Archive for September 2012

Monthly Archive

Screening For Risks Of Sudden Cardiac Death

More than anything else, we want our children protected from harm. Particularly when we hear about sudden cardiac collapse and death in young athletes. The far majority of children who suffer from sudden cardiac events and sudden cardiac death have no symptoms prior so comprehensive cardiac screening can improve protection for all children.

5 Things To Do Before The Sports Physical:

  1. Print out the pre-participation sports physical form and medical history form. Bring it to the appointment for your child’s doctor or ARNP to fill out. This form can help direct a more comprehensive sports physical and will require documentation of necessary medical history and physical exam findings as recommended by the American Heart Association.
  2. Find out about your own family’s medical history. Inquire is there is any heart disease, any history of seizures, or unexplained or sudden death. Complete that medical history form.
  3. Check in with your child/teen to find out if they ever have any symptoms during exercise that may require more attention–things like fainting or near-fainting, chest pain with exercise, easy fatigue with exercise.
  4. Find out if your school has an AED. If they don’t, work on having the sports director get one for play fields and gymnasiums.
  5. Refresh your CPR skills. Review how to do hands-only CPR (this links to a 1 minute video)

Your child’s physician or nurse practitioner can screen them however there are also free screening events for sudden cardiac death in our area include (please include others you know of in the comments and I will add to the list):

Nick Of Time Foundation (Auburn, WA on 9/29 & Renton, WA 10/3 and ongoing)

Play Smart Youth Heart Screenings (ongoing)

Antibiotic Use May Increase Risk For IBD

We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.

As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.

Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.

I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.

New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.

Research Finds Antibiotics May Be Associated With IBD Diagnosis

  • Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life. Read full post »

Miserable School Drop-Offs

Sometimes it feels like we’ve got it all in control, a new school, a new schedule, a return back to work obligations. We can set the alarm early, burn the midnight oil, pack the school lunch ahead of time, rise up and meet the challenge. Sometimes it all works and everyone thrives.

Sometimes, no.

Sometimes it is simply miserable to leave our children behind and trudge off to work.

Miserable.

It doesn’t mean we don’t care about our jobs or that we lack compassion, or a passion, intent, or drive to serve. It really can mean that we just love our children.

A recent drop-off at school reminded me. Read full post »

New Data On Infant Sleep You’ll Want To Know

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.

There are many things that go into the equation of how we get our babies to sleep thought the night. And those of us who struggled after our babies after 6 months of age are in good company. Research shows that about 45% of mothers say they struggle with their 6-12 month-old’s sleep.

Solving the sleep solution requires a diverse mix of instinct, patience with personal and baby temperament, timing, mood, advice we get, and good luck.

The reality is that there isn’t one perfect way to help support an infant who’s learning to sleep through the night. But there are few pearls I believe in: Read full post »

Too Much Salt? More Bad News

Salt is back in the news. Not surprisingly, salt continues to get a bad name because eating too much salt can put us at risk. This is a bummer for those of us who prefer a salt lick to a popsicle. And it’s especially bad if we developed a salt-eating habit in childhood. An article published today found that increases in salt intake are correlated with the finding of high blood pressure. Not news, exactly. But the article asserted that for each increase in 1000mg of sodium intake each day, the risk of elevated BP increased significantly. Every little grain of salt seems to count. This was especially true among children who were of unhealthy weight (over 1/3 of the children studied). Thing is, the longer we have high blood pressure, the more damage our bodies sustain. So if high pressures start in childhood, risks increase throughout our lifetime.

Blood Pressure In Children:

  • Normal blood pressure for children shifts and changes as they grow. Normal BP varies based on age, gender, and height. Your child should have their blood pressure routinely checked starting at 3 years of age. Ask the nurse, medical assistant, or doctor to report  your child’s blood pressure and confirm the numbers are normal for their age and height.
  • Salt may increase blood pressure by causing the body to retain more water, giving our blood more volume. When blood volume and pressure increases, the changes can load stress on our heart and our blood vessels. Over time, those longstanding increases can cause damage to our organs putting us at higher risk for heart problems and/or stroke. You should know however, there are many people who develop high blood pressure as they get older who don’t eat excess salt, for unknown reasons. Medically significant high blood pressure requiring treatment is rare in childhood but can start at any age. Even so, anyone who eats excess salt is at risk for elevating their pressures at any age.
  • Many children with high blood pressure don’t know it. The article reported that 15% of the 6000 children evaluated had high blood pressure. Boys were more likely to have high pressures.

Below is a video I published previously on where salt comes from in our diet, how much salt children can consume by age, and ways to help reduce our cravings for salt as a family. Number one thing to do in any household to reduce salt intake is to reduce processed food sources–canned and processed foods account for the majority of salt in our diets. Read full post »

Whooping Cough Shot: Does It Last?

A study published today in The New England Journal of Medicine evaluated the duration of protection against whooping cough after children get the DTaP shot.  Researchers wanted to find out how long the shot lasts. DTaP shots are given to infants, toddlers, and kindergarteners (schedule below) to protect them from three infections (Diptheria, Tetanus, and Pertussis –whooping cough). After these childhood vaccines, we give a “booster” shot at age 11. Because we know that many babies who get whooping cough are infected by teens and adults, all teens and adults are now recommended to get a Tdap shot to protect themselves and those vulnerable against whooping cough.

As researchers seek to understand the recent epidemics of whooping cough in the US, they have found more and more that the causes of these epidemics are multifactorial. Not only is it unvaccinated populations that allow epidemics, it may be waning immunity from shots given previously and waning immunity to natural infection, as well. Previously, it’s been estimated that our immunity to whooping cough wanes anywhere between 4 and 20 years after we get whooping cough, and that it may wane 4 to 12 years after the shot.

A little history: back in the 1990’s we switched from using the “whole cell pertussis” shot to using a vaccine that is “acellular.” Some health officials have had concerns that this “acellular vaccine” may not protect children as long. Although it does a great job protecting infants and toddlers, it may not last as long as previous immunizations. Some have wondered how long the kindergarten shot protects our children…

Physicians at Kaiser Permanente reviewed information about children in California during the 2010 whooping cough outbreak. What they found may have significant effects on how to protect our children going forward: Read full post »

Eye Candy: PODS And Capsules

Laundry and dishwashing capsules & “PODS” are all the rage. Frankly, I love them. They’re less messy, take up far less space in the cabinet, and enticing to use. Throw them in the washer without a single errant drop. They’re pretty to look at, too.

That’s the trouble though.

These PODS and capsules look more like Halloween candy than laundry detergent. But this soap [eye candy] poses a unique and dangerous risk. The film that forms the capsule is designed to dissolve quickly. Toddlers are at risk, as small children explore with their mouths not only their hands. Toddlers and preschoolers may be both drawn to the visual appeal of these concentrated capsules and to their balloon-like texture and squishy feel. I wrote (did a video) about this earlier, when WA State issued a warning to all ER doctors.

Concerns for ingestions are continuing here (nearly 3000 injuries were reported in US children between January and August, 2012) and around the world. Highly concentrated laundry detergent can erode tissues, cause swelling, and cause burns to the mouth, throat, airway, and eyes of children who touch, break open or ingest them. The majority of injuries from PODS and capsules have been due to ingestion, but there are reports of many eye injuries as well.

Curiosity rules a toddler’s exploration. Judgment lags way behind.

New information released last week in the UK helps categorize the concerns. The National Poison Information Center shared a brief where they detailed that capsules and PODS were the most commonly reported ingestions in young children over a 14-month period. A group of physicians at The Royal Hospital For Sick Children in Glasgow also authored an academic letter detailing their concerns, reporting on 5 children who had been admitted and cared for in the hospital after ingesting (eating) the PODS/capsules. Their letter highlighted:

Ingestion Injury From Detergent PODS & Capsules:

  • 5 children, between 10 and 22 months of age, were admitted to the hospital with serious injuries.
  • Injuries for the 5 children included serious swelling and damage to the throat and airway (arytenoids, glottis, supraglottis, esophagus, gastro-esophageal junction). Children demanding hospitalization varied in the care needed. One was managed with steroids and antibiotics alone, while the other 4 children demanded intensive care. Four of the 5 children needed breathing tubes, 2 of whom were on the ventilator for a week.
  • Fortunately, all children recovered from their ingestions.

Protecting Children From Detergent PODS/Capsules:

  • Young children are ruled by curiosity. Make sure that capsules and PODS are up and out of reach.
  • Don’t display them due to their visual appeal.
  • Don’t allow young children to help use the laundry or dishwashing capsules. Becoming familiar will likely cause them to want to touch, explore, and possibly gnaw on these capsules.
  • Until containers selling these products have a child safety lock/top, inform your friends and caregivers about the risk to young children.
  • With any ingestion, no matter what the size, call poison control immediately 1-800-222-1222.
  • Read more about it (including my interview) at US News & World Report or here at WebMD.
  • Print out this Poison Control fact sheet for your daycare or pediatricians’ office.

 

Circumcision For Newborn Baby Boys

Last week, the American Academy of Pediatrics (AAP) issued an update to their circumcision policy statement that attracted significant attention. In it, the task force clarified the previous neutral policy for boys’ circumcision. The AAP stated that research has advanced since it’s most recent report in 2005 to conclude the health benefits of circumcision outweigh the procedure risks. Like any medical test or procedure, circumcision carries both benefit and risk. With global data expanding about benefits of circumcision and protection against sexually transmitted diseases, the AAP changed its stance. Risks from circumcision are reported to be very unlikely and happen less than 1% of the time. Most common side effects can be a small chance of bleeding or a need for antibiotic ointment. The most frequently reported adverse event from parents is a concern not enough foreskin was removed. Fortunately, circumcision revisions are very rare.

The statement doesn’t go so far as to recommend that boys undergo circumcision, rather the task force stated that the procedure should be done under sterile technique by a trained, experienced clinician. Importantly, they stated for the first time that it should be covered by Medicaid and insurance. This with the hope that every family ought to have the right to make a choice for or against circumcision, not just those with private insurance.

Clearly, the decision to circumcise a newborn baby boy isn’t made simply in the content of medical data. Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief. Ultimately, the decision is a private one for families to make. A pediatrician, family doctor, or ARNP should help you go over medical benefits/risks as needed. As a parent, you go over the rest. Read full post »

First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »

First Day Of School: An Interview?

September is upon us. I’m back to blogging after my August pause. Life has been very busy and peppered with bits of flurry, but more on that later. School is about to start.

As we all return back to the routine of the fall and ready ourselves for winter, it’s a good time to check in on where we stand. This month really can feel like packing our cheeks with acorns. The transition to school brings on all sorts of stress, anxiety, sleep changes, and anticipation. Of course, it also brings great joy. So many parents, friends, and families relay sadness they feel on the first day of school (particularly Kindergarten). We shed a layer of innocence it seems when our kids advance. However, one good friend recently described his son’s first day of Kindergarten as one of the happiest of his life. He mentioned he could tell me, unlike other days, what his son was wearing, the pace of his son’s stride that morning as they walked to school, and how he remembers clearly the huge sense of pride both he and his son felt when they landed in the classroom. It was by all accounts, “Marvelous and immensely joyful,” he said. It’s his description that is allowing me to keep my chin up.

We flew kites with friends in celebration of the last night of summer tonight. I teared up at bedtime. It isn’t going to be pretty. Not only does F start Kindergarten this week, he also just announced a wiggly tooth. Be still my Mama-heart…

The beginning of the academic calendar marks a perfect time to pen in milestones for the memory books. Utilizing my coping mechanism for the school start this week, I did an impromptu interview with F on Friday. It wasn’t premeditated so it’s not entirely sophisticated and therefore, very reproducible. I’m hoping to make it an annual tradition to help me both mark transitions but also celebrate his incredible journey growing up. Here’s the 20-question interview with his verbatim responses. Please feel free to provide added suggestions for questions and I’ll do a a follow-up interview!

5 Year-Old Interview, 5 Days Prior To Kindergarten Start

  • What is your favorite color? “Yellow”
  • Favorite number? “5”
  • Favorite food?: “Strawberries”
  • Favorite toy?: “This is going to be a tiny bit hard……airplanes.”
  • What are you most happy about this summer? “I got to spend more time with Mommy and Daddy” (be still my heart, again)
  • Favorite memory from the summer? “Going through the Costco carwash.” (you can’t make this stuff up) Read full post »