Blog

Featured

Flu Season Fears: What should you do?

Headlines are making everyone nervous about this year’s flu season. Schools are closing due to high flu numbers. Parents are worried that their child will be the next that dies.

Yes, the risk is real.

But there are things to do.

First: Prevent

Vaccinate

Vaccines are the one of the best inventions to prolong our lives. They really can help. I know the flu vaccine (or any vaccine) isn’t 100% effective, but it does help. Everyone over 6 months of age should get a flu shot.

I’ve heard from many pediatricians taking care of kids hospitalized with influenza, and none of the dying kids were vaccinated.

Kids who were vaccinated this season might get flu symptoms, but generally not as severe.

It does take 2 weeks for the vaccine to be effective, so get it ASAP. Kids under 9 years old who haven’t been vaccinated for flu previously will need 2 doses a month apart. Call around to see where you can get it.

If your kids (or you) are scared of shots, check out these tips.

Not convinced? Check out these 10 Reasons to Get the Flu Vaccine.

Wash hands

Wash hands often. This goes without saying. Whatever you touch stays on your hands. When you bring your hands to your face, the germs get into your body. Teach kids to wash hands well too!

Cover!
cough, cold, urgent care, primary care, medical home
Cover your cough!

Teach kids to cover their cough (and sneeze) with their elbow. This collects most of the germs in the elbow. Hands touch other things, so if you cover with your hands, you need to wash them before touching anything.

The only time I don’t recommend the elbow trick is if you’re holding a baby. Their head is in your elbow, so you should use your hands to cover and wash often!

You can get masks at the pharmacy to cover your nose and mouth to protect yourself from catching something and to prevent spreading an illness you have. We have masks available for anyone who comes to our office. We ask those who are sick to wear them, but those who are well can also put them on to prevent catching something!

In my office you’ll see that most of our nurses and clinicians have opted to wear masks when seeing sick kids even though we all have had our flu vaccine!

Avoid the T-zone

Avoid touching your face. It’s a horrible habit that most of us have. Be conscious of how often you wipe your mouth, eyes, or nose. Those are the portals to our body. Avoid touching them unless you can wash your hands before and after. Show kids how the eyes, nose and mouth make a “T” and teach them to not touch their T-zone.

Stay home when sick.

I’ve heard many angry complaints from parents about exposures. One mother was sick because she was exposed at work and then her illness spread to her family. She was especially upset because the exposure was from a child of a co-worker who brought the child to work because the child was sick and couldn’t go to school.

Keep sick kids home. If you’re sick: stay home.

If you’re sick with a flu-like illnesss, don’t
  • run to the store.
  • send your child to school with ibuprofen.
  • go to work.
  • go to your child’s game.

Stay home unless you need to seek medical attention.

Tamiflu and other anti-virals

My office is getting inundated with phone calls requesting us to call out Tamiflu. In some instances it’s appropriate for us to prescribe it for prophylaxis, but often we want to see your child first. If your child has flu-like symptoms, I do not want to prescribe a treatment without first evaluating your child. I don’t want to miss a more serious case that needs to be hospitalized. I don’t want to treat bronchiolitis or another condition as flu and miss the proper treatment. More on treatment with Tamiflu below.

Prophylactic uses

Tamiflu can be used for prophylaxis after exposure, but don’t rely on it. (If you follow my blog, you know I’m not a Tamiflu fan.)

Newborns

Some of the calls we are getting are from mothers with influenza who have newborns and their OB’s have recommended prophylaxis for the baby. If the baby is under 3 months of age, Tamiflu is not approved for prophylaxis. (See the chart and corresponding footnotes from the CDC below.) If you are sick, try these tips to prevent spreading illness to your kids.

Community exposures

Many calls are from parents worried about a classroom (or other) exposure in a child who is not high risk. Unfortunately we cannot and should not use Tamiflu for routine exposures. Tamiflu itself is not without risk and if overused it will not be available for people who might really need it.

Big event coming soon!

A big birthday party, a big test, a planned vacation, etc do not make your child high risk. We really shouldn’t use Tamiflu inappropriately just because flu will make life inconvenient. Remember that all treatments have potential side effects and if we use them indiscriminately they will not be available when really needed.

Tamiflu prophylaxis is recommended for high risk people who have known exposure.

High risk includes:

  • children under 2 years of age
  • adults over 65 years of age
  • persons with chronic lung (including asthma), heart (except hypertension alone), kidney, liver, hematologic (including sickle cell disease), metabolic disorders (including diabetes mellitus) or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
  • persons with immunosuppression, including that caused by medications or by HIV infection
  • women who are pregnant or postpartum (within 2 weeks after delivery)
  • under 19 years of age receiving long-term aspirin therapy
  • American Indians/Alaska Natives
  • persons who are morbidly obese
  • residents of nursing homes and other chronic care facilities

Prophylactic and treatment options are summarized in this table from the CDC:

Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza
Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza

Finding Tamiflu

Right now it’s hard to find Tamiflu in many parts of the country, so you might not be able to get it after you’re exposed (or even if you’re sick with flu).

What’s better than Tamiflu?

Flu season can last through April, so taking it for 10 days now won’t help in 2 weeks when you’re exposed again. The flu vaccine protects more effectively and for a longer duration!

If sick: Treat

Most flu symptoms can be treated at home.
Fever and pain reducers

Use age and weight appropriate pain and fever reducers, such as acetaminophen and ibuprofen to keep kids comfortable. It is not necessary to bring the temperature to normal – the goal is to keep them comfortable. Don’t fear the fever – it is the immune system hard at work!

Offer plenty of fluids

Infants should continue their breastmilk or formula as tolerated. Older kids can drink water and it’s okay for them to eat. There is no need to avoid foods if a child wants to eat – I don’t know where the “feed a fever starve a cold” or other common myths started. Of course, appetite is usually down during illness, so don’t push foods. Push fluids.

Saline and suction

Saline and suction can go a long way to help relieve nasal congestion. Noisy breathing isn’t necessarily bad, but if the breathing is labored that’s another story. Check out the Sounds of Coughing to learn how to identify various breathing problems.

Cough medicine?

Pediatricians don’t recommend cough medicines due to high risk of side effects. Kids over a year of age can use honey. Some kids can get relief from menthol products. I’ve previously written all about cough medicines if you want to read more.

Natural treatments?

A lot of parents want to do natural treatments. Learn which have been shown to work and which haven’t.

For more…

For more on treating symptoms, visit my office website’s tips.

when not to go to the doctor

Not every person with influenza needs to be seen by a medical provider. I know we’re all scared, but in most cases there isn’t much doctors and other healthcare professionals can do to help.

Medical offices, urgent care clinics and ERs are overwhelmed with mildly sick people, which makes it harder for those who are really sick to be seen.

If your child is low risk (anyone who doesn’t meet the high risk criteria above) and is drinking well, overall comfortable with support measures, and doesn’t have any breathing distress, you can manage at home. Certainly if the situation changes, bring him in, but coming in before any signs of distress will not “ward off” the development of those symptoms.

When you should bring your child to be evaluated

If you think your child might have another illness, such as Strep throat, ear infection or wheezing, bring him in for evaluation and treatment.

When any signs of distress are noticed in your child: bring him in.

If your child is high risk (as described above) and has sick symptoms, he should be seen to determine if Tamiflu is appropriate. I do not recommend getting Tamiflu called in if a child is symptomatic. A child should have an exam to be sure there aren’t complications before just starting Tamiflu. I’ve seen several kids whose parents thought they had flu, but their exam and labs showed otherwise. They could be properly treated for Strep throat, ear infections, or pneumonias instead of taking Tamiflu inappropriately after an evaluation.

How can you tell if it’s the flu or another upper respiratory tract infection?

I have seen many kids who are brought in with a runny nose just to see if it’s early flu. No. No it’s not. Flu hits like a tsunami: fever/chills, cough, body aches, and fatigue. But the child was playing in the waiting room full of kids who do have flu, so you might recognize flu symptoms soon.

cold vs flu
From the CDC: How to tell if it’s a cold or the flu?

If your low-risk child had the flu vaccine, they may still get influenza disease. But if it’s mild, they can be treated at home. If symptoms worsen, they should be seen. Yes, there is a benefit to starting Tamiflu early, but we shouldn’t use it for low risk people who aren’t significantly sick. Even if you come in early, Tamiflu probably won’t be recommended if your child doesn’t meet criteria. Tamiflu has some significant side effects and is in short supply. We shouldn’t overuse it.

Flu testing

We currently have the ability to do a rapid flu test in the office, but there is a national shortage of the test supplies, so we might choose to not test your child if they don’t meet high risk criteria. I know at least one local hospital is out of rapid test kits and we probably won’t be able to get more this season if we run out.

Don’t come to the office or go to an urgent care or emergency room just to be tested.

Please don’t be upset if we do not test your child, especially if your child is not high risk and we wouldn’t recommend Tamiflu if they are positive.

If your child has classic flu symptoms, the guidelines don’t rely on test results for treatment, so if your child meets criteria for treatment, we can prescribe without a positive test.

Knowing test results doesn’t really help guide treatment when we have such high numbers of flu in the community. It does help early in the season to recognize when flu is coming to town, but we know it’s here. Pretty much everywhere in the US, it’s here.

Let’s work on stopping the spread.

Be healthy!


Share Quest for Health

 

Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.

 

I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:

 

Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.



Share Quest for Health

First Period Q&A with Teens

Over the years I’ve talked with many girls about what to expect during puberty. Some of the biggest questions we all have involve the mysterious first period. I have dug into the recesses of my brain to come up with all the questions asked over the years to put all the information down in one place, though I’m sure I’ve missed a few.

If you have a daughter starting puberty, please share this information with her.

Are there any other questions she has? Put them in the comments section and we’ll tackle them!

Is there a good way to know when I’ll start my period the first time?

puberty, periods, menstrual cycleYou will never know exactly when your period will start, but good clues that it is getting close to time:

  • It’s been about 2 years since your breasts started growing. (Remember those first bumps?)
  • There’s clear, white, or yellow stuff in your underwear sometimes. It can look like dried boogers or just a little crusty stuff in your underwear, but it’s not from being unclean or peeing in your pants. Your body is just getting ready for the full cycle of ovulation (when the egg is released) and the period. Your vagina is moistened with a clear fluid that can drain onto your underwear. Another thing you might notice is mucus is released once a month, about half way between your periods when the egg is released from your ovary once you’re on a regular monthly cycle. It often begins before the period starts. As long as there is no pain or funny odor, this discharge is normal. Talk to your doctor if it does smell bad or if you hurt or itch in that area.
  • Pimples. Pimples are common with puberty (and for years following). Many girls will notice that the pimples tend to worsen right before their period starts.


I’m too young for a period. None of my friends even have boobs! Can I stop it?

Puberty has such a wide range of normal ages so it is common for one girl to go things much sooner than her friends.

Puberty is most common between 9 and 16 years of age (though some girls notice breast buds as early as 7 or 8 years old).

The common age for a period to start is between 10-15 years old.

If you are outside of this normal age range, talk to your doctor about it because there are many reasons. Some can be as simple as your family tree (when did your mom or sisters start?) but some can be a medical issue that can and should be treated.

And the opposite issue:  All my friends have had their periods for a long time, but I barely have boobs. When will I start?

Again, there is a wide range of normal (see the question above).

Some families have a later puberty than others, so it might just be in your genes.

There are other reasons that deserve talking with your doctor about, such as being underweight– which delays puberty, and other medical issues that need an investigation to uncover a cause that might need to be treated. (That sounds like a mystery book, but your doctor will know what to do!)

Bottom line for early or late puberty: 

If you are outside the normal age range, please talk with your doctor.

Don’t be embarrassed to bring it up!

They might either reassure you that things are still okay, or they might help find the reason and get your body the treatment it needs. Some of these can be serious problems, so don’t be shy about going to the doctor.

This is one reason that a yearly physical exam is especially important until growth is complete — your doctor can help keep track of a normal growth progression.

How much blood will there be, and what does it feel like?

The amount of bleeding varies from day to day, month to month, and person to person.  It is common for the first 2 years to have irregular cycles, but many girls can begin to predict their blood flow volume pattern after a few cycles.

Many girls have some pain during their period. The blood flow does not hurt, but as the uterus contracts it can cramp. Like other muscle cramps, there can be pain from period cramps, but the amount of pain varies in different people.

Some girls have cramping with every period while others never feel anything.

It’s okay to take over-the-counter pain relievers (like ibuprofen or naproxen) to relieve pain. Some girls find it helpful to take ibuprofen or naproxen 2-3 times/day (per package directions) starting 3 days before the period is supposed to start to prevent the cramps.

Eating healthy foods, getting regular exercise, and sleeping well every night also seem to help.

For severe period cramps that keep you from doing what you want (or need) to do, talk to your doctor.

What do I do if I start my first period and I don’t have any pads around or I’m not at home?

First, don’t panic!

Wipe yourself well and put a wad of toilet paper in your underwear. This is only a temporary fix and isn’t very comfortable, but it will suffice for a short time to help protect leakage through your clothes.

Remember that ALL women have periods, so it’s nothing weird to adult women (or men, for that matter, since they live in a world with women).

Ask a teacher, school nurse, friend’s mom, aunt, or whoever is around for help. She will not judge you or get freaked out. Really.

How long should I wear a pad or tampon?

Pads should be changed if they are visibly full or after 4 hours, whichever is first. (Except overnight.) If left on longer, they start to have a foul odor, and you don’t want that!

Tampons should be changed every 2-6 hours, depending on the amount of blood flow you have that day. Tampons come in different sizes for light days, regular days, and heavy days. Don’t ever wear a tampon longer than 6 hours because it can allow germs to grow and cause a serious infection. For that reason I don’t recommend wearing them overnight.

Once your cycle becomes more regular, you should be able to predict the flow by the day of the period (and time of day, since that often varies too). Use a calendar to track the amount of flow as well as the days of your period until you get it all straight. Either an old fashioned paper calendar or an app designed to track periods can help. (Search for “period calendar” or “menstrual calendar” in your app store if you have a smart phone or tablet.)

What do I do with the pad or tampon after it’s been used?

Most pads are disposable. You can roll it up, wrap it in a little toilet paper (or the wrap it originally came in) and throw it in the trash can. (Use a single layer, ladies! Don’t be wasteful with a wad of TP!)

If you use re-usable pads, they will have to be washed before the next use. Talk to your parent about where to keep them between uses.

Many people flush tampons down the toilet, but that can lead to clogged toilets in many sewage systems. Never flush into a toilet that uses a septic tank. Tampons do not break up like toilet paper does and they will clog a septic tank system. If you aren’t sure, you can wrap it in toilet paper and throw it in the trashcan.

Never flush a plastic applicator. You can either put it back in the wrapper or wrap in toilet paper and throw it in the trash.

I leaked! Not only am I totally embarrassed that everyone will know, what do I do to clean up my underwear?

When a period first starts, it often comes without warning and underwear can get soiled.

Heavy flow days can also cause leakage onto your underwear. If you expect a heavy flow day, you can wear old underwear, prepare with a product designed for heavier flow, and go to the bathroom more often to change the pad or tampon.

Despite the best techniques, all women sometimes soil their underwear and even their outer clothes. If you can change right away, fresh blood is easier to clean than dried blood. (This goes for just about any spill in the kitchen too, so clean up as soon as you spill!)

If you’re at school, go to the nurse’s office. She can help and it probably won’t be the first time a girl has come to her for help– really! If you’re at a friend’s house, see if she has something you can borrow if you don’t have an emergency change of clothes.

In general, cold water to rinse out blood is better than hot. Because blood is made of proteins that change in heat, the heat can “cook” the blood into the clothing and make the stain permanent.  If you have laundry detergent you can put a few drops on the stain and rub it in. If you have a spray or stick stain remover, you can use that. Allow that to soak overnight in some cold water before putting in the regular laundry.

Basic tips:

  • Carry a clean set of underwear (and pants if needed) in a plastic bag to use in case of emergency.
  • Carry a stain stick (they sell these near the laundry detergent) if desired.
  • Rinse in cold water as soon as you can.
  • Rub stain remover or laundry detergent into the stain and let it soak. Put it in the plastic bag you carry if you aren’t home.
  • As soon as you get home put the soiled clothes in cold water (rub in more stain remover or laundry detergent as needed). Allow clothing to soak overnight.
  • After soaking overnight, rinse in cold water. Repeat a scrub and soak in detergent if needed.
  • Once you don’t see the stain any more, you can wash with the rest of your clothes like normal.

What about when a pad won’t work, like swimming or ballet? Am I too young for a tampon?

Tampons frighten a lot of girls, but they’re safe to use as soon as you’re comfortable using them.

They do not affect your virginity.

Tampons simply are a product that will collect the blood inside you so you don’t need to wear a pad on the outside.

Many girls use one with their first period. Others don’t use them at all. It’s up to you!

How exactly do you get the tampon in? 

First, some general anatomy. You need to know what things look like down there. You can use a hand held mirror to look at yourself and compare to this picture. This is a drawing, so you will look a little different, but you should be able to see the basic parts.

Tampons are inserted directly into the vagina (labeled “vaginal orifice” in the picture).

Much like an absorbent sponge, a tampon will gently swell as it becomes soaked with blood.

A string allows for easy removal from the body.

Tampons are convenient for swimming or exercising and can be paired with a panty liner – a type of thin pad or a regular pad for extra protection on heavy flow days.

When using tampons, women should change them every 4-6 hours.

It’s time to change the tampon, but I can’t find the string. Did it get lost up there somewhere? 

First: Don’t panic! Your tampon is not lost forever!

Sometimes the string can stick to the skin between your labia (labeled “labium magus” and “labium minus” above). You might need to feel around a bit. If there’s a mirror nearby, you can use it to look. Sometimes going pee can help the string fall down if it’s stuck around the skin somewhere.

If the string really is up in the vagina, you can put your finger into the vagina to see if you can slip the string back out.

If you can’t get the tampon out, tell an adult as soon as possible. If they can’t help you get it out (or if you don’t want them to try) you might have to go to the doctor to have it removed.

NEVER forget about a tampon that has been put in… you could get a serious infection if you leave one in too long.

I seem to always get spotting on my underwear when I wear a tampon, but the tampon isn’t full of blood yet. Why is that?

There are several reasons I can think of that blood can get on your underwear.

The first, of course is the tampon overflows because it was left in too long for the amount of flow you have at that time. But you can tell that when there is no more white showing on the tampon. If it isn’t full, there are other reasons to consider.

Was the blood on your skin when you put the tampon in? If you wipe after putting the tampon in, that can help this issue. Actually, more than wiping, pushing the toilet paper (TP) up towards where the tampon is (with the string out of the way) can show if there’s blood in the area. Repeat until the TP is clean. You can also wipe the folds of skin with a flushable wet wipe that is sold near the other feminine hygiene products or near the diaper wipes. This follows the same concept but wiping with a wet cloth works better than dry TP for many issues.

Another cause would be if the tampon is not inserted properly. Be sure it is completely in. Signs that it isn’t in also include being able to feel it when you walk or sit. If it’s in all the way, you should never feel it.

Did you pee or poop with the tampon in? This can move the tampon enough to let blood leak around it. Try changing the tampon and wipe after placing it each time you go to the bathroom.

Why do I need to pee so much when I’m on my period?

Many women gain water weight just before their period.

Have you heard women complaining of bloating? That’s the water.

Your body’s hormone changes cause this slow gain, and they also cause the release of the excess water back out of your body (called diruresis). This increases urine production.

Look at it in a positive light: you have to go to the bathroom often, so it reminds you to change your pad or tampon frequently!

Can you pee or poop with a tampon in?

Short answer: Yes.

But if you do, it is possible to have the tampon shift and cause leakage, especially if you have a bowel movement (poop).

If it is too soon to change the tampon and you need to go, you can hold the string to the side so it doesn’t get as soiled while you go.

Wipe carefully so you don’t pull on the string– you can keep holding it to the side while you wipe too.

My school uniform doesn’t have pockets. How can I carry a pad or tampon to the bathroom?

If your uniform is a skirt, you can wear shorts with a pocket underneath.

Some girls will be able to wear a tampon with a pad so that when they remove the pad mid-day, they leave the un-soiled pad on for the afternoon.

If you’re allowed to carry a purse, carry one every day for unexpected first period days and to get in the habit of always having it.

You can also talk with your school nurse or a teacher about what other girls do.

I track my periods on a calendar, but there doesn’t seem to be any pattern. Why aren’t they once a month like they should be?

Once a month is more of a phrase than a reality.

A typical cycle is about 21 – 35 days from start to start.

Bleeding can be as little as 2 days and up to 7 days.

The first 2 years after starting a period, many girls are irregular. After those 2 years, it becomes more predictable.

You might be different than your friend, but your cycle should be about the same each month after the first 2 years.

It does help if you track your cycles on a calendar or app.

My bleeding seems so heavy. I soak a pad within an hour and there are sometimes clumps in the blood. What is that?

If you’re having very heavy bleeding, talk to your doctor because you can be at risk for anemia (too low of blood counts from blood loss).

This can sometimes simply be your body adjusting to a period, but it can also be from a treatable condition.

Your doctor can help you decide what needs to be done.

How long will the bleeding last? 

The amount of bleeding and how long it lasts varies from person to person.

Some days there will be barely any blood (called spotting because it looks like just a spot of blood).

Other days are heavier.

Bleeding can last between 2-7 days normally.

Again, charting it on a calendar or app can help you figure out your pattern.

How do I keep from getting stinky?

Change is good

First, be sure to regularly change your tampon or pad.

If it goes without being changed, bacteria start to make a very foul odor.

You should change pads or tampons at least every 6 hours (except overnight, when the pad can be left on as long as you sleep). This is important to avoid infections as well as bad smells!

wipes

You can use flushable wet wipes instead of toilet paper to help clean the area better.

If you need them outside of your home you can carry some in a plastic zip lock bag and keep with your pads or tampons.

deodorant products?

There are feminine hygiene products with deodorant available, but who wants to smell flowery?

Seriously, I don’t recommend these because too many girls have an allergic reaction to them and who wants to have an itchy rash in the place you can’t publicly scratch?

Wash!

Once you go through puberty, your body in general smells more, so it is important to bathe regularly.

Don’t forget to do a daily wash of all the skin folds between your legs.

You can use any soap (avoid fragrances if your skin is sensitive), but be sure to rinse well! Soap that remains between the folds can cause rashes.

You can rinse the area by splashing a cup of clean water between your legs a few times. If you have a hand-held shower head available, that makes it easy to rinse the area well. You can also lift a leg so the shower water can rinse between your legs — but hold on so you don’t fall!

Do I need to wear protection between periods?

You might want to wear a panty liner when it is getting close to your next period, just in case you start, but it’s not necessary.

How do I know when the next one will be?

Over time it becomes easier to predict.

Keep track of the dates of bleeding as well as how heavy it is and any other symptoms. These can include pimples, cramping, mood swings, tiredness, constipation or diarrhea, back pain, sore breasts, bloating, food cravings, or headaches. All of these symptoms can help predict your cycle.

There are several apps available on the computer, smart phones, or tablets, many of which are free. I suggest going to your app store and reading reviews to pick your favorite.

How much more will I grow since I started my period?

Growth speeds during the years before your period, then slows after your period.

Some girls stop growing all together, but most still grow for the next 1-2 years.

Ask adult family members how they grew (if they remember) because growth patterns tend to follow parents and other family members.

What is PMS?

Common effects of PMS (Pre-Menstrual Syndrome) include: bloating, cramps, fatigue, moodiness, headaches, or pimples.

There are over-the-counter medications that can ease these symptoms. Ibuprofen or naproxen tend to work well.

If you have severe cramping and you are expecting your period, you can start the ibuprofen or naproxen three days before your symptoms start. This decreases the pain better than starting the medicine when the cramps start.

Some girls prefer wearing loose clothing or using warm compresses on their stomach.

Regular exercise can help monthly cramping, plus it’s healthy for your body, so keep moving!

Sleep helps regulate our mood. Many girls and women need extra sleep before and during their period. Listen to your body!

Mothers can share with their daughters their own tricks for coping.

My boobs hurt with my periods. Why is that?

Many girls notice breast tenderness during PMS (Pre Menstrual Syndrome).

Your hormones are changing at this time and they can cause the breasts to swell. The swelling causes tenderness.

You can help minimize this by eating right, exercising, and getting enough sleep (all month long).

Caffeine can worsen it, so avoid things with caffeine.

Where can I get more information?


ThePeriodBlog has a lot of great information, including how to insert a tamponinformation about your body,  counting your cycle, and more.

I rarely hear questions about the hormones or technicalities of puberty, but for more on the menstrual cycle check out All About Menstruation by TeensHealth. (They also include more related topics links at the bottom.)

A good review of puberty, including how it is staged is found on Young Women’s Health (Boston’s Children’s Hospital).

My favorite book for girls about puberty is now a series of books. The Care and Keeping of You and The Care and Keeping of You 2 are available from many retailers. I like that they go over everything from staying clean to eating right to the importance of sleep and more.

I’m a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. I link to these books because I recommend them highly, regardless of where you purchase them.



Share Quest for Health

E-cigarette Use In Our Kids – Let’s Stop It!

For many years I didn’t see many patients using tobacco. I admit I’ve been lax in talking about risks because there seemed to be more pressing things to discuss in my limited time at appointments. Recently I’m seeing more kids who are trying nicotine due to e-cigarettes. These are marketed as a safer option, giving kids a false sense of safety while filling their desire to take risks. E-cigarette use is not safe or cool.

Tobacco is a problem

Tobacco use is the leading cause of preventable disease and death in the United States.

Nearly all tobacco use begins during adolescence, when developing brains are most at risk of developing addictions.

In 2016, e-cigarettes were the most commonly used tobacco product among high school (11.3%) and middle school (4.3%) students. In 2017, nearly a third of high school seniors report vaping.

About 3 million adolescents in the US vape. Those who start using nicotine by vaping are more likely to transition to traditional cigarettes.

Monitoring the Future 2017 Survey Results
Source: Monitoring the Future 2017 Survey Results

 

Vaping by many names and looks

There are many terms used to describe the use of e-cigarettes, so it can be easy for parents to miss that kids are talking about it. The devices themselves can look like other common items.

Electronic nicotine delivery systems (ENDS), e-cigarettes, personal vaporizers, vape pens, e-cigars, e-hookah, or vaping devices are all terms used to describe the device itself.

The devices themselves can be easily mistaken for other things. ENDS can look like traditional tobacco products like cigarettes, cigars, or pipes.  But they can also look like flashlights, flash drives, or pens, so easily hidden from adults.

ENDS liquid nicotine delivery systems
This image from the AAP shows the various types of ENDS.

Some of the more common terms for the behavior include vaping and juuling.

Dripping is similar to vaping, but uses the liquid nicotine directly on heated coils.

Liquid nicotine is called e-liquid or smoke juice.

E-cigarette use is a safer option? No!

One of the selling points for e-cigarettes is that they could be a safer option than regular cigarettes and a way for smokers to quit.

Kids are confusing the “safer than cigarettes” propaganda to mean safe. It’s NOT safer than not smoking. Period.

In fact, there are many studies showing that the amount of carcinogens (cancer causing agents) in e-cigarettes is substantial.

For parents who choose to vape in the home to help prevent their kids from inhaling secondhand smoke, you might want to even reconsider that. Vaping releases chemicals into the air that can cause problems.

Accidental ingestion of liquid nicotine is a growing problem. Common symptoms of ingestion include vomiting, rapid heartbeat, difficulty breathing, increased saliva, and feeling shaky. One teaspoon of concentrated liquid nicotine can be fatal for the average 26-pound toddler.

e-cigarettes, vaping
E-cigarettes are a threat to health. Source: Facts For Parents About E-Cigarettes & Electronic Nicotine Delivery Systems

Liquid nicotine is enticing and available

E-cigarette juices are sold in flavors like fruit, candy, coffee and chocolate.

Nicotine is addictive. The more kids vape or smoke, the more addicted they become.

Although legally most states prohibit the sale of nicotine products to adolescents, liquid nitrogen is easily available to kids online.

Sadly these products are highly marketed to our kids. Sellers know that if adolescents try it, they are likely to become long term customers of various nicotine products.

Teen and tween brains

Our frontal lobe helps us make healthy choices, but it’s not fully formed until our mid-twenties. This leaves teens at risk for making very unhealthy choices and increased risk of addictions. Teen brains crave stimulation. They take risks to fulfil this craving.

As their brains are growing, experiences and substances affect it. Developing brains can learn and remember things efficiently, but negative experiences and substances also get integrated efficiently. This means teens are more likely to develop addictions than adults.

Kids who vape just once are more likely to try other types of tobacco. Their developing brains make it easier for them to get hooked.

One in 4 teens who use an addictive substance will become addicted, compared to one in 25 who first use an addictive substance after the age of 21 years.

About 90% of adult smokers started before their 18th birthday.

Talk to your kids

E-cigarettes and liquid nicotine are a danger to our kids.

Our kids are bombarded daily with suggestions and choices.

They will see propaganda that encourage vaping online, on television, and in retail stores.

Talk to your kids about all risky behaviors.

Learn 6 ways you can help protect your kids from risky behaviors.

Help them understand the risk as well as what to do to avoid peer pressure.

Encourage them to come to you with questions and concerns by remaining non-judgemental and being present. Encourage family meals and activities. Spend time together without screens – turn off the phones!


Share Quest for Health

Teen Dating Violence Prevention & Treatment

As discussed earlier, teen dating violence is a relatively common problem that can occur in any socioeconomic circle. It’s important to recognize teen dating violence, but it’s even better to learn teen dating violence prevention and what to do if you recognize trouble!

Family relationships

How we raise our children from infancy and continuing throughout their lives helps set the expectations for relationships.

Abusive home increases the risk

Teen Dating Violence Prevention & Treatment.Children who are raised in homes with abusive behaviors are much more likely to grow up to be in an abusive relationship.

If your home is not safe make every attempt to make it so.

Stop the cycle!

SEcurity

We need children to feel loved and secure.

Children who feel unloved might look for love in all the wrong places, trying to please others and end up being taken advantage of.

Love unconditionally!

Parenting

Kids need defined limits, but an ability to learn and grow into independence with experience. Being firm and setting boundaries is an important part of being a loving parent.

Parents are NOT their child’s friend.

You don’t need to be a friend to be an effective, loving, parent who is well loved and respected.

As your child grows and matures, it is important that you allow them to take more responsibility for their plans and actions.

Be a role model

Kids need help learning to stand up for themselves and to deal with anger and disappointment in a healthy way. Set an example for this. Life typically presents many opportunities to model these behaviors.

Show healthy communication in your relationships. Use positive phrases, respectful words, and compliment one another.

Don’t let one partner dominate. Take equal share of responsibilities and decisions.

Do things with your significant other and with other people. Expect that your partner will also spend time with others. Don’t be overly jealous. Relationships need trust. Always spending time together isn’t healthy and doesn’t allow you to each follow your own interests.

Respect others in your life and be sure they also respect you.

If you have not learned to control your temper, learn.

Ensure enough sleep for everyone at home, as we are all more short-tempered when tired.

There are many self-help books on this topic and counseling is available if you struggle in your own relationships.

Peer relationships

Friendships and dating relationships provide an opportunity for teens to learn and practice healthy communication, social skills, and managing strong feelings.

Teens need to develop independence while the trusted adults around them provide support and help them stay safe.

Talk to your kids about healthy choices and as they mature, allow them to make more decisions about what they do, when they do things, and who they are around. If you feel they aren’t making safe choices, let them know why.

Don’t be judgemental in how you approach things. There’s no faster way to turn a teen off to a conversation than putting him or her down or by making them feel like they’re being lectured.

Respect

Respect self

Kids should be taught to respect themselves in all they do: eat nutritionally, exercise, get enough sleep, wear helmets, buckle up, stay away from drugs, etc.

Respect others

Kids should be taught to respect others: say nice things, don’t ask others to do things that might cause them harm, respect their personal space and things, etc.

Demand respect

Teens should enforce that others treat them with respect.

If a friend does not treat them with respect, they can try first to talk with the friend about it if they feel safe doing so. If the friend does not change behaviors, they should take a break from the friendship.

Talking to teens

Start before they’re dating

It’s best to start talking about healthy relationships before your child starts dating.

Set expectations for how old they will be when they are allowed to go out in groups of boys and girls as well as when they will be allowed to go on an actual date. How well do you need to know the person they will date?

Talk about what they should do if they find themselves in a scary situation.

Discuss rules for friends coming to the house if you’re not home. Or if they’re allowed to go to a private area or if they must stay in the family room.

Talk about what to look for in a romantic partner, qualities that are important and not just superficial.

Ask how they would like to be treated and how they will treat their date.

Talk about sex. Kids who have sex at young ages are more likely to have multiple partners. Having multiple partners increases the risk of infections and dating violence.

Drugs and alcohol increase risk

Remind kids that alcohol and drugs impair our abilities to handle our emotions and actions. They do not excuse our actions, but we tend to not make good choices when we’re under the influence.

We also put ourselves at risk of a forced sexual encounter when we’re under the influence of drugs or alcohol.

Date rape can also occur if someone slips a substance into a drink, so they should always carry their drink or get a new one from a trusted source.

Starting the conversation

Use opportunities that present themselves to trigger conversations.

If you see people arguing in a television show, talk about what was and was not effective in how they handled the situation. Ask what your kids would have done differently.

If the news reports another #MeToo story, ask what your teen’s thoughts are on the subject. Talk about recognizing unhealthy relationships and how to get out of abusive situations.

Answering questions

If your child asks questions, don’t shy away. Don’t assume they’re too young to hear the answer because if they’re asking, there’s a reason.

You can certainly ask where they’re coming from to help guide your answer, but answer honestly.

If you don’t know what to say, offer to talk about it at a specified time in the near future, such as after dinner that night. That gives you time to think and plan what to say but let’s your child know you want to talk. Don’t forget!

Emotional support

Be there to just listen if your child needs an ear. Offer encouragement and advice. Do this routinely, not just if you’re concerned about a specific issue.

If you always offer an ear without harsh judgement or unsolicited advice, your kids are more likely to keep talking. (Note: Just because they want to talk doesn’t mean they’re ready to accept advice. Ask if you can offer advice and wait until they say yes.)

Remind teens that they are never to blame if someone forces them to do something sexually they don’t want to do. They need to feel open to share this pain with you or another trusted adult so they can get the help and support they need.

preventing teen violence
Preventing Teen Dating Violence. Source: VetoViolence

What if there is an unsafe relationship?

It can be frustrating if your child’s in an unhealthy relationship but isn’t ready or willing to leave.

It can be difficult to enforce ending a relationship. Be careful in how you approach the situation. Consider working with professionals at the school or in the community.

Advice to get out of a relationship will be better received if your teen understands how their relationship is not healthy. Help them understand the difference between healthy and unhealthy relationships.

They need to know it isn’t their fault and it isn’t under their control how another person acts. Ideally, your teen will be able to make the decision to leave the relationship.

I’ve actually seen a teen get pregnant on purpose because her parents refused to let her see her boyfriend. She decided that they’d have to allow him to see his baby (and by default, her). Of course it didn’t work as planned. She did get pregnant, but it didn’t help her relationship.

If you think they’re in immediate danger, you need to seek professional help.

There are many ways to get help

Abusers often monitor computer and phone use, so use caution.

SafeHome (KC Area)

From a safe computer, click here if you’re in the KC area.  From a safe phone call 913-262-2868. (Phones answered 24/7 confidentially at SafeHome).

Safety Plan (Love is respect)

Love Is Respect has a great safety plan for teens who are planning on leaving an abusive relationship.

DATING MATTERS®

Dating Matters is a free, online course available to educators, school personnel, youth mentors, and others dedicated to improving teen health. Learn what teen dating violence is and how to prevent it through graphic novel scenarios, interactive exercises, and information gathered from leading experts.

National Teen Dating Abuse Helpline

These resources are designed specifically for teens and young adults. It is managed by the National Domestic Violence Hotline (NDVH) and offers  support from trained Peer Advocates.

Call: 1-866-331-9474 Calls are answered 24 hours a day, 365 days a year.

Text: “loveis” to 22522

TTY: 1-866-331-8453

Web: www.loveisrespect.org

 

Teen dating infographic

Share Quest for Health

Teen Dating Violence: Recognition

Would you recognize signs of dating violence? Many teens don’t report it to friends or family. It can be difficult to recognize despite the significant prevalence. Victims might not say anything out of fear for their safety, embarrassment, low self-esteem, or not recognizing the abusive behaviors. Whatever the reason for the under-reporting, parents and other adults who interact with teens must recognize signs of dating violence to help protect our kids.

Relationships

Teen Dating Violence: RecognitionWe want our kids to develop healthy relationships where they can have fun, grow in their own identity, and be true to their own values. Healthy relationships are founded on honesty, trust, and communication. There is mutual respect.

Dating abuse can happen in any unhealthy relationship. It happens to smart people, rich people, girls, guys, LGBT, and can happen in any community. We see news stories of abusive relationships but it doesn’t always seem real. A new bride murdered.  A teen raped.  A sports figure accused.

Failed recognition

Unfortunately we don’t even know about most abusive relationships. People suffer silently.  How is a parent to know?

Can a teen see risk factors before becoming involved with a risky personality?

Abuser characteristics

Parents might look for the “type” of teen that they want their child to steer away from, but unfortunately, the abusers are not easily identified.

Abusers do not look like drug dealing, tattoo covered, pierced people in tattered clothing.

They are difficult to recognize on first glance because they tend to be popular, smart, good looking, and personable.

They are often good at reading people and responding to other’s desires, making them seem “perfect” initially.

Abusers manipulate others. Have you heard of gaslighting? It’s a common means to make the victim feel responsible.

They gain trust.

They weave deception.

Traits to watch for in an abuser:

  • Blames others for all problems
  • Jealous
  • Impulsive
  • Wants to move quickly into a relationship
  • Criticizes others
  • Does not respect personal boundaries
  • Denies responsibility for actions
  • Takes risks
  • Insulting (you’re fat, you’re stupid, no one else would love you like I do)
  • History of hitting or hurting others
  • Tries to monopolize your time and life – wants to control what you do, who you’re with, even what you’ll wear
  • Seems perfect initially (no one’s perfect!)
  • Mood swings or can’t manage anger or frustration well

What an abusive relationship might look like

Starting out – all seems great!

The relationship typically starts out well. A lot of laughs, good times.

If it didn’t, people would leave.

Power and Control cycle

Abusers have a power and control cycle that builds over time. They gain a little trust, then test with a little control.

Bit by bit they become more controlling and abusive. It builds so slowly many people miss the early warning signs and then are so swept by the cycle that it’s hard to leave.

Abusers want to know your every move, which at first might even seem flattering, but it is a control tactic. They might choose what you wear or where you go. Abusers monitor your phone calls to see who you talk to. They isolate you from your friends and even family so you lose your support group. They put you down so you feel no one else would like you or want you.  Abusers make you feel less of a person and they are “good” to put up with you.

They get jealous (again, flattering on the outset because they “care”). Abusers often apologize for hurting you, but then claim it is your fault that they behave that way.

In truth, they blame others for most of their behaviors and only take credit when things make them look good.

Cool tool

Breakthecycle.org has a really cool interactive wheel to see the relationship between words and actions. Move your cursor around the wheel to get more information on each topic in the orange part of the wheel.

Signs of an unhealthy relationship:

  • One or both people try to change the other
  • Control: one person makes most or all of the decisions
  • Isolation: one or both people drop friends and interests outside of the relationship
  • Fighting: one or both people yell, threaten, hit, or throw things during arguments
  • Verbal abuse: one or both people make fun of the other’s opinions or interests
  • Jealousy and control: one or both people keep track of the other all the time by calling, texting, or checking in with friends
  • Relationship moves quickly to “serious”
  • Mood swings, anxiety, depression, personality changes
  • Physical signs: bruises, cuts, scrapes, showering immediately when coming home
  • Abused feels guilty and “at fault” and makes excuses for their partner
  • Drug or alcohol use
  • Multiple sexual partners

Follow your instincts

If you suspect something is not right, act on your hunch and take action to address issues and leave the relationship early if problem behaviors persist.

 

If your teen is in a relationship with someone who is violent, your teen may:

  • Avoid friends, family, and school activities
  • Make excuses for a partner’s behavior
  • Look uncomfortable or fearful around a partner
  • Lose interest in favorite activities
  • Get lower grades in school
  • Have unexplained injuries, like bruises or scratches

If you think your teen might be an abusive person:

Teens who use physical, emotional, or sexual violence to control their partners need help to stop. Don’t make excuses if you think your child has a problem.

If your teen is abusive, he or she may have these characteristics:

  • Jealous and possessive
  • Blames other people for anything that goes wrong
  • Damages or ruins other people’s things
  • Wants to control a partner’s decisions
  • Constantly texts or calls a partner
  • Posts embarrassing information or pictures about a partner online

Next up:

How to prevent and seek help for teen abusive relationships.



Share Quest for Health

Teen Dating Violence: Stats to Know

Teen dating is an important way for kids to learn about themselves and others, but it can open them up to risky behaviors, heartache, and more. Violence in teen relationships is more common than you might realize, but recognizing warning signs can help protect our kids in their relationships.

Teen Dating Violence Awareness Month

teen dating violence statsFebruary is Teen Dating Violence Awareness Month, so it is a great time to learn about this all too common problem.

Today I’ll review the statistics to show just how prevalent it is.

Tomorrow I’ll cover how to recognize unhealthy relationships.

A third post will talk about what you can do to prevent abusive relationships and what to do if you recognize one.

What is teen dating violence and why should we care?

Definition

Teen dating violence is the physical, sexual, psychological, or emotional violence within a dating relationship, including stalking.

It can occur in person or electronically and can occur between a current or former dating partner.

Lasting effects

Youth who are victims are more likely to experience symptoms of depression and anxiety, engage in unhealthy behaviors (use of tobacco, drugs, and alcohol).

They often show antisocial behaviors and think about suicide.

Teens who are victims of dating violence in high school are at higher risk for victimization as an adult.

Dating apps

Dating apps isn’t what this post is about, but it deserves at least a mention. Certainly there’s a lot of teen dating violence with teens who meet in class or through a common friend, but this “service” opens up a Pandora’s Box of risky possibilities.

Teen dating apps?

Sadly, in researching this subject, the first many posts that showed up on my Google search for “teen dating” were teen dating apps. Not adults-only apps, or even apps that pretended to be adult-only.

Apps with “teen” and “dating” in the title.

One of the top search findings was a men’s website with an article about the “best” and “safest” teen dating apps. Yikes! This is on a website designed to attract adult men.

Another advertised that it was for kids 13-17 years of age. I’m not a fan of early teenage kids dating in general, but certainly a 13 year old is too young to safely navigate an online dating service!

As a mother of two teens, this is incomprehensible and scary to me. Why can’t kids meet the old fashioned ways ~ through friends, classmates, clubs, and activities?

On the other hand, I see the draw. So many teens of today haven’t mastered social skills. Kids of all ages today rely on texting to communicate with friends. They aren’t sure how to approach someone they don’t know. Teens find it hard to carry on a verbal conversation.

It’s easy to put your profile out there and search for someone with like-minded personalities. Easy, but not safe!

Thankfully, CommonSenseMedia.org had a high-ranking result to my search. Check out Tinder and 5 More Adult Dating Apps Teens Are Using, Too to see their stats and warnings. I highly recommend Common Sense Media in general for parents to help them moderate their children’s media intake: movies, games, apps, and more.

Dating violence: a very difficult and complex topic  

When teens find themselves in an abusive relationship, they often can’t find an easy way out. Sometimes they’re not even sure if the relationship is healthy or not.

How to separate?

Teens might share friends with their abusive partner. Their friends might think the abuser is wonderful, lending to peer pressure to stay together.

They typically go to school together, so it is difficult to avoid each other entirely.  

Teens might fear trying to leave the relationship safely.  

Victims often have feelings of love and attachment to the abuser, and hope that behaviors will change.

Drawing the line

If teens have lived with domestic abuse at home, they might think the abuse is normal.  

The abusive behaviors tend to lower the victim’s self esteem, making leaving feel less desirable since they feel no one else will ever care about them and a bad relationship is preferable to being alone.  

Guilt

Victims are often confused and made to feel like the abuse is their fault. They are told again and again that “if you didn’t do ___, I wouldn’t have had to ___.” They believe the abuser’s words.

Sometimes the abuse starts so gradually, it takes time to recognize that it’s there. By the time a victim realizes it, he or she may feel that if they say anything or get out of the relationship, others will think they’re stupid for not seeing it earlier. They continue to play the game of happy couple.

Bullying

Teens can experience cyberbullying even when not with their (ex-) partner.

There are no physical signs with verbal or online abuse, but the emotional scars can last a lifetime.

Even physical abuse (pinching, hitting, shoving, slapping, punching, or kicking) doesn’t always leave physical marks. If marks are visible, victims often make up stories to explain how they got there to cover for their partner.

Learn about abuse to help save someone you love from a dangerous relationship!

Stats- in other words, it’s a problem!

2015 National Youth Risk Behavior Survey

The CDC performs surveys of many risk factors on our children every other year. The 2015 National Youth Risk Behavior Survey is the latest reported. The 2017 report is expected to be published later this spring.

Nearly 70% of students nationwide dated or went out with someone during the 12 months before the survey. The statistics below represent a percentage of these 70% in the 12 months prior to the survey.

  • About 10% had been physically hurt on purpose (counting hit, slammed into something, or injured with an object or weapon) by their date or someone they had dated.
  • Over 10% of students had been forced to do sexual things they did not want to do by someone they were dating or going out with. These included being kissed, touched, or physically forced to have sexual intercourse.

The prevalence of physical teen dating violence did not change significantly from 2013 (10.3%) to 2015 (9.6%).

Other stats

Nearly 1.5 million high school students in the United States are physically abused by dating partners every year.

Females are more likely to be the victims (1 in 4 women have been assaulted by a partner).

Men are also at risk: 1 in 14 men report being victims.

Regardless of sex, it is likely that abusive relationships are underreported due to the nature of the problem.

Tomorrow: How to Recognize Teen Dating Violence 



Share Quest for Health

Show Your Kids Love On Valentine’s Day and Every Day

In honor of Valentine’s Day, I’m sharing 14 ways to show your child love.

1. Make time to be together

make time to be together
Make special memories and have daily routines together.

It goes without saying that the more time you spend with your family, the more bonding you can enjoy. This photo is from a time that I agreed to be in a show with my theatrical daughter, but not all family time has to be such a huge commitment.

Make a family game night once a week. Volunteer in your child’s class or participate in their extracurricular activities. Take walks. Go to the park. Build a puzzle together. Turn off electronics in the car and just talk.

Make little moments count!

2. Help kids learn from their mistakes

learn from mistakes
We learn best from our mistakes.

Kids make mistakes often. This means they have many chances to learn.

If we try to fix it all for them, it teaches them that they’re not good enough to do it themselves.

Don’t be harsh with your words when kids mess up. Harsh words scar and might keep kids from trying the next time!

Support kids and help them learn what went wrong. Try role-playing to see how they could have done it differently and maybe next time they can practice how to make a better choice.

Check out Bright Futures for more information on learning from mistakes.

3. Turn off screens and tune in

screen timeThere are many studies that show parents are distracted by their phones and computers.

Turn your screens off to be able to give full attention to your kids. Make sure they have screen time limits too.

I’m on my computer a lot now, but when my kids were young I only worked online when my kids were in bed. (Now they stay up later than I do, but they’re not home in the evenings.)

Even when I’m on call I don’t answer my phone during family meals because I wanted to model to my kids that family time should not have interruptions from phones. (Note: there are physicians who have to answer immediately due to true emergency calls, but they calls I get should not be emergencies.)

4. Assign chores

chores for kids

My daughter actually laughed at this one when she was reviewing my blog.

I’ve never been really good at enforcing chores on a regular basis despite the fact that I know they help kids build self confidence and grow into productive adults.

Be a better parent than I’ve been in this regard and have your child do daily or weekly chores. I know it’s faster and easier to just do things yourself, but your kids will benefit from the work!

5. Set limits

set limitsMy daughter also laughed at this one. She is totally the child who will debate any rule. She will follow them if they’re set, but she will attempt to show why the rule should be stretched. I’m proud of her for that characteristic. I don’t want kids that will just follow the leader, but I know that I can’t be an effective parent if there are no limits.

Kids need structure and limits so they can feel secure and learn within safety boundaries.

There are tips on limit setting for strong-willed kids on Aha Parenting that I really like.

6. Eat family meals together

eat as a family
Eating together has so many benefits. Make the time regularly!

Families that eat together stay together. There are studies showing that when families eat meals regularly together, kids benefit in many ways.

We tend to eat healthier if we eat home cooked meals. This leads to a healthier overall body.

Meal times also provide time for bonding. This can lead to less drug use and depression. It makes sense. If kids are connected to their parents, they will have less need to find other ways to make themselves feel good.

Studies show that kids actually do better academically if they eat with their family at least 5 days a week.

All this and it’s less expensive to eat at home. Bonus!

7. Read together

Read reading together

Okay, I’m cheating with this photo a bit. I didn’t ever take pics of reading with my kids, but took one a few years ago when my daughter was reading to her cousin during a car trip.

Despite not having photos of our nighttime rituals, books were the best part of bedtime when my kids were young.

They loved hearing stories. Sometimes we’d play “I spy” with the book we’d read so many times they had it memorized. Sometimes they’d read to me – more and more as they got older. They’d often try to bargain for more reading time. Reading was a great motivator for them to get dressed and brush teeth so we could get started!

Reading together is not only a great bonding time, but it also helps to set the stage for loving a great skill. Many studies over the years continue to  show that reading with children starting when they’re infants helps them learn to speak, interact and bond with parents. They will be more likely to be early readers. Reading with kids who already know how to read helps them feel close to you, understand the world around them and be empathetic citizens of the world.

8. Serve together

serve others
Serving others not only helps those you’re serving, but has also been shown to help the giver.

Doing community service or volunteering to help others has been shown to benefit not only the persons being served, but also those serving.

Kids can develop pride, learn new skills, gain empathy for others, and live new experiences by helping others.

Studies show that those who volunteer have lower mortality rates, greater functional ability, and lower rates of depression later in life than those who do not volunteer.

Volunteering allows families doing things together working on something productive. They can learn about themselves and each other through helping others.

9. Make physical contact

physical contact
Healthy physical contact can show love.

One of the love languages is physical touch. Sometimes we hear of improper touches and it can negatively impact the way we are able to interact with the kids around us. While I feel very strongly that we need to protect our kids against abusive touches, I also know that kids (and adults) need healthy and safe physical touch.

Never invade a child’s personal space if they don’t want you in it, but physical touch can be reassuring to kids. Give a hug or pat on the back. Tickling and playful roughhousing are fun ways to give physical touch. Dance. Hold hands or make up a fun handshake. Tousle hair as you walk by.

10. Don’t minimize worries

anxiety worry
Don’t minimize your child’s worries.

It’s tempting to just say that everything’s okay and to not worry, but when you say that your child just feels like he’s not heard. Over time he will stop talking to you about his worries.

If you have a hard time understanding your child’s anxieties (or anyone’s anxieties) read this great metaphor from Karen Young at HeySigmund.

Acknowledge the fears and teach your kids how to overcome them.

HeySigmund is one of my favorite blogs. It has great articles on helping kids learn to manage their anxieties.

11. Praise the effort

praise
Praise the effort, not the end result.

Our society tends to reward everything. Participation trophies are not helpful at growing resilient kids.

Poorly worded and empty praise can reduce children’s desires to take on challenges, lower achievement, reduce motivation and even make kids more interested in tearing others down.

Learn to show your kids that you’re attentive with phrases that show you acknowledge their effort or character traits without praising results.

For more on giving helpful praise, see Michelle Borba’s 6 New Rules for Praising to Raise Kind, Successful Kids.

12. Let them learn independence

independence
Let kids do things independently so they can grow into independent adults.

It can be hard to watch kids grow up and take things into their own hands, but it can be rewarding to watch them become independent.

Allowing kids to take on more responsibilities as they grow is a great way to show confidence in them. It can be hard to worry that your child will not remember all aspects of things required or that they will fail at something new, but allowing them to take ownership of things as they get older helps them learn not only the skill to accomplish things, but it also gives them the confidence that they can do things on their own.

13. Let them know you’re always thinking of them

thinking of the ones you love
Do little things to show you’re always thinking of them.

Giving gifts is a great way to show love and affection, but don’t overdo this one.

Not all gifts have to be costly or extravagant.

Leave a little note in the lunch box.

Buy a token gift for no reason occasionally.

Be there to cheer at their game or performance.

It can be that easy.

14. Say “I love you” every day

Saying “I love you” in words is also important. Some people aren’t good at saying it, but try.

I love you
Say “I love you” often!

I also encourage you to not only share moments, but get in front of the camera with your kids. I’m usually behind the camera taking the pictures, so there are very few photos of me with my kids at various life stages. Be in the photos so you can all walk down memory lane together.


Share Quest for Health

Keep that sparkle in their smile! Dental health tips.

February is National Children’s Dental Health Month, so a great time to talk oral health. Cavities are the #1 chronic health condition in children. Don’t underestimate the benefits of proper oral hygiene.

Why is a pediatrician writing about a dental issue?

February Dental Health MonthBecause cavities are a huge concern.

As stated above, they are the #1 chronic health condition in kids.

February is National Children’s Dental Health Month

This year’s slogan is…

(drumroll please)

Brush your teeth with fluoride toothpaste and clean between your teeth for a healthy smile!

fluoride and floss
Using fluoride and flossing are the best ways to prevent cavities!

The good news is that we can help prevent cavities with a few good oral health practices.

Don’t share germs

Cavities are caused by bacteria in our mouth, so don’t share saliva with your kids.

Evidence has proven that the transmission of saliva from a parent to child can be harmful to their teeth!  Parents with active tooth decay can pass the Streptococcus mutans bacteria through their saliva and give their children cavities!

Don’t “clean” your baby’s pacifier by putting it in your mouth.

Never offer your kids food that you’ve had in your mouth.

Don’t share silverware or drinks.

And finally, keep your own mouth healthy. Visit your dentist regularly. Brush your teeth at least twice a day with fluoride paste. Floss daily. Use a fluoride mouthwash for an added bonus. Not only does this model good dental hygiene to your kids, but if you don’t have tons of bacteria causing cavities you’re less likely to share them.

Stop sugars

Sugar feeds the bacteria that cause cavities. That’s why it’s so important to brush teeth before sleeping. Overnight the bacteria can grow more readily because the saliva production slows. (Saliva naturally helps keep our teeth clean.)

Most foods and drinks have sugar, even healthy foods. That’s okay. What’s important is that we get the food residues out of our mouths several times a day by brushing and flossing.

Foods that cling to your teeth for a long time such as milk, ice cream, honey, sugar, soda, dried fruit, sticky candy, cake, cookies, hard candy and mints, dry cereal, and chips are more likely to cause cavities than foods that are easily washed away by saliva.

Of course sticky candies are a known culprit, but juice is a big actor in cavity creation. Kids don’t need juice. Fruit is great, but juice is basically all the sugar from the fruit concentrated into a glass.

Sports drinks are another source of excessive sugar despite the healthy-sounding name. Kids don’t need the sugars in these drinks in most cases. Water is just fine for rehydration for typical young athletes.

Never put anything other than breast milk or formula in a bottle. Kids who drink juice in their bottle are at a much higher risk of getting cavities. There’s even a name. You guessed it: Baby Bottle Tooth Decay.

Kids who eat or drink anything before bed without brushing afterwards are at much higher risk – so don’t let your infants and toddlers fall asleep while drinking their bottle! Enforce brushing before bed!

watch acidic foods and drinks

Acidic foods are also very bad for teeth. Frequent exposures to acidic foods can erode enamel, making teeth more susceptible to decay over time.

Most carbonated soft drinks, including diet soda, are acidic. Regular sodas have the double whammy of sugar and acid. Keep kids from developing the habit of drinking sodas. They should be for a special treat no more than weekly and should be followed by at least rinsing the mouth with water.

A squeeze of lemon or lime can turn a simple glass of water into a fun beverage, but the acid can damage teeth if not limited. Citric fruits and juices can also irritate mouth sores.

Water, especially fluoridated water, is the best drink.

Limit snacking

As mentioned above, saliva helps to clean our teeth during the day. When kids graze on food all day or have a cup of juice, soda, or milk to sip all day, the teeth are constantly exposed to sugars.

Have set meal and snack times throughout the day. Between those times we should only have water. This is not only good for teeth, but also for weight management and the practice of patience and self control.

Brush

Most parents know that this is easier said than done. Kids hate brushing their teeth! But it’s such an important thing that it must be done despite crying and fighting.

Even before baby teeth appear you can start good oral hygiene. Gently wipe the gums and inside of the mouth every day, especially after feedings and before bed. You can use a clean wet cloth or a finger toothbrush.

When kids get their first tooth it’s time to start brushing! Brush baby teeth twice a day with a soft, age-appropriate sized toothbrush. Use a grain of rice sized amount of fluoridated toothpaste. This has been recommended since 2014, but many parents are surprised they are “allowed” to use fluoride in babies. Just because they sell infant toothpaste without fluoride doesn’t mean that’s the recommended product. Use a kid-friendly flavor though. Mint toothpastes tend to make young mouths feel like they’re burning!

When kids are adept at spitting out the toothpaste, they can use a pea-sized amount. Even adults don’t need more than that.

There are many things you can try to help your kids brush:
  • Entice with a song. Mouth Healthy from the American Dental Association has a great playlist.
  • Let them choose if you brush first or if they brush first. Either way you need to use the toothbrush on their teeth. They don’t actually brush well until at least 6 years of age, often later.
  • Try different toothbrushes. Some kids like electric brushes, others don’t. Most prefer soft bristles.

Floss

Kids need to start flossing once their molars start touching each other.

Dental floss is used to remove food particles and plaque. It’s very important to floss between teeth daily, preferably before bed.

There are many types of floss. Talk to your dentist about which is right for your family members.

Many kids can’t floss on their own, and even getting a parent’s fingers in to floss their mouth can be difficult. Pediatric Dentist Dr. Emily Day turned me on to Gum Chucks. They’re a great way to floss small mouths. I’ve even used them myself when I cut my finger and couldn’t wrap floss around my finger. (These are not paid endorsements – I just like the product and the dentist!)

To floss properly,  wrap the ends of the floss tightly around your fingers. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque. Unwrap clean floss from around your fingers as you go so that you have used the floss from beginning to end when you finish. Don’t forget to floss behind the back teeth.

When you first begin flossing, your gums may bleed a little. This is due to inflammation in the gums that comes from poor oral hygiene. The fix is to improve oral hygiene!

Fluoride

Fluoride helps to strengthen enamel. It is important to brush teeth with a fluoridated toothpaste, as mentioned above, and to drink water with fluoride.

Fluoride in drinking water has been shown to prevent tooth decay by at least 25% in both children and adults.

Most bottled waters and filtered waters do not provide the recommended fluoride. Some cities do not offer fluoride in their water. Talk to your doctor or dentist to find out if your child gets enough fluoride through water.

Topical fluoride should be applied every 3-6 months to your child’s teeth by your child’s pediatrician or dentist. Varnish sticks to tooth surfaces, which minimizes the risk of swallowing it. Fluoride varnish is recommended for all age groups once they have teeth.

Gum

Believe it or not, chewing sugar free gum after meals has been shown to help prevent cavities.

Young kids should not chew gum due to choking risks, but if older kids won’t go to the school bathroom after lunch, chewing sugar free gum (if allowed by school rules) might help.

Sealants

Your child’s dentist will likely offer sealants when your kids start getting their permanent molars. This can help seal the crevices in the molars to prevent food trapping. Sealants have been shown to reduce the risk of cavity formation by nearly 80% in molars.


Additional Resources

The American Academy of Pediatric Dentistry has a Mouth Monsters site that is full of ideas to help kids get good oral hygiene.

I love this oral health screening guide. It has photos of different tooth problems, a chart of when to expect teeth to erupt, and fluoride facts.

Share Quest for Health

Remembering Medications

Compliance taking a daily medication (or vitamin) can be troublesome for many.  I find myself counseling parents and kids how to remember medicines often.

Here are my favorite tips:

Use a pill box for pills

Pill boxes come in various sizes and either single daily dosing or am/pm dosing, depending on your needs.

Pill boxes allow you to:

  • be sure you have enough for the upcoming week
  • remember if they were taken today
  • keep several types of pills for each day together if taking more than one pill

Liquid medicines

Wash the syringe after each use.

Put it where you’ll see it. Remember the medicine needs to be out of reach from kids… not necessarily the syringe!

Empty the dish drain of all contents daily so you find the syringe and remember to use it.

Or put a clean syringe in visible sight where you often look. Tape it to the milk jug. Put it in a glass next to the kitchen sink or in a glass near your coffee pot.

Grab a pen/marker and draw a “calendar” (Mon am/pm, Tues am/pm, …) on the bottle with space to check off when you’ve given the medicine each day.

Refrigerated medicines

Put the medicine on a shelf that is eye-level, right in front. Don’t let it get pushed to the back.

Return the bottle to the fridge before giving the medicine to lessen the chance you leave it on the counter.

Remind older children who can access the refrigerator that the bottle is off limits!

Keep it where you’ll see it – but out of hands of kids

Keep medicine next to something you do daily (coffee, toothbrush) only if your kids are old enough to respect that it’s medicine. Use associations if you can’t put the medicine itself there.

Make associations with other objects

Use a specific glass that is unique that goes from table to dishwasher to table and never is put away.

Every time you empty the dishwasher, put water in the glass and set it on the table for medicine.

Refill the medicine 1 week before you run out

This allows you flexibility in case you forget to pick it up.

It also allows recognition that there are no refills if that was missed, giving one week to see your doctor.

You can have enough for vacations if you routinely do this, since you can only fill one week earlier than the last fill… plan ahead if traveling!

Keep tabs on number of refills left

The pharmacist should let you know with each refill how many are left. If there are none, call right then to set your next appointment if you haven’t already.

Regular prescription medications goes hand in hand with regular follow up with your doctor to manage the medication dosing. This is important for many reasons, so I try to give as many refills that will be needed until the next visit.
Ask your doctor how they handle refills before the medicine runs out so there are no delays in treatment.

Travel

If you travel often, it helps to keep an empty pill box in your toiletry bag, so when packing it you see the empty box that needs to be filled.

Or you could put a sticky note in the toiletry bag reminding you to pack them.

Use technology

Set your phone or watch to alarm at the times the medicine is due.  Change the tone to one that is unique to remind you.

There’s an app for that! You knew there was, right? There’s an app for everything. Search your app store for a medication reminder.

Put a reminder on your calendar to call for refills and/or schedule appointments before the last minute.

Leave sticky notes around the house or in your bathroom and kitchen if you’re more old school!

If forgetting’s a problem…

Keep some medication in your purse (or at the school nurse) to take if forgotten in the morning if this might still be a problem.

Remember to not leave your purse in the car or other places the medicine will get too hot or cold or in a place your children have access to it. We don’t want them sneaking into your purse for mints and getting a medicine instead.

If the school nurse will keep some, be sure to ask for a nurse’s note when getting the prescription.

Remember to schedule your next visit!

 If able, schedule the next visit before you leave the doctor’s office.  Bring your calendar to each visit!

Call as soon as you can to schedule if you don’t have your calendar available at the doctor’s office or you were unable to schedule for any reason.

If you notice no more refills on the bottle when picking up your medicine, call that day to schedule an appointment. The later you wait, the fewer appointment times will be available. Early morning and later in the day fill first!

If you always forget to call when your doctor’s office is open, look for options for them to call you. Leave a message on their office voicemail and be sure to leave the best time frame and number to call when they return your call. Utilize online appointment requests if available.

More reminders

  • Once habits form, it is easier to remember, but until then be sure to set reminders– especially if the medication must be taken at a certain time each day or if missed doses can be dangerous.
  • Learn what to do if you forget a dose by talking with your doctor or pharmacist. Some medicines are fine to skip a dose, others are not so forgiving and must be taken as soon as remembered.


Final Thoughts on ADHD Medicines

My last post was how to start and titrate ADHD medicines. Today I’d like to discuss more of the fine-tuning issues, such as what happens if medicine isn’t taken every day, how to remember it, what to do if parents disagree about medicine, and even how to plan for travel.

Time Off ADHD Medicines

starting ADHD medicinesOnce a good dose is found, parents often ask if medicines need to be taken every day. 

Stimulants work when they work, but they don’t build up in the body or require consistent use. (This is not true for the non-stimulants, which are often not safe to suddenly start and stop.)

Some kids fail to gain weight adequately due to appetite suppression on stimulants, so parents will take drug holidays to allow better eating.

Days off the medicine also seems help to slow down the need for repeated increases in dosing for people who are rapid metabolizers.

Drug holidays off stimulants were once universally recommended to help kids eat better and grow on days off school. Studies ultimately did not show a benefit to this, so it is not necessary. Some kids suffer if they are not on medications. Behavior issues, including safety issues while playing (or driving for older kids) can be a significant problem when not medicated. Self esteem can also suffer when kids are not medicated. 

Despite the fact that some kids need daily medicine, others don’t. When kids can manage their safety and behavior adequately, it isn’t wrong to take days off. Many kids want to gain better weight, and taking a drug holiday can help with appetite.

Talk to your child’s doctor if you plan on not giving your child the medicine daily to be sure that is the right choice for your child.

Remembering the medicine

It’s difficult to get into the habit of giving medicine to a child every day.  Tomorrow’s post will be about how to remember medicines

My favorite tip is to put the pills in a weekly pill sorter at the beginning of each week. This allows you to see if you’re running low before you run out and allows you to see if it was given today or not. These medicines should not be kept where kids who are too young to understand the responsibility of taking the medicine have access.

Controlled substances

Controlled substances, such as stimulants, cannot be called in or faxed to a pharmacy. Many physicians now have the ability to e-prescribe these.

Controlled substance prescriptions cannot have refills, but a prescriber can write for either three 30 day prescriptions or one 90 day prescription when they feel a patient is stable on a dose.

Stimulants are not controlled substances because of increased risks and side effects. Some of the more significant side effects of ADHD medicines are seen in non-stimulant medicines. 

They are controlled substances because they have a street value. Teens often buy them from other teens as study drugs. This can be very dangerous since it isn’t supervised by a physician and the dose might not be safe for the purchaser. It is of course illegal to sell these medicines.

The DEA does monitor these prescriptions more closely than others. If the prescription is over 90 days old, many pharmacists cannot fill it (this will vary by state), so do not attempt to hold prescriptions to use at a later time.


Acids and Stimulants

It has been recommended that you shouldn’t take ascorbic acid or vitamin C (such as with a glass of orange juice) an hour before and after you take medication.

The theory is that ADHD stimulants are strongly alkaline and cannot be absorbed into the bloodstream if these organic acids are present at the same time.

High doses of vitamin C (1000 mg) in pill or juice form, can also accelerate the excretion of amphetamine in the urine and act like an “off” switch on the med.

In reality  have never seen this to be an issue.

If anyone has noticed a difference in onset of action or effectiveness of their medicine if they take it with ascorbic acid or vitamin C, please post your comment below.

When Mom and Dad disagree

It is not uncommon that one parent wants to start a medication for their child, but the other parent does not.

It’s important to agree on a plan, whatever the plan is.

Have a time frame for each step of the plan before a scheduled re-evaluation.

If the plan isn’t working, then change directions.

Be cautious of how you talk about this with your child. If kids know it is a disagreement, they might fear the medicine or think that needing it makes them inferior or bad.

Do not talk about the diagnosis as if it’s something the child can control. They can’t.

Don’t make the child feel guilty for having this disorder. It isn’t fair to the child and it only makes the situation worse.

Having the medicine when you need it

Refills 

There is nothing more frustrating for a parent and child than to realize that there’s a big test tomorrow and you have no medicine left and you’re out of refills.

Technically none of the stimulant medicines can have refills, but a prescription covering 90 days at a time can be given. This can be done with a 90 day prescription or three 30 day prescriptions.

The technicality of this is sometimes difficult. You cannot call your pharmacy to request a refill. You must ask to have the next prescription filled if your physician provided 3 prescriptions for 3 months.

Be sure to know the procedure for refills at your doctor’s office.

Travel

It’s very important to plan ahead prior to travel if your travel involves the timeframe of needing new medication.

You must plan ahead so that if a refill will be needed during the trip you will either be able to fill a prescription you have on vacation or you will need to fill the prescription in advance.

Most people can get a prescription 7 days prior to the 30 day supply running out but not sooner, so you might need to fill a couple prescriptions a few days earlier in the month each to have enough on hand to make it through your vacation. It takes planning!

Sometimes you can work with your physician and pharmacist to get medicines early prior to travel. Talk to your pharmacist to see if they can help arrange this.

If you are out of town and you realize you forgot your child’s non-stimulant, call your doctor to see if they can e-prescribe it. Many of the non-stimulants are not safe to suddenly stop, so they are likely to send in a prescription. Insurance is not likely to pay for these extra pills if it was recently filled.

International travel will require that you find the laws in the other country to find out if you can bring controlled substances into the country. If you will need additional medicine while you are in that country, you will need to find a way to get the medicine.

 

Mail order

Some insurance companies will allow mail order 90 day prescriptions.

There are insurance companies that not only allow, but require them on daily medicines.

Others do not allow it.

In general I advise against a 90 day prescription if the dose is not established or if there are any concerns that it might not be the perfect dose. If there is any concern that it might need to be changed, a 30 day prescription is a better option.

If you will need to do a mail order, be sure you schedule your appointment to get the prescription early enough to account for the lost time mailing.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health