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Archive for October, 2011

Halloween Safety Tips

Monday, October 31st, 2011

Halloween is an exciting time of year for kids. Here are some tips from the American Academy of Pediatrics (AAP) to help ensure they have a safe holiday.

All Dressed Up:

• Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame. • Consider adding reflective tape or striping to costumes and Trick-or-Treat bags for greater visibility.

• Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes. • When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.

• If a sword, cane, or stick is a part of your child’s costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.

• Obtain flashlights with fresh batteries for all children and their escorts.

• Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as “one size fits all,” or “no need to see an eye specialist,” obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.

• Teach children how to call 9-1-1 (or their local emergency number) if they have an emergency or become lost.



Monday, October 24th, 2011


Bronchiolitis is a common illness of the respiratory tract caused by a viral infection that affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, making breathing difficult.


-most often affects infants and young children because their small airways can become blocked more easily than those of older kids and adults

-typically occurs during the first two years of life, with peak occurrence at about 3 to 6 months of age

-is more common in males, children who have not been breastfed, and those who live in crowded conditions Day-care attendance and exposure to cigarette smoke also can increase the likelihood that an infant will develop bronchiolitis.

Although it is often a mild illness, some infants are at risk for a more severe disease that requires hospitalization. Conditions that increase the risk of severe bronchiolitis include prematurity, prior chronic heart or lung disease, and a weakened immune system due to illness or medications. Kids who have had bronchiolitis may be more likely to develop asthma later in life, but it is unclear whether the illness causes or triggers asthma, or whether children who eventually develope asthma were simply more prone to developing bronchiolitis as infants. Studies are being done to clarify the relationship between bronchiolitis and the later development of asthma. Bronchiolitis is usually casused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis and are most widespread in the winter and early spring. Other viruses associated with bronchiolitis include rhinovirus, influenza (flu), and human metapnuemovirus.

Signs and Symptoms

The first symptoms of bronchiolitis are usually the same as those of a common cold:


-runny nose

-mild cough

-mild fever

These symptoms last a day or two and are followed by worsening of the cough and wheezing.

Sometimes more severe respiratory difficulties gradually develop, marked by:

-rapid, shallow breathing

-a rapid heartbeat

-drawing in of the breathing assessory muscles of the neck and chest with each breath, known as retractions

-flaring of the nostrils -irritability, with difficulty sleeping and signs of fatigue or lethargy The child may also have a poor appetite and not feed well or become dehydrated. Vomiting after coughing may occur as well.

Less commonly, babies especially those born premature, may have episodes where they briefly stop breathing (apnea) before developing other symptoms. In severe cases, symptoms may worsen quickly. A child with severe bronchiolitis may get fatigued from the work of breathing and have poor air movement in and out of the lungs due to the clogging of the small airways. The skin can turn blue (cyanosis), which is especially noticeable in the lips and fingernails. The child also can becomed dehydrated from working harder to breathe, vomiting, and taking in less during feedings.


The infections that cause bronchiolitis are contagious. The germs can spread in tiny drops of fluid from an infected person’s nose and mouth, which may become airborne via sneezes, coughs, or laughs, and also can end up on things the person has touched, such as used tissues or toys. Infants in child-care centers have a higher risk of contracting an infection that may lead to bronchiolitis because they are in close contact with many young children.


The best way to prevent the spread of viruses that cause bronchiolitis is frequent handwashing. It may help to keep infants away from others who have colds or coughs. Babies who are exposed to cigarette smoke are more likely to develop more severe bronchiolitis compared with those from smoke-free homes. Therefore, it is important to avoid exposing children to cigarette smoke. Although a vaccine for bronchiolitis has not yet been developed, a medication can be given to lessen the severity of the disease. It contains antibodies to RSV and is injected monthly during peak RSV season. The medication is recommended only for infants at high risk of severe disease, such as those born very prematurely or those with chronic lung or heart disease.


The incubation period ranges from several days to a week, depending on the infection causing bronchiolitis. Duration Cases of bronchiolitis typically last about 12 days, but kids with severe cases can cough for weeks. The illness generally peaks on about the second or third day after the child starts coughing and having difficulty breathing and then gradually resolves.


Most cases of bronchiolitis are mild and require no specific treatment. Antibiotics are not useful because bronchiolitis is caused by a viral infection, and antibiotics are only effective against bacterial infections. Albuterol nebulizer treatments (often used for asthma) are not very effective in opening the airways in bronchiolitis. Infants who have trouble breathing, are dehydrated, or appear fatigued should always be evaluated by a doctor. Those who are moderately or severely ill may need to be hospitalized, watched closely, and given fluids and humidified oxygen. Rarely, in very severe cases, some babies are placed on ventilators to help them breathe until they start to get better. The best treatment at home for most kids is time to recover and plenty of fluids. Making sure a child drinks enough fluids can be difficult, however, because infants with bronchiolitis may not feel like drinking. They should be offered fluids in small amounts at more frequent intervals. Indoor air, especially during winter, can dry out airways and make the mucus stickier. Some parents use a cool-mist vaporizer or humidifier in the child’s room to help loosen mucus in the airway and relieve cough and congestion. To clear nasal congestion, use a bulb syringe and saline nose drops. This can be helpful before feeding and sleeping. Sometimes, keeping the child in a slight upright position may help improve labored breathing. When to Call the Doctor Call your doctor if your child: -is breathing rapidly, especially if accompanied by retractions or wheezing -might be dehydrated due to poor appetite or vomiting -is sleepier than usual -has a high fever -has a worsening cough -appears fatigued or lethargic Seek immediate help if you notice your child having difficulty breathing and the cough, retractions, or wheezing are getting worse, or if his lips or fingernails appear blue.


Evaluation and Management of ADHD

Friday, October 21st, 2011

Evaluation and Management of ADHD

ADHD is one of the most studied conditions of childhood; research to date has shown
-ADHD is a neurobiological condition whose symptoms are also dependent on the child’s environment
-A lower level of activity in the parts of the brain that control attention and activity level are associated with ADHD
-ADHD frequently runs in families; sometimes a parent is diagnosed with ADHD at the same time as the child
-In very rare cases, toxins in the environment may lead to ADHD; for instance, lead in the body can affect child development and behavior
-Significant head injuries may cause ADHD
-Prematurity increases the risk of developing ADHD
-Prenatal drug exposure (illicit substances, alcohol, nicotine from smoking, etc.) increases the risk of ADHD
There is little evidence that ADHD is caused by eating too much sugar, food additives, allergies, or immunizations. You may have heard theories about diagnostic tests for ADHD, but there are no proven tests for ADHD at this time. Studies have shown that the following tests have little value in diagnosing an individual child:
-Screening for high lead levels in the blood
-Screening for thyroid problems
-Computerized continuous performance tests
-Brain imaging studies such as CT scans, MRIs, etc
-Electroencephalogram (EEG) or brain-wave test
Once the diagnosis is confirmed, the treatment outcome for most children is encouraging. There is no specific cure for ADHD, but there are many treatment options available. Each child’s treatment must be tailored to meet his individual needs. In most cases, treatment for ADHD should include
-A long term management plan with target outcomes for behavior, follow-up activities, and monitoring
-Education about ADHD
-Teamwork among doctors, parents, teachers, caregivers, other health care professionals, and the child
-An educational plan (IEP, 504) for school that tailors classroom instruction to the child’s individual learning style
-Behavior therapy including parent training
-Individual and family counseling
Treatment for ADHD uses the same principles that are used to treat other chronic conditions like asthma or diabetes. Long term planning is needed because these conditions are not cured. Families must manage them on an ongoing basis. Education about ADHD is a key part of treating your child. As a parent, you will need to learn about ADHD. Read about the condition and talk to people who understand it. This will help you manage the ways ADHD affects your child and your family on a day-to-day basis. It will also help your child learn to help himself. At the beginning of treatment, your pediatrician should help you set around 3 target outcomes (goals) for your child’s behavior. These target outcomes will guide the treatment plan. Your child’s target outcomes should focus on helping him function as well as possible at home, school, and in your community. You need to identify what behaviors are most preventing your child from success. The following are examples of target outcomes:
-Improved relationships with parents, siblings, teachers, and friends (fewer arguments with brothers or sisters or being invited more frequently to friends’ houses or parties)
-Better schoolwork (completing class work or homework assignments)
-More independence in self-care or homework (getting ready for school in the morning without supervision)
-Improved self-esteem (increase in feeling that he can get his work done)
-Fewer disruptive behaviors (decrease in the number of times he refuses to obey rules)
-Safer behavior in the community (when crossing streets)
The target outcomes should be realistic, something your child will be able to do, and behaviors that you can observe and count (with rating scales). Your child’s treatment plan will be set up to help him achieve these goals.


ADHD Medication

Friday, October 21st, 2011

ADHD Medication

For most children, stimulant medications are a safe and effective way to treat ADHD symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior. Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants respond well once the right medication and dose are determined. Two forms of stimulants are available: immediate-release (short-acting) and extended-release (long-acting). Immediate-release medications usually are taken every 4 hours, when needed. They are the cheapest of the medications. However, they can be abused/bought/or sold and have to be taken frequently at school. Extended-release medications are now the more preferred way to treat ADHD because of their smooth, gentle, sustained effects throughout the entire day. They are taken once in the morning, and children do not have to take a dose at school. Most extended-release capsules cannot be crushed or chewed; a few, however, can be opened and sprinkled on food or dissolved in water for children who have difficulties swallowing tablets or capsules. There are two newer medications that are non-stimulants which can be tried when the stimulant medications are ineffective or have significant side effects. It may take some time to find the best medication, dosage, and schedule for your child; he may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another. The medication dosage may also need to be adjusted. The dosage is not based solely on his weight. The dosage will vary over time to achieve the best results and minimize side effects. The medication schedule may be adjusted depending on the target outcome. For example, if the goal is to alleviate symptoms at school, your child may take the medication only on school days. It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects.

Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases can be prolonged or more severe. The most common side effects include -Decreased appetite/weight loss -Sleep problems -Social withdrawal Some less common side effects include -Rebound effect (increased activity or a bad mood as the medication wears off) -Transient muscle movements or sounds (tics) -Minor growth delay Very rare side effects include -Significant increase in blood pressure or heart rate -Bizarre behaviors (agitation, very emotional, obsessive-compulsive, hallucinations) Sleep problems do not exist for Strattera, but initially it may upset your child’s stomach. Tenex/Intuniv/Clonidine can cause drowsiness, fatigue, or a decrease in blood pressure. More than half of children who have tic disorders also have ADHD. Tourette syndrome is an inherited condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and tic disorders in most cases. Most side effects can be relieved by changing the medication dosage, adjusting the medication schedule, or using a different stimulant or trying a non-stimulant.

Close contact with your pediatrician is required until you find the best medication and dose for your child. After that, periodic monitoring by your doctor is important to maintain the best effects. To monitor the effects of the medication, your pediatrician will have you and your child’s teacher(s) fill out behavior rating scales; observe changes in your child’s target goals; notice any side effects; and monitor your child’s height, weight, pulse, and blood pressure.


Teenagers with ADHD

Wednesday, October 19th, 2011

The teenage years can be very challenging. Academic and social demands increase. In some cases, symptoms may be better controlled as the child grows older; however, frequently the demands for performance also increase so that in most cases, ADHD symptoms persist and continue to interfere with their ability to function adequately. About 80% of those who required medication for ADHD as children still need it as teenagers. Parents play an important role in helping teenagers become independent. Encourage your teenager to help himself with strategies such as
-Using a daily planner for assignments and appointments
-Allowing homework to be done on the computer and e-mailed to the teacher (reduces missing assignments)
-Making lists
-Keeping a routine
-Setting aside a quiet time and place to do homework
-Organizing storage for school supplies, clothes, CDs, sports equipment, etc.
-Being safety conscious (eg, always wearing seat belts, using protective gear for sports and a helmet for biking or skateboarding)
-Talking about problems with someone she trusts
-Getting enough sleep
-Understanding his increased risk of abusing substances such as tobacco and alcohol
Activities such as sports, drama, and debate teams are good places to channel excess energy and develop friendships. Find what your teenager does well and support her efforts to “go for it”. Milestones such as learning to drive and dating offer new freedom and risks. Parents must stay involved and set limits for safety. Your teen’s ADHD increases his risk of incurring traffic violations and accidents. It remains important for parents to be in regular communication with teachers and make sure that their teenager’s schoolwork is going well. Talk with your pediatrician if your teenager shows signs of severe problems such as depression, drug abuse, or gang-related activities.


Staying Healthy This Fall Season

Tuesday, October 4th, 2011

Staying Healthy This Fall Season

It’s hard to believe we are already into the fall season! School has been in session for one to two months now. What can you do for you and your family to promote staying healthy throughout the fall season?

Good health begins with the basics. Healthy nutrition practices are very important. Starting each day with a nutritious breakfast is vital. All too often, breakfast is skipped because of not enough time, it’s felt it isn’t important, or fear of gaining weight. Eating a healthy breakfast helps to kick start your morning. It helps to improve brain function and decision making and increases your metabolism.

It’s important to eat regular meals through out the day and also include healthy snacks. Include several servings of fresh fruit and vegetables, whole grain breads and cereals, low fat dairy products, and lean sources of protein. Make sure to have food sources from carbohydrates and proteins at all meals in order to sustain a healthy blood sugar level. Fats are important too! Healthy fats that is! Examples of healthy fats are almonds, walnuts, avocados, olive oil, and canola oil. Remember fats carry more calories so eat smaller amounts through out the day. Nuts are also a great source of fiber and vitamin E. Vitamin E is a potent anti-oxident that can help fight infections and improve immune system functions. Berries, such as, raspberries, blue berries, and strawberries are also potent anti-oxidents.

Adequate hydration is very important. Most individuals do not drink enough water daily. It is essential to drink 8 to 10 glasses of water a day. You can count milk or juice in that amount but should not include carbonated or caffeine-containing beverages in the daily requirement.

Sleep is especially important for good health and well-being. Some researchers say that sleep deprivation in teenage years may contribute to chronic health conditions later in life, including diabetes and cardiovascular disease. For the adult years, lack of sleep has been linked to Alzheimer’s Disease. It is essential to have between 6 and 8 hours of sleep consistently every night.

Personal hygiene is a given, especially during the cold and flu season. Hand-washing on a regular basis will help to alleviate the spread of germs and illness. Remember to always wash your hands before eating or any food preparation.

Keeping your children and adolescent’s immunizations current will help to protect them from serious illness and disease. Don’t forget to schedule your child’s flu vaccine for the upcoming flu season. We are also offering flu vaccine for parents, for your convenience.

Vona Lantz, MSN, CPNP


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