Parenting

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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).

Image c/o Journal of Entomology

A Few Prescription Lice Medications

There are 4 main medicines registered for use in the United States that can treat these “super” lice by prescription: Ulesfia (Benyzl Alcohol — suffocates lice but doesn’t kill eggs so you have to re-apply… but the medicine is not a neurotoxin), Natroba (Spinosad — kills lice and eggs), and Sklice (Ivermectin — kills lice and eggs) and Ovide (Malathion — kills lice and eggs). These meds are easy to use but not entirely cheap and may or may not be covered by your insurance. Ask your pediatrician what they think about giving you a prescription (ask: are they seeing lots of resistant cases in your neighborhood?) if you’re having trouble getting rid of lice. If your pediatrician is seeing many cases of difficult to treat lice they may be more apt to prescribe and you may want to start with a prescription. Not a lot of data out there that one of these medicines is far better than the other but I will say that like many of the OTC treatments, the prescription meds are pretty easy (one treatment and you’re done)!

PRO TIP: A nice chart comparing medicines and other tips for getting rid of lice here on Healthy Children from The American Academy of Pediatrics.

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 »

When Joy & Science Meet In Parenthood

I gave this little talk at Children’s recently about where joy and science meet– a lunchtime chat about life and balance and work and loving up our children. Ultimately, it was a sincere privilege to think of sharing a little bit of science and a lot of stories from my own tightrope walk as a mom to boys. I spoke about about how we get this done while bearing witness to our children and their enormity, while also working on our careers. In my mind it’s a messy palette of colors we use when watercoloring our lives as our children grow and make themselves into adults. We have big chewy highs and bits of beauty all the time. We also feel miserable when we don’t live up to what we’d hope for ourselves as parents. We all worry. It can be a little ugly. We all house doubt about who we are as parents. But joy is abundant in this lifetime with children and teens and little tips may help us connect with it more often…

There was a lot in this talk not included in the slides and images in the above Prezi, but hopefully you can enjoy a few of the lessons if you click on through it. Even Will Ferrell makes an appearance. I hope they invite me back even though I might have used a swear word or something. Read full post »

6 Tips To Help A Child With Autism Eat Better

There are ways to support picky eaters and children who refuse new foods. I’m back with Dr. Dolezal further discussing feeding challenges for children with Autism Spectrum Disorders (ASD). The first post explored why children with Autism have challenges with eating (almost 90% do). I often say that a typically developing child will not starve with a full refrigerator, but this advice just doesn’t hold up with ASD children. I love Ellyn Satter’s advice and mission in helping adults and children be joyful and confident with eating. Her resource and guidance inspires a “division of responsibility” that basically a parent’s role is most simply to provide great healthy food and a child’s job is to choose what and how much of it to eat. But we have to acknowledge that parents to children with ASD need more information about challenges and often far more support. Here are Dr. Dolezal’s 6 tips to help a child with autism, or any child who choses to eat only a few, certain foods, eat better.

Children who graze are really not open to trying new things. — Dr. Dolezal

Read full post »

Why Children With Autism Struggle With Eating

If you’re a parent to a child on the autism spectrum, take some comfort in knowing that up to about 90% of children with autism struggle with significant eating challenges. You are NOT alone in this. The challenges can range from picky eating to dependence upon PediaSure or g-tube for caloric intake. We know that children thrive in an expected world. But children with autism can take that to the margin where a preoccupation with sameness can drive them to eat only the same thing every day. Despite these staggering numbers, there are evidenced-based treatments and models of care that can help improve the lives of children and families from a nutritional and quality of life perspective. I had the pleasure of having Dr. Danielle Dolezal on the podcast to discuss this topic. The first podcast here is an overview of why children with Autism Spectrum disorders have these challenges with eating.

Rigidity and sameness contributes greatly to feeding picture. Eating is one of the most sensory experiences you can have.” ~Dr. Dolezal

Dr. Dolezal is the Clinical Supervisor of the Pediatric Feeding Program at Seattle Children’s Autism Center. She’s super smartypants and created the highly sought after (nearly 500 families on the wait list, unfortunately) interdisciplinary team model and program at the Autism Center. That means patients that have multiple factors contributing to feeding issues (medical, skill, motor, physiologic, and psychology) get to see a variety of team members under 1 roof. She started off her career with a masters in special education with special emphasis in early childhood and children who struggle with severe challenging behavior. She then got her PhD in child psychology with further emphasis in behavior analysis specializing in feeding disorders and severe challenging behavior. So needless to say….she knows her stuff. Her podcast is so good. Insistence on sameness is a common theme and can be horribly challenging for families who worry about their child’s nutrition.

A Few Quick Tips:

  • Try to not let your child slip into patterns of grazing, which is very common and leads to disrupted hunger/satiety patterns. This makes it difficult for them to try new foods because they graze to take the edge of the hunger all day long and are never really sitting down to eat a full meal at set meal times. They will be more apt and ready to try new foods if you keep to a set schedule. They don’t have to stay seated in a seat. They can stand up. But the food stays at the table.
  • Try celebrating and reinforce flexibility with something the child is already doing. So if they are eating dry/crunchy textures, try branching out to ANY type of cracker. Go from white cheddar Cheez-It to regular Cheez-It. Celebrate that as a new learning experience and new demonstration of flexibility.

Read full post »

Alternating Acetaminophen And Ibuprofen For Fever

Lessening a fever in your baby or child, with multiple medicines, can be tricky. And it may not always be necessary. Many pediatricians urge avoiding “fever phobia” and allowing a fever to stick around, especially if your child is acting well. See this recent piece, “The Case For Letting Fevers Run Their Course,” by Dr. Paul Offit, an infectious disease expert on this take, the data behind it, and why fevers can sometimes help children fight infection.

Lots of families consider alternating medications like acetaminophen and ibuprofen at home to treat pain and fever, but I’m unconvinced that this leads to better outcomes for kids and/or improved fever control. It’s not my recommendation that you try alternating medications, and this post is not here to endorse this approach, rather if you choose to, I’m hopeful that this will help you do it more safely.

It’s important to note that the dosing amount for one medicine AND the duration of time between doses for medicines can be different from one medicine to another. So it can get confusing, FAST. However, armed with a plan, alternating medicines can be a good way to feel in control of supporting your child with medicines that relieve fever, improving your child’s behavior and comfort.

First….and I know I said this but I gotta say it again: it’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers on the thermometer. What always matters most is how your child looks to you and how they appear. Fever is a natural response of the immune system — it’s a response to illness, not illness itself. Fever ultimately can be productive and may assist your child’s body in fighting off infection. There may be no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated.

Second…there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees it’s wise to get support. Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months. Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions, or see charts below.
Before giving your child any medicines, make sure you know your child’s weight. Dosing is always based on a child’s weight, not age.

Last… trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call your pediatrician for help! If the fever is unexpected in a way, consider calling in to get support and education.

Ok…now that we’ve got all that out of the way, here is one way you can alternate between medicines (acetaminophen and ibuprofen) every 3-4 hours: Read full post »

After The Vegas Shooting: What To Do Now And How To Talk To Children About Firearms

In the wake of the recent Las Vegas shooting, I went on the Seattle NBC affiliate, KING5 News, to discuss how to talk to your children about guns and violence. Frankly, it’s not the first time I’ve covered this topic and as horrifying as it is, it probably won’t be last. I’m upset and sad that these shootings are becoming a part of American culture and I’m committed to doing my best to learn and translate what the experts advise us to do to decrease deaths from firearms.

I have lost people I love dearly to firearms so like so many of you, this is personal.

No question that we can feel helpless after horrific events. Focus on what you can do and share that with your children. If there is a gun in your home, keep it locked, unloaded & separate from ammunition. Remember that exposure to violent media and violent video games will change your child’s relationship with firearms – the “weapon effect” is real – so think carefully about what video and media your children use. Common Sense Media is a great site to help you sort out your choices.

Guns And Violent Media – A Toxic Mix With An Available Antidote. <— read this, it’s amazing. Basically the gist: violent media changes what children think of and may do with firearms and firearm safe storage reduces firearm suicide and accidental shootings by 75%. Seventy-five percent reduction of suicide deaths and accidents from firearms just with storage. Talk about it, do it.

As individuals we obviously can’t prevent mass shootings by what we do in our homes today, but we can communicate openly and honestly in age-appropriate ways with our children, we can build a safer culture with our firearms in America, we can vote, and we can remind children all of the things we do to increase safety in their lives. We can make sure that those around us know how much we want to keep firearms out of children’s hands, too. This will help. Read full post »

1 Small Hack For Smarter Smartphone Parenthood

It’s the last official week of summertime around here. My babies love school and are eager about the beginning; it’s me nursing an increasingly bigger pit in my stomach as summer wanes and September nears. While my boys grow up I feel like I see more clearly the ways summertime affords juicy glimpses into the innocence of childhood. This summer I watched these little boys stay in their jammies past noon and watched as they dabbled in stories and books, make believe, competition, mindless daydreaming, Lego-building, risk-taking, and an earnest growing concern about safety in the world. To me the collection of those interests feels so earnest and utterly serene. Summertime is just slower.

I crave the de-clutter of long days without so much chaos. Without the stresses that the school schedule ushers in, the summertime-alarm-clock-free space lends priority to an actual circadian rhythm. We eat better, the days are less driven by rule following. I think we might laugh more. Less time spent rushing and shuttling from one thing to the next and more time listening. A lot more time goofing off. I mean my 8 year-old ran into my room first thing this morning in a cape! What life (with children) is ultimately about.

As this summer, in particular, wraps up I’m also recognizing with increasing fortitude the peril we’re under because of technology in our lives.

Nothing new or profound but I really feel it right now, more than ever. My work over the past years with The American Academy of Pediatrics Council on Communication and Media has shaped the study on device-use as a station in my work, but it’s my role as a mother that screams out louder in me right now. We could really mess this up. Not our kids, per se, I just mean how we all experience this precious gift. Read full post »

New Breast Pump Cleaning Guidelines From CDC

Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.

After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.

In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”

New CDC Breast Pump Cleaning Guidelines:

  • Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
  • Wash your hands before touching your pump parts or pumped milk.
  • Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
  • Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
  • Use running water and soap to clean breast pump parts that come in contact with breast milk.
  • Then let each piece and part air dry.
  • For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.

Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read full post »