Bullying Prevention Month

October marks the fifth anniversary National Bullying Prevention Month. This is a great time to educate yourself about bullying.

Try to maintain open lines of communication with your child and make sure your child understands how you feel about bullying. Is your child able to come to you and talk if someone is bullying them? Are you and your child aware of the school resources and staff that can help with a problem of bullying at school?

Some questions that you could ask your child are:
1. “Do you have any special friends at school this year? Who are they? Who do you hang out with?”
2. “Who do you sit with at lunch and on the bus?”
3. “Are there any kids at school who you really don’t like? Why don’t you like them? Do they ever pick on you or leave you out of things?”

Some key facts you should understand about bullying:

- Bullying is a form of violence. It involves a real or perceived imbalance of power, with the more powerful child or group attacking those who are less powerful. Bullying may be physical (hitting, kicking, spitting, pushing), verbal (taunting, malicious teasing, name calling, threatening), or emotional (spreading rumors, manipulating social relationships, extorting, or intimidating).

- Bullying can occur face-to-face or in the online world. It can involve children of any age, including younger elementary grade-schoolers and even kindergarteners. Bullying behavior is frequently repeated unless there is intervention.

There are many long-term consequences of bullying.

Consequences for the Target
Students who are the target of a bully experience fear, anger, frustration and anxiety which may lead to ongoing illness, mood swings, withdrawal from friends and family, an inability to concentrate and loss of interest in school. If left unattended, the targeted student may develop attendance and/or discipline problems, fail at school altogether or, in the worst cases, they are suicidal or retaliatory and violent.

Consequences for the Bully
Some acts of bullying result in suspension or expulsion of students and translate into child abuse and domestic violence in adulthood. Research shows that 60 percent of males who bully in grades six through nine are convicted of at least one crime as adults, compared with 23 percent of males who did not bully.

Consequences for the Bystander
Students who passively participate in bullying by watching may come to believe that the behavior is acceptable and that the adults at school either do not care enough or are powerless to stop it. Some students may join in with the bully; others who share common traits with the target may fear they will become the next target. Research indicates that witnesses to bullying develop a loss of their sense of security which can reduce learning.

Here are some websites that may be helpful:
kidsagainstbullying.org/
stopbullyingnow.hrsa.gov/
stopcyberbullying.org/

Dr. Sumita Ram
Pediatrician
Meriter Middleton Pediatrics
meriterkids.com

Milk and Your Toddler

Many parents ask me questions about transitioning their child from mom's milk/formula to cow's milk. Here are some tips that you should remember as you and your child make the switch:

Milk should be stored in a refrigerator that is cooler than 40 deg F. Once milk temperature reaches 45 deg or higher, bacterial growth can occur. Milk temperature can go up fairly rapidly, especially in warm weather. Generally speaking, milk should be used within 1 hour of taking it out of the refrigerator and should never be re-refrigerated.

Milk should be served at meal or snack times, but remember that toddlers should not walk around with a cup or constantly sip throughout the day. Those who constantly snack or sip their drinks give acid-producing bacteria a longer time to create damage/cavities.

In order for milk to be classified as "USDA organic," farms must meet the following criteria: cows are exclusively given feed grown without the use of pesticides or commercial fertilizers; cows are given periodic access to pasture and direct sunlight; cows are not treated with supplemental hormones and cows have not been given certain medications to treat illness. If you choose to give your toddler organic milk, make sure that it is treated with the conventional pasteurization process. Raw, unpasteurized milk may contain a wide variety of harmful bacteria including Salmonella, E. coli, Listeria, Campylobacter, and Brucella. These can cause illness and possibly death. Raw milk-related illnesses can be especially severe in infants and young children.

A toddler generally needs about 3 cups (24 oz) of total dairy, including milk and yogurt, daily. In general, toddler's tend to be picky and it can sometimes be hard to get them to accept a well-balanced variety of foods. Drinking too much milk may fill them up and make it more difficult to get them to eat other foods. Drinking excessive amounts of milk (more than 40 0z daily) can also lead to Iron deficiency anemia in some children, because milk can interfere with iron absorption in the intestines and can cause irritation in the GI tract leading to microscopic blood loss.

Dr. Sumita Ram
Pediatrician
Meriter Middleton Pediatrics
meriterkids.com

The New Rules of Head Lice: Part 2

Continued from yesterday's post ...

What should you do if your child has head lice? First, all other household members should be checked. So should any kids who were likely to have direct head-to-head contact. Anyone with live lice or eggs close to the scalp should be treated. Anyone who shares a bed with the infested person should also be treated.

Hair care items and bedding that have been in contact with the infested person in the 48 hours prior to treatment should be cleaned. (If it’s been longer than 48 hours, any lice will already be dead.) A temperature of 130 degrees or more (by washing or drying) will kill lice and eggs. Furniture, carpeting, and other fabric covered items can be vacuumed. Pediculicide sprays are not necessary. If there is a concern about eggs surviving and hatching, items that cannot be washed may be placed in a plastic bag for 2 weeks.

Unless there is known resistance in the community, the first step in treatment is permethrin 1% or pyrethrins which are available over-the-counter. Permethrin 1% is the most studied and the least toxic of the pediculicides (lice-killers). Conditioners and silicone-based additives will interfere with permethrin, as will vinegar which is often used in an attempt to loosen nits from the hair shaft. When rinsing off pediculicides, use a sink instead of a shower or bath in order to reduce skin exposure. Using warm instead of hot water will minimize absorption. There are many other prescription medications that can be used if these over-the-counter products fail.
For those who cannot afford or who would prefer not to use pediculicides, wet combing or using suffocation methods can be attempted. An example of suffocation would be applying petroleum jelly to the hair and scalp and leaving it on overnight under a shower cap.

Misapplication is the leading cause of treatment failure. No treatment will kill all the eggs, so retreatment at specific intervals is recommended. Shaving, although effective, is not recommended. Any product that is meant to loosen nits can also damage the hair itself. Acetone, bleach, vodka, and WD-40 do not loosen nits. Please do NOT use kerosene, gasoline, or any other such flammable or toxic substance. They are not effective; they are just dangerous. Do not use products that are meant for animals.

Infested kids should definitely get treated, but they should not be kept out of school. The chance of transmission may not be zero, but it is lower than in other settings where head-to-head contact is more likely. One study at a school where over 14,000 live lice were found showed zero lice in the classroom carpeting. In another study, infested people spread lice to pillowcases only 4% of the time. And remember, head lice don’t carry any diseases, unlike mosquitoes which transmit a large number of diseases.

Just to put things in perspective, dust mites (see photo) thrive in bedding, mattresses, carpets, furniture…anyplace where there are tiny flakes of shedded human skin. Their fecal matter is a leading cause of allergies and asthma exacerbations. They are much more insidious than lice, but they don’t keep kids out of school.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

The New Rules for Head Lice: Part 1

On July 26, the American Academy of Pediatrics updated its clinical report on head lice. It is common in school-aged kids, and it can be found all over the world. It affects all socioeconomic groups, and it can affect anyone regardless of hygiene. Mere mention of it can cause itchiness. It seems that resistance to standard treatments is on the rise. And yet, the AAP is pushing for kids to stay in school despite having lice. What’s going on?

Head lice are tan to grayish-white, and they are 2-3 mm long. Their eggs are even smaller. Their life cycle is about 3 weeks long. They feed by sucking tiny amounts of blood. Sensitization to their saliva as they feed is what makes us itchy, but this can take 4-6 weeks to develop. This means that by the time the diagnosis has been made, a kid in school has already been around other kids for a month. The good news is lice can only crawl; that means that they can only spread by direct contact. They cannot jump from head to head. This is also why brushing your hair will not prevent you from getting lice; it will only reduce the number of lice you are infested with. You are better off not sharing personal items (like hats, combs, brushes, etc.), but this is NOT an excuse to refuse to wear protective headgear. Lice that fall off or are combed off are usually injured or dead. Live lice and nits need our body heat to survive, so they are found close to the scalp (within 4-10mm). Farther than that, live lice only survive up to 48 hours, and eggs cannot hatch.

Many cases of “lice” are actually misdiagnosed. Dandruff, hair debris, dirt, and other insects have been mistaken for lice. This adds to the number of “resistant” cases. School screenings and forcing kids to stay home doesn’t reduce the incidence of live lice. Instead it means lost days in education and missed work days for the parents.

So what are we to do? The AAP does encourage parents to check their kids’ heads regularly and whenever the kids are itchy. Especially after sharing sleeping quarters, like at a camp, child care center, or sleepover. Using a louse comb on hair that is wet (with water, oil, or conditioner) is the easiest way to go about it. Eggs are most easily seen at the nape of the neck or behind the ears. Remember to look close to the scalp!

Please check back tomorrow, as I'll talk more about what to do if you find lice in your child's hair.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

What is Homeschooling?

The question most people ask me when I tell them that my children are homeschooled is, "I don't really know what that is. Can you tell me more about homeschooling?" If I could explain homeschooling in one sentence I would consider myself exceptional or fortunate. I will attempt here to give you an inkling of what homeschool is like for my family, but I also want you to know that homeschooling, by its very nature an individualized approach to education, is unique in every homechooling family. We are fortunate here in Wisconsin to have one of the best homeschooling laws in the country, and as a consequence, we have a unique variety of homeschoolers in our state.

For some people homeschooling consists of a small area in the home set up like a miniature classroom, complete with a small chalkboard and all the other paraphernalia we associate with school - desks, textbooks, etc. One or both parents may share in the teaching responsibilities and the children may take tests and do homework, just as they would in a brick and mortar school. Many families will purchase a prepackaged curriculum and some will even enroll in accredited online schools. An example of this would be the Wisconsin Virtual Academy (often referred to as WiVA). If this is your idea of what homeschoolers do, you are both right and wrong, because while this model may exist in many home schools, it does not represent all of us.

For many families homeschooling consists of no fixed curriculum. They approach teaching through a child-focused, self-directed form of education in which a mentor offers guidance with minimal restriction in what a child is free to explore. This form of homeschooling is oftentimes referred to as unschooling. Unschoolers believe that children have inherent learning abilities that are frequently stifled and even corrupted by traditional schooling. They believe that learning is a social process that can occur naturally and continually through collaborative activities. Just as children learn to walk, to interpret spoken language and to compose their own thoughts and speech, so too can they learn to read and write and do math with the guidance of their parents (and without being forced to do it). What's that you say? "But how can children learn unless we force them to learn? Isn't learning supposed to be work? Isn't it supposed to be unpleasant?" Well, ask yourself. Do you ever have to be forced to do things you are really interested in? If you enjoy quilting, or gardening, or even physics, do you ask someone to force you to do it? Have you found yourself enjoying going to the library to read up on something because you want to "learn" more about it? If so, you are guilty of unschooling. In a sense, then, unschooling is learning by living, and discovering your path through the guidance of a loving parent.

There is a third type of homeschooler, and though I don't have anything more than anecdotal experience to back me up, I think it is where most homeschooling families are, and that is somewhere in the middle of the two examples I presented above. Many of us start on one end of the spectrum and end up taking elements of both philosophies and integrating them in an approach that works for our respective families. This is kind of where our family is. It works well for us. I feel fortunate that my kids are excited about the things they are learning, that they are becoming critical thinkers and that they are being given the chance to find and pursue their passion in life. If you would like to read more about homeschooling I recommend The Homeschooling Book of Answers: The 88 Most Important Questions Answered by Homeschooling's Most Respected Voices by Linda Dobson.

Dr. George Idarraga

Pediatrician

Meriter Pediatrican
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics