My child swallowed…

It happens all the time. Kids put things in their mouth that aren’t supposed to be eaten. Parents often call after their child swallowed a toy piece, a coin, and many other things. Most of the time things will just pass — though I’m not a fan of watching the stools for the swallowed object because it just worries parents if they miss it.

Who swallows non-food things?

my child swallowedThe biggest risk group is children between the ages of 6 months and 6 years, but anyone can be at risk.

I have seen an older school aged child swallow a magnet after putting 2 small strong magnets on either side of their tongue to look like a tongue piercing.

Even adults have been known to swallow things such as needles – sewers put the needle in their mouth if you think about it.

Be prepared

Learn CPR

If you are around kids it is a good idea to know child CPR and refresh your skills every couple years.

Classes are often held at local Red Cross stations, hospitals, or fire departments.

You can also find classes by searching “CPR” and your zip code.

Know warning signs

For great information on signs and symptoms of choking and general treatment of choking, visit this KidsHealth Choking link.

Of course, prevention is key

Store medicines and cleaning products where kids can’t reach them.

Be especially alert when visiting other people’s homes – especially if they don’t have young children.

Watch kids carefully when outside.

Throw away broken toys that could have pieces break off.

Keep young kids away from toys designed for older kids.

When to talk to your pediatrician

If your child seems to put more non-food items in his mouth than other kids, he is at risk of pica.

Pica is when a person compulsively puts non-foods in his mouth. For more see the KidsHealth Pica link.

Poison Control Number – use it!

Poison Control number 1-800-222-1222. For more: http://www.aapcc.org
Poison Control number 1-800-222-1222. For more: http://www.aapcc.org

Always keep the poison control number (1-800-222-1222) stored in all your phones!

If you call me about a potentially toxic substance, chances are I will refer to poison control. They have the best database of substance risks and their treatments.

Don’t delay treatment by calling the doctor!

Things kids swallow and what to do:

Balloons:

Balloons are statistically some of the most inhaled or ingested foreign bodies.

One reason is they are so popular with kids. Young kids often will try to bite them.

They often are found at parties or other large crowds, where toddlers and young children are often less directly supervised.

Balloons can suffocate a child quickly if they are inhaled.

Call 911 if there is any difficulty breathing, drooling, or other signs of distress. This can mean the balloon was inhaled into the lungs, not swallowed.

If swallowed, they will pass on their own.

Prevention

Keep balloons away from young children and supervise school aged kids when around balloons.

Batteries:

If you think your child has swallowed a battery, whether or not he appears distressed, immediately take him to an emergency room.

If there is distress, call 911.

Batteries can cause voltage burns or leak, causing acidic burns as soon as four hours after being swallowed.

X-rays will confirm if the battery is in the chest or abdomen.

Batteries usually need to be removed to prevent serious injury.

Prevention

Be sure to keep all of your batteries, especially the small button batteries, safely stored away from children.

Make sure battery-charged items have the battery securely secured. Most now have covers secured with screws. If the cover is easily removed, your child is at risk!

Bugs:

Most of us has swallowed a bug some time in our life. You might not even know if a small one hides in your soda can and you take a big gulp.

A little extra protein, right?

Unless your child chokes, or if it has a stinger (bee, wasp) there is nothing to worry about.

If he’s choking, follow choking instructions.

If you suspect a bee or wasp was swallowed, especially if your child seems to be reacting to a sting in the mouth, or there’s sudden difficulty breathing, drooling, or choking, call 911. Serious reactions to stings in the mouth can occur.

Prevention

Watch kids closely when outside, especially those under 3 years of age or kids who are known to put things in their mouth.

Buttons:

Buttons are generally harmless unless they get stuck or inhaled rather than swallowed.

Signs of breathing difficulty, choking, drooling, or generalized distress should alert you to bring your child to be evaluated.

Buttons are not easily seen on X-ray, which can make identification of a stuck button a little tricky, but if you suspect an issue, talk to your doctor.

Prevention

Keep unattached buttons (the ones in your sewing kit) stored away from kids.

Monitor your children’s clothing and repair any loose buttons.

Cinnamon

Cinnamon is technically a food, but the cinnamon challenge is leading kids and teens to take a spoonful, which can be very dangerous.

The challenge involves something along the lines of swallowing a tablespoon of cinnamon without water.

Ingestion of the cinnamon powder stimulates the gag reflex followed by inhalation of the powder. This causes excruciating pain due to the chemical properties of cinnamon.

It can also trigger airway narrowing and an asthma attack.

And there’s more.

Cinnamon is powdered bark. The cellulose matrix of tree bark acts like a sustained release medicine, slowly releasing a painful and damaging chemical in the lungs.

The body cannot metabolize cellulose. When it’s eaten, it gets passed into the toilet. But if it’s inhaled, our lungs can’t metabolize it.

Prevention

Talk to your kids about the risks of accepting a challenge. It’s not just the cinnamon challenge. Dr. Irene Tien discusses more Dangerous viral challenges you need to know about.

On the surface many things seem just silly and not really dangerous. But unless they know all the risks and consequences and know it is safe, they shouldn’t do the challenge.

Don’t limit this talk to just cinnamon. Use it as an example, but we never know what the next crazy challenge will be – the next category includes a more recent challenge.

Cleaning products, laundry detergent, and other chemicals:

These are highly dangerous and you should call poison control with any suspicion of ingestion. 1-800-222-1222

Call 911 if there are signs of distress.

Prevention

Cleaning products should always be stored away from children to prevent the possibility of swallowing in the first place.

Even the “green” products are usually not safe with ingestion.

And it’s not just toddlers… for whatever reason teens swallowing laundry pods has become a “thing” – talk to your teens about the risks. See the cinnamon challenge information above.

Coins:

Coins are some of the most frequently swallowed objects.

These usually pass through the body without any problems, but many parents never see it come out the other end.

Since it is so common you would think there would be a consensus as to how to manage it.

There isn’t.

When there’s distress

Of course if there is any distress, drooling, breathing difficulty or coughing, your child should be seen immediately, ideally in an ER so that an immediate surgical consult can be made if necessary.

If it was inhaled into the windpipe instead of swallowed into the esophagus or stuck high in the esophagus causing compression on the wind pipe, it may need to be removed.

When there’s no distress

As for kids who swallow coins and have no symptoms, it isn’t as clear cut what to do.

Some doctors get X-rays for all children who swallow a coin to be sure it isn’t stuck in the esophagus. About a third of those stuck eventually end up passing, but most need to be removed.

Some physicians only obtain an X-ray if there are symptoms.

Some physicians remove the ones in the esophagus immediately, others will wait up to 48 hours if there is no distress.

Generally once it reaches the stomach it will pass.

Prevention

Keep coins out of the hands of kids under 3 years old, and supervise young children closely with them.

Remind kids to never put them in their mouth. Not only for the small choking risk, but eeewww… coins have been handled by many and are full of germs!

Crayons or play doh:

I used to wonder why so many things were labeled “non-toxic” — at least until I had a child of my own.

They put everything in their mouth!

These are generally safe (again, unless they choke), although it is possible that these things contain lead or other contaminants.

Prevention

As with everything, supervise young children when they’re playing.

If your child frequently puts them in the mouth, it’s probably a good idea to not allow your child to play with them unless you’re consistently watching them.

Talk to your doctor about pica if they continue to put non-food items in their mouth after 3 years of age.

Dirt or rocks:

Unless your baby chokes or bites down on a rock and breaks a tooth, dirt and rocks are generally harmless.

Prevention

Supervise young children when playing outside.

If your child seems to crave these and eats dirt compulsively, be sure to talk to your doctor about pica.

Energy drinks:

Energy drinks are a popular choice for many, but they contain caffeine and other stimulants that can make them dangerous for children.

Many adults drink caffeine in various forms, so mistakenly think energy drinks are safe. Learn the risks!

Risks from energy drinks

They can lead to dehydration because caffeine is a diuretic.

Energy drinks also can increase heart rate and blood pressure.

They can increase shakiness, anxiety, insomnia, and headaches.

Routine energy drink consumption has been shown to increase the risk of obesity and Type 2 Diabetes, due to the high sugar content.

People build a tolerance to caffeine, leading to increased consumption over time.

Teens are more likely to take dangerous risks when high on caffeine. This could result in injury or legal trouble.

Ingredients in energy drinks can interact with other medications one is taking.

Call poison control if you suspect problems from energy drinks

Prevention

If you drink energy drinks, keep them away from your children.

Talk to teens about the risks of energy drinks. There are deaths reported in teens who drink energy drinks and then participate in sports or alternate alcohol with energy drinks.

Grass or plants:

Unless the grass was recently chemically treated or if the plant is poisonous, there is little to worry about here.

If you’re unsure about a plant being poisonous, contact poison control.

If there is choking, do CPR and call 911.

Gum:

Contrary to popular belief, the occasional swallowed gum does not stay in your gut for years.

It isn’t digested like other foods, but unless it gets stuck along the way, it finds its way out just like all your other food.

Hand sanitizer

Hand sanitizer in small amounts, such as putting fingers in the mouth after rubbing sanitizer on the hands, is generally safe.

Larger amounts can be dangerous and you should call poison control if you suspect ingestion.

Prevention

Keep hand sanitizer away from young children and talk to school aged kids about risks.

Be alert of the sanitizer hanging from your diaper bag or purse!

Magnets

A single magnet is not a worrisome as multiple magnets, but since it often is not known exactly what a child swallows, it is always recommended to take your child to be evaluated if there is a suspicion of swallowed magnets.

They will need X-rays and if there are multiple magnets, they must be removed to prevent perforation of the gut.

Prevention

Keep all magnets away from young children.

Talk to older kids about the risk of swallowed magnets and be sure they understand that they can never put one near their mouth!

Medicines, vitamins, supplements

If your child swallowed (or potentially swallowed) a medication or supplement, call the poison control number ASAP.

Have the bottle with you so you can answer their questions.

Prevention

Make sure medicines and other pills are kept away from kids.

Talk to Grandma about either removing them from her purse or putting her purse out of reach when she’s visiting.

Share this free online brochure with your kids: Medicine is not candy.

Use this interactive site from Scholastic to help kids learn medication safety.

Nicotine:

Sadly, ingested nicotine has been an increasing problem since e-cigarettes have been on the market, but even regular cigarettes, cigars, and their ashes pose problems.

Effects of nicotine poisoning include vomiting, sweating, lethargy and tremors in mild poisoning and confusion, paralysis, and seizures in severe poisoning.

If you even think your child has eaten a nicotine product, call poison control (or 911 if significant symptoms).

Prevention

Keep all nicotine products away from kids.

Talk to teens about the risks of smoking and vaping.

Pet food:

As disgusting as it smells to me, kids love to eat pet food.

The biggest risk here is choking.

If they choke, use your CPR skills. If you’re not confident with CPR, call 911 and they will walk you through it.

Prevention

Keep pet food away from young children.

Pop-top from a can:

The flip top that opens a soft drink can is usually not a concern unless a child chokes on it.

It generally will pass through the intestines if swallowed, but if there are signs that it was inhaled or is stuck in the intestine, a child should be seen.

These do not show up on X-ray because they are made of aluminum.

Prevention

Kids should drink out of cups, not cans.

Keep cans away from young children.

Poop:

This one is gross, but happens more than any parent wants to know. Many babies stick their hand down their diaper and then the hand goes to his mouth.

While this is really gross, it does not cause any danger to the child. If it is his own poop, he will not be exposed to any new germs.

If your child finds someone else’s poop, usually animal poop, there is a little more concern for infection but still pretty low risk.

Symptoms of nausea, vomiting, diarrhea, and low grade fever usually happen within 30 minutes to 4 hours after the ingestion if they are affected. In this case, treat symptoms as you would any other stomach bug and call your doctor.

For specific information of various types of poop (even raccoon!) check out the Illinois Poison Control blog on poop. 

Salt, saltines, and baking soda:

These common kitchen items do not raise fear in many people, but if either is taken in large amounts, they can cause serious problems.

Salt

One tablespoon of salt in a toddler can cause seizures due to electrolyte imbalances. More can be deadly.

An aside: If your child seems to crave salt, talk to his physician. There are salt-wasting conditions that deserve immediate evaluation.

Another challenge

Kids and teens are challenged to eat several saltines without water.

The salt dries the mouth, allowing the cracker to form a powder that can be inhaled.

The coughing that occurs during the attempt encourages more inhalation.

Baking soda

One tablespoon of baking soda changes a body’s pH and can cause serious injury.

Treatment

If your child swallows significant amounts of salt or baking soda, call poison control immediately.

Prevention

Keep young children away from baking items.

Talk to older kids about using foods properly and not accepting challenges, as discussed above – see the Cinnamon section.

Sharp objects:

Any pointed object such as toothpicks, wire, chicken bones, open safety pins and hair pins can pierce the gut.

If you think or know your child has swallowed one of these, get the child to the emergency room immediately. If there’s distress, call 911.

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7 Ways to Keep Kids from Wandering and Getting Lost

Some kids never leave their parent’s side when out and about, but others wander without concern and are at risk of getting lost. I’ve had one of each, so I know first hand how scary it is to have a wanderer. Many parents worry that their kids will be abducted, but the large majority of lost kids leave on their own accord. Usually there’s no foul play and they can be found relatively quickly (though it seems like an eternity for a worried parent). What can you do to keep kids from wandering and getting lost?

Many times that parents realize their kids are missing, the child hasn’t made the same realization. Parents might be scared to death, but the child is fine – they are often enjoying an adventure and completely unaware of the problem.

Why do they wander?

Distraction and fun

Most of the time they have no clue what they’re doing, especially if they’re too young to really comprehend rules. They aren’t afraid if they’re focused on something else, which can be anything that gets their attention.

It doesn’t take much to get a child’s attention, especially if you’re at a new place.  The new place is also riskier because if they do get separated, they don’t know where they are or where to go for help.

Sometimes kids just want to do something fun because they’re bored. How many kids decide to play hide and seek while shopping? I’ve seen many crawl under clothing racks…

Small children can dart between people in large groups, making it hard to keep up with them without pushing and shoving others out of the way. They don’t realize when they’re focused on something that you’re not right there. Despite saying “excuse me,” I felt inconsiderate plowing through crowds to keep sight on my runner. (She was more than a wanderer…)

Parents get distracted too

Maybe you’re comparison shopping to decide which brand to buy. At some point you have to pay and talk to the cashier.

When your phone buzzes, it’s easy to answer a quick text. Studies show many parents spend a lot of time on their phones when they’re with their kids.

If you hear another child’s cry, do you look in their direction to be sure they’re okay?

And if you have more than one child, you can only really watch one at a time…

It only takes a second to look away from your own child for them to bolt and disappear.

A kid’s view

Kids don’t worry about wandering and getting lost. They get bored or get distracted.

I know one child who was lost at his brother’s sporting event. He decided he was tired and wanted to lay down, so he made it to the family vehicle and took a nap inside.

It all made sense to him, and he didn’t understand why all the parents (it was his brother’s game, so the whole team was looking for him) were upset.

We recognize that a small child roaming through a parking lot is dangerous, but he thought it was reasonable to nap in his familiar seat. He figured his parents would go to the car at the end of the game and find him.

Kids don’t think like adults. We need to talk to them about rules.

Stranger Danger

“Stranger danger” has a nice ring to it. It’s catchy to say. It’s commonly taught to kids.

But it isn’t effective or safe.

The large majority of strangers are good people. If a child is lost, they shouldn’t feel afraid to talk to the right stranger. I’ve heard of kids refusing to talk to caring adults, which delays reuniting them with their families.

The large majority of abducted (and abused) kids are victims of people they know – not strangers.

talk to kids about boundaries & rules

Kids should never be alone with an adult other than the “safe” people you’ve identified with them. This helps to protect them from predators they know.

They should know to never leave with a person unless that person knows a code word. Even if that person knows their name (it’s easy to listen and learn a kid’s name, or it might even be printed on their shirt or backpack) they shouldn’t leave with that person unless it was pre-arranged or they know a special code you’ve discussed.

All kids who are potty trained should know that there are places on their body that are private. Private mean no one should look or touch there unless you’ve given permission for that person. Permission should be given if they need help toileting (including wiping), bathing, or when it’s part of a medical check up. These private places include anything a swimsuit or underwear would cover.

See the bottom of the blog for resources on talking to kids about these big topics!

7 WAYS TO KEEP KIDS FROM WANDERING AND GETTING LOST
7 WAYS TO KEEP KIDS FROM WANDERING AND GETTING LOST

7 Ways to Keep Kids from Getting Lost

Preparation is key!

Talk to your kids about what they should do if they are separated from you.

A lot will depend on their age, maturity level and where you’re going.

If you know the place you’re going has a lot of distractions and crowds, such as an amusement park, you will need to plan differently than if you will be in a neighborhood park that is familiar or a family gathering where they know lots of people.

1. Supervision

When you’re out and about, it goes without saying that someone needs to be responsible for watching the kids.

This is especially true if you’re going with a group. Sometimes there are so many adults, it’s easy to think someone else is watching a child, but no one is. Make it clear who is responsible for watching each child.

If there are a lot of kids for each adult to watch, have the kids pair up with a buddy. They should not leave their buddy. Schools use this system for field trips and it helps keeps track of the kids.

Remind kids that they should never be alone with an adult, even one they know, unless it’s one of their safe adults. (A safe adult is someone you trust wholeheartedly.) There’s safety in numbers!

For your own safety and to avoid mistaken intentions, never be alone with a child who is not your own unless you have permission from their parent. Having two adults around in restrooms and other private areas is especially important!

2. Give kids identifying information

Until kids are old enough to know your phone number (and be able to tell it clearly to a stranger), have them carry it around in some manner. They should know that they can pull it out when needed.

You can make a bracelet with your number. Get number beads from a craft store and kids can help string them!

Put contact information on dog tags so they can wear it as a necklace. Even boys think this is pretty cool.

There are places to make customized temporary tattoos, or you can just use a permanent marker. This isn’t my first choice, but in a pinch, we all have markers.

3. Be ready to identify

I’m that parent who didn’t remember what I dressed my kids in most days. If they were appropriately dressed for the weather, I didn’t really care. But it does matter if you’re looking for a lost child.

If a child is lost and you’re stressed, it’s especially hard to recall what they were wearing.

In today’s world of everyone carrying a phone with photo capabilities, it’s easy to snap a picture.

Take a picture of your child before going to crowded areas. This photo will not only be recent, but will also show what clothing your child has on, which makes it easier to find your child.

4. Be prepared for boredom, hunger, and fatigue

When kids are tired, sick, hungry, or bored, they’re more likely to act up or try to make it fun.

Tired

Plan the trip around nap times as much as possible. Bring a stroller to let a tired child rest if needed.

Sick

Ideally we’d all stay home when sick. Bringing kids to public areas when they’re sick spreads germs.

Keep sick kids home whenever possible. It’s better for them and the community!

Hungry

If they will normally eat during the time of the outing, bring along something to eat.

Make sure the snacks are not going to leave a mess.

Don’t include nut products, since leaving residues around a public place could be life threatening to another child. (There are many other food allergies, so ideally you will wash their hands and wipe surfaces after any foods.)

Boredom

When you know the places you are going are not kid-friendly, try to make it into a game or at least get the kids involved.

The grocery store can be a place to talk to kids about choosing healthy foods. You can do simple math with them by figuring out how many apples you need for the family for the week or by choosing the better deal among differently sized packages.

If you know the kids will have to stay in one place for a while, such as waiting at the DMV, bring books, small toys or games to keep them occupied.

5. Practice

Practice with your kids what they can do if they’re separated. Their risks and abilities change as they get older, so you need to continue the conversation and adapt the plan over the years.

I sometimes would covertly watch my daughter when she ran ahead to see how long it took her to realize I wasn’t right behind her. I wanted to see what she would do when she did figure it out. By preschool she was a pro and knew what to do. She would yell my name or ask another child for help, but at least she stopped where she was and didn’t continue to run further away.

Adults look, kids stay put

I always suggest teaching kids to stay put if they realize they’re lost, unless they’re not in a safe place. If they’re in a street or other unsafe place, they should go to the closest safe location.

Kids should NEVER leave the building or area to look for you. You can teach older kids to go to the front of the store (or find a person in the uniform of the place you are) when you think they’re capable of doing this. Younger kids should just stay put.

Remind them that you will always look for them, and if they stay in one place it’s easier to find them. If they keep moving, they might go to a place you’ve already looked but left, so you won’t find them.

Get loud

Remind them that it’s okay to yell for you by name or whatever they usually call you, even if they’re in a place that’s usually quiet.

Safer Strangers

When lost, it’s okay to ask for help. This is why I don’t want kids to be taught stranger danger.

They should know that if an adult approaches them when they’re not lost, they should be cautious. If they’re at a park and an adult asks for a child’s help looking for their dog, that’s not right. Adults can ask other adults for help. They shouldn’t ask kids for help.

If an adult is offering to help when a child is lost, usually that’s okay. Yes, it’s possible that they’re taking advantage of the situation, but how likely would it be that a person of that caliber would be right there when your child is lost? Most people are good.

Kids should be told to give your phone number to a person who’s trying to help. It’s okay to give their name to a person who works at the place you are visiting. It’s confusing because kids are taught to not give their name and personal information to strangers, but it can help find parents names are shared.

Kids should be taught that they should not leave the area, especially with a strange adult. It’s okay if they help the child find the front of the store or a worker, but they should NOT take the child outside the building or park.

Ask another child for help

That child can then ask the adult they’re with to help your child.

Kids are generally safer to talk to and not as threatening to a child who’s already scared.

The other adult can call your phone if your child knows or is wearing your number. (Pay attention to your phone when looking for your child and answer calls from unknown callers!)

Ask a worker for help

Kids can also look for people wearing the uniform or nametag representing the place you are.

Point out what people wear when working at the location you’re visiting. Whatever it is, be sure your child knows what to look for.

We used to stop at the front of the store routinely so my daughter could be reminded what the cashiers wore. She could talk to someone with that uniform if she was lost.

6. Meeting place

Elementary school aged kids can learn where to meet you if they get separated when they show enough maturity and confidence.

Point out a customer service desk, a landmark at a park, or an easily found place where you are going. You can both go there if you get separated.

By middle school many kids like to be able to shop or play at a park with friends. If your child displays the maturity to do this, then it’s a great way for them to develop independence. Be sure that they know a time and place to meet and how to contact you if they need you before that time.

7. Restraints

I know “restraints” sounds so negative, but think about it.

It’s for safety, not punishment.

We restrain kids in the car because we know it can help to save their lives.

Not only can toddlers and preschoolers wander and get lost, but they can easily get injured when they’re not supervised.

Shopping carts and strollers

If your toddler or preschooler runs around, he’s not safe. If you strap him into a shopping cart or stroller, they’re safer.

Be sure to use the straps appropriately. They can keep kids from climbing or sliding out.

Our stroller just had a lap belt. The newer ones with shoulder straps would have prevented the time my daughter jimmied out of the lap belt and onto the concrete head first. I was pushing her in the stroller, trying to keep up with my son who was running ahead. I was unaware she was climbing out because I had my eyes on my son. She had quite the goose egg!

Leashes

I also have become a fan of leashes for young kids. I know many people think they’re cruel and only appropriate for animals, but I have had great experiences with them.

As mentioned above, my daughter was a runner. I lost her more times than I want to admit. She hated being strapped in a stroller – as I shared above. Of course she often refused to hold hands because she wanted freedom. Family outings that should have been fun quickly became miserable.

When I first got the leash my husband was horrified.

My kids loved it.

It was a cute monkey backpack with a leash. They loved taking each other for walks around the house and even fought about who would wear it. Since it was a backpack, they could carry favorite toys inside.

In public areas my daughter would wear it happily. When my husband saw how my daughter was so much happier having “freedom” while being leashed to us in public, he was sold on the idea.

Warning: if you use one, be ready for judging looks. That’s okay. If they have a runner, they’ll understand. If not, they have no idea.

Leash and book suggestions

I’m an Amazon Associates Member. I do get a small amount of money if you purchase from the following links, but there is no increased cost to you. As always, I only link to products that I recommend regardless of where you purchase them.

These wristband harnesses are great because they allow roaming while being safe, but do not look as much like a leash. There are two sizes, which can allow a child to go a bit farther than many of the backpack styles. It’s basically like holding hands from a distance!

I suspect you’d get fewer evil looks from strangers by using the wristband, but young kids might actually prefer the backpack styles because they’re cute and they can carry “stuff” in them.

I like these because they’re insulated for food storage in addition to having a strap for safety.

Going to Disney? I can see these popular there and for any Disney fan. I lost my 3 year old briefly several times on one Disney trip…

This monkey is similar to the one my kids loved. They’re also backpacks, so they can store a few of their favorite things inside. There are many cute designs.

Safety books



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8 Concussion Myths

Concussions are relatively common. Fortunately there have been campaigns to increase awareness, so more kids are being properly identified. There are still many myths related to concussion that need to be clarified.

signs of concussion
Source: CDC’s Head’s Up

Common myths and misinformation about concussions:

Concussion myths are common. Learn to recognize a concussion and what the experts recommend.
There are many myths about concussions. Learn the facts.

1. A normal head CT means no concussion and a full return to play is okay.

Concussions are not diagnosed by CT. Brain bleeds and masses can be seen on CT, but the damage done to the brain during a concussion is not seen on a CT.

Concussions are diagnosed based on symptoms, such as headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. Not all symptoms need to be present to make the diagnosis. Some symptoms develop over time and are not present at the time of injury.

A CT scan is usually not needed with head injuries. They involve radiation so are not without risk themselves. Unless there are signs of a possible bleed in the brain, skull fracture, or the type of injury suggests the need for a CT, a CT scan is not needed in the evaluation for concussion.

2. A minor hit to the head never causes concussions.

The force of a hit does not determine the severity of the injury.

It’s actually the force of the head moving back and forth, not an actual hit, that leads to changes in brain cells and chemical changes in the brain. A jolt to the body can also cause a concussion if the impact is strong enough to cause the head to forcefully move.

Some people with more significant problems initially also seem to heal more quickly than others with more mild injury.

It is very hard to predict how long it will be until all symptoms are resolved.

The most important thing is that if you have symptoms of a concussion, your brain needs rest and you should be seen by a doctor who is up to date on current treatment protocols for concussions.

3. After two weeks you can return to play without further testing.

Sadly I’ve had more than one patient who was given this advice from a medical professional, whether on the sideline at a game or in an emergency room or urgent care.

Although most concussions resolve within 2 weeks, not all do and returning to play before the brain is healed can lead to a more serious condition called “second impact syndrome.” Second impact syndrome is a very rare condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results, including death.

After a concussion clearance to return to play should only happen when the child, teen, or adult is re-examined and found to be symptom free.

Returning to play is done in a stepwise fashion, with each step lasting at least one day and only progressing to the next step if symptoms don’t resume. This starts with light exercise when there are no symptoms at rest, then progresses to moderate activity followed by heavy activity without contact, then full practice with contact (if the sport is a contact sport) and finally full competitive play if each step can be done without return of symptoms. If symptoms return, you back up to lighter activity.

Returning to play too quickly can prolong healing time and even lead to long term consequences.

Do not return to any activity that causes symptoms to worsen!

4. If a coach doesn’t recognize the concussion, it’s minor enough to return to play.

Coaches cannot see everything that happens on a field. If you had a head injury, tell your coach.

Even if you’re the star player.

Really.

You will do your team a favor if you take time to heal and can play again versus stay in the game and get more severely injured and are then out for good.

See these real stories of concussion survivors.

Someone who is trained in concussion evaluation should do a sideline evaluation.

If there is any chance of concussion, you should not return to play at all that day or until you are cleared by a doctor who understands concussions.

5. IMPACT testing is necessary.

IMPACT testing is a computerized test that measures neurocognitive functioning.

Neurocognitive testing can be done with other testing methods, but IMPACT testing is a specific computerized program.

If a neurocognitive baseline is done at least every 2 years, it can be compared to the same test after a concussion to check on status. Testing should only be done by a professional trained to perform and interpret the test.

Neurocognitive testing is one tool to help manage concussions and determine when it is safe to return to play, but at this time concussions are diagnosed based on symptoms and physical exam, not this testing.

6. Complete bed rest until all symptoms are gone is best.

Bed rest for the first day or two can help enforce brain rest and allow healing, but may not be required and prolonged bed rest is specifically not recommended.

Prolonged bed rest can increase stress in children who miss substantial amounts of school. This stress is thought to possibly prolong healing.

Depression is more common if bed rest is enforced beyond 48 hours. Socialization with friends and family can help provide emotional benefits that aid in healing.

This does not mean that people should participate in all social settings. They will likely need relative quiet, so even going to a sporting event to watch can lead to return of symptoms.

7. Concussions only impact sports.

Concussions take kids out of play, but other activities should also be limited until they are tolerated.

Lights, sounds and even smells can trigger symptoms after a concussion.

Things that take focus or a lot of brain work may cause symptoms to worsen. These include reading, watching television, or playing video games.

If anything leads to worsening of symptoms, it should be avoided.

Initially a child might need total restriction from these activities, and then can slowly add them back in small increments as tolerated.

Many kids need to have breaks during school and a decreased workload.

They shouldn’t take standardized tests until they can focus for a prolonged time.

If computers are used for school, it might be necessary to use paper books and worksheets and to limit computer use until it can be tolerated.

Concussion Symptoms:

 

  • headache (most common)
  • nausea
  • balance problems/dizziness
  • double or blurry vision
  • sensitivity to light and noise
  • fatigue or drowsiness
  • changes in sleep patterns
  • trouble comprehending and/or concentrating
  • depression
  • irritability, nervousness, or sadness
  • feelings of being “just not right” or in a “fog”

Danger signs that deserve immediate evaluation:

  • seizures
  • not knowing people or places
  • unusual behavior
I thought I added #8 above, but edited this to add it after it was posted earlier today…

8. Wake a child with a concussion often to be sure they seem normal.

This is a common misconception. And a scary thing to do.

No child wakes easily from sleep.

It used to be thought that we should wake people up after a concussion to be sure they could arouse well, but studies show that isn’t necessary.

Most people with a concussion want to sleep, and that’s okay. Brain rest is actually what’s recommended.

After a concussion, if a person is awake and able to hold a conversation and there are no other symptoms, such as dilated pupils or trouble walking, it is okay to allow sleep.

For more information:

  • Heads Up is a free resource for parents, athletes, coaches, and medical professionals
  • Acute Concussion Evaluation (ACE) Care Plan has all the typical symptoms of a concussion, general guidelines to healing, plus return to school and sport templates
  • Dr. Mike Evans has two great concussion videos:

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 want to tackle 7 Vitamin K Myths.

Refusing 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)

Science is hard to understand

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. A fetus doesn’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.

Getting the oral form isn’t easy

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.

Vitamin K in food

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. 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.

What do other countries do?

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.

  •  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.
Oral Vitamin K vs injectable (IM) Vitamin K

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. This is especially true 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. 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)

Hearing Loss in Kids

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!

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

Traveling with Kids

Many families travel when school’s out of session, which over the winter holiday season and spring break means traveling when illness is abound. I get a lot of questions this time of year about how to safely travel with kids. Traveling with kids can increase the level of difficulty, but it can be done safely and still be enjoyable!

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.
  • If you want more, I wrote a whole blog on keeping kids from wandering.

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!

Active Shooters: Reflections and Talking to Kids

Area flags are at half mast today as we are mourning the loss of innocent lives from another mass shooting at a Texas church over the weekend. We are sad for grieving families once again. What we can do to protect ourselves and our loved ones from random violence and acts of hate?

My generally safe town has had two incidents of violence that have made national news in recent years. A man opened fire at a Jewish Community Center and a Jewish Retirement Home and killed three innocent people. Another man shot two men eating at a local restaurant after yelling racial slurs and telling them to leave his country. One of the men died.

My kids have been on lockdowns at their schools on several occasions over the years. Our kids are getting used to lockdown drills and even real events. Thankfully none of the local school lockdowns turned tragic. Being a parent who cannot do anything while a school is in lockdown is stressful. Not knowing what is happening during a lockdown when my children are most likely sitting on a floor of a crowded dark room is terrifying. My kids have never felt that scared, even when it’s a real lockdown, probably because they’ve practiced and feel prepared. For many kids this seems to be the case, but I’m sure there are some who start having separation anxiety or other manifestations of trauma-related stress.
Today my front office staff saw policemen with weapons in hand enter our building and run down the hall. They did not come into our office.
We locked our front door, closed the blinds, and kept patients in exam rooms. We saw several police cars in the parking lot for our building and those near ours.
Our office manager called the police department to find out what was happening and not a lot was learned, but there was a potential active shooter in the area, so they recommended lockdown.
Because I was only in the office for meetings on my “day off” I was able to help tell staff and patients what we knew. I helped bring some of the families into the office. I checked Facebook and Twitter repeatedly to find out what was going on. (But I didn’t grab these screenshots until hours later.)

I had planned on updating our social media, but couldn’t find any real information to post.

At one point we were told they apprehended someone in a creek area behind our building and got the all clear to open back up and let people leave.
41ActionNews
A few minutes later we were told to put our building back on lockdown. No one knew what was going on.
Our receptionists covertly monitored the parking lot for patients so they could get the door for them – we didn’t want families stuck in a potentially dangerous parking lot. Several patients called that they would be late to their appointments because police had blocked one of the roads into our parking area.
I am very proud of my staff and the families that were in the building. Everyone remained calm. No one complained that they were told to not leave the building. I didn’t hear anyone complain when the rooms started to fill, which affected the flow of seeing patients. I must admit that I didn’t really feel scared during all of this, since it seemed like police were all over and our office felt secure. It was frustrating not knowing what was going on, but the anxiety was much worse when the potential shooter was near my children’s school and they were on lockdown.
It is sad that a false alarm like this must be taken seriously. I’ve heard that it was just a man with a stick. Or maybe it was just a prank. No one really knows at this time.
But what I do know is that there are many good people in this world. We can help each other in times of need. We can support one another. Mr. Rogers says:

When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.”

When you have to explain these things to your children, remember to keep it simple. Answer their questions, but don’t go deeper than they’re ready to go. Find out what they already know and help them to understand it in ways that mean something to them. Try to keep the news off when kids are in earshot and monitor their screen time online. It’s okay to share your feelings, but try to reassure their safety and list some positives, like Mr. Rodger’s mother did.

Resources for parents to talk to kids about tragic news, such as mass shootings:

Common Sense Media: Explaining the News to Our Kids
PBS: Talking with Kids About News – sorted by ages
HealthyChildren: Talking to Children About Tragedies & Other News Events
American Psychological Association: How to talk to children about difficult news

Lead by Example

We’ve all heard the saying: kids will do what they’re shown, not as they’re told. Lead by example.

It’s so true. Think about all the times your kids are watching you. They are learning from you.

What can you do to help them have healthy habits?
  • Eat your vegetables.
  • Get daily exercise.
  • Wear your seatbelt.
  • Stop at stop signs.
  • Don’t use your phone while driving.
  • Wear a life vest near a lake or river.
  • Maintain your composure during times of stress.
  • No phones at the dinner table.
  • Don’t tell lies- even little ones.
  • Get enough sleep.
  • Be kind to others.
  • Call home- your parents and siblings would love to hear from you.
  • Don’t permit violence in your presence.
  • Give your time and talents to others.
  • Take care of your things.
  • Limit screen time.
  • Brush your teeth at least twice a day and floss daily.
  • Wear a helmet when on a bike.
  • Don’t mow the lawn without proper shoes.
  • Make time for family.
  • Lead by example every day!

 

helmets, exercise
Exercising together safely as a family sets great lifelong habits!

It’s Back to School Time, Time to Think Safety!

Walking to school is wonderful for kids because they get exercise, which can help with focus at school and their overall health. It can be also be a time to talk with friends or family and build community bonds. As kids are heading back to school after the summer break, we must think about their safety.

Walking to school can pose dangers, especially if drivers are distracted talking to their own children or texting. Please stop texting and driving. Don’t touch your phone at all while driving. Calls and texts can wait. If they can’t, pull over and check the message while parked.

Really.

Talk to your kids about safety:

walking to school with others

Kids should walk with an adult until they show the maturity to walk safely without direct supervision. The specific age will depend on the area as well as the child’s maturity.

Are there safe sidewalks? Are there busy roads to cross? Are there other kids walking the same route? Are there homes along the way they can go to in case of emergency? How long is the walk?

When kids have mastered the route and are competent to walk the distance alone, find walking partners. Have kids stay in groups or with a walking buddy as much as possible.

See if your school can help arrange walking buses, where kids all walk the same route to school with adult walk leaders.

Find the safest route

Choose sidewalks wherever possible, even if that means the trip will be longer. If there are no sidewalks, walk as far from vehicles as possible, on the side of the street facing traffic.

If possible, avoid areas near high schools, where there are more teen drivers.

Cross streets safely

If there are crossing guards, use those intersections. If there are street lights, wait until the “walk” symbol appears.

Never cross in the middle of a block, use intersections.

Look both ways twice before crossing.

Do not text or play games when in the street.

Remind kids that if they are crossing a street, they should make eye contact with a stopped driver before crossing, even if there’s a “walk” symbol. Drivers turning right might turn on red and not notice small pedestrians.

Know the route

Teach kids to use the same route every day or discuss which route they will take each day if they use different routes.

If they don’t arrive to school or home as planned, you know the route to search.

Walk the routes with them until they know how to safely navigate each.

Avoid distractions

Listening to music (especially with earbuds), playing video games, watching videos, and texting all keep kids from paying attention to their surroundings.

Even talking on the phone is distracting, so don’t assume they are safer if they talk to you all the way home when you’re at work. They are more likely to trip and fall, step into a street without looking first, or not notice that they’re being followed if they’re distracted.

They should be aware of their surroundings at all times.

Getting a ride rules

Remind kids to never accept a ride from anyone unless you pre-plan it. Rain, snow, and cold weather make it tempting to hop in a car, so have kids dress appropriately for the weather and arrange safe rides as needed.

Contact information

Have kids keep important contact information in their backpacks in case of emergency. At least two people should be on this list. People on the list could include a parent, grandparent, or trusted adult friend/neighbor. Names and phone numbers should be included.

Going on wheels

If they are riding a bike, scooter, or skateboard to school, they should follow the rules of the road and proper safety.

Suggestions for adults:

Be alert

Be extra cautious when driving in the before and after school times, especially near schools and in neighborhoods.

Make your sidewalk walkable

Be nice and don’t use your sprinklers in the before and after school times so kids can stay on the sidewalks and not wander into the street to avoid getting wet.

In the winter, clear snow and ice as needed.

Never text and drive

Put your phone on silent and in a place you can’t reach it while driving.

Texts can wait.

Buckle up for safety!

If kids are in your car, make sure they are properly buckled.

Only teens and adults should be in the front seat.

Use an appropriate car seat or booster seat.

Kids shouldn’t wear their backpack in the car, nor should they unbuckle while in a drop off line to get their backpack on before the car is stopped.

Carpools

If your kids will carpool with other families, be sure they are in proper seats at all times.

It’s tempting to not use boosters for short drives, but it’s never safe to have kids improperly restrained. Find boosters that are easy to move between cars.

 

Talk to kids about safety when walking to school.

Dry Drowning – What Parents Need to Know

I thought about calling this one “We’re drowning in dry drowning phone calls” because we are getting many worried calls about dry drowning, but that’s overly dramatic and I hate headlines that make things seem like the sky is falling…

I had never heard of dry drowning until social media picked it up a couple of summers ago. Maybe I did as a resident, but since I’ve never seen it, I’d forgotten the term. Either way, it isn’t very common at all, but it is an emergency when it happens, so it’s good that we all know that it can happen. People also use the term secondary drowning and some experts differentiate the two by whether or not water actually gets into the lungs, causing swelling of the lung tissue, or if water irritates the vocal cords, causing them to spasm and close off. Either situation is potentially life threatening and they have similar symptoms. Note: Please see the addendum at the bottom. Several articles have emerged since the original writing of this post that clearly indicate there is no such thing as dry drowning.

One of the reasons I think so many parents are worried is that it is common for kids to go under water: in the tub and in the pool. Many get water in their mouth or complain that it went up their nose. Few actually get any into their lungs, which is where it can cause problems. How can you know when you need to worry?

Most of us recall a time we coughed briefly after inhaling liquid, and we were fine. So when is it worrisome? It’s when the water that gets into the lungs causes inflammation within the next day or two. This inflammation makes it hard for the lungs to work – the air tubes are swollen, so air can’t get through. Treatment is giving oxygen, sometimes with a ventilator (breathing tube and machine) until the inflammation goes down.

Symptoms you need to recognize and act upon by taking your child to an ER:
  • Cough: If your child has coughing for a minute or more after being in water, he’s at risk. This indicates that the child is trying to clear the airways. If water got down there and they cough most up, some can remain behind and lead to inflammation over time. Watching your child carefully for the next 3-4 days is important. This can be hard to recognize initially, so a complete evaluation is important if any other symptoms develop.
  • Difficulty breathing: Anyone who is struggling to breathe needs further evaluation. Signs can be rapid breathing, sucking in the ribs or the stomach, difficulty talking, or even a look of fear from difficult breathing.
  • Near drowning: If your child had to be pulled out of the water, he should be evaluated in an ER. Even if he seems fine afterwards. The reaction is delayed, so they can seem to be 100% better and then go downhill.
  • Behavior changes or confusion: If a child is confused, lethargic** or has a change in ability to recognize people, he should go to the ER. Serious illnesses can present with a change in mental status, including significant infections, concussion, heat exhaustion, brain tumors, and drowning. The ER doctor will ask what else has been going on to help identify the cause of confusion.  **Many people misuse the term lethargic. Lethargic isn’t the same thing as being tired after a long day. The medical definition is “Relatively mild impairment of consciousness resulting in reduced alertness and awareness; this condition has many causes but is ultimately due to generalized brain dysfunction.”
  • Vomiting: Vomiting after a day at the pool can be due to infection (from swallowing contaminated pool water), food poisoning (from food left in the heat too long) or dry drowning. It’s best to check it out in the ER.
What will happen in the ER?

Many parents don’t want to go to the ER because of high co-pays. We try to keep kids out of the ER as much as possible. But some issues are better taken care of in an ER. Most offices don’t have the equipment or staff to manage these issues well. Dry drowning can be life threatening, and the evaluation and treatment should start in the ER. I cannot say exactly what the doctor will do, since that will depend on your child’s symptoms and exam. There is no specific treatment for this, only supporting your child’s airway and breathing as the swelling goes down.

  • If the doctor thinks your child may have swelling of the airways, he might order a chest x-ray to look for pulmonary edema (lung tissue swelling).
  • An iv might be started to be able to give adequate fluids, since your child might not be up to drinking well.
  • Oxygen levels will be monitored and extra oxygen might be given.
  • Since the swelling worsens before it gets better, if there is a strong suspicion of dry drowning your child will be admitted for further observation.
  • Some kids need help breathing and are put on a ventilator (breathing machine) until the swelling goes down.
Prevention is important!
swimming
Watch your kids when around water!

As with many things, we should do all we can to be sure our kids are safe around water. This includes the bathtub and toilet as well as swimming pools, lakes, and ponds.

  • Childproof your home when you have little ones who might play in a pet water bowl or the toilet.
  • Teach your kids water safety. Swimming lessons can help them learn skills. Tell them to never try to dunk each other. They shouldn’t pretend they’re drowning because it might distract a lifeguard from a true emergency.
  • Learn infant and child CPR.
  • If you have a pool or pond at home, be sure there is a fence limiting access from your house.
  • Watch your kids closely and keep them within reach when they’re in water until they are strong swimmers. When they are strong swimmers you can let them swim outside your reach as long as lifeguards are present.
  • Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens. If someone can verbalize that they’re okay, they probably are. Drowning victims can’t ask for help. There is a video linked to this page of what to look for with drowning that shows an actual rescue.
From this site, signs of drowning:
  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs – Vertical
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back

Addendum:

    • I just read a post that gives references regarding drowning definitions. It appears I didn’t forget learning about dry drowning in medical school.

It isn’t really a thing.

The symptoms listed above that I recommend getting evaluated are still concerning symptoms, but they might be from another cause.

Check these out:

On “Dry Drowning”

Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning