Parenting

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3 More Things To Know About E-cigarettes


My goal here is to educate people about the risks and realities of e-cigarettes amid an environment full of popular misconceptions and half-truths. Talking about e-cigarette use in adults will NEVER be the same as talking about e-cigarette use and dangers for children and teens. Different groups, different realities, different risks, different use, and different vulnerabilities. Period.

E-cigarette use tripled among high school students last year alone. This is happening RIGHT NOW.

If we don’t get real about protecting children and teens from the availability, allure, and marketing of these e-cigs my fear is we’ll find ourselves rewinding progress made on nicotine addiction via declining teen use of tobacco cigarettes this past decade. In the past I’ve called e-cigs the gateway to the gateway drug which I still believe today. Nothing is currently better about e-cigs and liquid nicotine for teens today. There is no data to prove any benefit in having e-cigs around for teens and as time progresses liquid nicotine is still in arm’s reach for many children (one child has died from a toxic ingestion). Just this month the FDA has announced they will consider making changes to the packaging of liquid nicotine, but it will literally take congress and the FDA stepping up and prioritizing child safety to ensure in minimum liquid nicotine is sold in child-resistant packaging. Can you believe it’s this much of a challenge to protect children?

3 Things about E-cigarettes:

1. E-cigarettes Versus Typical Tobacco Cigarettes  Read full post »

Core Memories: Staggeringly Powerful

Sadness, Fear, Anger, Disgust, and Joy ... from Pixar's "Inside Out"

Sadness, Fear, Anger, Disgust, and Joy … from Pixar’s “Inside Out”

Over the weekend we saw the movie, Inside Out, with our boys. After reading previews of the film, I expected to be moved and somewhat thrilled by the look at mental health and emotions. But I walked away with a somewhat unexpected emotion: motivation.

Motivation for presence and for patience with my little boys. To me, the movie felt like a whisper, a gentle reminder in my ears to the power of each and every early experience our children take in. A prompt into the profound opportunity good — or even challenging — moments have to shape the foundation of a little developing human. Yes, we know this instinctively, but sometimes it takes a cartoon to jolt us back into focus. I’m motivated to remember that we can’t always carry the heavy load that EVERYTHING we do with our children matters all the time but it is nice to know some of these experiences really will stick forever. Read full post »

Storing Medicine Safely This Summer

How to Store Medicine More Safely

Storing medicines safely seems like a “no-duh,” I know, but it often isn’t…little mistakes here can have big consequences. Safe medication storage is an especially important topic in the summer when children are in their homes during more of the day and sometimes curiously exploring the house. Routines are shaken up and fortunately there’s more travel in the summer (yippeee!) which consequently leads to medicine in purses and travel bags, grandparents coming to visit (with their own medication), or families traveling to other homes where medicines might not be stored safely. This is not meant to be finger-waggy….I’ve just seen too many “if only I’d thought of that” moments after unintended medicine ingestion.

Do 2 things today quickly perhaps — make sure meds are up and out of reach in your own home and car (in a locked cabinet if toddlers around) AND have a designated place for summer guests to store their meds. This won’t take too long.

Check out the Know Your OTC Safety Infographic (here on the left) for data support: children mainly discover household medications when misplaced or on the ground (27% of the time), in a purse (20%), on the nightstand (20%), or in the pillbox that’s in arm’s reach (15%). Who’s coming to your house this summer that may mess this up? Can you make a place to put those lovely purses and beach bags when people walk in that’s up and out of reach? A hook reserved for guests only?


What You Need to Know About Safely Storing Medicine
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Raising A Couple Of Eagles

eagle jumpOn July 4th my 8 year-old little eagle walked up a tall ladder, waltzed across a platform full of teenage girls waiting to leap, and like a veteran champion approached the edge of the platform and jumped off. Arms in the air, feet forward and hardly a beat of hesitation, he took flight. What a gamer move. Next came twenty feet of free fall and a dock full of screaming enthusiasts. It all happened really fast and I think I may not have been the only one with two feet planted whose stomach dropped. Without question I had serious physiologic and neurologic shifts in my body as he leapt and fell, my stomach in my toes by the time he hit the water. What a wonder to see our children step up, look right at their fear, and then just push forward. Talk about leaning in…courage really is one of the most beautiful emotions to see in our children as they grow.

Raising children takes all sort of courage, of course. The odds at times feel stacked against us (overnight relentless wake-ups, temper tantrums, health challenges, worries about mental health, worries about physical health, resource restraints, failures, failures, failures). But nothing is typically stacked against most of us like other species. All parents face big challenges.

If you look carefully in the image, just behind my little eagle in free fall is a Bald Eagle’s nest. We’ve been watching a family of eagles raise two of their own this spring and summer. And the crazy thing? Eagles have staggering odds stacked AGAINST them. Some studies suggest a mortality risk for the 1st year of life is near 72% and I’ve also been told the mortality rate for an eagle during its first flight (around 10-12 weeks after hatching) is nearly 50%. Imagine — a developmental milestone with a flip-of-the-coin chance at survival. Parenting anything is staggeringly terrifying. Although some children are born with these kinds of odds due to congenital malformations or inborn errors of metabolism, most children in the U.S. come out with remarkable odds for survival. Modern medicine has enhanced this: sanitation, vaccination, child-safety restraints, and perinatal medicine has done wonders for our children.

My sweet little eagle had hesitated the last couple summers when looking up at the platform. And this summer he decided to take flight. Just a quick reminder for me that the risks, coupled with a brew of courage and enthusiasm, are likely ubiquitous, shared traits for all species raising little ones. I suspect the thrill that comes with successful first leaps is too…

 

A Few Thoughts On The 4th Of July

We all know fireworks are dangerous, but outside the obvious hazards (burns, injuries, oh my!), there are other things to be aware of to stay safe this weekend. The 4th of July is a crazy-fun, chaotic day filled with friends and family. Lovely for the time and space to celebrate freedom and lovely for the holiday to celebrate each other. All easy ways to get distracted though, and take your eyes off your children who might be playing in circumstances not typical of your run-of-the mill Saturday. Enter fireworks (which the American Academy of Pediatrics urges families NOT to use) but also swimming, or driving, in ways changed by the holiday circumstances.

  • Distraction: it really is this decade’s issue in a profound new way. If supervising little swimmers or children using fireworks, perhaps stay off your cell or smartphones. While you’re distracted and typing a “Happy 4th of July” text, your child could be grabbing a hot (burning at over 1000 degrees Fahrenheit) sparkler. It’s true that 3rd-degree burns happen with (or without) distraction but we can minimize the chances. If you’re opting-in, be there fully. The National Fire Protection Association states that the risk of firework injury is highest for young people ages 0 to 4, followed by children 10 to 14. These little loves need your full attention; of anything parenting teaches us it’s that our children can do nutsy things when we least expect it.
  • Remind your teens and their friends about of risks associated with teens on the road for the holiday. Pull a parent move and remind them to wear their seat belt, avoid texting and driving, and ban the use of alcohol for those behind the wheel. The 4th of July ranks as the deadliest day all year for teen drivers according to AAA.
  • Too much of a smarty pants for a problem? If you think you’re too smart for injuries on the 4th of July, hold on a second. Recent research found that higher levels of education do not protect against firework-related injuries. Even if you’re part of Mensa, this is a day to make back up plans.
  • Heat: Temperatures around the U.S. are HOT this time of year. Keep in mind that infants and small children are not able to regulate their body temperature in the same way that adults do. If you’re planning on spending the 4th of July outdoors with your children, make sure you have sunscreen, water and most wonderful— shade — available to them. Never leave children or infants in a car, even if windows open and don’t ever hesitate to call 9-1-1 if you see a child left unattended in a car.
  • Water Happiness: If you’re lucky enough to enjoy cooling off in the pool or lake, keep in mind that drownings are most prevalent in the summer months. Children ages 1 to 4 have the highest drowning rates. If you plan on boating, keep your child in an appropriate size life jacket at all times. I’ve recently shared advice about what to do immediately if you think an infant, child or teen is drowning here.

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Love Wins For Children

Orange denotes states where same-sex marriage is legal.

Orange denotes states where same-sex marriage is legal.

While I was out of the country last week there was remarkable progress when it comes to public health and the opportunity for children. It was wild to be so far away seeing the news unfold. First it was The Supreme Court Of The United States (SCOTUS) voting to allow subsidies for the Affordable Care Act (facilitating the federal government to provide nationwide tax subsidies to support poor and middle-class people when they buy health insurance). Then just a day later SCOTUS voted 5-4 in majority to make gay marriage legal in all 50 states. With the highest court in the land stating clearly that from here forward, “marriage is a right” we realize it changes the game. These laws are about dignity and rights and care but this is squarely also about families. As a mom and pediatrician this feels MOMENTOUS. Read full post »

School Is Out, Head Lice May Still Be Around

Head LiceThey’re a little gross, somewhat annoying and for most parents, inevitable. It also seems to me that for most of us they show up at the most inconvenient times. I’m talking about lice. With school coming to an end this month, you may think your child’s chances of picking up the little bugs will diminish. Unfortunately, according to the American Academy of Pediatrics (AAP) most cases of lice occur outside school. Between summer camp, sports and play dates there are still plenty of opportunities for lice to take shelter on the head of at least one family member. They’re certainly no picnic to deal with and they can also be unwittingly contagious during the school years. Clearly there’s nothing to be ashamed of when discovering lice but it doesn’t always feel that way. New guidelines from the AAP out last month offer some tips for getting your family lice-free as quickly as possible. Acting fast with a plan often diminishes all sorts of anxiety and discomfort for all. Read full post »

What To Do If Your Child Is Drowning: School-Age & Teens

6-2 boy swimmingThis is part two of the “What To Do If Your Child Is Drowning” series. Read about infants/toddlers here.

The purpose of these posts is to find out what you should do if you realize your child is actually drowning or struggling in the water rather than repeat the warnings of how to prevent it. I want to put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.

Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s shares information on what to do if you come upon a school-age child or teenager who is drowning. Preparing for this can help boost awareness and response if ever you support or discover a child in need for rescue.

Keep Your Own Safety In Mind

One of the most important things to be aware of if you see an older child or teen drowning is they are usually in water that is deeper and poses more risk to the rescuer. Always take time to consider personal risks before attempting a rescue. This requisite step plays counter to our instincts to act fast as parents and guardians of children…but I can’t overstate this. The size and strength of the child who is drowning should always be taken into consideration. Children and teens can be large enough to actually drown the rescuer.  Dr. Quan says,

For this age, the “Throw or Reach” rule is the key safest rescue action.

Reach to the child with something they can grab (a stick, paddle or your hands), only if you’re in a safe place and not at risk of being pulled in by the victim. Alternatively, you can throw something that floats (a life jacket, ball or safety ring) toward the child. Do not jump in to the water to rescue a drowning child or teen unless you are trained to do so. Only those who are experienced in water rescue and have some type of floatation with them should go into the water to perform a rescue.

If possible, get your child or teen comfortable in the water. If they have had some experience in water it might be easier for them to overcome panic and either reach for a flotation device or flip over, float and breathe.

If You Think A Child Or Teen Might Be In Trouble:

  1. Tell someone to call for help – a lifeguard or 9-1-1
  2. Stay well clear of the water and any incoming surf unless you are trained, qualified and equipped to make an in-water rescue in these conditions
  3. If the child has been taught to float, yell to them to flip over, float and not fight the current.
  4. Immediately throw the child who is old enough something that floats (e.g., a lifejacket, ball, body board, empty cooler with lid secured)
  5. If you can safely do so, reach to the child with something they can grab (eg., stick, paddle) – STAY out of the water.
  6. Safely remove the child from the water without endangering yourself.
  7. When you get the child to shore, if the child is conscious, provide warming and comfort. If the child continues to have any breathing trouble, such as shortness of breath, fast breathing, coughing, labored breathing or seems too tired, seek medical care immediately. If the child is unconscious, lie the child down on his back, chin up.
    1. If the child is blue or not breathing, give several rescue breaths ( mouth to mouth).
    2. If the child does not take breaths or respond on his own, start CPR (chest compressions with ventilation).
    3. After several rounds of CPR, call 911 if they have not been called yet.

To learn more about child CPR check out this article.

What To Do If Your Child Is Drowning: Infants & Toddlers

6-1 baby in waterWarm weather is here and summer is approaching and if mother nature is kind, we’ll have plenty of sun-filled days over the next few months to spend by the pool or at the beach. Unfortunately, this is also the time of year when drownings increase. Young children are especially high-risk because of their profound curiosity around water and lack of awareness of danger.

Drownings are preventable deaths but even the thought of them spooks most of us. Often, a drowning event looks, sounds, and appears unlike we’d expect. I’ve written before about the silent danger of drowning, but rather than reiterate the warnings of how to prevent drowning, this year I wanted to find out what you should do if you realize your child is actually drowning. Put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.

I tapped Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s for information on what to do if you come upon a infant/toddler, school-age child or teenager is drowning. Preparing for this can help boost awareness and response if ever you support or discover an infant or young toddler in need for rescue.

Drowning In Infants Is Different Than Older Children

Children ages 1 to 4 have the highest drowning rates. Because they are so small in stature and often easier to retrieve, drowning prevention for infants and toddlers will always be more important than water rescue techniques. Never leave children alone in or near the water, even for a minute. This includes the bath, a kiddy pool, a pond, a river, lake or larger pool. Close supervision is vital in preventing water-related injuries and drowning. Since it only takes seconds for a child to slip silently under the water, parents need to make sure there is always a lifeguard on duty, or another adult, or a parent watching attentively when children are in or around the water. Dr. Quan says,

For an infant, a child younger than a year old, drowning usually happens in a bath tub, bucket or ornamental pond or water collection device, so rescue does not usually pose a risk to the parent or rescuer. This small child is easily pulled out of the water if within arm’s reach.

What To Do If You Think Your Baby or Toddler Is Drowning:

  1. If the child is blue or not breathing, immediately give several rescue breaths (mouth to mouth breathing).
  2. If the child does not take breaths or respond on his own, start CPR (chest compressions with ventilations).
  3. After several rounds of CPR, call 911 if they have not been called yet. The video below gives a quick overview of infant CPR. You can also check out this article for more information.


 

Power Of A Google Search: Community

5-22 Addison

2-year-old Addison Hyatt survived a  pediatric stroke at birth. (Image courtesy: Kaysee Hyatt)

One Google search can sometimes change everything.

After learning something new about our child’s health or condition, especially for worried parents and caregivers, leveraging online search as a resource in diagnosis, clarification and education is typical behavior. Searching out support, camaraderie and tips online just makes sense. In fact, 2013 data from the Pew Research Center finds that 1 in 3 Americans goes online to search for information and support in finding a diagnosis. If you’re a woman, college-educated, or younger (under age 49) the likelihood of searching online increases and approaches 50%. Not only are we searching for health info and connection online, we’re doing it more so with mobile devices. Pew data from April 2015 finds that 64% of Americans have a smartphone and that 6 in 10 are searching for health info on a mobile device.

That smartphone in your pocket can connect you to information yes, but also to others like you.

Of course most clinical care still happens in the office and most decisions, especially important ones, are made offline. Yet preparing for visits, strengthening resolve, finding other parents in similar situations can potentially improve the way we care for and raise children with underlying medical challenges. It can also change how we feel about it. In my mind, one of the most precious resources will always be the people. This includes our family, our nurses, our therapists, our relatives, our clinicians and our peers. In the words of Susannah Fox, a technology and health researcher who is now Chief Technology Officer at the U.S. Department of Health and Human Services, when it comes to caring for yourself or others in your life, “Community is your superpower.”

I’m still the doctor who encourages online search, especially when looking for resources in networked communities. Social networks have simply shrunk the distance between us and facilitated robust connection. Finding others like you, who’ve been down the road before you, can often provide support, help reduce anxiety, provide tips and connect you with resources you didn’t even know existed. As a pediatrician, there’s no question that expert patients and their families often teach me about resources available to them I’ve not previously known — as a clinician I’m grateful. Once I review the sites and organizations, I can then share those communities and education sites with other patients I’m lucky enough to partner with.

Community is your superpower   ~Susannah Fox

Mom Kaysee Hyatt drives this point home. After months of concern surrounding her infant daughter’s delayed development, Kaysee Hyatt finally got the diagnosis: her daughter Addison had suffered a perinatal ischemic stroke at birth. After receiving the news, Kaysee was told to go start therapy but in her words “there really was no plan.” Out of curiosity and intent, she turned to the Internet. A Google search on pediatric stroke led her to CHASA.org (Children’s Hemiplegia and Stroke Association), a nonprofit group founded by parents that provides resources and dozens of discussion groups for families dealing with pediatric stroke. Kaysee told me that when she found the site and learned more, “It changed everything.” When talking with Kaysee what stuck with me most is how Kaysee’s sense of isolation dissolved when she found these resources online. She remembers that she was stunned to find so many families with strikingly similar stories to her own. “It was amazing,” she told me, “we all shared the same stories.”

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