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Abdominal pain Questions

#1. Abdominal pain

Q: What are the warning signs that abdominal pain may be very serious and may require surgery?

A:

Abdominal pain is a frequent complaint of children who come to the ER.  Although most children with abdominal pain have a condition that will resolve on its own, the pain may indicate a serious medical or surgical emergency.

The following signs and symptoms may be clinical clues that a child has a serious condition that may require surgery and thus require early detection.
  1. A fall or injury to the belly area (internal organ damage)
  2. Pain in the testicle (testicular torsion)
  3. A bulge or mass in the lower abdomen or genital area (hernia)
  4. Blood in the stool with lethargy and/or irritability (intussusception)
  5. Projectile vomiting (pyloric stenosis)
  6. Dark green emesis or bile (obstruction e.g., malrotation)
  7. Abdominal pain prior to vomiting (appendicitis)
  8. Lying still because movement makes pain worse (appendicitis)
  9. Pain in the lower right side of the belly (appendicitis)
  10. Increasing pain with high fever (perforated appendix)
  11. Pain in the upper right side of the belly, + family history (gallstones)
  12. Abdominal distention, history abnormal stools (Hirschsprung’s disease)

You should call your doctor anytime your child’s abdominal pain is not improving or is worsening, including not drinking well and any signs of dehydration.

And call your child’s doctor immediately for any signs or symptoms that may suggest a serious cause for the abdominal pain as listed above.

For more information, including different causes of abdominal pain, go to http://kidemergencies.com/bellypain2.html

Barbecue Safety Questions

#1. Barbecue Safety

Q: I read recently that eating too much grilled food can cause cancer. Our family grills food on a regular basis and I am now concerned for the safety of our two sons. What do you think?

A:My daughters and I enjoy eating grilled food as well so I appreciate your concern. During the summer months millions of Americans are enjoying the same activity.

Research has shown that grilling can create cancer-causing compounds in meat.

Among the compounds are heterocyclic amines (HCAs), which are created when heat acts on amino acids and creatinine in animal muscle.

The longer the cooking time and the higher the heat, the more HCAs.

That means that barbecuing produces the most HCAs, followed by pan-frying and broiling. Baking, poaching, stir-frying and stewing produce the least HCAs.

The following are some safety tips for limiting HCAs:

  • Before you barbecue meat, partially cook it in the microwave and then throw out the juices that collect in the cooking dish. Finish cooking the meat on the grill. Precooking a hamburger for a few minutes in the microwave reduces HCAs by up to 95 percent.
  • Flip hamburgers often. Doing so every minute reduces HCAs by up to 100 percent. This is likely because constant flipping keeps internal meat temperatures lower.
  • Marinate meat before grilling. This can greatly reduce HCAs. For example, one study found that chicken marinated for 40 minutes in a mixture of brown sugar, olive oil, cider vinegar, garlic, mustard, lemon juice and salt cut HCAs by 92 percent to 99 percent.
  • Don’t cook meat to “well done.” Use a meat thermometer and cook poultry to an internal temperature of 165-180 degrees F, ground beef, pork and lamb to 160-170 degrees F, and beef steaks and roasts to 145-160 degrees F.
  • One or two days before you barbecue, eat cruciferous vegetables such as broccoli, cabbage, cauliflower, kale and brussels sprouts. These vegetables contain compounds that activate enzymes in the body that detoxify HCAs.

Bisphenol A (BPA) Questions

#1. Bisphenol A (BPA)

 

 

 

Q: I read recently that using baby bottles can be dangerous for infants because of a chemical known as bisphenol A. Is this a real concern and how do I know if a bottle is made of this chemical?

A:This is a very “hot” topic in pediatric medicine at the moment. Even since I first added it as a topic in the Poisoning and Substance Abuse section late last year, more information has been presented.

Just in an article in last Saturday’s Atlanta Journal and Constituition (4/19/2008), it was reported that Canada became the first country to ban the use of bisphenol A (BPA) in everyday consumer products, including some baby bottles.

BPA is used in production of polycarbonate plastic and epoxy linings to add strength and resilience to the products.

Effects of BPA as of this point have been demonstrated in animals (e.g., breast and prostate cancer and reproductive problems) but not in humans, so whether or not this concern applies to human beings remains a point of disagreement among scientists.

Nevertheless, many are taking the approach of rather be safe than sorry.  Wal-Mart Canada began pulling all baby products containing BPA from its shelves last week and plans to stop selling these products in the US by next year.

For details on how to recognize which plastic products contain BPA and how you can minimize exposure in your child, go top Bisphenol A.
And for a video on this topic, go to BPA video.

Breastfeeding and Herpes Questions

#1. Breastfeeding and Herpes

Q: Is it possible that if you decide to breastfeed an infant can herpes simplex be passed to the infant?

A:

If you have genital herpes, it is generally safe to breastfeed your newborn. Genital herpes (herpes simplex) is spread through direct contact with sores and can be dangerous to a newborn.
Genital herpes sores can be transmitted to the breast. Most sources advise that if the herpes lesion can be covered, so the baby does not come in contact with it, breastfeeding can continue.
If you have sores on your nipple or areola, the darker skin around the nipple, you should stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears.

Choking on foods Questions

#1. Choking on foods

Q: At what age is it safe for children to eat peanuts?

A:

Children under the age of four and children with chewing and swallowing difficulties are at the greatest risk of choking on foods because, 1) they do not chew long enough to make food small enough to go down the throat; 2) they may not yet have the back teeth they need to grind foods; 3) they may try to swallow too much food at one time; and 4) they may have difficulty swallowing liquids and solids together.
Peanuts and peanut butter are on the list of foods that most often cause choking for toddlers and preschool children or for children with chewing or swallowing difficulties.
Others include:
  • Round-shaped foods (raw peas, whole grapes, raw carrots, seeds, nuts, hotdogs, round candies);
  • Slippery foods (peanuts, ice, or other wet items);
  • Dry foods (marshmallows, dried fruits, pretzel sticks, chips, popcorn);
  • Tough foods (chunks of meat, dried meats);
  • Sticky foods (spoonfuls of peanut butter or peanut butter on soft bread, clumps of raisins);
  • Hard foods (broccoli, cauliflower, hard candy);
  • Foods with non-edible parts (fish with bones, fruits with pits).

Here are some suggestions to modify potentially hazardous foods to reduce the risk of choking and make them safer for children:

  • Remove the skin from hotdogs, sausages, and frankfurters; cut them lengthwise, then cut them into small pieces or thin strips.
  • Chop, grind, or dice meats.
  • Chop nuts and grind seeds finely.
  • Dice or grate raw vegetables.
  • Steam, then slice or dice vegetables.
  • Remove the pit, then dice fruits like cherries, apricots, and peaches.
  • Spread peanut butter thinly over crackers or wheat bread.
  • Blend peanut butter with applesauce or jam before serving.
  • Serve bow-tie pretzels instead of pretzel sticks or potato chips.
  • Remove the bones from fish or serve fish pieces that have been boned.
  • Include plenty of liquids such as water, milk, or juice at meal and snack times and encourage children to sip in between mouthfuls.

Cleaning products Questions

#1. Cleaning products

Q: Do you have recommendations on how I can best keep my child safe while I am using detergents around the house for spring cleaning?

A:Maybe you could come do some spring cleaning around my house :) Home cleaning products are one of the most common poison exposures in young children.

The following are safety tips offered by the Soap and Detergent Association to help protect young children.

Parents and other adults should:

  • Install childproof locks on cabinets that house cleaning supplies. Never assume a cabinet is too high for a curious child.
  • Keep all household products in their original packaging, which includes first-aid information in the event of accidental exposure or ingestion of the product.
  • Read and follow the directions on the product label.
  • Don’t leave cleaning buckets with liquid in them unattended. If a child falls into a bucket, it may not tip over, and the child could drown in even a small amount of liquid.
  • Schedule house cleaning during “down times,” when children are having a nap or on a play date or at school.
  • Take out only the amount of cleaning product you need for the job you’re doing at the moment. Keep the rest securely stored until you need it.
  • Immediately clean up any spillage.
  • Avoid distractions or interruptions when children are present while you’re cleaning. If you need to answer the door, take the child with you. If the phone rings, let the answering machine get the call.
  • Post the Poison Control Center phone number (1-800-222-1222) by every phone in your home and save the number on your cell phone.

Constant Infections Questions

#1. Constant Infections

Q: I have 5 yr old twin daughters who attend preschool 3 days a week and a 14month old son. Over the last 6 months, the sickness has been non-stop in this house. Every month we are at the doctor and every month on antibiotics. Please help.

A:Thanks for your inquiry concerning your children’s health. This is certainly a common scenario. Let me pass along some information that may be reassuring to you.

Babies, toddlers, and preschoolers get about 7 or 8 colds a year. During the school-age years they average 5 or 6 colds a year.

Teens finally reach an adult level of about 4 colds a year. In addition to colds, children can have diarrheal illnesses (with or without vomiting)
2 or 3 times per year.

The main reason your children are getting all these infections is that they are being exposed to new viruses. There are at least 200 different cold viruses. Your children’s body will build up defenses (immunity) against these viruses when they are exposed to them.
But this takes time. It takes many years to build up immunity to cold viruses.

Your children will be exposed more if they attend day care, play group, a church nursery, or a preschool. Older brothers and sisters may bring home a virus from school. Colds are certainly more common in large families.

Many parents are worried that their children have some serious underlying disease because they get a lot of colds. A child with an
immune system disease doesn’t get any more colds than the average child. The difference is that a child with an immune problem will have
trouble recovering from illness. They also will have 2 or more bouts per year of serious infections such as pneumonia, sinus infections,
draining lymph nodes, or boils. In addition, a child with a serious disease does not gain weight very well or look well between infections.

I understand why you may be concerned about frequent use of antibiotics in your children. Given that the large majority of illnesses in
children are viral, antibiotics are unnecessary in most cases.

Since I do not have the luxury of examining your children, I cannot make a judgment on whether the antibiotics prescribed were appropriate. Certainly in some cases (e.g., severe ear infection, pneumonia, strep throat) antibiotics are required. You should feel comfortable discussing your concern with your child’s doctor the next time an antibiotic is prescibed.

Dehydration Questions

#1. Dehydration

Q: I always have a tough time knowing when to take my children to the doctor for a stomach bug because it is hard to tell when they are dehydrated. Can you give me some pointers?

A:I sure can but keep in mind first off that not all vomiting, and diarrhea for that matter, is due to the common stomach bug. There are many other potential causes, some of which can result from a serious medical or surgical condition.

For a review of vomiting and when to call your pediatrician, go to http://kidemergencies.com/vomiting.html

For a review of diarrhea and when to call your pediatrician, go to http://kidemergencies.com/diarrhea1.html

But to answer the question we will assume a child has a stomach infection with nonbloody diarrhea and vomiting that does not contain blood or bile (green-colored fluid).

With regard to dehydration, keep in mind that younger infants and children are more likely to become dehydrated than older children or adolescents because of several factors, including a smaller fluid reserve, a higher metabolic rate, and dependence on others for access to fluids.
The following are improtant signs and symptoms that would suggest that a child is dehydrated:
  • Urinates less frequently
  • No tears when crying
  • Dry, sticky mouth or tongue
  • Thirst
  • Headache
  • Sunken eyes
  • Sunken soft spot on the front of the head in babies (called the fontanel)
  • Lethargy (less active than normal)
  • Irritability (more crying, fussiness)
  • Darken urine (should be clear or very pale yellow)The most important concept to keep in mind is to prevent dehydration in the first place. For tips on prevention and treatment, go to Dehydration.

Drowning Questions

#1. Drowning

Q: We have a swimming pool at our home and have kids swimming in it almost daily. Can you provide me with some safety tips on how to prevent drowning?

A:As with so many other childhood injuries or deaths, drowning is entirely preventable.  The following 10 tips will help keep your children and others safe around the pool throughout the summer and fall:

  1. Never leave your children alone in or near the pool, even for a moment.
  2. You must put up a fence to separate your house from the pool. Most young children who drown in pools wander out of the house and fall into the pool. Install a fence at least 4 feet high around all 4 sides of the pool.
  3. Use gates that self-close and self-latch, with latches higher than your children’s reach.
  4. A power safety cover that meets the standards of the American Society for Testing and Materials (ASTM) adds to the protection of your children but should not be used in place of the fence between your house and the pool.
  5. Keep rescue equipment (such as a shepherd’s hook or life preserver) by the pool.
  6. Do not let your child use air-filled “swimming aids” because they are not a substitute for approved life vests and can be dangerous.
  7. Anyone watching young children around a pool should learn CPR and be able to rescue a child if needed.
  8. Stay within an arm’s length of your child.
  9. Remove all toys from the pool after use so children aren’t tempted to reach for them.
  10. After the children are done swimming, secure the pool so they can’t get back into it.

For more information on drowning, including who is at risk, click on Drowning.

ER visit Questions

#1. ER visit

Q: I find visiting the ER with my son, which I seem to have to do regularly for all his injuries, is always stressful to me. Could you give me advice on how to make these visits easier?

A:The ER is by no means a fun place for both child and parent to spend time – been there, done that too.

The fear of the unknown for a child in addition to a potentially painful procedure can make for a very stressful experience.
I can suggest several tips that may help you and your child handle the ER visit as best that you can and that will help the ER personnel do the best job for your child.

For details on these tips, click on the ER checklist. You will find helpful hints on the second page, among other useful information.

Febrile seizure Questions

#1. Febrile seizure

Q: My 10 month old son had a high fever for a day and then had a seizure for two to five minutes. He was seen by his doctor but is still irritable with fever and refusing to eat very much. What do you recommend?

A:Although the febrile seizure (a seizure caused by fever) itself is not harmful to your child and typically the result of a viral illness, there are other causes for fever that may be more serious, such as meningitis.

It can be difficult to recognize meningitis in young children, especially if they are under 12 to 18 months of age, and so a lumbar puncture, or spinal tap, may need to be done in these infants. The American Academy of Pediatrics recommends that a lumbar puncture be strongly considered in children less than 12 months of age after having a febrile seizure. They also recommend that a lumbar puncture be considered in children between the ages of 12 and 18 months. A lumbar puncture is only necessary for children over 18 months if meningitis is suspected, especially if they have already been treated with antibiotics.

So given your child’s age and his continued fever and irritability, I would recommend that you seek medical attention to have him reevaluated. Depending on their evaluation, a lumbar puncture will need to be strongly considered. Click on febrile seizure for a more in depth review.

Febrile seizures Questions

#1. Febrile seizures

Q: I have read that there is a risk for febrile seizures after a child is given the combined vaccine of MMR and varicella. Is this true?

A:The results of two separate studies, one conducted by researchers with the Vaccine Safety Datalink Project and one sponsored by Merck as a Phase IV study, was recently published in Infectious Diseases in Children and confirmed the suspected association between the first dose of the measles-mumps-rubella-varicella vaccine and an increased risk for febrile seizures in children aged 12 to 23 months in the first to second weeks following vaccine administration. According to one of the co-lead investigators, compared with separate dose-one injections of measles-mumps-rubella vaccine [MMR-II, Merck] and varicella virus vaccine live [Varivax, Merck] administered at the same visit, the available evidence supports a causal relationship between receipt of dose one MMRV vaccine [ProQuad, Merck] and increased risk for febrile seizures during the five to 12 days after vaccination.

CDC officials estimated a risk of about four to five febrile seizures per 10,000 children vaccinated with the first dose of MMRV compared with children who received separate injections of MMR and varicella vaccines at the same visit during the five to 12 days after vaccination, based on data from the two studies.

The Advisory Committee on Immunization Practices (ACIP) continues to recommend use of the MMRV vaccine in children aged 12 months to 12 years, but does not delineate a preference for MMRV vaccine vs. separate injections.

ACIP recommends two doses of vaccines to protect against measles, mumps, rubella, and varicella at ages 12 to 15 months and 4 to 6 years.

It is best to discuss this issue with your pediatrician. Pediatricians may choose whether to use MMRV, MMR and varicella vaccines seperately or MMR and varicella vaccines at different visits.

For more information, go to Febrile seizures.

Fever Questions

#1. Fever

Q: Two questions about fever: What is considered a temperature? What should I do at home to control the fever?

A:Our normal temperature is 98.6 degrees Fahrenheit, or 37 degrees Celsius. The technical definition of fever is a rectal temperature of 100.4 degrees Fahrenheit, or 38 degrees Celsius.

Remember that a temperature under the arm is one degree lower than a rectal temperature. A rectal temperature is the most accurate way to determine a fever in a child less than one year of age.

The body develops a fever in order to fight against infection by viruses and bacteria, and sometimes is present with other diseases. Most high fevers are caused by viruses and will go away without treatment for the infection itself. Antibiotics have no effect on viral infections so most causes of fever in children require no antibiotics.

What can you do to treat my child’s fever at home?

  • Encourage your child to take more fluids, including ice pops, because fever will increase the body’s fluid needs.
  • Dress your child in loose fitting, light clothing
  • Bathing your child with lukewarm water may help bring down fever. Never use cold water or alcohol to bathe your child.  Cold water will only cool down the skin, not the body temperature.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two forms of medication for children that may help lower your child’s temperature.

    • Tylenol is given every 4 hours as needed
    • Ibuprofen is given every 6 hours as needed, preferably not on an empty stomach
    • For specific dosing information, click on fever
  • Fevers do not necessarily need to be treated unless your child is feeling badly and looks ill. If your child is playful and looks good, it may be best just to watch it closely. The most important thing is not the height of the fever but how your child looks.

Click on fever for discussion on when to contact your pediatrician for a fever in your child.  Also, information on the use and dosing of acetaminophen or ibuprofen is available.

#2. Fever

Q: My 5 year old son daughter has had fever for 9 days now. The fever goes up to about 103 a few times a day. She was tested for strep throat 3 days ago but I was told that her fever was probably due to a viral infection. At what point do we need to start getting worried? Isn’t this a long time for a virus to cause a fever?

A:Fever for over a week in a child is a long time for any parent and can be frustrating for pediatricians too.

In many cases the fever is the result of a prolonged viral illness; however, sometimes fever may persist without an easily identifiable cause, and the child may be considered to have a fever of unknown origin (FUO).

The longer the febrile illness goes on the more important it is for your child to be carefully reevaluated in order to avoid missing an easily treatable disease.

A detailed history and physical examination is very important in the evaluation of a child with prolonged fever. This includes watching for any other signs and symptoms that may develop over time or that come and go during the illness (e.g., rash, joint pain).

It is likely that as your child’s fever continues, your doctor will want to perform further testing to reveal the source of the fever.
Further testing might include a chest xray, urinalysis, blood culture, testing for mono, a repeat blood count, a sedimentation rate (ESR) test to look for signs of inflammation, and/or an abdominal ultrasound or CT scan.

Therefore, the most important advice I can give you at this point in time is 1) to have your daughter reevaluated by your pediatrician and 2) to keep track of the details of your child’s illness for your pediatrician so that he/she can perform the most appropriate evaluation.

For more details on fever of unknown origin, including a partial list of the causes in children and important questions that your doctor may ask concerning your child’s illness, click on Fever of Unknown Origin.

Flu (Influenza) Questions

#1. Flu (influenza)

Q: My doctor has recommended that I start Tamiflu for my child who has the flu but I am concerned about the recent warnings concerning this drug. Do you think it is safe to use for my child?

A:This is a common question at the present time given all the media attention that Tamiflu has received.

Let me first start off with some facts about Tamiflu.

Tamiflu is an antiviral medicine given to treat flu (infection caused by influenza virus). This medication attacks the influenza virus and prevents it from spreading inside your body.

Your doctor may recommend Tamiflu to lessen your child’s symptoms and shorten the course of the illness, but they must be given before or within the first two days of the illness.

The Food and Drug Administration (FDA) has very recently approved the use of Tamiflu in children as young as 1 year who have had close contact with someone infected with influenza A or B.

Up until now, Tamiflu was only approved for the treatment of children older than 1 year who were themselves infected.

Tamiflu is generally well tolerated. It may cause mild-to-moderate nausea or vomiting in one out of 10 people. Taking Tamiflu with food may reduce the potential for these side effects. Other less common side effects may include sleeplessness and dizziness.

Due to recent reports from Japan of some children developing bizarre behavior (e.g., self-injury, delirium) and in some cases death while on Tamiflu, the FDA had asked doctors and parents in November to watch for signs of bizarre behavior in children taking Tamiflu.

It is unknown whether the strange behavior is tied to the drug, to the flu itself, or a combination of both.

The FDA Pediatric Advisory Committee then recently met and has found no link between the deaths of 12 children in Japan and Tamiflu.

Of the 12 children who died while on the antiviral drug, one had a fall and most of the others had heart and/or lung failure. Japan has prescribed Tamiflu over 11 million times for patients ill with the flu.

The FDA also found no link between the 32 cases of psychiatric disturbance and the use of Tamiflu.

At this point in time, the risk-benefit ratio for Tamiflu remains positive, supporting the use of the medication for the treatment of children greater than one year of age with the flu.

If your child is receiving Tamflu for the treatment of the flu and you are concerned that he/she may be experiencing altered behavior, you should contact your doctor for advice and management.

Adverse events should be reported to the FDA’s MedWatch system. Contact MedWatch online at www.fda.gov/medwatch or by phone at (800) FDA-1088 ((800) 332-1088).

#2. Flu (Influenza)

Q: How do I know whether my child should be vaccinated or not against the flu?

A:Because children aged 6 – 23 months are at substantially increased risk for influenza-related hospitalizations and because children aged 24 – 59 months are at increased risk for influenza-related clinic and ER visits, the Advisory Committee on Immunization Practices recommends vaccination of children aged 6 – 59 months.

Others reasons certain children should receive the flu vaccine include:

  • children and adolescents (aged 6 months – 18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk for experiencing Reye syndrome after influenza virus infection;
  • children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma;
  • children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal disease, hemoglobinopathies (e.g., sickle cell disease), or immunodeficiency (including immunodeficiency caused by medications or by human immunodeficiency virus [HIV]);
  • children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration.

For detailed information on the Flu, including it’s signs and symptoms and treatment, click on Flu.

Heat-related illness Questions

#1. Heat-related illness

Q: My 8 year old son is going to start playing football this summer but I am concerned about the heat. How can we prevent him from getting ill from heat exposure?

A:Given the heat and humidity across the country in mid summer, this is a very important question, especially given how preventable heat-related illness is and the fact that children are more likely than adults to suffer from heat illness.

The following are several heat safety tips for children who play summer sports.

  1. Your child should reduce the intensity of their activities when temperature and humidity are high. It is best to exercise in the early morning.
  2. To assess the environmental danger and determine when outside activity should be minimized or avoided, see the Heat Index Chart produced by the National Weather Service at http://www.srh.noaa.gov/bmx/tables/heat_index.html or listen out for your local weather forecast.
  3. At the beginning of a strenuous exercise program or after traveling to a hotter environment, a child should be allowed to acclimatize to the new regimen or environment.
  4. Children should also be well-hydrated before participating in activities, and periodic drinking should be enforced during activities.
  5. Water is an acceptable beverage for events lasting less than one hour but, if the event is longer than an hour, fluids containing glucose and electrolytes must be provided.
  6. Recognizing all forms of heat-related illness early and treating them aggressively, so that the patient does not progress along the continuum toward heatstroke, is crucial.
  7. Signs and symptoms of heat exhaustion are similar to those that may accompany viral illness, so it is imperative to be alert to the possibility of heat illness in the summer months.

For more details on these safety tips and for the signs and symptoms of heat-related illness, click on Heat.

Honey for a cough in young kids Questions

#1. Honey for a cough in young kids

Q: I saw in the news that giving a child honey will help treat their cough. Do you recommend using honey for children?

A:Since the U.S. Food and Drug Administration’s recent recommendation that cough and cold medicines not be given to children under 6 years old, us parents are certainly wondering what to give our kids when they come down with a bad cold.

Is honey the answer? Well according to a study published in the December issue of Archives of Pediatrics & Adolescent Medicine giving a child with a cough a single dose of buckwheat honey just before bedtime may relieve the cough and help him/her sleep better, compared to giving nothing or an OTC (over-the-counter) cough medicine.

The study from Penn State College of Medicine evaluated 105 children aged 2-18 who all were suffering from upper respiratory tract infections.

Thirty five of them were randomly selected to receive a dose of buckwheat honey (a dark variety), another 33 were given dextromethorphan (a cough suppressant), while the other 37 were given nothing. Those receiving treatment got it 30 minutes before bedtime.

Their parents had to fill in a survey assessing their child’s cough and sleep difficulty twice – once for the night before treatment, and then again for the night with treatment.

The researchers found that honey decreased the frequency and severity of children’s coughs associated with upper respiratory tract infections, thus improving both their sleep and their parents’ sleep. Dextromethorphan wasn’t any better than no treatment at all in a study comparing the three strategies.

Parents reported mild adverse events such as hyperactivity, nervousness, or insomnia in five children who received honey and two who received dextromethorphan, compared with none of the children in the no-treatment group.

Among the limitations of this study noted by the researchers was that much of the improvement in all groups “can also be attributed to the natural history of [upper respiratory tract infections], which generally improve with time and supportive care.”

How does honey work to relieve cough? There may be more than one reason for this: the type of honey used in the study was buckwheat honey, which is a dark honey containing higher levels of phenolic compounds than light honey, and phenolic compounds have antioxidant properties.

On the other hand, the mechanism of action involved with the honey treatment might only be its demulcent properties (soothe irritated mucous membranes and thereby remove the irritation that is fueling the cough reflex).

So to answer your question, I see no harm in giving a child a dose of honey before bedtime as long as they do not have a problem with marked hyperactivity or nervousness.

Keep in mind though that honey is a known source of bacterial spores that produce Clostridium botulinum bacteria, and in children less than 1 year old there is risk of infant botulism. Therefore, do not give honey to a child less than 1 year of age.

Kawasaki disease Questions

#1. Kawasaki disease

Q: My 2 year old has had high fever for almost 5 days now and has been quite irritable. Two days ago he had a strep test that did not show anything. Today he has pink eye and is not walking that well. His feet look red and swollen to me. What could be going on and what should I do?

A:Based on continued fever in your child, particularly with irritability, and with new signs and symptoms cropping up the easy answer here is that your child needs a thorough history and physical examination performed (but I know I can’t get away with just that).

The causes of fever in children are vast (for a detailed review click onfever). In most cases, a pediatrician can narrow down the diagnosis based on asking many detailed questions and examining your child’s body for important clues.

In your son’s case, on the surface one has to be concerned about Kawasaki disease. This is based on his age, high fever, irritability, red eyes and red, swollen feet.

Kawasaki disease is a febrile illness that causes inflammation of blood vessels throughout the body, including the coronary arteries (blood vessels around the heart). Therefore, it is crucial to make the proper diagnosis because if left untreated, Kawasaki disease can lead to serious complications. Recent evidence points in the direction of a viral cause for the disease.

For detailed information on Kawasaki disease, click on Kawasaki disease.

Your child’s case emphasizes the importance of observing a child closely during their illness and, if he/she does not improve or new signs and symptoms develop, then follow up with your child’s doctor is recommended.

Lawn-mower Safety Questions

#1. Lawn-mower Safety

Q: My husband mowed the lawn for the first time this year with our son nearby. Part of a stick shot out from the mower and almost struck our son in the head. I would like to pass along some safety tips to my husband. Do you have any advice?

A:This question is well-timed given the onset of spring.

According to experts at Johns Hopkins Children’s Center, each year in the United States, about 9,400 children are treated for lawn-mower related injuries such as lacerations, fractures and amputations of the fingers, hands, toes, feet and legs.

Of the lawn mower accident cases treated at the Johns Hopkins Children’s Center between 2000 and 2005, 95% involved amputations that required reattachment or reconstructive surgery.

The Hopkins experts offer tips for preventing mower-related injuries:

  • Children younger than age 6 should be kept indoors while a power mower is being used.
  • No child younger than age 12 should use a walk-behind mower.
  • Children under age 16 should not be on riding mowers, even if they’re with an adult.
  • If you’re mowing and see a child running toward you, turn off the mower immediately. Children can fall and slip into the blade, especially if the grass is wet.

For the remaining tips, go to Lawn Mower Safety.

Lead poisoning Questions

#1. Lead poisoning

Q: How do I know if my child is at risk for lead poisoning and when should I have him tested?

A:Lead poisoning is an important cause of learning disabilities, anemia (low blood count), growth problems and behavioral issues. Children are most commonly exposed to lead by the ingestion of paint chips or lead dust.

It is important for us all to be aware of the things that put our children at risk for lead poisoning and minimize their exposure to these risk factors.

Which children are at risk for lead poisoning?

Children under the age of 6 years because they are growing so fast and because they tend to put their hands or other objects into their mouths.
Children from all social and economic groups can be affected by lead poisoning, although children living in poverty who live in older housing are at greatest risk.

Prior to 1978, lead was a common ingredient of household paint, so children living or spending time in older homes with chipping paint are most at risk for lead poisoning.

When should my child be tested for lead exposure? 
Children need to be screened for lead poisoning if they have any of the following risk factors (or if you do not know if your child has these risk factors:

  1. Lives in or often visits a house that was built before 1950.
  2. Lives in or often visits a house that was built before 1978 and is being remodeled.
  3. Has playmates or friends that have high lead levels.
  4. Lives in a zip code where more than 27% of the housing was built before 1950 (check with your local health department to see if you live in a high risk area).
  5. Is a member of a high risk group, including living in poverty, receiving aid from Medicaid and/or WIC.

For a detailed list of more risk factors, click on lead poisoning.

Lightening safety Questions

#1. Lightening safety

Q: After a severe lightening storm we had last week it crossed my mind that I may not know the best way to protect my two sons. Do you have some advice?

A:This is a good question and timely as we move into the warmer months and afternoon thunderstorms are more prevalent.

I like the National Weather Service’s (NWS) website for lightening safety. The Service provides a document that has two main sections: lightning safety when a safe location is nearby and risk reduction when a safe location is not close.

According to the NWS the SAFEST location during lightning activity is a large enclosed building, not a picnic shelter or shed. The second safest location is an enclosed metal vehicle, car, truck, van, etc., but NOT a convertible, bike or other topless or soft top vehicle.

I like how the site offers scenarios in which we as a family might find ourselves and offers solutions. For example,

“You and your family are camping. As you and your spouse are preparing dinner on the camp stove, you here rumbles of thunder in the distance. You look around and you see your tent is nearby, and a large picnic shelter is just down the trail. Your car is about ¼ of a mile away parked at the trail head. What should you and your family do?

In this case, the smartest thing to do is to round up your family and get into your car. The tent is not a safe place to be as it offers NO protection from a lighting flash. The picnic shelter is also not a safe location. (Both the tent and picnic shelter will keep you dry…but they offer NO protection from a lightning flash). It is best to remain in your vehicle for about 30 minutes after the last rumble of thunder is heard.”

There is one for the family at the beach and the sports coach as well.

I will post the tips from the NWS for lessening the risk of injury When a Safe Location Is Not Nearby:

  1. Do NOT seek shelter under tall isolated trees. The tree may help you stay dry but will significantly increase your risk of being
    struck by lightning. Rain will not kill you, but the lightning can!
  2. Do NOT seek shelter under partially enclosed buildings
  3. Stay away from tall, isolated objects. Lightning typically strikes the tallest object. That may be you in an open field or clearing.
  4. Know the weather patterns of the area. For example, in mountainous areas, thunderstorms typically develop in the early afternoon, so plan to hike early in the day and be down the mountain by noon.
  5. Know the weather forecast. If there is a high chance of thunderstorms, curtail your outdoor activities.
  6. Do not place your campsite in an open field on the top of a hill or on a ridge top. Keep your site away from tall isolated trees or other tall objects. If you are in a forest, stay near a lower stand of trees. If you are camping in an open area, set up camp in a valley, ravine, or other low area. A tent offers NO protection from lighting.
  7. Wet ropes can make excellent conductors. This is BAD news when it comes to lightning activity. If you are mountain climbing and see lightning, and can do so safely, remove unnecessary ropes extended or attached to you. If a rope is extended across a mountain face and lightning makes contact with it, the electrical current will likely travel along the rope, especially if it is wet.
  8. Stay away from metal objects, such as fences, poles and backpacks. Metal is an excellent conductor.

For more information, go to http://www.lightningsafety.noaa.gov/outdoors.htm

Limp Questions

#1. Limp

Q: My 2 year old daughter has been favoring her right leg for the past 2 days and we are unsure if she injured herself. What could be the problem and when should we take her in to get checked out?

A:

The cause of a limp in a child can range from something as minor as a blister on a toe or something as serious as a life-threatening infection.There are many questions that need to be answered before a doctor can figure out what the cause of your child’s limp is, such as 1) does your child have fever or any other signs or symptoms in addition to the limp (e.g., rash) and 2) was there a recent viral infection before the onset of limp

Some of the common causes of limp in your child’s age group include trauma (e.g., fracture), infections (e.g., septic arthritis), and arthritis.

A limp in a young child should be taken seriously and the best advice is for an early evaluation by your doctor.

For more information on the causes of limp in children, including questions you should be prepared to answer, click on Limp.

Pediatricians Questions

#1. Pediatricians

Q: I am 35 weeks pregnant and looking for a pediatrician. Can you recommend questions that I should ask to help me make the best decision?

A:I agree with you doing interviews with prospective pediatricians before the birth of your child. It should make a big difference rather than meeting a total stranger with your newborn. All pediatricians should gladly sit down with you either with other parents, or by yourself.

I can think of many questions that you should consider asking but I will narrow it down to ten that I feel are very important:

  1. Are they affiliated with the hospital you are giving birth at?
  2. What are their philosophies on topics such as breast feeding, circumcision, vaccinations and antibiotics.

  3. How does the practice provide for after hours call?

  4. Does the practice take your insurance and if so how is it handled?
  5. If there are more than one doctors in the group, do you have a primary doctor, or do you see them all?
  6. Do they do any emergencies in office, or do you have to go to the ER.
  7. How long in advance do you have to schedule a well-child visit? Sick child visit?
  8. Do they have any evening or weekend hours?
  9. How does the group handle consultations for lactation and behavioral issues?
  10. Most importantly, how comfortable do you feel with the pediatrician. This will be an important relationship so it should be someone that you get along well with.

Poison prevention Questions

#1. Poison prevention

Q: My 4 year old son gets into everything, including my medication and cleaners. What products and chemicals are really dangerous and how can I secure my home to insure his safety?

A:These are excellent questions. Because there are so many chemicals available it is safest to consider all medications and chemicals as potentially toxic to your child if they get into them. That said, you can find out about the potential dangers of a specific product by either checking the label or calling your poison control center at 1-800-222-1222.

A partial list of dangerous household items can be found by clicking onPoison Prevention. For products, that in general, are harmless if touched or swallowed can be found by clicking on Harmless Substances.

Poison prevention takes very little time at little cost and is crucial in protecting the health of our children. You will find a list of poison prevention tips by clicking on Poison Prevention.

Pool chemicals Questions

#1. Pool chemicals

Q: We have two young children and a pool. Last week while I was putting chemicals in the pool my daughter developed a hacking cough. Could the cough have been caused by the pool chemicals and do you have suggestions for making our pool area safe?

A:The pool is a wonderful place to cool off during the hot summer months; however, in addition to drowning, there are other potential health risks to children, including pool chemicals.

Poison centers receive hundreds of calls each year related to such pool chemicals as chlorine tablets, pool shock treatments and chlorine or chloramine gas generated by improperly mixing chemicals.

These concentrated pool chemicals when mixed with water create a strong type of bleach. If these substances make contact with the eyes or are swallowed, burns to the throat, lungs, intestines and eyes can occur.

If the dust from these chemicals is inhaled, which often occurs when first opening a container, coughing and shortness of breath can result. The dust or vapors also can cause skin rashes and eye irritation. Children who have asthma are especially sensitive to this dust.

Researchers in Europe have found that childhood asthma could be associated with exposure to chemicals in swimming pools. The 2006 study concluded that increases in asthma in Western Europe and the UK could at least partly be attributed to the byproducts of chlorine in the air and water in indoor pools, which would not be expected to be as well ventilated as an outdoor pool.

Here are some tips to prevent exposure to pool chemicals:

  1. Follow label directions in the use, storage and disposal of a chemical.
  2. Store chemicals in their original containers, out of reach of children, and in a cool, dry, well-ventilated area with a locked entry
  3. Do not store chemicals outside in the sun.
  4. Seal all original containers of pool chemicals after use.
  5. Dispose of chemicals safely and securely.
  6. Mix chemicals in a well-ventilated area.
  7. Always add chemicals to water—not water to chemicals.
  8. Never add chemicals to the pool while someone is in the water.
  9. Never mix chemicals unless the label specifically instructs you to do so.
  10. When removing the lid of a chemical’s container, turn your face to one side or point the container away from you.

What to do if your child is exposed to a pool chemical:

  • If pool chemicals come in contact with skin, wash immediately with a lot of clear water.
  • Chemicals in the eyes must be quickly flushed with a gentle drip (do not use water under pressure such as that from a shower head, sink sprayer or faucet) of room temperature water for at least 15 minutes.
  • If pool chemicals have been inhaled, immediately get the victim to fresh air and call the poison center right away for further treatment advice.
  • In any type of exposure, the poison center should be called immediately at (800) 222-1222.

Sled Safety Questions

#1. Sled Safety

Q: My 8 and 5 year old sons love to sled but always seem to get banged up. Can you offer any advice to keep them safe?

A:Having three nephews I know it “comes with the territory” to some degree, but I would like to pass along the following safety tips from the National Safety Council to help prevent sledding accidents in children:

  1. Before use of any sled or toboggan, parents should carefully inspect them for any broken parts or sharp pieces.
  2. Children who are 8 years old or younger shouldn’t sled unsupervised.
  3. Dress warmly and in layers, including a hat and gloves.
  4. Sled only in wide-open areas that are far from lakes, roads and traffic.
  5. Don’t sled down extremely steep hills.
  6. Don’t sled in areas with trees, rocks, shrubs and other potential obstacles.
  7. Don’t sled down a hill head-first. Always feet-first.

Spider bites Questions

#1. Spider bites

Q: I took my 3 year old child to the doctor for a strange looking skin lesion on his arm 3 days ago, and she said it may be caused by a brown recluse spider bite and to just watch it. Is it OK to just watch it and how can this be prevented in the future?

A:Brown recluse spider bites occur mainly in the central and southeastern US.
You can identify this poisonous spider by its light to dark brown color with a violin shaped marking on it’s back (see photo called Brown recluse spider).

After a brown recluse bite, the skin around the bite can react in a couple of different ways:

1) a small red bump develops surrounded by some redness OR
2) a “red, white, and blue” reaction develops where a small red bump, called a vesicle, develops surrounded by a pale area which is then surrounded by a reddish-blue area (see photo called Brown recluse spider bite).

Five to seven days after the bite, the bite area typically turns black, called an eschar (see photo called Brown recluse bite 2). This eschar usually falls off 7 – 14 days.

After a month or two an ulceration develops which can take a long time to heal.

In rare cases, within a day or two of the bite, other signs and symptoms may develop such as a fever, sore muscles, vomiting, and the break down of red blood cells in the body.

With regard to your first question, as long as you have frequent follow up with your doctor, just watching the skin lesion for now sounds reasonable.
If this lesion is the result of a brown recluse spider bite and other signs and symptoms were to occur, in general, you would have expected them to have already developed (1 – 2 days after the bite).

Treatment for a brown recluse bite includes pain medication if needed, wound care by your doctor and a tetanus shot if indicated.
A medication called dapsone is sometimes used after this type of bite to try to slow down progression of the skin lesion; however, this medication can have serious side effects in young children and studies have not concluded a true benefit. There is no antivenin available for this type of spider bite.

For your second question on how to prevent this from happening again, first do not be too hard on yourself.
Remember, this problem may or may not have resulted from a spider bite.

But to lessen the risk of a child being bitten by a spider the following is suggested:

1. Avoid wood or rock piles and dark areas where spiders live.
2. Inspect their area of play first if in places such as a basement, closet or playhouse in the yard.
3. Watch where they sit when in areas of high risk.
4. Teach your child to avoid playing with spider webs (you can also use the photo gallery to teach children which spiders are venomous).
5. Shake out their shoes for spiders before putting them on.
6. If they are to play in areas where a spider is likely to be then they should preferably wear long pants with shoes.

For details on what to do if your child is bitten by a spider and what doctors and nurses will do for your child when you arrive at the hospital after a spider bite click on Spider Bites.  Black widow bites are discussed as well.

Strangers Questions

#1. Strangers

Q: Maybe I am paranoid but I worry a lot about my child being abducted by a stranger. Can you give me some information on how to prevent this from happening?

A:I see no paranoia here. In today’s society teaching our children about “Stranger Danger” is an extremely important tool to prevent abduction. The Coalition for Children, Inc. has some very good information on this topic. The main areas of discussion on their website include, 1) Who are the Stranger Offenders, 2) the Child’s Point of View, 3) the Safe Child’s Approach, and 4) the Stranger Rules Checklist.

The Checklist includes the following:

A stranger is anyone you don’t know. You can’t tell the good guys from the bad guys by how they look. You are responsible for keeping yourself safe when you’re by yourself.

You are responsible for taking care of yourself, not for grownups. Adults who need help should go to another adult.

Instinct is nature’s way of talking to you – listen to that inner voice.

The 4 stranger rules you should always follow when you’re not with an adult who it taking care of you are:

  • Stay an arms reach plus away from strangers. Stand up, back up and run to someone who can help you if you feel afraid.
  • Don’t talk to strangers.
  • Don’t take anything from strangers – not even your own things.
  • Don’t go anywhere with someone you don’t know.

Check out http://www.safechild.org/strangers.htm for more information.

Teen Drug Abuse Questions

#1. Teen Drug Abuse

Q: I read a news report that teenagers are abusing a drug found in nonprescription cough medicines to get high now more than ever. I have found bottles of Robitussin in my 15 year old son’s room and he has been acting agitated lately. How do I know if he is abusing a cough medicine and what can I do about it?

A:The news report you read refers to a research study published in the December issue of Archives of Pediatric and Adolescent Medicine titled “Dextromethorphan Abuse in Adolescence. An Increasing Trend: 1999-2004″.

Dextromethorphan has been used safely for years as a cough suppressant and is available in many over-the-counter (OTC) cough and cold preparations.

The increase in dextromethorphan abuse in adolescents is most likely due to the hallucinogenic effects of these easily accessible inexpensive over-the-counter products and the false perception that high-dose dextromethorphan is safe.

But high doses of dextromethorphan may result in rapid heartbeat, high blood pressure, agitation, loss of muscle control and psychotic reactions.

Dextromethorphan abuse was recognized as early as the 1960s; since the late 1990s, adolescents have been increasingly abusing over-the-counter dextromethorphan products because of their easy accessibility and false perception of safety. Several states, such as California and New York, have even proposed legislation to control the sale of dextromethorphan-containing products to minors.

From 1999 through 2004 a 15-fold increase in adolescent dextromethorphan abuse cases was reported to the California Poison Control System and a 7-fold increase was reported nationally. The highest frequency of abuse was in adolescents aged 15 and 16 years.

According to California Poison Control System reports, Coricidin HBP Cough & Cold Tablets was the most commonly reporteddextromethorphan-containing product abused, followed by dextromethorphan-containing Robitussin formulations.

With regard to your specific question, you have already taken the first step towards helping your son through close observation. You recognize his change in behavior and have noticed a potential source for this change.

There are many signs that may clue a parent in that their child may be using drugs. Some may be noticeable at home, others at school. Some may be emotional signs, others physical. For a detailed list of these signs click on Teen Drug Use.

Also available on our website are the answers to such questions as: 1)”What is the best way to approach my child if I suspect that they are using drugs”? and 2) “What can I do to help prevent my child from using drugs”?

To find the answers to these questions and 20 helpful tips for preventing drug use in your teenager, click on Teen Drug Use.

#2. Teen Drug Abuse

Q: I have a 12 year old son and I am suspicious that one of his friends sometimes uses drugs. Should I have my son tested for drugs and if so how should it be done?

A:As a big proponent in the prevention of drug use in kids, I appreciate your concern; however, subjecting children to routine drug testing is usually not a good idea for a number of reasons:

  1. Drug testing creates a counterproductive climate of distrust and resentment between children and their parents or school administrators.
  2. Drug testing is prone to errors and often inaccurate. For example, eating poppy seeds or taking certain cold medications may give a positive result for a drug the child is not even using.
  3. Many teens are likely to be aware of Web sites that offer methods of defeating drug tests.
  4. Several illegal drugs are undetectable in urine more than 72 hours after use, and standard tests do not detect often abused drugs such as Inhalants and Ecstasy.
  5. Some kids may respond to testing by avoiding drugs such as marijuana and instead abusing less detectable, but more dangerous drugs.

And according to a recent statement by the American Academy of Prediatrics (AAP), screening teens for illicit drugs has not been shown to cut down on their drug use.

The AAP’s stance on this issue, for which I agree, is that parents suspicious of drug use by their child should consult the child’s pediatrician rather than rely on school-based drug screening or home kits.

For more information on drug use in kids, including how to recognize if a child is using drugs, click on Teen Drug Use.

Toothpaste Poisoning Questions

#1. Toothpaste Poisoning

Q: Is it really true that a child can get really sick from eating too much of their toothpaste?

A:Believe it or not, poison centers around the country get approximately 20,000 calls a year on this very topic.

The concern is for the fluoride that is in most children’s toothpastes.  Ingestion of fluoride-containing toothpaste in a child typically results in a benign course, with the most frequently observed toxic effects being nausea and vomiting from gastric irritation.

The overwhelming majority of kids that swallow some of their fluoride-containing toothpaste from the tube do not require evaluation in an ER and serious cases are extremely rare.

However, in large exposures, which are unusual, significant toxicity can result, including low calcium and magnesium blood levels, heart rhythm disturbances and neurological problems such as tremors or seizures.

Typically, a poison center will base the decision to refer a child to an ER on the amount of toothpaste ingested and the development of any symptoms.

For a table on the potential amount ingested of concern, go to Toothpaste Poisoning. Also, you will see the review of a true case in which a young child required hospitalization and treatment.

Remember, if you have questions or concerns, call your local poison center at 1-800-222-1222.