My Parents Versus My Dentist

I will always remember my childhood dentist, Dr. Tarentino.  I will especially remember his eyes, boring down into my mouth as intensely as his drill.  Though my parents were smart people with advanced degrees in Theology, they could be remarkably naive about personal health care.  As a toddler I loved to walk around with a bottle in my mouth, and they let me. Since milk was expensive and filling, they substituted Kool-aid for my habit.  Thus my memories of Dr. Tarentino, his eyes, and the scream of the drill.

We non-dentist doctors see lots of tooth problems in the Emergency Department.  There are too many kids out there with bad dental hygiene, which leads to cavities, which leads to tooth pain and infection.  Yet only a few minutes per day of tooth care prevents such misery.  First, supervise your kid’s brushing.  Many parents tell their kids to go brush their teeth, and minutes later the child reports- job done!  But how good a job?  When kids are left alone to brush, they often just do a couple of strokes on a couple of teeth before moving on.  From an early age, be there to watch your kids brush every time, insuring that they get all tooth surfaces, brushing gently instead of scrubbing like they were taking off old paint.

Start tooth care at an early age.  After all, your kids get teeth in the first year of life.  Get them used to brushing as soon as they have teeth, again, gently!  You don’t want it to hurt and make them hate brushing.  If it is a habit when they are so young, it gets ingrained as a habit for the rest of their lives.  Bring them to the dentist early as well- as young as age two. Then they learn that the dentist can be fun and every dental visit won’t mean pain.

Unlike my parents, avoid that sugary diet.  We all have bacteria in our mouths, no matter how much brushing and flossing. Dental hygiene keeps down that bacteria that hurts our teeth.  Sugars in our diet feed that bacteria, which turn that sugar into acids which burn into our teeth.  Those burn holes are cavities.

It always seems that the tooth pain cases come in at night.  The lights are down, the house is finally quiet, there are no more distractions for a kid.  WIth the quiet of bedtime comes the realization that something has been hurting- ouch, its my tooth!  The child cries and the mom finally has time to notice that the side of the child’s face is swollen. They rush into the Emergency Department with their tooth infection.

However, dental infections are not sudden emergencies.  By their very nature, they are slow-growing illnesses.  It starts with a cavity.  Over weeks and months, the mouth bacteria that started the cavity chew deeper into the tooth.  The cavity finally gets deep enough to infect the gums.  The infection causes inflammation, swelling, and terrible pain in one of the most sensitive parts of the body.

Actually, dental infections don’t start with a cavity.  They start with bad mouth care. As we mentioned above, unsupervised brushing, along with not flossing and too much sugar, allow mouth bacteria to get out of hand and begin to eat into the child’s tooth surfaces. Tooth infections also start with children not getting enough flouride in their diet. The American Academy of Pediatric Dentistry is very clear on the science- communities with flouride in their water save lots of money and anguish not having to care for so many rotten, painful teeth.  In places where the water is not flouridated (Louisiana), the AADP recommends flouride supplements for children.  In other words, Louisiana children should take flouride just like they would take any other vitamin.

Back to my parents, who let me toddle about with a kool-aid bottle in my mouth and thus support my childhood dentist’s practice .  My parents were wonderful people who did more good in the world than I can ever hope to approach.  They raised three happy successful boys. Just don’t follow their lead in their third son’s dental hygiene.




The Ugly Truth About the Runs

This week’s guest columnist is Dr. Eric Guilbeau, a family practice resident at the University Hospital and Clinics here in Lafayette.

Emma comes home from school and tells her mom that her belly hurts and she doesn’t feel good.  Mom tells here to lie down and rest and she will feel better.  About 30 minutes later Emma yells for mommy!  When mom walks in she finds vomit in the bed, all over the pillow and sheets.  Mom grabs Emma and runs to the bathroom where Emma starts to vomit again, now with diarrhea.  After a day or two mom brings Emma to the Emergency Department because Emma has no energy and cannot eat or drink.  Emma is diagnosed with Gastroenteritis.

Gastroenteritis is commonly known as “the stomach bug,” “stomach virus,” or even more simply “virus.”  Sometimes people use “rotavirus” to mean all vomiting and diarrhea viruses, though rotavirus is just one of many viruses that cause these symptoms.  Viruses are microscopic chemical machines that invade the body.  They enter the body by the mouth through contaminated food or when the victim puts a contaminated hand in the mouth.  The viruses burrow into the body’s cells, take the cells over, and start the fun.

The signs and symptoms of gastroenteritis start about 1 to 3 days after the virus enters the body.  It takes that long, what we call the “incubation period,” for the virus to spread and take over enough of your stomach and intestines to start the symptoms.  Thus if Emma touched an infected doorknob at school on Thursday and a few minutes later played with her lip, she could expect to start acting sick by Friday or Saturday.

What can Emma then expect?  Watery diarrhea, vomiting and nausea, fever, headache, and fatigue.  Usually kids will vomit for the first half-day, then have diarrhea for a few days more.  However, it can be normal for symptoms to last 7 to 10 days!  Parents should seek help when the child has lots of pain, bloody diarrhea, or is dehydrated.  Parents should watch for worsening pain, increasing sleepiness, no urine for 12 hours, dry mouth, sunken eyes, no tears when crying.

Sometimes when we tell a parent a diagnosis like Gastroenteritis, the parent gives us a skeptical look.  How can we know just by looking- shouldn’t we run some tests?  Well, the vast majority of illnesses are diagnosed from the medical “history.”  The history is simply the story of your child’s illness.  When did he start getting sick?  How much did he vomit and have diarrhea?  Was he around other sick kids or family?  How is he acting now?  Is he making urine?  Then the doctor uses the physical exam to confirm what she thinks is the diagnosis, and further assess for signs of dehydration or more serious illness- dried out mouth, decreased circulation, tender stomach, patient responsiveness.  Tests are only necessary if the doctor is concerned about serious dehydration or a more serious illness that is masquerading as gastroenteritis, like appendicitis.

How is gastroenteritis treated?  The most important management is preventing dehydration.  Most gastroenteritis is mild and can be treated at home: pedialyte and breast feeding for infants, dilute juices or sports drinks like Gatorade or Powerade (Gatorade G2 is particularly good) for older kids.  If your child cannot stop vomiting or has worsening dehydration, she might need IV fluids.

Here are some home instructions for parents:  After the child stops vomiting, feed with only clear fluids as above for six to eight hours.  This lets the stomach settle before trying solid foods.  Ease back into eating after about 6 to 8 hours of the fluids; the stomach may not be ready for food or milk before then.  Avoid fatty or seasoned foods and let your child get plenty of rest.  The first two days of vomiting and diarrhea are not good times to rush your child back to school.

Most importantly, teach your kids to prevent getting Gastroenteritis.  Teach them to wash their hands after using the bathroom and before eating.  Teach them not to put their hands in their mouth so much. When they do get sick, keep them home for to rest from school. Loving care at home is the best medicine.




The Dark Side of Fluffy and Rover

It really wasn’t the boy’s fault.  He was playing in his yard when a stray dog wandered over. The dog jumped up and bit the boy on the side of his face. The dog fled and Animal Control couldn’t find it.  Rabies is in the area and there was no way to know if the dog was rabid without capturing and quarantining it. So we had to assume the worst, and start the boy on the rabies vaccines.  The vaccines aren’t so bad- no worse than regular vaccines.  But the rabies immunoglobin, a medicine to prevent the rabies virus spread, must be injected right into the wound.  It was not a good night for the boy or me.

Dog and cat bites make up plenty of pediatric ED visits.  Usually it’s a neighbor’s animal or the family pet at fault.  Occasionally it is a stray.  When a child gets bitten, there are lots of medical problems to address.  The most obvious worry is the wound itself.  Kids explore with their faces and hands and want to touch and look closely at any animal. If they get too close and the animal feels threatened, it protects itself by lashing out with tooth and claw. The resulting face wounds sometimes leave scars that even plastic surgery can’t hide. Then there is the worry about infection.

There are three infections that dogs and cats can transmit.  The biggest worry is rabies. Rabies is a virus that wild animals get by biting each other.  Rabies attacks the brain, makes the animal go mad and bite other animals (and thus pass the virus on), and then the animal dies.  It is very rare for any animal, or human, to survive rabies once the infection takes.  The next concerning infection is Pasteurella, a bacteria for which we give antibiotics.  The only face laceration I remember getting infected was from a dog bite, though the child was on antibiotics.  The third infection is Tetanus.  This is another good reason to be sure your kids are vaccinated because like rabies, tetanus often kills.

The newspapers recently ran a story from Oregon about a 22 pound cat named Lux who attacked his family.  The seven month old baby pulled Lux’s tail, so Lux swiped the baby in the forehead with his claw.  Then he got so aggressive that he trapped the parents in a bedroom until police arrived.  Even more concerning, the family is keeping the cat, getting it “therapy.”  Now, cats are carnivores, meat-eaters who are hard-wired to hunt, kill, and eat.  Some are nicer and more family friendly than others, but I doubt that any therapy will help Lux and a baby get along.

My point is not to give cats a bad rap as pets, but to illustrate safety issues.  The first thing is to not have a pet with a toddler.  Toddlers are explorers.  When they explore things they touch them, peer at them, and grab and pull on them.  Dogs and cats are often patient with such behavior, but not always. You can’t know when the ancient purpose buried in their DNA (defend, hunt, kill, eat) will come out with such treatment.  Wait until your kids are school age before getting a dog or cat.

Another safety concern is fencing for dogs- to keep them in, or out.  Fences keep your dogs and kids in and away from the neighbors. They also keep other neighbor’s dogs or strays out.  Also, pick a dog breed that is less aggressive.  Terriers, pit bulls, chows, and breeds like them are more aggressive and more difficult to train.  Poodles and retrievers tend to be safer with kids.  Veterinarians can help you pick a breed and tell what behavior to look for in an individual dog.  Finally, teach your children how to treat pets and other animals. Pets are not play-things or wrestling partners.  They need to be played with in appropriate ways, and need to be trained to do the same with your kids.

Feel free to get a pet: dogs, cats, and humans have been great companions for thousands of years.  However, dogs and cats have been hunters for even longer- treat that knowledge, and them, with respect.


Ah Choo! My Child Always Has A Cold!

This week’s column is from Dr. Susila Shanmuganathan, a family practice resident at the University Hospital and Clinics here in Lafayette.  

Another runny nose?  Don’t they know this is an Emergency Department, and cold viruses are hardly an emergency?  When we finally interview mom though, her frustration comes through.  Her child has been sneezing, rubbing her eyes and face for weeks, and mom is fed up.  The kid coughs all night and none of the cold remedies have touched it.  Maybe its not just a virus that should have gone away weeks ago.

Does your little one always have the sniffles?  Is she constantly rubbing her eyes and wiping her nose?  Your child may have Allergic Rhinitis, also known as seasonal allergies or hay fever.

Allergic rhinitis is a common problem in infants and children.  The symptoms can vary, the most common being a clear runny nose, sneezing, and itchy red eyes.  Kids may have dark circles under their eyes (“allergic shiners”) or a crease across their nasal bridge caused by constantly wiping their noses upwards (the “allergic salute”).   Children may also have a cough that is worse at night.  These symptoms are often worse at certain times of the year when there are more pollens and other allergens in the air.  Some people have allergies to year-round, indoor allergens like dust, pets, and molds.

So what the heck is an “allergen?”  What is pollen exactly?  Allergens and pollen are tiny bits of plants or animals that are so small they cannot be seen.  Often they are so small and light that they float through the air.  When they get up some kids’ noses or in their eyes or in their lungs, the kids’ immune systems react against the allergens and try to flush them out. The body makes extra mucus and tears to wash them away.  The body also makes sneezing and coughing to blow the allergens out.

Allergies can be a real burden.  All that itching and sneezing and coughing- it really irritates. It’s harder to play, it’s harder to pay attention in school, it’s harder to sleep- life is a lot less fun!  So what can you do to control these symptoms?  First, there is no need to get frazzled.  There are some simple things you can try at home before visiting your doctor or allergist.  The easiest thing is to avoid exposure to allergens that seem to make your kid worse- pets, dusty areas, certain plants.  Look for weather reports with pollen counts. If the day’s pollen counts will be high, avoid outdoor activities.

For medicines, you can start with an over-the-counter antihistamine like loratidine (Claritin) or cetirizine (Zyrtec).  Though you can use these medications on an “as needed” basis, it may actually be nicer for your child to use them every day so you don’t end up chasing symptoms.  It’s best to start these medicines right before your child’s allergy season and use them every day throughout that season.  As stated before though, some kids have year-round allergies and need to be on medicine every day all year.

If your kid needs better medicine than those, see your doctor about nasal steroids such as Nasonex, Flonase, or Nasacort.  They are a little more trouble to use, but they work better than the antihistamine syrups.  If those don’t cut it, then it is time for allergy testing to better find out what allergens to avoid.  Your child may need more medicine, or allergy shots. Many parents worry that their child won’t tolerate getting an injection every week.  It’s a judgement call between the parent and the allergist: sometimes the shots are a whole lot better than living with constant itching and sneezing and sleep deprivation.

But remember, there are simple things you can do at home and symptoms to look for before you worry and head to your doctor or the ER.  Avoid the pet dander and pollen.  Try the first-line antihistamines.  Although our kids might love animals and the outdoors, sometimes it may take their breath away…Ah choo!




Screamin’ Down The Road- Traveling With Children

On January 13, 1982, Air Florida Flight 90 crashed into the icy Potomac River in Washington during take-off.  Joe Stiley, one of the few survivors, saw the crash coming, seeing out his window how the plane was falling to the river.  He tucked into the “brace” position and told his secretary sitting next to him to do the same.  The plane crashed into a bridge and then into the Potomac.  Joe blacked out and awoke with the cabin full of water. He methodically unbuckled his seat belt, undid his secretary’s, and they swam to the exit and to the surface.  Joe was one of the few people who bothered to read the safety card every time he flew, note his nearest exit, and count how many seat rows to that exit.

In disasters like these, surviving comes down to following safety instructions to the letter, immediately.  When you are flying, read that safety card every time.  Look up and find where your exits are.  Read how to open the emergency doors.  If the oxygen masks come down, put yours on first so you don’t black out before you can get your child’s on. Leave your luggage behind- trying to take it with you slows down everyone else’s exit.

However, don’t be put off from air travel.  My family and I love to fly and it is as safe as sitting in your bedroom.  Disasters like above are very rare.  In fact, the most dangerous part of any flying trip is the car ride to the airport.  Most of us drive more when traveling with our families and cars are much, much more dangerous than airliners.

So wear those seatbelts and buckle your kids into car seats properly.  Check your tires before long car trips.  And here are a few tips to keep your kids happier so they don’t distract from your driving.  Let them drink only water.  If kids drink soda or juice, they will have to take more bathroom stops.  With water, they only drink if they are truly thirsty. Have snacks and entertainment for them- DVDs, games, books.  On long drives my family loves books on tape.  We so enjoyed Harry Potter that even after an 8 hour car ride, we would sit in the driveway at home just to hear the end of a chapter.

Hotels are another safety and comfort consideration.  At 5am one morning in a hotel in Mobile, the fire alarm went off.  Being well trained by their Emergency Dad, my family popped immediately out of bed and headed for the exit.  In fact Mr. Prepared was the last out, having a little trouble getting my shoes on.  We were all the way down the stairs before all-clear was called.  On our way back up, we were surprised how few other guests had even peaked out to see what was going on.  In a real fire, I sure like my family’s chances better than theirs.

In her book The Unthinkable, Amanda Ripley shows how people survive disasters.  In airplanes it means following your safety card like Joe Stiley above.  In hotels it means practicing finding your exit, crawling on your hands and knees under smoke. Count the doors to the stairwell.  Go down the stairs- it’s fun to pop out and find yourself in some forgotten alley and make your way back.  Don’t stay above the fourth floor- that’s as high as Fire Department ladders reach, in case fire traps you in your room.

Again, keeping your kids comfortable in hotels makes traveling more fun.  Use that hotel pool!  Exercise after sitting in a car all day will help them sleep.  Keep your usual routines- eat together, read bedtime stories, be calm and unfrustrated.  Bring comfort medicines- ibuprofen or tylenol for aches, cough drops for dry throats in dry hotel air.  Searching for a pharmacy at 11pm in an unfamiliar town is a real drag!

So when traveling, be prepared.  Review and follow all safety tips.  Buckle up.  And don’t forget your bathing suits!


Seizures And Fevers: No Brain Frying Here!

This week’s guest columnist is Dr. Devan Szczepanski, a family practice resident at the University Hospital and Clinics here in Lafayette. 

Mrs. Breaux gets a phone call at work from Sue’s daycare.  Sue needs to be picked up because she has a fever.  When Mrs. Breaux arrives, the teacher explains that 15 minutes earlier Sue fell to the floor and began shaking all over.  The shaking lasted about one minute, then Sue relaxed and slept for about 10 minutes.  Now she is waking up and when Sue sees her mom she runs over with bright red cheeks and gives mom a hug.  The teacher is concerned and insists Mrs. Breaux bring Sue to the Emergency Room. However, Sue’s mom has seen this before and knows there is no need for panic. Marco, Sue’s older brother, also had febrile seizures.

Febrile seizures are much more common than people think!  Up to 4% of children will experience the “hot shakes” before 5 years old.  They sure make parents scared. Many parents are worried enough about fevers alone.  Imagine adding some seizure activity to the mix!  But the good news is that febrile seizures are perfectly safe and do not need a 9-1-1 call if the parent understands what to watch for.

By “febrile seizure” we mean, simply, a seizure that goes along with a fever.  The child will have a temperature of 100.4 or greater, pass out, have rhythmic jerking of arms, face, or legs for a few minutes, and then be confused and sleepy afterward.  The sleepy period, which we call the “post-ictal state,” lasts about 10 to 20 minutes and is followed by full awakening.  Often the seizure happens first and then later the fever is noticed.  Febrile seizures follow the rule of “S“: occur between Six months to Six years of age, are Short in duration, occur Soon after illness begins, and are more common among Siblings.

There is a lot of good news about febrile seizures.  Seizures don’t hurt babies’ brains. Kiddos grow out of them.  Only very few go on to have epilepsy (life-long seizures). Higher fevers do not increase a child’s chance of having a seizure.  Just because a child has a temperature of 104 doesn’t mean he is going to seize.  Some seize at 100.5, some 105, and the vast majority of kids with fevers of any height don’t have seizures.  Most kids who have a febrile seizure never have another.

So what to do if my child has a seizure?  The safest thing is to “hurry up and wait!” Meaning, don’t try to stop the jerking by restraining the child, don’t start CPR, don’t force things into the mouth.  Your only job is to make sure the child can’t hurt themselves by bumping into furniture or slipping under water in the tub (another reason to never leave your child alone in a tub!).  Please keep track of the length of time the seizure lasts.  This is important because the decision for further tests or treatment is often based on how long the seizure lasted.

When to worry?  If the seizure lasts longer than 5 minutes, call an ambulance. Paramedics carry medicine that can stop a seizure that lasts too long.  If the child does not wake up soon enough after a seizure (again, about 10 to 20 minutes), this may mean the child is more sick than from a regular virus. Get her seen.

So if the fever is not frying my baby’s brain, then why is she having a seizure?  GREAT QUESTION!  All the “wise ones” of science have tried time and again to answer this question.  Ultimately, it appears that it is mostly genetic.  Your child has inherited a brain that is wired to occasionally seize when she has a fever.  And then she outgrows that.

While it is important that your child see a doctor soon after the episode to be sure everything is okay, the main thing to remember is that while febrile seizures can be scary to watch, the seizure does not cause lasting harm.  In the words of Dr. Hamilton, the fever will not “fry your baby’s brain.”  Only YOUR nerves!


No Clean-Plate-Clubs Here

A high school friend of mine, Alice Flaherty, was a picky eater.  Alice could only stomach a peanut butter and jelly sandwich for lunch.  She went on to become a famous Harvard Neurologist and had a picky eater for a daughter.  So she wrote a terrific children’s book called “The Luck Of The Lock Ness Monster,” which is available at the Lafayette Public Library.  The little girl in the book is of course a picky eater, and during an ocean voyage throws her oatmeal overboard every morning rather than eat it.  A little worm swimming by the ship turns out to love oatmeal, eats it up every morning the girl dumps it, and grows to be the Loch Ness Monster.  More fun stuff happens in the book, but the point is clear.  It is okay to be a picky eater.

However, many parents fret over their kids who don’t scarf down their food.  They worry that their kids won’t gain weight, won’t grow well, and will be sickly.  Then when the child does get sick and eats even less, the parent’s worry magnifies and they rush to the doctor or worse, the Emergency Department.

Some kids are just picky eaters.  One in five kids do this, and certainly a whole 20% of the child population is not wasting away.  Picky eaters grow well, gain weight, and develop strong brains and bodies.  When they get sick they often eat even less, but so do the “good” eaters.  And when they get well the picky eaters will go back to eating the amount that is normal for them just like the “good” eaters, and catch up on their weight.

Picky eating only really becomes a problem when parents make it one.  Some parents can’t leave well enough alone.  They badger their kids to eat more, to clean their plates. They argue with each other and the child about eating.  They make their child stay at the table longer than everyone else.  Meals become an endless fight, a power struggle that both child and parent resent. Or some parents go to the other extreme, cooking special foods just for that picky child.  Some let the child snack on junk food endlessly.

The solution to picky eating is to let the child be picky!  Don’t push and push the kid to eat- that won’t work, and it makes eating more of a chore than it already is.  Don’t make the child stay at the table until they clean their plate either- let them get up when everyone else does, whether they finish their portion or not.

Certainly give the child food that is easier to eat.  Food that is too chewy like steak, or too hard like raw vegetables, will not be eaten.  Strong flavors like spicy, acidy, or sour won’t be a hit.  On the other hand, don’t go to extremes to accommodate the picky eater.  Don’t cook different food just for them, let them eat what everyone else is having.  If they don’t like something particular that everyone else does, that is okay.  Encourage the child to try one bite, and then take it or leave it (it can take more than five tries before a child discovers that they like something!).

If the child just won’t eat anything that you prepared, have a back-up food that is easy for you and that they will eat, so they won’t be hungry later.  Good back up foods are simple sandwiches, yogurt, breakfast cereal.  Again, don’t fix anything special- no need for a special production when you have already cooked for everyone else.

Finally, don’t make a meal into a fight.  Meal time is time for the family to get together and have pleasant conversation and good time together.  No drama necessary!  No arguing about food or dessert or clean plates, keep it upbeat.

When should you worry about eating?  Only when the child has scale-proven weight loss over a period of weeks.  If a child or teen steadily loses weight, then it is time to see your doctor.  Weight loss could mean diabetes, depression, anorexia, or other serious conditions.  However, picky eaters still gain weight and grow, so if that is the case, no worries!  Picky eating is okay, clean plate or not.




Wet The Bed? It’s Okay.

This week’s guest columnist is Dr. Frank Betanski, a family practice resident at the University Hospital and Clinics here in Lafayette.

If you have kids, especially a son, you may know the feeling: waking your child in the morning, pulling back the sheets, and getting the pungent smell I call the “Ammonia Sunrise.”  Nocturnal Enuresis (fancy words for bedwetting) is a common problem. Parents of kids who wet the bed come in feeling frustrated and helpless.  The kid has been potty trained for years- except at night!  Bedwetting takes a toll on the patients too. Embarrassed to go on sleepovers, they feel left out. Summer camp or overnight visits to relatives can also be sources of stress rather than anticipation.  I have even heard parents broadcasting their daughter’s daily accident tally at preschool pick-up!  That’s not helping the embarrassment, mom and dad!

Let’s start with facts: 1) Bedwetting is defined as urination that happens at an inappropriate time and place.  2)The diagnosis of Nocturnal Enuresis is not made until 5 years old; nighttime dryness is actually the final stage of potty training.  3) At 5 years old, one in five children still wet the bed.  4)  Its genetic, not psychological.  If mom or dad wet the bed, there’s a good chance the child will too.

Bedwetting was once thought to be a psychological condition.  We now know that children who wet the bed do not have emotional problems.  Bedwetting is not an act of rebellion or laziness.  It is so common that it can hardly be called “abnormal.” Bedwetting is also not a result of harder-sleeping children.  Sleep studies have shown that children who wet the bed sleep no deeper than other kids.  Surveys of parents, however, show that they still think their kids who wet the bed are “deep sleepers!”

How can you treat bedwetting?  The best treatment is the bedwetting alarm.  Originally developed in 1938, it is now found at most shopping centers.  The alarm has been shown to be 75% effective.  The alarm has sensors in the child’s pajama bottoms that detect wetness.  When the child begins to urinate, the alarm wakes the child up.  He then gets out of bed and finishes peeing in the toilet. The idea is that the child learns to wake up when he feels a full bladder and goes pee in the bathroom before going in the bed.

The bedwetting alarm also has a high “found in the trash” rate- 20% of parents get frustrated when the device does not train the child right away, and toss it.  This is because the bedwetting alarm is a training tool, not the training!  Parents have some work to do to make it effective.

First, parents shouldn’t fuss at their children when they wet the bed.  Its not their fault! Reassure that they are not misbehaving.  Praise them when they help clean up and change the sheets: it’s an opportunity to teach responsibility.  When the child is awakened by the alarm and has some urine left over to pee into the toilet, it’s high-five time!  They may not be dry-all-night yet, but they are on their way.  Be patient- it takes many nights for the alarm to help.

Limit fluids, especially caffeinated drinks, before bedtime.  Certainly no sodas or sugary juices at dinner or after.  These drinks are so tasty that children will drink and drink and take in more fluids than they need.  You don’t want a bursting bladder after bedtime.

Some parents wake their kids up to use the bathroom one or two hours after they fall asleep.  For sleepovers have your child wear a pull-up.  This sounds odd but can make a big difference.  If they are embarrassed about the pull-up, send them in loose-fitting PJs- no one needs to know.

Sometimes kids are prescribed medicines to stop bedwetting, but the American Academy of Pediatrics cautions that these drugs are a last resort and not recommended for children under 5 years old.  These medicines may help in the short term, but do not solve the problem in the long run.

When to see your doctor?  When the child has had nighttime dryness, and then begins to wet the bed again.  This can be a sign of a new medical problem such as urine infection, diabetes, constipation, or stress.

But if your child has wet the bed since successful daytime potty training, don’t stress. Teach them to help clean up, and that it’s okay.

Non Emergencies in the Emergency Department

I walk into the room, introduce myself, and ask my usual lead-in question: “When did things first start going wrong?”  The mom answers “She started with this rash last night, and this morning it has spread all over.  Just look at it!”  The mom yanks up the toddler’s shirt and sweeps her hand to show me the extent of the child’s scourge.

And the child’s skin looks….normal.  I put on my reading glasses and peer closer.  Still, I am hard-pressed to identify anything that could be remotely called a rash.  The mom offers: “Its those bumps that worry me.”  Ah yes, I can see that the child’s skin has tiny bumps that at first you don’t notice, but alter the skin’s texture a little bit.  I straighten up, complete the rest of my history and physical, and inform the mom that no, the child does not have measles or chicken pox or flesh-eating bacteria, but a dry, irritated skin condition called eczema.  A change of soap, more lotion, and it should be fixed up in a few days.

Winter is a busy time in the Pediatric Emergency Department.  Bronchiolitis makes babies cough, influenza makes all ages feel and look miserable, and asthmatics wheeze.  Kids are kept indoors by the cold and cough on each other and spread the contagion.  Emergency Departments and doctor’s offices are filled to the brim with sick children.  And then everybody waits longer to see the harried practitioners.

The majority of theses illnesses involve coughs and fevers.  Fevers and coughs are not emergencies, and there are some simple things to know that can keep you from having to wait for hours in the Emergency Department or at your doctor’s.  Fever itself is not an emergency.  Fevers do not harm your child- they do not cook kid’s brains and they rarely cause seizures.  Fever is actually one of the body’s natural mechanisms to fight illness- fever is a good thing!  When your body senses that you are sick, it sets your brain thermostat higher.  The higher body temperature makes it harder for infection to grow in you, and your immune system can get on top of the infection.

What is more important with fever is how the kid is acting with the fever.  Certainly the child will be tired and miserable, but that is easily treated with medicines like ibuprofen (motrin, advil) or acetaminophen (tylenol, pediacare).  As long as your child is drinking some, breathing comfortably, and is mentally “with it,” your child is doing okay. Most fevers are caused by viruses that will pass in a few days without need for a prescription.

Likewise, most coughs are not emergencies.  Sure, coughs are irritating, particularly at night when everyone wants to go to sleep.  But as long as the child is breathing comfortably, then home remedies are as good (or better!) than any prescription.  Put your kid to bed with their his head elevated, get the vaporizer going next to the bed, put on some Vicks-Vaporub.  Give some ibuprofen or tylenol to ease that scratchy throat.  Don’t waste your money on cough syrups- science has shown over and over that they don’t work.

There is no prescription that reliably helps coughs either.  Everyday I get parents who ask for a prescription for colds.  As I tell them, no one has invented any medicine that helps dry up runny noses or suppresses cough.  Doctors sometimes prescribe anti-histamines, codeine, or other things, but these medicines rarely help and often cause more trouble than they are worth.  They can make a child more awake and antsy and irritable, and the kid still coughs!

So please don’t be like the mom above and rush to the Emergency Department when your child has a rash or a fever or a cough.  We are busy enough with the children who are lethargic or working hard to breathe, with kids with broken arms and head injuries and lacerated faces.  Long lines of the non-emergent just makes everyone wait longer, only to be told the things that could have been done at home.  If you are not sure, call your doctor to see if you should come to the office or come to the ER.  Do your part to keep non-emergencies out of the Emergency Department.



Is It Broken?

A lot of my columns are about how to keep your child out of the Pediatric Emergency Department.  Possible fractures, though, are one time where coming in is the best move. More on this from our two guest columnists, Dr. Nicole Miller and Dr. Sonja Wilson, Family Practice residents at the University Hospital and Clinics here in Lafayette:

James woke up Christmas morning and ran downstairs to see what Santa brought.  A note on the Christmas tree said “look outside!”  He opened the back door to find a new trampoline!  James quickly dressed and ran out to enjoy his new toy.  After a few bounces though, he found himself on the ground crying in pain.  His shin was swollen, and it hurt too much to get up and walk.  James and his parents went to the Emergency Department and found that he had fractured his leg.  On Christmas Day!

The holidays are here and with this will come new toys and activities.  Kids will be out of school and spending time on bikes, ATVs, trampolines, and scooters.  In the ER at Lafayette General we will be seeing more visits for injured hands, wrists, arms, feet, ankles, and legs.  What is a family to do?  Start by preventing these injuries!

Part of preventing fractures is having good bone health.  This starts with a healthy diet. The American Academy of Pediatrics (AAP) recommends that kids get 400 International Units (IU) of Vitamin D every day.  One cup of milk is 100 IU.  Vitamin D can be found in a variety of foods and drinks, including soy products and orange juice.  Your skin can make Vitamin D as well, as long as it is exposed to sunlight.  Kids should have at least 15 minutes in the sun every day.

How to prevent an injury?  The AAP recommends against having children operate ATVs or other gasoline-powered vehicles, and recommends against having a trampoline.  These are known to have a high risk of causing fractures or even more life-threatening injuries. The key to safe toys is to keep in mind the age, size, and maturity of your child.

When buying new toys like bikes and skateboards, don’t skimp on the safety accessories! Also buy helmets for bikes, and helmets and knee/elbow/wrist guards for skateboards. Learning to ride a bike also means learning traffic rules for bike safety.

Find a safe place for your child to play.  Avoid busy roads, hills, and streets with multiple parked cars.  Always supervise your kids while playing.  Even with all of this protection, kids get hurt.  Kids play and explore and fall down.  Usually this results in simple bruises and sprains, but sometimes a broken bone results.

When should you worry?  Signs of fracture include bruising and swelling over a bone, a snapping sound on impact, difficulty walking or using the injured limb, and obvious crookedness in the limb.  It is harder to tell if young children have a fracture; they can’t tell you about the pain they are experiencing.  If a toddler stops using a hurt limb- bring them in.

So what should you do if you think your child has a fracture?  First, limit movements of the hurt limb- apply a splint of rolled up magazines taped around the hurt bone.  DO NOT GIVE YOUR CHILD ANYTHING TO EAT OR DRINK UNTIL YOU SEE A DOCTOR!  If the bone is broken your child may need sedation or anesthesia to fix the bone, and an empty stomach is essential before sedation.  Then bring them in to a place with an x-ray machine.

While some practices and urgent care clinics have x-ray, that is not all you need for fracture care.  The facility also needs to be able to put on a splint or cast and have access to an orthopedic surgeon.  For some fractures the bone may need straightening, and then the facility needs to be able to safely sedate the child and/or have an operating suite equipped for children.  Call ahead to the place you plan to go to be sure it has all the services your kid might need.

Have a safe holiday season Acadiana!