When to call 911: Conditions that require immediate attention
Child is unconscious or is choking/turning blue or struggling to breathe
A seizure that lasts longer than 5 minutes, or any seizure if your child has never had one before
Fall from a height of 10 feet or more, or if you child cannot move or talk following an injury. In this case, it is important not to move your child - wait for an ambulance to arrive.
Injury to an arm or leg with: bone protruding through the skin, limb is awkwardly bent or child cannot move the injured extremity.
Burns that are blistered, severely swollen or appear white or charred; any electrical burn
Uncontrolled bleeding from a wound; animal bite from a potentially rabid animal or bite accompanied by difficulty breathing
Fever with a stiff neck (possible meningitis)
Unexplained rash accompanied by shortness of breath or chest tightness
Severe vomiting or diarrhea and dehydration -- signs may include no urine output for several hours, no tears when crying, skin or lips look purple
When to call your pediatrician or doctor's office:
Child has mild asthma symptoms (shortness of breath or wheezing)
Seizure that lasts less than five minutes, if the child has had previous seizures
Fall from a relatively short distance - off playground equipment or down a short flight of stairs; child is conscious and can move/walk
Swelling, tenderness and pain at the site of an injury, but child can still move injured part
Burns with slight swelling or redness
Cuts that are more superficial, but not bleeding profusely; cat or dog bites with minor bleeding and no other symptoms
Unexplained rash without other symptoms
Vomiting and diarrhea without obvious signs of dehydration
Wednesday, July 25, 2012
Handling Childhood Emergencies - part 1
Many parents feel ill-equipped to handle household injuries and emergencies. With some preparation and training, you can start to feel equipped and ready for some common emergencies that may happen in your household.
When emergencies happen, parents have to be ready to make quick decisions: whether to call 911 for emergency aid/ambulance, whether to take their child by car to an emergency room, or call their child's regular doctor for advise. If a child is not in a life-or-death situation, their physician's office should be able to see them sooner than an overwhelmed and busy emergency room. It is important to know, however, what the pediatrician's office can handle -- asthma flare-ups, injuries, etc. Most physicians are equipped to see you on a same day basis if the office is open, and give medications (like breathing treatments or steroids) and order X-rays if needed. Some doctors' offices do not do stitches, so if your child has a laceration that may need to be repaired, an urgent care center or emergency room is more appropriate. Find out the closest emergency room and urgent care center to your home, and which hospitals or after hours clinics your physician prefers. Once you know where to go, write down the directions and keep them easily accessible in your house.
When visiting an ER or urgent care center, be prepared to answer the following:
Proof of insurance coverage if any, regular doctors' name, address, phone number
Time of your child's last meal (in case anaesthesia is needed)
List of your child's medical conditions (if any), regular medications taken, and date of last tetanus shot
Consent form for someone else (grandparent, babysitter) to seek emergency care for your child; it should read "I hereby grant [name] permission to seek emergency medical help in the event that my child [name] is injured or otherwise in need of medical care. I will assume financial responsibility for treatment rendered during this time". This can be handwritten. Place a phone number (such as a cell number) where you can be reached if needed.
Emergency room physicians also like to remind parents to bring any medicine or cleaning substance that children have swallowed to the ER with them. In a panic, most parents forget this and then cannot recall exactly what their children have ingested.
It is wise to keep these written instructions together near the kitchen refrigerator or phone in case you need to grab them quickly.
A list of emergency numbers should also be posted by a central telephone, including: pediatrician's phone number, phone number for the local ER or after hours clinic, phone number for poison control.
The local poison control center can be invaluable in the case of an accidental ingestion, and can direct you in home treatment vs. the necessity for an emergency evaluation. Give poison control any specific information that you can - oftentimes, it is necessary to estimate how much a child has ingested, especially with medications.
When emergencies happen, parents have to be ready to make quick decisions: whether to call 911 for emergency aid/ambulance, whether to take their child by car to an emergency room, or call their child's regular doctor for advise. If a child is not in a life-or-death situation, their physician's office should be able to see them sooner than an overwhelmed and busy emergency room. It is important to know, however, what the pediatrician's office can handle -- asthma flare-ups, injuries, etc. Most physicians are equipped to see you on a same day basis if the office is open, and give medications (like breathing treatments or steroids) and order X-rays if needed. Some doctors' offices do not do stitches, so if your child has a laceration that may need to be repaired, an urgent care center or emergency room is more appropriate. Find out the closest emergency room and urgent care center to your home, and which hospitals or after hours clinics your physician prefers. Once you know where to go, write down the directions and keep them easily accessible in your house.
When visiting an ER or urgent care center, be prepared to answer the following:
Proof of insurance coverage if any, regular doctors' name, address, phone number
Time of your child's last meal (in case anaesthesia is needed)
List of your child's medical conditions (if any), regular medications taken, and date of last tetanus shot
Consent form for someone else (grandparent, babysitter) to seek emergency care for your child; it should read "I hereby grant [name] permission to seek emergency medical help in the event that my child [name] is injured or otherwise in need of medical care. I will assume financial responsibility for treatment rendered during this time". This can be handwritten. Place a phone number (such as a cell number) where you can be reached if needed.
Emergency room physicians also like to remind parents to bring any medicine or cleaning substance that children have swallowed to the ER with them. In a panic, most parents forget this and then cannot recall exactly what their children have ingested.
It is wise to keep these written instructions together near the kitchen refrigerator or phone in case you need to grab them quickly.
A list of emergency numbers should also be posted by a central telephone, including: pediatrician's phone number, phone number for the local ER or after hours clinic, phone number for poison control.
The local poison control center can be invaluable in the case of an accidental ingestion, and can direct you in home treatment vs. the necessity for an emergency evaluation. Give poison control any specific information that you can - oftentimes, it is necessary to estimate how much a child has ingested, especially with medications.
Wednesday, July 11, 2012
Vaccine Studies: Examine the Evidence
I usually don't cut and paste or forward too many medical spam articles, but this is a great synopsis of the articles that have addressed concerns regarding immunizations (specifically MMR) and autism. The consensus of multiple medical studies is that there is NO link between vaccines and autism.
Most physicians believe that vaccines have been associated or thought causal in the lay press solely because of timing -- many childhood vaccines are given in the 6-12 months prior to the development of classic signs and symptoms of autism.
If parents remain overly concerned about autism, they can choose to delay some vaccines (such as MMR or Varicella) until their children are 18-24 months old, the age at which symptoms of autism usually become apparent.
HealthyChildren.org - Vaccine Studies: Examine the Evidence
Most physicians believe that vaccines have been associated or thought causal in the lay press solely because of timing -- many childhood vaccines are given in the 6-12 months prior to the development of classic signs and symptoms of autism.
If parents remain overly concerned about autism, they can choose to delay some vaccines (such as MMR or Varicella) until their children are 18-24 months old, the age at which symptoms of autism usually become apparent.
HealthyChildren.org - Vaccine Studies: Examine the Evidence
Friday, July 6, 2012
Help! My baby/toddler won't stay asleep!
This is a common topic that we address with parents -- probably because sleep issues are common AND distressing to parents, who are sometimes at a loss when it comes to solving the issues surrounding sleep and nighttime for young children.
Waking during the night is normal at 3-6 months old, and 30% of babies are "signalers" who cry and expect a parental response to their crying. By 8-9 months old, 60-70% of infants can self-soothe when they wake at night, giving them the ability to put themselves back to sleep. 20-30% of toddlers are night wakers. When problems are not addressed at this age (and self-soothing behaviors taught), sleep problems will continue for many children -- into early elementary school.
The goal when approaching any sleep issues is to help your infant/todder or child be able to fall asleep on their own without "props" or excessive parental strategies. All children need a bedtime routine, and this can be started and maintained from a young age. It is important to be consistent at bedtime - doing the same things every night, putting children to bed at the same time every night. We often refer to the "bedtime routine" and this is family specific - it may include a bath, bottle or feeding for young infants, cuddling, story time or soft music. It is very important to put your child to bed while sleepy BUT not completely asleep. I repeat: sleepy but NOT asleep. This is important. Do not let your baby or child fall asleep somewhere else and move them. Learning to fall asleep on their own is the most important skill your child needs to acquire.
Dr. Charles Zeanah, a professor of Pediatrics and Psychiatry at Tulane University, recently spoke at a pediatric meeting and outlined his approach which he called a "hardball strategy": Leave your child in the bed at bedtime. If they continue to cry, go in the room after 5 minutes, soothe the child by using words or gentle touch, but do not get them out of the bed. Leave again -- and repeat at 5 minute intervals if the child keeps crying. As your child adapts, these intervals can gradually be lengthened -- 10 min., then 15 min, etc. In my practice, this "crying it out" strategy takes 5-7 days to work. As a parent, you have to be "all in" and invested in this strategy and follow it to the letter for it to work. It is also very important that both parents (or caregivers) be consistent in the approach.
A more gentle strategy is to respond to the crying but to sit next to the child's bed soothing them - but again, not getting them out of the bed. You can sit next to the bed until your child falls asleep. The next night, sit farther away and gradually move farther away each night -- letting your child see you is important in alleviating some fear. I know personally that this strategy works - especially for toddlers who can either get out of the bed (and love to come to their parent's bed - if they can get away with it) or who continue to call out/cry/cajole for parents to come back in the room. My husband and I tried this approach when my daughter was 2 years old and bedtime avoidant. I tried to be as boring as possible in the 5-10 minutes I stayed in her room - I didn't engage with her, and spent the time lying on the floor reading. Eventually, she gave up needing us in her room in order to fall asleep.
Remember -- your goal is to help your child fall asleep without you :)
Waking during the night is normal at 3-6 months old, and 30% of babies are "signalers" who cry and expect a parental response to their crying. By 8-9 months old, 60-70% of infants can self-soothe when they wake at night, giving them the ability to put themselves back to sleep. 20-30% of toddlers are night wakers. When problems are not addressed at this age (and self-soothing behaviors taught), sleep problems will continue for many children -- into early elementary school.
The goal when approaching any sleep issues is to help your infant/todder or child be able to fall asleep on their own without "props" or excessive parental strategies. All children need a bedtime routine, and this can be started and maintained from a young age. It is important to be consistent at bedtime - doing the same things every night, putting children to bed at the same time every night. We often refer to the "bedtime routine" and this is family specific - it may include a bath, bottle or feeding for young infants, cuddling, story time or soft music. It is very important to put your child to bed while sleepy BUT not completely asleep. I repeat: sleepy but NOT asleep. This is important. Do not let your baby or child fall asleep somewhere else and move them. Learning to fall asleep on their own is the most important skill your child needs to acquire.
Dr. Charles Zeanah, a professor of Pediatrics and Psychiatry at Tulane University, recently spoke at a pediatric meeting and outlined his approach which he called a "hardball strategy": Leave your child in the bed at bedtime. If they continue to cry, go in the room after 5 minutes, soothe the child by using words or gentle touch, but do not get them out of the bed. Leave again -- and repeat at 5 minute intervals if the child keeps crying. As your child adapts, these intervals can gradually be lengthened -- 10 min., then 15 min, etc. In my practice, this "crying it out" strategy takes 5-7 days to work. As a parent, you have to be "all in" and invested in this strategy and follow it to the letter for it to work. It is also very important that both parents (or caregivers) be consistent in the approach.
A more gentle strategy is to respond to the crying but to sit next to the child's bed soothing them - but again, not getting them out of the bed. You can sit next to the bed until your child falls asleep. The next night, sit farther away and gradually move farther away each night -- letting your child see you is important in alleviating some fear. I know personally that this strategy works - especially for toddlers who can either get out of the bed (and love to come to their parent's bed - if they can get away with it) or who continue to call out/cry/cajole for parents to come back in the room. My husband and I tried this approach when my daughter was 2 years old and bedtime avoidant. I tried to be as boring as possible in the 5-10 minutes I stayed in her room - I didn't engage with her, and spent the time lying on the floor reading. Eventually, she gave up needing us in her room in order to fall asleep.
Remember -- your goal is to help your child fall asleep without you :)
Tuesday, June 12, 2012
RIsks of CT scans in Children
I just recently read two articles on the risks of radiation exposure through CT scans in children - one on-line via Fox News, and one in the local Washington Post newspaper.
A 20 year study was recently published combining data from the US, Canada and Great Britain. The results show that exposure in childhood to the radiation equivalent of 2-3 Head CT scans can triple the risk of developing brain cancer later in life, and a child exposed to 5-10 CT scans is three times as likely to develop leukemia than a child who had no scans done.
Children are more sensitive to radiation than adults due to growing bones and tissues, as well as their relatively lower body weights.
This is sobering information that doctors have been alerted to for awhile -- I have been to several conferences at which childhood radiation exposure was discussed, from X rays to CT scans. A CT scan gives great definition, and is useful in looking for bleeds (in the case of head trauma) and solid tumors. Many emergency rooms use CT scans as part of an evaluation of abdominal pain, when the diagnosis of appendicitis is entertained, but not clear cut. Yes, doctors do sometimes practice defensive medicine, but no one wants to miss the appendicitis, the brain tumor or a devestating bleed from a case of head trauma in an otherwise healthy child.
There are alternatives: ultrasound exams do not expose one to radiation, and an MRI (Magnetic Resonance imaging) exam may give great definition of some structures without radiation. An MRI is typically more expensive, may be denied by your insurance company, and requires your child to remain motionless for a more prolonged period of time.
Many experts have weighed in on either side. Per Dr. Raymond Sze at Children's Hospital in Washington DC, "If the benefit to the child is greater than the theoretical risk, then (the CT scan) is appropriate".
A campaign called Image Gently is designed to alleviate concerns of providers and parents, and reduce radiation exposure through greater education. In addition to recommending that scans only be performed when medical benefits are clear, it also recommends limited scanning -- only the area of the body absolutely necessary. Image Gently also recommends evaluation of other imaging modalities like ultrasound and MRI. Donald Frush, chairman of the American College of Radiology's pediatric radiology commission, has said "People need to ask: Is it necessary? Can you do another test, such as an MRI? Can you wait a couple of days?"
Doctors suggest parents discuss CTs with the ordering provider and act as advocates for the children by asking if facilities take steps to reduce radiation exposure in children.
As a parent, I do understand the concerns of exposing one's child to radiation unnecessarily. At the same time, I am a doctor, and need to weigh the risks and benefits with my parents whenever I am ordering studies of any kind.
A 20 year study was recently published combining data from the US, Canada and Great Britain. The results show that exposure in childhood to the radiation equivalent of 2-3 Head CT scans can triple the risk of developing brain cancer later in life, and a child exposed to 5-10 CT scans is three times as likely to develop leukemia than a child who had no scans done.
Children are more sensitive to radiation than adults due to growing bones and tissues, as well as their relatively lower body weights.
This is sobering information that doctors have been alerted to for awhile -- I have been to several conferences at which childhood radiation exposure was discussed, from X rays to CT scans. A CT scan gives great definition, and is useful in looking for bleeds (in the case of head trauma) and solid tumors. Many emergency rooms use CT scans as part of an evaluation of abdominal pain, when the diagnosis of appendicitis is entertained, but not clear cut. Yes, doctors do sometimes practice defensive medicine, but no one wants to miss the appendicitis, the brain tumor or a devestating bleed from a case of head trauma in an otherwise healthy child.
There are alternatives: ultrasound exams do not expose one to radiation, and an MRI (Magnetic Resonance imaging) exam may give great definition of some structures without radiation. An MRI is typically more expensive, may be denied by your insurance company, and requires your child to remain motionless for a more prolonged period of time.
Many experts have weighed in on either side. Per Dr. Raymond Sze at Children's Hospital in Washington DC, "If the benefit to the child is greater than the theoretical risk, then (the CT scan) is appropriate".
A campaign called Image Gently is designed to alleviate concerns of providers and parents, and reduce radiation exposure through greater education. In addition to recommending that scans only be performed when medical benefits are clear, it also recommends limited scanning -- only the area of the body absolutely necessary. Image Gently also recommends evaluation of other imaging modalities like ultrasound and MRI. Donald Frush, chairman of the American College of Radiology's pediatric radiology commission, has said "People need to ask: Is it necessary? Can you do another test, such as an MRI? Can you wait a couple of days?"
Doctors suggest parents discuss CTs with the ordering provider and act as advocates for the children by asking if facilities take steps to reduce radiation exposure in children.
As a parent, I do understand the concerns of exposing one's child to radiation unnecessarily. At the same time, I am a doctor, and need to weigh the risks and benefits with my parents whenever I am ordering studies of any kind.
Thursday, May 10, 2012
Sports Physicals
It is the time of year that we Pediatricians start seeing more kids for school and sports physicals. Here in Virginia, any sports physical done after May 1st is good for the following school year (so fall, winter and spring sports are covered). I admit that I have a bias toward having your regular pediatrician do your child's physical. I have seen too many kids go to "Urgent Care" facilities or "School Physical day" at various schools (staffed by volunteers) in which important things were missed or possible medical problems were not addressed.
Here are some things that are covered by a sports physical:
Growth parameters - weight, height; if your child has lost or gained a significant amount of weight (again, previous weights/heights are important info that your pediatrician's office has in your child's medical record). Children grow quickly, and weight gain may not be worrisome if there is also a corresponding growth in height. We can calculate a Body Mass Index (BMI) that takes both weight and height into account together.
Vision screening - if your child wears glasses or contacts, we may want to know what their vision is both with and without their corrective lenses; we may recommend that your child wear corrective lenses while playing sports, depending on their eyesight.
Assessment of pubertal development, screening for hernias or testicular problems in boys
Assessment of menstrual history for girls
Screening labwork - including blood counts, urinalysis, cholesterol; we may be able to perform these tests in our office.
Blood pressure measurement - If your child has an elevated blood pressure (or high cholesterol), this will be something that we want to continue monitoring
Cardiac (heart) screening for risk factors leading to heart disease including assessment of heart murmurs
Assessment of any sports-related injuries that you may have sustained in the previous year; ideally, a sports physical should be done 6 weeks prior to beginning sports in order to determine if any physical therapy or rehab is needed in the interim; for example, ankle sprains are common injuries, and athletes may need to wear an ankle brace or sports splint to prevent re-injury
Assessment of current diet and nutritional intake - some teens skip meals or do not get enough calcium or iron; we can make recommendations based on our interview with you
This is also the time to mention any issues that you are worried about with your child. A teen who has a relationship with their pediatrician is more likely to be honest with us about sensitive topics, which they may not mention to someone they have never seen before.
Get into the habit of scheduling well visits for your children. As physicians, we feel that this is important.
Here are some things that are covered by a sports physical:
Growth parameters - weight, height; if your child has lost or gained a significant amount of weight (again, previous weights/heights are important info that your pediatrician's office has in your child's medical record). Children grow quickly, and weight gain may not be worrisome if there is also a corresponding growth in height. We can calculate a Body Mass Index (BMI) that takes both weight and height into account together.
Vision screening - if your child wears glasses or contacts, we may want to know what their vision is both with and without their corrective lenses; we may recommend that your child wear corrective lenses while playing sports, depending on their eyesight.
Assessment of pubertal development, screening for hernias or testicular problems in boys
Assessment of menstrual history for girls
Screening labwork - including blood counts, urinalysis, cholesterol; we may be able to perform these tests in our office.
Blood pressure measurement - If your child has an elevated blood pressure (or high cholesterol), this will be something that we want to continue monitoring
Cardiac (heart) screening for risk factors leading to heart disease including assessment of heart murmurs
Assessment of any sports-related injuries that you may have sustained in the previous year; ideally, a sports physical should be done 6 weeks prior to beginning sports in order to determine if any physical therapy or rehab is needed in the interim; for example, ankle sprains are common injuries, and athletes may need to wear an ankle brace or sports splint to prevent re-injury
Assessment of current diet and nutritional intake - some teens skip meals or do not get enough calcium or iron; we can make recommendations based on our interview with you
This is also the time to mention any issues that you are worried about with your child. A teen who has a relationship with their pediatrician is more likely to be honest with us about sensitive topics, which they may not mention to someone they have never seen before.
Get into the habit of scheduling well visits for your children. As physicians, we feel that this is important.
Tuesday, April 10, 2012
Video Games and Kids
I discuss video games a lot when I see kids for well child visits. There are definitely positives and negatives about video games, and I think it is important to know what your kids are playing. I have three kids and a husband that I play games with at home. At our house, we have "game night" every Saturday night. I don't have the manual dexterity of my husband or stepson, but I can sing Journey songs on Rock Band 3 with the best of them :)
I read an article recently discussing Internet/video game addiction by Mike Rich, who runs the Center on Media and Child Health in Boston. This is a link to his website, which is pretty informative:
http://cmch.typepad.com/mediatrician
I read an article recently discussing Internet/video game addiction by Mike Rich, who runs the Center on Media and Child Health in Boston. This is a link to his website, which is pretty informative:
http://cmch.typepad.com/mediatrician
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