Teens

All Articles in the Category ‘Teens’

Screening For Risks Of Sudden Cardiac Death

More than anything else, we want our children protected from harm. Particularly when we hear about sudden cardiac collapse and death in young athletes. The far majority of children who suffer from sudden cardiac events and sudden cardiac death have no symptoms prior so comprehensive cardiac screening can improve protection for all children.

5 Things To Do Before The Sports Physical:

  1. Print out the pre-participation sports physical form and medical history form. Bring it to the appointment for your child’s doctor or ARNP to fill out. This form can help direct a more comprehensive sports physical and will require documentation of necessary medical history and physical exam findings as recommended by the American Heart Association.
  2. Find out about your own family’s medical history. Inquire is there is any heart disease, any history of seizures, or unexplained or sudden death. Complete that medical history form.
  3. Check in with your child/teen to find out if they ever have any symptoms during exercise that may require more attention–things like fainting or near-fainting, chest pain with exercise, easy fatigue with exercise.
  4. Find out if your school has an AED. If they don’t, work on having the sports director get one for play fields and gymnasiums.
  5. Refresh your CPR skills. Review how to do hands-only CPR (this links to a 1 minute video)

Your child’s physician or nurse practitioner can screen them however there are also free screening events for sudden cardiac death in our area include (please include others you know of in the comments and I will add to the list):

Nick Of Time Foundation (Auburn, WA on 9/29 & Renton, WA 10/3 and ongoing)

Play Smart Youth Heart Screenings (ongoing)

First Day Of School: 6 Tips For Sleep

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

  1. 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 »

Fear Of Needles

Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).

Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.

However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.

Most parents with asthmatic children get flu shots yearly, early in the season. But not all.

When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.

“Why?” I asked.

Read full post »

Hands-Only CPR

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…

Instructions for Infant CPR (babies under 1 year of age)

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR consists of doing 30 chest compressions (with your fingers) and then 2 gentle, 1-second rescue breaths, then 30 compressions again. Repeat.

Instructions for Child CPR (children under 8 years of age) &  Video Explanation

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR ratio is 30 compressions for every 2 breaths. This is the same compression-to-breath ratio as infants. However, the position of your hands for compression is different.

If you’re local, you can take infant, child, or adult CPR classes at Seattle Children’s.

4 Tips For A Healthy 4th

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:

  1. 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.
  2. 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.
  3. 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.
  4. If you think you’re too smart for injuries on The Fourth 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.

Picking A Summer Camp

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 »

If It Were My Child: No Football For Now

This is a position post where I take a stand that represents no one other than myself as a mom and a pediatrician. The reason I clarify this, is that my position is a strong one. No one wants to go up against someone like the NFL, it seems. But let me say this very clearly: It if it were my child, I’d never let them play football. No way. For my boys, the risks are too large, the sentiments too cruel, and the gains simply not worth it. There are plenty of other sports teams out there to grow, exercise, form friendships, and excel. I never want my children to be a part of any institution that houses intent to harm another human being. Although direct harm may not be a tenet in pee wee football, we all know that young sports teams are built to emulate the pros. If the NFL is the inspiration, for now, count my boys out. This isn’t just about the risk of concussion…

On my way into clinic on Saturday morning, I heard the alleged tape of Gregg Williams directing players to seriously harm opposing teammates. In the tape Mr Williams, the previous defensive coordinator for the New Orleans Saints, employed his players to inflict harm on multiple players–for example, attempt to tear the ACL of Michael Crabtree and work to re-concuss another player, Kyle Williams. Let me point out, some data finds the harms of concussions (particularly in adolescents) may be longstanding, and the risk of a second concussion may rarely be deadly.

In the tape you hear Gregg Williams repeatedly say, “Kill the head, the body will die” followed by, “We want his head sideways.” The tape goes on to capture more directives for harming additional players. It’s nauseating and provoking–got my fingers shaking during my drive. And really more than anything else, it was wholeheartedly disappointing. Particularly for me as a pediatrician. When parents now ask me about football, instead of talking about concussions as a significant risk, I’ll also be talking about ethics, sportsmanship, and integrity.

The great thing is that as parents we have lots of choices. Read full post »

Cocoon A Newborn, Only An Email Away

This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.

In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.

Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.

Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.

You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.

Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.

Write an email to family and friends to explain.

A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »

What Is The Cinnamon Challenge?

 

I’ve been mentioning the cinnamon challenge in clinic with my teen patients after I learned about it earlier this month. Read this nice summary. The challenge is to swallow a teaspoon of cinnamon in less time than it takes me to explain what it is (60 seconds). Reality is, my patients tend to know about the challenge, but their parents don’t. I usually talk about it along with a whole list of other topics while their parents are out of the room (bullying-the choking game-sex-drugs-violence-texting & driving or other threats to their safety). Recently, a patient was able to explain the challenge to her mom with me in the room right after her mom returned and joined us. We discussed the reasons the cinnamon challenge can be life threatening and stupid.  Teens don’t want to get hurt, but they really do want to be strong, and ohhhh, competition is seductive. Teens (like most grown-ups) love to preserve that feeling of invincibility. Precisely why the challenge has caught on.

The cinnamon challenge has its own website and has gone viral with the help of social media. The topic has been viewed online more than 60 million times with some pages boasting over 10,000 “likes.”  The reason? The challenge itself is so visual and so inexpensive to replicate, teens are capturing videos of the challenge and putting them on YouTube, Facebook, Twitter and on their phones. Pretty funny, right?

This is the part where I sound like a doctor. The dangers from the cinnamon challenge are real; multiple children have been hospitalized. Some children have had serious complications including loss of consciousness, collapsing lungs, ICU care, and days on a ventilator. Cinnamon is easily aerosolized but not easily dissolved. Once it lodges into tissue, it can cause great havoc and remain there. Coughing while gasping and/or choking on cinnamon can cause it to be easily inhaled or aspirated or swallowed leading into tissues in our bodies. We worry most about it collecting in the lungs.

The challenge is real. The side effects even more so.

 

Sudden Cardiac Death: What Parents Can Do

As a parent and pediatrician, any mention of sudden cardiac death leaves me feeling uneasy. The stories of young athletes dying or falling on the field are agonizing. All of us here on earth would like to do something to prevent these deaths.

Researchers and cardiologists are working tirelessly to understand predictors for sudden cardiac death in children alongside techniques to improve screening and prevention for young athletes. Dr Nicolas Madsen talked with me about recent work here in Washington State. There’s a video at the end of this post from the interview. I’m lucky, I met Dr Madsen when he was a medical student and now he’s an old friend. He’s one of those bright lights: a compassionate physician and father of three who just gets it and wants to solve big problems. He’s about to finish his fellowship here in Seattle and while completing his training, he’s uncovered some holes in the system. He’s helped me understand how to screen children better. As a parent, there are some simple things you can do to improve the screening your child receives prior to athletic participation.

“Sudden Cardiac Death is a needle in a haystack, but a very sharp one.” Read full post »