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The information provided by The Pediatric Group, PLLC website is information of a general nature and is intended for informational purposes only. It should not be relied on for personal medical reasons and should not be relied upon as providing specific medical advice or for diagnosis or treatment. All information contained on this website is presented as is, without any warranties of any kind, express or implied.

Please note that visiting this website alone does not establish a physician-patient relationship with any physician engaged by The Pediatric Group, PLLC. You should consult your own physician for specific advice for your own personal situation.

Docs' Talk

This section features articles written by our doctors on a variety of topics.  We hope you find this information helpful.

Recent News

• What is a PA?
  
• Best Bones Forever campaign targets bone health in girls
  
• The latest on H1N1 Influenza, or "Swine Flu"
  
• FDA's release on possible Singulair link to behavioral/mood changes

Breast Feeding

• Starting Off Right
• Medications in Mom's Milk
• Why Breast is Best

• Sibling Rivalry
• Tips for First-Time Parents 

• Ages 1-3 years: Becoming a Civilized Person
• Helping Your Child Succeed in School
• Sleep Problems

• Mercury Exposure
• New Vaccines for Adolescents

• Asthma - It Can Be Breathtaking!
• Cold and Cough Medications for Children <2 Years Old
• Colic
• Green Runny Nose - Does Your Child Need An Antibiotic?
• My Child is Always Sick! How Many Infections is "Too Many"?
• Skin Rashes - Seeing Spots in Children

• Choosing a Physician for Your Child
• Holiday Treasures
• Keeping Your Family Healthy - A Lot More Than Avoiding the Flu
• Making the Most of Check-ups
• TV and Your Child (We Promise Not to Guilt You)

• Calcium: An Important Key to Strong Bones
• Childhood Obesity, Part I: Healthy Lifestyles Begin at Home
• Childhood Obesity, Part II: Partnering with Schools and Your Community

• Enjoying the Outdoors & Staying Healthy
• Oklahoma's Outdoor Perils
• Riding in the Backseat
• Summer Sun, Summer Fun

• Minimizing Motion Sickness & Travel-Associated Illnesses
• Preparing Families for Travel to Developing Countries
• Traveling Safely with Your Children

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What is a PA?

Physician Assistants are health care professionals licensed to practice medicine with physician supervision.  As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services.  A PA's practice may also include education, research, and administrative services.

Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training.  Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners.  Thus explains the “PA-C” in the title.  To maintain a national certification, PAs must log 100 hours of continuing medical education every two years and sit for a comprehensive recertification exam every six years.  Graduation from an accredited physician assistant program and passage of the national certifying exam are required for state licensure in Oklahoma.

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BEST BONES FOREVER!

Campaign Targets Girls as Bone Health Risks Rise

(North Las Vegas, NV)—The U.S. Department of Health and Human Services (HHS) announced a new campaign, called Best Bones Forever!, designed to improve bone health and decrease the risk of osteoporosis. Research shows that bone fracture rates are increasing, and few adolescent girls get the recommended amounts of calcium and vitamin D—the building blocks for strong bones.
 
 Osteoporosis is often called a “pediatric disease with geriatric consequences.” Childhood and adolescence are the key windows of opportunity for building strong bones and warding off the disease. In girls, close to 90 percent of bone mass is built by age 18. Girls, in particular, are at greatest risk for bone problems. Osteoporosis is four times more common in women than men, and adolescent girls consume calcium and participate in physical activity at lower rates than boys. The new campaign empowers girls ages 9 to 14 to build the Best Bones Forever!
 
 “We want girls to know that if you’re older than nine, now’s your time!” said Secretary Sebelius. “Building strong bones now will help you stand tall for a lifetime.”
 
HHS recommends girls look for foods with calcium and vitamin D, which is necessary to help bones absorb calcium. One recent study found 70 percent of kids in the U.S. had below-normal levels of vitamin D, with deficiencies increasing as kids age from childhood to adolescence. The federal government recommendation for daily calcium consumption increases from 1,000 milligrams (mg) to 1,300 mg at age nine. The guidelines for physical activity for kids are 60 minutes daily, including three days of bone-strengthening activity.
 
The new campaign embraces an issue close to every girl’s heart: friendship. Best Bones Forever!, developed by the HHS’ Office on Women’s Health (OWH), urges girls and their BFFs (best friends forever) to ‘grow strong together, and stay strong forever.’ Research shows that girls whose friends like milk are more likely to have higher calcium intake. Similarly, physical activity also gets a boost among girls whose friends have positive attitudes toward sports.
 
The message for parents is one of urgency. Girls between the ages of 9 to 18 are in their critical bone-building years. Campaign materials and a Web site for parents empower them to “Act now to help her build her Best Bones Forever!” When asked about who has the biggest influence on what they eat, girls ages 8 to 15 first cite parents (83 percent), followed by “themselves” (60 percent), and friends (19 percent).
 
“Parents can make a big difference in helping their kids build strong, healthy bones, and the things that improve bone health are also good for overall health,” said Dr. Wanda Jones, Deputy Assistant Secretary for Health (Women’s Health), HHS. “So go ahead and stock the fridge with foods rich in calcium and vitamin D, like yogurt, milk, cheese, tofu with added calcium, and leafy greens. Encourage her to be active, and do things as a family such as taking walks after dinner.”
 
Best Bones Forever! updates and revamps an earlier national bone health campaign for girls called Powerful Bones. Powerful Girls, which was first launched in 2001. In order to appeal to girls as they mature, the new campaign has adopted an edgy vibe, trading the earlier campaign’s cartoon spokescharacter for the ‘exskullmation’ point. This new iconic symbol is designed to get girls excited about building the Best Bones Forever!
 
The Best Bones Forever! community pilot program also launched today in three sites: North Las Vegas, NV; Ulster County, NY; and Pinal County, AZ. Coalitions in each site will bring the campaign to their communities through a range of activities. They will also be executing and evaluating a bone health behavior change program for parents and girls called BodyWorks. Adapted from OWH’s existing family health and fitness program for parents, BodyWorks will feature a new complementary physical activity program just for girls in these communities. Results from the community pilot program will demonstrate which activities can be replicated in towns across the country.
 
Best Bones Forever! is a public-private partnership that brings together organizations from across the country. Founding partner, National Osteoporosis Foundation, tops a partner roster that also includes: Girl Scouts, Girls Inc., Action for Healthy Kids, the American Academy of Pediatrics, American Alliance for Health, Physical Education, Recreation and Dance, National Association of School Nurses, the National Institutes of Health, Women's Sports Foundation, and more. For more information on campaign partners and activities, go to the campaign Web site for girls at www.bestbonesforever.gov or for parents at www.bestbonesforever.gov/parents.

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The latest on H1N1 influenza, or "Swine Flu"

With the regular influenza season rapidly approaching, and H1N1 influenza present in our community, it is vital that the pediatricians of The Pediatric Group comply with the CDC’s recommendations for the use of antiviral therapy (Tamiflu and Relenza).  Please see the link http://cdc.gov/h1n1flu/vaccination/acip.htm for the CDC’s complete recommendations, but the basic elements include:

Persons with suspected H1N1 influenza who present with uncomplicated febrile illness typically do not require treatment unless they are at higher risk for influenza complications.  Treatment is recommended for:

• All hospitalized patients with confirmed, probable or suspected H1N1 influenza
• Patients who are higher risk for seasonal influenza complications

High risk pediatric patients are identified as follows:

• Children younger than 5 years old Persons with the following  conditions: Chronic pulmonary (including asthma), cardiovascular, renal, hematological, neurologic, neuromuscular or metabolic disorders (including diabetes mellitus); Immunosuppression; Pregnant women;
  

• Persons younger than 19 who are receiving long-term aspirin therapy; Residents of nursing homes and chronic care facilities

FDA's release on possible Singulair link to behavioral/mood changes

FDA is investigating a possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide. There has been NO PROVEN association at this time. The case reported in the news are only accusing a link to their child's suicide and Singulair; nothing has been substantiated at this time. We are not uniformly recommending discontinuation of this medication at present. If your child has anxiety or mood changes, discontinue the medication and contact us immediately. If your child is on Singulair for mild or seasonal allergy symptoms, make an appointment with your child's doctor to discuss possible alternative therapy

Minimizing Motion Sickness & Travel-Associated Illnesses
Vijaya L. Malpani, M.D.

As summer approaches many families will be taking trips by car or air, or taking a cruise.   Unfortunately, nothing spoils a vacation more quickly than having your child become sick while traveling.   Here are some tried-and-true ways to help minimize some problems associated with travel.

A family car trip is both a popular and economical way to enjoy a family vacation.  Always use a car seat that is age- and weight-appropriate for your child.  If possible, plan to travel at night so your children can sleep during most of the ride.  If it’s not possible to travel at night, consider leaving early in the morning when there is a good chance your child will fall back asleep for at least part of the trip.

Every child’s reaction to car travel is different.  Although motion sickness rarely occurs in infants, it can be common in toddlers and preschoolers, but will usually disappear by age six.  If your child has experienced motion sickness in the past, ask your pediatrician about using Dramamine or Benadryl to make the next trip easier for him or her.  I suggest that you start a motion sickness medication 1-2 days before the trip begins to see how your child will react.  It may also be helpful to plan your route along major highways to avoid bumpy, jarring side roads or city streets.  I also recommend that parents cover the window nearest the child(ren) with a sun-blocking screen or curtain to avoid sunburn and to help keep the temperature in the car moderated.  

Some children do not travel well on an empty stomach.  Therefore, you should have plenty of bottled water and healthy snack foods on hand, such as unsalted crackers, vegetables with dip, or bananas, all of which are good for an upset stomach.  Ginger snaps and graham crackers are also helpful to prevent nausea.  If all else fails, however, I recommend that you carry a plastic bag and an extra set of clothing (for each child) so that you can quickly clean up your child (and perhaps prevent additional members of the family from getting nauseated).

Air travel has its own set of challenges as well.  For air travel with children under age 1 year and under 20 pounds the American Academy of Pediatrics recommends that a rear-facing car seat be utilized to prevent injuries during turbulence.  Children up to age 7 years who weigh between 20-40 pounds should use an FAA-approved forward-facing child safety seat.  Only once your child is heavier than 40 pounds can he or she safely use the regular airline safety belt.  

Ear pain can also be troublesome for infants and children, both on takeoff and as the plane descends in preparation for landing.   Infants may be helped by having a pacifier during this time, and older children can be encouraged to swallow frequently or permitted to chew gum to help equalize ear pressure.  

Family cruise vacations are rapidly becoming more common.  If your child has asthma or another chronic medical problem be sure to bring adequate supplies of daily and rescue medications, as well as a nebulizer or other required equipment.  Do not pack these items; instead you should carry them on so that they are not misplaced or lost during loading.  Motion sickness (sea-sickness) can be a particular problem because of the continuous motion of the ship.  Just as with car travel, Dramamine and Benadryl can provide relief for some children.  

Food-borne illness can be an additional challenge when taking a cruise.  Be wary of foods that have been displayed on a buffet, as they may not have been constantly maintained at the proper temperature.   Also, make sure meats are thoroughly cooked, and attempt to select whole fruits rather than those that have been pre-cut.  

With a little foresight and preparation, your family vacation should be full of fun, memories and quality family time shared together, rather than your child’s sickness spoiling the trip.


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Tips for First-Time Parents
by Vijaya L. Malpani, M.D.

Parenting is a challenging task, especially when you are raising your first child. Every child is unique and has his or her own special needs. Before your first baby is delivered, it is worthwhile to meet with a pediatrician for an appointment called a prenatal interview. The purpose of such a visit is to become acquainted with your doctor’s ideas about development, immunizations, car safety and most importantly, what to expect when you bring your baby home.  I encourage both parents to come for the prenatal interview.  This allows the father to be more involved in the infant’s care, and helps both parents to have the same information and expectations for this exciting time.

The three important things I recommend to all parents are:

1. Consistency:  Carefully consider behavioral guidelines before you implement them, and make sure both you and your spouse agree to the strategy.  For example, if you decide you are going to hold and comfort your child every time she cries, do it all the time.  Your child is learning from the moment she is born; if you pick her up sometimes but not others, she emotionally learns that you may not be reliable.  Inconsistent behavior confuses children, who cannot be expected to comprehend the reasons for different actions at different times.   All care givers should follow the same guidelines.
   
2. Follow through:  Effective discipline helps children learn self control and co-operation. Say something to the child only if you mean it! Be firm. Say what you have to say once or twice and then leave the situation. Children learn structure, guidance and logical thinking from you.  If you promise a consequence for a particular action, good or bad, make sure you follow through.  This is one way your child learns he can rely on your word.  In other words, don’t make threats that you can’t carry out.
   
3. Positive Behavior Management:   All small children experience frustration at times, and their level of development doesn’t allow them to effectively process or appropriately express this difficult emotion.  Frustration is frequently the cause of tantrums and “acting out.”  Don’t raise your voice (or your hands) to manage your child’s frustration; instead, ignore the tantrum and don’t give in.  Obviously, if your child is in danger, remove her from the situation.  Attempt to distract your child by saying, “let’s do something else.”  Try not to use too many negative words. Negativity in the first seven years of a child’s life stays with them the rest of their lives.  Separate your child’s actions (“we don’t hit”) from his or her person ("you are such a bad boy”).

• Distracting your child
• Ignoring misbehavior when appropriate
• Structuring the environment
• Controlling the situation, not your child
• Involving the child through choice and consequences
• Planning time for loving
• Letting go
• Increasing your consistency
• Noticing positive behavior and showing appreciation
• Excluding a misbehaving child with a time out

1. Use a broad spectrum sunscreen of at least SPF 15 and apply every time you aregoing to be in the sun for at least 20 minutes.
2. Apply to dry skin 15-30 minutes before going outside.
3. Pay particular attention to the face, ears, andhands and generously coat skin not covered by clothing. One ounce of sunscreen is needed to completely cover the exposed areas of the body of an adult.
4. Reapply every 2 hours or immediately after swimming or strenuous exercise.
5. Limit sun exposure between 10 a.m. and 4 p.m.
6. Avoid deliberate tanning, wear protective clothing and seek shade.

1. the maintenance of a healthy lifestyle with good nutrition, adequate exercise and a good balance of work and play
2. the promotion of good mental health and strong self-esteem in children.  Parents can facilitate this goal with age-appropriate limit-setting mixed with positive encouragement for mastery of the next developmental challenge
3. providing a safe environment, free from known hazards, and having a preparedness plan for managing personal emergencies as well as community disasters
4. development of a strong sense of family - one of cohesiveness, mutual respect, and open communication.

• When your child asks why you are having a baby, remember that it is not necessary to attempt to justify your decision to add a new member to your family.  Many child psychology experts relate that a simple statement of fact such as, “our family is having a new baby,” is sufficient.>/li>
• Make it a practice to allow your child to make some decisions every day.  Making choices between two different sets of clothing or two different books for a bedtime story, or allowing your child to select the vegetable for the family meal will help your child to feel more in control of his or her environment.
• Help your child learn to express his or her emotions by providing words that can be used to identify feelings.  When your child is excited about an activity, a simple statement such as, “you are excited about going to the park,” gives your child an expressive handle on the energy and anticipation he or she feels.  If it has been necessary to place your child in time-out, a sentence like, “I know you are frustrated and angry right now,” assists the child in placing a label on his or her feelings.  A child who learns to label and constructively express emotions prior to the birth of a new sibling may have an easier time telling you about feelings he or she is experiencing as a result of the changes in the family structure.
• Choose small items to wrap and have on hand as gifts for the older child when friends and relatives bring gifts for the new baby.
• Try not to introduce too many changes into the child’s world when the new sibling arrives.  For instance, it will be helpful to make sure that your older child continues to sleep in the same room or bed even after the new baby comes home.
• Let the big brother or sister make some choices for the new baby both before and after the birth.  For example, allow the older child to select the color of a new blanket, or allow him or her to choose a new toy for the baby.
• Read books together with your child about becoming a big brother or big sister.

• Office hours, after-hours availability and type of answering service.
• Coverage when the physician is not in the office and if a nurse practitioner or physician assistant is routinely seen for some appointments.
• Appointment availability for illnesses and for routine visits such as physicals.
• Usual waiting times and any evening or weekend hours.
• How phone calls for routine questions are handled.
• Which hospitals the physician admits to and which ER he or she would prefer.

• In the first place, young children are more susceptible because their immune systems are relatively naïve---meaning that they have not had as much experience in fighting off infections as older children and adults; therefore, they get infections more easily and it takes their immune systems longer to limit illness and eliminate it.
  
• Secondly, young children are more prone to exposure because of their habits of touching and mouthing objects, drooling and spreading secretions over surfaces they are near; and also because they are frequently in contact with other children in large concentrations, e.g. at day care centers, church nurseries, or school-aged siblings who are exposed to large numbers of their own peers.  It is estimated that 2/3 of children in day care are sick more than 60 days per year.
  
• Thirdly, infections frequently follow one another in succession because of seasonal prevalence factors, giving little time between episodes for thankful good health.  Often, it is difficult to remember those 4 days that Katie was well.  Alternately, it is nearly impossible sometimes to tell where one infection left off, and the next began.  
  
• Finally, when the last piggy bank has been cracked open for yet another bottle of stuffy nose, coughing, can’t get to sleep, fever medicine that provides no relief, it seems like the “last straw”, and those middle of the night fears begin to nag that something abnormal is going on…..and sometimes it is true……but the greatest majority of the time, the situation is completely normal.

1. The need for more than four courses of antibiotic treatment during a year.
2. The occurrence of more than 4 new ear infections in a year in children after 3 to 5 years of age.
3. The occurrence of pneumonia more than twice in a year.
4. The occurrence of more than 3 episodes of bacterial sinusitis in a year.
5. Any unusually severe infection like blood infections or pneumonia; or infection caused by bacteria that do not ordinarily cause infections in children at the patient’s age.

The predominant myth is that the color of the mucus is an indicator of whether there is an “infection” or not.  That is, the yellow or green color is often believed to represent some kind of infection requiring treatment with antibiotics.

While it is true that the nasal mucus of patients with sinusitis or other bacterial infections is often thick and yellow or greenish in color, the color itself is not a diagnostic feature.  The nasal mucus in a child with a viral respiratory illness or a “cold” has a rather predictable pattern in the changing color of mucus over the 10 to 14 days that a cold lasts.  Initially, the mucus is clear or slightly cloudy.  Within a couple of days, the mucus changes to cloudy and yellow to green in color.  By the end of the 10 to 14 days, the mucus changes back to cloudy then clear again before the cold is over.  Also, often with a cold, the mucus is discolored in the morning, but clears up during the daytime.  Therefore, since discolored mucus occurs with the common cold and with allergies as well as with sinusitis or other bacterial infections, it is not a very good predictor of a bacterial infection by itself.  It follows that green mucus does not dictate the need for antibiotics.  

Since most viral infections like colds don’t improve with antibiotic treatment, it is important to use other clinical signs and symptoms to distinguish between the expected kind of green mucus that happens with a cold, and that which accompanies a bacterial infection.   One sign that can be readily identified by parents is the length of time that the mucus has been discolored.  If the “green runny nose” has lasted longer than 2 weeks, is persistent throughout the whole day and is associated with daytime and nighttime coughing, or fever, then the chance of a bacterial infection is greater.  On the other hand, a child with only a 3 day history of runny nose, regardless of the color of the mucus, is much more likely to have a cold or a problem with allergies than a true bacterial infection.

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Childhood Obesity:  Part I
Healthy Lifestyles Begin at Home
Janice A. Filler, MD
October 2005

We are hearing a lot about lifestyles lately…especially in relationship to the nationwide epidemic of obesity.  The answer to the problem of obesity is not as simple as “eat less, exercise more”.  In fact, short-term fixes like “fad diets” clearly don’t work and can be dangerous in children.  The answer requires a long-term commitment from the whole family to change their health habits.

The incidence of obesity has doubled in children and tripled in adolescents over the past two decades.  As a direct consequence, adult diseases like Type 2 diabetes are being seen in children at alarming rates. Twenty years ago, Type 2 diabetes was unheard of in children.  In Oklahoma today, the incidence of Type 2 diabetes accounts for about half of all new cases of diabetes diagnosed in children.  It follows that the complications of diabetes, like kidney failure and blindness will likely be seen at younger and younger ages because of the earlier onset of disease.  Furthermore, diabetes is only one of the bad health consequences of early obesity.  There is clear association between obesity and high blood pressure, strokes, and certain cancers, as well as orthopedic,  respiratory, and psychological problems.

We already know that the treatment of obesity with diets and medications have poor success rates. The hope is that by changing our families’ lifestyles we may be able to prevent obesity.  Changing one’s lifestyle is an arduous task, and must involve every family member, regardless of whether they are overweight.  Remember that parents are the leaders and major role models for such change.  Some tips for adopting a healthier lifestyle include:


1. PLAN to eat together at least 3 or 4 times weekly at the evening meal.  Parents can’t be good role models for healthful eating habits if children never see them eat.  Studies show that this practice not only helps with overweight in children, but appears to decrease the incidence of drug use and other undesirable behaviors as well.
   
2. TURN OFF the television during mealtimes and limit TV viewing to no more than 60 minutes daily for children.  Forbid any eating or snacking in front of a television or computer.  This means adults, too!
   
3. ENGAGE in family fitness activities.  Take a family walk after dinner with the dog or set up a volleyball net in the backyard.  Set a goal for at least 30 to 45 minutes of “huff and puff” exercise for at least 5 days each week.  Make it a HABIT!
   
4. MAKE A HABIT of parking far away and walking to an entrance with your kids and praise them for making this extra effort to stay healthy with you.
   
5. DON’T become the “food police”.  Help children make healthy food choices most of the time.
   
6. SET A GOOD EXAMPLE for drinking water.  Keep sodas (diet and non-diet) and other junk food out of the house.  Limit juice intake, too.  Six fluid ounces daily is adequate for most children.  There’s more than enough access to these unhealthy choices outside the home.
   
7. SET A GOAL of getting children to eat 5 servings daily of fruits and vegetables, and encourage consumption of low fat dairy products.
   
8. EDUCATE yourself and your children about appropriate serving sizes.  Remove excessive portions from plates before serving, and avoid leaving serving bowls on the table.  Share servings when eating out, to reduce the portion sizes.

If you are concerned that your child is obese, or if you have obesity risk factors in your family history, it may be time for you to visit the pediatrician for a check up.  The pediatrician will be able to calculate your child’s body mass index (a good correlate of body fat) and give you some guidance regarding the child’s risk of becoming an obese adult.  Family risk factors include, but are not limited to the following:


1. Obesity in one or both parents;
2. History of gestational diabetes in the mother;
3. Excessive weight gain in infancy, especially in formula-fed infants, and early rebound weight gain after the usual toddler and pre-school slow-down in weight gain;  (Doctors call this “adiposity rebound” and it usually occurs around age 5.  When it occurs early, it is a risk factor for persisting obesity.)
4. Obesity in a child after age 9 is a strong predictor for adult obesity.

If you are uncertain about how to plan for healthy mealtimes, consult a dietitian or your pediatrician.  A useful website for family nutrition is:  www.healthierus.gov/dietaryguidelines.  Watch for Part 2 of this series to learn what you can do to change how schools and your community can help you in your commitment to make a long-term change for your family.

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Childhood Obesity:  Part II
Partnering with Schools and Your Community
by Janice Filler, M.D.

In Part I of this two-part series, the topic of the parents’ responsibility to change the family’s lifestyle was highlighted as the primary defense in combating the skyrocketing rates of obesity in our children.  However, no family lives as an “island”, and creating a consistent supportive environment is critical to success in adopting a healthier lifestyle.  Therefore, Part II will deal with what parents can do to actively promote cooperation and support from their extended families, their children’s schools and the community at large.  

Many parents have reported that their attempts to change their children’s habits have been ignored or even sabotaged by persons in their extended families.  Grandparents, aunts, uncles, nannys and friends, whether accidentally or deliberately, have been guilty of offering unhealthy foods, excessive servings or second helpings and have permitted sedentary behaviors because they want to please the child.  Usually these behaviors are rationalized by the adult as not being important because it is “just this once”, or because “he just begged me for it” or “she was so unhappy and I just wanted to make her feel better”.   We have all been guilty of rewarding or comforting children with food and “favors” such watching a video, skipping his usual required chores or missing ball practice, or other replacements for physical activity.  What we don’t recognize, however, is that these “permissive” adult behaviors send the wrong message to children; namely, that pain, or sadness, or disappointment can be “fixed” with food or other indulgences.  This is different from a comforting hug, words of encouragement and acceptance which is what children really crave and need.  If this scenario applies to your attempts to keep your family healthy, here are a few things to consider:


1. Seek solidarity with your spouse/ co-parent and present a unified request to the extended family for help and compliance.
2. Express your commitment gently but firmly and be willing to risk some disgruntlement from the offenders in the best interest of your children.
3. Suggest non-food alternatives for rewards and guidelines for mealtimes away from home.

Schools also present opportunities for partnering to sustain the changes started at home.  Luckily, following the active involvement of the Oklahoma Fit Kids Coalition, there have been some recent legislative changes that make it easier to gain the cooperation of schools. This year, Senate Bill 265 was passed which requires schools to limit or exclude items in vending machines considered to be of  “minimal nutritional value” as defined by the USDA.  Further, Senate Bill 312 will mandate one hour per week of physical education in grades K through 5.  Neither of these bills, however, will take effect until July 2007.  In the interim, it is vital for parents to “weigh in” on the issue with their children’s schools, and to keep a watchful eye on the progress of the school to implement these legislative mandates.  One way to do this is to participate in your school’s Safe and Healthy School Committee.  These establishment of these committees was mandated by legislation passed in 2004.  The membership is open to parents, teachers, school administrators, and appropriate school and child advocates and creates an opportunity to look for ways to improve the diet and activity level of students during the school day.  This means that parents can get involved to examine the “outside” fast food vendor and vending machine practices of each school and encourage changes to offer healthier options.  For example, Norman Public Schools have partnered with Great Plains Bottling Company to offer incentive pricing for healthier choices starting two years before the mandate by legislation.  Parents can also advocate to limit access to “junk food” except for certain school activities such as athletic competitions, or special assemblies.  By participating with PTA groups, parents can encourage teachers and other parents of elementary grade students to bring healthy snacks or toys/novelties for birthday or other celebrations rather than sugary items

Finally, look to the community to encourage development and access to child- and family-friendly physical activities.  Organize a neighborhood family volleyball or badminton tournament.  Ask your local gym to start an after-school kid’s hour for exercise/court time.  These gyms don’t have to offer access to expensive and child-inappropriate weight machines or trainers, but organized aerobic programs should be easily cost-effective.  Then spearhead the effort to get kids signed up for the activity so the partnership with the gym is worthwhile.  Provide a constant role model for an active lifestyle.

Nothing will change without personal commitment to the challenge…..and no reward is greater than a community of healthy kids.

Learn more about the ongoing efforts of the Fit Kids Coalition.

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TV and Your Child (We Promise not to Guilt You)
Colleen Dooley, MD
September 2005

Again this summer, there has been a rash of articles about television viewing and children. It may have gotten to the point where parents decide to tune out because some of the information is conflicting, and virtually all of it is guilt-inspiring to already overtaxed parents. I will try to condense some of the recent information.

The American Academy of Pediatrics recommends no TV viewing in children younger than 2 years and to limit TV to two hours or less per day in children older than 2. Some are recommending that all electronic media (computer games, videos) be included in these two hours.

This summer, the "Archives of Pediatric and Adolescent Medicine" published three well researched new studies on the negative effects of television on children. The first tested a group of third graders and found that the children with TVs in their bedrooms scored lower on achievement tests. They also did better if they had access to a computer in the home.

The second article followed a group of children from birth to age 26. Increased hours of TV in childhood and adolescence correlated with a higher likelihood of not finishing school.

The third article looked at the amount of TV watched by a group of children younger than 3 and then looked at tests of math and reading at age 6-7 years. The more hours per day spent watching TV when young, the lower the scores on their standardized tests.

A recent review of media in "Pediatrics" found good evidence that adolescents who are exposed to television with sexual content have more permissive attitudes toward premarital sex and overestimate the frequency of some sexual behaviors.   

There is also evidence that educational television may be of value to children academically.

My own children are now old enough to buy their own cable service, but I still realize how hard it is to control media in the home. These are some suggestions that might help.

• Don't automatically turn on the TV when walking in to the house. Try out some new coming home rituals.
• Unless there is a compelling family reason, try to avoid having TVs in the children's bedrooms.
• Allow children to decide which shows they really want to watch (subject to parental approval) and plan to turn off the TV at the end of the desired show.
• Watch some of their shows with your children. If you see something you disagree with, use that as a discussion opportunity at the end of the show. This is great values education.
• Try to have meals at the table, not in front of the TV. The added benefits to nutrition and family communication are immense.
• Consider watching educational TV. If your children see you interested in a show on PBS or Discovery, they are likely to join you.
As with everything in parenting, no one does a perfect job every day.  Accept the fact that there will be days when life is so overwhelming that you need an electronic babysitter.   

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Not Another Shot, Mom! – New Vaccines for Adolescents
By Colleen Dooley, M.D.
August 2005

School is starting and even though your children may be beyond the age for kindergarten shots, it is a good idea to review their vaccine status annually. Changes in vaccine recommendations are occurring with increasing frequency and more are likely to be coming over the next several years. There are two new vaccines approved for young people 11 and over. The saving grace this year is that these are recommended but not required so you don't have to line up at your doctor's office this month.
   
Menactra is the name of a vaccine to prevent several types of meningococcal disease. Meningococcal infection can cause meningitis and infection of the blood stream. This vaccine replaces an older vaccine which did not give long term immunity and was used mainly for students entering college or the military. Menactra appears to be much more effective than the prior vaccine for meningococcus.

One of the peak ages for meningococcal disease is 11-19 years. Despite the fact that multiple antibiotics can kill this bacteria in the lab, in humans the disease progresses so rapidly that 10-14% of infected people will die from it and almost 20% of survivors will have permanent disability, including amputation, deafness and neurologic problems. This can occur despite early and aggressive treatment with appropriate antibiotics.

One dose of the vaccine is currently recommended for 11-12 year olds entering middle school or older students entering high school or college. Side effects have been minimal, primarily fever or arm pain at the injection site. Currently, many colleges are requiring the vaccine before admission as a freshman. Once supplies of the vaccine are plentiful, it will be recommended for all young people 11 years and older.

The other new vaccine for this age group is the Tdap. This is tetanus, diphtheria and acellular pertussis (whooping cough) in a dosage suitable for adolescents and adults. The good news is that it can be given instead of the traditional adolescent diphtheria tetanus booster that has been recommended for many years. Therefore, it will not be an extra shot.

Until now, the last dose of pertussis vaccine was given at entry to kindergarten. It is part of the preschool DPT. By adolescence, immunity from that dose would begin to decrease. Two-thirds of pertussis disease is now diagnosed in adolescents and adults. The number of cases of pertussis diagnosed in the U.S. has been increasing since 1980. Nearly 19,000 cases were reported to the CDC in 2004, the highest number of cases in 40 years. The increase has been mainly in infants younger than 5 months of age and in adolescents and adults. The younger infants have not yet had enough time since their vaccinations to develop adequate immunity and older people are seeing the result of their decreasing immunity. Older babies and young children have not had an increase in disease because they are in the years where they still have good vaccine protection. To put this in perspective, there is still 97% less reported pertussis disease than before pertussis vaccine was introduced in the 1940s. However, physicians realized there was room for improvement and that is why work was done to develop this vaccine which could be used in older age groups.

In teens and adults, the disease is usually not fatal but can cause significant illness, including weeks of cough that causes missed school and work, vomiting and sleep disturbance. It may also cause secondary pneumonia and rib fractures. The most serious problem is that infected people may spread the disease to infants who can develop pneumonia, seizures and encephalopathy. Infants may die from pertussis despite all available treatments. Seventy-five per cent of pertussis diagnosed in infants can be traced back to an infected family member.

These vaccines would be worth discussing with your adolescent's physician at the next well child or sports physical visit. It always helps to bring a copy of the immunization records to these visits so that your records can be kept current. When you have to do forms for camp or college, it is much easier if your information is up to date.

An excellent web site for vaccine information is www.vaccine.chop.edu/parents. This site is from the Children's Hospital of Philadelphia and has accurate information on all the standard immunizations, not simply the new ones mentioned here.

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Asthma – It Can Be Breathtaking
By Vijaya L. Malpani, M.D.
September 2005

Just exactly what is asthma?  Asthma is a chronic lung disease often linked to allergies, heredity and environment that causes inflammation and restriction of the airways.  The inflammation leads to recurring episodes of coughing, wheezing, chest constriction and labored breathing.  Patients with asthma have problems with expiration (breathing out) compared to patients with croup or bronchitis, who have problems breathing in (inspiration).

Symptoms include coughing, wheezing, shortness of breath, tightness in chest, and constant throat clearing.   The duration (length of time) of these symptoms and their severity vary from time to time and in different times of the year.

Asthma triggers vary from person to person and time to time.  Airways become sensitive to certain triggers, often after multiple exposures.  Asthma can also be triggered after certain viral infections.  Common triggers that can led to wheezing are dust, animal dander, pollen, an infection, breathing cold air, exercise, reaction to certain medications, and cigarette smoke.  It cannot be emphasized enough, however, that the worst things for an asthmatic to be exposed to are smoking and cigarette smoke.  Obesity, gastroesophageal reflux, and chronic sinus drainage are some of the issues that have to be dealt with while caring for a patient with asthma.

Asthma can be grouped into four major classes depending on symptoms and lung function.  Therapy can be designed accordingly.  With regular follow-up and maintenance medications, asthma can be controlled.  The aim of good asthma management should be for the patient to be able to participate in all activities at school and lead a normal life.  With the advent of new drugs and inhalers, this can be well achieved in most patients.

A peak flow meter is a small device that should be prescribed for all children who require inhalers or asthma medications.  It measures a patient’s forced expiratory volume in one second. 

Steroid inhalers are used for mild persistent to severe persistent asthma.  Many parents have reservations about using steroid inhalers, as they are afraid that steroid use may cause decreased growth, or steroid addiction.  Overall, inhaled steroid usage is safe and decreases the inflammatory process in the airway which leads to the wheezing.

Home nebulizers are prescribed for severe flare-ups (exacerbations).  For patients participating in sports, a rescue inhaler consisting of a bronchodilator, usually Albuterol, is prescribed and should be taken 20 minutes before sports activities begin.

Parents must notify school officials such as teachers, principals, the school nurse and any sports coach of their child’s condition.  School authorities should know what to do in case of an acute asthma attack.  Students should have access to their inhalers at all times. 

If a patient has acute airway closing due to a known allergen (for example, peanuts) or certain foods, an Epipen injection should always be available for immediate use.

Patients with asthma who require some kind of medication throughout the year or patients who need to use their rescue inhaler 1-2 times a week should be seen on a regular basis by their doctor to monitor medication compliance and help maintain good breathing status.  Additionally, it is very important that asthmatics receive a flu shot each flu season.

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Making the Most of Check-Ups
by Kala Sigler, M.D.
August 2005

Can you relate to this scenario? Jane stands with her body barring the door to prevent her five year-old, Johnny, from breaking loose again and running through the halls of the pediatrician’s office. He’s already knocked over the container of tongue depressors and Jane spent five minutes on her hands and knees gathering them. She’s so flustered that the list of questions she had in her mind have completely left her. Now she’s dreading the interaction with her child’s pediatrician rather than looking forward to it.

It’s time to schedule those back-to-school check-ups!  Don’t delay. Check-ups, or other visits to your doctor don’t have to be painful…even for the parent. With a few helpful tips, parents can become better equipped to make these visits more productive and pleasurable. Parents can even be a blessing to their pediatrician! Over the years I have come to appreciate many things from my patients and their parents.

Inquiring Parents: I am thankful for parents who ask questions. That tells me that thought and preparation have been put into their child’s visit. Questions help give parents confidence, and know that their concerns will be addressed. When parents ask questions, they are more likely to leave happy and satisfied. When my parents are happy…I’m happy!

I love to answer questions, and consider it a huge part of my job to address parents’ concerns. Even at that, it always tickles me when I ask parents if they have and questions and they whip out the yellow legal pad filled with their list! I painstakingly and lovingly address each one. When my parents are happy…I’m happy!

Attentive Parents:  I’m thankful for parents who pay attention during the exam. Distractions can hamper effective communication. It’s the nature of the business that there will be distractions. Babies cry. Toddlers become wrecking balls with a mission. School aged children ask questions, talk while Mom’s talking, can’t sit still. Teens roll their eyes, pop their knuckles, tap their fingers. Moms and dads fret over what their child is doing to distract them. Even in less than ideal circumstances, if parents are able to even give me half of their minds, we can usually end the visit with success. When my parents are happy…I’m happy!

Compliant Parents:  I am thankful for parents who follow instructions.  It’s not a pride thing.  It’s really not.  I do not fly by the seat of my pants.  If I lay out a plan, it’s done deliberately, with the ultimate goal of helping my patient.  I’m not always right.  Sometimes I have to adjust the plan and try a different approach, but we can at least get to that point if the parents have adhered to the original plan that was recommended.

A perfect example of this is a mother who brings her child in for this awful rash that “just won’t go away.” Well, I just saw Jimmy for that rash that I diagnosed as eczema three weeks ago. Sure enough, it looks no better. I begin with a few questions. “Mrs. Jones, did you change the soap you bathe Jimmy with?” “No,” she responds. “Did you use the medication I prescribed twice daily?” I ask. “Well…no,” she admits sheepishly. “Did you go buy the lotion I recommended and use it twice daily?” Again she responds, “Uh…no.” 

No wonder things aren’t better!! Compliance with the plan I lay out makes such a difference in how quickly a child gets better. When the child gets better, parents are happy. When my parents are happy…I’m happy!

Organized Parents:  I am thankful when I have avoided the seemingly inevitable “Oh, Doctor, by the way…” comment that comes as I am already half way out the door. Now, don’t get me wrong, some “by the ways” aren’t bad. “By the way, Doctor, I meant to ask you, how many times can I give Grace that cough medicine today.” Simple. No big deal. 

The “by the ways” that really get me are ones like this: “Oh, Doctor, by the way, I meant to ask you about Suzy’s bedwetting. I know she’s seven now, and we should have discussed this before, but she’s never had a dry night.” Ouch, those really get me! An entirely separate visit is needed for a problem such as that. Organized parents don’t put me in situations like that. Now the opposite is true…when I’m happy, my parents are happy!

I would venture to say that most pediatricians are like me – we love the interactions we have with both our patients and their parents. As you prepare for the coming school year, and plan those required annual check-ups, think about ways you can make those visits more pleasant. You might even be a blessing to your pediatrician by going to your next visit as an inquiring parent, an attentive parent, a compliant parent, and an organized parent.

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Colic
By Hamed Albiek, M.D.
July 2005

It’s 7:00 p.m. and here you go again.  Your newborn starts her new nightly routine of screaming and crying for 2-3 hours straight.  You’re stressed out, exhausted, and feel helpless.  You’ve changed her diaper, burped and fed her, and still she cries inconsolably.  You ask yourself, “why is this child crying?  Isn’t there anything that will help?”  The chances are pretty good that your baby has colic.

So what is colic, anyway? 
Colic is defined as unexplained severe crying spells that occur daily, usually in the early evening hours.  Usually the baby will scream, draw her knees to her chest and clench her fists.  Her face turns red, she grimaces, and may pass a large amount of gas.  This behavior usually begins at around 2-3 weeks of age and ends somewhere between three and six months of age.

Does colic affect my baby’s growth and development?
Colic does not affect a child’s growth or development.  It is a self-limited condition; this means the condition will resolve by itself without any treatment, but it can last for weeks.

What can I do to help my baby?
First of all, you and your pediatrician should rule out any physical condition that might contribute to your child’s distress.  Gastroesophageal reflux (GERD) and formula intolerance are two common possibilities.  Once these conditions are eliminated from consideration, colic is likely the culprit.

If you and your pediatrician conclude that your baby does indeed have colic, here are a few simple things to try:

1. Feed your child slowly in an upright position.
   
2. Try bottles that prevent air swallowing, like “Dr. Brown’s Natural Flow Bottle.”
   
3. Swaddle your baby.  Swaddling is accomplished by wrapping your child very snugly in a soft sheet or cuddly receiving blanket.
   
4. Play soothing music (try Mozart rather than Smashing Pumpkins or Green Day.)
   
5. A car ride is sometimes effective.
   
6. Children frequently soothe when their parent holds them closely and makes soft motions such as gentle rocking.  Quiet singing or humming may also be helpful.
   
7. Massage your baby’s tummy.
   
8. Try placing your child on your chest as you lie down.  Some will find your body heat comforting.
   
9. Make the house quieter and calmer.  Blaring TVs or noisy computer games should be turned off.
   
10. If you are breast feeding, decrease your caffeine intake by reducing or eliminating coffee, cola beverages, and chocolate.  Eliminate gassy foods such as eggs, beans, and some vegetables from your diet.  Avoid excessive milk intake (not more than 2 glasses/day).
    
11. Ask your pediatrician about a different choice of formula.
    
12. Ask your pediatrician about the use of herbs such as fennel seeds, ginger, anise, peppermint tea.  They can be very helpful but, like any medication, should not be used without your doctor’s knowledge and advice.
    
13. Medications are also available.

Is it my fault that my baby is colicky?
It is absolutely not the parents’ fault.  Don’t take it personally!  One theory is that your baby has immature bowels.  If this theory is correct, food stays in the bowels longer and natural fermentation causes gas which may bring about cramps and colic.  Remember that this colicky period will be over in around three months and there are many things that can help you get through it.  It is very important that parents take a break and give each other some time to regroup.  It’s okay to ask for help; talk to someone who has had a colicky baby.  They can give you encouragement and support.

In summary, 10-30% of babies get colic to some degree.  No one knows for sure why it occurs, and it will go away with time.  Meanwhile, talk to your pediatrician and try some of the things he or she recommends to help your baby (and your family!) get through this trying time.

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Riding in the Back Seat
by Kala H. Sigler, MD
June 2005

“I call shotgun!”  This is the battle cry of many pre-adolescents as they prepare to load into the car, and I suspect, based on the staggering statistics about who is riding in front seats, many of your children between the ages of six and twelve years are grappling to get up front.  I think it’s easy for most parents to understand why children under the age of six years should be in car seats.  It’s the law in Oklahoma, if you weren’t aware.  Beyond that, children under the age of six will clearly be more injured in crashes if they are not in a car seat.  

As children get older, their likelihood of sitting up front increases.  According to a study by the Partners for Child Passenger Safety (PCPS), almost 20 percent of seven-year-olds are riding up front. That number increases to 25 percent of nine-year-olds, and slightly over 40 percent of 12-year-olds.  

You may be saying to yourself, “So? What’s the big deal about where these kids sit?  Why can’t my child between the ages of six and twelve years sit up front?”

Statistics speak for themselves.  These facts come from a study by the Partners for Child Passenger Safety (PCPS): “Across all age groups through age 15, unrestrained children in the front seat had the highest risk of injury while optimally restrained children in the rear were always at the lowest risk. Children in the front seat were 40 percent more likely to be injured compared to rear-seated children.  For appropriately restrained 13-to 15-year-olds, there was no additional risk when they were seated in the front row as compared to the rear row.”

Researchers from the Insurance Institute for Highway Safety found that, while passenger airbags reduced adult fatalities by 18% in frontal crashes and 11% in all crashes, airbags increased the fatality rate in children less than 10 years by 34%.   That’s a staggering statistic! The obvious argument that may arise is what about vehicles that allow one to turn off the passenger side air bag?  While I am not aware of specific statistics that speak to that particular subset of accidents, with the study cited above showing that children in the front seat were 40 percent more likely to be injured compared to those in the rear seat, I’m not sure I would be willing to take that gamble with my child.  Are you?

Bottom line?  Kids under 13-years-old are safest in the back seat.  No matter how they pressure parents, no matter how grown up they are or want to be, they are safest in the back seat.  Bottom line.



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Seeing Spots in Children - Rashes and Other Skin Conditions
By Denise Scott, M.D.     June 2005

Ah, the carefree days of summer!  Warm weather, relaxation and that itch that won’t go away!  Now that summer is just around the corner, don’t be surprised if rashes start showing up in your children.  The question is when to worry and when to seek medical attention?  What is of concern and what is simply a nuisance?  The more common types of rashes seen this time of year are reviewed. 

First, contact dermatitis.  This category includes poison oak, ivy and sumac and typically requires direct contact with the plant, so “leaves of three, let them be!”  Because it is the plant oil that causes the rash, this rash is not contagious.  The earliest treatment is to remove the plant oil by washing thoroughly with lots of a strong soap and warm water.  This type of rash leads to clear blister formation in patches, often in a linear configuration, that is terribly itchy.  Steroid creams and oral antihistamines are helpful to control the itching but high dose oral steroids may be needed in severe reactions.  For widespread rash and/or facial involvement, a doctor should be seen.

Scabies is another cause of a very itchy rash that can also occur in a linear fashion with small blisters and pustules.  This is caused by a small arachnid, the mite, which burrows into the skin and deposits eggs that leads to severe itching.  The most common areas for this rash include the armpits, groin, arch of the foot and web spaces between the fingers and toes.  Unlike poison ivy, this disease is highly contagious, but symptoms may not occur until several weeks after exposure.  Treatment includes the overnight application of a prescription lotion and washing all bedding and linens in hot water.

Infectious rashes are of greatest concern this time of year and include both viral and bacterial causes.  Strep throat is a  year-round infection and is not uncommonly associated with a rash.  This is caused by Group A Streptococcus and is also called scarlet fever.  The classic findings include a red rash with fine bumps with the feel of coarse sandpaper.  This will typically begin on the neck and upper trunk then spreads within 24 hours.  As the rash fades 3 to 4 days later, peeling of the face and hands may occur.  Because younger children may not complain of a sore throat, medical attention should be sought and a throat swab can be carried out in the office.

Viral infections associated with rashes are common this time of year.   Hand-foot-mouth syndrome, a very common childhood illness, is caused by coxsackie virus.  This may be associated with fever, severe throat and mouth pain from small oral ulcers and small red spots or blister-like lesions to the palms and soles and sometimes up the legs to the buttocks.  No specific treatment is needed except hydration and treatment for fever or mouth discomfort.

Chickenpox is not seen as frequently now as in days  past due to the vaccine. This disease is highly contagious but may not show up until 3 weeks after exposure.  This too is associated with fever.  The rash first appears as small red bumps that progress rapidly to clear blisters that crust and scab within a week.  The rash is extremely itchy and, like scabies, oral antihistamines are useful.  It is important to prevent secondary bacterial infection of the skin, so frequent oatmeal baths and lathering the skin up with an antibacterial soap is helpful.  Although chickenpox is usually a mild disease, complications are common which can be life-threatening, especially in infants and immunosuppressed individuals.

Fifth disease or parvovirus infection is a fairly benign disease in children but may be more severe in adults. Typically this is seen in early spring and begins with bright red cheeks or a “slapped cheek” appearance followed by a red lacy-looking or fishnet-appearing rash to the trunk, arms and legs.  This becomes much more apparent after bathing or exercise and may be slightly itchy.  Adolescents and adults may experience severe joint and muscle pain as well.

Finally, the rash of Rocky Mountain spotted fever must be mentioned since ticks are already prevalent.  This usually occurs within 2 weeks following a tick bite, with symptoms of fever, headache and fatigue.  The rash consists of rose-red flat spots and bumps that begin on the arms and hands then spread to the trunk and includes the palms and soles.  Over several days it will become more red and purple with more severe systemic symptoms.  Medical attention should be sought as soon as possible as this can be a fatal disease without treatment.

While many rashes in children are benign and self-limited, those associated with fever and other systemic symptoms should be evaluated by a physician.  Not only is it best to begin treatment early in the course of illness, but also it is necessary to know whether others are being exposed to something contagious.  So the next time you’re seeing spots, beware!

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Summer Sun, Summer Fun:  A Guide to Summertime Precautions for Children
by Denise C. Scott, M.D.

It’s that time of year again…summer sun, summer fun, summer camps! Along with the sunshine, however, come sunburns, mosquitoes, ticks and poison ivy!  Before the summer fun begins, take a few precautions to keep your children, and yourself, free from these annoyances to better enjoy your time outdoors.

First, sunburn prevention. Avoid peak sun hours between 11 a.m. and 3 p.m. Sunscreen should be applied 20 to 30 minutes prior to going outdoors. Look for children’s PABA-free, waterproof lotions with an SPF of at least 30 that offers broad-spectrum protection (blocks both UVA and UVB rays). Remember to reapply after heavy sweating or swimming. Stay in shaded areas as much as possible to avoid both sunburn and heat exposure.  Some clothing lines, such as Solartex and Sunveil, offer clothing with UV sun protection.

Contact dermatitis includes poison ivy, oak and sumac, all of which exist in our state – learn to identify these plants as avoidance is the best measure!  All three of these plants emit an oil, urushiol, an irritant that makes you itch.  Because it is an oil, it does not evaporate and can linger for up to a year.  This oil will also vaporize when it is burned, the vapor then is carried in the smoke and covers everything it comes in contact with.

If contact with this irritant is made, wash thoroughly with lots of soap and hot water as soon as possible to remove any plant oil.  The rash is not contagious, only the oil can spread the rash. All clothing should be removed and washed as well. Over-the-counter anti-itch lotions and steroid creams can be useful, such as calamine lotion, hydro-cortisone cream, oatmeal based products such as Aveeno or oral Benadryl to ease the itching. For more severe outbreaks or allergic reactions, prescription creams and/or oral steroids may be required. The old adage “leaves of three, let them be” is the best advice!

This brings up another itchy topic, insect bites! Evening is the worst time for mosquitoes, but ticks are present all the time. Insect repellants with the active ingredient, DEET, in concentrations up to 20% are safe for children. It is best to spray the outside of the clothing then use a light layer on exposed skin areas, avoiding the mouth and eye areas and hands in young children.

Another very effective measure is to spray all clothing prior to packing with permethrin (permanone), concentrating on collars, sleeves and cuffs. Unlike DEET, permethrin is actually an insecticide that is applied only to fabric, such as clothing or mosquito nets, and will kill insects that come in contact with it.  It will stay active on clothing for two to four weeks, even after washing and will not harm or stain fabric.  It is effective against mosquitoes, ticks and flies. This CANNOT be used on the skin. The best combination is to apply DEET to the skin and permethrin to clothing.  A bandana treated with permethrin, worn around the neck can deter ticks from attaching to the head and neck.

Children should be instructed in conducting “tick checks” from head to toe, concentrating on the warmest areas of the body (armpits and groin) where ticks tend to migrate. If signs of illness occur within 7 to 14 days of a known tick bite, medical attention should be sought as Rocky Mountain Spotted Fever is of utmost concern. Symptoms can include fever, rash, headache and muscle aches. To remove a tick, use tweezers, grasp the tick as close to the skin as possible, pull out gently, then wash the area with soap and water and apply an antibiotic cream. 

Lastly, water, water, water. Adequate hydration cannot be overemphasized. Heat cramps and heat exhaustion can be prevented with good hydration and not being overactive in the heat. A few simple precautions will preserve your child's fun in the sun!


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What's All the Fuss About Cold Medicines for Kids?

In October, 2007, pharmaceutical companies stopped selling infant cough and cold medications marketed specifically for children under 2 years of age. In fact, those products were taken off the shelves of retailers across the country. Why? The primary reason is that these cold medicines have not been shown to be beneficial and, of more concern, are proven to have serious side effects when not used appropriately.

What are cough and cold medicines? These are medicines that help alleviate the symptoms of congestion, cough, and fever. They do not shorten the course of the illness or treat the disease. The active ingredients typically include some of the following:

• Decongestants-  include pseudoephedrine, phenylephrine, and oxymetazoline. Decongestants are supposed to help alleviate a congested nose. They have shown no benefit in children and have been the cause of recent deaths due to side effects including high blood pressure and arrhythmias. Dosing has not been studied in children and is calculated for children based on adult dosing.
• Antihistamines-  include diphenhydramine, hydroxyzine, chlorpheniramine, brompheniramine, and clemastine. These agents help with allergic symptoms but have no benefit for the common cold -- except to make your child sleepy.
• Antitussives/Cough suppressants-  include dextramethorphan, carbetapentane, and codeine. Again, studies in children have shown no clear benefit but severe side effects when not used appropriately.
• Antipyretics-  include acetaminophen and ibuprofen. These may reduce fever; however, high doses can be dangerous.
We do not recommend any cough and cold medications for children less than 2 years of age. However, antipyretics are appropriate for fevers greater than 101.5° Fahrenheit, but be certain that you are giving the right dose at the right time interval. For children less then 6 years of age, cough and cold medications have no clear benefit, but may be used at your pediatrician's discretion. If your child is greater then 6 years of age, some of these medications may play a beneficial role.

Again, when giving medications,
• Always ensure that you are giving the appropriate dose at the right time interval, and according to the directions.
• Secondly, if you are giving a combination of medicines, ensure that you are not giving the same ingredient in two different medicines (for example: acetaminophen is contained in Children's Tylenol and also in Children's Tylenol Cold).
• Finally, always use the enclosed dosing device (syringe, cup) and not a kitchen spoon.
So, what should you do when your infant has a cold?
1. Use nasal saline to help thin secretions.
2. Use a nasal bulb suction- especially prior to feeding and sleeping.
3. Elevate the head of the bed with either a blanket UNDER the mattress or large textbooks under the legs of the crib (remember, NO pillows should be placed in the bed as pillows are a suffocation hazard).
4. Use a cool mist humidifier during sleep.
Please remember to contact your pediatrician for any fever in an infant less than 2 months of age, a cough lasting longer than 2 weeks, and any signs of respiratory distress.

For dosing instructions for Tylenol and Motrin please see the dosing chart under the My Child is Sick heading.
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