Category: Essentials of Life- eat, sleep, drink, pee, poop, love
For families with young children, holiday time can be magical yet stressful. Often families travel great distances to be together and parties tend to run late. Fancy food and fancy dress are common. And winter holidays, well, they occur in the winter, usually during flu season, stomach virus season, and in general multi-illness season. Here are some suggestions about how to keep your kids healthy and happy during this time.
We preface by referring you to suggestions # 1, 2, and 3 of Part 1of A Happy, Healthy Holiday. HANDWASHING, HANDWASHING, AND HANDWASHING will prevent spread of germs. In addition:
1. Traveling 400 miles away from home to spend the week with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home and you have chronic fatigue from arguing with her/walking her back to bed. Knowing that even the best of sleepers will often have difficulty with sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual exhausing home routine of waking up every hour to walk her back into her room. That way everyone gets better sleep. Similarly, if you have a very picky eater, pack up her favorite portable meals and have them available during the fancy dinners. (But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters.) Good sleep and good nutrition keep children and their parents healthy and happy.
2. Think of giving your children a wholesome, healthy meal at home before a holiday party which you know will be filled with junk food and food that may seem “foreign” to your children. Hunger fuels tantrums, so eliminate that meltdown source by taking them to the party with full bellies. Also you won’t feel guilty letting them have some of the sweets because they already ate a healthy meal.
3. Speaking of sweets, ginger-bread house vomit is DISGUSTING. Dr. Kardos found this out first-hand with one of her children after a holiday party where the hostess served the kids a beautiful (and generous sized) ginger bread house for dessert. While Dr. Kardos was engrossed in conversation with a long lost friend, one of her boys over-ate. Make sure you supervise what your child is eating at parties.
4. If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs. Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, kisses can spread cold and flu germs, as well as stomach virus germs.
5. On the flip side, there are some family events, such as having your 95-year-old grandfather meet your baby for the first time, that are once in a lifetime. While you should be cautious on behalf of your child, you can balance caution while looking at the whole context of a situation before deciding whether or not to attend a gathering.
6. Once you have children, their needs come before yours. (Of course there is a healthy balance-but that is a talk for another day.) Although you have anticipated a holiday reunion, your child may be too young to remember it. An ill, overtired child makes everyone miserable. If your child has a cold, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, and is in general crying, clingy, and miserable, just leave the party. You can console yourself that when your child is older his actions at that gathering may be the stuff of legends, or at least will make for a funny story.
7. For the allergic families- think twice before you drag in a live Christmas tree into your house. The trees are often covered in dust and mud. Washing the tree off with a hose in the driveway will keep the sneezing down to a minimum. Every year Dr. Lai tells families about rinsing off the tree in the driveway. Most parents dismiss the idea as too time consuming. However, she is pleased to report that a family recently told her they did rinse the tree and it did help keep the allergens at bay.
8. No one else baby proofs. Remember this when you are on the road. We worry less in our own homes. But with their medication pills lying on the end tables and their menorah candles within a toddler’s reach, other people’s homes should make us more cautious. One year at holiday time Dr. Lai’s family was in a hotel room and her six year old came running up saying “look what I found”…It was a pill of Viagra.
We wish you all the best this holiday season.
Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod
Emma’s dad and I both peered at the filamentous growth dangling from his nine year old’s right nostril. “Yes,” I said, “it’s definitely a wart.”
Emma’s dad replied, “When I was a kid, I heard the way to get rid of a wart was to cut a potato in half, rub it on the wart, and bury it in the backyard.Legend had it, by the time the potato disintegrates, the wart will begone.”
“I wish it were so easy,” I replied.
Warts are caused by skin-dwelling viruses. On the feet, warts can sometimes be mistaken for calluses. One distinguishing feature is that warts sit in the skin like this:
Fine “feeder” blood vessels extend from the wart into the skin. Therefore, if you scrape off the top layer of a wart, a dotted pattern usually appears from above. The dots will not appear in a callus. View from above:
There are simply no glamorous ways to get rid of warts. Most treatment modalities destroy warts by pulverizing the home they live in, a.k.a. your skin. Your doctor maybe armed with various agents such as liquid nitrogen, or dimethyl ether propane,which produces a chemical “freeze” and dries up the wart. Another agent called cantharidin (otherwise known as “beetle juice”) is a caustic liquid derived from the blister beetle (pictured here.)
Application of beetle juice causes the warts to blister. Some doctors will even manually take a scalpel and cut out the warts. Like I said, there are no glamorous treatments. However, more gentle creams which stimulate the immune system, such as Imiquimod (Aldara) are showing promise.
Over the counter remedies exist in a milder form. Commonly used wart removers such as Compound W, Dr Scholl’s Clear Away Wart and Duofilm all contain salicylic acid. The acid slowly dries up the warts. When applying salicylic acid, after a few applications make sure you peel the dead crusty top layer off the wart. Without peeling, future medicine will not reach the wart. These methods can take weeks to months to work, but they do work.
And don’t forget the duct tape. Duct tape, the great all-purpose household item, has also been shown to speed up the resolution of warts.Scientists hypothesize the constant presence of the adhesive somehow stimulates a natural immune response. If you try duct tape, have your child wear the duct tape over the wart for several days in a row and then give a day off. Effects should be seen within a couple of months if not sooner.
The prevention of warts is tricky. Some people just seem genetically predisposed. However, your best bet for keeping warts away is to keep your child’s skin as healthy as possible. Warts tend to gravitate towards areas of skin broken down by friction such as feet or fingers. Liberally apply moisturizing creams daily to prone areas. After a summer of wearing flip-flops and walking on the rough cement by the side of a swimming pool in bare feet, many children end up with warts on the bottom of their feet. I know a teen whose warts on the tips of her fingers stemmed from months of guitar strumming.
Turns out that even without treatment, 60% percent or more of all warts will disappear spontaneously within two years.
Coincidentally, I think that’s also the time it takes for a potato half to disintegrate.
Naline Lai , MD
© 2009 TwoPeds in a Pod
Addendum, January 14, 2010
A lot of Halloween festivities in our area have been dampened by H1N1 flu. For all the parents of the boys and ghouls in a similar situation, this picture will make you smile. It was sent to me by Ben’s mom. It is flu from the perspective of a kindergarten boy. The arrow points to Ben’s nose. Note the huge boogie to nose ratio. The red represents “boss germs” and the purple ones are the “just plain mean” ones.
Don’t let the “Boogie” man get your family this Halloween
Naline Lai, MD
© 2009 Two Peds In a Pod
As the first batches of the H1N1 vaccine are distributed, is my pleasure to introduce our first guest blogger Kimberly Lafferty. A mom and well respected scientist, she brings us information on the H1N1 vaccine. Dr. Lafferty holds a doctorate in pharmacology from University of North Carolina at Chapel Hill and a masters of business administration from Pennsylvania State University. She completed a fellowship in clinical research and drug development and is a mom to a young child and an infant.
Naline Lai, MD
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As a mother of two young children, I am always concerned about their health and well-being. So, naturally, I am especially concerned about the novel influenza A/H1N1 strain that has led to the current global pandemic. But, as a pharmacist with over ten years experience in the pharmaceutical industry (mostly in research & development), I also know the importance of good research and making decisions based on the best available scientific evidence. Therefore, I have spent quite a bit of time researching the novel H1N1 virus and the soon-to-be available vaccine. Below is a summary of my findings:
1. While most people infected with H1N1 have had only mild to moderate symptoms, there have been deaths associated with this virus. Many of these have been in people with underlying chronic health conditions, but some deaths have occurred in otherwise healthy, young people.
2. According to the CDC (US Center for Disease Control and Prevention) on 10/1/2009, 100 pregnant women in the U.S. have required treatment for H1N1 influenza in intensive care units; 28 of these have died. Pregnant women are especially vulnerable to infections (due to a weakened immune system) and are at especially high risk of complications from the H1N1 strain.
3. The H1N1 vaccine is made by the same companies and by the same processes as the seasonal flu vaccine. It is also undergoing the same lot testing and release procedures as the seasonal flu vaccine. The only difference between the seasonal vaccine and the H1N1 vaccine is that the H1N1 vaccine contains only one strain of influenza while the seasonal vaccine contains three. While the strain in the H1N1 vaccine is different from the strains in the seasonal vaccine, the seasonal flu vaccine has been safely admininstered to millions of people over many years, including children.
4. Because the H1N1 vaccine is made the same way as the seasonal flu vaccine, clinical trials were officially not necessary for this vaccine. However, the NIH (National Institute of Health) and the manufacturers are separately conducting clinical trials, not only to verify the safety of the vaccine, but also to determine the optimal dose and dosing schedule needed to ensure that people who are vaccinated become immune to the H1N1 strain of flu.
5. The H1N1 vaccines currently approved in the U.S. do NOT contain adjuvant (or “immune boosters”). Adjuvants are used in European seasonal flu vaccines and the European H1N1 vaccine.
6. As with the seasonal influenza vaccine, the H1N1 vaccine will be available in preservative-free formulations. These will most likely be targeted to young children and pregnant women.
Since there are a lot of myths and misinformation out there regarding the H1N1 vaccine, focus your own research on independent, credible sources such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention(CDC), the Food and Drug Administration (FDA), and your state/local health departments. One important resource is www.flu.gov.
Kimberly Lafferty, Pharm D, MBA
The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. Vaccine distribution is expected in the next month.
Why the recent American media hub-bub over “the flu” and “the swine flu”? Both are forms of the same virus called influenza. Usually known as “the flu,” this year, “the flu” is called the seasonal flu in order to distinguish it from “the swine flu,” properly known as the 2009 H1N1 flu. Getting hit by any form of influenza can feel like being hit by a ton of bricks. Just ask my husband. Last winter, the same man who ran his first Marathon in the fall, couldn’t run 500 feet for nearly a month after his bout with the seasonal flu. Complications from either form of influenza include sinus infections, pneumonia and even death. Influenza infections in the States occur mainly from October to April each year. Usually, only the seasonal strain is of concern, but this season there is the added concern that the 2009 H1N1 strain, which first leaped into the spotlight this past spring, will also add to the total number of people affected by influenza.
Both influenza forms are viral illnesses which predominantly cause airway symptoms. Classic flu symptoms are sudden onset of nasal discharge, cough, high fever, headache and achiness. A virus is a category of germs which are named for the way they reproduce. Examples of viruses vary wildly. Chicken pox, the common cold, and Human Immunodeficiency Virus (HIV) are all caused by viruses. Whether an illness is caused by either a virus or a bacterial germ does not necessarily reflect the severity of an illness. To add to the confusion, people sometimes call any viral illness which causes stomach upset “the stomach flu.” “The Stomach flu” is not caused by an influenza virus. If your child has diarrhea and vomiting alone with no stuffy nose or cough, they are not likely to have a form of influenza.
How do I protect my kids against either the Seasonal Flu or H1N1?
Wash, wash, wash.
Hand washing with soap and water for 15 seconds has been proven to decrease germs. For young (or impatient) children , have them sing the Happy Birthday Song until they are done. One note- alcohol containing hand sanitizers do kill germs; however, most brands contain a greater percentage of ethylene alcohol than distilled drinks. Hand sanitizers contain over 60 percent alcohol versus 30-40 percent alcohol in liquor. According to my sister, Melisa Lai, MD, a Boston area toxicologist, toddlers have ended up in comas from alcohol poisoning after drinking hand sanitizer.
Both forms of influenza are spread through air via coughing and sneezing. Tell your kids that they don’t want boogies from other kid’s noses to go into their nose. If their noses can touch the noses of other children, then they are too close. Cough away from other kid’s faces. If we use national standards for spacing between sleeping cots in daycares (Caring For Our Children Health and Safety Standards, 2nd edition), children are ideally kept two feet apart.
Keep ‘em away from crowded places.
Any parent knows, keeping playing children two feet apart from each other is near impossible. If your child is sick, keep them away from crowded places such as birthday parties, school and daycare. If your child is already ill, you do not want them to catch a secondary illness on top of their current illness. For the protection of your child and others, keep your child at home until he/she is 24 hours fever free. This school and daycare exclusion criteria is already recommended not only for influenza by the American Academy of Pediatrics, but for all illnesses (www.AAP.org). A few days ago, the Centers for Disease Control http://www.cdc.gov/h1n1flu/schools/ published the same guidelines for influenza.
There are two types of immunizations against the seasonal flu. Because the seasonal influenza strains change from year to year, the vaccine changes and need to be given yearly. One is a nasal spray for children two years old and up. The other type is injected into muscle and is approved for those six months and above. Because the vaccines are made up in eggs, children with egg allergies cannot receive the vaccine. Under nine years of age, the first year a child receives the seasonal flu vaccine, two doses are required. If only one immunization was given the first year, the child will require two the second year. If your child is ill or had a reaction to the seasonal vaccine in the past, ask your doctor about administration of the vaccine.
As of this writing, vaccines for the H1N1 flu are still not available. Vaccines are expected to be available in the late fall. Uncertainties about the H1N1 formulations, side effects and distribution still persist.
The priority groups for the seasonal flu immunization and the 2009 H1N1 flu immunization are slightly different. The main difference between the set of recommendations is that those over 65 years of age are not a target groups for the 2009 HINI vaccine but a target for the seasonal flu vaccine. Also, college aged (19-24 years) adults are part of the 2009 H1N1 target group but not of the seasonal flu vaccine target group.
According to the Advisory Committee on Immunization Practices, a working group of the Centers for Disease Control which meets to review infectious disease data and recommends national guidelines for immunizations, the following groups are the priority groups for influenza vaccination:
Priority groups for the seasonal influenza vaccine:
1. Children aged 6 months up to their 19th birthday
2. People 50 years of age and older
3. People of any age with certain chronic medical conditions
4. People who live in nursing homes and other long-term care facilities
5. People who live with or care for those at high risk for complications from flu, – includes Health care workers, Household contacts of persons at high risk for complications from the flu, Household contacts and out of home caregivers of children less than 6 months of age (children too young to be vaccinated)
6. Pregnant women
Priority groups for the 2009 H1N1 influenza vaccine:
1. All people from 6 months through 24 years of age
2. Household contacts and caregivers for children younger than 6 months of age
3. People aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
4. Healthcare and emergency medical services personnel
5. Pregnant women
Is there treatment?
Treatment is generally supportive. Have your child drink plenty of fluids and get as much rest as possible. Fever reducers such as ibuprofen (i.e. Morin, Advil) and acetaminophen (i.e. Tylenol) may help keep children comfortable enough to do the things such as drink and sleep that will make them better. Outpatient antiviral does exist but the strains of flu can morph, thus rendering them sometimes ineffective. Antiviral medications are for children whose illness is moderate or severe or if they are at high risk of complications. Generally antivirals work best within the first 48 hours after onset of symptoms. Antibiotics such as Amoxicillin and a “Z-pack “will not kill influenza viruses. Antibiotics are prescribed if there is bacterial infection overlying the influenza infection.
This winter, although your family may escape both strains of influenza, remember, there are plenty of “flu-like” illnesses out there which can also wreck havoc on your child’s health. Hopefully, if the threat of the seasonal and 2009 H1N1 flu forces us to pay attention to good hygiene habits, we may overall end up with a healthier winter.
For the most up to date information on influenza: www.CDC.gov
Naline Lai, MD