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

Be a PAL to a Friend with Food Allergies

Food allergy occurs when the immune system mistakenly attacks a food protein. Ingestion of the offending food may trigger the sudden release of chemicals, including histamine, resulting in symptoms of an allergic reaction. The symptoms may be mild (rashes, hives, itching, swelling, etc.) or severe (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be potentially fatal.

According to the Food Allergy and Anaphylaxis Network, approximately 12 million people in the U.S. have food allergies. That’s one in 25, or 4% of the population. Food allergies are more prevalent among young children – one in 17 under the age of three has food allergies.

Kids who have food allergies need help to keep them safe. The Food Allergy & Anaphylaxis Network encourages you to become a PAL – Protect A Life from Food Allergies. You can be a PAL by:

1. Never taking food allergies lightly. Don’t joke about it, or tease kids who have food allergies. And most importantly – NEVER, NEVER try to trick someone into eating food they’re allergic to.

2. Don’t share food with kids who have food allergies. It may contain something harmful to them.

3. Wash your hands after eating. Beside being a healthy habit – you’ll clean off any food that’s on your hands.

4. Ask what your friends are allergic too and help them avoid it. Reading food labels can be tricky. If there’s a question, it’s better that the child not eat it. Consider celebrating with non-food treats and activities – like games, stickers and other prizes.

5. If a friend becomes ill, get help immediately. Tell an adult immediately if your friend with food allergies starts vomiting, gets a swollen face or lips, has difficulty breathing, starts coughing sneezing or eyes begin to water or their skin gets bumpy, red and itchy. An allergic reaction can happen anytime, anywhere, even several minutes after eating. Always be on the alert.

For more information go to http://www.foodallergy.org/.

Dr. Viren Bavishi
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

Fever: What Parents Need to Know

When should a parent worry about a fever in their child? With the flu and cold season lurking just around the corner, now is a good time to know how to treat a temperature and when to report it.

First of all, some basic information is good to know. Fever is a normal response of the body’s immune system, and everything designed to kill infection works better when the core temperature of the body rises. When we sense a foreign invader, our “thermostat” resets to a higher temperature—101.5 taken rectally usually being the cut-off. (Remember that rectal temps are better indicators of core temperature and will generally run about a degree higher than one taken under the arm.)

It is important to note that very few fevers are dangerous, the rare exceptions being a “broken thermostat” which only happens in severe hyperthermia (heat stroke) and malignant hyperthermia (a rare condition brought on by anesthesia). As a matter of fact, many children go on with their normal routine and act happy.

So when do you treat fever? When the child is uncomfortable or it becomes difficult to determine just how sick they are. For instance, I only gave anti-pyretics to my kids when they looked sick—never simply in response to what the thermometer read. In these instances, Tylenol (acetaminophen) is the drug of choice, Ibuprofen as a second line drug. (Aspirin is never used in children because of the risk of Reye’s syndrome.)

It is important to be more aggressive when the diagnosis underlying the fever is in question—always in infants under two months of age. Also, because a child with a high fever can look very ill, observing what happens when the fever is brought down reassures us that nothing serious is going on in terms of infection. So, always call for fever in an infant under two months, and in children who don’t respond to anti-pyretics.

To Summarize:
• Most of the time fever is beneficial, helps us to get rid of the infection
• Treat only for comfort and to help aid in the diagnosis
• Call for any fever in children under two months, and also in children who you think may be ill (fever lasting more than a couple of days, or children who don’t respond when the fever comes down)
• While anti-pyretics such as Tylenol and ibuprofen are safe, they are not always necessary
• Always call if you are unsure about what to do!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

National Turnoff Week

This week, September 19-25th, is National Turnoff Week. The Center for Screen-Time Awareness organizes this challenge which is endorsed by the American Academy of Pediatrics (AAP). Families are challenged to turn off their television sets, computers, electronic games and other electronic devices for the entire week. Most people in the United States, children included, watch too much TV and spend too much time in front of their computers.

Besides the negative health effects from these sedentary activities, studies have shown that children who watch too much TV are more likely to have behavioral and aggression problems. The AAP recommends that children have no more than 2 hours of “screen” time per day (TV, computer time, video games, etc.) and that children younger than the age of 2 years watch no TV at all. Despite these recommendations, the average American child watches 3 hours of television a day.

This week, think about stepping up to this challenge. Right now, you are probably thinking, “what on earth are we going to do instead?” Think about reading books, playing board games, putting together puzzles, doing an art project or redecorating a room in the house. If the weather is nice, take a nature walk, visit the zoo, clean up your neighborhood or plant some flowers. Visit an apple orchard, pick some apples and make an apple pie together. The possibilities are endless! The goal is to have fun and reconnect as a family.

Once you have done this for the week, think about making this part of your routine. Pick two or three days a week to unplug the electronics and “tune in” to each other. Your family will be happier and healthier because of it! Are you and your family up to the challenge?

I would love to hear what you think about this challenge and what activities you and your family have planned! Post your comments under the article on facebook.com/meriter.

Dr. Nicole Baumann-Blackmore
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Child Passenger Safety Week: What you need to know (Part 2)

As we approach Child Passenger Safety Week, here are some important things to think about and remember:

Even though it is not required, REAR FACING UNTIL TWO YEARS of age is safest. Children who are 12 to 23 months old are FIVE TIMES SAFER if they face the rear rather than the front. Some folks worry about injury to the legs, but lower extremity injuries are rare in the rear-facing position which offers much better protection against spinal injuries. Many car seats available today have higher height and weight limits allowing you to use them longer than older seats. Every seat has a height and weight limit, and these limits can vary depending on whether the seat faces the rear or the front.

Children younger than 13 years old should ride in the back.

Car seats have an expiration date, usually 6 years after the manufacture date. Please do not use a seat that is more than 10 years old.

Car seats need to be replaced after an accident. Some insurance companies will cover the replacement cost. It may be possible to reuse a car seat after a minor crash. See http://nhtsa.gov/people/injury/childps/childrestraints/reuse/restraintreuse.htm for guidelines.

Avoid secondhand seats unless you are sure it has not been in an accident and it has not been recalled. It should have a sticker stating the manufacturer, the manufacture date, and the model number. You will need an owner’s manual which is often available online.

Car sear injuries can happen OUTSIDE of the car, especially in children younger than 4 months of age. Suffocation or head injury due to falls can occur. If the seat must be elevated (like on a counter), then the child should be strapped in, the surface should be firm, the seat should be far from the edge of the surface, and there should be constant supervision.

If you plan on using a car seat on a plane, it should be FAA certified. Car seats are recommended on flights for children up to 4 years of age. Install them just as you would in a car with a lap-only belt. The car seat should be put in a window seat.

For an overall reference, check out http://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Information-for-Families.aspx.

Be safe and enjoy the ride!

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Child Passenger Safety Week starts 9/19 and ends with National Seat Check Saturday on 9/25

Motor vehicle accidents are a leading cause of injuries and fatalities in children. Many of these injuries can be prevented, but OVER 75% OF CAR SEATS ARE USED OR INSTALLED INCORRECTLY. In some places, that number is as high as 95%.

What goes wrong? The car seat is not fastened tightly enough to the car. The child is not strapped in tightly enough. Clips, straps, or the seat itself is in the wrong position. The child is advanced to the next level of restraint too soon. Not all car seats will fit all cars. That’s why it’s important to get your car seat checked.

Even if you can’t make it on Seat Check Saturday, you can find a nearby certified technician who will check your seat for free at http://www.nhtsa.gov/Safety/CPS.

Wisconsin law states that ALL passengers are supposed to be restrained regardless of age or position in a car. Straps should be at or BELOW the shoulders for rear-facing children. You must be BOTH 1 year old AND at least 20 lbs to face the front. Straps should be at or ABOVE the shoulders for forward-facing children. You must be BOTH 4 years old AND at least 40 lbs to sit in a booster seat. Booster seats help to position children so that they fit appropriately under a lap/shoulder belt (which is why booster seats are not appropriate for airplanes).

Children are not required to use a booster seat when they are 8 years old, OR they are at least 4 years old and over 57 inches, OR they are at least 4 years old and over 80 lbs. However, when graduating from a booster seat, the child should be able to sit up against the seatback with knees bent comfortably at the edge of the seat. In this position, the seat belt should be over the collarbone and hips, NOT the neck or belly. Children who move out of booster seats prematurely are at increased risk of internal injuries from the seat belt or even ejection from the car.

For more about child seat laws in Wisconsin, see http://www.dot.wisconsin.gov/safety/vehicle/child/docs/booster-seat-law-facts.pdf.

Check back tomorrow when I'll post additional important car seat safety facts!

Dr. Tracy Lee

Pediatric Hospitalist

Meriter Hospital

meriterkids.com