that sneaky acetaminophen shows up in all sorts of combination medicines” so watch out! If you’re dosing acetaminophen for fever make sure you’re not double dosing if you’re also treating other symptoms with medicine.

3. The syringe or dosing cup -KEEP IT! Keep the dosing devices that comes with the OTC medicine you buy (use a rubber band as needed to attach it to the bottle)! No question that it is confusing to dose medicines based on weight. In the past, data finds that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions — thankfully this is changing and there is national push to have pediatricians write and explain doses only in milliliters or milligrams as opposed to dosing and explaining in “teaspoons” and “ounces.” As we work to standardize this there will still be some confusion. Read full post »

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.

Do You Have An Anxious Child?

No question, hands down, I get more requests from friends, family, and acquaintances for help finding support and and advice parenting anxious children than any other pediatric issue in the school years. So it’s my sincere DELIGHT to introduce and partner with Dr. Kathy Melman on my podcast. Dr Melman runs the outpatient psychiatry and behavioral health clinic and has decades of experience advising families and supporting anxious children. She helps translate the facts around what causes anxiety, how to discern anxious behavior from clinical anxiety, and helps parents understand just what we know and what we don’t. Her tips and advice below!

Where Does Anxiety Come From?

1. Anxiety is a normal emotion and a natural part of life. Fear exists in all of us and there are typical fears that are seen at different developmental stages such as Stranger Anxiety (clinging and crying) at 7-9 months of age. This happens as the child goes through developmental changes such as the stronger ability to differentiate familiar faces from those that are unfamiliar. Anxiety is a normal and important emotion that is adaptive and protective. For example, anxiety helps us stay away from dangerous situations such as leaving or not entering a building when we see smoke or fire or smell something burning. Imagine living at a time or in a place without grocery stores or restaurants for securing food, without homes with locking windows and doors. Imagine that we instead have to venture out to hunt and gather food with concern about dangerous animals or people lurking behind a bush. In this situation, concern about safety is warranted and being vigilant, scanning the environment to pick up on danger cues would help someone survive. The rush of adrenaline that occurs when highly anxious is called the “fight or flight” response and it helps someone escape or avoid dangerous situations.

2. Environmental Stress: Anxiety increases in more stressful situations. This can includes fear of safety, homelessness, instability with frequent moves or other important life changes, loss or death of caregivers or other important people, war, hearing or seeing disturbing news, economic difficulties, abuse, sexual assault, bullying at school, high pressure, expectations and demands in school, home and/or activities. Even in healthy, safe environments, all children experience some anxiety. For example, occasional or short lived worries occur when a child is faced with an especially stressful or new, unfamiliar situation. These are real issues with all that is going on in the world right now.

3. Environmental Learning: Dr. Melman reminds, “Children Learn What Children Live.” Modeling matters. Listen to what Dr. Melman shares in the podcast about overprotection and the risks of being over-involved.

4. Avoidance. Anxiety is maintained and strengthened by avoidance. Through avoidance, you don’t get to see that your worst fears will not happen and that you can, in fact, do it! Let’s look at an example of a child invited for a sleepover at a friend’s house. Perhaps this child is not experienced with sleeping away from home and struggles with sleeping in his own room and bed at home. The idea of a sleepover sounds fun and then reality hits as the time to go to sleep approaches. The child becomes panicked, maybe with physical symptoms such as heart racing and pounding and stomach aches. He has thoughts that he won’t be able to fall asleep or that something bad will happen like a robber breaking in, and calls his parents to pick him up which they do. The child starts to feel relieved and no longer anxious as soon as they learn that they can escape this feared situation by going home. The child’s fear and desire to escape and avoid is strengthened because of the strong relief is experienced when rescued and by the fact that parents agreed that there was a need to come home rather than an ability to cope, ride out this wave of distress, stay the night and see that nothing bad happened and that he could, in fact, be courageous!

5. Expecting Bad Things to Happen: Anxious thinking also plays a role in where anxiety comes from.

6. Genes: Anxiety Disorders runs in families. What can we do if our child has a genetic loading for anxiety disorders? While we can’t change genes, we can aim to reduce stress in our lives and change our own modeling and reactions. We can learn to understand and accept our child’s temperament/wiring and empathize with our child’s feelings while also teaching our children how to think more realistically about the world, to expect less danger in situations, and encourage our child to approach in a gradual and consistent manner the situations that he or she fears. We can give our children skills to cope more effectively with challenging situations.