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!


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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

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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.



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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 



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7 Vitamin K Myths Busted

Social media has allowed the sharing of misinformation about many things, especially medically related things. When the specifics of something are unknown to a person, pretty much anything that’s said can sound reasonable, so people believe what they hear. This happens with many things, such as vaccine risks, chelation, and vitamin K.

I am especially frustrated when parents refuse to give their newborns vitamin K after birth. Since 1961, the American Academy of Pediatrics has recommended giving every newborn a single shot of vitamin K given at birth. This is a life saving treatment to prevent bleeding.

Life saving.

Vitamin K works to help our blood clot. Insufficient levels can lead to bleeding in the brain or other vital organs. Vitamin K deficiency bleeding or VKDB, can occur any time in the first 6 months of life. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classical and late. Unfortunately there are usually no warning signs that a baby will have significant bleeding, so when the bleeding happens, it’s too late to do anything about it. Why parents don’t want to give this preventative life saving treatment is usually based on incorrect information.

This is a matter of a fairly low risk of bleeding if you don’t give vitamin K: 250-1700 per 100,000 within the first week, and 4-7 per 100,000 between 2 and 12 weeks. You might notice that the number is variable – it’s hard to study since the large majority of babies have gotten vitamin K over the years and the risk is low even without vitamin K. However, when there is bleeding it has significant consequences: lifelong disability or death. And we also know that there’s very low risk from the vitamin K and it works very well to prevent bleeding. So why take the chance of not giving it?

Conspiracy Theories, Misunderstandings, and Science

This is not a governmental conspiracy to somehow kill children. It’s a world wide attempt to help children survive and thrive. The World Health Organization (WHO) guidelines:

  • All newborns should be given 1 mg of vitamin K intramuscularly [IM] after birth [after the first hour during which the infant should be in skin-to-skin contact with the mother and breastfeeding should be initiated]. (Strong recommendation, moderate quality evidence)

Most people look at scientific information and can’t make heads or tails of what it means.

Photo Source: Hemorrhagic Disease of the Newborn

That coupled with the fact that things we read that make us react emotionally (such as fear that something will harm our child) makes us remember and associate with the information that created the emotion, whether it is right or wrong. This can lead parents to make dangerous decisions for their children while trying to do the right thing.

Myth Busting

I’m going to attempt to de-bunk the most common concerns I’ve heard because the best way to combat misinformation is to help explain the facts as we know them.

1. If every baby’s born with too little vitamin K, that’s the way we’re supposed to be.

Babies are born with very little vitamin K in their body. If they don’t get it with a shot, they need to either eat it or make it. Breast milk has very little vitamin K and babies won’t be eating leafy greens for quite awhile. Formula does have it, but it takes several days for vitamin K to rise to protective levels with formula and the highest risk of bleeding is during that first week of life. (Of course if you’re using this argument because you want babies to be all natural, you probably won’t be giving formula at this point.)

Bacteria help us make vitamin K, but babies aren’t colonized at birth with these gut bacteria.

Just because they’re born that way doesn’t mean they’re supposed to stay that way. Inside the mother the baby is in a very different situation. They don’t breathe air. They don’t eat. They don’t have gut bacteria. Their heart has a bypass tract to avoid pumping blood to the lungs. This all works well in utero, but must change once they leave the womb. Change takes time, and during this time they are at risk. Why not minimize the risk if we know a safe way to do it?

2. The package insert has a big warning at the top that it can kill.

There are many reasons why we should not use the package insert of a medicine or vaccine to make healthcare decisions. These have been discussed before so I won’t go into all the details but please see these great blogs on how to read and use package inserts:

It is true that there is a black box warning on the top of the vitamin K package insert. This has scared some parents from wanting to get the vitamin K shot for their newborn.

Screen Shot from Package Insert 

Reactions to IV (intravenous) vitamin K are much more common than IM (intramuscular) injections. The difference is anything given by IV goes directly into the bloodstream and back to the heart. But we don’t give vitamin K by IV to newborns.

IM injections go into the muscle, allowing very slow absorption of the medicine. This not only decreases reactions to the injected vitamin, but also helps the level of vitamin K stay elevated for a prolonged time after a single injection.

I only found one report of a newborn with a significant reaction to vitamin K. The authors of the paper did note that IM vitamin K has been given for many years to babies all over the world without significant reactions and could not explain why the one infant had such a significant reaction.

Since we must always look at risk vs benefit, the very, very low risk of a serious reaction from receiving vitamin K IM is preferable to the benefit of the prevention of VKDB.

Another great resource on this topic is Dr. Vincent Iannelli’s That Black Box Warning on Vitamin K Shots.

3. Vitamin K causes cancer.

Many years ago there was a small study that suggested vitamin K led to childhood cancers. This issue has been extensively studied since then and no link has been found.

Vitamin K does not cause cancer.

Rates of cancer have not increased in the years since vitamin K has been given to the large majority of newborns worldwide. This is reported in the Vitamin K Ad Hoc Task Force of the American Academy of Pediatrics report Controversies Concerning Vitamin K and the Newborn.

4. Bleeding from vitamin K deficiency is rare or mild.

In the US bleeding from vitamin K deficiency is rare because most babies get the vitamin K shot soon after birth. In countries where vitamin K is not used routinely, bleeding is not rare at all. Some communities of the US where vitamin K is being refused by parents are seeing an increase in newborn bleeding.

Early VKDB occurs within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs which inhibit vitamin K. These drugs include anticonvulsants, anti-tuberculosis drugs, some antibiotics (cephalosporins) and blood thinners to prevent clots. Early VKDB is typically severe bleeding in the brain or gut.

Classic VKDB typically occurs during the first week of life. The incidence of classic VKDB ranges from 0.25-1.7 cases per 100 births.

Late onset VKDB occurs between 2 and 12 weeks usually, but is possible up to 6 months after birth. Late VKDB has fallen from 4.4-7.2 cases per 100,000 births to 1.4-6.4 cases per 100,000 births in reports from Asia and Europe after routine prophylaxis was started.

One out of five babies with VKDB dies. Of the infants who have late VKDB, about half have bleeding into their brains, which can lead to permanent brain damage if they survive. Others bleed in their stomach or intestines, or other vital organs. Many need blood transfusions or surgeries to help correct the problems from the bleeding.

5. It’s just as good to use oral vitamin K.

Early onset VKDB is prevented well with the oral vitamin K in countries that have oral vitamin K available, but late onset VKDB is an issue. Children with liver or gall bladder problems will not absorb oral vitamin K well. These problems might be undiagnosed early in life, putting these kids at risk for VKDB if they are on an oral vitamin K regimen.

There is no liquid form of vitamin K that is proven to be effective for babies in the US. That is a huge issue. Some families will order vitamin K online, but it’s not guaranteed to be safe or even what it claims to be. This is an unregulated industry. It is possible to use the vitamin K solution that is typically given intramuscularly by mouth, but this requires a prescription and the taste is questionable, so baby might not take the full dose. It would be an off-label use so physicians might not feel comfortable writing a prescription. The other issue that might worry physicians is with compliance in remembering to give the oral vitamin K as directed, since most studies include babies with late onset bleeding who had missed doses.

Most of us get vitamin K from gut bacteria and eating leafy green vegetables. Newborns don’t have the gut bacteria established yet so they won’t make any vitamin K themselves. They may get vitamin K through their diet, but breastmilk is very low in vitamin K, so unless baby is getting formula, they will not get enough vitamin K without a supplement. It is possible for mothers who breastfeed to increase their vitamin K intake to increase the amount in breast milk, but not to sufficient levels to protect the baby without additional vitamin K.

Many countries that have used an oral vitamin K protocol, such as Denmark and Holland, have changed to an intramuscular regimen because the oral vitamin K that was previously used became no longer available.

There are various oral vitamin K dosing strategies that can be reviewed in the linked abstract. In short:

  •  Australia and Germany: 3 oral doses of 1 mg vitamin K are less effective than a single IM vitamin K dose. (In 1994 Australia changed to a single IM dose and their rate went to zero after the change.)
  • Netherlands: A 1mg oral dose after birth followed by a daily oral dose of 25 mcg vitamin K1 may be as effective as parenteral vitamin K prophylaxis.
  • Sweden: (a later study) 2 mg of mixed micellar VK given orally at birth, 4 days, and 1 month has a failure rate of one case of early and four cases of late VKDB out of 458,184 babies. Of the failures, 4 had an undiagnosed liver issue, one baby’s parents forgot the last dose.

When vitamin K is given IM, the chance of late VKDB is near zero. Oral vitamin K simply doesn’t prevent both early and late bleeding as well — especially if there is an unknown malabsorption disorder, regardless of which dosing regimen is used.

6. My baby’s birth was not traumatic, so he doesn’t need the vitamin K.

Birth trauma can certainly lead to bleeding, but the absence of trauma does not exclude it. Late vitamin K deficient bleeding (VKDB) cannot be explained by any birth traumas since they can occur months later.

7. We’re delaying cord clamping to help prevent anemia and bleeding. Isn’t that enough?

Delayed cord clamping can have benefits, but decreasing the risk of bleeding is not one of them. There is very little vitamin K in the placenta or newborn, so delaying the cord clamping cannot allow more vitamin K into the baby.

Still not convinced?

Read stories about babies whose parents chose to not give vitamin K:

For More Information:

Evidence on: The Vitamin K Shot in Newborns (Evidenced Based Birth)

Help! My Child Stuck ____ Up His Nose!

Help! My child stuck ___ up his nose!

If you’ve ever said these words, you know how awful it can be to know your little one has something stuck up there but cannot blow it out. The longer it has been there, the more chance there will be secondary complications, such as irritation to the nasal mucosa (“skin” in the nose) or infection.

Sometimes the first sign of  something in the nose is a foul smell to their breath and thick yellow or green discharge from only one side of the nose. This is due to infection from the body’s rejection of the object. (Usually a cold or allergies affects both nostrils, right?) These kids should be seen at the doctor’s office for further evaluation and treatment.

Sometimes you are lucky enough to find out about the foreign object soon after it is placed up the nose, before complications arise. But even then, how do you get it out?

Some parents feel most comfortable with a medical professional removing it. That’s fine. Call your doctor’s office and they’ll be happy to help.

Regardless of where you decide to get the thing out: keep calm! Try to keep your child calm because if they are crying they can suck the object in further. A common problem is parents get upset, and this just gets the child upset. Even if you’re going crazy on the inside, maintain your calm on the outside.

To actually get something out of the nose, sometimes doctors need to use their special equipment to get it out. But there’s a really good trick I learned from an ER doc friend long ago that can even work at home: blow it out for them.

It’s called the “Mother’s Kiss” but dads can give it a try too.

This is something you can try at home or in your doctor’s office if you’re nervous or unsure how to do it. Never try to reach up there with something to pull it out… you might push it in higher and get it stuck in a turbinate– see the picture below.

The basic problem is kids who put things up their nose don’t usually have the ability to blow hard enough to get it out. If you blow into their mouth you can often force the object out. (Think of CPR, only you don’t block the nose to force the air into the lungs- that would be bad!) 

It’s important to not block the exit from the other nostril and not to do this if something is up both nostrils.

There are those kids…

We don’t want to force the air into the lungs and cause problems there!

In my office we often put Neo-Synephrine in the nose to shrink the nasal passageways to make it easier for the object to be blown out, especially important if the object has been there awhile and there is mucosal swelling.

And then the kiss…

Blow into the mouth with a quick puff of air. This forces air up the back of the throat into the nose. Don’t block either nostril as you do this. The blow can be repeated several times if not successful at first. The parent usually ends up with a cheek full of mucus along with the object!

Of course, if this fails, you will need to bring your kiddo in to be evaluated. Sometimes with fancy tools we can remove the object. If it is deep into the nose or into the turbinates, an Ear Nose and Throat specialist might be required.

As always, prevention is the best cure. Keep small things away from kids and when they are working with craft beads, eating corn, playing on a gravel road, or otherwise in the vicinity of small objects, keep an eye on them!

nose picking, objects up nose
Kids will pick their nose and stick things up there…

Hearing Loss

Most of us associate hearing loss with old age, but it is increasingly common for children and teens to suffer from mild to moderate hearing loss. Nearly 15% of kids have hearing loss according to the CDC. Hearing loss can be due to many things that are difficult to control, such as heredity, infection, and medications. In kids and teens it is oven due to a preventable cause: noise.

Where does the excessive noise come from?

Even young children are exposed to more loud noises through toys, television, and gaming devices than children of years past.

Widespread use of ear buds for prolonged periods can take its toll on hearing. Unlike the bulky headphones used when I was a child, ear buds deliver sound directly into the ear canal without any sound buffering in between. Most often the ear buds are used with iPods and other mp3 players are low to mediocre quality, so they are unable to transit the bass as effectively. Many kids turn the music up to hear the bass. If others can hear the music coming from ear buds, they are too loud!

Loud concerts or sporting events can also expose our ears to excessive volumes for a prolonged period of time.

Not all excessive noise is from kids being undisciplined – some kids are helping out the family or trying to earn extra cash by mowing lawns or using power tools, which puts them at increased risk.

How much is too much?

According to the Centers for Disease Control and Prevention (CDC), being exposed to more than 85 decibels (dB) of sound for eight hours can damage your hearing. At 105 dB, hearing loss is possible after a mere 5 minutes.

If you’re like me, that means nothing because how much is 85 dB? There is a great chart of common sounds and how loud they are on this page from the CDC. There are also several free apps available for download on smartphones and tablets – search “sound meter” or “decibel” and read reviews before downloading. Take advantage of these — and because it’s in the phone, kids might actually have fun playing around with them and learning about their environmental risks at the same time!

Signs of hearing loss

One early sign of excessive noise is ringing in the ears, but most people with hearing loss never realize it’s happening because it’s slowly progressive. If you notice your child asking “what” more often or complaining that the television is too quiet when others hear it well, it is a good idea to have their hearing tested.

Consequences of hearing loss

There are many potential consequences to hearing loss:

  • Learning – you have to be able to hear the lecture.
  • Behaviors – if directions and instructions are missed, a child might incorrectly be seen as misbehaving.
  • Friendships and social skills – if a child can’t follow a conversation they aren’t easy to talk to or play with.
  • Job availability – many jobs require hearing at a certain level.

Prevention

Talk to your kids about the risks of their habits that involve loud sounds. Unfortunately kids won’t always take parental advice to heart because they have a feeling of invincibility, but studies show if they learn about hearing loss they are more likely to use protection. Even more so, what their friends are doing alters their behavior. Teach not only your kids, but also their friends. If they’re all going to a loud event, consider giving them all ear plugs. Once hearing is damaged they can’t gain the hearing back, so prevention is key.
Ways to protect include:
  • Wear hearing protection (earplugs) when mowing the grass and attending loud events, such as concerts or sporting events.
  • Turn down your music! Some music players have alerts when the volume goes too loud, but those can be ignored if the child doesn’t understand why it’s important to lower the volume. If others can hear the music you’re listening to through ear buds, turn it down.
  • Lower the maximum volume setting on your iPod or mp3 player. To do this, go to “Settings” and select “Volume Limit” under Music. Set it at about 60% of the full volume, that way you can’t accidentally turn your music too high.
  • Use big headphones instead of ear buds. They offer more external noise cancelling, which allows the music to be heard better at lower volumes. They are also physically further from your eardrum, which helps.
  • If you must use ear buds, use high quality buds that transmit bass if you are tempted to turn music up to hear the bass.
  • Follow the 60/60 rule: No more than 60 minutes of listening at a time, and no higher than 60 percent of maximum volume. If you go under “settings,” you can actually set your iPod for maximum volume setting of 60 percent, so you can’t accidentally turn your music up too loud.
  • Higher pitched sounds have greater potential to damage your ears than lower pitched sounds. Turn down the volume when a high-pitched song comes on.
  • Try not to fall asleep with ear buds or headphones on. The time of exposure matters and why waste sleep time damaging your ears?
  • If you need “white noise” to fall to sleep, put together a playlist of soft songs or sounds and have it play at a low volume from a speaker on your bedside table. Use your clock’s “sleep” function, which will automatically turn off your music after a set amount of time to ensure the music doesn’t end up playing all night long, which saves energy in addition to your hearing.
  • As always: model these behaviors for your children. If they see you mowing the grass with loud music blaring in your ears, they will grow up to do the same. If you wear ear buds many hours of the day, they will see that as a normal and acceptable behavior.

What happens that hurts our hearing?

Don’t let your kids and teens ruin their hearing!
Keep the volume down – Too loud and too long can damage your hearing shows a man listening to music. Below it the music soundtrack and volume levels are shown. The video then breaks to showing what happens to the hair cells in our ear with these volumes, which makes the damage more understandable because you can see it happening.

Resources:

CDC’s Hearing Loss main page

Motion Sickness

School vacation often leads to travel, which brings up a lot of questions about motion sickness, also known as car sickness, sea sickness, and air sickness. If your child suffers from motion sickness, there are many options – though some take awhile to show benefit, so plan ahead!

motion sickness

Whether it’s the threat of a long car trip, concern about flying, or anticipated problems on a cruise, there are many kids who suffer from motion sickness. Kids 2 – 12 years are the most likely to suffer from motion sickness. It’s less common in teens and adults and very rare in infants and toddlers. It is more common in women and people with migraines.

Motion sickness is thought to be triggered when the inner ear senses motion but the eyes don’t. These mixed signals coming into the brain can cause nausea, dizziness, vomiting, paleness and cold sweats. Motion sickness often happens on ships and boats, but it also can affect kids when they travel in planes, buses and cars. Motion sickness is often worst if there is a bumpy or curvy ride. It can also be triggered by strong smells, which is why avoiding gas stations (if possible) can help prevent it. Sometimes trying to read a book or watching a movie during travel can trigger motion sickness. In both children and adults, playing computer games can sometimes lead to motion sickness.

Some general tips to avoid motion sickness:

  • Look out the window during travel. Don’t watch other moving objects (such as cars) — watch the horizon. Teens and adults can benefit from sitting in the front seat. Younger children (12 and under) are safer in the back seat.
  • Avoid strong smells, such as those at the gas station, if possible.
  • Eat small amounts of high protein, non-greasy foods during travel. Spicy and fatty foods can exacerbate symptoms. Crackers can help.
  • Sleep. Or at least close eyes.
  • Take deep, controlled breaths.
  • Use a headrest to prevent head movement.
  • In a plane: sit over the wing and recline when possible.
  • On a ship: stay on deck where you can see the horizon as much as possible. Avoid the bow and stern.
  • Take breaks for fresh air and a short walk if possible.
  • Some people believe that opening the car window for fresh air helps, but close windows if the air quality is poor or irritates the rider.
  • No smoking or e-cigarette use in the car. Ever. Even when no one is in the car with the driver. The compounds left behind can be dangerous to children.
  • Avoid reading books or playing video games when traveling. Movies are tolerated more often than reading, but if they are not tolerated, stop them.
  • Be aware that some medicines increase the risk of motion sickness. Avoid these if possible. A full list is included in the link, but those more commonly used in children and teens are ibuprofen, some antibiotics, some antidepressants, and hormones (birth control pills).

Medicines for motion sickness:

All medicines have side effects, but many of the ones that seem to help motion sickness can have significant side effects, so risks and benefits must be considered. Note that none of these medicines is approved under 2 years of age, but motion sickness is uncommon in infants and toddlers.If you decide upon a medicine, be sure to keep it out of reach of children to avoid overdose. Remember that during travel childproofing is more difficult!

In case of suspected overdose, call your local poison control center at 1-800-222-1222. Put this number in all of your phones for easy access in times of emergency.

If a person is not breathing or unconscious, first call 911 and initiate CPR.
  • Benadryl (diphenhydramine) is an over the counter antihistamine that can help some kids over 2 years of age with motion sickness. Follow the over the counter package directions for weight – based dose and give it 30 minutes before travel and before meals and at bedtime if needed. It can lead to excessive sleepiness – or hyperactivity in some kids, so be careful! If your child has never had Benadryl, I recommend doing a test dose at home before travel to be sure they don’t get wired or irritable on it.
  • Dramamine (dimenhydrinate) can also help kids over age 2 and is available over the counter. It also should be started 30-60 minutes before traveling and every 4-6 hours (for 12 years and up) and every 6-8 hours (for children under 12 years) as needed. Side effects include drowsiness, dry mouth, blurry vision, thickened mucus in their airways, feeling excited or restless, and increased heart rate.
  • Dramamine Less Drowsy (meclizine) is also available over the counter and can help prevent motion sickness in children over 2 years of age. Meclizine comes as a regular and chewable tablet and a capsule. It should be taken 1 hour before you travel. Doses may be taken every 24 hours if needed. Side effects include drowsiness, dry mouth, and blurred vision.
  • Phenergan (promethazine) is sometimes prescribed for motion sickness. Some significant warnings exist for children, so see the attached link and talk to your doctor about the risks and benefits of this medication. The drug comes in suppository and tablet form. When promethazine is used to treat motion sickness, it is taken 30 to 60 minutes before travel and again after 8 to 12 hours if needed. On longer trips, promethazine is usually taken in the morning and before the evening meal on each day of travel. Side effects include dizziness, anxiety and drowsiness. It can slow or stop breathing in children.
  • Zofran (ondansetron) is a prescription medicine that is used to treat nausea and vomiting. See your doctor to discuss if this prescription is appropriate for your child for motion sickness.
  • Prochlorperazine is an antipsychotic that helps treat severe nausea and vomiting. It comes as tablets and suppositories. Prochlorperazine should not be used in children under 2 years old or who weigh less than 20 pounds. Prochlorperazine requires a prescription, and a full discussion of risks and benefits should be done with your doctor before taking this medicine. See the attached link for full list of potential side effects as well as other drug interactions.
  • Metoclopramide has been used for treatment of motion sickness, but carries significant risks. Please see the attached link for details.
  • scopolamine patch can be considered for teens and adults but should not be used in kids under 12 years. Some experts discourage any use in all children due to significant side effects, which include sedation, blurred vision, disorientation and mouth dryness. See attached link for complete list of side effects. If it is used, the patch is placed behind the ear 4 hours before travel and left in place for up to 72 hours.

Alternative treatments:

  • Ginger has been shown to help prevent motion sickness, but the specific dose is not clear. Kids can drink ginger tea or ginger ale or suck on a ginger lollipop or lozenge – only if old enough to not choke. To make ginger tea: dissolve 1/8 – 1/4 teaspoon of powdered ginger in a cup of hot water or boil two slices of fresh ginger root (each about 1/8 of an inch thick)in one cup of water for about 10 minutes. Sweeten to taste, and offer small sips throughout the day.
  • Accupressure wristbands are sold in pharmacies and online, and though research is not conclusive, I have seen decent benefit from these. They fall into the “it won’t hurt to try” category in my opinion. I don’t know if it is the power of s
    uggestion (placebo effect) or a real benefit, but I have seen several families rely upon these successfully.
  • If your child suffers from motion sickness often, there are some studies that support vestibular training. It will not work for your vacation next week, but can be considered for children who suffer to help long term. Have your child work with a physical therapist trained in vestibular training.

Traveling with Kids

Many families travel when school’s out of session, which over the winter holiday season means traveling when illness is abound. I get a lot of questions this time of year about how to safely travel with kids.

Sleep disturbances

Sleep deprivation can make everyone miserable, especially kids (and their parents). Make sure your kids are well rested prior to travel and try to keep them on a healthy sleep schedule during your trip.
  • Bring favorite comfort items, such as a stuffed animal or blankie, to help kids relax for sleep. If possible, travel with your own pillows.
  • If you’re staying at a hotel, ask for a quiet room, such as one away from the pool and the elevator.
  • Be sure to verify that there will be safe sleeping areas for every child, especially infants, before you travel.
  • Try to keep kids on their regular sleep schedule. It’s tempting to stay up late to enjoy the most of the vacation, but in reality that will only serve to make little monsters of your children if they’re sleep deprived.
  • If your kids nap well in the car, plan on doing long stretches on the road during nap time. If kids don’t sleep well in the car, be sure to plan to be at your hotel (or wherever you’re staying) at sleep times so they can stay in their usual routine.
  • Some families leave on long trips at the child’s bedtime to let them sleep through the drive. Just be sure the driver is well rested to make it a safe trip!
  • If you’re changing time zones significantly, plan ahead. Jet lag can be worse when traveling east than when going west. Jet lag is more than just being tired from a change in sleep routine, it also involves changes to the eating schedule. Kids will often wake when they’re used to eating because the body is hungry at that time. Try to feed everyone right before they go to sleep to try to prevent this. Breastfed infants might have a harder time adjusting because mother’s milk production is also off schedule.
  • Tired, sick, and hungry all make for bad moods, so try to stay on track on all accounts. Sunlight helps regulate our circadian rhythm, so try to get everyone up and outside in the morning to help reset their inner clocks. Keep everyone active during the day so they are tired at the new night-time.

Keeping track of littles

  • Toddlers and young kids love to run and roam. Be sure that they are always within sight. Use strollers if they’ll stay in them.
  • Consider toddler leashes. I know they seem awful at first thought, but they work and kids often love them! I never needed one for my first – he was attached to parents at the hip and never wandered. My second was fast. And fearless. She would run between people in crowds and it was impossible to keep up with her without pushing people out of the way. She hated holding hands. She always figured out ways to climb out of strollers – and once had a nasty bruise on her forehead when she fell face down climbing out as I pushed the stroller. She loved the leash. It had a cute monkey backpack. She loved the freedom of being able to wander around and I loved that she couldn’t get too far.
  • Parents have a number of ways to put phone numbers on their kids in case they get separated. Some simply put in on a piece of paper and trust that it will stay in a pocket until it’s needed. Others write it in sharpie inside a piece of clothing or even on a child’s arm. You can have jewelry engraved with name and phone number, much like a medical alert bracelet. Just look at Etsy or Pinterest and you’ll come up with ideas!
  • It’s a great idea to take pictures of everyone each morning in case someone gets separated from the group. Not only will you have a current picture for authorities to see what they look like, but you will also know what they were wearing at the time they were lost.

Airplane issues

  • The great news is that air travel is much safer from an infection standpoint than it used to be. Newer airplanes have HEPA filters that make a complete air change approximately 15 to 30 times per hour, or once every 2-4 minutes. The filters are said to remove 99.9% of bacteria, fungi and larger viruses. These germs can live on surfaces though, so I still recommend using common sense and bringing along a small hand sanitizer bottle and disinfectant wipes to use as needed. Wipe down arm rests, tray tables, seat pockets, windows, and other surfaces your kids will touch. After they touch unclean items sanitize their hands. Interestingly, sitting in an aisle seat is considered more dangerous, since people touch those seats during boarding and when going to the restroom, so if you’re seated in the aisle pay attention to when surfaces need to be re-sanitized. Sitting next to a sick person increases your risk, so if there is an option to move if the person seated next to you is ill appearing, ask to be moved.
  • Most adults who have flown have experienced ear pain due to pressure changes when flying. Anyone with a cold, ear infection or congestion from allergies is more at risk of ear pain, so pre-medicating with a pain reliever (such as acetaminophen) might help. If you have allergies be sure to get control of them before air travel. The best allergy treatment is usually a nasal corticosteroid.
  • It has often been recommended to offer infants something to suck on (bottle, breast or a pacifier) during take off and landing to help with ear pressure. Start early in the landing – the higher you are, the more the pressure will change. Older toddlers and kids can be offered a drink since swallowing can help. Ask them to hold their nose closed and try to blow air out through the closed nostrils followed by a big yawn. If your kids can safely chew gum (usually only recommended for those over 4 years of age) you can allow them to chew during take off and landing.
  • Airplane cabin noise levels can range anywhere from 60 – 100 dB and tend to be louder during takeoff. (I’ve written about Hearing Loss from noise previously to help you understand what that means.) Use cotton balls or small earplugs to help decrease the exposure, especially if your kids are sensitive to loud noises.
  • The Car Seat Lady has a great page on knowing your rights when flying with kids.

Cruise ship issues

  • Learn about cruise-specific opportunities for kids of various ages. Many will offer age-specific child care, “clubs” or areas to allow safe opportunities for everyone to hang out with people of their own age group. Cruises offer the opportunity for adventurous kids to be independent and separate from parents at times, allowing each to have a separate-yet-together vacation. Travel with another family with kids the same ages as yours so your child knows a friendly face, especially if siblings are in a different age group for the cruises “clubs”.
  • Talk to kids about safety issues on the ship and make sure they follow your rules. They should always stay where they are supposed to be and not wander around. There’s safety in numbers, so have them use a buddy system and stick with their buddy. Find out how you can get a hold of them and they can get a hold of you during the cruise.
  • Of course sunscreen is a must. Reapply often!
  • Be sure kids are properly supervised near water. That means an adult who is responsible for watching the kids should not be under the influence of alcohol, shouldn’t read a book, or have other distractions.

Car seats (for planes, trains and automobiles)

  • I know it’s tempting to save money and not get a seat for your child under 2 years of age on a plane, but it is recommended that all children are seated in a proper child safety restraint system (CRS). It must be approved for flight, but then you can then use the seat for land travel.
  • I always recommend age and size appropriate car seats or boosters when traveling, even if you’re in a country that does not require them. Allowing kids to ride without a proper seat will probably lead to problems getting them back in their safe seat when they get back home. Besides, we use car seats and booster seats to protect our kids, not just to satisfy the law.
  • So… my section header was meant to be cute. Trains don’t have seatbelts, so car seats won’t work. But they are a safe way to travel. Car Seat for the Littles has a great explanation on Travel by Train.

Motion sickness

When should pregnant women and new babies avoid travel by air?

  • A surprising number of families either must travel (due to a job transfer, death in the family, out of state adoption, or other important occasion) or choose to travel during pregnancy or with young infants.
  • Newborns need constant attention, which can be difficult if the seatbelt sign is on and needed items are in the overhead bin. New parents are already sleep deprived and sleeping on planes isn’t easy. New moms might still have swollen feet and need to keep their feet up, which is difficult in flight. Newborns are at high risk of infection and the close contact with other travelers can be a concern. And traveling is hard on everyone. But the good news is that overall young infants tend to travel well.
  • It is advisable to not travel after 36 weeks of pregnancy because of concerns of preterm labor. Pregnant women should talk with their OB about travel plans.
  • Some airlines allow term babies as young as 48 hours of age to fly, but others require infants to be two weeks – so check with your airline if you’ll be traveling in the first days of your newborn’s life. There is no standard guideline, but my preference would be to wait until term babies are over 2 weeks of age due to heart circulation changes that occur the first two weeks. Waiting until after 6 weeks allows for newborns to get the first set of vaccines (other than the Hepatitis B vaccine) prior to flight would be even better. Infants ideally have their own seat so they can be placed in a car seat that is FAA approved.
  • Babies born before 36 weeks and those with special health issues should get clearance from their physicians before traveling.
  • Overall traveling with an infant is not as difficult as many parents fear. Toddlers are another story… they don’t like to sit still for any amount of time and flights make that difficult. They also touch everything and put fingers in their mouth, so they are more likely to get exposed to germs.

Illness prevention

Who wants to be sick on vacation? No one. It’s easy to get exposed anywhere during the cold and flu season, so protect yourself and your family.
  • Teach kids (and remind yourself) to not touch faces – your own or others. Our eyes, nose, and mouth are the portals of entry and exit for germs.
  • Wash hands before and after eating, after blowing your nose, before and after touching eyes/nose/mouth, before and after putting in contacts, after toileting or changing a diaper, and when they’re obviously soiled.
  • Cover sneezes and coughs with your elbow unless you’re cradling an infant in your arms. Infants have their head and face in your elbow, so you should use your hands to cover, then wash your hands well.

 

Make sure all family members are up to date on vaccines.

 

Keep records

Take pictures of your passport, vaccine record, medicines, insurance cards, and other important items to use if the originals are lost. Store the images so you have access to them from any computer in addition to your phone in case your phone is lost.

Have everyone, including young children, carry a form of identification that includes emergency contact information.

Create a medical history form that includes the following information for every member of your family that is travelling. Save a copy so you can easily find it on any computer in case of emergency.

  • your name, address, and phone number
  • emergency contact name(s) and phone number(s)
  • immunization record
  • your doctor’s name, address, and office and emergency phone numbers
  • the name, address, and phone number of your health insurance carrier, including your policy number
  • a list of any known health problems or recent illnesses
  • a list of current medications and supplements you are taking and pharmacy name and phone number
  • a list of allergies to medications, food, insects, and animals
  • a prescription for glasses or contact lenses

Enjoy!

Last, but not least: Enjoy your vacation!
Be flexible.

Don’t overschedule. Your kids will remember the experience, so make moments count – don’t worry if you don’t accomplish all there is to do!

Take a look at some of the Holiday Health Hazards that come up at vacation times from Dr Christina at PMPediatrics so you can prevent accidents along the way.

Take pictures, but don’t make the vacation about the pictures. Try to stay off your phone and enjoy the moments!

Which Supplements Help Prevent and Treat Infections?

I don’t know anyone who wants to get sick, so most of us try our best to avoid illnesses. We do this by washing our hands and encouraging our kids to cover their coughs. We avoid sick people as much as possible (though we don’t always stay home when we should). We should routinely get enough sleep (most Americans fail in this regard) and eat more fruits and vegetables (again, most of us fail to get the minimum recommended amounts of plants in our diets).

All of these measures can help, but can we get more help from nutritional supplements or other natural remedies? What will boost our immune system?

I’m often asked if vitamin C, zinc, or essential oils will help various ailments or boost our immune system. I know that many people try natural products that are promoted to boost or support the immune system. They’re hopeful that stimulating immune system activity will help the body fight off a virus. But research doesn’t show that our immune system works that way. A virus can cause illness even in healthy people. If you want to read an in-depth summary of how our immune system works, the Skeptical Raptor has done a nice job discussing the complexities and why it’s not as easy as eating healthy and taking supplements. Not to mention the fact that we don’t necessarily want an overactive immune system, which is associated with allergies and autoimmune diseases.

One thing we need to remember first and foremost in the discussion of supplements is that this is an under-regulated industry. The FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. For this reason I hesitate to recommend supplements at all. Even though I do recommend Vitamin D supplements because studies support the need for additional Vitamin D in most people, I cannot endorse one particular product. Over the years many supplements, homeopathic products and herbs have been reported to have significant variances in amounts of product and unnamed contaminants, including lead and other hazards.

Summaries of supplement and other “natural treatment” effectiveness:

  • Probiotics may actually help prevent the number of infections. There are many, many types of probiotics, so further studies are needed on how to choose the best strain.
  • Zinc has been shown to help prevent upper respiratory tract infections in children and teens and to decrease the duration of the common cold symptoms. It is best given as a lozenge to help with absorption. Intranasal zinc has been linked to a permanent loss of smell and should not be used. High doses can cause significant side effects, so talk to your doctor and pharmacist before supplementing.
  • Nasal saline rinses show benefit in treating symptoms of upper respiratory tract infections. Learn how to do these correctly before trying it though. I often recommend Nasopure products as an unpaid endorsement. They’re a local company with a very helpful website. Use their library to learn how to properly use nasal rinses in kids as young as 2 years of age.
  • Honey may reduce the frequency of cough and improve the quality of sleep for children with the common cold. Honey should never be used in children younger than 1 year of age because of the risk of botulism.
  • Echinacea has consistently been shown to be ineffective in many studies. I know that many people have heard of its benefits, so if you aren’t convinced that you shouldn’t waste money on it, see the NCCIH’s Echinacea page.
  • Garlic shows overall low evidence of benefit.
  • Vitamin C can shorten the duration of illness mildly with daily supplementation.
  • Chinese herbal medicines do not have high quality studies so effectiveness is unknown.
  • Geranium extract (Pelargonium sidoides) has insufficient evidence of benefit for cold and cough symptoms.
  • Turmeric‘s supposed anti-inflammatory properties have not been shown to be effective by research.
  • Essential oils have the potential for beneficial effects – but they also have the potential for adverse reactions. Although they are touted as a cure for many ailments, published studies regarding the uses of aromatherapy have generally focused on its psychological effects on stress and anxiety or its use as a topical treatment for skin conditions. Both Young Living and dōTERRA have received warning letters from the FDA about improper marketing and unsubstantiated claims for uses of their oils. While many people think essential oils are safe, they can lead to significant problems. Some people suffer from allergic reactions to oils. They can increase sensitivity to the sun when applied topically. Tea tree oil and lavender have estrogen-like effects and caution should be used with these. Some of these substances can even lead to seizures, liver damage, and death if used improperly. Ingestion of the oils is a growing concern – as more households have them, more children are ingesting them.
Alice Callahan’s “Immune-Boosting” Supplements Won’t Protect You from Back-to-School Germs is a great review of many of the supplements touted to prevent or treat illnesses. Her background in nutrition provides a solid base for reviewing claims that many of us don’t understand completely.
Generally supplements are not recommended, but if you choose to use them, use them cautiously.
  • Supplements contain a wide variety of ingredients – including vitamins, minerals, amino acids, and herbs. Research has confirmed health benefits of some dietary supplements but not others. The woo can be strong in this area, so be cautious where you get your information.
  • Supplements have been known to include unlisted ingredients and to have inconsistent levels of product. When they are recalled, there is no mechanism in place to identify and notify people who have purchased affected products.
  • Find a reliable source to evaluate effectiveness and risks. Some reports have shown that people who take supplements have higher risks of cancer, liver damage, birth defects, bleeding, and other health problems. When looking for information, use noncommercial sites (National Institutes of HealthFood and Drug AdministrationUS Department of AgricultureNational Center for Complementary Health) rather than depending on information from sellers.
  • Natural does not mean safe. I’ve always said that I wouldn’t give my picky eater marijuana to stimulate his appetite and encourage him to eat. Not even if it was organic. That usually gets the point across. You need to know the risks of a product, even if it’s natural.
  • If supplements will be taken, talk to your doctor and pharmacist about drug interactions. Sometimes it’s difficult to know the risks because not all ingredients are included on the label and not all ingredients have been well studied, especially in combination with other supplements and medications.
  • Most dietary supplements have not been tested in pregnant women, nursing mothers, or children. Remember just because something’s natural doesn’t mean it’s safe. Arsenic is natural but I wouldn’t advise taking it in high doses.
  • If something sounds too good to be true, it probably is. There are no miracle cures. Avoid being manipulated by advertising. It’s easy to fall prey because we all want to feel better quickly and parents want their kids to be healthy. But if it claims to be 100% effective or to have no side effects, it’s probably false advertising. Personal accounts of something working are as likely to be based on bias or coincidence as to be from real benefit. Rely on large clinical studies that have been reproduced by other researchers.
  • Dr. Chad Hayes has a very long, but wonderful post on how many of the integrative medicines are not simply not beneficial but potentially dangerous – Citations Needed: The curious “science” of integrative medicineMy experience at “Get Your Life Back NOW!”
This post isn’t about antibiotics, but they don’t work against viral illnesses any better than supplements. They don’t prevent the development of ear infections or pneumonia, so even if your child seems to always develop these complications, your doctor should not prescribe them preventatively. Don’t use antibiotics for routine upper respiratory infections, stomach bugs, and other viral illnesses.

Do you know what really boosts your immune system?