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Daily Dose

Pokemon GO

1:30 to read

My office is suddenly a bit more “interesting” after a 13 year old boy who was bored while waiting in an exam room took out his phone and started playing Pokemon Go!!  Who knew that there was a Pokemon in my office…or was there?  

If you have children between the ages of 8 -15 I bet someone in your house is playing Pokemon Go - and it is not just kids, many adults are also engrossed in the new game as well. I can remember my sons playing with Pokemon cards years ago, and I don’t think I understood the game then, but it was certainly entertaining for them and they spent hours trading cards with their friends…wonder where those cards went…maybe they are a valuable antique now?

At any rate, as I am trying to understand the game I am also seeing a lot of news coverage about the Pokemon Go rage that is sweeping the country.  There have been several interesting news stories about accidents that have happened while people are so busy looking for the Pokemon on their phones and not paying attention to their surroundings…they have fallen into water, run into walls and almost been hit by cars, fortunately no one has been seriously injured.

One mother of 2 boys who are engrossed in the game told me that her boys sit in the backseat of the car “screaming at her to slow down”!  She said she was not going fast and could not figure out what all of the commotion was about until they continued to ask her to slow down to a crawl….in order that they might see if they were passing any Pokespots??  Unfortunately, she informed them that she needed to go with the flow of traffic and they were out of luck for the moment. Who knew your “tweenage” children would ask you to drive slowly!

As I have been reading a bit more about Pokemon Go I am learning about “augmented reality” and how “an artificial digital world can be mapped onto the real physical world”. It seems that this is not new technology, but with the advent of Pokemon Go being available for free on every cell phone around the country,  it will not be long before we see this phenomena in other aspects of our lives. 

The game and the technology displays a Pokemon floating on your phone’s screen and it appears as if it is in the real world in front of you. (brings back the ad, “is this real or is this memorex?”).  I must say, I really don’t understand it and it is a bit scary how the digital and physical world seem to overlap.

In the meantime, I have found a new game to discuss with my patients, and my office has a new mascot….I just don’t understand how he got into the exam room and if he is watching me all of the time?  

Daily Dose

College Drug Overdose

1:30 to read

Colleges are gearing up for a new school year and already there has just been a death reported at a fraternity house at Texas A&M University.  This news hit close to home as the adolescent who died was from a Dallas suburb and several of my patients attend Texas A&M and were even in the same fraternity.  

The misuse of opioid medications is a national epidemic and the drug scene on college campuses seems to be increasing. The misuse of opioid medications includes drugs which have been obtained both legally (by prescription for pain management) and illegally. Many of the college students that I take care of have recently told me that these drugs which include oxycodone, hydrocodone, codeine, morphine and fentanyl are relatively easy to obtain in dorms, frat houses, classrooms, and on line via social media sites.  All of these opioids are chemically related and interact with opioid receptors in the brain to produce pleasurable effects and relieve pain. Some students reported that friends often offered to “share” their unused pain relievers and would even offer them for free! Unfortunately, unintentional drug overdoses due to opioids also continues to rise and has more than quadrupled since 1999. Adolescents just don’t seem to realize the power of these drugs!

In the case of the recent death in our area, the teen was found unresponsive and not breathing in the early morning hours after a fraternity party. It was thought that he had combined alcohol (probably excessive) with an opioid. The toxicology reports are pending….but the police reported they found marijuana (which seems to be almost everywhere) and other drugs including not only opioids but also MDMA (Ecstasy), LSD and other drug paraphernalia. 

Just like alcohol poisoning following binge drinking, opioids also cause respiratory depression and loss of consciousness   The combination of the two may be even more deadly, which could occur even if this was the first time the teen had used opioids. There is an antidote to opioid overdose, Naloxone (Narcan) which may be injected (or given intranasally) to counter the effects of an opioid drug overdose.  It is now available over the counter and my be life saving if given soon enough, by helping to reverse the respiratory depression and allow the person to be transported to a hospital for life saving care.

If you are just sending your child off to college or back to college PLEASE talk to them about alcohol and drugs and reiterate that the combination may be even be more deadly!!  Even one time use could be the last time….so tragic.

 

 

 

 

 

Daily Dose

Tummy Aches

1:30 to read

I am getting a lot of phone calls and texts with concerns about  tummy aches. I have even started seeing patients in the office with complaints of “my tummy hurts”, and we are just in the first week of school. I know that school nurses are dealing with this common complaint as well.   Amazingly, I don’t see very many complaints of tummy aches during the “lazy days of summer”…but once school starts they seem to become more prevalent.

Don’t get me wrong…while the tummy aches are real and painful, they are usually not due to anything serious.  In many cases I see,  the abdominal discomfort may be due to a bit of anxiety and stress that often comes as children get back into the classroom.  While the child may not be aware of “stress”,  their body does sense it and the gut responds with abdominal pain. 

The children that I am already seeing are all healthy and growing well. They do not appear to be “ill” when I see them, but will complain that their tummy hurts. When I have them point to where the pain is, they typically point right around their belly button (periumbilical).  If asked to point to the one place where it “hurts the most”  they typically still cannot localize it…it’s just all over! Having generalized pain is typically a good sign, rather than having point tenderness in one area.  Upon further questioning they do not have a fever, have not had vomiting or diarrhea, DO NOT wake up in the middle of the night with abdominal pain and often cannot remember if they “pooped“ today or yesterday but usually swear that their “poop” is “normal” . (I am not always sure about that - stool history in kids is quite hit and miss!) 

A few of the children say that eating makes their tummy ache worse while others report it feels better if they eat. They typically are not having issues with a specific food.  (It also depends what they are given to eat - often they will eat their favorite food if given the opportunity).  

For some of the children the pain is “bad enough” that they come home from school, but once home their parents report that after an hour or so they seem better.  Other children stay in school, but the minute a parent picks them up they start saying “my tummy hurt all day at school”!  

I remember that one of my sons often had tummy aches during the school year and we were talking about it the other night (he is now an adult).  He says he remembers being worried about school and “hiding” in the morning when it was time to go to school (I would be looking all over for him as his older brother was already out the door, and anxious that he would not get to school on time,  while I had the younger brother on my hip as I searched the house).   Talk about getting a stomach ache…mine was in knots by the time I would get to work.  It would only be several hours later when I would get the phone call from the school nurse that he was there with a tummy ache.  He now says that he remembers that by the time he was 8 years old it all just changed and it went away. 

Many times all it takes is a little reassurance that the tummy ache is not serious. I tell the children that everything on their exam is normal which is a good thing. Sometimes it seems to help a tummy ache if I prescribe the child some extra fiber and maybe a Tums  a good source of calcium too). Who knows if it is placebo effect… but just by doing something they feel a bit of relief. The one thing I do know…they need to keep going to school and it usually gets better once they are settled back into a school routine.  

 

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Daily Dose

Marketing Healthy Foods to Kids

1:15 to read

The marketing of foods to children continues to be a hot topic.  As any parent knows…by the time your child is 3, 4 or 5 years old…they can often point to the box of sugary cereal with their favorite cartoon character on it, or identify a sign (McDonalds, Chic-Fil-A, Pizza) although they are not yet reading.  Companies are very clever when it comes to marketing…especially to children who drive a lot of consumer choices.

But, a recent article in Pediatrics shows how marketing may also drive healthy food choices. The study entitled, “Marketing Vegetable in Elementary School Cafeterias to Increase Uptake”, looked at the number of students who chose fresh vegetables from the salad bar at 10 elementary school cafeterias in a large school district over a six-week period.

The study included four different groups. In the first group the schools displayed vinyl banners with branded cartoon vegetable characters. These banners were then wrapped around the salad bar bases. The characters displayed “super human” strength related to eating vegetables (the Popeye of my generation - with his spinach).  The second group of schools showed short television segments which had vegetable characters delivering healthy nutritional advice. In the third group of schools both the salad bar banners and TV segments were used to promote healthy nutrition and food choices.  The fourth group was the control group and received no intervention.  The intervention schools also had decals with the vegetable characters placed on the floor which directed the children to the salad bars.

The results?  Nearly twice as many students ate vegetables from the salad bar when they were exposed to the banners.  More than 3 times as many students who were exposed to both banners and TV segments went to the salad bar (more girls than boys ). Interestingly, the marketing campaign also increased the number of students who chose a vegetable serving in the regular lunch line as well. 

So, it seems that branded marketing strategies may be used in a positive way to promote healthier food choices among young children.  Now we just have to get the advertisers to change some of their branded messaging aimed at young children from the “junk” to the healthy foods, as we have data to show that kids will choose good foods…especially if their super heroes like it too!

Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

Daily Dose

Timeout!

1.30 to read

When I am seeing toddlers for their check ups, the topic of behavior is usually at the top of both the parent’s and my list for discussion.  Once a child is walking and beginning to talk, all sorts of new behaviors seem to occur! 

Parents ask, “how do I stop my child from hitting or biting?”  “What about misbehaving and not listening?”  The toddler years are challenging for behavior as a child is gaining independence, and testing as well.  Toddler and teens have some of the same attributes and it is important to begin behavior modification during the toddler years. 

Time out is the most commonly used behavior modification and not only will parents use this method at home, but preschool and day care teachers begin using this technique as well. This is the age that children begin to understand rules and consequences. 

So how do you “do” time out and when?  I usually start using time out when a child is between 15 -18 months of age. While I try to ignore and distract tantrums, I use time out for biting, hitting and those age appropriate yet inappropriate behaviors. 

I pick a chair in the house (we had a small set of table and chairs which seemed perfect) and every parent needs a kitchen timer to use for time out.   It is important to get at your child’s level when disciplining them as well. Tell them why they are going to time out and then have them sit in the chair for 1 minute per year of age.  (Trust me a minute sometimes feels like forever!)  

Here is the trick, if your child will not just sit in the chair (and many won’t), go behind them and hold them in the chair as if you were a human rope.  In most cases the child will be crying and trying to get up out of the chair, but you calmly hold them in the chair from behind. No eye contact!  Once the timer goes off, you let go of them, go back around so that you make eye contact again, get down to their level, and explain once again that they had to sit in the chair because they (fill in the blank).  

Time out takes time and patience.  If you are consistent about using time out for misbehaving, your child will learn to sit in the chair.  For some it may only take 1 time and others are more head-strong and it may take months of “human rope” before they decide to sit alone. 

Don’t give up!!!  This is a very important lesson for children to learn and you will use time out many times, not only in that little chair, but in other venues as your child gets older.    

Daily Dose

Parenting is Hard

1.30 to read

Did you read the online article about a mother selling her 4 tickets to the One Direction Concert on eBay? It seems that it may have been a hoax but the gist of the matter was this “fake” mother was selling tickets that she had purchased to take her daughter and friends to the concert. In the online post, the mother (using some very inappropriate language) said that she was selling her tickets to punish her daughter for her inappropriate behavior. 

I applaud parents who do set boundaries and limits which also means having consequences when children break the rules. In many circumstances taking away something often teaches children a lesson.  I disagree with posting it all over the internet. This is a discussion that can and should happen in the home, between parent and child (of any age), rather than sharing the issue and humiliating their child. 

I often relate a similar story with my own children when talking about consequences with parents. When my boys were about 7, 5 and 2 we had tickets to breakfast with Santa and a parade after that. The older boys had been before and really looked forward to this annual event.  They were at the age that they constantly bickered and fought (often) and it just wore me out. 

The day before the event I told them that if they did not stop fighting they would not go to breakfast with Santa.  Well, it must not have been an hour later that the older two were fighting and I said, “that’s it, you are not going to see Santa or the parade!”  I picked up the phone and called a friend who had two children and asked if she wanted to join us the following day to see Santa.  The following day the 2 year old and I left the house and the 7 and 5 year old starred out the window crying as I backed out of the driveway.  I will never forget those sad faces. I was equally sad as I too loved taking the kids to this annual, but they had just pushed and pushed. They still say they remember that punishment and my friend still has the picture of her kids on Santa’s lap! 

The moral of this is really two fold. A parent’s job is to be a parent and at times it is hard, really hard. But teaching children about consequences for their choices and behavior is one of the most important jobs a parent has. With that being said, humiliating your child is never appropriate, even when you are pushed to the limits.  Being a parent means you can’t resort to acting like your child.

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit clue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

That's your daily dose for today. We'll chat again tomorrow.

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