We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting. That is distracted eating at it’s finest. It exemplifies the problem of eating without intention. Not eating because of hunger. Not even eating healthy foods usually. Just eating because it’s there.
What happened to sitting around the table and eating as a family without the tv or cell phones?
What is distracted eating?
I see many kids who always have distracted eating. Parents often worry that they’re not eating enough, but they’re typically getting too many unhealthy foods.
Distracted eating is eating when your mind is elsewhere. It’s the opposite of intentional eating, where we enjoy our meal and make smart choices about what and how much we eat.
It occurs when kids are distracted by a television or video game while eating. When any of us eat in front of the screen, we don’t focus on what goes into our mouth.
Or when parents allow kids to carry food around the house all day and take a bite here and there.
It can happen when any of us eat because it’s there and we aren’t listening to our body’s hunger cues.
The youngest distracted eaters might fit into another category all together, but they certainly aren’t intentionally eating. These are the babies who parents “dream feed” – basically feed them while they’re sleeping.
This can be because parents think they don’t eat as much as they should when they’re awake. Or maybe parents want to get one more feed in before they go to bed so baby will let them sleep.
I know many parents rely on it, but I will never recommend it for many reasons.
It can disrupt their normal sleep cycles if you feed during periods of deep sleep.
Dream feeds also feed a baby who might not be hungry or need to eat. It’s hard to know when to stop.
After the first 4-6 months most babies don’t need to eat at night, but they are trained to eat at that time.
Once they get teeth it can increase the risk of cavities if they eat without brushing teeth before returning to sleep.
There are also risks of choking, though if they’re being held, it won’t go unrecognized. A parent can use CPR techniques to help them.
As kids move into the toddler years, they often become picky with foods and eat small volumes. This is normal.
Parents need to offer healthy foods and feed small frequent meals. Think of snacks as mini meals so you will offer healthy foods – and no, goldfish crackers are not healthy foods. Young children tend to eat about six small meals a day. Each meal offer either a fruit or a vegetable and a protein to help ensure your child gets enough of these food groups daily.
Unfortunately, some parents solve the “problem” of kids not eating a lot at meal times by allowing them to carry around food all hours of the day. This might be cereal, crackers, milk, or whatever the favorite food of the week is.
This allows the child to snack all day, which means they’re never hungry, so they don’t eat at meal times. Parents will think it’s better than eating nothing, and even think that since it’s cereal or milk it’s healthy.
But it’s not.
Risks of constant snacking
Snack foods are usually highly processed and have little nutrition.
Constantly nibbling doesn’t allow the body to learn hunger cues.
Nibbling throughout the day doesn’t allow saliva to clean teeth between feedings, which increases the risk of cavities.
If kids drink excessive milk they are at risk of severe malnutrition. Parents argue that milk is healthy, but they are thinking of mother’s milk or formula for infants. Cow’s milk has protein, calcium, and other nutrients, but it is not a complete meal substitute. I have seen children need blood transfusions due to severe iron deficiency anemia from excessive milk intake. Blood transfusions. It can be that bad. Yes, your child might like milk. And he might refuse to eat at meal time. But if you keep giving milk he will never get hungry enough to eat the food offered.
Feed while watching tv
Other parents realize that kids will eat more if they feed the child, especially if the child is watching tv. This is wrong on many levels.
Once kids are able to feed themselves, it is a great skill to use. They work on fine motor skills when self feeding.
When offered healthy options, kids will eat when hungry and stop when full. When parents do the feeding, they keep pushing foods until the plate is empty. Many parents have an unrealistic expectation of how much food a child should eat and overfeed the child.
If a child is watching tv while eating, the focus is on the screen, not the food. Again, the child then doesn’t listen to hunger and satiety cues.
Self feeding is an important skill.
I see several kids each year who will be going to full day school for the first time and parents worry that they won’t be able to eat lunch because they never self feed. Many of these kids are overweight because they’ve been overfed for years yet the parents often think the child doesn’t eat enough.
Beyond the first birthday, most toddlers should be able to self feed. Many infants can do so even earlier. They don’t need a lot of teeth to eat small pieces of foods. Of course hard, round, chewy foods should be avoided for all young children, but most foods can be safely given to young kids at the table.
Don’t wait until your child is school aged to realize they’re behind on this important skill!
Eating together as a family is one of the best things you can do to raise healthy and independent children. As long as you use the time wisely.
If families eat while watching television or playing on smart phones or tablets, no one is connecting during the meal. No one is really enjoying the food or the conversation.
There are many studies that show the more often families eat together the less likely kids will develop obesity, get depressed, do drugs, smoke, and consider suicide.
Kids who eat with their families are more likely to eat healthy foods, do well in school, delay having sex, and have stronger family ties.
Help stop the habit of mindless eating.
Encourage eating at the table as a family as much as possible.
Offer healthy food choices and let everyone decide how much of each thing to eat.
If you worry that your child isn’t eating adequately, talk to your pediatrician.
MyPlate offers portion sizes for children, tips on healthy foods, activities for kids to learn about nutrition, and more.
During the winter months more people get sick, so more people are treated with antibiotics. While antibiotics can help treat bacterial infections, they do carry risks. One of those risks is an allergic reaction. This is one of the reasons pediatricians avoid using antibiotics liberally. Most of the time our bodies can fight off the germs that cause illness and antibiotics don’t help treat viruses at all. How do you know if it’s an antibiotic allergy or just a rash?
Rashes are common
When someone is on a medicine and they develop a rash it can sometimes be hard to sort out if symptoms are part of the illness, a non-allergic drug reaction, or an allergic reaction.
There are many people who had a rash while taking an antibiotic as a child and were told that they are allergic to that antibiotic, but really aren’t. Unfortunately this can lead to more expensive and broader-range antibiotics being used inappropriately and unnecessarily.
About 2% of prescription medications (not just antibiotics) cause a “drug rash”. The rash usually begins after being on the medicine for over a week (earlier if there was previous exposure to the medicine), and sometimes even after stopping the medicine.
It can look different in different people.
Some get pink splotchy areas that whiten (blanch) with touch.
Often the rash seems to worsen before it improves, whether or not the medicine is stopped.
Skin can peel in later stages.
It can itch but doesn’t have to.
Some people have mild fever with these symptoms.
Adults vs kids
In adults this type of rash is often a sign of allergic reaction, but in kids a rash is most often a viral rash – meaning they have a virus that causes a rash but they happen to be on an antibiotic (or other medicine).
This is why diagnosing allergy versus drug reaction is tricky.
These symptoms can mean allergy to the drug, but (especially in kids) is often just a symptom of a virus (or some bacteria, such as Strep or Mycoplasma).
Up to 10% of children taking a penicillin antibiotic (which includes the commonly used amoxicillin and augmentin) develop a rash starting on day 7 of the treatment. (It can be earlier in people who have had the antibiotic previously.) This rash tends to start on the trunk, looks like pink splotches that can grow and darken before fading. It does not involve difficulty breathing, swelling of the face or airway, or severe itching.
Because of this reaction many people live their life thinking they have an allergy to penicillin, even though many of them don’t.
Up to 80 -90 % of people who have mono develop a rash if they are treated with a penicillin antibiotic (like amoxicillin).
This is common since symptoms of Strep throat and mono are very similar, and penicillins are the drug of choice for Strep throat. Some people with mono have a false positive test for Strep throat, meaning they do not have Strep but the test is positive.
This is why it is very important for the medical clinician to take a careful history of symptoms and do an exam, even with “classic” Strep symptoms. (If I had a dollar for every parent who says the symptoms are just like all her kids when they get Strep, can’t I just call it in…) Always be sure to get a Strep test and full exam to evaluate if it is really Strep or possibly mono. Blood tests for mono can be ordered if clinically indicated.
Never treat a sore throat without a full evaluation.
Doctors will take a careful history of all symptoms of the illness, the timing of when the rash developed during the illness and when the medicine was given.
If it is a classic viral rash, nothing further needs to be done. If there are symptoms (see below) that help identify a true allergy and make a clear diagnosis, then avoidance of that medication should be done.
Be sure all your doctors and pharmacists know of this allergy.
It’s graduation season, which has me thinking of all the ways our kids grow over the years. They’re born, then just a few years later they are in kindergarten. In just a blink of the eye they get a locker in middle school. Then high school is over. The world awaits… Where does the time go? How do we prepare kids to leave the nest?
Over the years I have spent a lot of time reflecting about at all the life skills my kids have learned and what they need to learn to be successful, independent, healthy and happy.
One important thing to master is personal safety. I talked extensively about teens and alcohol in a previous post. Please take the time to review it and discuss it with your teens.
I have never really thought that school is about learning the actual subjects. It’s more about learning how to learn. How to organize. How to be responsible. I have always told my kids I don’t care what grade they get as long as they learn what they need to and do their best.
Home life is also a process of learning. We need to teach our kids how to live healthily and respectfully with others. Kids can learn to take care of themselves more and more each year. We need to teach them to be responsible with money. Ideally they will learn to argue a point without losing control of their emotions or being hurtful.
In all of this reflection, I came up with a list that I have shared with my kids, and I invite you to share it with yours.
Skills needed to leave home successfully:
Good hygiene habits
Brush teeth twice daily. Floss once a day.
Shower or bathe daily. Wash hair as needed for oil control.
Wash hands often.
Shave as needed.
Brush hair at least daily and get a hair cut regularly.
Clip and groom nails regularly, both fingers and toes.
Use personal hygiene products correctly, including deodorant, facial acne cleansers, etc.
Wear clean clothes and change underclothing daily.
Get adequate sleep to wake fresh and ready for the day. Set an alarm and get up on your own.
Eat healthy foods and limit junk food and sodas.
Be able to prepare simple healthy meals.
Take vitamin D daily.
Understand common over the counter medicine indications and how to use them appropriately.
Understand why you are taking medications (if you are), how to take them, and what is needed to get more. This depends in part if it’s over the counter or a prescription medicine.
Know your medical history, including any allergies and chronic health care problems.
Learn how to obtain your vaccine record.
Know how to take care of common injuries until they are healed.
Exercise regularly, at least 3 times a week.
healthy strategies to handle stress
Prayer or meditation
Sketch or other artwork
Talk to someone openly—don’t hold bad feelings in!
Take a long bath
Think before speaking
Schedule down time
Think about the problem from different points of view
Break big projects into small parts to be able to complete in parts
Grocery shop on a budget to incorporate nutritional balance.
Properly clean dishes and tidy up the kitchen after eating.
Balance a check book, make a budget, and pay bills on time.
Do easy repairs around the house.
Understand health insurance plans – how to get them, what they cover, what is excluded.
Manage the basics of money investment, retirement planning, savings.
Handle a road side emergency.
Find important numbers (doctor, dentist, insurance, etc).
Clean a bathroom, use a vacuum, and dust.
Sew basic clothing repairs (buttons, hems, etc).
Get help when needed.
Apply for a job and build a resume.
Choose words carefully: they can build someone up or crush someone down.
Be a good friend and responsible family member
Be clear with plans: Look at the family calendar when making plans. Get permission from all parents involved; let family know where you will be and when you will be home.
Keep a phone available to be able to call when needed. Answer calls/texts from parents and others in an appropriate amount of time!
Treat everyone with respect: family, teachers, friends, and strangers.
Require that others treat you with respect.
Do random acts of kindness occasionally.
If you feel unsafe, leave the situation. Tell a trusted adult as soon as possible.
Do only things you and your parents will be proud of.
Things to do to show you are getting ready to leave the nest…
Complete assigned homework and chores without reminders or nagging.
Keep your room picked up and clothes off the floor.
Hang your towel to allow it to dry between uses.
Clear dishes from the table.
Clean up after projects or play. Return all things to their proper place after using them.
Throw all trash in the trashcan. Recycle things that are recyclable.
Responsible use of cell phone, computer, and other electronics. Turn off before bedtime to allow uninterrupted sleep.
Spend and save money responsibly. Never spend more than you can afford. Use credit cards wisely.
Take pride in your work: schoolwork, chores, job, and helping others. Do it to the best of your ability and ask nicely for help as needed. Recognize that work is not always fun, but necessary. Doing tasks with a good attitude will help.
Time organization skills: Do not procrastinate until the last minute. Plan ahead and do big projects in small steps. Be prepared with all materials you will need for a project and ask in advance if you need help acquiring items. Use tools (apps, calendar, checklists).
Take care of your things. Keep them in proper working order, clean, and put away.
Accept consequences with grace.
Know when to trust and follow others and when to take your own path. Make independent decisions based on your own morals. Have the courage to say “no” if something goes against your beliefs.
A final thought
As a mom of a college freshman on a campus where they don’t allow freshmen to have cars, we found that having his own Amazon Student Prime membership helped. We started the year with him asking me to order things, but it was easier if he could do it himself.
Of course be sure your student won’t abuse the privilege if you’re footing the bill, but if they need something and don’t have the ability to shop locally, this is a game changer! And it would make a great graduation gift.
Prepare kids to leave the nest
Don’t be intimidated by this list! Many of the ideas are things they should be learning along the way.
During the school years teachers increase expectations each year. You can do the same… start with baby steps and then really buckle down in high school to be sure they’re ready!
Most parents and even most teens are aware of the risks that come with drinking alcohol, yet many of us drink. Teens and alcohol use have long been problematic. The teen brain is known for being impulsive and seeking thrills, which increases the incidence for many types of risky behaviors. When teens drink alcohol, they risk many serious consequences.
Teens who drink alcohol are more likely to binge drink than adults. Binge drinking is particularly dangerous because a lot of alcohol in a short amount of time doesn’t allow the liver to clear the alcohol as it’s consumed. This leads to higher blood alcohol content and more associated problems.
Binging can quickly lead to intoxication, which can lead to many of the problems to be discussed below.
A cycle often develops when teens start drinking. The more they drink, the more likely they are to drink again. This can lead to risks with each exposure, and to long-term problems with alcoholism. People who begin drinking before age 15 are 4 times more likely to develop alcohol dependence than those who begin drinking at age 21.
Consequences of teen alcohol use
It’s illegal in the US
Drugs and alcohol should be treated with respect and used only with good judgment. This judgment should take into consideration laws and safety.
Possession of alcohol by a minor is illegal, so teens in the area where others are drinking risk getting into legal trouble simply by being there. Each state’s laws are different, but all states have a minimum drinking age of 21 years.
You do not have to be driving to be convicted of violating a minor in possession (MIP) law. If you are holding an unopened beer and are under the state’s drinking age, you can still be convicted of a MIP offense.
Teens don’t have to be legally drunk under most state’s driving under the influence (DUI) laws to be found guilty of MIP.
While it’s true that the laws are not always enforced to the fullest extent, there are many states where possession can lead to mandatory suspension of a driver’s license. Jail time and fines are possible, especially for repeat offenders.
These charges also can impact sport team participation and college scholarships. They remain in government records forever, which can affect the job prospects of otherwise stellar candidates and cause major damage to their long-term career aspirations.
Adults who make the alcohol available to teens can also be held accountable.
Teens who drink are more likely to become abusive, commit a crime, or get into a fight. Each of these situations can increase legal troubles.
Our brain does not fully develop until the early to mid 20s and early use of drugs or alcohol is impacted in two ways due to this. Teens fail to realize the full implication of their actions and alcohol can prevent proper brain development.
Teens often cannot understand the consequences of their actions due to brain immaturity, yet they are held accountable for their actions. They tend to be impulsive and crave thrills. Teens want to please peers and fit in. All of these typical teen traits can put them at risk to try known risks, including drugs and alcohol.
Not only does the underdeveloped brain put kids at risk to drink, but drinking impairs the way the brain grows.
Short-term or moderate drinking can impair learning and memory far more in teens than in adults in the mid 20s and beyond. Adolescents need to only drink half as much as adults to suffer the same negative effects.
Studies have shown physical changes in the brain in kids who drink, especially in the hippocampus and frontal lobe. Our hippocampus helps us learn and remember things and the prefrontal lobe is important for judgement, planning, impulse control and decision making.
Damage to the brain from alcohol during the teen and young adult years can be long-term and irreversible.
When our brains are under the influence of alcohol, our bodies become uncoordinated. We lose judgement capabilities.
When drunk, one is more likely to fall, get into an accident, or get into a fight.
Many teens are hospitalized each year due to intoxication itself or the injuries resulting from being drunk.
We all know the mantra to never drink and drive, but driving isn’t the only serious risk with drinking. Simply drinking too much alcohol can lead to coma and death.
If you choose to drink, you should ideally have food and water to help slow absorption. Unfortunately many teens drink excessive amounts of alcohol in a short amount of time without water or food. This might be due to the fact that they want to quickly drink before going to a school function, where no alcohol is permitted. Or maybe they are challenged to chug beer or down several shots. I’ve seen teens not eat during the day to “save calories” because they want to drink in the evening and not gain weight. These patterns are especially dangerous.
Drinking and driving is never safe, even if you feel you are still sober. Unfortunately alcohol impairs our ability to judge if we are sober or not. Underage drivers are more likely than adults to suffer impairment behind the wheel.
Car crashes are the leading cause of death for teens, and about a quarter of those crashes involve an underage drinking driver. In 2016, young drivers, 16-24 years old, made up 39 percent of drivers involved in fatal alcohol-impaired crashes.
To reduce alcohol-related fatal crashes among youth, all States have adopted a minimum legal drinking age of 21. NHTSA estimates that minimum-drinking-age laws have saved 31,417 lives between 1975 and 2016.
Despite the large numbers of people killed in alcohol related traffic accidents, the majority of underage drinking related deaths are not traffic related. Deaths occur from homicides, suicides, burns, falls, and drownings. Some kids drink to the point of alcohol poisoning and stop breathing.
Being under the influence of a substance can also put you at risk for being raped or having unprotected sex.
I don’t believe that anyone scan consent to sex if they’re under the influence of drugs or alcohol, yet we know that being intoxicated is associated with sexual activity.
My favorite example to help understand consent is the Cup of Tea video, which is nicely discussed in the linked blog from EducateEmpowerKids.org.
When under the influence, the chances of using proper protection from infections and pregnancy falls. Drinking is associated with sexually transmitted infections and unplanned pregnancy.
Do not drink from a container that has been left unsupervised – someone could slip something in it.
I encourage kids to stay with a group when they’re out. No one should be allowed to leave the group unless it is pre-arranged. You should not allow a friend to make this decision if they are under the influence.
Drinking isn’t going to make you cool. In fact, it can lead to you saying and doing embarrassing things. You lose coordination, so can look very foolish. You might even get so drunk that you vomit on or pee on yourself.
No one wants to deal with a hangover the next day, but heavy drinking can easily lead to one. That’s definitely not cool.
And your “friends” have cameras with them at all times these days. One simple mistake or moment of poor judgement can be forever recorded… and potentially seen by parents, school administrators, your coach, or your boss. Even your future children could see your moment of disgrace if it’s uploaded or shared.
Depression is a risk factor to start drinking. People attempt to make themselves feel better with alcohol. Of course the alcohol leads to other problems, which tend to worsen the depression.
If you feel like you’re depressed, help is available! Talk to your parents, your school counselor, or your doctor.
If you feel like you want to hurt yourself, call the Suicide Hotline. Put a number in your phone now or search it in time of need.
Suicide Prevention Hotline 1-800-273-TALK (8255)
1-800 –SUICIDE (784-2433)
It’s no secret that alcoholic drinks can pack in a lot of calories. When people consume alcohol regularly, they are much more likely to become overweight or obese.
Increased weight is associated with many health conditions, including heart disease, diabetes, metabolic problems and liver disease.
Find a way to say no.
Just say no. (Only really confident people can be secure enough to not give a reason.)
Tell your friends that if your coach finds out, he’ll kick you off the team.
Say that your parents smell your breath when you get home. If you’re caught, your parents will probably tell other parents. (That will scare them into even asking you again!)
Offer to be a safe ride home if you have a car and are allowed to drive friends.
Say you don’t want the calories.
State that you want to be on top of your game for whatever you’re doing. For instance, if you’re playing cards you might not be able to strategize as well or keep a poker face if you’re under the influence. If you’re swimming you want to be safe. Since many people get tired when drinking alcohol, you can simply say that you don’t want to fall asleep at the party.
If you’ve already been in trouble for drinking, admit to that, and let them know that you don’t want to suffer consequences again.
Plan on doing things that keep people busy and are fun rather than just going somewhere to “hang out.” Go to a sporting event or a movie. Bring frisbees to a park. Go for a bike ride. Play a competitive card or board game.
Not only is an antibiotic NOT needed for viral illnesses, but taking them when not needed can increase problems.
Risks of antibiotics involve diarrhea, yeast infections, allergic reactions, and more.
Every time we take an antibiotic, we assume the risks associated with the antibiotic. If we have a significant bacterial infection, the risk is warranted. But if we have an infection that the antibiotic will not kill, it is an unnecessary risk.
Most of us have heard of superbugs, but there is a misconception about how they work.
Using antibiotics inappropriately can allow bacteria to learn to evade the antibiotic, which makes it ineffective. This means that new antibiotics need to be used to treat infections, which increases the time of illness, the cost of treatment, and the risk of untreatable illnesses. Some bacteria develop resistance to all known treatments, which can lead to death.
“The Last time amoxicillin didn’t work and we had to use something else. Can we use that one again?”
A lot of parents think that if one antibiotic failed with a previous infection, they need a different one. This is not true.
The bacteria develop resistance to an antibiotic. Bacteria can share their genetic material with other bacteria, leading to the quick spread of resistance.
Even someone who has never used an antibiotic can be infected with a resistant bacteria, which makes it harder to treat their infection.
Unfortunately, without a bacterial culture it is impossible to know what the best antibiotic is for any specific infection. We use the type of infection and the bacterial resistance pattern of the area to make the best choice.
It’s not the person that becomes immune to an antibiotic
Very often parents request a different antibiotic because “amoxicillin never works for my family.”
A person does not become immune to a type of antibiotic.
Start with an antibiotic that has a narrow coverage usually
A first line antibiotic is an antibiotic that covers the type of infection that is present, but isn’t so broad that it includes more bacteria than needed. It can also be called narrow-spectrum.
One infection with a superbug might require a strong antibiotic, but the next bacterial infection in the same person might respond well to a first-line treatment, such as amoxicillin.
It’s always wise to start with the first line antibiotic for the type of infection unless a person’s allergic to that antibiotic. It doesn’t matter if it worked the last time or not.
Broad spectrum antibiotics are needed for some serious infections
Remember that broad-spectrum antibiotics that have great killing power can increase the risk of killing the good bacteria that your body needs.
If you have a serious infection, they might be needed. In this case the benefit outweighs the risk.
Each new infection is a new bacteria.
The type of infection will determine the most likely bacteria. A culture from the infection (if possible) will specify exactly what bacteria is the cause and which antibiotics will work.
First line antibiotics are chosen based on type of infection as well as local resistance patterns. Upper respiratory tract bacterial infections tend to use different antibiotics than urinary tract infections or skin infections because different bacteria cause different types of infections.
Most people can tolerate antibiotics, but allergic reactions can be serious. It’s not worth the risk if the antibiotic isn’t needed in the first place.
Talk to your doctor about any drug allergies you suspect your child has and why.
Many kids will get loose stools when they take antibiotics.
Probiotics can help re-establish a healthy amount of good bacteria in the gut and slow the diarrhea most of the time.
Unfortunately there is a type of bacteria commonly called C. diff that can overpopulate after antibiotics and cause severe diarrhea. C. diff causes thousands of deaths every year in adults and children, most often following antibiotic use.
If diarrhea develops during or after antibiotic use, talk to your doctor’s office during regular office hours for advice. If there are signs of dehydration, severe pain, blood in stools, or other concerns you should have your child seen quickly.
Antibiotics kill not only the bacteria causing an infection, but also the “good” bacteria (gut flora) in our bodies.
Our bodies are a habitat for healthy bacteria and yeast. I know this seems unnatural or unhealthy to many people, but we need these bacteria and yeast in a healthy balance.
Gut flora is made of many types of healthy bacteria. These bacteria help us with many functions, such as digestion and weight regulation. Good bacteria make products that lower inflammation in the intestines. They also make neurotransmitters which affect our mood.
Different “good” bacteria can be affected depending on which antibiotic is used.
As mentioned above, our bodies are an ecosystem of bacteria and yeast. When bacteria are killed off with an antibiotic, it throws off the balance and allows the yeast to overgrow.
Yeast keeps the digestive system healthy and helps our immune system. It can help our body absorb vitamins and minerals from food. Despite what you read online, yeast are very beneficial to us – as long as they remain in healthy balance.
There are a lot of people selling products to treat overgrowth of yeast, which is said to cause all kinds of problems. These types of overgrowth are not recognized as true overgrowth by most physicians, but there are true yeast infections.
Yeast can cause infections of your skin (ringworm), feet (athlete’s foot), mouth (thrush), and penis or vagina (yeast infection). At risk people can develop blood infections with yeast. These can be life threatening. Serious yeast infections tend to occur in diabetics, immunocompromised people and those who were treated with antibiotics.
If you suspect a yeast infection, talk to your physician.
Risk vs benefit
When antibiotics are needed to fight a bacterial infection, it is worth the risk of taking the antibiotic.
The balance flips if you have a common cold – don’t take the risk for something that isn’t needed or beneficial.
Antibiotics do not and will not help treat a cold. Ever.
Don’t try to use an antibiotic to prevent a cold from developing into something else.
Improper use of an antibiotic simply has too many risks and will not help, so there is no benefit.
Prevention is key!
If you’re not sick, you don’t even think about looking for an easy fix for a viral illness.
Use proper handwashing, vaccinate against vaccine preventable diseases, and stay home when sick!
A lot of parents question the timing of vaccines. What happens if a vaccine booster is delayed? Does the series need to be restarted? Is it even worth it if it’s late?
There are so many questions about delayed vaccines…
This is not about a delayed schedule.
Intentionally delaying vaccines, especially during the infant schedule, puts kids at risk for catching a disease.
I always recommend giving vaccines according the standard vaccine schedule. This helps protect our children and our communities.
A bit about insurance…
There also might be insurance issues if vaccines are given out of the standard age range. Details of coverage should be in the fine print of your individual contract with your insurance company and your physician will not know coverage specifics. You should talk to your insurance company to see if there are limitations on vaccine coverage if you are vaccinating outside the standard vaccine schedule.
Most insurance companies cover the infant series until 2 years of age. I recommend getting those done prior to the 2nd birthday if at all possible, not only for the protection of your child, but also potential increased costs to you if your insurance company has age restrictions.
The “kindergarten” vaccines are given between 4 and 6 years of age and then there are “tween/teen” vaccines at 11-12 and 16 years. These also might fall into age restrictions of your insurance company, so talk to an insurance company representative if you have questions on payment.
Life happens, and sometimes there are inadvertent delays in vaccinating.
The typical question I’m asked regarding what happens if a vaccine booster is delayed is along the lines of one of these questions:
“He is due for his kindergarten shots on July 5th, but we’re on vacation then. Is it okay to wait until the end of July?”
“Tweeny is getting her first HPV vaccine today, but she has a big out of town tournament the week she is due for the 2nd dose. Can she come later?”
The answer to both questions: yes.
Vaccines are recommended with minimal intervals. If there’s a delay for whatever reason (missed appointments, scheduling conflicts, temporary immune compromise-such as cancer) it’s usually recommended to catch up as soon as possible.
Vaccine series do not need to be restarted if the interval has been longer than recommended. You give the next required dose and make sure successive doses fit minimal intervals and age limitations.
Minimal intervals will be discussed in a future post.
Exceptions to completing the series
There are a few vaccines that should not be given if too much time has passed.
There are two types of rotavirus vaccine. One is typically given at 2, 4, and 6 months. The other is given at 2 and 4 months. Either is considered acceptable. It is recommended to use the same type to complete the series, but they can be interchanged if needed.
The minimum age for the first dose is 6 weeks and the maximum age for dose #1 is 14 weeks 6 days.
Vaccination should not be started for infants age 15 weeks or older due to safety concerns in older infants. If an infant of 15 weeks 1 day or older has not started the rotavirus vaccine, they should not start it.
The maximum age for the last dose of rotavirus vaccine is 8 months and 0 days. If an older infant has not completed the series, it is not recommended to do a catch up.
The Hib vaccine also has different versions and a variable schedule due to vaccine types and combination vaccines. It is either a 3 or 4 dose series. The earliest it can be given is 6 weeks, but it standardly starts at 2 months.
At least one dose is recommended after the first birthday for children under 5 years of age.
It is not recommend to give Hib vaccine after 5 years of age to healthy children. Some high risk people should continue to get the vaccine beyond their 5th birthday.
Again, there are various types of pneumoccal vaccine, but the one routinely given to infants is the PCV13.
The youngest an infant can receive this vaccine is 6 weeks, but it’s typically given at 2, 4, 6 and 12-15 months. If a child misses doses, they should do catch up vaccines at least 28 days apart and at least one dose after the first birthday, unless they are over 5 years of age.
Some schools require at least one dose, so children over 5 years who have never had this vaccine may be required to be vaccinated despite the CDC guidelines. While this is safe, it may not be covered by insurance. (Another great reason to stay on the routine schedule as much as possible!)
DTaP and Tdap (D and d = diptheria, T = tetanus, P and p = pertussis/whooping cough)
The DTaP vaccine is typically given at 2, 4, 6 months and then boosters at 15-18 months and 4-6 years of age. If the full series hasn’t been given, it is okay to complete it up until the 7th birthday with the DTaP.
If the child is over age 7, the Tdap should be given instead of the Dtap. These cover the same diseases, but the Dtap has a higher diphtheria component than the Tdap (as indicated by the capital letters).
The Tdap is the booster that is usually given at 11-12 years of age, but can be used as early as 7 years if the Dtap series was not completed or if there is a wound requiring a tetanus booster.
If additional doses are needed after one Tdap, Td boosters can be used to complete the primary series.
Tetanus boosters are recommended every 10 years and with each pregnancy. The Td vaccine is recommended for most of these boosters. Exceptions are that the Tdap should be used during pregnancy and can be used if the Td is not available.
In the US, the standard polio vaccine schedule is 4 doses at 2, 4, 6-18 months and 4-6 years.
In other countries it is given soon after birth and there are additional doses. Even if a child has had more than 4 doses, if one was not given after the 4th birthday, an additional dose is needed.
Conversely, if the 3rd dose was given after the 4th birthday and 6 months or more after the previous dose, a 4th dose is not needed.
The typhoid vaccine is not on the standard US vaccine schedule. It’s recommended for many travelers and it might involve at-home compliance, so I decided to include it.
The injectable typhoid vaccine is recommended for 2 years of age and up and can be repeated every 2 years. Talk to your doctor to see where it is available, since they may or may not keep it in stock.
The oral typhoid vaccine is the one that can be complicated. It can be given to children over 6 years of age through adult years. It is boosted every 5 years. Even though it is a vaccine, it is given in pill form by mouth. It should be given on an empty stomach every other day for a total of 4 doses. The pills should be kept in the refrigerator, which can make them hard to remember. Because they are a live virus vaccine, they should not be taken with antibiotics. If antibiotics are required during the week of administration, the vaccine won’t be as effective and doses might need to be repeated. If there are forgotten doses, talk to your physician to be sure the series does not need to be repeated.
So… What happens if a vaccine booster is delayed?
Talk to your pediatrician (or the people where you get your vaccines) to make a plan to catch up on immunizations.
Good news! The CDC has a catch-up schedule that gives a timeline of when to give various vaccines if you’re off the typical schedule.
There’s even a cool vaccine scheduler that you can use to estimate what vaccines your child needs.
Talk to your physician to help decide how to catch your family up on their vaccines.
I see many kids each month who complain of being too tired. Parents often fear the worse, such as low iron or even cancer. There are many things to consider, but there are a few very common reasons that could explain why a child or teen is tired. I’m also including some less common things that make kids feel tired, but are common worries of parents. Always remember that common is common. Serious causes of being tired will not happen with fatigue as the only complaint.
Here are 10 reasons a child or teen is tired:
1. Not enough exercise
Strenuous aerobic exercise helps our bodies get healthy, quality sleep. Better quality sleep improves our performance, both physical and mental.
If you lay around, you tend to feel more relaxed, lazy and tired. Getting up and moving can help.
Many kids sit all day at school, then come home to sit more doing homework, watching tv, or playing video games.
Limit time on screens, especially before bedtime. We need to encourage kids to get up and move, ideally outside.
Make it fun!
Take a walk to a park, then play
Go on a bike ride
Join a sports team
Try yoga — there are many online videos to get you started
Several of these ideas you can do with your kids. Make it a family goal to be active together! It models the healthy habits you want your kids to live.
2. Celiac disease
Celiac disease is an autoimmune disease in which people can’t eat gluten (a protein found in wheat, barley and rye) because it will damage their small intestine. This can lead to malnutrition and anemia (low red blood cell counts). Symptoms vary, but often include abdominal pain, diarrhea, constipation, fatigue and bloating. In kids it can affect puberty and growth. Celiac disease can run in families.
There are a lot of people who say they feel healthier when they avoid gluten for non-celiac gluten sensitivity. These people have symptoms that are found in celiac disease, such as abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but do not test positive for celiac disease. It is not clear what the etiology of this is, but removing gluten seems to improve symptoms.
It’s uncommon for kids to have fatigue as the only symptom of celiac disease, but if you are worried about their symptoms, schedule a visit with their physician to discuss it as a possibility.
A quick warning…
Do not remove gluten from their diet without talking to your doctor. Gluten in the diet is needed for testing, which is needed to confirm celiac disease.
Celiac disease is important to diagnose and treat due to chronic issues that can occur from long-term damage to the intestines. If a child doesn’t have a true diagnosis, it is more likely they will not remain compliant with the diet changes that are required.
We often think we would recognize a depressed child or teen. We picture them crying often or appearing sad, but this is not necessarily how they appear. Yes, they can cry and appear sad, but sometimes they don’t.
Depression doesn’t always look like you’d think.
Sometimes parents think their child is angry. Or parents are mad because a teen stops trying at school. The child might get into fights.
Common symptoms of depression:
Sadness, crying and tears
Losing interest in things they usually enjoy
Appearing angry or irritable
Boredom and apathy
Isolation from friends and family
Headaches, stomach aches, and other ill type symptoms
Thyroid problems are relatively common and can be present at birth or develop later in life.
Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. About 5% of people over 12 years of age has hypothyroidism.
People with hypothyroidism might feel depressed, be tired, have poor focus, and become forgetful. They might gain weight or have slowed growth. They might feel colder than others or have constipation. Sometimes they’ll develop a swelling in their neck called a goiter.
Most of these are very common symptoms that are not specific to thyroid problems. Having some of them does not necessarily mean that there is a problem with the thyroid. If there are several of these symptoms, it’s relatively easy to screen for thyroid problems with a blood test.
Schedule an appointment to talk to your pediatrician if you’re concerned about a thyroid problem.
5. Too much sugar
Although the body needs sugar for energy, eating too much refined sugar can cause weight gain, chronic disease and sugar crashes. Excess weight can make it harder to exercise and sleep, both of which help us not feel tired.
Limit the juices, candies, and other high-sugar / low nutrition foods. I know this is easier said than done when kids beg and cry for candy. It’s even harder to limit when kids grab their own snacks.
Keep easy to eat healthy snacks available as much as possible. Don’t buy the junk. Kids will get plenty of it outside the home. If it’s not at home, they won’t grab it.
Most adults have grabbed a caffeinated beverage to help ward off fatigue, but caffeine can lead to poor sleep and more tiredness. It can become part of an unhealthy cycle.
Kids don’t need caffeine. If they do have it, it should be before noon. Caffeine can stay in your body for about 8 hours and keep you from sleeping.
Children under 10 years of age should not have caffeine due to jitteriness, irritability, and other side effects. It’s recommend that kids who are 10 – 12 should get no more than 85 mg per day. Teens should have 100 mg or less. Up to 400 mg of caffeine a day appears to be safe for most healthy adults.
Mixing caffeine with certain medicines or alcohol can increase its problems.
Our red blood cells bring oxygen to the cells of our body, and when the levels are low we can feel tired. Other symptoms are irritability and pale skin coloring. Often there are no symptoms with mild anemia.
There are many causes of anemia. Blood work can help to identify anemia and its causes. Treatment depends on the cause.
If you’re worried about anemia, schedule an appointment with your pediatrician. A history and exam will be needed to determine if labs are indicated.
It makes sense that if you don’t sleep enough, you’ll be tired. When people have insomnia, they do not sleep enough hours.
There are many causes of insomnia, but all can lead to insufficient sleep. Addressing the underlying cause is important.
Nicotine (growing in popularity among kids due to vaping)
If your child is struggling to sleep, schedule an appointment to discuss potential reasons and treatments.
9. Sleep apnea
Sleep apnea happens when a person stops breathing during sleep. It’s usually caused by something blocking the upper airway. You might hear snoring followed by pauses in the breathing pattern, gasps, or choking sounds.
Because the airway is obstructed, oxygenation levels can fall briefly. This triggers the brain to wake up to open the airway. When this happens repeatedly throughout the night, sleep quality is affected. A person wakes feeling tired.
Not enough sleep is the common thread to many of these.
Not enough sleep is the #1 reason I find for kids being tired. They need more sleep.
Studies show that many of us just don’t sleep enough. It’s important for kids to get adequate amounts of sleep. If your child is tired and is not able to sleep sufficiently, talk to your pediatrician about ways to improve sleep and decrease fatigue.
Spring is a beautiful time of year. The flowers bloom, the birds chirp… it’s like we’re all awakening after a long, cold winter. But with the flowers (and birds) comes pollen. And with pollen comes allergies. I don’t want anyone to be afraid to enjoy the beautiful outdoors, so learn to control allergies.
Why treat allergies?
I often hear parents say that they don’t want to give their kids medicine to treat allergies because, well, it’s medicine. They prefer to be natural and the symptoms don’t seem “that bad”.
Before you decide if the symptoms require treatment or not, be sure to recognize all the potential consequences of allergies. It’s not just a runny nose and sneezing.
For people with asthma, allergies are a known trigger. It’s especially important that people with wheezing tendencies keep up on allergy prevention and treatments.
Some will chronically mouth breathe, which can affect the growth and development of their jaw, lead to bad breath, and increase the risk of cavities. Dr. Deborah Burton, an ear, nose, and throat specialist, discusses these and other consequences of mouth breathing in one of her DrMommaSays blogs.
How do you know it’s allergies?
Allergies can cause runny nose, headache, congestion, sneezing, watery eyes, itching eyes, sore throat, itchy throat, and itchy skin. Not all symptoms need to be present.
An upper respiratory tract infection (AKA common cold) can also cause a runny nose, headache, congestion, sneezing, watery eyes, and sore throat. The difference is the cold symptoms tend to not last as long as allergies. There also could be a fever, body aches, and a general feeling of “not well” with viral infections.
Seasonal allergies tend to follow a seasonal pattern, so they can be easier to recognize than allergies to indoor allergens.
These days it’s easy to track pollen counts online. If you realize that every day the counts for one type of tree or grass is elevated you have symptoms, that’s strong support that you’re allergic to that plant.
Of course, it’s possible to get a cold on top of your allergies, which adds to the confusion sometimes.
Treatments to control allergies
It is best to treat before the symptoms get bad. Treatments include not only medicines, but also limiting exposure.
Use what you can to prevent and treat allergies, which most often means using more than one of the following treatments.
Limiting exposure can help decrease symptoms.
Avoid Bringing allergens into the Home
Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.
Keep the windows closed. Sorry to those who love the “fresh air” in the house. For those who suffer from allergies, this is just too much exposure!
Beloved pets cause unique issues
If someone’s allergic to animals or suffers from year long symptoms, learn if your family pet is a problem.
When you have pets that go outdoors and then into the home, bathe them regularly.
Don’t let pets on the couch or beds and keep them out of the bedrooms of allergic sufferers.
If you know a family member is allergic to an animal, don’t get a new pet of this type!
If you already have a loved pet someone in the home, consider allergy shots against this type of animal. Talk to your pediatrician and consider a trip to an allergist.
Wash and clean
Wash towels and sheets weekly in hot water.
Vacuum and dust weekly. Consider cleaning home vents. Consider hard flooring in bedrooms instead of carpeting.
Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them.
Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms.
Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don’t smoke near them.
And for those of you who vape, it’s not better. We’re still learning the risks of e-cigarettes because vaping is relatively new, but early data supports staying away from e-cigs!
Wash it off of you!
Wash hair, eyelashes, and nose after exposures — especially before sleep. They all trap allergens and increase the time your body reacts to them.
Learning to rinse your nose
I have found the information and videos in Nasopure.com‘s library to be very helpful. You can teach kids as young as 2 years to wash their noses. Note: I have no financial ties to Nasopure… I just love the product and website!
I am an Amazon Affiliate member, so if you buy from this Amazon link, I do get a small percentage.
If you wear contacts
If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts.
I don’t want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help.
Antihistamines work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms.
Some people respond well to one antihistamine but not others, so sometimes you must use trial and error to find the right one.
In general I prefer the 12-24 hour antihistamines simply because it’s very difficult to cover well with a medicine that only lasts 4-6 hours, such as diphenhydramine (Benadryl) and they’re less sedating. Long acting antihistamines include loratadine -Claritin (24 hour), fexofenadine- Allegra (12 hour for kids, 24 hour for teens and adults), and cetirizine- Zyrtec (24 hour).
Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best.
If they make your child sleepy, giving antihistamines at bedtime instead of the morning might help.
Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.
Antihistamine and decongestant combinations
Antihistamine and decongestant combinations are available but are not usually recommended. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.
Once control of the mucus is achieved, a decongestant isn’t needed. Giving a medicine that isn’t needed just increases the risk without increasing the benefit.
If you need a decongestant initially, you can use one with your usual antihistamine.
Most decongestants on the shelves are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine.
Decongestants do NOT fix a cold, they only dry up some of the mucus.
They are available both as over the counter allergy drops and as prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better. Most insurance companies don’t cover prescription allergy eye drops well, so you might want to check your formulary before asking for a prescription. This is usually available on your insurance website after you log in.
If your child resists eye drops
Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye.
It helps control both allergies and asthma and is best taken in the evening.
Once a person has been on montelukast for a couple of weeks, they usually don’t need an antihistamine any longer.
Montelukast is available only by prescription, so make an appointment to discuss this if your child might benefit.
Steroids decrease allergic inflammation well. These include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma).
The nasal steroids are discussed above and are highly recommended for kids and adults who tolerate putting a spray in their nose.
Other steroids require a prescription, so a visit to your provider is recommended to discuss proper use.
What if all of the above isn’t helping to control allergies?
Maybe it’s really not allergies.
There are many things that can seem to be allergies but aren’t. If proper treatment is not working, reconsider the diagnosis.
It’s possible that the allergy treatment is working, but you caught a cold on top of the allergies. Both are common, so they can occur together.
Allergies to things other than foods are rare before 2 years of age. If you’re treating allergies in an infant or toddler, be sure to keep your pediatrician in the loop.
I’ve known people who are treated for years by an allergist for allergies, but when they’re tested due to a poor response, they have no allergies. They might have frequent infections or other irritants like smoke exposure. Learn to control these issues too, starting with good hand washing, avoid touching your face, and avoiding smoke.
Allergy testing is possible by blood or skin prick testing, but can be costly. Not to mention the fact that kids tend to not like needles, which are used with most testing.
Allergy testing isn’t recommended for most allergy sufferers. It can be used to guide allergy immunotherapy, which involves routine allergy shots. Most suffers don’t need allergy shots, but if you think your child would benefit (and allow them), talk to your doctor.
In most cases I don’t find test results very helpful for environmental allergens because you can’t avoid them entirely. You can limit exposures as discussed above, regardless of test results.
Tracking patterns and symptoms to identify allergies
By tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time. Reports of pollen and mold counts are found on Pollen.com.
Rather than testing, note animal exposures and household conditions and any symptoms seen with exposures.
Write symptoms and exposures weekly (or daily). It often doesn’t take long to see patterns. Testing is important if allergy shots are being considered.
Need help tracking allergy symptoms? There’s an app for that! Here’s one review I found of allergy apps. I don’t have any personal experience of any, so please put your favorite in the comments below to help others!
Wrong medicine or wrong dose.
Some people have more severe allergies and need more than one treatment. I personally use eye drops, nasal spray, and an oral antihistamine in addition to nasal washes and daily (sometimes twice daily) showers when my allergies flare.
Switching types of medication or adding another type of medicine might help. If you need help deciding which medicines are best for your child, schedule an office visit with your PCP for an exam and discussion of symptoms.
Some kids outgrow a dose and simply need a higher dose of medicine as they grow. Talk to your pharmacist or physician to decide if a higher dose is indicated.
Is Nothing working?
Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above.
Schedule an appointment with your pediatrician to discuss if this is an option for your allergy sufferer.
This blog is generally about pediatric health, but sometimes the principles are similar in adult medicine, so I’m sharing a personal story.
I was visiting my parents out of town and came down with fever, chills, and a sore throat. Due to the fatigue and shaking chills, I wasn’t sure if I’d be able to drive the 4 hour trip home the following day. I decided to go to a walk in clinic to see if there was a treatment to help get me on my feet again.
Although it’s less common for adults to get Strep throat, I wanted to have my throat swabbed because I had been exposed to just about everything at work.
If it was just a viral illness, fine. I’d tough through it with fluids and a fever reducer for the body-shaking uncomfortable chills.
But a child had gagged and coughed in my face earlier that week when I was doing a throat swab – and he had Strep. If I had Strep (as I hoped), then an antibiotic would treat the cause and I’d be back in shape in no time.
I could technically call out an antibiotic for myself, but I didn’t want to do that. That is poor care and I would never recommend treating anyone with a prescription without a proper evaluation.
I followed my own advice and went to a walk in clinic since I was out of town. If I was at home, I would have gone to my primary care physician because I believe in the medical home.
The provider walked into the exam room looking at the nurse’s notes saying it sounded like I had a sinus infection. (I use the term provider because I don’t recall if he was a physician, NP, or PA.)
He hadn’t even examined me or gotten any history from me other than answers to the cursory questions the nurse asked. Not to mention that my symptoms had just started within the past 24 hours and didn’t include any form of nasal congestion or drainage.
I’m a physician and know that sinusitis must have persistent symptoms for much longer than 24 hours. But I kept that thought to myself for the moment.
He did a quick exam and started writing a script to treat my sudden onset of fever without cough/congestion.
He literally started writing the script as he was telling me, once again, that I had a sinus infection.
Now I couldn’t stay quiet any longer.
I said I really just wanted a throat swab to see if it was Strep. I didn’t want an antibiotic if it wasn’t Strep throat.
He argued for a bit about the validity of rapid Strep testing.
I argued that I did not meet the criteria for a sinus infection and that the rapid strep tests are indeed fairly reliable (not perfect).
As a pediatrician I won that argument easily. In the end I was swabbed.
The test was negative. I most likely didn’t have Strep throat after all.
He still gave me a prescription for a commonly used antibiotic called a Z-pack, which I threw away.
Did I get better?
I felt better the next day, so if I had just taken the z-pack, I would have thought it worked.
Ironically, the Z-pack is not a very good antibiotic against Strep, the one reason I would have taken an antibiotic. Resistance rates are high in my area, so unless a person has other antibiotic allergies (which I do not) I would not choose it for Strep throat.
But my body fought off an unnamed virus all by itself. That’s what our immune system does. Pretty cool, right?
No. Not cool.
Well, yes… it is cool that we can get better with the help of our immune system and no antibiotics. But not cool that a less knowledgeable person would have taken the prescription without question.
Unfortunately, I think many people trust the medical care provider, even when he or she is wrong. Even smart people don’t know how to diagnose and treat illnesses unless they’re experienced in healthcare, so anyone could be fooled. Especially since we’re vulnerable when we’re sick. Even more so when our kids are sick. We want to do anything to help them.
False security in an unnecessary treatment.
Many parents come into my clinic wanting an antibiotic for their child because the child has the same symptoms as they have and they’ve been diagnosed with a sinus infection, bronchitis, or whatever. They’re on an antibiotic and are getting better, so they presume their child needs the same.
Most of the time they both likely have a viral illness, and the natural progression is to get better without antibiotics, but it’s hard to get buy in to that when a parent’s worried about a child. Even harder when the parent is certain that their antibiotic is fixing their viral illness.
Confirmation bias is the tendency to process information by looking for, or interpreting, information that is consistent with one’s existing beliefs.
A false belief is reinforced when we think we get better due to an antibiotic. It doesn’t prove that the antibiotic worked, but our minds perceive it as such.
We want to believe something works, and when it appears to work, it affirms our false belief.
The wrong treatment plan.
In my example, not only did I not have a sinus infection, but if I did have a false negative Strep test and actually needed an antibiotic for Strep, the Z-pack wasn’t a good choice.
False negative tests mean that there is a disease, but the test failed to show it. False negative tests are the reason I usually do a back up throat culture if I really think it is Strep throat and not a virus.
If the wrong treatment is given, not only do you fail to treat the real cause, but you also take the risks associated with the treatment for no reason.
Doesn’t the doctor (or NP or PA) know the antibiotic won’t work?
Yes, they know (or should know) how antibiotics work and when they’re indicated. But unfortunately, there are other factors at work when quick fixes are chosen.
Top 3 reasons that lead to patients getting unnecessary prescriptions:
One problem is that it’s much easier to give a prescription rather than taking time trying to teach why a prescription isn’t needed.
The faster they see a patient, the more patients they can see and the shorter the waiting time is, which makes people happy.
I see many unhappy parents who follow up with me because their child is still sick and the “last doctor” did nothing. I have previously blogged about the Evolution of Illness so will not go into it in depth here.
Sometimes it’s hard for physicians, NPs, and PAs to not try something to make a sick person better. After all, that’s why we do what we do, right? We want to help. We’ve all heard of patients who get progressively ill because an infection wasn’t treated quickly and we don’t want to “miss” something.
While missing a significant illness can happen, it’s not common. Common is common. Most upper respiratory tract infections are viral. It’s knowing how to recognize worrisome symptoms that comes from experience.
Physicians (MD, DO)
Physicians spend years of not only classroom training, but also clinical training to learn to recognize warning signs of illness. Even a brand new physician has at least 2 clinical years during the total 4 years of medical school. Then they spend at least 3 years of residency seeing patients in a supervised capacity before they can work independently. That’s at least 5 years of 60-80 hour work weeks.
The physicians in my office, including myself – now 18 years in practice – still ask for help if we feel it could be beneficial. Sometimes a second set of eyes or putting our heads together helps to put things into a clearer picture.
Trust that if we say it’s a virus, it’s a virus. We know that bodies can still be significantly sick if it’s Just A Virus, but most of the time you can manage symptoms at home. Listen to what we say are warning signs that indicate your child should be reassessed. Bring your child back if symptoms worsen or continue longer than typical. Symptoms can worsen, but taking an antibiotic does not prevent that progression in most cases.
Be sure to question if you do not understand or agree with an assessment or treatment plan, as I did in my example above. It is essential to have this type of communication for the best care.
Nurse Practitioners (NPs) and Physician Assistants (PAs)
I love the NPs in my office. They do a fantastic job and make patient access easier. They see a lot of sick kids and do a great job treating when needed and giving “just” advice when that is what is needed. (That’s usually harder, trust me.)
They are always able ask questions if they don’t know what to do or for a physician to see a patient if a parent wants a second opinion.
I do not want this to become an argument if NPs and PAs are good. They are needed in our healthcare system to help patients get seen in a timely fashion. I welcome and appreciate them as part of the healthcare team.
But I do want to acknowledge that the training and background can vary widely, and I think it’s important to know the experience of your provider. It is not as regulated to become an NP or PA as it is to become a physician.
Many NPs have years of work experience before returning to school to get their advanced degree. But newer online programs do not require much clinical experience. At all.
If they then begin working independently without much supervision, they learn as they go and may or may not learn well. I’m not saying they’re not smart, but I also know how lost I felt those first months as a new physician after many supervised hours, and I know they have a small fraction of those supervised hours. I can’t imagine doing that as a new grad!
This is why I think that all new practitioners should work with others who have more experience, so they can learn from the experience of others. I worry when inexperienced people work alone in clinics, with no one to bounce questions off of.
We can’t see what your child experienced last night if we’re seeing them in the morning and symptoms changed. Many symptoms are worse overnight, which makes it difficult to assess during the day. Of course if symptoms are urgent at night, go to a 24 hour facility that can adequately evaluate the situation.
If you are able to wait until regular business hours, you must describe it so we can understand it.
If you feel uncomfortable with the treatment plan, talk to the provider. List your concerns and let them address them. That’s not the same thing as demanding a prescription or further testing. It means asking for more information about why they feel the current plan is the correct one.
Many hospitals, clinics and insurance companies are surveying patients to see if “good care” was provided. These surveys are used to place providers on insurance contracts and decide payment and salaries.
People are happier and think care is better if something was done. A lab, x-ray, or prescription (whether needed or not) is “something” people can identify.
People do not feel that information about viral illnesses and what treatments can be done at home is as worthwhile as a tangible treatment, even if it’s the correct treatment. They see the prescription as making the cost and time taken for the office visit “worth it” even if it is bad care. Leaving empty handed (but with proper treatment) doesn’t satisfy.
It happens all the time. Kids put things in their mouth that aren’t supposed to be eaten. Parents often call after their child swallowed a toy piece, a coin, and many other things. Most of the time things will just pass — though I’m not a fan of watching the stools for the swallowed object because it just worries parents if they miss it.
Who swallows non-food things?
The biggest risk group is children between the ages of 6 months and 6 years, but anyone can be at risk.
I have seen an older school aged child swallow a magnet after putting 2 small strong magnets on either side of their tongue to look like a tongue piercing.
Even adults have been known to swallow things such as needles – sewers put the needle in their mouth if you think about it.
If you are around kids it is a good idea to know child CPR and refresh your skills every couple years.
Classes are often held at local Red Cross stations, hospitals, or fire departments.
You can also find classes by searching “CPR” and your zip code.
Know warning signs
For great information on signs and symptoms of choking and general treatment of choking, visit this KidsHealth Choking link.
Of course, prevention is key
Store medicines and cleaning products where kids can’t reach them.
Be especially alert when visiting other people’s homes – especially if they don’t have young children.
Watch kids carefully when outside.
Throw away broken toys that could have pieces break off.
Keep young kids away from toys designed for older kids.
When to talk to your pediatrician
If your child seems to put more non-food items in his mouth than other kids, he is at risk of pica.
Pica is when a person compulsively puts non-foods in his mouth. For more see the KidsHealth Pica link.
Poison Control Number – use it!
Always keep the poison control number (1-800-222-1222) stored in all your phones!
If you call me about a potentially toxic substance, chances are I will refer to poison control. They have the best database of substance risks and their treatments.
Don’t delay treatment by calling the doctor!
Things kids swallow and what to do:
Balloons are statistically some of the most inhaled or ingested foreign bodies.
One reason is they are so popular with kids. Young kids often will try to bite them.
They often are found at parties or other large crowds, where toddlers and young children are often less directly supervised.
Balloons can suffocate a child quickly if they are inhaled.
Call 911 if there is any difficulty breathing, drooling, or other signs of distress. This can mean the balloon was inhaled into the lungs, not swallowed.
If swallowed, they will pass on their own.
Keep balloons away from young children and supervise school aged kids when around balloons.
If you think your child has swallowed a battery, whether or not he appears distressed, immediately take him to an emergency room.
If there is distress, call 911.
Batteries can cause voltage burns or leak, causing acidic burns as soon as four hours after being swallowed.
X-rays will confirm if the battery is in the chest or abdomen.
Batteries usually need to be removed to prevent serious injury.
Be sure to keep all of your batteries, especially the small button batteries, safely stored away from children.
Make sure battery-charged items have the battery securely secured. Most now have covers secured with screws. If the cover is easily removed, your child is at risk!
Most of us has swallowed a bug some time in our life. You might not even know if a small one hides in your soda can and you take a big gulp.
A little extra protein, right?
Unless your child chokes, or if it has a stinger (bee, wasp) there is nothing to worry about.
If you suspect a bee or wasp was swallowed, especially if your child seems to be reacting to a sting in the mouth, or there’s sudden difficulty breathing, drooling, or choking, call 911. Serious reactions to stings in the mouth can occur.
Watch kids closely when outside, especially those under 3 years of age or kids who are known to put things in their mouth.
Buttons are generally harmless unless they get stuck or inhaled rather than swallowed.
Signs of breathing difficulty, choking, drooling, or generalized distress should alert you to bring your child to be evaluated.
Buttons are not easily seen on X-ray, which can make identification of a stuck button a little tricky, but if you suspect an issue, talk to your doctor.
Keep unattached buttons (the ones in your sewing kit) stored away from kids.
Monitor your children’s clothing and repair any loose buttons.
Cinnamon is technically a food, but the cinnamon challenge is leading kids and teens to take a spoonful, which can be very dangerous.
The challenge involves something along the lines of swallowing a tablespoon of cinnamon without water.
Ingestion of the cinnamon powder stimulates the gag reflex followed by inhalation of the powder. This causes excruciating pain due to the chemical properties of cinnamon.
It can also trigger airway narrowing and an asthma attack.
And there’s more.
Cinnamon is powdered bark. The cellulose matrix of tree bark acts like a sustained release medicine, slowly releasing a painful and damaging chemical in the lungs.
The body cannot metabolize cellulose. When it’s eaten, it gets passed into the toilet. But if it’s inhaled, our lungs can’t metabolize it.
On the surface many things seem just silly and not really dangerous. But unless they know all the risks and consequences and know it is safe, they shouldn’t do the challenge.
Don’t limit this talk to just cinnamon. Use it as an example, but we never know what the next crazy challenge will be – the next category includes a more recent challenge.
Cleaning products, laundry detergent, and other chemicals:
These are highly dangerous and you should call poison control with any suspicion of ingestion. 1-800-222-1222
Call 911 if there are signs of distress.
Cleaning products should always be stored away from children to prevent the possibility of swallowing in the first place.
Even the “green” products are usually not safe with ingestion.
And it’s not just toddlers… for whatever reason teens swallowing laundry pods has become a “thing” – talk to your teens about the risks. See the cinnamon challenge information above.
Coins are some of the most frequently swallowed objects.
These usually pass through the body without any problems, but many parents never see it come out the other end.
Since it is so common you would think there would be a consensus as to how to manage it.
When there’s distress
Of course if there is any distress, drooling, breathing difficulty or coughing, your child should be seen immediately, ideally in an ER so that an immediate surgical consult can be made if necessary.
If it was inhaled into the windpipe instead of swallowed into the esophagus or stuck high in the esophagus causing compression on the wind pipe, it may need to be removed.
When there’s no distress
As for kids who swallow coins and have no symptoms, it isn’t as clear cut what to do.
Some doctors get X-rays for all children who swallow a coin to be sure it isn’t stuck in the esophagus. About a third of those stuck eventually end up passing, but most need to be removed.
Some physicians only obtain an X-ray if there are symptoms.
Some physicians remove the ones in the esophagus immediately, others will wait up to 48 hours if there is no distress.
Generally once it reaches the stomach it will pass.
Keep coins out of the hands of kids under 3 years old, and supervise young children closely with them.
Remind kids to never put them in their mouth. Not only for the small choking risk, but eeewww… coins have been handled by many and are full of germs!
Crayons or play doh:
I used to wonder why so many things were labeled “non-toxic” — at least until I had a child of my own.
They put everything in their mouth!
These are generally safe (again, unless they choke), although it is possible that these things contain lead or other contaminants.
As with everything, supervise young children when they’re playing.
If your child frequently puts them in the mouth, it’s probably a good idea to not allow your child to play with them unless you’re consistently watching them.
Talk to your doctor about pica if they continue to put non-food items in their mouth after 3 years of age.
Dirt or rocks:
Unless your baby chokes or bites down on a rock and breaks a tooth, dirt and rocks are generally harmless.
Supervise young children when playing outside.
If your child seems to crave these and eats dirt compulsively, be sure to talk to your doctor about pica.
Energy drinks are a popular choice for many, but they contain caffeine and other stimulants that can make them dangerous for children.
Many adults drink caffeine in various forms, so mistakenly think energy drinks are safe. Learn the risks!
Risks from energy drinks
They can lead to dehydration because caffeine is a diuretic.
Energy drinks also can increase heart rate and blood pressure.
They can increase shakiness, anxiety, insomnia, and headaches.
Routine energy drink consumption has been shown to increase the risk of obesity and Type 2 Diabetes, due to the high sugar content.
People build a tolerance to caffeine, leading to increased consumption over time.
Teens are more likely to take dangerous risks when high on caffeine. This could result in injury or legal trouble.
Ingredients in energy drinks can interact with other medications one is taking.
Call poison control if you suspect problems from energy drinks
If you drink energy drinks, keep them away from your children.
Talk to teens about the risks of energy drinks. There are deaths reported in teens who drink energy drinks and then participate in sports or alternate alcohol with energy drinks.
Grass or plants:
Unless the grass was recently chemically treated or if the plant is poisonous, there is little to worry about here.
If you’re unsure about a plant being poisonous, contact poison control.
If there is choking, do CPR and call 911.
Contrary to popular belief, the occasional swallowed gum does not stay in your gut for years.
It isn’t digested like other foods, but unless it gets stuck along the way, it finds its way out just like all your other food.
Hand sanitizer in small amounts, such as putting fingers in the mouth after rubbing sanitizer on the hands, is generally safe.
Larger amounts can be dangerous and you should call poison control if you suspect ingestion.
Keep hand sanitizer away from young children and talk to school aged kids about risks.
Be alert of the sanitizer hanging from your diaper bag or purse!
A single magnet is not a worrisome as multiple magnets, but since it often is not known exactly what a child swallows, it is always recommended to take your child to be evaluated if there is a suspicion of swallowed magnets.
They will need X-rays and if there are multiple magnets, they must be removed to prevent perforation of the gut.
Keep all magnets away from young children.
Talk to older kids about the risk of swallowed magnets and be sure they understand that they can never put one near their mouth!
Medicines, vitamins, supplements
If your child swallowed (or potentially swallowed) a medication or supplement, call the poison control number ASAP.
Have the bottle with you so you can answer their questions.
Make sure medicines and other pills are kept away from kids.
Talk to Grandma about either removing them from her purse or putting her purse out of reach when she’s visiting.