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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.  

 

Daily Dose

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Daily Dose

Healthier School Lunches

1.00 to read

With everyone back in school after a nice summer break, what better time to discuss school lunches, especially as they relate to healthy choices.  The USDA (Department of Agriculture) has just issued new national guidelines for school lunches which will begin this school year.  The new guidelines include calorie and sodium limits for foods served on the school lunch line and are age dependent.   

The new guidelines also include the recommendation for more whole grains, and dark green, orange or red vegetables (color on the plate). Students buying school lunches must choose at least one fruit or vegetable at every meal.  Portion sizes may also be smaller as well. 

These changes are all geared at helping students understand the importance of healthy eating and making good nutritious food choices.  It is hoped that as students get “used” to seeing and eating healthier school lunches, the choices that they make at home may become better as well.  

Students will also be able to choose from fat-free, low-fat and lactose-free milk and will be required to have 1 serving a day.  Flavored milk will be required to be fat free. 

Lastly, half of the grains served in a school lunch must be whole grain and by 2014 school year all grains must be whole grain rich. 

So, if you are planning on packing your child’s lunch this year, remember these guidelines as well. I think that a combo of packing healthy lunches on some days, while letting your child buy a school lunch on other days seems to be the perfect balance.  Let your children help pick out healthy food choices to put in their packed lunch and they might even pick up a few ideas from the new school lunches this year too. 

You can find the new guidelines at http://1.usa.gov/Qzd5Z7

 

 

Daily Dose

Update: Back-to-School Vaccines

Which vaccines do your kids need as they head back to school? Dr. Sue fills you in. With only a few days or weeks to go (for some) before school resumes, it's important to know August happens to be National Immunization Month.  For every age child that is getting ready for school there are, immunizations that are necessary and for any child who has missed or lapsed immunizations it is a good time to update and “catch-up”.

Children entering kindergarten (ages 4-6) will need to have had a  DTaP (diphtheria, tetanus and acellular pertussis), an IPV (inactivated polio), MMR (mumps, measles, rubella) and Varivax (chickenpox) vaccines.  (These are all booster doses). It has also been recommended that children over the age of 1 year (who have completed their 4 dose Prevnar series with Prenvar 7) and who are under the age of 6, receive a booster dose of the newer Prevnar 13 . (see previous blog from Spring 2010). For those children between the ages of 11-12 years there are also booster doses (for older children and adults too) of the tetanus, diphtheria and pertussis vaccine (TdaP) as well as the meningococcal vaccine.  These shots are typically given before entering 7th grade. If your child is over the age of 11 years and has not yet received the meningococcal vaccine I would go ahead and get it, even if they are still in later elementary school and it may not be “required”.  (The names of the vaccine are Menactra or Menveo). This vaccine prevents a devastating form of meningitis and bacterial blood infection that often leads to a rather rapid death in the adolescent and young adult age group. There is also the recommendation that all adolescents who “missed” receiving a meningococcal meningitis vaccine during their high school years receive a dose prior to entering college. In fact, in the state of Texas, this is the first year that ALL college freshmen must show proof of immunization prior to moving into their dormitory.  This is due to the fact that meningococcal meningitis has a higher attack rate for adolescents and young adults, especially those living in close living quarters, such as a dormitory. Once you get the vaccine it takes awhile for your body to develop antibodies and therefore immunity, so college students who get vaccinated once arriving at school, will also have to wait 10 days before they are allowed to move into their dorm.  If you son or daughter is heading to college in the next several weeks, go get the vaccine now, so that you will have a 10 day window to show proof of vaccination. With outbreaks of pertussis on the west coast, and actually clusters throughout the United States, this is a good time to reiterate that all adults should have a tetanus, pertussis and diphtheria vaccine too!! That means every 8–10 years and you want to make sure you have gotten the vaccine containing acellular pertussis, which prevents the adult population from spreading whooping cough to infants who have not yet been immunized or who are just getting their own 3 dose series. Even adults need to continue getting vaccinated and the TdaP vaccine is recommended for adults until 65 years of age. What can you expect from me over the next few weeks? Updates about flu vaccine once again. How time flies! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Parent-Teacher Conference Time

It is that time of year when parents have the privilege of meeting with their children's teachers to discuss academic progress and the fall semester.Now that I have finished doing homework with the younger set, I have returned to the office and ALL of my 27 messages are related to school conferences. It is that time of year when parents have the privilege of meeting with their children's teachers to discuss academic progress and the fall semester. From preschool through high school, conferences are in full swing. I loved getting to sit down with my children's teachers to discuss their progress and really to compare notes, parent to teacher, as to how our boys were progressing in school. You may have heard me say that I believed in the "no news is good news" perspective, and did not call the school etc, unless summoned.

But conferences really are a time of gathering information and discussing this information with your children, whether there is good news or "bad" news to discuss. This is the time of year when attention issues seem to become evident. It may be inattention, impulsivity, excessive talking, lack of focus or incomplete work, but all of these problems deal with attention. Many younger children may be in their first classroom and are still adjusting to a full day of school, following directions, and completing work. But, if you child has been in school and is not showing maturation on these fronts, and teachers continue to discuss your child's attention, focus and concentration, it is important to follow up with your pediatrician. Attention Deficit Hyperactivity Disorder (ADHD) is common in up to 10 - 15% of children of school age and is usually diagnosed in elementary school. If your child has symptoms suggestive of attention issues, call your pediatrician to discuss further workup and evaluation, beginning with teachers and parents rating scales. It is important to note any concerns with your doctor and to continue evaluating your child as needed. Remember, there are more conferences in the spring, and this is a good time to set goals with your child. That's your daily dose, we'll chat tomorrow.

Your Child

Recess Is Important for Kids

1.45 to read

Add recess to reading, writing and arithmetic says a report from the American Academy of Pediatrics (AAP.)  The pediatricians believe that recess can be as important to a child’s overall development as standard classes and should never be denied, especially as a punishment.

"We consider it essentially the child's personal time and don't feel it should be taken away for academic or punitive reasons," said Dr. Robert Murray, who co-authored the new policy statement for the AAP.

According to the authors, recess is a “crucial and necessary component of a child’s development.”

Other reasons given for the importance of recess are that it helps students develop better communication skills, counteracts the time sitting in classrooms, and may foster skills such as cooperation and sharing - all good things.

The authors noted that previous research has found that children are able to pay closer attention and perform tasks better after a recess break.  A year ago, 14 studies were reviewed and researchers found that kids who get more exercise do better in school. Recess and sports related activities offer children the opportunity to exercise and burn off excess energy.  They also get a chance to recharge their brains and bodies.

Other organizations have recommended that children need recess as well. The American Heart Association and U.S. Centers for Disease Control and Prevention (CPSC) both call for schools to offer recess to kids.  You might think that recess in schools is a given, but in a 2011 survey of 1,800 elementary schools, researchers discovered that a third of the schools did not offer recess to their third-graders.  However, most schools do offer recess of between 15 and 30 minutes once or twice a day.

Is there a particular time of day that helps kids most?  Before lunch seems to be the consensus from government agencies, CPSC and the U.S. Department of Agriculture. Previous studies have found that children waste less food and behave better for the rest of the day when their recess is before their scheduled lunch, the pediatricians' statement notes.

They also agree that PE should not be substituted for recess. "Those are completely different things and they offer completely different outcomes," said Murray. "(Physical education teachers are) trying to teach motor skills and the ability of those children to use those skills in a bunch of different scenarios. Recess is a child's free time."

Free time means no structured activities by adults such as games. "I think it becomes structured to the point where you lose some of those developmental and social emotion benefits of free play," said Murray.

"This is a very important and overlooked time of day for the child and we should not lose sight of the fact that it has very important benefits," he added.

I remember recess fondly.  A group of friends would gather and run from one end of the schoolyard to the other at full gallop. The first one back would win the honor of becoming the “lead horse.” Yes, in our recess fantasy we were a heard of horses – whinnying and throwing our heads around (showing off our glorious manes.)

It was fun and exhilarating as we trotted around strutting our stuff.

Recess isn’t only important because it breaks up the monotony of sitting, studying and listening, it can also spark the imagination!

Source: http://news.yahoo.com/pediatricians-kids-recess-during-school-0547374

Your Child

“Opt-Out” of Letting Schools Sell Your Child’s Personal Information!

2:00

If your child is in school, you may have unknowingly given the school the right to sell your child’s private information to data brokers and marketing companies. It happens every year and many parents don’t know they could have signed a form preventing the sale.

Schools are allowed by federal law to sell your child’s personal information to anyone unless you fill out an “opt-out “ form. If you don’t fill it out, personal information such as your child’s name, address, email, telephone number, age, gender, height and weight and photo can be sold.

Not only can your child be subjected to a ridiculous amount of advertising from marketing companies, anyone can use that information to locate your child if they really want to find him or her. They can also contact your child through personal emails or phone and have a picture to identify them.

"Directory information may sound innocuous, but it can include sensitive information about each student that is quite detailed," said Pam Dixon, executive director of the World Privacy Forum. "And after the school releases this data, it is considered to be public information and you've lost control of it. I don't think most parents know this."

Under the Family Educational Rights and Privacy Act of 1974 (FERPA), a student's directory information includes home address, email address, telephone number, date and place of birth, height and weight, the clubs or sports teams they've joined - even a photograph.

FERPA was written before the creation of the Internet, when a student's personal information was stored in a file cabinet and privacy was not such a big issue. Today, the data is just what a stalker, abuser or identity thief needs.

FERPA also gives parents the right to see what “directory information” the school has about their children. You have a right to block or limit access to that information. But, the window of time you can do that is short, sometimes just a few weeks after school begins. Once the time frame expires, you cannot stop the release of your child’s personal information until the next school year.

This is especially important for domestic violence survivors who are hiding from their abuser. Information that's released without their knowledge could jeopardize their safety.

"When there are situations where the survivor has left with the child and has custody of the child and they're living elsewhere, they want to know that their abuser doesn't know where they are living," said Kaofeng Lee, deputy director of the Safety Net Project at the National Network to End Domestic Violence. "If this information is available, the abuser could get access to where this child is going to school which will pinpoint exactly where the family is now living and make it possible to find them."

Many schools do not do a good job in letting parents know about the form. Some have even neglected to provide the form to parents and some schools have worded the forms in such a way as to discouraged parents from signing them.

It’s a battle for your child’s data and parents need to be aware that they have the right and the means to protect that information from getting out to marketing firms and individuals.

Congress is scheduled to review FERPA to see what further privacy protections are needed to keep students and families’ information private in the digital age. Until then, parents have to seek out and make sure that the opt-out forms are signed, sealed and delivered.

A warning to parents; this isn’t a one-time fix either. You must sign these forms every year that your child attends school.

Source: Herb Weisbaum, http://www.nbcnews.com/business/consumer/student-privacy-n423466

 

 

 

Your Child

Early Childhood Trauma Tied to Learning, Behavioral Problems

2:00

When children five years old and younger experienced a traumatic event in their lives, the fall-out from that event can show up in learning and behavioral problems by the time they enter kindergarten, according to a new study. 

Traumatic events, also known as Adverse Childhood Experiences (ACEs), can range from physical, sexual or psychological abuse and neglect, substance abuse, mental illness, violence in the home to a family member in jail; anything that causes a great deal of stress or fear in a young child’s life.

The study, "Adverse Experiences in Early Childhood and Kindergarten Outcomes," in the February 2016 online edition of Pediatrics, includes data on more than 1,000 children in large U.S. cities whose teachers rated school performance at the end of kindergarten.

Students who'd experienced one or more previously reported ACE were significantly more likely to struggle in the classroom, displaying below-average language, literacy and math skills, as well as aggression and social problems.

The more adverse events a child experienced, according to the study, the more academic and behavior problems increased.

While it’s often said that children are resilient, and they are to a certain extent, when they are exposed to continuous traumatic situations, their body’s natural way of dealing with stress changes and the stress becomes toxic resulting in a higher risk of behavioral challenges, sickness and mental health problems.

Children who experience traumatic stressors will often look to the adults who care for them for reassurance that things will be okay and that they will be protected.

The most important adults in a young child's life are his/her caregivers and relatives. These adults can help reestablish security and stability for children who have experienced trauma by:

•       Answering children's questions in language they can understand, so that they can develop an understanding of the events and changes in their life

•       Developing family safety plans

•       Engaging in age-appropriate activities that stimulate the mind and body

•       Finding ways to have fun and relax together

•       Helping children expand their "feelings" vocabulary

•       Honoring family traditions that bring them close to the people they love, e.g., storytelling, holiday celebrations, reunions, trips

•       Looking for changes in behaviors

•       Helping children to get back on track

•       Setting and adhering to routines and schedules

•       Setting boundaries and limits with consistency and patience

•       Showing love and affection

Sometimes professional help is needed for children to learn new coping skills. In some cases family therapy is desirable. Parents or caregivers may wish to consult their pediatrician, their child's teacher, and/or their childcare provider for suggestions of professionals who specialize in early childhood mental health.

The authors of the study said they hope the findings encourage policymakers and practitioners to find ways for early childhood professionals like pediatricians and educators to work together to support at-risk children and their families. 

Sources: https://www.healthychildren.org/English/news/Pages/Early-Traumatic-Experiences-Tied-to-Learning-Behavioral-Difficulties-in-Kindergarten.aspx

http://www.nctsn.org/content/helping-young-children-who-have-been-exposed-trauma-families-and-caregivers

 

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