Category Archives: All ages

The consequences of lead poisoning in children

The tragic, preventable events in Flint, Michigan, have brought to the nation’s attention the results of lead poisoning, especially in children. It’s a good time to remember that lead poisoning can be a risk, no matter where you live.

How are children exposed to lead? Lead can be inhaled in polluted air (which is why lead was removed from gasoline decades ago). Children can be exposed through paint containing lead, either by eating paint chips or when lead paint is removed and is introduced into the air. They can also ingest lead through tainted drinking water, which is what has happened in Flint.

Children are at greater risk than adults because their bodies absorb higher percentages of lead. In addition, their developing bodies are more easily and irreversibly damaged.

Some of the worst and most obvious problems that result from lead poisoning occur in the central nervous system. Brain development can be greatly affected, especially in those under the age of two. Such problems are permanent.

Other severe effects can include anemia, kidney problems, endocrine issues (including the inhibiting of normal growth), and gastrointestinal concerns (like vomiting and constipation). Both small motor and large motor skills suffer from lead poisoning.

Because lead so severely affects the central nervous system, children often exhibit serious behavioral problems like aggression, impulsive behavior, and difficulty with attention—problems that don’t end with childhood. Later in life, these individuals experience a much higher than normal incidence of substance abuse.

The growing understanding of the severity of the consequences of lead poisoning has caused the Centers for Disease Control and prevention to modify its definition of toxic lead levels over the past several decades to one twelfth of its former measurement (from 60 micrograms/deciliter in 1970 to 5 mcg/dL in the current definition).

So, what can we and you do to prevent lead poisoning? First, make sure you limit your child’s exposure to lead. If you’re concerned because you live in an older home, you can have your water tested to be certain that no lead is leeching into the system from pipes. Make sure that any lead paint has been removed.

In our office, we assess lead levels at the one year checkup. In addition, we have increased our frequency of using a verbal questionnaire to screen for risks, starting at six months of age.

Together, we can reduce or eliminate your child’s risk of toxic lead exposure.

***Much of the information in today’s blog was gleaned from “Pediatric News,” Vol. 50, number 3, March 2016.

Children with special needs and their parents

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If you are not the parent of a special needs child, you know someone who is. We encourage you to send them this link of a terrific article we’ve found, entitled, “10 Things I Wish My Parents Knew While Raising a Child With Special Needs.” Sally Ross Brown, a person with cerebral palsy, tells her own story and inspires the rest of us. Read it here

Learning CPR and how to use an AED

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We hope you never need to use CPR (cardiopulmonary resuscitation), but everyone should take a course so that you’re prepared in case the need ever arises.

Administering CPR is different with infants, children, and adults. Smaller bodies require different techniques and have different breathing and heart rates.

In a CPR course you will learn how to identify if someone needs CPR, how to be sure the airway is open, and how to administer CPR. Of course, calling 911 is essential if someone is not breathing.

You can take a course with the American Red Cross or, in Georgetown, through the fire department or health department.

Probably you have seen the proliferation of AEDs (automated external defibrillators) in public places. This article from the National Institutes of Health describes AEDs and the need for them this way:

“An automated external defibrillator (AED) is a portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest (SCA).

SCA is a condition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it’s not treated within minutes. In fact, each minute of SCA leads to a 10 percent reduction in survival. Using an AED on a person who is having SCA may save the person’s life.”

You don’t have to have a medical background to be able to use an AED, and the training isn’t difficult. The device itself is not terribly expensive to have in a workplace. For a few hundred dollars you can be prepared to save someone’s life.

Blood pressure checks for children and teens

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Did you know that it’s possible for children to develop hypertension (high blood pressure)? Sometimes it is a genetic issue; sometimes it’s related to diet and lack of exercise. On rare occasions it can signal a serious underlying condition.

If your child’s blood pressure is too high, the pediatrician may want to do some tests to determine the cause, especially if the child is of normal weight. If obesity is the cause of hypertension, the doctor and nutritionist will help you develop a diet and exercise program to normalize weight and blood pressure. You will want to make sure that your child loses weight in a safe manor. Normal weight can also help prevent many other serious health issues, like diabetes.

Here’s a chart from emedicine and the American Academy of Pediatrics that gives normal ranges for heart rate (pulse), blood pressure, and respiration for children and teens.

Age	Heart Rate (beats/min)	Blood Pressure (mm Hg)	Respiratory Rate (breaths/min)
Premature	120-170 *	55-75/35-45†	40-70†
0-3 mo	100-150 *	65-85/45-55	35-55
3-6 mo	90-120	70-90/50-65	30-45
6-12 mo	80-120	80-100/55-65	25-40
1-3 yr	70-110	90-105/55-70	20-30
3-6 yr	65-110	95-110/60-75	20-25
6-12 yr	60-95	100-120/60-75	14-22
12 > yr	55-85	110-135/65-85	12-18

* From Dieckmann R, Brownstein D, Gausche-Hill M (eds): Pediatric Education for Prehospital Professionals. Sudbury, Mass, Jones & Bartlett, American Academy of Pediatrics, 2000, pp 43-45.

Also check out this article from the American Academy of Pediatrics about hypertension in children and teens. It gives lots of good information in how to prevent high blood pressure, signs and symptoms, and the importance of early detection.

At Georgetown Pediatrics, we typically start testing blood pressure in 3-year-olds. It’s something you should mention to your child because she might be frightened by it. Let her know it will squeeze tightly but won’t hurt. Some children even experience what health professionals call “white coat syndrome,” meaning a fear of medical offices and personnel. You can help your child get over this fear by not expressing any concerns in front of him, but speaking positively about doctors, nurses, and staff. Tell him that all those people like him and want him to stay healthy. Smile when you talk about them, be positive when you are in the office.

As your medical home, we always want your child to feel as comfortable as possible here.

Nosebleeds

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Most children will have nosebleeds from time to time, and causes range from hay fever to weather (cold, dry weather dries the membranes in the nose), from a familial trait to no explanation at all. Nosebleeds usually don’t last long and generally a child bleeds from only one nostril.

What to do when a nosebleed occurs? According to an article on the website of the American Academy of Pediatrics, here are the basic ways to control a nosebleed:

“Stay calm; the nosebleed is probably not serious, and you should try not to upset your child. Your child will pick up on your emotional cues.
Keep your child sitting or standing and leaning slightly forward. Don’t let him lie down or lean back because this will allow blood to flow down his throat and might make him vomit.
Don’t stuff tissues or another material into the nose to stop the bleeding.
Firmly pinch the soft part of your child’s nose—using a cold compress if you have one, otherwise your fingers—and keep the pressure on for a full 10 minutes. Don’t look to see if your child’s nose is bleeding during this time; you may start the flow again.
If bleeding hasn’t stopped after 10 minutes, repeat the pressure. If bleeding persists after your second try, call your pediatrician or take your child to the nearest emergency department.”

When should you be concerned enough to call your pediatrician or get to an emergency room? The article referenced above lists the guidelines to call the doctor if:

“Your child is pale, sweaty, or not responding to you.
You believe your child has lost a lot of blood.
Your child is bleeding from the mouth or vomiting blood or brown material that looks like coffee grounds.
Your child’s nose is bleeding after a blow or injury to any part of the head.”

Generally speaking, a nosebleed isn’t serious and you can easily stop it at home. However, check out the advice above if you have concerns.

Artwork by Corinne

Bullying is a serious matter

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October is National Bullying Prevention Awareness Month. That means now is a good time for us to talk about this important subject.

Bullying can occur at school or on the bus, in the neighborhood, on the playground— anywhere. Cyber bullying is also on the rise, where people use the internet or phone apps to harm others.

At the very least, bullying lowers self-esteem. But as we know, continual bullying can cause children and teens to withdraw socially, may create depression or other mental health issues, and can even result in physical harm.

Parental awareness is essential. It’s almost certain that your child will, at some point, either be on the receiving end of bullying behavior, or will bully someone else, or both. An article on the American Academy of Pediatrics (AAP) website references a study from 1999, in which four out of five teens admitted to participating in bullying behavior at least once a month. Those who have been bullied often go on to mistreat others.

Conversations about appropriate behavior and language need to begin early between parent and child. Don’t hesitate to correct your child or teen when you hear name-calling or witness unkind behavior, even between siblings. They can learn early the boundaries between acceptable and unacceptable behavior. Teach them how to express themselves, especially when hurt or angry, by using language that doesn’t cross the line into disrespect. Don’t tolerate violent acts against people or animals.

Of course, your kids are not always near you, and you won’t be aware of everything that happens to them or everything they do. Continue the conversation about bullying; remind them to walk away from confrontations and to inform a responsible adult if they experience or witness bullying. Talk about kindness; role-play sticky situations. Monitor their internet and cell phone activity and discuss what you find there.

Teach your kids some nonviolent and non-confrontational ways to handle conflict. There are excellent resources for this in the article mentioned above, also here and here.

Remember that school counselors and other therapists can be really helpful if your child or teen is a victim or perpetrator of bullying, and our office can always make a referral.

As children get older, remind them that they help create a safe environment for others. They can be a positive force by refusing to contribute to an atmosphere of hatred.

As the school year continues, things can get very hectic. Don’t forget to pay attention to what’s going on with your youngsters. Ask questions, be supportive, get help when needed. Let’s keep our schools and community safe for everyone’s children.

Artwork by Shawna

How to save money on your prescription medications!

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If you are buying any prescription medications for your child, your teen, or yourself, then you know how pricey they can be. Sometimes they are covered by insurance; sometimes insurance only pays a fraction; and there are drugs that are not covered by insurance and families that don’t have prescription coverage at all.

No matter your situation, there are still ways you can save, even as prescription drug prices continue to rise.

Buy a generic drug alternative. Not all drugs have generic versions, but when they do the generic is usually quite a bit less expensive. Ask your physician or pharmacist if there is a generic available for a particular drug.

Talk to the doctor. In addition to knowing about generic alternatives, your pediatrician may know of a less expensive option for the drug your child is taking. There won’t always be another alternative, but it’s certainly worth asking about.

Look for cheaper prices. If you think the drug prices at your pharmacy are too high, call around. Sometimes there can be quite a difference from one pharmacy to another.

Look online for coupons or other resources. Some pharmaceutical companies have special programs for uninsured patients, or for patients who have difficulty paying even with insurance. In addition, you can often find coupons for particular drugs from a pharmaceutical company.

Drugs aren’t likely to get cheaper anytime soon, and yet they are often necessary. We want to help you find less expensive alternatives. Please ask us.

Ticks

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Ticks and spiders are both arachnids, but their method of attacking the skin is very different. While a spider merely bites, a tick burrows under the skin to gorge itself on blood. Sometimes ticks on the body can go unnoticed for a few days, which is why it is important to do a body check of your kids when they have been playing outside in the spring and summer. Ticks like hiding places— under your child’s hair, between the toes, etc. After it is finished feeding, the tick will drop off the body.

How to remove a tick? Very carefully! See this brief description from the Centers for Disease Control and Prevention (CDC) about safe removal.

There are a few tick-borne diseases that can be very serious.

Rocky Mountain spotted fever (RMSF) is carried by the dog tick or wood tick, which is usually about a quarter inch long. The disease is caused by a particular type of bacteria, and the symptoms, according to an American Academy of Pediatrics ( AAP) article, include: “Flu-like symptoms such as fever, muscle pain, severe headaches, vomiting, nausea, and loss of appetite. A rash develops in most cases of RMSF, typically before the sixth day of the illness. This rash tends to appear first on the wrists and ankles, but within hours it can spread to the torso. It can also spread to the palms of the hands and soles of the feet. The rash is red, spotted, and raised. Other symptoms may include joint pain, stomach pain, and diarrhea. In severe cases, the blood pressure can drop and the patient may become confused. As the infection spreads, many organs, including the brain, can be affected.”

If your child has any of these symptoms and you suspect a tick bite, call your pediatrician immediately.

Lyme disease is most common in the Northeast, North Central, and West Coast states. It is spread by deer ticks. The most common symptom is what is sometimes called a “bull’s-eye” rash. This rash is a pink or red circle that can expand over time, even to a diameter of several inches. Another AAP article lists further symptoms:

“Headache
Chills
Fever
Fatigue
Swollen glands, usually in the neck or groin
Aches and pains in the muscles or joints.”

Lyme disease is very treatable in most cases, but if left untreated can cause long-term health problems.

There is also another tick-borne disease that presents itself a little like Lyme disease. It’s called STARI (Southern Tick-Associated Rash Illness) and is most prevalent in, as you may guess, more southern states like ours. The organism that causes this disease is, as yet, unknown, but it is carried by the lone star tick. The rash is similar to the one caused by Lyme disease (see above) and other symptoms according to the CDC include “fatigue, fever, headache, muscle and joint pains.” If your child presents with any of these symptoms and you suspect she has been bitten by a tick, contact your pediatrician immediately. For easy-to-read information about STARI, there is a good series of short articles from the CDC here.

Use insect repellent and avoid places where ticks live, when possible. Have a safe and enjoyable rest of the summer and fall!

Spider bites

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Both spiders and ticks are common in our area. We’ll deal with ticks next time.

While most of their bites aren’t dangerous to most people, it’s good to be informed about different types of spiders, their bites, and diseases that might result from some of them.

Spiders use a venom to anesthetize and paralyze their tiny prey. The venom from most species is not dangerous to most humans (see below for exceptions). Watch for signs of infection and report those immediately to your pediatrician. If you are concerned that a bite is getting much larger, note the edges with a Sharpie marker so you can see if it’s continuing to grow.

The female black widow spider can be extremely poisonous to humans, sometimes even fatal. She has an hourglass shape and is dark colored with yellow or red on her abdomen. Symptoms can be severe muscle cramping and pain. Call EMS if you think someone has been bitten by a black widow spider.

The brown recluse spider is fairly common in Kentucky, and can also be fatal at times. People often don’t know they’ve been bitten until the bite starts to swell and get painful. Reactions greatly vary. Call EMS if you are concerned about a brown recluse bite.

According to this article by the American Academy of Pediatrics (AAP), here are things to watch for after a spider bite, and a signal to call your pediatrician or EMS:
• “Tiny fang marks
• Pain
• Pain begins as a dull ache at the bite site
• Pain spreads to the surrounding muscles
• Pain moves to the abdomen, back, chest, and legs
• Blister at the bite site
• Mild swelling and a blue-gray mark at the bite surrounded by lightening of skin color
• Progressive soft tissue damage; the skin becomes dark blue and then black (necrotic).”

Wash the affected area with soap and water, and treat a bite with an ice pack (make sure you put a layer of cloth between the ice pack and the skin) Another resource for your questions about spider bites is the Poison Control Center.

As with anything, whenever you have a concern, call our office.

Stinging insects

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Nothing quite puts a damper on outdoor fun like a sting from a bee, yellow jacket, hornet, or wasp.

Art by Corinne

While most stings, though annoying and painful, aren’t dangerous, sometimes they can be severe in certain cases.

First things first – how to avoid getting stung:

Check the spots where your child plays for nests of stinging insects. Nests can be in trees or bushes, on structures like houses and barns, under picnic tables or by the porch. If you see an unusual number of the same type of stinging insects in one area, it’s possible there is a nest nearby. Once you’ve located a nest, you should consider calling an exterminator. If it is a honey bee hive, locate a beekeeper who will almost certainly be interested in collecting a new hive, and who knows how to do that safely. On rare occasions you might see a honey bee swarm. This occurs when a hive has gotten too large and is in the process of dividing. Be very careful to avoid the swarm and call a beekeeper immediately.
Wear shoes outdoors. Even sandals or flip-flops are not good protection from stinging insects hiding in the grass.
Wear light-colored clothing, and don’t wear anything with a floral pattern. Bees can be attracted to that as if it were a real flower!
Watch what you eat outside. Insects are attracted to sweet foods and beverages and other food items like peanut butter.
Don’t allow your child to touch even a dead stinging insect; the stinger still contains venom.
As difficult as it may be, don’t swat at an insect because that may make it attack.
Read about these and other preventative measures in this article by the American Academy of Pediatrics. The article contains this additional warning: “If you have disturbed a nest and the insects swarm around you, curl up as tightly as you can to reduce exposed skin. Keep your face down and cover your head with your arms.”

So, what to do after a sting?

If the child or adult is highly allergic to stings, watch closely for signs of anaphylaxis. Another article by the AAP describes an anaphylactic reaction like this:

“A severe life-threatening allergic reaction is called anaphylaxis.
The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting.
Anaphylactic reactions to bee stings occur in 4 out of 1,000 children.
The onset of widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis. Your child’s doctor will decide.”

In the case of anaphylaxis, administer epinephrine in the form of an EpiPen or AUVI-Q, if available, and call 911.

More common reactions to stings are redness and swelling, pain and itching.

If the stinger is in the skin (only honeybees leave their stingers behind), scrape it out with your fingernail, or if it’s completely under the skin just leave it alone and it will be shed naturally.

Here are the AAP’s recommendations for care after a sting:

“Meat Tenderizer:
- Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye). This may neutralize the venom and decrease pain and swelling.
- If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes.
Local Cold: For persistent pain, massage with an ice cube for 10 minutes.
Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.
Antihistamine: If the sting becomes itchy, give a dose of Benadryl. (See Dosage chart)
Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream to the sting area 3 times per day (No prescription needed).
Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 7 days.
Call Your Doctor If:
- Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
- Redness lasts over 3 days
- Swelling becomes huge or spreads beyond the wrist or ankle
- Sting begins to look infected
- Your child becomes worse
- And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.”