Friday, October 25, 2013

Halloween Safety Tips

Halloween can be such a fun holiday, but as you can imagine, as an advice nurse we tend to hear about some of the misfortunes that can come along as part of the festivities.

Carving a pumpkin can be a very fun tradition.
Please make sure that your child's level of participation is consistent with their age and ability.
*Do watch out for the sharp implements and make sure you assign your younger child to the safer tasks. (young kids can draw on the pumpkin rather than carving.)
*Clean up the mess. Pumpkin flesh is slippery and can cause falls and injuries when dropped on the floor. Layer newspaper or old cloths under your carving workspace and clean up spills right away so no one slips or trips.
* Skip the candles, which may cause fires. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick (available in many colors) or flameless candle to safely illuminate your jack-o'-lantern.

Choosing a costume
Want to hear a terrifying statistic?
Children are more than twice as likely to be hit by a car on Halloween than on any other day of the year.
*Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors.
*Have kids use glow sticks or flashlights to help them see and be seen by drivers. Is your dog going along with the trick or treaters? Have them wear a glow in the dark collar! 
*When selecting a costume make sure it is the right size to prevent trips and falls.
* Be sure to wear flame-resistant costumes. Remind your child that they need to pay very close attention to their surroundings and avoid walking near any candles or flames...especially if they have loose flowy costumes.
*If a sword, cane, or stick is a part of the costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he or she stumbles or trips.
*Since masks can sometimes obstruct a child's vision, try non-toxic face paint and makeup as another option. 
*Always test the make up in a small area first.  Always completely remove it before bedtime to prevent possible skin and eye irritation.
*Make sure that your child doesn't have any latex sensitivity because you do too heavy of an exposure. Many masks are made of latex. We actually just had a patient who had an allergic reaction to the hair tinsel.
You may want to do a test run of the costume and make up a couple of days ahead of time to rule out any allergies.

Trick or treat rules

*Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without supervision, remind them to stick to familiar areas that are well lit and trick-or-treat in groups.
*Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so be especially alert for kids during that time if you are out driving

*A good meal prior to parties and trick-or-treating may discourage youngsters from filling up on Halloween treats. 

*bring plenty of water along when you go trick or treating. Just trust me on this one. 

*Make sure that your children know that after trick or treating, the grown up needs to pick through trick or treat bag and toss anything that looks suspicious.

* Some candies are real choking hazards. If you have a younger child in the house, make sure they don't have access to the stash

* If you have a child with nut allergies (I am sure this is NOT your favorite holiday) make sure that they turn over ALL the candy so that you can separate out anything that might cause trouble. 

Expecting trick-or-treaters or party guests?

*Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
*Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks.(Okay, fine...maybe you don't want to be  that house, but I had to put it on the list) 
*Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls.
*Keep candle-lit jack o'lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.

Now..what do we do with all this candy!!!

Make a plan about how much candy they can eat at one time.
It is okay to be a little more liberal than usual for a day or two, but come to an agreement about a reasonable candy intake over the next few weeks.
Some dentists and orthodontists have buy back programs, where they will give your child a reward for turning in their candy.

Remember that candy freezes (and some of it is actually better that way...frozen snickers bars, yum)

My daughter Lauren was about 6 when she caught on that mom and dad were pilfering through her trick or trick bag and stealing all the good stuff. After that she guarded her stash more carefully.

Haunted Teeth 
Click below for some tips about keep your teeth healthy..especially on Halloween

Have a fun and safe holiday!

Friday, October 18, 2013

Nurse Charity talks about biting

Now that preschool is in full swing for fall we have been getting a fair amount of calls about biting.  Unlike other forms undesirable behavior- (pushing, hitting, scratching, hair pulling, pinching, verbal and social bullying), the emotional fall out from biting seems to escalate quickly, emotions run high and very soon it is family against family, teacher against parent, and some very bewildered children.  So lets talk about biting, how to create a safe space for your child (either biter or bitee), basic first aid and in the process- put some common biting myths to bed.    
 We get two types of calls at our office-  The angry, upset parent of the bitee convinced their child has been set upon by a rabid entity bent on the destruction of their child.  And tearful, panicked parents of the biter, worried they have a human vampire on their hands, facing informal expulsion from their playgroup, or  worse, formal expulsion from the pre-school.

So here is the cold, hard truth- 
 Biting is a normal developmental stage for a lot of little mammals, humans included  (aged 2-4).  And the children of some pretty fantastic, present, kind, thoughtful limit setting people get to be the parent of the casual and habitual biter.  

What follows is a nice run down of what actually works for Biting (No, biting them back does not work- trust me I tried it.  My son wandered around for a week, showing the bruise on his arm to random strangers, and saying "My Mama bit me!"  Do not let this be you!) 

1.  Make this a Safety issue.  This is a goal all parents, teachers
and children can get behind.

2.  The play group/pre-school should make it their goal to prevent aggressive behavior of any kind by members, not just biting.  So the plan should apply universally to undesirable, unsafe behavior.

3. Create a "safe place" to help isolate the biter.  Remember they
maybe just as upset and bewildered as the child who is bitten,  and
kids tend to strike back very quickly.  Teachers and volunteers need
to move quickly to separate children, and KEEP CALM!
Depending on the age group, I would suggest a cozy
playpen type space, so even one adult can manage the situation. Pick
up the biter (or hitter or scratcher etc), say- "no don't bitebiting
hurts" and set the child into the safe place.  Then the teacher/parent is free to put all of his or her attention to the child who was hurt.  
4. Safety Break- Biter in the safe place, bitee being looked after and smothered in kind loving attention.  I suggest a 3-5 minute break to allow emotions to cool, and normal activity to resume.  
5. First Aid- Wash with cold water, small amount of antiseptic soap, and apply a cold compress if necessary.  Don't panic- they very, very rarely break the skin, and prompt washing with antibacterial soap, and a good water flush is enough to clean a superficial wound.  A bandaid is often helpful even if the skin is not broken. Fill out required paperwork (if any). Notify parents.
6.  Allow the separated child to return to the activity in progress.  (and this is KEY) Be warm and welcoming to both children.

7. If the skin is actually broken, a bite can become infected and might need to be evaluated.

Things to avoid! 

Apologies- they are not developmentally appropriate for this age
group.  Your child can apologize till they are blue in the face- it
might make the parent feel better- it will not sway or help the child
This is something that happens when adults overlay their

feelings onto small children, and it opens up a huge can of worms.  You ask your child to apologize before he is ready it comes out forced, the other parent gets even more upset.
Or they refuse all together.  Yikes!!  The child bitten refuses to accept the apology!  Double yikes!!   Other
parents often take this as an opportunity to yell at your child, which is not helpful and can undo many of your family rules and consequences.

Wound tending- Many attachment parenting books talk about letting the biter help tend the wounds of the bitee- More trouble than it is worth.  Sometimes the child who was hurt will not let the child help- leading to more tension.  Or the care taking role your child wants to take is
prohibited- for example my child once wanted to provide a band-aid to
the child he hurt.  The pre-school refused to let him.  

A lot of reasoning, yelling, shaming, etc.- Keep the talking about biting age appropriate   A lot more discussion other than- "Biting Hurts, no biting."  in a clear firm, almost dead pan voice is all that is required.   Even a baby genius does not have adult empathy or rationalization skills, and yelling at them does not actually make them anything but tense and afraid- which sets the stage for (yep, you guessed it), more biting.  Also after having followed a lot of biting children in the past few years, including my own, some children are not biting out of aggression.  Often times they are biting out of love (no really- biting feels good to the biter- and so they assume it feels good to the bitee as well), or a simple desire for more personal space.

Now for the hard part-  if biting becomes a pattern 

Someone needs to shadow the habitual biter at school/playgroup and keep a log, who does s/he bite?  when does s/he bite?  what happened that day, what is the weather, what is happening at home.  Is there anyone who gets bitten more than others? Why is that? (friend who is always in close proximity, love bites to favorite people, too noisy of an environment, too many kids in one play area, not enough toys to child ratio, retaliation of aggression).

Ok then one needs to teach the other kids to help the habitual biter/hitter/scrathcer/pincher stop-
again this is a safety issue.   Many parents and teachers will resist
this step making a single child the scapegoat.  Do not let this happen!  It
is a safety issue- everyone will be safer if the kids know what to do
if they notice their playmate is getting upset.  It empowers potential
victims.  It does not in anyway condone biting (or hitting or pushing
or scratching or any other aggressive behavior).

Usually kids are taught-

Take a step back
say "No bite" (no Hit, No scratch").
put out a stop hand

This also helps teachers who may have not been paying attention to come quickly.

Books and videos you may find helpful!! (Trust me I read and watched them them all, so you did not have to!)

Book: Teeth are not for Biting! Elizabeth Verdick and Marieka Heinlen 

Video: Time Out Tot, the Behavior Coach.

Friday, October 11, 2013

Slap Cheek

Slap cheek is one of those illness that seem to come around a couple of times a year. It is not unusual to see it in late Fall/ early Winter.
It is also known as Fifth disease or Erythema Infectiosum.
(Fun fact,  it got the name Fifth disease back in the 1880 s when childhood diseases that caused rashes were referred to by a number. This was number 5 out of 6... Others on that list included measles and scarlet fever)
It is caused by  Parvovirus B19.

Just like Hand Foot Mouth, Slap Cheek is a fairly contagious rite of passage.
It is mostly spread through respiratory secretions, but can also be carried through infected blood.
Most people get it while they are still children  (usually between 4-15) and thus  have immunity as adults.

 Unless we had a bad case of it most of us don't actually know whether we have had it. You can check with Grandma, but I bet she doesn't remember either.The symptoms may have been mild enough that no one paid much attention.
This illness can be quite variable. Some kids don't seem too impaired while others are miserable.
The really mild cases can present with a child who has a red chappy cheek for a day or so, and that's it!
The sicker kids can be achy (joint pain is common for those old enough to voice their complaints) and fussy with high fevers on and off for several weeks.
The common denominator (hence the name) is one or both  cheeks usually appear very red and chappy. For most patients, the red cheeks are followed by a lacy, mottled rash  that works it's way up and down the body.  It tends to cover the arms and legs more than the trunk. (of course there are exceptions, some kids don't read the text books and present any which way that they like)
There may be several days in between symptoms. 

Very rarely kids can get quite ill with this... in my many years here I have NEVER had any patients who didn't get over it completely without any lasting adverse affects, so relax, but remember Nurse Judy's rule.....any fever that is lasting 4 or five days needs to be checked on.

The most important thing to note about slap cheek is that it can be dangerous to a fetus. If a woman is infected in the early stages of pregnancy there is an increased chance of miscarriage. 
Remember, most women had this as a child and are therefore not at risk. But since most people also don't really know if they had it or not, It is best to avoid contact with pregnant women as much as possible if your child has been diagnosed with this. If you are pregnant and may have been exposed, talk to your OB about getting a blood test to check your immunity.

The incubation period is thought to be about 4-21 days after the exposure.
(In other words if you come in to our office and walk out with a red didn't get it here, that would be way too soon)
The kids are most contagious at the very beginning of the illness when the main symptom is probably simple fussiness. The  cheeks might be red, but you reasonably figure that this could simply be caused by being a little warm. Frankly, by the time the rash is in full throttle they are probably not very contagious anymore.

Treatment is symptomatic.
Treat the fevers as needed with Tylenol/ Ibuprofen and tepid baths.
Make sure your child gets plenty of fluids and rest as needed.

My best daycare and school guidelines are to keep a child home if they are fussy or have a fever, but if you have a happy child with a red cheek, it seems unreasonable to expect you to stay home from work. Chances are, once one of the kids in daycare shows up with it, everyone has already been exposed.

This virus can cycle on and off for a few weeks before it is done with  you.

Friday, October 4, 2013

Read Aloud: Nurse Jen's book review

This week I am taking a break from discussing an illness  (or poop) and turning it over to Nurse Jen who wants to let you know about a book that she thinks is well worth sharing.
The opportunity to read out loud to your children is precious time that I hope you cherish.
(I offered to read to my 23 year old just this week and she rolled her eyes at me.)

Nurse Jen reminds us that kids never outgrow a good book!
Parenting books can be helpful - but where to start? The choices can be overwhelming. Following is a recent favorite of mine.

The Read Aloud Handbook, By Jim Trelease
This book has been around for 30 years but somehow I missed it! Luckily, I heard about the release of its seventh edition this summer and I am so glad I found it. The first half addresses the reasons why we should read aloud to our children - even after they are able to read on their own.  Trelease says "Reading alone and reading aloud are not mutually exclusive. We can do both - and should."  Reading aloud to children of all ages improves listening comprehension, builds the parent child emotional bond, expands attention spans, increases vocabulary, and improves grammar just by hearing the English language.

If that doesn't convince you this anecdote might - Trelease tells the story of an admissions director at one of the nation's most prestigious small colleges who states "The best SAT prep course in the world is to read to your children in bed when they're little. Eventually, if that's a wonderful experience for them, they'll start to read themselves."  But don't stop when they get bigger, keep the ritual going well after your children learn to read on their own.  
It's easy to start, try these tips:

·         Spread books throughout the house! In one study, children with the most interest in reading came from homes where books were spread throughout the house, not just one or two places.  You'll be more tempted to pick up a book and read aloud for a few minutes if they are stashed in multiple places throughout the house.

·         After you've read to your child at night, allow your older child to stay up 15 minutes longer to read on their own - just like mom and dad. Give your older child a bedside lamp and tell them you recognize they are responsible enough to stay up a little longer reading. Model this behavior for them, if they see you reading for fun they are more likely to turn to reading for pleasure. Think of it as your homework.

·         Make it a challenge, set a goal of 10 consecutive days of reading aloud together. Trelease cites an incredible example of a father and child aiming for 100 consistent nights of reading together. What they got was 3,218 in a row, only ending when the child went to college. She then went on to write a nationally published literary memoir about the stories she and her father shared.

The second half of the book is a "treasury" of read aloud books.  This book list notes the appropriate grade level and a summary for each book recommended. My kids eagerly read through it checking off the books we have already read together and more importantly circling the books they want to start reading together right away!
                                 ~Nurse Jen