Bug Off!

It’s so exciting that spring is finally here after our long Wisconsin winter! Continuing on the summer theme, I’d like to talk about protecting kids from those pesky mosquitoes. Ordinarily, the bites of mosquitoes are just a nuisance. The bite may cause itching or swelling (a lot more swelling in some people than in others — and, yes mosquitoes definitely prefer some of us more than others).

Here are some tips to avoid mosquito bites when outdoors:
- Don't use scented soaps, perfumes or hair sprays on your child.
- Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
- Avoid times when mosquitoes bite. Generally, the peak biting periods occur just before and after sunset and again just before dawn.
- Wear appropriate clothing. Long-sleeved tops and long pants made of tightly woven materials keep mosquitoes away from the skin. Be sure, too, that your clothing is light colored. Keep trouser legs tucked into boots or socks.

You will also need to use an insect repellant. DEET-containing products are the most effective mosquito repellents available. DEET has been used for over fifty years with a very good safety profile. Other products have not necessarily been as thoroughly studied as DEET, and may not be safer for use on children. The American Academy of Pediatrics Committee on Environmental Health feels that products containing DEET up to concentrations of up to 30% are safe for use in children 2 months and above. In choosing the strength of DEET to use, keep in mind that the more DEET a product contains, the longer the repellant can protect against mosquito bites.

Products containing citronella, lavender, mineral oil and soybean oil generally do not last very long. Herbal products containing lemon eucalyptus oil as a repellant are the only ones found to have effectiveness similar to DEET containing products. Those are only recommended in children above the age of 3 years old.

When using DEET containing repellants in children, keep in mind the following safety tips:
- Select the lowest concentration effective for the amount of time spent outdoors. It is generally agreed that DEET should not be applied more than once a day.
- Apply the product to your own hands and then rub them on your child. Avoid children's eyes and mouth.
- Do not apply repellent to children's hands. (which often end up in their mouth)
- To make sure your child’s skin will not react to the repellent, apply the product to a small area of skin, arm or leg before general use.
- Use just enough repellent to cover exposed skin and/or clothing. Do not use under clothing.
- After returning indoors, wash treated skin with soap and water. Wash treated clothing before wearing again.
- Do not apply over cuts, wounds or irritated skin.
- Do not spray DEET-containing products in enclosed areas. DEET products will NOT repel stinging insects such as wasps and bees.

Questions or comments? Please post them on our Meriter Facebook Page.

Enjoy your time outdoors,

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Keeping Summer Fun

Whoever thought that age four would be the time to start worrying about extracurricular activities? The arrival of the YMCA and MSCR summer guides began my internal debate.

Perusing through the pages of both guides peaked my interest in many activities. I haven’t played tennis is over five years, and the adult tennis class sounds like fun. If only I was ten again, I could go to summer camp. . . Okay, back to my four-year-old. Up until this year, he was too young for many activities. Promoting a healthy lifestyle (including physical activity) at this age is very important for life-long health, but do I sign him up for karate or swimming or gymnastics or yoga or outdoor soccer or a soccer camp or a multi-sport camp or . . . The list goes on and on, and it will only get longer as he gets older.

As with all families, our time is limited, and I want to make the most of the time we are together. I also look forward to having trips to the library, zoo, park and many of the other amenities offered by living in Madison. We also want to take short weekend trips to explore new places and if I fill the summer with scheduled activities, when will we go exploring? My son has taught me that spontaneity can be the most fun. Children benefit from structure in some activities, but also need time to explore the world on their own and create their own adventures. My husband and I thought it was a great idea to go see the St. Patrick’s Day parade. My son enjoyed the parade, but had just as much fun running around the Capital lawn playing hide-and-go-seek. I don’t want to limit these opportunities to create his own fun (and mine, for that fact) by scheduling away all our free time.

The American Academy of Pediatrics has a good article to help guide parents: http://www.healthychildren.org/English/healthy-living/fitness/Pages/Physical-Activity-Make-the-Right-Choice-for-Your-Child.aspx.

So, I continue to have the internal debate, but for the time being, my son is only scheduled in 1-2 activities per week. I am planning to keep all weekends free in the summer for exploring and discovering what fun we can have on our own. The most important thing is for us to figure out what works for our family, stay active and have fun.

Dr. Dana Johnson
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics

When April showers bring more than May flowers

Yes, spring is finally here … I always look forward to this season. You can see the grass turn green, flowers starting to bloom. Ah, fresh air. But for some people it may be a season that brings misery. Seasonal allergies are common at this time of the year. According to the Asthma and Allergy Foundation of America, more than 40 million Americans suffer from indoor/outdoor allergies. Unfortunately, kids can suffer from seasonal allergies as well. In fact, if a parent has allergies, the risk is higher for the child to develop them. I guess my kids can blame my wife and me for theirs.

What are the symptoms? Sneezing, clear nasal discharge and itchy eyes, are typical complaints. Sometimes a pattern of chronic colds may occur at the same time of the year as well. Other complaints may include throat clearing, stuffy nose, itchy nose and throat. In some individuals, a cough may be present. Children with allergies may have dark circles under their eyes, called "allergic shiners." And everyone has seen the classic "allergic salute." My son can demonstrate this very well. (It’s the process of itching or rubbing the nose upward with their palm.) Untreated allergies may also affect a child’s sleep patterns as well, which in turn, may affect their school or sports performance.

Sometimes the symptoms of a cold may be mistaken for allergies and vice versa. But, duration, fevers, color of discharge, as well as other symptoms can be used to differentiate between the two. For example, a fever may accompany a cold, but you would not expect that with seasonal allergies. If you are not certain, my advice would be to discuss this with your child’s doctor.

Treatment:
· Limit the time spent outside or during the peak times of pollen count
· Change clothes and wash your child’s hair after they play outside
· Keep the windows closed, or turn the air conditioner on (assuming it’s warm outside)
· Tree pollen counts may be high early in the morning during spring. During the summer, try to avoid the afternoons or early evening, to avoid grass pollen. Ragweed allergy is prevalent in the fall season and high during midday.

Medications: There are many medications to treat allergies, ranging from over the counter anti-histamines to prescription nasal sprays and medications. I’m certain you have seen the commercials. The variety of medications in the pharmacy can be quite overwhelming. My advice would be to talk to your child's doctor. You want to make certain the symptoms are consistent with seasonal allergies and not any other condition, and you also want to make sure they are age-appropriate. Allergy medications and homeopathic remedies may also have side-effects that can cause drug interaction, serious and dangerous side-effects and cause injury.

I hope that you and your family are able to enjoy this vibrant time of year.

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriter.com/pediatrics

To fly or not to fly … with a toddler

A number of years ago, my wife and I decided to take a trip to California with our 22-month old daughter, Sophia. We reserved a hotel, arranged for a rental car, and booked the 4 hour flight to San Diego. Like anyone else, I was looking forward to vacation. I imagined showing Sophia the ocean, visiting the zoo, and just getting away from the every day routine. It was all good until a friend questioned my sanity, saying to me “Flying with a toddler is crazy. She’ll probably cry the whole flight.”

Happy visions of strolling along the beach were replaced with nightmare-ish visions of my daughter screaming the entire flight, or throwing sippy cups and toys at the heads of the passengers in front of us. Determined to get our vacation off to a good start, my wife and I came up with a plan. We made lists of what we needed to bring on the plane and armed ourselves with books, toys, games, food and plenty of diapers.

Finally the day came. Sophia ran from window to window looking at all the airplanes. I boarded first and installed the car seat, and my wife waited until the end to board, letting Sophia burn off a little extra energy. At first, things were great. Sophia sat happily in her car seat, drank some juice and ate cheerios. Then, about an hour in, she got squirmy and we read some books and colored. Two hours in, the fussiness started. We got out the toys and she played happily for a while. About three hours into the flight, we reached the level of desperation and brought out...the finger puppets. Yes, one for each finger. My wife sang songs and I made the finger puppets dance. Sophia laughed and all was right in the world. Of course, she fell asleep just as the pilot started the descent.

Overall, it was a successful flight—minimal ear pain for Sophia, minimal angry looks from fellow passengers (people around us were very nice) and minimal tears. Truly, flying with a child does not have to be stressful, especially if you set realistic expectations and plan ahead.

Here are a few tips on flying with babies and young children:

Dealing with ear pain: Babies and young children may cry in response to the sudden change in cabin pressure, which can cause ear discomfort. Usually this occurs during take-off and landing. The act of sucking, by nursing, bottle feeding, or using a pacifier, may help alleviate some of this pain.

Do not use Benadryl or cough and cold remedies: I often get asked about giving Benadryl or cough and cold medications prior to flying. I usually do not recommend them because 1) they are not approved for children under two years of age and 2) some children actually have the reverse effect and become “hyper.” Also, even if it does make your child sleepy, it may make them more irritable after they wake up. I highly recommend talking with your child’s doctor if you have questions about this.

Separate seat vs. lap child: If at all possible, purchase a seat for your infant or child (children under 2 years of age fly free as a “lap child” on most airlines). You’ll have more room to move, and more importantly, your child will be safer. When turbulence kicks in or an emergency landing takes place, it can be very difficult to keep the child safely in your lap, regardless of how tightly you hold them. According to the American Academy of Pediatrics, “Preventable injuries and deaths have occurred in children younger than 2 years who were unrestrained in aircraft during survivable crashes and conditions of turbulence.” Also, check with your airlines for discounted seats for infants. You can use a car seat on the airplane. Just make sure that is an FAA approved car seat.

Wait to board the plane: While many airlines allow families with small children to board first, this often means that your child will be sitting in the seat for quite a while before the plane actually departs. If you are flying with another adult, one can board first and get everything settled (including car seat installation), and the second can follow later with the child.

Keeping the seat belt on: For older children who have not flown before who will not be using a car seat, have a few play sessions at home, pretending to be on a flight . Use an old belt, or anything you have that can be buckled. Have a few discussion prior to the trip about the importance of keeping the belt on, and stress that the plane will not take off unless everyone is buckled up.

Be prepared. Flights are often delayed, so bring plenty of food and drinks (check the TSA Web site to see what is allowed), plenty of extra diapers and several changes of clothes (including a spare short for each parent in case of “accidents”). Also, bring familiar and favorite toys or games. While new toys might be a good distraction for older children, babies and younger children often prefer playing with the toys they use everyday.

Allow ample time: The process from checking in your bags to the arriving at your gate may be long. Allow yourself enough time to get through the security screening process as well. If you have older children, it is important to talk about the screening process ahead of time. Their personal belongings such as dolls, toys and games, will be placed under an x-ray screen, but will return to them after they walk through the security screen themselves.

Have realistic expectations: Your child will probably cry at some point during the flight. Accidents and spills may happen. You probably won’t have much time to read that magazine you picked up at the airport. But, with a little preparation and planning, you can make flying a great experience for the whole family!

More than 7 years later, my daughter is a seasoned traveler. She even packs her own carry on bag and entertains herself on flights by reading or drawing. I’ll admit, it’s nice to have some time to myself to catch up on reading during the flight, but there is a part of me that misses the songs and the finger puppets.

Safe travels……
Viren Bavishi, D.O.
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics