RSV- Don’t Panic?

This week’s guest columnists are Drs. Brian Allen and Chris Fontenot, Family Practice residents at University Hospital and Clinics here in Lafayette.

Winter- the season of holidays, travel, and people congregating indoors. Friends and family share hugs, gifts, food, and germs.  Just as common as sharing good tidings and Mardi Gras are those three letters that strike fear into parents: RSV.

RSV, or Respiratory Syncytial Virus, is the most common cause of a condition called Bronchiolitis.  Bronchiolitis is an illness in babies and toddlers where the smallest airways in the lungs get inflamed, decreasing oxygen delivery to the bloodstream. Worsening inflammation causes a “whistling” sound as the air squeaks through those narrowed airways, a.k.a. wheezing.

Anyone can get RSV.  For people over age 2 and adults, it’s simply a cold.  Only babies under age 2 get bronchiolitis.  Even then, if your kid has RSV, don’t panic. Most babies have only a cold as well. RSV is rampant from November through April, particularly in January and February.  Also know that kids don’t stay immune to RSV: some unlucky babies get it twice in a season!

The basic symptoms of RSV are runny nose and congestion, cough, fever, and decreased appetite.  Babies with colds can have trouble feeding, because clogged noses make it hard to suck the bottle or breast, and breath.  More concerning signs of RSV, when we call it bronchiolitis, are rapid breathing (breathing 60-80 times per minute), wheezing, and worsening feeding.  Kids may have “retractions,” where the skin over the ribcage sucks in as they tug in breaths. Infants may grunt with every breath. Children with grunting, retractions, fast breathing, or worsening drinking need attention immediately.

RSV is highly contagious.  It travels on water droplets that are coughed, sneezed, or breathed out.  The virus lasts up to two hours after landing on surfaces like furniture and counters, where others can unknowingly touch, pick it up, and infect themselves.

“Your child tested positive for RSV” is a painful phrase for parents.  Parents ask, “Are you sure,” and “Will she have to stay in the hospital?”  The answer to “Are you sure”, weirdly, doesn’t matter!  As we alluded above, RSV isn’t the only virus to cause bronchiolitis, that condition with coughing, fever, wheezing, and  congestion- many others cause it too.  We don’t recommend testing most kids for RSV, since whether the test is positive or negative, what’s important is how your child is handling bronchiolitis, not which virus caused it.

The mainstay of treatment is “supportive care.”  The first support is hydration.  It’s important that children drink plenty, to keep mucus moist, thin, and easy to handle. When an infant or toddler can’t drink because of congestion, they begin to dehydrate.  Their mucus gets dried and sticky and gums up their already inflamed airways.

Breast milk or formula are best, but extra clear fluids can help.  Pedialyte is a good option for infants; its designed to hydrate babies if they can’t handle milk.  Babies tend to vomit with bronchiolitis when they gag on mucus and have upset stomachs from swallowing it, and Pedialyte is easier to absorb than milk. However, Pedialyte tastes a little too salty for older children, so these kids can hydrate with dilute juices and sports drinks.  If a kid just won’t drink, he may need admission for IV fluids.

Breathing also needs support.  Bedside humidifiers and nasal saline may help hydrate and thin mucus.  Elevating the head helps noses and upper airways stay clear too. When babies starts to struggle to breathe like we discussed above, need oxygen and other respiratory support, it’s time for admission.  Unfortunately, nebulizer breathing treatments don’t help.  Breathing treatments are often prescribed with bronchiolitis since the symptoms look like asthma, which treatments do help.  However, multiple studies have shown that nebulizers for bronchiolitis are a waste of time and money.

Finally, keeping your child isolated is important for others to not get RSV- it’s highly contagious, and the cough and “viral shedding” last for weeks.  No daycare until baby is fever free and coughing much less.

So don’t panic if your child has RSV. Like we said above, most kids will just have a nasty cold, only a few need hospitalization.  Fever medicine, fluids, patience, and TLC usually take care of it.

Is Chapped Lips An Emergency?

One of last year’s fun news stories was a 911 call from a man whose cat wouldn’t let him in his house.  After a three hour stand off, and after the police and 911 operator finished laughing themselves silly, an officer was dispatched and apparently talked the cat down.

Similar absurdities happen in Emergency Medicine.  Once when I worked in Baltimore, a mom brought her child in for chapped lips.  Thinking that no one would come to the ED for such a minor thing, I searched for the “hidden agenda,” some underlying worry explaining mom’s thinking.  Like if her Uncle Frim had lip cancer and she feared her son had it too. However, after an exhaustive history, there was no such issue: her son simply had chapped lips.

It’s sometimes difficult telling the public when to call 911 or not, and when to bring kids to the Emergency Department or not.  We want to encourage people to get emergency help so they don’t blow off potentially serious issues.  On the other hand, we don’t want the Emergency Department and EMS systems clogged with non-emergencies.

Most pediatric ED visits are not emergencies, but families come for many reasons. First, parents get scared for their kids.  They love their kids and when they get sick or hurt, parents sometimes rush for help rather than call their doctor for advice or wait for an appointment.

Often parents can’t get their kid seen in the office that day.  An appointment for next week doesn’t help when your child won’t stop vomiting, or needs x-rays.  Sometimes when the parent does call for advice, the mom is told to go to the ED, rather than office staff taking time to talk the situation through, giving advice that could keep the child home.

Sometimes when a child gets sick or hurt, a doctor’s office or school is worried about caring for a potential emergency.  They aren’t used to emergencies and don’t want to miss something, or get sued.

Almost daily we see kids in the Emergency Department who were in car crashes, seem fine, but the parents want them “checked out.”  You can’t fault this reasoning; they care about their kids and are worried.  However, when the “crash” involves cars backing into each other in a parking lot, and the child was strapped into a car seat, maybe an ED visit is overkill.  Unless the lot has cars speeding into their slots like the Indy 500 pit stop.

Too often the ED is used as a walk-in clinic, rather than for true emergencies.  The point of this blog is to inform you about what real emergencies are, what can wait to see the doctor, and what you can take care of at home.  So let’s review common issues appropriate for the ED, and things that are not emergencies.

Kids who are short of breath, tugging to breathe, belong in the ED.  Of course bring any children with possible broken bones, cuts that need stitches or won’t stop bleeding, or severe pain. When kids get lethargic (difficult to arouse), they need to get seen.  However, there are gradations of cuts and limb injuries, and lethargy: kids with fever get lethargic, but recover with anti-fever medicines.  If it isn’t obvious if it’s an emergency or not, call the doctor’s office.  If they can’t help, go to the column in this blog to the immediate right side of the page.  Click on your issue to read specifics about what is an emergency, and what can be handled at home.

Things that are commonly not emergencies: fever, coughing, rashes.  Fever doesn’t hurt kids- it doesn’t cook their brains and is rarely associated with seizures.  The height of the fever doesn’t correlate with how sick the kid is either: a child with a 104 temperature isn’t sicker than a child with 101.  Coughing also isn’t an emergency- kids cough when they get colds and if they aren’t otherwise short of breath, it can wait.  Again, see the column to the right.

This is a busy time of year for the Pediatric Emergency Departments, so use common sense when deciding to visit.  Use your doctor’s call line, or this blog when in doubt.  But if you still can’t decide, bring your child in. Better safe than sorry, but you can leave the chapped lips at home.

ADHD Or Just Bad Behavior?

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

Is your child ”bouncing off the walls” or “just won’t listen?”  Pediatricians and family physicians see lots of kids with behavior problems.  Parents or teachers often want to know if this is ADHD (Attention Deficit Hyperactivity Disorder) or just bad behavior?

ADHD is a hot topic.  Some claim that ADHD is only bad behavior from ineffective parenting- “she just needs a good spanking!”‘  On the other extreme, some kids receive ADHD medication who don’t need it. Regardless if you believe ADHD is real, here are tips on helping kids act better.  Kids who don’t have ADHD respond to these tips; kids who do may respond less consistently, but will still be happier and better behaved.

Spanking?  Many ask, to spank or not to spank?  A bigger question is why are you spanking?  If you do spank your child, avoid doing this in anger.  Only spank for behavior that’s dangerous, like running into the street, not for something small. Explain why you’re punishing. He may not understand right away, but kids get more than you think and will eventually catch on.

More importantly, reward good behavior.  Positive reinforcement is MUCH more effective than punishment.  Saying things like “Thank you for being so quiet,” and “You did a good job picking up your room” is great behavior modification. Every kid (and adult!) likes praise, and kids will work to earn more.

Don’t be sarcastic, or make fun of your child.  Young children are sensitive, and cutting remarks and mean-spirited teasing hurt feelings.  Pre-teens and teens don’t like that either.  If you are unpleasant to your children, they will grow up thinking that it’s okay to be abused and to abuse others

Build family traditions.  Many households lack structure or traditions.  Do something together!  Go to a park or to church every Sunday, or have Friday night pizza as a family. Kids look forward to these things- it’s something to do with mom and dad. Also keep extended family in mind and make time for them.

Keep a home routine, or “rhythm.”  Chaotic homes make chaotic children.  Some kids who seem to have ADHD just aren’t used to having to sit still and follow along; they never learned how at home.  We know it’s especially important to have a routine home life for children with autism or ADHD, but every kid behaves better and is happier with structure.

Keep the same bedtimes.  Don’t let kids stay up later with phones or watching TV-that’s cheating!  Eat meals together at regular times. Give your children daily and weekly chores. Even kids as young as 5 years-old want to help, and should start picking up after themselves.  Be realistic though; the seven year old shouldn’t be shingling the roof.  5-6 year-olds can clean rooms, 8-9 year-olds can help with dishes and take out trash, and 13 year-olds can mow lawns and babysit younger siblings for short periods.

Expect your children to RESPECT others.  Respecting adults and peers is important. The Golden Rule, “Treat people as you want to be treated,” even very young children understand.  This is the South- we expect ”yes sir” and “no ma’am.”  Doing this will help your kids earn respect in turn. 

Set a good example by respecting others in speech and action.  Your child should never hear you curse.  If (or when?) you do mess up, be honest with your children and tell them you expect better from yourself, and them.

Don’t argue with your kids, or ask them “why” they did something.  If they misbehave, punish them appropriately and briefly explanation why they acted badly.  Asking them why makes it personal, as if they are bad inside and not just simply making a mistake.  If they argue with your reasoning, don’t engage them in the argument.  As Dr. Hamilton used to say to his kids, “This isn’t an argument, this is simply how you should act.”

The most challenging child can benefit from these tips. Try them out; if you don’t make progress with difficult behavior, you’re not alone!  Talk with your doctor or school counselor.  They can help you with behavior techniques, to help your kids be the best they can be.

Can Hospitals Make You Sick?

It’s tough to care for friends.  My friend Jennifer had delivered her third baby.  My patient was baby Julia, who had a rough start, needing oxygen for the first days of life.  Jennifer was exhausted from labor, delivery, and worry.  But the fourth day I had good news: “Julia can go home today!,” I said.

Jennifer burst into tears.  Puzzled and a little freaked out, I asked  “What’s wrong, Jennifer, what did I say?”

“How come Julia can’t come home?” she sobbed.  I then understood that Jennifer had simply mis-heard me.

“Sorry if I wasn’t clear, but Julia CAN go home,” I explained, and Jennifer recovered.  Whew!

Parents and children often feel vulnerable in hospitals.  A recent article in the BBC News Magazine discussed how hospitals sometimes make you sicker, instead of being places of recovery.  The article stated that of patients in the US admitted to hospitals, 20% have to be re-admitted within a month.  For some reason those patients weren’t healed in the first try.

Hospitalization can be stressful, rather than purely healing.  The most obvious stressor is that your child is sick enough to be admitted in the first place.  You’re worried, your kid’s scared, and she’s tired and hurting.

Hospitals also cause sleep deprivation, just when you need your sleep the most! Patients are awakened all night for vital signs and medications.  When the patient tries to nap in daytime, interruptions continue: morning blood draws, doctors’ rounds, staff and families chattering away in halls, food carts rumbling back and forth.  It’s hard to get even three to four hours of uninterrupted sleep.

There’s also pain, which of course kids hate- needles for blood draws, IVs, and procedures.  Finally, the food: it’s hard to serve hundreds of meals on several floors, hot and delicious, and few hospitals have mastered this. Then they take away your food if you have a procedure- must have an empty stomach for anesthesia!

So how can you make your child’s hospital stay safer and more restful?  First, hospitals have been doing their part.  Since a 1990 government report on hospital-acquired infections, Lafayette General and others are policing doctors, nurses,and techs on hand washing.  Hand sanitizer stations are now all over.  Programs to reduce IV and other catheter infections have made infection rates plummet.

Surgeries have new rules for safety.  The news used to carry stories of surgeons amputating the wrong leg.  Comedian Dana Carvey (who played Garth in the Wayne’s World movies) was also in the news after his heart surgery. In 1997 he had bypass surgery for a blocked heart vessel.  Unfortunately, after cracking his chest, the surgeon bypassed the wrong vessel.  So Carvey had to undergo a second open heart surgery. Hospitals now have protocols to ensure that we operate on the right patient, on the right part, at the right time.

There’s lots you can do to make your child’s hospitalization safer too.  First is to have a patient advocate.  For kids, this is usually the parent.  However, some parents are overwhelmed by their children’s illness and care- tests, medications, therapies, when can we go home, when will my child get better?  Then parents need their own advocate to help sort it all out.

The most important thing an advocate can do is remind staff to wash their hands. And their stethoscopes.  Second is to make sure everyone introduces themselves, and keep straight all the players.  Who is the nurse, the doctor in charge, the specialist?  Third, be sure the right therapy is happening to the patient.  What’s this medication you’re giving, what’s it for?  Why this test or procedure, how necessary is it?  Lastly, an advocate can prevent sleep interruptions, like making a sign for the door requesting minimal wake-ups. And the sign should say “please keep quiet in the hall!”

Hospital care is complicated, and not without risk.  Hospitals like Lafayette General are doing their part.  But patients and parents need to do their part too, like Dr. Kate Granger. Though Dr. Granger was a doctor, when she became a cancer patient she was treated impersonally, until she started a twitter campaign to get doctors to simply introduce themselves.  You shouldn’t have to go that far, but making a sign for your child’s door is a great start.

Put Me Back In Coach!

Dave was the quarterback for my college fraternity’s football team.  Though it was flag football, Dave got knocked down a lot, and several times hit his head on the ground.  For days he would act confused, repeat questions over and over, and finally recover. He graduated to go on to fly Navy jets and finally got a helmet to wear!  Dr. Blake McDonald, a Family Practice resident at the University Hospital and Clinics here in Lafayette, discusses concussions this week: pay attention!

Concussion is an injury caused by a blow to the head.  This injury impairs neurologic function: concussions interfere with coordination, thinking, emotions, and sleep.  They eventually heal, but it takes time.

Concussions aren’t bleeding in the brain or skull fractures- they aren’t detected by CT or MRI scans.  They can be measured by neuropsychological tests, where the patient interacts with a computer program or a paper-and-pencil test.  In other words, concussion is a functional injury, not a structural one.

Concussions are a big problem, bigger than statistics report.  About 144,000 people per year visit ERs for concussions, but one review estimates that there may be up to 3.8 million recreation and sports concussions per year in the U.S.  And that doesn’t include injuries in grade school and middle school athletes.

Football is the riskiest sport for concussions in high-school boys, soccer and basketball for girls.  Rugby, ice hockey, cheerleading, and lacrosse also probably have high concussion rates, but their data are limited since these are often club activities rather than official school sports.

Headache and impaired coordination are the main physical symptoms of concussion. Loss of consciousness is another physical sign, but this only happens in 10% of concussions- you don’t have to be knocked out to have a concussion!

Concussions also affect cognitive function- the ability to think and remember. Kids with concussions have trouble with homework, concentration, and thinking clearly.  Memory is also impaired- a concussed child may not remember what happened for some time before and after the injury.  Some kids have short term memory loss, asking the same question over and over.

Besides causing physical symptoms and thinking deficits, concussion can affect emotional stability.  Concussed kids are often tearful and depressed.  They can be emotionally “labile,” meaning one minute they are acting silly, the next minute moody. Kids with concussions sleep a lot.  This worries parents who have heard not to let head-injured kids sleep.  But sleeping late and napping with a concussion is part of normal healing.

So how can we help concussions heal?  Management involves avoiding activities that slow natural recovery.  This means allowing time for physical, cognitive, and emotional recovery, and not worsening things.  Even the NFL now recognizes that if you send an athlete back out who has impaired coordination, concentration, and thinking, they stand a greater chance of getting more hurt.

Cognitive and physical rest are the mainstays of management.  Cognitive rest means staying home from school.  Upon return, concussed kids may need shorter school days and reduced work.  They may need more time for assignments or tests.  If headaches return, the child may need to be out of school longer.  Videogames and computers can worsen symptoms too.

To be allowed to return to full school work or sports, the child must be symptom-free- no headaches, normal coordination, no trouble thinking or remembering, no more fatigue or depression.  This can be a problem with motivated athletes who hide their symptoms to stay in the game.  Coaches, teachers, and parents need to be vigilant.  If a kid hits her head and then seems impaired, the approach is simple: “when in doubt, sit them out!” Coaches and trainers should be aware of sideline tests for concussion to detect impairment.

When kids do return to school or sports, they need a “graduated” increase in intensity.  This means slowly increasing class work and home work.  In sports, it means slowly increasing physical intensity, then adding complexity (like adding drills and plays), then scrimmaging, then full play.  Worsening symptoms during that time mean “back off!”  

Though there’s been much prevention talk about mouth guards, better headgear, altered sports rules, the best tools to prevent and treat concussions are education and recognition- for athletes, parents, coaches, trainers, teachers, administrators.  And doctors and nurses too!

Gassy Babies?

My wife’s nephew Jordan had colic bad.  In his first months of life he cried non-stop, only quieting in his swing.  His mom was so frazzled from fatigue and frustration that when my wife offered to babysit for a weekend,  she ran far and fast.

My wife soon discovered that the swing had a wind-up motor (there were no electric swings in those days) that lasted 20 minutes.  That weekend she lived her sister’s life of sleeping in 20 minute increments.  She would wind up the spring, Jordan would sleep while rocking, and she would sleep too.  But when that spring wound down and Jordan creaked to a halt, he would snuffle, then squirm, then begin wailing.  My wife would wake up, roll over to the edge of the bed, crank up the spring, and both would go back to sleep for another brief spell.  Being awakened every 20 minutes for one night is bad enough, but imagine a whole weekend.  Or a whole month.

Living with a colicky baby can be miserable and frustrating.  Colic is a phenomenon where baby in the first months of life cries a lot, for no apparent reason.  Babies feed well and grow, they are not sick with coughs or fevers, they poop and pee normally, yet they cry as if in pain.  Colic usually starts in the first few weeks of life, peeks at about one month old, and then slowly goes away.  Babies often start crying in the afternoon, cry all evening, and fall asleep sometime after midnight.  Some babies, like Jordan, cry around the clock.

It’s almost easier to say what colic isn’t, rather than what it is.  Colic looks like gas pain, with babies cramping and pulling up their legs.  But no baby has yet been able to report to us: “Yes, this is gas pain I’m having.”  It isn’t problems with digesting formula; changing formulas seldom makes it better.  It isn’t constipation; baby’s pooping pattern doesn’t relate to the pain.  It isn’t reflux; spitting up doesn’t correlate with pain either, and reflux medication rarely helps.

One thing colic certainly is, is stressful.  Parents worry that something is wrong, and frustrated about how to stop it.  They are sleep-deprived, worse than the usual new parent.  This makes some parents angry: at baby, at the world, at the helpless doctor with few answers.

It’s a common worry for the pediatrician: Parents bring their baby in with a problem like colic, where baby cries and is unhappy.  We listen carefully to their story, we examine baby head-to-toe, looking for clues to why baby is hurting.  When we exhaust the other possibilities- ear infections, diaper rashes, thrush- we diagnose colic.  We tell the parents about colic, what to expect, and what to do about it.  Then comes the parental reaction we all fear, “That’s it doc?  That’s all you got?”

A lot of pediatrics is like that- having to disappoint parents.  Colic, like cold viruses in babies, doesn’t have any snappy answers, any tests that say “Aha, this is it!”  There is no shazam medicine, no miracle antibiotic, that will make baby quit crying.  Many medicines have been tried.  Mylicon, which is essentially baby Gas-X, some swear by.  There are other remedies like deewee, gripe water, chamomile. Science hasn’t shown any of these work.  Like we said above, reflux medicine hasn’t been shown to help either.  The only medicine that may help is Tylenol.

What does help?  First, breast feeding.  Breast fed babies statistically have less chance of colic, and if they do have colic it’s less miserable than that of formula-fed babies. Second, basic baby comfort things like a pacifier or swaddling can help.  The most reliable way to stop colicky crying is a car ride. Something about the vibration and white-noise of the engine makes fussy babies calm.  You can simulate this at home- put baby in a swing with a white-noise maker going, or the vacuum or a fan.

However, if baby is crying with other symptoms- fever, cough, worsening feeding, rash, call your doctor.  Inconsolably crying babies with other symptoms may have more concerning illnesses.  But if baby is feeding well, gaining weight, and well in every other way, then it’s into the car!  Good thing gas is cheap right now.

Pearly Whites

My brother-in-law was in a bar on a cruise ship.  A woman from ”coal-mining country” liked him so much she exclaimed, “Ain’t you pretty- you got all your teeth!”  Teeth are important for good looks, and good health.  Listen to this week’s guest columnists: Drs. Libby Going and Rati Venkatesh, Family Practice residents at the University Hospital and Clinics here in Lafayette. 

In the Pediatric Emergency Department, we see lots of coughs, fevers, injuries of all sorts, and concerns about kid’s teeth.  While infrequent, parents sometimes come to ask about tooth care.  And we see lots of visits for tooth and mouth trauma.

We saw a precious two year-old girl recently, with big brown eyes a red bow in her hair, and a runny nose.  She was bubbly and fun but when she smiled, her teeth took away some pizazz.  They were brown stubs, an obvious case of “bottle rot.”  Her parents had been putting her to bed with a bottle, the milk sitting in her mouth all night, destroying her teeth.

Dental care is important early in life.  Start good habits for both baby teeth and permanent teeth.  Even before baby has teeth you should gently clean his gums with a wet washcloth.  When you see that first tooth and document it in the baby book, it’s time to start cleaning that tooth.  Use a soft baby toothbrush and a very tiny smear of toothpaste.

When you celebrate that first big birthday, baby enjoys her first cake, and you get that picture with icing all over her face and high chair.  Then it’s time to schedule a dentist appointment.  The first visits to the dentist are for a check-up, and to get the child used to the dentist. Dental visits aren’t the horror we feared when we were kids- children should learn early that dentistry is pretty painless.

What your child eats is also important for healthy teeth.  Sippy cups filled with juice or milk (or worse, soda!) lead to tooth decay.  Limit juice or milk to meal time only, with water offered the rest of the day.  And again, no bed time bottles after you have gently brushed those pearly whites.

Falls, sports injuries, and plain horsing around cause all sorts of injuries, but one of the scariest is a knocked-out tooth.  There’s screaming, blood, and an ugly gap.  What to do depends on whether it’s a baby tooth, or a permanent one.  Baby teeth usually start coming out in the first two years, and fall out on their own about age 6.  They are then replaced by the permanent teeth, which need to last the rest of the child’s life.

The best way to handle knocked-out teeth is prevention.  Mouth and face guards are very important for sports at risk for tooth injury- those with regular impacts, sticks, and flying objects- like football, baseball, hockey, softball, and lacrosse.  Cheering too- cheerleaders are often flying objects themselves!

What to do when a tooth gets popped out?  If it’s a baby tooth, don’t worry, just call your dentist.  Your kid may have a gapped-tooth picture for awhile, but her permanent tooth should grow in fine.  If it’s a permanent tooth, that’s more trouble.  It’s important to get that tooth back in so it won’t die, but take root and live.

First, pick up the tooth by the whitest part (the crown)- don’t touch the root.  If it’s dirty, rinse it for 10 seconds only.  Then match it to it’s hole and push the root into the socket.  Have your child bite down on a cloth to hold it in place, and call your dentist.  Put that tooth in with the outside facing out- backwards teeth make for future orthodontic trouble.

Scared to put that tooth back in?  Many are, with all that blood and crying.  Have your kiddo spit into a cup, and put the tooth in the saliva.  Or put it in milk.  Then immediately see your dentist.  Teeth re-implanted within one hour have better chances of surviving.

Mouth and dental emergencies can be scary, so it’s important to have a dentist by the first birthday.  Then you have an expert to call when things get hairy, and you can keep your child’s smile pretty.

The Good Ole Days Weren’t Always Good…

My father-in-law, Howard Fournet, grew up on a farm during the Great Depression.  The farmhouse was on Johnston St. (a gravel road then) in Lafayette, where the Albertson’s now stands.  The University of Louisiana’s athletic fields were the Fournet’s cow pastures.  It was hard living: the boys woke before dawn to milk cows, shared one bathtub’s water for ten, shared beds, and ate what they grew.  One year the boys all failed school because of sleep-deprivation, when times got so bad they had to let the hired hands go and do all the work themselves.

For Howard, going to Army Boot Camp in World War II was a vacation.  He got to sleep all the way to 6 am!  Three meals per day, daily showers, clean clothes, his own bed! And “work” was playing soldier all day.  He had never had it so easy.

As Billy Joel sings, the good ole days weren’t always good.  As far as health goes, there were fewer vaccines, so kids got more bad infections- more meningitis, blood infections, pneumonias.  Cars were less safe- no car seats or even seat belts, so kids got more horrific injuries in crashes.

While it wasn’t heaven when I was a kid either, many things were healthier.  With fewer TVs and only a few channels, we spent lots more time outside playing.  We had more recess and P.E. at school, more art, more music, less homework. We had more freedom to explore by foot and bike- the world was less crowded and our parents weren’t afraid of kidnapping. Eating was healthier- more home-cooking, and less junk food and prepared food.  With all that exercise and good food, there was much less obesity.

In the old days there were some good child-rearing choices and some bad ones. This raises the question- what choices do we make now when it comes to diet, exercise, and other facets of child-rearing?  What’s good, what’s bad, and what don’t we know yet?

When my friends complain about how hard we had it as kids, I think of the Monty Python skit about four guys who trade stories about their childhoods, trying to one-up each other about how rough it was.  In Python style, the tales get progressively more absurd, until they are saying things like “We lived in a brown paper bag in a septic tank,” getting up at 3 am to clean the bag, eat “a handful of cold gravel” for breakfast, go to work at the mill for 14 hours per day, and once back home “Dad would thrash us to sleep with his belt!”

I didn’t have it quite that bad growing up, but like we mentioned above, many things are better for kids today than in the “good ole days.”  There are more vaccines to protect kids from deadly diseases.  Cars are safer and car seats protect kids better.  We know more about healthy diets: cooking with less fat, high-fiber foods, buying foods grown locally, and eating less processed food.

However, we are unsure of some new things in child-rearing.  One is organized sports. When I was growing up there was little league baseball and football, but most of our exercise was running and biking the neighborhood.  Today kids spend way more time in super-organized sports- select soccer, baseball, volleyball, softball.  Those kids are getting lots of exercise, but we don’t know if the injury toll from repetitive practices and increased intensity is worth it.

Another unknown is the price of kids having phones.  It’s easier to stay connected with kids when they are away, and they can access lots of information from the net. But all that time texting and talking instead of experiencing the world around them- is that bad? And if they’re less bored because there’s always a phone game to fill idle time, is that good?  Or is some boredom maybe better, forcing kids to play and think creatively, rather than playing the phone?

These are important questions for we parents as we raise kids.  Choosing foods and vaccines and car seats is easy; life-style choices like sports and phones are harder. These are the Advanced Parenting choices not available in the Good Ole Days.

Junior Springs A Leak

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

Kids get a lot of bloody noses. While they’re usually only a mild inconvenience, nosebleeds freak out some parents.  They get alarmed at the blood- it looks like a lot! However, kids rarely lose a worrisome amount of blood. Another myth about kid nosebleeds: they are caused by high blood pressure, and are a harbinger of complications like stroke.  Finally, kids don’t choke to death on blood trickling down their throats.

Many nosebleeds seen in the Emergency Department are from minor injuries- bumps on the nose from balls and siblings, and nose picking.  Nosebleeds also happen in dry climates, because of allergies and colds, and because of some medications.  While dry climate is not a Louisiana issue, air-conditioning removes humidity, causing dryness indoors.  However, allergies are common here, and with that comes allergy medication. Allergies make for runny noses, then allergy medicines dry out the nose and mucus.  The dried-out inside of the nose and mucus get cracked, a crack runs through a vein, and pow!

Regardless of cause, the initial treatment for nosebleeds is the same.  Apply pressure to stop bleeding and allow clotting.  Applying pressure means gently pinching the nostrils together without causing pain.  We have all been told growing up to lean the head back. This does very little to stop the bleeding, but very effectively causes blood to drain down the back of the throat.  While saving her shirt from blood stains, for the kid it only leads to gagging and coughing and nausea.

Gently squeeze the nostrils closed for ten minutes.  It takes that long to make a clot. Don’t keep checking to see if the bleeding is done during that time: letting go interrupts the clotting process.  Hold for the whole time, watching a clock.  Sometimes when parents let go and bleeding continues, they really get nervous.  Don’t panic!  Again, no kids bleed to death from nosebleeds. Close the nostrils for another ten minutes and hang on. Sometimes a few drops of Afrin help slow bleeding.

Injuries cause lots of nosebleeds, besides dry noses and allergies that we discussed above.  Misplaced elbows, thrown toys, a wall that leaps in your child’s way, all these cause bloody noses.  Then there’s many children’s favorite pasttime- picking (many adults enjoy this too).  Nose picking is a double whammy on nose tissue.  It often starts with itchy noses from allergy and dry air. Then when your kid scratches that itch, his fingernail tears the already dried out, cracked, and fragile tissue, nicks a vein, and it’s off to the races.

Like we said, stopping nosebleeds is usually easy.  Squeeze the nostrils closed gently for ten minutes, not letting go to check if it’s stopped until time is up.  If that doesn’t work, do it again.  But what if after all that your kid’s nose is still bleeding and you’re out of decorative dishtowels, and your furniture and carpet look like a Jackson Pollock nightmare?

If the bleeding won’t stop after a couple of tries at direct pressure, then it may be time to bring your child in.  Another issue is if an injury caused the bleeding, should the nose be looked at for other problems besides the bleeding itself?  If there is a large amount of swelling around the bridge of the nose, or every time you touch your kid’s nose they pull away and let out a howl, then maybe it should be looked at.

After a nosebleed, there are often some “aftershocks” of bleeding.  If nosebleeds are recurrent you might put a humidifier in the bedroom, and run the air conditioning less.  If bleeding continues on and off for more than a week, it’s time to see an Ear/Nose/Throat (ENT) specialist.  Sometimes kids get a raw spot inside their noses that just won’t heal, and the ENTs have the tiny scopes to look inside, find the raw spot, and cauterize it.

All in all nosebleeds are a side effect of growing up.  They are rarely dangerous, and cause more alarm than real trouble.  Remember not to panic, and you can always call the people who are trained to help when you are concerned.

You’ll Put Your Eye Out!

It was a mystery to mom: her 10 year-old, autistic boy suddenly was rubbing his eyes and crying.  When she pried his hands away, she saw that his eyes were red with swollen lids, and he obviously hurt.  Was it allergies?  Did pink eye come on this fast?

She checked him over to see if he had gotten into anything, felt a lump in his pocket, and pulled out the pepper spray canister that she kept in her purse!  Mystery solved.  She ran his eyes and face under cold water and brought him in.

Eye illnesses and injuries often freak people out.  Sight is important, and many fear losing it.  Eyeballs themselves are kinda freaky.  No haunted house is without missing eyeballs, misshapen eyeballs, or eyeballs in a bowl.  Eyes can be mysterious- movies and TV enhance drama by highlighting or shading an actor’s eyes. Emotional response to eye problems makes for a lot of Emergency Department visits.

The most common eye problem in the ED isn’t an emergency: conjunctivitis. Conjunctivitis is what many call “pink eye,” where the eye is red, watery, and itchy. Sometimes the eyes water clear, sometimes the discharge is green and gooey.

Most conjunctivitis is from infection, usually viral.  Like most viruses, pink eye lasts only a few days and goes away on it’s own without antibiotics.  Contrary to popular belief, pink eye is not terribly contagious, and the American Academy of Pediatrics doesn’t consider it a reason to skip school or daycare. Pink eye can also be from allergies to pollen or pet hair exposure.  This “allergic conjunctivitis” lasts as long as the child is exposed, and tends to stay watery and not get gooey and discolored.

Swelling around the eye also worries parents.  Usually baby wakes up with one eyelid dramatically swollen, and is rushed to the ER.  Baby seems fine, cooing away and not sick, but it LOOKS bad!  These are usually due to insect bites, and swelling around the eye is more dramatic than bites to other areas because of loose skin and abundant blood supply there.

In the iconic movie “A Christmas Story,” 9 year-old Ralphie Parker yearns for a Red Ryder BB gun.  A running gag is Ralphie’s subtle and not-so-subtle begging to his parents and Santa for the gun.  He is invariably turned down with the line, “You’ll put your eye out!”

At the end (spoiler alert!), Ralphie gets his BB gun and promptly shoots himself in the eye, or actually, shoots his glasses off.  Fortunately for Ralphie, his glasses saved his eye.  Unfortunately, in real life BB guns can “put your eye out.”  I’ve seen too many BB injuries to eyes and faces of kids, and too many real gunshot wounds there too.  Despite advances in eye surgery, eyesight and/or the eye itself are often lost.

Therefore, preventing eye injuries is the best way to preserve vision.  If your child is doing something with potential injury, have them wear safety glasses.  Basketball great Kareem Abdul Jabbar turned geeky protective glasses into cool.  During a college game he got his cornea (the clear dome in front of your iris and pupil) scratched.  Corneal abrasions are intensely painful, and after that he wore glasses.  Corneal abrasions can come from flying particles while woodworking, weed-eating, shooting, and from many sports.

Eye strain is another form of eye injury.  In my childhood, parents warned that watching too much TV would “strain” our eyes.  Not knowing what that meant, we ignored them.  It turns out eyestrain is real and much more prevalent today, with smaller screens that have more detail than old TVs, and kids spending way more time looking at them.  Growing up we had one TV at home, and you could tell who the rich kids were because they had two!  Now most kids have a screen in their pocket, or more likely in their faces.

Symptoms of eyestrain are watery and itchy eyes, blurry vision, headaches, and light sensitivity.  Eyestrain can be reduced by keeping screens clean, enlarging text, and rest from screen time.  Put off getting your child a phone.  Get their phone when they NEED it, not because they want it for entertainment.

Like with the Red Ryder BB gun, you don’t want them to put their eyes out!