Talking to children after a tragedy

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The recent shooting in Orlando leaves every parent—and anyone who cares about children and teens—in the position of wondering what to say and how to say it. You are reeling from the news, and you want to protect the children you love from being hurt by it.

There is no perfect way to handle tragedy with youngsters, but here are a few basic guidelines. All of the quoted information below comes from an article you may want to read in its entirety, from the American Academy of Pediatrics (AAP).

“No matter what age or developmental stage the child is, parents can start by asking a child what they’ve already heard. Most children will have heard something, no matter how old they are. After you ask them what they’ve heard, ask what questions they have.”
“In general, it is best to share basic information with children, not graphic details, or unnecessary details about tragic circumstances. Children and adults alike want to be able to understand enough so they know what’s going on. Graphic information and images should be avoided.”
“Keep young children away from repetitive graphic images and sounds that may appear on television, radio, social media, computers, etc.”
“With older children, if you do want them to watch the news, record it ahead of time. That allows you to preview it and evaluate its contents before you sit down with them to watch it. Then, as you watch it with them, you can stop, pause, and have a discussion when you need to.”
“Today, most older children will have access to the news and graphic images through social media and other applications right from their cell phone. You need to be aware of what’s out there and take steps in advance to talk to children about what they might hear or see.”
“The reality is that even children as young as 4 years old will hear about major crisis events. It’s best that they hear about it from a parent or caregiver, as opposed to another child or in the media…

The underlying message for a parent to convey is, ‘It’s okay if these things bother you. We are here to support each other.’”

What if you have an older child or teen? “After asking your child what they have heard and if they have questions about what occurred during a school shooting, community bombing, natural disaster, or even a disaster in an international country, a parent can say something such as: ‘Yes. In [Orlando, Florida]’ (and here you might need to give some context, depending on whether it’s nearby or far away, for example, ‘That’s a city/state that’s pretty far from/close to here’), there was disaster and many people were hurt. The police and the government are doing their jobs so they can try to make sure that it doesn’t happen again.’”

If your child seems to be overwhelmed with anxiety after a tragedy, and that feeling doesn’t get better with time, talk to your pediatrician. You may also request our office to refer you to a counselor who specializes in working with children or teens. Signs that they are having trouble coping include problems with sleeping or eating (too much or too little); physical symptoms such as tiredness, headaches, digestive issues; or behavioral changes.

It is only natural to be upset when a tragedy occurs. Every adult feels that way, and so do children and youth. If you haven’t had a conversation with them about it, today is a good time for that discussion.

Mosquitoes are back!

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During our recent warm spell, you may have heard the distinctive, high-pitched buzz of a mosquito passing by, and you realize that this is the beginning of several months of those little pests.

Pests they are, yes, but mosquitoes can also carry serious diseases. Some of the mosquito-borne illnesses are limited to tropical or subtropical areas, but some can also affect us here.

West Nile Virus, for example, is carried by mosquitoes and can infect humans and animals. It usually causes no symptoms at all, but in some instances can cause encephalitis, which can even be fatal.

Recently we’ve heard about the Zika virus. It is spread by mosquitoes (and can also be sexually transmitted). So far, the virus hasn’t come this far north except by someone who has traveled to an affected area, and those who returned infected from their travels have not spread it to others. To read about the possible spread of Zika to new areas this year, and to learn about its symptoms and results, you can find a series of informative articles by the Centers for Disease Control and Prevention (CDC) here. Zika is especially dangerous in pregnant women because it can cause very serious birth defects.

Good health means good prevention, so it is always advisable to keep insects at bay.

Avoid mosquitoes by remembering that they are most active at dawn and dusk, and they love damp, dark areas like woods, mulched gardens, areas around ponds, etc. Wear long-sleeved shirts and long pants when you think you may be exposed to mosquitoes, and use repellent. Never use a repellent on a child younger than two months, and never spray directly into a child’s face (spray it on your hands first, then rub onto the face). An article about insect repellents from the American Academy of Pediatrics (AAP) gives great information about repellents and children.

Be proactive in eliminating as many mosquitoes as possible from your home and yard. The Health Department of Northern Kentucky gives these suggestions on their website:
- Survey property for areas of standing water. Dispose of tin cans, old tires, buckets, unused plastic swimming pools or other containers that collect and hold water. Do not allow water to accumulate in the containers for more than two days.
- Install or repair screens. Some mosquitoes like to come indoors. Keep them outside with well-fitting screens on both windows and doors.

And, Dr. Riebel in our practice says that her favorite form of mosquito control for our area is the purple martin! These lovely birds love to fly around your yard in the evening, scooping up insects.

Have a safe and healthy warm-weather season, and try to keep mosquitoes and the diseases they carry at bay.

The consequences of lead poisoning in children

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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.

Fluoride varnish: a new treatment for very young children

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Tooth decay, as you know, continues to be a growing problem among children and adolescents. Sugary diets and infrequent brushing can lead to cavities at young ages. And tooth decay at a young age almost always is a sign of more tooth decay as the child grows.

How to get ahead of the problem early? The American Academy of Pediatrics (AAP) recommends a fluoride varnish two to four times per year for very young children who have yet to visit a dentist. We will begin offering a fluoride varnish in our office soon.

Will insurance cover such an important treatment? You bet. All insurances are required to cover fluoride varnish, but some have a limit on how many treatments per year, even though it is a recommended service as often as every 3 months.

We’ve written before about the importance of fluoride in protecting the enamel of children’s teeth. New guidelines emerged from the AAP to stress brushing with a tiny amount of fluoride toothpaste even in the very young, although previous guidelines had recommended no fluoride before the age of 2.

Now the guidelines have been strengthened further to encourage a fluoride varnish.

Fluoride is a mineral that strengthens tooth enamel, which covers each tooth. Yes, there is fluoride in public water systems, but it may not be enough. In addition, many in our community drink water from wells and cisterns, or drink bottled water.

A fluoride varnish is simple to apply in the pediatrician’s office, with a small brush to coat the top and sides of each tooth. It’s a liquid that hardens quickly, and the teeth should be brushed about 4 to 12 hours afterwards at home. The treatment is painless, and most children like the taste. The varnish may temporarily leave a dull or yellowed appearance, but the teeth will return to a normal color after the varnish is brushed off.

This article from the AAP contains more information about fluoride varnish, including how to care for your child’s teeth immediately after the varnish is applied:

“Your child can eat and drink right after the fluoride varnish is applied. But only give your child soft foods and cold or warm (not hot) foods or liquids.
Do not brush or floss teeth for at least 4 to 6 hours. Your child’s doctor may tell you to wait until the next morning to brush or floss. Remind your child to spit when rinsing, if he knows how to spit.”

Dental health can’t start too early. Talk to your pediatrician soon about a fluoride varnish to protect your child’s teeth in the years to come.

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.