Parenting

All Articles in the Category ‘Parenting’

What Is Dry Drowning

There was a media blitz on “dry drowning” last summer, just about this time, on a topic that is stirring up angst and worry among parents again this year. There’s good reason it makes parents nervous – drowning at baseline is a preventable tragedy that is terrifying to think on–  and it’s the leading cause of accidental death to children between age 1 to 4 years, and the second leading cause of accidental death in those between 5 and 14 years. Everyone is scared of it for good reason. But “dry drowning” (a submersion injury that happens in a different way from what most of us think about when we think about children drowning) sends people through the roof, in part because of misunderstandings. And the language, and the misleading nature to it all.

What Is “Dry Drowning?”

The term in itself is a bit confusing (and a little controversial among doctors — most emergency room doctors and pediatricians don’t want to use the term AT ALL). Pediatricians prefer and recommend referring to both dry and secondary drowning as “submersion injuries”. Drowning is drowning — but drowning, in and of itself, doesn’t mean death, it means exposure to water, by submersion, and injury from it. Technically speaking, as I understand best how parents and media talk about it, dry drowning is when a small amount of water causes spasms in the airway and the soft tissues in the airway (epiglottis, larynx) thus causing the airway to close up and make breathing very difficult. This is rare – but would happen within a few minutes of water entering the mouth and throat and being pushed back towards the airway, instigating spasm. This happens immediately after exiting the water. The spasm can be very dangerous and typically would cause sputtering or coughing or choking. This is an immediate reaction to water entering the airway.

Secondary drowning, as some call it, is when water gets into lungs and causes inflammation or swelling inside the lungs, making it difficult or impossible to transfer oxygen effectively to the rest of the body. Water can enter the lungs in small amounts even 24 hours before showing signs of increasing distress as inflammation builds. The injury from a submersion injury like this wouldn’t happen out of the blue. This distress and inflammation would happen over time with coughing, feeling or acting ill, distress, coughing again, vomiting, or difficulties in doing regular activities.

Most important, thankfully, is these two unusual submersion injuries, are exceedingly rare, only representing 1-2% of drowning deaths.

Let me be clear with a scenario here….you take your child to the pool, they go under the water for a few seconds and pop up sputtering and maybe coughing a bit. They appear normal in all aspects within seconds (talking, breathing, eating, alertness, giggling, playing, etc.) and you go home. They eat a normal meal and head to bed without any cough or trouble. Your child is not going to suddenly die in their sleep from “dry drowning” without a single symptom. It just doesn’t physiologically happen this way. It’s where the term feels like it’s a scary lurking monster. And submersion injuries aren’t like that. With a submersion injury to the lung, a child would typically show signs of lung irritation, fatigue, coughing, and trouble breathing first. If at any time your child does that, of course call your pediatrician or head in immediately if you’re concerned after swimming.

What Parents Need To Know:

  • No question submersion injuries are preventable. Supervision is always our 1st line of defense! Just being present, not walking away, not allowing distractions (cell phone, alcohol, sleep, etc) will always be the best line of defense, especially with young children or new swimmers. Always closely watch children near or in water. Any tiny pool of water is a risk, especially for toddlers. Make sure lifeguards are present when children are at pools. If you don’t feel lifeguards are doing their job – speak up! Learn what to do if you spot a child you think is drowning. Learn CPR for infants and children, too.
  • Teach your child how to swim. Start as early as 1 years of age or younger if your infant is ready to be in the water with you. Data supports that children over age 1 have some protective benefits from swim lessons. Although swim lessons will not prevent all drowning, it will help children be safer around water as they age. Never use swimming lessons as a reason to leave children alone. In my mind, no one should ever swim alone.
  • Put your child in a U.S. Coast Guard-approved life jacket when playing in or near the water, on a dock or in a boat, raft or inner tube. Supervision and a life jacket are two of the most important things you can provide to protect your child from drowning.

Symptoms Of Submersion Injuries Or “Dry Drowning:”

  • Persistent coughing and/or increased “work of breathing” after swimming
  • Sleepiness out of proportion after swimming
  • Forgetfulness or change in behavior, in context of other changes after swimming
  • Throwing up (a sign of stress, and sometimes from inflammation in lungs)

For all children pulled from the water for concern of injury:

  • Call pediatrician or 911 even if you think they are ok (no hurt in checking in with them)
  • Monitor for 24 hours after submersion

Some Data To Keep Drowning In Perspective:

  • Children ages 1 to 4 have the highest drowning rates. They DEMAND constant, in arm’s reach supervision.
  • Immersion-related drownings are preventable and you being around and watching changes the game!
    • 91% of deaths were associated with lack of direct supervisor
    • 82% of deaths were 4 years or younger
    • 70% occurred at home (this means home pools, hot tubs, bath tubs, kiddie pools, etc.)

Resources:

Is Co-Sleeping Safe? Do You Do It?

The short answer to the title is —- not really, and the risk varies. But I sure get why so many parents want to co-sleep despite most pediatricians urging against it.

I was up early yesterday morning listening to NPR when a story about parents’ love and desire to sleep with their babies grabbed my attention. The headline reads: “Is sleeping with your baby as dangerous as doctors say?” I mean, parents (like me) want(ed) to co-sleep and bond with their babies, of course, especially when their babies fuss and cry and especially when parents are exhausted. Every pediatrician hears and understands the parent who says something like, “By 3am I was just so tired I plopped her in bed with me after feeding and gave up on the bassinet.”

Parents ARE tired and want to make that crying, noise, and a baby’s sadness go away. The piece opened up the challenge in parents feeling judged or insecure about sharing truths with pediatricians who have strongly advised them to separate sleeping spaces. Many parents may feel that if they continue, in overwhelm, or instinct, or in love to bed-share and co-sleep, they have to keep it from their pediatrician.

The rub here is pediatricians want what is best for families and what’s best for the bond between babies and their parents. But they also want to protect babies as best they can with the evidence fueling guidelines and advice.  How we’re talking about this may miss some salient points in American family lives.

Putting babies on their back in safe sleep environments has proved so helpful for protecting babies. But the guidelines may have focused too little on the risk that comes with over-tired parents who just can’t follow the advice and the risks co-sleeping may pose particularly when a tired, working mom co-sleeps out of desperation. Sleep experts have helped me understand that sleep deprivation changes arousal and it may be riskier for an over-tired parent to co-sleep than a better rested one. Read full post »

Sore Throat Versus Strep Throat

When you or your child has a sore throat, it can be hard to tell if it might be something that needs medical intervention, like Strep throat. Strep throat is an infection caused by group A Streptococcus (GAS). When you confirm (by throat swab in the lab) that GAS is present, your child needs 10 days of antibiotics. If the test is negative, it’s unlikely you need any Rx medical treatment! More below:

  • Sore Throat
    • Tonsillitis refers to tonsils that are inflamed. Inflamed tonsils (and even when they have white stuff on them) doesn’t necessarily mean your child needs antibiotics. If enlarged tonsils make it hard to swallow or changes the sounds when your child breaths, they need to see a pediatrician.
    • Pharyngitis refers to an inflamed throat. Most episodes of pharyngitis are caused by infections from viruses. Some are caused by other bacteria that live in the throat that aren’t as problematic as GAS and don’t require antibiotic treatment.
    • Viruses, bacteria, allergens, environmental irritants (such as cigarette smoke), and chronic postnasal drip can all cause a sore throat. Most tonsillitis & pharyngitis will typically resolve on their own without prescription treatment.
    • Try acetaminophen or ibuprofen for pain, throat lozenges, warm beverages, gargling salt water and get lots of rest. In time, sore throats typically improve in a few days.
  • Strep throat is an infection caused by a specific type of bacteria, Streptococcus. Infections from the bacteria can be minor or severe. When your child has Strep throat, their tonsils are usually very inflamed, they likely have a fever and swollen lymph nodes in the front of the neck, a BAD sore throat, and sometimes a headache. Many children complain of lots of pain with swallowing. Strep throat symptoms typically come in isolation from other “cold symptoms.” With typical strep, most children do not have cough, runny nose or hoarseness (changes in your voice that makes it sound breathy, raspy, or strained). No one can diagnose strep throat just by looking at your throat. Instead, healthcare professionals use two tests to see if group A Strep bacteria are causing a sore throat. A “rapid strep test” involves swabbing your throat and gives results quickly, usually in about 15-20 minutes. The test is accurate about 95% of the time meaning only 1 in 20 people (5%) who have a negative test actually may have the infection. If the rapid test is positive, your doctor or provider will prescribe antibiotics. If the test is negative, your healthcare professional may likely send the swab for a full throat culture (to catch the 5% that falsely didn’t show an infection). A throat culture involves sending a throat swab to a lab for 1-2 days to see if bacteria grow from the sample. If it turns positive, then your child should be treated with an antibiotic for 10 days.

Great information from the American Academy of Pediatrics on the differences between a sore throat and strep.

E-cigarette Studies In Teens Bust Safety Myths

Two new studies out today on e-cigarettes showed e-cigs remain a significant concern for teen users. E-cigs were found to pass along carcinogens (cancer-causing chemicals) to those who used them and are associated with future tobacco cigarette smoking in teens. Data out today in Pediatrics finds that teens who used e-cigarettes had up to three times greater amounts of five volatile organic compounds (carcinogens) in their urine compared to teens who did not use e-cigarettes at all. Teens using fruit flavored e-cigarette products, often the preferred choices for teens, produced significantly higher levels of acrylonitrile (a volatile organic compound, known to be toxic). Teens who used both e-cigs and tobacco cigs had even higher levels of the carcinogens overall.

Let’s be clear, e-cigarettes are not “safe” nor do they provide health benefits for teens. It’s our obligation to help teens and parents everywhere understand that…the data keeps accumulating as more and more teens use e-cigs across the country. E-cigs tend to increase smoking of traditional tobacco cigarettes, too. My worry is many teens believe e-cigs are safe to use. More and more, I’m certain they are not.

Relevant E-Cigarette Statistics:

  • About 95% of adult tobacco users started using before they turned 21 years of age. In the study out today, E-cigs were positively and independently associated with progression to being a regular, established smoker. Researchers conclude, “data suggest that e-cigarettes do not divert from, and may encourage, cigarette smoking” in teen population. Especially in those who have a tried a few cigs but not yet established a smoking habit. Rather than being a “safer” choice e-cigs enhance the choice to smoke traditional cigs in teens.
  • Use of e-cigarettes rose 900% between 2011 and 2015. And between 2014 and 2016, US middle and HS students used e-cigs more than any other tobacco product.
  • 85% of e-cigarette users ages 12-17 use flavors. In the study out today, carcinogens and toxic substances were increased in teens’ urine in those who used e-cigs compared with those who didn’t. Added risks may be in fruit-flavored e-cigs preferred by teens; even higher levels of a specific toxin (acrylonitrile) was detected.

Read full post »

What’s The Right Age For A Smartphone?

What’s the right age to get your child a cell or a smartphone? I wish I had a concrete, data-driven, definitive answer for you. I think the answer is a balance between what’s right for your family and when you think your child is responsible enough to manage the risk that comes with opening up an entire new world online and the risk that comes with losing something expensive. Research from Pew Research Center out this month (Feb 2018) finds that when it comes to adults, nearly all of us (95%) have a cell phone and 77% of us have a smartphone. But when it comes to parents specifically, we’re different– we’re all in it seems, 95% of parents with children under age 8 have a smartphone (not just a cell).  What we’re modeling in our own lives with our phones makes this even harder. If we are addicted to our phones what does it mean for our child? When it comes to having a child get a cell or smartphone of their own, Techcrunch reported in 2016 that children, on average, get a cellphone in the US at age 10.3 years. You may have strong reactions to that number.

The biggest reality IMO is that the biggest issue may not be the age of initiation for a phone or device but rather how we help our children use it, follow rules, and sincerely work to avoid “addiction” to it in life. We just don’t want to have our children (or ourselves!) pulled away from life in meaningful ways…this being alive thing is just too precious.

Half of teens feel addicted to their mobile devices, and the majority of parents (60%) feel their kids are addicted, according to a 2016 Common Sense report on tech addiction. A recent study (somewhat contested) of eighth-graders by Jean Twenge, author of iGen, found that heavy users are 56% more likely to say they are unhappy; 27% more likely to be depressed; and 35% more likely to have a risk factor for suicide.

Common Sense Media launched a new campaign to protect young minds from the potential of digital manipulation and addiction. The campaign, called Truth About Tech, aims not just to help us as parents but also to influence the tech industry in making products less intrusive and less addictive.

In my family, I’ve told my boys we can talk about a cell phone at age 12. But we do let them use an iPod and an iPad and holy moly, it’s not easy….nor perfectly executed. When and how you introduce devices to your children will always be a personal decision — for you and your family — and it will always demand your longstanding attention and follow-along. The good news in the overwhelm, you can always change up the rules as you go, especially if the ones you make aren’t followed! The AAP Family Media Plan is a great tool to start the conversation together as a family and allows you to print it out and put it up in the house as an easy reminder of what was agreed upon.

Read full post »

From The Mouths Of Babes: Read This Twitter Thread

I can’t stop thinking about this tweet thread. I think it may be one of the most precious threads on Twitter. Hopefully that’s saying something since I’ve been plugging along, almost daily, on Twitter since 2009.

Here’s my experience with it…I’m sure you have your own and I’d love to hear about it in the comments if you’d be willing to share:

Yesterday, I woke early with insomnia around 4am-something in the morning. Instead of doing what I should have, I grabbed my phone and found myself on Twitter. Just before 5am I read a beautiful series of tweets from a South African pediatrician who cares for children at the end of life. He’d taken to Twitter in the early morning hours (Seattle time) to share messages from children at the end of life. Distillation of what they enjoyed most. Things they knew. Worries, gratitudes, and love housed within them. Innocent and nearly angelic.

I read it. I cried. I re-read it. I sent it to a few people I love. For some reason I didn’t retweet it. I have no idea why except that I think I held it so dear I wasn’t even sure what to say. I plopped it into a blog post from 2 days ago, I sent it to some smart researchers who work with children and teens and think/study/intervene on ways to improve resilience, happiness, and stress.

A perspective from the front-line-end-line-solid-lines-of-meaning in being alive is an ever-relevant and precious gift. Hard to think of any other advice that matters more. When I read the tweet thread in the early morning hours it had something like 100 likes on it. There are now, as I type this, about 100,000. That’s a lot; clearly I’m not alone in meaning-making with this. Read full post »

Widespread Influenza in US: Ways To Protect Your Family

It’s flu season, no doubt about it, with widespread influenza infections all over the United States (see the CDC updated maps with high-levels of ILI [Influenza-like illness]). Influenza is a virus (there are many types or “strains”) that cause terrible fever, cough, respiratory distress, pneumonia, ear infections, and sometimes hospitalization and death. As you’ve likely heard from the media blitz the last week or so, it’s shaping up to be a pretty nasty year – and some public health workers are concerned not only about this surge or “peak” of flu season coming early, but that it may be bigger and more dangerous than we expected. Washington is still bracing (we have lower levels) but many areas are inundated and hospitals and ERs are full. Any Google search on “flu” will give you headlines like this: Hospitals Face a War Zone, Flu Season is Bad But Might Get Worse (which is true, it might), and this with the data update this week: Flu Season Has Killed 30 Children (which is also true and dreadful).

5 Simple Things To Do During Flu Season To Help Your Family

Read full post »

How To Treat Lice And When To Ask for A Prescription

This is a follow up post to my recent post on treating head lice. It’s all just a major inconvenience. And worse than having lice is having lice again and again. And even worse than your child getting re-infested may be treating lice with an ineffective therapy. Enter…..”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “super”) in that some lice may have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter (OTC) treatments (permethrin).

A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. Lice were sampled from 48 states at well over 100 different centers to evaluate their patterns of mutations that may render them resistant to OTC medications. Do note that the study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast.

Do you have a super lice? It may be hard to know. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that may work better. But REMEMBER though, that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed. Working with your school and with others where your child may have been exposed is always a part of this when a child continues to have lice after a treatment. There are some medicines (see section below) that may help if the OTC meds are not working. The chart below shows where the resistant bugs were detected (red is fully resistant, orange shows intermediate resistance, and green showed no resistance to OTC meds). Read full post »

How To Treat Head Lice

As parents, many of us have been there. You’re going about your day and BAM…fear and anxiety start creeping in as soon as you read the email, that perhaps again, there’s an outbreak of lice. Someone in your child’s school has lice and your child may have been exposed…blah, blah, blah. Nothing about this ever feels benign, even though it always is. Lice just feels a gross inconvenience. This post details the lice life cycle, the ways lice spread, and ways you can treat lice with both OTC or prescription medicines.

Lice infestation is common for US children and has nothing to do with cleanliness. The Centers For Disease Control (CDC) estimate 6-12 million lice infestations a year in the United States, but something you cross your fingers doesn’t make its way into your home or hair.

How Lice Live And How Lice Spread

Head lice feed on tiny amounts of blood from the scalp and if they are not on a person’s scalp, they can usually only survive about a day. This is good news for remembering that lice won’t crawl around your home for days — ever. They just can’t. Lice lay their eggs close to the scalp and when on the head can live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Remember that head lice usually only survive for less than 1 day away from the scalp at room temperature. Their eggs cannot hatch at room temperature lower than that near the scalp. So once they fall off a child’s head, lice pose very little threat. You don’t have to vacuum the carpet, sterilize the toys, wash the house top to bottom after your child has lice. I mean you can, but don’t do it for the lice :-).

Lice is typically passed through close person-to-person contact.  Lice crawl, they can’t hop or fly (phew!). Lice mainly move from head-to-head and less commonly move from one person to another on a hairbrush or hat or costume.

Lice At School – Why Kids Don’t Get Sent Home Anymore

The American Academy of Pediatrics and CDC have fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice. When recurrent infestations occur this can be frustrating but no child really ever needs to miss school for lice. Schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist. The rationale for not sending kids home:

  • Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
  • Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
  • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
  • Misdiagnosis of nits is very common during nit checks conducted by non-medical personnel.

 

Over The Counter Lice Products


Most of the time the very best bet for lice are OTC, easy-to-use treatments. The FDA has approved over-the-counter (OTC) lice products as safe and effective when used according to the Drug Facts label instructions. There are 3 main ingredients used to treat lice: Permethrin, most commonly found in the OTC product Nix or Piperonyl Butoxide and Pyrethrum Extract, most commonly found in Pronto or Rid. Each product has different and specific treatment instructions, like if hair needs to be shampooed first or if dry hair is needed, the age a child has to be for these products to be used on their scalp and if and when a second treatment is recommended. If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They’re not cheap (starting around $100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals. Read full post »

MLK Day, The New Year And Tiny Habits

I’m quieted today by the profound example of Martin Luther King Jr. and one of his many enduring proclamations,

“Life’s most persistent and urgent question is, ‘What are you doing for others?”

The answer I often feel is “not enough.” While most of us spend portions of our everyday caring for or enriching the lives of others, the enough-ness and potency of feeling we’re doing enough, or giving back in satisfactory ways, can yo-yo.

There’s not a better moment than now to augment who you are and what you do with your days.

We’re halfway through the first month of 2018 and perhaps today is a beautiful moment to pause on what we do each day routinely and how we contribute. Even in the tiniest ways. Resolution season is dying down so I suggest we think less resolutions and more intentional habit formation. More intention for you and your life I believe will likely translate to more for others.

BJ Fogg, a behavioral psychologist and founder and director of the Stanford Persuasive Technology Lab, created a behavior model (see the graph below) that when dissected and simplified, details that making change in your life and forming a lasting habit is a blend of how much motivation you have for the change, the challenge of actually doing the behavior and the need for a triggering event to get the desired change habitualized. In some senses, if you have high motivation for a new habit or change, even if something is hard to do, you’ll do it with a proper trigger. If you have low motivation for the new habit, even if something is easy to do, you may not. But triggers and other barriers and thresholds can throw this all off. He recommends implementing “tiny habits” to drive change in your life by following 3 steps.

1. Start small. Make it teeny tiny. Read full post »