Keeping Kids Healthy by Mary Jo Singleton

Keeping Kids Healthy

Keeping Kids Healthy A collection of informative and practical articles

Dr. Sally S. Robinson Dr. Keith Bly

ÂŠ Copyright 2007 Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas All rights reserved. This book may not be reproduced, in whole or in part, in any form, except by reviewers, without the written permission of the publisher. Book design and cover art: Mary Jo Durso Singleton

Keeping Kids Healthy

Second printing - 2007

Keeping Kids Healthy

Foreword Dear Friends,

From time to time, a special opportunity presents itself to us here at UTMB Children’s Health. It gives us a chance to share the remarkable talent which we’re so very proud of; health care providers whose passion it is to care for children. This book is one such opportunity. Authored by two extraordinary pediatricians, Dr. Sally Robinson and Dr. Keith Bly have made it their life’s mission to make children healthier and happier. Their dedication to this book is proof of that. It contains articles, hints and tips which will help parents and their little ones lead healthy, safe and productive childhoods.

This opportunity would not have been possible without the love, support and generosity of Mr. and Mrs. Irwin Herz, Jr. Fervent supporters of our hospitals, clinics and community, Buddy and B.J. Herz, as they are better known, are champions of children’s health and welfare. They’ve served on numerous local committees and continue to lead the charge on ensuring that the children of Texas remain a top priority. And, it just so happens Dr. Robinson and the Herz’s have forged a tremendous relationship … she was, after all, their children’s pediatrician!

Drs. Robinson and Bly began penning these columns in the late 1990’s. They did so because they felt a strong sense of community involvement. As health leaders in the area, they wanted to educate parents. Their only hope has been and continues to be that they’ve taught parents and saved lives. I think they have. UTMB Children’s Hospital-Exemplary Science, Extraordinary Heart. Enjoy! Warmest regards,

Lawrence Stanberry, M.D., Ph.D. Chairman, UTMB Department of Pediatrics Director, Sealy Center for Vaccine Development

Keeping Kids Healthy

About the Authors

ally Robinson, M.D. is a Professor of Pediatrics in the Division of Children’s Special Services and has served as Medical Director of Children’s Hospital here at University of Texas Medical Branch. Dr. Robinson has been a member of the UTMB Pediatric faculty since 1976, and since her appointment at the institution, she has served many roles, including Medical Director for Pediatric Rehabilitation Services, Division Chief of both Special Services Division and Inpatient Division, and the Director of the Chronic Care Clinic and Special Services Clinic. Throughout her career she has served as an advocate for children with a variety of medical conditions and societal backgrounds throughout Texas and around the world. Through her current interest in telemedicine, she strives to help children receive care through advanced technology when their families and doctors may not have the ability to physically transport supporting machinery and patients a long distance to a major hospital. Dr. Robinson holds memberships in many scientific societies, including the Texas Pediatric Society, the Galveston County Medical Society, and the American Academy of Pediatrics. In 2001, Dr. Robinson became the inaugural holder of the Q.T. Box Professorship Award for her dedication to her patients and commitment to her students.

eith Bly, M.D. is an Assistant Professor in Pediatrics. After receiving his M. D. from Case Western Reserve University in Cleveland, Ohio, Dr. Bly completed his residency at UTMB in the Department of Pediatrics and was named Pediatric Chief Resident in 1996. Since his appointment as Assistant Professor, Dr. Bly has excelled as a talented physician educator, actively involved in the medical education of UTMB residents and students, including regular presentations for the Pediatric Resident Lecture series and the Emergency Medical Clerkship Series. Dr. Bly mentors a number of resident research projects and is a member of the UTMB Graduate Medical Education Committee that develops resident curriculum. His efforts in education have earned him multiple awards, including Outstanding Junior Faculty in Medical Education Award for Pediatrics as well as the “Golden Rattle” Award for Excellence in Resident Teaching.

Keeping Kids Healthy

Table of Contents

Foreword................................................................................4 About the Authors ................................................................6 Table of Contents...................................................................7 Handwashing ........................................................................8 New Yearâ&#x20AC;&#x2122;s Resolutions . ......................................................10 Summer Dermatoses ...........................................................11 Child Safety Seats ...............................................................13 Back Pack Safety .................................................................14 Soft Drinks and Sodas ........................................................15 Scoliosis . .............................................................................17 Safety at Home ...................................................................18 Read to Young Children . ....................................................20 Earwax ................................................................................21 Childhood Obesity . ............................................................22 Girls Sports Injuries ............................................................23 Household Poisons ..............................................................24 Avoiding Bee and Wasp Stings ...........................................25 Kids and Sports Injuries ......................................................27 Sports Injuries to the Head or Abdomen ............................28 Allergies ..............................................................................30 Sleep Deprivation . ..............................................................32 Vaccinations ........................................................................34 Calling 911 . ........................................................................35 Sunburn . .............................................................................36 Pool and Water Safety .........................................................37 Recreational Water Illnesses . ..............................................38 Swimmerâ&#x20AC;&#x2122;s Ear ....................................................................39 Caring for Your Pet .............................................................41 Antibiotics . .........................................................................42 Biking Safety .......................................................................44 Eye Injuries .........................................................................45 Teething ..............................................................................46 Nosebleeds ..........................................................................47 Children and Their TV Habits ............................................48 Medicines and Children ......................................................49 Bed Wetting ........................................................................50

Keeping Kids Healthy

Gun Safety ..........................................................................51 Burn Injuries .......................................................................52 Food Allergies .................................................................... 53 Hearing Loss . .....................................................................54 Bullying ...............................................................................55 Fever . ..................................................................................54 Immunizations ....................................................................57 Pertussis or Whooping Cough ............................................58 Seizures ...............................................................................61 The Sunshine Vitamin: Vitamin D .....................................62 Scald Burns .........................................................................63 Mental Health in Children .................................................64 Sibling Rivalry . ...................................................................65 Headaches ...........................................................................66 Cutting: Self Injury .............................................................67 Asthma ................................................................................69 Postpartum Depression .......................................................70 Cardiopulmonary Resucitation . ..........................................72 Childhood Cancer Awareness .............................................73 Abduction ...........................................................................74 Breast Feeding .....................................................................76 How to Increase Breast Milk Supply ..................................77 Breast Feeding and Sore Nipples . .......................................78 Appendicitis ........................................................................80 When Your Child is Expecting a Sibling ............................81 Child-proofing Your Home . ...............................................82 Infant Sleep .........................................................................84 The Dangers of Smoking . ...................................................85 Fire Safety ...........................................................................86 Bathing . ..............................................................................88 Keeping Children Home from School ................................89 Luekemia . ...........................................................................90 Anemia ................................................................................91 Product Safety .....................................................................92 Essential Fatty Acids ...........................................................93 Toy Safety for Children . .....................................................94

f someone asked you what the first defense against getting sick and spreading illness was, what would you say? A survey showed that most parents feel that diet and exercise, regular check-ups and immunizations are the best way. However, the answer is that hand washing is the most effective way to keep germs from spreading. Bacteria and viruses can be transmitted through contaminated water and food, droplets released during a cough or a sneeze, dirty hands, contaminated surfaces, and a sick person’s body fluids. Germs can also lurk in many places that you wouldn’t suspect, such as toys, pens, pencils and crayons, cafeteria plates and trays, playground equipment, pet cages and food dishes, board games, spoons, knives and forks, remote controls, computer keyboards, phones, escalator/stair railings, cloth towels, toothbrushes, bathroom cups, doorknobs, sink handles, and light switches.

Handwashing

It is important for you to teach your child to wash their hands by keeping your hands clean, as well. Teach your child by washing your hands together with your child several times a day so he learns how important this good habit is. Here are some simple steps for scrubbing germs away. Wash hands with warm water because it kills germs better than cold water. Make sure the water isn’t too hot for little hands.

If you touch one of these sources, you can pick up germs and become infected after touching your eyes, nose or mouth. And once infected, the whole family may come down with the same illness. Good hand washing is the first defense against the spread of illness, yet only about one in three people wash their hands after using the restroom. You can prevent catching and spreading many diseases, including the common cold and more serious illnesses such as meningitis, bronchiolitis, influenza, hepatitis A, and most types of infectious diarrhea, by simply washing your hands.

Keeping Kids Healthy

Handwashing

Use soap and rub hands together for about 20 seconds (enough time to sing the “Happy Birthday” song) to create lots of bubbles. Antibacterial soap isn’t necessary — any soap will do. Make sure to wash the “in-between” places — between the fingers and under the nails where germs hide and don’t forget to wash wrists! Rinse all of the soap off of your hands with warm, running water. Dry hands with a paper towel or a clean towel.

Keeping Kids Healthy

Teach your child to wash their hands: • • • • • • • • • • • • • •

BEFORE setting the table BEFORE emptying the dishwasher AFTER using the restroom AFTER changing a baby’s diaper AFTER sneezing, coughing and/or blowing your nose AFTER touching garbage AFTER cleaning the house AFTER touching your pet or other animals AFTER touching blood AFTER playing in the yard AFTER shaking someone’s hand AFTER visiting someone who is sick AFTER riding on the school bus AFTER getting a scrape on your knee or a cut on your hands • AFTER cleaning up spills • BEFORE AND AFTER changing the litter box • BEFORE AND AFTER eating or cooking • BEFORE AND AFTER playing with younger brothers or sisters Don’t underestimate the power of hand washing! A few seconds spent at the sink with your child could very well save you trips to the doctor.

hen we think of New Year’s resolutions, we’re more likely to think of when we are going to break them than of keeping them throughout the year. In fact, we hardly hear of such resolutions for more than a week at the turn of the year. But we want to offer some resolutions that parents need to think seriously of keeping, because performing them and helping family members to perform them over the course of many weeks will improve overall physical, social, emotional and mental health of the whole family.

Resolve to: • Agree on sensible sleep practices for the family. Remember to place babies on their backs to sleep to lessen the chance of Sudden Infant Death Syndrome (SIDS). Older kids, adolescents and even parents will find that the family’s emotional weather will be less stormy when everyone gets a good night’s sleep. School and work performance will improve when tasks are approached with a rested mind. • Teach children about the value of hand washing before eating or preparing food, when suffering from a cold, and after going to the bathroom. Don’t forget to have kids wash hands upon leaving the doctor’s office or daycare centers. Both of those see lots of kids with colds who leave their germs behind. • Encourage kids to brush and floss teeth to prevent cavities and gum disease. The worst

New Year’s Resolutions

dental damage occurs later in life when teeth rot from decay and gums and bone lose their grip on a tooth, but while not everyone can afford expensive dental reconstructive care, we can all afford dental floss, a brush and toothpaste. • Make your home a healthy environment for kids to live in. Make it smoke free for everyone, parents and guests alike. Keep household poisons and chemicals in a securely locked cabinet, and invest in a gun locker to safeguard firearms. • Protect kids against sun damage with a lotion containing sun protection (SPF) of 15 or greater. Protect eyes with brimmed hats and sun glasses with ultraviolet protection. Cancers and retinal damage in later life can almost always be traced to sun abuses in childhood. • Practice safe driving habits. Always buckle up when driving. Keep children less than 14 years of age in the back seat in a car seat or booster appropriate to age and weight. • Practice helmet safety. Statistics from accidents clearly show that bicycle helmets reduce the risk of brain injury to cyclists of all ages by 88%. The AAP advises that infants less than 12 months of age have necks too weak to ride in bicycle seats or be carried on bicycles in backpacks or frontpacks. Above all resolve not to be a parent who says “Do as I say. Don’t do as I do.” Children adopt adult behaviors long before they learn to make reasonable decisions. Much of good parenting is learning to lead by following the best advice you can give your children.

Keeping Kids Healthy

Summer Dermatoses

t’s been a long summer. It might feel like the sun’s been in short supply, and maybe you’re trying to squeeze that last outdoor activity in before the kids head back to school. If so, it’s a good time to remember you’re sharing the outdoors with nature and lots of critters: ticks, fleas, poison oak, poison ivy, and the sun can all pose potential health risks to your child. It’s a good idea to take precautions against the elements and keep a keen eye out for your child’s skin and possible reactions to the following items found all around us.

Poison Ivy, Poison Oak Did you know Poison Ivy causes the most common allergic reaction? In fact, it affects about half the U.S. population, but, children with eczema are most susceptible to the rash. Most often, the rash appears within 2 days of exposure. You’ve probably seen it before: Small, pink, circular bumps on the skin called papules. While they don’t contain any puss, they are itchy. And, the first instinct to relieve the itchiness is to scratch. But, be warned. That will only make symptoms worse and could lead to infection. The rash will peak in one to 14 days. The best solution includes calamine lotion and cool compresses to soothe the skin. If symptoms persist, or if they become severe, seek advice from your child’s pediatrician.

Don’t Let the Bed Bugs Bite Fleas, ticks, and yes, bed bugs. They’re all culprits of summer dermatological issues. If your child is allergic to their bites, you might find patches of small, red bumps on localized areas of the skin. It usually affects younger children on their arms and legs and other uncovered areas of the body. The best defense for your child is to cover up and use kid-safe insect repellants. But, in this heat, that doesn’t always happen. If your child develops these small, itchy bumps on the skin, you can help relieve the symptoms with a mild skin cleanser. Also, applying a topical hydrocortisone can bring a little relief.

Keeping Kids Healthy

Sensitivity to Sun We all know about the harmful effects of the suns rays, but did you know some people are actually allergic to too much sun? In fact, overexposure to sunlight can cause a rash in some children. The rash typically shows up within a day after exposure and appears as . . . you guessed it, itchy, red spots. It’s most often noticeable on the front of the neck, chest, arms, and thighs. Sometimes called sun poisoning, the rash can be avoided by applying plenty of sunscreen with a minimum 30 SPF, limiting exposure to the sun, and gradually increasing time spent in the sun to build up tolerance levels. In the event of a rash, you should seek a physician’s care.

Overall, here are some good tips: • Insect repellant is not recommended for children under 2 months of age. • Limit insect repellant application to once a day • Don’t combine insect repellant with sunscreen. • Apply the repellant to your own hands, first, and then rub it on your child’s skin • When you come back from a day spent outdoors, a nice bath with soap and water is a terrific idea. The outdoors are terrific if you’re prepared. If not, they can be downright painful and itchy. Follow these simple steps for a great summer to remember.

Poison Oak

Keeping Kids Healthy

Child Safety Seats

ick, tick, tick… A few seconds… is all that it takes to buckle your child safely into a car seat. But what can happen if the child is not buckled in correctly?

Research shows that the leading cause of death for children and young adults ages six through 14 are traffic related injuries. Every nine seconds someone is injured and every thirteen minutes someone dies in a vehicular accident. Victims of a car wreck which are not properly secured by seat belts have medical treatments that cost 50% more than secured victims. 85% of this medical treatment is absorbed by society and not the individuals involved. Another important factor, and one that is often over looked, is that many children are improperly buckled into their safety seats. Children, 12 and under, should always be restrained in the back seat of a vehicle. This is the safest place in a car. The safety seat, booster seat, or seatbelt should be one that is appropriate for the child’s age and weight, and should be properly installed; or the protection that the seat is meant to offer will be of no use in a crash. Tips for installing a safety seat correctly:

• Always install the seat tightly with no more than 1 inch of movement side to side • Use a tether strap on forward facing seats. The tether strap is located at the back of the safety seat, has a hook, and anchors to a tether anchorage on the vehicle. (Consult the vehicle owner’s manual for the tether anchorage location.)

Keeping Kids Healthy

• Adjust the harness straps through the correct harness slots. Straps for rear-facing seats are positioned at or below the child’s shoulders. Straps for forward-facing seats are positioned at or above the child’s shoulders. • Once the child is secured in the safety seat, make sure the harness is snug and will only allow one finger width between the strap and the collar bone. • Make sure that the harness straps lie flat and do not twist; and make sure the chest clip is flat against the chest and is at armpit level. • NEVER install a car seat near an active airbag. During a collision the airbag can inflate and cause serious head and neck injuries. • The National Highway Traffic Safety Administration’s Web site lists child safety seat inspection stations by zip code so you can find help near you. (http://www.nhtsa.dot.gov/people/injury/childps/ CPSFitting/Index.cfm) Have a great trip and remember: Buckle up for safety!

Backpack Safety

distribute weight more evenly across the body, multiple compartments to distribute weight, and does not have a width greater than the child’s chest.

Backpacks that have metal frames, such as those used by hikers, are better for your child’s back, but may not fit into lockers at school. Backpacks on wheels are also better for your child’s back, but many schools do not allow them, as other children may trip over them in hallways. Check with your child’s school to see what their policy is for these types of packs. Parents can help prevent backpack-related injuries by:

ackpacks are great for kids to carry items back and forth from school to home, but backpacks that weigh more than 15% of your child’s body weight may cause health problems for your child. Neck, shoulder and back pain may develop from carrying a heavy backpack everyday.

The spine is made of 33 bones (called vertebrae) that have disks in between them that act as natural shock absorbers. A child carrying an unusually heavy backpack leans their head and chest forward to compensate for the weight of the back, which puts stress on the back and neck. If your child uses only one strap to carry their backpack, the spine’s natural shock absorption ability is reduced because only one side is carrying the weight and your child will end up leaning to one side to make up for the extra weight in the pack. Backpacks, if used properly, can be very useful for children. When choosing a backpack check to make sure that it has two wide, padded straps that fit over your child’s shoulders, a padded waist or chest belt that will

• Making sure that the backpack is the right size. • Teaching your child to pick up and put on the backpack correctly. Your child should face the backpack, bend at the knees, grab the pack with both hands to lift it, and put one strap on at a time. • Encouraging your child to use his or her locker frequently during the day instead of carrying all of his or her books at once. • Telling your child to avoid carrying unnecessary items in his or her backpack. If your child does need to carry heavy items, such as sporting equipment, the heavier items should be placed in the back of the pack, closer to the body. • Helping your child with homework planning. If you notice that he or she is putting off assignments until the weekend help him or her manage homework time during the week to avoid having a heavier pack on Fridays and Mondays. • Putting sharp objects, such as scissors, that can poke through the backpack in protective containers. If your child experiences back, shoulder or neck pain, struggles to get his or her backpack on or off, leans forward when carrying his or her pack, or has numbness or weakness in his or her arms or legs, contact your pediatrician.

Keeping Kids Healthy

Soft Drinks and Sodas

here are many ways to encourage healthy lifestyles for your family members. Lately there has been a lot of discussion about soft drinks in schools and how they contribute to the increasing obesity problem in the US. Almost 25% of children in the US are overweight. In an effort to control the growing number of children that are becoming overweight in the United States, the American Academy of Pediatrics is urging school officials to remove soft drinks from vending machines in schools and replace them with healthier drinks, such as milk, 100% fruit juice or water. Other suggestions for limiting access to sodas while children are in school include turning off vending machines during regular school hours and placing the machines in out-of-the-way places so they are not as noticeable. The federal government has already issued regulations that that ban soft drink machines in food service areas in schools.

In the last 25 years, the number of soft drinks consumed by children has doubled and between 56 and 85 percent of school-age children drink at least one can of soda a day. Sweetened drinks, such as cola, are the number one source of excess sugar in childrenâ&#x20AC;&#x2122;s diets.

Simply speaking, weight gain occurs when a person consumes more calories than they use and the unused calories are stored in the body as fat. The US Department of Agriculture suggests a maximum of 18 teaspoons of sugar a day for a person on a 1,600 calorie a day diet, which is a typical amount for a 5 year-old child. One 12-ounce serving of soda contains 150 calories and about 10 teaspoons of sugar and children that drink more than one serving a day increases their risk of becoming overweight by 60%. But obesity is not the only health risk associated with sweetened soft drinks. Many colas contain approxi-

Keeping Kids Healthy

mately 30-40 mg of caffeine. This amount is significant for children because caffeine acts as a stimulant, which can make it difficult to sleep. Caffeine also can lead to dehydration because it increases the production of urine. The high sugar content in sweetened soft drinks also promotes tooth decay and the acids that they contain can damage the teeth by wearing away tooth enamel. A child that drinks several soft drinks a day has lower daily intakes of important nutrients, including protein, vitamin A, and calcium, that they would normally receive from drinking milk. Sodas are not the cause of obesity in children, but they do make the risk of weight gain higher. An occasional soft drink will not harm anyone, but parents should monitor the number of sweetened soft drinks that their children have and suggest healthier drinking alternatives.

Scoliosis

Keeping Kids Healthy

Scoliosis

coliosis, a condition that causes the spine to curve too much in the wrong direction, affects approximately 6 million people in the U.S. Scoliosis develops gradually and is often not detected until a child is between 10 and 14 years old. No one knows what causes the most common type of scoliosis, idiopathic (meaning “unknown cause”). It is not caused by poor posture, diet, exercise or the use of backpacks. It is thought to be hereditary, so other family members may have it, and though it occurs equally in girls and boys, girls are more likely to develop more severe cases. When a person has scoliosis their spine curves into an “S” or a “C” shape from side to side. When this curve is severe, it can be visible and cause pain. Severe curvature of the spine can lead to other health problems and eventually affect the heart and joints, but in most cases, it is mild enough that it doesn’t require medical treatment. In some cases, scoliosis is noticeable – one shoulder blade may be higher than the other or the curvature of the spine is visible. Most schools and doctors screen for scoliosis. When a child is diagnosed with scoliosis, your doctor will check his or her spine regularly (every 6 to 9 months) to make sure the curve does not get worse.

Signs and symptoms of scoliosis include uneven shoulders, one shoulder blade that sticks out further than the other, uneven waist, one hip higher than the other, and leaning to one side. Risk factors that can affect the chance that a scoliosis curve will get worse include: • Sex – girls are more likely than boys to have greater curvature of their spine • Age – if scoliosis appears at a younger age it is more likely to worsen • Angle of the curve – the greater the angle of the curve, the more likely it will worsen • Location – Curvature in the mid to lower spine

Keeping Kids Healthy

is less likely to worsen than those located in the upper spine. • Spinal problems at birth – Children born with scoliosis are more likely to continue to have problems Treatment is not always necessary, but severe cases of scoliosis may require treatment. Scoliosis is treated with braces that hold the spine in place to keep the curve from getting worse. Some are designed to be worn at night, while others are worn during the day.

Sometimes a child with scoliosis may need surgery to correct the curvature of his or her spine. Surgery to correct the curvature of the spine involves fusing the bones in the spines together using metal rods, hooks, screws and wire to hold everything in line until the bones heal. The operation takes about 6 hours. A child that has this operation will be able to get out of bed the next day and walk. He or she will not need to wear a cast or a brace and will get out of the hospital in about a week. If your child is diagnosed with scoliosis at school call your family doctor to schedule a physical examination.

arents consider their home safe for their children, but evidence indicates that unintentional injuries are the leading cause of death in children under the age of 14 and half of these injuries occur at home. We can avoid, or at least minimize such accidents by taking the following preventative steps and give children basic safety guidelines beginning in their preschool years.

Safety at Home

Outdoors • Supervise young children at all times when they are playing outside. • Check your yard for poisonous plants or mushrooms and tell your child that they should not eat these. • If you have a yard, fence it in completely and keep your gate locked if children are playing there. Indoors • Put gardening and yard tools in a secure place. • Teach your child the difference between indoor Also, keep children inside when an adult is using and outdoor toys. For example, learning that your a power mower or weed whacker and do not ride furniture is not playground equipment will not with your child on riding mowers because they can only help your furniture last longer, but your chileasily fall off and get run over. dren are less likely to break any bones if they are • Don’t allow children near gas grills or barbeques not leaping from a chair to the sofa. even when not in use. • Don’t allow children to play in the kitchen or • Make sure that playground equipment installed bathroom. Both rooms are full of multiple danin your yard is secured to the ground. Cut off the gers for children. Top heavy toddlers can drown ends of bolts that stick out and close open “Sin toilets and buckets of mop water. Lock away hooks” because clothing may get caught on them hazardous items, such as knives, cleansers, matches, and cause serious injury. razors, shampoo, and alcoholic beverages. Keep • More than 70 percent of playground injuries are trashcans locked in a closed cabinet or pantry, caused by falls. Make sure that the surface under because things that you throw away are potential playground equipment is soft. It is recommended dangers for your child. to have a 9-12 inch layer of mulch or sand under • Install guards on windows (that don’t interfere playground equipment. Children should only play with your fire escape plan) to prevent children on age-appropriate playgrounds. Teach your child from opening a window and falling out. Install how to properly play on outdoor equipment. gates with child-proof latches at both the bottom and top of stairs. Lock doors that lead outside and It only takes a little time to look for and remove potential dangers that may cause a lifetime of regret. install locks out of your child’s reach. • Secure and stabilize bookshelves and televisions so that your child cannot pull them down and get pinned underneath. • Teach older children which toys are potential choking hazards for their younger siblings.

Keeping Kids Healthy

othing is more important to success than learning to read. Those of us who can’t read have fewer advantages than those that can. Reading is just as important for babies as it is for adults. Early exposure to reading increases the chances of success in school, and children who share books with their caregivers at an early age have less difficulty mastering reading once they enter school. Sharing books with children at an early age helps them to develop their vocabulary, communication skills and imagination. The US Department of Education suggests that you begin reading to your baby at six weeks of age because babies pick up the rhythm of the language spoken around them. Though six weekold babies may not know the difference between reading and talking, as they grow, they will begin to focus on the reader’s expressions, and later on the books themselves. Sharing books can be a special time that you and your child spend together. Designate a certain time of day, perhaps naptime or bedtime to read together. Choose a comfortable, well-lit spot to read, away from distractions, such as television. Cuddle or sit close to your child. Reading is a wonderful way to bond with your baby, who will soon begin to associate reading with being close to you.

Make sure that both you and your child can see the book, point at pictures and words and read with expression. Babies typically like books with bright colors and pictures of faces, while toddlers enjoy looking at books about activities that they are familiar with, such as learning to dress themselves and going to bed. Allow your baby to “explore” the book that you are reading. Let your child turn pages or even take the book out of your hands. “Board” books are good for babies because they will more than likely try to chew on the book or throw it. Your child may also flip quickly through the book and just play with the pages at first, but he or she will eventually understand what reading is.

Read to Young Children

Make reading a positive experience. Adjust the time that you spend reading to your child’s attention span. Keep in mind that this may not be the same everyday. If Johnny crawls off of your lap to go do something else, don’t force him to come back. Also, don’t worry about teaching letters, sounds or syllables to your infant. This is something that will come with time. Instead, focus on the enjoyment of reading. Most importantly, let your child see you reading. Just as they imitate other everyday activities that parents do, children will also mimic reading. Toddlers that have been exposed to reading at an early age pick up books and “read.” By watching you, your child will learn to value reading. One of the greatest satisfactions we can have is to see a child mimic our good actions. Even if you do not read well, your child will learn to read better by reading with you.

Keeping Kids Healthy

Earwax

along with whatever the wax has trapped, along with them. So, essentially, the ear canal cleans itself.

Never stick a cotton swab, finger or anything else in your child’s ear to remove earwax (and be sure to tell your children to never stick anything in their ears). Because the ear canal and eardrum are delicate, they can be damaged if something is put in them. And if you poke around in the ear with a cotton swab, you can push the wax and pack it further back in the ear. This can cause blockage in the ear, damage the eardrum, or scratch the delicate skin in the ear canal, which can lead to infection. Plus, if you have a small child, they may one day find a cotton swab lying around and try to stick it in their ear or in the ear of a brother or sister.

arwax, also known as cerumen, is a thick, sticky liquid that has a very important job – to trap anything that flies, crawls, or is blown into the ear canal, such as dirt, pollen, tiny insects and bacteria, and keep them from going further in the ear, where they can cause damage. It also contains special chemicals that maintain the ear canal’s acid balance and fight infections inside the ear canal. So earwax is not a bad thing – its job is actually to keep your ears clean.

Earwax isn’t really “wax” like the kind in a candle (paraffin) -- it is actually closer to the oil that is produced by glands in the skin on your body. Earwax is produced by similar glands that are located in the ear canal. So what do you do about keeping your child’s ears clean and getting rid of earwax? In most children, you don’t have to do anything. Your body sheds skin cells every day. Your ear canal is lined with very fragile skin and these skin cells move very slowly and carry the wax,

Keeping Kids Healthy

Blockage of the ear canal is known as impaction. An impaction occurs when several layers of ear wax have been pushed back into the ear. The inner ear does not have oil glands like the skin in the ear canal does, and the wax will harden. A person with an impaction may have pain, dizziness, ringing in the ears, reduced hearing, and may feel that their ears have been plugged. If your child has these symptoms, call your doctor.

Some people’s ears produce extra wax or even hard wax. Let your child’s doctor know if you think his or her ears produce more wax or if their earwax seems especially hard. The doctor may prescribe a medicine to soften the wax, squirt warm water into the child’s ear to soften the wax, suction the wax out, remove the wax with a special medical tool, or send your child to an ear specialist. It’s impossible to reduce the amount of earwax that your child produces, but you can reduce wax build-up bye using wax-softening drops, avoiding using things such as cotton swabs to clean the ear, telling your child to not put anything in your child’s ear, and limiting ear cleaning to the outer ear only.

n the last two to three decades, the number of overweight children has doubled. Almost one child in five is considered overweight. Obesity can lead to risk factors for heart disease, such as high cholesterol and blood pressure, sleep apnea, orthopedic problems, liver disease, asthma, as well as low self-esteem and depression. The likely cause of the increase in the amount of overweight children is more than likely the same reason that adult obesity is on the rise: overeating and lack of physical activity. The following are a few suggestions to help your family start a program to improve eating habits and increase physical activity.

• Focus on gradual changes in both eating and exercise patterns, rather than enforcing immediate changes. • Encourage your child to exercise. Make physical activity part of your family’s daily routine. children should exercise for at least one hour every day. Plan family activities that involve exercising, such as biking, hiking, or washing the car. • Limit the amount of time spent watching television and playing video games. • Supply healthy snacks, such as yogurt, fruits and vegetables, to help your child learn to make healthy food choices. • Give your child water or juice rather than soda or other drinks high in sugar. • Provide balanced meals and limit the amount of times that your child eats fast food per week. • Let your child help you plan and prepare meals with you. If your child helps decide what’s for dinner, they will gradually learn about nutrition and may be more willing to try new foods that they helped you make.

Childhood Obesity

• Try not to use food as a punishment or reward. For example, don’t offer dessert as a reward for finishing a meal. This teaches your child that sweets are more valuable than other foods. • Encourage your child to eat slowly and eat together as a family, if possible. Try to make mealtime a time for sharing what your child did at school that day, etc. • Don’t force your child to eat if he or she is not hungry. • Involve the entire family, rather than just focusing on an overweight child, when it comes to changes in eating habits and physical activity. Be supportive and let your child know that they are okay no matter what they weigh. Your child may realize that he or she has a weight problem and therefore, needs your support and acceptance. The goal of promoting a family eating and exercise program is to get healthier, rather than to reduce your child’s weight. Children should not be put on restrictive diets because they need calories to develop properly, but changing eating and exercise patterns helps children “grow” into their weight without adding extra pounds.

Keeping Kids Healthy

Girls Sports Injuries

ccording to the American Academy of Pediatrics (AAP) Section on Sports Medicine and Fitness, between 1982 and 2001, 50 percent of the catastrophic injuries to female athletes were in cheerleading. The increasingly competitive nature of the sport has lead to ever more dangerous stunts like tosses and pyramids.

If your daughter participates in cheerleading, athletic dance, or ballet, she may be more exposed to a group of conditions caused by intense competition—eating disorders, amenorrhea (the absence of menstruation) and as a result decreased bone mineral density.

It is not uncommon for girls to come to the conclusion—whether on their own or from the suggestions of teachers, coaches or peers—that they need to lose weight. If they make the decision without adequate professional consultation, they may take the first step toward weakened bones and joints. Parents who suspect either disrupted nutrition or absent menstruation should consult with their daughter’s pediatrician. All three of the above sports should be considered high impact sports that may generate serious injuries. Twenty-two percent of all injuries in this category occur in ankles and are fractures, dislocations, bruises, sprains and strains. Gymnasts with weak arches who perform barefoot will suffer from shin splints and stress fractures in the bones of the foot. Because form dictates a landing with hands up and back hyperextended, they are subject to spondylolysis—a stress fracture of the vertebra, in this case usually the fourth or fifth lumbar (the lowest) vertebra in the back Growing bodies are in danger of skeletal growth plate injuries. In the long bones, such as bones in the arms and legs, there are growth areas at each end where lengthening occurs as a child grows. Sometime during the teen years, these areas close, and are replaced with solid bone. An injured growth plate or growth area of these arm and leg bones that doesn’t heal can result in stunted growth and other skeletal problems.

Delayed menstruation in teen-age girls is most common in very thin or very athletic girls who are underweight, and whose bodies have not experienced the normal puberty-related rise in body fat that is required to trigger the beginning of menstrual cycling. Left untreated, Parents need to remember that while their daughthe eating disorder with the consequent absence of menters may wear short skirts and wave pom poms, they are struation can lead to decreased bone density, putting girls involved in highly competitive and intense sports with at increased risk of osteoporosis and stress fractures. little or no protective gear. Of the three ‘sports’ athletic dance, cheerleading and Do not encourage your child to “play through the pain” ballet, the latter is the most appearance oriented. Balof sudden injury. If pain persists and makes a sport intollet lessons often occur in a group before a mirror. Girls erable, or if you see a visible distortion of arms or legs, or cannot help but see competing girls and know that other if a child favors an injured limb, take her to the doctor. girls can see them as well.

Keeping Kids Healthy

t’s important for parents to remember that not all poisons are in the garage or basement. A number of poisons can be found throughout the house. Small children are both curious and fast, so parents have to exercise special care not to leave dangerous products open or within their reach. Take a tour of your house or apartment to see if some of these dangerous conditions exist. • In the kitchen, check that all detergents, bleaches, cleaners and especially drain cleaners, as well as soaps and bug killers are not under the sink in an unlocked cupboard, but up high in a cupboard with a childproof lock. Products containing lye are extremely dangerous. Don’t keep these in your home. Keep alcoholic drinks up out of the reach of children. • Buy products with child-proof or child-resistant caps. Opening them should require thumb pressure beyond the ability of small children.

Household Poisons

• In the bathroom, besides checking that soaps are out of reach, keep medicines, cosmetics, colognes, toothpaste and mouthwashes out of reach, and preferably locked up • Don’t leave pills in open bottles or in a dish of “the day’s dose of medicine.” Make sure all product labels are clear—both on medicine and on products that might be found anywhere in the house. In an emergency you will need to know what product was involved. • Flush medicine down the toilet after the expiration date has passed. Don’t discard it in the wastebasket. • In the bedroom, remember that perfumes and cosmetics and purses that may contain them probably contain products dangerous to a young child. Don’t keep headache medicines, especially gel caps and other candy look-alike medications on the night stand. • In the living room, know the names of your plants and whether the leaves or blossoms are poisonous. • In the basement and garage make sure that insect sprays, lighter fluid, paint and turpentine or other thinners, rust removers, gasoline, oil, fertilizers, antifreeze, weed killer, bug or rat killers, and all other chemicals are out of reach and locked up. • Homes built or last painted before 1978 may contain lead. Flaking paint on the outside of the house can contaminate the ground, exposed, lead-based paint on window sills or doors can cause lead poisoning leading to brain damage. If you suspect the presence of lead paint, call your local health department. If you think that your child has been poisoned, call the Southeast Texas Poison Center at 1-800-POISON1. Do not use syrup of ipecac before calling and being directed to do so by the Poison Center or your family physician.

Keeping Kids Healthy

Avoiding Bee and Wasp Stings

n allergic reaction is the greatest risk that can occur with an insect sting. The second, and more common, risk is an infection at the sting site. Some sensible tips to avoid being stung are to: • Stay away from stinging insects such as wasps and bees, and avoid their hives and nests. The hive views this as a threat and will attack. • If the hive needs to be sprayed with insecticide, wait until dark when the insects are less active, and keep children away from the area. • Be cautious when choosing the clothing you or your children wear outdoors. Insects are attracted to brightly colored clothing and can easily get caught in loose fabrics. • Avoid wearing perfumes and cologne outdoors in the summer. • Cover food and drinks when they are not in use • If you or your children are stung, use the edge of a credit card or similar tool to scrape the stinger off. Take care not to squeeze the venom sac. A pair of tweezers can also be used to remove the stinger. • Apply a cold pack of ice wrapped in a towel or a cold wet wash cloth to the area for a few minutes.

Keeping Kids Healthy

• If your child’s doctor gives approval, administer an oral over-the-counter antihistamine for pain or itching; be sure to follow dosage instructions for your child’s age and weight. If your child is stung and has an allergic reaction, seek medical attention as quickly as possible. If your child is known to be allergic to insect stings, do the following:

• Have your child wear a medical alert ID bracelet • Keep an emergency kit available, especially during the seasons when insects are most active • Have a supply of pre-loaded epinephrine auto-injectors available and know how to use them. This medication is light sensitive. Do not use if it is brown or discolored. • Seek medical attention as soon as possible after the epinephrine is administered. And last of all, remember if your child is stung anywhere in or on the mouth seek immediate medical attention. Stings that occur on the mucous membrane of the mouth can quickly swell and cause airways to be blocked.

Keeping Kids Healthy

Kids and Sports Injuries

cry jolts the air from across the field. You rise from the bleachers, heart in your throat as you realize … your child has been injured. More than 3.5 million children ages 15 and under are treated for sports-related injuries each year. Children are more susceptible to sports injuries because they are still developing and growing, and most of these injuries occur during practice rather than during the actual game.

Many elements contribute to sports injuries in children. Some of those elements include equipment that is ill-fitting or too large for the child; the child not stretching and warming up the muscles properly, and the lack of strength in the muscles surrounding the joints. American Academy of Pediatrics (AAP) Section on Sports Medicine and Fitness suggests these tips on how your child can avoid sports injuries:

• Choose sports that are age-appropriate. The AAP recommends that children be at least 6 years old before playing team sports. • Before beginning a sport, get into shape. Get a physical exam and talk to your pediatrician about a conditioning program. Conditioning may include stretching, endurance training and aerobic exercise. • Prepare for activity with warm-up exercises and end with cool-down exercises. • Don’t overdo. Start out slowly with any new physical activity and gradually increase your training program or activity. Take time off from playing if tired or in pain. • Stay well hydrated by drinking enough water or sports drinks. Dehydration can cause fatigue and increase the chance of injury. • Wear athletic shoes that fit well and are in good condition. • If injured, see a pediatrician right away.

Keeping Kids Healthy

If the injury is orthopedic in nature the “RICE” method should be used to treat the injury until your child is able to see their pediatrician,

• Rest: Reduce the use or stop using the injured area for at least 48 hours. A leg injury might require you to stay off it completely. • Ice: Put an ice pack, ice bag or plastic bag of crushed ice on the injury for twenty minutes at a time, several times a day. • Compression: Ask your pediatrician if compression should be used to reduce swelling of an injured joint. • Elevation: Keep the injured area elevated to help decrease swelling. A pillow can be used to help elevate an injured leg or arm. Teamwork, fun, discipline and coordination are all excellent reasons to encourage our children to participate in sports; and while we want them to be active in sports that will benefit them for life, we want them to be safe in their play.

Sports Injuries to the Head or Abdomen

n a continuation of our discussion on sports injuries from last week [page27], we need to remind parents that there are other more serious types of injuries that occur in sports related accidents; these are head injuries and blunt trauma injuries to the abdomen. These types of injuries require a very different type of immediate attention. According to the Academy of American Pediatrics, injuries to the head can be divided into two categories; external and internal. External, while frightening to see, usually just involves a scalp injury. While seeing your child’s scalp bleeding may cause your heart to skip a beat, internal head injuries are far more serious because of the implications of a life threatening brain or skull injury.

Some blows to the scalp may cause swelling below the skin from the blood leaking into the scalp, this called a “goose egg” and may take days or weeks to disappear depending on the amount of fluid/blood that leaked. Below is a list of what to do and what to look for if a scalp injury occurs.

• If the infant or child loses consciousness, even for a brief moment; does not stop crying; complains of head or neck pain; or is not walking normally; call your pediatrician immediately. • If your child is not an infant and has not lost consciousness, but is behaving normally after a blow to the head or a fall, apply an icepack to the injured site for no more than 20 minutes at a time to reduce swelling. (Wrap the bag of ice or frozen vegetables in a washcloth. Do not apply the ice directly to the injured area as this will cause damage to the skin.) • Observe your child for 24 hours for any change in behavior. If you see any reason for concern, call the child’s pediatrician immediately, this may be a sign of internal injury.

• If the trauma occurs near bedtime, check the child every few hours for twitching legs or arms and change in color or breathing. • If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless your child’s doctor has advised otherwise). • If color and/or breathing are not normal, or if you aren’t comfortable with your child’s appearance (trust your instincts), arouse your child partially by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she doesn’t protest, try to awaken your child fully. If your child can’t be awakened or shows any signs of internal injury (see below), call your child’s doctor or an ambulance. Of a more serious and life-threatening nature are internal injuries to the head and/or abdomen. Call for emergency medical attention if any of the following symptoms occur after a head or abdominal injury. For either type of injury: • Loss of consciousness • Neck pain • Pupils of unequal sizes • Pale clammy skin • Bleeding from the nose, ears or eyes • Abnormal or rapid shallow breathing • Weak pulse which my be evidence of shock • And for the abdomen, a guarded curled-up position Concussions are also considered a type of internal head injury. A concussion is the temporary loss of normal brain function as a result of an injury. If your child sustains an injury to the head, watch for the following signs that indicate that he or she may have a concussion: • Feels dizzy, or light-headed • Trouble remembering things that have happened immediately before or after the accident. • Nausea or vomiting

Keeping Kids Healthy

Sports Injuries to the Head or Abdomen • Headaches • Blurred vision and sensitivity to light • Slurred speech or saying things that don’t make sense • Difficulty concentrating, thinking, or making decisions • Difficulty with coordination or balance If you suspect a concussion, contact your pediatrician or take your child to the nearest ER.

While it is impossible to prevent all childhood injuries, there are ways of helping your child in avoiding them. Some of the ways to minimize the chances of injury are to childproof your home; make sure that your child wears protective headgear and equipment when participating in sports activites; always have your children wear safety belts in the car or use an age appropriate safety seat. If your child is injured, make sure that he/she takes it easy and do not allow them to resume playing sports until the injury has healed completely.

Keeping Kids Healthy

t’s officially Springtime — the weather is getting warmer, birds are singing, flowers are blooming, and if your child has springtime allergies, their nose is more than likely beginning to run.

Allergic rhinitis, or hay fever, common in infants and children, is passed on to children from their parents. In fact if one parent has allergies, a child has a one in four chance of having allergies also. If both parents have allergies, the chances increase to three out of four. Seasonal allergies usually develop around the age of five. Asthma is an early sign of developing allergies and is usually diagnosed between age one and three.

Common symptoms of hay fever include a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, sore throat, and a cough. Children with allergic rhinitis may also develop dark circles under the eyes caused by nasal congestion, known as “allergic shiners”.

Hay fever is caused by pollen and is one of the most widespread allergies. Some allergies can be avoided. For example, you can prevent an allergic reaction to some things, for example, by not eating food that you are allergic to, not taking medicine that you are allergic to, and staying away from animals that you are allergic to you. But pollen is in the air and there is no easy way to avoid it.

Besides moving to an area where the pollen count is not as high, the severity of seasonal allergies can be reduced by limiting exposure to pollen. For example, symptoms of pollen allergy may not be as serious if you keep windows closed in the car and at home, limit outdoor activities when pollen counts are highest (in the morning, for example), use a clothes dryer or hanging clothes inside instead of outside, take a bath daily, and

Allergies

dust and vacuum your house frequently. But it is not often possible or practical to stay indoors and that is why medication is the normal treatment for pollen allergy. Commonly used allergy medications include decongestants, antihistamines and steroids. If symptoms are mild, over-the-counter medications can be used. However, you should be aware that over-the-counter antihistamines may cause drowsiness. Antihistamines block substances that are released when your body reacts to pollen or other allergens. They relieve sneezing, itching, runny nose and eye symptoms, but they do not relieve congestion. Decongestants shrink inflamed tissues in the nose. They open up air passages and reduce pressure in the sinuses, but they provide only useful temporary relief. Anti-inflammatory nasal sprays also reduce nasal inflammation and they work right in your nose.

If over-the-counter medications don’t work, your pediatrician may give your child prescription medication. Many of the newer medicines don’t cause drowsiness and are prescribed for daily use. They won’t work as well if just used as needed. If your child’s symptoms don’t improve with prescribed medication, your pediatrician may suggest that you go to an allergy specialist, or that your child begin receiving allergy shots. Allergy shots are injections of substances that you are allergic to. Whatever method your child uses to treat allergy symptoms, it is important to treat them early to avoid other more serious conditions, such as asthma, sinus and ear infections.

Keeping Kids Healthy

ost families in the US are not getting enough sleep. In the past 25 years, sleep has declined. Doctors blame this on several factors, including television and the internet. “There are increasing opportunities for children to do things other than sleep,” says Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute. “There are so many more distractions today for children -- the Internet, email, TV, computer games, cell phones, etc.... It’s all the things children have access to that allow them to go on with their daily activities even though it’s encroaching on what should be sleep time.” Experts say the sleep habits formed in childhood can affect a child’s health, mood, and productivity -- both now and in the future. That’s why it’s especially important to help children establish good sleeping habits early in life to reduce the risk of problems later on.

“The most common problem we’re seeing among children is sleep restriction — just not spending enough time in bed in order to get a good night’s sleep,” says Hunt, who presented new research on sleep problems during childhood and adolescence at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston. For children ages 7 to 11, Hunt says a good night’s sleep means at least nine hours, and most adolescents need at least eight and a half hours of sleep each night in order to function at optimal levels. But meeting that quota is becoming more difficult for many children whose bedtimes are growing later while their school start time is getting earlier.

When children are consistently sleep deprived, experts say it not only negatively affects their health, but it can also make it harder for them to control their behavior.

Sleep Deprivation

David Kaplan, MD, professor of pediatrics and preventive medicine and biometrics at the University of Colorado School of Medicine, says these children often show signs of attention deficit disorder (ADD), have trouble focusing, and become more fidgety.

“We also know that sleep deprivation has an effect on automobile deaths and crashes,” says Kaplan, who is also chair of the AAP’s committee on adolescence and spoke at the conference. He says it’s estimated that about 100,000 traffic crashes are caused by drowsiness and fatigue, and drivers under the age of 25 cause more than half of these accidents. Researchers say sleep problems are a family issue, and it’s important for the family as a whole to recognize the importance of sleep for every member. “Sleep does matter,” says Hunt. “There is no substitute for getting a good night’s sleep on a regular basis. Sleep is just as important as diet and exercise to our health.”

Some tips for establishing a healthy sleep routine and ensuring your child gets enough sleep include the following:

• Set a regular bedtime for children and stick to it. • Establish a relaxing pre-bedtime routine with your child, such as reading or a warm bath. • Take as many distractions (TV, computer, etc.) out of the bedroom as possible. • Avoid giving the child foods or beverages containing caffeine less than six hours before bedtime. • Make the bedroom as conducive to sleep as possible — the temperature should be comfortable, the noise level low, and the room dark. Experts say parents should seek medical attention if their child continues to show signs of excessive daytime sleepiness, despite following the advice above. Although rare, sleep disorders such as sleep apnea and narcolepsy may also occur in children.

Keeping Kids Healthy

ome parents wonder why they should have their children vaccinated when the diseases do not seem as common as they used to be. Vaccines are not 100% effective in a small percentage of the population. Diseases, such as measles, diphtheria, and whooping cough are spread through the community by people that have not been immunized, have not received all of their vaccinations, or people for whom the immunizations don’t work. These highly contagious diseases can spread quickly.

Vaccinations

If your child has missed some of their scheduled vaccinations, it is not too late to get them protected. Remember, if they have only received a few of the required vaccinations, they do not have the maximum protection level against the disease and could still get sick.

For example, there was a measles epidemic in the US from 1989 to 1991. There were about 55,000 cases and over 120 deaths (half of which were in children under five who had not been immunized).

Some parents do not get their children vaccinated because they are afraid of possible side effects, but the risk of side effects associated with vaccines compared with the risk associated with the actual diseases is smaller. In the long run, it is worse to not get immunized and catch the disease. Many of the diseases that vaccines prevent can’t be effectively treated or cured, so a child that does not get their child vaccinated runs the risk of that child catching a disease that can’t be treated. Also, just because a disease is not currently present in a community, it can be reintroduced if someone leaves the community and goes on a vacation for example, is exposed while they are away, and returns to the community.

Vaccines stimulate the body’s immune system, make it stronger and teach it to fight specific diseases. Children that have not been immunized are 35 times more likely to get the disease. Some parents want to wait to have their children immunized until they go to school, but infants are more vulnerable to disease because their bodies cannot fight off disease-causing bacteria and viruses. Also, the effects of disease are more serious for babies than older children.

Keeping Kids Healthy

Calling 911

eaching your child how and when to call 911 can be one of the easiest and most important lessons that they will ever learn. Because time is important during an emergency, your child should be prepared beforehand so that they will know what to do.

Children need to know exactly what an emergency is. Ask your child what they think an emergency is and what should be done if there is one. Questions like, “What would you do if someone tried to break into the house?” or “What would you do if there was a fire?” will give you a chance to talk about different emergencies and what needs to be done if one happens. If you have special circumstances in your house, such as a person with a heart condition, epilepsy, diabetes, or an elderly grandparent, make sure that your child is prepared to spot specific emergencies for which they will need to call 911.

Role-playing is a good way to practice what to do if an urgent situation arises. Acting out different emergency situations will show your child the steps that he or she will need to take and help them remember what to do if something does happen. Talking about emergency workers, such as police officers, firefighters, and paramedics will also help children get an idea of what kinds of emergencies can happen and who can help them in those situations. Teach your child the difference between an emergency and a non-emergency. For example, if there is a fire, an intruder in the house, or an unconscious family member they will need to call 911, but if they skin their knee or their bicycle is stolen, they should not call.

Tell your child that calling 911 as a joke is not acceptable and often considered a crime. Make it clear that an unnecessary call to 911 can delay a response to someone that really needs help and that in most areas a call to 911 can be traced. This means that emergency workers may be sent

Keeping Kids Healthy

to the location from which the prank came, while there is someone across town in a real emergency situation.

Your child should know your street address and phone number to give to the 911 operator. However, make sure he or she knows that a 911 operator is the only stranger they should give this information. Tell your child that the operator will probably ask where they live, what type of emergency is happening, who needs help and if they person is awake and breathing. Let them know that it is alright to be afraid in an emergency, but that they need to stay calm, speak slowly and clearing to the 911 operator. If your child is old enough to understand, explain that the operator may give him or her first-aid instructions before emergency workers arrive. Also, keep a first-aid kit on hand and make sure that your child knows where it is and how to use it when they are old enough.

Keep a list near the phone of emergency phone numbers, as well as a number where you or other family members can be reached. Also, write important medical information about each family member, such as medical conditions, allergies to medications, and insurance information on the phone list. If your child is too young to understand the list, tell them to give it to the emergency workers when they arrive.

unburn is the skin’s reaction to ultraviolet (UV) radiation exposure. UV rays can cause invisible damage to the skin, which can lead to premature aging of the skin, as well as skin cancer. Most of the damage that the sun causes to our skin happens when we are children. Even a few serious sunburns can increase your child’s chance of getting skin cancer. Unprotected skin can burn in as little as 15 minutes outdoors and tanned skin is damaged skin. Most sun damage usually occurs during daily activities, rather than just during trips to the pool or the beach.

With so many sunscreen products on the market, it is sometimes confusing to tell what you should buy to protect your child. A sunscreen that has both UVA and UVB protection and an SPF (sun protection factor) of 15 or higher (higher if your child has fair skin) offers the best protection against sun damage.

Your child can still get sunburned even on a cloudy day, so sunscreen should be used daily because clouds only slightly filter UV rays. It should be applied in a thick coat at least 30-45 minutes before going outside and reapplied at least every 2 hours to all exposed areas, including rims of ears, lips, the back of the neck and the tops of feet.

Sunburn

If your child is swimming or sweating a lot, you should reapply more often, even if using a waterproof sunscreen.

If your child has sensitive skin, use a sunscreen with ingredients that physically block the sun’s radiation, such as zinc oxide or titanium dioxide. If using a combination sunscreen/ insect repellent, make sure that the sunscreen has a high SPF because Deet lowers the effectiveness of sunscreens. Besides using sunscreen other steps to protect your child from the sun include:

• Having your child wear protective clothing, including a hat and long sleeve shirt and long pants. Most clothing only has an SPF of 5-9, so sun damage can still occur with a shirt on. • Limiting sun exposure between 10 AM and 3 PM. The sun is at its strongest during these hours. • Putting a brimmed hat on your child. • Protecting eyes with sunglasses that filter UVA and UVB radiation. • Keeping babies under one year out of direct sunlight. Move your baby to the shade or under a tree, umbrella or stroller canopy and dress them in clothes that cover their arms and legs. • Some medications can make your child more sensitive to the sun. If your child is on medication, check with your doctor. Side effects of some medications that increase sun sensitivity include rash, redness, and swelling. If your child does get sunburned: • Bath in cold water or use cool compresses • Give a pain reliever if necessary • Use Aloe Vera gel or hydrocortisone cream • Keep your child out of the sun until the burn heals Call your doctor if the sunburn is severe, forms blisters, or if your child has symptoms of heat stress, such as fever, chills, nausea, vomiting or feeling faint.

Keeping Kids Healthy

Pool and Water Safety

hh, the joy of cool refreshing water in a swimming pool right outside the back door of your home on a hot summer day! This can be bliss for your family and friends if all the correct safety measures are in place to protect children against entering the pool without proper supervision.

According to The American Academy of Pediatrics, from 1990 to 2000, drowning was the second leading cause of unintentional injury death among US children between 1 and 19 years of age. Teaching your child to swim does not necessarily make him/her safe in the water. Unlike the movies, drowning children rarely thrash about but rather slip quietly under the surface of the water. The U.S. Consumer Product Safety Commission (CPSC) states that 77 % of the children had been seen 5 minutes or less before being missed and subsequently discovered in the pool.

Different methods of protection can be put into place that will create as close to a fail safe system as possible. Supervision is the best method, but in 69 % of the drownings, supervision was not in place when the accident occurred. There are other measures that when employed offer secondary levels of protection. Some of these extra layers of protection include: A fence completely surrounding the pool; locks placed high on the gates leading to the pool; alarms on the gates; swimming lessons when your child becomes mobile; and CPR in case there is an accident. CPSC offers the following tips for pool owners:

• Never leave a child unsupervised near a pool, bathtub, or any water activities. • Instruct babysitters about potential hazards to young children in and around swimming pools and bathtubs and the need for constant supervision around water. • Flotation devices are NOT a substitute for supervision. • Never use a pool with its pool cover partially in place, since children may become entrapped under

Keeping Kids Healthy

it. Remove the cover completely. Or pool covers with alarms are now available. • Place tables and chairs well away from the pool fence to prevent children from climbing into the pool area. • Keep toys away from the pool area because a young child playing with the toys could accidentally fall in the water. • Have a telephone at poolside to avoid having to leave children unattended in or near the pool to answer a telephone elsewhere. Keep emergency numbers at the poolside telephone. • Learn CPR (cardiopulmonary resuscitation). • Keep rescue equipment by the pool. Even though supervising children in the pool can be challenging, you will feel better knowing that these security measures are in place to help make the time in and around your pool as safe as possible.

Recreational Water Illnesses (RWIs)

Chlorine in swimming pools does kill the germs that may make people sick, but it doesn’t kill them right away. Most germs that can cause RWIs are killed by chlorine in less than an hour, but some can survive for days even if the pool has been properly disinfected. You can prevent the spread of RWI’s by:

hen most people think of risks associated with swimming they usually think of sunburns or drownings. However, most swimmers don’t realize that they can get sick from the water that they are swimming in. Recreational water illnesses (RWIs) are spread by swallowing, breathing, or coming in contact with water that has been contaminated in swimming pools, hot tubs, at waterparks, lakes, rivers, or oceans.

Symptoms of RWIs include skin, ear, respiratory, eye, and wound infections. The most commonly reported RWI is diarrhea. If a swimmer has diarrhea, the germs that they carry can contaminate the water if they have an “accident” in the pool. People with diarrhea can easily contaminate large pools or waterparks because their stool contains millions of germs. Lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste and water runoff following rainfall and some common germs can live for long periods of time in salt water.

If contaminated water is swallowed, a person may become sick and many diarrhea-causing germs do not have to be swallowed in large amounts to make a person ill.

• Not letting children swim if they have diarrhea, especially if they wear diapers. • Telling your children not to swallow pool water and to try to avoid even having water get in their mouth. • Teaching your children good hygiene habits, such as taking showers before swimming and washing hands after going to the bathroom. You should also be sure to wash your hands after changing diapers. • Washing your child thoroughly (especially their bottom) with soap and water before swimming. Everyone has invisible amounts of fecal matter on their bottoms that end up in the pool. • Taking children on bathroom breaks and checking diapers often. • Change diapers in a bathroom, not beside the pool. Germs can spread to surfaces and objects in and around the pool and spread illness. Other RWIs, such as eye, skin, ear and respiratory infections are caused by germs that live naturally in the environment. If a pool has not been properly treated the germs can increase to the point where they can cause swimmers to be sick. Children, pregnant women, and people with compromised immune systems (such as people with AIDS, people that have received an organ transplant or those that receive certain types of chemotherapy) are more likely to get sick from RWIs.

Remember you share the pool with everyone else that is in the pool. Healthy swimming behaviors are needed to protect your family from RWIs and help stop germs from getting in the pool.

Keeping Kids Healthy

Swimmer’s Ear

wimmer’s ear, also known as otitis externa, is an infection of the outer ear and skin in the ear canal. It is different from an inner ear infection (otitis media), which is usually accompanied by cold symptoms, such as a runny nose or congestion.

Swimmer’s ear occurs when water gets stuck in the ear canal after swimming or bathing. Water can irritate the skin in the ear canal and bacteria or fungus can invade and cause an infection. This infection is similar to an infection that can occur on the skin from a cut or bite and it is not contagious. To prevent swimmer’s ear, you can buy over-thecounter ear drops, or make your own by mixing equal amounts of white vinegar and rubbing alcohol. Place 5 to 10 drops into each ear immediately after swimming, allow the drops to stay in the ear for a few minutes and then drain them out onto a tissue. The alcohol evaporates any water in the ear and the vinegar kills any bacteria or fungus that may have gotten in the ear. This is not a treatment for the infection, but may prevent your child from getting one. Other things that you can do to prevent swimmer’s ear include not letting your child put objects into their ears (including cotton swabs), drying your child’s ears thoroughly after water gets into them, and not swimming in polluted water.

Symptoms of swimmer’s ear include itching on the outside of the ear or in the ear canal, decreased hearing, pain when you push on the small flap that covers the ear canal or if you gently pull on the ear, and pain on the face in front of the ear. Pain in only one ear is also a sign that your child has swimmer’s ear. There may also be a greenish-yellow discharge from the ear opening. If you suspect that your child has swimmer’s ear, consult your doctor. Even though it is not common, severe

Keeping Kids Healthy

or untreated swimmer’s ear can spread to the cartilage and bone that surrounds the ear canal, so it is important to consult your doctor, especially if there is drainage coming from the ear.

To relieve pain, put a warm cloth or heating pad against your child’s ear and give your child acetaminophen.

If the infection is severe and the ear canal is swollen, your doctor may prescribe antibiotic-steroid drops. The antibiotic will kill the bacteria or fungus and the steroids will soothe and heal the inflamed skin. If the ear canal is especially swollen, your doctor may place a “wick” in the ear, which is a piece of cotton or sponge that will ensure that the drops reach deep into the ear canal. Drops are usually given for about 5 to 10 days and your child should not swim or get water into the ear while it is being treated. Remember to follow-up with your pediatrician after your child’s treatment period ends and call your doctor immediately if your child continues to have drainage from the ear, continued fever, dizziness, ear pain that lasts longer than 48 hours, or a stiff neck.

Keeping Kids Healthy

Caring for Your Pet

aking care of a pet for your child can teach them responsibility, as well as respect for nature and other living things. But pets can carry infections that can be passed to your family.

Animals can spread germs just like people can. Diseases passed from animals to people are called zoonoses and children, elderly people, people with compromised immune systems, and pregnant women are most likely to get them. Some common diseases that pets can have are not transmitted to humans, but pets can also carry bacteria, viruses, parasites and fungi that can cause people to become sick. These germs can be transferred to humans through bites, scratches, and contact with an animal’s waste, saliva, or dander (flakes from hair, feathers, or skin). Pets also carry ticks and fleas in their fur, which can bite people and transfer parasitic eggs or germs to people. Several diseases are spread more commonly by cats and dogs than by other pets, such as cat scratch disease, ringworm, toxocariasis and toplasmosis.

Cat scratch disease can be transferred through a cat scratch or bite. Symptoms of the disease include a pusfilled sore at the site of the injury, swollen, tender lymph nodes, fever, headache and fatigue. These symptoms usually go away without treatment, but your doctor may prescribe an antibiotic. Worms are the most common parasite that cause infections in cats and dogs. Eggs that worms lay may fall onto clothes or furniture and fleas that carry the eggs can bite you and spread the infection to you. Some worms can enter your body through the skin.

Ringworm is caused by several kinds of fungus and is highly infectious. If your pet has patches of hair missing, scaly skin or is constantly grooming, it may have ringworm. Itchy, red circular areas on skin may be ringworm.

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Toxoplasmosis, or litter box disease, can be spread to humans through contact with a parasite that is present in cat feces, soil, or undercooked meat. Your cat will probably not have any signs of the infection, but a person that has been infected will feel like they have the flu. Signs of toxoplasmosis include swollen lymph nodes, fatigue, fever and headache. Always wash your hands after cleaning your cat’s litter box, and if you are pregnant, have someone else clean the litter box because toxoplasmosis can cause miscarriage, premature birth and mental retardation in newborns. Toxocariasis is an infection caused by roundworms. Dogs get roundworms more often than cats and the infection is more severe for children than adults. Symptoms may include hives, muscle pain, fever, cough, wheezing, abdominal pain, and in rare cases, toxocariasis can lead to partial blindness and swelling of the organs and central nervous system.

You can prevent contracting germs and parasites from your pet by: • Washing hands often after petting, feeding or cleaning up after your pet • Not sharing food with your pet and keeping your dog or cat out of the kitchen when handling food • Not kissing your pet on the mouth or touching your pet’s mouth • Keeping your pet’s living area clean • Wearing gloves when cleaning out your cat’s litter box or disposing of your dog’s waste • Wearing shoes outside • Controlling fleas and ticks • Keeping your pet leashed when outside and keeping them away from other animals • Taking your pet to the Vet for regular check-ups If you suspect that you or your child has contracted a disease from your pet, see your doctor and take your pet to the Vet.

our child’s nose has been running green for the past few days. He has a fever and a cough. You take him to the doctor, who tells you that he has a cold. Every year, your family probably faces its share of colds, sore throats, and flus. When you bring your child to the doctor for these illnesses, do you automatically expect a prescription for antibiotics?

Many parents do. And they’re surprised, maybe even angry, if they leave the doctor’s office empty-handed — after all, what parent doesn’t want their kid to get well as quickly as possible? But your child’s doctor could be doing you and your child a favor by not reaching for his or her prescription pad. Antibiotics, first used in the 1940s, are certainly one of the great advances ever to occur in medicine. But overprescribing them has resulted in the development of resistant strains of bacteria that don’t respond to treatment. Plus, a child who takes antibiotics when it isn’t necessary runs the risk of adverse reactions, such as stomach upset and diarrhea.

To understand how antibiotics work, you have to understand the two types of germs that can make your child sick: bacteria and viruses. Although certain bacteria and viruses cause diseases with similar symptoms, the ways these two organisms multiply and spread illness are actually quite different.

Bacteria are living organisms existing as single cells. They cause illness by invading healthy human or animal cells, making toxins, or multiplying into clumps that interfere with normal body processes. Antibiotics are effective against bacteria because they work to kill these living organisms by stopping their growth and reproduction. They typically do this by destroying the protective cell wall of the bacteria.

Antibiotics

Viruses, on the other hand, are not alive and cannot exist on their own - they are collections of molecules that can “live,” grow, and reproduce only after they’ve invaded other living cells. Some viruses can be fought off by the body’s own immune system before they cause illness, but others (such as certain colds, flus, and chicken pox) must simply run their course. Because they are not alive and do not contain cell walls, viruses do not respond to antibiotics at all.

Taking antibiotics for colds and other viral illnesses not only won’t work, but it also has a dangerous side effect: over time, this practice helps create super-strains of germs that are much more of a challenge to kill. This is called bacterial resistance. When a sick child takes antibiotics too often - and for the wrong reason - “good” bacteria that live naturally in the body are unintentionally wiped out along with the “bad.” The resistant bacteria, capable of causing disease when present in larger numbers, may survive and start overgrowing. This makes it harder for antibiotics to work the next time the child is truly sick with a bacterial infection. This is a widespread problem, especially in North America, and one that the U.S. Centers for Disease Control and Prevention calls “one of the world’s most pressing public health problems.” Bacteria that were once highly responsive to antibiotics have become increasingly resistant. Among those that are becoming harder to treat are the germs that cause pneumonia, urinary tract infections, many middle ear infections, skin infections, and meningitis. So what should you do when your child gets sick? To minimize the risk of bacterial resistance, keep the following tips in mind. Seek your doctor’s advice. Letting milder illnesses (especially those thought to be caused by viruses) run

Keeping Kids Healthy

Antibiotics

their course to avoid the development of drug-resistant germs may be a good idea - but it’s still best to leave what constitutes a “mild illness” up to your child’s doctor. Even if your child’s symptoms don’t worsen, but continue to linger, be on the safe side and have him checked out.

Ask questions. At the office, ask questions about whether your child’s illness is bacterial or viral, and discuss the risks and benefits of antibiotics. One recent study found that more than 80% of middle ear infections will clear up on their own without antibiotics (many of them are actually probably viral infections). This means that, depending on your child’s symptoms and physical exam, your child’s doctor may want to wait and see how your child feels in a day or 2 instead of offering an automatic prescription for antibiotics. Ask your child’s doctor about ways to treat the symptoms that are making your child uncomfortable, such as a stuffy nose or scratchy throat, without the use of antibiotics. The key to building a good relationship with your child’s doctor is open communication, so work together toward that goal. Use the medication properly. Antibiotics are only effective if taken for the full amount of time prescribed by the doctor - and they take time to kick in, too, so don’t expect your child to feel better after taking his first dose. Most children take 1 to 2 days to feel a lot better. Similarly, don’t let your child take antibiotics longer than prescribed.

And most important, never use antibiotics that have been lying around your home - they may be expired (many liquid medicines expire after 2 weeks). Never take antibiotics that were prescribed for another family member, either - doses for children vary, and if your child did have an illness requiring antibiotics, you’d want to make sure you were treating it correctly. Saving antibiotics “for

Keeping Kids Healthy

the next time” is a bad idea, too. Any remaining antibiotic should be thrown out as soon as your child has taken his full course of medication.

earning to ride a bicycle is a big obstacle on the road to growing up. How do you pull the other foot off the ground without crashing or find your balance once dad lets go of the seat with a push and a yell of “You’re doing fine”? Learning to ride on two wheels is almost as hard as learning to stand on two feet. When a child finally rolls away under his or her own pedal-power, mom and dad can’t help but see it as a step toward independence. But riding presents dangers that children are unaware of, and riding on the streets can be very dangerous. The AAP provides the following tips for safe biking: • Helmets are necessary, even when riding in the neighborhood. Just as most accidents happen in the home, most biking accidents happen where most kids are riding—on driveways, on sidewalks, on bike-paths near home. • Substitute helmets seldom are adequate. Biking helmets are made to be light and protective without obscuring vision but with straps to secure it firmly. A football helmet restricts vision to the side

Biking Safety

and may slip down over the eyes. Baseball hard hats may fly off before the moment of impact. Be sure to buy appropriate equipment for each sport your child participates in. • Don’t buy your child on an oversized bike to grow into. Buy a bike appropriate to age and size. A child should be able to sit on the seat with the balls of both feet on the ground and hands on the handlebars. First bikes should have foot brakes. Young kids’ hand muscles and reflexes are not up to handling hand brakes. • Instruct children not to ride facing traffic. A quarter of all bicycle-car accidents result from bicycling against traffic and surprising the oncoming driver. Children should always ride on the right side of the road. • Teach your child the proper hand signals. These signals are an important part of the rules of the road. If a child cannot maintain balance while giving the appropriate hand signals, he or she should not be allowed to ride in the street. Hand signals are necessary to warn drivers of intentions to alter course. Kids love to run and play in the dusk and dark, but night riding requires special skills and equipment. Reflectors and reflective vests may not be enough to protect your child when riding at night. The glare of headlights will blind and confuse a child riding on the street. Never allow your child to ride at dusk or after dark. Biking is lots of fun if done safely, but parents have to remember that every year hundreds of thousands of children are seriously injured in bicycle falls. Worse, more than 600 children die from bicycle accidents each year. Don’t count on the fact that because you rode safely your son or daughter will, too. Traffic congestion and drivers’ habits have changed for the worse. When it comes to the safety of your child, don’t count on luck.

Keeping Kids Healthy

Eye Injuries

very year, about 30,000 children under five yearsold hurt their eyes by misusing toys and other household objects, falling, playing with household cleaning products and utensils, and in auto accidents.

A person with an injured eye may have sensitivity to light, redness and swelling of the eye and eyelid, blurred vision, pain in or around the eye, cut or torn eyelids, unusual pupil size or shape, and bleeding in or around the eye. A blow to or around the eye may cause massive swelling and bruising to the eyelid (a black eye) within 24 hours of the injury. Pain, reduced vision, and discoloration can be a sign of internal eye damage and your child will need medical attention right away. There are several things that can be done to prevent eye injuries from occurring:

• Don’t buy toys with sharp edges, rigid points or spikes. • Supervise children when they are playing with flying toys or toys that fire projectiles. • Buy safety scissors for your child and pay close attention when they are using them. • Keep children a safe distance away when using power tools, mowing, or working on an automobile. • Store household cleaning products out of reach of young children. • Keep kitchen utensils, desk supplies and tools where children cannot reach them. • Buy goggles for older children that play sports. • Have your child wear sunglasses when outside to prevent damage caused by ultraviolet light. Your child will need medical attention if he or she has cuts or punctures to the eye, chemicals have gotten in the eye, or a foreign object is imbedded in the eye.

For cuts and punctures to the eye, cover the eye without applying pressure. Do not wash the eye with water or try to remove any objects that may be stuck in the eye or lid.

Keeping Kids Healthy

For chemical exposure to the eye, rinse the eye area with water, holding the eye open if necessary. Seek medical attention right away and call your local Poison Control Center. Be ready to give them the name of chemical. Sometimes foreign objects get into the eye. To find the object, have the child look up, down, and side-to-side. If you see the object on the surface of the eye, try to flush it with water or saline or try lifting the upper eyelid and gently pulling downward on the lower lid to produce tears that may help wash the object out of the eye. Rinse the eye again after the object has been removed. Do not rub the eye, or try to remove anything that appears to be lodged in the eye. If rinsing the eye does not flush the object out, cover both eyes with a cloth (do not apply pressure) and call your child’s doctor. If your child gets a black eye, apply a cold compress. Prop up your child’s head with an extra pillow and avoid any pressure on the eye. If there is pain, severe discoloration, vision problems, or if there is any noticeable injury to the eyeball, there may be internal damage or broken bones around the eye and your child will need medical attention.

here are many old-wives tales surrounding teething, including that it gives a baby fever, makes them fussy, causes drooling and gives them diarrhea. Teething has been blamed for many conditions throughout history, including as a cause of death. The symptoms associated with teething are not present in every infant. Some babies may show an increase in chewing, drooling, and decrease in appetite, but some infants have no symptoms at all.

Teething

If you think that your child is teething and is uncomfortable, give him or her something cold, such as a clean, damp wash cloth that has been placed in the freezer for 30 minutes, a chilled (not frozen) teething ring. If you choose to use a teething ring, avoid the ones that are filled with liquid because they may break. Older infants can be given a frozen bagel, banana or even a Popsicle.

You can give your child acetaminophen or ibuprofen, but do not give it for longer than three days. Never place an aspirin tablet or rub whiskey or any other kind of alcohol on your baby’s gums and never tie a teething ring around a baby’s neck because it can get caught on something and strangle your child. Over-the-counter topical anesthetics that contain benzocaine, but no saccharine or alcohol may also help relieve your child’s pain. Benzocaine numbs the surface of your baby’s gums, but may cause your child to become allergic to other anesthetic “caines” so caution is advised.

A runny nose, fever, vomiting and diarrhea are signs of illness not of teething, but a baby’s temperature may be slightly higher than normal if he or she is teething. If your baby develops a high fever, vomits or has diarrhea, contact your pediatrician.

Babies usually begin to get their first teeth between 4 and 12 months of age. Some infants get their first tooth before and some do not get one until after they turn one. On rare occasions, babies are born with one or two teeth or will have a tooth appear within their first few weeks. Usually the first tooth that appears is one of the lower front teeth. Most children have all 20 teeth by their third birthday.

For most infants teething is painless, but some do experience some discomfort. A baby’s gums may become swollen and red about four to five days before or after their tooth appears, but the swelling does not last for weeks or months.

Remember – don’t take the chance and blame teething for what may be a sign of illness.

Saliva production begins at around two to three months of age, when the salivary glands begin working. Many parents think that drooling is a sign of teething, but it is just part of a baby’s normal development.

Start brushing your child’s teeth twice a day when they appear. It may be easier to use a piece of clean gauze at first until the tooth has fully emerged from the gums. Baby’s first toothbrush should have very soft bristles and a small head. Use a low-fluoride toothpaste until your child’s permanent teeth appear. Replace toothbrushes every three months.

Keeping Kids Healthy

Nosebleeds

any children get an occasional nosebleed. This can be disturbing for both the parent and child because it seems like a lot of blood has been lost. If your child gets a nosebleed, it is important that you remain calm and try to keep your child calm. The amount of blood lost is usually minimal and nosebleeds are not very serious.

The nasal membrane, or lining of the nose, keeps dust and other particles from going through the nose into the body. Nosebleeds occur when small blood vessels in the nasal membrane break. Unexpected nosebleeds can happen when the nasal membrane has been irritated by lots of sneezing, blowing, or coughing due to allergies or a cold. They are also common in the winter because heaters produce dry air that can cause the lining of the nose to dry out. Children can also break nasal blood vessels when they pick their nose. If your child gets a nosebleed, stay calm and try to calm your child. Have them sit or stand, lean their head forward. Use tissues or a damp washcloth to catch the blood. They should not lie down or lean their head back because they will may swallow blood, and they will vomit. Pinch the soft part of the nostrils for 10 minutes without letting go. This applies pressure to the blood vessels and allows the blood to thicken and form a scab. If the bleeding does not stop, try holding the nose for another 10 minutes.

There are several things that you can do to try to prevent frequent nosebleeds. Remind your child to not pick their nose. When the lining of the nose dries out, it sometimes feels itchy. Children pick their nose to get rid of the itchy feeling. You can apply a very small amount of petroleum jelly with a cotton swab or saline nose drops in each nostril to relieve the dryness. A humidifier may be useful, but may aggravate allergies.

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If your child gets nosebleeds often and they are hard to stop, talk to your pediatrician. Nosebleeds are not normally serious, but if they occur frequently, your childâ&#x20AC;&#x2122;s doctor may run some blood tests to see if their blood has trouble clotting.

You should call your childâ&#x20AC;&#x2122;s doctor or go the emergency room if the bleeding lasts for more than 15 minutes after you have tried to stop it, if your child has lost a large amount of blood very quickly (more than about 3 teaspoons), if your child is if you think your child has a broken nose, if the bleeding is going down the back of the throat rather than coming out of the nose, if your child feels weak or ill, if your child is having trouble breathing, if your child is bleeding from other parts of the body, such as the gums or ears, if the bleeding occurs three or more times in 24 hours, or if your child has put something up their nose.

Children and Their TV Habits

elevision; it entertains, it is educational, it opens the world to learning about new cultures that children, in their normal lives, may not have a chance to be exposed to. While there are many positive things about TV, there are also many negative influences as well, issues that we as parents do not want them to be exposed to at such a tender age.

TV violence in one such issue that children are overly exposed to during their viewing time. Because children under the age of eight (8) can not tell the difference between fantasy and reality, viewing violence can lead to aggressive behavior. Seeing their heroes on TV use violence to resolve a problem teaches children to use the same violent skills to solve their problems but without learning the real world consequences.

We can help our children if they are exposed to violence on the television by using the opportunity to open a dialogue about violence and how to settle conflicts in real life. Questions that you may ask your child are: What could have been done instead of hitting the person? Who was hurt and how does the character feel now? When we view TV with our children it allows us to use the time to discuss family values in relationship to sex, drugs and violence. This is important because only when parents are watching with their children can these conversations take place. Studies have shown that positive attributes displayed during a program are enhanced and negative ones diminished when co-viewing is part of TV time. Another area of concern for children who spend too much time in front of the television is the physical health problems which can develop. Watching many hours of TV decreases the amount of physical activity a child takes part in. Children spend less time out outdoors playing and interacting socially. Studies are strong and growing that those children spending many hours

a day in front of the TV consume nearly an extra 200 calories per hour during this time.

Risk taking behavior is also common and growing among children who spend long hours watching the television. Many programs depict the use of alcohol and or drinking scenes, either during the show or during commercial time. These exposures led children to think that if they drink they too can have as much fun as the characters portrayed on the TV. Commercials, especially during sporting events, are very intense. There also is concern for the teen-aged audience that watches music videos. These videos often depict a combination of sexual violence against women and careless use of drugs. Sympathy towards victims may be impaired when these videos are watched, and studies show that when teenagers view TV with sexual content, they are more likely to engage in it. Watching TV is inherently neither good nor bad. It can cause harm to young viewers if watched too often and the content viewed is inappropriate; or it can be beneficial when used as an opportunity to enhance their education.

Keeping Kids Healthy

Medicines and Children

ith so many different kinds of over-thecounter and prescription medications available to treat and prevent illness, it is often confusing for parents to know what type, if any, their child needs.

When giving medicine to children parents should remember:

• Never give your child medication that was prescribed for someone else. • Don’t use leftover medicine to treat your child’s symptom. If you have medicine left after your child has completed their treatment, throw it away and don’t save it because it may expire. • If you buy an over-the-counter medication, check the packaging for tampering. Do not use medications if the packaging has been cut, torn, or sliced. Also, be sure to check the expiration date. • Carefully read instructions on all medicines. Medications usually come with printed inserts that list side effects, as well as dosing directions and warnings. Call your doctor or pharmacist if you have any questions about the instructions or side effects. • Prescription medicines have labels or instructions on the bottle that tell you how to take the medicine. For example, a label that says “take with food or milk” indicates that the medicine may upset your child’s stomach or that food will improve absorption of the medicine. • Most medicines need to be taken in a certain amount and at certain time intervals. If a label says “take every 6 hours,” this means that the medicine is taken 4 times a day. In general, it doesn’t mean that you will need to wake your child up during the night to take the medicine. There are several ways to measure medicine. A dosing syringe or plastic dropper allows you to dispense the medicine into your baby’s mouth. This makes it less

Keeping Kids Healthy

likely that he or she will spit it out. Be sure to store the syringe out of your child’s reach because it can be a choking hazard.

Older babies and children may use a dosing spoon, which has a long handle that children can easily grab and children that can drink from a cup can use dosage cups that come with over-the-counter medications. Never use kitchen spoons to measure your child’s medicine. They do not provide exact measurements. Ask your pharmacist if you need help finding a measuring device to give your child the correct dose.

Many medications are given only as needed for certain symptoms, such as medicines that relieve pain or cold symptoms. However, many prescriptions will need to be finished. Antibiotics, for example, help kill bacteria and prevent it from growing, so it is important to finish all of the antibiotic even if the symptoms disappear because the amount that your doctor prescribed is the amount necessary to kill the bacteria.

Never give aspirin to children younger than 12 years old and children under 19 years should not take aspirin during viral illnesses. A child that takes aspirin when they have a virus, such as the flu or chicken pox, may develop Reye syndrome, which can be life-threatening. Some over-the-counter medicines may contain aspirin and others may contain aspirin, but use different names for it, such as salicylate or acetylsalicylate, so read the label before giving it to your child.

Using medicine safely means knowing when your child needs them and when they don’t. Check with your pediatrician if you are not sure if your child’s symptoms call for medical treatment.

he little girl woke up surrounded by cold, wet sheets. Groggy and in the dark, she had to really concentrate to figure what had just happened. In just seconds, she snapped to the fact that, again, she’d wet her bed. Again, she’d have to strip the bed, put the soiled sheets in the hamper, and sleep the rest of the night on her barren mattress.

She didn’t know that there was a name for this, or that it affected millions of boys and girls around the country. All she wanted was a good night of sleep in a dry bed.

Nocturnal enuresis (En-yur-ee-sis) is extremely common and chances are there are other children in your child’s class experiencing the same thing. It doesn’t necessarily mean that there’s something wrong with your child. In fact, it may be hereditary. If you think back to when you were a child, if you wet your bed, it’s likely it will or is happening to your little one. Twenty percent of children ages 4-12 wet their bed, and it affects boys more than girls, with boys making up about two-thirds of the count.

Nocturnal enuresis happens because the child can’t feel their bladder fill up throughout the night. It doesn’t mean that your child is lazy or dirty. It’s not a behavioral or learning problem. It’s just something that happens. It’s more common among deep sleepers because, well, because they’re sleeping deeply and don’t feel the signal that tells them to wake up and urinate.

Bed Wetting

While bed-wetting typically resolves itself, you may want to take some proactive measures so you and your child can have a good night’s rest. There are two ways to approach this.

Believe it or not, there are enuresis alarms that sound when the bed gets wet. It’s suitable for children ages 5 years and older, and it teaches your child to respond to the body’s own alarm system, signaling them it’s time to go to the bathroom. Discuss this option with your pediatrician.

Institute a reward system for your child during dry nights. And, try to limit your child’s liquid intake after dinner. Have your child change their own bed sheets when they’ve wet their bed. This is a good idea for children who are five years and older. As a parent, you should have clean sheets ready to go. Utilize this as a way to make sure your child takes part in making the rest of their sleep time comfortable. It should not be used to punish or shame your little one.

Last, train your child’s bladder during the day time by asking them to wait a little longer before going to the bathroom during the day. By asking them to hold their urine for longer times, you help encourage behavior that will be important overnight.

While medicine isn’t a cure for bed-wetting, some may help regulate the body’s urine storage and production. Talk with your doctor about the best approach. They’ll conduct a physical and test your child’s urine to make sure there aren’t any problems with the urinary So, as a parent, how can you help? Well, it’s important tract or bladder. to remember that your reaction to your child’s bed-wetThe good news is most children outgrow bed-wetting ting is pivotal in how your child deals with this issue. by the time they’re 15. And, think of it this way — It’s The wrong kind of reaction can lean to self-esteem prob- an opportunity for you and your child to conquer somelems that only worsen over time. thing together! If you’re child wets their bed, stay calm. Focus on the fact that they didn’t do it on purpose and create ways to try and encourage your child to take part in fixing the problem.

Keeping Kids Healthy

Gun Safety

irearms are a leading cause of death in children. Between 1979 and 2001, over 93,000 children have died as a result of gunshot wounds. This includes both accidental and intentional injuries. Deaths resulting from firearms for children in the US under 15 years-old are 12 times higher than in 25 other industrialized countries combined.

More than 40 percent of American households with children have guns. In many of these homes, the guns are stored loaded and within the reach of a child.

Children seem to get a general idea of what guns are before they can even speak, even toddlers.

Children under 10 are not capable of understanding that guns can kill. There is no clear answer as to whether or not toy guns are harmful to a child’s recognition of fantasy or reality. Some gun owners feel that children should not play with toy guns and should be taught that guns are not toys, while others feel that it isn’t a problem. Parents should decide on their own whether or not they want their child to play with toy guns. Toy guns for older children can be dangerous because some of the toys look like real guns.

• Lock and store bullets in a separate location. Children have been killed playing with guns that they thought were empty, but had one bullet left in the chamber. Ask police for advice on safe storage and gun locks. • Talk to your child about gun safety. Tell your child that if he or she sees a gun they should stop, not touch the gun, immediately leave the area where the gun is, and tell an adult. Teach them that guns are not toys and that if a friend wants to show The best way to prevent your child from being shot them a gun it is not tattling to tell an adult beaccidentally, of course, is to not have a gun in your home. cause it can prevent an accident. Whether or not you own a gun please remember: If you own a gun or have found one in your home and want to get rid of it, call your local police station, but • Guns should be stored unloaded and locked up. don’t call an emergency line to do so. The weapon will Just because you have the gun hidden, don’t assume that your child doesn’t know where it is. Re- be checked to make sure that it was not used in a crime and then it will be destroyed. member that other adults may have guns in their homes. Speak with the parents of your children’s Even if you feel that owning a gun is your right as a friends to find out if they keep a gun at home. If citizen of the US, your duty to your child is to protect they do own a gun that is not locked up, urge them him or her. Teach your child gun safety and don’t assume to lock it up. that they will already know not to play with one if they come in contact with a gun.

Keeping Kids Healthy

Burn Injuries

• Place covers on electrical outlets and keeping electrical cords out of reach. • Keep matches, lighters, candles and other flammable items out of your child’s reach. • Install and regularly checking smoke alarms. • Buy flame retardant sleepwear for your child.

Have an escape plan for your family that you practice. This includes teaching your child what to do in case of a fire: urns are a common injury in children. Every • Cover mouth and nose with a moist towel or and year, almost 40,000 children are hospitalized article of clothing. because they have been burned and over 1,000 • Crawl under the smoke to safety and stay as low of these children die from their injuries. to the ground as possible • Touch any door to see if it is hot and if it is, The most common burn injury in younger children usudo not open it ally occur after the child accidentally knocks over a cup of • Avoid elevators and find the nearest stairway coffee, grabs the handle of a pot of boiling water on the stove, marked “Fire Exit” if you live in an apartment or touches a household appliance, such as a curling iron. building There are three types of burns: first-degree, which • Never stop to take personal belongings occur after brief contact with heat and cause redness, • Stop, drop, and roll if an article of clothing pain and some swelling; second-degree, which are more catches on fire severe and usually result in blisters and intense redness; If your child gets burned: and third-degree, which are the deepest burns and may • Remove clothing from the burned areas unless the be painless due to nerve damage. clothing is stuck to the skin. Burns are preventable injuries. Steps that you can • Run cool (but not cold) water over the burn until take to keep your child from getting burned include: the pain lessens. • Lightly apply gauze bandages if it is a small first• Set the temperature of your hot water heater to degree burn. 120° F to prevent scalding burns from the bathtub faucet or sink. Seek medical attention if: • Do not leave your child alone in the bathroom or • Your child has a second- or third-degree burn. kitchen. There are other obvious dangers in these • A large area of your child’s body has been burned. areas of your home, as well. • The burn came from a fire, an electrical wire or • Do not carry hot liquids or food near your child socket, or it is a chemical burn. and don’t allow your child near stoves, hot barbeque • The burn is on the face, scalp, hands, or genitals. grills, hot ovens, heaters, or other hot appliances. • The burned area is swollen, has pus, increased • Use the back burners on the stove and turning pot redness or there is red streaking near the wound. handles inward.

Keeping Kids Healthy

Food Allergies

hen you think of allergies, you probably picture red, watery eyes, sneezing, and runny noses. But unlike the seasonal-type allergy described above, food allergies, such as nut allergies, can cause serious problems for your child. People that are allergic to nuts must avoid eating nuts or any products with nuts in them. This can be more difficult than you might think.

An allergic reaction to peanuts may be mild or severe. Severe peanut allergy can cause anaphylaxis, which is a sudden, severe allergic reaction, and can cause several problems in different systems of the body at once. Anaphylaxis can produce hives, faintness or unconsciousness due to low blood pressure, swelling, tightening of the throat, asthma symptoms, vomiting, stomach cramps, diarrhea, tingling feeling in the lips or mouth, or even death. In most cases, a child will not have an allergic reaction the first time they are exposed to peanuts. A person who is allergic to nuts or any other food may not have a reaction for many years and then suddenly their body does not treat the nuts as food. Instead, their immune system kicks in and produces antibodies, which are chemicals the body produces that fight infection, and begins to fight against the protein in the nuts. One of these chemicals released into the bloodstream is histamine.

Antihistamines are medicines that stop histamines from working, but they do not work quickly enough to control symptoms that occur from a food allergy. Antihistamines alone cannot control anaphylaxis. Adrenaline, or epinephrine, is a drug that works against all of the effects of all of the dangerous substances that are released in anaphylaxis. For serious allergic reactions, adrenaline needs to be injected.

Keeping Kids Healthy

Food allergies are difficult to diagnose. In general, doctors recommend that parents not give their children foods containing any nut products until after they are 2 years-old, especially if there is a family history of food allergies. Pregnant or nursing mothers should stay away from peanut products.

There is no cure for food allergies and the only way to prevent an allergic reaction to foods, such as peanuts, is by avoiding them. If your child has an allergy to any foods, make sure that they are aware that they should not eat any products containing those foods and that relatives, teachers, and parents of their friends know. Some general tips to remember for a child that is allergic to nuts are:

• Avoid foods with an unknown list of ingredients. Avoid fried foods, especially from restaurants and fast food places that may be made with peanut oil. • Make sure that everyone who handles your child’s food knows that they are allergic to nuts, even when you eat out. • Talk to your child’s daycare supervisor or principal and make them aware of your child’s allergy. • Talk to your child’s doctor about keeping medication on hand at all times in case your child has an anaphylaxis episode.

Hearing Loss

earing loss in infants and children is not a common occurrence, but the effects, when it occurs, may devastate parents.

Repeated temporary interruptions in hearing during the intense period of development in the six months after birth can have permanent effects on language facility later in life. Infants need to receive auditory feedback if they are to learn the speech motor skills involved in talking. Some signals that a child may have hearing difficulties are if he or she:

• has a speech or language delay • uses gestures to communicate instead of speech • watches you closely when you talk • does not wake up to loud sounds or • has a change in voice quality Middle-ear infections, which we have discussed in the last two articles, are one of the most common risk factors associated with hearing impairment. Additional risk factors include other viral and bacterial infections, conditions such as low birth weight that lead to a stay in the newborn intensive care unit or a family history of permanent childhood hearing loss. Parents with a child who has had repeated bouts of otitis media, should ask their pediatrician if the disease may have impaired the child’s hearing.

Keep in mind that this condition occurs in only a small number of children. But because the first six months of life involve important developmental changes, the American Academy of Pediatrics Task Force on Newborn and Infant Screening recommended that all newborns have screening before they reach one month of age, with audiologic confirmation of significant hearing loss by the time they are three months of age and intervention by six months of age. Infants that have failed the first hospital screening should have had a second screening to determine whether the baby needs to be seen by an audiologist. Parents who may have missed this second screening or are concerned that a child’s hearing, speech or language usage does not seem appropriate to the milestones described in most baby books should consult with their baby’s doctor without delay. If you have questions, your pediatrician will explain the importance of hearing to your child’s full development. In many cases, mild temporary hearing loss causes no lasting problems. In others, prompt intervention by medical caregivers and speech therapists can do much to alleviate or compensate for hearing loss. Children with more serious hearing loss can usually develop a proficiency in spoken language by means of using a personal hearing device. Though many toddlers accept a hearing device, it is not unusual for a child to resist having something in their ears. Parents should practice understanding of a small child’s rebellion. In serious cases with permanent hearing damage, parents will have to consider either learning visual sign language along with their child, or in appropriate case having a cochlear implant, inserted into the middle ear to transmit sound waves.

Keeping Kids Healthy

Bullying

ullying is not new in public and private schools. Arriving students have always suffered a temporary pariah status upon entering a different school. Big kids have long insulted, abused and in other ways lorded it over the smallest students. The clique that runs the school uses various forms of verbal abuse to ridicule those who are different.

Recent studies, though—one in Maine and another by the Department of Health and Human Services (DHHS)—found that there is a strong association between bullying or being bullied and four violence-related behaviors—carrying a weapon, carrying a weapon in school, frequent fighting and being injured in a fight. We can understand why 70 percent of boys who bullied in and away from school tended to carry a weapon in school or away from school. But 70 percent of boys who were bullied did, too. The percentages for girls, though lower, confirmed the association. This would seem to indicate that allowing a child to be bullied may predispose him or her to violence. The child beater’s child has no example of good parenthood to follow.

The Main Project Against Bullying found that eighty percent of Maine adolescents reported being bullied in school. Ninety percent of 4th through 8th graders were victims. In Maine, 15 percent of students bully regularly or are bullied regularly. The worst is that students report that 71 percent of teachers and adults present ignored teasers and bullies. Children identified as bullies by age eight are six times more likely than non-bullies, according to the Maine report, to have been arrested by age 24, and five times more likely to have long criminal records by age 30. Aggressive behaviors become more resistant to alteration after the age of eight.

Keeping Kids Healthy

Here are some ideas for parents:

• Don’t be surprised that your child is being bullied. Aggressive and sometimes violent behavior in the schools occurs nationwide. • Talk to your child about the daily experience at school and be suspicious but sensitive to ‘closed doors’ and unwillingness or unhappiness to speak about school. • A bullied child is in a struggle with an individual or group with more power than he or she has. Bullying is about power. So be sympathetic and understanding. Don’t demand impossible heroic or stoic behavior. Your child has the right to attend school without fear of aggression or abuse.

• Find out if the practice takes place in spite of the efforts of teachers, administrators and other adults or with their tacit acceptance. Teachers may be terrorized, too. • Speak with school administrators about the school’s policies on bullying. What degree of tolerance for teasing and insults does the school accept? If the policies are positive, ask what you can do to help. • If you are unhappy with the meeting, consult with members of your parent’s association to see if other children are reporting bullying and abuse. Face the problem with your child. Seek out other parents with bullied children who will work with you. This may lead to new friends for your children. Together with other parents seek the backing of the parents association to convince the school administration to remove bullies from buses, playgrounds and classrooms and improve conditions for learning at the school.

ost people feel that 98.6° F is normal body temperature. The truth is that “normal” body temperature varies from person to person. Some people have a normal temperature that is a little higher than 98.6 and some have a lower temperature. Most people’s body temperature changes throughout the day. It is usually lower in the morning and higher in the evening. Most children’s temperature stays the same from day to day – until they get sick, either from a bacterial infection or a virus.

Fever

Fever is not dangerous. It will not cause damage to the brain unless it rises above 107° F and infections rarely cause fevers over 106.2° F. Temperatures over 107 are usually caused by heatstroke, head trauma, toxic ingestion, or side effects from anesthesia.

In general, our body temperature rises when our body is fighting infection. Fever is actually a good thing -- it shows that our immune system is working to fight whatever illness we have. Fever occurs when the hypothalamus, which is located in the brain and acts as the body’s “thermostat”, responds to substances that are released in the blood by invading bacteria, viruses or toxins. The hypothalamus raises the body’s temperature and signals white blood cells to attack the invaders.

Make sure that your child drinks a lot of fluids. Loss of fluid due to sweating increases and can cause dehydration, which can make your child’s temperature rise. Don’t force your child to eat because people that have fever do not usually have much of an appetite. Once the infection has passed, your child will regain their appetite as well as any weight that may have been lost while they were ill.

If you choose to reduce your child’s fever, you may give them acetaminophen or ibuprofen. Follow the instructions on the package or talk to your pediatrician to determine the amount that your child should take. Do not use aspirin to reduce a fever. Aspirin has been linked to Reye’s syndrome, which is a disease that causes severe liver dysfunction and brain swelling.

Fever is only one part of an illness and for children under eight years-old, fever is not a reliable sign to determine how sick they are. Infants and toddlers can be very ill without having a high temperature, while children three to eight years-old can be running around as they normally do with a very high fever. The important thing is to see how your child is acting, rather than what the thermometer says.

Reducing fever may not make your child get better faster, but it will relieve some of the discomfort that the fever may be causing them. Also, if you reduce the fever, you may be able to tell if they are feeling miserable because of the fever or the infection.

Make sure that your child is wearing lightweight clothing. If your child feels cold, give him or her warm liquids. If your child complains of being too hot, dress him or her lightly.

Keeping Kids Healthy

Immunizations

If your child is exposed to the illness, his or her body is ready to fight it off and he or she does not get sick. This is known as immunity.

The numbers of cases of many of the diseases that children are now vaccinated against have declined by 95% or more since the start of widespread vaccinations in the United States. This is one reason that some parents don’t feel that it is necessary to have their child receive vaccinations. However, what these parents don’t realize is that the bacteria or viruses that cause the diseases that the immunizations are intended to prevent are still around. And because the immunizations are not 100% effective for everyone, a child who has been immunized can still be at risk for contracting these diseases. Other parents worry that their child will contract the disease that the vaccination is trying to prevent. Even though vaccines contain parts of the bacteria or viruses, it is impossible to get the actual disease from any immunization made with the dead cells of the virus or bacteria.

Vaccination rates are fairly high in the United States, but there is no way of telling if everyone that your child comes into contact with has had their vaccinations, especially those that travel to and from other countries.

hildren need to be immunized to protect them from dangerous, but preventable childhood diseases. Vaccines prepare your child’s body to fight potentially deadly diseases. Defense cells, called antibodies, are created by the fight germs in the body. Each immunization contains a dead or weakened germ that causes the particular disease. Your child’s body makes antibodies that recognize specific parts of the bacteria or virus and learns to fight off the illness.

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Immunizations are not 100% effective, but they do work in 85%-99% of all cases, which makes them one of the most effective methods for preventing disease. Even though it may be difficult to watch your child get a shot and hear them cry, it is much better than watching your child suffer through diseases such as diphtheria, pertussis, pneumococcal disease, or the measles, which are all potentially deadly. For more information about vaccines visit the NNii website at www. immunizationinfo.org

Pertussis, or Whooping Cough

t has been reported that pertussis, or whooping cough, has been showing up in our area. Whooping cough is a highly contagious, but vaccine-preventable respiratory disease caused by bacteria.

Pertussis, also known as whooping cough, is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It’s characterized by severe coughing spells that end in a “whooping” sound when the person breathes in. Before a vaccine was available, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30.

Although pertussis can occur at any age, it’s most severe in un-immunized children and in infants under 1 year of age (early immunization can usually prevent this serious disease in babies). About 40% of all pertussis infections occur in children less than 1 year old, and only 15% occur in children over 15 years old. Half of all deaths from pertussis occur in infants under age 1, and serious complications are more common in this group. The incidence of pertussis among adolescents and adults has been increasing in the last several years. This is an important fact, because coughing adolescents and adults who may not realize that they have pertussis are currently the major source of infection for infants and children.

The first symptoms of pertussis are similar to those of a common cold: • Runny nose • Sneezing • Mild cough • Low-grade fever After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, the child may turn

Keeping Kids Healthy

Pertussis, or Whooping Cough red or purple. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.

Although it’s likely that infants and younger children who become infected with B. pertussis will develop the characteristic coughing episodes with their accompanying whoop, not everyone will. However, sometimes infants don’t cough or whoop as older children do. They may look as if they’re gasping for air with a reddened face and may actually stop breathing for a few seconds during particularly bad spells. Adults and adolescents with pertussis may have milder or atypical symptoms, such as a prolonged cough without the coughing spells or the whoop.

Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person’s nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment. Pertussis can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization. DTaP immunizations are routinely given in five doses before a child’s sixth birthday. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child’s doctor will have the most current information. Experts believe that up to 80% of non-immunized family members will develop pertussis if they live in the same house as someone who has the infection. For

Keeping Kids Healthy

this reason, anyone who comes into close contact with a person who has pertussis should receive antibiotics to prevent spread of the disease. Young children who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member. The incubation period (the time between infection and the onset of symptoms) for pertussis is usually 7 to 10 days, but can be as long as 21 days.

Pertussis can cause prolonged symptoms. The child usually has 1 to 2 weeks of common cold symptoms first. This is followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer. The last stage consists of another several weeks of recovery with gradual resolution of symptoms. In some children, the recovery period may last for months. If you suspect that your child has pertussis, he or she will need to visit the doctor. The doctor will make a diagnosis by first taking a history and doing a thorough physical exam. He or she might take samples of mucus from your child’s nose and throat to determine whether your child has a pertussis infection. These samples are sent to a laboratory, where they can be examined and cultured for B. pertussis bacteria. Blood tests and a chest X-ray may also be done.

If your child has pertussis, it will be treated with antibiotics, usually for 2 weeks. Many experts believe that the medication is most effective in shortening the illness when it’s given in the first stage of the illness, before coughing spells begin. But even if antibiotics are started later, it’s still important because they can stop the spread of the pertussis infection to others. Ask your child’s doctor whether preventive antibiotics or vaccine boosters for other family members are needed.

Whooping Cough continued on page 60

Pertussis, or Whooping Cough

ome children with pertussis need to be treated in a hospital. Infants and younger children are more likely to be hospitalized because they’re at greater risk for complications such as pneumonia, which occurs in about one in five children under the age of 1 year who have pertussis. Up to 75% of infants younger than 6 months old with pertussis will receive hospital treatment. Infants and younger children are more likely to require hospitalization because they’re at greater risk for complications such as pneumonia, ear infection, dehydration, and seizures. In infants younger than 6 months of age, pertussis can even be life-threatening. While in the hospital, a child may need suctioning of thick respiratory secretions. The child’s breathing will be monitored, and oxygen may be needed. Intravenous fluids might be required if the child shows signs of dehydration and is having difficulty eating. The child also will be isolated from other patients, with special precautions to prevent the infection from spreading to others, including hospital staff and visitors. If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your

child’s doctor prescribed. Giving your child cough medicine probably will not help, as even strong cough medicines usually can’t relieve the coughing spells of pertussis. As your child recovers, let your child rest in bed and use a cool-mist vaporizer. This will help loosen respiratory secretions and soothe irritated lungs and breathing passages. (If you use a vaporizer, be sure to follow directions for keeping it clean and mold-free — usually with small amounts of bleach.) In addition, try to keep your home free of irritants that can trigger coughing spells, such as aerosol sprays, tobacco smoke, and smoke from cooking, fireplaces, and wood-burning stoves.

Children who have pertussis may vomit or not eat or drink as much because of frequent coughing. So, give your child smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, too, including: thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to urinate (or in infants, fewer wet diapers).

Call your child’s doctor if you suspect that your child has pertussis. Also, call your child’s doctor if your child has been exposed to someone with pertussis, even if your child has already received all of the scheduled pertussis immunizations. Your child should be examined by a doctor if he or she has prolonged coughing spells, especially if these spells:

• Make your child turn red or purple • Are followed by vomiting • Are accompanied by a whooping sound when your child breathes in after coughing If your child has been diagnosed with pertussis and is being treated at home, seek immediate medical care if he or she has difficulty breathing or shows signs of dehydration.

Keeping Kids Healthy

Seizures

any children have seizures, known as febrile seizures, which are triggered by fever or a sudden rise in temperature in babies and small children. Many people have heard of seizures caused by epilepsy, but febrile seizures are different from epileptic seizures, which are recurrent periods of unconsciousness and convulsions, and are not triggered by fever.

About one out of 25 otherwise healthy children will have at least one febrile seizure. They usually occur between the ages of 6 months and 5 years in children whose immediate family has a history of febrile seizures. If a child has a seizure soon after a fever begins or if their temperature is relatively low, the child’s risk of having more seizures is higher. While seeing your child lose consciousness and go into convulsions is scary for a parent, the majority of seizures associated with fever are harmless. During a seizure: • • • •

Your child’s arms and legs may twitch and jerk. His or her eyes may roll back in their head. He or she may lose consciousness. He or she may lose bladder or bowel control.

If your child has a seizure: • Stay calm, but act immediately to prevent injury. • Place the child on his or her side or stomach on the floor or the ground. Make sure that they child is away from any hard or sharp objects. • Loosen any tight clothing, especially around the neck. • Do not hold down a child who is having a seizure. • Remove anything that is in the child’s mouth, but do not put anything into his or her mouth. • Make sure that your child is breathing and call for emergency help if your child’s lips have turned a bluish color or the seizure lasts for more than 5 minutes.

Keeping Kids Healthy

After your child has a seizure, he or she may be drowsy or confused. Febrile seizures usually don’t last for longer than a few minutes, but if the seizure lasts for longer than 15 minutes the child should be taken to the nearest medical facility.

This type of seizure is hard to prevent, as it is usually the first sign of a fever. Febrile seizures are not necessarily prevented by fever-lowering medications such as acetaminophen or ibuprofen. The majority of children that suffer from febrile seizures do not need to be treated with medication. Remember that the most important thing for a parent to do when their child is having a seizure is to remain calm. Febrile seizures are harmless and they do not cause brain damage. Contact your child’s doctor as soon as possible after the seizure because fever is often a sign of infection.

The Sunshine Vitamin: Vitamin D

e have all heard how important Vitamin D is in promoting healthy bone growth in children and its lasting effect on their bones and teeth from Childhood until adulthood. This is because Vitamin D helps our bodies absorb calcium. But did you know that almost Âź of adolescents tested have a Vitamin D deficiency? Children with a Vitamin D deficiency are at risk for stunted growth and weakened bones which will in turn mean that they will be at risk for osteoporosis later in life. During childhood in under-developed countries a deficiency of Vitamin D can cause rickets, a disease that weakens and softens the bones of children. A victim of rickets has a bow in the long bones of the legs, which will persist into adulthood if not treated. It is also known that a long term lack of Vitamin D can also be linked to diabetes, some cancers and high blood pressure.

The body produces Vitamin D through exposure to sunlight. It is also found in foods like milk that has been fortified with the vitamin, eggs and fish. Other foods and drinks can be fortified with vitamin D as well. This can mean that if your child does not drink enough milk or get enough sunshine in the winter, their Vitamin D levels can drop to levels of concern. A fact to remember is that getting some sun each day may not be enough to produce the level of vitamin needed, especially if your child wears sunscreen. This is why taking a supplement or drinking fortified milk is important. Your pediatrician can test for levels of the vitamin if a problem is suspected.

The American Academy of Pediatrics recommends a multi-vitamin supplement containing 200 international units of Vitamin D per day for babies that are breast-fed only, or for children and adolescents who drink less than 3 six ounce glasses of fortified milk a day.

Keeping Kids Healthy

Scald Burns

o one wants to be burned. Even the smallest burn hurts more than a cut the same size. Larger burns not only hurt but can result in significant pain, permanent scarring, loss of use of limbs and even death. Most scald burns can be prevented. Scald burns occur from accidental spills of hot liquids or from hot tap water. Scald burns happen most often in children under the age of five and the elderly. Several things can be done to prevent these burns. For accidental spills always make sure that the handles of pans are turned away so that young children can not reach up and grab them and extension cords to coffee pots and other electric cookers are not hanging off the counter.

Some facts about how quickly you or your child can be burned. Approximately one second exposure to 160 degrees F water will result in a third degree burn which is the most severe burn and will leave a scar. Thirty seconds of exposure to 130 degrees F will cause a third degree burn. This means that children and the elderly who can not move out of hot water quickly or canâ&#x20AC;&#x2122;t feel the heat will be burned severely in a very short time of less than Â˝ of a minute.

In the United States most home water heaters are heated by either gas or electricity and have a thermostat. You can measure how hot the water is by collecting water from the tap in a cup after letting it run for two minutes. Using a meat or candy thermometer measure the temperature for 30 seconds. The temperature should be less than 130 degrees F ideally 120 degrees F. If it is not, lower the temperature and measure again in 24 hours.

Always stay in the bathroom when bathing your child. Keep your child out of the bathtub until the water is filled. Start with cold water and add hot water to make it warm. Mix the water with your hands to avoid hot spots and then measure with your elbow. Never leave your children alone in the tub particularly if they are able to turn on the hot water tap. If you must leave the room, take your child with you. Drain the tub after use. Bathing in the sink requires extra care as most sinks have a single lever to turn on the water and it is very easy to turn on very hot water. Treatment of scalds is to put the scaled skin in cold water or cold wet cloths. If still red, hurting or blistered after 30 minutes, go to the emergency room. Do not apply any cream, ointment, butter, oil or ice. Turn down your hot water heaters and save your child from a disfiguring burn. The only persons who should not have their hot water turned down are persons with problems with their immune system.

Keeping Kids Healthy

Mental Health in Children in identifying the early warning signs, the potential for making a difference in these children’s lives would be enormous. And as a result the children and society will benefit in the long term. If you recognize any of these warning signs in your child, please seek medical help:

issy fits. Temper tantrums. The blues. Like adults, children suffer from these conditions from time to time. But what if it has become an insurmountable problem for your child? When should you seek help for your child? A frank discussion with your pediatrician is a good place to begin researching the seriousness of your child’s problem.

According to the Surgeon General at the US Department of Health and Human Services, “in the United States, 1 in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet, in any given year, it is estimated that less than 1 in 5 of these children receives needed treatment. The long-term consequences of untreated childhood disorders are costly, in both human and fiscal terms.” Unfortunately there is a serious stigma that is placed on people with mental health issues. Because of feelings of embarrassment or guilt, parents may avoid seeking help for emotional, developmental and behavioral issues for their children. If families and the public are educated

• Feelings of sadness and hopelessness that will not go away • Sudden changes in school work and grades • Anxiety and worry, inability to concentrate • Unable to over come the loss of a grandparent or parent • Anger, crying, overreacting to everyday events • Injuring animals • Damaging others property • Setting fires • Racing thoughts that are too rapid to follow • Suicidal thoughts • Hearing unexplained voices or seeing things that no one else can • Withdrawing from family and friends Many services are available to help diagnose emotional, behavioral and developmental problems in children. Most communities have family group support meetings. From your family physician, seek referrals and information about treatments and services. Libraries are great sources of information. It is important to remember that even though mental problems can be painful and severe, help is available. Excellent websites include: • • • •

http://www.nimh.nih.gov/ www.cdc.gov/mentalhealth/ www.samhsa.gov http://www.apa.org/ppo/issues/tfpacmi.html

Keeping Kids Healthy

Sibling Rivalry

t’s normal for brothers and sisters to argue and compete for their parents’ attention. Sibling rivalry teaches kids to manage conflicts, share, cooperate, and express their ideas and feelings.

• Don’t punish one child in front of the other. When it’s necessary to punish or scold your child, do it alone in a quite, private place. Scolding him in front of another child can lead to his being teased. • Give your children— especially older children Children can learn how to properly deal with conflict — his or her own space. Keep each child’s own through their interactions with brothers and sisters. When personal things apart from shared ones. they argue, they are learning that they are not always go• Don’t try to treat your children equally. If one child ing to get along with everyone, even those with whom we needs a new pair of shoes and the other doesn’t, are closest. Telling your child that sometimes people feel don’t buy shoes for both children. angry, sad and frustrated with those around them will give Children also learn how to respond to conflict by watchhim or her a healthy view of reality. Teaching your child ing their parents deal with conflict. If they see you dealto identify these emotions as normal can help him or her ing with your emotions in a constructive way, they will respond to them in a healthy way. learn to as well. Tell your children that there are three ways to solve an argument – physically (which is never a good way to solve a problem), by using appropriate words and talking the problem through to come to a compromise, and by taking a time out away from the conflict to think about it. • Allow your older child to help care for the younger one. Helping to feed a baby or change a diaper can strengthen the relationship between siblings. Encourage your child to be proud to be a big brother or big sister. • Don’t point out your children’s differences in front of them. Your child might interpret comparison as criticism and may think that he’s not as good or as loved as his sibling. • Stay out of your children’s arguments if you can. You may have to step in and settle a spat between toddlers or preschoolers, but older children will probably settle an argument themselves if left alone. • Let your children know that violence is unacceptable. Make sure your children are made aware that violence will not solve a problem and praise them when they solve their arguments peacefully.

Keeping Kids Healthy

any adults know what it’s like to have headaches, but children also get them. In fact, by the age of 5, 25 percent of children have had at least one headache and by the age of 15, 75 percent have experienced a headache.

Even though a headache may feel like the pain is coming from the brain, what usually causes the pain comes from outside of the skull in the nerves, blood vessels and muscles that cover the head and neck or from pressure increases in the blood vessels inside of the skull. The muscles and blood vessels can swell or tighten and put pressure on surrounding nerves. Children can develop headaches for a variety of reasons, including dental cavities, ear infections, and sinusitis. They can also come about due to lack of sleep, stress, bumps on the head or they can be triggered by certain foods and drinks. Children can also suffer from migraines and tension headaches. Headaches are classified in two different categories, primary and secondary. Primary headaches include tension headaches, migraines, and cluster headaches. Secondary headaches result from specific causes that include infection, meningitis, tumors, or head injury.

Most headaches will go away on their own with little or no medical intervention, but you should take your child to a doctor to talk about their headaches if the headaches: • • • • •

Are very painful Wake the child from sleep Will not go away easily Develop after a head injury Affect your child’s vision

Headaches

• Are accompanied by a tingling sensation • Cause your to act differently • Occur more than once a month • Keep your child from going to school • Are accompanied by fever or a stiff neck • Occur early in the morning without nausea Having your child lie down in a cool, dark room or giving him or her acetaminophen may help. You should not give your child pain medication every day because it can make your child’s headaches worse over time. Other steps that you can take to try to prevent your child from getting headaches include:

• Making sure that your child drinks enough fluid. Children need about 4-8 glasses of fluid a day • Not giving your child caffeine • Keeping your child on a regular sleep schedule with at least 8-10 hours of sleep per night • Not letting your child skip meals • Avoiding foods that seem to trigger headaches • Avoiding overly-busy schedules or stressful situations If you decide that your child should see a doctor because he or she is experiencing headaches frequently, your doctor will examine your child’s medical history and may ask you to keep a record of your child’s headaches by writing down how severe they are, what seems to help or make them worse, and what seems to trigger them. Your doctor may also suggest a change in diet, a change in sleeping habits, relaxation exercises, or, if necessary, may prescribe medication to control the headaches. If your child is given a prescription, you will need to inform his or her school nurse, so that your child can receive treatment as school if he or she gets a headache there.

Keeping Kids Healthy

Cutting: Self Injury

The Reason Behind the Pain It is difficult to understand why people cut themselves, especially children. Many times, self-injury begins when someone is feeling overwhelmed or desperate due to emotional pain or pressure. The act of cutting gives them momentary relief from situations that seem insurmountable. At times, it’s simply done for attention – a cry for help, perhaps. In some rare cases, self-injury arises out of developmental issues. Self mutilation has been linked to Lesch-Nyham Syndrome, a neurological disorder first discovered in the mid-1960’s.

he small, thin slices on the inside of her arm seemed almost invisible to the girl, but not to the sharp eyes of her concerned mom. Quietly, her mother took her aside and asked about the marks. Lying at first about the cat scratching her, the girl, barely a teenager, realized her mom knew better and confessed that she had cut herself with a razor. She told her mom of the hurt and sadness she felt at school when bullied by her peers. Mom immediately set up a doctor’s appointment to seek help for her daughter.

Seeking Help The most important message for children and teens who engage in this self-destructive behavior is that there are more preferable ways to deal with problem causing it. Mental health professional are available to help someone get over the emotional pain that causes him or her to want to cut themselves. This may prove difficult, however, because getting a loved one to admit to the behavior and admit that they need help is often the hardest step. Though, once they have opened up about cutting, most patients say that they feel a great sense of relief.

Once the person admits to self-injury, the problem(s) that led to the self-injury need to be identified, addressed, and resolved. But the exact reason may be hard to identify. Again, a professional mental health specialist can help work through this stage with their patient. This specialist can help the person overcome the problem The small cuts are usually in places that are not visible and break the pattern that comes with cutting. Once the to others, on the belly, thighs and chest; but the cuts can pattern is broken, the health care professional will help also occur on the wrists, arms and legs. Although the the patient find other, more appropriate ways of dealing cuts typically do not go across, as in a suicide attempt, with and relieving the emotional stress. cutting should not be considered a fad. It is a very serious problem and usually happens because the child feels frightened, invalidated and disrespected. Self-mutilation is not new, but it is more recognized and discussed these days. Cutting is more common among girls than boys, but boys also try to self-injure. It normally first appears during the teenage years and can continue into adulthood.

Keeping Kids Healthy

Asthma

sthma is the number one reason that children miss school in the United States and the most common chronic illness that sends kids to the emergency room.

Some children have only mild, occasional asthma flareups, or only show signs after exercising, while others have such severe asthma that it affects how active they are and causes changes in the way their lungs function. Asthma is a chronic inflammatory lung disease that causes airways to tighten. Asthma flare-ups often appear to happen without warning, even after weeks or months without having. All children that suffer from asthma have airways that are overly sensitive to triggers, such as exercise, allergies, viral infections, and smoke. When children with asthma are exposed to triggers such as these, their airway linings become inflamed, swollen, fill with mucus and the muscles that line the airways tighten and shrink, which makes it difficult for air to move through them. A child experiencing an asthma flare may cough, wheeze, have tightness in his or her chest, have an increased heart rate, sweat, and have shortness of breath. There are four main categories of asthma:

• Mild intermittent asthma – brief flare-ups that occur no more than twice a week. The child rarely shows symptoms between flare-ups. • Mild persistent asthma –flare-ups more than twice a week and symptoms occur at least twice a month and may affect normal physical activity. • Moderate persistent asthma –daily symptoms and take medicine daily. • Severe persistent asthma – continuous symptoms with frequent wheezing, coughing or shortness of breath that may require emergency treatment or hospitalization.

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It’s not easy to diagnose asthma because children with asthma have different patterns of symptoms. Some children may cough all night, but seem fine during the day, while others seem to get chest colds that don’t go away easily. Doctors normally rule out all other possible causes of a child’s symptoms before diagnosing asthma. The doctor may ask the family for asthma and allergy history, perform a physical exam, and may order tests, such as chest X-rays, blood tests, and allergy skin tests.

The doctor will also want to know symptoms and how severe they are, when and how often they occur, how long they last; your child’s allergies; how often your child gets colds; and things that seem to trigger the flare-ups.

Each category of asthma is treated differently because no single remedy works for every child. There are two categories of asthma medications: quick-relief, or “rescue” medication, and long-term preventative, or “controller” medications. Prescription asthma medications treat symptoms and causes, so they control asthma effectively. Over-the-counter medicines, home remedies and herbal medicines should not be substituted for prescription asthma medicines because they cannot quickly and effectively treat the causes or reverse the flare-ups. Your doctor will provide a written, step-by-step plan detailing what to do between flare-ups and how to recognize and manage them when they do occur. Families that take the time to learn more about asthma are often the most successful in controlling it. Check out local support groups or contact organizations, such as the American College of Allergy, Asthma and Immunology at (800) 842-7777 or the American Lung Association at (800) LUNGUSA.

bout one in ten women experience a condition known as postpartum depression after giving birth. Postpartum depression can sometimes go undiagnosed.

There are three forms of depression that may occur after giving birth. The “baby blues”, which may begin within a few days of giving birth, can cause the mother to feel mild sadness, irritability, fatigue and anxiety. This mild depression may only last from a few hours to 1 to 2 weeks after delivery and does not always require professional treatment. Postpartum depression, also known as PPD can begin at four weeks after delivery, but may not appear for months. Symptoms are similar to the baby blues, but they are felt much more strongly and may last as long as 1 year. When a mother’s ability to function is affected, she should get treatment from her health care provider. The rarest and most serious form of depression that can affect new mothers is postpartum psychosis. It can begin within the first 3 months after delivery. Women affected by postpartum psychosis can lose touch with reality. They may hear and see things that aren’t really there and may suffer from insomnia, irritability, and may act strangely. Women who suffer from postpartum psychosis need immediate treatment will almost always need medication and some may be hospitalized so that they do not hurt themselves or others.

Symptoms of PPD may include feelings of sadness, inadequacy, failure, hopelessness, guilt, shame, worthlessness or helplessness; exhaustion; tearfulness; weight loss

Postpartum Depression

or gain due to under or overeating; confusion; anxiety; fear of harming the baby; and fear of being alone or going out. Those suffering with PPD may also have decreased energy or motivation, insomnia or excessive sleep, nightmares, irritability, withdrawal from social events, poor hygiene and an inability to cope with routine tasks. Postpartum depression can affect women of all ages, economic status and racial backgrounds. Any woman who is pregnant, recently given birth, miscarried, or weaned a child from breastfeeding can develop PPD.

There is no clear cause of PPD. It may be due to hormonal and other chemical changes that occur in a woman’s body during pregnancy or childbirth. Other things that can contribute to PPD include not getting enough sleep, feeling overwhelmed with a new child to take care of, increased stress from changes in work and home routine, feelings of loss of control, or having less free time.

Postpartum depression is a treatable condition. The type of treatment depends on how severely the mother is suffering. It is sometimes treated with medication and mothers are often advised to go to support groups to talk with other women that are suffering from PPD.

A new mother should try to take care of herself as well as her new baby by getting lots of rest and napping when the baby naps, not worrying about getting all of the household chores done and most importantly talk with her husband, partner, family, friends and doctor about her feelings, especially if she feels she may be suffering from PPD.

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Cardiopulmonary Resucitation (CPR)

ardiopulmonary resuscitation, or CPR, is a first-aid technique used to keep people who have stopped breathing and whose heart has stopped beating, alive while medical help is on the way.

CPR can be an extremely important skill for a parent to learn. If the brain goes without oxygen for more than 5 minutes, brain cells begin to die rapidly. Eight minutes without oxygen-rich blood can result in permanent brain damage or death. It may be necessary to administer CPR during many different emergencies, such as near drowning, choking, blood loss, electric shock, carbon monoxide poisoning, heart attack, stroke and drug overdose.

CPR has two main goals – to get blood flowing through the body so that it will reach the brain and to keep air flowing in and out of the lungs. CPR consists of two basic actions – blowing forcefully into the victim’s mouth to push air in to the lungs and pushing on the victim’s chest to get their blood flowing from their heart. Reading about how to give CPR, as you are about to do, is helpful and will give you a basic understanding of it, but we strongly recommend that you take a CPR course. Call your local chapter of the American Heart Association, as they offer basic life support courses and have certified instructors that use videos, printed materials and demonstrations on mannequins to teach proper CPR techniques. CPR is a skill and must be practiced, so the course should be repeated every 2 years. This will also allow you to keep up with any new advances in CPR techniques.

CPR is most successful when administered as soon as possible. It should only be performed on someone that is not breathing and whose blood is not circulating adequately. The following are basic steps of CPR:

• In order for CPR to work, the person must be lying on his or her back on a flat surface. • If the victim is a child, it is important that you perform CPR for 1 minute BEFORE you call 911. If the victim is an adult, call 911 first. • Check to see if the victim is breathing and that there is nothing blocking his or her airway. • If the person is not breathing, breathe twice into the victim’s mouth. This is known as ‘rescue breathing’ and forces air into their lungs. • If rescue breathing alone does not work, you will have to begin chest compression. Position hands in the center of the chest. • Firmly push down on the chest 15 times. • Give two more breaths and pump 15 more times until help arrives. Even though these steps may sound simple, they must be performed in a specific sequence to accurately mimic the body’s natural breathing pattern and the way that the heart pumps. Taking a course in CPR will not only teach you this sequence, but will teach you to be effective in an emergency and you overcome the panic that people sometimes feel when put in this type of situation. Call the American Heart Association at 1-800-242-8721 to find out where CPR courses are being held locally.

Keeping Kids Healthy

Childhood Cancer Awareness

eptember is National Childhood Cancer Awareness Month. Though childhood cancer is rare, it is the main cause of death by disease in children ages 1 to 14 and the second overall cause of death in children; accidents are the first. Approximately 1 in 330 children will be diagnosed with cancer by the age of 19. However, with early diagnosis and treatment, the overall cure rate for childhood cancer is 75%.

More than likely your child will not get childhood cancer, but being aware of the early signs and symptoms is just as important as teaching him or her to look both ways before crossing the street and can make a huge difference if he or she does. Early signs of cancer include:

• Continued, unexplained weight loss • Headaches with vomiting, at night or early morning • Increased swelling or persistent pain in bones, joints, back or legs • Lump or mass, especially in the abdomen, neck, chest, pelvis or armpits • Development of excessive bruising, bleeding or rash • Constant infections • A whitish color behind the pupil • Nausea which persists or vomiting without nausea • Constant tiredness or noticeable paleness • Eye or vision changes which occur suddenly and persist • Recurrent fevers of unknown origin Cancer is a group of diseases that have a common disease process – cells grow out of control, develop in abnormal sizes and shapes, ignore their boundaries within the body, destroy cells growing around them, and spread to other organs or tissues in the body. Cancer can be caused by external factors, such as tobacco, chemicals, radiation and infectious organisms, or internal factors,

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including hormones, genetic mutations, and immune conditions. The most common childhood cancers are leukemia, lymphoma, and brain cancer.

Survival rates of children that have cancer have improved significantly in the past 30 years. Treatment usually includes a combination of surgery, radiation and chemotherapy, depending on the type of cancer.

Even if your child does not have cancer, there are ways that you can help those that do. The Rainbow Connection, a local non-profit organization dedicated to families and children living with cancer or blood disorders sponsors a camp for children with cancer and their siblings every summer. They also promote community education on the disease, as well as support activities for parents from the time that their child is diagnosed. The camp, which has a 24-hour medical team onsite and is staffed by volunteers, emphasizes each child’s wellness, not their illness. The camp’s philosophy centers around the fact that children with cancer or blood disorders are normal children with special needs. It is a place for them to rediscover their self-esteem and confidence and allow them to enjoy a memorable experience through activities such as fishing, swimming, canoeing and other camp-type activities. For more information on The Rainbow Connection please visit www.rccamp.org. For more information on childhood cancer please visit www.childrensoncologygroup.org or http://www.curesearch.org/.

erhaps nothing is more terrifying to a parent than to think that one day their child may be abducted. Unfortunately, almost daily, we hear reports of missing children or near abductions. Though not every parent has to face the experience of having their child go missing, it is important to teach your child to be cautious without causing him or her to become too afraid or anxious.

According to a study done by the U.S. Department of Justice, ninety percent of all missing children have misunderstood directions, miscommunicated their plans, are lost, or have run away. Of the 10% of missing children that are abduction, the majority have been kidnapped by a family member in a custody dispute. In most cases of abduction, the child knows the person that has kidnapped him or her. About 100 children per year are abducted in the stereotypical way that is portrayed on television and in movies. Only about half of these children come home. * Tips to help prevent abductions include:

• Knowing where your children are at all times and who they are with. • Teaching your child to stay in groups when he or she goes anywhere. • Checking with your local law enforcement to see if there are any sexual offenders in your area. • Keeping custody documents in order. • Having ID photos taken of your child every six months and having your child fingerprinted. Local police departments often sponsor fingerprinting (and sometimes DNA collection) programs. • Keeping your child’s medical records and dental records up-to-date. • Teaching your child online safety and being aware of any “friends” he or she may be talking to on the internet.

Abduction

• Setting boundaries for your child concerning where he or she may go. Supervising your child when at the mall, movie theater, park, public bathrooms and fundraising door-to-door. • Never leaving your child alone in strollers or shopping carts. • Choosing babysitters, day care providers carefully. • Talking to your child about strangers. Make sure he or she knows not to take anything from a stranger or go anywhere with someone he or she does not know even if the person says that they know you. • Telling your child to run away and scream if someone follows him or her or tries to force him or her into a car. • Teaching him or her to say no to anyone who tries to make him or her do something that you’ve said is wrong. • Telling your child to tell you or another trusted adult if a stranger asks personal questions, exposes themselves or makes them feel uncomfortable. Tell your child that it’s ok to tell you even if the other person has made them promise not to or threatened them. • Teaching your child to always ask permission before leaving the house, yard or play area or going into someone’s house. • Teaching your child that an adult should not walk up to a child and ask for directions or help finding a lost pet. • Make sure that your children know their address, phone number and who to contact in case of an emergency. If you discover your child is missing, first try to remain calm and contact your local law enforcement immediately – the first few hours are critical. Obtain a case number, ask who will be handling the investigation. Ask that your child be entered into the National Crime Information

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Abduction

Center (NCIC). Provide the police with a recent photo of your child, a description of when and where you last saw your child and what he or she was wearing. In addition to contacting the police, you may consider calling the National Center for Missing and Exploited Children (800-843-5678) for support and advice.

Keeping Kids Healthy

reast feeding is the best nourishment for newborn infants. Nursing offers advantages not only to the infants but to the mothers as well. All mothers should know the advantages of breast feeding before making the decision not to breast feed their infant. Dr Sunil Jain, a neonatologist in the UTMB Department of Pediatrics, offers the following information about the advantages of breast feeding for babies and their mothers: How do infants benefit from breast feeding?

• Human milk is nature’s perfectly designed food for helping your infant’s body and brain grow. No artificial formula can come even close to the breast milk. An infant’s digestive tract can process breast milk easily and allows for the production of loose bowel movements that the infant can comfortably pass. Up to 6 months of age, your infant does not need any other nutrition other than breast milk. • Breast feeding helps protect your infant from ear infections, pneumonia, diarrhea, and other serious illnesses. • While breast feeding, you and your infant give comfort to each other. An intimate relationship develops that increases the bond between the mother and her infant. • Breast fed infants have less skin problems and asthma than formula fed infants. • Breast feeding reduces the chances of your child becoming overweight.

Breast-Feeding

• Breast milk is a perfect ready made food for your infant, available anytime and anywhere. You can travel with your infant confidently knowing that breast milk will be accessible whenever hunger strikes. • Breast feeding can provide birth control during first 6 months after delivery if you are only breast feeding your infant and your menstrual periods have NOT returned. There is always a small risk of pregnancy while breast feeding. If you are worried, use another form of birth control as well. • Women who breast feed are less likely to get breast cancer or ovarian cancer. All mothers should thoughtfully consider the advantages that breast feeding provides their infants as well as the advantages to themselves. Remember, the success of breast feeding is best measured by how much you and your infant enjoy nursing.

How does mother benefit from breast feeding?

• Breast feeding causes your body to release a hormone called oxytocin which helps to return the post-pregnant uterus to its normal size. • Breast feeding uses many calories and can help the mother to lose some of the extra weight gained during pregnancy.

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How to Increase Breast Milk Supply

ast week [page 76] the benefits of breast feeding to infants and their mothers were discussed. In this second installment on the advantages of breast feeding, Dr Sunil Jain, a neonatologist in the UTMB Department of Pediatrics, offers the following information about how to make sure that the milk supply for the baby remains sufficient. Basically, the more milk that is removed from the breasts, the more milk the breast will produce. For the breast to meet the baby’s demand for nourishment:

• The baby must regularly and effectively suck from the breast and the breasts must regularly and effectively be emptied during feeding or by pumping the breast. • If your milk supply is low, it can be increased by stimulating and emptying your breasts more often. Low milk supply is one of the most common breastfeeding problems for nursing mothers and this is due to the failure to empty the breasts completely. Others causes of low breast milk supply are: • A sleepy baby who does not nurse enough or suck vigorously. • Mother and baby being separated during first week after delivery due to illness either in the baby or in the mother. • Improper breast sucking by the baby and hence the breasts are not emptied. • Using formula supplement which cause the baby to nurse less frequently. • Mother remains sick after delivery. • Stress of work • Sore nipples How to increase breast milk supply: • Try to nurse your baby more often • Drink plenty of fluid, eat well, rest and get support from friends and family • If you are working, pump your breasts to empty them regularly, every 2 – 3 hours.

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• If you have sore nipples or breast infection, get treatment, your milk supply may increase as the nipples heal or the infection is treated. How do you know your baby is getting enough breast milk? You can not see how much milk your baby is getting when nursing. However, you can tell whether breast feeding is enough for your baby if you look for some of the indirect evidences of well-nourished baby during first month of life.

• If your baby is hungry after every breast feeding or you do not feel your breasts are full 5 days after delivery, ask your pediatrician to check the baby’s weight. • Your baby should nurse vigorously and you should hear baby swallowing regularly while nursing. • You can tell that your baby did not get enough breast milk if he/she cries, chews his/her hands or needs pacifier after breast feeding. • All babies should start passing ‘milk stools’ 4 to 5 days after birth. Milk stools look like cottage cheese and mustard. If your baby is passing greenish stools 5 days after birth, you should have your baby weighed to see if he/she is getting enough milk. • Babies pass colorless urine at least 5 to 6 time’s everyday. If 3 days after birth, your baby’s diaper has reddish brick dust on it, your baby’s urine is concentrated because he/she is not getting enough breast milk. • Babies pass stool almost after every breast feed for first 3 to 4 weeks. If you baby is passing less than 4 stools each day, this could be again because he/she is not getting enough breast milk. • Once your milk comes in, your baby should gain at least one once everyday for first couple of months. If your baby does not gain enough weight, your milk supply may be low or your baby may not be nursing effectively. Your baby’s doctor can help you in developing a feeding plan for you and your baby or can refer you to a lactation consultant.

Breast Feeding and Sore Nipples

n this third installment on the advantages of breast feeding, Dr Sunil Jain, a neonatologist in the UTMB Department of Pediatrics, offers the following information about the treatment and prevention of sore nipples while nursing.

Breast feeding should be enjoyable and comfortable experience. Unfortunately, sore nipples are a common problem among nursing mothers which often leads the mother to quit nursing. But sore nipples can be prevented or treated. Causes of sore nipples – The most common cause of sore nipples is the position of the baby’s mouth on the breast and how he is latching on to the nipple. If the baby is not latching on correctly, he may not be getting enough milk. Other possible causes of sore nipples are an infection of the nipples or breast or improper nipple care.

Treatment of sore nipples – • Make sure the baby is positioned correctly to nurse. First, support your breast with one hand and put 4 fingers below your breast and thumb on the top (C-hold). Your fingers should be behind the areola (the darkened area around the nipple) so that you will not touch your baby’s mouth. With your hand, hold baby’s head, neck and upper back. Move your baby onto your breast, so that the chin and lower jaw touch the breast first. • Do not let your baby take only the tip of your nipple. Make sure the baby gets enough of the lower part of the areola in his/her mouth. • During feeding, support your breast from below so the nipple and areola are not pulled out of your baby’s mouth by the weight of the breast. • Make sure your baby is facing you.

• Babies suck harder at the beginning of feedings. After your baby has nursed briefly and milk flow has begun, move her to the second breast with sore nipple. This should make nursing more comfortable because the baby will suck less vigorously. • Wash your nipples with soap and water when you bathe. If you wear breast pads, change them as soon as they become wet. Do not allow your nipples to dry out too much. • You should use a pump to express breast milk if nursing is very painful. This can be done for 2 to 3 days to allow healing of your nipples. • Watch for breast infection. A cracked nipple may make you more susceptible to getting a breast infection. Call your doctor immediately if – • Your nipples sting or burn and you have shooting pain in your breast after nursing. • The nipple pain keeps you from nursing long enough to trigger your let-down reflex. In this case, pain medication may be helpful. • Your baby is not satisfied after most nursings. • Your nipples have a yeast infection; you see white patches in your baby’s mouth.

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he appendix is a small finger-shaped structure that is attached to the large intestine on the lower right side of the abdomen. The appendix does not serve any purpose in the body. The appendix can become infected when it is blocked by something, such as a piece of food that was being digested or if a person has had an intestinal infection. This is known as appendicitis.

There is no known way to prevent appendicitis and the only way to treat it is to remove it surgically. If an infected appendix is not removed, a life-threatening situation occurs because it may burst and spread its infection throughout the abdomen in as little as 48 hours. Symptoms of appendicitis include:

• Sharp, intense pain around the belly button that spreads to the lower right side of the abdomen • Fever • Loss of appetite • Nausea and vomiting • Diarrhea (in small amounts with mucus) • Frequent urination or a strong urge to urinate • Constipation • Swollen or bloated abdomen (especially in infants) Many of these symptoms are common signs of other childhood illnesses. Because it can be confused with stomach cramps or indigestion, it is important to contact your child’s doctor.

Appendicitis

The pain associated with appendicitis usually begins around the belly button area and may move downward to the right. In appendicitis, pain begins before nausea and vomiting, which is a sign that the child does not have an intestinal infection. The pain may be so intense that it can keep a child up at night. A child with appendicitis may not want to move around because it feels better when he or she lies down and curls up. For children under 2 years, the most common signs of appendicitis are vomiting and a bloated or swollen abdomen. A child this young may also have abdominal pain, but they are too young to tell adults.

Appendicitis is an emergency and cannot be treated at home. The appendix will need to be removed surgically. It is usually diagnosed through blood testing, as well as through X-rays, ultrasounds or CT Scans. Blood tests show the number of white blood cells present in the body. A high number of white blood cells means that there could be an infection in the body. The doctor may also order other tests, such as an X-ray, ultrasound, or CT scan. These will allow the doctor to see an image of the appendix.

If the doctor decides that a child has appendicitis, the appendix will need to be removed surgically. Surgical removal of the appendix is called an appendectomy. A person that has an appendectomy will receive anesthesia, which will put him or her in a deep sleep so that they do not feel any pain. The surgeon will make a small cut in the abdomen and remove the appendix. The surgery will leave a small scar. After a person has an appendectomy, he or she will stay in the hospital for a few days. A child will normally need about one to three weeks to recover completely after the surgery before returning to school.

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When Your Child is Expecting a Sibling

omehow, the sleepless nights and mounds of diapers are a faint memory. The colic, the crying, and the feedings weren’t that bad, were they? In fact, as you’re reading this column, somewhere between the coffee and creamer, the spilled Cheerios on the breakfast table, and buzzing around to get out the door to work, you take that brief moment, glance at your little one and think, “we’re ready for baby number two.” This is no easy decision. There are tons of changes to consider; hard questions you must ask of yourself and your partner, all the while answering them candidly and honestly. Are you ready, both emotionally and financially, for another baby? Is your home big enough to withstand another person living with you? True enough, how much space do babies really take up at first? But, then they start crawling, real estate inside your home will go for a premium. And then, there’s the other part that is some times considered last in the family planning process, if at all. Is your baby ready for a brother or sister? The firstborn sees you, the parent, as the source of everything — clothing, food, shelter, love and attention. It’s understandable they’d consider the addition of another child as a threat -- the interruption of all these things they’ve come to depend on.

What to expect when your baby’s expecting a sibling During the pregnancy of second or third baby, some parents feel a certain amount of guilt over not being able to focus solely on the first-born. There are ways to help alleviate these feelings and, at the same time, easing the transitional time for your first child. Involve your first-born as early in the process as possible. Things like shopping for new baby items, touring the hospital and birthing area in advance, and describing fetal ultrasound images are all ways to engage your child in this wonderful process.

Keeping Kids Healthy

When the baby does arrive, enlist the older child’s help. It will give them a sense of empowerment and allow them to feel like they’re an important part of the process. Also, carve out an area of your home that belongs “exclusively” to your older child. That sends the message that they’re still an important, valued, and treasured member of the family. And, allow them to make some of their own choices like, which pair of socks to wear or what luncheon meat to have on their sandwich. This will give them a sense of independence and self-sufficiency. Keep some small, gift-wrapped items on hand.

When visitors come, showering gifts on your newborn, you can pull out one of the small items to make your first-born feel included! And, it might be a good idea to try and spend quality time with your older child every day, even if it’s just for a few minutes.

There’s interesting information about sibling rivalry. In a recent article in Contemporary Pediatrics, research found that girls tend to be more jealous than boys. And, it’s usually more intense if the children are of the same sex. Also, your behavior as a parent affects sibling rivalry. Exhibiting favoritism toward one child or another makes matters worse. But, a loving relationship between parents is a positive influence on easing some of those jealous emotions between brothers and sisters. And, here’s where your keen parenting skills must come into play. Keep an eye out for your older child. This is a time of tremendous change for them, and each child exhibits these feelings in different ways. Sibling rivalry may be as old as parenting itself. But, with the right skills, it can be a wonderful way to bring out the very best in each child.

f you’re a new mom, your head’s probably swirling with all sorts of advice about child-proofing. Between the books you’ve read, feedback from friends, and admonishments from family, you might be stuck somewhere between the,“Eh. . . kids will be kids” mentality and shrink-wrapping your house to keep anything from coming in or going out!

Childproofing Your Home

• Use smoke detectors and carbon monoxide detectors throughout your home. Carbon monoxide kills because you can’t see it or smell it. Smoke detectors give you a fighting chance to clear out your home in the case of a fire. Both are relatively inexpensive, and as long as you maintain them, they provide peace of mind for your family. • Remember to throw away items likes razor blades, And, even if you’re a pro at parenting, maybe there’s safety pins, and other choking and cutting hazards some stuff you’ve forgotten. in garbage cans that are locked up or out of reach. If your baby or toddler can get to it, like say, a Well, take a deep breath. We’d like to set the record small trash can in the bathroom, there’s no telling straight on some tips that will make your life easier, what dangers lurk inside. your baby safer, and give you the confidence to tell your • When you step out with your child, always strap friends you’ve got the baby-proofing covered. them in to an approved car seat. If you’re not sure how to properly install it, your local police or fire • Invest in some good safety latches for drawers and department can probably help you. cabinets in your kitchen and bathroom. While it’s • Don’t ever leave your child in the car alone. Never. no guarantee your child won’t get into something, Ever. Excruciating Texas heat and car fumes can it certainly makes it more difficult. Also, store be deadly. And, we’ve all heard about carjackings cleaning agents, detergents, and other similar items that end up horribly. Take your baby with you and high up. If your child does happen to gain access show them off! to these potentially dangerous products, call your • Set carriers down on the ground and make sure local poison control or 911 immediately. you’re placing them in an area where they’ll be safe. • Look into safety gates, placing then at the bottom If you set the carrier on a countertop or table, there’s and top of stairs in your home, and using them to a chance your baby will fall and injure them selves. separate rooms or areas that pose a potential haz• Clip this column out of the paper and keep it on ard, like the garage. the refrigerator for future reference. • Plug your sockets with protectors and use door Most, if not all of the items mentioned, are available at knob covers. Both are cheap ways to protect your precious little one. You won’t believe how fast tod- your local hardware store. And, it takes no more than a dlers and children can slip out of your house and weekend to whip your home into a baby-safe place. As into harms way. always, if you aren’t sure about the best way to approach • Place anti-scald devices on your showerheads and this to-do list, or for other great ideas about home safety faucets. There are even devices that will sound an and your child, talk with your pediatrician. alarm letting you know when the water temperatures just right or when it’s become too hot or too cold. And, it bears repeating: Never, ever leave your child unattended in a bathtub or pool. Ever.

Keeping Kids Healthy

ow that you have decided to put your baby to sleep on his or her back and have inspected the crib your mother-in-law bought for the new arrival to see that the mattress is a tight fit, and now that you have removed the fluffy blankets and stuffed animals, you might wonder how long this baby is going to sleep.

Infants sleep anywhere from 16 to 20 hours a day, but unfortunately for mom and dad, they seldom sleep more than 30–45 minutes at a time. They sleep two-thirds of the day away, and yet they are constantly springing back to life after these catnaps.

Infant Sleep

where between four and six years of age, it is normal for children to drop the nap altogether.

Babies don’t follow any schedule during the first weeks of life other than waking to feed before going back to sleep. This is kind of hard on mom and dad. Breastfeeding mothers have it especially hard. Remember that baby is doing some important work of completing the stages of development that could not be finished in the womb.

Early on, mom and dad should settle on a daytime nap and bedtime schedule for older babies and children. This schedule should respect the above sleep needs. Remember that even four-year-olds need at least 10 hours During the first four to six years of a child’s life that pattern of naps and shorter waking periods through both of sleep a night. day and night begins to change. Somewhere between six months and a year baby learns to sleep through the Finish each play day with a quiet quality time that night, sleeping 10-12 hours in a block, though still napends at the established bedtime. Left to themselves, chilping for about five hours during the day. From then on, daytime naps become fewer and shorter until by the age dren might watch TV until late at night. Instead, share 30 minutes of quality time listening to quiet music, readof three years, a child needs about 10-12 hours sleep at ing a book, talking about the day. It will be much more night and only about one hour during the day. Somevaluable to your children. It gets them ready for bed with a ‘helping’ of your attention and affection that will allow them to accept your firm insistence that bedtime is bedtime and that it is normal for you to leave the room. Make attending to last minute chores—picking up the toys, brushing teeth, going to the bathroom or changing diapers, selecting a stuffed animal—part of the bedtime routine. A favorite stuffed animal or blanket can be a part of parting time, but this period should have well defined limits and should end with your saying goodnight, turning off the light and leaving the room. Tell them you look forward to greeting them in the morning to discuss all of their pleasant dreams. Calmly following such a bedtime schedule with each child from an early age will go a long way to minimizing sleep behavioral problems.

Keeping Kids Healthy

The Dangers of Smoking

f you read these articles, in all likelihood you are the parent of young children. So we have a couple of questions to ask you that often remain unasked in polite society. Is there a smoker in your home? Do you smoke? If so, according to an article in Contemporary Pediatrics by Dr. Dana Best of George Washington School of Medicine and Health Sciences and Dr. Sophie Balk of Albert Einstein College of Medicine, the smoke that wafts around the house is sufficiently toxic to be causing your children very serious and long-term medical problems, such as lifelong reduction in lung function, increased ear, throat and breathing infections, asthma, and more dangerous periods under anesthesia should your children require surgery. The smoker really has to stop. If it is you, then you know that you really have to stop—for the welfare of your family, of your children. Consider this:

• Exhaled tobacco smoke contains, among other things, carbon monoxide, ammonia, formaldehyde, hydrogen cyanide, nitrogen oxides, sulfur dioxide—and nicotine. The addictive qualities of nicotine, enjoyed while you are smoking, make smoking an efficient way to addict your children to smoking (and we might add, sell more cigarettes). • Environmental tobacco smoke (ETS) hits kids harder because their higher metabolism causes them to take it into their bodies faster where it can affect developing lungs and other organs.

Keeping Kids Healthy

• Strong evidence links ETS to ever increasing development of asthma symptoms in children and increased rates of lower respiratory (chest) illness, middle ear infection, tonsillectomy and adenoidectomy, cough and sudden infant death syndrome. • Adults exposed to ETS throughout their lives have higher incidences of lung cancer, atherosclerosis and coronary heart disease. Such effects may be even more pronounced in children. • While it has been shown that if you quit smoking, your lungs will slowly recover, it has also been shown that children in the formative years exposed to ETS lose potential lungpower for life. It’s hard to quit “cold turkey.” Failure is not a matter of weak will or a bad habit, according to Best and Balk. Nicotine targets brain receptors in the “reward” centers and areas concerned with alertness, arousal and memory. In the process nicotine changes the way we feel about life. It improves memory, increases alertness, pain endurance and pleasure, and reduces hunger. That’s a lot to give up. But giving up is easier today due to nicotine replacement therapy, devices that allow you to slowly withdraw from the lure of nicotine without polluting the air around you. For stubborn resistance, Best and Balk say that using two nicotine replacement therapies together—such as gum and the patch—sometimes enhances the effect. Be sure to see if your insurance company supports programs for quitting smoking. Check community billboards for classes and company in your effort.

When you become overwhelmed by the task, remember that smoke puts your child’s development at risk. The last thing you want to bequeath to your children is the illness brought by a lifetime addiction to tobacco.

hen a fire starts in a home, the inhabitants often have no more than minutes to escape. Confusion about what to do wastes those valuable minutes. Early warning, given by smoke alarms, is very important. Fire alarms dramatically increase the survival rate of all of the family. Twothirds of home fires that kill children under age 5 occur in homes without a working smoke alarm. Parents should install an alarm on each level of the home and outside bedrooms or other sleeping areas. Remember to test alarms monthly and change batteries at least once a year—preferably twice, at bi-annual time changes. If an infant sleeps in a separate room, place an alarm in the room. Keep the door closed to protect against the smoke of a hallway fire. Use a baby monitor to hear it if the alarm sounds. Familiarize older children with the sound of the smoke alarm, and instruct them to leave the dwelling and go to a predetermined meeting place outside the home and not return.

Matches, lighters and other heat sources are the leading causes of children’s deaths. Kids have a natural curiosity about fire, and learning how to strike a match or use a lighter is not much different from learning how to tie shoelaces, or hop on one foot. So store matches and lighters out of children’s sight and reach. Child-resistant lighters are not childproof.

Fire Safety

If a child is curious about fire or has been playing with fire, calmly and firmly explain that matches and lighters are tools for only adults to use. Ask children to tell you when they find a lighter or match, and to bring it to you. Reward them with praise. Of course, adults should never play with matches in front of children. Inspect your house to see that it is fire-safe. Don’t overload electric circuits or outlets. Have the heating systems checked annually. Smokers should use deep ashtrays and dampen ashes before disposing of them.

In the same way we prepare for hurricanes, families need to prepare a detailed escape plan in case of fire in different areas of the house. Draw a diagram of your house including windows and doors, and plan two routes of escape out of each room. Teach kids how to feel doors with the back of the hand to see if they are hot and never to open a hot door. Plan for the abilities of each member of the family—especially those who may not be able to escape on their own. Teach children how to crawl under the smoke to reduce smoke inhalation, and how to drop and roll if their clothes catch on fire.

Practice the plan with members of the family. Children as young as three years of age can follow an escape plan if they have practiced it often. Teach your children not to hide when they encounter fire—not even if they have started it. Firefighters in protective gear can look frightening. Take kids to a fire station to meet firemen and learn why they wear these suits. they are friends and come to help.

Keeping Kids Healthy

Bathing

bathing is sufficient. Daily bathing isn’t necessary, but the diaper area must be cleaned with gentle soap and rinsed adequately. Be sure any diaper wipes you use do not contain alcohol.

When washing the skin of older babies and small children, use lots of water and little soap. The overuse of cleansers, either too often or in too great an amount dries skin, resulting in irritation, itchiness and flaking.

he skin is a wonderful covering to have for our body. Skin is soft and sensitive to a range of emotions through touch. It allows easy and complicated moves. If you cut it, it immediately starts to heal. If you get an infection, cells come swarming to neutralize the invader. It protects our kids and us against infections caused by bacteria and viruses, and its pigments protect us against the sun’s UV rays. It keeps the body cool by allowing sweat to evaporate from its surface. It keeps our body warm by closing the pores. It mediates between the ideal environment inside and the conditions in the world around us without much of a thought on our part.

So what does mom or dad need to know about a new baby’s skin? The baby has been bathed in amniotic fluid for months—without soap. Water makes up a great part of this fluid, and it follows that moisture, or water, is an important quality of skin. Water is also the most important ingredient in cleaning baby. Until the umbilical cord falls off, sponge

• When bathing a small child who looks forward to playtime with tub toys, keep the water soap-free until the cleaning part of the bath begins. • Avoid bubble baths. Evidence shows that they increase the incidence of urinary tract problems. • In addition, when drying, blot the skin, don’t rub, and avoid powders that the baby might inhale into his lungs. A number of substances babies bump into in the world after birth, irritate and/or dry the skin. Baby needs to avoid those. Avoid using adult products, many of which are harsher, on children. (Lots of smart moms realize this and use baby products on their own skin.) Choose child-safe products labeled baby and child-safe. Avoid:

• Anti-bacterial cleansers and soaps. • Dyes and fragrances • Alcohol-containing products which dry and irritate the skin Before washing baby’s clothing, don’t forget to check your box of laundry detergent. Again, opt for a product that is free from fragrance, dye and preservative additives. If necessary, do a separate wash for the baby clothes with less soap and an extra rinse.

Think of washing skin as a way of nourishing, moistening and supporting it in all of the functions it does for us, not as punishing it for getting dirty. With the proper care it will aid and protect your child for a lifetime.

Keeping Kids Healthy

Keeping Children Home from School

ost children get sick at some point during the school year. In fact, the average schoolage child may get 6 to 9 common colds per year and many parents send their children to school sick, where they spread what they have to other children.

Sometimes it is difficult for parents to tell if their child is too sick to go to school. It can also be hard for parents take off of work, especially in single-parent households or families in which both parents work, but it is extremely important to keep children home or make arrangements for someone to watch them, to avoid exposing other children to whatever they have.

eye, which can be highly contagious. Your child may need medicine to clear up this infection in severe cases. • A child with an unexplained rash, ringworm (a fungal infection of the skin), or impetigo (a bacterial infection in which red, itchy blisters appear on the skin) should not go to school. Many of the above illnesses can be prevented by teaching your child not to share food, drinks, brushes, combs, or clothing, to cover mouth and nose with a tissue when coughing or sneezing and throw away used tissues, and to wash their hands for 15 to 30 seconds – FREQUENTLY.

Guidelines to help you decide whether or not to send Be sure to keep your child’s school informed of curyour child to school if he or she is not feeling well include: rent telephone in case your child becomes ill or injured. School is important, but sick children need to be at • A child with a temperature of 100.4 degrees or higher should be kept at home. They are more than home so that they can rest and so that they do not cause likely contagious if they have fever. Please do not other children to become ill. give your child medicine to reduce their fever and send them to school. The medicine will wear off, the fever will come back and you will more than likely have to pick them up anyway. • Children who have vomited or had diarrhea in the last 24 hours should not be sent to school. This is a standard policy at many schools. Check with your child’s school to see what their policy is. • Bacterial diseases, such as strep, should be treated with antibiotics for 24 hours before your child returns to school. • If your child has had lice, he or she should not go to school until they have been treated for 24 hours and all dead lice and eggs have been combed out of their hair. • Ear infections are not contagious, but are painful and are often accompanied by fever. Your child should stay at home until the pain and fever go away. • A child with red, swollen eyes that are draining pus should be kept at home. They may have pink

Keeping Kids Healthy

eukemia is cancer that affects bone marrow, which is the spongy center of the bones and where blood cells are made. It is the most common type of childhood cancer -- 35% of all children diagnosed with cancer have leukemia. It is most common in children under 10 years of age. Blood consists of three main types of cells -- white blood cells (also called leukocytes), red blood cells (erythrocytes) and platelets. Leukocytes protect the body against disease; erythrocytes carry oxygen to the body; platelets help blood to clot. Leukemia is cancer of the white blood cells. When a child has leukemia, abnormal white blood cells grow in large numbers in the bone marrow, where they become crowded and eventually flow into the blood stream. But, because these leukocytes are abnormal, they cannot fight infection and crowd out healthy leukocytes, erythrocytes, and platelets. The cure rate for leukemia is very good. Most children that undergo treatment, which usually consists of chemotherapy, sometimes combined with radiation.

Symptoms of leukemia are lethargy; back, leg and joint pain; headache; trouble standing or walking; easy bruising, unusual bleeding; frequent nose bleeds; bleed gums; red pinpoints on the skin (known as petechiae); fever that lasts several days; loss of appetite; swollen lymph nodes; tender or bloated stomach; swollen liver or spleen; night sweats; irritability. In general, leukemias are divided into two types: acute (rapidly developing) and chronic (slowly developing). 98% of all leukemias are acute. Acute leukemias are divided into acute lymphocytic leukemia (ALL) and acute myelogenous leukemia, depending on whether or not specific types of white blood cells called lymphocytes are affected. ALL is the most common type of acute leukemia and usually occurs in children between ages 2 and 8, but it can occur in any age group. Lymphoma is a cancer that affects the lymphatic system, which keeps the body’s fluid levels in balance and

Leukemia

protects the body against infection. Lymphatic tissues that are affected by lymphoma include the lymph nodes, thymus, spleen, tonsils, adenoids, and bone marrow, as well as a network of channels that carry fluids throughout the body. Many types of cancer may eventually spread to parts of the lymphatic system, but lymphomas originate in the lymphatic system.

Lymphomas are separated into two general categories – Hodgkin’s disease and non-Hodgkin’s lymphoma. Hodgkin’s Disease affects about 3 in 100,000 Americans, and is most common during early (between 15 and 40 years of age) and late (after age 55) adulthood. It characterized by a painless enlargement of lymph nodes located in the neck, above the collarbone, under the arms, or in the groin, caused by specific types of malignant cells. Non-Hodgkin’s Lymphoma (NHL) may occur at any age, but it rarely occurs before age 3, but is slightly more common than Hodgkin’s disease in children under the age of 15. In NHL, lymphocytes grow abnormally, just as they may in ALL, making it difficult to distinguish between lymphoma and leukemia. People with lymphoma usually have little or no bone marrow involvement, while those with leukemia have extensive bone marrow involvement. If the spleen or liver are involved in the lymphoma, they will be enlarged. Lymphomas are usually treated with a combination of chemotherapy, radiation and/or bone marrow transplants. The cure rates vary depending on the type of lymphoma and how far the disease has progressed.

Symptoms of lymphoma include swollen lymph nodes, facial swelling, weakness or tiredness, night sweats, unexplained fever, unexplained weight loss, abdominal pain or swelling, generalized pain, breathing difficulties including occasional cough, and difficulty in swallowing.

Keeping Kids Healthy

Anemia

ron is a mineral that the body uses to make hemoglobin, which is a pigment in the blood that carries oxygen to every part of the body. If the body does not get enough iron, then hemoglobin production decreases and this affects the production of red blood cells. A less than normal amount of hemoglobin and red blood cells in the bloodstream is known as anemia.

Children are at a higher risk for anemia during rapid growth periods, such as infancy and adolescence, as well as children between 1 and 3 years because toddlers stop drinking formula and eating infant cereal, which are fortified with iron.

Formula-fed Infants should always take iron-fortified formula, except in rare cases of iron-metabolism defects (which needs to be diagnosed by a doctor). Switching from formula or breast milk to whole milk too soon (before the child turns 1 year of age) can put a child at risk for iron-deficiency anemia. Anemia develops slowly, so those suffering from it don’t show any signs or symptoms at first. Signs of anemia will slowly progress and include:

• fatigue and weakness • pale skin and mucous membranes • rapid heartbeat • irritability • decrease in appetite • dizziness or lightheadedness Iron-deficiency anemia is often diagnosed during a routine exam, such as your child’s yearly check-up. Your child may need blood tests to determine iron-deficiency anemia. These test include a complete blood count to reveal low hemoglobin levels and hematocrit (which is the percentage of the blood that is made up of red blood cells); the reticulocyte count, which measures the num-

Keeping Kids Healthy

ber of immature red blood cells being produced; serum iron, which measure the amount of iron in the blood; serum ferritin, which determines the body’s iron stores.

Most cases of iron-deficiency anemia are due to low dietary iron intake, but changes in diet and use of multivitamins with iron aren’t usually enough to replenish iron stores, so your child’s doctor may prescribe a separate daily iron supplement. Iron supplements should not be given to your child without consulting your doctor first. Too much iron is can poison your child.

Iron is absorbed best when taken on an empty stomach, but it can occasionally cause stomachache. Children that have stomach pain when taking iron supplements may need to take them with a small amount of food, but iron should never be given with milk or drinks that contain caffeine because their ingredients interfere with iron absorption. Vitamin C has been shown to increase iron absorption, so including plenty of sources of Vitamin C in your child’s diet is a good idea.

Your child’s doctor may want to repeat blood tests after a month to see if iron levels have improved. If your child responds well to treatment, the doctor may continue the supplement for several months. Once the iron levels return to a normal level, they can be maintained by providing your child with an iron-rich diet. Your doctor may want to recheck your child’s iron levels about 6 months after your child stops the supplement therapy.

e hear about the recall of children’s products all the time. Paint chips contain lead, small parts fall off and can be swallowed by small children, clothing is not fire resistant—it is hard to imagine all of the small dangers that kids are subject to.

But did you know that the Consumer Products Safety Commission keeps a web site where consumers can report an injury from a product? You can reach the Consumer Product Incident Report at www.cpsc.gov/ incident.html. This commission does not have control over safety issues caused by vehicles, car seats in on-road vehicles, foods, medical devices or bad business practices, but their site links to the appropriate agency on the another page: www.cpsc.gov/federal.html. If you don’t have a computer at home, many local libraries have computers the general public can use. Or you can make a phone report at 1-800-638-CPSC, the safety commission’s HotLine. You can even sign up to get regular Email updates on recalled items. As parents and grandparents, we are constantly bombarded by advertisements for children’s products. As a group, we can help to insure the safety of all children by taking a moment to report dangerous products. Of course, sometimes through rough use a wheel falls off, but small plastic bows, or other decorations on dolls, for example, are dangerously attractive to a marauding creeper in search of new items to test in his mouth.

Product Safety

So many products have been recalled, that it is difficult to find one in your search through the lists. Fortunately, CPSC has a page for recalled items by groups at www.cpsc.gov/cpscpub/prerel/category/topic.html. The categories of most interest to parents are one on clothing, household products, infant/child products (not including toys), sports/exercise, and toys. Because many old toys and other children’s articles make their way into charity bins, it can be important to verify that damaged toys will not be able to hurt a child that may receive it. In particular, take care to verify that use has not left them with loose parts and that clothing items are fire resistant.

• Car seats for babies should be checked for cracked plastic parts and appropriate safety anchors. • Seams of stuffed toys should be carefully inspected and mended if necessary. • Electric toys should not be passed on with old batteries. Check to be sure there is not evidence of battery leaks in the battery holder. • Despite recalls, parents continue to use products that can cause injury or death. • Old cribs with wide spaces between the slats can trap infants’ heads • Jackets and sweatshirts with long neck drawstrings, meant to keep a youngster warm, can get snagged on a handlebar and cause strangulation. • Old window blinds with looped pull cords have in the past become caught around kids’ necks. When you see a dangerous item in a store, take a moment to discuss it with the store manager. Express your concerns in a calm and rational way. Let him know in a friendly way that parents depend on him to be alert for unsafe toys and that safety is an important part of your decision about where you will shop.

Keeping Kids Healthy

Essential Fatty Acids

nlike animals that are born with hardwired instincts and are ready to go running with the herd or hunting with the pack, humans are born with nervous systems, muscles, and bones that cannot perform voluntary movements or support the body’s weight. Much of a baby’s first year or two is spent completing development begun in the womb.

Children’s bodies need a steady supply of calcium to form good bones and a surplus to bank against the calcium withdrawals of old age.

Every baby and child needs a supply of what are termed “essential fatty acids”—in health store parlance, omega 6 and omega 3 oils. The human body cannot manufacture the long chains of these fatty acids. They are “essential” because an insufficient supply of omega 6 fatty acids can lead to growth failure and eventual death while too little omega 3 fatty acids may lead to slow infant development and heart disease. Vegetable oils, such as canola, soybean, corn, safflower and peanut oil are rich in omega 6 oils. Canola and soybean oil as well as fresh fish are rich in omega 3. Feeding the infant human milk through the first year is the best way to supply these essential oils. If mother incorporates them in her diet starting during pregnancy, her milk will contain an supply adequate for sound development both in the womb and during the first year of life. Though some infant formulas are fortified with omega 6 fatty acids, few if any have yet incorporated omega 3.

Infants fed human milk get about 50 percent of their total energy from fat. Commercial infant formulas meet this requirement. Skim milk does not supply the necessary fat. Without fat, infants have to consume twice the amount of milk to get the energy necessary for development. Digesting skim milk also stresses the infant’s

Keeping Kids Healthy

kidneys. Substituting juices and sugar water for mother’s milk or formula, satisfies hunger without supplying nutrition necessary for development. Dad needs to restrain himself from wanting junior to be the youngest baby on solid foods at the office. Solid foods and juices are best added after 6 months of age and should not supply more than 25 percent of the energy until after 9 months of age. Discuss dietary changes with your pediatrician, keeping in mind the early requirement of supplying almost half of an infant’s energy from fats. After weaning, healthy infants should receive up to 16 oz of whole cow’s milk a day and not reduced-fat milk. Whole milk contains approximately 50 percent of energy from fat just as human milk does. To date, we know of no group that has recommended reduced-fat milk for healthy children between 1 and 2 years of age. Not all head starts for children occur at expensive preschools. Almost all parents can provide the most important head start of all—proper nutrition during the first years of the developing brains and bodies of their children.

he U.S. Consumer Product Safety Commission (CPSC) was created in 1973 to develop safety regulations for all consumer products. The CPSC spends more than half of its budget every year testing children’s toys, as well as other items on the market for children.

When buying presents for your child remember to choose toys that are age-appropriate. No matter how mature you think that your child is, he or she should not play with toys that are meant for an older age group. Ageappropriate levels for toys are determined by safety factors rather than by intellectual and developmental factors. When choosing toys for infants, toddlers, or preschoolers:

• Make sure that toys are sturdy, as this age group will pull and twist toys and may try to put them in their mouth. • Make sure that squeeze toys, rattles and teethers are large enough and cannot be squeezed down small enough to become lodged in your child’s throat. • Avoid toys with cords or long strings because they present a strangulation hazard. Don’t hang toys with strings or ribbons in your child’s crib or playpen. • Avoid marbles, coins, balls or games with balls that are 1.75 inches in diameter or less. • Avoid walkers. Walkers are one of the main sources of injuries in this age group. • Avoid thin plastic toys that can break into small pieces and leave jagged edges. • Buy art supplies that are labeled non-toxic.

Toy Safety for Children For your older child:

• Buy helmets and other safety equipment when you purchase bicycles, scooters, skateboards or skates. Turn the helmet over and look inside for CPSC or Snell stickers. • Toy darts or arrows should have soft tips or suction cups at the ends. • Toy guns should be brightly colored so that they cannot be mistaken for real weapons. Children should be taught to never point darts, arrows or toy guns at people. • Children younger than 16 years of age should not use BB guns or pellet rifles. Besides the obvious risk of eye injuries, these “toy” weapons cause about four deaths per year. • Avoid toys that make loud noises. Some toys produce noise at a level that can damage your child’s hearing, including some toy phones, horns, sirens, cap guns, and musical toys. • Electric toys are required to meet certain safety standards for construction and wiring. Look for Underwriters Laboratories (UL) labeling to be sure that they are approved. Adults should always supervise children playing with electric toys. When buying toys online remember that websites are not required to post safety warnings associated with toys. Some toys sold on the internet may not be required to comply with toy regulations in the U.S. If buying discounted toys or toys on auction sites, be sure to check to see if the item has been recalled by the CPSC.

For the latest information about toy recalls or to report an unsafe toy, go to the CPSC website, www.cpsc. gov or call their hotline at (800) 638-CPSC. If you have any concerns about whether a toy is safe for your child or not, do not let your child play with it.

Keeping Kids Healthy

KEEPING KIDS HEALTHY

DRS. ROBINSON AND BLY

UTMB DEPARTMENT OF PEDIATRICS