High Anxiety

My son’s transcript showed he had failed Business Law, a bad start for a kid considering applying to law school for…business law.  After emailing his professor to ask the particulars, he stumbled through the day in a haze of misery.  When he found himself enjoying something- a joke or nice weather, the happiness was quickly extinguished by the thought, “I’ve failed.”  One big worry: how was he going to explain this in a law school interview?

Later that afternoon his professor replied- it was just a mistake. My son’s final exam grade had not been entered into the system yet, which triggered the fail mark.  It would be fixed, and my son breathed an enormous sigh of relief.  But it took some time to shake that feeling of dread that haunted him for half the day.  Anxiety can be sticky.

Many teens, and elementary school kids too, are plagued by anxiety.  There’s school- worry about grades, fear of bullying, tense relations with teachers.  Home can make a kid anxious too- divorce, yelling, sometimes abuse. Many kids have concerns about their neighborhood- they have to live with the threat of crime, violence, and drug dealers on the corner.  Finally, kids see the news too, and worry about the world.  They hear stories about environmental collapse, threat of deadly epidemics, and the possibility of nuclear armageddon.

We are born with the tendency to be anxious.  Anxiety is a motivator cultivated by evolution, keeping us from getting eaten.  Worried about that sabre-toothed tiger eyeing you?  Good, run away!  Even animals as primitive as lizards have anxiety.  Just approach one, watch it twitch and scuttle about, before tearing off.

Some kids and adults are better at handling anxiety than others.  And many kids have manifestations of anxiety that look like illness.  That’s when we see them in the Emergency Department.  Sometimes the signs in kids are subtle- headaches, stomach aches, fatigue.  Sometimes they have more concerning symptoms, like chest pain or fainting. And occasionally we see true panic attacks.

When I was in high school, worried about getting grades good enough to be a doctor, I failed a french test.  The big red “F” on the paper burned into my brain at first period. But it wasn’t until fifth period that I became shaky, broke out in sweat, and was led sobbing to the nurse.  She called my parents to admonish them about putting too much pressure on me.  My mom replied, “It’s not us!  The stupid doctor thing is all his idea!”

Anxiety can make kids short of breath, and thus parents bring them to the Emergency Department. Some are just hyperventilating, but kids with asthma can have true attacks triggered by anxiety.  In fact, in the mid-twentieth century, when medicine was full of freudian theory, many thought asthma was a psychological disorder.  Even in the face of real wheezing, the noise was attributed to patients’ “suppressed cries for help”- wheezing was those cries fighting to get out. Fortunately, asthma is now recognized as true disease.

Sometimes it’s hard to tell the difference between a panic attack and medical emergencies like asthma.  Both kids have trouble breathing.  Both complain about chest pain and tightness.  And whether their shortness of breath is due to airway narrowing or panic, either kid looks anxious!  Occasionally it can be tough for even doctors to tell panic attacks and asthma apart, despite stethoscopes and oxygen monitoring.

How do we manage anxiety?  Kids handle anxiety differently.  Some aren’t bothered by stress, those proverbial ducks letting worries roll off their backs like water.  But some need help.  Counseling can help kids tell the difference between true medical problems like headaches and stomachaches, and those symptoms being triggered by worry. Many don’t recognize when they’re having anxiety, and knowing if you’re anxious, and why, is a big step in coping with it.

Counselors can also help kids identify management strategies.  For some, exercise helps “burn off” anxiety.  For others it’s prayer, meditation, yoga or other relaxation techniques.  A few kids need medication, to temporarily get them through rough patches as they learn to cope.

If you think your child is anxious, talk to them about their feelings, and maybe see their doctor to explore it more.  You want to do that before worry becomes panic attacks, and needing to come see me.

Sore Throats Hurt!

This week’s guest columnist is Dr. Chris Fontenot, a Family Practice resident at the University Hospital and Clinics here in  Lafayette.

Dreaded words at 7 pm on Friday night: “Mommy, Daddy, my throat hurts.”  Doctor’s closed, nowhere to turn.  It’s a common complaint, especially in my house with three girls. You’ve had sore throats yourself, and know-they hurt!

Pharyngitis- doctor talk for throat inflammation- accounts for about 12 million office and ER visits yearly.  Pharyngitis has two main causes- viral (about 85% of cases), and bacterial (about 15%).  Many viruses cause sore throats, like adenovirus, rhinovirus, and influenza (“the flu”).  The most common bacteria is Group A Streptococcus, a.k.a. Strep Throat.

It’s hard to tell the difference between strep and viral pharyngitis.  Besides throat pain, both cause headache, fever, and fatigue.  However, viruses tend to have more cough and runny nose.  But having those doesn’t exclude strep!

There’s a few rules for doctors to separate the two.  First, strep throat happens mostly after age 3- red throats in babies and toddlers are rarely bacterial.  Second, if the child has a fine-bumpy, sand-papery rash on the trunk and face, that’s the “scarlet fever” of strep. The most important rule is that, according to the US Centers for Disease Control (CDC), it’s tough to differentiate the two without a strep test.

The test is a throat swab that indicates if strep bacteria is present. It’s a good test, but not perfect, catching about 85% of strep throats.  Thus your doctor must weigh the symptoms, the exam, AND the strep test to decide if your child has strep.  If it’s strep, he needs an antibiotic.  If it’s viral, antibiotics don’t kill viruses.

This is the kicker for parents.  Sore throats hurt, and everyone wants them gone. Many want antibiotics, thinking they will help.  But they won’t stop viruses, and we don’t give unnecessary antibiotics for good reasons.  Antibiotics have side effects- yeast infections, stomach upset, and possibly allergic reactions.  Most importantly, when your body is exposed to antibiotics, bacteria can develop resistance to the antibiotics, and when you do need them to fight that bacteria, they won’t work.

We’ve all had throat pain, and it’s miserable.  Dr. Hamilton tells of having yearly sore throats as a teenager.  When he got them, he remembers praying for the pain to go, counting the days of misery, and vowing to never again take feeling good for granted!

Like we mentioned above, there’s no cure for viral sore throats.  The virus must run it’s course, typically 2 to 4 days.  If it’s a bacterial strep throat, which again is the minority of cases, only then will an antibiotic help.  So how to treat those viral illnesses that your child must “ride out?”

Dr. Hamilton doesn’t remember taking medicine for his sore throats, besides throat sprays and lozenges.  And often when we see kids in the Emergency Department, parents haven’t given anything for pain either.  For your child’s sake, please do!

There’s two medicines for pain and fever, perfectly safe for kids: Acetaminophen (brand name Tylenol) and Ibuprofen (Advil and Motrin).  These come in many forms and flavors to make them easier for kids to take- liquids, chewable tabs; and for toddlers who spit out medicine instead of swallowing, acetaminophen rectal suppositories. No prescription necessary.

Many parents, afraid to overdose their kids, don’t give enough medicine for the pain or fever.  Again, it’s quite safe to give what’s advised on the box for your child’s age or weight.  Still unsure?  Call your doctor’s office to double-check dosing.

Give lots of fluids to help your kid feel better.  She may not eat much, and that’s okay. Fluids are more important, and she’s not going to starve in a few days.  If she does want food, light meals are best, like grits, oatmeal, or soup.  Popsicles and ice cream can soothe throats too.

Keep your child out of school or daycare- don’t let them spread the illness to others. They won’t feel like learning anyway.  If your child has strep, they must stay out of school for at least 24 hours after starting antibiotics, since it’s highly contagious.

If your kid keeps getting strep after strep infection, your doctor can refer him to an ENT surgeon for tonsillectomy.  For the vast majority of sore throats though, 2 to 4 days and things will pass.  Push fluids, give pain medicine, and don’t take feeling good for granted again.

Training Dogs and Toddlers

My feisty little poodle, Milou, is all dog.  He’ll fetch endlessly, race around the yard chasing squirrels, and occasionally catch one in a lightening-fast wrestling match. Unfortunately he has a shrill bark that annoys everyone, especially my back-fence neighbor.  When he’s yelling at squirrels there’s no shutting him up.

One morning I was shouting “Come!” to get Milou inside.  Ignoring me, he continued yapping at squirrels through the fence, no matter how angry I got.  Why wasn’t he answering the command we had drilled and drilled?  Then I realized, I wasn’t using the same voice I did in practice!  Instead of a harsh, loud “Come!”, I usually used an upbeat happy voice; and practiced “sit” and “stay,” before walking away a few feet, and then “come.”

So I called out, “Sit!”  His head came around, yapping cut off.  ”Stay?”  His front paws came around.  ”Come?”  He tore back up the lawn and into the house, squirrels forgotten. I had re-learned the old training rule- dogs listen to voice tone more than actual words.

I remembered this some nights later at work, as I heard a mom shout at her 18 month-old daughter, “Sit down!  Shut up!”  I couldn’t see what was going on behind the exam-room curtain, but apparently the toddler wasn’t listening, as mom continued her tirade. The problem with dogs and toddlers, I thought, is that they don’t really speak English.

Silly as it sounds, training dogs and toddlers is similar.  Neither understands the meaning of words- meanings must be demonstrated by action.  Both want to please their parents, they just don’t know how, and need to be shown.  Both need consistent, kind guidance, with positive reinforcement of good behavior.

Take potty training.  First, your toddler sees what you do on the toilet.  Then you sit her on the potty, and wait patiently through many sessions until she poos or pees. When it finally happens, you reward that desired behavior with praise, and in the case of my daughter who loved band-aids, a pink band-aid stuck on her arm. You repeat that cycle for more sessions until she gets the hang of it.

My daughter who loved bandaids as a potty-training treat, hated time-outs.  No surprise, as time-outs are a punishment.  But she really hated them. When we put her in the chair, she would jump back out, until we strapped her in. When we turned her to face away, she would kick at the wall to knock her and the chair over.  After a few scares, we kept the chair just far enough away.

Time-out is another action-based training technique useful for teaching toddlers and dogs (and hockey players).  Instead of giving a positive reinforcement like treats or praise, time-out removes positive reinforcements from the trainee to show that a specific behavior is not desired.

Most parents use time-outs, and they are much more effective than harsh punishments like spanking.  However, a recent study in the journal Academic Pediatrics reported that 85% of parents do at least one time-out technique incorrectly.  64% made multiple mistakes.  Such errors included talking with the child while he was in time-out, giving multiple warnings before time-out, and allowing him books, computers, or toys while in.

To be most effective, you must remove all interesting interactions from time-out, including facing a wall so there’s nothing to look at. The child should be put in immediately for bad behavior, no warnings.  Multiple warnings only teach toddlers that they have multiple chances at bad behavior before punishment.

Place the child in with minimal emotional input- a firm voice telling them simply why she’s in time-out, no embellishments or scolding.  If your child wants to deny it or start arguing, ignore that.  Your toddler wants conversation and attention, so silence between you and him is the rule.  And no toys or screens in time-out- it’s supposed to be no fun! Time-out should last one minute per year of age: 2 year-olds get 2 minutes, 3 year-olds 3 minutes, etc.

Finally, all training, whether positive reinforcements with rewards, or time-outs with removal of rewards, requires consistency.  Like we mentioned above, dogs and toddlers don’t really “speak english;” they don’t understand the meaning of words.  Meaning must be taught by action, again and again, until it sticks.  And the amount of persistence equals the amount of good behavior you can expect from your toddler.  Or your dog!  

Rashes- The Home Triage

This week’s guest columnist is Dr. Justin Pratt, a Family Practice resident at the University Hospital and Clinics here in Lafayette. 

The nurse’s note read “rash.”  When I walked into the exam room, the mother’s eyes were wide with fear.  ”Doc, over the past 2 days he’s been having a reaction to the antibiotic he got earlier this week.  I gave Benadryl this morning and the rash is still there!  Is he going to be okay?”  Meanwhile, the patient, an 8 year-old boy, was lying in bed laughing at cartoons on TV. The rash certainly wasn’t bothering him much, unlike his mother!

Rashes can be distressing for parents of infants and children. They can appear out of nowhere, cover a large part of the body, and look awful.  The good news is that most rashes are not life-threatening and don’t need immediate attention. Some are caused by direct irritation of the skin, some indirectly like with allergies, and some by infections from viruses, bacteria, or fungus.

In the case of the boy I saw that Saturday night, his rash wasn’t a sign of anything bad, though it certainly looked weird.  It consisted of flat, paisley-shaped red blotches all over his body.  It didn’t hurt, didn’t itch, and he didn’t feel too bad. This rash, called erythema multiforme, turned out to be due not to the antibiotic,but from an infection called mycoplasma, a.k.a. “walking pneumonia.”  We changed his antibiotic to cover that infection, and off he went.

Every year there are about 12 million visits for rashes and other skin concerns.  68% of these are with the patient’s own doctor, leaving 32% to walk-in clinics and Emergency Departments.  How do you know if your kid can wait to see their pediatrician, or needs immediate attention?

First, don’t panic at the site of a rash, no matter how much of your child it covers.  Rashes are like fevers- the height of the fever and the amount of rash don’t correlate with severity. It’s more about how your child is acting with the rash.  If she’s calm, drinking easily, breathing comfortably, and awake and with it, then it’s not an emergency. Give benadryl for the itch, call your doctor for reassurance, and chill out.

This advice about how to respond to your kid’s rash, brings up an experience I had in my last year of medical school.  It wasn’t about a pediatric patient- it was ME!  I woke one morning after an itchy night.  I turned to my wife to ask if she had used a new laundry detergent on our sheets, and was met with a look of shock: “Justin, ARE YOU OK!?!” Besides being a little itchy, I felt fine.  ”Look in the mirror!  I think you need to go to the hospital now!”

I was covered with a rash from head to waist, my face beet red.  A little startling to see, but then I remembered my training.  When did it start?  During the night I guess.  Was I breathing okay?  Yes.  Were my throat, tongue, or lips swollen?  No.  Was it getting worse? Didn’t seem so.  Did I feel ill or have fever?  No. There, no emergency honey.

Was the rash raised and itchy?  Yes- thus probably allergic.  Was there peeling, crusting, pain, or weeping?  No- therefore probably not an infection.  Were there tiny red freckles that didn’t blanch when pressed on?  No- again not a serious infection.  What was different in the past few days?  Soaps, detergents, food?  Wait, I’d been stung by a hornet yesterday! The rash I had was urticaria, commonly called hives, a delayed reaction to the sting. When I saw my allergist later that day, she prescribed steroids, an antihistamine, and in two days I was better.

When deciding whether your child’s rash can wait for the pediatrician, or needs to be seen immediately, remember the important questions:  Does he appear ill (looking past that awful rash!).  Is there lip, tongue, or throat swelling?  Is she not breathing comfortably? Are there tiny red freckles that don’t blanch when pressed?  If yes, proceed to the nearest Emergency Department.

If no to these questions, relax!  Give benadryl, tylenol, or ibuprofen for itching, fever, or other discomfort.  Call your pediatrician if you need further guidance.  Like fevers, rashes are generally not emergencies.  Take a deep breath, take two benadryl, and call me in the morning. 

A Tale of Two Teenagers

Hard to believe, Amy loves the Army.  She’s in boot camp, enjoying lots of exercise, full days, new jargon to learn, and she even likes the lectures on Army protocol. It’s stressful to be sure; it’s supposed to be tough.  Some girls are fainting, some are washing out because they can’t hack it, some stay up too late and lose sleep. Amy has her eyes on the prize- graduating and moving up.  When she gets anxious, she swallows it and moves on. Uncharacteristic for her, she’s eating well and going to bed early.  Her parents are proud, not only for her accomplishment but for how far Amy has come.  Her life wasn’t always this way.

From an early age, Amy was having a rough go.  She had trouble paying attention in first grade, though she was highly intelligent.  She angered some teachers with her pointed, seemingly rude commentaries, though other teachers “got” her. She was tried on ADHD medications, which helped for a time, but then began causing side effects where Amy acted confused and panicky.  By high school, it was clear Amy was depressed.  She was sullen, didn’t get along with most of her classmates, and scraped out poor grades. Despite grasping the material, she just didn’t care enough to get papers in on time or study for tests.

Amy had no obvious reason for depression.  She had two loving, educated parents and two happy siblings.  At the first sign of trouble with attention or mood, she got the best doctors and therapists.  As Amy got older and was able to verbalize what was going on inside, it seemed her depression was “chemical:”  she was just born that way, with no external reasons like bullying or her looks.

Anti-depressant medication helped, as did continued counseling.  Her parents cheered her on through thick and thin, and as she got older Amy’s life began looking up.  College was much better than high school as far as academics and having friends. She had positive dreams for her future.  Joining the Army wasn’t her parents first choice; heck, even with a bachelor’s degree she enlisted rather than take on the responsibility of being an officer. But now they were singing a different tune.

Sharon has it much worse than Amy.  I saw Sharon in the Emergency Department last month.  She came by ambulance after being beaten by a gang of boys.  They ran up behind her, knocked her down, and kicked her repeatedly in the head and chest. There had apparently been some bad blood between Sharon’s friends and other factions in the neighborhood.

From our computer record I saw that Sharon had had a tough life already, though only 15 years-old. She had been seen by us twice for sexual assaults, another time for being beaten up, and once to be admitted to a psychiatric hospital for suicidal thoughts. She came from a rough house in a rough neighborhood.  Her mom obviously had mental illness of her own, from the pressured speech of hyperactivity or drug use, to her peculiar tattoos.  Mom yelled a lot, at Sharon and us, though this seemed to be not from anger but how she usually spoke.

Certainly Sharon’s depression has not gotten the attention that Amy’s did.  Though she had been in hospital for depression, Sharon isn’t on anti-depressants and isn’t in counseling.  Chaos rules her home life: her father’s gone, and she bounces between mom’s and the homes of several other families. Her school and neighborhood aren’t safe.

Despite all this, I have some hope for Sharon.  Kids can be resilient, and Sharon still had an occasional smile and some spunk, despite what just happened.  Mom also did seem to care about her, as did an aunt with her who seemed more emotionally stable.  They agreed that counseling was a good idea, and to see her doctor about a psychiatric referral.

Some kids like Amy are born with depression.  Some like Sharon, besides having inborn depression, also have life stresses that contribute.  Both kids need attention- counseling and maybe medicine to get them through bad patches. If your kid seems depressed, telling them to buck up and act happier isn’t enough.  You should ask about suicidal thoughts, why he is depressed, and see his doctor.  Depression is rough, so better that your kid gets the attention that Amy got, rather than Sharon’s. 

The Mumps Is Not A Muppet

This week’s guest columnist is Dr. Rati Venkatesh, a Family Practice resident at University Hospital and Clinics here in Lafayette.

This winter we’ve seen nearby outbreaks of Mumps in Arkansas and Texas.  Last week a mother brought her 3 year-old daughter into the Emergency Department worried about just that.  The girl had fever and headache and mom had just heard the news.  Instead the girl turned out to have influenza virus, which causes many of the same symptoms.  But this raised the question: what exactly is the Mumps?

Though it sounds like a muppet character, the mumps is an illness caused by a highly contagious virus.  The classic sign of mumps is swollen parotid glands, which are glands at the back of your cheeks.  When they swell you look like a chipmunk. Mumps usually starts with fever, headache, and maybe vomiting.  Symptoms also include cough, runny nose, poor appetite, muscle aches, and generally feeling run down.  Sure sounds like the flu- no wonder that mom was worried!

The biggest concern about mumps is that in rare cases it can cause encephalitis, or brain infection and swelling.  In teenagers and adults, it can also cause exquisitely painful swelling of testicles or ovaries.  Before the mumps vaccine was invented in 1967, people were understandably scared of this disease. Now with the MMR (Measles/Mumps/Rubella) vaccine, mumps has mostly passed into history books, except for the occasional case.

If there is a nearby outbreak, what do you do?  First, speak to your doctor.  If your child has concerning symptoms, she can order the mumps blood test.  A big clue to whether your child has the mumps is exposure- was your child around someone with mumps? Figuring this out can be tricky, because it can be weeks after exposure before you begin to have symptoms.  Who remembers where they were two weeks ago- it’s tough enough remembering what you had for lunch yesterday!  So usually when it comes to the individual kid, we count on the classic chipmunk-cheeks to make the diagnosis.

How do you get the mumps anyway? Transmission is by respiratory droplets, which means an infected kid coughs and sneezes, or wipes his slimy hands, on his playmates.  The new victims stick those virus-laden droplets on their fingers, into their noses and mouths.

So to prevent mumps, kids should do the things to prevent catching other infectious diseases, like colds and stomach viruses: they should wash their hands.  Frequent hand-washing should be taught and encouraged at home and school.  Hand sanitizer dispensers are readily available in public places, and are a reasonable substitute.  I teach kids to wash hands to the Happy Birthday song- if you wash all surfaces of your hands using the amount of time it takes to sing the song, you’ve done a great job of disinfecting.

Also use disinfectant wipes to clean household and school surfaces.  Those respiratory droplets and their viruses can linger on tables and doorknobs, and contaminate unsuspecting hands that touch them later.  Teach your kids to cough and sneeze into the crook of their elbows- this keeps grubby hands from infecting surfaces too.

If your child gets the mumps, the only treatment is for symptoms- there’s no medicine to make it go away quicker.  Use acetaminophen (Tylenol) or ibuprofen for pain and fever.  The chipmunk cheeks or swollen testicles of mumps can really hurt, so don’t skimp on those medicines!  Ice packs can also soothe these sensitive parts.  Most kids and adults get over mumps in about 2 weeks.  Occasionally children need hospitalization for pain control or IV fluids.  If they get encephalitis, they’ll need intensive care to control brain swelling.

Vaccination is great protection against mumps.  Kids get their first MMR shot at 12 months-old, and the second before kindergarten.  This vaccine is very safe, much safer than the car ride to the doctor’s to get it!  Some get a mild fever a week after vaccination, but serious complications are quite rare.  Like any vaccine, your child is incredibly more likely to catch and be harmed by mumps, than be harmed by the vaccine.

So all concerned moms and dads out there, if your child has flu-like symptoms (cough, fever, headache, fatigue) with swollen cheeks, it might be the mumps!  See your doctor for testing.  But with vaccination, odds are you won’t ever be in this worrisome place.

2016- The Worst of Times?

My son came home from college, shaking his head. His fellow millennials were lamenting that 2016 was the worst year ever: “David Bowie and Prince died!” My son’s response: “Worst year ever?  What about 1939?”  Nazis starting World War II was a lot worse than some celebrities passing away.

As a pediatrician, I saw many good things about 2016. While preparing for my yearly mission trip to Honduras, I’m reminded of positives for even the most impoverished U.S. citizens- clean water, with no risk of cholera.  And while some American kids go hungry, there isn’t the abject starvation of the third world.

Though we worry about the environmental impact of coal, oil production, and car exhaust, we enjoy pretty clean air compared to the third world.  Their vehicles and factories have unregulated emissions, families cook inside over open fires, and farms often practice slash-and-burn techniques.

In fact, Americans suffer from too many good things.  Too much food and too much sitting around looking at screens leads to obesity.  2016 has highlighted another rising glut- too much information.  The recent presidential race has revealed growing anxiety about which information is real, which is made up.  Is this candidate telling the truth?  Where are they getting their facts?  What are the facts, and where to find them?

There was a recent political cartoon depicting two people looking at cellphones, wondering if the news they were reading was real or fake, and how they could find out. Standing behind them was a newspaper stand.  A subtext of the joke is that many no longer trust information from traditional sources, like newspaper and TV media, government, or science.  Too many conspiracy theories, too many scandals, have undermined faith in these traditional institutions.

As a doctor, my decision-making relies on good data.  It’s a professional duty to find facts for the good of the patient. Newspaper and TV media and government scientists are the same.  The vast majority of journalists and scientists are professionals, diligent about getting facts right.  You can trust them for the best information, better than random websites. When looking for medical information, like about vaccines, go to the Centers for Disease Control or the American Academy of Pediatrics, rather than some un-credentialed crank.

Besides cataloging the year’s best and worst, a favorite new year pastime is making New Year’s Resolutions.  I’m not big on resolutions myself. Doctors have to continually make new good habits and throw out old ones, as medical knowledge evolves. Nothing’s special about New Year’s when it comes to medical innovation.

I don’t encourage New Year’s resolutions in others either, as humorist Dave Barry wrote, “so that you can become a better you- a more-attractive you, an organized you, a you that is…well, less like you.”  This column is always about making good habits all year, throughout your childrens’ growing-up, so they are safer and happier.

Good habits aren’t actually hard to make when there’s quick results. New Year’s resolutions, the good habits that we continually fail to make, are the ones that require persistence to get to the pay-off.  Losing weight or exercising are commonly failed resolutions because it’s months before you look or feel better, while you suffer through cravings and pain.  Quick pay-off habits, like always putting your car keys in your left pocket so you never lose them, are easy to develop.

Here’s an easy habit to keep your kids happy, healthy, and safe: get them a doctor and dentist.  Many kids I see in the Emergency Department don’t have these. Some kids don’t get sick much, so their parents stopped taking them for yearly check-ups. When the kids do get sick, they get taken to a walk-in clinic or ER.

However, doctor and dentist practices help you keep good habits.  At yearly check-ups, they discuss how to keep your kids well, appropriate to their age and development.  If your kid’s a toddler, they discuss tooth-brushing and toddler-proofing the house.  For teenagers, it’s about acne, wearing seat belts, and not getting pregnant.

My dentist’s office books my next appointment before I leave.  Six months later I get two phone calls to remind me when to come. That’s a slick outfit- they keep their patients coming in, and my my teeth stay clean.  Get your kids a dentist and doctor with such a well-run office.  They’ll do your New Year’s resolution work for you. 

Forever Seared Into My Memory

This week’s guest columnist is Dr. Aaron Foster, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Forever seared into my memory is the image of my friend, running down the dock at summer camp, his body engulfed in flames.  Behind him trailed burning footprints, lighting his path in the night.  All boys are fascinated by fire, and at age 14 we discovered that aerosol bug spray was flammable, and would briefly burn on your skin without causing injury.  This led to the scene of my friend, doused in flaming insect repellent, running down the dock to jump in the lake.  Luckily he survived the ordeal unharmed, minus some hairs on his head and eyebrows.

Many children, though not as foolish as we were, are not as lucky either.  According to National Institutes of Health (NIH) statistics, a quarter of all burns treated in the U.S. involve kids under age 16.  While teenage foolishness may be unavoidable, burns are largely preventable.  The incidence of burns, and most importantly severe burns, has decreased in recent decades.  This is due to improved building codes, education in schools about fire escape planning, and smoke detectors.  Yet burns do still occur, and fortunately most of these are minor.

As a medical student I spent time on a burn ward, and saw many different types and severities of burns.  One thing that stood out for me was the disproportionate number of young children admitted for burns.  According to the NIH, most pediatric burns happen to kids under age 5.  Most of these are scald injuries, and occur in the kitchen.  And given that we adults are in charge of the kitchen, these are avoidable.

Preventing burns includes common sense things like keeping small children out of the kitchen while cooking.  Don’t carry children and hot food at the same time.  Advice that might seem less obvious: turn the pot handles on the stove inward, so they don’t stick out where kids can grab them.  Make sure appliance cords don’t hang over counters either, for the same reason- curious children grab stuff, and if that stuff is hot toasters or pots full of boiling soup, disaster can ensue.

Several times in the past in this blog, Dr. Hamilton has mentioned that most of the burns he sees are when little kids take hot bowls of noodles out of microwaves.  Someone else happens along, bumps that big, in-the-way microwave door, and the bowl spills on the child.  In my time as a medical student on the burn ward, I also saw a lot of kids burned when they pulled on a tablecloth that had a container of hot liquid on top.

As we mentioned above, kitchen burns can be prevented with a little extra care.  Small children should be kept out of the kitchen while hot food is being prepared, and should never operate microwave ovens without an adult hovering.  Pot handles and electric cords should be out of reach.

After age 5, burns happen more with open flames.  This includes campfires and bonfires, and fireworks.  Open fires should be contained within fire pits, with no flammables (extra wood, long dry grasses) close by.  Kids shouldn’t wear loose flowing clothing near fire, or clothes that easily catch fire with a spark (synthetics).  And though it seems obvious (to the sober), don’t throw lighter fluid or gasoline on open flames.  We see too many kids who get engulfed when those fluids become an exploding cloud.

Though we do our best to prevent children from harming themselves, burns happen. Fortunately the vast majority do not require seeing a doctor.  Small burns can be managed at home by remembering the 5 C’s.  Clothing- immediately remove any clothing involved, so that the hot liquid or flaming clothes don’t continue to burn. Cooling- cool water stops the burning process, and feels good too!  Cleaning- soap and water is sufficient, to minimize infection if the skin barrier is compromised.  Cover- put on antibiotic ointment generously and cover with gauze.  This also soothes, and prevents infection. Comfort- pain relief with Tylenol or ibuprofen.

When should kids see a doctor for burns?  Burns that blister, or are larger than the area of the patient’s hand, or involve faces or joints, should get seen.  Kids should have up-to-date tetanus vaccines, since burns increase the risk of tetanus infection. 

‘Twas The Night Before Christmas- AAUGH!

According to the American Academy of Pediatrics, Christmas is only slightly safer for kids than riding bikes no hands, eyes closed, on the roof.  The AAP website has a three page list on avoiding flaming disaster in the living room.  To be fair, their are some extra hazards in the season.  However, my experience in Pediatric Emergency is less about Ralphie shooting out his eye with a Red Rider B.B. Gun, and more about toddlers chewing Christmas tree light bulbs.

Toddlers love putting brightly colored, shiny objects in their mouths.  Decorative light bulbs have thin glass, easily cracked when bitten. Fortunately, the curious kids get only a few minor cuts in their mouths and quickly heal. Occasionally we see more traumatic ingestions when toddlers get a tiny bit of Christmas lodged in their airway or esophagus and need surgery for removal.

No matter how well your house is toddler-proofed, with cabinets locked and choking hazards swept away, Christmas undoes all that.  It’s impossible to police boxes of decorations, toys with tiny pieces, things hanging off Christmas tree branches. Thus one more holiday stress: having to watch your cruising babies extra carefully with all that stuff around.  Best advice: keep decoration ambitions small and manageable.

The next realistic Christmas safety worry is kids and dogs.  Kids and dogs interact more during the holidays, either with new dogs as presents, or visiting friends and relatives with dogs.  Trouble starts when kids want to meet the pooch, poochie gets nervous about approaching strangers, and bites them in the face. Best advice: don’t get a new dog until your children are 5 years-old, when they can learn to treat animals safely. Closely supervise interactions between your child and others’ pets.

Fires are another seasonal worry.  The Christmas tree tradition started in Germany, with candles on them for illumination.  My dad lived there in the 1950s and told of proud Germans who eschewed electric bulbs for old-fashioned candles, and the busy Fire Brigades racing from one tragic house fire to another.  Even with electric bulbs, trees fires are possible. Trees dry out easily, are covered with flammable ornaments, kindled with paper wrapped gifts, and stand next to overloaded power sockets.  Keep tree water filled, and unplug lights overnight.

Besides physical risks for kids at Christmas, the season is emotionally stressful. Parents get overwhelmed, and kids too.  We’re looking for Peace On Earth and Good Will among men, yet find ourselves cutting each other off for parking spaces at the mall.

One source of stress is that during Christmas we are supposed to be happy, and are disappointed when the season isn’t any happier than usual.  The disappointment is even more acute when we become less happy due to seasonal hassles.

The list of things that drag on us at Christmas continues: overeating, driving through traffic to shop in mad crowds, dragging decorations out, extra cooking.  And while visiting family is usually a good time, you also visit some you don’t like (you moved so far away for a reason).

Kids get stressed too. They overeat, and eat too many things that cause stomach-aches. They stay up too late, and are exhausted the next day.  They get sick- it’s the cold and flu season after all.  And parents aren’t paying them enough attention because we’re too busy on a regular day, and adding a Christmas list makes that worse.

Besides the safety cautions from above, you need a strategy to minimize holiday hassles for you and your kids.  Most importantly, keep it small.  When it comes to decorations and shopping, small and tasteful beats big and garish.  Make small amounts of special Christmas food and involve the kids when you do, so cooking becomes more of a positive for you both.

Second most important: keep the kids’ routine.  Make bedtimes and meal times pretty normal.  If things get chaotic, kids get more stressed.  Again, make sure your kids are mostly eating a regular healhy diet.  And like we say in almost every column in this series, everyone’s should wash hands- that’s the best prevention for illness.

Humorist Dave Barry wrote: “No matter how hectic it gets, you need to remember what the holidays are all about…exactly how much can you charge on your credit cards before going to jail?”  Don’t be that Christmas parent; keeping it simpler equals Peace On Earth.

You Don’t Want The Flu!

This week’s guest columnist is Dr. Chad Mathews, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Flu season is here.  If you’ve never had the flu, you’re fortunate.  Dr. Hamilton tells the story of when he had it.  Besides the cough, headache, and body aches, he was under the covers shivering violently from fever despite having taken both ibuprofen and Tylenol.  He was shaking so badly he swore he had something worse than influenza, though tests showed that’s all it was.  Since then Dr. Hamilton gets the shot every year.

The “flu” we’re talking about is the Influenza virus.  It affects all ages, little ones too.  It usually attacks the upper airways, causing cough, runny nose, and sore throat.  It can also affect the GI tract, with vomiting and diarrhea.  What’s universal is a whole week of misery, with headache and fever and hit-by-a-truck fatigue.  It’s particularly rough on babies, and children with asthma, who are at risk for complications like pneumonia and dehydration.

While most viruses have no treatment and must run their course, influenza is one of the few with a medicine that can help- Tamiflu.  Tamiflu may shorten the time kids are sick, and make them less contagious.  It should be started within 48 hours of onset of illness or it won’t help at all, and it only shaves a few days off the week of misery.

Thus the best treatment will always be prevention.  Influenza is highly contagious, easily passed between kids by coughing and sneezing on each other, and touching each other with infected hands; in other words flu is passed when kids “slime” one another.  Kids should therefore be taught to cough and sneeze into their hands or elbow crook, and wash their hands often.

The other extremely effective weapon against influenza is vaccination.  To illustrate the vaccine’s effectiveness, a 2014 study showed 74% decreased pediatric intensive care admissions in vaccinated kids; meaning 74% fewer kids got influenza’s life-threatening complications.  And a flu vaccine not only protects the kid who gets it, but all the other kids around him whom he WON’T infect.

I know one old Cajun who just won’t get the influenza vaccine.  He agrees it’s a good idea and used to get the vaccine every year.  However, he got sick every year right after the shot.  In fact, it seemed he was getting the flu itself- long lasting cough, fever, aches, fatigue, upset stomach.  “Ain’t goin’ do it,” he exclaims, “had enough gittin’ sick from dat shot!”

Like we mentioned above, influenza virus is highly contagious, and highly miserable.  It comes around in wintertime, makes you and your kids feel rotten for a whole week, and spreads easily.  Besides hand washing and avoidance, vaccination is the best way to prevent getting it.

Why do you need a shot every year?  Don’t you stay immune?  Unfortunately, every year the influenza virus changes chemically- it evolves to fool your immune system and sneak by.  So every few years scientists have to make predictions about how the virus might change, and tweak the vaccine’s design. Then you need the new shot to cover the new strain.

What about that old Cajun who believes he gets the flu from the shot?  I’ve encountered other families who refused the vaccine because of this concern.  However, it’s impossible to get influenza from the vaccine.  This is because the virus in the vaccine is either “inactivated,” meaning it’s ability to reproduce in your body has been removed, or the vaccine is “recombinant,” meaning that only pieces of the virus are in the vaccine.

So saying you can get the flu from the vaccine is like saying you are going to drive your car to the store, even though the engine has been removed (“inactivated”), or the only parts of your car available are the steering wheel and a fender (“recombinant”). Either way, you’re not getting to the store.

People who seem to get influenza from the vaccine are actually catching the flu (or other illnesses) around the time they’re getting vaccinated, but before the vaccine can “take.”  If you’re in the office waiting for your shot, and the kid next to you already has it and coughs on you, too late!  You’re going to get sick before your immune system has a chance to build immunity to the virus.  Bad luck!