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Daily Dose

Too Sick To Go To School

1:30 to read

Now that we are really in the throes of sick season I am often asked…when should you keep your child home from day care or school?  I noticed a recent article in one of the pediatric journals on this topic…which emphasized that hand washing and vaccines are still the best way to prevent transmission of infectious diseases. 

 

But, with that being said, especially at this time of year when so may upper respiratory tract infections are circulating do you need to keep your child home?  The short answer is that most minor illnesses are not a sufficient reason to keep a child home. That includes most colds and coughs. But if your child is running a fever, or seems terribly uncomfortable or is ill enough to “require extra care” by a day care worker or teacher they need to stay home. A day at home for some TLC (tender loving care) is often the best medicine, especially for the first day or 2 of a viral upper respiratory infection when a child may have a fever.

 

I am also asked about GI illnesses and whether a child with diarrhea needs to stay home from day care. It seems that some day care facilities now exclude a child from care if they are having more than 3-4 loose stools/day, even if they are still playful, fever free and eating and drinking.  The recommendation by the CDC does not require a child with diarrhea to stay home, if the stools can be contained within the diaper.  This gets back to good hand washing!  A child with vomiting is a different story and should not be sent to school or day care.

 

I am seeing a lot of children with pink eye (conjunctivitis). Pink eye may be caused by both bacteria and viruses. Transmission occurs by direct contact with contaminated secretions from the eye or via respiratory droplets. Unless a child has other symptoms to keep them out of daycare they should be allowed to return to school once appropriate therapy has been started.   

 

Even with good hand washing it is not unusual for children who are crawling and walking to get up to 11-12 viral infections in a season! This is often difficult for a family with two working parents, as the decision is made whether a child can attend day care and who will stay home if the child needs to be home.  At the same time, young parents will often get several of their children’s viral infections as well- even with good handwashing. What parent has not had their child cough or sneeze directly into their face (this is not purposeful but age related), and within several days you find yourself sick! This is a hazard for us pediatricians as well.

 

Lastly, do not “try” to figure out “who got your child sick”. There are just too many places we all go on a daily basis where we are exposed to viruses and bacteria. Trying to “track down” the exposure for most of the common infectious diseases that children get is a big waste of time. Serious illnesses like meningitis, mumps, measles etc are a different story…but fortunately, because of vaccines this is rarely the case.

 

So keep up hand washing and hope for the best during this time of year.

Daily Dose

Lice is Tough to Treat

1:15 to read

What are kids bringing home from school besides their homework? Lice! The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

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Daily Dose

Paddling in School

1:30 to read

I just finished reading an online post from a pediatrician in another state whose daughter has just started kindergarten. It seems that in her state, and her school, they may still “paddle” children for misbehaving. WHAT?!?!

In fact, the school sent a note home with her child that re-iterated the “school rules” surrounding paddling and asked that the parent sign the note that they agreed to paddling. Are you kidding me…what parent would sign a note agreeing to let someone HIT their child?  Parent’s have been arrested for spanking their children in a public place….but now you can let someone else paddle your child? 

I talk to parents about discipline even before their child turns one. Many a parent will tell you I am “the strict” doctor.  From the beginning, I discourage spanking (although I will admit to spanking my own children several times during their childhood - usually out of total frustration and never felt good about it) and begin with some simple strategies. For example when your 6-7 month old learns that they can make a new shrieking sound to get attention “ignore the behavior” and it will often go away.  Or, what about telling your child that you “will not pick the food up off the floor if they throw it” and then following through….they will not go hungry I assure you.

As children get older I discuss re-directing, time-out, taking away a toy.  For the older child it may be taking away screen time, missing a birthday party and for the teens taking away the cell phone,car or being grounded at home with parents.  But spanking and paddling is never part of the discipline/behavior modification discussion. And now I find out that there are still 19 states that allow paddling in their schools!! 

The mother of this child had not been aware of this rule. She could not believe that she was asked to sign a form to allow her child to be paddled. In this case we are also talking about 5-7 year olds who are just starting school where they will begin to learn school rules and expectations of kindergarten and 1st graders. Every teacher seems to have many strategies for discipline and behavior modification. Not one that I spoke with mentioned spanking or paddling. I am not sure that I even agree with taking away “recess” for misbehaving from this age group…(another conversation)  but certainly not corporal punishment.

The interesting part of this story is that the behavior issues were related to little boys “playing guns”  while they were on the playground. The school has a “zero tolerance for acting out play with guns”  but allows you to hit a child???  What kind of mixed message is that about violence? I know that while raising our three sons, despite our protests about violence and guns,  they seemed to turn anything we gave them into a “play gun” and that was long before they were ever even given a Nerf gun. 

Do your schools have policies regarding corporal punishment? I feel as if I have gone back in time 50 years - only all of this information came from that entity called the internet!!!

 

Daily Dose

Sleep

1:30 to read

Bedtime routines are very important!  Many kids are getting up earlier and earlier for some sort of practice (often before the sun comes up) so going to bed on time makes everyone in the house wake up in a better frame of mind and mood for the day ahead.   

 

Bed time battles are typical for a toddler who has learned to ask for “one more book”, or for the elementary school child who swears “they are not tired” but who falls asleep during bath time.  But who knew there would be even more battles with teens and their electronics??

 

Numerous studies have shown that electronics disrupt sleep.  But, trying to convince your adolescent son or daughter that they need more sleep is a daily struggle. While the studies on sleep recommend that teens get between 8 to 9 hours of sleep, most teens are not even close to that!  (90% report less than 9 hours).

 

During the summer teens keep all sorts of crazy hours and many get the majority of their sleep during what we would consider to be “daytime” hours…as they go to bed at 2 or 3 am and sleep past noon.  So, the minute that school resumes after summer vacation they already have sleep issues trying to “re-adjust” their biological clocks…and then you throw in the use of electronics right before bed and you have the perfect storm for sleep deprivation and daytime fatigue.

 

The American Academy of Sleep Medicine found that “adequate sleep duration on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health”.  There isn’t a parent around who doesn’t want happy, rested, studious and healthy kids…of all ages. If you throw in less moodiness for teens who get more sleep most parents would sign their teens up on the spot.

 

Why do we all need to disconnect from electronics in order to have better sleep?  That blue light from the electronic screen…of any shape for or fashion works against sleep. It signals the brain to suppress melatonin secretion, which is the hormone that makes us get sleepy at the end of the day. The light from the screen also confuses the brain of it being daytime and increases alertness which may delay sleep…even after turning off the screen.

 

Try this new family rule, parents included, that all screens (phones, tablets, computers) will be off and docked outside of the bedroom at least 30-60 minutes prior to bedtime. While your teen may insist that they won’t use the phone, it is often too tempting to not “cheat” once you are in your own room and asleep. 

 

While this may initially be hard to enforce, once it is the family routine it becomes less of a battle. Everyone will have an easier time falling asleep and staying asleep, and maybe get a few more hours of “shut eye”.    

 

 

Your Child

Getting Ready for a New School Year!

2:00

As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her kidsdr.com Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto http://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!

Source: http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Back-to-School-Tips.aspx

 

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

Daily Dose

Dealing with Tragedy

1.30 to read

I cannot stop thinking about the horrific tragedy in Newtown Connecticut.  As a parent, my heart is broken for the families in Newtown whose children, brothers, sisters and mothers were killed.  There really are no words to express the emotions we all have. 

At the same time, I worry about the many children who have seen or continue to see the images of this massacre.  Unfortunately, there continue to be mass shootings and tragedies that monopolize the news on air, online and in print making it hard to “shield” young children.  The news never stops and these events are all too common. 

But a parent’s job continues to be to try and make sure that children feel safe and secure.  Although it seems to be harder and harder to do these days, parents must continue to protect their children both physically and emotionally. This means telling your child to wear their seat belt, lock the door when you leave the house, wear your bike helmet, and to never play with matches...the list goes on and on.  

It also means having age appropriate discussions with your children about “stranger danger”, weather related disasters and now school lockdowns.  The discussions surrounding this latest national tragedy should be tailored to the age of the child, but regardless of their age, I think the discussion should always end with, “mommies and daddies are here to love and protect you and that will never change.”  

There is no way to process this tragedy nor is there a guide as to how to go forward.  Despite all of the news stories there are no answers, but only questions as to why? 

Hug your children, maybe grab an extra kiss and be thankful for your  family.  Let us also say a prayer for the community of Newtown, both those who were lost and for the living, for their grief is unimaginable.

 

Your Child

Your Kindergartener’s First Day at School

2:00

Whether it’s your little one’s first time, or your child is a seasoned pro, the first day of school brings both excitement and apprehension. It’s not only kids who are slightly hyperventilating… parents are too. Why? Because school is a big deal!

Let’s start with Kindergarten. It doesn’t get much cuter than to see the excitement on a kindergartner’s face on the first day of school.  Between experiencing a certain amount of separation anxiety and their first taste of independence, these little ones are spinning in multiple directions. That’s one reason mom or dad needs to keep their cool - you can cry in the car on the way home.

Some schools offer parents and children a “get to know your school” pre-school visit. If you and your child have the opportunity to visit the school in advance – take it!

The more familiar your child is with the school, the better at calming his or her anxieties on the first day. It’s also good for mom and dad to be acquainted with the teacher and the lay out of the school before your little one starts class.

On the big day, try and arrive a little early. Introduce yourself and your child to the teacher.

Help your little one get the lay of the land. Show him where the bathroom is and explain that they can go anytime they need to- but they will need to ask the teacher first. Also mention that sometimes accidents happen, and that teachers know this. Some schools will ask parents to bring an extra set of underwear and clothing to be kept in the child’s locker for such occasions.

Lunchtime is going to be an unfamiliar experience for these first-timers. You can ease their fears by taking them to the school cafeteria and letting them know that their teacher will tell them when it’s time for lunch. Explain how some children will bring their lunch from home, and some will get their lunch from the cafeteria line. Let them know that they will get to sit with the other children in their class.

Another tip to help your child understand how lunchtime will work is by taking her to a cafeteria-style restaurant before the school year begins. Explain how once they start school, lunchtime will be kind of like eating at a cafeteria. It can also be a good time to talk about healthy food choices.

If you’re going to pack a lunch for your child, begin a couple of weeks before school starts and practice the routine. You can get their input on what kinds of foods they might like and experiment with some healthy choices to see which ones they like the best.

You can also explain that there may be a naptime during the day. They don’t have to actually go to sleep, but they may get a chance to lie down on a cot and rest.

Let your child know that either you or another caregiver will pick them up from school at a certain time. If your child rides the bus, explain the process and how the adults will make sure they are kept safe.

Also, have a backup plan in case someone is going to be late or cannot pick your child up. Give the school a list of people you will allow to pick up your child when you can’t make it.

When it’s time to say goodbye, smile, wave and encourage your child to have a great day. The more relaxed you are, the less threatened your child will feel. Some children get very clingy and start crying – it’s a natural first-day-at-school- reaction to unfamiliar surroundings and circumstances. This may go on for a week or so. Teachers are pros at helping parents say good-bye. Enlist their help. Also know that some kids head off to class without even looking back. It's not a reflection on you- it's just that some personalities are always excited about a new adventure. 

As the school year progresses there will be lots of conversations about school and all the changes it brings. Remember to stay positive and give easy to understand information that correlates to your child’s age.

Stay informed on how your child is doing at school. You may want to set up a meeting with his or her teacher on a regular basis.

Once you’ve said good-bye and you’re out of the school building -go ahead and fall apart. It’s natural for parents to have some of the same emotions that their child is having. Your little one is growing up and has just passed an important milestone in life. You have too.

Source: Ruth A. Peters, Ph.D.

http://today.msnbc.msn.com/id/14244318/ns/today-back_to_school/t/tips-calm-your-childs-first-day-jitters/#.TlPNHHO1lvE

Daily Dose

Back-to-School & ADHD

Back to school and ADHD. How soon can you tell if your child has attention problems?This is the first full week of school for many students across the country and with just a few days of school under their belt, parents have already begun dialing and texting their pediatrician about their child's attention issues and ADHD.  

I have to smile/laugh, as I have already received more than a handful of phone calls directly related to the subject of ADHD.  This happens every year, somehow it has become predictable, and I can only continue to be amazed that any parent would think that a few school days is enough to determine anything about how the school year is going to go!  I mean REALLY (like my teenage patients like to say), I think everyone has ADHD for at least the first 7–10 days of school. That includes most teachers, administrators, school nurses, and yes, the students! Despite the fact that we all talk about “getting ready” for back to school, and establishing the bedtime routines, and early morning awakenings, followed by a healthy breakfast and an afternoon snack and homework done at a reasonable hour, it takes some time to really get it together.  It brings to mind the movie 'Home Alone' when they are all so organized for their early morning trip and then it all falls apart when the alarm clock doesn’t work and the “rush” begins. I saw a lot of tired children yesterday, who admitted that they had not gotten to bed as early as had been planned, but have better intentions for the next night. That seems more like reality for most of us. So, how can a parent call after 1 day of school to say “Johnny went back on his medication today and I don’t think it is working”, or “Sarah seemed to be distracted at school today and did not bring the right book home for homework and I think we might need to have a conference about ADHD”.  Does that sound silly to you? It happens every year. Think about your first day on any “new” job, it is often unorganized, difficult to focus, hard to remember what you need to bring to the meeting, or what form you fill out next.  Yet alone finding out where the bathrooms are, where you park etc. It is the same thing for our children as they start a new year. They may be in a new school, or at least a new classroom, often filled to the brim as new students are added at the last minute. They have never met the teacher before, who is also going to be giving them numerous directions for his or her classroom rules and expectations. They have to find the bathrooms, cafeteria, library and playground. They may have lockers far away from their classes, the text book that they thought was going to be used might have already changed. The list is endless.  Getting back into a “good school routine” is a bit of a journey and not a race, and giving a child a few days to figure it out seems to be more appropriate to me. With that being said, I called each of my patients back and basically discussed waiting for a week or two to get everyone settled in before making medication changes, or having conferences with teachers or pediatricians about attention issues.  Patience seems to be the word that comes to mind and remembering that starting any new “job” takes a bit of time to become adjusted. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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