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I'm a pediatrician by training with an undergrad degree in journalism. I spend my days teaching and mentoring future pediatricians. My wife and I spend our evenings and weekends keeping up with very active twins. This blog will chronicle my thoughts on current children's health care issues and trends, trials and tribulations as a parent and husband mixed in with a lot of life experience.

 

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About Our Author

photo William Stratbucker, MD
Archives
 
Monday, July 16, 2012
Active Family, Active Child
by William Stratbucker, MD at 12:46 PM

A new study published today suggests that sports team participation is one of the ways that our children can avoid becoming obese. Most who hear of the study will say that that is common sense and we didn’t need a potentially costly study to tell us that. While I have some problems with some of the statements made by the authors as they interpreted their findings, I do believe that studies like these are important. Let me explain. These researchers called several hundred families with children in early high school in Vermont and New Hampshire. They asked for their weights and heights and if they participated on a sports team in the past year and if so, how many teams. They found that if a child was not on any sports team or on only one team during the year, that they were more likely to be obese than those kids on 2 teams or more. Just being on one team did not protect the children as much as those on 2 or more teams.

What I see as the real information for parents here is that kids needs year round activity. Some find this by participating on multiple sports teams and some find it outside of teams altogether. But, the most important fact is that way too many children are not finding their way to enough activity at all. The most successful families at maintaining healthy weights are those who are active together. When your child asks you, the parent, to play in the hot weather outside in the summer, you need to say “yes.” If it is a cold winter day with snow on the ground, parents need to turn off the television and put down the smartphone and go outside with their children. Parents are modeling behavior every day for their children. This goes far beyond activity levels. Children learn what is acceptable from their parents on all levels: speeding in a car, wearing seatbelts, wearing bike helmets, smoking, texting while driving. What parents should do is say to themselves, “Do I want my child doing this behavior?” And if not, then they need to model the behavior they want from their child.

The other thing I think this study helps highlight is that many families don’t know what appropriate levels of activity for children are. When I hear a parent say to me as a pediatrician that their child is “active,” I’m not sure what they mean. Sometimes they simply mean that their child is outside. My question to them is, “they are outside doing what?” Just being outside is not enough. The kind of activity that we as pediatricians believe our children need is, on average, one hour of moderate to vigorous activity per day. This means anything that increases your heart rate, breathing rate and, many times, makes you sweat. While walking the dog, playing outfield on a baseball team or being goalie in soccer are all potentially fun and certainly beat sitting and playing a video game, they are activities that count toward moderate or vigorous activity. Now, if the dog runs and you chase it, or you run laps during baseball practice, or you take turns in positions in soccer and get time running the field – that counts. This type of activity leads to better sleep, which leads to better attention in school and more energy the next day want to be active again.

Let me know your thoughts on this subject or others you would like to discuss in this forum. Until next time, be active with your family.

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Friday, March 23, 2012
Don’t Take Things at Face Value
by William Stratbucker, MD at 02:46 PM

Guest blogger Daniel P. McGee, MD, is a Spectrum Health Medical Group Physician who practices as a pediatric hospitalist at Helen DeVos Children's Hospital.Dan McGee, MD

I was recently a guest WOOD TV-8 to discuss arsenic found in organic baby formula. It's important to recognize that just because something is called "natural" or "organic," like this baby formula was, doesn't automatically mean it is safe or healthy.

Thinking about this brought to mind a related idea—what are the common "old wives' tales" many parents take at face value? Here are a few to consider:

If your son goes outside with wet hair, he can get a cold.
False. Colds are caused by viruses, period. That said, it's good for a child to have dry hair and a hat on when they go outside in the winter, since so much body heat can escape through the head. If you are trying to prevent colds, the best thing you can do is help your child develop good hand washing habits.

If your daughter sucks her thumb, it will ruin her teeth.
False. Thumb sucking helps calm babies and young children and can be considered good for them. However, if children continue this habit as they get older and their permanent teeth are coming in, it can affect their teeth.

If your son cracks his knuckles, he will grow up to have arthritis.
False. However, cracking can lead to problems over time, as it may weaken the ligaments in your child's fingers and could make them more prone to injury. If your child likes to crack his or her knuckles, help them break the habit.

Children can only get tetanus if their skin is punctured by something rusty.
False. Tetanus exists on many surfaces, including those that appear clean. The tetanus bacteria can also live in an animal's mouth, so, for example, if a boy gets a dog bite, he could get tetanus. Children with burn injuries are at high risk for tetanus as well.

Reading in the dark will damage your child's eyesight.
False. Reading in the dark won't hurt children, but their eyes may get tired sooner. Support their reading habits by making sure there is good lighting wherever they like to read.

Have you heard any other old wives' tales that I can address?

- Dr. McGee

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Friday, February 24, 2012
UT What? Urinary Tract Infections
by William Stratbucker, MD at 12:20 PM

Alejandro Quiroga, MD, is Spectrum Health Medical Group physician who practices at Helen DeVos Children's Hospital.

If you're like me, you are probably busy from the time you wake up until the time you go to bed, and there are some topics you likely haven't thought about much. One of those topics may be urinary tract infections, commonly known as UTIs. It's particularly possible if your child has never had one but they are not uncommon. Parents always like to be informed so I wanted to share my insight as to how to prevent a UTI, what are the symptoms and what to do if you suspect one in your child.

Signs of UTIs in Young Children
With infants or children younger than two, it is important to look closely at the signs, since UTI symptoms may not cause obvious.

  • Fever – This may be the only symptom you notice in your infant.
  • Loss of appetite
  • Crying while urinating
  • Blood spotting in the diaper
  • Irritability
  • Inability to gain weight or develop normally
  • Odor in the urine
  • Diarrhea or vomiting

Questions to Ask Older Children
With older children, you can help diagnose whether or not they have a UTI by asking them questions such as:

  • Are you having pain or burning when urinating?
  • Is your urine reddish, pinkish or cloudy?
  • Do you feel like you need to urinate frequently, but are only passing small amounts?
  • Are you starting to wet the bed, or have there been changes in anything related to going to the bathroom?
    Does your urine smell unusual?
  • Do you have pain in your lower abdomen?
  • Do you have any pain in your back, just below your rib cage?

There is a link between constipation and UTIs. When a child is constipated, it can prevent them from properly emptying their bladder, and when this happens, bacteria can grow. So, if your child is constipated, watch for the signs of UTI as well.

Preventing UTIs
There are many steps your child can take to prevent UTIs, and as a parent, we should educate our children.

  • Teach kids to wipe properly after using the toilet. For girls in particular, they should wipe from front to back.
  • For uncircumcised boys, teach them how to clean inside the foreskin.
  • Avoid bubble baths as they have been linked to UTIs

UTIs can lead to more serious infections and should never just be treated at home. Contact your child's physician if you think they may have a UTI.

- Dr. Quiroga

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Wednesday, February 08, 2012
Kids and Privacy: How Much Do They Need?
by William Stratbucker, MD at 02:04 PM

Guest blogger Steven L. Pastyrnak, Ph.D., is a Spectrum Health Medical Group psychologist who practices at  Helen DeVos Children's Hospital.

How much privacy does a child need? The answer isn't always simple and straightforward. The amount of privacy needed usually depends on a number of things, such as your child's age, his or her awareness and desire for privacy and your family's own values. Although there are no absolute rules, I personally believe that when a child is old enough to be aware of his or her need for privacy, then it is a parent's responsibility to honor that need.

For Young Children
The younger your child is, the less likely that he or she will express a need for privacy. For instance, your toddler may like to run around the house without clothing and to prefer company when they are taking a bath or learning to use the "potty."

At some point during the toddler years though, your child may begin to express a need for privacy. This is an important part of growing up, and it is okay for you to allow your child safe privacy when they ask for it. What do I mean by "safe"? Here are a few examples:

  • Allowing a two-year-old to take a bath without supervision may not be safe.
  • Letting a three-year-old keep the bathroom door closed when using the toilet, however, should be reasonably safe.
  • Letting your three- or four-year old change his or her clothes alone should be safe.

School age kids may ask to surf the Internet alone. While it is certainly okay (and typically preferable) to respect your child's boundaries, maintain a balance with regard to safety. Establish ground rules about what you will or will not allow versus monitoring your child without his or her knowledge. In this way, you can also build trust while keeping your child safe.

For Older Children
As kids reach school age, most have a healthy awareness of their bodies and want more privacy. However, if kids are not showing enough modesty or are not respecting the privacy of others, then it is good to start providing direction. Also, be aware that while you may be more or less open in your own household with regards to things like keeping doors open or displaying nudity, other families may have different approaches. Teach your child different expectations apply to different households. Also teach your child to discuss with you if they witness something that makes them feel uncomfortable in someone else's house.

For Teens
Teens are very aware of their need for privacy and will sometimes go to great lengths to maintain it. Kids at this age may be secretive and unwilling to share their thoughts, even when asked. While it is important for parents to be aware of what their kids are involved in and with whom they are involved, it is still okay to allow them some privacy in order to help them establish trust and build independence.

"Sexting" has become as popular as cyber-bullying, and social media and online access mean a teen can instantly make his or her private life public, on a whim. And once they do, often they regret it or there are other ramifications. Emphasize to your teen that online postings can never be private, even if they feel private, and it will never go away.

Be very clear in your expectations of when and how your kids will interact with peers. Coach them to use social media to send positive messages, and always to be positive in their communications, and they likely will never go wrong or regret it later.Set limits on when your teen can use social media, his or her phone or the Internet.Allow them more privacy if they demonstrate that they can handle it.

- Dr. Pastyrnak

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Thursday, December 29, 2011
Should Kids Have New Year’s Resolutions?
by William Stratbucker, MD at 11:12 AM

Guest blogger Steven L. Pastyrnak, PhD, is a Spectrum Health Medical Group pediatric psychologist and practices at Helen DeVos Children's Hospital.

Parents sometimes ask me, "Is it healthy for kids to have New Year's resolutions?" My answer is a resounding yes! It certainly is okay for kids of most ages to set goals and to identify areas where they can improve in their lives—and New Year's resolutions offer a unique opportunity to do this in a more formal way, which can make a child more aware of them, and therefore more determined to stick to them. I also believe that starting this process at an early age is good, because it helps set a precedent and a child learns to regularly develop—and realize—goals now and in the future.

The key to making New Year's resolutions with your child is to keep expectations reasonable, take into account the developmental level of your child and to check up and coach your child to make sure he or she is sticking to the resolutions. Also, make sure any resolution is about developing positive behaviors, instead of avoiding negative ones—for example, instead of setting a goal with a young child of "not hitting," make the goal "keep my hands to myself."

With Young Children

Some preschoolers, typically those who are four and above, can understand very simple goals and set New Year's resolutions. Here are some ideas you may want to suggest for a young child:

  • Brush your teeth in the morning and at night
  • Clean your room before bed
  • Be nice to your brother or sister

I suggest posting a drawing that depict s your child's New Year's resolution. Also give them gentle reminders so they don't forget their resolution.

With School Age Kids

As kids reach school age, parents may still participate in setting goals; however, kids may begin to have ideas of their own. Suggestions for this group include:

  • Eat healthy
  • Study more for school
  • Try a new activity

With Teens and as a Family

Families should consider setting New Year's resolutions together, especially as they relate to things such as eating healthy and exercising. These resolutions can be especially powerful because families support each other in a shared goal. It also might be good to identify a reward if everyone participates, such as having a movie night, game night, or doing something else special that everyone enjoys.

In our family, we tend to set and reset our goals not only at the beginning of the year but throughout it. As my kids are now teens, they tend to focus goals on things such as their schoolwork, extracurricular activities and keeping active.

All of us have the potential for falling into our comfortable (and not necessarily healthy) habits and it hasn't been unusual for my kids to inspire me to do something because I see them working toward the goals that they set for themselves. Here's to keeping our 2012 resolutions.

- Dr. Pastyrnak

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Tuesday, December 06, 2011
Button Batteries: Please Help Spread the Word!
by William Stratbucker, MD at 10:05 AM

Jennifer Hoekstra is the Safe Kids Program Coordinator at Helen DeVos Children's Hospital and an injury prevention specialist.

Just a few weeks ago, I attended the National Safe Kids conference in Charlotte, North Carolina—and ever since I have been relentlessly working to get the word out about a hidden danger that is in nearly every home: coin lithium batteries or "button" batteries.

How many times you have seen an infant or toddler, either yours or someone else's, chewing on a remote control or mom's set of keys? Do you realize how dangerous this can be? Button batteries are in many of these devices and can cause severe injuries or death when swallowed.

A recent survey reported that 66 percent of parents have never heard of button battery risks. Another 56 percent reported that they intentionally give their children electronic devices more often than their own toys, because their children prefer playing with them.

Button batteries are in dozens of electronic devices that most of us have and leave within reach of children, such as:

  • Remote controls
  • Watches
  • Calculators
  • Bathroom scales
  • Flameless candles
  • Singing greeting cards
  • Talking books

The scary thing is, button batteries can easily fall out of devices—most compartments for button batteries are not required to be secure, because the products they are in are not designed for children.

Since the batteries are so small, they do not cause choking, but rather lodge in the child's throat—so a child can swallow them without a parent even realizing what has happened. If swallowed, the saliva ignites a chemical reaction with the battery, and it begins to burn the esophagus within two hours. Yet, because the child is not choking, the parent may not even be aware of what is happening. If you ever suspect a child has swallowed a button battery, go immediately to the emergency room.

After the conference, I came home and went from room to room in my own house to check for button batteries. One place I found one was in our bathroom scale—on the floor and within easy reach of all my children. I removed it immediately. I also found a button battery in the remote control of our portable DVD player, which I also immediately moved out of reach.

Thankfully, right now, the number of children who have been seriously injured by button batteries is relatively small. However, the trend is alarming—in the past five years, the number of swallowing incidences that have caused serious injury or death has quadrupled.

Here is my checklist to help you and your family stay safe:

Keep items with button batteries out of reach.Tell everyone you know about this danger, including babysitters, grandparents or others who care for your child.Get help fast if you suspect a child has swallowed a button battery.Store unused batteries in a locked cabinet, along with other hazardous items.

One final thought: The holidays are coming soon. If you purchase electronic devices as gifts, be sure to check if they use button batteries, and, if so, keep them out of reach!

- Jennifer Hoekstra

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Tuesday, October 18, 2011
Help Manage a Child's Fear about Halloween
by William Stratbucker, MD at 01:45 PM

Guest blogger Steven L. Pastyrnak, PhD, is a Spectrum Health Medical Group pediatric psychologist and practices at Helen DeVos Children's Hospital.

Halloween is right around the corner. Most kids look forward to the fun and enjoy the costumes and trick or treating. But it is also a time when some children can feel more fearful, especially kids around the ages of 3 to 6.

During this time, kids develop an awareness of what they perceive as potential dangers in the world—tornados, monsters, the dark, etc. However, they do not yet have a well developed understanding of how they are in control of their environment or of the likelihood of dangers. Kids in this age group also develop an active imagination and cannot always differentiate between a real danger versus an imagined one or understand that things like nightmares are not real. It is important to keep in mind that this is a temporary stage that many kids go through. By the time most kids reach the first or second grade, they develop a better understanding and many of these fears subside.

Bedtime Checklist for Young Children

A common problem when a young child feels fearful is that they can't get to sleep. If this is happening to your child, there are a number of things you can do to help them feel more secure at night:

  • Do a "monster check." At bedtime, have your child watch as you carefully check through the closets and under the bed and offer reassurance that nothing is there. Keep a nightlight on.
  • You can also keep the door open with a light on in the hallway or let your child sleep with a flashlight.
  • Reassure your child that you are close by. Even if you believe your child already knows this, repeating the words every night can go a long ways towards making your child feel safe at bedtime.

Tips to Relieve Fears in Older Kids

There are also techniques you can use with older children when they are scared, whether it is at bedtime or another time of day:

  • Concentrate on breathing slowly. I like to tell children to breathe in slowly like they are smelling a flower, and out like they are blowing out a birthday candle. Slow and controlled breathing is the same technique used by adults in practices like yoga—and it works.
  • Coach them on how to direct their imaginations towards positive images. For instance, before bed, you can ask them to imagine a peaceful or fun place they might like—such as the beach or an amusement park. Help them focus on the calming and fun details in their "picture" so when you leave the room they have something positive to direct their mind towards.
  • Develop new and positive associations with things to help them feel secure. For instance, at Halloween, your child might see a scary mask and associate it with danger. To overcome that fear, you could go with them to a store and let them try on different masks.
  • Have them recite positive affirmations. I like to call this the "Jedi Mind Trick." Have them say to themselves positive statements like, "I am strong," "There is nothing to be afraid of." The more that they practice, the more they will internalize the positive messages and block out the scary ones.

Another thing to keep in mind—your child's fears might seem irrational to you—or sometimes even a bit humorous. But this is not cause to tease or to scare them further, which can create some trust issues. I remember early in my career, sometime after the movie "E.T." came out, two different children came to my practice in the same week who were frightened of the E.T. character and could not sleep. Although a parent might not understand a fear like this, you still must respect that the fear is real to your child, and to be as reassuring as you can.

On a related note, though, I think when you can use humor with your child you should—when you can genuinely laugh at something, it is hard to be afraid of it.

- Dr. Pastyrnak

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Wednesday, October 12, 2011
New Billboards Raise Awareness of Suicide Prevention
by William Stratbucker, MD at 10:04 AM

Guest blogger Steven L. Pastyrnak, PhD, is a Spectrum Health Medical Group pediatric psychologist and practices at Helen DeVos Children's Hospital.

Have you noticed the new billboards around Grand Rapids? They show mothers holding photos of their teen sons who have committed suicide. They read: "No one is better off without you. Just ask mom."

These billboards send a powerful and important message. Oftentimes when an individual is considering suicide, he or she feels that the world would be better off without them. Or they may not even consider the impact that this may have on family and friends. If these billboards inspire just one person to seek help, then the campaign is certainly worth it.

Although the rate of teen suicide is not necessarily increasing in our area, I do have concerns. It seems that life is becoming more complicated for kids and some have problems adjusting. There is a combination of factors contributing to this: pressure to grow up too quickly, being faced with a barrage of unrealistic images of who and what they should be, and being subjected to more sophisticated bullying via the Internet. Also, with increased online communication, kids can even seek out others to discuss such things as cutting behavior and suicide.

The Warning Signs of Teen Suicide

If you notice changes in the following areas, your teen may be experiencing depression which can contribute to suicidal thoughts:

Behavioral changes
Is the child acting differently than usual? Is there an increase in risk-taking behaviors or aggression? Is the child involved with drugs and/or alcohol? Are they having a difficult time keeping a job?

Emotional changes
Is the child increasingly sad? Does he or she no longer enjoy the things that they used to? Does the teen talk about feeling helpless or hopeless? Be aware that instead of appearing sad, some teens become more irritable or are quicker to anger.

Academic changes
Is the child suddenly struggling with academics?

Physical changes
Is the teen eating more or less than usual? Having sleep problems?

Social changes
Is the teen having more conflicts or fewer social interactions? Does he or she talk or write about death? Do friends or family have concerns about the child's Facebook postings?

It's important to note that some kids do not exhibit any clear warning signs.

How to Support Your Child

How can you support your child when you suspect that he or she may be struggling with his or her emotions? Keep these things in mind:

Initiate conversations with your child about a range of issues, even if it may be uncomfortable
Kids are not always able or willing to talk about how they feel on their own. Also, it is absolutely okay if you are concerned about your child to ask directly if they have had thoughts about hurting themselves or ending their lives. Kids are typically open when talking about those things. Be a good listener, too.

Promote a healthy lifestyle
Promote good nutrition, good sleep habits, regular exercise, limited media exposure and other healthy habits.

Know that depression is an illness, not a character flaw
Just like treating an illness, kids with depression may need a full range of supports and services. Get your child to a counselor. Talk to your doctor about medication strategies if necessary.

A suicide attempt is serious and shouldn't be taken lightly. National statistics show that if a teen has made one attempt, even just a gesture, there is a 50 percent chance they will try it again, and there's a 20 percent chance that another attempt will happen within a year. These subsequent attempts oftentimes become more harmful. However, with improved education and open communication, there is hope.

- Dr. Pastyrnak

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Friday, October 07, 2011
Does Your Child Suffer from Social Media Overload?
by William Stratbucker, MD at 03:44 PM

Guest blogger Allison Fabian, DO, is a Spectrum Health Medical Group family medicine physician.

Recent polls show that nearly one-quarter of kids "Facebook" (yes, it's now a verb) more than 10 times a day, and at least 50 percent of kids are logging in more than once a day. Do you know how often your child "Facebooks" or uses other social media?

My son Aiden is two, so he's not using Facebook yet—but I can tell that time will come sooner than I think. Already, he can turn on my Mac and play the virtual piano, watch a movie on my iPad and take pictures of himself with my iPhone. We also Skype with grandma and grandpa twice a week. It's amazing to think how rapidly technology and social media is evolving and how it has become integrated into our family life.

There definitely are some great things happening with kids and social media—for instance, I can now accept confidential e-mails through My Spectrum. It is a great way for teens (or adults) to email their physician and ask questions or schedule appointments.

But, I have to admit I have plenty of concerns: the overuse, misuse or unsupervised use of social media by kids can have all sorts of negative and long-term repercussions. To ensure social media is a positive influence on your child and family, I encourage you to get involved and stay involved.

Safety
Tell your kids never to share phone numbers, addresses or personal information, even if it seems harmless. Kids don't realize how easy it is for information to get into the wrong hands.

Health
Some teens and tweens tell me they use Facebook for three to four hours a day—in addition to watching a few hour-long TV programs. This is after sitting in their desks at school most of the day. This is practically a recipe for obesity and poor health!

What's fact, what's fiction
Today, most teens get their health information from their peer group or the Internet—and social media forums combine these two sources. It's true that this can be a helpful resource for teens, however, with something as important as their health, kids need your help sorting out what's fact from fiction.

Here today—not gone tomorrow
What's posted today could exist indefinitely. Have candid discussions about the appropriateness of what your child is posting. Ask questions such as, "Would you be embarrassed if your grandma/college admission representative/coach saw this?"

After you've had a conversation and continue to dialogue with your kids, there's ongoing work to be done.

1. Set screen time limits
I usually set the upper limit at two hours a day, which includes the time spent using the computer for homework.

2. Monitor the use of portable devices
This is perhaps even more important than monitoring your kids' home computer usage.

3. Don't spy—it leads to mistrust
Instead, stay involved. For instance, go through "friend lists" with your kids regularly. If it's someone you don't recognize, ask questions.

4. Keep up with technology
Gain solid technology skills, so you can both support and monitor your child's online presence.

5. Set clear boundaries
Even though I have a 2-year-old, I know the boundaries I set now will help set the stage for years to come. No matter what age your child is, set clear limits around technology and social media use.

- Dr. Fabian

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Thursday, October 06, 2011
“Cocooning” Can Help Prevent Whooping Cough
by William Stratbucker, MD at 12:14 PM

Guest blogger Daniel P. McGee, MD, is a Spectrum Health Medical Group Physician who practices as a  pediatric hospitalist at Helen DeVos Children's Hospital.

Pertussis, commonly known as whooping cough, has been on the rise for the last few years. Last year, we had almost 1,600 cases in Michigan alone. This year, it’s on the rise again—in fact, it’s come to the point that I no longer find it unusual to see a case of whooping cough in the hospital. Sometimes we'll have two kids hospitalized with it at the same time.

So what can parents do to prevent it, especially in infants who are unprotected until they've completed their first three shots in a series—which happen at two, four and six months? It helps to understand how children are contracting pertusiss. When a source of pertussis in an infant can be identified:

  • 75 percent of the time it's an immediate family member (mom, dad, sibling or grandparent) 
  • 25 percent of the time it's linked directly back to grandma or grandpa

Cocooning Can Help Protect a Baby

On September 26, 2011, the American Academy of Pediatrics issued a formal recommendation for grandparents who care for infants to get immunized.  This is part of a strategy know as “cocooning” which involves immunizing all who come in contact with a baby—such as parents, siblings, grandparents and other caretakers—in order to create a protective barrier around a baby who is not fully immunized. I highly recommend adopting this strategy as well.

Vaccines prevent millions of children and adults around the world from contracting serious diseases and illnesses every year. Yet, unfortunately, in recent years there has been a lot of misinformation out there regarding immunizations and health risks. Because of this, some of the adults in your family and caregiver circle may object to being immunized. In this case, what can you do?

Why Adults Should Be Vaccinated

I suggest discussing the facts in a straightforward manner, asking them to review reputable information about pertussis (such as on the American Academy of Pediatrics or Centers for Disease Control and Prevention) and urging them not to do it for themselves, but for the baby. Here are five key points to emphasize:

  1. Pertusiss is highly contagious.
  2. Even if a baby is immunized, he or she is not fully protected until six months.
  3. 75 percent of the time, it is an adult who brings the disease home to the baby.
  4. If an adult gets whopping cough, it is much less severe—I would consider it more of an annoyance. But babies are much more severely affected and it can be life threatening.
  5. We now know that immunizations don't last forever, which is why adults need to be re-immunized.

One final thought: Through my work at Helen DeVos Children’s Hospital, I see firsthand what happens to babies who contract pertusiss, and I can tell you it is very difficult. In fact, pertussis used to be called the “100-day cough”—that probably gives you a sense of what’s involved. An infant or child who has it coughs repeatedly in a violent and rapid manner until they are out of air, then inhales and makes a loud "whooping" sound that gives the disease its nickname—then they start coughing again and this continues for weeks. Although the cough usually becomes less severe over those 100 days, it can be extremely challenging. Children have stayed at Helen DeVos Children’s Hospital for two weeks or longer after contracting pertussis.

-  Dr. McGee

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Monday, October 03, 2011
National Child Health Day
by William Stratbucker, MD at 10:39 AM

Today is National Child Health Day. Helping Children Lead Healthy Lives is the theme for the event this year. A web site was created by those behind the activities of the day to feature important resources to assist families in finding health care services.

Resources featured on the site include:

  • 311 Prenatal Hotline
  • Insure Kids Now
  • Family-to-Family Health Information Centers
  • Text 4 Baby
  • Find a Health Center Locator
  • Maternal and Child Health Program

National Child Health Day organizers hope the information will reach thousands of families to assist them in finding vital health care services. I learned about the day from Jon L. Nelson who is the Acting Associate Administrator for the Maternal and Child Health Bureau.

As doctors, we know families are finding information in new ways all the time. Text 4 Baby is one of my favorite. Text 4 Baby is a service supported by several funders making it free to receive healthy text messages about your expectant infant or recently delivered baby. If you are pregnant or know someone who is or who has recently delivered, you or they may be interested in receiving the messages.

I direct many families to healthychildren.org which is sponsored by the American Academy of Pediatrics. The site includes many frequently asked questions from parents and answers from pediatricians. Our web site offers KidsHealth content where families can research answers to many common questions.

Where have you located information about finding healthy family-oriented activities in your area? Do you use the web to find healthy recipes and have you sought access to your medical information available through MySpectrum or possibly your family's insurance provider that is helpful in promoting health?

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Sunday, September 04, 2011
Best Tip for Back to School? Nail Down the Bedtime Routine
by William Stratbucker, MD at 05:13 PM

 Guest blogger Candace Smith-King, MD, is Spectrum Health Medical Group pediatrician with Helen DeVos Children's Hospital.

Can you believe school starts on Tuesday for many children? I don’t know about you, but for me, it feels like summer just started!

So what should you do to get ready for the new school year? I say establishing or re-establishing your school year bedtime routine is one of the most important.

Here’s why: Summer is a time when parents are sometimes more loose with schedules and allow their kids to stay up late, or sleep less or more than usual, which is okay once in a while. But in order to be at their very best, stay healthy and do well in school, kids need a certain amount of rest every night. It definitely varies from child to child, but there are some averages regarding how long certain age groups should sleep: 

Preschoolers (3 to 5 years): 10 to 12 hours per day, including one midday nap of 1 to 2 hours and nighttime sleep.

School-Aged Kids (6 to 12 years): 9 to 11 hours per night. Keep in mind they tend to take 15 to 30 minutes to fall asleep.

Adolescents (13 to 17 years): 9 to 10 hours per night, but many do well with 8 hours of sleep per night. Teenagers get sleepy later than preteens and often have trouble falling asleep. Keep in mind they may not fall asleep for 20 to 30 minutes after lying quiet in bed.

5 Steps to Peaceful Slumber
Having a bedtime routine is the best way to ensure good sleep for your child. Here is a good basic routine that seems to work well with most kids, regardless of their age (even teens need a bedtime routine):

1. Take a bath. Bathing can be fun and relaxing—I recommend bathing kids daily, or every other day. Make sure there is always an adult present with young children, as children have drowned in only an inch of bathwater. Let your kids bathe and play in the water for 5 or 10 minutes—that’s really all they need. Older kids (8 and up) can shower, if they prefer.

2. Have a healthy snack. This can be done prior to bath time, if you prefer. I only allow healthy “easy” snacks prior to bedtime—carrots, apples, grapes, pears, Triscuits, etc.  Water (or warm skim, 1 percent or 2 percent milk) is an option, too. But if you’re worried about bedwetting, skip the liquids.

3. Brush teeth. Remember, no matter how sleepy your child is, teeth must be brushed. This is not up for debate!

4. Establish quiet time. How you do this mostly depends on your child’s age. If your child is between three and seven, I suggest reading a book. For kids ages 7 to 11, have them read to you or let them read independently. Sometimes older kids like to listen to music. This is fine, just make sure it’s calming and not explicit. “Quiet time” should happen for 15 to 30 minutes (older children may need more time). On a related note—watching TV is too stimulating and is not a good quiet time activity.

5. Tuck your child in. “Tucking in” makes a child feel special and gives that child “one on one” time with a parent. This is a great time to tell your kids how special they are to you and how much you love them! 

Also, consider your child’s personal preferences when nailing down a bedtime routine. For instance, my three-year-old son has to have his Spongebob fleece throw in order to sleep; my 10-year-old son has to have the fan on in his room no matter what; and my 14-year-old daughter has to be stress-free to fall asleep, so I limit her cell phone and Facebook use prior to bedtime.

I wish you and your kids a good night.

– Dr. Smith-King

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Friday, August 26, 2011
Good idea, bad title? My thoughts on "Maggie Goes on a Diet"
by William Stratbucker, MD at 04:09 PM

Do we need more diet books for sale? What does the word "diet" even mean? Most people probably think of the word "diet" as meaning eating less for the purposes of losing weight. Others use the word to simply describe what we eat on a daily basis regardless of our weight status or whether we are trying to change what or how much we eat. It doesn't matter if we need more books on the subject of "diet" because they sell. They will keep coming.

A new book - Maggie Goes on a Diet - hits store shelves in October. I have seen the cover but it is not available to read yet, so, I haven't and neither have any of those discussing the book via social media. It's no surprise that the book is fueling online discussion. I would like to continue the discussion here.

Before you share your thoughts, let me explain something. I run a program at Helen DeVos Children's Hospital with several colleagues and our aim is to help obese children achieve a healthy weight. We do not simply suggest that children eat less. That is neither healthy nor likely to work in the long run. We do, however, recommend a diet. We don't typically use this word, but when we do, it is in the context that everyone has a diet. Some diets have been shown in research studies to lead an obese person toward a healthy weight. If you think of using red light, yellow light and green light labels on food choices as a "diet," then fine. Red light foods, for example, are those you would only consume in small amounts infrequently.

A diet is what, when, where, with whom, how fast and how much you eat and drink.

The new book has a concerning title. It seems to me that most people would interpret this to mean that the 14-year-old girl is starting to eat less. It is my hope that the author explains the true meaning of the word diet and that the teenager changes what, when, where, with whom, how fast and how much she eats and drinks. I also hope that the author talks about all of the other healthy choices a teenager can make to achieve a healthy weight like not smoke, get enough sleep, attend to her mental and physical health by visiting with a doctor among many others.

The other concerning issue with the book is that it is written about a 14-year-old but the intended reading audience is much younger - reportedly advertised to readers as young as six. Young children have many different concerns related to weight compared to a 14-year-old. Many with a body mass index (BMI) that puts them in the obese range do not need to lose weight. As long as the "diet" is modified and height growth continues, the BMI will drift lower over several months to years. A BMI should change over the course of time.

My last hope for the book is that it does not make it appear that these lifestyle changes are easy and that the weight changes for a 14-year-old come in an unrealistic period of time. Also, yes, teasing is commonly directed at children with obesity. This problem is getting added attention in schools but needs more. It appears that one of the outcomes of this girl's weight loss is to become popular in school and a star soccer player. I'm hoping instead that the author provides a more realistic outcome. The girl could, for example, share her thoughts about what it means to her to have achieved her goals toward living more healthy. She could describe her more active life and why she feels better adhering to goals like getting enough sleep and eating more nutritiously. She could describe how things have improved in her family life by incorporating more family meal time and active play time.

I don't know the author or his intentions. I hope they are good ones similar to those of us who work at the Healthy Weight Center. I challenge all of us to seek the information to live as healthy as possible. I also challenge you to post constructive comments related only to information you know, because like me, you haven't read this book either!

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Tuesday, August 16, 2011
Fostering Creativity in Your Kids
by William Stratbucker, MD at 11:52 AM

Guest blogger Amy Davis is a certified child life specialist at Helen DeVos Children's Hospital.

Are you facing the last days of summer with a couple of bored kids on your hands? Right now, my own children (Keaton, age 4, and Caroline, 21 months) are young enough that they are easily entertained, but many parents tell me it's especially challenging at the end of summer keeping things exciting around the house. So, I'd like to give you a few tips on how to foster creativity in your child, and also take a moment to talk about why doing so is so important.

When a child is given time to express him- or herself creatively, such as through an art project, that child also is being given a chance to think on his or her own and make new discoveries. So, when you give your child crayons, glue and paper, understand that it is about more than just finding a fun activity to occupy time: you are helping your child discover who he or she is, and are helping to build decision-making skills that your child can benefit from now and throughout life.

5 Ways to Give Your Child a Creative "Boost" and Beat Summer Boredom

Now that we're coming up on the last days of summer, your child may be telling you that he or she is bored. As a parent, this can be frustrating; however, keep in mind that being bored is often your child's way of asking for attention. Also, when your child is in school, he or she is used to having a schedule. In summer, the structure disappears, and, unless you establish it, your child will likely get bored because he or she can't think of enough things to do on his or her own.

Here are some techniques you can use to give your child a "boost" in the right direction.

1. Ask open-ended questions.
2. Brainstorm with your child.
3. Provide supplies, but let your child decide what to do with them.
4. Give your child encouragement
5. Include your child in what you are doing.

By allowing your child to help you prepare dinner and clean up, for instance, you now have more time to spend with them before bedtime. When a parent praises a child, that child will want to continue to do things independently. Find random supplies from around your house-string, yarn, bottle caps, beads-whatever you'd like. Then ask questions such as, "What could we do with all of this? Build a castle? Make a dinosaur?" Sometimes there can be too many choices.

For instance, you may suggest to your child that he or she draw a picture, but your child doesn't know what to draw. It's good to help narrow down the choices. (Note that this is not just a technique for young children. For instance, perhaps you go online with your teen and find some interesting science experiments that can be done at home.) If your child asks a question, instead of immediately answering, ask, "What do you think?" or "Can you tell me more about it?"

Here are a few last specific suggestions: One thing that helps keep things interesting for my own children, and more organized for me, is to keep their toys in bins, and store some of them in a closet. When I notice my children getting bored with what's out, I let them choose a new bin out of the closet and put another back in.

One more tip that only takes a minute or two: On occasion, create a surprise "fun bag" to entertain your child. The night before, toss in whatever you'd like-it could be almost anything, like a used egg carton, ribbon, coins, tape, etc.-then the next day let your child open it and discover what's hidden inside. He or she can use the supplies to create whatever he or she wants.

Enjoy these last days of summer with kids at home.

- Amy Davis, CCLS

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Wednesday, July 13, 2011
Sharing Big News with Your Child
by William Stratbucker, MD at 09:25 AM

Guest blogger Adelle Cadieux, PsyD, is a pediatric psychologist with the Spectrum Health Medical Group and Helen DeVos Children's Hospital.

There is no perfect way to share big news with your child, but no matter what the news, it's important to remember you know your own child better than anyone else. So, think about what your child's reaction might be before you share your news.

For instance, your child could be excited that you are moving, or very upset. Also, it's best to never assume that something will be a big deal to a child, even though it is to you. Therefore, I recommend taking a low-key approach to sharing whatever news you have-for instance, don't "announce" it-this sets kids up to have a reaction. Instead, state that there is something you want to talk about.

I'd like to share a personal story of how I shared big news with my own five-year-old son: we had to let him know our dog, Teemu, was likely going to die, and knew that it probably would happen before he returned home from daycare that day. Prior to this, we spent many months talking about how Teemu was getting old and sick and needed to be treated more gently and how he was not going to be with us for much longer. So, that morning we spent extra time saying goodbye to Teemu, sharing special memories and crying together. When Teemu wasn't home when our son came home from daycare, we were all sad but our son was somewhat prepared. After several weeks he began asking questions about when Teemu would come back and we needed to explain to him several times that he would not be coming back. Sometimes the questions stirred more emotion in me than it did my son.

Although there is no "one size fits all" approach to sharing big news with your child, here are some general guidelines:

  • Provide basic information at first, and details later. Too much detail initially can be overwhelming.
  • Recognize that your child's verbal skills develop more quickly than his or her ability to understand abstract concepts such as death, loss (like a move or divorce), so even though he or she may be familiar with the words, the meanings behind them may be hard to grasp.
  • The older your child is, the more likely he or she will want more details, so be prepared to answer questions.
  • Encourage your child to ask questions.
  • Listen to your child (what your child will be concerned about may be different from what you assume). Example: When we were considering moving, I had many thoughts of what my son would be concerned about; however, the only thing that mattered to him was if he would get to bring his toys. When I reassured him he would, he was fine with the idea of moving.
  • If you are moving, walk around your neighborhood and talk about the things you will miss and things you will be glad to leave behind.

Some children do better with advanced warning and some children will worry if given too much warning. It helps, though, to discuss the steps of the transition and timeframe for those steps. Younger children have more difficulty understanding the concept of time. Using a calendar to mark off days and countdown to each step can help: five more days and we'll pack, seven more days and the moving van comes, eight days we'll be in the new house, etc.

- Dr. Cadieux

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Monday, June 13, 2011
Achoo! Managing Allergies
by William Stratbucker, MD at 11:43 AM

Guest blogger Karyn Gell, MD, is an allergist and immunologist.

Are your child's sneezing, coughing, blowing, itching, headaches and/or asthma symptoms worse than usual? That's understandable. With all the rain we've had, mold may be particularly plentiful, but pollens are the worst troublemakers in the spring, with spurts of warm weather this year bringing both trees and grass into the picture. It will probably get worse before it gets better as we now move into summer.

We've just had a little dry spell which keeps pollen suspended in the air. That yellow dust coating your car or porch is also coating your child's eyes, nose and throat. The ocular and respiratory mucosal surfaces provide sticky areas for pollen deposition, and in an allergic child there may be intense sneezing, itching of the eyes, nose, and throat, and wheezing in asthmatics. Just this week at my son's baseball game, I noticed many kids on the field were rubbing their eyes vigorously because of severe itching.

Reducing Pollen Exposure

Here are some tips to reduce your child's pollen exposure:

  • Use air-conditioning in your home and car.
  • Keep your windows closed at night.
  • Use dust mite-proof covers for the bedding.
  • Wash all bedding in hot water weekly, including mattress pads and blankets.
  • Vacuum frequently.
  • Don't forget to bathe Fido and Fluffy and keep them out of the bedroom.
  • Do a good "spring cleaning" of the bedroom and throughout your home.
  • Wear a mask and goggles for yard work.

Over-the-Counter regimens may be helpful for your child. I find the following to be most beneficial:

  • Saline nasal irrigations (e.g., Sinus Rinse, Nasaline or Neti Pot)
  • Antihistamines (e.g., cetirizine, loratadine, or fexofenadine, with or without a decongestant such as pseudoephedrine)
  • Antihistamine eyedrops (e.g., ketotifen)
  • Nasalcrom or Opticrom

I would avoid topical decongestants such as Afrin or Vicks Spray for longer than three to five days and any ocular drops that "take the red out," as they can be addictive if used longer.

Is It a Cold-Or Allergy?

In my 19 years of working as an allergist, this is one of the questions parents ask me most often. It can be confusing-both allergy and summer colds can present with congestion, mucus production, and fatigue.

Here are a few tips to help you tell the difference:

  • If a cat sits in your child's lap while you are visiting relatives and his or her eyes itch and he or she begins sneezing, it's probably an allergy.
  • If your child feels feverish and has yellow or greenish drainage, your child may have an infection
  • Colds are generally viral and last seven to 10 days, but allergies can last an entire season or be present year-round.
  • If you notice symptoms about the same time every year, it's likely allergy.

Many parents wait too long to send their child to an allergist. Children with allergies have more doctor visits, days of feeling ill, missed school, more frequent infections, difficulty concentrating, fatigue and a "couch potato" feeling. Once a child is treated aggressively, however, quality of life quickly improves.


- Dr. Gell

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Tuesday, May 31, 2011
Is Indoor Recess Worth Cheering About?
by William Stratbucker, MD at 03:56 PM

"Attention students! Sorry for the interruption but we will have indoor recess today due to the rain," said the voice on the speaker at my children's school one recent rainy morning.

"Yes!" at least four of the six kids sitting within a few feet from me. I was volunteering in my child's classroom.

While I was not surprised by the announcement as it was pouring outside, I was caught completely off guard by the children's mostly unanimous and simultaneous response. So, as a researcher, I asked a question.

"Why are you so happy about indoor recess?"

One first-grade girl said plainly and quickly, "Because, when we have indoor recess we get to play with the toys in the room. If we have to go outside for recess we have to make up games by ourselves to play and just move our body parts around."

I think what she meant was that sometimes it's challenging for kids to think of what to do when given a few minutes on the playground. I hope she didn't mean that she's already decided that sitting inside and not moving is preferable to being able to go outside and run around for a few minutes with friends. I fear that some school age kids would rather not go out for recess as they are either intentionally not included in team activities or games or, worse, are teased or bullied during this time of relatively low close supervision.

One of the other students said the reason he exclaimed "yes" to indoor recess was just that he didn't want to get wet. The girl who responded previously - She said, "Yah, you like outdoor recess because you play soccer."

I worry our schools are not doing enough to provide closely supervised, constructive, fun activities during recess that includes anyone interested. Could this have led to that girl's explanation as to why she'd rather sit inside? With formal physical education time limited in schools, it makes what happens at recess that much more important. There is some medical evidence that kids who are more active tend to do better in school.

The comments from students were from those at the same school which started a running club for kids on Wednesdays during afternoon recess staffed with parent volunteers. We saw a very interesting trend. When we provided a structured, closely supervised activity that was encouraged by the parent volunteers and the school staff, we had all kinds of kids taking advantage. We didn't keep statistics or obtain demographics on the kids who participated and those who didn't but it seemed to be an outlet possibly for that girl who couldn't think of anything to do. The other trend that was noticed is that the boys were able to start up a game of soccer quite easily and play right up until the bell rang again. It didn't seem that way for the girls. But on Wednesday, we had several of them (and non-soccer-playing boys) joining us to run laps for the small incentive of a plastic bracelet charm.

What are your thoughts or your experiences about recess at school for your kids? Do you think we need more structured activities to involve those who are reluctant to move their body parts around? Or do you think it doesn't matter what happens at recess and kids should be allowed to be kids, regardless of whether they are moving around or not?

- Dr. Stratbucker

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Tuesday, May 31, 2011
What's the best form of hydration? Water, not sports or energy drinks.
by William Stratbucker, MD at 11:48 AM

Guest blogger Kyle Morrison is a pediatric exercise physiologist at the Helen DeVos Children's Hospital Healthy Weight Center.

A report released today by the American Academy of Pediatrics (AAP). It says that kids should never consume energy drinks and rarely consume sports drinks-and stresses that parents need to know the difference between the two drinks.

Just so you understand the difference, RockStar and Monster are examples of energy drinks, which are highly caffeinated beverages claiming to boost energy, and Gatorade and PowerAde are examples of sports drinks that supposedly help with hydration and athletic performance.

Professionally, I absolutely agree with this advice from the AAP, and as a future parent, I do, too. I am becoming the father to a six-year-old boy this summer, and can only think of a few situations when I would even consider giving him a sports drink-perhaps if it was one of the hottest days of summer and he seemed dehydrated and no water was available; or if he was very ill and dehydrated, and a sports drink was the only option available to me at that time.

As for energy drinks, I would never give one to a child under any circumstance. Did you know that a Wired x505 energy drink contains a mind-blowing 505 milligrams of caffeine-the equivalent of about 14 cans of soda?

Drinks Designed for Adults, Not Kids

Here's something interesting to consider: The first sports drink, Gatorade, was developed for the Florida "Gators" football team. The players were training in the swelteringly Florida summer heat and were becoming severely dehydrated, sometimes losing 5 to7 pounds after a single training session. A biochemist analyzed their sweat and saw it contained sodium, potassium and amino acids and from this research, developed Gatorade-for adult athletes who train for long durations each day. Children's physiology and sweat are different; kids have fewer sweat glands per square inch of their body and sweat much less than adults. It is therefore more important for children to cool their bodies during extend activity and water is the best means of doing this.

There are so many other reasons why water is a better choice: sports drinks are high in sugar and calories and can contribute to obesity; children can get a "sugar high" and become less effective athletically once they crash; they are also terrible for the health of your child's teeth.

Breaking the Sports Drink Habit with Young Children:

  • If your children are used to drinking sports drinks, they probably will not want to give them up. Stay firm, and know you are doing the right thing for your children.
  • If you can't go "cold turkey," start by diluting your sports drinks, gradually increasing the water. Or consider drinks that have few or no calories, such as Crystal Light. (That said, I believe the goal should always be to drink pure water.)
  • Remember juice is not a good alternative since it contains excess sugar and calories.

Breaking the Energy Drink Habit with Teens:

  • Be aware that your teen may have developed a dependence on the caffeine in these drinks. Your teen may experience headaches, shakiness, fatigue or other symptoms as he or she breaks the habit of drinking them on a daily basis.
  • Elite snowboarders, skateboarders and other young athletes endorse energy drinks, yet it's likely few drink them. Talk to your daughter or son about how these drinks are marketed and how this might be influencing their habits.
  • Instead of trying to force the issue, give your teen the facts, and let him or her know you care about them making healthy decisions.
  • Lead by example-if you are consuming these drinks your child will think it is okay for him or her to also.

- Kyle Morrison

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Tuesday, May 24, 2011
“Smoking Smarties” : Should Parents Be Concerned?
by William Stratbucker, MD at 02:37 PM

Adolescent medicine specialist Eugene Shatz, MD, is this week's guest blogger.Eugene Shatz, MD

For those of you who don't have any idea what I'm talking about (don't worry-I didn't either, until I looked it up online) it's when kids crush Smarties candy in the wrapper until it becomes powdery. They then inhale the powder and blow it out, to mimic cigarette smoking. Kids who are more "talented" apparently even learn how to blow smoke rings.

 

I'm always surprised at the new ways kids and adolescents come up with to entertain themselves and test boundaries. The latest trend I was surprised to hear about was kids "smoking Smarties."

Should parents be concerned about this latest trend? In my opinion, concerned, no, but aware, yes.

Here are some things to be aware of:

  • Smoking Smarties could cause irritation to the back of throat or bronchial tubes. If you watch YouTube videos of kids smoking Smarties (yes, I did this) you'll notice they don't really inhale, but rather keep the powder in their mouths. Still, particularly if your child has asthma or bronchial problems, smoking Smarties could be dangerous.
  • Some people believe smoking Smarties can be a gateway to smoking cigarettes or using drugs. Again, everyone is entitled to their opinion, but personally, I don't think this is a concern. I put this in the same category as smoking candy cigarettes-probably not something you want your kid doing, but not something that is going to cause serious damage either.

Talk About It-But Not Too Much

I think the more you amplify things or tell a kid not to do something, the more curious they can become. So I say, talk to you kids about smoking Smarties. But take a casual approach-try not to make a big deal out of it. Just tell them that pretending to smoke is not something anyone should be doing.

A Trend I Do Find Concerning

There is one trend that I do find concerning, and one that is worthy of your attention-it's kids spending too much time with electronic media. Here are just some of the negative ways it plays out:

  • Kids aren't getting enough outdoor exercise. Parents should talk to their kids about spending time online versus spending time outdoors. Kids need to get outside and ride their bikes, run, mow the grass, play football, chase butterflies-anything that gets them out and burning calories.
  • Kids aren't getting enough opportunities to build their social skills. Kids need to learn how to interact face to face with people of all ages and backgrounds. Limit all screen time-it is a reasonable thing to do and will help your kids develop these all-important skills.
  • Kids aren't being supervised enough when they are online. Internet time needs to be limited and monitored, just like TV time. Get filtering software so kids can't get to inappropriate sites. Don't let them spend hours alone in their rooms online.

The bottom line is: don't hover over your kids, but be involved in their lives and know what they are being exposed to, whether it's smoking Smarties or something they're finding online.

- Dr. Shatz

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Monday, May 09, 2011
Is Registering a Product Worth the Time?
by William Stratbucker, MD at 11:59 AM

Guest blogger Jennifer Hoekstra is the Safe Kids Program Coordinator at Helen DeVos Children's Hospital and injury prevention specialist. 
 

When I was pregnant with my first child, I bought a crib that I loved at a garage sale.  I used it for my second child as well.

 

When I was setting it up for my third child, my sister was helping me. She asked if I had heard about the recalls happening on so many cribs. I said I had, then it hit me-what if a recall was on my crib?  I checked, and unfortunately there was-and it was quite a serious one. I was devastated! Thankfully, we had Pack-and-Play and didn't have to buy a new crib.  

 

Although safety is my career now, and it is also a top priority in our home, I wasn't tuned into the importance of product registration at that time. Thankfully, nothing happened, but it could have-and I could have prevented it by just registering my crib.

 

What to Register

Do you register your products and stay informed of recalls? This is one thing every parent should be doing. You probably don't need to register every product you own, but you should register these: your car seat, stroller, crib, high chair, safety gates, swing and bouncy seat.

 

More Reasons Why

Need some convincing? Here are some good reasons why you should register your car seat (but these reasons apply to other products, too):

  • Registering a car seat is not like registering your toaster. You won't get put on any mailing lists, and it only will take a few minutes of your time.
  • You'll be notified of recalls; if you don't register you may miss the information, unintentionally placing your child in an unsafe situation.
  • If there is a recall, the manufacturer can send you a free repair kit immediately.
  • Manufacturers are always testing their products. If they discover something unsafe, the only way they can contact you is through your registration.

Getting Recall Info

In addition to registering products, I also recommend getting recall information sent to you from these organizations:

  • The Consumer Product Safety Commission at www.cpsc.gov. Go to "Get Involved," then click, "Sign Up for Safety News and Recall E-mails."
  • The Highway Safety Research Center at www.hsrc.unc.edu. Click on "Safety Information," then "Child Passenger Safety" then "Child Restraint Recalls" and finally "Sign up for automatic email notification of updates to the HSRC recall list" to get car seat recall information sent to you.

Remember that a safe product in itself is important, but it's only safe if a parent uses it properly.

 - Jennifer Hoekstra, CPST-I

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Thursday, April 28, 2011
Think twice about getting an exotic pet
by William Stratbucker, MD at 03:21 PM

Guest blogger Karen Dahl, MD, is a pediatric infectious disease specialist at Helen DeVos Children's Hospital.

Boy with pet kitten

Pet ownership can be a wonderful experience for families. I have enjoyed having dogs, cats and rabbits as pets myself.

However, I am not an advocate of families owning exotic pets, such as certain rodents, reptiles and monkeys because they put children and families at serious risk-not only can exposure to these animals cause injury and infection, they can carry serious exotic diseases that your physician may not be familiar with and therefore are difficult to diagnose and treat.

Children under the age of five are at an even greater risk than other age groups because they still have immature immune systems and are more likely to put their hands in their mouth, increasing the risk of acquiring an infection. The Centers for Disease Control and Prevention (CDC) recommends that infants and children under five years old avoid contact with the following animals:

  • Reptiles (lizards, snakes and turtles)
  • Amphibians (frogs, toads, newts and salamanders)
  • Baby chicks
  • Ducklings

Additionally, children under five should be extra cautious when visiting farms and having direct contact with farm animals, including animals at petting zoos and fairs.

Here are just some examples of diseases you or your child can contract that are transmitted by exotic pets:

  • Salmonella: Reptiles turtles and chicks carry high rates of salmonella. In children and adults, the bacteria can cause severe cases of diarrhea, fever, vomiting, abdominal cramps and even death. A child can pick up the bacteria from a person who handles the pet, but also from household surfaces the animal may have touched.
  • Bubonic Plague: The plague is carried by wild rodents such as prairie dogs, which have been sold as pets in recent years.
  • Herpes B: Carried by macaque monkeys, and also known as monkey B virus or B virus. In humans, the virus leads to an illness that can cause death. Monkey bites are the primary way humans get herpes B virus. Human herpes B virus infection carries a case fatality rate of approximately 70 percent.
  • Rabies: Carried by wolf-dog hybrids. No USDA-licensed rabies vaccine is approved for wolf-dog hybrids-that is because there is no proof that the canine vaccine is effective in a wolf-dog hybrid. Raccoons and foxes also are reservoirs for rabies and should never be kept as pets.
  • Rat Bite Fever: Transmitted by a bite, kiss or lick from a pet rat. This is a serious illness, often resulting in hospitalization and untreated, can be fatal. (Several years ago, I treated a young girl for rat bite fever. She was hospitalized with fever, joint swelling and pain, and a rash, just after Christmas. Her parents had bought her a blue rat as a Christmas present, but were unaware of the risks associated with this type of pet.)
  • Influenza: Can be transmitted between humans and ferrets.

Exotic pet ownership is on the rise in the U.S., increasing by 75 percent since 1992. There are many Web sites that offer not only North American-based exotic pets, but for a price, buyers can purchase animals worldwide, such as reindeer, llamas, camels, kangaroos, iguanas, parrots, pythons, marsupials or other creatures that are in demand. What this means is, even if you don't have an exotic pet yourself, chances are one of your child's friends may have an exotic pet or buy one at some time.

To help keep your child safe, I recommend you follow safety and preventive measures offered by the American Academy of Pediatrics:

  • Match the size and temperament of your pet to the age and behavior of your infant or child, and provide close supervision to reduce the possibility of injury.
  • Wash hands immediately after contact with animals, animal products, or their environment.
  • Supervise hand-washing for children younger than 5 years old.
  • Do not allow nontraditional pets to roam or fly freely in the house.
  • Do not allow animals in areas where food or drink are prepared or consumed.
  • Keep animals free of parasites, ticks, and fleas. Maintain current vaccines like rabies.

If you are still thinking about having an exotic pet, talk to your pediatrician first so you understand the particular concerns related to the animal you are considering. Pediatricians at Helen DeVos Children's Hospital can offer advice on proper pet selection and provide information about safe pet ownership and responsibility to minimize risks to you and your children. Your veterinarian is another source of information on what diseases can be transmitted by animals. If your child ever becomes ill, it is important to inform your health care provider of the types of animals your child has been exposed to so unusual diseases and infections can be considered.

- Dr. Dahl

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Thursday, April 21, 2011
“Come on, you can do better!”
by William Stratbucker, MD at 10:28 AM

While in the moment, this might seem like the best thing to yell from the sidelines at your son or daughter as they compete in spring soccer on a cold, damp Saturday morning. Everyone wants their child or team to succeed. I happen to think there are many other more appropriate ways to motivate your child to perform at the best of his or her ability.

 

My 6-year-old daughter is running track for a second season and her twin brother couldn't decide between soccer and baseball so he will be doing both. I've agreed to coach baseball and was recently trained to be a certified soccer referee.

 

We've all heard the sideline comments. We've heard the overzealous coach, parent or grandparent barking at one of the kids on the team to "shoot now!" or "run faster!" I'm also guilty at times of a few like "Get that rebound!" Sometimes we need to be loud to overcome the other noise at athletic events when encouraging our children. However, some of us need to make different decisions about what we say, when we say it and how often we yell. I asked my son after a winter basketball game as he walked out of the gym in shorts into 10 degree weather if he heard anything that anybody said when they yelled from the bleachers in the noisy gym. He said, "Nope, not anything."

 

After that, I changed my approach. I waited until a break in the game and had time to say one thing to him directly that he did great.

 

I see kids who are overweight or obese almost every day in my pediatric practice. I want them to be out running around and having fun while they are doing it. I want those who do not have a weight problem to be preventing one by participating in organized sports. What I don't want is a child - any child, regardless of body type or skill level - to feel shameful of their performance during a sporting event.

 

We cannot be innocent bystanders anymore. If you see (or more likely hear) a parent or a coach overstepping their bounds, say something to them. I'm not talking about the mom who is yelling "go, go, go!" as her daughter streaks down the sideline ready to center the soccer ball to an awaiting teammate. I'm talking about the comments like "Get over there and guard that kid!" or "What is wrong with you out there!" This goes for parent-coach interactions and those with the referees.

 

Kids are motivated appropriately by praise and the joy of playing with teammates. Yes, they also want to win but really, we need to decide if that is their true goal or ours as parents and coaches. I'll have it easier coaching elementary aged students where the competition isn't as fierce as the older kids, but I'll be thinking about this as I work with my rising baseball stars.

 

My suggestion is that if you hear someone making inappropriate comments that you address it with the team's coach first and expect the coach to interact with the parent if necessary. If it is the coach who is the offender, approach other parents to see if your concerns are valid and ask others to have a conversation with the coach with two of the parents.

 

What have you heard on the sidelines? What have you done about it? What is your suggestion to others on how to handle the situation?

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Thursday, April 07, 2011
Is Reading Encouraged in Your House?
by William Stratbucker, MD at 08:22 AM

Ensure Reading Success Through a Reading-Friendly Home

Emmy David is a teacher and educational liaison at Helen DeVos Children's Hospital and is our guest blogger.

There is so much evidence that teaching children to read is not only important, but critical to their future success.  According to the U.S. Department of Education, children who have not developed basic literacy skills by the time they enter school are three to four times more likely to drop out in later years. 

Here at Helen DeVos Children's Hospital, I work as a teacher/education liaison, where I provide educational assistance to school age patients. In this role, I see firsthand how important reading is, and I know that being able to read at a young age can make a world of difference academically. Not only are children who are able to read earlier more confident readers, their writing becomes better, too. Reading with a parent or other family member also helps children and parents communicate and they form better bonds that can last a lifetime.

One of the best ways to ensure your child's reading success is to create a reading-friendly home. Here are some tips on how to do this:

  • Create an inviting physical space. Include your child in designing this space, and make sure it is quiet and comfortable. Does your child prefer to sit up, lie down or lounge in a chair?  Does he or she prefer soft lighting or being at a table near you?  You can also consider using a rag rug or special blanket that is only used when reading that becomes a portable "reading area."
  • Create a calm "psychological" space, too. Never force your child to read-showing children by example is always the most persuasive, so make reading an important part of your own day. Also, make sure family members know that when your child is reading, he or she should not be bothered.
  • Discover your child's own interests. What does your child want to read? The more interested he or she is in the subject, the more excited your child will be about reading.
  • Keep bringing new books into your home. In addition to finding books at the library or bookstore, why not trade books with friends? When you keep new books coming into your home, you help ensure your child stays interested in reading.
  • Don't be frustrated by repetition. Children sometimes choose to read the same book over and over again for weeks.  Many children feel empowered knowing something ahead of time, like how a conflict in a story will be resolved. 
  • Talk about the parts of the book you love. Pointing out funny parts, great illustrations and explaining the author's intent will get your child talking about what they love and treasure about stories and reading as well.
  • Let your young child tell you stories. Young children can begin to develop a love of reading even before they can read. In addition to reading them stories, have your child tell you stories-either ones he or she remembers or makes up.
  • Let siblings, grandparents and babysitters read to your child, too. Even though story time can be a coveted part of the day for parents, it is good to share the experience from time to time.

How do you encourage your children to read? What do you think are barriers to them reading?

-          Emmy David

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Tuesday, March 29, 2011
Emotional eating isn’t just for adults.
by William Stratbucker, MD at 07:11 AM

Emotional eating isn't just for adults.

Kimberly Slendak is a licensed master social worker in the Healthy Weight Center at Helen DeVos Children's Hospital. She is our guest blogger this week.

Sometimes the most intense cravings for food occur when people are faced with strong emotions. For instance, people eat in response to negative emotions (i.e., to relieve stress or boredom) as well as positive emotions connected to birthdays, holidays and other celebrations. This is known as "emotional eating," and can sabotage healthy lifestyle efforts. There are things you can teach your children to avoid emotional eating.

Become more aware of your own habits around food.
Do you find yourself turning to food when you are stressed? Do financial concerns or health-related issues make you crave your favorite "comfort food" as a way to "get through it"? Although some people may actually eat less in the face of strong emotions, the majority eat more. Additionally, do you see birthdays and other celebrations as an opportunity to overindulge with "permission"?

Be aware that children model their caregivers and can learn to use food in these same ways. Then, before you know it, both adults and children automatically reach for a treat whenever feeling an emotion without thinking about it. Find new ways to tame your stress-such as through yoga or meditation-and model these behaviors for your child

Find new ways to reward or comfort your child
Do you frequently reward your child with food-such as offering a trip to the ice cream shop for a good grade? When your child is sad or disappointed, do you offer food or sweets as a way to help cheer your child up? Many parents do these things with good intentions, and an occasional treat to celebrate can be a positive experience. However some parents make it a habit to reward or comfort their children with food, and that is often when a child begins to associate feelings with food.

The next time you want to reward your child, consider taking him or her on a special outing or purchasing a special toy or other item. If your child needs comfort, talk and listen to him or her, give an extra hug or go on a walk together instead of offering a food. Additionally remember that what most children crave even more than food is verbal praise from adults.

Establish a consistent eating environment.
Establish uniform rules for eating that will help to discourage emotional and boredom eating. For instance, making a household expectation and rule that food should always be eaten in the kitchen or dining room, while sitting down at the table will help decrease the chance your child will overindulge in his or her favorite snack while his or her mind is preoccupied and distracted by the TV, homework or video games. Also, maintaining a structured and routine eating schedule helps your child learn when to expect his or her next meal so he or she is less likely to overeat knowing food will be available in another few hours. Finally, refrain from keeping supplies of comfort foods in your home if they are hard for your child to resist.

Talk to Your Child About Eating

Talk to you child about his or her habits and about making healthy choices. Here are some questions and ideas to help get you started:

  • Do you feel like eating when you are happy? Sad? Worried? Angry? Frustrated? Bored? Scared?
  • Are you truly hungry? Is your hunger physical? Help your child recognize the importance of understanding the body's natural response to being hungry, such as listening for a rumbling tummy. Also help your child understand the body's response to being overfull with too much food. Help your child learn to manage the amount of food he or she eats at one time.
  • Sometimes it can take a while to make the connections between food and emotions. It might help to keep a journal, where your child can write down his or her feelings and times when he or she feels like eating.
  • Make a list of activities with your child that he or she can do when bored instead of eating.

Even if your child is of a healthy weight now and has good eating habits, habits can change. For instance, as your child matures he or she may look for new ways to deal with stress, and one of those ways could be through emotional eating. Establishing healthy habits now will lead to healthy habits later.

- Kimberly Slendak, LMSW

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Wednesday, March 02, 2011
Six Months, Six Milestones
by William Stratbucker, MD at 01:21 PM

Dr. Burdo-Hartman is a neurodevelopmental pediatrician at Helen DeVos Children's Hospital and a guest blogger.

Many exciting changes happen to a baby during the first six months of life. They learn to roll over, grasp things in addition to sitting up. Many parents wonder what milestones their children should reach. Here are six milestones to look for and tips to encourage development:

Your baby should be inquisitive
At six months, most babies are ready to explore. They reach for things, and bring objects close to their faces to look at, taste and feel.

Tip: Make sure objects your baby wants to hold are safe and large enough so they are not choking hazards. Yes, your baby will probably drool and it will be messy, but the tongue and mouth are one of your baby's most sensitive areas, so allow this exploration.

Your baby should be making lots of noise
Babies at this age love to hear themselves. They are moving out of "cooing" mode and making more "ba" "la" and "ga" sounds.

Tip: Help your baby develop in this area, by singing, even if you don't sing well; making silly faces and funny noises he or she enjoys; showing how your tongue works; reading out loud.

Your baby should enjoy imitating your actions
Imitation is a form of flattery in adults, but with babies, it is necessary in order for them to learn.

Tip: Try different forms of play to help your child develop in this area such as blowing "raspberries" at them and see if they imitate you, or clap and see if your baby tries to bring his or her hands together, too.

Your baby should start using more large motor skills
In addition to sitting on his or her own your baby is likely bringing his or her legs up and looking at his or her feet. Also, notice your six-month-old reaching out and grabbing toys and objects and moving them from hand to hand, another milestone. Your baby is developing the urge to stand and bear weigh at this time, which will eventually allow him or her to learn balance.

Tip: "Floor time"- allowing your baby to play and safely explore on the floor-is probably one of the most important things you can offer your baby at this age. In my opinion, a baby should spend about half of his or her time on the floor, preferably with you.  We do not recommend using walkers or exersaucers-they do not help develop trunk strength, and injuries can occur.

Your baby should be making lots of eye contact
Your baby should spend a lot of time looking at you. This is normal and good, and important for social as well as physical development.

Tip: Primary colors are good for babies this age-they can't see pale colors, and need more bold differences. That said, babies can get overstimulated, so avoid fiery, fluorescent colors, toys with flashing lights, and overly "busy" toys. Remember-your baby is still learning about simple things, such as what a rattle is.

Your baby should be starting to show his or her independence
You'll probably first notice independence developing when eating-your baby will begin to do some self-feeding, such as starting to hold his or her own bottle.

Tip: Encourage you baby to feed him or herself, even if messy. Also you need to make sure bite sizes are manageable for them, since they are only able to chew with an up and down motion at this age.

You can help your baby most is to encourage him or her and offer safe ways to explore, and at the same time just keeping things simple. It is important to remember that every child is unique, and the actual age when a normally developing child reaches a milestone can vary.

- Dr. Burdo-Hartman

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Monday, February 07, 2011
When is high too high? The truth about fevers
by William Stratbucker, MD at 03:14 PM

Guest blogger Cynthia Norman is the nurse manager of the Helen DeVos Children's Hospital emergency department.

 

Chances are, if you are a parent, your child has experienced at least one fever and will likely experience another. How will you respond the next time it happens?

In the emergency department (ED) at Helen DeVos Children's Hospital, many parents bring their children in for fever each day, and we work together to help identify the source. Some of these fevers are concerning, but some are not, and I think it is important for you to be aware of this and not automatically become worried if you child has a fever. In order to help you know what to do when you child gets a fever, I'd like to offer some of my perspective on the subject.

Learn more about fevers before your child gets one.

Excellent guides are available online that describe specifically what to watch for in children with fevers and when to seek medical attention versus treating symptoms at home. Your child's pediatrician is a great source for information and it is fine to consult your child's doctor before using the Internet or the ED. Our Web site is a good resource. Look at the Should I call the Doctor feature if you are looking for advice in a particular situation. Another portion of our site Health Information from A to Z is another good resource.

Bring your child in to the doctor or ED if:

  • You have an infant under two months who has a fever
  • Your child's fever persists, even after two days with fever reducers (known as "antipyretics") which include acetaminophen (Tylenol) and ibuprofen (Motrin), among others
  • You feel worried or need a second opinion
  • Your child has a productive cough, persistent vomiting, stiff neck, localized pain, painful urination, parched mouth, is listless, overly sleepy or is not taking liquids. This is a partial list-check the online guides I referenced above for complete lists.

How you treat your child is dependent on his or her age. For children under two months old, a fever is 100.3 degrees when taken by rectum. If your child under two months of age has a fever, you need to consult your pediatrician before treating a fever. For children three to six months, we recommend using acetaminophen as directed on the label. For those six months and older, alternate ibuprofen and acetaminophen, and follow label directions. Learn the recommendation for your child's age.

Be aware that infants and young children have a higher risk of dehydration than older children.

Always offer children fluids, no matter what their age, but be especially careful that young children are not becoming dehydrated. All fluids that they will consume are good-Jello, popsicles, water, juice, Pedialyte and even ice chips.

If you follow these recommendations, but your child's fever persists and you are preparing to bring him or her to the ED, please consider the following:

  • Give your child appropriate fever reducers before bringing your child to the ED. Some parents avoid doing this because they want us to see how bad the fever is, but they should not wait. Why? Fevers make children uncomfortable and their visit to the ED will be easier if they don't have the discomfort associated with fever. In fact, when children come to the ED with a fever, we give fever reducers even before the doctor sees them so the physical exam will go better.
  • It can take a while to identify the fever's cause. We sometimes see parents who are distressed when we send them home without medicine-they feel like we didn't do enough. However, sometimes the cause of a fever takes a while to present itself and sometimes it's okay for a child to have a fever. For instance, we might x-ray a child for a lung infection, take a urine sample or check their blood, yet still not see anything that is readily treatable. If the fever persists and the child returns to us a day or so later, we sometimes find a cause for the fever. In these cases, some parents might assume we missed something on the first visit, but this is not necessarily the case.
  • Children get better sooner when parents partner with us. Illness, fevers and treatment are sometimes a "process." It would be nice if every time a patient has a symptom we could always identify the cause, however, it doesn't work that way. We count on partnering with parents and see ourselves as consultants who can help evaluate the seriousness of the fever and hopefully determine its cause. If we don't find a cause during the ED visit, we will talk about what to watch for at home and ask parents to return or seek help from the primary care doctor. We always want to know if parents are uncomfortable with the plan or if they have questions or concerns.

Always trust your instincts and take cues from your child. If a parent says to us "something's not right" we value that and listen. Some kids feel miserable when they have a fever, but others keep playing and remain content, so the most important thing you can do is know your child well and understand how your child copes with fever or illness, then share that valuable information with us.

- Cynthia Norman BSN, RN, CEN

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Wednesday, January 26, 2011
Reward Children without Food
by William Stratbucker, MD at 02:21 PM

"Now that you're done getting your shots, let's go to McDonald's" is a phrase I frequently hear in my office.

 

Parents are rewarding children with food far too often. No where is this more common than at some schools where birthdays and holidays are celebrated with treats. A patient of mine recently lamented that she was missing two classmates' birthdays being celebrated that day with cake and candy. Two in the same day!

 

With more than 30 kids in the classroom and needing to squeeze in all the summer birthdays, the patient received a birthday treat almost once a week. This must stop. I'm all for celebrations, but we need a strong dose of common sense when it comes to our children's experience with food.

 

After a day of first grade, my two six-year-olds couldn't be happier to show me their new pencil toppers (tiny rubbery gizmos that go on the end of your pencil and look like some sort of animal) that they received from a classmate to help celebrate turning another year older. They just don't miss the cake. There is a time and place for celebratory foods, but it is not weekly in the classroom.

 

President Obama signed the 2010 Hunger Free, Healthy Kids Act late last year. The passage of this bill was highlighted in a local newspaper article. One aspect of the legislation is a limit on school-based celebrations with unhealthy foods. With our nation needing to find ways to reduce extra calories in our children's diets, this is a much needed step. The bill also brings many more children access to healthier school breakfasts and lunches.

 

If children are to be rewarded for putting up with shots or getting their grades up at the end of the semester, why not a trip to the book store or even the library if finances are tight? We must stop rewarding children with unhealthy food. I admit that on occasion my family celebrates with food. When it is a family birthday we have cake and ice cream. Most dinners, though, end without dessert. It is not a nightly occurrence and when it does happen, we don't make a big deal about it.

 

I encourage you to talk with your child's school about limiting classroom treats or walk through to see what they are offering your child in the vending machines? What, if anything, will you send to school with your child when it is their birthday?  How are you celebrating without food?

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Tuesday, December 07, 2010
Does Your Child Wash His or Her Hands Properly?
by William Stratbucker, MD at 12:29 PM

Michelle Lancaster is an infection prevention nurse at Helen DeVos Children's Hospital. She is our guest blogger this week.

As an infection prevention nurse at Helen DeVos Children's Hospital, I help prevent the spread of germs within the hospital by teaching patients, families and employees about ways they can stay healthy. One of the most important ways to help stop the spread of germs is through proper hand washing. This is true not only in the hospital setting, but anywhere you go. I wanted to share some hand washing tips for you and your child:

  • Make hand washing fun! Young children especially can be turned off by soaps with an unappealing scent or grainy texture. Finding hand washing supplies your child likes may mean he or she will wash more frequently and thoroughly. Letting the child help pick out the soap or a fun towel might make hand washing seem like less of a chore.
  • Steer your child towards a liquid, moisturizing soap, if possible. Bar soaps don't always dry well between uses and can harbor germs. Also, hands can get dry, especially in wintertime, so look for a soap that moisturizes.
  • Teach your child to rub his or her hands together until bubbles form. Wet hands well with warm water, then apply soap and work into bubbly lather for 20 seconds before rinsing.
  • Have your child sing "Happy Birthday" twice while washing. Some families sing the "A, B, C's", count to 20 or use a timer; you could also have your child make up their own hand washing song. Make sure they wait to rinse off the soap until after the singing is complete.
  • Make sure to clean all surfaces of the hand. Many children think the palms of their hands are the only areas that need cleaning. Remind them that hand washing includes the front and back of hands, fingernails, thumbs and wrists.
  • Alcohol-based hand sanitizers are just as good as soap if used correctly. Be sure to use enough product so that it takes you 20 seconds to rub it all in. Pay attention to all areas of the hands
  • Make sure your child follows the rules at school, too. Be sure to give them alcohol-based hand sanitizer that can be kept in a desk or backpack and used often during the school day.
  • Teach your child to share hand sanitizer with their friends- at lunch, in class, on the playground, it's nice to share and rarely do people refuse a squirt of hand sanitizer.

When to wash hands is just as important as how to wash them. Teach your child to wash at these times (and keep these times in mind for yourself as well):

  • Before and after preparing food
  • Before and after meals
  • Before and after using the bathroom (or, for parents, when changing a diaper)
  • Before and after taking care of or being with someone who is sick.
  • After blowing your nose, coughing or sneezing
  • After handling animals or their waste
  • After handling garbage
  • Before and after treating cut or wound

Remember to use soap and water whenever hands are visibly dirty or after toileting; hand sanitizer works well in most other circumstances. Keep hand washing fun and be a good role model for healthy living by washing your hands often.

Remember, good health is in your hands.

- Michelle Lancaster, BS, RN, CIC

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Sunday, November 14, 2010
Obesity Prevention Starts Before Birth
by William Stratbucker, MD at 05:06 PM

You might be saying "my child is too young to have to worry about obesity." Please, read on. Many parents will soon bring their infant to the doctor only to discover that a healthy baby is not one that is overweight. As many of you know we launched the Helen DeVos Children's Hospital Healthy Weight Center in April and we are off and running (literally) with five to17 year-old patients working on reducing their body mass index (BMI) and increasing the understanding of healthy nutrition and activity among the patients and their parents. The excitement of our center is only tempered by the extent of the problem of childhood obesity in our community. Children in West Michigan are not necessarily more at risk than children elsewhere. Every child is at risk in today's society.

We know that not every child who has a problem with weight or even all children who have already developed a consequence, like high blood pressure or school bullying, will be able to be seen at our center, so we are working hard to get the messages out to all others who can play a role in reversing this epidemic and in prevention.

Parents certainly play an incredibly important role in preventing obesity and responding to the concern of a health care provider when weight becomes an issue. There are many things that we know and are learning more about every day when it comes to obesity prevention. Several that apply to children age two and older are represented by our7 6 5 4 3 2 1 message. But, for newly pregnant mothers, infants and toddlers up to age two, we know several things that can help as well.

Here are the basics, mostly in chronologic order:

1. Prenatal care is very important. Starting at conception, children develop risk factors for becoming obese. The health status of the mother, including pre-pregnancy weight, smoking status, nutrition during pregnancy, appropriate pregnancy weight gain, managing gestational diabetes and developing a plan to breastfeed are all considerations related to obesity prevention before the baby is even born.

2. Breastfeeding an infant is important for so many reasons but it may be one of the best ways to prevent obesity. Babies get great nutrition from breast milk but they also learn how to eat and how much to eat. It seems there are many elements in play including the ease at which bottle-fed babies can be overfed to the availability of breast milk compared to formula that are behind this effect. Regardless, prospective parents need to strongly consider breastfeeding if possible.

3. Post-partum support is also very important. New parents should visit with the infant's medical home physician by the fifth day of life to start establishing healthy behaviors. There, resources can be made available on post-partum depression and healthy adjustment to providing for a new member of the household and lactation support. All mothers should attend their follow-up appointments with their OB.

4. Health supervision in the doctor's office over the first two years can be a source of education for the family and observation of the growing infant/toddler to detect early signs of excessive weight gain. Many healthy habits need to start in the first two years of life that impact obesity risk and these should be the main focus of the infant's health supervision visits during this time. Parents should not only write down the baby's weight and length into the baby book, but also the weight-to-length percentile. This is a form of the BMI (used after age 2) to detect too-rapid weight gain.

5. Don't smoke. Prenatal smoking and smoke exposure in the first two years of life are both risk factors for obesity independent of other factors. The explanation of the link is elusive but this highlights the importance of assisting newly pregnant moms who smoke with quitting as soon as the pregnancy test is positive.

It is never too early to think about how to prevent obesity in your family. For more information about childhood obesity and resources for your family, visit the Healthy Weight Center portion of our Web site.

If you have specific questions about your child's health, risk for obesity or if you feel your child is overweight, call your child's doctor's office. Detection and treatment of obesity starts with your child's doctor.

Have you discovered any ways that helped you get off to a great start with your infant? Have you taken any steps to actively prevent obesity within your family? If you've been alerted that your baby is overweight, what were you told and what did you do?

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Wednesday, October 27, 2010
When the Going Gets Tough
by William Stratbucker, MD at 12:31 PM

 Deborah Cloney, MD, is a pediatric gastroenterologist with Helen DeVos Children's Hospital. She is this week's guest blogger.

Constipation is one of those topics that parents generally don't choose to talk about. But it is such a common issue, that if they did talk more about it, particularly ways to avoid it, fewer children would have to suffer through it.

So, let's talk about kids and constipation. First, it helps to know that it is extremely common-as a pediatric gastroenterologist, at least once a day I treat a child who is dealing with constipation, and I've been doing so for the past 19 years. At Helen DeVos Children's Hospital, there are about 1,000 patient visits per year due to constipation.

Kids become constipated for many reasons. However, many times these reasons are related to behavior, based on their attempts to avoid large, painful bowel movements-if they've had one, they will likely try to avoid the next one.

As a parent, you often have an opportunity to help your child avoid constipation. In fact, a healthy diet and a calm, patient manner are often what help most in preventing constipation or preventing a more severe case of constipation from developing. Here are other ways you can help:

  • Make sure your child is drinking lots of water and getting plenty of high fiber foods.
  • Be aware of early warning signs. If your child complains of frequent stomachaches or has blood when he or she wipes, these may be signs that he or she is becoming constipated. If this is happening, you may also want to try a pediatric fiber supplement, but make sure your child drinks enough fluid with it, or else it won't work.
  • Don't put pressure on a toddler who is potty training. They may hold back out of fear or anger. Also, don't allow your child to play video games or read books while they are on the toilet waiting for a bowel movement-it is important for a child to learn the signals their bodies send them, and concentrate on the task at hand. That said, I recommend spending no more than 5 minutes waiting on the toilet for a bowel movement. If it doesn't happen by then, let your child do another activity.
  • Talk to your early school age child about using the bathroom at school. A child this age may be afraid or embarrassed to have a bowel movement away from home. Address their specific concerns, then talk to them about constipation and the importance of going when you have to go.
  • Don't stop communicating with your older child about constipation. Older children can become used to constipation and no longer want to talk to you about it. However, they need to be reassured that you are there to help them and that communication is important. At the same time, they should be made aware that there are consequences to chronic constipation. For instance, over time, they can lose their ability to sense when they need a bowel movement and can accidentally leak fecal matter. Severe constipation can also cause urinary problems, as an impacted stool can press on the bladder.

If your child is already constipated, you may want to contact your pediatrician for advice-it's likely you will not even need to go in for a visit at first, but your doctor should be able to offer recommendations, such as a non-stimulant stool softener. If you follow your pediatrician's advice, and the constipation remains (or if it returns), you may want to schedule an office visit. If it continues, your pediatrician may refer you to a pediatric gastroenterologist.

One final note-in my practice, I often see children who have had chronic constipation, so they now leak fecal matter. Many parents think a child is doing this on purpose, but they are not. Their rectums have become full, and they really are not aware that it is happening. So if this has happened to your child at some point, please be gentle and patient with them. It isn't their fault.

Once, quite a few years ago, I treated a teen who was constipated. At the last visit, the mother and daughter told me that no longer having to deal with constipation literally changed their lives. I'll always remember this-even though it seems so simple, constipation is something that has a major impact on a person's life. Once it is treated, though, a child can focus on new things and rewarding activities.

- Dr. Cloney

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Monday, October 18, 2010
Use Halloween as an Opportunity to Promote Year-Round Safety
by William Stratbucker, MD at 10:23 AM

Jennifer Hoekstra is the Safe Kids Program Coordinator at Helen DeVos Children's Hospital and an injury prevention specialist. She is our guest blogger this week.

As an injury prevention specialist, one of the reasons why I like Halloween is I see it as a chance for parents to enjoy anticipating the holiday with their children, but also to use it as an opportunity to reinforce good safety habits that should be followed throughout the year.

To have a safe and enjoyable Halloween, first, I suggest you start brainstorming with your child in advance about his or her costume instead of trying to pull something together on Halloween Day-chances are greater that if you try to make a costume at the last minute, it won't be as safe.

Once you've decided on a character and are ready to make or buy a costume, keep the following safety guidelines in mind. Remember, most of these tips can also be used when choosing any type of clothing your child wears throughout the year.

  • Make sure the costume is flame-resistant. If you're purchasing a costume-including masks, beards and wigs that go with them-check that they are labeled "flame resistant."
  • Avoid costumes with big or long sleeves, flowing skirts or scarves. Many times people light jack-o-lanterns or have bonfires on Halloween, so having a close-fitting costume helps minimize the chance it will catch on fire.
  • Check that your child's costume is short enough. This will help prevent your child from tripping and injuring him- or herself.
  • Buy or make costumes that can be seen in the dark. If your costume is not reflective, add reflective tape that will glow when headlights shine on it.
  • Make sure your child carries and uses a flashlight. Also, if you haven't used the flashlight in a while, test it before Halloween Eve.
  • Wear good walking shoes. Walking in the dark is challenging and it is easy for children to trip and fall. Do not let your child wear high heels or other footwear that is not sturdy.
  • Make sure your child can see. If your child is wearing a mask, make sure it is secured properly so it will not cover his or her eyes. Also, headwear should also be secured so it does not slip down over your child's eyes.
  • Consider non-toxic face paints or cosmetics instead of a mask. Masks pose a safety risk because they can slip and restrict breathing or obscure vision. If a mask is used, make sure it has large eyeholes and fits securely.
  • Check all costume accessories. Make sure all materials used are soft or flexible, including any type of weapon, such as a sword.

Now, here are a few important safety precautions to go over with your child before he or she goes trick or treating:

  • Young children should stay with an adult.
  • For older children, plan and review a trick or treating route that is acceptable for them to navigate alone. Agree on a specific time when they should return home.
  • No running. Also, do not walk between parked cars, in the street or in other people's yards.
  • When going to the door to trick or treat, watch for jack-o-lanterns, Halloween décor or any furniture that might present a danger.
  • Do not to eat any candy or treats before an adult has carefully examined them at home.
  • Only trick or treat at homes where you know the residents and make sure their outside lights are on, so you know trick-or-treating is welcome.
  • Teach your children how to call 9-1-1 if they have an emergency or become lost.

Unfortunately, almost every year we see at least one Halloween related injury at Helen DeVos Children's Hospital. This year, let's follow these safety tips and enjoy the planning, preparations, and parties.

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Thursday, October 07, 2010
A Safe Ride Every Time
by William Stratbucker, MD at 11:25 AM

Jennifer Hoekstra is the Safe Kids Program Coordinator at Helen DeVos Children's Hospital. She is our guest blogger this week.

How often do you drive in a car with your child? If you're like most parents, each and every day you leave your home and go somewhere together. And if you're like most parents with young children, chances are your child's car seat is improperly installed-four out of five car seats are.

As the Safe Kids Program Coordinator for Helen DeVos Children's Hospital, one of the things I do is coordinate safety inspections at our four different car seat inspection stations. We carefully track data at these sites, and have found that locally, the misuse rate of car seats is 94.6 percent. Let's work together to change this statistic. The biggest errors we see in Kent County include:

1. Loose harness straps

2. Loose installation

3. The chest clip being placed too low

Do you think you might be part of the 94 percent? You have a chance to find out. Join me on Saturday, October 23 at Kohl's Rivertown in Grandville between 10 a.m. and 2 p.m. for a car seat check up event. The event is sponsored by the Kohl's Cares for Kids Program. Kohl's has supported Helen DeVos Children's Hospital and Safe Kids over the past 10 years and sponsors the local program, Birth to Booster: "Kohl's Kids Ride Safe at Every Stage".

Throughout the week, Kohl's Rivertown and Helen DeVos Children's Hospital will be offering:

"Ask the Expert"
Although the actual event is just one day, the week is dedicated to educating the community about child passenger safety. Our team of certified child passenger safety experts will be available just outside the mall entrance to Kohl's. Our schedule includes:

October 18 from 10 a.m. to 1 p.m
October 19 from 5 p.m. to 9 p.m.
October 20 from 10 a.m. to 1 p.m.
October 21 from 10 a.m. to 1 p.m. and from 5 p.m. to 9 p.m.

 Booster seat voucher
Parents who visit us during the week and who have a child that fits the appropriate booster seat range (must be between 40 and 100 pounds and shorter than 4'9") can receive a voucher for a free booster seat. This voucher can be redeemed on Saturday at the event at Kohl's Rivertown. Your child must be with you on Saturday at the event to receive your free booster seat.

Monthly Car Safety Inspections Offered at Four Sites

If you aren't able to make it on Saturday, I hope you will take advantage of our car seat safety inspection sites-they are free and offered monthly at four convenient locations. When you come with your child and car seat, we will show you how to properly adjust the straps, secure your child and lock the car seat into your vehicle.

Choosing and Using Your Car Seat

In the meantime, I want to make sure your child is as safe as possible now. Therefore, here are some tips and suggestions.

When choosing a car seat:

Choose a seat based on how well it fits in your car and how easy it is to use. If a car seat is easier to use, you are more likely to use it correctly.

Look closely at the front adjustment. Can you tighten and loosen the harness straps from the front of the car seat? I prefer seats where you don't have to take the car seat out of the car to adjust the straps.

Look for multiple harness slots. This allows a wider variety of children to use the seat, and also can accommodate your child as he or she grows.

When using the car seat you have purchased:

Know that what the law says, and what we consider best practices (and encourage through our Safe Kids program) are not necessarily the same. Best practices are the practices that will give your child the best chance to be safe if he or she were ever involved in a crash. Consider the following:

The law says children can turn forward facing once they reach 1 year and 20 pounds. However, the best practice is to keep kids rear facing as long as possible - to the maximum limits of each car seat (usually 30-35 lbs.). Kids are five times safer rear facing than they are forward facing and rear-facing seats are 71 percent effective in reducing infant death.

The law says children under 4 must remain in the back seat. The best practice, however, is that children under 13 stay in the back seat. This is because the seat belt does not usually fit them properly and their body structures are not fully developed or equipped to take the impact of a frontal airbag if it deploys.

The law says kids can stop using a booster once they are 8 years old or 4'9" (57"). But the best practice is to use a booster seat until the child is 4'9" and the seat belt fits the child correctly. Note that children ages 4-8 riding in boosters are 45 percent less likely to sustain injury than those riding using just the vehicle seat belt.

Take that extra step and use your car seat as safely as possible.

- Jennifer Hoekstra

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Monday, September 20, 2010
Protecting Your Child from Whooping Cough
by William Stratbucker, MD at 04:56 PM

Karen Dahl, MD, is a pediatric infectious disease specialist at Helen DeVos Children's Hospital. She is our guest blogger this week.

Some parents have been contacting Helen DeVos Children's Hospital, wanting to know more about the resurgence of pertussis-the bacterial infection also known as whooping cough-here in Michigan. It's good to know parents are getting informed about the issue and want to take action and help protect their children as well as help prevent the infection from spreading to others.

Here are some facts you should know:

  • Anyone can get whooping cough, but it is more common in infants and children-and is especially serious in infants, since they do not complete their primary vaccine series until they are six months of age. Infants may turn blue with a coughing spell or even stop breathing.
  • Whooping cough causes uncontrollable coughing in unimmunized persons-in fact, a child may cough so hard that he or she has choking spells or vomits.
  • The "whooping" part of the name comes from the sound that's often made when the child takes a deep breath in after a coughing spell.
  • Pertussis in adolescents and adults is less dramatic and often goes undiagnosed, but is still contagious. Young children and older partially immunized people usually don't make the "whoop" sound.
  • Pertussis is one of the few infections that doesn't cause a fever, and many people think that a cough without fever isn't serious. However, any cough that has lasted more than two weeks should be evaluated.

To understand what's happening with the resurgence of whooping cough in the U.S., it's helpful to know some history: In the 1920s and 1930s, before there were pertussis vaccinations, there were approximately 250,000 cases each year. Then vaccines came on the scene, and by 1976, the incidence of whooping cough in the U.S. had decreased by over 99%. Since 1980, though, the incidence of whooping cough has risen, with epidemics occurring about every three to five years in the U.S. This increase may be due to adolescents and adults with waning immunity, and also to parents opting to delay or decline immunization of their infant children.

California, Pennsylvania, New York, South Carolina, as well as Michigan, have experienced whooping cough outbreaks this year. So what's happening?

The real issue is that parents aren't getting the necessary booster shots for their children and themselves, and the vaccine loses its effectiveness over time. Should you be worried? If you and your child are immunized and up to date on boosters, you have done everything you can to prevent infection and disease. However, be aware that the pertussis vaccine isn't 100% effective, so even immunized people can get sick, but usually this is a milder illness.

About immunization:

  • Check your hosusehold's pertussis vaccine records. Children should receive pertussis-containing vaccines at 2, 4, 6 and 15-18 months, as well as at 4-6 years of age.
  • A booster is given at 11-12 years of age, and every 10 years after that (combined with a tetanus booster).
  • Pertussis is now part of what used to be called the tetanus/diphtheria "Td" booster-but now it is called "Tdap" and includes pertussis.
  • If you are expecting a baby in your household soon, or if you have a young child, make sure everyone's immunizations are up to date, especially adult care givers.

Pertussis boosters are being offered to women either during the second or third trimester or post partum to help protect their infants. If you are offered this vaccine, remember the purpose is to protect your newborn infant.

Whooping cough in older children isn't serious, but they should still stay up to date on their immunizations. This is because when they come in contact with infants under 6 months of age, they put that infant at risk.

Antibiotics can help shorten the duration of illness if given early in the disease. However, antibiotics are prescribed even if the diagnosis is delayed to help prevent transmission to others. If there is a case of pertussis in your household, all household members should receive antibiotics to help prevent whooping cough. If there is a case in daycare, antibiotic prophylaxis is recommended for all children in that daycare.

If your child needs a pertusiss immunization, schedule an appointment now. If you believe your infant has pertusiss, see your doctor right away.

- Dr. Dahl

 

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Tuesday, September 14, 2010
Bullying Is Not a Normal Part of Growing Up
by William Stratbucker, MD at 07:25 AM

Kimberly Slendak is a licensed master social worker with the Helen DeVos Children's Hospital Healthy Weight Center. She is our guest blogger this week.

Did you experiencing bullying when you grew up? Even if you weren't involved yourself, it's likely you witnessed bullying by others. Unfortunately, today, bullying is still common behavior. One study reports that 86 percent of children ages 12 to 15 said they get teased or bullied at school-that makes bullying more prevalent than smoking, alcohol use, drugs, or sex among that same age group.

But, some people argue, isn't bullying just a normal part of growing up? My answer is absolutely not. In my experience, children who are involved with bullying are exposed to an environment of aggression. They may be stunted in their peer relationship growth and may suffer academically. Bullying not only causes harm in the moment, but can also have life-long effects on a person's self-esteem and confidence levels. So, whereas occasional peer conflict is inevitable, bullying is not the same and is much more serious. In a conflict, both sides have equal power. But bullying involves the intentional, one-sided use of power to control another.

There are some myths around bullying that I'd like to address before offering tips on how to help your child avoid it:

Myth #1: My child would tell me if he or she was being bullied.
Maybe, but maybe not. Children may not tell for a number of reasons: they believe adults won't be able to stop the bullying; they may not even recognize that they are being bullied; they are afraid; and they may think that telling an adult will result in worse treatment from the child bullying them.

Myth #2: Most bullying is physical.
The most common form of bullying, for both boys and girls, is verbal bullying such as name calling. It is also common for kids to bully each other through social isolation. And, if you are a parent, you should also be aware that bullying not only is still a reality in the schoolyard, but it's moved into cyberspace-online chat rooms, e-mail, and text-messaging-and is rapidly increasing.

Myth #3: Obese children are always the victims.
A 2004 study showed that overweight and obese school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. Another study reported that younger obese boys were more likely to be victims of bullying, whereas older obese boys were more likely to carry weapons and be the bully, compared to boys of normal weight.

Fortunately, as a parent, you can teach your child new behaviors that will help him or her navigate bullying situations. It all begins with becoming more aware yourself, so I'd like to start with a short assessment. Have you noticed any of the following behaviors in your child? If so, they could indicate your child is being bullied:

  • Changes in diet, overeating or under eating, leading to weight changes
  • Changes in the amount of exercise or physical activity your child participates in
  • Fear of riding the school bus
  • Cuts or bruises
  • Damaged clothing or belongings
  • Frequent "lost" lunch money
  • Frequent requests to stay home from school
  • Frequent unexplained minor illnesses
  • Depression or lack of enthusiasm for hobbies or friends
  • Decline in school performance
  • Changes in sleep patterns
  • Heightened anxiety, lack of concentration, panic attacks

If you suspect your child is the victim of bullying, ask him or her to tell you what's going on. Be sure to explain in advance that you know he or she is not to blame, and that it is the right thing to tell you. Here are some ways to help your child cope if he is she is being bullied:

  • Encourage your child not to fight back.
    Bullying lasts longer and becomes more severe when children fight back. Physical injuries are often the result. Also, tell your child to stay near a supervising adult when bullying is likely to occur.
  • Tell your child to report all bullying incidents that happen at school to a teacher, the school guidance counselor or a school administrator.
    Know your school's policies and explain to your child that these rules are in place to protect students from harassment, bullying, and physical violence. Talk to your child's teacher or other school staff so they are aware of the situation.
  • Help your child be specific in describing bullying incidents.
    Being specific, and even documenting bullying incidents by writing them down can be helpful in determining patterns and gaining control.
  • To help your child regain a sense of safety, have him or her to extend invitations for friends to play at your home or to attend activities together.
    It may also be helpful to involve your child in other social activities outside of school.
  • Notify the police if your child is assaulted.
    Also, keep in mind that restraining orders are not just for adults. You can get a restraining order so that the bully is required by law to have no contact with your child. 

Finally, don't hesitate to talk with your child's pediatrician, your family physician, school counselor or another professional for help-remember, bullying is not normal and a professional can help you develop new strategies and coping mechanisms.

- Kimberly Slendak, LMSW

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Friday, September 03, 2010
Power Lunches Aren't Just for Parents
by William Stratbucker, MD at 10:31 AM

Registered dietitian Erin Webley is a specialty dietitian educator with the Helen DeVos Children's Hospital Healthy Weight Center. She is our guest blogger this week.

Eating a healtErin Webleyhy lunch refuels your child's body and will help him or her stay more focused and energized throughout the afternoon. So what's better-a school lunch or one you pack at home?

Although meals provided at schools can offer good nutrition, it can be harder for children to make healthy choices at school. For instance, many school lunches are highly processed and are pre-packaged in large serving sizes. Additionally, many a la carte items available are high in fat and sugar-laden. These are just some of the reasons why I advocate for packing your child's lunch.

A packed lunch is more likely to appeal to your child's individual tastes, be more balanced and have appropriate serving sizes as opposed to the limited options available at school. But it's important to remember that just packing a lunch itself is no guarantee that it will be better.

Always think balance when preparing meals and snacks for your child. Include foods from at least three of the food groups, making sure to always include a veggie and/or fruit. Foods like fruits, vegetables, whole grains, lowfat dairy and lean protein have vitamins and nutrients that help children feel their best. With beverages, I recommend offering water first, although low-calorie flavored water is okay sometimes, too. Low-fat milk is another good option. Always avoid pop, juice and drink boxes.

I find the best way to establish a routine of packing your child's lunch is to simply make a list of foods and meals your child likes that are also healthy so you know what to buy and prepare. Here are some good-tasting and healthy options to get you started:

  • Pack one serving of whole grain crackers, 3-4 tablespoons of hummus, and sliced veggies to dip. Fruit and low-fat milk can be purchased at school and will round out this lunch.
  • Pack one serving of baked tortilla chips, salsa, a quarter cup low-fat cheese, black beans and salad greens. Include a large, empty container and your child can mix all together for a yummy taco salad.
  • Wrap low-fat string cheese in lean lunch meat, then cut in half. Serve with whole grain crackers and a small can of low sodium vegetable juice to drink.
  • Add fruit (canned in light syrup or fresh) to low fat yogurt or cottage cheese. Add whole grain cereal or nuts for more crunch.
  • If your child is tired of regular bread for sandwiches, try other whole grain varieties like pitas, flatbreads, wraps, crackers and small bagels. Be sure to go light on the mayo and add veggies whenever possible for a balanced meal.
  • Make a healthy dip by mixing ranch powder into fat free sour cream or low-fat Greek yogurt.
  • Fill a thermos with soup, casseroles or other stew-like leftovers. Always keep hot foods hot and cold foods cold to avoid the risk of food borne illness.

Once you have your ideas, find a variety of good, reusable containers and have been grocery shopping, you are ready to start packing. Here are some time-saving tips that will help make the process simple and quick:

  • Plan ahead and start simple. In general, packing a lunch should take less than 10 minutes. Start simple with two to three menu ideas, then rotate through them for a of couple weeks. Add more recipes as you get more comfortable with the new routine.
  • Involve your child in the process. Have your child pre-pack his or her napkins, silverware, or other meal items. Younger children can count out finger foods and pre-pack them in containers or plastic bags.
  • Portion out a week's worth of daily servings for non-refrigerated items like crackers, dry cereal and nuts.
  • Cut vegetables and store them water for the week to help them stay fresh. You can then quickly grab and pack some each morning.
  • Portion out leftovers for lunch while you are serving dinner.
  • Freeze leftover casseroles, soups and other foods. It then is easy to thaw them out, heat and pack them in a thermos in the morning during breakfast (make sure to heat hot foods thoroughly before packing).

One important note on portion control: As a registered dietitian, I see firsthand many children who are struggling with obesity issues, and I think it is important to know that even children who eat healthy can become obese-it is simply a matter of consuming too much food. So, please also be aware not only of the quality of the food you are serving your child, but the portion size as well.

Getting in the habit of packing healthy lunches for your may take a little time, but the rewards for you and your child will be worth it. Start with simple choices and don't be afraid to be creative.

- Erin Webley, RD

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Tuesday, August 24, 2010
Backpacks 101
by William Stratbucker, MD at 08:31 PM

Robin Fisher is a physical therapist and a board certified clinical specialist at Helen DeVos Children's Hospital. she is this week's guest blogger.

Now that it's back-to-school time, I want you to take a moment and think about your child's backpack. Not the style or features, but how he or she carries it and how much weight your child totes. A safe backpack weight is considered 10 to 15 percent of a child's total body weight. So, if your child weighs 75 pounds, his or her backpack (and its contents) should weigh no more than 8 to 11 pounds.

However, according to a 2009 study conducted by the American Physical Therapy Association, as many as 55 percent of children in the U.S. carry backpack loads that exceed the maximum safe backpack weight. Doing so is especially dangerous to children with young, growing muscles and joints, since carrying too heavy a load can cause injury.

I often see children with neck, back or shoulder pain in my role as a physical therapist. Backpacks can sometimes be a contributing factor, especially since children wear them daily, and if worn improperly or if they carry too much weight, it can lead to postural misalignment which leads to pain. 

In addition to determining the proper weight for your child, here are some tips that will help ensure your child's backpack is safe and comfortable:

Choosing a backpack:

  • Purchase a backpack with padded, wide straps. This allows your child to carry the load on more of his or her body. 
  • Choose a backpack with a padded back. A padded back can reduce pressure on your child's back and prevent the pack's contents from digging into his or her back.
  • Buy a backpack with a waist belt. It will help distribute some of the load to the pelvis.
  • If you are considering a model with wheels, take care. These styles often do not fit in lockers, cannot go through snow and still need to be lifted if there are stairs or curbs to maneuver. 
  • Make sure the backpack fits close to your child's body. Having a backpack that doesn't fit properly causes increased stress on the body. Ultimately, this will make the backpack seem like it weighs more than it actually does.   
  • Akways make sure any backpack you choose has reflective material so your child is visible to drivers at night.

Loading a backpack:

  • Weigh your child's backpack before the first day of school. Be sure to weigh it again periodically, especially as the contents may change or increase during the school year.
  • Load the heaviest items in closest to your child's body. They will be easier to carry that way. 
  • Make sure the weight is evenly distributed throughout the backpack. Uneven distribution can also causes stresses on your back, neck and shoulders. Strive for balance.  

Wearing a backpack:

  • Always wear both straps when wearing a backpack. Wearing one strap or carrying a backpack in one hand can cause uneven stresses on the body which can lead to bad postureand back, neck and shoulder pain. 
  • Use compression straps on the sides or bottom of the backpack. When tightened, these straps compress the contents of the backpack and stabilize the items inside.
  • Use proper body mechanics when lifting a backpack to put on. Your child should bend down facing the backpack, lift it with his or her legs, and keep the pack close to his or her body, then put it on.  Bending over can cause undue stress on your child's back. 

A note on messenger bags: If your child wants to carry a one-strap, messenger-type bag, follow the same weight recommendations as with a backpack. Also, be sure that the shoulder strap goes across your child's body instead of it hanging down from one shoulder.  Also with one-strap bags, tell your child to regularly alternate which shoulder he or she is wearing the strap on. 

If your child is experiencing back, neck or shoulder pain, consult your physician or a physical therapist. Warning signs that your child's backpack could be causing injury include: pain when wearing the backpack; tingling or numbness in the arms; and red marks on the shoulders.

- Robin Fisher, PT, PCS, C/NDT

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Thursday, August 12, 2010
Helping a Child Deal with the Death of a Loved One
by William Stratbucker, MD at 12:49 PM

Nancy Kingma, MA, BSN, RN, LLP, LPC, NCC is a bereavement services coordinator at Helen DeVos Children's Hospital and director of Camp Compass. She is our guest blogger this week.

Dealing with the death of a loved one is one of the hardest things we have to face as a human being. For children, the grieving process can sometimes be even harder, since along with feeling sad, children may also be confused about death and what it means. I sometimes see well-meaning parents who have sent confusing messages to their children, such as saying a loved one has "gone to sleep" instead of saying that a person has died, in an attempt to protect them.


That is why I always advise parents and adults to tell children the truth about death in a gentle, simple manner that is appropriate for that child's age. Once the child has had time to process the news, the parent or adult should be available to answer as many questions as the child has-this will help build trust and allows the child to grieve.


Here are other ways you can assist a child who is dealing with the death of a loved one:

  • Use the words "death" and "die." Words such as "passed," "lost," or "passed away" may be used in an attempt to soften the harshness of death. These words are confusing, especially to a small child who may reply, "If he is lost, let's go find him."
  • Let the child know that feelings are okay. There are no "right" or "wrong" feelings when it comes to grief. Parents and adults can help a child to identify his or her feelings, then provide constructive ways of dealing with them. For instance, some suggestions for working through anger could be playing a game of soccer or hitting a punching bag.
  • Share your feelings with the child. Just as we may feel the need to protect our children, they may also feel a responsibility to protect parents and adults. By sharing your feelings, you can both better cope with the grief.
  • Assist the child in finding his or her own meaningful way of saying good bye. This could be writing a letter or putting something special into the loved one's casket.

Our region is fortunate to have another resource for parents or caregivers helping children cope with death of a loved one. The resource is Camp Compass, a one-day camp for children who have experienced the death of someone significant in their life.


The annual camp is scheduled for September 25, 2010. Each year dozens of volunteers including nurses, child life specialists, social workers, therapists, physicians and teachers join together to volunteer their time to work with grieving children. The primary goal of Camp Compass is for campers, ages 5 to 15, to have fun while grieving in a safe environment. In addition to group discussions, participants benefit from a number of activities, many of which teach coping skills, such as making memory quilts or boxes and playing games.


On the morning of Camp Compass there is a two hour parents' support session conducted by a therapist or social worker. The session gives parents an opportunity to gain an understanding of grieving children and are given tools and resources to help support their children.


I'd like to share just a few sections of a letter I received from a mother whose child attended Camp Compass. I think it will give you an even better feel for how valuable the program can be:

I can't say enough to thank all of you for the amazing experience my daughter had last Saturday with all of you....She kept repeating things like: "Mom, it was SO much fun...Mom, isn't it cool that I got to pick out my own stuffed animal?!...Mom, we even got to....we talked about..." etc....In fact, I am not exaggerating when I tell you she said "Outside of Disney World, this was the most fun camp, Mom!!...I know she felt her grief was understood, "normalized" and that, for once, there were other kids like her!! Tonight she sleeps with her garden pot nightlight, made that day, and her new "teddy" chosen from many stuffed critters that greeted the children upon their arrival at camp. I am forever grateful and have already recommended next year's camp to another mom for her children who recently lost their father in a tragic car accident....

Click here if you would to register for this year's camp or learn more.

- Nancy Kingma

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Monday, July 26, 2010
Tips for Masking and Chasing a Medicine's Taste
by William Stratbucker, MD at 10:12 AM

Diane Sinsabaugh is a Clinical Pharmacy Specialist in Pediatric Oncology/Bone Marrow Transplant at Helen DeVos Children's Hospital. She is our guest blogger this week.

When most parents find out their child has an illness requiring frequent medication, one of the last things they think about is how the medicine will taste to their child. But for many kids, concerns about the taste-sometimes even more so than the actual disease or illness-is what they think about most.

As a registered pharmacist, I've been aware of this since early in my career, and am always on the lookout for ways to educate parents and help kids who must take medicine that has a bad taste-after all, if a medicine tastes bad, children won't want to take it, or worse, may find a way to fool their parents into thinking they've taken it, when actually they haven't.

That leads me to my first and most important point: being straightforward is what is best when it comes to giving your child medicine. Therefore, one of the things I strongly recommend is to never trick a child into taking a medicine-for one, it will only work once, but for another reason, it will likely leave your child angry, distrustful, and perhaps even less secure.

What I recommend is to mask a medicine's taste and include your child in the process, so he or she can help pick flavors-this works much better than mixing medicine with mild tasting foods or in water. Any flavors that your child likes may work, but first get a sense of whether the medicine has more of a salty or sweet taste. If it is salty, choose a flavor that complements a salty taste like tomato juice, soup broth or tortilla chips. Vice versa, if it's sweet, go for a sweet masker.

I like to give maskers and chasers "themes" to help make the experience more positive for kids, and I'm sure you can come up with a few of your own. Here are a few masking ideas:

  • "A Kid'll Eat the Middle": Most kids like eating the cream inside a sandwich cookie first Therefore, put the medicine inside the cream and so your child can eat it first, and follow up with the hard cookie "outsides."
  • "Go Greek": Remove the pimento from a green olive, insert a pill then replace the pimento.
  • "Ice Cream-less Sundae": Coat a pill with a thick chocolate, cherry, strawberry, caramel or butterscotch topping.
  • Some medicines have such a strong taste, that they really can't be masked. In these cases, I recommend "chasing" them with a favorite flavor. A few suggestions:
  • "Thin Mint Sans the Scout": Put the medicine in chocolate syrup and chase it with peppermint candy.
  • "Reese's Re-Mixed": Put the medicine in peanut butter and chase it with chocolate.
  • "S'mores Without a Campfire": Put the medicine in marshmallow cream and chase it with chocolate sauce and graham crackers.

It's important to know the perception of taste tends to be much stronger for liquids than solids. So, if the pharmacist gives you a choice between a solid tablet or a liquid formulation, choose the tablets. They will be much easier to "mask."

I also have just a few final thoughts I'd like to leave you with regarding young children:

  • Very young children are often extremely motivated to learn how to swallow capsules to avoid a bad taste. Kids can practice swallowing using mini-sized M&M's or "Nerds."
  • "Pill glide" is a fruit-flavored spray you may want to try, which helps make swallowing tablets and capsules easier.

Even if your child does not need medicine now, chances are at some point, he or she will, so I hope you keep these tips in mind for when that comes. Your child is sure to thank you for it.

- Diane Sinsabaugh, RPh

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Thursday, July 15, 2010
Kids and Body Image
by William Stratbucker, MD at 07:55 AM

Kids and Body Image

Dr. Cadieux is a child psychologist and this week's guest blogger.

 Media portrayals of unrealistic or unhealthy body images, sometimes through use of computer technology to make a model look thinner or improve "flaws" is bombarding our children with ideas of how their bodies should be.

Children and adolescents definitely pick up on these messages. Kids of all ages and sizes can adopt a negative body image and believe they must strive to make their bodies "perfect." It's also important to recognize that increasingly more and more boys are having issues with body image. And, of course, peer pressure continues to plays a significant role in how your child views his or her body.

I'm going to share some good news in a moment, but for now, here are some sobering statistics:

  • Half of all girls and a third of all boys use unhealthy weight management strategies
  • 81% of 10-year-olds report that they are afraid of being fat
  • 46% of 9-11 year olds are "sometimes" or "very often" on diets

But, before you become too discouraged, consider this: as a parent, you hold an enormous influence over your child, and therefore, your own attitude towards weight and body image will likely be the greatest influence on your child's beliefs about these topics. You can make a difference. That's important to remember.

That said, we all know most children don't want to be told what to do-and they usually listen best when we think they aren't listening. That's why, instead of lecturing your child, one of the best ways to help your child maintain a positive body image is to be aware of what you say about yourself. If you're a mother, do you sometimes make negative remarks about your own body and say you look or feel fat or need to lose weight?  If you do (and 80% of all women report that they are dissatisfied with their bodies, so it's likely you've got company), just keep in mind that your child is more likely to take on a negative view of his or her own body, too.

Of course, I also hope it goes without saying that any negative comment a parent makes about his or her child's body, or other people's bodies, can have a negative impact on the child. So, even if a child is overweight, a parent should never use negative comments to try to "help" the child to lose weight.

Here are some ways you can encourage a positive body image in your child:

  • Be accepting of your own and others' bodies
  •  Pursue your own individual and social activities, try new things and encourage your child to do the same
  • Offer positive comments to your child about their characteristics, abilities, efforts
  • Focus on effort and improvement in yourself and child, not perfection
  •  Pick up a magazine, and talk about and challenge messages being sent through the advertisements
  •  Eat healthy, and limit, but do not eliminate low-nutrient "junk" foods
  •  Be physically active with your child

Remember: Your attitudes and behaviors are probably the biggest factor in how your child will view his or her own body. Make sure your child knows that while maintaining your health is important, body shape or size does not determine happiness, self-worth or success. When you send your child these positive messages, everyone wins.

- Dr. Cadieux

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Wednesday, July 07, 2010
Using Medicine Safely
by William Stratbucker, MD at 02:13 PM

Morgan Cole, PharmD, is the pharmacy manager at Helen DeVos Children's Hospital. He is our guest blogger this week.

Giving kids medicine safely can be a complicated task. It's possible to give your child medicMorgan Cole, PharmDine safely and prevent dangerous reactions with knowledge and double-checking.

Using medications safely means knowing when they are necessary, as well as when they are not. Always check with the doctor or pharmacist if you are unsure whether medication is necessary.

In many cases, supportive treatments may be the best bet for a quick recovery, especially with cases of the flu or the common cold. Getting enough rest will allow the body to heal, and plenty of clear liquids will help your child avoid dehydration from body fluids lost through vomiting, diarrhea, perspiration and nasal secretions.

To ensure the safe use of prescription or over-the-counter (OTC) medicines, discuss your child's allergy symptoms with your doctor and pharmacist. Once treatment has been established, you should know:

  • The name and purpose of the medication
  • How much, how often and for how long the medicine should be taken
  • How the medicine should be administered
  • Whether the medicine be taken with or without food
  • How the medicine should be stored
  • How long the medicine can safely be stored before it needs to be thrown away
  • Common side effects or reactions
  • What happens if your child misses a dose

Dosages of prescription and OTC medicines depend on a child's weight so make sure the doctor and pharmacist have current information about your child. Too little medication can be ineffective and too much can be harmful.

Sometimes medicine should be given on an as-needed basis. OTC drugs that relieve symptoms such as aches, pains or fever should only be taken as recommended. We do not recommend OTC cough and cold medicines such as phenylephrine, pseudoephedrine, dextromethorphan, etc., be given to children under the age of 4 years.

In most circumstances acetaminophen is preferred in children to treat fever and pain. Generally speaking, never give aspirin to children, unless prescribed by a physician.  Using aspirin during an illness caused by a virus (such as the flu, chickenpox or an upper respiratory infection) can cause Reye syndrome, a potentially life-threatening disease with symptoms that include nausea, vomiting and extreme fatigue that progresses to a coma.  Some OTC medicines contain aspirin, so it's important you read labels and check with your doctor before using them. Be aware that some aspirin-containing medications use words other than aspirin such as salicylate or acetylsalicylic acid.

However, many medications should be taken until finished as prescribed by the doctor - even if your child begins to feel better.  Antibiotics help to kill bacteria in the body, so it's important to finish all doses even after symptoms disappear because the infection can return if the antibiotic is stopped too early.

Other tips I like to share with parents who are worried about using medication correctly include:

  • Don't try to diagnose your child's problem yourself. Always check with your doctor if you're unsure whether symptoms require medical treatment. You may also look at "Should I Call the Doctor?" on our Web site.
  • Never use leftover medications. For example, doctors may prescribe or pharmacists will sometimes dispense more liquid medication than is needed in case some is spilled or measured incorrectly. If you have liquid left over after your child has completed the course of treatment, throw it out. For medicines taken as needed, pay attention to the expiration date to make sure you are not giving an outdated medication.
  • Never give your child medication that has been prescribed to someone else. Even if two people have the same illness, they may require different drugs with different doses and directions.

  • If you're purchasing OTC medications, check the packaging for possible tampering, and don't use medications in cut, torn or sliced packages.

I also encourage you to develop a relationship with a local pharmacist so that your family's medication history is in a central location. Your pharmacist and pharmacy are an extension of your health care team and play a vital role in the health of your child.  

- Morgan Cole

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Wednesday, June 30, 2010
Kids and Mowers Don't Mix
by William Stratbucker, MD at 09:36 AM

My colleague, Mike Forness DO, an orthopaedic surgeon at Helen DeVos Children's Hospital, is this week's guest blogger. 

We all have passions in life.  As a pediatrician, helping children is clearly one of my passions.  What's another passion? Preventing lawn mower injuries.

As parents and caregivers, we simply can't underestimate the power of a lawn mower. The powerful machines are dangerous on so many levels. A mower has extremely sharp blades moving at high speeds that can project objects at more than 200 miles per hour and with a force greater than a gun.

Can you help me prevent injuries this summer by observing the five N's?

  • No bare feet. Sturdy shoes should be worn when mowing.
  • No one in the yard. Keeping children inside is the best protection.
  • No riders. Never let a child ride with an adult on a riding mower.
  • No child operators. Children under 12 should not operate a push mower and children under 16 should not operate a riding mower.
  • No mowing in reverse.

Lawn mower accidents often require multiple surgeries as the accidents injure growth plates in a child's leg.

Other injury prevention tips:

  • To prevent injuries from flying objects, such as stones or toys, remove objects from the lawn before mowing begins.
  • The adult mowing should wear hearing and eye protection.
  • Start and refuel the mower outside, not in a garage or shed.
  • Mowers should be refueled with the motor turned off and cool.
  • Never pull the mower backward or mow in reverse.
  • Always turn off the mower and wait for blades to completely stop before removing the grass catcher.
  • Never reach under a lawn mower with your hands to unclog the discharge chute or free a jammed blade.
  • Turn off the lawn mower to cross pathways and roads

-   Dr. Forness

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Thursday, June 24, 2010
Men Experience Stress as New Dads and Other Thoughts on Fatherhood
by William Stratbucker, MD at 04:52 AM

"Daddy, you have hair growing in your ear," my daughter said to me as she gave me a Father's Day hug. That's not quite what I expected to hear from her but continue to be amazed at the things she observes and, in turn, teaches me.

As parents, we sometimes think our only role is to teach our children - after all, the word discipline means "to teach." But, children have so much to teach us as well. When my wife and I discovered we were going to have a baby, we went through many of the "normal" reactions of future parents readying ourselves for the challenge. Then we found out we were having two babies! Now that they've just finished kindergarten, we, like many others, are up against our newest challenge of juggling summer camps, daycare and work schedules.

I was recently quoted in USA Today about the changes that some fathers go through around the delivery or adoption of their first child. You can read the story to find out what interesting purchase I needed to make for my wife at Babies 'R Us. The newborn period is a time of stress for both parents and no parenting book can truly explain what one can expect. Some handle the stress of becoming a parent better than others. Many of the responses to stress are genetic and not in our control but require that we learn new coping strategies. The article focused on hormones men experience around the time of the birth of their child. We've known for quite some time that the delivery of a baby is a spark for the onset of depression in women, but now we are starting to understand better that men too are at risk for postpartum mood disorders.

As a pediatrician, I am concerned for the health not only of the infant during delivery, but also of the parents. If the parents of a developing child are not physically and mentally able to handle the challenges that await, it can be harmful to the infant and, in some cases, tragic. Child abuse in the first year of life peaks when the infant is around two months old - the same time that the infant is at the peak of crying.

Pediatricians need to look out for parents who might be struggling during the initial stages of an infant's life to help guide them to resources to get help with depression or other social stressors that may be impacting the care that they can give to their new baby. Friends and relatives of new parents can look for signs of stress or depression and offer to help the new parents. Instead of asking to help hold or feed the infant, offer to help clean the house, buy groceries or cook dinner to allow the parents more time to bond with the baby. To learn more about postpartum mood disorders and the value of a true pediatric medical home, listen to my interview for Health Radio from earlier this year. You can also participate in an upcoming Spectrum Health Web chat about postpartum depression. Click here for more information.

Kids can teach us many things about ourselves and we need to be resilient in our responses to the challenges that they pose. The role of being a parent is one of teaching and of learning. What pieces of advice do you have for new parents or those expecting their first baby soon? Are there things you wish you had known then that you know now?

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Monday, June 14, 2010
Keeping Kids Active
by William Stratbucker, MD at 12:29 PM

My colleague Kyle Morrison, an exercise physiologist with the Helen DeVos Children's Hospital Healthy Weight Center, is this week's guest blogger.

Encouraging kids to be active is one way parents can help children maintain a healthy weight. Parents can instill a love of physical activity and help kids fit it into their everyday routines. Doing so can establish healthy patterns that will last a lifetime.

Healthy, physically active kids also are more likely to be academically motivated, alert and successful. They will have stronger bones, better manage their weight and sleep better. It can be hard to motivate some kids to be active.

Three keys include:

1. Choosing age-appropriate activities is essential: If you don't, children may be become bored or frustrated.

2. Giving kids plenty of opportunity to be active: Kids need parents to make activity easy by providing equipment and taking them to playgrounds and other activity hot spots, including community pools, ice rinks, parks and playgrounds.

3. Keeping the focus on fun: Kids are far less likely to participate if they don't enjoy it.

When kids enjoy an activity, they want to do more of it. Practicing a skill - whether it's swimming or riding a tricycle improves their abilities and helps them feel accomplished, especially when the effort is noticed and praised. These good feelings often make kids want to continue the activity and even try others.

The best way for kids to be active is by incorporating physical activity into their daily routine. Toddlers to teens need at least 60 minutes daily. This can include free play at home, active time at school and participation in classes or organized sports.

It's helpful to think of being active in categories. Here are my recommendations.

Preschoolers: Preschoolers need play and exercise that helps them continue to develop important motor skills - kicking or throwing a ball, playing tag or follow the leader, hopping on one foot, riding a bike, freeze dancing or running obstacle courses.

Although some sports leagues may be open to kids as young as four, organized and team sports are not recommended until they're a little older. Preschoolers can't understand complex rules and often lack the attention span, skills and coordination needed to play sports. Instead of learning to play a sport, they should work on fundamental skills.

School-age: With school-age kids spending more time watching television and playing computer games, the challenge for parents is to help them find physical activities they enjoy and feel successful doing. These can range from traditional sports like baseball and basketball to Scouting, biking and hiking.

As kids learn basic skills and simple rules in the early school-age years, there might only be a few athletic standouts. As kids get older, differences in ability and personality become more apparent. Commitment and interest level often go along with ability, which is why it is important to find activities that children feel successful participating in and will do on a consistent basis. Schedules start getting busy during these years, but don't forget to set aside some time for free play.

Teenagers: Teens have many choices when it comes to being active - from school sports to after-school interests, such as yoga or skateboarding. It's important to remember that physical activity must be planned and often has to be sandwiched between various responsibilities and commitments.

Do what you can to make it easy for your teen to exercise by providing transportation and the necessary gear or equipment. In some cases, the right clothes and shoes might help a shy teen feel comfortable biking or going to the gym.

In addition to a child's age, it's important to consider his or her fitness personality. Personality traits, genetics and athletic ability combine to influence kids' attitudes toward participation in sports and other physical activities, particularly as they get older.

Your positive attitude as a parent can go a long way. It will often help a child who is reluctant to exercise or be active. It's helpful if you are active yourself and support your kids' interests.

- Kyle Morrison

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Friday, May 28, 2010
Swimming Lessons Approved for Infants and Toddlers
by William Stratbucker, MD at 08:51 AM

Dan McGee, MD, a pediatrician and hospital medicine specialist is our guest blogger this week.

  

As the parent of two former competitive swimmers, I am a big advocate for swimming. I couldn't be happier with the recently revised American Academy of Pediatrics guidelines on swimming for infants and toddlers.

 

New evidence suggests children ages 1 to 4 may be less likely to drown if they have had formal swimming instruction. The academy is now recommending parents enroll their children in swim lessons based on individual readiness, including the child's frequency of exposure to water, emotional development, physical abilities, and certain health concerns related to pool water infections and pool chemicals versus sheer age alone.

 

Regardless of age, I support the following American Academy of Pediatrics guidelines and encourage you and your family to observe the guidelines as many of you look forward to a long holiday weekend.

 

  • Never - even for a moment - leave small children alone or in the care of another young child while in bathtubs, pools, spas or wading pools, or near irrigation ditches or standing water. Bath seats cannot substitute for adult supervision. Empty water from buckets and other containers immediately after use.
  • Closely supervise children in and around water. With infants, toddlers and weak swimmers, an adult should be within an arm's length. With older children and better swimmers, an adult should be focused on the child and not distracted by other activities.
  • If children are in out-of-home child care, ask about exposure to water and the ratio of adults to children.
  • If you have a pool, install a four-sided fence that is at least four feet high to limit access to the pool. The fence should be hard to climb and have a self-latching, self-closing gate. Families may consider pool alarms and rigid pool covers as additional layers of protection, but neither can take the place of a fence.
  • Children need to learn to swim. Classes may reduce the risk of drowning in younger children as well, but, because children develop at different rates, not all children will be ready to swim at the same age.
  • Parents, caregivers and pool owners should learn CPR.
  • Do not use air-filled swimming aids, such as inflatable arm bands, in place of life jackets. They can deflate and are not designed to keep swimmers safe.
  • All children should wear a life jacket when riding in a boat. Small children and nonswimmers should also wear one at water's edge, such as on a river bank or pier.
  • Parents should know the depth of the water and any underwater hazards before allowing children to jump in. The first time you enter the water, jump feet first; don't dive.
  • When choosing an open body of water for children to swim in, select a site with lifeguards. Swimmers should know what to do in case of rip currents

- Dr. McGee

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Wednesday, May 19, 2010
Kids, Sports and Asthma Do Mix
by William Stratbucker, MD at 03:01 PM

I'm excited to include a new feature of Double Duty: guest bloggers. I hope you'll enjoy reading and engaging in conversation with other Helen DeVos Children's Hospital physicians. My colleague John Schuen, MD, specializes in treating children with chronic lung conditions with such as asthma.

As a pediatrician and specialist in children's lung issues, I'm often asked if kids with asthma can participate in sports and go to summer camp. The answer is yes! Being active and playing sports does more than help a child with asthma stay fit, maintain a healthy weight and have fun - it can actually strengthen a child's breathing muscles and help the lungs work better.

For these reasons, your child's doctor may recommend exercise as part of the asthma treatment plan. If you have your doubts about whether sports and asthma mix, consider all the professional and Olympic athletes who have asthma. Nearly 17 percent of U.S. Olympic athletes had asthma and 30 percent of them won medals in the 1996 Olympics.

There are two important things to remember when preparing your asthmatic child for a sports or camping experience.

1. Your child's asthma must be under control in order for them to participate

2. When your child's asthma is well controlled, he or she can - and should - be active just like anyone else.

If your child has asthma and wants to experience a traditional summer camp but you're not comfortable sending them away, consider Helen DeVos Children's Hospital Asthma Camp. Our camp is designed for children ages 8 to 13 years old. Children participate in traditional camp activities such as canoeing, crafts, archery, swimming, hiking, an overnight campout and an honor's campfire at Camp Tall Turf in Hesperia, Michigan. They are supervised by pediatric physicians and nurse practitioners in the case of an asthma flare up. It's a safe environment for kids with asthma to experience the joy of summer camp while being medically supervised. Visit the asthma camp page to learn more.

- Dr. Schuen

 

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Tuesday, April 13, 2010
Tackling Childhood Obesity One Step at a Time
by William Stratbucker, MD at 08:37 AM

When our first patient walks through the doors of the Helen DeVos Children's Hospital Healthy Weight Center, it will symbolize the beginning of a new era of pediatric care in Michigan. The patient will be obese, possibly sick from carrying too much weight around for anywhere from 5-17 year, but will have made one of the best decisions of their young life. The patient, along with the parent or guardian, will have decided that the time is now to change unhealthy lifestyle choices. The time is now to step up and get help from the Helen DeVos Children's Hospital Healthy Weight Center. The decision for the patient may come with a significant amount of fear but also a huge amount of hope.

 

The poor choices made in the past may have been eating too much, too often, at the wrong times and of the wrong foods. Or perhaps the patient will have been far too inactive, either without the motivation to run and play, no safe place to be active, exposure to too many distractions like television, gaming, phone or computer screens or maybe not in the state of mental health that allowed for enough movement that burns sufficient calories. Future posts here on the Double Duty blog will address specifics about how you can keep your family healthy and active.

 

The critics have and will say again "Just eat less! You don't need a center for that." Well, for what is probably the most common example of "it's easier said than done," this problem we have of childhood obesity is far more complicated than that. Our society, and growingly societies around the world, is set up to fail many children and lead them to becoming obese at a very young age. The accessibility and acceptability of food that promotes the consumption of far too many calories and parents who are in a situation of needing to provide for their kids but not necessarily aware or able to control their children's consumption of these foods are some of the issues. A lack of safe places to run around, a perceived lack of time in the day, competing activities at home or in school that de-prioritize healthy play time and activity in place of sitting and looking at a screen and not allowing sufficient physical education in place of classroom education in school are others. There are real concerns about the poor quality and unhealthy content of foods that are routinely marketed or made available to kids and which parents and schools buy for children to eat or drink without possibly knowing the consequences.

 

The staff members at the Helen DeVos Children's Hospital Healthy Weight Center plan to help turn the lives of these patients and families around. We will work as a cohesive team providing assessments for diseases that come with obesity like diabetes and fatty liver. We will assess food diaries and calorie expenditure. We will check for hurdles that slow the ability to change but don't prohibit it like lack of transportation or treatable depression. We will maintain an active and educational Web site,  where families, schools and medical offices can find the information they need and to connect with resources and events throughout our community.

 

For patients who enter our doors it will be unlike any other doctor's office visit. It will be much more. It will look a lot like what the future of health care holds for all patients as our team provides coordinated, multidisciplinary care. Our secretary will have already "met" them over the phone and our social worker will have already worked through many barriers to making it to our center. The time spent with the doctor will be de-emphasized and visits with our dietician and exercise physiologist will be just as important. These team members will individualize a prescription for leading a healthier life at a healthier weight for each child and family.

 

The patient who comes today will join a team of medical professionals whose members all have the same goal: finding ways for that patient to lead a healthy life with a healthier weight. Staff members at the Healthy Weight Center have loftier goals. Our hope is that:

 

  • What we do will catch on with what other pediatric clinicians and medical office staff do in our area of the country
  • One person or many people who work in medical offices, schools, daycares or restaurants in our region will step up and make changes
  • When a child comes to the doctor their weight is assessed - every time - and a discussion is held with the family - every time - about healthy choices they can and should be making
  • Schools will build more curricula about healthy eating and activity, and that they will allow kids to play and learn ways to be active when they are not at school
  • Restaurants will offer healthier food choices for kids making it easy for parents to pick healthy food by serving kids' meals with a fruit and vegetable - every time - just like what is suggested to happen at home
  • Cities will decide that we can find a way to build bike paths on streets or add support to making parks even more enjoyable
  • Parents will start buying healthier foods such as calorie-free drinks and cook more at home, have family meal time more often, limit screen time, provide  a chance for kids to play hard and sleep well at night and not be alarmed when their child's medical office or school wants to bring up the subject of healthy weight

There are many strategies and recommendations for advice to give families about making choices that will lead their children, and themselves, to live with a healthy weight and one without the many risk factors that promote diseases that can happen at such young ages and require expensive and time-consuming medical care. Our hope is that these messages get out to those who need them. We don't, however, have all of the answers which is why we plan a robust research program in collaboration with experts from Michigan State University to study the causes of obesity and the strategies employed to lead families to make changes.

 

We hope today is the start of a reversal of the epidemic of childhood obesity in our area of the world. We know we will not do this alone and can't do this without committed patients and families. We can't do this without a committed community of schools, restaurants, policy makers and philanthropists. Our team is committed. Helen DeVos Children's Hospital is committed. In fact, Spectrum Health's annual gala will support our center this year. We hope things will be different in our region and that the efforts of our communities will make a difference for the children who live here. The patient who walks through our door today has taken the first step.

 

What steps are you taking or will you take within your family, school, workplace or community? What steps do you think others in our community can and should take? Please share your thoughts.

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Tuesday, March 30, 2010
The Decision to Vaccinate
by William Stratbucker, MD at 09:06 AM

The long overdue retraction by the British Medical Journal Lancet of a 1989 study linking injection of the MMR vaccine to autism should reassure parents that this important vaccine is safe and will protect their children from life threatening disease.

 

Not only is the original study that tried to show an association between the vaccine and gastrointestinal symptoms completely discredited, but the subsequent studies which investigated the safety of MMR have all shown the vaccine to be safe.

 

Now, parents who have to decide whether to vaccinate their child against measles, mumps and rubella can feel good that the combination shot saves the child pain (one shot versus three), saves time (one visit instead of three), and is safe.

 

Much damage to the perception of vaccine safety was done by Dr. Wakefield and his unethical "study." In recent years the folks who wanted to believe in this theory have inappropriately extended their concern to preservatives like thimerosol and now to the H1N1 vaccine. As a result, a percentage of our population is either partially vaccinated or totally unvaccinated.

 

When you decide not to vaccinate your child, you put your child at risk of getting that illness and you also put all children exposed to your child at higher risk of getting that illness.

 

Let me explain. If a child is not vaccinated for a particular illness, they obviously are at an increased risk as there is no way their immune system has any way of fighting off the virus or bacteria. When a child receives a vaccine, there is a small chance that their immune system will not make a response, leaving this child susceptible to the offending organism should it ever come around. This non-responding child is at a higher risk of coming across the organism when around unvaccinated children. The more unvaccinated children, the higher the risk for the child whose parents tried to make her immune.

 

As a parent of two kindergartners, a part of me wants to know if their classmates are fully vaccinated. I don't know if they are vaccine responders or not. Doctors don't typically check to make sure. I don't want my fully vaccinated kids or other kids to be at a higher risk of coming across a vaccine-preventable illness. Perhaps, if there were unvaccinated kids in their classroom, I would insist that I know my children's immune status. And, perhaps, if it showed that they did not respond to a vaccine, then we could try again to see if they would respond.

 

I endorse the recommended vaccine schedule that is published each year by the American Academy of Pediatrics and Centers for Disease Control. Yet, I see and hear many things in the media and popular press that annoy me as they are comments that are not fully grounded in up-to-date medical science or even common sense.

 

As a pediatrician I've received too many digital alerts from the American Academy of Pediatrics. You see, these alerts are about deaths. The AAP is now routinely sending out urgent emails to us when they are informed of more deaths of children in the U.S. from vaccine-preventable illnesses.

 

We are all trying to do what is best for kids. I have both a medical education which has taught me to stay current in scientific study and I have, at least, a sufficient amount of common sense (although my wife might argue this one sometimes). Here is what I know for sure:

 

  1. Children should not die in the U.S. (or anywhere for that matter) from vaccine-preventable diseases.
  2. Causes for many medical conditions, including autism, are not yet discovered.
  3. Vaccines that are currently recommended for all children in the U.S. have been tested to a degree that makes me comfortable with their safety.
  4. The benefits of vaccinating children and adults against disease far outweigh the known side effects.

 

When deciding whether to fully vaccinate your child, you are deciding whether to put other children at higher risk of injury or death. Hemophilus Influenza Type B (HIB), is the bacteria that causes meningitis or brain infection. HIB kills unvaccinated children, partially vaccinated children and those who are vaccinated but happen to not have responded to the vaccine.

 

I want to stop getting e-alerted that children are dying in the U.S. from HIB. I want to stop hearing outdated, factually inaccurate medical advice in the media, on websites and in the popular press. I want our limited resources to be going toward just some of the much more urgent needs in our society. One urgent need is to have available the appropriate developmental resources for those children who have autism or another form of developmental delay. I feel the pendulum of vaccine fear swinging back toward the reality of the need to protect our children from many illnesses that we truly should fear. Doctors and medical scientists have the best interest of children at heart. Those who are opposed to recommended vaccination have been quite vocal and it is time for those who choose to vaccinate to be heard. I want our families to trust medical science. I want all children to have a medical home where they can be taken to a doctor. I want all children to be fully vaccinated.

 

I want to hear from you on this important public health issue.

 

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Monday, March 01, 2010
12 Tips for Parents
by William Stratbucker, MD at 01:26 PM


My colleague Pat Crum, parent educator with the Helen DeVos Children's Hospital Center for Child Protection, pointed out March is parenting awareness month. There are many worthy recognition months but parenting awareness is particularly important to me as the father of twins and a pediatrician.

Parenting is a full time job. I would actually argue it's one of the hardest jobs in the world. Here are Pat's 12 tips to help us be the best parents possible.

1. Take care of yourself. It is easier to meet your child's needs if you take care of your own. Over-commitment and fatigue are two of the greatest distractions from positive parenting. Take time to relax and enjoy the company of your children.

2. Speak calmly and firmly to your children when they misbehave. Tell them what they have done and what would have been a better choice. Respond to disruptive behavior immediately, consistently and decisively.

3. Realize it is okay for your child to say "no". Parents feel challenged when children say "no" or question authority. Disagreeing respectfully is a skill that must be learned and one parents can teach. Keep in mind that you want them to have the skill to say "no" to peer pressure and inappropriate situations.

4. Allow your child to practice being powerful in useful and appropriate ways. Show them a positive way to make a contribution. Let them know their actions count. Most parents want to raise a child who will be a self-reliant adult, who can make good decisions and who has the confidence to be whatever he or she chooses.

5. Give your children a voice in family rule making and the consequences for breaking rules. Fewer rules are better and should be clearly understood before a problem arises.

6. Focus your attention on what children are doing right, and you will see more of that. What you pay attention to is what you get more of. Children feel safest when the limits are firm and consistently enforced. Otherwise they may constantly push and test the limits. Children of all ages have a strong need for attention and will repeat behaviors that get a strong reaction, whether positive or negative.

7. Be patient. Being rushed is not compatible with a child's natural rhythm. The dawdling, which is sometimes seen by parents as a challenge to their authority, is normal for children. Time runs much slower for kids than the hectic pace of working adults.

8. To manage the behavior of young children, use distraction and lots of supervision. Discipline calmly. Don't assign consequences when you're angry.

9. Young children are developmentally programmed to explore. Tell them what they can do instead of punishing for what they can't do. For optimum learning, create an environment that is safe for exploration. Give them plenty of interesting things to do.

10. Put problems on your family meeting agenda and let kids brainstorm a solution. Kids are more likely to cooperate when they are involved in the solution.

11. A sense of humor is a valuable tool in working with children. A silly or playful attitude will often ease a tense situation, end a power struggle and invite children's cooperation. Laughing together is a great way to strengthen family bonds.

12. Respect others and children will respect you. We model respect through our daily interactions with others. Our children learn respect from what they observe and receive from us.

What is your best piece of parenting advice?

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Thursday, January 28, 2010
Helping Haiti
by William Stratbucker, MD at 12:22 PM

On the date of my last blog post, Jan. 12, 2010, the nation of Haiti experienced a horrific natural disaster that we have all heard about and witnessed through extensive media coverage. This earthquake has ended the life of many Haitians and changed life forever for those who survived. The coverage of the story in the media has been intense and graphic at times and difficult for adults to comprehend, let alone our children who are hearing of this news at home, at school and elsewhere. We've heard stories of despair and miracles. Many rescue workers, relief specialists and medical personnel from our area of the world have responded to help the Haitians start to heal.

For those of us here and geographically, if not emotionally, distant, we've been allowed to sympathize with these neighbors. Many have asked how they can help and several options have become available.

But, how does a small child here, who is exposed to either images on television, in the newspaper or through inevitable discussion of this tragedy make sense of this information? When is a child old enough or mature enough to comprehend that there are bad things in the world that happen to good people? Many children in our country are not a stranger to family tragedy and sometimes at very young ages.

Our two five-year-olds were immediately curious as the images of suffering children were shown on television and in the newspaper. We did not allow them full access to the news reports. My wife and I talked about what an earthquake is and what they can and did do to the country of Haiti. We reassured them that earthquakes are not likely to cause such damage to our own home because of where in the world we live but that we have to be aware of other natural dangers. It was important to us not to avoid the topic of this tragedy with our children, but to find a way to teach respect for others and instill a responsibility for the care of those in need.

For the past year, our children have been given small chores around the house and, if successfully completed, they earn a few cents to a dollar to save for a meaningful purchase. Our daughter decided right away that she wanted to save for an American Girl Doll. It is more difficult for my son to plan ahead so he went along with his sister and he too decided an American Girl Doll would be fine to earn. Over the last week or so, we helped our children decide on a few extra things they could do to help around the house so they could earn some extra money to be able to donate to the Haitian relief effort.

Others who have small children or work with or teach children have had to confront the awkwardness of questions and fears about the earthquake in the past several days. Some have chosen to teach about Haiti and the wonderful people and culture. Others have helped organize collections of needed supplies and other donations.

This is an important time not to avoid discussion of this tragic event with your children, but to teach the values of responding to our neighbor's need in any way you feel you can.

How have you talked about the situation in Haiti within your family? How have you responded? Money is tight and not everyone is able to donate. What other ways have you thought of contributing to the long-term healing of Haiti?

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Tuesday, January 12, 2010
Reading Resolution
by William Stratbucker, MD at 09:46 AM

Many of you set new years' resolutions and some may have already broken them. One common act that many vow to do more of each year is reading. Children this time of year are recovering from the holiday break and need to dig in to their school studies.

Countless research studies have supported the benefits of reading in childhood and confirmed it as a healthy activity. Infants and young children benefit from being read to by adults. My childrens' school employs third graders to read to the kindergarten students. Both clearly benefit from this exercise.

As you and your children look to what can make 2010 a good year, think about reading. I, for one, am happy you've chosen to read this blog and hope that you can gather helpful information and access to new resources.

Finding the time to read more is sometimes hard. Children need to complete homework and other potentially less healthy activities compete for their time.

Developing a nighttime routine is healthy for families with young children and it should include reading. Many pediatricians suggest the four Bs: bath, brush, book and bed.

When my children were three and we'd get to the book part, they would negotiate for more and more books each night. And, now, if I skip even one sentence on page five of Alice in Wonderland, my daughter catches me and makes me go back and re-read it.

Looking for ways to encouraging reading in your home? This article will help you create a reader friendly home. This article provides insight to help coach a reluctant reader to enjoy the practice of reading.

 I'd like to generate some discussion on this topic. If you have a special way to get your children reading, let us all know. How have you included reading in your family's routines? What is your child's favorite book? Post your responses here or on our Facebook page and we'll learn from all of you. Happy reading!

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