Thursday, January 26, 2012
Flu - Stay away!
Lots of people have been asking about whether or not I've been seeing lots of cases of influenza lately. My answer? Not yet. Every year, in the Charlotte, influenza starts to rear it's ugly head sometime after the 1st of the year, and usually lasts into March. Already 3 weeks into January, we're still not seeing many (if any) cases of influenza, which is a great thing, but certainly not an indicator that we're out of the woods. Experts are expecting the peak of influenza season to hit us sometime in February of this year. So, is it time to panic? No, but it is time to start thinking smartly. I've made no secret of the fact that I'm a huge supporter of all children over 6 months of age getting a flu shot, so if you haven't done that yet, there's still time. Also, get outdoors and get your kids outdoors - the weather in Charlotte has been pretty mild lately, so put off that homework until a little later in the afternoon and give them some good outdoor play time after school. There is strong evidence to support that fresh air has positive effects on the body's immune system, and that being indoors in a closed space for long periods of time is one of the biggest factors in terms of why influenza spreads so easily during the winter months. I'll keep everyone posted on influenza activity in the Charlotte area over the coming weeks. In the meantime, make sure those kiddos are getting plenty of fresh fruits and vegetables, plenty of exercise, and plenty of sleep....the three things that I consider to be the core components to good health!
Friday, January 6, 2012
Sleepwalking
The first time my oldest daughter sleepwalked, my husband and I were totally unaware that was what was happening. We'd tucked her into bed about 2 hours before, and we were just getting ready to head upstairs for the night ourselves, when we rounded the corner of the hallway downstairs to find her standing in the foyer, seemingly wide awake. Once we landed (we had both jumped about 10 feet in the air, we were so startled to see anyone standing in the foyer), we immediately began to investigate, "What are you doing up? Why are you just standing there? Did you have a bad dream?" After we realized that she was clearly not awake, we quietly escorted her back to her bed. The next morning she had absolutely no recollection of the event.
Sleepwalking falls into a category of conditions referred to as parasomnias. Parasomnias includes everything from sleepwalking to sleeptalking to sleepeating to night terrors to bedwetting to teeth grinding. Parasomnias are extremely common during early childhood (from about 18 months through age 7 or 8) and as children get older they are likely to outgrow the problem, usually by early to mid teenage years. Of course, some adults still suffer from nighttime walks through the house, but that percentage is fairly small. So what causes parasomnias? Well, it's a disruption in one of the stages of sleep (there are 5 stages of sleep that we all cycle through about 4-5 times a night). Sleepwalking typically occurs during stage 3 of sleep, which often happens about an hour or two after falling asleep. It tends to run in families, so if one or both of the parents had a history of sleepwalking or another parasomnia themselves, the child is more likely to have issues as well. Aside from genetics and being a normal phenomenon in childhood, there is no specific cause that has been identified. Sleepwalking is not caused by children going to bed too late or too early, being sick, having emotional trauma, having low iron or other vitamin deficiencies, or any other identifiable trigger. The only concern with sleepwalking is the obvious safety issues that arise when a child is prone to wandering out of their bed at night. Here are a few tips that parents might consider, if you have a child who sleepwalks:
1. Consider installing a door chime style alarm on his/her bedroom door, that would alert you when the door is opened in the middle of the night.
2. Remove any objects from the child's room that might be potentially dangerous (sharp objects, etc.)
3. Keep windows in the entire home locked, not just in the child's bedroom.
4. Keep external doors locked in the entire home.
5. If a child is prone to getting into a particular part of the home (the pantry, the refigerator, a particular closet, for example), consider putting a child-proof lock on the doors of those locations.
If you're interested in a much more in-depth look at this issue, here's a link to a great overview article:
http://www.medscape.com/viewarticle/491438_8
Sleepwalking falls into a category of conditions referred to as parasomnias. Parasomnias includes everything from sleepwalking to sleeptalking to sleepeating to night terrors to bedwetting to teeth grinding. Parasomnias are extremely common during early childhood (from about 18 months through age 7 or 8) and as children get older they are likely to outgrow the problem, usually by early to mid teenage years. Of course, some adults still suffer from nighttime walks through the house, but that percentage is fairly small. So what causes parasomnias? Well, it's a disruption in one of the stages of sleep (there are 5 stages of sleep that we all cycle through about 4-5 times a night). Sleepwalking typically occurs during stage 3 of sleep, which often happens about an hour or two after falling asleep. It tends to run in families, so if one or both of the parents had a history of sleepwalking or another parasomnia themselves, the child is more likely to have issues as well. Aside from genetics and being a normal phenomenon in childhood, there is no specific cause that has been identified. Sleepwalking is not caused by children going to bed too late or too early, being sick, having emotional trauma, having low iron or other vitamin deficiencies, or any other identifiable trigger. The only concern with sleepwalking is the obvious safety issues that arise when a child is prone to wandering out of their bed at night. Here are a few tips that parents might consider, if you have a child who sleepwalks:
1. Consider installing a door chime style alarm on his/her bedroom door, that would alert you when the door is opened in the middle of the night.
2. Remove any objects from the child's room that might be potentially dangerous (sharp objects, etc.)
3. Keep windows in the entire home locked, not just in the child's bedroom.
4. Keep external doors locked in the entire home.
5. If a child is prone to getting into a particular part of the home (the pantry, the refigerator, a particular closet, for example), consider putting a child-proof lock on the doors of those locations.
If you're interested in a much more in-depth look at this issue, here's a link to a great overview article:
http://www.medscape.com/viewarticle/491438_8
Wednesday, January 4, 2012
Will the real dose of infant tylenol please stand up?
I've gotten more than a few calls lately from parents who are rightfully confused about the recent change in the formulation of infant tylenol. The old infant tylenol drops (with that little awful medicine dropper attached to the lid of the bottle) are now a thing of the past.
But...to confuse things as much as possible, many stores are still stocking the old formulation, sometimes right beside the new liquid formulation, not to mention that many parents still have the old infant drops in their medicine cabinets at home. If you count yourself among the many confused parents out there, here's the skinny on the new infant tylenol dosing guidelines. READ THE FRONT OF THE BOX OR BOTTLE THAT YOU HAVE AND MATCH IT UP TO ONE OF THE CHARTS BELOW.
Infants’ Acetaminophen
Concentrated Drops – "Old" Concentration
80 mg/0.8ml
Infants’ Acetaminophen
Oral Suspension – "New" Concentration
160 mg/5ml
But...to confuse things as much as possible, many stores are still stocking the old formulation, sometimes right beside the new liquid formulation, not to mention that many parents still have the old infant drops in their medicine cabinets at home. If you count yourself among the many confused parents out there, here's the skinny on the new infant tylenol dosing guidelines. READ THE FRONT OF THE BOX OR BOTTLE THAT YOU HAVE AND MATCH IT UP TO ONE OF THE CHARTS BELOW.
Infants’ Acetaminophen
Concentrated Drops – "Old" Concentration
80 mg/0.8ml
Weight (lb) | Age (mos) | Dose (ml) |
6-11 lbs | 0-3 mos | 0.4 ml |
12-17 lbs | 4-11 mos | 0.8 ml |
18-23 lbs | 12-23 mos | 1.2 ml |
24-35 lbs | 24-36 mos | 1.6 ml |
Oral Suspension – "New" Concentration
160 mg/5ml
Weight (lb) | Age (mos) | Dose (ml) |
6-11 lbs | 0-3 mos | 1.25 ml |
12-17 lbs | 4-11 mos | 2.5 ml |
18-23 lbs | 12-23 mos | 3.75 ml |
24-35 lbs | 24-36 mos | 5 ml |
Tuesday, January 3, 2012
New year, new resolutions, new villages
Yes, the calendar officially flipped over to 2012 this past weekend. More importantly, for me, my oldest baby is getting ready to turn 9 (gasp!), I just signed up for my 7th marathon this spring (yikes!), my mother is undergoing a kidney transplant in 2 weeks (hurray!), I'm gearing up for a certain, ahem, milestone birthday this year (ahhhh!), and I officially closed the book on the first full year of the life of Pediatric Housecalls (roar!). As I fight the urge to feel overwhelmed at all that life has in store this coming year I find myself looking forward to finding new ways to connect to others....to create that "village" that sustains so many of us. And I guess that since I personally anticipate calling upon my own "village" for help a lot this year, I'd like to make a better effort at contributing to that collective "village" that I imagine all of you rely on to help you make the best decisions, accomplish your greatest dreams, and move forward with ease and confidence. So here you go...my renewed committment to sharing information, and connecting to my patients and families. I plan on meeting you all here more often this year, and I hope that you'll consider me part of your village.
Tuesday, November 8, 2011
Is Tylenol safe to give to children with asthma?
Here are the facts:
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.
- 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.
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.
Wednesday, September 7, 2011
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!
Friday, August 19, 2011
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.
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.
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