One of the most important forms I fill out in the office is the allergy action plan. The action plan is a spelled-out, step-by-step instruction form on how to care for a child who has a food allergy in the event of an accidental ingestion. Food allergies can be serious, even life threatening, yet adults are often unprepared to respond with speed and confidence. We know that 16-18% of children with food allergies have an accidental ingestion at school.
This past weekend a friend and pediatrician showed me how she is protecting her son at his new school. Instead of only filling out the paper forms for his severe food allergy, she and her son created a Youtube video action plan. Turns out, it worked. Not only was it viewed by the teachers who may need to support him in the case of an accidental ingestion, it was broadcast throughout the school. This is the new world in which we are lucky enough to live.
If your child has food allergies, consider bringing the paperwork to life. Not only can you inform caregivers on proper use and timing of antihistamines or Epipen injection, you can confirm and review the plan with your child. All you need is a smart phone and some time on Youtube. Every child’s allergy action plan is unique. If you’re confused about when to give your child diphenhydramine (Benadryl), when to use an inhaler (albuterol), or what symptoms demand injection with an Epipen (epinephrine), don’t hesitate to call the doctor now to review.
Bringing School Paperwork to Life:
Allergy Action Plan Form courtesy of Food Allergy & Anaphylaxis Network (FAAN). The form is fantastic–there’s even a spot for your child’s photo, decreasing chances for confusion.
A study published today in The New England Journal of Medicine evaluated the duration of protection against whooping cough after children get the DTaP shot. Researchers wanted to find out how long the shot lasts. DTaP shots are given to infants, toddlers, and kindergarteners (schedule below) to protect them from three infections (Diptheria, Tetanus, and Pertussis –whooping cough). After these childhood vaccines, we give a “booster” shot at age 11. Because we know that many babies who get whooping cough are infected by teens and adults, all teens and adults are now recommended to get a Tdap shot to protect themselves and those vulnerable against whooping cough.
As researchers seek to understand the recent epidemics of whooping cough in the US, they have found more and more that the causes of these epidemics are multifactorial. Not only is it unvaccinated populations that allow epidemics, it may be waning immunity from shots given previously and waning immunity to natural infection, as well. Previously, it’s been estimated that our immunity to whooping cough wanes anywhere between 4 and 20 years after we get whooping cough, and that it may wane 4 to 12 years after the shot.
A little history: back in the 1990’s we switched from using the “whole cell pertussis” shot to using a vaccine that is “acellular.” Some health officials have had concerns that this “acellular vaccine” may not protect children as long. Although it does a great job protecting infants and toddlers, it may not last as long as previous immunizations. Some have wondered how long the kindergarten shot protects our children…
Physicians at Kaiser Permanente reviewed information about children in California during the 2010 whooping cough outbreak. What they found may have significant effects on how to protect our children going forward: Read full post »
We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.
Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.
Typical Sleep Needs For Children And Teens
Preschoolers:10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
School-age children:10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm. Puberty brings on changes to their sleep cycle and thus shifts them later.
12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities, it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.
6 Tips To Help Your Child Prioritize Sleep For School
Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »
Although this video feels a little bit like a video game (and takes you back to the 1970’s), it’s 1 minute of your life you don’t want to miss. Recommendations for CPR have changed this past decade. If you don’t have time to re-certify, take 1 minute and watch this video. Don’t ever be afraid to help immediately in a emergency situation where a teen or adult has potentially suffered a cardiac arrest. Channel your inner-John Travolta. Your actions can only help. Check out the American Heart Association CPR page for more. You can take a CPR class IRL (in real life) or online.
Bystander CPR dramatically improves survival from cardiac arrest, yet far less than half of arrest victims receive this potentially lifesaving therapy.
Parents who have learned how to do CPR are often more confident about their ability to manage an emergency of any kind. As a mom, I always feel more confident after reviewing these recommendations.
CPR For Infants & Children Is Similar But Different
Click on these links for drawings and nice summaries of CPR recommendations. Hands-only CPR is not recommended for children. However, the rate of compressions for infants and children also matches the Stayin’ Alive beat…
This post sounds a lot like it’s written by a doctor (I’m colored by the holidays I’ve spent working in the ER). I feel strongly about not using fireworks with children. Fireworks have always kind of freaked me out. When I was a child my father loved fireworks, he used to terrify us by surprising us with hidden explosions in the bushes and whirling bottle rockets off the deck. I like professional fireworks in the sky but I do tend to keep a good distance from the others…scarred for life, I guess.
The Fourth is one of those days we can do better. As the holiday week(end) begins, take a minute to plan ahead. The Fourth of July is one day where we don’t follow our typical routine, and each year July 4th marks a day with a huge bump in injuries. Talk to your children about ways to protect themselves and plan ahead to protect your young children from potential injuries:
Children between the age of 5 and 14 are the highest risk for firework injuries—over double the risk of the rest of us. I don’t recommend you use any fireworks but if you do, make some serious rules. Ensure that adults don’t let young children light fireworks and supervise older children using any type of firework. Nearly 1/2 of all injuries each year from fireworks occur in children under age 15. Research finds that the hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. “Every type of legally available consumer (so-called “safe and sane”) firework has been associated with serious injury or death.
Sparklers seem fairly benign, yet use caution with your kids if you let them hold them. Sparklers burn at 1200 degrees Fahrenheit–hot enough to cause a 3rd-degree burn.
Remind your teen children and their friends about of risks associated with teens on the road for the holiday. Pull a parent and remind them to wear their seat belt, avoid texting and driving, and ban the use of alcohol for those behind the wheel. The Fourth of July ranks as the deadliest day all year for teen drivers according to AAA.
Food allergies have more than doubled in the developed, Western World over the last 50 years and the reasons remain unclear. Yet recent data finds 8% of children in the US with a food allergy with 1/3 of those children at risk for severe or life threatening reactions. A Pediatrics study published today has some sobering news about our ability to protect children from allergic ingestions. When it comes to allergies and deadly reactions 2 things are necessary:
Avoidance of known triggers/allergens.
Treatment of anaphylaxis (severe reactions) promptly with epinephrine.
Trouble is, children get exposed to known allergens by mistake and people are often nervous or unsure about how and when to use an Epipen (epinephrine in a pre-measured syringe). All parents/caregivers/teachers/coaches need to practice use of an Epipen & refresh why/when to administer it to an allergic child.
Researches followed over 500 infants and young children allergic to milk and eggs (and many to peanuts) between 3 and 15 months of age. During the 3 years of the study, the majority of children (72%) had an exposure to an allergen that caused a significant reaction. Of the allergic reactions, 42% were reactions to milk, 21% to egg, and just under 8% to peanut. Reactions were most severe when a child was exposed to peanut, followed by milk, and then egg.
Over 1/2 of the ingestions occurred after a non-parent adult offered an allergic food. Read full post »
New research shows that there is a 6-fold increased risk for drowning when at the pool of a friend or relative.* Something about being at the home of a friend or relative may change the way we supervise our children. In the Florida study, 79% of patients that were seen in an ER for drowning accidents were at a home pool.
We also know that young children under age 5 drown more in home swimming pools than anywhere else. Anyone can drown in any body of water. But more than anything else I can say, know that children are more vulnerable to drowning due to their size, maturity level, insatiable curiosity, swimming skill level, familiarity with water, and communication skills. Babies and children can drown in any collection of water over 2 inches deep. The Florida research also shows that where we are and who we’re around while swimming may change levels of supervision and distraction.
Plan Ahead When Children Swim in Pools:
Never let anyone swim alone.
When swimming, young children need constant eyes-on, non-distracted supervision. Put down the book, put down the cell phone, and put down the alcohol. As best you can, focus only on your children. There are too many tragic stories of quick phone calls and book chapters that have left children unprotected. If you’re at a party, designate one adult to provide constant supervision.
Know about safety equipment present at the pool, watch for risks from entrapment around drains, pool covers and pool equipment, and have a phone nearby. Call 911 immediately if you’re concerned about a potential drowning accident — seconds matter.
Enroll your children in swimming lessons and update their skills every single year. However, never trust swimming lessons to be protective for drowning. Your supervision is paramount. I’ll post more on this next week.
Drowning injuries and deaths are preventable but often silent and quick. Young children under age 5 drown more than any other group, but nearly 1000 children die annually from drowning.
*When I say “drowning victims” in the video, I didn’t mean to imply all those patients in the study died. Of the 100 study subjects with drowning accidents, only 10% had life-ending drowning accidents. Fortunately, 90% of the patients that presented to the ER after a drowning accident survived and had full neurologic recovery.
We had a marvelous Father’s Day weekend. On Saturday we started a Dad-coached soccer team with some friends which was surprisingly successful. And then on Sunday, we completed our first-ever family bike ride on the Burke-Gillman trail. Everyone had two wheels of their own, including Grandma. Although O ended up in the ditch at one point after steering off-course, it was an injury-free ride and we proclaimed it a success. I think we all felt really grown up. We gave my husband a mixture of homemade gifts (paintings) and then a trite, expected one (a necktie). We played ball in the yard, pulled weeds from the grass, and Jonathan got a bit of time to himself for a run. When we went out for Italian food and ordered Shirley Temples we formally celebrated the fortune of having a father parenting so actively in our lives. The boys began the day with exclamations and closed it with a final, “Happy Father’s Day” after the lights went out. It was then that I realized it’s prime time for this holiday in our home.
I get that Father’s Day isn’t this Hallmark in everyone’s home and I certainly understand it won’t always be like this. These manufactured holidays bring up thoughts of the tension and distance many of us feel from our own fathers. I also think about my friends and patients who have lost their fathers and those children who are separated from their fathers due to work, military commitments, or unique family circumstances. Last week one of my colleagues pointed out that children had eras in their lives where Father’s Day was on the map; young children adore and celebrate but then retreat as we’d expect during the late school-age years. “They tend to check back in during young adulthood,” he said.
And it got me thinking: is there a way to keep the intimacy of preschool-parenthood alive? Read full post »
As you construct a schema for your summer, plot vacation time, and plan for summer camps, more than anything I think you should build in some unstructured time. Carve out hours, half, or even full days each and every week with an absent itinerary. Wide-open days inspire creativity (in us all) and allow children to stumble upon a little boredom. I would suggest boredom is a helpful tool for everyone here and there, especially our children. Just think of the motivation that comes from it! Read this perspective: What Caine’s Arcade Teaches Us About Modern Parenthood.
Good thing for those of us who are less organized: unstructured time comes without difficulty as the camps fill up and we run out of options. Now (May) is the time to sign up for many camps, so get on it. The unstructured time I mention is only delightful if peppered into a summer filled with adventure and discovery. Summer camps offer a great place and space for fostering independence, building skill and esteem, and forging new friendships. Choosing a camp may feel entirely daunting if your child has special health needs, you have limited money for camp, or you’ve never separated from your child for long periods prior. Here are a few tips and resources I’ve found that may help: Read full post »
Flying with toddlers is far more difficult than flying with an infant in my opinion. It’s the need to get up, run the aisles, move around, have another snack, read a different book, take an abbreviated nap, go pee, and that minute-attention span that makes it not only exhausting but nerve-racking for most of us. Although the challenge is real, success comes with having a good plan, allowing extra time, and packing the right snacks, toys, and books to keep your toddler occupied. That 3,000 mile flight at 30,000 feet can be a ton of fun! The above tip came from a friend years ago. Prepare for the worst and expect the best when flying with toddlers–hopefully this blue tape idea sticks. (ha)
Now dealing with tantrums while up in the air is another challenge in and of itself. Many of us heard about the toddler kicked off an airplane, and have also heard about the opinion for commercial airline children-free flights. Although I wholeheartedly disagree that we should segregate flights by age, I do think these stories in the news media elevate our anxiety for flying with our children. Don’t let it. You’re always the best one to support and help your child on the ground or up in the air. Don’t let the public shake that truth. My tips for dealing with tantrums at 35,000 feet aren’t very different from those on the ground: provide consistency, provide distraction, and provide comfort. But more, set yourself up for success by clearing the tension with passengers sitting next to you ahead of time. Acknowledge the challenge. I’ve found it not only decreases my own anxiety, it allows for a much better reception when things don’t go as planned. Click to read full post for my additional 1-minute video explanation and a few ideas. What are yours? Read full post »
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.