Halloween Safety Tips

Halloween should be a fun time for kids. Help keep everyone safe by following a few simple tips.

Halloween is a favorite holiday for many kids – they get to dress as their favorite characters and get treats! But it’s also a time that kids are at increased risk. Consider a few safety tips to help keep it safe for all of our kids.

Food allergies and other health conditions

First and foremost, many kids have medical reasons to not eat many of the treats they get on Halloween.

Keep these kids in mind and have non-food items to give out. Check out my post on Teal Pumpkins to learn more.

Before the big day

Clear your sidewalk of any potential hazards for trick-or-treaters, such as low hanging tree branches, toys, electrical cords, and other obstructions.

Get flashlights, pumpkin lights, or glow sticks for your Jack O Lanterns.

Let kids participate in pumpkin decorating according to their abilities.

  • Toddlers can paint pumpkins. Get creative with rhinestones and glitter.
  • Kids can help remove the seeds after an adult removes the top – though many don’t like the texture of the goo!
  • Let school aged kids help design the Jack O Lantern. An adult should do the carving until kids are mature enough to handle a knife safely. Kids can:
    • Trace a template or their own drawing onto the pumpkin.
    • Use cookie cutters to press into the pumpkin as a template to cut.
    • Try tools designed to punch out pumpkin pieces to create a fun Jack O Lantern – just search online for “Pumpkin Punch Decorating Kit” and look for kid-safe tools.
  • For more pumpkin decorating safety tips, see Safewise.

Trick-or-treating safely

At least one member of each trick-or-treating group should have a cell phone.

Feed kids before going out. This will help keep them from snacking on their treats before you have a chance to check them.

Adults should closely supervise young children.

Don’t force children to trick or treat if they’re not comfortable with it. This does not toughen them up. They can still participate by helping to decorate or by handing out treats.

Talk to older kids about safety as they earn the responsibility to go out with friends.

  • They should know the boundaries in which they can roam.
  • Be clear on when they should check in and when to be home.
  • Do not go to homes without a porch light or otherwise decorated to show they are participating.
  • It should be understood that they should never enter a home without your knowledge.
  • Only accept hand made treats from people you know.
  • Kids should always stick with their group and not fall behind or run ahead of the group.
  • Respect property and people. Be mindful of younger trick-or-treaters and stay out of their way. Don’t try to frighten them and let them go first. Say “thank you” and be polite. Trick or treating does not give permission to trick others. They should respect peers who might be afraid of a haunted house or other things on Halloween and not pressure them to do things they don’t want to do. No one should make fun of anyone for being scared.

If you’re driving, be very attentive to parked cars and other objects that could limit your view of kids about to go into the street.

Keep your own pets safely away from the crowds and watch your kids around unfamiliar animals.

Costume safety

Add reflective tape to costumes to help visibility in the dark.

Masks can hinder the ability to see well – use makeup instead. Test a small patch of skin in advance to be sure your child’s skin isn’t sensitive to it.

Kids can carry a lighted trick-or-treat bucket, wand, or other accessory or wear a glow stick bracelet or necklace.

Avoid costumes that are too long and increase the risk of tripping.

Weather is unpredictable. Make sure you can add layers if it’s cold or remove layers if it’s warm.

If kids are going to be walking for trick-or-treating, be sure their feet will be comfortable and their shoes safe. Plastic costume heels are not safe for our little princesses!

If a sword, magic wand, or other accessory is part of the costume, make sure it’s not sharp or too long for them to safely carry. Talk to kids about how to safely carry it so they don’t accidentally hit other people. Leave it at home if you think they would tire of carrying it or if it could be mistaken for a real threat.

Do not use contact lenses unless they’re prescribed by an eye specialist.

Be safe on Halloween! @pediatricskc

For more

See the following AAP Healthy Children pages: Halloween Safety Tips and Decorative Contact Lenses: What Teens and Parents Need to Know.

Flu Vaccine 2019-2020

It’s flu vaccine season. There have been shipping delays, but vaccine is starting to show up in doctor’s offices around the country. As soon as it’s available, get your family vaccinated!

Every year we have some sort of complication in trying to vaccinate our patients against influenza. This year is no different. Shipping delays have lead to problems this year. Of course it’s not new that pharmacies get their vaccine shipments before individual physician offices. Dr. Smith of Partners In Pediatrics wrote about this way back in 2013. She, along with many of us, remain frustrated year after year.

We finally have received sufficient amounts of influenza vaccine to have flu vaccines clinics, so it’s time to review all of this years recommendations. I’ll be summarizing the AAP’s Recommendations for Prevention and Control of Influenza in Children below. (COMMITTEE ON INFECTIOUS DISEASES. Recommendations for Prevention and Control of Influenza in Children, 2019–2020. Pediatrics. 2019;144(4):e20192478).

I’ve addressed all the reasons to not vaccinate previously.

Don’t presume your kids can simply take medicine to feel better if they get the flu. The antiviral medicines don’t work well and have side effects. It’s safer and more effective to get the vaccine.

If your kids are afraid of shots, take a look at these ways to help them not be so scared.

Recommendations for Influenza Vaccination 2019-2020

  1. All children over 6 months of age without medical contraindications should get a vaccine to prevent influenza. (Legitimate contraindications to the influenza vaccine.)
  2. There is no preference over the injectable vaccine (inactivated vaccine) or nasal vaccine (live attenuated vaccine) as long as it is age appropriate. *Note: There is a significant shortage of the nasal vaccine, so do not wait for it. It is highly likely that you will not be able to find it this season.
  3. There are now formulations of inactivated flu vaccines that have the same dose for everyone over 6 months of age. (Previously 6-36 months had a smaller dose and those 36 months and over got a larger dose.) This should make the availability of the dose your child needs more likely.
  4. Children 6 months to 9 years of age who have received no previous influenza vaccine or only 1 dose before July 1, 2019, should receive 2 doses of influenza vaccine. Think of the first-ever dose in young children as a primer dose. A booster dose is needed every season. Everyone under 9 years of age getting vaccinated for the first time needs their primer dose and a booster dose at least 4 weeks later. Children who have previously received ≥2 total doses of influenza vaccine at least 4 weeks apart before July 1, 2019, require only one dose for 2019–20. The 2 doses of influenza vaccine do not have to have been administered in the same season or consecutive seasons. If they had only 1 flu vaccine before July 1, 2019, they need 2 doses this season.
  5. Vaccines should be offered as soon as they become available and ideally will be given by Halloween. (I have concerns with this statement because of the shipping delays previously mentioned. If it is later than Halloween and your family has not yet been vaccinated, it is NOT too late. Get the vaccine – even if your family has already had the flu this year. You can get different strains in the same season!)

Related posts

Flu Season Fears: What should you do?

Flu Vaccine Season 2018-2019 reviews many common concerns that apply to this season as well.

10 Reasons Not To Get the Flu Vaccine, Reconsidered: Fight Flu!

The flu shot doesn’t work

And finally… I can’t resist sharing this fantastic video.

Vaping Risks

As we learn more about the risks of vaping, our children are being enticed to try it with tasty flavors and the false reassurance that it’s safe. Learn the facts and what you can do to help those with addictions quit.

Vaping risks have long been unknown, or at least downplayed. It has even been suggested that a smoker who wants to quit could use vaping to kick the cigarette habit.

When a mall kiosk vaping salesperson first called out to me while shopping with my then tween daughter many years ago, he got an ear full from both of us. I’m sure the sales guy targeted me because I was with an impressionable tween and he really wanted to peak her interest but couldn’t approach her directly. My daughter was young, but even her gut feeling was that this inhalational device was not smart or safe and she let him know it.

I’d like to take credit for raising her right, but that would imply that all the parents of kids who have fallen to the “vaping is fun and safe” propaganda somehow did something wrong. They didn’t. I’m just lucky that my daughter thinks for herself and generally makes safe decisions.

Fast forward to today and I can’t keep track of all of the severe lung disease reports and deaths attributed to vaping. When I started writing this, there were 250 cases of lung disease and 2 deaths. Now there are over 350 cases of severe lung disease and 7 deaths. No single device, brand, liquid or ingredient has been tied to all cases. Many of those afflicted have reported vaping THC though some only report using nicotine. It has been recently reported that vitamin E acetate is a potential cause, but investigations continue into the source.

Why are people calling vaping an epidemic?

According to the latest National Youth Tobacco Study more than 3.6 million middle and high school students currently use e-cigarettes. Nearly 5% of all middle school students and over 10% of high school students are current e-cigarette users.

In my state of Kansas alone, as of the first of this year, there have been at least 20 ER visits for patients with a history of vaping and concerns for significant lung disease. In 2017, 10.6% of Kansas high school students reported current use of electronic vapor products. The adult numbers are smaller, with 4.6% of those 18 years and older reporting current use of electronic cigarettes in Kansas.

This is a problem of young people.

Despite the fact that when electronic cigarettes came on the market and claimed to be a way for smokers to kick the habit, they have been marketed heavily to kids with enticing flavors. Many non-smokers have taken up the habit of vaping. After many years of declining nicotine use, the rates are now growing rapidly, mostly due to electronic cigarettes.

Tobacco Product Use Among High School Students – 2018

Tobacco Product Use Among High School Students – 2018

We’re still learning

Since I last wrote about vaping in e-Cigarette Use in Our Kids about a year and a half ago, we are learning even more vaping risks. It’s never too soon to talk to your school children about the dangers.

Once they’re hooked it’s hard to stop, even if they want to. The number of regular adolescent users is growing at an alarming rate.

What we know

The device itself

E-cigarettes, vapes, e-pipes, and other vaping products are battery-powered devices that allow users to inhale aerosolized liquid.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid. They can hide in plain site because they look like common items, such as USB flash drives and pens.

There are many reports of these exploding while charging, in pockets, and even in the mouth of users.

What goes in the device?

E-cigarettes are usually filled with a liquid containing nicotine, which is highly addictive and harmful to the adolescent brain. Nicotine can impact learning, memory and attention span, and contributes to future addiction to tobacco and other substances.

The vape juices are flavored, and each flavor comes with it’s own chemical additives. Some of these are more irritating to the lungs than others, but all have potential side effects.

The FDA is finally working on getting non-tobacco flavored products off the market to help prevent new users from starting the habit.

Flavors of vape juice include chocolate mint, cola, cherry vanilla, cream soda, and more. What kid wouldn't want to try these? @pediatricskc

Some seemingly resourceful people put other substances in their vaping device, but that is now being recognized as increasing vaping risks.

Teens have found that vaping THC, the chemical responsible for most of marijuana’s mind-altering effects, enables them to escape parental detection because they don’t smell like they do when they’ve smoked marijuana. They may vape cannabis-infused oils in place of e-liquids designed for the vaping device. They often end up consuming more THC than they would with a traditional joint.

Unfortunately vaping risks increase when the substance vaporized is not sold by an authorized retailer.

E-cigarette aerosol contains many potentially harmful chemicals regardless of the juice put into the device. These include ultrafine particles, volatile organic compounds, heavy metals (nickel, tin and lead) and other cancer-causing chemicals.

What we’re learning

Vaping risks are much greater than initially recognized.

The vapor can contain substances that are addictive and can cause lung disease, heart disease, and cancer.

For many years there was no monitoring or tracking of complications from e-cigarette devices. After being available for about 10 years, the FDA requested that physicians report any possible lung disease related to e-cigarette use.

In a very short time hundreds of possible cases of lung disease has been linked to vaping from across the US. At least 7 people have died from illness related to vaping.

The majority of people with illness thought to be due to a component of vaping have vaped THC, but some only report vaping nicotine products.

What is this mysterious illness?

News reports are calling the lung problems associated with vaping a “mysterious illness” because no one knows the exact cause or mechanism of lung damage.

Symptoms can include shortness of breath, coughing, or chest pain. Some patients reported vomiting, diarrhea, or other stomach problems, as well as fever or fatigue. If you vape and have these symptoms, it is imperative that you seek immediate medical attention.

Recommendations:

  1. Do not start vaping.
  2. If you smoke or vape and would like to quit, seek professional help.
  3. Never buy vaping cartridges from a non-authorized seller.
  4. Be cautious of vaping from a friend’s device – you cannot be sure where they bought their product.
  5. Do not modify the vaping device. If it appears to be damaged in any way, dispose of it safely.
  6. If you vape and develop a cough, shortness of breath, chest pain, vomiting, diarrhea, or other concerns go to the Emergency Department.
  7. Do not charge your vaping device while you sleep or with a charger that is not designed for your device.
  8. Do not allow your vaping device to come into contact with metallic objects (such as coins or keys).

If you suspect you have an illness related to vaping, after you’ve been to a doctor, file a report with the Safety Reporting Portal.

Where to get help:

Unfortunately parents can’t use standard discipline techniques to get their kids to stop vaping once they are addicted. Addiction treatment is complex and difficult. Work with professionals.

Your child must be invested in stopping the habit or any treatment will fail.

A pediatrician might know local resources, such as therapists who have expertise in addictions. Your physician may also recommend medications to help stop the habit or refer to a physician who specializes is addiction.

Check out the many helpful tips on SmokeFree.gov for teens.

For More Information:

Vaping: What you need to know (KidsHealth)

America’s e-cigarette epidemic (Pediablog)

Know the Risks: e-cigarettes and young people (Surgeon General)

Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS) (FDA)

CDC Vaping Information

Bike safety

Bike safety starts before you even get on the bicycle.

Summer’s in full swing. I love to see neighborhood kids out playing. We don’t see that enough these days. I want kids to have fun outdoors for fresh air and exercise. Bike safety should be taught early on and encouraged every time people young and old are on bikes.

Twice already this summer kids have told me about friends who had ugly accidents due to wearing flip flops or sandals on a bike. My patients hear the message to cover their heads with a helmet and feet with proper shoes before bikes and scooters. These kids listened but not their friends.

My favorite bike safety tips are in this easy to read and share infographic.

Bicycle safety is important. Start even before the ride by making sure the bike is in good shape and the right fit and that the rider is prepared. @pediatricskc

Measles: All about the measles vaccines

Two measles vaccines are part of the standard vaccine schedule in the US. Do you know when outbreaks change the recommendations?

In my last post I discussed why we should worry about measles. Today I’ll talk about the measles vaccines available to prevent the disease.

What measles vaccines are available?

There are two types of measles vaccines in the United States: MMR and MMRV.

There is no longer a separate measles vaccine available in the US.

MMR

The MMR includes protection against measles, mumps, and rubella. This vaccine can be used in infants 6 months and older and is the only vaccine approved over 13 years of age for those who need to catch up on vaccines.

The CDC recommends that MMR and varicella vaccines be given as separate injections for the first dose in children 12-47 months of age.

MMRV

In addition to measles, mumps, and rubella, the MMRV has protection against varicella (chicken pox). The MMRV can be used from 12 months through 12 years of age (until the 13th birthday).

Using the MMRV vaccine has the benefit of one fewer injection, but there are some downsides.

  • It cannot be used as an early dose of measles protection prior to 12 months of age.
  • The MMRV should not be used in those 13 years and older.
  • The MMRV has a higher risk of fever within 42 days after vaccination compared to the MMR and Varicella vaccines being given in separate injections, even when they’re given on the same date in children 12-24 months of age. There is less data on children 24-47 months of age, but it is likely that they also have this increased risk.
  • The MMRV has a higher risk of febrile seizures from 5-12 days after vaccination compared to the MMR + Varicella being given in separate injections, even if given on the same date.

What is the typical age of vaccination?

One of the measles vaccines is recommended routinely at 12-15 months and then again at 4-6 years.

Either the MMR or the MMRV can be used at these standard times.

If the MMR is used, a separate varicella vaccine can be used at the same time or at a different time.

Can the 2nd dose be given early?

Yes. An early 2nd dose does count as the second dose as long as it is separated by at least 28 days from other live virus vaccines.

Early second doses do count toward the required two doses after the first birthday. There is no minimum age for the second dose, as long as both doses are after the 1st birthday and a month apart.

What does the booster dose do?

Contrary to common belief, the MMR/MMRV second dose is not a booster to increase the immunity of the first dose.

About 93% of people respond to their first measles vaccine and are protected against the measles. They are protected and wouldn’t need a booster, but we can’t easily tell if any individual person is immune after the first dose. It is also possible that a person is immune to some of the MMR/MMRV components but not to all of the components, so another dose is needed for protection to be more reliable.

The second vaccine helps more people convert to being immune. After the second dose, 97% of people are immune to measles.

There are some people (3%) who are not immune despite two doses, which is why we sometimes hear of a vaccinated person still getting the disease.

Herd immunity is one reason why it is important for everyone in a community who is eligible to get the vaccine to be immunized. By immunizing the community, we can protect those in the community who are not able to be vaccinated due to young age or medical condition and those who are vaccine non-responders.

High risk situations: outbreaks and travel

It is recommended to receive an MMR (or MMRV if age indicated) if there is a local outbreak and the health department recommends an early vaccine or if an infant 6-12 months of age will be traveling to an area of increased risk.

Infants and children in high risk areas can get the second dose as early as 4 weeks after the first.

Either of the measles vaccines can be used as long as they are indicated for the age of the person being vaccinated.

More about early doses

MMR can be given to infants at least 6 months of age if they are considered high risk due to travel or outbreaks.

It is not recommended for all babies to get an early vaccine at this point.

Local health departments help to advise whether or not local conditions warrant early vaccination.

International travelers should be vaccinated against measles after 6 months of age due to the higher risk of exposure during travel.

Why not give to babies under 6 months?

Under 6 months of age an infant is considered protected from his or her mother’s antibodies. These antibodies leave the baby between 6 and 12 months after birth.

The antibodies prevent the vaccine from properly working, which is why we generally start the vaccine after the first birthday, when the antibodies have likely gone away.

Does an early dose count?

Any measles vaccine dose given before the first birthday does not count toward the two doses required after 12 months of age, but might help protect against exposure if the immunity from the mother is waning.

As mentioned above, an early 2nd dose does count as long as the first dose is after the 1st birthday and the second dose is at least 28 days later.

Is it safe to give the MMR before 12 months?

It is safe for a child to get extra doses of the vaccine if needed for increased risk of exposure between 6 and 12 months.

As discussed above, it is not because of safety that it is not routinely given earlier. It may not be effective at this age if the baby still has maternal immunity.

What’s the deal with live virus vaccines?

All live virus vaccines must be given either on the same date or a month apart. If they are given too close together on different dates they are less effective and the second one given does not count.

Other types of vaccines do not have this restriction, only live virus vaccines.

Examples of live virus vaccines include:

  • MMR
  • MMRV
  • Varicella
  • FluMist (only the nasal influenza vaccine, not the injectable flu vaccine)
  • Oral typhoid (not on the routine vaccine schedule, but recommended for international travel)
  • BCG (a vaccine against tuberculosis that is used in some countries, but not the US)
  • Oral polio (a vaccine no longer used in the US, but still in use in other countries)
  • Yellow fever (not on the routine vaccine schedule, but required prior to visiting some countries)
  • Zoster (a vaccine for older adults, not children)

For example…

If your child has FluMist (the nasal flu vaccine) on October 1st, if he or she gets the MMR or MMRV on October 15th, the MMR/MMRV won’t count.

This is becoming more difficult to track as pharmacies, work places, and other clinics offer vaccines. I can think of one instance where a parent had a child get a nasal flu vaccine a couple of weeks before the other parent brought the child in for kindergarten shots. The 2nd parent was not aware of the flu vaccine, so the live virus vaccines given at the routine well visit had to be repeated a month later. The child was not happy!

Always get documentation of the vaccines your child gets and be sure if it’s not done at your child’s primary care office that they get a copy! If you’re transferring to a new physician, request a transfer of records in writing before your first visit to your new medical home so they have what they need to best care for your family!

Tuberculosis testing with PPD

Although this is not a live virus vaccine, tuberculosis testing can also be affected by live virus vaccines.

A false negative skin test can occur if any live vaccine is given during the month BEFORE the TB skin test is done.

If MMR vaccine is given, you should wait at least 4 weeks before doing the TB skin test unless it is given on the same date.

All vaccines, live or inactivated, can be given on the same day or at any time AFTER a TB skin test is done.

What if someone who hasn’t been vaccinated is exposed to measles?

Unvaccinated people who are exposed to measles can be given post-exposure prophylaxis unless they have a vaccine contraindication.

If the MMR vaccine is given within 72 hours of initial measles exposure it may provide some protection or lead to a less severe infection.

Immunoglobulin (IG) can be given within 6 days of exposure to provide some protection.

If you think you’ve been exposed, contact your physician and/or the local health department.

Who shouldn’t be vaccinated?

The long list of medical contraindications to vaccines that some promote is not valid. There are very few contraindications to getting the MMR vaccine. These include:

  • Age less than 6 months of age
  • Anyone who has had a severe allergic reaction (anaphylaxis) after a previous dose or to a vaccine component or neomycin
  • Those with a known severe immunodeficiency (chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy, and some with human immunodeficiency virus [HIV] infection)
  • Pregnant women

Some conditions have precautions, but not true contraindications, to the MMR vaccine. The risks and benefits of vaccination should be discussed if a person has the following:

  • Moderate or severe acute illness
  • Tuberculosis testing (see separate section above)
  • Antibody-containing blood products within the previous 11 months
  • Those who have received a live virus vaccine in the previous 4 weeks
  • Seizure history

What about adults?

People born before 1957 are presumed to be immune to measles because they lived through several measles epidemics before the vaccine became available.

It is not considered necessary to check titers for these adults unless they are in a high risk group, such as healthcare providers. If their titers do not show immunity, they should be vaccinated according to current recommendations.

Adults born after 1957 should have documentation of two measles vaccines or the disease. Before 1980 it was only recommended to have one vaccine, so some adults may require another dose.

If documentation is not available, titers can be done to see if you’re immune or need a vaccine. Some may choose to simply get an MMR. Talk to your doctor.

Checking titers

Titers can show if people are at risk, but are not recommended routinely. Because of the overall high level of protection (97%), the cost-benefit ratio of testing titers routinely is not in favor of testing.

Certain persons, such as healthcare providers, may have to show immunity or get additional vaccine doses.

What are the vaccine recommendations for measles during an outbreak? How do they differ from the routine schedule? @pediatricskc

In summary

Two doses of one of the measles vaccines available is recommended for everyone after their first birthday. A dose can be given between 6 and 12 months if there is high risk but it does not count toward those two.

The MMR vaccine can be used in any person over 6 months of age if they are needing a measles vaccine, as long as they have not received another live virus vaccine in the previous 28 days.

The MMRV vaccine can be used between 12 months and 13 years of age. There is a higher risk of fever and febrile seizures with this vaccine compared to the MMR + Varicella vaccines given separately (even on the same date).

The first measles vaccine provides protection 93% of the time. The second dose increases the protection to 97% of people.

It is very important that where you are getting your vaccines has access to previous vaccines given, especially if you are getting any live virus vaccines. Keep a copy of all your family member’s vaccines available at all times.

If you are changing primary care physicians for any reason, have your records transferred prior to your first visit. This must be done in writing, but your doctor must provide these. The cost of these records will be determined by the hospital or clinic and state laws.

Always keep records of your family’s vaccine records easily available. You will need these for school entry, many camps, some volunteer or work positions, and more.

Getting one of the measles vaccines is not the only type of vaccine to get. We’re seeing outbreaks of measles currently, but any of the vaccine preventable diseases can make a come back if given the opportunity.

Measles: What’s all the fuss about?

Why is everyone so worked up about the measles showing up all around the country? Is it really a big deal?

Measles is a big deal. If you understand that, you can stop reading right now. If you’re not sure why it’s so important that we vaccinate against this disease, read on. If you’re worried about the vaccine and haven’t protected your children with it, you need to learn about the disease.

Measles is highly contagious.

But it’s also preventable.

If all eligible persons are vaccinated, we can protect those who can’t be vaccinated due to young age or medical condition. This herd immunity is very important to our communities. Sadly, our herd is not protective at this point. Too many are not vaccinating due to unwarranted fears. This leaves too many vulnerable to disease, which allows infection to spread rapidly.

There are a very limited number of conditions that are true medical exemptions, but if herd immunity is high enough we can keep measles from spreading. Using false exemptions drops that herd immunity rate, leading to outbreaks like we’re seeing now.

We’ve been getting a lot of questions about the vaccine and the risks of the disease, so here’s a quick run down of the risks of a measles infection. I’ll cover the vaccines in the next post.

Why worry?

Measles is highly contagious and can be deadly.

Symptoms commonly include fever, rash, diarrhea, pneumonia, and ear infections.

Subacute sclerosing panencephalitis (SSPE) is a rare form of chronic progressive brain inflammation caused by measles virus. It can show up many years after someone is presumed to be healed from the disease, much like shingles can affect a person years after chicken pox disease.

For every 1,000 reported measles cases in the US, approximately 1 case of encephalitis (brain inflammation) and 2-3 deaths is found. The risk for death is greater for infants, young children, and adults than for older children and adolescents.

How contagious is measles?

Measles can be spread through the air of a room 2 hours after an infected person leaves. The rash doesn’t usually appear until approximately 14 days after exposure, 2 to 4 days after the fever begins.

A person is contagious 4 days before the rash starts, so can unknowingly spread the infection for days. They remain contagious for another 4 days after the rash starts.

Over 90% of susceptible people who are exposed will get sick.

Are you willing to put your kids at risk by delaying the vaccine knowing the risks of natural infection?

Why is everyone so worked up about the measles showing up all around the country? Is it really a big deal? @pediatricskc

What vaccines are available?

There are two types of measles vaccines in the United States: MMR and MMRV.

There is no longer a separate measles vaccine.

We’ll go into these options next time. Stay tuned!

Update: Here’s Measles: All about the measles vaccines

Prevent Drowning

Drowning is one of the most common preventable causes of death in infants, kids, and teens. Learn how to protect against this tragedy!

Summer is on its way. We’ll soon be visiting lakes and pools to cool off from the heat. Unfortunately drowning is the leading cause of unintentional injury-related death in children between ages 1 and 4. It continues to be a top cause of unintentional death among other age groups through the early adult years. Fortunately there are many precautions we can take to help lower the risk.

I wrote about Sun and Water Safety last summer, and want to remind everyone about the risks of drowning. I also wrote about Dry Drowning previously, but it seems that it isn’t really a thing – see the addendum in that post.

What are the risks?

About 1 in 5 people who die from drowning are children 14 and younger. Each year about 300-500 children under 5 years of age drown.

For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries. Even though they’re not fatal, they have significant consequences.

Over half of drowning victims treated in emergency departments require hospitalization for further evaluation and treatment. These nonfatal drowning injuries can cause severe brain damage that may result in long term disabilities such as memory problems, learning disabilities, and a permanent loss of basic functioning.

What increases the risks?

  • Lack of Swimming Ability: Many adults and children report that they can’t swim. Swimming lessons can reduce the risk of drowning among children. See the link at the bottom for more on swim lessons.
  • Lack of Barriers: Barriers, such as pool fencing and alarm systems, prevent young children from gaining access to the pool area. A 4-sided fence reduces a child’s risk of drowning 83% compared to 3-sided fence with the house as the forth side. A great guide on barriers is from the US Consumer Protection Service.
  • Lack of Close Supervision: Drowning can happen quickly and quietly anywhere there is water. This includes bathtubs, swimming pools, pet water bowls, and buckets. This is why non-swimming times account for most drowning accidents.
  • Location: Most children 1-4 years of age drown in home swimming pools. More than half of the drownings among those 15 years and older occurred in natural water settings, such as lakes.
  • Failure to Wear Life Jackets: Most boating deaths are caused by drowning, with 88% of victims not wearing life jackets.
  • Alcohol Use: Among adolescents and adults alcohol use is involved in up to 70% of deaths associated with water recreation. 
  • Seizure Disorders: For persons with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.

How can you recognize drowning?

Movies show people splashing around and yelling for help as they drown.

Don’t let that fool you. Movies are not reality.

Signs of drowning:

  • Head low in the water, mouth at water level
  • Eyes glassy and empty, unable to focus
  • Head tilted back with mouth open
  • 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
  • Appear to be climbing an invisible ladder
  • Trying to roll over on the back

Most drowning victims are silent. They don’t splash to get your attention. Watch this video from Inside Edition that captures several drowning victims:

Assign a water watcher to keep an eye on young children in water. #drowning @pediatricskc

Teach water safety

Learn how to swim and teach your children to swim as well. If your child(ren) are good swimmers, be sure to still have rules about pool use and limit pool access. Even strong swimmers can drown. See the link in the resources below for infomation on swim lessons.

No one should swim alone. If your children are not able to follow that rule, the pool should not be accessible to them. Gates and alarm systems can be used to limit access to home pools and hot tubs.

Not all teens are safe swimmers, but they don’t often fess up to their friends. They are also at risk of making impulsive decisions to drink alcohol near water, forego their life vest on a boat, jump off a cliff into water, or other things that could put them at risk. Talk to your teens about safety – in and out of the water! Encourage teens to learn CPR.

Water safety in easy-to-see graphic form

From https://twitter.com/DrEmMontgomery/status/1109249128712810497

The @AmerAcadPeds updated their policy statement on #drowning prevention this week. #watersafety pic.twitter.com/8B57ZprmvJ— Emily Montgomery, MD (@DrEmMontgomery) March 23, 2019

Making home water safer

All pools should have a 4 foot fence around all sides. This includes below-ground pools as well as portable pools. It is much less safe to use the house as one of the borders, since young children can escape out the door and into the pool, but if you must use your home, take precautions. Install an alarm system to alert you if the door to the pool area is opened. Use a pool or spa cover when the pool or spa is not in use.

A short word on portable pools. They can include inexpensive blow up pools and larger pools. Portable pools present a real danger to young children because they are often not seen as a threat. Portable pools account for 10% of the total drowning deaths for children younger than 15 . They should be drained, covered, or fenced to protect children. Don’t leave them in the yard unattended.

Ask neighbors to put a proper barrier around their pools or hot tubs.

Ensure any pool or hot tub (spa) you use has anti-entrapment safety drain covers.

Have life saving equipment such as life rings, floats or a reaching pole available and easily accessible.

If you have a home pool, be sure that it's protected from your kids. @pediatricskc
From https://downloads.aap.org/DOPA/Drowning-Prevention/pool_safety_english.pdf

It’s not just pools that are risks…

Bowls and buckets

Keep pet water bowls out of reach of young children.

Drain any buckets of water after they’re used.

Toilet dangers

Close bathroom doors and toilet lids to keep young ones from playing in the water.

Bath time

Monitor young kids and those with seizure risks in the bath the entire time. Do not leave the room even for a few moments.

Don’t read or check your phone when you’re watching kids in the tub, just like at the pool.

Drain the bath tub before young kids even get out. This not only helps your kids not climb back in (a common reason to need stitches when kids slip trying to climb in), but it also prevents them from drowning in left over water.

For more:

Swim Lessons: When to start and what parents should know

Infant water safety: protect your new baby from drowning

Drowning Prevention for Curious Toddlers: What Parents Need to Know

Water safety: Tips for parents of young children

Water safety for teens

Teen drowning can be prevented with safety measures: Teens don’t always follow the rules. Their impulsivity and thrill seeking behaviors put them in a unique risk for dangers.

For pool barrier guidelines and suggestions, see the Safety Barrier Guidelines for Residential Pools Preventing Child Drownings from the US Consumer Product Safety Commission. This is important for all pools and hot tubs, including portable pools.

Pool Dangers and Drowning Prevention – When It’s Not Swimming Time: Remember to keep all pools, tubs, and buckets of water secure at all times.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)

Momo. Hoax or not, scary things happen online.

It’s not just Momo… Even if she started as a hoax, we DO need to protect our kids online.

The news is full of stories about Momo and other scary things our kids are exposed to online. Many stories say this is a hoax. YouTube has said this would be against their rules. It doesn’t really matter if this started as a hoax or if it’s against the rules. The fact is that our kids are exposed to things online.

Our kids do see inappropriate things

I recently saw a preschool aged child for a well visit. During the visit it came up that the child had been exposed to Momo online. When the mother learned that the child saw scary Momo videos, she came up with a great plan. They took images of Momo and transformed her into funny faces, much like what I did for the image above.

I think this mother’s idea is great. She took a character that was scary to her child and made it funny. She used the opportunity to talk to her child. It became a great teaching moment.

Our kids can never “un-see” what they’ve seen, but we can help them to not view it as so scary. If you are unable to do this alone, talk to your pediatrician or a therapist.

We know that traumas impact a child’s development. They can develop significant anxieties and suffer if things are not quickly and adequately addressed.

When things happen we need to find ways to help our kids process them. If your child’s mood or behavior suddenly changes, it is quite possible that they have experienced a traumatic event of some sort. If they won’t talk to you, seek professional help.

What can we do to prevent online exposures?

We can’t stop all exposures, but we can do many things to help protect our kids. This includes monitoring software, anti-virus software, and teaching our kids how to behave responsibly and safely.

Increasing responsibility

Our kids will be online, whether it’s at home or at school or at a friend’s house. They are growing up with the world at their fingertips through the internet, so we must teach them to use it wisely.

Like in other benefits and responsibilities of growing up, our kids should have fewer limits and less monitoring as they show maturity. We cannot expect them to be responsible online at 18 years of age if they never practice with supervision along the way.

Give your kids age-appropriate allowances for games, videos, and other online experiences. I love to use Common Sense Media to learn about movies, games, and other media.

Set up parental controls.

Research parental control software. It’s easy to search “parental control apps” or “parental control software reviews” to find the pros and cons to various brands.

One of my favorite sites that exposes safety concerns has a great post for parents: 5 tips for setting up your child’s device for safety from a tech mom.

Learn to safely monitor phones and specific apps.

Choosing the best for your family is not easy, but read several reviews to find what is best for your family’s needs.

Adult supervision and guidance

If our kids are playing outside, they will have close supervision when they’re young, less as they get older.

Online use should be no different.

Your 3-4 year old should not go to the park alone and they shouldn’t go online alone. If they are online, project the screen to the television so you can watch along or sit with them and play along with them. They should not be online when you are busy doing something else. It is not a safe babysitter.

As kids get older and can understand how to navigate the internet more safely, they can have less and less direct supervision. This does not mean they can have a free for all. Parents can still help them choose age-appropriate sites and have software to keep blocked sites from being accessible.

You can’t just avoid online use

Several parents over the years have tried to end the conversation when I bring up social media safety by saying, “we don’t allow any of that.”

It is not sufficient to simply not allow any social media. Our kids and teens will come across it, whether it’s their own account or a friends.

What things did you do as a teen that your parent didn’t know about? It’s even easier for kids to hide social media accounts than it is for them to do many of the things we used to do as kids.

As kids grow

Talk to older kids and teens about why pornography sites are harmful.

Have discussions about oversharing. Predators look for ways to identify where kids hang out. Kids shouldn’t give a team name or mention that their soccer game is tomorrow morning at 9. That innocent information can help a predator find them. Even photos with identifying information, like a school shirt or team jersey, can be risky if shared publicly.

Kids sometimes get tricked into sharing photos that are inappropriate. This includes pornographic images as well as snapshots identifying where to find them.

Talk about their digital footprint. Schools and employers will look at your child’s online history. It needs to be positive and what they post today will be there forever.

Teach kids basic right and wrong

We cannot protect our kids from everything, but we can teach them to be good decision makers.

Use real life examples and daily experiences to help your kids learn to make safe choices. Let them accept more responsibility and make more choices as they get older. Allow them to make the wrong choice sometimes. They’ll learn from these little mistakes much more than they would if you refuse to let them do that little mistake. This helps to prepare them to make the right choice with the riskier options as they grow.

For example, if your middle school child wants to stay up late to watch a movie but you know he has an early soccer game, discuss the situation with him. Let him make up his own mind in the end – without being judgmental. If he struggles getting out of bed and disappoints his teammates because he’s too tired, is that really the worst thing in the world? I bet the next week he won’t beg to stay up late so much. Just don’t play the “I told you so” game or give attitude about it. That will make him mad at you.

Let kids learn from their own mistakes without discussion or lecture. Kids learn from things like this if we let them. Trust me, there are lots of opportunities for them to learn to make safe, responsible choices as they grow.

In the end, if our kids want to find an inappropriate site or do something they’re not supposed to do, they will. If they use good judgement and make safe choices in other aspects of life, they are more likely to do so online too.

Be vigilant

It’s not just Momo… Even if she started as a hoax, we DO need to talk to our kids about risks online.

We need to keep up with online challenges and apps.

Follow your kids on their social sites. Talk about what sites they can and cannot use, but remember that it is easy for them to set up hidden accounts. That’s why it’s so important to talk to your kids and let them make their own choices as they grow. If you don’t allow options and never let them fail, they will not learn. The more you restrict them, the more they’ll hide from you.

Monitor for new apps. Learn how kids hide them. If your child has an iphone, they can be hiding them in these ways.

Keep track of the time your child spends online. Go to your app store and search “time on phone tracker” or check out these popular apps that track time:

For more:

In addition to the many links above, these articles are highly recommended:

A conversation about ADHD

Listen in as I talk about ADHD. I even throw in several stories from my own experiences in parenting a child with ADHD.

I was recently interviewed about parenting a child with ADHD. I encourage parents of kids with ADHD to listen.

As a pediatrician I have the benefit of seeing many families affected by ADHD, and that has helped me to be a better parent. It has also given me support when things don’t go well because I know I’m not alone.

If you’re feeling frustrated with parenting, especially when it’s related to those issues common to kids with ADHD, I encourage you to listen.

I hope that you will feel like you’re not in this alone. 

Topics discussed:

  • What is ADHD?
  • How is ADHD diagnosed?
  • Co-existing conditions
  • Things that are mistaken as ADHD
  • Ways to manage symptoms other than medicine
  • How symptoms of ADHD change over time
  • And more!

Listen:

For More Information:

Developmental Age in ADHD

Supplements for ADHD

Medications for ADHD: Starting out and titrating

Remembering Medications

Medications: Types and side effects

Alternative Treatments for ADHD

Genetics of ADHD

What does brain imaging tell us about ADHD?

Brain function 101: Why medicines help ADHD

Practical at home tips for illnesses

When your family gets sick, what can you do before running to the ER or clinic?

When cold and flu season is in full gear, it’s helpful to know common things that can help us prevent and treat whatever is in town. Many of the viruses that run around each season don’t have specific treatments, but there are things that we can do at home to treat symptoms and keep people more comfortable. There are also things we can all do to prevent the spread to other family members or back into our community.

What can be done to feel better?

Remember that nothing can be done to treat most viruses. Our body’s immune system will take care of that, but we can do things that help us feel better during the illness.

It’s hard to make them better, but we can make them feel better

Most cough and colds last several weeks. Vomiting and diarrhea can last a couple weeks as well.

During the cold and flu season, it can seem like kids are sick every day for months because they catch one on top of the other. Some of these days they might simply have a runny nose, and those days can last most of the year in young kids.

It’s when they seem uncomfortable or distressed that we need to do more. Treat the symptoms that bother them.

Identify the symptoms that are concerning, such as difficulty breathing or dehydration, and seek treatment at your doctor’s office for those.

What about fever?

Notice I did not list fever as one of those symptoms.

Doctors don’t do anything special for fever in vaccinated children over 2 months of age.

Fever can accompany other symptoms that may be concerning, but it in itself is not the concern unless it is a newborn, unvaccinated child, or one with a chronic condition that you’ve been warned has increased risks.

Comfort measures

Pain control with acetaminophen or ibuprofen may be helpful. Follow the package directions for weight. Dosing for kids under 2 years of age can be found on my office website or you can ask your physician.

Remember the goal is not to bring temperatures to normal, but to keep kids comfortable. If they’re in pain from sinus pressure, a headache, sore throat, body aches, or earaches, it is okay to give a pain reliever even with a normal temperature.

Get the mucus out

Suction your infant’s nose before feeding and before putting him down to sleep. This helps clear the mucus from the airway and makes breathing easier. Encourage nose blowing for those old enough to know how to blow.

Use saline to irrigate the nose. They sell drops, sprays, and nasal wash systems to be used, depending on age and personal preference. 

Hydrate

Encourage your family members over 6 months of age to drink more water than normal when sick. Kids often won’t eat well when they’re sick. That’s okay. It is important that they drink well though so they can stay hydrated.

Young infants should not drink water, but you can encourage more of their milk or formula when they have cough and colds.

If your child has vomiting or diarrhea, avoid cow’s milk products. These often lead to more vomiting. Breast milk can be offered in small amounts frequently to infants who are breastfeeding. Electrolyte solutions (with sugars and salts) can be given to infants and children for hydration.

Clean air

DO NOT let anyone smoke around your child or in your home. Smoke can make the wheezing and coughing worse, even if done in a separate room in the home.

Smoke residue on hair and clothing can cause irritation to your child’s airways. I can usually identify smokers or people who spend time with smokers when they’re in my clinic. (Thankfully that isn’t often.) It isn’t unusual for me to start coughing when they’re in a clinic room with me. If you must smoke, go outside and wear a jacket that can be removed to minimize what is on your shirt when you go inside and hold your baby.

I’ve even started coughing when around someone who was vaping. I know people claim that the vapor is safe around others, but my lungs don’t like it. Keep it away from your kids. Talk to your kids about the risks of vaping so they don’t start the habit.

Rest

Encourage those who are sick to get extra rest. We often sleep poorly at night and need daytime naps to get enough sleep when we’re sick. 

Dry air

A cool mist vaporizer or humidifier can help your child breathe easier. Change the water every day. Clean the machine per the manufacturer recommendations. 

Infection control

It just isn’t possible to keep kids from being contagious when they have a virus. They love to touch everything and share germs, so keep them home until they’re well enough to return to normal daily activities.

Stay home!

Our health department now recommends that everyone with influenza stays home for 7 days following the start of symptoms.

How long should you stay home? It varies by illness. www.questforhealthkc.com

You can return to work, school, and activities with other illnesses when the fever is gone (without using fever reducers) for 24 hours, there’s no vomiting or diarrhea, and you’re generally feeling well enough to return. If not, stay home and rest or visit your doctor.

Cover the cough!

Cover your cough properly - don't use your hands! www.questforhealthkc.com

Teach kids to sneeze and cough into their elbow or a tissue. Wash hands after handling tissues. 

Wash, wash, wash

Good handwashing can help decrease the spread of viruses.

Wash hands often. If soap and water isn’t available, use hand sanitizer. The more things you touch, the more often you should wash.

Teach kids to wash properly. Have them rub soap on their hands for 15 – 20 seconds- be sure they scrub palms, backs of hands, fingers, spaces between the fingers and even under the fingernails. 

Wash

  • Before preparing food
  • After toileting or changing a diaper
  • When they’re obviously soiled
  • Before eating
  • After sneezing or coughing into hands or wiping nose
  • Before and after touching eyes
  • When taking care of a wound wash your hands before and after washing and treating the wound
  • Often when taking care of someone who is sick
  • After touching trash or soiled objects

Consider having separate towels for each family member in your bathrooms to decrease the spread of germs when they wipe their mouth after brushing their teeth.

Hand sanitizer is a good option when washing isn’t available, but it is not helpful against some germs, so handwashing is preferred.

Use lotion as needed to keep your skin moisturized. Dry skin damages the barrier that helps prevent germs from getting into our bodies.

Germs can live on objects and surfaces for 2 or 3 hours – sometimes longer. Clean your child’s toys often with soap and water.

Don’t touch your face. Eyes, ears, and noses are the doors into our body.

Avoid handshakes and other hand to hand contact. Try a fist bump or wave!

Help prevent the spread of germs. Don't shake hands. Offer a fist bump or wave. #infectionpreventiontip

Avoid taking young children to large groups of people during the cold and flu season, especially if people are showing signs of illness.

Vaccinate.

We can help prevent many of the most serious illnesses by staying up to date on our vaccines.

Everyone over 6 months of age should get a flu vaccine. There are very few contraindications to a flu vaccine and many benefits. Really.

And finally… avoid kisses that spread illness!

For more:

Fever Is

When is a fever too high

Tamiflu

Evolution of illness

Cough Medicine: which one’s best?

Cough sounds

How long will a cough or cold last?

RSV has a bad rap… for good reason

Strep throat: new school guidelines

Sore throat: strep vs viral

How to use nose sprays correctly

Improper use of antibiotics

Why wait to see your usual doctor?