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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.


Thursday, August 4, 2011

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!
 

Monday, July 11, 2011

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!

Thursday, June 30, 2011

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!!

Tuesday, June 21, 2011

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.

Thursday, June 2, 2011

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!

Wednesday, May 25, 2011

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?