ADHD—diagnosis, treatment and your concerns

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You hear so much about ADHD these days. It’s in the news. You likely know children, teens or adults who’ve been diagnosed with it. Debates continue about under- and over-diagnosing, and about medicating.

First, just what is ADHD?

ADHD is Attention-Deficit Hyperactivity Disorder. Of course, nearly all children will sometimes be hyperactive and lack focus. How do you know when it’s a problem worth taking to your pediatrician?

The American Academy of Pediatrics has a great article covering the basics of ADHD in which they say, “Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.” We might add that family life is also greatly affected by a child with ADHD. This same article deals with concerns about medications and why more children are now being diagnosed with ADHD than, say, 10 or 20 years ago.

Another fascinating article about the trend is here, from MacClean’s.

The bottom line is this: yes, it’s a real problem. And yes, it may also be over-diagnosed.

Families of children and teens who have ADHD find that the right medication in the right amount can profoundly help. Specific testing is needed up front, then some time is often required to pinpoint and adjust the proper medication. In addition, coping mechanisms for studying, chores and social skills can assist parents in dealing with ADHD.

At Georgetown Pediatrics, we are conscientious in making the right diagnosis for your child. Four of our physicians (Dr. Hambrick, Dr. Hoddy, Dr. Sweigart and Dr. Forster) are specially trained to diagnose and design a treatment plan specific to your child. With compassion we can help you find your way to a less stressful future with your family.

If you have concerns that your child may have ADHD, contact our office for an appointment.

Stomach virus recovery

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“Stomach bugs” are making their rounds right now. Rotavirus, in particular, is quite contagious and may have even made the rounds through every member of your household. It causes diarrhea, vomiting, stomach pain, etc. Sound a little too familiar?

What to do?

According to the American Academy of Pediatrics, usually, the virus goes away on its own. Watch, though, for dehydration and high fever. Dehydration can be serious in a small number of cases. Give small amounts of fluids until the vomiting ceases. Water is fine, but fluids like Gatorade can add electrolytes. Stay clear of acidy drinks (like orange juice) and milk.

Be watchful regarding dehydration. Pay attention to the frequency of urination. The urine will become more concentrated and less frequent, but child should still be urinating.

While your child is sick, give a very bland diet: avoid dairy, fried foods, fast foods, hot dogs, etc. Some good foods are bananas, rice, applesauce and toast (BRAT).

However, it’s recommended that as soon as the stomach is settled, you should return to a balanced diet of fruits, vegetables and protein (meat, yogurt).

Call the pediatrician if diarrhea and vomiting don’t subside within three days, if there’s been no urine output for 10 hours, or if the fever is high or doesn’t subside. See our blog about when to be concerned about a fever.

As always, stay healthy!

Tanning beds?

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Checking the thermometer—or even looking out the window—in Central Kentucky this week, it’s hard to believe that spring break is just around the corner. Many people will be heading south for a little sun and warmth. Others are just dreaming of summer days here, with days by the pool or sunbathing in the back yard. And still others are imagining prom pictures and how they’ll look in that special dress or tux.

Whether preparing for a trip south, wanting to look your best or thinking ahead to summer, lots of people turn to tanning beds for a “base tan” in March and April.

In Kentucky’s current legislative session a physician has introduced a bill banning the use of tanning beds in the state by anyone under the age of 18. It’s a bill we support, and here’s why:

Indoor tanning (tanning beds) is associated with an increased incidence of skin cancers, including melanoma (the most dangerous kind).
The use of indoor tanning has increased among teens, especially girls, in recent years.
Depending on the particular tanning bed used, you may receive up to 15 times the UVA rays that you would receive from exposure to midday summer sun.
Tanning has cumulative effects. The more sunburns, and even tanning, your body receives over the years increases the odds you will develop skin cancers. Tanning also causes premature skin aging and damages all the layers of the skin.

A tan does not make you more healthy; the facts support the opposite—tanning causes long-term damage.

So, don’t allow or encourage your teens to use tanning beds. Read more from the American Academy of Pediatrics here.

Should we go gluten-free?

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“Gluten-Free” is the new catchword for “healthy diet,” or so it would seem if you read grocery store labels. Do gluten-free foods really make your family healthier? It’s not always a simple answer.

Just what is gluten? It’s a protein found in wheat and some other grains. Why do some people avoid gluten? There are several reasons.

Less than 1% of the population cannot eat gluten because they have celiac disease. According to the National Institutes of Health page on the subject, “celiac disease is an immune reaction to gluten, a protein found in wheat, rye, and barley.” It can be diagnosed as early as infancy or at any later time, and you can find a list of symptoms here from the American Academy of Pediatrics. The only way to get relief from those symptoms is to completely eliminate gluten from the diet, a task that isn’t easy because so many products contain wheat flour.

Others think that a gluten-free diet makes them feel better, though that could simply be because they are eating fewer carbohydrates and calorie-laden fast foods.

Still others believe that gluten contributes to behavioral problems or may even have a link to autism. Those ideas remain unproven, but there is a great article here.

Gluten-free advocates often tout a huge list of health benefits that are completely without scientific basis.

Celiac disease cannot be diagnosed without specific tests. If it’s something you suspect your child may have, talk to your pediatrician. And if you have to put your child on a gluten-free diet, you need to speak to a dietician about what nutrients you may be missing in the process. Don’t forget that our office has a dietician on staff for just this type of consultation.

Bottom line: there’s nothing wrong with eating gluten-free foods, but don’t go totally gluten-free without consulting your pediatrician.

Screen time for computers and games

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A couple of weeks ago we dealt with content of video games here. If you missed it, check out that important information about monitoring what your kids are playing. It’s also important to supervise all computer screen time.

Make sure all the computers to which your youngster has access are in open places in the house. Search the browser history at regular intervals, and make sure you have his passwords for all social media accounts so you can check that activity. Let him know ahead of time that this is one of the rules for the privilege of using the computer and smart phone. Take a look at texts and other accounts on her phone, and remind her of safety rules:

Never give out personal information online or over the phone.
Never assume that someone you “meet” online is giving you accurate information, and never arrange to meet such a person face to face.
If you get concerned about someone contacting you, tell your parent without fear of judgment.
Never use your phone or computer for pornography (especially child pornography, which is illegal), sexting (a form of pornography), sending any inappropriate information, or for hurting or bullying someone else. If you receive such content inform a parent or teacher immediately.

In addition to content, you should be aware of time. Screen time of any kind (television, movies, computer, video games) means fewer hours are available for physical activity, face-to-face interaction, reading and homework. Screen time isn’t necessarily bad in itself, but you should monitor the amount of time.

The American Academy of Pediatrics gives great advice about video games in this online article, including the recommendation to limit video game time to one hour per day. The same goes for other types of screen time. If your teen or child is spending much more time than that in front of a screen (unless, of course, it’s for school), engage him in conversation about what other activities might take the place of some gaming hours. Allow her to choose from a list of fun ways to spend her time.

Reading. If your children don’t like to read, read to or with them. Pick an age-appropriate book and take turns reading pages or chapters. Bedtime is great for this.
Physical activity. One of the problems of screen time is its sedentary nature. Inactivity leads to weight gain and all sorts of accompanying health issues. Get your youngster involved in a team or individual sport. Go walking or swimming. Shoot hoops in the driveway or play catch in the backyard.
Board games. Remember Candy Land? Connect Four? Pictionary? Games are widely available and great fun. They afford great opportunities for interaction, and for learning life skills like winning, losing, and cooperation.
Face time. Not the phone app, the real face time. Find something you and your teen can share and enjoy: cooking, eating, hiking, stamp collecting, whatever works for you. Time invested is time well-spent. You will reap the rewards in getting to know your child better, and they will reap the rewards in knowing you.
Channel that interest in computers to online learning games, or learning video games. Check out learning games on Amazon, or try one of the websites like Adapted Mind, where you can get a 30 day free trial of games for grades 1-6 (if you continue on with membership there’s a monthly fee).

Bottom line: be in charge of what your children do, even if they aren’t always in favor of your monitoring and limits. It’s your job, and you are aiding in their full development.

Flu vaccinations are working

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Having encouraged all of you to be vaccinated against the flu, we think this is a good time to give you a local update.

Here are some very interesting statistics:

So far this season, Georgetown Pediatrics has administered 4200 doses of flu vaccine, including both shots and nasal mist.
We have had 76 positive flu tests in our office. Of those 76, one was influenza type B, one was both influenza A and B, and 74 were influenza type A (H1N1).
Only 22 patients who received flu vaccine in our office also tested positive in our office for the flu. Of course, some patients may have been diagnosed with the flu elsewhere or had the flu and weren’t diagnosed at all, or some may have received the vaccine elsewhere. Even so, we are happy to note that only 1 in 190 patients who received our vaccines tested positive for flu here.

The bottom line is that flu vaccine works.

Something else you should know: it isn’t too late to get the vaccine. Even if you’ve already had the flu, it was likely type A, and you can still contract type B. Both types are covered by the vaccines. Once kids are back in school after these snow days the virus is bound to be spread more.
We often see cases of influenza B all the way until spring break, so don’t hesitate to come in. Just remember that if you receive the nasal mist you will test positive for the flu for about two weeks, because it’s a live vaccine and the test is a nasal swab.

As winter drags on, you may not be able to stop the snow and ice, but you can certainly lower the risk of your family getting the flu.

Video games—pay attention to what your kids are playing

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As technology increases at home and school, video games have increased in number. Each year they become more realistic-looking and exciting. But they are also often violent, and may contain language and themes inappropriate for your youngster.

Playing video games has benefits, to be certain. They help young people learn eye-hand coordination and computer skills, things they will need to keep up in the modern world.

But there are down sides, too. Big ones. Questions and concerns about content top the list, but you should also be aware that many online games require the sharing of personal information and location.

First, content. The debate continues regarding whether or not violent video games encourage violent behavior. Opinions abound, but the bottom line is that you should monitor and decide what your child or teen can or cannot play. In addition to violence, language and themes may often be too adult.

Understand ratings. The ESRB (Entertainment Software Rating Board) rates virtually all video games in terms of content, age-appropriateness, and interactive elements (including whether or not location and other information is shared). All three of these areas are important.
Content and age-appropriateness. The ESRB website has a great video and also written language to help you understand ratings and how they define words such as “animated blood” and “adult humor.” The basic content and age ratings are:
- Early Childhood;
- Everyone;
- Teen (13 and up);
- Mature (17 and up);
- Adults only.
- Pay attention! Games rated “Mature” have truly adult themes (sex, violence, language) and are simply NOT appropriate for younger ages. Even those with a rating of “Teen” may surprise you with their level of violence and tasteless language.
- PREVIEW. Learn about games before you buy. This website at Common Sense Media is a great source of information. If your youngster is asking for a particular game, look for the title here to see some screen shots and other details.
- Interactive elements. If you are concerned about private information being shared, or worry your child or teen might be connecting (accidentally or purposefully) with people you don’t know, READ THIS.

One important note about violence. Whether or not your teen or child plays violent video games, you should pay attention if he exhibits violent behavior. If she is violent with you or other family members, with schoolmates or with animals, talk to your pediatrician about finding a counselor.

Bottom line: know what your child is doing, watching, playing. Video games are fun, but you need to be aware of content and privacy.

My head hurts!

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A headache is a common complaint for some children and teens, and nearly all kids will get one every now and then. Causes are numerous. Usually, a headache is nothing to worry about, though there are times when you should go to the ER or call your doctor immediately (see below).

Headaches can be caused by things like strong smells, stress and anxiety, a cold or the flu, allergies, even changes in the weather. Other common causes include:

Hormonal changes. Puberty is often a time when headaches begin or worsen.
Diet. Nitrates and caffeine, in particular, can cause headaches at any age. Does your child or teen get a headache several hours after drinking a caffeinated beverage? Or eating a hotdog?
Lack of enough sleep. Make sure your child gets an age-appropriate amount of sleep every night.

Some children have migraines, which can (but don’t always) run in families. The pain can be strong and on one side of the front of the head or the other. Your child may express a need to lie still in a dark room, and other symptoms may include nausea.

If your child’s headaches are not severe, pay attention to patterns before coming to the see the doctor. Keep a diary of food and beverage intake (paying special attention to caffeine and nitrates), amount of sleep, allergy attacks, even weather conditions.

There’s an app for that. Here are a couple of phone apps that can help you keep a headache diary to determine what some of your triggers (causes) might be.

An Apple app by drug company Novartis.
An Android app by Froggyware.

If headaches are bad and persistent, see your pediatrician.

Keep in mind there are times when you should seek medical help immediately.

If your child has suffered a blow to the head in an activity, fall, or accident and has a headache. This could be a sign of concussion.
If the headache is severe and other symptoms include high fever.
If the pain is sudden and severe.
If the headache awakens the child at night.
If the headache is accompanied by dizziness, weakness, or other neurological symptoms.

By paying attention, you may be able to help your child or teen reduce their number of headaches, and if they are severe, to get help immediately.

Apps to suit your life and lifestyle

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Last week we dealt with websites. Want to be more mobile? There are many apps for your smartphone or tablet that can help you keep your family healthy.

Here we’ve listed just a few to get you started, all of them inexpensive or free.

From the American Academy of Pediatrics, several great apps are available, all of which you can order here.
- KidsDoc. Cost: $1.99. This app helps you figure out what to do if your child is sick. You enter your child’s symptoms and are given advice, including options like: Call 911, Call Your Child’s Doctor Now, Call Your Child’s Doctor within 24 hours or Manage at Home. Suggestions for managing at home will tell you how to care for your child’s particular ailment.
- Car Seat Check. Cost: $1.99. Enter your child’s age, height, and weight. You’ll get reviews of appropriate car seats, installation help, and safety information.
- Healthy Children. Cost: FREE. Look up health information by age, find out what first aid is best for particular injuries, see what immunizations are needed for particular ages.
- ADHD Tracker 1.0. Cost: FREE. If your child, age 4-18, has already been diagnosed with (and treated for) ADHD, this app gives a streamlined way to complete and submit a behavioral assessment.
- Iron Kids. Cost: $3.99. Keep your child healthy and fit and sport-ready with this workout.
- Other sources and apps.
  - Ages and Stages. Cost: FREE. This app by Parenting magazine allows you to enter your own stage of pregnancy, or your child’s age, to get information tailored for you.
  - Breastfeeding Management 2. Cost: $1.99. The Massachusetts Breastfeeding Coalition sponsors this app. You can get answers to frequently asked questions; enter your child’s age, weight, and frequency of feeding to determine how many ounces each feeding should be (especially helpful if you’re pumping); research medications and breastfeeding.

Technology and health have always gone together. These apps can keep you up to date and on top of health issues.

Artwork by Kennedy, age 2

Medical websites you can trust

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As we enter 2014, many families will decide to be healthier this year. One way to be on top of your health is to be knowledgeable. The problem is that there is so much information out there, it can be overwhelming. Even worse, a lot of the advice is misleading, incomplete, trying to sell a product, or just plain wrong.

What to do, then, if you’re looking answers to your pediatric health questions? We have a few sites we trust that you may find helpful.

Your first stop should be here, on our own website. There you’ll find 21 links that we trust to provide good information, on everything from general health and pediatrics to a few common illnesses and conditions, such as allergies, asthma, and disabilities. Here are a few of the best:

American Academy of Pediatrics. If you read our blog, you know that we refer to the AAP regularly. They are the go-to organization for reliable information on the health of children and teens, including physical, social, psychological, and intellectual health. Some of their pages are full of statistics and medical jargon, but check out healthychildren.org. It’s very readable, practical, and up-to-date. You can search your topic or question by typing it into the search box.
The National Institutes of Health has a huge amount of information. Some of it is written for health professionals, but much of it—particularly the medline plus section—is also written for the general population. It’s a great source of health information for all ages, birth to old age. You can even sign up here to receive e-mail updates on children’s health topics.
The Centers for Disease Control and Prevention gives you an alphabetized list of topics and diseases for your research.

If you have a particular issue you’re interested in researching, check with your pediatrician, who can suggest additional specific resources.

Happy internet hunting, and Happy New Year!

Artwork by Audrey