tag:blogger.com,1999:blog-68874747023329078112024-03-13T08:50:51.011-07:00Medical MomA mom and pediatrician sharing helpful tips for parentsCigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-6887474702332907811.post-1568949118792445942016-02-29T13:38:00.002-08:002016-03-09T09:51:54.139-08:00Getting Ready for CampCamp is a great way for kids to improve their social skills, exercise, and explore new things.<br />
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If you are considering sleep away camp, but aren't sure if it's the right thing to do, <a href="http://www.huffingtonpost.com/michael-thompson-phd/sending-kids-to-summer-camp_b_1539726.html" target="_blank">click here</a> for a psychologist's perspective on camps away from home.<br />
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Whether you decide on day camp or sleep away fun, here are some tips to get ready:<br />
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<b><span style="color: blue;">Day to Day</span></b><br />
<b><span style="color: blue;"><br /></span></b>
<u>Sunscreen</u><br />
Lather up your child with a full shot-glass worth of sunscreen every morning. Then send them to camp with a sunscreen stick, so they can reapply it as needed throughout the day (especially before and after water activities, and at lunch time). Get new tubes of sunscreen every year, and pay attention to expiration dates. Sunscreen should be thrown out 1 year after it is opened. Any sunscreen you use should be SPF 30 to 50. For more information on sunscreen choices, <a href="http://mommedicine.blogspot.com/2013/05/fun-in-sun.html" target="_blank">click here</a>. A hat and clothing are also good ways to protect your child from harmful rays.<br />
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<u>Insect Repellent</u><br />
If your child will be in an area with mosquitos or ticks, don't forget the insect repellant. These only need to be applied once a day. If there are deer ticks in the area, please do a tick-check daily to make sure none are taking a ride, especially in the hairline. Ticks usually have to be attached to the skin and feeding for 24-48 hours before they transmit diseases like Lyme Disease, so a daily tick check can really prevent your child from getting sick. If you do find a tick, pull it out completely with tweezers, or follow the tips at <a href="https://www.healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/How-To-Remove-A-Tick.aspx" target="_blank">HealthyChildren</a>. Do not apply vaseline and do not burn the tick, as this can cause the tick to vomit into the host and transmit disease. For more information on insect repellants in kids, click <a href="http://www.redwineandapplesauce.com/2014/06/30/bug-off-facts-for-parents-about-mosquitoes-insect-repellents-and-health-risks/" target="_blank">here</a> (Tara Haelle talks about the latest science and studies on types of repellents) and <a href="http://pediatrics.about.com/od/summersafety/a/0707_insect_rep.htm" target="_blank">here</a> (Dr. Iannelli discusses what to buy).<br />
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<u>Food</u><br />
If your child is going to a day camp, don't forget ice water and healthy snacks and lunch, for maximum energy and hydration. At sleep-away camp, food in the cabins can attract bugs, so it's better to leave it at home.<br />
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<u>Safety</u><br />
Teach your child to swim before they go to a camp with a pool or lake. Empower them to be protective of their body, and not to allow unwanted touches. For more help with that, see <a href="http://mommedicine.blogspot.com/2014/07/private-parts-talking-to-your-child.html" target="_blank">here</a> and <a href="http://themamabeareffect.org/empowering-our-children.html" target="_blank">here</a>. Finally, remind them to wear helmets for certain sports (rock climbing, skateboarding, bicycling, and horseback riding are popular camp activities).<br />
<b><br /></b><b><span style="color: blue;">Help From Your Pediatrician</span></b><br />
<b><span style="color: blue;"><br /></span></b><u>Forms</u><br />
Most camps require health forms to be completed by your primary care physician before you can attend camp. If you have had an annual physical office visit less than a year from the form due date, most offices will complete your forms without a visit. Some camps require the forms to be completed with a doctor's visit after April, in which case you should make an appointment as soon as possible. Either way, you will need to contact your PMD office well in advance of when you need the forms completed. Some camps are now also requiring immunization records. If you have an up to date yellow immunization card you can give the camp a copy. If you don't have one, get a copy from your pediatrician (it's a good idea to have these at all times anyways).<br />
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<u>Medications</u><br />
If your child will need to take any medications at camp, even over the counter ones, get the medication forms from camp and send them to your prescribing physician at least a couple of weeks before they need to be submitted. You should also speak to your doctor about prescribing extras for camp, especially <a href="http://mommedicine.blogspot.com/2015/01/wheezing-tips-for-kids-using-inhalers.html" target="_blank">inhalers and spacers</a>. If your child has asthma, or wheezes, send a copy of their <a href="http://www.pacnj.org/plan.html" target="_blank">Asthma Action Plan</a> to the camp.<br />
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<u>Allergies & Special Diets</u><br />
If your child has real allergies or medical diets (like with celiac disease), inform the camp ahead of time, and call to make sure they can accommodate your child safely. Allergy warning bracelets can help avoid accidental ingestion at camp, by reminding staff before they share food or special camp treats. If your child has a possibly anaphylactic (life threatening) allergy to insects, food, or anything, be sure to send an <a href="https://www.epipen.com/en/about-epipen/how-to-use-epipen" target="_blank">Epi-Pen or Epi-Pen Jr</a> set (2 pens in case of anaphylaxis, not just 1) to the camp. You should also have an <a href="https://www.epipen.com/en/have-a-plan" target="_blank">allergy plan</a>, so the camp (and you) knows when to use the pen. You may need extra forms to be filled out, to be able to have these used at camp, and an extra prescription, so call your primary care or allergy doctors' office at least a month before camp starts to have this done. Teaching your child the symptoms to look for, and how to use the epinephrine is also important.<br />
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You can read more about creating a <a href="https://www.healthychildren.org/English/news/Pages/AAP-Helps-Young-Campers-Stay-Safe-and-Healthy.aspx" target="_blank">healthy camp experience at the AAP's parent site</a>, but most importantly, have a fun summer!<br />
<br />Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-44872425847949397262015-11-05T14:09:00.002-08:002015-11-05T15:06:03.098-08:00Car Safety<span style="color: purple; font-size: large;">Motor vehicle injuries are the leading cause of preventable death and disability in children in the USA. Using the right car seat the right away can prevent your child from getting hurt!</span><br />
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<u><b><span style="color: blue;">Vehicle Safety Information & CarSeat Review Sites:</span></b></u><br />
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<a href="http://www.cdc.gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html?s_cid=fb_tbi799" target="_blank">The CDC </a><br />
<a href="http://thecarseatlady.com/" target="_blank">The CarSeat Lady</a> (PICU mommy doctor who specializes in car safety)<br />
<a href="http://csftl.org/" target="_blank">CarSeats For the Littles</a><br />
<a href="http://carseatblog.com/" target="_blank">The CarSeat Blog</a><br />
<a href="http://www.safekids.org/car-seat" target="_blank">Safe Kids Worldwide</a><br />
<a href="http://www.maine.gov/dps/bhs/child-passenger-safety/cps-general/cps-styles.html" target="_blank">Bureau of Highway Safety</a><br />
<a href="http://www.safercar.gov/parents/index.htm" target="_blank">NTHSA Car Safety</a><br />
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<tr><td class="tr-caption" style="text-align: center;">My tall 7 year old son, very comfortable in his full car seat, making a silly face</td></tr>
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<u><b><span style="color: blue;">The Biggest Mistakes Parents Make:</span></b></u><br />
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<b>1) Not installing the carseat properly</b><br />
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Most parents think they have installed the car seat correctly themselves, but <span style="color: purple;">71% of car seats are not installed or used correctly</span>!<br />
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The best thing to do is have your car seat installed and checked by a certified professional. You can find car seat inspection locations <a href="http://www.safercar.gov/cpsApp/cps/index.htm" target="_blank">here</a> and <a href="http://www.safekids.org/events/field_type/check-event" target="_blank">here</a>.<br />
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You can get advice on how to install all types of car seats <a href="http://www.safercar.gov/parents/CarSeats/How-To-Install-Car-Seats.htm" target="_blank">here</a>.<br />
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<b>2) Putting the baby/child in with straps too loose, too high or low, and the chest clip not at the chest</b><br />
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Many parents place their child in the seat, but leave the chest clip too low and/or the straps too loose. <a href="http://thecarseatlady.com/strapbabyin/" target="_blank">The Car Seat Lady </a>has a nice video explaining how to get your new infant in the seat just right. Remember, the chest clip should always be at armpit level. See above graphics (borrowed from the internet) for more information.<br />
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<b>3) Turning a toddler forward facing too soon</b><br />
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Children should be at least 2 years old and have reached the maximum weight or height for rear-facing in their chair, before being turned around. Regardless of age or size, <span style="color: purple;"><b>it is 5 times safer to be rear-facing</b></span>!!<br />
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<a href="https://www.youtube.com/watch?v=Sc2zgrVwTh4&list=PL8E566DFC66A00903&index=37" target="_blank">This video</a> demonstrates why kids under 2 years old are in greater danger when facing forward in a crash.<br />
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<a href="http://pediatricpartners.blogspot.com/2012/04/car-seat-confusion-and-booster-boo-boos.html" target="_blank">This blog post by Dr. Stuppy</a> is my favorite explanation on why kids should be rear-facing and stay in car seats as long as possible.<br />
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<a href="http://csftl.org/rear-facing-car-seat-myths-busted/" target="_blank">This website</a> goes over common car seat direction myths.<br />
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<b>4) Putting a child in a booster, instead of a car seat, too soon</b><br />
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Parents often want to move their kids to booster seats as soon as possible, for the convenience of having a lighter, more portable, cheaper seat, but it's NOT convenient if your child is hurt in a minor accident because you moved them too soon (and it will cost you a lot more money than a new car seat, too).<br />
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Children will always be safer in a 5 point restraint (aka harness system), than using a regular seat belt. I often remind my patients that race car drivers use a harness system, and don't rely on simple seat belts to keep them safe.<br />
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More information on how to decide when your child can move to a booster can be found on <a href="http://csftl.org/harness-or-booster-when-to-make-the-switch/" target="_blank">CSFTL</a> and <a href="http://thecarseatlady.com/booster-seats/" target="_blank">TheCarSeatLady</a>.<br />
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<b>5) Letting the child use a regular seatbelt too soon</b><br />
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This is also a matter a cost and convenience, as well as peer pressure, but don't let what other people do put your child at risk. Most children need to ride in a booster seat until at least age 10, since they need to be at least 57" (4 foot 9) to fit with a regular seatbelt. <a href="http://thecarseatlady.com/why-should-kids-use-boosters-cant-they-just-use-the-seat-belt/" target="_blank">TheCarSeatLady</a> has another good explanation on how and why booster seats work. Aside from height, they also need to be mature enough to sit straight and still i the car, since if they are leaning over in a crash, the seatbelt will not be in the proper place, and may not protect them as well as it can.<br />
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<b>6) Letting a child/tween sit in the front seat</b><br />
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Children that are not fully skeletally mature (e.g. have not gone through puberty yet), and are younger than 13 years, should not sit in the front seat. <a href="http://kckidsdoc.com/back-seat-until-13-why-your-pre-teen-should-get-the-back-seat.html" target="_blank">Dr. Burgert</a> does the best job explaining why on her blog. Regardless of age, size, or type of seat, everyone is safer in the back seat.<br />
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<span style="background-color: #fefefe; line-height: 15.36px; white-space: pre-wrap;"><span style="color: purple; font-family: "georgia" , "times new roman" , serif;">No one wants to think about getting into a car accident, especially when you're transporting your most precious cargo. But with tens of thousands of deaths from motor vehicle collisions every year, no parent can afford to take chances. The odds are reasonably high that you will be involved in some kind of car accident before your littlest one turns 18. If your children are with you, you want to have done everything in your power to reduce the risk that they will suffer serious injury, and you will demonstrate to them the importance of car safety for when they have families of their own.</span></span></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-63025275309419035172015-02-14T10:49:00.001-08:002015-02-18T09:47:19.830-08:00From Mom to Mom: Vaccine Science Made Simple<div style="text-align: center;">
<i>This is a guest post by <span style="text-align: right;">Kimberly Mulligan, PhD from the d</span><span style="text-align: right;">epartment of biological sciences at </span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">California State
University Sacramento</span></i></div>
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Hi parents! Scientist here. I decided to write a long post
about vaccines to help shed some light on how vaccines work and, hopefully,
bring some clarity to topics of debate. The amount of misinformation about
vaccines feels a little out of control to me. And no matter what you think
about vaccines, it’s tough to wade through this information without a
scientific background. FYI, my science background: PhD in developmental biology
from Stanford University, postdoctoral research at UCSF on the molecular basis
of brain development with an emphasis on a group of genes implicated in autism
and other neuropsychiatric disorders, and I just joined the faculty at CSUS
this January where I teach molecular cell biology and will have a research
program focused on the molecular basis of neurodevelopment and neuropsychiatric
illness. Ok, on to the fun stuff. (It’s
long because I wanted to be comprehensive and address all of the questions I
usually get about vaccines.)<o:p></o:p></div>
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First, I ask that you read this with an open mind. Having an open mind is an integral quality of
good scientists – it is the only way to objectively analyze data. (Open minds are
wise minds!) I also want to add that this debate gets nasty, but in the end we
all love our kids and want what’s best for them (as a mama of two, I get
that). I am not judging, I do not feel
that is my place as a scientist – my place as a scientist is to arm you with
information and help you better understand that information. <o:p></o:p></div>
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Important vocabulary: pathogen = disease-causing bacteria or
virus<o:p></o:p><br />
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<b>Q: Ok, so what are
vaccines? (I feel like this very basic question is often not clearly
answered.) <o:p></o:p></b></div>
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<b>A:</b> Usually they
are viruses or bacteria that have been modified so they cannot hurt you, but
still look like pathogens to your immune system. That part is key. When a weakened
pathogen (or “acelluar” pieces of a pathogen) enters your body your immune
system responds by making antibodies that will bind specifically to that
pathogen, and target it for destruction. Here’s the really cool part – our
immune system makes cells called memory B cells that will stay in our body for
a really long time (depending on how strong the vaccine is). These memory B
cells are primed to make antibodies specific for that pathogen if you were to
get infected again. This is important because our immune response can take a
long time - long enough for pathogens to have debilitating and sometimes lethal
consequences. If you have those B cells ready to go, your body makes specific
antibodies that will get rid of the pathogen before it hurts you. <o:p></o:p></div>
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<b>Q: What about the
other scary sounding stuff in vaccines? <o:p></o:p></b></div>
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<b>A:</b> They are all
there to make sure the vaccine stays safe and effective. And while they sound awful,
they are all actually totally safe in the amounts present. For example,
formaldehyde sounds scary, but did you know that it is a normal metabolic
byproduct that your body produces in small amounts constantly? You produce more
formaldehyde over a matter of minutes than you get from a vaccine. Another fun
fact: there is 4-15 times more formaldehyde in a single apple than any one
vaccine. And your body simply processes it and gets rid of it (again, it knows
how since you are always producing it). Aluminum? Present in things ranging from organic pears
to natural breast milk. One of the first things biochemistry students learn is
that dose matters. Yes, large amounts of aluminum and formaldehyde are bad…but
large amounts of water can be lethal. Oh, and mercury-containing thimerosol is
no longer in early childhood vaccines because it was removed due to public
outcry. However, there is still zero scientific data to suggest that thimerosol
has any detrimental effects. In fact, the type of mercury in thimerosol is
ethyl mercury, which is readily flushed from the body. The bad mercury that our
body has a harder time getting rid of is methyl mercury (found in tuna). <o:p></o:p></div>
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<b>Q: Why should you
trust a big pharma who profits from vaccines?
<o:p></o:p></b></div>
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<b>A:</b> My first
answer is that you don't have to. There are a lot of scientists who have
published research on the safety of vaccines that are not affiliated with big
pharma and do not profit from the results of their findings. They are people
like me – who became scientists because they wanted to help learn more about
biology in order to diminish human suffering. We work for academic
institutions, not big pharma. We ask questions without a vested interest in the
answers. These are the scientists that can provide you with unbiased
information. You can do a search for yourself on the largest database of
scientific journals here: <a href="http://www.ncbi.nlm.nih.gov/pubmed">http://www.ncbi.nlm.nih.gov/pubmed</a><u><span style="color: blue; mso-themecolor: hyperlink;"><o:p></o:p></span></u></div>
<div class="MsoNormal">
You will find that when you search for studies on autism and
vaccines, of the hundreds of studies conducted, there is still no scientific
data to suggest a link between the two. For example, every epidemiological
study conducted on populations of children living in the same community has
shown autism occurs at the same rate in vaccinated and unvaccinated children. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q. What is currently
thought to be the cause of autism?<o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> It is
currently thought that autism is a neurodevelopmental disorder that often begins
<i>in utero</i>. A number of the autism risk
genes identified affect how the brain develops during gestation. There were
actually a couple of papers very recently published indicating specific
mutations in a large number of candidate risk genes for autism<sup>1, 2</sup>.
There has also been research showing the influence of environmental factors
like maternal antibodies that are present in the womb, which were identified by
scientists at the UC Davis MIND Institute<sup>3</sup>. Autism is a very
complicated disorder, and we certainly don’t have all of the answers! But,
again, there has been an overwhelming amount of time and money dedicated to
investigating a potential link between autism and vaccines, and every study has
come back with the same results: there is no data to suggest a link between
autism and vaccines. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: Back to the
big-pharma-makes-a-lot-of-money-argument. <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Yes, they do. They
make money on every drug they produce. I have opinions on big pharma’s business
practices that I won’t go into now because it actually has nothing to do with
the argument about vaccine effectiveness or safety. For better or for worse,
our entire medical system is profit based (our entire economy is, actually). The
people at the forefront of the anti-vaccination movement also make a lot of
money. That is not why I don’t believe them, though. I don’t believe
anti-vaccination proponents because of the absence of scientific data to
support their claims. As a scientist, I only believe what the scientific data supports.
I read research, not opinions. (That is not meant as a slight to anyone! I am simply stating my practices. I know that
reading primary research papers can be like reading a different language if you
do not have a science background, so I would not really expect any
non-scientist to have this practice. It’s the same reason I don’t read
economics papers. Bleh!)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: What about
vaccine-related injury? <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> The overall
risk is something like 0.003%. And the VAST majority of those 0.003% have minor
allergic reactions. Severe allergic reactions can occur, though they are
extremely rare. There have been a few cases of autoimmune disorders being
triggered by a vaccine. It is not entirely clear whether the vaccine was
actually the trigger because it could have been triggered by any pathogen. Importantly,
people who are immunocompromised, meaning they have a weakened immune system (chemotherapy
patients, HIV patients, genetic immune deficiencies, etc.), cannot be immunized
because their immune systems are so weak that even the weakened virus might
hurt them. All of these people fall into the class of people who should not get
vaccinated and for whom herd immunity is so important! <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: What is herd immunity?
<o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> It’s kind of
basic math. Viruses cannot replicate on their own. They need to infect a host
cell in order to replicate. If they don’t make it into a host cell, they will
eventually die. Here's an easy example: a person infected with a virus walks
into a room where there are 20 vaccinated people separating him from a single
unvaccinated person. That virus cannot move from the infected person and replicate
in any of the vaccinated people because once it gets into their bodies, those
memory B cells start pumping out antibodies that kill it before it can
replicate and spread. Therefore, those 20 vaccinated people make it harder for
the virus to make it to the single unvaccinated person. If half of the people
were unvaccinated, that virus would get to have a replication party in all of
their cells and would have a much easier time surviving, multiplying, and spreading.
Herd immunity is just a basic principle about how infectious pathogens spread. If
someone tells you it doesn’t exist, you should be wary of any other scientific
information they give you because it means that they have never taken or
studied immunology or microbiology and are not qualified to have an educated
discussion about those topics.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The tricky thing about vaccines and herd immunity is that herd
immunity really only works when a high percentage of the population are
vaccinated. If not, then viruses have an easier time spreading around our
communities, putting at risk our neighbors who cannot be vaccinated (newborns,
cancer patients, etc.), and who are also much more likely to die as a result of
infection. That is why the scientific community is so scared. We feel that even a single death from a
vaccine-preventable disease is a tragedy. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: Isn’t natural
immunity better than vaccine-induced immunity? <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Well, the
immune response is stronger because the pathogens are not weakened, so if you
make it through the illness you will, in theory, have a great supply of those
memory B cells. The problem is that a lot of these vaccine-preventable
pathogens can cause blindness, deafness, brain damage, paralysis, or death. I
know of a mama who has a sister who contracted rubella while she was pregnant. Her
baby was born blind and deaf because of the infection. So, yes, she now has
great immunity to rubella. But she would give anything to have had
vaccine-induced immunity prior to her pregnancy.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: Why do some
vaccines not give lasting immunity? <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Each vaccine
has a varying degree of effectiveness. By effectiveness I specifically mean the
quantity and quality of memory cells that will stick around in the immune system
post-vaccine. For example, the smallpox vaccine gave immunity for 65 years
whereas the pertussis vaccine only lasts for about 10 years. This is the
purpose of boosters. Boosters essentially tell your immune system that it is
still important to mount a defense against the pathogen, and replenishes your
stock of memory cells.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: I heard a lot of
adults are to blame for the current measles outbreak. Should adults get
vaccinated, too?<o:p></o:p></b></div>
<div class="MsoNormal">
<b>A.</b> Absolutely! If
you are unsure of your immunity, you can talk to your medical provider about
checking your titer (a measure of your immunity), or you can just get a
booster. Even if you’ve had a booster, but can’t exactly remember when and your
provider doesn’t do the titer test, getting another booster cannot hurt you.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: Why do babies
often get fevers after being vaccinated? <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Part of the
natural immune response is the release of molecules called chemokines, which
cause fever. As a mama, I know how scary it can be when your little one has a
fever, but a post-vaccine fever is indicative of a robust immune response and
means they are making great memory B cells. That does not mean you shouldn’t
treat your baby’s fever! (Please consult
your pediatrician on when you should treat your baby’s fever.) <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: What’s up with
vaccine shedding? <o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Vaccine shedding is something
only possible with a live attenuated virus. This is different from the
pertussis vaccine, for example, which is an acellular vaccine, meaning it
contains various pieces of the pertussis bacterial molecules and is not
infectious at all, cannot cause illness ever, and cannot shed. Again, a live
attenuated virus is a weakened virus that reproduces so slowly that a normal
immune system will take care of it before it causes any harm. If a person is
immunocompromised, live attenuated vaccines cannot be used because their immune
system might not be able to handle even a weakened virus. The nasal spray flu
vaccine does have a risk of vaccine shedding because the vaccine is
administered directly to the mucus membranes of the nose. Therefore, if that recently
immunized person were to sneeze onto an immunocompromised person, there is a
theoretical possibility that the attenuated virus could give that immunocompromised
individual the flu. This is why it is recommended to stay away from
immunocompromised individuals for a week after getting the nasal spray flu
vaccine. Other live attenuated viruses
are injected into muscle. Some of the weakened virus will get into the
lymphatic system, which is where all that good immunity will happen (production
of specific antibodies, effector cells, and memory cells that will stay around
for a long time). From there, some of the vaccine can enter saliva and mucus,
although it is going to be a much lower amount. I think this is why the CDC
only has the recommendation to steer clear of immunocompromised individuals in
the case of the nasal spray flu vaccine. BUT, and this is critical, the virus
that would potentially be shed post-vaccine is the attenuated (weakened) virus
that does not cause illness in a person with a normal immune system. This is
why vaccine shedding does not cause disease EVER in a person with a normal
immune system. It would essentially be like getting an ultra-tiny dose of a
vaccine (not enough to even cause an appreciable immune response that would
lead to acquired immunity). This is anecdotal, but when my daughter was
newborn, my husband did not realize this about the nasal spray flu vaccine when
he took our 2 year-old to the doctor…and he got him the nasal spray form of the
flu vaccine. I’m happy to report that my newborn daughter did not get the flu.
I actually wasn’t really worried; it’s a very minimal risk….but when a person
is severely immunocompromised it is important to worry about any potential risk<span style="font-family: "Tahoma","sans-serif"; font-size: 10.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Q: If I have a baby
that is too young for MMR, could a booster given to a breastfeeding mama give
the baby passive immunity through antibodies present in the breast milk?<o:p></o:p></b></div>
<div class="MsoNormal">
<b>A:</b> Passive
immunity is the transfer of active antibodies from one person to another. This
happens during pregnancy when antibodies present in mama cross the placenta to
the developing fetus. <span class="uficommentbody">I recently spoke to an immunologist friend about passive
immunity through breast milk. I myself was considering getting the MMR booster
to help my 7 month-old baby girl, but he said (sadly) it probably would not
boost her passive immunity an appreciable amount (for a virus as strong as
measles, anyway). There are five classes of antibodies (IgA, IgG, IgD, IgE, and
IgM). The type that is most effective in preventing infection from something
like the measles is IgG. These antibodies cross the placenta during pregnancy
and give passive immunity to the baby when it is newborn. The primary type of
antibody that gets into breast milk is IgA. It provides some protection, but
it’s just not as great as IgG.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="uficommentbody"><b>Q: If newborns
get passive immunity from mama during pregnancy, why are they susceptible to
illness? <o:p></o:p></b></span></div>
<div class="MsoNormal">
<span class="uficommentbody"><b>A:</b></span><span class="uficommentbody">
Passive immunity only lasts for a short time. That’s because antibodies tend to
not survive very long (a few weeks to a few months, on average). Unfortunately,
the effector cells and memory cells that are responsible for making the
antibodies in mama do not cross the placenta. The memory cells are the cell
types that stick around for years to provide lasting immunity. I read a study
that indicated 88 percent of babies of vaccinated mothers have passive immunity
to measles at 4 months, and that number dropped to 15 percent by 8 months of
age<sup>4</sup>. Although, and this is important, the amount of antibodies
acquired through passive immunity may not be sufficient to protect the baby
from a strong pathogen. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span class="uficommentbody"><b>Q: What about
the alternative vaccine schedule versus the CDC recommended vaccine schedule?<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span class="uficommentbody"><b>A:</b></span><span class="uficommentbody"> I've
never found evidence to support the alternative vaccine schedule. It is my
understanding that it is something to make parents feel more comfortable. There
are a lot of factors taken into account for the CDC schedule, which have to do
with considerations like when the acquired immunity will be best. For example,
MMR is not given until 12 months because they want to make sure that all
passive immunity acquired from mama during pregnancy is gone by the time the
vaccine is administered because those circulating antibodies would decrease the
immune response to the vaccine. So MMR can be given at 6 months, but is better
at 12 months...and I recently read a study indicating even a little tiny bit better
at 15 months<sup>5</sup>; but, you could possibly do the initial shot earlier
than 12 months and then get the booster early if you are concerned about
measles in your community (of course, talk to your doc about these decisions).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I hope this was helpful! Again, I have no financial interest
in this debate. As the mama of a 7 month-old baby girl who is not old enough to
have MMR, a 2 year-old little boy who only now has partial immunity, and as the
stepdaughter to a wonderful man who spent his final 9 months severely
immunocompromised due to chemotherapy, I am certainly emotionally invested in
the debate. But as a scientist who has read thousands of pages of scientific
research, I only want to help spread knowledge and quell fear. <o:p></o:p><br />
<br />
<b><span style="color: #cc0000;">For links to more information about vaccines please check out this post: </span></b><a href="http://mommedicine.blogspot.com/2013/03/immunization-information.html" target="_blank">http://mommedicine.blogspot.com/2013/03/immunization-information.html</a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
References<o:p></o:p></div>
<div class="MsoNormal">
<sup>1</sup> Iossifov I, et al., The contributions of de novo
coding mutations to autism spectrum disorder. Nature. (2014) 515(7526)<o:p></o:p></div>
<div class="MsoNormal">
<sup>2</sup> De Rubeis S, et al., Synaptic, transcriptional
and chromatin genes in autism. Nature. (2014) 515(7526) <o:p></o:p></div>
<div class="MsoNormal">
<sup>3</sup> Bauman MD, et al., Maternal antibodies from mothers of children with autism
alter brain growth and social behavior development in the rhesus monkey. Transl
Psychiatry. (2013) 9;3 <o:p></o:p></div>
<div class="MsoNormal">
<span class="uficommentbody"><sup>4</sup></span><span class="uficommentbody"> De Serres, et al., Passive
immunity against measles during the first 8 months of life of infants born to
vaccinated mother or to mothers who sustained measles. Vaccine. (1997) </span>15(6-7):620-3<span class="uficommentbody">.<o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span class="uficommentbody"><sup>5</sup></span><span class="uficommentbody"> Hinman A., et al., </span>Comparison of Vaccination
with Measles-Mumps-Rubella Vaccine at 9, 12, and 15 Months of Age. J Infect Dis.
<span class="slug-pub-date">(2004) </span><span class="slug-vol">189</span><o:p></o:p></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-53513414268456588192015-01-05T11:50:00.000-08:002015-01-05T11:51:34.456-08:00Wheezing: Tips for Kids Using Inhalers<div class="MsoNormal">
<b>Children with wheezing,
reactive airways, asthma, bronchospasm, or difficulty breathing are often
prescribed a metered dose inhaler with a spacer device.<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: magenta;">There are different
kinds of metered dose inhalers (“MDI”):</span><o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><i>1)<span style="font-size: 7pt; font-stretch: normal; font-style: normal;">
</span></i><!--[endif]-->A <b>“rescue
inhaler”</b> contains <b>Albuterol</b> or
Levalbuterol, which opens up the lungs and reduces inflammation <b>for quick relief</b>. Brand names include
Ventolin, ProAir, Proventil, or Xopenex. These are equivalent to putting 1 vial
of Albuterol or Xopenex in a nebulizer and sitting with the mask on your child
for 15 minutes. These are usually used on an as-needed basis, up to every 4
hours. <i>If your child needs to use this
every 4 hours for more than 24 hours, needs it more often than every 4 hours, or
needs this more than twice every week, please call your pediatrician.<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]--><i>2)<span style="font-size: 7pt; font-stretch: normal; font-style: normal;">
</span></i><!--[endif]-->Some inhalers are used to <b>prevent</b> asthma, wheezing, and breathing trouble. These are only
effective when used <b>every day</b>. They
are not used for fast-acting relief of an acute breathing difficulty, but may
help when used during cold or allergy season, or if started right at the
beginning of an asthma exacerbation or when a child is exposed to known
triggers. Brand names of some of these medicines include <b>Flovent, Qvar</b>, Symbicort, Dullera or Advair. Flovent and Qvar are
like using the Pulmicort/Budesonide in the nebulizer. <i>Please discuss if and when you should use these with your physician.<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]-->3)<span style="font-size: 7pt; font-stretch: normal;"> </span><!--[endif]-->There
are also inhalers that contain powder or are not used with a spacer. Some brand
names are: Maxair autohaler, Asmanex Twisthaler, or Pulmicort Flexhaler. None
of these need a spacer to work effectively, but these are only for older
children.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Please see the
“Asthma Education For Kids” <a href="https://www.youtube.com/playlist?list=PLvFDl8yDYTntIsWcmIzsJZxneM6BXvxv0" target="_blank">playlist from BoosterShotComics </a>on YouTube,
especially <a href="https://www.youtube.com/watch?v=Et_alsghel8&index=1&list=PLvFDl8yDYTntIsWcmIzsJZxneM6BXvxv0" target="_blank">episode #1: “Iggy & The Inhalers” </a>to better understand the roles
of different medications used for wheezing or asthma.</b> <a href="https://www.youtube.com/watch?v=IfEsOiR9K_s&list=PLvFDl8yDYTntIsWcmIzsJZxneM6BXvxv0&index=4" target="_blank">Episode 4</a> explains
how to use a spacer with mouthpiece.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: magenta;">There are 4 main
brands of spacers.</span></b> They may be cheaper online than from a pharmacy, but
always require a prescription.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]-->1)<span style="font-size: 7pt; font-stretch: normal;"> </span><!--[endif]--><b>Aerochamber</b> with flow-vu. This brand is
a clear tube with colored ends and teddy bears on the side. It has a two-way
valve (to get the medicine in and air out) and is anti-static (so the kid can
inhale all of the medicine and it won’t stick to the sides). The flow-vu allows
you to see when a child gets a breath with a good seal. There is a small orange
one for infants, yellow medium one for age 1-5 years old, blue one with mask
for older children that still need a mask, and blue one with mouth-piece for
older kids that can seal their lips around it instead of having to use a mask
(more comfortable, kids can usually start doing this around age 6).</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]-->2)<span style="font-size: 7pt; font-stretch: normal;"> </span><!--[endif]--><b>Vortex</b> Non-Electrostatic Valved Holding
Chamber. This device also has a two-way valve and is anti-static. It is metal,
so it is more durable and machine-washable. It comes in 1 size with different
sized masks that fit on the end. This has the advantage of only needing one
device as the child grows older (you just switch the mask on the end, not the
whole device).</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]-->3)<span style="font-size: 7pt; font-stretch: normal;"> </span><!--[endif]--><b>Optichamber</b>. The original device is a
plastic tube with 1-way valve that most pharmacies try to give our patients.
Some versions are NOT anti-static, therefore much of the medicine sticks to the
plastic, instead of being inhaled by the child. The single valve can make some
children feel suffocated when breathing into the mask. I do NOT recommend this
device. However, there is now an <b>Optichamber
Diamond </b>version, which is anti-static, has a 2-way valve, and can be used
comfortably. It comes with different size masks or a mouth piece, all clear,
and very soft.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<!--[if !supportLists]-->4)<span style="font-size: 7pt; font-stretch: normal;"> </span><!--[endif]--><b>InspiraChamber</b>. This is a clear,
anti-static, valved chamber, with purple ends. It offers very soft masks with a
special place in the small mask to fit a pacifier, to calm the child while they
inhale. It also has a flap that moves, so you can see if the child is taking a
breath with a good seal and getting the medicine. It will be available after
February 2015.</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
<br /></div>
<div align="center" style="text-align: center;">
<b><u><span style="color: #cc0000;">How
to Use Your Inhaler:</span><o:p></o:p></u></b></div>
<div align="center" style="text-align: center;">
<b><u><br /></u></b></div>
Before using a new inhaler for the first time, put it into the spacer and
press it 15 times to prime the device (e.g. makes sure the medicine is coming out in an even dose, and not just the propellent).<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiD8HhyphenhyphenPKc8XllMEc4Lxq9ihVrhZ3jgYefI8nIcwH2cOQ8e5JpXNvIrTuvV67qdycdGPk-Utxgr9NR5YeaVLlDbZYw2Uhgy2MhimLJNF4eKKIMihpUP0UdrhWSzeYLtQrXco7UKOpBsMC4/s1600/Feb22MDI+(2).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiD8HhyphenhyphenPKc8XllMEc4Lxq9ihVrhZ3jgYefI8nIcwH2cOQ8e5JpXNvIrTuvV67qdycdGPk-Utxgr9NR5YeaVLlDbZYw2Uhgy2MhimLJNF4eKKIMihpUP0UdrhWSzeYLtQrXco7UKOpBsMC4/s1600/Feb22MDI+(2).jpg" height="320" width="240" /></a></div>
<div style="text-align: center;">
<span style="font-size: x-small;">my son playing with his inhaler and spacer a few years ago (C) 2015</span></div>
<br />
<b><span style="color: #cc0000;">To use a spacer with a mask: </span><o:p></o:p></b><br />
<ul type="disc">
<li class="MsoNormal"><b>Shake the inhaler before each use.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Put the inhaler mouthpiece into the spacer.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Hold the mask over your child's nose and mouth and create a good
seal. Holding your fingers like the letter C can help. If you’re using a
device with flow-vu, you should see the flap move with each breath the
child takes. Otherwise look at the child’s chest to count breaths. <o:p></o:p></b></li>
<li class="MsoNormal"><b>Press the inhaler.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Have your child breath in and out six times (about 30 seconds).<o:p></o:p></b></li>
<li class="MsoNormal"><b>Remove the mask and let your child breath normally for a minute.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Repeat if more than one puff was prescribed (most inhalers need 2
puffs per dose).<o:p></o:p></b></li>
</ul>
<div class="MsoNormal">
While your younger child may not like the spacer and mask
being held over his mouth and nose, it will go much quicker than using a
nebulizer. <b>Let the child play with it
and practice putting it on stuffed animals or family members to make them
comfortable.</b> Some children will allow you to use it if they get to be the
ones to hold it or press the inhaler (just make sure the seal is tight over
their face so they get all of the medicine).</div>
<div class="MsoNormal">
<br /></div>
<b><span style="color: #cc0000;">To use a spacer with mouthpiece
(older children and adults): </span><o:p></o:p></b><br />
<ul type="disc">
<li class="MsoNormal"><b>Shake the inhaler before each use.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Put the inhaler into the spacer.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Have your child seal their lips around the mouthpiece and exhale.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Press the inhaler.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Have your child breath the medicine in and hold their breath for
about 30 seconds. If they can’t hold their breath, they can take another
breath or 2 in to get more medicine from that puff (any extra medicine
should be sitting in the chamber).<o:p></o:p></b></li>
<li class="MsoNormal"><b>Take the spacer out of their mouth and have the child breath normally
for a minute.<o:p></o:p></b></li>
<li class="MsoNormal"><b>Repeat if more than one puff was prescribed (most inhalers need 2
puffs per dose).<o:p></o:p></b></li>
</ul>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
</div>
<div class="MsoNormal">
<i>Keep in mind that
while many experts believe that an MDI with a spacer is as good as, or better
than, a nebulized treatment, some parents prefer a nebulizer, and that is okay.</i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
If you are not sure if your child is actually wheezing, or what they have, <a href="http://pediatricpartners.blogspot.com/2013/12/my-childs-cough-and-breathing-sounds.html" target="_blank">this blog from Dr. Stuppy can help</a>, with descriptions of different kinds of coughs and breathing, along with youtube video links.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If your child does NOT have asthma, reactive airway disease, wheezing, bronchospasm, or difficulty breathing, my post on <a href="http://mommedicine.blogspot.com/2012/08/coughs-colds-and-croup.html" target="_blank">Coughs, Colds and Croup </a>may be more helpful.</div>
<div class="MsoNormal">
<i><b><br /></b></i></div>
<div class="MsoNormal">
<i><b>Please note that this guide is NOT intended to diagnose or treat any illness or condition. Always speak to your own physician for advice. </b></i></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-84276804947501201712014-07-29T21:13:00.001-07:002014-07-30T13:31:17.786-07:00Private Parts: Talking to Your Child About Their Bodies, Behavior, and Babies<span style="font-family: Times, Times New Roman, serif;">It is important to start speaking with your children about their bodies and behavior at an early age. If you create an open dialogue, without shame, your children will feel free to bring you their questions throughout their lives. This is often an uncomfortable topic for parents, so I have created a list of books and resources to help you get through it (scroll down). I also encourage you to discuss any questions you have on the topic with your child's pediatrician (we are always here to help!).</span><br />
<div>
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div>
<b><u><span style="font-family: Times, Times New Roman, serif;">Some tips:</span></u></b></div>
<div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Watch out for everyday opportunities to teach your child about privacy and hygiene.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Encourage your child to ask you questions, to learn that they can feel comfortable coming to you with their thoughts.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Try to be calm and open about the topic (pay attention to your body language and tone of voice).</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Give simple and short answers.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Make sure your answers are age appropriate.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Young children take everything you say literally, so avoid metaphors.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Use anatomically correct terms for their body parts (i.e. penis and vulva, not "weewee")</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Avoid shame and ridicule.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Become closer to your child by showing them that you accept & support their feelings.</span></span></li>
<li><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Set rational and consistent limits.</span></span></li>
</ul>
<br />
<div>
<span style="font-family: Times, Times New Roman, serif;">Here is a great blogpost by Dr. Claire McCarthy on getting started with the conversation: "<a href="http://www.kevinmd.com/blog/2014/02/6-tips-talking-kids-sex.html" target="_blank">6 Tips For Talking To Your Kids About Sex</a>."</span></div>
<div>
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div>
<span style="font-family: Times, Times New Roman, serif;">I also recommend looking at the website "<a href="http://themamabeareffect.org/empowering-our-children.html" target="_blank">Empowering Our Children</a>," which is designed to teach parents how to protect their children from sexual abuse.</span><br />
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<span style="font-family: Times, Times New Roman, serif;">The "<a href="http://www.scarymommy.com/dont-play-vulvas-table/" target="_blank">ScaryMommy</a>" website has a good post on what these conversations with toddlers may look like.</span></div>
<div>
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div>
<u><b><span style="font-family: Times, Times New Roman, serif;">My Book Recommendations:</span></b></u></div>
<div>
<u><b><span style="font-family: Times, Times New Roman, serif;"><br /></span></b></u></div>
<div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">For parents to read overall:<o:p></o:p></span></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></i></b></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“Everything You NEVER Wanted
Your Kids To Know About Sex (but were afraid they’d ask)” by Dr. Justin
Richardson & Dr. Mark Schuster</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">This is the best book for parents to read on the
subject. It tackles every sexual stage of development from infancy (yup, some
babies masturbate) through adolescence, as well as age-less topics, such as
homosexuality. I recommend starting to read this book when your child is young,
although it’s never too late to learn.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">For parents to read on tough
questions kids ask in general (not on sex):<o:p></o:p></span></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></i></b></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="color: blue; font-family: Times, Times New Roman, serif;">“The Top 50 Questions Kids Ask”
by Dr. Susan Bartell</span></span></li>
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“Questions Children Ask &
How To Answer Them” by Dr. Miriam Stoppard</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">These books cover tough questions that kids bring up in
general, like spirituality, fear, and growing up. The first book is good for
uncovering the real meaning behind some questions, and figuring out the best
way to respond.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Books to read with your children (or
for them to read by themselves), by age group:<o:p></o:p></span></span></i></b></div>
<div class="MsoNormal">
<b><i><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></i></b></div>
<div class="MsoNormal">
<b><span style="font-family: Times, Times New Roman, serif;"><i>Toddlers & Pre-Schoolers: </i><span style="font-size: small;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><i><span style="font-family: Times, Times New Roman, serif;"><br /></span></i></b></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“Amazing You: Getting Smart
About Your Private Parts” by Dr. Gail Saltz</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">My favorite overall book for toddlers. Teaches basic
anatomy, privacy, and even how babies are born.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpVDC7DcCu7h7TCi-BtPOW-lfbLmphO_4mpB4c5TxO9TLsFjqQXIX6GOyEUvbXQpNZwJaPHNdZgCez6rZ4SZ3l9qT3o9tnngkzLvu3lw2VKK4xJG0W5T6w2UFf3fNYj5xzlouTZWhi7os/s1600/AmazingYou.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Times, Times New Roman, serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpVDC7DcCu7h7TCi-BtPOW-lfbLmphO_4mpB4c5TxO9TLsFjqQXIX6GOyEUvbXQpNZwJaPHNdZgCez6rZ4SZ3l9qT3o9tnngkzLvu3lw2VKK4xJG0W5T6w2UFf3fNYj5xzlouTZWhi7os/s1600/AmazingYou.jpg" height="269" width="320" /></span></a></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="color: blue; font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“When You Were Inside Mommy” by
Joanna Cole</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">A very simple book on pregnancy and birth to read to young
children. No lies (e.g the stork), but no anatomy or private parts mentioned
either.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“What Makes a Baby?” by Cory
Silverberg</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: small;">This book is great for families that </span>conceived<span style="font-size: small;"> via IVF,
adoption, surrogacy, or traditional means. It talks about sperm, egg, uterus,
and birth, but each as its own thing, and at the end it asks, “Who was waiting
for you to be born?” Technically accurate, but simple, with cartoonish illustrations.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“Where Did I Come From?” by
Peter Mayle</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">This is the classic “how babies are made” children’s book,
but take a look through this book before buying it, as it is may be too
explicit for some families (see the anecdote at the end of this blog post).<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“My Body Belongs To Me” by Jill
Starishevsky</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">This book discusses inappropriate touching/abuse. It
does not discuss development or how babies are made.<o:p></o:p></span></span><br />
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">School Age Children:<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt;"><span style="color: blue; font-family: Times, Times New Roman, serif;"><br /></span></span></b></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="color: blue; font-family: Times, Times New Roman, serif;">“It’s So Amazing! A Book About
Eggs, Sperm, Birth, Babies, and Families” by Robie Harris</span></span></li>
</ul>
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Covers all of the basics, including proper anatomy, mostly with diagrams, and a little cartoon guidebird.</span></span></div>
<div>
<span style="font-family: Times, Times New Roman, serif;"><br />
</span><br />
<div class="MsoNormal">
<span style="font-family: Times, Times New Roman, serif;"><b><span style="font-size: 12pt;">Tweens:</span></b><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt;"><span style="color: blue; font-family: Times, Times New Roman, serif;"><br /></span></span></b></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;"> “It’s Perfectly Normal: Changing Bodies,
Growing Up, Sex, and Sexual Health” by Robie Harris & Michael Emberley</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">Very similar to the school-age version by Harris (above),
but with more words, less illustrations, and more details.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><br /></span></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;"><span style="color: blue;">“The Care & Keeping of YOU:
The Body Book for Girls” by American Girl</span><o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-size: 12pt;"><span style="font-family: Times, Times New Roman, serif;">My tween patients report that they love this book. It goes
over what to expect in puberty and how to take care of girls’ changing bodies.
This book includes discussions on hygiene and how to use menstrual products. There is a new version with the number 2 on it, and a version for boys.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: small;"><a href="http://pediatricpartners.blogspot.com/2013/09/first-period-q-with-tween.html" target="_blank">Dr. Stuppy</a> and the <a href="http://www.amightygirl.com/blog?p=3281" target="_blank">Mighty Girl </a>website also have good posts on </span>discussing<span style="font-size: small;"> puberty.</span></span></div>
<div class="MsoNormal" style="margin-left: 0.25in;">
<span style="font-family: Times, Times New Roman, serif; font-size: small;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="color: purple; font-family: Times, Times New Roman, serif;">An Anecdote:</span></u></b></div>
<div class="MsoNormal">
<b><u><span style="color: purple; font-family: Times, Times New Roman, serif;"><br /></span></u></b></div>
<div class="MsoNormal">
<span style="color: purple; font-family: Times, Times New Roman, serif;">When I was 3 years old, my mother (who is a pediatrician as well) read me the book "Where Did I Come From?" I went to my religious nursery school and proceeded to tell everyone, "I was the fastest sperm!" Some of the other parents were not happy when their own children went home and repeated the same thing to them. My mom got a stern 'talking to' by the school. We still laugh about it, to this day. The moral of the story? Teach your children about their bodies and development before anyone else does, or you may not be happy with what they learn ;)</span></div>
<div class="MsoNormal">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Times, Times New Roman, serif;">For newer blog posts on the subject, as they come out, you can also follow my pinterest boards on <a href="http://www.pinterest.com/motek42/teenagers/" target="_blank">Teenagers</a>, <a href="http://www.pinterest.com/motek42/parenting/" target="_blank">Parenting</a>, and <a href="http://www.pinterest.com/motek42/kids-health/" target="_blank">Kids' Health</a>.</span></div>
</div>
</div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-1922181387705991832013-10-02T13:09:00.003-07:002013-10-02T13:09:24.075-07:00Vomiting and/or Diarrhea<span style="color: #351c75;">Vomiting and diarrhea viruses are not fun for anyone. Doctors refer to the most common cause of these symptoms as "viral gastroenteritis". Some kids just vomit, some kids just have diarrhea, and the most unlucky have both. </span><br />
<br />
Most of these illnesses do not need to be treated with medications (antibiotics can make it worse, since they also kill the good bacteria in your tummy), and anti-diarrheal medicines (like Imodium) can be harmful to children. The most important thing is to keep your child HYDRATED (more on that below). If you suspect your child has vomiting or diarrhea from food poisoning or any other type of foreign ingestion, please call <span style="color: #cc0000;">poison control 1-800-222-1222</span>, who are free and staffed with physicians 24-7!<br />
<br />
<b><span style="color: #351c75;">How can you tell if your child is starting to get dehydrated?</span></b><br />
- their mouth/lips seem dry<br />
- they are urinating (peeing) a little less than usual<br />
- they are thirsty<br />
<br />
<b><span style="color: #351c75;">Now what?</span></b><br />
<span style="color: #351c75;">You need to <b>keep your child hydrated!</b></span><br />
- A baby can continue to breast feed or take infant formula, if they are just a little dehydrated. If they vomit after every feeding, or are refusing the breast/bottle, then try to hydrate them with an Oral Rehydration Solution, like Pedialyte. Warning: the plain ones taste like salt water, so I suggest getting a few flavored ones and trying them out, to see which ones they will take. If they refuse the bottle completely, you can try feeding them via a syringe or spoon, giving small amounts every 15 minutes.<br />
- A child who is getting electrolytes from food (such as chicken soup, or crackers, even if it's just a little bit) can hydrate with water. If they are not taking in any food, or if they are throwing up the food, please <span style="color: blue;">hydrate them with an ELECTROLYTE solution (aka Oral Rehydration Solution, aka ORS). You can buy them at most USA markets (under brand name Pedialyte, or generic versions), you can make your own by mixing 1 liter (5 cups) clean water with 6 level teaspoons (=2 tablespoons) sugar and 1/2 teaspoon salt. You can add a little bit of orange juice or a banana for potassium. Common substitutions are rice water, congee, green coconut water, or mixing gatorade with water (although I do not recommend doing this, since it is hard to get the right balance of electrolytes this way). If your child does not want to drink, try giving them sips every 15-30 minutes, or giving them the ORS/Pedialyte in frozen popsicle form.</span><br />
- For every age, and everybody in the hous<span style="background-color: #93c47d;">e, <span style="color: magenta;">WASH YOUR HANDS A LOT</span> to prevent spread/transmission of the stuff that gets you sick. Teach</span> everyone to wash their hands in warm water, scrubbing for at least 20 seconds (2 rounds of the Happy Birthday song). Try and use real soap and water, instead of no-rinse hand sanitizers, since they do a better job at killing the tummy microbes.<br />
<br />
<b><span style="color: #351c75;">But what if they keep vomiting?</span></b><br />
- Let their tummy rest.<br />
- Call your pediatrician, or go to the hospital, if they have signs of dehydration (see more below).<br />
- Ask your pediatrician if your child is old enough and healthy enough for a medication against nausea/vomiting.<br />
- Start with no food, but still give an electrolyte fluid (aka ORS above), for the first 12 hours.<br />
- When they are ready/want to eat, give bland foods (e.g. the popular rice, toast, soup) and avoid foods that are fried, acidic, oily, or contain lactose.<br />
<br />
<b><span style="color: #351c75;">But what if they have icky diarrhea?</span></b><br />
- Change the diaper or bring them to the toilet frequently. Use a LOT of diaper cream to keep the area from getting chapped/sore. Put on a zinc cream (like the purple desitin) as if you are icing a cake - this acts as a barrier layer, to prevent acidic poop from sitting on the skin.<br />
- Feed them binding foods, like rice.<br />
- Sometimes the microbes that cause diarrhea, also cause a temporary lactose (the sugar in cow's milk) intolerance, so avoid lactose-containing stuff, like cow's milk and cheese. You usually have to do this for 2-4 weeks after the onset of the illness, until their GI system is back to normal.<br />
- Try a children's probiotic with lactobacillus once per day, such as children's culturelle.<br />
<br />
<b>When my patients get sick this way, I often refer them to the great patient resources at UpToDate, such as this one on nausea and vomiting in children:</b><br />
<a href="http://www.uptodate.com/contents/nausea-and-vomiting-in-infants-and-children-beyond-the-basics?detectedLanguage=en&source=search_result&search=patient+information&selectedTitle=7~150&provider=noProvider">http://www.uptodate.com/contents/nausea-and-vomiting-in-infants-and-children-beyond-the-basics?detectedLanguage=en&source=search_result&search=patient+information&selectedTitle=7~150&provider=noProvider</a><br />
<b>or this one on diarrhea in children:</b><br />
<a href="http://www.uptodate.com/contents/acute-diarrhea-in-children-beyond-the-basics?source=see_link">http://www.uptodate.com/contents/acute-diarrhea-in-children-beyond-the-basics?source=see_link</a><br />
<br />
<b><span style="color: #cc0000;">How can you tell if your child is dehydrated enough to warrant intervention (like an urgent care or ER), or at least a call to your pediatrician?</span></b><br />
- they are not urinating (peeing) often enough (every 4-6 hours for a baby, every 6-8 hours for a toddler/child, every 8-12 hours for an older child/adolescent)<br />
- they are crying, but can not make tears<br />
- they are an infant whose fontanel (soft spot on top of the head) is more sunken than usual<br />
- eyes look very sunken<br />
<br />
<b><span style="color: #cc0000;">What are some other signs that I should call my pediatrician about, or head over to the local urgent care/ER?</span></b><br />
- persistent high fever (above 102.5 F)<br />
- any fever in an baby younger than 3 months old<br />
- severe abdominal (tummy) pain<br />
- abdominal pain that moves to the lower right side<br />
- lethargy or decreased responsiveness<br />
- bloody (red or black) or bright green (like pea soup) vomit or diarrhea<br />
- diarrhea not improving after 1 week<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPxCTMdFFSZoIEB5Bch7ulm34Sd9pcawUHsx9THUOXs5DTwYQ3rYMDeiLslbrs8p5H8htK9RhWVUziPgWGqA3Nj-VTZne9oLSH2HA5xU0HkY3-c23dD4GLdGCHYFkbHXxJ9Y5QDizXE90/s1600/Dec13Latkes%252520%2525289%252529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPxCTMdFFSZoIEB5Bch7ulm34Sd9pcawUHsx9THUOXs5DTwYQ3rYMDeiLslbrs8p5H8htK9RhWVUziPgWGqA3Nj-VTZne9oLSH2HA5xU0HkY3-c23dD4GLdGCHYFkbHXxJ9Y5QDizXE90/s320/Dec13Latkes%252520%2525289%252529.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Soon your baby will be back to enjoying (throwing) his food (c) 2013</td></tr>
</tbody></table>
<span style="color: blue;">The good news is that the gastroenteritis season is almost over, so hang in there. However, we are getting into cough and cold season, so see my August 2012 post for tips on that:</span><br />
<span style="color: blue;"><a href="http://mommedicine.blogspot.com/2012/08/coughs-colds-and-croup.html">http://mommedicine.blogspot.com/2012/08/coughs-colds-and-croup.html</a>)</span><br />
<span style="color: blue;"><br /></span>
<span style="color: blue;"><br /></span>Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-71996708538502712792013-05-21T16:47:00.001-07:002017-05-01T11:39:08.184-07:00Fun in the Sun:<h2>
<span style="color: #cc0000;">Sunscreen Tips and Links</span></h2>
<div>
<span style="color: magenta;"><br /></span></div>
Before going out to have fun in the sun, you should apply sunscreen to yourself and your child.<span style="color: magenta;"> Reapply sunscreen every 2 hours, and after every time you get wet or sandy (rubbing the sunscreen off). </span>Harmful UV rays come through clouds, so a cloudy day is no excuse to skip the screen.<br />
<br />
<span style="color: #cc0000;">SPF 30-50 are best. SPFs that are higher than that do not add significantly more protection.</span><br />
<br />
The safest sunscreens are <span style="color: yellow;">barrier sunscreens</span>. These are sunscreens that use <span style="color: yellow;">zinc oxide or titanium dioxide</span> as the active ingredient, which sit on the skin to provide a shield from the sun. Since they are not absorbed systemically, I recommend using only these types of sunscreens<span style="color: yellow;">*</span> on infants (in addition to shielding clothing and hats).<br />
<br />
<span style="color: yellow;">Chemical sunscreens</span><span style="color: orange;"> </span>are those that contain chemicals which are absorbed into the skin to provide protection. These are newer, but still safe when used correctly. Some of the active ingredients in chemical sunscreens include, but are not limited to,<span style="color: orange;"> </span><span style="color: yellow;">octinoxate, octocryleme, oxybenzone</span><span style="color: orange;">.</span> Most sunscreens on the market today use these, and there are many more options that kids like with these formulations, such as sprays, colors, and different textures. The best sunscreen is the one you can actually get on your child everyday. The aerosol spray sunscreen versions should only be used outside, in well ventilated areas, and below the neck, because they are meant to be sprayed evenly on the skin (you should see a layer of sunscreen forming), and not breathed in. They are a quick way to reapply sunscreen on kids at the beach or park, but can be avoided at home.<br />
<br />
A lot of people are wondering about vitamin D. Although our skin can make vitamin D by being exposed to UVB light from the sun, the amount of sun it takes is variable by region and skin type, and enough sun to make enough vitamin D will also increase skin aging/wrinkles and cancer risks, so I still recommend using sunscreen, then getting vitamin D in your diet. For more information, see<br />
<a href="http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/">http://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/</a><br />
<span style="color: magenta;"><br /></span>
<span style="color: magenta;">Do not use combination insect-repellent and sunscreen mixes. Insect repellents should not be applied more than once per day, and should not be applied to babies.</span> For more information on insect repellents see <a href="http://pediatrics.about.com/od/summersafety/a/0707_insect_rep.htm" target="_blank">here</a> and <a href="http://www.redwineandapplesauce.com/2014/06/30/bug-off-facts-for-parents-about-mosquitoes-insect-repellents-and-health-risks/" target="_blank">here</a>.<br />
<br />
I used to link to the Environmental Working Group's sunscreen ratings, but their methodology has been ignoring science, and based on fear-mongering lately, so I stopped. For more information on that, see <a href="http://www.redwineandapplesauce.com/2014/05/01/formaldehyde-chemophobia-ewg-and-the-most-important-thing-to-know-about-toxic-stuff/?utm_source=feedly&utm_reader=feedly&utm_medium=rss&utm_campaign=formaldehyde-chemophobia-ewg-and-the-most-important-thing-to-know-about-toxic-stuff" target="_blank">here</a> and <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2014/03/is_formaldehyde_dangerous_no_but_johnson_johnson_removed_it_from_baby_shampoo.html" target="_blank">here</a>.<br />
EWG also warned against "nano particles" with no scientific basis. For information on them see this article from <a href="http://www.cancer.org.au/preventing-cancer/sun-protection/nanoparticles-and-sunscreen.html" target="_blank">cancer.org</a>.<br />
<br />
*Here are some<span style="color: orange;"> </span><span style="color: yellow;">examples</span> of sunscreens that use <span style="color: yellow;">barrier (mineral) ingredients</span>, in alphabetical order:<br />
<span style="color: yellow;">Aveeno Mineral Block</span><br />
<span style="color: yellow;">BabyGanics Cover-Up Baby Pure Mineral Sunscreen Stick</span><br />
<span style="color: yellow;">Banana Boat Natural Reflect Sunscreen</span><br />
<span style="color: yellow;">Burt's Bees Baby Bee Sunscreen</span><br />
<span style="color: yellow;">California Baby Sunscreen</span><br />
<span style="color: yellow;">Mustela Sun Cream and Sun Lotion</span><br />
<span style="color: yellow;">Neutrogena Baby Pure and Free</span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8iUSEQ6Hu8yXfHIu4RhS1ZDBGk6t9JIk9LTfdd0gWdKBInvrYNaL0FUoC95UuGiPwZJmCFWUbIZT9cn9EiyNvV1xeFHmLWggh_2OlTdQwFewXWjhY1H99KiIZSMF_IhTOGlICVZl_twA/s1600/Jul2santamonica.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8iUSEQ6Hu8yXfHIu4RhS1ZDBGk6t9JIk9LTfdd0gWdKBInvrYNaL0FUoC95UuGiPwZJmCFWUbIZT9cn9EiyNvV1xeFHmLWggh_2OlTdQwFewXWjhY1H99KiIZSMF_IhTOGlICVZl_twA/s320/Jul2santamonica.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Here my son demonstrates proper beach attire with sunscreen (c) 2011</td></tr>
</tbody></table>
<br />Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-66156543796600720172013-03-15T12:02:00.002-07:002013-08-27T13:29:01.300-07:00Immunization InformationThere are a lot of great sites out in the world wide web that have information to help parents make an informed choice about vaccinations; however, unfortunately, there are also a lot of bogus sites that rely on anecdotes to promote myths, so I am including just a few links to help people find scientifically accurate information on vaccines:<br />
<br />
My favorite book for vaccine information is "Vaccines and Your Child: Separating Fact from Fiction" by Paul Offit. It is short and covers all of the questions that parents frequently ask about immunizations. Here is the link to it on amazon:<br />
<a href="http://www.amazon.com/Vaccines-Your-Child-Separating-Fiction/dp/0231153074/ref=sr_1_1?ie=UTF8&qid=1363372723&sr=8-1&keywords=offit">http://www.amazon.com/Vaccines-Your-Child-Separating-Fiction/dp/0231153074/ref=sr_1_1?ie=UTF8&qid=1363372723&sr=8-1&keywords=offit</a><br />
<br />
The Children's Hospital of Philadelphia has a wonderful Vaccine Education Center, which covers the same material as in Dr Offit's book (above), as well as videos, FAQ pages, and more.<br />
<a href="http://www.chop.edu/service/vaccine-education-center/home.html">http://www.chop.edu/service/vaccine-education-center/home.html</a><br />
This is a great place to start if you want information on aluminum (which your child gets more of in breast milk than vaccines), formaldehyde (which our own bodies produce, and is also found naturally in things like pears), and other vaccine ingredients.<br />
<a href="http://www.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-ingredients/">http://www.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-ingredients/</a><br />
<br />
A great place to go once your child (or you) has gotten a vaccine and you have questions about it, or if you know of a specific vaccine that is coming up for your child, is the USA's Center for Disease Control. They put out "Vaccine Information Statements" on each vaccine that is routinely given in the USA:<br />
<a href="http://www.cdc.gov/vaccines/pubs/vis/">http://www.cdc.gov/vaccines/pubs/vis/</a><br />
They are also the best site to check out what vaccines you need for foreign travel:<br />
<a href="http://wwwnc.cdc.gov/travel/page/vaccinations.htm">http://wwwnc.cdc.gov/travel/page/vaccinations.htm</a><br />
Remember to check out the site and make an appointment at a travel clinic at least 6 months before traveling to areas which may have diseases that are not in your home country.<br />
The USA government also has a general vaccination information site:<br />
<a href="http://www.vaccines.gov/">http://www.vaccines.gov/</a><br />
<br />
The U.S.A. has a vaccine adverse events reporting system (VAERS), but it allows anyone to "report" anything they likem without being the least bit accurate. Check out this great post on the subject:<br />
<a href="http://momswhovax.blogspot.com/2011/10/incredible-hulk-vaccine-side-effect-or.html">http://momswhovax.blogspot.com/2011/10/incredible-hulk-vaccine-side-effect-or.html</a><br />
<br />
If you have specific concerns about vaccines, or have heard some of the myths, please see the skeptcial raptor's blog, which covers each of the myths:<br />
<a href="http://www.skepticalraptor.com/vaccine.html">http://www.skepticalraptor.com/vaccine.html</a><br />
Especially this post:<br />
<a href="http://www.skepticalraptor.com/skepticalraptorblog.php/mmr-vaccines-do-not-cause-autism/">http://www.skepticalraptor.com/skepticalraptorblog.php/mmr-vaccines-do-not-cause-autism/</a><br />
<br />
If you want to see what happens when a child does NOT get vaccines, check out Shot By Shot's videos:<br />
<a href="http://shotbyshot.org/">http://shotbyshot.org/</a><br />
<br />
If you are a visual learner and only have 5 minutes, check out this beautiful infographic on vaccines:<br />
<a href="http://www.vaccinews.net/2012/09/infographic-a-brief-history-of-the-fight-to-save-lives/#">http://www.vaccinews.net/2012/09/infographic-a-brief-history-of-the-fight-to-save-lives/#</a><br />
If you have more than 5 minutes, Vaccinews's blog is also a good site to learn more about vaccines.<br />
<br />
A cute and very short blog post about the chicken pox vaccine:<br />
<a href="http://mytwohats.com/2012/08/20/why-vaccinate-for-varicella/">http://mytwohats.com/2012/08/20/why-vaccinate-for-varicella/</a><br />
In addition to her wonderful points, I would add that you should give your child the varicella vaccine because you do not want your child to suffer from shingles when they're older, as it is very painful and can cause disability. Shingles is caused by the varicella (chicken pox virus) living inside you. If you never get the chicken pox (disease), then you can not get shingles.<br />
<br />
Here are some other good web sites:<br />
The American Academy of Pediatrics: <a href="http://www.aap.org/">www.aap.org</a><br />
National Network for Immunization Information: <a href="http://www.immunizationinfo.org/">www.immunizationinfo.org</a><br />
Every Child By Two: <a href="http://www.ecbt.org/">www.ecbt.org</a><br />
<br />
My pinterest immunization board: <a href="http://pinterest.com/motek42/immunizations/">http://pinterest.com/motek42/immunizations/</a><br />
<br />
This is just a small list, and I recommend that you discuss any concerns with your pediatrician. Also note that some people can not get certain (or any) vaccines, and therefore, rely on herd immunity (their community being vaccinated) to protect them.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7fFFl6umkI_y7QHvaVbTu53cW-sL9to-QaPkp2UPuNAPkqVOcnzsO3LzPXv7C7GPqQ_ag5PDNREAV1S9iWjDh1IhQ7W5QpC8wV8wakGapbO1cfKeQecHnTDusnQWob-ExkADUtJWaV-w/s1600/IMG_20120317_133434.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7fFFl6umkI_y7QHvaVbTu53cW-sL9to-QaPkp2UPuNAPkqVOcnzsO3LzPXv7C7GPqQ_ag5PDNREAV1S9iWjDh1IhQ7W5QpC8wV8wakGapbO1cfKeQecHnTDusnQWob-ExkADUtJWaV-w/s320/IMG_20120317_133434.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My beautiful, fully immunized, son (c) 2012</td></tr>
</tbody></table>
<br />
<br />
<i>Due to the high number of antivax trolls trying to post spam, I am disabling comments for this post. Sorry!</i><br />
<br />Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-78481761077876300712012-08-26T11:17:00.002-07:002012-08-26T11:28:03.390-07:00A Basic Review of Eczema & A New Blankie<br />
<div class="MsoNormal">
<span style="color: #365f91; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-themecolor: accent1; mso-themeshade: 191;">Eczema</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> (also known as “atopic dermatitis”) <span style="color: #365f91; mso-themecolor: accent1; mso-themeshade: 191;">is a skin
condition where allergens or other irritants make your child’s skin itchy, red,
rough, and/or flakey.</span> Doctors sometimes refer to it as “an itch that
rashes” because the scratching or rubbing usually comes before any changes in
the skin. In its mildest form it is often just considered “sensitive skin”, but
in its most severe form it can require hospitalization and serious drugs to
alter a child’s immune system.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="color: #365f91; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-themecolor: accent1; mso-themeshade: 191;">In order to prevent an eczema flare, or to relieve mild irritation, it is
important to keep the skin moisturized, as well as avoiding “triggers”</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
which the skin responds to by becoming inflamed. Common triggers are:
chemicals, harsh soaps or cleaning products, perfumes/fragrances, dyes,
synthetic fabrics (e.g. polyester), wool, sweat, dry air, stress, sudden
temperature changes, and anything the child is allergic to (e.g. food allergies
and/or pet dander).<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How do you avoid so many things? For serious eczema,
an allergist can help you identify specific triggers that make your child’s
eczema worse. However,<span style="color: #e06666;"> everybody can take some
simple steps to help their child with sensitive skin:</span></span></div>
<div class="MsoNormal" style="text-indent: 0px;">
</div>
<ol>
<li><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%; text-indent: -0.25in;"><span style="color: #cc0000;">Daily
bath</span> to clean the skin. Eczematous skin gets infected easily, since open areas
take away your immune system’s biggest barrier. Use <span style="color: #e06666;">warm water</span> (not too hot or
cold), and <span style="color: #e06666;">bath briefly</span>, since long baths can make the skin worse. Use
<span style="color: #e06666;">soap-free cleansers</span> (e.g. original Dove bar or Cetaphil). As soon as the child
gets out of the bath, <span style="color: #e06666;">pat the skin dry</span> (rubbing makes things worse) and cover
it in<span style="color: #e06666;"> a layer of moisturizer</span> (ointments lock in the moisture best, which is why
so many people love Aquaphor for their sensitive skin).</span></li>
<li><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Always
use<span style="color: #e06666;"> dye-free, fragrance-free soaps and cleansers</span>, especially for the laundry.
Many people use Dreft detergent for their baby’s clothes, but this is full of
chemicals. Run all of the baby’s laundry through an <span style="color: #e06666;">extra rinse cycle</span> to be
sure to get rid of any chemical residue.</span></li>
<li><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Re-apply
your <span style="color: #e06666;">moisturizer (e.g. Aquaphor) a few times a day</span>.</span></li>
<li><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Keep<span style="color: #e06666;">
fingernails short</span> to avoid scratching.</span></li>
<li><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Many
older children (and adults) with eczema report their symptoms worsen at night,
so make sleeping conditions as comfortable as possible. A<span style="color: #e06666;"> cool mist humidifier</span>
can help keep the air cool and moist. Use distilled water in the humidifier, do
not use any menthol or scented discs in it, and clean out the reservoir with
vinegar every 3 days. Children age 2 and older may be helped by taking an
<span style="color: #e06666;">antihistamine</span> before bed (discuss this with your pediatrician before giving it
to your child).</span></li>
</ol>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="color: #0b5394; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Babies have a larger
surface area to body mass ratio then older kids/adults, and their skin is
thinner.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> This makes them especially susceptible to irritants, and you want to
avoid using medicated creams as much as possible, since more is absorbed into
their system then in older children/adults. </span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A mother whose baby has severe
eczema created a blanket to help relieve her child’s skin irritation, and she
gave me a blanket to try out. It is the <span style="color: #0b5394;">Elli & Nooli Organic Cotton
Pique Blanket</span> (</span><a href="http://www.amazon.com/Loopiblanket-Organic-Blanket-Pacifire-Fastner/dp/B008MBMYZ8/ref=sr_1_2?s=baby-products&ie=UTF8&qid=1346005373&sr=1-2&keywords=elli+%26+nooli">http://www.amazon.com/Loopiblanket-Organic-Blanket-Pacifire-Fastner/dp/B008MBMYZ8/ref=sr_1_2?s=baby-products&ie=UTF8&qid=1346005373&sr=1-2&keywords=elli+%26+nooli</a><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">). </span><br />
<a href="http://ecx.images-amazon.com/images/I/31gPQddK36L.jpg" imageanchor="1"><img border="0" height="200" src="http://ecx.images-amazon.com/images/I/31gPQddK36L.jpg" width="200" /></a>
<br />
<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">I brought it to work to try with a few patients, and then brought
it home to my toddler son. It is designed for infants, but since it is big
enough to swaddle them comfortably, it is actually big enough (30” x 40”) to
cover my toddler in bed (although he will soon outgrow it). This is now my
son’s favorite blanket, and since giving it to him over a month ago, he insists
on using it every night to sleep. He reports that it is “comfy”. The </span><span style="color: #0b5394; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">certified
organic cotton</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"> means that it is less irritating than other fabrics, as well as
being chemical-free and pesticide-free. The pique weave (</span><span style="color: #0b5394; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">tight weave forming
raised mini squares all over</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">) keeps air flowing under the blanket, and even
allows some air exchange through the blanket. It keeps my child warm, without
over-heating, so he is not sweating at night, despite living in a house with no
air conditioner during a heat wave (for the past 2 weeks only, we are moving
soon). </span><span style="color: #0b5394; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">Overall, I really like this blanket, and would recommend it for babies with sensitive skin.</span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><i><span style="color: #990000;">Please note that although this post mentions many brands (e.g. Dove, Cetaphil, Aquaphor, Elli & Nooli), this is NOT a sponsored post, and I have no financial stake in any of these companies.</span></i></span></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-35867504714765021962012-08-09T17:18:00.000-07:002014-05-05T14:55:31.787-07:00Coughs, Colds, and Croup<br />
<div class="Normal" style="text-align: left;">
<b><span style="font-size: 11pt;"><span style="color: blue;">Even though it's a beautiful summer here in Southern California, we are still seeing some coughs, colds, and croup, so here are my tips to help keep your family comfortable as they clear their viruses:</span></span></b></div>
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<b><span style="font-size: 11pt;"><br /></span></b></div>
<div class="Normal" style="text-align: left;">
<b><span style="font-size: 11pt;"><span style="color: #073763;">Helping a child with nose congestion:</span></span></b></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Use
a <u>nasal saline mist</u> (such as Little Noses nasal saline mist) to spray moisture
into each nostril and help clear her out. I like the mists more than the drops
because you can hold the canister right below her nose and spray it in, without
touching the canister to the actual nose, and without sticking anything directly
up the nose. These are also sterile, so you don't have to worry about the water source.<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Use
a <u>humidifier</u>. Only put distilled or sterile water into it (not tap water). Clean it at least every 3 days. Do NOT use the menthol or eucalyptus discs/drops that come with some humidifiers.<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">If
she suffers from allergies and is over age 4, you can use an over the counter
antihistamine to help decongest her (e.g. children’s Benadryl). Under age 4:
ask your pediatrician about these. Do NOT use the over the counter medications
known as “decongestants” or “medicated cough syrups”, as these have been shown
to have more risks than benefits in children under age 6 years old.<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">If
he is very congested you can <u>steam</u> up your bathroom and sit in the bathroom
with your child. Make sure the air is okay and the child does not have any
access to the hot water. Never leave a child alone in the steam!</span><br />
<span style="font-size: 11pt; text-indent: -0.25in;">- If you want to, you can use a vapor rub on the feet or chest of a child. It has not been proven to help or hurt. However, do not let the rub get near her nose or mouth! </span><span style="font-size: 11pt; text-indent: -0.25in;">Vapor rub placed under the nose has been reported to cause wheezing in some children, and it is dangerous to ingest.</span><span style="font-size: 11pt; text-indent: -0.25in;"> Call poison control if your child eats any of this, or gets it in their eye 1-800-222-1222 (an important number to keep in your cell phone for emergencies).</span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Children
under age 2 years usually can not blow their noses, so help decongest them
(e.g. get the boogies out) by using a <u>Nose Frida</u> (<a href="http://www.fridababy.com/">http://www.fridababy.com/</a>) which is a
device you put in the nostril and use to literally suck the snot out. Sounds
gross, but there is a filter (which needs to be changed every day) which
prevents you from getting any snot in your mouth. You can do this before feeds
and before sleep, or just as needed to clear out the mucus in your baby’s nose.
I like this better than traditional nasal aspirators because it’s much easier
to clean, is difficult to put it too far into the baby’s nose, and it gets a
lot more of the snot out. The key to good suction is to hold the other nostril closed, when you suck out boogers from the first nostril (should take less than 1 second).<o:p></o:p></span></div>
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</div>
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<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://www.fridababy.com/wp-content/uploads/2011/10/main-ss.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="NoseFrida the Snotsucker!" border="0" src="http://www.fridababy.com/wp-content/uploads/2011/10/main-ss.jpg" height="113" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Snot Sucker</td></tr>
</tbody></table>
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<b><span style="font-size: 11pt;"><span style="color: #073763;">Helping a child with a “wet” or “phlegmy”
cough:</span><o:p></o:p></span></b></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Do
all of the above for nasal congestion plus the following:<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Have
her sleep propped up at 30 degrees so the mucus drains easily (if over 1 year of age).<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Give
children over age 1 year a big spoonful of honey twice a day. </span><span style="font-size: 15px; text-indent: -0.25in;">The honey has now been shown to help relieve cough symptoms in kids & help them sleep, in 2 published randomized control trials (scientific studies). The honey they used was NOT "raw", which can have dangerous bacteria in it.</span><br />
<span style="font-size: 11pt;">- Warm liquids, such as chamomile (caffeine-free) tea and lemon, or chicken soup, can help people feel better. <o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Zinc may help shorten colds and soothe sore throats, but this has not been proven conclusively. You can get this in some non-medicated cough syrups,
such as Zarbees (for over age 1 since it also contains honey), or in zinc
lollipops (over age 2, observing child while they eat them) at CVS (I haven’t seen them anyplace else- let us know in the comments if you find them in other places). If he is over age 7 years you can give him the zinc cough drops that are
available at all pharmacies.<o:p></o:p></span></div>
<div class="Normal">
<br /></div>
<div class="Normal">
<b><span style="font-size: 11pt;"><span style="color: #073763;">Helping a child with a dry, barking, or
croupy cough:</span><o:p></o:p></span></b></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Do
all of the above for nasal congestion & wet coughs plus the following:<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">Use a <u>cool-mist humidifier</u>. Use distilled/sterile water in it. Clean it at
least every 3 days by rinsing out the water tank with distilled vinegar and
then washing that out.<o:p></o:p></span></div>
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<span style="font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="font-size: 11pt;">If
the child is having a coughing fit, or breathing like Darth Vader, take him for
a walk outside in the cool air, or hold him in front of an open freezer for a
few minutes, to reduce the swelling in his throat. If that is not helping, call
your pediatrician for immediate medical advice, or call 911 if he is actually having trouble breathing.<o:p></o:p></span></div>
<div class="Normal">
<br />
<span style="color: #073763;"><b>Check out other mom pediatrician blogs on the topic, such as this one from Dr. Stuppy:</b></span><br />
<a href="http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html">http://pediatricpartners.blogspot.com/2013/12/but-snot-is-green-or-how-can-we-treat.html</a><br />
<br /></div>
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<b><span style="font-size: 11pt;"><span style="color: #073763;">Other Important Stuff:</span><o:p></o:p></span></b></div>
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<span style="color: #993300; font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="color: #993300; font-size: 11pt;">If your child is wheezing, noisy breathing, breathing hard,
breathing quickly, breathing with flared nostrils, or other signs/symptoms not
mentioned, please <b>call your pediatrician or 911, or take them to the ER immediately</b>. This information is not intended to act
as a substitution for speaking to your physician or using common sense!<o:p></o:p></span></div>
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<span style="color: #993300; font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="color: #993300; font-size: 11pt;">If your child is breathing so hard that they have trouble
walking or talking, or if their lips or fingernails turn blue, please call 911
for immediate medical assistance.<o:p></o:p></span></div>
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<span style="color: #993300; font-size: 11pt;"><br /></span></div>
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<span style="color: #6600cc; font-size: 11pt;">-<span style="font-size: 7pt;">
</span></span><span style="color: #6600cc; font-size: 11pt;">Some of the products listed above can be found on my pinterest
health board: <a href="http://pinterest.com/motek42/kids-health/"><span style="color: #6600cc;">http://pinterest.com/motek42/kids-health/</span></a>. I
have not been paid to review any of these products and I do not get money from
their sales- I am just letting you know what has worked in my experience.</span></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-12519059515867588492012-04-28T15:26:00.000-07:002017-05-13T15:03:58.937-07:00Traveling with Children<span style="color: blue;">Fortunately for us modern moms and dads, anywhere we want to go is just a plane, train, or automobile ride away. Despite the conveniences of modern transit, traveling with children remains a difficult endeavor. Here are a few tips to make your journey a little smoother:</span><br />
<br />
<span style="font-size: large;">1) Know your rights.</span><br />
This sounds funny, but a lot has recently changed in U.S.A. airport security rules. For example children under 12 do not need to remove their shoes during screening. According to the TSA's website, you may carry as much juice and milk for toddlers as you "need until you reach your destination". The precise definition of how much you need varies by who is screening you at security. During one trip with my then 1 year old, the security agent at LAX insisted that 3 small juice boxes was too much for a 5 hour flight, and threw all of our drinks away. I did not know enough to argue and instead I spent $$$ buying some non-organic, non-dilute juice for my child at the airport :( This also brings up the point to <b>remember to be flexible, and give your self extra time for the unexpected.</b><br />
For the latest information, check out the government's website:<br />
<a href="http://www.tsa.gov/travelers/airtravel/children/index.shtm">http://www.tsa.gov/travelers/airtravel/children/index.shtm</a>
<br />
<br />
<span style="font-size: large;">2) Know your company.</span><br />
Certain airlines and hotel chains are better at hosting children than others. Conversely, some airlines have recently banned children from first class on their flights, so don't expect an upgrade (or even friendly service) on those airlines. Malaysia Airlines is going to institute a "child free zone" even in their economy cabin on some flights. In general, European and Asian companies have been known to be friendlier to children on flights than USA airlines, often providing coloring books, special snacks, small toys, and other treats for families. Some airlines offer pre-boarding for families with infants and toddlers, while others have none. This may be more annoying than you think. When traveling with our then 2 year old, we had to wait until first class, business class, and everyone with a silver/gold card from the airline boarded (more than half of the passengers) before we were allowed to get on with a toddler, car seat, and hand luggage. Trying to get past the tiny aisle with people everywhere and a large car seat was not fun, and I think it disturbed the other passengers as well. Allowing us to board early, install the car seat and settle in would have prevented a lot of hassle for everyone. However, when we got to our destination we stayed at a hotel that provided us with squeaky bath toys and other amenities in the room that made us feel like family.<br />
Here is a recent article from yahoo on the most family friendly airlines:<br />
<a href="http://travel.yahoo.com/ideas/best-airlines-for-families.html">http://travel.yahoo.com/ideas/best-airlines-for-families.html</a>
<br />
<br />
<span style="font-size: large;">3) More tips just for flying with children:</span><br />
- Try and book a flight with<b> as few stops as possible</b>, as take-off, landing, and boarding are the toughest times.<br />
<br />
- Make sure you <b>have assigned seats together</b> in advance. Many companies have been separating families on flights, and then you rely on your fellow passengers to switch seats so you can sit together.<br />
<br />
- I take our <b>car seat</b> when flying with my son, to make sure he is strapped in securely during our flight. This also ensures that he has a safe car seat for automobile travel when we arrive at our destination. It is also easier for him to fall asleep during the flight in his car seat, and more difficult for him to annoy other passengers by kicking them or climbing on the chairs. We use a GoGo Kidz Travelmate to turn the car seat into a stroller at the airport.<br />
<br />
- <b>To avoid pain from the changes in pressure in the ear during flights</b>, teenagers and adults can chew gum or drink water to encourage swallowing, and thereby open up the eustachian tubes in their ears to relieve the pressure. For babies the best way to do this is breast (or formula) feeding. Breast (or formula) feeding has the added bonus of providing sugar to the infant, which is a natural pain reliever. For toddlers, diluted juice in a straw cup works well. Older children can suck on lollipops to get them swallowing (and happy and distracted by candy). Nasal sprays can also help relieve congestion and prevent pain during the flight, but speak to your pediatrician about this (salt water sprays can help babies with stuffy noses, while kids with ear infections or sinus problems may need a prescription nasal spray). If all this ear tube talk is confusing, check out the ear anatomy pics here:<br />
<a href="http://pinterest.com/motek42/ear-infections/">http://pinterest.com/motek42/ear-infections/</a><br />
<br />
- I recommend <b>waiting as long as possible before flying with infants</b>. The younger an infant is, the less developed their immune system, and the more likely they are to get sick. The air on airplanes is re-circulated so it is very easy to pick up germs from other travelers, even ones who are seated far away from you. Infants younger than 2 months old who catch an illness with fever may have to undergo extensive testing, including blood, urine, and spinal fluid exams if they get sick. I know this is not possible for all families, but waiting until your infant is 9 months or older can save you a lot of hassle and illness later on. In addition, the USA is currently experiencing a surge in measles cases, most of which can be traced to foreign travel- see these links for more information:<br />
<a href="http://www.reuters.com/article/2012/04/19/usa-health-measles-idUSL2E8FJDSD20120419">http://www.reuters.com/article/2012/04/19/usa-health-measles-idUSL2E8FJDSD20120419</a>
<br />
<a href="http://wwwnc.cdc.gov/travel/page/measles-for-air-travelers.htm">http://wwwnc.cdc.gov/travel/page/measles-for-air-travelers.htm</a><br />
And don't forget to check the CDC website, and make an appointment with your pediatrician at least 2 months prior to any foreign travel, so you can get medications and vaccinations for your trip.<br />
<br />
<span style="font-size: large;">4) Have your bags packed with items that will keep your child calm, quiet and comfortable. </span><br />
I prefer small, light items. If you are used to distracting your child with your phone or other electronic items, keep in mind that you will not be able to use them on take-off or landing, and they might run out of batteries on long car trips, so make sure to pack low-tech items as well. I recommend packing a carry-on or car bag with:<br />
<ul>
<li>baby wipes (good for cleaning up messes for kids of all ages)</li>
<li>snacks</li>
<li>your own sippy cups or bottles</li>
<li>four more diapers than you think you need</li>
<li>several different sizes of ziplock bags (for messes, soiled clothes, soiled diapers, and they are just generally handy to have)</li>
<li>a medical bag (children's acetaminophen, children's ibuprofen, children's benadryl, bandaids)</li>
<li>sunscreen (the sun through a car's windows can burn a child, and then sun through a plane's window has more radiation than down on the ground, so slather yourself and your child with sunscreen to avoid sunburns and -much later- skin cancer)</li>
<li>lollipops for age 4 and above</li>
<li>extra clothes (even for older children, as it's easy to get spilled-on during a flight or car trip, and you never know if, when, or where you'll get stuck)</li>
<li>books</li>
<li>re-usable stickers</li>
<li>dry-erase crayons and board</li>
<li>a soft blanket</li>
<li>your child's lovey (favorite blankey, stuffed animal, or other comfort item). </li>
</ul>
I've linked to a few of these items, as well as book suggestions, on pinterest:<br />
<a href="http://pinterest.com/motek42/traveling-with-children/">http://pinterest.com/motek42/traveling-with-children/</a><br />
<br />
This blog has many more great travel tips, and this link is for a funny story illustration why you shouldn't feel bad about that huge carry on with all of the extra supplies:<br />
<a href="http://eatpackgo.com/pack/pack-diaper-ninja/">http://eatpackgo.com/pack/pack-diaper-ninja/</a>
<br />
<br />
<span style="font-size: large;">Traveling with children is a lot more stressful than traveling alone, but with patience, planning, and a large bag it can be a fabulous adventure.</span><br />
<br />
<b><span style="font-size: large;">Have any good tips or links of your own? Please tell us in the comments!</span></b><br />
<b><span style="font-size: large;"><br /></span></b>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5gUg55TT8AzKEULtE7SHqY2bquCrbJQfJkkqaGtyLC2Fy6_HKoUlKNzZNC781vyqyBwc0m2Xcdgx4985f49KxtBmwndomKL_VAYSgu8sJqvqwQMfMA7xSRI3lnNlwZPYLHYMwafckbHM/s1600/DSC01800.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5gUg55TT8AzKEULtE7SHqY2bquCrbJQfJkkqaGtyLC2Fy6_HKoUlKNzZNC781vyqyBwc0m2Xcdgx4985f49KxtBmwndomKL_VAYSgu8sJqvqwQMfMA7xSRI3lnNlwZPYLHYMwafckbHM/s320/DSC01800.JPG" width="320" /></a></div>
<div style="text-align: center;">
<span style="font-size: x-small;">(photo of my son in his car seat, looking out of the airplane window, photo taken by me 2009 (c) )</span></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-40093206435299335772012-03-19T16:37:00.002-07:002017-05-02T16:32:27.360-07:00Preparing for a Perfect Pediatrician Experience<br />
<div class="MsoNormal">
Taking your precious baby to the doctor can be a harrowing
experience, but with a little preparation, it can go as smoothly as a baby’s
bottom. Here are some tips for getting your children, and yourself, ready for
your next visit:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
1)<span style="font-size: 7pt;"> </span>Prepare
your children in advance by <u>reading books about going to the doctor</u>, so
they know what to expect. This is especially important for toddlers, who are
old enough to remember prior visits involving shots, but is also good for older children. Try to do
this far in advance of any appointment, such as having a regular bedtime story
about visiting the doctor, so your child considers it a regular thing. If your
child loves a certain character, e.g. Elmo or Dora, read them a book involving
that character’s visit to the doctor. Otherwise, I recommend books like the Usborne
First Experiences series. I pinned links to these books (and others) on my
pinterest boards (<a href="http://pinterest.com/motek42/">http://pinterest.com/motek42/</a>).</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
2)<span style="font-size: 7pt;"> </span>Get
a <u>doctor play set</u> and have your child practice using the stethoscope,
otoscope (ear light), and other tools on their family members and stuffed
animals.</div>
<div class="MsoNormal">
<br /></div>
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3)<span style="font-size: 7pt;"> </span>If
your child has a “luvvy” (<u>special blanket or toy to make them feel comfortable</u>),
be sure to bring it with you to the visit, even if they only use it in bed at
home. This will help comfort them.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
4)<span style="font-size: 7pt;"> </span>For
young children, <u>bring a doll</u>, so the physician can check the doll first,
lessening the fear the child may have about the medical tools. You can also
have the doctor check mommy or daddy first, but in my experience children are
comforted more by having their doll checked then their parents. It works even better when the doll has ears and a mouth that opens.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
5)<span style="font-size: 7pt;"> </span>Bring
<u>snacks and drinks</u>. You never know if you will have to wait a while for
the doctor to see you, or just sit and wait for a test result. <b><u>Sugar has been found to be a natural
pain reliever</u></b> in babies, and I find that breast milk or formula for
babies, juice or a lollipop for toddlers, calms them down faster than anything
else after shots. One caveat- <u>do not let them eat/drink during the visit</u>,
especially if they will have their throat checked (like for sore throat or tummy pains), as the food pieces can get
in the way of the doctor having a good look, and can interfere with tests, such as the one for strep throat. </div>
<div class="MsoNormal">
<br /></div>
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6)<span style="font-size: 7pt;"> </span>Bring
<u>diapers, wipes and baggies</u> for soiled items (these are good things to
have in your bag at all times, prior to school age). You can not rely on
your pediatrician having the size or brand of diapers your child uses on hand.
Wipes come in handy for many things, not just cleaning little butts, and the
pediatrician visit often brings out the snot, spit-up, and other fun stuff.
Help the next patient have a more pleasant experience by placing any soiled
items in a sealed bag, so the room does not smell bad. An extra baggy also comes
in handy for soiled clothes and toys.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
7)<span style="font-size: 7pt;"> </span><u>Dress
your child appropriately, and bring a blanket</u>. Clothes that are easiest to
remove or lift-up are best. No need to dress fancy. You should also
bring a small blanket to cover your baby, since they will likely have their
clothes removed for vitals signs (measuring) by the nurse, and you don’t put
them back on until after the physician has checked your child. If you have an
older child, at least have them remove any jackets and tight or complicated clothing.</div>
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<br /></div>
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8)<span style="font-size: 7pt;"> </span><u>Bring
ANY MEDICATION you have given your child</u>, even if your doctor prescribed
it, it is herbal, or over-the-counter. This is the best way to avoid diagnosis
and medication errors.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
9)<span style="font-size: 7pt;"> </span><u>Entertainment.</u>
Quiet books, reusable stickers, or even movies on your phone are a good way to
keep children quiet while waiting for the physician or nurse. These can also be
good tools for calming children down if they get upset during the visit. I do NOT recommend these as temper tamers for everyday use, but they are fine on special occasions.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
10)<span style="font-size: 7pt;"> </span> Don’t forget a <u>list of questions to ask the
doctor</u>, so you make sure to get the most out of your visit. You may also
want a <u>paper and pen</u> to write down any diagnoses or instructions, so you
don’t forget how much ibuprofen you are supposed to give when your toddler wakes
up screaming at 3am. If your doctor has not brought it up, you may want to ask
them what do if your child worsens, and when to return.</div>
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<br /></div>
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11)<span style="font-size: 7pt;"> </span> If you need a copy of vaccination records or
school forms, contact the office in advance, and do not forget <u>your
paperwork</u>! You should also bring your <u>insurance card</u> (if you have
one and expect the insurance to cover your visit) each time.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
12)<span style="font-size: 7pt;"> </span> When possible, try to <u>schedule your visits
for the first time slot</u> of any shift, so that you can avoid a possible wait
if the office gets backed up. You should also <u>try to schedule visits for the
middle of the week</u>, or early afternoon, as Mondays, Fridays, weekends, and
evenings tend to be the busiest times in the office. Alternatively, you may want
to try the last appointment of the day. This will have the greatest chance of
having to wait, but then neither you nor the physician feels rushed.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
13)<span style="font-size: 7pt;"> </span> Give yourself <u>an extra 15 to 30 minutes</u>
to get to the appointment, find parking (or deal with public transportation
delays), and complete any forms. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -.25in;">
14)<span style="font-size: 7pt;"> </span> Finally, <u>try to relax</u>! When you have a
positive attitude, your child will feel better too <span style="font-family: "wingdings";">J</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Have any tips of your own? Please put them in the comments!</b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfpSZ2ETGCS7nE9NU4nfftH6__97QjdohLcfNkLyWUiJQEpS8NO1v4Av2qpYK51B9Rb8NA9BtWUELga2jztwo5Z-hfroywpJSg9Zan8H-JxNXGGjzh8Njew52-LOBMnNdOi2HBnn7zkRE/s1600/Aug12Doc%252520%2525282%252529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfpSZ2ETGCS7nE9NU4nfftH6__97QjdohLcfNkLyWUiJQEpS8NO1v4Av2qpYK51B9Rb8NA9BtWUELga2jztwo5Z-hfroywpJSg9Zan8H-JxNXGGjzh8Njew52-LOBMnNdOi2HBnn7zkRE/s320/Aug12Doc%252520%2525282%252529.JPG" width="320" /></a></div>
<div style="text-align: center;">
<span style="font-size: x-small;">(my son becomes comfortable with the stethoscope at home (c) )</span></div>
</div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-38219971282887631182012-02-22T15:05:00.000-08:002012-05-08T11:26:17.311-07:00Interviewing a PediatricianRecently, one of my friends asked me what questions she should ask when interviewing a prospective pediatrician, so I thought I'd share my answer with everyone:<br />
<br />
1) What insurance do you take?<br />
Of course, this is only important if you're using insurance. I know several families now that have health insurance for emergencies, but pay for general health maintenance out of their own pockets. This reduces their overall medical expenses (because they have a cheap insurance plan, only for emergencies), and allows them to see whatever doctor they like. These families usually use free clinics for vaccinations, or pay out of pocket. This only works if your family is healthy. If you choose the latter option, ask about visit prices instead.<br />
<br />
2) What hours is the office open for well visits? For sick visits? When is your chosen primary pediatrician actually in the office during the week?<br />
Keep in mind that the smaller the office, the less hours they are usually open. So if you want to do well visits at night or on weekends, you will probably have to go with a very large practice, and may be seeing a different doctor (or nurse practitioner) each time.<br />
<br />
3) Who covers for your physician when they are not in the office, not on call at night, or they are on vacation?<br />
For night call, is the person on the phone a physician from your practice, a physician from another practice, or a physician extender (NP or PA) or nurse?<br />
<br />
4) Do you use electronic medical records?<br />
These can reduce errors, and allow the physician on call (if they are a doctor from the same practice) to access your chart at night and on weekends, if needed.<br />
<br />
5) Can I always get a same day sick visit appointment?<br />
<br />
6) Who answers regular questions by phone during the day? What I mean by this one is, does your pediatrician call you back if it is not urgent? Does a nurse handle most questions about illnesses on the phone? Does another physician answer the phone when your physician is not available?<br />
<br />
7) Are there any physician extenders (nurse practitioners or physician assistants)? Are they the ones to see you for same-day sick visits or phone calls, or will your physician or their partner see you?<br />
<br />
8) Are there separate sick and well waiting rooms? Are there separate sick and well exam rooms?<br />
This reduces the chance of your baby being exposed to a virus<br />
<br />
9) What is your vaccine policy?<br />
If the physician allows un-vaccinated children in their practice, consider that your baby (who is too young to be vaccinated for certain diseases) may be exposed to somebody in the waiting room with measles, chicken pox, etc...<br />
<br />
10) How often do you see the baby for child for regular check-ups?<br />
This can actually vary quite a bit between pediatricians for the first 3 years of a child's life. After that, your child is seen for an annual well check every year.<br />
<br />
11) Do you have a website? Do you use email to communicate with patients?<br />
<br />
12) What hospitals do you cover? Will your chosen primary physician be the one to see your baby everyday in the hospital (when they are born and if they are admitted later) or will one of the covering physicians see them?<br />
<br />
13) What kind of parenting resources can you offer?<br />
<br />
14) Where is the best place to park or closest public transportation stop?<br />
I have found (at least in big cities, such as LA and NY), that the best place to park for my doctor appointments is often somewhere other than the valet parking in the medical building. The website or administrative assistants at your pediatrician office should be able to tell you the best (free) place to work, as well as help you get there by public transportation, if that's your preferred mode of transport.<br />
<br />
<b>That's all I can think of for now, but please leave your tips in the comments section!</b><br />
<div class="separator" style="clear: both; text-align: center;">
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<div style="text-align: center;">
<span style="font-size: x-small;">[My son is too young to be your pediatrician right now, but isn't he cute? ;) (c) ]</span></div>Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-56974034010802996362011-11-29T11:47:00.001-08:002012-08-17T11:17:30.051-07:00A Spoon-full of Sugar Helps the Medicine Go Down<i><span style="color: #073763;">Lots of parents have trouble getting their children to take medicine, so here are some tips to help:</span></i><br />
<br />
<b><span style="color: #073763; font-size: large;">Some techniques to help medicine go down easier:</span></b><br />
<br />
Marry Poppins was right- a spoon-full of sugar helps the medicine go down! More accurately, a spoon-full of chocolate syrup will cover up the taste of most yucky medications. Apple sauce and yogurt are other common foods used to mask bad tastes. Many medications can be made to taste like your child's favorite flavor by the pharmacist before you even pick it up, so ask about this when you submit your prescription. Some medications come in "orally dissolving tablets" which kids (age 3 and older) can put in their mouth and they will dissolve without having to chew or swallow.<br />
<br />
Liquid meds are often easiest to give to babies with a syringe (a tube that looks like shot, but does NOT have a needle on it), which you can get at any pharmacy, baby store, or from your physician. Squirt small amounts of medication into your baby's cheek and they'll usually swallow it. Don't squirt it directly onto their tongue or into the back of their throat, as this can lead to gagging. Follow-up with breast milk or formula (whatever they normally drink), before giving the next part of the dose. Alternatively, you can put the liquid medication in a bottle nipple along with a little breast milk/formula, and have them suck directly from the nipple, without the bottle attached. I do not recommend mixing the medication in a whole bottle, unless you know the baby will take the whole thing regardless of taste.<br />
<br />
Most baby stores also sell special devices to help kids swallow medications,such as something that looks like a bottle, but keeps the medication separate, so you know exactly how much the child takes. I do not recommend giving children medications with droppers, because it's difficult to measure the amount you're giving, difficult to get all of the medication out of the dropper, and difficult to clean and dry the dropper fully between each use.<br />
<br />
<b><span style="color: #073763; font-size: large;">Learning how to swallow pills:</span></b><br />
<br />
Once your child is ready to swallow pills (often by age 5!), it's a great help to teach them how, since many medications are easier to take in pill form, the older they get, the bigger the dose, and some medications are not available in liquid/ chewable form. Starting young can also be beneficial in preventing anxiety associated with swallowing pills. Adolescents and adults often have trouble swallowing pills because they fear that the pill will get stuck in their throats. Relaxation techniques and deep breathing can help. Looking in a mirror, sticking your tongue out, and saying "aaah" out loud (this lifts the palate so you can see your throat), can help people see that their throat is much bigger then the pill, and ease some of the anxiety.<br />
<br />
The first step in learning how to swallow a pill is to practice with something that is NOT medication. I recommend starting with small, smooth, round candies (such as mini m&m's), and progressing to slightly larger candies (such as regular m&m's). People with anxiety may want to start with tiny candies, such as sprinkles. Other people prefer to start with tiny bread balls (made from mooshing a tiny piece of bread between your fingers), and go progressively bigger, since the bread dissolves easily in the throat. You will also need a big glass of water, juice, or carbonated beverage (such as sparkling juice, which the pill can float on).<br />
<br />
Younger kids can be told to just try swallowing the candy without chewing, because they are often successful without thinking about it. Older children, or those without a natural tendency to swallowing whole pieces, can start by visualizing the item floating down their throat on water, like a little boat. They should start by making sure the mouth is moist, by salivating or taking a sip of their drink. Nest place the candy as far back on the tongue as possible, using the teeth to scrape the candy to the back of the tongue (a mirror helps some people see how far back it is). Then take a big gulp of the liquid, which should float the candy and allow it to be swallowed, just as you would usually swallow any regular drink. Some children will swallow the candy (and later pills) more easily by drinking the liquid through a straw.<br />
<br />
When it comes to taking real medicine, some people hide their pills in mini-marshmallows, which are slippery when wet, and therefore easier to swallow. I recommend trying this without medication first, since these are bigger then most pills. You can also try covering the pills in chocolate syrup, applesauce, yogurt, or jam (but see the warnings below before trying that).<br />
<br />
I suggest experimenting with these techniques in a relaxed environment until you find something that works for you.<br />
<br />
<b><span style="color: #990000; font-size: large;">Warnings:</span></b><br />
<br />
These techniques are for generally healthy children, with normal anatomy and mentation! They should not be used for children with any anatomical abnormalities, dysphagia (trouble swallowing regular foods or drinks), or any medical conditions that effect swallowing, the head/face, the GI system, or the neurological system.<br />
<br />
All children should be supervised when practicing swallowing candies, and when taking ANY medication. NEVER tell your child that the medication is candy, as this can cause them to sneak some more when you're not looking (many medications these days actually do taste like candy). Always keep medications (over the counter and prescription) and vitamins/ supplements out of reach AND in a LOCKED container. Kids are good at climbing and getting into high cabinets, purses, closets, and other hiding places.<br />
<br />
Please speak to your pharmacist (who is usually in the back of the store, who has spent at least 5 years in post-graduate university studies, getting a doctorate degree in pharmacy), about what you can take your medication with, and whether you can cut, crush, chew, or open the medication. Many medications should NOT be taken with grapefruit juice. Some medications should NOT be taken with anything dairy. Some pills can be crushed and mixed with foods, where as others can not. Your pharmacist and/ or physician are the best people to speak to before taking your medication with anything but water.<br />
<br />
<span style="color: blue; font-size: large;"><b>Good luck & feel free to leave your own tips & experiences below :)</b></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfThuo58kojpbsZGp9F4WYYdQFORRMhyphenhyphenVRXHibryNRqaeoF-A5ZCfOC2zHSj4q8wYfG0dnfgNJ4gYj3QSiR7kKGDk1j7Hsb9L4-vFpfGfrpoVCvY4KcnX76GlcsmndYZ6FDXIl1lUr848/s1600/LiorMetsMay09.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfThuo58kojpbsZGp9F4WYYdQFORRMhyphenhyphenVRXHibryNRqaeoF-A5ZCfOC2zHSj4q8wYfG0dnfgNJ4gYj3QSiR7kKGDk1j7Hsb9L4-vFpfGfrpoVCvY4KcnX76GlcsmndYZ6FDXIl1lUr848/s320/LiorMetsMay09.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My son loves taking medicines! (c) 2009</td></tr>
</tbody></table>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-55560944046946034942011-09-15T23:00:00.000-07:002014-10-21T20:25:33.328-07:00Tips for Stopping Bad Habits (giving up the bottle, paci, and thumb)<br />
<div class="MsoNormal">
<b><u><span style="line-height: 115%;"><span class="Apple-style-span" style="background-color: white;"><span class="Apple-style-span" style="color: #20124d; font-size: large;">When should you quit?</span></span><span style="font-size: small;"><o:p></o:p></span></span></u></b></div>
<div class="MsoNormal">
<b><u><span style="font-size: 12pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;">The bottle
should be the first thing to give up, between 12 and 18 months. Continuing to
give a bottle at bedtime increases the child’s risk for ear infections and
dental problems. Your toddler should be drinking 16oz-24oz (2-3 cups) of milk
per day. Less than 16oz does not give them enough calcium and vitamin D, but
too much milk can cause iron deficiency anemia and fill up your child,
preventing them from eating other nutritious things.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;">The pacifier
is usually the next thing to give up, between 1 and 3 years old. It is
important to stop in order to prevent ear infections and poor teeth/ jaw
alignment. The pacifier has also been blamed in some for lisps, and delayed
language development (the child may use it as an excuse to not speak properly).<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;">Thumb
sucking is the hardest to stop, and most pediatricians recommend no
intervention until age 4, since most kids will stop sucking their thumb on
their own before then.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;">Sleeping
solely in the child’s own bed is a very personal decision, as there is nothing
medically wrong with sharing the bed with a toddler (unlike in infancy, when
you must be careful of how you co-sleep to prevent SIDS). However, teaching
them to sleep on their own is a way to help children learn to self-comfort, as
well as providing the whole family with better sleep.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<b><u><span style="line-height: 115%;"><span class="Apple-style-span" style="color: #20124d; font-size: large;">How Do We Stop?</span><span style="font-size: small;"><o:p></o:p></span></span></u></b></div>
<div class="MsoNormal">
<b><u><span style="font-size: 12pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal">
<b><span style="line-height: 115%;"><span class="Apple-style-span" style="color: red; font-size: large;">Some tip for breaking any habit:</span><span style="font-size: small;"><o:p></o:p></span></span></b><br />
<b><span style="line-height: 115%;"><span class="Apple-style-span" style="color: red; font-size: large;"><br /></span></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-size: 12pt; line-height: 115%;"> (1)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: 12pt; line-height: 115%;">Decide if you want to stop the
behavior completely all at once (“cold turkey”), or wean it off gradually
(usually by limiting the activity to bed time).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;"> (2)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Do not turn it into a confrontation
with the child. Let them know you are here to help them stop the habit, and why
you want them to stop.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">(3) </span></span><span style="font-size: 12pt; line-height: 115%;">Have them come up with alternative
methods of self-soothing with you. Ask them, “What can you do instead?” Guide
them to choosing something that is reasonable.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;">(4)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Point out that their older siblings,
friends, even characters that they like, do not use a pacifier/ suck their
thumb/etc… and let them know “big kids” don’t do it. Example while watching
Dora The Explorer, “Wow, look what a big girl Dora is! She and Boots have all
these adventures and she doesn’t suck her thumb, even when Swiper comes.” Point
out how much your child has changed/ grown in other ways, and let them know how
proud you are of them.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;">(5)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Do not prohibit them from
self-soothing in high anxiety situations, or when there is a big change (such
as a new sibling being born or a parent going on a business trip).<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;">(6)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Make sure they are aware they are
doing it (by pointing it out in a helpful, positive way), and distract them
with something else to do.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;">(7)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Give them an acceptable substitute,
such as a blanky/lovey, small stuffed animal, special new cup, or small cloth
square to keep in their pocket (this last item can be rubbed by the child with
fingers in pocket, especially when substituting for thumb-sucking or nail
biting). Make sure the child is involved in choosing the new item, and knows
why. If you decide on a lovey that your child gets attached to, make sure you
have 3 identical ones in rotation, so one can always be in the wash, one in
use, and one back-up.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="line-height: 18px;">(8)</span><span class="Apple-style-span" style="line-height: 115%;"> </span></span></span><span style="font-size: 12pt; line-height: 115%;">Reward charts can be helpful for
children who are age 3 and above (the older, the better). This is a sheet with
calendar spaces for 2 to 4 weeks, with the last space with a pre-determined
prize, such as a trip to a special place (e.g. Disneyland), or special new toy.
The child puts a sticker or X in the space every day that they don’t do the
habit, in some cases only consecutive days of not doing the habit are allowed
to be charted.<o:p></o:p></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><br /></span></div>
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<b><span style="font-size: 12pt; line-height: 115%;">The bottle</span></b><span style="font-size: 12pt; line-height: 115%;"> is the most important thing to give
up, for your child’s health. At 12-18 months transition to a sippy cup, then around 21 months transition to a regular cup for meals and snacks (sippy and straw cups
are fine to use when going out). Start by holding the cup for the child, and teaching
them to hold it themselves with very small amounts of water in it (to reduce
spills/ clean up). You can also give gradually less milk in the bottle until
there is none (e.g. decrease the amount of milk in it by 2oz each day).<o:p></o:p></span></div>
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<b><span style="font-size: 12pt; line-height: 115%;">The pacifier</span></b><span style="font-size: 12pt; line-height: 115%;"> is usually a difficult transition
because of age, and the new toddler’s desire for independence. In addition to
the general tips above, you can also try the following:</span><span class="Apple-style-span" style="font-size: 9px;"> (1) </span><span style="font-size: 12pt; line-height: 115%;">Give it away to a baby (not the child’s new sibling, since that can lead
to jealousy), or a favorite character (such as on a trip to Disneyland). Make
sure the child participates in the giving away ceremony. (2)</span><b><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-size: 12pt; line-height: 115%;">Have the pacifier sewn into a stuffed animal (like at one of the Build a
Bear workshops), then the child can sleep with the stuffed animal. (3)</span><b><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-size: 12pt; line-height: 115%;">Cut a hole in the pacifier, so the sucking action stops working. (4) </span><b><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-size: 12pt; line-height: 115%;">Make a necklace out of the pacifiers, and hang it on their crib. Let the
child know if they don’t use the pacifiers for a certain amount of time they
get a pre-determined reward. This works well with older children, with a reward
chart.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHq757EHE0mHVJI6oTG4nt6SZkA6h2rvDbOf5_r0QaAWN0_7jJcf_HvXTNLvRqkuPr0kPBveyWb1IGSm98GXMBq1XOYNsO-6VTjEL63SMnOPCi62FP1-JJMkjxQQm-kQlPwdV3YaeZWeA/s1600/PaciJune2010.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHq757EHE0mHVJI6oTG4nt6SZkA6h2rvDbOf5_r0QaAWN0_7jJcf_HvXTNLvRqkuPr0kPBveyWb1IGSm98GXMBq1XOYNsO-6VTjEL63SMnOPCi62FP1-JJMkjxQQm-kQlPwdV3YaeZWeA/s320/PaciJune2010.JPG" height="320" width="244" /></a></div>
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<span style="font-size: x-small;">[Photo of my son while still happily sucking his pacifier at 9 months old (c) ]</span></div>
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<b><span style="font-size: 12pt; line-height: 115%;">Thumb sucking</span></b><span style="font-size: 12pt; line-height: 115%;"> is the hardest habit to break, since
you can’t take away their fingers. For this reason, and since most toddlers
stop thumb sucking on their own, it is recommended to wait until the child is 4
years old before intervening. Peer pressure at that age also helps them try to
stop (at least in public), and they respond better to reasoning. First try all
of the above tips in the general section, especially pointing out when they do
it, distracting them, giving them a substitute, and reward charts. In addition,
you can provide a barrier by tying socks or mittens on their hands (there is no
need to spend money on the fancy devices that do the same thing). Some girls
respond to having a manicure. Other children are better reminded to stop by
placing bandaids on the thumbs. I think bitter nail polish should only be used
as a last resort, since this seems like a punishment to me, and I try to keep
the experience positive, letting the child know that their parent is there to
help them. The key at this age is that they need to want to stop, which means a
lot of discussion in the house about why it is important to stop.<o:p></o:p></span></div>
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<b><span style="font-size: 12pt; line-height: 115%;">Bedtime </span></b><span style="font-size: 12pt; line-height: 115%;">is usually a big struggle with
toddlers, so each family needs to decide for themselves how they want to handle
it (pick and choose your battles). If the parents want the bed to themselves,
or simply want the toddler to sleep on his own, the younger you start with
sleep training, the easier it is. If your toddler is getting up in the middle
of the night and coming to your bed, you can firmly, but simply, bring them
back to bed each time. A music box or sleep sheep (white-noise maker) that they
associate with going to sleep can really help (be sure to use this at regular
bedtime and naptime as well). Another option is allowing them to sleep in your
room, but not in your bed, so they feel close to the parent, but not
comfortable. You can put a simple mattress down on the floor, or even just a
blanket. This minimizes the parents waking up, which can be a big help to
everyone. Another option which some people recommend, but which I never use,
because it just seems cruel and unsafe, is to put a baby gate or lock on the
child’s bedroom door, so that they cannot open it and leave their room at
night. Whatever method you choose, or even if you choose to let the child sleep
in your bed, just try to provide minimal attention when they wake up, since you
do not want to reward them for getting up in the middle of the night, and
everyone needs a good night sleep.</span></div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.comtag:blogger.com,1999:blog-6887474702332907811.post-81864112441630921742011-09-15T21:54:00.000-07:002012-11-21T17:03:40.548-08:00About myself & the blogosphere<br />
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Hello everyone, I am excited to be joining the blogosphere. I have decided to start a blog in order to provide general pediatrics advice in a longer format than I usually have in clinic, as well as share my experiences as a mother. This information does not substitute speaking to your physician, and all opinions are my own<span style="color: red;"> </span>and do not necessarily express the opinions of my employers<i>.</i> The following is my bio:</div>
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I grew up in Los Angeles, California, graduating from the Hamilton High School Academy of Music. My mother is a pediatric rheumatologist, giving me some extra insight into how medicine has changed over the past 30 years.</div>
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The University of California at Berkeley is where I spent my under-grad, receiving my B.A. with honors, majoring in Inter-Disciplinary Studies, Environmental Science. I went on to get a Master’s degree in Regulatory Science from the University of Southern California School of Pharmacy, which led to a position in clinical research at Childrens Hospital Los Angeles. While working there I realized research was not enough for me, and I wanted to be a doctor too. I love medicine because it allows me to be a scientist, teacher, and detective every day, as well as help the next generation of children grow up healthy.</div>
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I obtained my M.D. from the Ben-Gurion University Medical School for International Health in Collaboration with Columbia University Medical Center. I received the Dean’s Award for Outstanding Contribution to the Medical School for International Health. The school not only has an outstanding emphasis on clinical skills, but also allowed me to work with diverse populations, including a very short time in Ethiopia, and a senior project with the Bedouin community.</div>
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My internship and residency in pediatrics was completed at Maria Fareri Children’s Hospital, Westchester Medical Center,<span style="color: red;"> </span> New York Medical College, where I was their American Academy of Pediatrics Delegate. I am honored to have received the Pediatric Residency Leadership Award. I am a member of the American Academy of Pediatrics and the Los Angeles Pediatric Society. I am certified by the American Board of Pediatrics.</div>
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I am happy to have recently moved back to Los Angeles with my family. I am lucky to have a wonderful, supportive husband, and a beautiful toddler son, who teaches us something new each day.<br />
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I am now seeing patients at Roxbury Pediatrics in Beverly Hills, CA. You can check us out at <a href="http://www.roxburypediatrics.com/">http://www.roxburypediatrics.com/</a></div>
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Thank you for taking the time to read my thoughts!</div>
Cigal MDhttp://www.blogger.com/profile/14389394263265656420noreply@blogger.com