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

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

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

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

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

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

This past Thanksgiving I spent a day at one of my favorite havens- Boy Scout Camp.  No TV, plenty of outdoor activity for the boys, and limited junk food.  However, this past visit had its disappointments- many of the kids I taught were already obese.  There were kids surfing their iPhones around the campfire.  The Trading Post did brisk business in candy bars and soda. 

I usually don’t mind the Trading Post or iPhones.  However, most of those kids already have a steady diet of soda, junk food, and electronic entertainment every day of the year.  Goodies that were once a special treat away from home have become the norm at home. 

This over-consuming of junk food and entertainment leads to other medical problems besides being merely fat and idle.  These kids feel bad about themselves.  They do worse in school.  They fill doctors’ offices and emergency departments with complaints of stomach pain and constipation.  They will grow up to have early heart attacks, depression, diabetes, strokes, gall bladder attacks, cancers, knee and foot pain. 

Obesity is not entirely our fault.  Humans and other animals were biologically programmed eons ago to eat, store fat, and rest when food was plentiful, as a hedge for when food was scarce.  Now, in our modern society, times are always good when it comes to finding calories.  And biology had no need in the bad old days to provide us with an off switch for eating and resting.

Our biological bent to obesity is now also aided and abetted by the food industry.  In the 1950s the industry had a dilemma: how do you convince an already well-fed people to eat more, in order to accelerate profits?  They invented “food science,” where chemists manufacture additives to make food more delicious and more delicious-looking.  They invented advertising based on psychology to sell us that food and get us hooked, like addicts and their first taste of heroin. 

And it worked.  Who doesn’t love junk food, myself included?  Even in France, where they are famously fussy about their good food, McDonald’s does its biggest business outside of the US.  So how can we save our children from what we have wrought on them?  And what about our planet, which is groaning with the burden of  supporting our junk food habit?  And what of the unfairness, the sin, where billions in the world still go to bed hungry?

The answer is that our brains must take charge over our biology.  The hard work starts at home- don’t buy junk food and soda!  Don’t bring it into the house!  Make sure your kid gets a fruit with every meal.  Give them a vegetable with lunch and dinner- if only a handful of carrot sticks (my favorite go-to vegetable).  All grains should be high fiber- whether it is wheat bread or high fiber breakfast cereal.  Dinner should be eaten with all the family members together, talking about their days and their lives, practicing conversation, stimulating each others’ brains,  rather than watching TV. 

More hard work- be firm with your kids about the TV.  It should not be turned on at all on school days.  Computers should only be used for school work on school days- not for surfing, watching videos, or playing electronic games.  Kids should never have a TV,  computer, or game system in their bedroom.

If your kids are bored and whining and start to fight, stay strong!  That boredom is incentive for them to go out and start exploring and making their own fun, which is how kids grow good brains and strong bodies.  That is when they learn to love books, friendships, board and card games, sports, and outdoors.  Soon the no-TV/computer rule becomes easier to enforce.

Play is the work of childhood.  It is now harder and harder to protect your childrens’ play from the onslaught of advertising, junk food, and electronics.  But this is part of the hard work of parenting, so your kids can be kids again.

We can tell by the paramedic’s voice on the radio if a child is truly sick.  This time his voice has that urgency that says “be ready.”

Moments later they come trundling in, oxygen cylinders hissing, monitors beeping, and the little baby in the big stretcher struggling to breathe, chest heaving.  Into the trauma room, baby is lifted onto the ED bed, trailing monitor wires.  Nurses and techs move in, changing oxygen tubes, starting IVs, hooking up monitors, putting on stethoscopes. 

After a brief talk with the parents and a quick exam of the baby, I see that the baby has Bronchiolitis.  The breathing treatments we give have little effect- baby still struggles to breathe.  Baby is admitted to the Pediatric Intensive Care Unit for IV fluids, oxygen, and monitoring.  She will get better eventually, but it will take time and care.

Bronchiolitis is a common winter ailment for infants and toddlers.  Many people recognize this ailment when it is called RSV, but the RSV virus is only one of the many viruses that can cause it.  Bronchiolitis starts as a cold, with runny nose and cough.  In some little kids it progresses to fever, wheezing (a whistling sound from low in the lungs), and trouble breathing.

Bronchiolitis is one of those frustrating illnesses where modern medicine offers little to stop its progression or ease its distress.  Plenty of fluids help, maybe a vaporizer at the bedside, and Tylenol for fever and comfort.  Sometimes nebulizer treatments help, but like in our case above often they don’t.

The good news is that most babies with Bronchiolitis just have a bad cold.  The treatment for that is described in the “Colds in Babies” category, which you can access from the Categories column on the right side of this page.  A few babies wheeze like an asthmatic and need more attention.  Very few babies need to be in the PICU and it is rare for one to die.

So if your baby has a cough and runny nose but is breathing and drinking comfortably, all is well.  Start the vaporizer and Tylenol, maybe have your baby sleep sitting up in a car seat or swing  (no propping on pillows!).  If you think baby is wheezing or tugging for breath, or is having trouble sucking a bottle for its work of breathing, come right in and see us.

When I was in medical school, one of my professors told a story of when he was snowed in in a cabin in the woods, and one of his kids got a cough and runny nose.  He had no cold medicine with him, so he mixed his own like they did in the cowboy days- whisky, honey, and lemon.  “And by God,” he told us, “it worked!”

The science of treating coughs and colds has not come very far since those days.  There is still no medicine that science has shown helps much for coughs and runny noses from cold viruses.  When the drug companies come out with a “new” cold medicine, like they did most recently with Mucinex, it is just the same ineffective ingredients in a new package. 

Now, some people swear by their favorite cough medicine.  “Works every time!” they crow about their Robitussin or Dimetapp.  However, what is working is the Placebo effect, a psychological trick where if you believe in the medicine, it seems to work.  When you test the medicine in a blinded study, where you can’t tell the medicine from a dummy fluid, patients report no difference between the medicine and the dummy.  In 2007 scientists tested honey against dextromethorphan (the “best” of the cold remedy ingredients).  Guess who won- honey! 

Most prescription cough and cold medicines are no better.  Most of these are anti-allergy medicines, and if your cold is from a virus instead of an allergy, good luck.  The only prescription that has been shown to really help for coughs is codeine, and that really only for dry, hacky coughs.  And you can’t give codeine to a kid under 3 years-old.

So next time your child gets a cold, try the things I talk about in the “Cold in Babies” category.  Don’t ever smoke in the house.  And feel free to try your favorite grandma remedy- chicken soup, honey, lemon.  Just please leave out the whisky!

There is a lot of press and a lot of worry out there about the current flu.  When there is a lot of worry, people clog the area emergency departments, often with kids who do not need to be there.  Crowded ER waiting rooms also are great places to catch the flu.  Here is some information to help you not to panic, and to avoid the hassle and risk of an unnecessary ER visit.

First, the current flu virus is the “swine flu,” which the experts are calling “novel H1N1 influenza.”  The influenza virus gives you a cough, runny nose, fever above 101, headache, sore throat, body aches, upset stomach, and sometimes red eyes.  It appears not to be any more serious than the regular influenza we see in the winter.  Of the very few children who have died from the current flu, two-thirds were already very sick from severe chronic diseases that often kept them bedridden.  Children under 5 years old and those with chronic diseases like asthma are those who have some increased risk if they get the virus.  Shots for the swine flu will not be available until at least November.

WHEN TO STAY HOME:  If your child has a runny nose and cough, but no fever, he likely does not have the flu.  Stay home.  If there is influenza in your school or apartment building, but no fever in your kid, stay home.  If your child has a fever but is drinking and breathing comfortably, stay home.  Some parents have reported to me that their kids have been sent home from school for simple colds and require a note to return.  However, the national Center for Disease Control (CDC) have given the schools guidelines with the following language:

    “Simple runny noses without fever is not influenza.”

    “Do not require a physician note to return to school.”

When in doubt, call your doctor.  They are there to help you decide if you need to be seen in the office or the ER.

WHEN TO SEE YOUR DOCTOR:  When your child has a fever over 101 for more than 3 days, or acts sick with fatigue, poor drinking, or complains of pain.

WHEN TO GO TO THE ER: When your child is short of breath, difficult to arouse, or has stopped drinking and has not made urine for 18 hours.

Every pediatrician has come to know The Look.  The parent’s face falls.  They are obviously disappointed, sometimes angry.  It happens when the parent came in expecting that the doctor will prescribe an antibiotic for their child’s illness, only to be told an antibiotic will not help.  There are only two times in my 17 year career that I have been yelled at and insulted to my face by a parent.  Were they at times of terrible stress and tragedy, a diagnosis of cancer or a death?  No, they were both when I diagnosed a viral illness in a smiling, obviously not very sick child and told the parent that an antibiotic was not necessary.

This October the national Center for Disease Control (CDC) is declaring a Get Smart About Antibiotics week.  From October 5 to 11 they will be having a media campaign to promote better public knowledge about when patients need antibiotics, and when they don’t.  October is a good time for this, given that child illnesses will be rising as kids swap germs at school, and the flu season starts (as if it already hasn’t!).  Many kids will get sick and their parents will be hoping for something to make them better.

Most of those illnesses will be caused by a virus, and antibiotics don’t kill viruses.  Viruses are those bugs that cause runny noses (even green runny noses), coughs, vomiting and diarrhea, most sore throats, and most fevers.  These illnesses get better on their own in 3 to 4 days.  Their treatment is to ease the symptoms with vaporizers, fluids, fever and pain medicine, and such.  For more information on these, see the Categories column on the right side of this page.

Antibiotics are for treating infections caused by bacteria.  These are the bugs that cause some ear infections, skin infections and boils, Strep throat, certain pneumonias, and bladder infections. 

So many parents wonder “why not just give an antibiotic, just in case?  What’s the harm?”  Many doctors hate to disappoint parents, give in to this argument, and prescribe unnecessary antibiotics when pressured by families.  Well, here is the harm:  antibiotics are not entirely safe drugs.  Patients can have allergic reactions to antibiotics, sometimes severe reactions.  Sometimes if a patient gets an antibiotic and then stays sick, the antibiotic can negate the ability of later tests to tell the diagnosis. 

The biggest reason not to give antibiotics is the risk of bacteria developing resistance to antibiotics.  This has been happening for decades and has given rise to bacteria resistant to multiple antibiotics.   Some patients get very sick with these super-resistant bugs like MRSA and VRE.  The newer antibiotics to attack those infections are so strong that the patient can get sick from the antibiotic too. 

Experts worry that the day may come when all bacteria develop resistance to all antibiotics.  This is why the CDC, the American Academy of Pediatrics, and other expert groups are anxious to get doctors to stop prescribing unnecessary antibiotics; and to get parents to stop pressuring their doctors for them.

Next time your doctor says your child has a virus, be patient.  Give it a few days of fever medicine, vaporizers and throat sprays, chicken soup and honey.  If your child is not better then, it is fair then to call your doctor about getting another look.

Feel free to comment about your experiences with viruses and antibiotic disappointments!

People used to have difficulty naming their fears about when their child hit their head.  Now their fear has a name- Natasha Richardson.  Everyone has heard a story like the famous actress’s.  A person hit their head, looked well at first, then did not wake up in the morning. 

Fortunately, this story of delayed death after head injury is rare in adults.  It is almost unheard of in kids.  When children hit their head the severity is obvious right away.  They come to the ED in two distinct presentations- still unconscious and obviously very sick; or they come in awake, alert, and essentially well.

When can you stay home with your head-injured child then, and avoid a costly and time-consuming ED visit?  Here are the good signs:  your child was not “knocked-out,” his fall was from a distance less than three times his own height, he has no vomiting, and he has no headache.  Some toddlers will get sleepy after crying their hearts out from their sore head.  That is OK- you can let your child sleep, as long as she has not vomited, has drank a little, and acted “with it” since the injury.  After an hour or two, if your child has not awakened, you should wake her up to be sure she walks and acts normally.

What about when baby falls off the bed or out of the car seat and hits her head?   Babies are a little different than older kids- they get skull fractures more easily.  A baby under a year old who hits her head should get checked out if she has any swelling on her scalp.  Of course, she also needs to be seen if she has any loss of consciousness, vomiting, or acts “out of it.”

What if your child was knocked out, is vomiting, or complains of a headache?  Certainly bring him in to get checked out, but don’t panic.  Most of those kids have a concussion but not a bad brain bruise or brain bleeding.  A concussion is when the patient get “his bells rung.”  He feels tired, sick to his stomach, has a headache.  After a normal CT scan, if he can drink without vomiting, he can go home.  The concussion might last for days. 

 The one really important precaution for concussions is that the patient must not take a risk of hitting their head again while they are sick.  The child must not do sports or other risky activity until cleared by their own doctor in a follow-up exam.

Have a head injury story of your own?  Feel free to tell us by clicking on the comments button and writing us.

School is starting and the media is going nuts (and rightly so)  about swine flu spreading in schools.  The CDC is predicting an another outbreak this fall.  This morning Tracy and I talked about the most important way to keep your kids from getting swine flu, or any other school illness- teach them to wash their hands!

For more info, click on the “Staying Well” Category on the lower right side of this page.  Please add your comments, or your stories of examples of bad hygiene.

In most of my blog entries, I discuss how to stay out of the Emergency Department.  However, getting a deep cut that needs stitches is one of those times that it is probably best to bring your kid to the ED.  Here are some good things to know.

What cuts need stitches?  These are cuts that are through the skin where you can see fat inside, cuts that are gaping open, cuts that will leave as wide a scar as the cut itself.  One old wives tale is that if you wait too long, the cut can not be stitched.  This is not true- if you are out fishing, get a cut, and can’t get in before four hours, you can still get stitches and minimize infection and scarring.

Do I need a plastic surgeon?  Many parents wonder about this since so many of kid’s cuts are on their faces.  Kids meet the world with their big and heavy heads, and parents worry that cuts on foreheads, eyebrows, lips, and chins will leave noticeable scars.  It is an old wives tale again that plastic surgeons do some magic with these cuts that ED doctors don’t.  For the vast majority of those cuts, the plastic surgeon would do nothing different than the ED doc- sew it up!  All cuts leave some scar, but most kid scars on faces fade after six months to a year and are barely noticeable.  If the scar ends up looking bad, then it is time to see the plastic surgeon for a “scar revision.”  But again, the plastic surgeon would do nothing different for the first closure.

Will it hurt?  If your ED is really with the times, they will numb the cut with an anesthetic gel- no shots needed!  It takes about three applications over 30-40 minutes.  The gel works great for faces, scalps,  and most limb cuts.  It can not be used for fingers and toes.  Then the cleaning and stitching are painless.   However, fidgety babies and toddlers will still need to hold still for their stitches and may need to be on the velcro “papoose” board.  Then there will often be plenty of screaming because no toddler likes to be trapped.  At least they won’t feel the stitches themselves!  Also, there are no reports of toddlers needing psychotherapy later in life because they were traumatized by the papoose experience.

How do I take care of the stitches?  After stitches are put in, keeping them clean and covered is important to lessen scarring.  Yet another old wives tale (that many doctors believe!) is that stitches should be left out in the open.  In fact, stitches heal faster and with smaller scars if they are cleaned gently once per day with plain soap and water, then covered with over-the-counter antibiotic ointment and a bandage.  No swimming, no long soaks, no peroxide.  Peroxide is best for a one-time, first cleaning of a cut, but after that too much peroxide poisons tissue and slows down healing.

Finally, few cuts with stitches need antibiotics.  If they are cleaned well and on a body place with good blood circulation (faces, scalps), infections are very rare.  The cuts that need antibiotics are those from animal bites, or dirty wounds on limbs.

If you have any questions about the stitching experience, or have a stitching story to share, please comment!

This morning Tracy Wirtz and I talked about drowning prevention.  Whenever I talk about drowning the worst cases I have seen come to mind, but also the silliest.  One day I was in the Emergency Room when the ambulance brought in a 13 year-old who came close to drowning in a local hotel pool.  He was awake and alert on arrival, but everyone was understandably shaken.  The hotel pool had a deep end but no life guard. 

The 13 year-old could not swim, the parents told us,  but enjoyed bobbing in the shallow end, going to the bottom and then pushing up out of the water.  Well, he bobbed and bobbed his way unwittingly to the deep end until he could no longer bob up high enough to reach the surface.   The boy described to us looking up at the surface, seeing his parents helplessly looking back down on him.  They could not swim either.

If it is not apparent by now that this was not a group of deep thinkers, here came the kicker: to try to rescue their boy, the parents told me that they shouted down to him “Get out of the pool!”  They could not make the connection that “not being able to swim” means “he can’t get himself out of the pool.”  Eventually a more capable adult jumped in and hauled the boy out.  

This story illustrates several drowning prevention points.  Water is inviting and fun.  If you do not know how to be safe, though, water is deadly when you get (literally) in over your head.    Being safe means knowing how to swim, swimming where there are lifeguards, and knowing what to do if there are kids by the water who do not know how to swim.

No toddler should be left alone by any water, including tubs and wading pools and shallow ponds.  Like our goofy parents above, toddlers can not tell what is safe and what isn’t.  Then it is easy for them to stumble, hit their head on hard tub sides or rocks, and go face down and unconscious into the water.  All home pools should be fenced on all four sides with unclimbable fences and toddler-proof latches (too high for them to reach).  Having the pool open to the back sliding door is an invitation for disaster. 

Toddlers thus need to be watched all the time near water.  It is impossible to watch a toddler always and everywhere, but near water you can not slip.  My last drowning death was a two-year old whose parents lost track of him at home and he was found face down in the backyard pond.  Near deeper water, toddlers should wear life jackets.

Older kids should have swimming lessons, always swim with a buddy, and swim in guarded pools or with alert, capable adults.  Throwable rescue floats , like life rings with rope, should be handy.  Ideally, adults should know CPR.  Drowning victims are only saved when their breathing is restored at water-side.  Bystander CPR is the key to survival- brains die of lack of oxygen before most ambulances have a chance to get to the scene.  The only time in my experience that an ambulance crew revived a drowned toddler was when the firehouse was across the street from the scene.  

Besides toddlers, the other group at high-risk for drowning is teenagers.  Their tragedies often begin with drinking, and then swimming, boating, or diving in unguarded lakes or rivers.  Since teenagers are such bad listeners, the time to warn them about this is when they are still young elementary school kids.  That is the time of life when kids absorb the lessons they need for later.

If any of you readers have any other tips or exciting stories of drowning survival, feel free to comment!