School Age

Common Sense Media Screen Image http://www.commonsensemedia.org/mobile-app-reviews/roxies-maze-ing-vacation-adventure

It’s been a relief to realize that there is great online content for my 6 year-old. He still doesn’t use the computer (outside of school). The main reason, I’ve not been in a rush to enmesh him in technology. It’s clear he’ll catch on fast when it becomes important to him. Previously when reading up about apps and games, I always felt like nothing suited his timid-conflict-averse mentality. So when we found a couple beautiful apps last night, I was pumped. Screens can be delicious. Later this week, my 6 year-old and I set off on a trip alone, just the two of us. He’s joining me on a work trip to The Netherlands (speaking here) and although real books will tide him over at times, there is somewhat of a saving grace in the fact that the iPad exists.

I’m seriously thrilled. I can’t wait for this special trip with my son and this time together.

But I’m also normal– there are parts of me very cognizant of the 10+ hour plane trip ahead of us. As a working mom on a working trip, he’ll be stuck amidst a few meetings. On the plane, we’ll read books, work on his journal, yet ultimately I’ll need to plug into my work for a few hours. When I do so, I’m thrilled that the iPad will be on his lap. Living in 2013 does have unique parenting luxuries and one of them is some of the brilliant screens out there. Screens can be great fun for us all when we do it right.

Last night, my husband and I spent some time online reading about good apps to load. We were sincerely delighted to find a couple gems (see below). We ended up completely entranced by 2 apps, in particular. I can’t wait to show these to my 6 year-old on Thursday.

Thoughts On Apps For Young Children:

• I love using Common Sense Media to learn about new apps, games, movies, and books. Not only do they provide age-based filters for search, they detail enough about the platforms that I can really cater to my kids’ individual interests and limitations (my 6 year-old is scared of most movies and really hates any kind of conflict). You can search by ages (if you’ve got more than 1 child with access to a device) or by interest (dinosaurs, sports, or magic) and you can also just quickly browse the “editor’s picks.” Read full post »

Salmonella infections affect children more frequently and more severely than adults. Although most salmonella infections arise from contaminated or undercooked food (chicken, eggs, beef, and dairy typically), reptiles, pet foods and now amphibians are an important source of infection to keep in mind for our children.

Today, a new study published in Pediatrics links Salmonella infections to pet frogs here in the US. This is the first study to detail amphibians as an important source of Salmonella infections. 8 tips for preventing Salmonella are at the end of this post.

New research tracked an outbreak of a particular strain of Salmonella between 2008 and 2011. In 44 states, researchers identified 376 cases of Salmonella in children and adults with an average age of 5 years. Over 2/3 (69%) of the cases were in children under age 10. The source of these salmonella bacteria was tracked to a breeding facility that shipped an aquatic frog, the African dwarf frog, to pet stores and people around the country. Although the African dwarf frogs are not always handled, many people were presumably infected from touching the frog’s contaminated water bowl or may have been infected when aquariums and equipment were cleaned in sinks also used for food preparation.
The study uncovered an important truth:

Few patients and families were aware that Salmonella could be spread from reptiles and amphibians.

Even when we parents are aware, some children still get infected. It’s essential that children who handle reptiles and amphibians always wash their hands after playing with the pets or help clean or care for their aquariums. This data hits close to home as my son had Salmonella gastroenteritis when he was just 4 months of age after a trip to Central America. Read full post »

Ear infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990′s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read full post »

Television programming for children is abundant. Screens are a luxurious fixture in most of our lives and I’m not here to tell you to turn them off. Well, at least not today. In fact, that tactic, the one where we pediatricians urge families to turn off the TV, really isn’t working. Children tend to increase their TV viewing time as they age and preschool-aged children in the United States spend over 4 hours per day watching television at home and in day care. My good friend, Dr Claire McCarthy, offers up her opinion in this week’s Pediatrics.

Television viewing is only on an upswing over the past 5 years as more and more devices interdigitate into our children’s lives. I’m a perfect example. When my first son was born 6 years ago we had one television in our home and one computer. Today, we have a smartphone, an iPad, a computer, and a television. The screen choices continue to grow, the television shows continue to become more alluring, and the opportunities for viewing with new convenience is abundant. It’s true: some of the stuff out there designed to delight our children is awesome.

But not all of it.

So as our children continue to tug on our sleeves and hang on our pant legs asking for the iPhone just after they beg for TV time before dinner, we need to think clearly about an action plan. We need to make a thoughtful “media diet.” We need to think ahead of time what time we’ll offer up the devices and what content we want them to see. We should care–it really changes how they think and what they do. When we use a media diet, I suggest we’ll improve both our own satisfaction as parents and our children’s lives. Dr Dimitri Christakis, a pediatric researcher here at Seattle Children’s suggests:

We often focus on how much kids watch and don’t focus enough on what they watch

New research out today by Dr Christakis finds that our time and energy working to improve what our children watch, not just how much they watch, can have a positive impact on their behavior. Even for children as young as 3 years of age. Read full post »

Norovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012″ was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.

When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…

Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus… Read full post »

This is a little trick I use to help coach anxious children whose minds just seems to “spin.” Patients have given me great feedback over the years that “blowing colors” really helps. Sometimes it’s for children and teens who can’t drift off to sleep, sometimes for those who are worriers, and sometimes for those who get anxious or overwhelmed at school. Blowing colors is a great exercise to return to regular belly breathing patterns, buy time and space for mindfulness, and improve control over feelings of overwhelm. See if it helps…

Greatest thing is–this is a good tool for a child or teen to regain control.  They can use the exercise anywhere, at any time. Lots of children and teens who get anxious feel ashamed of their anxiety and don’t want to reach out for help. Reassure them that no one will ever know they’re blowing colors or changing the hue of a room. Practice at home before bed, in school during moments of overwhelm, or even remind a child or teen they can blow colors while out with friends or at a sleepover.

TV before bed delays children going to sleep. We’ve all heard that TV isn’t necessarily good for our children right before bed, but something about that fact tends to go against instinct. In my experience, most of us feel like television and video-streaming is relaxing to our minds. Bum news is, it’s the opposite. Viewing TV or video or screens prior to sleep tends to rev up our brains, disrupt our sleep, and may even cause nightmares (especially for preschoolers). The light from computers and screens may inhibit melatonin, the hormone that helps us drift off to sleep.  A new study published this week reminds us about TV realities at bedtime.

I’m as guilty as everyone else. I love to let my children watch a TV show after dinner in the hour before bed. We all crave that downtime with our full bellies and the work of our day behind us. We all want some quiet. Here’s the thing:

Researchers surveyed over 2000 children between 5 and 24 years of age. They inquired about the last 1 1/2 hours of their day–not surprisingly they found that TV before bed was common. Across all ages, watching TV was the most common activity for children before bed, about half of the children watched TV for at least 30 minutes. When they surveyed what time children went to sleep, they confirmed the concerns about TV and bedtime. The children with more TV viewing went to sleep later. Conversely, those with an earlier bedtime had significantly greater time in non-screen sedentary activities and self-care prior to going to sleep. Most research shows that our children’s sleep deprivation is due to late bedtimes, not early rising. Children sleep about 1 hour less now than they did 100 years ago. Consequently, we’re also more fatigued, distracted, obese, and hyperactive these days–all things associated with sleep loss. Strategies that help us go to sleep on time are essential for our very tired country…

TV Tips To Improve Our Children’s Sleep:

• If your child is having trouble falling asleep, work hard to make sure they don’t spend any time in front of a screen 2 hours prior to bedtime. Explain to them why you’re doing this–the TV winds them up, not down.
• Get all screens out of the room where your children sleep. No TVs, cell phones, tablets, or iPods in bedrooms or in bed with children. Make rules for a sleeping station for phones in your kitchen. Phones go to bed at say, 9pm.
• Buy a new alarm clock if a child says that their phone must wake them up in the AM. I find alarm clocks online for less than $15.
• If your child loves TV, shift the time of day they watch television. Consider using all screens as devices of privilege. Let children earn an hour with their TV or video game while you prepare dinner for great citizenship at home and/or school.

“We don’t benefit from ignorance. We don’t benefit from not knowing the science of this epidemic of violence.” Obama said. “Congress should fund research into the effects violent video games have on young minds.”

Only a month after the Newtown, CT tragedy I was pleased to hear the President’s plan today to decrease gun violence and his steadfast effort to improve the safety of our communities by decreasing violence, death, and suffering from firearms.  Delighted to hear that the government is looking to ensure that it’s safe to talk about firearm safety in the exam room (at a federal level) and also that he’s implored Congress to study the effects of video games on young minds. That being said, we do know a bit about the effects of video games on young minds. An American Academy of Pediatrics (AAP) 2009 Media Violence statement noted, “The strength of the correlation between media violence and aggressive behavior found on meta-analysis is greater than that of calcium intake and bone mass, lead ingestion and lower IQ, condom non-use and sexually acquired human immunodeficiency virus infection, or environmental tobacco smoke and lung cancer—associations clinicians accept and on which preventive medicine is based without question.”

To be clear, the $10 million that Obama is granting the CDC to investigate the effects of violent video games on our children is not a ton of money. And their tone, according to Stephan Dinan of The Washington Times places more responsibility in our hands — “But overall, the White House said that while limiting guns is the role of the government, controlling what Americans see in movies and games is best left to parents.”

As parents and pediatricians, community members and mentors, and American citizens, there are things we can do now to improve our children’s exposure to and absorption of violence.

Thoughts On Children’s Massive Exposure to Violence

• Data finds that witnessing violent acts in the media (in a game, TV, or video) can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Research finds, “Consistent and significant associations between media exposure and increases in aggression and violence have been found in American and cross-cultural studies; in field experiments, laboratory experiments, cross-sectional studies, and longitudinal studies and with children, teens, and young adults. Read full post »

Influenza virus causes “the flu.” It’s a crummy cold that spreads easily causing high fever, body aches, runny nose, terrible cough, and rarely it can cause vomiting and diarrhea, too. The flu isn’t the “stomach flu.” It’s deadlier than that. It’s more dangerous for babies and young children, and for the elderly. It’s also particularly dangerous for those with asthma, diabetes, and people with neurologic or immune problems. This post is a bit of a plea: people are dying from the flu and there are ways we can potentially save others’ lives. Click through to read 5 myths about the flu and watch a 3-min interview I did for HLN television yesterday.

The bad news: We’re having a bad flu season. More people have the flu this year than at any time last year. This is early—flu usually peaks in Feb or March. The most dominate strain of flu that’s moving around the US is the strain called H3N2—it’s known to cause more serious disease. As of today, we have over 80% of our states reporting widespread circulating levels of flu. Here in Washington many people have been hospitalized from complications of the flu. Further, in Washington 6 people have died, one of them a child under the age of 12. A healthy 17 year-old died in Minnesota just this week. Flu is not just your “common cold,” it can be far worse. Eighteen children have already died this season. As of November, we didn’t even have 1/2 of our population with a flu shot. The goal to protect us all is 90%.

I’ve never had a family in clinic get influenza illness and then refuse the flu shot the following year.  They come in early and often for their shots. It’s that bad of an illness.

The good news: We have a vaccine for the virus that causes the flu. The flu shot and flumist nasal spray are effective and that H3N2 strain that we’re worried about, it’s in the flu shot and the nasal flu spray this year. It’s not too late to get a flu shot. You’ll be protected against the flu somewhere from 10 day to 14 days after getting it. Go out now and protect yourself and your family. By getting a shot you protect yourself, your children, and all those more vulnerable in our community unable to get the shot (those infants under 6 mo of age, those on chemo, or those with contraindications to the shot).

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There’s a new law today in Washington State requiring carbon monoxide (CO) alarms in apartments, condos, and single-family residences. You should have a CO detector on every level of your home (more tips below). I know you’ve heard that CO poisoning is not only dangerous but also potentially fatal. We also often hear horrific stories of accidental deaths from carbon monoxide after natural disasters. A recent study found disaster related deaths are particularly common (your power’s wiped out so you bring in a generator or grill for heating or cooking and get exposed to CO). Using a generator indoors is the most common cause of CO poisoning, followed by use of a grill. Unfortunately, over 400 people die in the US each year from CO poisoning—all of which could be avoided with proper education and detection in the home. The odd thing is that we often get to see CO toxicity play out on our favorite television shows (think Mad Men)~ the ever-again scene where someone clogs up the exhaust pipe of a car with a banana or handkerchief and dies (or attempts to) due to the toxic fumes.

One generator running inside a home, garage, or basement creates the equivalent carbon monoxide of 6 idling cars. Precisely why a generator needs to be 20 feet from inside spaces and away from open windows/doors. Carbon monoxide is found in combustion fumes–it can be produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, gas ranges, and heating systems. You likely know all this. But…

The thing to know: carbon monoxide in and of itself is more dangerous to babies and young children. Infants in utero, newborns, and young children process carbon monoxide differently, have more severe reactions, and may see effects faster than adults. If you and your young child were in a room that was filling with carbon monoxide, it’s your baby or child that would suffer the consequences first. They may not know how to tell you about their complaints and if they were sleeping you may not even know. Hence all of us needing a CO detector.

The Science of Carbon Monoxide Poisoning:

The red blood cells in our blood circulate oxygen to all of our muscles and organs for survival. When carbon monoxide (CO) is in the air it can function as a disguised villain. When carbon monoxide is inhaled into the lungs via contaminated air, the red blood cell picks up the CO instead of just oxygen. Each carbon monoxide molecule that attaches to a red blood cell displaces a spot for oxygen. Therefore the circulating red blood cells go around the body without oxygen causing improper circulation. Organ failure and death can result after higher and higher level of our cells are bound to CO instead of oxygen.

The graphic is from the Centers For Disease Control (CDC)’s comprehensive review on CO poisoning.

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