Elementary school kids Archives - Page 38 of 40

Child (or anyone) abduction prevention tips

Mud is everywhere. My jeans are splattered—the result of chasing after my dog who was running loose in the neighborhood. Unlike my children, my dog might go home with any stranger. Then again, I wonder, would my children ever be tricked into wandering off with a stranger? Every week there seems to be a story about an attempted child abduction circulating via email. I brought this up with Doylestown Township Pennsylvania Police Chief Stephen White who shared with me a few ideas on how to protect your children beyond telling them “don’t take candy from strangers.”

In order to distinguish between a real police officer and an impostor, tell your child that if he is confronted by someone who claims to be a police officer, have him tell the officer to call for another one. Real officers rarely work without a partner.

Never allow your child to give her home address or other personal information out in an online chat room or email exchange. Tell her not to assume that new “friends” online are children. Pedophiles constantly cruise through social networking sites and chat rooms looking to hook up with juveniles.

Go to a Megan’s Law website and familiarize yourself with offenders living in your zip code. Megan’s Law is an informal name for laws in the United States requiring law enforcement to make information about registered sex offenders public. The determination of what information is released is decided on a state-by-state level. Here is state by state information about Megan’s Law. In Pennsylvania http://www.pameganslaw.state.pa.us/ and in New Jersey http://www.state.nj.us/njsp/info/reg_sexoffend.html

Naline Lai, MD
© 2010 Two Peds in a Pod

Traveling With Children

As I pack for an upcoming family vacation, I am reminded of the numerous questions over the years that parents have asked me about traveling with children. Often they ask, what is the best way to travel that will allow everyone to enjoy the vacation?

Ha,ha, I think to myself. The real answer is to hire a sitter or enlist grandparents to babysit and leave the kids at home. My husband and I always refer to family vacations as “family displacements.”

No, really, family vacations are wonderful experiences as long as you hold realistic expectations. First you have to get there.

Easier said than done.

When traveling by air, parents wonder if they should bring a car seat for the plane. Young children who sit in a car seat in the car should sit in a car seat in an airplane. Unfortunately, not all car seats fit into the airplane seat properly. The best advice I can give is to bring your car seat and make an attempt to fit it properly. If it doesn’t fit properly, you will still need it for the car ride from the airport after you arrive at your destination. Not all car rental facilities provide car seats.

Another question I am frequently asked about long plane rides is “Should I give my child Benadryl (diphenhydramine) so he/she will sleep through the flight?” Unfortunately, Benadryl’s reliability as a sleep aid is spotty at best. Most kids get sleepy, but the excitement of an airplane ride mixed in with a “drugged” feeling can result in an ornery, irritable child who is difficult to console. I advise against this practice. On the other hand, Benadryl can help motion sickness and is shorter acting than other motion sickness medications.

Ear pain during an airplane’s descent is also a common worry. Yes, it is true that ears tend to “pop” during the landing as the air pressure changes with altitude. Some young children (and their parents) find this sensation very unpleasant. However, most babies are lulled to sleep by the noise and vibration of an airplane and are unaffected. If your child is safely in a car seat, I do not advise taking him out of it to breastfeed during landing. Offer a pacifier if you feel he needs to suck/swallow during the landing, and offer an older child a snack so she can swallow and equalize ear pressure if she seems uncomfortable during the landing.

Speaking of food, try to carry healthy snacks rather than junk food when traveling. Staying away from excessively salty or sweet food will cut down on thirst. Also, keep feeding times similar to home schedules in order to prevent toddler meltdowns.

Remember that young children hate to wait for ANYTHING and that includes getting to your destination. Bring along distractions that are simple and can be used in multiple ways. For example, paper and crayons or pencils can be used for: coloring, drawing, word games, origami, tic-tac-toe, math games, etc.

When traveling internationally, check the Center for Disease Control website www.cdc.gov for the latest health advisories for your travel destination. Do your research several weeks in advance because some recommended vaccines are available only through travel clinics. Also, some forms of malaria prevention medicine need to be started a week prior to travel.

Please refer to our “Happy, Healthy Holiday” blog post from 12/10/2009 for further information about keeping kids on more even keel during vacations. In general, attempt to keep eating and sleeping routines as similar to home as possible. Also remember to wash hands often to prevent illness during travel. Finally, locate a pediatrician or child friendly hospital ahead of time in case illness does strike. Unfortunately, most illnesses cannot be diagnosed by your child’s health care provider over the phone.

While traveling with young children can seem daunting, the memories you create for them are well worth the effort. And it DOES get easier as the kids get older. Now I can laugh at the image of my husband with two car seats slung over his back lugging a large diaper bag and a carry-on, leading my preschooler struggling with his own backpack filled with snacks and air plane distractions, while I am balancing two non-walking twin babies, one in each arm, as we all take our shoes off for the airplane security checkpoint.

We’ve come a long way, and so can you. Happy Travels!

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod

Ankle Strengthening Exercises- what to do after an ankle sprain

Today, our esteemed guest pediatric physical therapist Deborah Stack helps us with therapy for twisted ankles. Dr. Stack has been a physical therapist for over 15 years and heads The Pediatric Therapy Center of Bucks County in Pennsylvania. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

______________________________

As I watched my ten-year-old play basketball today, my first question was “Will my child might finally get the ball into the basket?” My second question was, “Will all the kids make it through the game without spraining an ankle?

Kids are playing competitive sports at younger and younger ages and children are suffering sports injuries earlier as well. Acute ankle trauma is responsible for 10 to 30 percent of sports-related injuries in young athletes.¹With all the rapid starts, stops, and turns on the basketball court some injury is inevitable. But what is an ankle sprain? What can you do to help your child from joining the crutches crew? What do kids need to do to get back to full play after an injury?

A sprain is stretching and or tearing of ligaments that connect bones to one another. Sprains are graded from one to three with one being the mildest and three being the most severe. In a grade one sprain the ligament simply is overstretched. Grade two sprains involve partial tearing of the ligaments and grade three feature a complete tear. This could happen for a multitude of reasons, from play or even an accident that might not have been their fault, this type of sprain may need attention from a doctor, especially if it is after an accident.

The most common ankle sprain is an inversion sprain where the ankle turns over so the sole of the foot faces inward and damages the ligaments on the outside of the ankle. In younger children, the ligaments tend to be stronger than their bones,so growth plate fractures occur instead of sprains. Therefore, if a child refuses to walk on his leg or seems to be in excessive pain, you should have your pediatrician rule out a fracture.

To help avoid injury, make sure those sneakers are in good condition. Pull laces snug and tie them securely. High top sneakers are recommended for basketball for added protection. Physically three things are needed for a healthy ankle: range of motion, muscular control, and proprioception. Proprioception is the information that comes from your joints and muscles to your brain and lets your brain know what position the ankle is in.

My child turned his ankle. Now what do I do? Remember the acronym RICE: rest, ice, compression, elevation. Rest means to stay off the ankle. For more severe sprains this may mean using crutches for a few days. Ice should be applied (over a thin towel to protect skin) immediately and then for up to 20 minutes every few hours until swelling is minimal. Compression refers to wrapping an elastic bandage over the area. When you use a bandage, it is important to make sure the bandage is not too tight and that any bandage is wrapped at an angle, not straight around the leg, to prevent circulatory problems. The ankle should also be elevated above the level of the heart several times a day while swelling is still present. Recline on the couch while putting ice on for 20 minutes.

How does your future Olympian get back into the game? Range of motion exercises can begin as soon as they can be done without pain, preferably in 48-72 hours. Ankle circles and alphabet letters (below) are two good exercises. These should then be followed by isometric (muscle contraction without movement) and isotonic strengthening exercises (toe and heel raises, see below) such as the ankle heals. Finally, rehab is not complete until the child works to regain proprioception on balance boards, compliant foam etc. One low-tech option is to stand on a firm pillow while watching television. For a bit more excitement, try some Wii balance board games. Remember, full ligaments strength does not return until months after an ankle sprain.²Without full rehabilitation, the ankle is prone to reinjury.

So tell your child to play, but play smart. An ankle sprain is a real injury and needs proper attention before your child returns to the court.

Exercises

Ankle circles³
Sit on the floor with your legs stretched out in front of you. Move your ankle from side to side, up and down and around in circles. Do five to ten circles in each direction at least three times per day.

Alphabet Letters³
Using your big toe as a “pencil,” try to write the letters of the alphabet in the air. Do the entire alphabet two or three times per day.

Toe Raises⁴
Pull your toes back toward you while keeping your knee as straight as you can. Hold for 15 seconds. Do this ten times at least three times per day.

Heel Raises⁴
Point your toes away from you while keeping your knee as straight as you can.Hold for 15 seconds. Do this ten times at least three times per day.

1. Perelman M, Leveille D, DeLeonibus J, Hartman R, Klein J,Handelman R, et al. Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study. J Foot Surg. 1987;26:95–135.

2. Wolfe MW, Uhi T, McCluskey, L.Management of Ankle Sprains. Am Fam Physician 2001;63:93–104.

3. http://www.med.umich.edu/1libr/sma/sma_anksprai_rex.htm

4. http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/010.html

Deborah Stack, PT, DPT, PCS
www.buckscountypeds.com
© 2010 Two Peds in a Pod

Always something-those rubber bands

The newest trend in kidville- trading rubber bands in various shapes. The kids wear the bands like bracelets and strut around with the colorful bands jutting out in all directions from their arms and wrists. The elementary school crowd is fascinated by them. Teachers, who find them a distraction, are not as enamored. Somewhere there is one teacher today who is particularly appalled. During a check up, a nine year old told me today that a classmate was sent to the nurse’s office- the reason? The bands were on so tight that they were cutting off circulation to the classmate’s arm.

Always something.

Naline Lai, MD

Holes In Your Head: Sinus Infections

You have a hole in your head.

Actually, you have several.

You, your children, and everyone else. These holes are called sinuses.

These dratted air pockets in your skull can fill with puss and cause sinus infections. Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.

Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses). When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose. If your child’s sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain. A sinus infection of the frontal sinuses manifests itself as pressure over the forehead. The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses. Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections.

Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.

The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey. However, nasal drainage from a cold virus is often green/yellow on the third to fourth day. If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.

Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.

Hydrate your child well when she has a sinus infection. Your child’s body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain. Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic. The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks may be necessary. Misnamed, “sinus washes” do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.

Who knows. Someday we’ll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.

Naline Lai, MD
© 2010 Two Peds in a Pod

How to Help Your Bedwetting Child

bedwetting “Help, Mommy, Daddy, I wet the bed!”

As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This post addresses primary bedwetting (doctors call this “primary nocturnal enuresis”), kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently should go see their pediatrician to rule out medical causes of new bedwetting.

Here are a few things parents of bed-wetters should know.

Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training. Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!! signal to your child. Quick hint here: nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.

About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.

However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.

· Do NOT punish your child for wetting the bed. It truly isn’t his fault.

· It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.

· By all means let your child wear training pants at night or at least put some form of water repellent mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.

· Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.

Older kids might become self-conscious, and their self-esteem gets impacted by their bedwetting. Typically this happens between the ages of 8 to 10 years, when sleep-overs and camp gain popularity.

Ways to help your child approach potentially awkward situations include:

Have the sleep-over at your house and have our child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”
Tell your child that he does not have to share the reason for not wanting to sleep away from home.
Alternatively, he can tell his friends that YOU, the mean parent, will not allow him to attend sleepovers yet.
If your child is motivated to try to become dry overnight, you can try a bed wetting alarm system. These systems work well over a period of several months. With alarms, both parents and children have to be active participants.

Additionally, there is one medical option.

Talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix.” The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form. Your child could either take it only for sleepovers or can take it for a few months at a time if bedwetting compromises his self-esteem. Note that even after months of dry nights on medicine, your child will likely bed wet if he stops taking the medicine. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.

Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bed-wetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.

While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.

Julie Kardos, MD and Naline Lai, MD
©2010 Two Peds in a Pod

Dry winter skin – guidance from a guru

It’s that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA. She did her dermatology training at Hahnemann University and at St Christopher’s Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low. Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment. A few MUST DO’s include:

1. Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which “waterproofs”the skin and keeps moisture in, but without that greasy feel.

2. Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.

3. Avoid irritants such as anti-static sheets in the dryer. Even if they say “free”, they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.

4. Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works…they’re often impregnated with aloe for extra moisture.

Mary Toporcer, MD

Count down the pounds: six simple guidelines to helping overweight children

A common question that many parents ask us in the office is “How can I help my overweight child?”

Our newest podcast provides six simple rules for healthy eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your children, how to portion their foods, and how to change their behavior to help them lose excess pounds and maintain a healthy weight.

(If the podcast is not embedded in your RSS reader page,visit the www.TwoPedsInAPod.com home page directly.)

Julie Kardos, MD and Naline Lai, MD

STREP THROAT Part 2: diagnosis, treatment, and when to worry

How can I tell if my child has strep throat?

The definitive way to diagnose strep throat is for a health care provider to get a sample of the sore throat germs from your child by using a long cotton swab to gently swipe the sore throat and send the germs to a laboratory for culture. The laboratory lets the germs grow to determine if the Strep Throat bacteria grows from your child’s throat.

Thus, strep throat cannot be diagnosed over the telephone. Nor can health care providers rely solely on physical exam findings, because while there is a “classic” look to strep throat, some kids have normal appearing throats yet the test reveals strep, while others have yucky looking throats but in fact have some other viral infection causing their sore throat and thus do not need antibiotic treatment since antibiotics do not cure viruses. Health care providers ask questions about your child’s symptoms and perform a thorough physical exam and then do a “strep test” if they are suspicious that your child may have strep throat.

Many pediatric offices use rapid strep tests to help make a quick decision about treatment because the strep culture takes about 48 hours or so to finalize. These tests are fairly reliable, but sometimes the quick test is negative (shows NO strep) even if strep is present, so most offices will send a culture back-up if the rapid test is negative (no strep germs found). The other problem with the quick test is that once your child has strep, the quick test stays positive for about a month, even if your child no longer has strep disease. So if a child is treated for strep throat and then develops another sore throat within a month of treatment, that child needs a strep culture back up if the office quick test is positive.

To further complicate matters, some kids “carry” the strep germ in their throats but never develop the disease (no sore throat or illness symptoms). These kids will test positive for strep but do not require treatment. This is why we do not routinely check kids for strep throat unless they have symptoms of strep throat.

My child was treated for strep throat. We used all of the antibiotic. Three days later his sore throat is back. Why did this happen?

The most common reason for getting two episodes of strep throat close together is that your child contracted the germ again, usually from a classmate in school. If your child gets strep throat again, it is usually not because the antibiotic didn’t work but rather it is from bad luck. Most doctors treat a second episode of strep with the same medicine used the first time around.

Luckily, strep throat has not shown much, if any, resistance to standard antibiotic therapy. The reason that children (and adults) are treated for a full course of antibiotic is that this duration is known to prevent some of the complications of strep throat. You should give your child the complete course of antibiotic her health care provider prescribes, even if she “feels better” part way through the treatment. In addition to treating with antibiotic, be sure to provide pain medicine such as acetaminophen (brand name Tylenol) or ibuprofen (Motrin or Advil) to treat sore throat pain as needed.

Reasons to contact your child’s health care provider during treatment would be increasing pain, inability to swallow, or looking worse instead of better during the course of treatment.

STREP THROAT Part 1: what is it, who gets it, and why do we care about it?

You just got the call from the school nurse, who tells you: “I have your child here with me and she has a sore throat. I think you need to take her to the doctor to see if it’s strep throat.”

What exactly IS Strep Throat?

Strep throat is a throat infection caused by Group A streptococcus bacteria. Symptoms can include sore throat, fever, pain with swallowing, enlarged lymph nodes (glands) in the neck, headache, belly pain, vomiting, and rash. Not all symptoms are present in all kids with strep throat.

Symptoms do NOT include cough, profuse runny nose, or diarrhea. Only about 15 percent of all kids coming to our offices with a main concern of “sore throat” are going to actually have strep throat. That means that MOST kids with sore throats will turn out to have something other than strep throat, usually some form of virus causing pain or post-nasal drip.

Who gets Strep Throat?

The most common age for kids to get strep throat is between ages 5 to 12 years old. For some reason, kids younger than 3 years are not as prone to strep throat. Also strep throat is seen less often in adults than school aged kids. Some children appear really ill with strep throat and other kids just have a bad sore throat, but with pain medicine can look quite well.

So why do we care about strep throat?

Most children’s immune systems are really good at fighting the strep germ off and in fact most kids will get better from strep throat even if they are not treated. However, some kids’ immune systems get a little haywire when fighting the strep germ, and in addition to making antibodies (germ-fighting cells) to fight the strep, they make antibodies against their own heart valves (immune system gets confused) which causes rheumatic fever. It has been shown that treating strep throat with antibiotics shortens the duration of strep throat only by about one day, but more importantly prevents the body from making the wrong kind of immune cells, or antibodies, against the heart valves thus lowering the risk of rheumatic heart disease.

Strep throat can also lead to other complications such as scarlet fever (strep throat plus sandpaper-feeling rash on the skin), peritonsilar abscesses (pus pocket in the tonsils) and kidney inflammation (first symptom can be cola-colored urine).

Stay tuned for Part 2 about Strep Throat: how it is diagnosed and treated.