Is This Really “That”?

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

I recently saw a 4 year-old named Mary in the Emergency Department.  She vomited once while eating lunch, and was brought in by both parents for evaluation.  Mother appeared more concerned about the episode, and said “Mary is always happy and active, but she’s acting tired since she vomited.  I’m always with her, she’s not herself.”  However, the father said “Mary only vomited because she doesn’t like pickles, so she spit them out.  Then she ate some of my fries and finished her lemonade.”  At this point mom looked at me and said, “I’m worried about food poisoning.”

Most visits to the ER are not emergencies.  However, it’s reasonable for parents to be concerned about a symptom like vomiting.  Parenting isn’t easy, and when folks see their child in distress, it often sticks them right in the heart.  So how do we decide that this is a benign problem, which only needs us to reassure the parent; or decide that this could be a serious problem that requires more attention?

FIrst of course, we listen to the story of what happened.  This story is the “medical history,” which also includes asking about related symptoms, and the child’s past illnesses.  Then we examine the child, to match the story with what’s happening in the kid herself.

In Mary’s case, we have a girl who vomited only one time, which typically isn’t severe enough to worry about bad things like dehydration or appendicitis.  When I examined her, I saw a child who was active and playful, with plenty of moisture in her mouth, good circulation, and normal vital signs.  This confirmed that Mary was doing well.  I reassured mom that Mary’s condition was mild, that she was going to be okay, and mom was relieved.

Parents can do this exercise at home, and avoid a costly and time-consuming ER visit.  If your child is eating and drinking well, breathing normally, and active, they are probably not having an emergency.  However, if they are acting excessively tired, vomiting for several hours in a row, in severe pain, or having trouble breathing, then it’s time to see a doctor; if not your own, then in the ER.

Omar is a 9 year-old boy whose mother is concerned about a rash that appeared on his arm. It first appeared last week, and then went away a few days later.  It looked like a sunburn, according to mom, but she was worried that it was something else bad.

Mother had not discussed the rash with Omar’s pediatrician since “every time I call the office, they give me an appointment for the next 2 or 3 days.”  Like with Mary above, the first thing is to take a history: was the rash itchy, did it hurt, were there any accompanying symptoms like fever, cough, or diarrhea?  Mother thought it might be the sunscreen she applied, though she said “it’s not a new brand, he’s used this before.”

Next is the physical exam.  I checked Omar’s skin for lingering signs of the rash, and also did the basics- listened to his lungs and heart, felt his belly, looked in his mouth and throat.  There was no rash, and he otherwise was well, an active and polite 9 year-old boy.  Mom was happy to hear that Omar was fine, we discussed the possibilities of what caused his rash (sunscreen irritation versus sunburn on a patch she missed with the screen), and they went on their way.

Many parents come to the Emergency Department for questions that worry them, and often because they can’t get into their child’s doctor.  These worries can be profound- is this cancer, or in Omar’s case, is this a sign of a potentially bad allergic reaction in the future?  When parents have these questions that keep them up at night, they come to the ER.

Fortunately, the answer is most often benign.  And if the child looks fine in the basic ways- is eating and drinking, is breathing comfortably, is active, then the answer can wait until the next available appointment with your doctor.  If the child is truly sick, with persistent vomiting, shortness of breath, worsening fatigue, and you can’t get into your regular practice, then by all means, come in!

Old Wive’s Tales: Are They Really True?

Today’s guest columnist is Dr. Asma Khan, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Whenever any couple has a newborn, their world changes completely!  Suddenly every decision is colored with thoughts of the child’s well-being.  It’s unavoidable and it’s beautiful.  But as the couple embarks on raising this new child, something less magical happens.  Meemaw, Nana, and Auntie Gertrude all have something to say about how he should be raised.  Much of the advice is good, but some is Old Wive’s Tales.

I heard some Old Wive’s Tales this past month in the Pediatric Emergency Department. One baby had fever for a few days, and mom was feeding only pedialyte.  When I asked why, mom said that her doctor told her you shouldn’t give feverish babies formula because it curdles in their stomach and they vomit.  Now, this doctor is one of my colleagues in the Family Practice residency, so I emailed her.  The doctor in question swore up and down that she never says this, so mom probably got the advice from some other revered source (grandmother, perhaps???) and grafted it onto her doctor!

This idea of milk curdling in children’s stomachs is a myth.  The thought is that when the child has fever, milk curdles because of the heat, just like milk curdles when heated on the stove.  The child then has indigestion and vomits.  In fact, there’s no reason to deny a fevered child milk.  If the child tolerates milk, by all means feed it!  Milk is a better fluid to give a sick child than water if she is refusing to eat, so she gets some nutrition.

Now, your child may vomit when ill.  This is because of the illness itself, not because of milk.  Some infections cause vomiting, just like they cause fever or cough or diarrhea.  If your child vomits, then we stop milk.  Milk can be more difficult to hold down on an upset stomach.  With vomiting we advise to switch to clear liquids like pedialyte or sports drinks for 6 to 8 hours.  When the vomiting has stopped you can go right back to the milk.

Do you know why kids hate to wear coats?  It’s because parents and grandparents insist that they wear one out in the cold.  ”You’ll catch a cold if you don’t bundle up, sweetie!” is a line we have all heard when we were kids. But to kids, coats are a pain to put on and encumbering when they play.  Also, some kids love to defy authority, so being told to put on a coat becomes the exact opposite of what they want to do!

However, kids don’t “catch colds” because they didn’t wear a coat.  Winter viruses are not from the weather.  Coughs and runny noses are caused by viruses that you catch from another person, and a coat doesn’t prevent that. Periodic hand-washing is much better prevention for the common cold.  Having a coat on in the winter keeps you comfy, but your child running around the backyard is already pretty warmed up.  Let him run free for a bit and then make sure he cleans up before sitting down to that stew.

“Feed a cold, starve a fever” is another Old Wive’s Tale, that dates back to the 1500s. The belief was that eating warmed up the body, while not eating cooled it down.  Thus “starving” was felt to be a way to control fever.  Likewise if baby had a “cold,” you wanted to feed baby to warm it up.  This is all a myth and the saying should be “feed your child,” period.  Fever is not the main ailment, it’s one of the body’s natural responses to fight infection.  When your child has fever, it’s a message to you to feed him as much (or as little!) as he wants, so he has the strength to get healthy.

These are a few tips as you go along the beautiful and scary journey of parenthood.  If other family member’s advice sounds dubious, check with a professional source when it comes to your child’s health.  If it’s the best chocolate cake recipe you’re after, always listen to Meemaw or Nana or Auntie Gertrude!



Ghost Stories vs. Rational Worries

Occasionally I am surprised by some parent’s beliefs.  There are a lot of “old wive’s tales” out there which I am used to: fever curdles milk in baby’s stomachs, fever will cook baby’s brain, blowing cigarette smoke in ears is good for ear pain, etc.  One day, however, a mom asked me “do cats really steal babies’ breath?”  I had a millisecond hesitation that a mom could really believe that, but recovered and answered the question like this:

Cats like to sleep in warm places, and I am sure some time in the past a cat jumped into a newborn’s crib, snuggled up to the warm infant, and accidentally smothered it.  This is how crib death happens- baby smothers by rolling face down in thick bedclothes or a pillow and is not mature enough to be able to roll back.  Once the cat did this, the act became myth- that cats, already associated with the supernatural, have the ability to ”suck” the life out of babies like in horror movies. 

It is natural for people to try to explain how things happen, and make the explanation more supernatural and exciting.  When it comes to child care the explanations sometimes become too exciting and lead to needless anxiety.  One of the main reasons I write this blog is to help parents separate the wild fears that bring them to the Emergency Department from the real worries.  

Here is a quick list of things NOT to worry about, in addition to those already mentioned: children hitting their heads and dying after a long interval of looking well, children choking to death on blood from bloody noses, babies choking to death on mucus, babies and children choking to death on vomit, swallowing tongues during seizures, spotty rashes being measles.  For further explanations of these, look to the appropriate Category on the right of this blog page.

Real trouble looks like this: children getting increasingly lethargic and unresponsive, breathing hard and fast, head injury with loss of consciousness and vomiting, fever in a baby under two months old.  These are the right reasons to go to an Emergency Department, rather than because baby has rattling breathing from a runny nose. 

 Of course, when in doubt call your doctor.  They can help you separate the real worry from the wild fear over the phone.  And besides not sleeping with baby in your bed, keep the cat out of the room too.