We know that winter can be a time of joy, with warm fires, hot cocoa, and time spent with family. But it can also be a time of worry, with colds, flu, COVID and norovirus outbreaks. We’re here to help you understand what norovirus is, how to prevent it, and what to do if your child gets sick.
Norovirus is a highly contagious virus that causes gastroenteritis, or inflammation of the stomach and intestines. It’s the leading cause of foodborne illness in the United States, and outbreaks often occur in schools, daycare centers, and cruise ships.
The symptoms of norovirus include nausea, vomiting, diarrhea, stomach cramps, headache, and fever. They usually start 12 to 48 hours after exposure and can lead to one to three days of misery for the whole family.
Norovirus is spread by contaminated food or water, touching contaminated surfaces, and then touching your mouth, or by coming into close contact with someone who is infected (Good luck staying away from your toddler). It’s important to wash your hands frequently, especially after using the bathroom or changing a diaper.
The best way to prevent norovirus is to practice good hygiene, such as washing your hands frequently with soap and water for at least 20 seconds. Avoid close contact with people who are sick, and clean and disinfect contaminated surfaces. If you or your child has norovirus, stay home until you have been symptom-free for 48 hours to prevent spreading the virus to others.
If your child gets norovirus, the most important thing you can do is keep them hydrated. Dehydration is a common complication of gastroenteritis, and it’s especially important for children to drink plenty of fluids because they can become dehydrated more quickly than adults.
Breast milk, formula, and oral rehydration solutions, such as Pedialyte, are the best fluids for children with norovirus. Avoid giving your child sugary drinks, such as soda and fruit juice, because they can make diarrhea worse. Yes, even watered-down 100% fruit juice is still watered-down sugar water. If they are older and no longer exclusively drinking milk, then avoid dairy. Like sugary drinks, dairy can worsen diarrhea and as a result, also worsen dehydration.
Dehydration can be serious, especially in children, so it’s important to know the signs
If your child is showing signs of dehydration, have them evaluated by a pediatric expert immediately.
Norovirus is a highly contagious virus that can cause vomiting and diarrhea. The best way to prevent norovirus is to practice good hygiene, such as washing your hands frequently. If your child gets norovirus, keep them hydrated with breast milk, formula, or an oral rehydration solution. Be aware of the signs of dehydration and have your child evaluated by a pediatric expert if showing signs of dehydration.
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We wish you a happy, healthy and hopefully not too loooong of a winter!
Many parents bring their child to us in the ER worried their little one is dehydrated. When a child is fighting an infection and has a fever, they need more liquid than normal to stay hydrated, and unfortunately more often than not they are drinking and eating much LESS than normal. This can lead to dehydration. Fortunately, usually it is mild and your child does not need hydration through an IV in the emergency room. But it is important to realize when they do, and what you can do to help them at home.
If your child is sick and doesn’t want to eat, don’t push it – it’ll just make them feel worse and then less likely to drink. If they are vomiting, I recommend NO food for a good 24 hours unless they are begging for it. It is MUCH more important they take in fluids than solid foods. Fluids like Pedialyte, sports drinks mixed with water, and popsicles are all good choices. If your child is very young and just refusing to take the bottle or sippy cup, you can syringe feed them liquid. This is labor intensive, but it can definitely help prevent dehydration in babies – give 5mL of liquid every 5 or so minutes with a syringe in the back corner of the cheek. Unfortunately, there is not much you can do to help keep them hydrated if they are vomiting everything you give them. In this case, they need to be seen by a doctor who can prescribe medicine to help with the vomiting and prevent dehydration.
How do you know if your child is dehydrated? You can check for many of the signs I look for in the ER right at home. When I am evaluating a child in the ER for dehydration, I pay attention to how sleepy they are, if they produce tears when crying, I look at their lips and mouth – are they dry and sticky/tacky, is their heart rate very high, are they urinating less than normal, I look to see if their eyes look dark and sunken, and when I press on the tips of their fingers I see if it takes more than 2 seconds to turn from white back to pink. These are all things you can do at home too. If you are worried about dehydration, it is best to call your pediatrician or Health-e Pediatrics for advice. Most of the time it is mild and can be treated at home, but sometimes your child may require an IV for fluids in the ER.
It is common for a child to get dehydrated when ill, but thankfully not often to the point of needing to go to the ER for IV fluids. Don’t try to give solids if your child doesn’t want them – liquids are much more important. Watch for these signs of dehydration and contact Health-e Pediatrics or your pediatrician if your child appears dehydrated to you.
I look over to our dining table to see my 2-year-old standing there, right on top of the dining table, looking at me mischievously. She is definitely our “travieza” – Spanish for little troublemaker. Of course, instinctively, I scold her to get off the top of the table, but in a 2-year-old little independent girl’s mind, that means to stay on top. She then promptly starts sprinting across the table and steps right off the edge, falling headfirst onto the hardwood flooring. Head first!
She did not cry instantly, which is not good. I like crying after injuries, it means they did not lose consciousness and are responding appropriately to pain. So my heart starts racing as my pediatric ER doctor mind also races, and I run over to pick her up. She has a huge goose egg already forming on her forehead. She then starts crying (phew, good thing), but seems very out of it and sleepy, and not answering my questions. If I weren’t an ER doctor myself, we would’ve gone straight to the ER. But, rather, I held her and watched her over the course of the next half hour. She was sleepy but did not vomit. Eventually she was able to eat a little, took some Tylenol, and continued to improve. She had a concussion, but thankfully nothing worse!
Head injuries are so incredibly common in this toddler age as children explore their environment, learn the laws of gravity, and push their coordination limits. Head injuries are common, but serious brain injuries from them are not thanks to the very strong bone surrounding this most precious organ. So what thoughts were going through my mind as I held my little sleepy two-year old in my arms? When I evaluate a head injury in the emergency room, the very most pressing and urgent condition I need to make sure is NOT happening is a bleed inside the head. Since the skull is enclosed, if there is bleeding inside, there is no room for that blood to go, it starts pushing on the brain causing damage. If the bleeding is too much, it can cause part of the brain to be pushed lower down into the neck area. This is rare, but I’ve seen it numerous times, and it requires IMMEDIATE action.
So the next question is, how do I know if there is a bleed inside the head just by looking at the child and talking to the parent? How do I determine if a child needs imaging to look for a bleed?
When I evaluate a head injury I consider the child’s age – in children under the age of 2 I have a lower threshold to image. Did they lose consciousness when they hit their head? I clarify the mechanism of the fall (how high was the fall, onto what surface did they land, etc.). I look to see where the injury on the head is – forehead being the best, back of the head or over the temples being the most dangerous. How the child is acting after the fall is important – are they still dazed, are they vomiting, are they answering questions and interacting with me normally?
Usually, the symptoms we are looking for happen within 4 hours of the injury. We try not to image children, if at all possible, as imaging exposes the child to radiation that can increase a child’s risk of developing cancer in the future. If I see a child that I am worried about, I will typically watch them in the ER for 4 hours. If they vomit or I am concerned about developing signs of a brain bleed, I will then image.
X-rays are not sufficient to evaluate head injury in children. The skull in children has many suture lines (still growing and developing), which can look like fractures on X-ray, and X-rays don’t evaluate inside the brain at all. If emergent imaging is necessary, we will get a CT scan, which unfortunately has more radiation, but will give us the information we need. Therefore, if your child needs imaging you will need to go to an ER, not an urgent care.
If imaging reveals a skull fracture, there really isn’t much we do about that – you don’t cast the head as we would other broken bones! We advise on limited activity (as much as possible in a toddler) to decrease any risk of repeat injury to that already damaged covering of the brain. If imaging reveals a bleed, even then, often we monitor, observe, and watch. Occasionally surgery is necessary, which will involve a brain surgery specialist.
Once I make sure I do not think there is any chance of bleeding in or around the brain going on, I then evaluate for concussion symptoms (see article to read more about concussions), or signs of a skull fracture. After that, I look for any other injuries that may have happened during the fall – dental, eye, or other body injuries.
Bottom line – if your little one has a head injury or fall, call your pediatrician for guidance. If it is after-hours, your child can be evaluated by an ER doctor at Health-e Pediatrics, to determine if imaging is necessary or if you are safe to let your child recoup at home. Of course, if your child is not acting right or vomiting after a head injury, do not delay and seek care in the ER.
So painful, and always in the middle of the night, middle ear infections are the worst for the little ones! However, there is a huge misconception out there that ear infections always need to be treated with antibiotics. Antibiotics are WAY overprescribed for otitis media (fancy word for middle ear infection). Typically the middle ear area is able to drain into the nose through a little tube that connects this part of your ear to the inside of your nose. But when children have colds and congestion in their nose, fluid gets backed up into the middle ear and causes pain and pressure. This pressure builds up and is notoriously worse when the child lays flat to sleep, hence waking up at midnight crying in pain and holding their ear. Usually this is from a virus. Now sometimes, bacteria can grow there and these infections can progress to become more serious bacterial infections. At this point they would need antibiotics, as true bacterial infections can spread into the bone behind the ear. However, in most cases your body does its job fighting the virus, and it will resolve after a few days on its own.
That doesn’t diminish the fact that they are still super painful. Whether caused by a virus, a bacteria, or just fluid and mucus, they most certainly HURT. I advise ibuprofen (over 6mo old) every 6 hours, and definitely right before bed, if your child seems to have ear pain or is waking up in the middle of the night crying. Use our calculator at healthepediatrics.com to determine the correct dose for your child.
Swimmer’s ear is an infection of the outer canal part of the ear, which is the outer part that you can sort of look into if you stare into the ear, and the part people shouldn’t but do clean out with a q-tip. Typically you will see pus discharge coming out of the ear, and it will be painful to lift the ear up and down. With a middle ear infection, moving the ear doesn’t change the pain. When this canal stays wet, bacteria love moisture and cause irritation and pus in this canal. These infections usually clear up with some mild antibiotic drops.
Not all ear aches are infections. I felt so bad for my sweet teenage patient at 6am one morning who came in with an ear ache. Looked in her ear with my scope to find a magnified eyeball staring right back at me! What a way for her (and me!) to start out our morning. Needless to say I removed a live bug immediately – can you believe she didn’t want to keep it as a souvenir?! I have looked in so many ears in my day, and kids put everything in there! If your child is complaining of ear pain or has discharge from their ear without any common cold symptoms, you may want that ear looked at by their doctor to make sure there is no bead, or bean, or fuzz, or bug or who knows what else in there!
Ear wax is natural, and not “dirty”. Ear wax, aka cerumen, helps keep the ear canal healthy and clean. Your body removes ear wax on its own. Sometimes, however, it can build up and harden, becoming itchy and irritating, or cause decreased hearing. If this is the case, it may need to be removed. There are drops that can help soften the wax, so it falls out naturally, or your doctor can remove it with a special tool. You should NEVER USE A COTTON SWAB, pen cap, paperclip, or anything else that looks like it could be stuck in the ear to pull out wax. This area is delicate. Doing this may cause damage and pain to the ear canal or deeper more important hearing structures.
Ear infections are most certainly painful, but antibiotics are not always the answer. Often the body can fight these infections off on its own, and the best treatment for your child is pain medication only. Use our calculator at healthepediatrics.com to maximize the dosing of ibuprofen for your child. And ear aches are not always infection – think about something your toddler may have thought fun to put in their ear, bugs, or wax causing discomfort as well!
Don’t cry over spilled milk! Unless it is breast milk, that is, then that deserves a few tears. Breast milk lives up to its nickname of “liquid gold”. As a pediatrician, I am an unwavering advocate for breastfeeding your baby for oh so many good reasons. I cannot encourage new mothers enough to at least try exclusive breastfeeding if they have the option. As a mother of 4 nursed babies, I completely get that it can be hard and tiring, and even painful (well often painful) at first, but it will become much easier after time. Stick with it and it is completely worth it – for both you and your baby!
Well, first off for you, mom, you will lose your baby weight much faster, and won’t get your period back nearly as quickly, bonus and bonus! Did you know it also decreases your risk of ovarian and breast cancer? Breastmilk is very easy for your baby to digest, and, in my experience I see WAY less colic in breastfed babies, and almost never see a constipated breastfed infant. Formula can get expensive, and when breastfeeding you don’t have to worry about constantly cleaning bottles and nipples. Amazingly, breast milk also passes on disease fighting parts of your blood to your baby, so your child gets less colds and less ear infections, among other more serious infections. And moreso, breastfeeding has been shown to decrease your child’s chance of getting diabetes and some types of cancer later on in life. Some studies show that breastmilk can even increase your child’s IQ! Breastfeeding is surely the smart choice!
Too many new mothers quit breastfeeding or add formula too soon because they think they’re not producing enough milk. While this can be the case, it is often not. A new breastfeeding mother should nurse her baby frequently on demand, and start immediately after birth. The foundation for a terrific milk supply later on is actually in the first week of the baby’s life. It is pretty amazing if you think about it, (well I think EVERYTHING about your body growing a baby is amazing, but that is for another day), your breast milk actually changes in amount and content to meet your growing baby’s needs. A full term newborn’s stomach is only the size of a marble at birth and can handle less than 1 teaspoon of milk at a time. By day 3, it can hold up to 1 ounce. By one week old, 1.5 – 2 ounces, and at one month old 2.5 to 5 ounces. Drinking plenty of water and nursing often are key to milk production. You can tell if your baby is getting enough nutrition by weight gain, and keeping track of wet and dirty diapers.
Your body produces milk in response to your baby suckling. It is basically a supply and demand relationship. The more your baby nurses, the more milk you will produce. If you aren’t producing enough milk, don’t fret. Even if your doctor or lactation consultant advises to supplement with formula for your baby’s weight gain, you can still get your milk supply back up to exclusively breastfeed, and then ditch the formula when your supply increases. You need to “trick” your body into making more milk. To do this, I often suggest pumping for 15minutes after you breastfeed. This will stimulate your body to make more milk. It is also important that your baby is emptying your breasts efficiently, so make sure his/her latch is good during each feeding. If you have milk leftover in your breast, then your body thinks you already have too much, and production will go down to match the perceived baby’s needs. Also, make sure you are drinking plenty of water. Personally, I found mixing 1/3 Gatorade with 2/3 water helped me, but maybe it was just because I drank more water if it was flavored. There are various herbal supplements, such as fenugreek, and prescription medications that can increase milk supply. If pumping and frequent nursing are not enough, you can talk with your doctor or lactation consultant about these options. Herbal supplements are typically used in combination with increased breastfeeding frequency, pumping, and maximizing milk removal.
Some medications do pass through breast milk, but the list is smaller than during pregnancy. Many common medications are safe, but consult your doctor prior to taking any medication while breastfeeding. Alcohol also passes through breast milk, so if you want that glass of wine with dinner, you should consider “pumping and dumping”.
Maternity leave over? I know, it is sad, I did it four times. Now time to figure out the pumping and the storage of your liquid gold.
When going back to work, you will need a good pump, a cooler to keep your milk cold, BM storage bags and a permanent marker for labeling your storage bags, scotch tape for the door sign, and something to clean your pump supplies between each pumping session. Also, don’t forget an extra top/blouse just in case you leak a bit of breastmilk onto your clothing, and nursing pads for inside your nursing bra. You may also find that a pumping bra (which is basically a tight elastic strapless bra that has little slits for the pump parts to go through) could be helpful for hands-free pumping if you really need to get some work done while pumping. I did not know these existed with my first, but discovered their necessity by the 4th! Ask your supervisor ahead of time where you can pump. Most workplaces should have an area that is clean, quiet, and private for this. Have a sign ready that you have in your bag with tape that you can tape to the door so no one disturbs you. I have pumped in all sorts of places at work, including many bathroom stall pumping sessions, but hopefully you have better accommodations than this!! Carry a water bottle around with you and drink frequently at work. You need more liquid than normal when nursing, and it can be easy to forget to drink while at work. Lastly, if you are stressed and uncomfortable, this will make it harder for your milk to let down. Some moms record on their phone their baby’s hunger cry from a previous nursing time, and play it to help with milk letdown.
First off, try to pump immediately before work. Get to work early, pump for 20-minutes before your workday starts so that you can maximize the break time you have during your workday. Have the timing of pumping built into your schedule ahead of time, either in your mind, or actually scheduled if you can. Things ALWAYS come up – if you keep postponing pumping until tasks are done, pretty soon it is an hour later. Eventually your supply will diminish if you keep doing this. Believe me, I know. Just go pump – those tasks can wait 15 minutes. Prioritize timing your pumping so that you can get away every 3 hours or so when your child is very young, and every 4 hours as they get a bit older. Let your colleagues know you’re unavailable for the next 15-min. so they can cover for you if that is needed. When pumping make sure to empty both breasts entirely. If you are rushed and stop 5 minutes early without emptying your breasts, you will see that your supply starts to diminish – not worth the extra 5 minutes you get. At first, sessions may take you more than 15 minutes, but as this becomes part of your routine, and more comfortable, you should be able to finish in 15 minutes.
Bring a cooler to put your bottles of milk into – although clean and natural, most colleagues don’t appreciate bottles of breast milk in the employee fridge. If you will be home within 4 hours, you don’t even need to put the milk in the cooler! (Expressed breast milk is fine at room temperature (<77-degrees) for up to 4 hours.) I actually just put my pump supplies in the cooler bag with the bottles since I didn’t have time to thoroughly clean them between pumping, but hopefully you wouldn’t be as rushed and could store your cleaned pumping supplies out of the cooler. You can purchase breast milk freezer bags. I then labeled the bags with the date and amount. It is helpful to know the amount for when you need to thaw out milk for the babysitter. I pumped into bottles, then transferred to storage bags right away. Do not fill them too full – Breast milk expands when frozen! Then when I got home I could easily slip the storage bags in the freezer (lay them flat until frozen, then you can pack the frozen bags one after the other standing up to conserve room) and wash the supplies so they would air dry by the next morning. Do not cheapen out on freezer bags – I bought the discount ones figuring they were just bags, and they leaked more than once! Not again. Also, when thawing out from the bag make sure to put the bag in a bowl to collect any milk that leaks out. A frozen bag rips somewhat easily after weeks of being moved around in the freezer. You can store BM in the fridge for 4 days, and up to a year in the freezer. If you won’t use it soon, freeze it to protect the quality of the breast milk contents.
Room air = 4 hours
Fridge = 4 days
Freezer = 1 year
I know this is a lot to take in and pumping is such a pain, but know that all of this effort is so worth it for your baby! With time pumping becomes easier, more efficient, and just part of the routine. You can do it – keep feeding your baby the absolute best nutrition their little growing body can get!
Do not feel like you are alone. There are many good resources out there to help you successfully breastfeed. Check out La Leche League International to find a lactation consultant near you. Your child’s pediatrician and your OB are also great resources.
Asthma. I love asthma. No, not having asthma – treating asthma. I love learning about asthma. I love teaching about asthma. I’ve published articles in the Journal of Asthma. I once won an award about research on singing with asthma. I even got to present my research on asthma at a national conference. Now let me educate you a bit on asthma.
I like to describe the lungs as upside down trees, with bigger air tubes leading to smaller and smaller air tubes. These air tubes are surrounded by a thin layer of muscle. In asthma, this muscle gets really angry, really easily. Breathing in air that is too cold, or working too hard during exercise can irritate this muscle. A little common cold virus sneaking in and bopping around inside, or a pollen particle climbing along the tube can really annoy this muscle. When this muscle gets angry, annoyed, and irritated it tightens up. If the muscle gets angry enough, it starts sweating, and liquid builds up inside the tube. When a tube tightens up, the inside of the tube gets smaller. A smaller tube filled with liquid makes it more difficult for air to move through. This is what causes the difficulty breathing, and wheezing we experience with asthma.
Fortunately, (another reason why I love asthma!) we have excellent medications that can help. Inhaled albuterol surfs its way all the way down to that lung muscle and tells it to chill, relax, just take a deep breath (pun intended). The muscle often needs to be told a couple of times (a few puffs), but usually obeys albuterol and loosens up, making the airway tubes bigger again, which makes breathing easier. When using the inhaler directly into the mouth, the medicine is only able to reach the mouth. Albuterol has no idea how to communicate with the tongue and teeth, so eventually gives up and does not do its job. It needs to get all the way down into the lungs where it can work its therapeutic magic, and to do that it needs to be given with a spacer and mask.
Now we know how to stop the airways from constricting, but there is still liquid inside. That is where steroids, such as prednisone and dexamethasone, come in. These medications are a bit slow, and don’t work for a couple hours, but are great at cleaning up all that liquid inside the tubes. Usually, they take about 5 days to clear it all up.
Sometimes lung muscles are too sensitive, or it is impossible to stay away from the allergens that anger them, and they are constricting too often and too easily. These lung muscles need daily reminders to calm down. Inhaled steroids, such as Fluticasone and Budesonide, among others, can do this job. They only work little by little when taken every single day to help calm the muscles from tightening. They are considered daily preventative medications, and won’t work like albuterol does during an actual asthma attack.
If your child has a persistent night time cough, you may want to talk to their pediatrician about asthma. Coughing, feeling chest tightness and shortness of breath, and chest pain can be signs of an asthma attack, and you should give albuterol every 3-4 hours to help open up your child’s lungs. If this is not helping and symptoms persist, it is time to see the doctor. In a severe attack, you can see your child’s ribcage outlined when they breath – looks like the skin is sucking in between the ribs, and they will be breathing faster. If this is the case, you should give albuterol and head in to see your child’s doctor ASAP.
Now, maybe you still don’t get as excited about asthma as I do, but hopefully you understand a bit more about what is going on in a child’s lung during an asthma attack!
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No matter how popular an antibiotic gets, it will never go viral. The main point I want you to get from this article is that antibiotics do NOT kill viruses. Antibiotics should only be used for infections caused by bacteria. And viruses are the culprits in childhood illness far more often than bacteria – viruses cause cough and cold symptoms, fever, most sore throats in kids, some pink eye, most vomiting and diarrhea illnesses, and even ear infections.
Not only do antibiotics not work to treat many infections in children, they can do more harm than good. Antibiotics can have side effects like diarrhea, upset stomach, yeast infections, and allergic reactions. Overuse and incorrect use of antibiotics can lead to antibiotics losing their effect on true bacterial infections. Bacteria are actually really smart, and can mutate when they encounter an antibiotic, so that it no longer kills them.
Now that I have painted a bad picture about antibiotics, rest assured there is definitely a place for these life-saving medications. If your child truly has a bacterial infection, these medications are absolutely necessary and should be given so that the infection doesn’t spread and cause worsening illness.
Some of the more common reasons children need antibiotics are for urinary tract infections, skin infections, strep throat, ear infections (although often these are viral), occasionally sinus infections in older kids, and pneumonia. Your doctor can determine if your child has a bacterial infection or a viral infection, and will prescribe antibiotics only if necessary.
Let’s go over some of the more common antibiotics we prescribe for kids so you are a bit more familiar with these medications should the need arise for your child in the future. Amoxicillin is one of the most common antibiotics I prescribe. It is my first line go-to for ear infections (if antibiotics are indicated, which is not always the case for ear infections), and pneumonia. I also like to use it for Strep throat. Augmentin is Amoxicillin’s cousin. It has a little extra boost of bacteria fighting power and is used in some cases when amoxicillin is not strong enough. We don’t just jump to this one, though, because it notoriously causes diarrhea as a side effect. It is necessary, however, for dog bites to prevent infection. Clindamycin is also one of my favorites. It is great for skin infections, and actually the oral version is just as good as giving it through an IV line directly into the bloodstream. This antibiotic, however, tastes incredibly gross, so can pose a challenge to get into a little one (or a big one for that matter!). Keflex (Cephalexin) is my go-to for urinary tract infections. Bactrim (TMP-Sulfa) can also be used for skin infections and urinary infections, but I don’t use this one unless I have to, as children tend to have more allergic reactions to this med than others. These are the most common antibiotics I prescribe for children, but the list of available antibiotics goes on and on (just ask anyone in medical school microbiology class – ugh!).
Unfortunately, many children report getting a rash with amoxicillin. This, however, is not always an allergy. Amoxicillin, among other antibiotics, is often incorrectly prescribed during viral infections. Viral infections often give a full body rash and can mimic the rash from an allergic reaction. Since the child, who has a virus, is also on amoxicillin, the rash then is attributed to an allergy to the medication rather than due to the virus the child has.
Bottom line, antibiotics should not be used every time a child gets sick. There are particular cases when they are indicated. Your doctor will be able to determine if an antibiotic is truly indicated, and if so which antibiotic choice is best for your child’s illness.
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In the Central Valley we are ALL hot – ALL summer long. School’s out and summer is here – time to sing and dance and celebrate being done with this crazy school year, but mind you with record breaking temperatures here in Central California, feelin’ too Hot Hot Hot can be dangerous for our little ones. Heat exhaustion and heat stroke are real dangers in these parts, and precautions need to be taken when the triple digits hit.
First and foremost I’ll bring up summer car safety. TOO MANY babies die from preventable heat stroke from being left in a car on a hot day. I do NOT want to treat your child for heat stroke in the ER this summer, so please read on and spread the word. The internal temperature of a car can heat to temps 30-40 degrees F hotter than outside. Without getting into too much of the physics – basically sunlight energy enters through the windows, is absorbed in the car, and is unable to escape, EVEN WITH OPEN WINDOWS. In a parked car, the temperature can rise 20 degrees F in just 10 minutes. This means that if it is 90 degrees F outside, a typical summer day in Fresno, it takes LESS THAN 10 minutes for the car temp to rise to over 107 degrees F – a lethal temperature for a baby stuck inside the car. On top of this, a child’s temperature can rise 5 times faster than an adult’s, and they aren’t as good at cooling themselves off by sweating. As you can see, it only takes minutes in hot summer temperatures to create a dangerous situation for a child in a parked car.
Please do not leave your child (or dog, or grandma for that matter) unattended in a car, no matter how small or quick the errand is. I advise you to leave your wallet and cell next to the carseat so that you have no chance of forgetting about your sleeping baby in the back (it happens). Leave your car locked when at home, and keep your keys out of a child’s reach. If you ever see a child in a parked car, unattended, call 911. Do not be too shy or afraid to call, dispatchers do not take these calls lightly and you could save a life.
Babies and toddlers are not the only children to suffer from heat related illnesses. Older children may not be stuck in car seats, but they too must take precautions under the sweltering sun. Don’t push it too hard to win that soccer game, and don’t expect to get a PR in your 5K on a triple digit day. Rest and hydration are imperative during all summer exercise. On a normal, “non-sweaty” day, children ages 4-8 years old need about 5 cups of water per day, and older children need 7-8 cups per day. So on a hot day, playing outside, they need much more than this. A teen, for instance, should drink about 40 gulps of water per hour while exercising in heat. Water is typically best, but if sweaty vigorous exercise will extend beyond 1 hour, then an electrolyte sports drink is beneficial as well. Be proactive and encourage your child to drink consistently when playing outside. If a child is thirsty, that means they are already dehydrated. If you know that a meet or game is coming up, make sure to pre-hydrate ahead of time. When your urine is clear, you are hydrated. Dark urine is a sign of dehydration.
Initial signs that the heat is getting to your child, and they need a break are face flushing, rapid heart rate, and excessive thirst. Take a time out, drink a bunch of gulps of water, and lay or sit down for a bit in the shade. If your child is feeling lightheaded, has a headache, has muscle cramps, sticky lips, or feels excessively hot or cold with goosebumps – these are signs of heat exhaustion and they need to take a break for the rest of the day, they’ve already pushed themselves too much and it can be dangerous to pursue further exertion in the heat. Heat stroke is very dangerous and the extreme of heat illness. This can happen in a young athlete who is dehydrated while continuing vigorous exercise in the heat. All these earlier warning symptoms may continue in addition to high fever, severe headache, confusion or actual loss of consciousness, slurred speech, seizures, rapid breathing, and vomiting. Heat stroke can result in brain damage and death and is not something to take lightly. If an athlete has any of these symptoms they need to be evaluated urgently, and cooling measures should be taken immediately such as ice to the neck, armpits, and groin, and fanning with cool water mist.
NEVER for any reason leave a young child alone in a car on a hot day. Drink plenty of liquids during exercise, and stop at signs of heat exhaustion – your body is telling you it is done with the heat for the day. Apply ice packs to the neck, armpits, and groin to cool down.
Have you seen the movie on Constipation? Neither have I, it hasn’t come out yet. I asked the librarian for a book on constipation. She said: “It comes out in a week or two”. Ok, ok, that’s enough. In all seriousness constipation is really a common issue for so many children. I would venture to say that in my experience, it is the most common reason children complain of abdominal pain. Constipation is having hard, dense stools that are hard to pass – often the stools are described as small pebbles or balls. Your child may be constipated and still stool every day or may go 4 or 5+ days without a bowel movement. This is especially true in infants. A baby’s stooling patterns constantly change, and I often remind parents that it is not necessarily how often their child has a bowel movement, but the consistency and difficulty of passing the stool that constitutes a diagnosis of constipation. Constipation is not common before introducing solid foods, especially in breastfed babies. They can go a week without stooling and this can be normal. They often will appear constipated to a caregiver – grunting, face reddening, the facial grimace of straining – this can also be normal. It takes a lot of coordination for babies to get that stool out, and this process takes a long time to learn and master!
In older children, often a stool will be so hard that it causes a small tear in the child’s bottom as it passes through. This tear bleeds a bit, resulting in blood on the toilet paper or in the toilet water. This can be really scary for a parent (and a child!), but is incredibly common with constipation. Luckily that bottom area heals fairly well and fast, but this problem can cause a vicious cycle. If it is painful one time, often the next time your child needs to go number 2, they will hold it in because they’re scared it will hurt. The more the stool stays in the gut, the drier, bigger, and harder it gets, and the worse the constipation gets.
This is a fancy medical term for severe constipation. Basically, the stool inside the rectum (the last part of the intestine before stool is released) gets super hard and dry and big and stuck. The rectum gets stretched and liquid starts seeping past and around this hard stuck ball of stool, and then leaks out into the child’s underwear. This can look like watery diarrhea, but in fact is the exact opposite problem. This can be very embarrassing for the child, as they are not able to control this leakage.
The first treatment for constipation is changing what goes into the gut – the child’s diet. One of the most effective and easy(ish) fixes is to increase the amount of water your child drinks in a day. Drinking plenty of water makes the stool softer and easier to pass. And, as we all know, eating foods high in fiber can help prevent constipation – but, as we all know, that is easier said than done in a picky eater. Blueberries, mangos, and pears with the skin on them are all high in fiber and tasty for kids. You can make smoothies with frozen strawberries, maybe even a little chocolate to sweeten a bit, and then hide a burst of fiber in that blender with some kale and ground flax and chia seeds. An evening snack of popcorn with your weekend movie can add some fiber as well. Beans and veggies are of course full of fiber, and if your child will eat those, then more power to you!
Sometimes diet alone will not suffice, and we need to add some medication to get your child to have softer stools. If you think your child is to the point of needing medication for constipation, I recommend talking to his/her doctor before starting any medication regimen. MiraLax is a common medication prescribed for constipation in kids. It only works when taken with a ton of water, as it works by bringing all of that water into the intestines to soften the stool. Glycerin suppositories are also commonly used to start things moving from the other end – they’re not fun, but will do the trick. Laxatives and enemas are less often used, and need to be recommended by a physician before using in a child.
Well, I am finally done writing about constipation. This one was a real struggle to get out.
Constipation is not how often a child goes number 2, but rather how hard the stool is to pass and how dense and dry it is. Drinking plenty of water, and eating fiber can help with constipation. Sometimes medicine is necessary, in which case you should speak with your child’s doctor.
While unloading your groceries you drop the bananas on the floor. Ugh! You pick them up, no bruising, no dents, no cuts. You set them back on the counter. When you’re done unloading all of your groceries, you go to eat one of the bananas. You find the outside now is a bit bruised. You then peel it and notice that most of it looks ok, but one part is browned and mushy. It tastes fine, but you know it is just not 100% good banana. Well in a concussion, your brain is the fallen banana. (And you thought I was going to have you slip on the banana peel to start this article on concussions, didn’t you? That would be cruel.)
Falling with the head striking the ground often causes injury to your outside “peel” – like a bruise or cut, and swelling. A hard enough fall can an injure your brain itself. A concussion results from the brain moving back and forth quickly, causing it to “bounce” against the skull. This then causes swelling, stretching, and bruising to your brain cells. This damage can cause a person to lose consciousness and completely forget the incident all together when they wake up. They may vomit, become confused, disoriented and dazed, and even have behavioral changes. A concussion will undoubtedly cause headache as well.
When you sprain your ankle playing soccer, you have to sit out and allow it to heal before going back to play; Analogously, in a concussion, your brain was injured, and it is imperative that it rests before being used again. So how do you “rest” your brain? I evaluate a LOT of children with concussions in the ER (notoriously from a football injury), and this is the one positive I can tell the child after delivering the disappointing news that they are out of football for the rest of the season – they get a doctor’s note for NO HOMEWORK! They basically have a prescription to be lazy. No school, no reading, no TV, no electronics. They should do mild non-contact aerobic activity where there is NO chance of a repeat head injury. They are to do basically nothing that takes a lot of brain power or focus. This is “resting” their injured brain.
A stepwise approach back to normal activity then proceeds. When the child is completely symptom free for a full 24 hours, then little by little they can resume normal activity as long as they stay symptom free. Their progress should be followed closely by a doctor, who then can advise when it is appropriate to resume sports and school again. It is incredibly important that the child does not sustain another head injury before their brain completely recovers from the first. Their brain at this stage is very vulnerable and easily damaged further with even light collisions. A second concussion on top of the initial one can result in something called “second impact syndrome,” which is devastating and can cause permanent brain damage or death.
Thankfully the majority of children suffering a concussion completely recover within 1 month and can go back to normal activity. However, 1 out of 10 will continue to have prolonged symptoms for months, and occasionally years after a concussion. If the child has a history of migraines, is female, or the initial event was severe, they are more likely than others to have prolonged symptoms. If they don’t follow a conservative, monitored step-wise approach back to sports and school, they are also more likely to suffer from concussion symptoms longer.
Spring is here with inviting weather! Get your children outside on those bikes and rollerblades, but PLEASE make sure to protect their most important organ with a helmet. If a head injury does occur, consult with their doctor on how to care for their injury. After sustaining a concussion, a step-wise approach back to normal life as well as prevention of a recurrent head injury are necessary to prevent prolonged symptoms and serious long term consequences.