Tweens Archives - Page 28 of 34 - Two Peds in a Pod®

Allergy Meds- the quest for the best antihistamine

The antihistamine quandry

Junior’s nose is starting to twitch

His nose and his eyes are starting to itch.

As those boogies flow
You ask oh why, oh why can’t he learn to blow?

It’s nice to finally see the sun

But the influx of pollen is no fun.

Up at night, he’s had no rest,

But which antihistamine is the best?

It’s a riddle with a straight forward answer. The best antihistamine, or “allergy medicine” is the one which works best for your child with the fewest side effects. Overall, I don’t find much of a difference between how well one antihistamine works versus another for my patients. However, I do find a big difference in side effects.

Oral antihistamines differ mostly by how long they last, how well they help the itchiness and their side effect profile. During an allergic reaction, antihistamines block one of the agents responsible for producing swelling and secretions in your child’s body, called histamine.

Prescription antihistamines are not necessarily “stronger.” In fact, at this point there are very few prescription antihistamines. Most of what you see over-the-counter was by prescription only just a few years ago. And unlike some medications, the recommended dosage over-the-counter is the same as what we used to give when we wrote prescriptions for them.

The oldest category, the first generation antihistamines work well at drying up nasal secretions and stopping itchiness but don’t tend to last as long and often make kids very sleepy. Diphendydramine (brand name Benadryl) is the best known medicine in this category. It lasts only about six hours and can make people so tired that it is the main ingredient for many over-the-counter adult sleep aids. Occasionally, kids become “hyper” and are unable to sleep after taking this medicine. Other first generation antihistamines include Brompheniramine (eg. brand names Bromfed and Dimetapp) and Clemastine (eg.brand name Tavist).

The newer second generation antihistamines cause less sedation and are conveniently dosed only once a day. Loratadine (eg. brand name Alavert, Claritin) is biochemically more removed from diphenhydramine from than Cetirizine (eg. brand Zyrtec) and runs a slightly less risk of sleepiness. However, Cetirizine tends to be a better at stopping itchiness.

Now over-the-counter, fexofenadine (eg brand name Allegra) is a third generation antihistamine. Theoretically, because a third generation antihistamine is chemically the farthest removed from a first generation antihistamine, it causes the least amount of sedation. The jury is still out.

If you find your child’s allergies are breaking through oral antihistamines, discuss adding a different category of oral allergy medication, eye drops or nasal sprays with your pediatrician.

Because of decongestant side effects in children, avoid using an antihistamine and decongestant mix.

Back to our antihistamine poem:

Too many choices, some make kids tired,

While some, paradoxically, make them wired.

Maybe while watering flowers with a hose,

Just turn the nozzle onto his runny nose.

Naline Lai, MD with Julie Kardos, MD

Spring Break Surprises: preparing for illness

As spring break approaches, here are some ways to handle sickness while traveling with your children when you are far away from your children’s primary care provider.

If your child has a health condition that is intermittent, such as asthma, bring his inhaler, spacer, or any other medication. Even if he hasn’t had a flair up for months, it is much safer to travel prepared. Don’t forget your child’s epi-pen if she has a history of food allergies. If your child’s healthcare provider holds a United States license and you are not in the United States, your healthcare provider can not call in routine medications.
If your child has a complicated health history, bring a typed summary of his health history including current medications.
Decide beforehand where you will seek medical help if your child becomes ill . Maybe it is a pediatric or family medicine office that accepts new patients, a walk-in clinic, or an emergency room that sees children. Your child’s health care provider’s ability to diagnosis and treat your child is limited over the phone. Kids are much safer diagnosed in person with the benefit of a thorough physical exam.
Travel with the basics: 1) pain reducer such as ibuprofen or acetaminophen for headaches, minor injuries, or aches associated with fever, 2) a quick acting allergy medicine such as diphenhydramine (brand name Benedryl) in case of an allergic reaction such as hives, 3) anti-itch cream such as hydrocortisone in case of annoying bug bites or contact rashes such as poison ivy, 4) a topical over the counter antibiotic in case of skin scrapes, and 5) band aids. Remember to first wash any break in skin with soap and water.
Bring your child care provider’s telephone number. Even if she cannot provide a final diagnosis, she can provide advice and guidance as to whether or not you need to take your child to a local health care provider.
Make sure your child is fully vaccinated. You can’t vouch for the health of other people you encounter on your travels. It is much easier to prevent illness than chase it after it strikes. Likewise, practice good hand washing hygiene.
Travel outside of the United States may require specific vaccinations or preventative medications. Call a local travel clinic or check www.cdc.gov for advice on specific countries.

Kids have a knack for knowing just which week of the year their family will travel and then get sick during that one planned-for week. I remember the spring vacation that our twins awoke with fevers on our first day away from home. Fortunately, my children travel with their pediatrician. Families who leave their pediatrician behind when they go on vacation can empower themselves with the knowledge of how to handle illness away from their medical home.

Or, there’s the option of inviting the pediatrician along… especially if you’re headed somewhere warm…

Julie Kardos, MD with Naline Lai, MD

Social media: the stats, risks and benefits

The American Academy of Pediatrics issued a clinical report today on the impact of social media on our children and teens. Ironically, Dr. Lai heard about it first on her Facebook.

Julie Kardos, MD with Naline Lai, MD

©2011Two Peds in a Pod®

Explaining tragedy to children

When the first news of the earthquake and subsequent tsunami rolled in from Japan last week, my family started to track down news of my cousin who resides in Tokyo with her husband and two sons. We were relieved to hear of shaken china and toppled bookshelves but no injuries. My nephew was on a school field trip that day and the bus was delayed, but he got home safely the next day. They were physically safe, but mentally shaken.

Even though the event may be half a world away, explaining a large scale tragedy such as what happened in Japan to children is tough; especially in this case when the uncertainty of a nuclear meltdown still looms and images of a struggling Haiti still fill the newsfeeds.

Understand that kids sense your emotions even if you don’t tell them. Not telling them about an event may make them concerned that they are the cause for your worried hushed conversations. Break away from your discussion with adults to say, “ Do you know what we are talking about? We are not talking about you.”

Tell the facts in a straight forward, age appropriate manner. Answer questions and don’t be afraid to answer with an “I don’t know.” Preschoolers are concrete in their thinking—dragons are real and live under their bed, so don’t put any there that do not exist. For a preschooler a simple “Mom is sad because a lot of people got hurt,” will suffice. Young school age kids will want to know more details. And be prepared to grapple with more high level questions from teens.

If the kids ask,” Will that happen here?” or “Why did that happen?” Again, reassure in a simple straight forward manner. For instance you can say, “Many people are working hard to prevent something like that here.” Consider answering the question with a question. Asking “What do you think?” will give you an idea of exactly what your child fears. You can also reach out to other family supports for help with answers. Say to your child, ”I wonder what our minister or school counselor has to say about this, let’s ask.”

Routine is reassuring to children, so turn off the background 24 hour television coverage and make dinner, take them to sports activities, and get the homework done.

Give your kids something tangible to do to be helpful. Help them set up a coin donation jar at school or put aside part of their allowance for a donation.

If your child seems overly anxious and fearful, and her worries are interfering with her ability to conduct her daily activities, such as performing at school, sleeping, eating, and maintaining strong relationships with family and friends, then seek professional help.

You may not hold the answers to why a large scale tragedy strikes, but you do hold the ability to comfort and reassure your children.

Naline Lai, MD with Julie Kardos, MD

Teaching kids a culture of over eating- parts 2&3 of Pediatric Childhood Obesity

In Part 1 of our talk, we presented the problems with pediatric obesity and provided six seemingly simple rules to follow that can help encourage your kids to become or maintain a healthy weight. But why is it so hard to follow these rules? In Parts two and three of our talk, we play out several common scenarios that illustrate our culture of over eating and suggest ways to change this culture.

As always, we welcome your comments and suggestions.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

What to do about childhood obesity-part 1

Worried about your overweight child? Last week we gave a talk in which we outlined six simple rules which you can use as a starting point for getting your child to a healthy weight. We also discussed ways to change our “culture of overeating” which unfortunately teaches our children to eat even if they are not hungry.

While the copy of the video recorded on the auditorium equipment did not turn out, the good news is that the presentation was captured on a different camera. It’s a little blurry, and the recording starts after the introduction slide (pictured here), but the audio is fine… think of it as an augmented pod cast.

We wish to thank our attendees for their many questions and for engaging in thought- provoking dialogue at the end of the session. Stay tuned for part 2.

Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®

New recommendation for teen meningococcal booster vaccine

New American Academy of Pediatric recommendations include a booster vaccine against the cause of meningococcal disease (Neisseria meningitidis) for older teens in addition to the one routinely given to tweens. Olga Pasick, mom of a teen who died of meningococcal disease, shares her personal experience and talks about the updated guidelines.

I wish I had known the importance of vaccination for meningococcal disease before it was too late for my son. Back in September of 2004, David was a happy, healthy 13 year old, who came down with flu-like symptoms one evening. He first felt cold, then spiked a high fever, and vomited throughout the night. In the morning we called the pediatrician to have him seen. Everything ached, and he needed help getting dressed. That’s when I noticed purplish spots on his chest and arms. I didn’t know how serious that symptom was. As soon as the doctors saw him, they knew he had meningococcal disease. He was rushed to the ER for a spinal tap and treatment. Unfortunately, the disease spread quickly and his organs failed. David died within 24 hours of first developing those flu-like symptoms from a potentially vaccine-preventable disease. Unbelievable… and heartbreaking.

Meningococcal disease is spread through respiratory droplets, such as coughing or sneezing, or through direct contact with an infected person, such as kissing. About 1 in 10 people are carriers, and don’t even know it. It doesn’t affect everyone. It is difficult to diagnose because symptoms are similar to the flu, and include high fever, headache, stiff neck, nausea, vomiting, exhaustion and a blotchy rash. The disease spreads quickly and within hours can cause organ failure, brain damage, amputations of limbs, and death.

The CDC (Centers for Disease Control and Prevention) and the AAP (American Academy of Pediatrics) recommend meningococcal vaccination for all 11-18 year olds. If vaccinated at age 11-12, a booster at age 16 is recommended. If vaccinated at age 13-15, a booster is recommended at age 16-18. No vaccine is 100% effective, but it is the best preventative measure we can take. Since the vaccine only covers four of the five major strains of the disease, continue to be aware of the symptoms.

Because of my experience, I became a member of the National Meningitis Association’s (NMA) Moms on Meningitis (M.O.M.s) program. We are a coalition of more than 50 mothers from across the country whose children’s lives were drastically affected by this disease, and are dedicated to supporting meningococcal prevention.

Visit the NMA website for more information and to view powerful personal stories of those affected. Talk to your doctor about vaccination. It could save a life. How I wish those recommendations were in place six years ago.

Olga Pasick
Wall, New Jersey

Flu vaccine coverage

The bad news is that influenza is now circulating in all 50 states. The good news is that according to the Centers for Disease Control, the vaccine covers all currently circulating strains.

The best news: the ground hog predicts an early spring.

For the latest in updated flu information www.cdc.gov

Julie Kardos, MD and Naline Lai, MD

When your child’s bedtime seems too late, or, will I ever get a late night alone with my spouse again?

A mom recently wrote to us about her grade school aged child’s bedtime creeping later while her wake up time stayed the same. She wondered how to reclaim the earlier bedtime.

Many parents notice as their kids get older, they seem to take longer to fall asleep at night or push their parents for a later bedtime. This trend is largely biological— the older kids get, the less sleep they need. Also as kids age, their body clocks naturally signal them to stay up later at night and sleep later in the morning. Sometimes children are worried about something and this stress prevents them from falling asleep. Parents should ask their kids what they think about while lying in bed at night. However, many times the child is just fine emotionally but begins shifting sleep patterns anyway.

According to sleep experts, adults function best on 7-8 or more hours of sleep per night. In kids and teens, a wide variation exists for how much sleep is sufficient for any individual. In general, if your child is easy to awaken in the morning, cheerful, able to concentrate during the day, easily completes school work and homework and is not having emotional outbursts, then she is sleeping enough. So, when your grade school child transitions from getting 11-12 hours of sleep per night to getting 10, if her days are still rosy, then this sleep shift is okay. Some people just don’t need very much sleep.

If your child needs more sleep, it’s tough to simply move his bedtime up earlier. To him, the sudden change will feel like he flew from California to New York. A gradual approach works best. Put your child to bed first very near the time that he is already falling asleep, even if that seems inappropriately late.

For instance, if your child won’t fall asleep until 11:00 pm, establish a soothing night time routine that ends with reading in bed or listening to soothing music for a few minutes, and turn out the lights out at 10:45 pm. Avoid television within an hour of sleep time because this can interfere with falling asleep. No matter how late he fell asleep, even on weekends, make sure he wakes up at the same time every morning. Once he falls asleep consistently within a few minutes of lights out, move the bedtime another fifteen minutes earlier. Continue to do this until the daytime sleep-deprivation symptoms have resolved. A child may still need an alarm to wake up in the morning but if he is well rested, he should wake easily.

Be sure to limit or avoid caffeine (found in soda, tea, coffee, some sports drinks, and chocolate) because caffeine stays in the body 24 hours and hinders falling asleep. Also, make weekend sleep routines, including wake up times, as similar to weekdays as possible. If you allow a child to sleep until noon on Saturday and Sunday, he will never be able to fall asleep early on Sunday night and he will start the school week sleep deprived.

Time to end this post. I’ve got to go put my kids to bed. Sweet dreams.

What? That’s not what we said: Real Simple Magazine

Take a look at the February 2011 issue of Real Simple magazine. We are two of the experts cited on page 124. The good news is that some of our thoughts on the essentials of a medicine cabinet were integrated into a photo-essay piece. The bad news is that children’s cough medicine is listed as a component of the medical cabinet. While the other contributors to the piece may encourage use of over-the-counter cold and cough medications, we discourage use.

Of concern, safety and effectiveness of cough and cold medicine has never been fully demonstrated in children. In fact, in 2007 an advisory panel including American Academy of Pediatrics physicians, Poison Control representatives, and Baltimore Department of Public Health representatives recommended to the U.S. Food and Drug Administration (FDA) to stop use of cold and cough medications under six years of age.

Thousands of children under twelve years of age go to emergency rooms each year after over dosing on cough and cold medicines according to a 2008 study in Pediatrics . Having these medicines around the house increases the chances of accidental overdosing. Cold medications do not kill germs and will not help your child get better faster. Between 1985 and 2007, six studies showed cold medications didn’t have significant effect over placebo.

So why are children’s cough and cold medicines still around? A year after the advisory panel published their recommendations, FDA advised against using these medications in children younger than two years but data about these medications in older children is still rolling in. FDA continues to advise caution with these medications. The producers of cold medicines said at that point they would launch new studies on the safety of medication for those two to twelve years of age. In the meantime pharmaceutical companies stopped manufacturing cold medicine products for those under two years of age and changed the labels to read “for four years old and above.”

Yes, watching your child suffer from a cold is tough. But why give something that doesn’t help her get better and has potential side effects? There is plenty to do besides reach for cold medicine. Give honey for her cough if she is over one year of age. Run a cool mist humidifier in her bedroom, use saline nose spray or washes, have her take a shower with you, and teach her how to blow her nose. Break up that mucous by hydrating her well- give her a bit more than she normally drinks.

If you have young children and want to make your medicine cabinet truly “real simple” then take out the over the counter cough and cold medication.