Is Tylenol safe to give to children with asthma?

Here are the facts:

• Nearly 9% of children in the U.S. suffered from asthma in 2005...that was likely an underrepresentation of the true number of cases and 6 years later, the numbers have undoubtedly risen.
• 13 million school days are missed each year due to asthma in children
• There are somewhere in the range of 3,000 deaths each year in the U.S. due to asthma
• The annual estimated economic cost of asthma in the U.S. is $19.7 billion.

If reading those statistics doesn't make a strong argument that we should be devoting more time to identifying better ways of treating asthma in children, then I don't know what does.  If you have a child with asthma, you know first-hand, how it impacts your entire family.

An article is published in the upcoming December issue of Pediatrics journal, that looks at a possible link between Tylenol (or generic acetaminophen) use and asthma in kids.  It has been a well-established fact that some people with asthma can have asthma flare-ups if they take aspirin.  Now, the most widely-given over-the-counter medication, acetaminophen, is being called into question, in terms of its safety for children with asthma.  The article looked at multiple studies that have been conducted in recent years, one of which involved over a half a million children in 54 different countries.  In some cases, when children took acetaminophen more than once a month, their risk of asthma was nearly tripled.  It's unclear to the researchers whether increased use of acetaminophen causes asthma in children, or whether children who are already predisposed to having asthma just tend to take acetaminophen more often.  It's also unclear whether taking acetaminphen less often (say, once or twice a year) has any impact on a child's risk of asthma.  Either way, it makes a strong argument to turn to alternative treatments for fever in chidren, like ibuprofen (Children's Motrin/Advil).  There does not appear to be that same association between ibuprofen and asthma in children.  (And no, I'm not getting paid by the makers of ibuprofen to say that!)

Those that know me well, know that I am not an alarmist, and I certainly wouldn't say that it's time to panic.  This is a no-brainer for me, though.  The alternative treatment sits right next to acetaminophen on the shelf at the pharmacy.  I'll be recommending ibuprofen for fever control in children with a history of asthma or a strong family history of asthma, from now on. 

When the doctor's kid is sick!

As I was standing in front of an open freezer door, with my croupy 4-year old in my arms last night around 1am, I realized what an interesting position it was to be in.  Although standing and staring at the frozen bag of edamame on the middle shelf of our freezer may seem like a bizarre thing to do in the middle of the night with a sick toddler, that's not actually what I'm referring to when I say that I felt like I was in an odd position! (Tip - cold freezer air is great for calming down airway distress from croup!)  What I realized, is that I tend to glide through my days, dishing out advice, prescriptions, and treatments, for a variety of childhood illnesses, and only when one of my own children gets sick, does it really hit home about how distressing it is for parents to see their children suffering.  I've always said that having children of my own, drastically changed how I practiced as a pediatrician, and last night was a reminder of how and why that still rings true for me.  Being awakened by a coughing, "barking" child, who's panicked because she feels like she can't breathe, trying desperately to calm her while inside I'm also trying to calm myself, feeling overjoyed when the noisy stridor begins to subside and a hint of a smile returns to her face, and making it ok to turn on an episode of Oobi (possibly one of the strangest shows on Nick Jr., but for some reason beloved by small children) at 2am, just to distract your child a little...all of these things add up, for me, to one big thing:  Understanding.  Understanding that when our kids are sick, the world seems to temporarily slow down.  Understanding that when our kids are sick, it takes superhuman parent strength to respond with calm, controlled action instead of worry and panic.  Understanding that parents will do just about anything on the planet to make their children feel better.  Understanding that when it's my child that's sick, it's the most important thing at that moment, and that's no less true for every other parent out there.  Understanding that having a sick child throws a wrench into the whole family's schedule, plans, expectations.  An understanding that I just don't think I'd have, if croup didn't occasionally come knocking on my own family's door from time to time at 1am!

Crib Safety - The Latest Guidelines

Earlier this year, the federal government released new safety standards for cribs in the US and just this week, the American Academy of Pediatrics released a consumer public safety announcement reflecting these new guiddlines.  The one that grabbed the headlines was a recall and strict prohibition of the manufacture and sale of cribs with drop side-rails.  This was an important change, due to at least 32 infant suffocation and strangulation deaths due to drop side-rail cribs since 2000.  This was a landmark in crib safety in this country, as federal crib safety standards had not been updated in over 30 years.  It's important for parents to be aware of the issue of drop side-rail cribs, but there are also several other pieces of the new federal crib safety guidelines that all parents should be aware of.

1.  Childcare centers, in-home child care facilities, and public domains that provide cribs like hotels, have until December 28, 2012 to comply with these guidelines.  With this in mind, if parents are aware that their children are going to be exposed to any of these settings, it's important to ask about the cribs that are provided.

2.  If you currently own a drop side-rail crib, the American Academy of Pediatrics and the Consumer Product Safety Commision are strongly urging parents to consider getting a new crib that meets the updated safety guidelines.  If this is not possible, the recommendation is to frequently check the integrity of the crib, including the hardware, making sure that all parts are secured tightly and that there are no missing or broken parts.  Consider having your child sleep in a pack-n-play (as long as it is not a model that has been recalled).

3.  If you are unsure whether or not the crib that you currently own has been recalled, go to http://www.cpsc.gov/ and click on infant/child recalls.

4.  This safety guideline applies to all cribs, even those sold at resale locations like garage sales and consignment sales.  Additionally, drop side-rail cribs may not be donated to thrift stores or child care facilities/nurseries.  Any cribs that do not meet current safety guidelines should be broken down and disposed of.

Musings from my Minivan

It's always entertaining for me, when people find out what I do for a living.  It usually goes something like this: 
Them..."What do you do for a living?"
Me...."I'm a pediatrician."
Them..."Really, that's great!  Where do you practice?"
Me, smiling..."Out of my minivan!"
That is usually met with some confused stares and silence, at which point, I explain my housecalls practice to them.  The fun part is hearing the variety of responses.  I've met several new families this week, and in honor of these new relationships, I thought I'd share a few of my favorite moments over the course of the first 7 months in the life of Pediatric Housecalls.
1.  Child..."Mommy, when is the doctor going to be here?"
     Mother..."Honey, this is the doctor."
     Child...(silently looking me up and down)..."No mommy, the real doctor."
2.  I am not sure why, but for some reason, I have about an 80% rate of kids asking me to come see their
     playroom after I'm done examining them.  This is usually followed by about a 99% rate of horrified looks
     on their parents' faces, as the thought of a pediatrician walking unannounced into their playroom dashes
     through their mind in slow-motion.  Since the playroom in my own house always looks like a page out of
     the Pottery Barn Kids catalog, complete with organized and labeled baskets (not!), and only filled with
     uber-educational books, games, and puzzles (not!), I typically politely decline the offer.  And then
     exchange silent smiles of relief with the mother.
3.  I always let the kids pick where they'd like to be examined.  Usually they choose the couch, a
     comfortable chair, the floor, their bed...but not this 5 year old little boy...no, he had a sense of humor
     way beyond his years, as he stared me dead-serious in the eyes and said, "How 'bout inside my firetruck
     tent?"  I could hear his mom laughing behind me as we climbed inside.
4.  And lastly, here's my true modern-day 2011 version of an episode on Little House on the Prarie.
     At 7:50pm on a Tuesday night, a mom called me to see if I could come see her son, who had fallen
     asleep earlier that evening, but who had now awoken in tears, complaining of ear pain.  Within 15
     minutes, I was on her doorstep, tiptoed upstairs to his bedroom, diagnosed an ear infection, gave him
     some pain reliever and his first dose of antibiotic, and emailed his prescription to the pharmacy, all
     while he never got out of his bed, his little sister was still happily sleeping down the hallway, and his
     mother didn't have to get out of her sweats to drag 2 kids out of bed (her husband was out of town) to 
     go to an urgent care. I have to admit, I felt a little like Doc Baker, pulling up in a rainstorm on his
     horse and carriage, to take care of sick little Nellie Olsen.  OK, so there were a few minor differences,
     like the fact that Doc Baker didn't have a GPS system (or a car, for that matter), Nellie's dad was in the
     barn throwing hay, not in Japan on business, and the treatment of choice was something like quinine
     and rubbing alcohol instead of a bubblegum-flavored antibiotic, but hey, it was close enough!
I truly LOVE what I do for a living, and it's stories like these that make it all the more fun!  I may have an
unconventional practice, and I may throw people for a loop when they hear what I do, but I wouldn't go back to traditional practice ever again.  This is way too entertaining!
 

Second-hand smoke around kids: One more reason it's BAD NEWS!

As we were leaving the grocery store yesterday afternoon, my 4 year old noticed two people standing outside the store smoking.  In a most genuine display of admonishiment and judgement that only a preschooler can display without being considered politically incorrect, she says to me wide-eyed, "Look Mom!  Those people have SMOKERS!"  Smokers, of course, being her term for cigarettes.  Being within earshot, they glanced over at her, and we exchanged sheepish grins.  I didn't proceed into a long-winded lecture, and I fought back the temptation to follow up her comment with some audible remark about how smoking is very bad for a person's health.  No, in that moment, I took the high road, kept my opinions to myself, and let the words of a 4 year old speak for themselves...in the end, probably much more poignant than any disapproving glance or stare from me would have accomplished.
This week, a new study was published in the journal, Pediatrics, that reveals that children who are exposed to second-hand smoke have a 50% increased likelihood of suffering from things like ADHD, learning disabilities, and other neurobehavioral problems.  It's not rocket science that smoking is bad for your health, but now we have yet one more reason to back up what we've been saying for years:  Adults' smoking is BAD FOR OUR CHILDREN'S HEALTH!  Arm yourself and your kids with this news, and feel free to share the endearing comments that your own children deal out to smokers everywhere!

Vasovagal Syndrome - a.k.a. When Kids Pass Out!

I was at my daughter's swimteam practice the other morning, when I overheard a conversation between two moms about one of their sons who had passed out during a painful office procedure at a doctor's office the previous day.  He was fine, but it sounded pretty scary. 
About 3 weeks ago, I made a houescall to a sweet little 8 year old girl who had passed out while playing miniature golf with her family.  She, too, was fine, but as you can imagine, the family was more than a little distressed over the event.
While at a monthly bunco girls' night gathering a while back, one of my friends passed out.  Granted, we had been enjoying an awesome bottle of red wine (okay, and someone also brought a pitcher of margaritas), but trust me...the half a glass of wine that she had sipped on at that point in the night certainly had nothing to do with her passing out.  (Although we laughed later that to a casual observer, seeing a bunch of women flittering about in a panic, one passed out on the couch, another knocking over her wine, some in tears, and another rushing off to call her husband the surgeon on his cell phone, the scene probably would have looked like something off of Housewives!)
Just last night, while having a conversation with some running buddies, I learned that one of them had a tendency to pass out for no apparent reason.  His doctor had told him he had some "condition" but he couldn't remember the name of it.
"Vasovagal syndrome" I exclaimed!  "That's it!"  he said.
And so....since it seems like every friend, child's playmate, patient, or neighbor I know has had some experience with this, I figured that it might be a worthwhile topic to post about!  If you have a child that has had something like this happen and can relate, or if you know of someone who has, feel free to chime in with your own input! 

The term, "vasovagal syndrome" comes from the vagus nerve, which is a large nerve running the length of the body, that when stimulated, causes a person's blood vessels to suddenly relax, and good-old-fashioned gravity takes over, pulling blood downward, away from a person's brain, and presto, they are on the floor!  Often children will describe "tunnel vision" right before they pass out.  They usually "come to" within a matter of seconds, but the alarming part is that sometimes as their nervous system is "re-setting", they will have little twitches and eye movements, that can be mistaken for a seizure.  With vasovagal syndrome, the person awakens pretty quickly, and other than feeling a little tired, they're usually feeling fine a short time later. 
If it happens, the most important thing for observers to do, is to remain calm.  Once the child begins to wake up, ask them if they are hurt anywhere, and have them lie on their left side for a few minutes before they try to sit up.  Contact your pediatrician, to let them know that it happened, but most likely, there won't be any need for testing unless it starts to happen fairly frequently.  Vasovagal syndrome is not serious and is extremely common.  Sometimes it can occur if children haven't been drinking enough in the summer heat, and their blood pressure drops a little.  My oldest daughter had it happen in the middle of Harris Teeter, right after she accidentally pinched her finger in the cart.  (Pain is often a trigger).  Sometimes extreme emotion will trigger a person to pass out.  (Think Scarlet O'Hara).  And sometimes, it happens for no good reason, which is the most frustrating scenario of all!  The bottom line, however, is that scary as it may be to witness, it isn't dangerous, and it's certainly no cause for panic. 
Happy 4th to everyone!!

Food Allergies - The Latest Buzz

I can't turn on the news or look at my homepage the last day or so, without reading the headline "Food allergies more common than previously thought!"  Gee, do you think so?  Well, if my kids' classrooms are a reflection of the rest of the country, I'd say this study sort of stated the obvious, right?  This past year, each of my 3 children had at least one, and in one classroom there were six kids with food allergies.  Peanut is certainly the most common, and the most talked about, but the other ones ranged from milk to eggs to wheat to treenuts.  All the while througout the school year, the other parents and I would remark to each other about how none of us remembers having this many kids with food allergies when we were growing up. 

The recent study that's making all the headlines was the biggest food allergy study to date in the U.S.  It included 36,000 kids and revealed that about 8% of kids in the U.S. suffer from food allergies.  This is double what was previously found in older studies.  What's even more interesting than the flat statistic, is examining how the data was collected.  Survey phonecalls were placed randomly to families asking about whether or not their children had food allergies.  If parents answered "yes" to this question, then the researchers followed up by asking "to what foods".  Parents were also asked if their child's food allergy had ever been diagnosed by a physician, and they were also asked to list what their child's symptoms were.  From there, researchers "weeded out" any answers that seemed less than valid.  (Example:  If a parent stated that their child became bloated after drinking milk, but had never been tested or formally diagnosed with a milk allergy, this child was not counted.) 

So, what should we take away from this study?  It's really hard to know.  Since the information was based on parent-report only, it's impossible to know if all of the food allergies reported were accurate.  Some say that the method of collected the data makes the results of the study skewed, overestimating the prevalence of food allergies in children.  In my world, it almost doesn't matter whether the national prevalence of food allergies is 8% or 4%, if my child is one of the ones with food allergies.  These families suffer tremendous burden, whether it be having to be their child's advocate at school, to ensure the classroom and the lunchroom is a safe place for their child to be, or whether it's the burden of having to be mindful at every restaurant, birthday party, and neighborhood cook-out.  There are lots of theories floating around about why there seems to be an increasing prevalence of food allergies from one generation to the next.  No definite explanation has been agreed upon.  One thing that we can all agree upon, however, is that food allergies constitute a real, serious health issue for the children in this country.

UVA rays, UVB rays - What's a litte one to do??

At least once a day, this time of year, I get asked a question or two about sunscreen use in kids.  What does that SPF number really mean?  Are sunblocks like zinc oxide safer than other kinds of sunscreens in kids?  Can you put sunscreen on a baby under the age of 6 months?
Here is my best synospsis of the ins and outs of sunscreen use in babies and kids.  Enjoy!

1.  First, understand the difference between UVA and UVB rays.  UVA rays are the sun's wavelengths that cause tanning.  It used to be thought that UVA rays were only bad because they caused premature aging of the skin.  Now we know that UVA rays also pose skin cancer risks.  UVB rays are the ones that cause painful, red sunburns, and these are the rays that have long been associated with increasing skin cancer risk.  The take-home message?  Both UVA and UVB rays are potentially damaging to your skin, and both can lead to skin cancer, so look for a sunscreen that provides "broad-spectrum" protection against both of them.

2.  SPF rating is a standardized way of describing how long someone can be out in the sun, before they get a sunburn.  This rating system was really designed to make people aware about their risks and protection from UVB rays.  An SPF of 15 means that a person can be outside, exposed to sun for 15 minutes, before they would start to develop a sunburn.  An SPF of 60 means it would take 60 minutes.  Of course, there are other factors that affect this, like, how well you applied the sunscreen and if you are swimming or sweating and therefore losing some of that protection.  SPF really does mean something, so the higher, the better!

3.  What about safety of these chemical sunscreens in kids?  Sunscreens that provide this "broad spectrum" protection against both kinds of rays are safe to use in kids.  Zinc oxide (the thick white paste that our mothers used to lather on our noses) is a physical blocker to the sun.  It does not provide full-spectrum protection, but for some kids with skin sensitivities to some of the other sunscreens, it's a good alternative.
 
4.  What about use of sunscreen in babies under 6 months?  For years, the recommendation was to avoid putting sunscreen on very small babies.  While it's still the recommendation that small babies avoid exposure to the sun during peak hours (between 10 and 4), and if at all possible, should be kept in a shaded area, we recognize that life's not always that simple!  My youngest was only 3 weeks old when we dragged our newly-annointed family of 5 to the beach that year, and (gasp) yes, I had her out at the beach with me for short periods of time under our little tent.  There will inevitably be times when young babies will be in a position of potential sun exposure, and if and when that happens, it's perfectly fine to apply a thin layer of sunscreen.  Avoid the hands (because they're sure to be in their mouths!) and wash it off when you come back inside, but otherwise, don't panic or feel like you're breaking the rules. 

So, as you gear up for another summer with fun in the sun, hope this sheds some light on the sunscreen issue for you!  Happy summer!

Can genetic testing predict a future soccer star?

My oldest daughter just made the pre-challenge soccer league.  In order to qualify for this, the girls have to try-out and be evaluated against other girls their age, so we were quite proud of her for making this step-up from recreational soccer!  For a split second, I'll admit, I fast-forwarded about 10 years, and envisioned her as the next Mia Hamm...complete with soccer scholarship to Chapel Hill and all!  Then, reality quickly pulled me back down to earth, and although my mother's pride wasn't squelched, my grandiose and warped daydream thankfully came to a grinding halt!
That same day, I listened to a discussion on NPR about the latest fad of retail genetic testing kits that are being marketed to parents, much like me, as a way of predicting their children's athletic prowess.  For $200, these kits are being offered to parents, with the claim that they can identify certain genetic markers that can indicate where a child's athletic strengths lie.  The idea being, that if you identify the next Mia Hamm at the age of 8, you'll somehow be able to hone those skills earlier, and maybe even more importantly, you'll make certain that she doesn't miss her "calling", and you can sign her up for every soccer camp, clinic, and league in your area early on. 
So just how do these test kits supposedly identify these genetic markers for athletic gifts?  In a nutshell, there are certain genetic combinations that are linked to things like muscle endurance, speed, or strength, and these companies argue that when these traits are identified early on, they are able to predict which kids will go on to be the fastest or the strongest, and from that information, parents will be able to determine which sports their kids are best suited to.  Sound a little fishy?  It's not just fishy, it turns out, it goes against good old common sense.  On MULTIPLE levels.  Never mind that there are so many more variables in a child's life that determine whether or not they will go on to become a super-star athlete beyond just having the DNA required for it.  Never mind that things like personal motivation, interest, family dynamics, life circumstances, exposure, and millions of other day to day experiences in a child's life undoubtedly shape their futures, including their future athletic endeavors.  Never mind that their are hundreds, if not thousands, of other genetic markers associated with traits that can be useful and even critical in certain sports, that aren't being tested for with these kits.  Ever see the movie Rudy?  Think his genetic test at age 5 would have identified him as being a future Notre Dame football standout?  Never mind all of these common-sense arguments against why these tests might not be able to do what they claim they can do.  NOW consider for a moment the oddity of pre-determining a child's destiny.  Is it a parent's responsibility to maximize their child's potential?  Or is a parent's real responsibility to love, support, and nuture their child, so that their child has the confidence to find their own way in the world?
I know where I stand on the issue.  If we do have the next Mia Hamm, I for one would like to find out when the rest of the world does.  Where do you stand?

Infant Sleep

I love, love, love when people ask me about sleep in babies/children!  Not only do I love to talk about it, because I enjoy being able to "rescue" people from their sleepless fog, but also because I've probably lived through just about every sleep issue imaginable with my one or more of my own kids!  I feel like that gives me some "street cred" when it comes to dishing out advice about this topic!  Since I had a question directed at me most recently from a new mom needing a "refresher" on how to create good sleep habits for her infant, I'm going to focus on that age group. 
First off, let me say, that I think every parent on the planet needs to read what I consider to be the "sleep bible":  It's a book by Marc Weisbluth called "Healthy Sleep Habits, Happy Child" and it has a wealth of information on the subject.  On the flip side of that, I do recognize that every baby and every family is different and there is certainly not a one-size-fits-all method to addressing sleep issues in infants and children.  Here are my top 3 points that I do feel are non-negotiable.  Not only are they non-negotiable in my mind, but they are, I feel, essential, to getting off on the right foot with encouraging good sleep habits from day 1:
1.  Never put your baby in bed to sleep with you.  Beyond the extremely dangerous nature of this practice, I have other issues.  Yes, I know that the family-bed is a well-accepted practice in almost every other country and culture around the world except in mainstream America and I know that people say they don't worry about the risk of suffocation because they make sure there are no loose pillows or heavy bedding around the baby that would put them at risk, but that's a risk that I'm not willing to take.  This is one point that I will never back down on.  Risk of suffocation aside, I have other issues with having your baby in bed with you, and that's this:  Unless you plan on having a family-bed indefinitely, don't start it to begin with.  Sure, we've all heard the occasional story of that 5-year old, who finally decided on his own, that it was time to sleep in a big-boy bed, but that's not the norm.  The norm, is that any child who's been allowed and even encouraged to sleep with their parents from an early age, will continue to want this arrangement for a very long time.  Don't be under the misconception that you'll "just do this while he's little."  Unless you are buying into the family-bed as a long-term solution, don't go down that road.
2.  Swaddle your infant!  I have never (repeat never) met a baby who didn't love to be swaddled.  I can't tell you the countless parents who have said to me, "Oh not my baby.  We tried swaddling but he just kicked out of it and really seemed to hate being constrained like that."  To those parents, I say, nonsense!  You're just not giving it a good enough shot.  If your baby seems to be one of those babies who tries to kick their way out of being swaddled, try this:  The next time you are ready to lie your baby down for a rest, swaddle him tightly.  (I love those velcro blankets that I call the swaddling-for-dummies blankets).  After you swaddle him, don't immediately lie him down, hold him in your arms for a while and let him settle down some.  My son used to immediately fight and punch at the swaddle, but I would just hold him tightly up against my chest, keeping the swaddling blanket snuggled around him.  It sometimes took 5 or more minutes for him to stop fighting it, all the while as I held him tightly in my arms and didn't let him out of the swaddle, but then, like magic, I'd feel his whole body relax, and from that point on, he was off to sleepy land!  Babies instinctively get more "fired up" the more tired they get, and they often need help settling down.  Swaddling not only helps them do this, but it mimics the enclosed feeling of being in utero, and also takes the startle reflex out of the equation.  The startle reflex, or the Moro reflex, is the reflex in infants, where their arms and legs will often unexpectedly flail out to the sides, usually at the most inconvenient of times...say, for example, when you are trying to gently lie your sleeping baby down in their basinette so you can get a little rest yourself.  Swaddling takes that reflex off the table, so to speak.  I recommend swaddling up until about 4 months of age, or until they are able to flip over...once they achieve that developmental milestone, it's time to stop swaddling.  It's also never too late to start.  If you haven't been swaddling up to this point, and your baby is, say, 6 weeks old, you can absolutely start now!  That "settling down" period may take a little longer, but just be patient.  They'll love it in time.
3.  Aim for a sleep-wake-feed-play-sleep-wake-feed-play pattern.  This is drastically different from a feed-sleep-wake-play-feed-sleep-wake-play pattern.  Why??  Because with the first pattern, you're not teaching your baby to associate eating right before sleeping, and that will be key on down the road, when you're trying to get them to sleep through those middle-of-the-night feedings.  Too often (myself included), we fall into the second pattern, where we nurse our babies to sleep.  It's easy, right??  They naturally want to doze off!  It may be easy in the short term, but trust me - in the long term, you're setting yourself up for problems!

That's enough for now!  Here's a link to an interesting study that actually looked at the average age at which most babies start sleeping through the night.  You might be surprised (and relieved) to learn how early this usually happens, when you follow a good plan!

http://www.webmd.com/parenting/baby/news/20101025/most-babies-sleep-through-night-at-3-months

Controversy in screening for sudden cardiac death in student athletes

Most of us saw the gut-wrenching coverage this past week of the student athlete in MI who collapsed on the basketball court moments after hitting the game winning shot for his highschool basketball team, and died later at the hospital.  It turns out that he had an undiagnosed heart condition, known as dilated cardiomyopathy.  I'm not sure how it's possible to read something like that, if you're a parent, and not have a visceral reaction to it.  It's every parent's worst nightmare.  Inevitably, discussions ensue in the aftermath of something like this, going back and forth about whether something could have been done to prevent it.  Was there some way his physician should have known?  Were there warning signs?  Should everyone with children involved in sports be concerned?  How do I know if my child has silent heart disease? 
These exact questions have been the center of much controversy in the pediatric and pedatric cardiology fields around the world.  Some countries, like Italy, have mandated universal screening with a 12-lead EKG before sports participation.  Other countries, like Denmark, have conducted studies looking at whether a universal screening program would be effective in reducing deaths, and have found no proven benefit.  The most recent, and comprehensive study to date, done in Israel, addressed this again, and found no proven benefit to a universal screening program.  For anyone interested, here is a link to the study details:
http://www.medscape.com/viewarticle/738577?src=mpnews&spon=9
I am curious to get some parent feeback about thoughts, opinions, and comments regarding this controversy.  Currently in the U.S., the standard of care is pre-participation screening with a history and physical only.  Share your opinions about whether or not you think universal EKG screening should be mandated in the U.S.

There are only a few absolutes in this life...

...and one of them is that fevers, vomiting, and ear infections in kids always have a nack for showing up after 5pm!  After leaving the home of one very sweet little boy tonight, who's late-night ear ache was yet one more piece of evidence supporting my theory, I was inspired to post a few things about ear infections.  Here you go:
 - The #1 sign of an ear infection in a verbal-aged child?  The complaint of isolated ear pain.  That may sound ridiculously obvious, but it's absolutely true.  A cold can cause some ear plugging and pressure, but there's usually no difference between sides.  An ear infection, however, tends to cause severe pain, isolated to the side of the infection, often so severe that the child awakens from sleep in tears.  One little girl I saw recently described the pain as something "drilling in my ear."  If you're an adult who has had one of these gems of an infection any time recently, you can appreciate how spot-on that little girl was with her description of how awful the pain is.
 - The #1 sign of an ear infection in a pre-verbal child?  It's anybody's guess.  That's not a lie.  Ear tugging, fussiness, fever, decreased appetite - none of these symptoms are reliable indicators of an ear infection - it's impossible to predict without having their eardrums examined.  There are also always those stories of people who's children are examined for an entirely different reason, and are found to have an ear infection, much to their shock and amazement.  It happens!
- Risk factors for repeated ear infections include: age under 2, having family members who smoke, being in group daycare, bottle-propping, and poorly controlled allergies. 
- Treatment of ear infections in a pre-verbal child consists of a standard course of antibiotics.  For older children, if the pain is mild and manageable with OTC pain-relievers, it's perfectly acceptable to watch and wait without giving antibiotics.  The theory here, is that if a child is verbal enough to reliably localize and express their pain, they'll be able to tell you if it's getting worse, in which case you could start the antibiotic at that point.  Not everyone chooses to go that route, though, and depending on the severity of the infection, the child's previous history, and other factors, your doctor may choose to treat your older child's ear infection with an antibiotic immediately, instead of waiting.

For more information on ear infections, here's a link to a more in-depth article:

http://www.parents.com/baby/health/ear-infection/what-you-need-to-know-about-ear-infections/?page=3

Clean eating!

Since I'm on the topic of healthy eating, I wanted to share a list of fruits and vegetables that historically have lower pesticides used in the growing process.  "Organic" and "Pesticide-free" aren't always the most affordable choices in the supermarket, and if you shop at bulk-membership warehouses (like I do, and most of my friends with multiple kids do), those can be hard to find!  Here's a list of ones that you can feel good about, regardless of their label:
1. onions
2. avacado
3. sweet corn
4. pineapple
5. mangos
6. sweet peas
7. cabbage
8. kiwi
9. asparagus
10. canteloupe
11. watermelon
12. eggplant
13. sweet potato
14. grapefruit
15. honeydew
Hope you find this list helpful - there's something from just about every season, so happy clean eating!

Jamie Oliver - Where are you...

when I need you??!!  Before bed last night, my 8-year old daughter begged me to let her buy school cafeteria lunch today.  "I haven't bought lunch since before Christmas!" she declared.  Knowing that was true, I caved, and gave her the okay, but as soon as I did, all I could picture in my head was that frightening food the cafeteria labels as "trail mix."  The first few times she came home last year and told me she had "trail mix" at lunch, I have to admit, I was kind of impressed.  Trail mix seems like a pretty forward-thinking good protein-packed snack to be offered in a school cafeteria.  Even more impressive, was the fact that my daughter had reportedly chosen this, over, say, a chocolate chip cookie.  Patting myself on the back for raising such a good eater, I spent the next several weeks in blissful ignorance, until...
I discovered that "trail mix" was actually a little plastic cup filled with marshmallows and froot loops, and maybe a raisin or two thrown in there to make it look good!  If you're a parent of an elementary-aged child, join with me in screaming out loud a collective, "WHAT???!!!"
And, so began my distrust of the school lunch menu and my general suspicion that things like "milk", "chicken", or "green beans" might actually be code for other things!  So, this morning, I did what any other self-respecting parent would do, and served her a healthy breakfast of fruit and oatmeal, as if that would somehow cancel out what she'll be eating in just a few hours from now.  Ahhhhhhhh!
So, with that in mind, I turn back to Jamie Oliver, renowned chef and host of "Food Revolution" (which by the way filmed in Huntington, WV, very close to where I grew up in WV), for some good tips on keeping things healthy in your family kitchen.  These tips come from an interview he gave to MSN recently, so in case you didn't catch it, here you go:
1.  De-clutter your kitchen - allow it to be the space that it was intended to be, where you prepare food.  Don't fall into the trap of having your kitchen be the free-for-all space where you can find anything and everything except the cutting board.
2.  If you don't want your family eating it, don't buy it!!  I've been saying this one for years!  If you don't want your kids to have sugary snacks and chips, don't buy them, put them on the shelf, and then expect them not to crave them!
3.  If you don't know how to cook, spend some time learning a few simple cooking technique from a friend, family member, or neighbor who does know how to cook!  Healthy foods aren't hard to prepare, but you do have to prepare them (as opposed to most unhealthy foods that come conveniently pre-packaged and require almost no cooking skills.
4.  Have a goal to cook fresh foods at least once a week.
5.  Teach your kids about the dangers of unhealthy foods now.  What good does it do us as parents to hound them about wearing their bike helmet, if we let them come inside when they're done and pound down a bag of chips that's going to lead to things like obesity, heart disease, and diabetes on down the road!

If you'd like to sign Jamie Oliver's petition to improve the condition of school lunch in your area, click the link below!
http://www.jamieoliver.com/campaigns/jamies-food-revolution/petition

"In the great green room, there was a telephone, and a red balloon...

...and a picture of the cow jumping over the moon."  Who doesn't have the entire Goodnight Moon book memorized??!!  There was a time in my early mommy years when I thought I might never be able to go for a run again without inadvertantly having those hypnotizing words pop into my head and play over and over and over!  (Now it's the lyrics to Justin Bieber songs, but I digress...)
I read an interesting study this morning out of Loyola University Health Systems talking about the impact of reading on childhood development.  It's no big secret that reading to children is good for their cognitive development, but what was interesting was how they were able to break it down by age-group and derived benefit.  For example, they found that for infants, parents reading to them is a very valuable experience, but it turns out it's not so much what you read, as how you read it.  Have an important work report that you are saddled with, but suffering from the mommy-guilt that we all suffer from - you know, the guilt that you're not spending quality time with your infant when you're home in the evenings?  No worries - just read that work report out loud, in a sing-songy voice, and your baby will love it just as much!  As babies morph into toddlers, they love faces, so books with pictures of other babies, children, and even adults are always favorites.  A photo album will even do, as long as you narrate the pictures that you're looking at.  Narration and interactive reading, where you point to pictures, ask your child questions, and have dialogue mixed in the middle of reading, have been found to be extremely beneficial to children's language development.  So, if you're a Type A Personality, like me, you're just going to have to get over the fact that interruptions mid-sentence are part of the process!  Your kids may even (gasp) want to shut the book and get a new one after you've only read the first two pages!   It's not a sign of ADHD...it's a sign that they're enjoying books, and wanting a rich literary experience!   As children move through the toddler stage, they love repetition.  Hence, the Goodnight Moon reference.  If they want to read the same book over and over again, don't worry that they're not getting exposed to enough variety.  It's very normal for them to want to read the same book every night for two weeks in a row.  Go ahead and just surrender to the fact that you'll always be able to finish those words by heart:
"....goodnight stars, goodnight air, goodnight noises everywhere."

A group that's doing great things to promote literacy in children: http://www.readingfoundation.org/
A great idea for a birthday gift for the baby or toddler who has everything?  Donate a book in their name to a local library, to their preschool classroom, or childcare center!

When will this sick winter ever end??

If you're feeling like you need to Clorox all of your walls, floors, and doors, and you're contemplating whether or not you need to develop, patent, and mass-market an antibacterial lotion that you could just coat your children in from head to toe, you're not alone!  This winter has been pretty brutal in terms of childhood illnesses.  Thankfully, it's been brutal in the not-life-threatening-but-just-pesky-enough-that-I-can't-get-all-of-my-kids-healthy-at-the-same-time sort of a way.  Nonetheless, it's frustrating - I know first-hand with all of the illness that's been floating through my 3-kid household.  When a trying sick season attacks your family personally, it's tempting to scream, "What am I doing wrong???!!"  The first reality, is that every year, from October through March, we see an upswing in typical childhood illnesses.  I remember in med school when I rotated through pediatrics for the first time.  The doctors I trained under kept referring to "RSV Season" and "influenza season."  I remember thinking, "Pediatric illnesses are so bad that they actually refer to on them as seasons??!"   The second reality, is that it doesn't take much to make a so-called perfect storm.  Here's what I mean:  your daughter started preschool this year, your son suddenly developed an obsession with sticking his fingers in his mouth , you took that trip to visit the cousins up in NY and they were all sick, your kids got invited to exactly 57 birthday parties in a span of 3 weeks...the list could go on and on, but the bottom line is this:  If you've had the misfortune of suffering from a particularly long winter sick season in your home, shed the guilt, quell the worry, and wear it proudly as a badge of parental honor that this was your year, and next winter it'll be the family down the street who's children haven't missed a single day of school this year.  It's the law of averages!

Lastly, I thought I'd share some information on the use of temporal artery thermometers.  If today's post applies to your family, and if, like my kids, your children look at you sideways when you suggest that you need to check their temperature, you may be interested to read this recent study on temporal artery thermometers! (Right-click on the link to take you directly to the page).

http://appliedclinicaltrialsonline.findpharma.com/appliedclinicaltrials/Phase+News/New-Study-Finds-Temporal-Artery-Thermometry-Equiva/ArticleNewsFeed/Article/detail/707862