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 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.
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.
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:
Influenza is not a just a bad cold. People sick with the flu can suffer from fevers, cough, sore throat and body aches. If you want to prevent this and more complications, don’t brush off getting the flu vaccine. There are many reasons to get the flu vaccine.
Complications of flu
Flu can lead to complications, many of them severe, and death.
Complications include pneumonia, ear infections, and sinus infections.
There’s good news though. There’s a vaccine to help prevent the flu.
Reasons to get the flu vaccine
There are many reasons people don’t get the flu vaccine, but many of those reasons deserve a second thought.
1. The flu vaccine doesn’t work.
While it’s true that the vaccine has variable efficacy, it’s important to get the vaccine each year. The more people vaccinated, the less likely the flu will spread through a community. Take a look at this really cool representation of how herd immunity works. How it was developed is described on IFLS.
No one claims that the vaccines against influenza work perfectly. The influenza virus can mutate by shifting and drifting.
Until there’s a universal flu vaccine, we must rely on experts to look at the viral patterns and predict the strains that will be most predominant in the upcoming season and make a vaccine against those strains.
Even if there’s not a perfect match, it can still help those who are vaccinated have a lesser illness.
That’s worth something.
2. I got the flu from the vaccine.
The influenza vaccine that is currently available cannot cause the flu. Only live virus vaccines can lead to forms of the disease.
The vaccines available in the US this season are either an inactivated or a recombinant vaccine. These do not cause flu symptoms. The vaccines cannot mutate to cause symptoms. They simply don’t work that way.
There are many reasons you could have gotten sick after a flu vaccine that were not due to the vaccine.
You were exposed to influenza before the vaccine had time to take effect and protect.
You caught a strain of influenza that wasn’t covered in the vaccine.
You caught one of a number of other viruses that cause flu – like illness.
The vaccine did cover the type of virus you have but your body didn’t make the proper protection from the vaccine so you were still susceptible.
In each of these scenarios, you still would have gotten sick if you hadn’t had the vaccine, but if you recently had the vaccine it’s easy to understand the concern that the vaccine caused the illness.
The FluMist is a live virus vaccine, so it could cause mild symptoms of influenza viruses, but it is not recommended for use in the US this year.
3. I can prevent the flu by being healthy.
It is important to eat right, exercise, get the proper amount of sleep, and wash hands. All of these things help keep us healthy, but they don’t prevent the flu reliably.
We cannot boost our immune system with megadoses of vitamins. (Vaccines are the best way to boost our immune system.)
Organic and non-GMO
Organic and non-GMO foods don’t offer any benefit to our immune system over other healthy foods.
If these things did as some claim, people generations ago would have been healthier since they ate locally grown organic foods, got plenty of fresh air, and exercised more in their day to day life than we do these days.
One of the major causes of death historically (and still today) is from influenza, but it has been shown that the flu vaccine reduces the risk of death. Why not help your body prepare for flu season with the vaccine?
4. Flu vaccines shouldn’t be used during pregnancy — they’ve never been tested and can lead to miscarriage.
Pregnancy is considered a high risk condition for severe complications of influenza disease and the vaccine can help prevent those complications.
There are some who assert that since the package inserts state the vaccines have not been studied in pregnancy that they aren’t safe, but in the next breath they say that they aren’t safe because a study showed a high rate of miscarriage after the vaccine.
The first part of the argument is one of the many ways the package insert is misused.
Package Inserts – no big secret, but don’t misuse them
Think about it… you can’t argue that it’s never been studied and then quote a study. It’s been studied.
The Vaccine Safety Datalink is a huge database designed to document adverse events associated with vaccination, allowing researchers access to a large amount of data.
The flu vaccine has been safely given to pregnant women for over 50 years.
Despite a recent small study suggesting a potential risk of miscarriage, the flu vaccine has been studied extensively around the globe and found to be not only safe but effective at decreasing the risk of influenza disease during pregnancy and beyond.
5. I have a chronic illness and don’t want to get sick from the shot.
People with chronic illnesses (including diabetes, heart conditions, and asthma) are more at risk from serious illness from influenza disease.
The influenza vaccine can prevent hospitalizations and death among those with chronic diseases. People with chronic diseases should be vaccinated, as should those around them to protect with herd immunity.
The flu shot cannot make anyone sick, even those who are immunocompromised.
You do not need to avoid being around someone who is sick or immunocompromised if you’ve recently been vaccinated.
6. If I get the flu I’ll just take medicine to feel better.
There is no medicine that makes people with influenza feel better reliably.
There is no medicine that decreases the spread of influenza to friends and family of those infected.
We can take fever reducers and pain relievers, but they don’t treat the underlying virus.
They suppress our immune system so we don’t make as much inflammation against the virus, which decreases the symptoms and our body’s natural defenses.
As for antiviral medicines, I have written about Tamiflu and why I rarely recommend it.
Megadoses of vitamin C or other vitamins, homeopathic treatments, essential oils, and other at home treatments have not been shown to significantly help.
It is important if you get sick, you should limit contact with others. This means missed school and work for at least several days with influenza. Prevention with the vaccine simply is better than trying to treat the symptoms.
7. I don’t like shots. (Or my child doesn’t like shots.)
I’m a pediatrician. Most of my younger patients hate shots.
Like really hate shots.
They cry, scream, kick, try to run and hide — you name it, they’ve tried it to try to avoid shots. They fear shots, but we can help them with techniques that lessen the pain, and they often say “it wasn’t that bad” afterwards.
People who have had only hives after egg exposure can safely get flu vaccines following standard protocols.
People who have symptoms of anaphylaxis with egg exposure that requires epinephrine (respiratory distress, lightheadedness, recurrent vomiting, swelling – such as eyes or lips) should still get the vaccine, but they should be monitored at the appropriate facility (doctor’s office, hospital, health department) for 30 minutes to monitor for reactions.
9. Vaccines are only promoted to make people money. Doctors are shills.
Flu Vaccine Information and Recommendations for the 2017-2018 Season
Both trivalent (3 strain) and quadrivalent (4 strain) vaccines are approved for use this year. There is no preference officially of one over the other, but the vaccine should be appropriate for age.
No FluMist Nasal Spray flu vaccine is recommended. The nasal spray did not work well in the last few seasons it was used in the US. Until it is understood why it wasn’t effective then how to make it effective, it will not be recommended.
Pregnant women should be vaccinated to protect themselves and their baby.
Everyone over 6 months of age should be vaccinated. Children 6 months to 8 years who have only had one flu vaccine in their past will need two doses this season. This is because the first dose acts as a primer dose, then a booster dose boosts the immune system. Once the body has had a boost, it only needs a boost each year to improve immunity.
Infants under 6 months of age can gain protection if their mother is vaccinated during pregnancy and if everyone around them is vaccinated. They cannot get the flu vaccine until 6 months of age.
People with egg allergy can be vaccinated. If there is a history of anaphylaxis to egg, they should be monitored for 30 minutes.
The CDC is encouraging everyone to be vaccinated by Halloween if possible, but it’s not too late to be vaccinated after that if not yet done this season. It takes up to 2 weeks for the vaccine to be effective. Flu season typically starts in January, but the peak can be as early as November and as late as March.
It is acceptable and encouraged to give the flu vaccine along with other recommended vaccines needed.
We’ve all heard the well-intentioned slogan “Breast Is Best” in reference to supporting breastfeeding. Breastmilk is made just for our babies, so yes, it is a great source of nutrition. But it isn’t the only option and there are many reasons mothers give formula and even with exclusive breastfeeding there comes a time that infants need additional sources of nutrition.
I decided to write on this topic because I see so many mothers struggle to feed their baby and they feel like a failure if they don’t exclusively breastfeed.
And then to top it off I saw a blog that encouraged exclusive breastfeeding without any foods or supplements until one year of age.
I knew someone had to counter that thought before it becomes popular.
It shouldn’t be a badge of honor to breastfeed to the point of potential harm to the infant, and some ultra-crunchy moms are bragging about it as if it is.
Mom Guilt Has Gotta Stop
You’re not a failure if you feed your baby, regardless of what you feed your baby as long as it’s age appropriate.
Your baby needs nutrition and hydration.
While most babies under 6 months of age can get all their nutrition from breastmilk, some need a boost, especially at the beginning of life.
If you’re not producing enough milk, you’ll need to give your baby some formula as well (or use a milk donor). Usually this is temporary – just until your own milk supply increases or until your baby starts enough solid foods that the supplement isn’t needed.
I’m not suggesting that every newborn who struggles at the breast should be supplemented, but if your doctor says the baby’s blood sugar is low or the baby is losing too much weight, it’s not only okay, but it’s necessary to supplement.
Benefits of Breast Milk
Most of us have heard by now the many benefits of breastfeeding for the baby, including:
Immune system benefits. (Which means fewer infections, meaning not only helping babies stay healthy, but also leading to fewer lost work days for working parents and fewer sleepless nights for all parents.)
Decreased risk of Sudden Infant Death Syndrome.
Decreased risk of asthma in a child who has breastfed.
Decreased risk of diabetes when the baby grows up.
Decreased risk of obesity as the baby grows up.
Decreased risk of certain cancers in the child, such as leukemia.
Improved cognitive development of the child.
Benefits for mothers include:
Less bleeding, both in the immediate postpartum period from contracting the uterus after birth, and fewer menstrual cycles during breastfeeding.
Decreased risk of getting pregnant while breastfeeding – though this is not 100% effective! If you’re not wanting to get pregnant don’t rely on breastfeeding alone.
Easier return to pre-pregnancy weight.
Decreased risk of ovarian and breast cancers.
Decreased risk of Type II diabetes.
Decreased risk of postpartum depression.
Decreased risk of heart disease.
Less missed work (see immune system benefits above).
Cost – breastmilk is free and formula is expensive. Breast pumps should be covered by insurance.
When Breast Milk Isn’t Enough, Isn’t Desired, or Isn’t Safe
Despite the benefits, breastfeeding not always possible or desired.
In the US, 8 out of 10 mothers start breastfeeding during the newborn period.
Only half are still nursing at 6 months, and less than a third are still nursing at 12 months.
There are very few contraindications to breastfeeding:
Classic galactosemia is a rare genetic condition in which a baby is unable to metabolize galactose.
It is one of the conditions we screen on the newborn screen.
Galactose is the sugar made from the lactose in milk. When galactose is not metabolized, it will reach high levels in the blood and become toxic, causing cataracts in the eyes, damage to the liver and kidneys, and brain damage.
The galactosemic baby will fail to thrive on breast milk or formula based on cow’s milk. The treatment for this condition is to remove all sources of lactose from the baby’s diet and give soy formula.
Mothers who have HIV and are able to feed formula made with safe water should not breastfeed according to current guidelines.
Treatment makes a difference, so if you’ve potentially been exposed to tuberculosis, talk to your physician and get tested.
Chemotherapy or radiation treatment
There are times that you need to take care of you.
If you require chemotherapy or radiation, do these to improve the chances your baby will have you as a mother. If that means he needs to have formula, that’s okay.
Most medications are compatible with breastfeeding.
You can look on Lactmed to learn if a particular medicine is safe or what other options are recommended.
Some mothers do not want to breastfeed for various reasons.
That’s okay. It isn’t for everyone.
No one should say things that make these mothers feel guilty. They brought new life into the world. That alone is an amazing feat. As long as the baby is fed age-appropriate and formula that has been approved for use in infants, it is great.
Babies can thrive on formula.
Just be careful of the many alternate formulas and milks that are advertised online.
Some mothers really want to exclusively breastfeed but they have problems.
Working with a lactation consultant and physicians (both mother’s and baby’s doctors) might help if there is a correctable condition, such as
insufficient breastfeeding attempts per 24 hours – not feeding frequently decreases supply
tongue tie treatment can improve latch and milk transfer from the breast into baby
jaundice, which makes baby sleepy and not feed as effectively
identifying and treating hormonal problems in mother
identifying and stopping medicines or herbs that might be inhibiting milk supply
stopping nipple shields as soon as possible – the use of nipple shields can decrease breast stimulation and lower supply
avoid unnecessary supplements – supplementing with formula can decrease supply overall because the mother’s breast makes milk based on how much is used (This does not mean you should avoid formula if it is medically necessary.)
Even when breastfeeding goes well for both Mother and Baby, it is not sufficient to be the sole source of nutrition for the entire first year of life.
There are some mom blogs that support exclusive breastfeeding for the first year of life, and that is not safe.
I’m not linking any of them here because I don’t want to promote them, but if you don’t believe me just do a quick search and you will find some.
While breast milk is fantastic for young infants, it does not have the nutritional components to exclusively feed for the second half of the first year.
If they are not eating foods rich in iron (meats, legumes, egg yolk, leafy greens) they will need an iron supplement.
Many of the bloggers who support exclusive breastfeeding do not want any supplements at all. Just breast milk. It simply isn’t enough to support the older infant’s growing brain and body.
Vitamin D is important for us all, but it is not passed through breast milk well unless a mother is taking at least 6400 IU/day.
Historically we could make vitamin D with the help of the sun, but we now know that sun damages our skin so it is safer to protect against excessive sun exposure. This puts us at risk for vitamin D deficiency.
The AAP recommends that newborns begin supplementing with 400 IU/day of vitamin D soon after birth, and increase to 600 IU/day at 6 months of age.
The supplement should continue even if they transition to Vitamin D fortified cow’s milk at 1 year of age.
Feeding with food from fingers or a spoon also encourages healthy development of fine motor skills.
It is important for older infants to learn to eat from a developmental standpoint.
Once they can sit fairly well, turn away from food or open their mouth in response to food, they are showing signs that they are ready to start eating.
They don’t need teeth to move foods around in their mouth and make chewing motions.
They are much less averse to new things typically when they’re younger, so if babies are delayed past a year they are much more likely to be picky eaters and not get the nutrition they need during childhood.
It’s been years since I’ve written about car seat safety and since September 17-23, 2017, is Child Passenger Safety Week I thought I’d take a moment to review car seat safety basics and share some of my favorite car seat safety links.
Most parents are now aware that all infants must be in a rear facing car seat, but many turn their toddlers around too early or let older kids move to the next level too soon.
I tell kids all the time that the state law is the bare minimum, but it isn’t necessarily the safest way to ride. I use the example that in my state an adult can ride a motorcycle without a helmet, but that’s not safe. They usually agree, and I think it helps them understand that just because it’s legal to do something, it doesn’t make it safe to do.
Kids learn from the behaviors they see their parents display, so all parents should buckle up for safety!
Which car seat is best?
When looking for a car seat or booster seat, don’t assume spending more money will buy a better seat.
You need to be sure it fits your vehicle and your child.
Whatever seat you buy, be sure to register it so you are notified of any recalls.
Infants and children under 2 years or 30 pounds
Infants and children under 2 years should ride rear facing unless they are bigger than the height or weight maximum for the seat.
Children over 2 years who still fit in the height and weight requirements of the rear facing car seat can still ride rear facing safely.
Another safety factor for infants and young children: don’t leave them in the car!
Young children often fall asleep in the car.
If sleep deprived (no parent is ever really well rested) and in a hurry, even the best parent can be distracted and forget about the sleeping baby.
Kids over 2 years (and those larger than the rear facing car seat maximum height or weight) should use a forward facing car seat with a 5 point harness.
They should continue the harness until they are mature enough and big enough. This means they must be capable of staying seated during the duration of the drive. Of course they must meet the minimum height and weight requirements for a booster seat.
Learn to use the tether properly with your forward facing car seat.
There are limits to using the LATCH system. LATCH stands for “Lower Anchors and Tethers for Children.” It was developed to help parents more easily install seats in cars and eliminate seatbelt incompatibilities. What you may not know is that the LATCH anchors are currently designed for a maximum combined weight of the child and child seat of 65 lbs. Once the child + seat exceeds this weight, the seat must be installed using the vehicle seat belt, not LATCH. Depending on the weight of the child seat, your child may weigh quite a bit less than 65 lbs and need to stop using the LATCH.
Moving to a booster
Children should remain in a booster seat until the vehicle’s lap and shoulder seat belt fits them properly.
This is generally between 10 and 12 years of age and about 4 foot 9 inches, but varies based on the size of the vehicle’s seat.
Everyone should always use the vehicle’s seat belt (or car seat harness) when riding.
Have your kids take the 5 Step Test to see if kids can safely ride without a booster.
Sitting up front
Only teens and adults should sit in the front seat. It’s always safer in the back seat.
If you look at the sticker on the passenger side visor, it will say something to the effect that children 12 and under are safer in the back seat. That means wait until 13 years of age to sit up front.
Airbags can be dangerous if a passenger is too short for it to hit properly in the chest. The force of the airbag can cause significant injury to the face or neck. If the airbag is turned off, the passenger is at risk of hitting the dashboard or being ejected from the car.
Even big kids don’t have the muscle or bone strength to be safe up front. They aren’t mini-adults.
In the winter months it’s important to avoid over bundling infants and children in car seats.
Car Seat Stickers are a great way to notify first responders who to call if you’ve been in an accident and aren’t able to communicate.
I recommend putting them under the cloth part of infant seats so they aren’t visible when you’re carrying the seat in public. You can put a small sticker on the handle to let emergency personnel know to look under the padding for emergency contact information.
Once kids are out of the infant seat you can put the sticker on the outside of the seat, just not over any important information. Never cover the height/weight max information or other things you’ll want to see later.
My office gives stickers from the W.H.A.L.E. Program to patients, but you can print your own at home and attach them to your seat with wide clear tape. Information to include would be:
Child’s name, birth date, address, allergies, important health history, medications
Parent’s names and phone numbers (cell and work)
One emergency contact name and phone number (not a parent)
Doctor’s name and number
Childcare provider name and number if applicable
After an accident
Remember that if you’re in an accident, your car seats might need to be replaced. Talk to your insurance company.
Many kids are scared of shots. Some even fight parents and nurses when it’s time to get shots. The more they fight and worry, the worse it gets. But it doesn’t have to be that way.
Increasing the fear
In general there are some things that increase anxiety about shots or just make them seem bad.
Do not tell kids it won’t hurt. Shots can hurt. Lying doesn’t help. It just minimizes their fear and makes things worse. It might hurt, but how much is variable. Pain is a very individualized feeling. You can describe it as a pinch. Some kids do better with advance warning.
Never tell kids they won’t get a shot at the doctor’s office. They might be due for one (or more) and if they were specifically told they won’t get one, they are usually more upset.
Don’t threaten kids with shots if they misbehave. This makes kids see shots as a negative.
Siblings can increase anxiety with their teasing. Don’t share the need for shots with siblings and if it’s possible to leave siblings at home when one child will need shots, that might work best.
Some kids worry more because parents are worried or presume the child will be worried. When the parent starts talking about shots in a worrisome manner it feeds into the fear. Try to be factual. Don’t start telling them it’s okay and not to worry. That tells them there’s something to worry about.
Some kids do best if they don’t know shots are coming. If they ask if they’ll get shots at an upcoming visit, you can say you don’t know. If you think your child will lose sleep for days worrying about the shots, this is often the best way to handle it. Then the doctor and nurse at the office can deliver the news and it isn’t your fault.
How to prepare
If you want to prepare your kids before bringing them in for shots or if you just need some help when you’re at the office, follow these tips:
Risks and Benefits
I often ask kids if they’ve ever gotten hurt playing outside. They usually say yes. Then I ask if they still wanted to play outside again. They usually say yes. I might sound surprised that even though they know that they can get hurt, they still want to play, but then I “realize” that it was because the benefit (playing) outweighs the risk (getting hurt). Then we talk about the benefits of the shot are so much more than the quick poke and a little pinch feeling. This works really well for the middle school shots because they’re old enough to get the connection.
Don’t pre-treat with an oral pain reliever. Studies have shown that acetaminophen and ibuprofen decrease the immune response, which might make the vaccines less effective.
Don’t tell kids to not cry. It’s okay to be scared and to feel pain. Let them know what is and is not okay. If they cry it’s okay. It is not okay to kick, hit, run, or do anything that can harm others or themselves.
Educate kids about how vaccines help us. There are many resources available. When they understand why the shots are good for them, it helps them to accept them.
Practice what happens when we get shots.
Have them practice sitting still and making their arms loose.
Wipe the arm with a tissue as you explain the person giving the shot will clean the area with a very cold wet tissue to clean the area. (I avoid the term alcohol swab because the term alcohol confuses younger kids who learn about drug prevention in school.)
Pinch the arm to show them there will be a small pinching feeling.
Put a bandaid on the area if they like or just explain that they can get a bandaid when it’s over. (If your child hates bandaids, tell the person giving shots that they prefer to not have them.)
Let them practice giving you a “shot” too.
Show that the poke will be fast and they can move their arms up and down afterwards to make the sting go away.
Bring a comfort item from home, such as a stuffed animal or blankie.
There is evidence that blowing out or coughing during the injection helps decrease the pain. We often recommend this for kids old enough to blow or cough.
Sometimes we’ll entice preschoolers with bubbles or pinwheels. It really helps!
Other forms of distraction can help too. Telling stories, reading books, or watching a video on a smart phone or tablet are great distractions.
Sit vs Lay Down
Studies have shown that allowing kids to sit (rather than force laying down) during shots is perceived as less painful. The less restraining the child needs, the better. It makes sense that if they need to be held down they will be more scared and it will be perceived as more painful.
I have seen tweens and teens prefer to lay down if they have a history of getting light headed with needles or they’re worried about fainting.
Order of vaccines
Ask the person giving the vaccines to save the most painful vaccine for last, if applicable. (Our nurses do this routinely.)
Pain DISTRACTOR devices
Our office sometimes uses Buzzy when kids are especially afraid of shot pain. As long as the child isn’t overly worked up and they aren’t opposed to the coldness of the ice, Buzzy works fantastically! If kids have worked themselves into a frenzy it isn’t sufficient to distract in this way.
I used to think bribery was not a good parenting technique… until I had kids. It can be very effective. If you can promise a reward for being brave, such as stopping for a smoothie or getting a favorite treat, that can work wonders.
Just do it
I like this Dr. Mom’s take on getting shots. Dr. Corriel knows that her son will just need to do it. Fear and all.
Help with anxieties in general
(great for life worries, not just shots!)
Build up bravery
After kids do things that they were afraid of, congratulate them for the attempt. Remind them that even though they were scared they did it. This helps set the pattern that they can be brave when faced with any fear.
Kids can even keep a list of things that they did despite being scared to try. Make a “Bravery Book.”
They can use the list whenever a new fear pops up to see how many things they’ve already done and how brave they really are.
video to future self
I’ve started recommending that parents take a video of kids to show their future self if they can say it didn’t hurt as much as they worried it would.
We all tend to remember the anxious phase of excessive worry, but forget that it wasn’t that bad.
Show the video the next time shots are due. Their own self stating it wasn’t bad can be reassuring!
Use a meditation app, such as Stop, Breathe & Think. It’s free and helps with general anxieties as well as mindfulness. Download it and use it at home several times to let them get comfortable using it.
The large majority of the parents who bring their children to my office want their children to be vaccinated against any disease we can protect them against. The HPV vaccine is one exception. While most of my patients are given the Gardasil at their 11 or 12 year check up, some parents still “want to do their research” or “have heard things” so they decline to protect their kids at those visits. Sadly they often return year after year and say that they still haven’t done their research, so their child remains unprotected. Sometimes they’ll say that they will let their child decide at 18 years of age. Sadly, by that age many will have already been infected.
The first argument is that it won’t last long enough.
It is therefore possible that the protective effects of the vaccination will wane at the time when women are most susceptible to the oncogenic effects of the virus (those over 30), providing protection to those who do not need it (adolescents) and failing to provide protection to those who do (women over 30).
Studies show protection lasts 10 years and hasn’t dropped by that time. If future studies show a booster is needed, we can add that. That in no way should mean to not give protection for the years it is really needed – adolescence and young adult life. I cannot agree with the statement that providing protection “to those who do not need it (adolescents)” at all. Yes teens need protection. I’ll get more into their risks below. And the fact that women over 30 are more likely to develop the cancer does not mean that is when they come into contact with the virus. It’s kind of like saying that kids don’t need to brush their teeth because they don’t have cavities. If you wait for the cavities to develop, it’s too late!
The second argument is based on old version of the vaccine.
We now use the 9 valent variety, which covers the large majority of cancer causing strains. Again, even if there are other strains, why not protect against what we have?
Natural immunity lasting longer than vaccine immunity?
The argument that natural immunity will last longer than the vaccine immunity is not a valid argument. Natural immunity can wane with some diseases too, and if we can protect against the disease, it is preferable. Boosters for many vaccines are needed when we know immunity wanes. That’s okay. Some parents advocate to not vaccinate and get the real disease. When their kids get whooping cough they’re miserable. Many are hospitalized. Some even die. I’d rather do boosters! (This may be a bad example because I don’t think our booster for whooping cough lasts long enough and there are complications with giving boosters more often, but ongoing surveillance and research will continue and hopefully improve the situation.)
The cost issue is interesting.
If it was not cost effective in the long run, insurance companies wouldn’t pay for it. It’s that simple. They’ve done the math. Australia is a great example. Their cancer rates are down because HPV is a mandatory vaccine.
The risks listed have all been shown to not be as risky as once shown.
Second, even if your child is a virgin at marriage, their spouse might not be. Or the spouse could die and they remarry.
Or there could be infidelity in marriage.
There may not be signs of this virus during an infection. Testing for HPV is recommended for women over 30 years of age, but is not available for men at any age, so teens and young adults will not know if they have the virus or not.
And we know that abstinence only teaching fails. Some people raised in strict Christian households have sex outside of marriage.
Teaching kids to protect themselves is much more effective to prevent many sexually transmitted infections, but condoms don’t always protect against HPV transmission.
And there’s always rape. One out of four women has been sexually assaulted. One in four! What a horrible thing to be raped. Then to find out you get cancer from that…
It didn’t yet know that the cancer rates in Australia would fall like we now know.
We’ve learned much more information than they knew in 2011 when it was written.
We know the HPV vaccine is safe.
It is best given before the teen years to induce the best immune response and to get kids protected before the risk of catching the virus becomes more likely.
It isn’t a lifestyle choice to get this virus, as it seems the author claims. People have sex. This virus and other infections can spread through sex. But this virus is also spread without intercourse (such as through oral sex or skin to skin contact without sex), which is why 80% of the adult population has had the virus at some point.
If you don’t think the risk is real
Someone You Love is a documentary that follows several women with HPV related cancer. If you still think the vaccine isn’t worth it for your child, watch it. I am not paid in any way to recommend this. It simply is a powerful documentary that shows the devastation of HPV disease and you should see that before saying your child doesn’t need protection.
Do I recommend the vaccine?
I strongly feel this is a safe and effective vaccine. So much so that my own teens received three doses of the original Gardasil and one dose of Gardasil 9 despite no official recommendations for this booster. I want to protect them in any way that I can.
If I had any concerns about its safety I would not have given it to my own children.
I don’t think I can list any study or give any argument stronger than that.
Those of you who follow my blog or are my patients know that I’ve never been a fan of Tamiflu. I’ve written To Tamiflu or Not To Tamiflu and I’ve posted Tamiflu from guest blogger, Dr. Mark Helm. Despite the CDC’s recommendation to use Tamiflu frequently, I rarely prescribe it. And when I do, I often find that the whole course isn’t completed because the kids don’t tolerate it well – usually vomiting, but occasionally they’ve had scary hallucinations. I haven’t seen very much benefit, especially given the cost (and often the difficulty of finding it during peak flu season).
As I’ve said before, Tamiflu doesn’t seem to work as well as needed and it has significant side effects. Not all studies done on Tamiflu were published. Only studies showing a little benefit and minimal side effects were considered in making the recommendations to use it. If many studies show no benefit but aren’t published, it makes it seem better than it is. Most studies are done in adults, but studies in children for prevention of flu and treatment of flu also fail to show much benefit.
A 2013 review of all the studies done in adults found only a 20.7 hour reduction in symptoms (yes, less than one day). In the elderly and those with chronic diseases (among the highest risk adults) no reduction was found. They also found no evidence of decreasing the risks of pneumonia, hospital admission, or complications requiring an antibiotic. This same review also showed more side effects than commonly reported. Nausea, vomiting, and psychiatric side effects are common.
Will the CDC join in?
I hope that the CDC reviews its recommendations for antiviral use before the influenza season hits this year. Until then, plan on getting your family protected with the flu vaccine. It isn’t perfect, but it does help keep us from getting sick and it can help save lives!
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.
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.
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.
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 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.
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.
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!
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.