And They All Came Tumbling Down

This week’s guest columnists are Drs. Anna Malesky and Alicia Ortiz, Family Practice residents at the University Hospital and Clinics here in Lafayette.

It was our sixth shift in the Pediatric Emergency Department when we began to notice a theme.  On the Adult side of the ER, we saw falls in the elderly- on the Pedi side, we saw even more in kids.  Usually the mother can barely tell the story while clutching her infant tight to her chest.  Parents often blame themselves, or each other- who was supposed to be watching?

On one shift we saw a three-month old who fell out of her car seat on to the street, while the seat was being transferred from the car to the stroller.  She had been unbuckled after the car stopped, mom assuming belts were only necessary when it was moving. In the next room was a six-month old who had rolled off his parents’ bed.  Both kids had fallen from high enough to warrant head CT scans, to insure they had no brain bleeding or skull fractures. Both CTs were normal, and the parents were relieved.

It’s important to keep infants strapped in their car seats anytime they’re in them, not just in the car. It drives our nurses crazy when parents bring a baby into the ER, swinging them in their car seats, unbuckled- an accident waiting to happen.  Also, never leave babies on beds.  It’s no fun to discover that they can roll over by hearing a thud and a shriek from the bedroom you left “for just a minute.”  In that vein, babies should never sleep with parents on couches or beds either.  Not only could they roll out while you’re sleeping, but it’s also a risk for SIDS- babies can smother to death in bed or on couches with adults.

Infants also shouldn’t be carried around by younger children.  Kids in their pre-teen years and younger just aren’t strong enough, or reliable or careful enough, to be trusted with such a precious cargo.  Heck, even many teens can’t be trusted either.  Ask yourself, would you let that child or teen carry around your favorite 15 pound china bowl?  How much more valuable is your baby?

Keeping kids safe from falls is not limited to infants or toddlers.  Last week we had a pediatric trauma case, a nine-year old, who was riding on the back of a bike.  A seventeen year-old was steering, not looking where he was going, and ran them into a parked car.  Both kids flipped onto the car roof.  Neither were wearing bike helmets. Fortunately the nine-year old, after a lot of x-rays and CTs, ended up only with some cuts and scrapes.  Others aren’t so lucky.

According to the U.S. Centers For Disease Control (CDC), “injuries due to transportation were the leading cause of death in children” for 2016.  This includes kids killed in bike accidents, many of which would be prevented by bike helmets. Louisiana regularly ranks as the top second or third state for bicycle accident deaths. Earlier this summer Dr. Hamilton was showing friends from Maine around New Orleans. They were appalled at how no one was wearing bike helmets- apparently everyone in Maine does.

The other important tip to avoid injuries from falling off bikes, is not to fall off them! When they first start riding, children should be taught the rules of the road for bikes- riding with traffic, staying in bike lanes, obeying the same rules as cars. This means stopping for red lights and stop signs, and checking both ways before crossing, unlike our kids above. Supervise your kids on their bikes until you’re confident they’ll be safe. Make it a “family ride” when you do this, to bond with your kids, get in some exercise, and keep them out of harm’s way.

Finally, your kids will eventually turn 16 and get a learner’s permit.  While this affords them some independence and frees you from chauffeur duties, it’s important that they know that motor vehicles are dangerous, and can cause significant harm to others.  You don’t want your teen making other bicyclists and pedestrians fall- by being hit by your car!  When riding with your teen, besides enforcing the rules of the road, teach them vigilance for pedestrians and bicyclists.  Of course, vigilance means no texting and driving- ever.

Drama In Real Life

April 29th was a bad day in Lafayette.  Around midnight at Festival Internationale, two people began arguing.  Possibly fueled by alcohol, the fight escalated, someone pulled a gun, and one person ended up dead, and two injured by stray shots.

Interpersonal drama brings many kids to the Emergency Department too, particularly teenagers. Someone says the wrong thing, feelings are hurt, punches are exchanged, and we see the ensuing facial and head injuries.  Teens are particularly vulnerable to these escalations.  Already at an emotional age, with hormones surging, feelings are raw and easily chafed. Teens are also often in the early stages of learning conflict resolution. They are unskilled in managing feelings and arguments without resorting to shouting and violence.

Several outside forces can inhibit teens from maturing into rational adults too.  A lot of media these days portrays immature behavior as something fun to watch and emulate. Reality TV consists of knuckleheads gossiping about each other on camera, making wars out of simple disagreements.  Then the assailants confront each other and scream obscenities for the enjoyment of the TV audience.  And the combatants are always so good-looking, just like teens want to be.  

Social media amplifies drama as well.  When I see fights brewing at festivals, it’s not just two teens having a tiff.  There’s usually a crowd of “friends” swirling around, egging them on, joining the shouting.  With social media, the crowd is even bigger, with unlimited gawkers available through screens and sites, taking sides, trading barbs. Simple arguments become electronically-enabled riots.

Some teens learn poor conflict resolution at home too.  When some parents fight, their negotiating skills look like the Jerry Springer show. Rather than a calm discussion of differences, these parents try to intentionally hurt the other’s feelings, verbally “aiming to kill,” instead of speaking respectfully.  When kids grow up living with such behavior, they rarely learn a better way for themselves. 

Like we discussed above, social media can fuel conflicts between people.  Once on Facebook, I saw a picture of a friend’s teenage son at a party.  His round smiling face, his arms draped around two friends, reminded me of actor Jonah Hill  (a cute Jonah Hill, not the overweight creep he sometimes portrays). So, bonehead that I can be, I said so in a comment. The backlash from he and his parents, and my wife, still makes me cringe with embarrassment.

Thus one problem with social media: it’s easier to commit a social faux pas with a keyboard.  When you’re face to face with a person, you naturally edit what you say, to not offend.  There’s non-verbal cues that help you to not say dreadful things. This in-person behavioral check doesn’t operate when interacting online.

Secondly, when you’re angry at another person, this social media disconnect makes it easier to intentionally wound.  In World War II, fighter pilots were rarely troubled by killing their enemies, though viciously machine-gunning each other in one-on-one combat.  This was because they concentrated on the other plane, not the pilot inside. Likewise today, it’s easier to say the meanest thing that comes to mind online, because you’re saying it to a machine. But screens are like fighter planes- there’s a real person hidden inside that gets hurt.

So how can you counter the forces of Reality TV and on-line depersonalization, that turn your teen into a screaming drama king or queen?  Begin before your child’s a teen. In pre-teen years, games should be played less on screens, and more face-to-face. Board and card games, tag and backyard ball, are all conflict-resolution exercises for kids. Negotiating the rules, playing fair, keeping friends, all happen in those arenas, not in video games.

You must also model good behavior yourself.  Parents should have arguments that aren’t death matches, but calm settlings of differences. Feeling wronged and needing vengeance are innate human traits- show your kids how you bypass those cruder motivations, to stay friendly.

Finally, texting and messaging are certainly convenient, but elementary school kids should spend more time together in person than on screens. Phone and computer time should be limited, like limiting how much candy kids eat. And explain that there’s real people on the other side of the screen, not computer-generated enemies.  Then it’s easier to avoid comparing someone to Jonah Hill.  

2016- The Worst of Times?

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

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

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

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

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

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

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

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

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

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

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

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

Ghost In The Graveyard

There’s only about 4 weeks left of summer vacation here in Louisiana.  Summer’s been terrific, but now family vacation and your kid’s camps are done.  You’ve made some good memories, but now the kids are bored and have reverted to lounging about playing video games.  No one goes outside, with the heat during the day and the mosquitoes at dusk.

However, it’s not too late to continue a great summer, have fun with the kids, and generate some more memories.  Sometimes to find ideas for this blog, I check the New York Times Wellness Blog, and recently found their series called “The Intentional Summer.” They’ve come up with more ideas for parents and kids to beat boredom and salvage what’s left of summer; and get the kids outside for more exercise.  So I’m going to shamelessly borrow from them.

I asked my three kids, now grown, if they’d ever played a game called “Ghost In The Graveyard.”  The older two replied, “that rings a bell,” and my youngest had no clue. This reflects studies that kids now spend more summertime indoors than outside, as opposed to my generation who spent more time out than in.  We didn’t have video games and only 5 or 6 channels on TV, so we had to play outdoors with the neighborhood kids to avoid boredom.  Many of those kid-run games have gone forgotten.

Now it’s up to parents to revive the games of their youth, for their kids. Get your kids and their friends together and teach them the classics- Flashlight Tag, Capture The Flag, and Ghost In The Graveyard.  If you don’t remember the rules, look them up online.  Once you set the kids loose, they won’t be able to stop, particularly with Ghost In The Graveyard. This game has suspense, hide-and-go-seek, and lots of running.

Sending your kids outdoors takes some planning.  To beat the heat, they’ll need plenty of water, and perhaps playing in the evening when it’s cooler.  But evening is when mosquitoes are worse, so you’ll need bug spray.  But it’s worth it, for their health and happy brains.

When reading the New York Times ” Intentional Summer” series, I found an excellent family activity they called the Quest.  I had done several summer quests as a kid myself, as you probably have too.  It’s time to use what summer you have left to get your kids outside on their own adventures.

One of my summer quests was what I’ll call The Quest For the Six Pack Of Coke.  My parents did not buy soda, so once when I wanted some Coca-cola (about age 8), I had to get it myself.  First I had to earn the $ 1.00 it cost.  I went around the neighborhood drumming up jobs, and after raking grass and pulling weeds I had four shiny quarters. Then I had to plan the bike ride, an all afternoon trek to the supermarket and back. It became a sunny day ride through seldom-traveled neighborhoods that seemed like foreign lands. Like all quests it was more about the journey than the destination.

Send your kids on their own quests.  Half the journey is the planning, and you can help  with that: bicycle maintenance, planning routes to balance safety and adventure, and the road home.  Instead of a six pack of soda, the quest can be a specialty store like one that makes in-house chocolates, or similar exotic destinations. There’s a modern version of the scavenger hunt called Geocaching, where fellow scavengers have hidden little prizes all over the country. Look up online how to go find the prizes, in parks and neighborhoods, and join your kids on a ready-made adventure.

Another version of the Quest is the Excursion, where your family visits a familiar destination like the library or grocery store.  But instead of driving there, you walk or bike. Again, half the fun is the planning:  what route to take, where to stop for ice cream and drinks, carrying groceries, managing heat and mosquitoes.  You’ll need water, hats or bike helmets, bug spray.  Then adventure happens when you find yourself in places that look familiar when whizzing by your car window, but are totally new when you walk or bike them.

So save summer from boredom and the computers.  Send your kids on a Quest or take them on an Excursion.  Or closer to home, help them find The Ghost In The Graveyard. 

Teens Behind The Wheel! Look out!

My three teens may not believe it, but I also once was a teen.  And one night I was bombing down a snowy road in our old iron Jeep Cherokee, the radio blasting my rock station, not a care in the world.  Then I topped a hill and headed down.  Now, four-wheel-drive is fine for getting you started on slippery ice and snow, but it’s no help slowing you down.  And down I went, at speed.

The hill had a turn and when I put on the brakes, I started sliding out of control towards some trees. So I pumped the brakes as best I could, made the turn, and headed for the intersection at the bottom.  Unable to stop, I hung on and hoped for the best.  Just before I crossed that road, a Honda Civic zipped by. Luckily that was it for traffic.  I skidded across and came bumping to a stop on a snow-covered lawn.  After a few minutes I was able to quit shaking and drive away.

My wintery adventure illustrates some safety issues with teen drivers.  Teens are inexperienced drivers.  They haven’t had enough time on the road to learn things like braking in time or driving slow enough for road conditions.  Teenagers also like speed. Speeding is fun, even though it’s not safe.  Teens don’t think about consequences. They’re temporary sociopaths- who cares about the future, I’m all about here and now. Though I had driven and jogged over that hill thousands of times, I didn’t foresee going over in a heavy car on snow.

Teens are also easily distracted behind the wheel. Like teen me, they listen to the radio too loud.  They drive with friends and have intensely important conversations, or a lot of laughs.  They talk on phones.  They text.  These things take a teen’s eyes and mind off what is out front.  Another car slams on the brakes, a red light is ignored, a turn is too tight, disaster ensues.

The above safety issues with teen drivers are why their car insurance is so expensive. Teenagers crash- they incur car repair bills and medical expenses.  So what can we do to keep our teens safer while they gain experience behind the wheel?  Fortunately Louisiana has Graduated Driver Licensing. This system allows teens to gain experience while keeping them, and those driving around them, safer.

The first rule in GDL is when a teen gets a permit at age 15, they must drive at least 50 hours before they get their license.  This means they should spend about one full hour per week driving with an adult, hopefully more.  15 of those hours should be gaining experience driving at night.  When a teen gets licensed at 16, there are more rules for that first year of solo driving.  By Louisiana law, no driving after 11 pm.  Teens can’t have passengers after 6 pm, except an adult over 21.  They can’t use cell phones.  And no texting. Ever. Even after 17.

Here are some ideas to keep your teen driver even safer. First, try to delay when they start driving.  The older teens get the more their brains mature, and they become safer drivers. Take advantage of teen procrastination.  Don’t drive them to the Office of Motor Vehicles on their 15th birthday- let them decide when to go in their own good time. Wait for them to badger you incessantly before you (eventually) get around to bringing them. Before you go, make them look up what they will need to bring to get their permit, and get those things themselves- this alone will buy you another few weeks of brain maturity.

Also, wait another year or two after 17 before you let them drive with friends or with a phone, or with the radio on.  More time driving with good concentration will help form better driving habits.  Finally, limit the time they drive in the rain, on the highway, at night, or at rush hour.  They do need to get experienced driving in adversity, but take it slow.

I’ve got three teens on the road myself and followed these rules and my wife and I still worry at night.  Look out!  Teens on the road!

Call Poison Control! 1-800-222-1222

One of my favorite movies is a 1991 comedy called Defending Your Life, starring Albert Brooks and Meryl Streep.  The premise is when someone dies, before going to heaven he must defend his life in a trial with lawyers and judge. The evidence presented is scenes from the deceased’s life.  At one point for fun the prosecutor shows scenes of Albert Brooks just being stupid.  He shows the character in the bathroom picking up shampoo instead of mouthwash, taking a swig, and then spewing shampoo all over.

A similar goof happened to two kids last month.  They picked up hydrocortisone cream instead of toothpaste while brushing.  They started brushing with the cream and I am sure re-enacted Albert Brooks.  I found this pretty funny, because I KNOW brushing with hydrocortisone is harmless.  The two moms didn’t know this.  One mom called Poison Control, who told her that this was perfectly safe and she could stay home.  The other mom didn’t call and came to the Emergency Department, waited an hour to get seen, to have me say her kid was fine.

So here are things that I have seen kids, usually those pesky exploring toddlers, eat that are perfectly harmless.  Shampoo and hydrocortisone cream, of course.  Sugar ants (had invaded a restaurant’s soda machine and mom found them floating in her daughter’s drink).  Poinsetta leaves (turns out that these are only mildly irritating on contact, maybe leading to some brief vomiting and diarrhea at worst).  Ibuprofen (brand names Motrin or Advil).

Here are some things kids drink that are USUALLY harmless in small doses. One of the most common toddler ingestions is household bleach.  A few teaspoons is harmless, which is usually all they can stand before gagging and spitting.  Tylenol, Aspirin, and ADHD medications are also okay in small amounts. Call Poison Control to be sure.  They can help you decide if your child needs to be seen. If your child should be checked out, Poison Control calls the Emergency Department to alert us you are coming.

Occasionally a child poisoning is not as goofy as those kids from above who brushed their teeth with hydrocortisone.  Once police were called to a house where the parents were fist fighting.  When the officers entered they found a 3 year-old boy lying unconscious among empty pill and liquor bottles.  When the child got to us he was breathing but unarousable.

We tested the boy for everything we could- brain bleeding, alcohol poisoning, narcotics, etc.  All the tests came up negative, but there are many medicines we do not have tests for (real life is not like CSI:Miami). There was a grandmother in the house also, who took eight medicines. Worried that the child took one of those, we reviewed the list with Poison Control.  Four of the drugs could have made this kid like he was.  We admitted him for observation and fortunately he woke up the next morning and was fine.

What kinds of grandma medicines could have done this?  Many adults take blood pressure medicines, heart medicines, and diabetes pills.  All these can hurt kids.  Other dangerous medicines include antidepressants, anti-anxiety drugs, and narcotic pain medications. Believe it or not, one of the most dangerous medications a toddler can take is adult iron pills.  Keep all these medicines where small children absolutely cannot get them!  Elderly people often organize their many pills in plastic daily dispensers; if the grandkids are around and granddad leaves it out, that’s big trouble waiting to happen.  Toddlers who see granddad pop his pills will imitate him and do the same.

Finally, do not leave fuels like gasoline and kerosene around in cups.  To a toddler, a cup is an invitation to drink.  They don’t understand the difference if that cup was filled with old lawnmower gas or juice.  Be just as careful with drain cleaners like Drano or Liquid Fire- these can be deadly too.

Again, when in doubt call Poison Control.  They can tell you if you need to come in, or stay home and not wait in Emergency for me to tell you: brushing with hydrocortisone is pretty funny, and safe.

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.

 

 

 

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!

 

 

 

Welcome To My New Blog!

My blog has moved to a new home.  Entries from my old blog came over, and can be found in the archive in the column to the right of this page.  As before, my emphasis is to help you understand what is an emergency, and what is not.  Too many parents bring their kids to an emergency room for things that are not emergencies.  Hopefully reading some of my columns will help you take care of your sick or injured child at home. 

Please feel free to comment on what I have to say, ask questions, or add your own stories.  As before though, I can not give advice on individual patients- that is your own doctor’s job!

Belly Pain- Is it an Appendix?

A common reason for parents to bring their kids to the ED is belly pain.  Doctor’s offices and “quick care” urgent care clinics also send us a lot of kids with belly pain.  Everyone has the same  basic concern- is it appendicitis?  Does the child need an operation?

I often encourage families to stay home or wait to see their doctor for things that are obviously not emergencies.  Runny noses, fevers, diarrhea, rashes, even ear pain- Stay home!  Give ibuprofen!  Belly pain, though, should not be waited on very long.  Belly pain lasting more than a few hours needs to be discussed with a doctor, first on the phone, and then in the office or E.D.

What is appendicitis?  The appendix is a tiny pouch that usually hangs off your intestines in your right lower side.  Appendicitis is when poop gets trapped in the appendix, gets infected, and the appendix slowly swells like a boil.  With swelling and infection comes pain, fever, and nausea.  A “ruptured” appendix is when the appendix bursts and the pus and infection spread throughout the abdomen.  We always hope to diagnose appendicitis and get it out before rupture, but that is sometimes just not possible.

Though most belly pains turn out to be stomach virus or constipation, the diagnosis of appendicitis can be tricky.   Early on appendicitis can act like stomach virus and fool the doctor.  Sometimes the child is admitted to the hospital, the doctors and surgeons debate and ponder, and finally days later the surgeon decides to take the patient to surgery for the pain.  Only then, with the patient opened up, does the surgeon look in and go “ah-ha” and make the diagnosis.

With belly pain, first call your doctor.  Some doctors are comfortable making the diagnosis in the office and then sending the patient right to a surgeon.  Some refer the family to the ED for diagnosis.  Make sure you take your child to a hospital that cares for children and has surgeons available.  In Lafayette, that is Lafayette General Medical Center and usually Women’s and Children’s Hospital too.

What does a child with appendicitis look like?  First, the pain starts as a steady, slowly worsening pain.  Often the pain starts in the middle of the belly, under the belly  button, and later is more in the right lower side.  Kids with appendicitis lose their appetite and sometimes vomit later in the illness.  They also often have later fevers.  This is usually unlike stomach virus, where kids vomit first, have early fevers, and have crampy belly pain that comes and goes away.

At the hospital, the ED doctor and surgeon often make the diagnosis and decide on surgery by just taking a history (hearing the “story” of the illness) and examining the child.  Few tests are needed besides a few blood tests.  CT scanning is usually unnecessary.  One estimate is that only 10% of appendicitis cases need a CT to make the diagnosis.  CT adds a lot of radiation exposure, and sometimes can miss an appendicitis or mislead the doctors with extraneous information.

The surgery itself is usually uncomplicated and safe, as long as the appendix hasn’t ruptured.  The child often goes home in a day or two after surgery.  If the appendix has ruptured, that means recovery takes a week or two of antibiotics and care in the hospital.

So if your child has belly pain, but is walking, smiling, eating and the pain goes away soon, it probably is not appendicitis.  If he or she starts with pain that is steady and worsening over some hours, come on in!