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

Backpack Tips

I remember seeing a child with a complaint of shoulder pain in the office during the last school year. Did she have a history of trauma? No. Was she in athletics? Perhaps it was overuse. No. Did she ever injure her shoulder in the past? No, but she did complain of numbness and tingling in her arm as well. Was she sleeping on a lumpy or worn out mattress? No. It turns out that the problem was her backpack. She routinely carried about 40 pounds of books on her right shoulder every day and eventually she developed shoulder pain and nerve irritation.

Kids haul around a lot of stuff in those backpacks and they are a known source of shoulder and back pain in children. So much so, that there are medical studies devoted to the subject. As the school year begins, it's a good time to make sure your child's backpack meets criteria for carrying her homework, books and personal items in as safe and comfortable manner as possible.

Here are some things to look for in a backpack:

• The straps should be wide to distribute weight evenly. They should be easy to adjust.


• The pack should always be worn on both shoulders in order to allow easy balance. Some packs have a waist belt that can help to distribute weight better. Padding in the backpack reduces pressure points on the back.


• The pack itself should be fairly light-weight so that it doesn't contribute much weight to the load. Some packs have wheels that allow them to be rolled like luggage. This is helpful, but keep in mind that in the winter they can't roll through the snow.

You may also talk to your child and help her to organize her things efficiently in all of the compartments of the backpack. Heavier items should be centered on the back if possible. Encourage your child to make stops at her locker throughout the day rather than carry all of her supplies for the day at once. If despite these measures the pack seems to be too heavy (more that 20% of your child's weight) talk to the school and other parents to encourage changes. Hopefully, with these measures you won't need to worry that your child will come home complaining of a back ache.

Dr. George Idarraga
Pediatrician
Meriter McKee
meriterkids.com

Another School Year… Another Flu Season

It’s hard to believe it’s already that time of year again. Here’s what’s new for flu season 2010-2011:

This years’ flu shot contains the H1N1 (“swine flu”) strain and 2 other strains of flu virus most likely to cause seasonal flu this year. Regardless of whether you received seasonal flu vaccine, H1N1 vaccine, or both vaccines in 2009, vaccination with a 2010-11 seasonal influenza vaccine is necessary. Although the World Health Organization announced the end of the H1N1 pandemic this month, the virus does continue to circulate. The CDC recommends that all people age 6 months and older receive the flu shot — not just people in high risk categories.

Each year, it is estimated that there are 200,00 people hospitalized due to influenza and there are 36,000 deaths related to complications of influenza.

According the Flu Resource Center here is a list of some of the top places cold and flu germs hide:
1. Handshakes, sneezes, kisses
2. Kitchen sink sponges and dishcloths
3. Restrooms and toilet seats
4. Doorknobs
5. Drinking fountains
6. Shopping carts

The best protection against the flu are to WASH YOUR HANDS FREQUENTLY and GET VACCINATED.

Meriter clinics are anticipating having flu vaccine available early September, so remember to check our Web site or to call your primary care physician’s office for availability.

Sumita Ram, M.D.

Pediatrician

Meriter Middleton Pediatrics

meriterkids.com

What is Swimmer's Ear?

While on vacation, my son started complaining about his ears hurting when I put on his shirt. At first I just thought it was him being a typical 4 year-old, but it caught my attention when it really seemed to bother him when I bumped his ear while brushing his hair and then later when giving him a hug. Turns out my son had developed swimmer’s ear after having spent several days in the pool.

Swimmer’s ear is a common summer occurrence, but can occur year round even in people who do not swim. It is also called otitis externa because it is inflammation of the external ear canal. The inflammation can be caused by a number of things, but is most commonly caused by water in the ear canal that causes skin breakdown. The loss of skin integrity allows bacteria or fungus to enter the skin and cause inflammation. Other things that can cause skin breakdown and lead to otitis externa are using Q-tips, a foreign body in the ear canal, hearing aid, a rash that extends into the canal or drainage from a perforated ear drum.

Children usually complain of itching or pain in the ear. Children may have drainage from the ear as well. It often hurts when either the tragus (the prominence in front of the external opening of the outer ear) or pinna (the largely cartilaginous projecting portion of the external ear) are moved.

Physicians diagnose otitis externa by looking in the ear with an otoscope and by the tenderness elicited with movement of the ear. It is often treated with prescription ear drops. Oral antibiotics are sometimes used if the infection is severe or spread beyond the ear canal. There are over-the-counter ear drops but these will not treat otitis externa that has already developed. The drops should be put in the ear with the child laying on his or her side and remaining there for 3-5 minutes for the medication to have contact with the skin of the canal. The ear canal should be kept as dry as possible during the healing process. Avoid swimming and bathing that would get the canal wet. A cool air blow-dryer can be used if the ear does become wet.

Once a child has had otitis externa, steps should be taken to prevent it in the future. Ear plugs are an option, but sometimes if they enter the canal, they can also cause irritation. Drying the ears after swimming and bathing is important. First dry with a towel. You can again use a cool air blow-dryer. Another option is a couple drops of 70% rubbing alcohol solution or a mixture of ½ alcohol plus ½ vinegar placed in the canal will help dry up any water in the canal.

Enjoy the warm weather while it lasts!

Dr. Dana Johnson
Pediatrician
Meriter McKee
607.417.8388
meriterkids.com

Rotavirus (or the lack thereof): A vaccine success story

As a hospitalist, I see a sicker patient group. Only when a parent is very worried or a clinic provider feels they need ongoing attention do I see a child in the ED or in the hospital. Now, as we approach the end of summer, I can’t help but feel like something is missing. Five years ago, it was common in the spring and early summer to have children in the hospital for vomiting, diarrhea and dehydration from rotavirus. Rotavirus is a common virus that infects most children under 5 years of age and is most severe for children under 2 years of age. Every year there was a significant number of children who needed to stay in the hospital for IV fluids while they recovered from this virus. So, where did it go?

If your child is less than 4 years old then you may remember an oral vaccine received at the 2, 4 and 6 month visits. In 2006, the FDA approved the vaccine RotaTeq® and shortly thereafter, it was recommended routinely for infants. Since that time there have been other similar vaccines approved as well. This vaccine is not 100% effective in preventing rotavirus, but its goal was to reduce the severity of illness and prevent the need for hospitalization.

Recently, there have been some published studies on the effect this vaccine has had in the United States. One study showed a 46% decrease in need for hospitalization. Another study showed 100% effectiveness in preventing hospitalization compared to children who did not receive the vaccine. Wow! As a younger physician, it has been wonderful to see the impact vaccines can have on the health and well being of our children.

Although I love meeting the children and their families, I am glad more kids are at home. Staying in the hospital is no fun for anyone. To rotavirus, I say good riddance and you won’t be missed.

Dr. Jim Bencivenga

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

What Every Parent Should Know About Concussions

As a parent, it is exciting to watch your young athlete from the side-lines, making a great catch or kicking a goal. Also, as a parent, safety is always something that is in the back of our minds. One injury I would like to address is a concussion. It has brought recent media attention due to famous athletes or movie stars sustaining an injury to the head. However, it can affect any athlete.

What is a concussion?
A concussion is any injury to the head that potentially affects the function of the brain. It is usually the result of a blow or jolt to the head. However, it is important to know that it can also be secondary to a blow to any part of the body that causes the brain in the head to move back and forth, as per definition from the CDC. It is important to be aware of this because an athlete can sustain a serious concussion without a blow to the head. For example, imagine a hit to the shoulder, causing your head to move back and forth like whip lash.

A CDC study found that among youth ages 5 to 18 years old, the sports and recreation activities that generated the greatest number of emergency department visits for Traumatic Brain Injury were popular activities such as bicycling, football, basketball, playground activities and soccer.

What are some signs of a concussion?
After a blow to the head, talk to your doctor if you have any of the following signs of concussion:

• Headache
• Vision disturbance
• Dizziness
• Loss of balance
• Confusion
• Memory loss (called amnesia)
• Ringing in the ears
• Difficulty concentrating
• Nausea
• Feeling foggy or groggy
• Sensitivity to light or noise

However, some athletes may just say that they “don’t feel right.” This could be a sign of a concussion as well. Remember, you do not need to have loss of consciousness in order to have a concussion. If an athlete has been suspected to have a concussion, they should be evaluated by a physician. Secondly, due to new rules and regulations, the athlete will not be able to play that day and will need medical clearance by a physician in order to return to play for future games.

Recovery and safe return to play:
It is crucial to allow enough healing and recovery time following a concussion to prevent further damage. Research suggests that the effects of repeated concussion are cumulative over time.

Most athletes who experience an initial concussion can recover completely as long as they do not return to contact sports too soon. Following a concussion, there is a period of change in brain function that may last anywhere from 24 hours to 10 days. During this time, the brain may be vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of permanent brain injury increases.

I encourage you to visit the CDC Web site to understand more about concussions.

Meriter Pediatrics now offers ImPACT concussion management baseline testing. Think of it as a pre-season physical for the brain!

Dr. Viren Bavishi
Pediatrician
Meriter Middleton Pediatrics
608.417.8388
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

Feeding your Baby: The Transition to Solids, Part 2

(This post is continued from yesterday's Part 1 segment)

So, when do you start your baby on solids? My advice is to watch your baby and see when he wants to start solids. It should not be until she has developed enough body and head control to be able to sit up in a high chair, but babies vary on when they can do this. It’s generally in the four to six month range. For my first daughter, it was at five months that she could sit in a chair, but she didn’t eat solids until six months of age. After your baby can sit up in the high chair, you’ll naturally start putting him there, likely with some toys on the tray, when you have things you need to do (like eat your own dinner!)

There will come a day when you see your baby watching the food make its way from the plate to your mouth with great interest. Then she’ll give you a look like “I’d like some of that!” This is when you need to convince him, at your next sit-down together, that what you were eating was mom’s milk (or formula) mixed with a small amount of rice cereal and "sure, you can have some." Just put a small amount in, and keep in mind that you want it to be runny at first, and the mixture will continue to thicken for a couple of minutes as the flakes absorb moisture. Put a small amount on a spoon and hold it up in front of baby. If she’s ready, she’ll lean forward and take the spoon into her mouth. If he doesn’t seem all that interested, it’s no big deal. The essential source of nutrition for a baby is human milk (or formula) from birth to six months, and from six months to one year, it’s still the major source for nutrition. You can try again later.

I do recommend starting solids by nine months, because by that time we’re talking about picking things up (like Cheerios) and learning to eat various things is an important part of brain development. Nutritionally speaking, a baby can do just fine on nothing but mom’s milk (or formula) until one year of age. Generally, everybody can’t wait to feed the baby, and I can recall only one time I’ve ever had to urge a mother to start solids with her baby at a nine month well child check.

Now, I just described using rice cereal mixed with human milk or formula because that’s been the most common first food advised over the past 40 years, and it’s what I gave my own kids. I should note, however, that not everybody agrees with this. Some feel that pureed meat should be the first food, because it is an excellent source of bio-available iron and zinc, for which some older babies have deficiencies. One thing is certain: do not give honey to a baby less than one year of age, due to the small, but real risk of infant botulism. If you’ve been nursing your baby, she’s been exposed to the variety of flavors that is in your own diet, so adding a little dried spice or herbs could be o.k., but don’t add salt or sugar to your baby’s food.

That’s all we have space for today — ask questions in the comment section and I’ll try to address them!

Dr. Julia Mason
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Feeding your Baby: The Transition to Solids, Part 1

If you have a baby, you’re probably getting advice (from all corners!) on how to feed her. Everybody can agree these days that mom’s own milk is the best food for babies, but after that, there can be a lot of confusion. I’m going to focus today on the transition from human milk or formula to “solid foods.”

Some new parents are being advised by relatives that they should start the baby on solids, (which usually means baby rice cereal) basically, as soon as possible. This may be because several years ago mothers were actually being advised by their pediatricians to start rice cereal at earlier and earlier ages. The hope was that adding rice cereal to the bottle (and that’s what we’re talking about, because a typical baby less than four months old is not going to slurp food off a spoon) would help the baby sleep through the night, or eat less often, or have less spit-up. This advice is no longer being given, except by the well-meaning grandmothers who are passing on what they were told. Still, you can find “infant feeders” in the baby section of stores which are basically just bottles with an extra large hole in the nipple, to allow the thicker cereal mixture to come through. (Just because something is sold in stores doesn’t mean it’s a good idea to buy and use, even with baby supplies.)

Giving a baby solid foods early is not going to make him sleep through the night at a younger age. Babies do tend to sleep longer periods of time as they get older, and they start solids when they get older, but giving solids to a three month old is not going to turn her into a seven month old. Babies sleep through the night when they sleep through the night (and you should know that the technical definition of this is "greater than five hours of sleep," not the eight hours you’re dreaming of). There are things you can do to encourage this behavior, but that will have to be the topic of another post. Feeding solids to a baby less than four months old is not going to get them to sleep for longer periods. It may help with spitting up, but I wouldn’t advise it unless the problem is severe. It will lead to weight gain, and I think we’ve all figured out that this is not necessarily a good thing. For many babies, rice cereal will cause constipation.

Visit again tomorrow for part 2, when I'll discuss the appropriate time to start the transition to solids.

Dr. Julia Mason

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

The Importance of Vaccinating Parents and Siblings to Protect Babies

“Whoop” This is the awful high-pitched inhaling sound people can make after a burst of coughing associated with pertussis. This sound is what gives it the common name: “Whooping Cough.” It has also been called the "100-day cough" due to the duration of the cough.

For adults, getting a case of whooping cough is annoying and sometimes painful given the severity of the cough, but usually only slightly worse than the common cold, especially early on. Many adolescents and adults don’t even develop the stereotypical “whoop.” For children, especially infants, this illness can be deadly. 85% of the deaths associated with pertussis occur in infants less than 3 months of age.

The good news is that we have a vaccine for pertussis. Fortunately, there has been a dramatic decrease in the number of pertussis cases since the introduction of the vaccine in the 1940’s, but we continue to see outbreaks every couple of years. Currently, California is experiencing an outbreak and there have been cases in Wisconsin as well.

The vaccine is given in a combination vaccine with diphtheria and tetanus, usually at ages 2, 4, 6 months, 12-18 months and 4-5 years. The vaccine is not fully effective until 3 doses are given, so children that are less than 6 months are at higher risk of getting the illness. Teenagers and adults tend to be those that spread the disease, because their illness is not as severe and many do not even know that pertussis is what is causing their illness. They also have waning immunity from the vaccines they received as a young child. Fortunately in 2005, a booster vaccine was developed.

This vaccine should be used in place of one tetanus booster. It contains tetanus, diphtheria and acellular pertussis (Tdap). Anyone that is around small children, especially new parents, should make sure they have received the Tdap vaccine. It is recommended that any new mother that is not immunized should receive it during the immediate postpartum period. If she is around children less than 12 months old during her pregnancy, she should receive it during the pregnancy.

If you have questions about your or your child(ren)’s immunization status, please be sure to discuss them with your primary care provider.

Dr. Dana Johnson
Pediatrician
Meriter McKee
3102 Meriter Way
Madison, WI
608.417.8388
meriter.com/pediatrics

Getting the Okay to Play

Summer vacation has just started, but soon enough the annual mad dash to get those pre-participation sports physicals will begin. The state of WI requires that all students participating in organized sports have a physical examination by a qualified provider every two years to make sure they are healthy enough to participate in sports. These can be done as early as April first.

Keep in mind that the earlier the the exam is performed, the more time your doctor may have to investigate any problems that may be found. It is rare to find a condition such as a congenital heart disease or arrythmia that would completely disqualify an athlete. The pre-participation physical more often discloses issues that require follow up such as physical therapy, nutritional counseling, or referral for previous undiagnosed hypertension. It gives the opportunity for prevention of injury with effective conditioning programs. And it gives the opportunity to get certain conditions, such as asthma, better controlled before sports season begins. In addition, the sports physical is an opportunity for adolescents to develop a relationship with their physician who can also address issues not directly related to sports such as “high risk” behaviors (e.g. drug and alcohol use, use of sports enhancing substances, unsafe sexual practice).

Medical histoy is one of the most important parts of the sports physical and family history is a very good indicator of any potential conditions your child may be at risk for. Medical history questions are on the WIAA form that you can bring home. Please take the time to obtain your family’s medical history and answer the questions as well as you can.

Make a list of the following items:

• Chronic medical problems such as asthma, diabetes, seizures
• Previous hospitalizations and surgeries
• Past orthopedic problems/injuries/fractures
• Current medications
• Allergies
• Family history of any heart disorder (especially family members under 50) or any unexplained sudden death in the family history of concussions or head injuries (even if no one called it a concussion)
• Whether you’ve ever passed out, felt dizzy, had chest pain or significant trouble breathing during exercise/sports

Have fun, enjoy your summer. Don’t forget to schedule your sports physicals early!

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

Too Much Sugar - Part 2

(...continued from Tuesday's post...)

The kinds of calories that we eat affect are bodies in different ways. For example, fat in the diet has no effect on our insulin levels. Protein generally does not have much impact on insulin levels either, but in excess amounts protein can also be stored as fat. Carbohydrates exist in many forms such as complex carbohydrates and simple sugars. The rate at which a carbohydrate is absorbed into the blood affects the body's insulin response. In general, carbohydrates that are absorbed rapidly will cause higher increases in insulin levels. This can be a problem because insulin is a storage hormone. Broadly speaking, it promotes fat storage and inhibits our ability to burn fat. People who have chronically high insulin levels tend to hold on to their fat and will actually burn their muscle for energy when their glycogen stores are low. If you are insulin resistant, you are in a tough hole because you have decreased muscle mass (muscle at rest is metabolically active and burns more calories than fat) and your body has a hard time burning fat. That is why so many obese people have a hard time losing weight.

Glycemic index takes the body's insulin response into account. High glycemic index foods tend to lead to higher blood sugar levels, higher insulin levels, insulin resistance, and over time, lead to higher body fat levels and increased risk for obesity, heart disease and diabetes. Some high glycemic index foods include: white bread, pasta, rice, many cereals, foods containing a lot of simple sugar (candy and most desserts), sweetened beverages and low fiber baked goods. Low glycemic index foods include: vegetables, most fruits, minimally processed grains, legumes, lean meats and natural fats. You can “Google” glycemic index and easily find references on the internet. But a simpler rule to follow is avoiding processed food. Processed food is mostly that stuff in the middle of the grocery store. You know what I'm talking about. Man-made food. Stuff that comes in a box that you add boiling water to, or that you get in the freezer section and you throw in the microwave or heat up in the oven. Ready to eat. That's what I call factory food. It tends to have all sorts of stabilizers and preservatives in it. If the bacteria and mold won't eat it, why should you?

Soft drinks, juices and sports drinks are basically sugar water. Remember the 4.2 grams of glucose in your bloodstream. Well, a 12 ounce can of Coca Cola contains 39 grams of sugar (high fructose corn syrup - we'll save that battle for another day). Sorry to beat up on you Coke, it could just as easily be Pepsi. But let's face it, I had to dig around on your website for 10 minutes and bounce my way through 5 pop-up pages just to get to your nutritional information. Are you trying to hide something? I don't know many teenagers who limit themselves to a mere 12 ounces of a soft drink. So the average 12 ounces of soda contains almost 10 times your body's active glucose load.

I think I can say with a degree of certainty that we consume too much sugar. In fact, the average American consumes 300 to 600 grams of carbohydrate in all its forms on a daily basis. It is no wonder so many of us are overweight. For healthy weight management I recommend between 100 to 150 grams of carbohydrate daily (that's for an adult). It should come in the form of vegetables and fruits (yes, vegetables and fruits are nature's carbs). If you read Dr. Grant's post and are running regularly (please give it a try - you'll only have yourself and Dr. Grant to thank) you can allow yourself more. Read his excellent introduction to running for novices.

Endurance athletes can burn through a lot of glucose. But please try to avoid processed foods and sugary/high glycemic foods in your diet, and I promise you it will be easier to maintain a healthy weight. Eat foods that are as unprocessed as possible and avoid anything that is "modified" "processed" "trans" "partially trans" "inverted" or any other industrial sounding word.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
6008.417.8388
meriterkids.com

Too Much Sugar – Part 1

I recently read that the average adult has about 1 teaspoon of glucose (sugar) in his or her bloodstream at one time. That's a normal size adult with a normal blood glucose level. So that's about 4.2 grams of sugar dissolved in the bloodstream at any time. It doesn't seem like very much but even a small excess of sugar (glucose) in the blood, if present for a long time, can start to cause all sorts of damage.

People with poor blood glucose control, be they type 1 or type 2 diabetic, or even pre-diabetic, are at risk for all sorts of medical problems: kidney disease, heart disease, hardening of the blood vessels, loss of vision, nerve damage, poor blood circulation - to name a few. That is why when we consume sugar, in any of its forms, the pancreas secretes insulin to transport the sugar (glucose) out of the bloodstream and into cells where it won't cause harm.

So what does our body do with the sugar we consume? Some of it will be used as fuel to support our immediate metabolic needs. Some of it will be stored as glycogen in the liver and muscles. Our brain will burn a significant portion of it and store a small fraction of it in glial cells (a type of nerve cell). The average brain can go through about 500 Calories of glucose a day. You may have heard that the brain runs only on glucose. Well, that's not entirely true. The brain needs a minimum of about 20 percent of its Calories from glucose, but it can actually run mostly on ketones, another type of fuel that our body can use. Our red blood cells run exclusively on glucose. If there is excess sugar present after all this it will be stored as - fat. Yes. Fat. It's important to remember that this is a dynamic process. We are constantly consuming and expending energy, and hopefully if the intake matches the output, our weight stays constant and we don't get fat.

So why are so many of us overweight and obese? Well. While inactivity definitely contributes to obesity, it turns out that the answer is a little more complicated than “calories in = calories out.” Visit again on Thursday when I’ll post “part 2” to answer this question.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
608.417.8388
meriterkids.com

The Importance of Family Time

When I was growing up, my parents always made it a point to sit down and eat dinner as a family. Although like most siblings, my sister and I would often end up arguing or bothering each other, it was our family time to catch up and talk at the end of the day. If I had a good day, it was my chance to share my happiness with my family. If my day wasn't so good, it was my chance to unburden myself at the end of a long day. Sometimes I did not talk, but instead listened. I listened to my sister talk about her plans for the weekend with her friends, or about the teacher who she was sure hated her. I heard about my father’s day at work or about something interesting my mom had heard from her friends. Sometimes, on occasion, I even heard stories from my parents about their childhood.

Flash forward many years later, I have two children, a great wife, and a wonderfully hectic life. Between work and extracurricular activities, we seem to always be on the go. However, despite the occasional craziness, we try to maintain one constant--the family dinner. Of course, due to busy schedules, it isn't always possible for all of us to eat together. So, we've created another family tradition, sharing time before bed. We spend a few minutes before bed talking about what made us happy during our day and what made us feel not so happy. And if there's time, my wife and I take a few minutes to tell family stories, either about our children when they were smaller, or about our own childhoods.

I truly believe that it is important for families to consistently take the time to talk at the end of the day. Families may choose dinner or bedtime, or even some other time that works best for them, but regardless of what they do, the end results is the same--bringing the family closer and bringing security to our children. In fact, studies have suggested that teens that engage in family dinners more than 5 times a week were less likely to engage in smoking, drinking or using drugs, and in fact, performed better in school.

Now being a parent, I completely understand why my parents made this a routine. Times are different now, compared to then, but the need to connect as a family still remains. I'd be interested to hear what "family-time routines" you've started - please leave me a comment on Facebook.

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriterkids.com

What to Watch for: Hand, Foot and Mouth Disease

Summer is a time for children to play outside, be active, and enjoy freedom from the classroom. However, summer is also the season when some of the most common pediatric illnesses rear their ugly heads. One of these illnesses that is showing up recently in children in the Madison area is Hand, Foot and Mouth disease (HFMD).

HFMD is a viral illness that typically occurs during the summer months in children ages 10 years and younger. The usual symptoms include fever, mouth sores and a rash. The fever is often the first symptom to develop. This is typically followed by the development of blisters in the mouth, and sometimes on the hands and feet (hence the name!). Some children may also develop this blistery rash on their buttocks and genitals. As one can imagine, with these blisters, children may refuse to walk, eat or drink and may cry with urination.

Unfortunately, there is no specific treatment for HFMD. The most important steps a parent can take to help their child through this illness is to give acetaminophen or ibuprofen for comfort and fever reduction and to make sure that the child is getting plenty of fluids. Children with HFMD are at risk for dehydration because the mouth pain prevents them from drinking enough liquids. Offering popsicles or soup can help to soothe the throat while also providing fluids.

If you fear that your child may have become dehydrated or have other complications from HFMD, please contact your child’s primary care provider.

The best way to fight HFMD is through stopping the spread of the virus. Help children have a happy and healthy summer…teach them good hand washing!

Dr. Nicole Baumann-Blackmore
Medical Director, Pediatric Hospitalist Program
Meriter Hospital
meriterkids.com

Swimming Safety

Summer break is finally here and kids will soon be spending more time in and around water. Swimming is a great way for kids to get exercise and stay cool during the summer, but it is important to swim safely.

Remember to protect children from the sun. Sunburn is a risk factor for skin cancer. In 2003, a total of 45,625 new cases of melanoma were diagnosed in the U.S., and 7,818 people died from the disease. Check out Dr. Johnson’s Sun Safety blog (March 22, 2010).

Drowning is the second leading cause of unintentional injury deaths for children ages 1 to 14.

• Never – even for a moment – leave small children alone while in bathtubs, pools, spas or wading pools, or near standing water. With infants, toddlers and weak swimmers, an adult should be within an arm’s length.


• If you have a pool, install a four-sided fence. This includes inflatable and above ground pools.


• Children need to learn to swim. AAP supports swimming lessons for most children 4 years and older. New studies suggest classes may reduce the risk of drowning in younger children aged 1-4 as well.


• Parents, caregivers and pool owners should learn CPR.


• Do not use air-filled swimming aids (such as inflatable arm bands) in place of life jackets.


• Counsel teenagers about the increased risk of drowning when alcohol is involved.

Check out the American Academy of Pediatrics (AAP) updated guidelines on water safety and drowning prevention: http://www.aap.org/advocacy/releases/may2410studies.htm#drowning

Learn basic facts about recreational water illnesses.
The number of recreational water-associated outbreaks is increasing with a total of 78 outbreaks affecting 4,412 people reported for 2005-2006. The CDC recommends the following steps to prevent outbreaks:

• Never let your child swim when they’re not feeling well.


• Don’t let them swallow pool water.


• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers.


• Take your kids on bathroom breaks or check diapers often.

Public and pool users can test water at their local pool or hot tub. Free test strip kits can be ordered at: http://healthypools.org/freeteststrips/

You can check the quality of water at local lakes and beaches at the following sites:
http://www.wibeaches.us/apex/f?p=BEACH:HOME:620813377447211 and http://dnr.wi.gov/lakes/

Stay cool!

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

Taking Time to Enjoy Summer

I remember that when I was a kid, summer seemed to last forever. I couldn't wait for the school year to end because I knew that those endless days were just around the corner. Those last few weeks of the school year were agony - the weather had already turned and we would sit in our desks perspiring (schools didn't have air conditioning in the stone age) and pretending that we were dutifully attending to our studies, but really we were dreaming of the summer's promise.

I recall afternoons spent shooting hoops on the Bauer's driveway or playing baseball with all the other neighborhood kids in the empty lot across the street - the ball diamond was a well worn path in the weedy grass. Sometimes we would cross the train tracks to go across the big highway (two lanes really, but to us it seemed tantamount to crossing a national border) to buy a few pieces of candy, some Zots, Pop Rocks, Root Beer Barrels, with the change we had managed to hoard from Dad's pockets. Aside from Little League and swimming lessons, my three brothers and I didn't really get a lot done over the summer. Or at least it seemed that way. I did manage to catch you-know-what from my Mom once when I went fishing all day and forgot about my piano lesson. But as I look back upon my childhood summers I do realize that they were a valuable component of my upbringing. I now appreciate that I was given the opportunity of free time, time that I could spend exploring, playing, engaging in what I found value in, even as a kid. I learned a lot about myself. And I learned a lot about how to occupy my free time without being told what to do.

I worry that we are depriving our children this same opportunity when we overschedule them. I hear ads on the radio offering academic day camps - so kids won't forget all the precious knowledge that has been pumped into them over the school year. (Not to disparage, but when's the last time you used the quadratic equation?) I think it's important to maintain a sense of balance in our childrens' summer schedules. They really do need some unscheduled time over the summer. Sometimes a kid just needs to be a kid.

So as summer approaches, I ask you to keep in mind, and think back to your own childhoods, what you remember most fondly about your summers growing up. And to give your kids some free time.

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

Get Rid of Your Unwanted Medications at MedDrop

With the recent voluntary recall on Infants’ and Children’s Tylenol, Motrin, Benadryl, and Zyrtec, you may have some bottles sitting around in the cabinet gathering dust. (For more information about the recall and to get a refund or product coupon, please see http://www.mcneilproductrecall.com/.) Maybe there are some nearly empty vitamin drops, unfinished antibiotics, old inhalers, or even unused pain pills? Maybe there are medications that have expired, and you just haven’t gotten around to disposing them?

There’s no point in keeping them in the house. Expired medications can be ineffective. Leftover meds can be a safety risk with kids or pets in the house. But, throwing medications into the trash or flushing them down the toilet can harm the environment, affect our water supply, and in the end, come back to us in ways we don’t want.

MedDrop is a volunteer run program where you can drive through with your meds, answer some very basic questions (e.g., what is your zip code; is the drop-off place a good location for you), and feel good that the meds will be disposed of in a safe manner.

Saturday, June 5, from 9am to 1pm, volunteers will be at three locations: LaFollette HS, Middleton HS, and the Sun Prairie Recycling Center. You can bring prescription meds, over-the-counter meds, meds for pets, inhalers, vitamins, and even illegal drugs (which will be taken with no questions asked). If possible, please keep them in their original containers. The meds and their containers will be disposed of in a way that will maintain patient confidentiality, but feel free to cross off your name and other personal info if you like. Just leave the name of the medication visible, so the volunteers can properly dispose them.

For addresses, detailed instructions, background information on the program, volunteer opportunities, and lots more, please check out their Web site.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Get in Shape this Summer

Looking to run a road race this fall? Preparing your son or daughter to join the cross-country team? Just want to shed a few of those hibernation pounds? Nothing like a good jog on the Lakeshore Path or a run through the Arboretum to get yourself ready for the upcoming year! Experienced runner or novice jogger can “shape up” in a matter of 6-8 weeks by following a couple of simple rules.

• Train a minimum of four days a week. If you’ve never run before, start by using a combination of walking/jogging for a couple of miles every other day. If you’re an experienced runner start at a daily mileage you feel comfortable with.

• Increase your distance by about 10% a week. (i.e., if you just ran 25 miles, move up to 28, then 31, etc.) For variety, add in a short temp run by increasing your pace to the point where it just becomes difficult to converse. Once a week, try to go “long and slow.” A good mid-preseason schedule might have two easy runs, one tempo run, one long run and one medium distance run.

• Vary the scenery and the terrain. Madison has so many wonderful places to enjoy. And don’t forget to keep yourself well-hydrated!

• Go for a family run! Baby joggers (for children up to four) and bicycles can be a great way to get everyone involved in the outing!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

What is the Meriter Pediatric Center?

I am so excited! Not only is this my first opportunity to write a blog, but also the long-awaited opening of the Meriter Pediatric Center is only a day away! On Tuesday, May 18th, the hard work of so many over the past two years will finally come to life. A Pediatric Center is a new concept for many of us, so I thought I would take this opportunity to explain what you can expect of a visit to the Meriter Pediatric Center.

The Meriter Pediatric Center is an 8-bed unit, located adjacent to the Emergency Department, which is staffed by Nurses, Physician Assistants, Pediatricians, and Emergency Physicians, all of whom are trained to care for children. The Center was designed specifically with children and their families in mind, and will centralize care for the majority of children receiving emergency and inpatient services at Meriter Hospital. For children 17 years of age and younger who come to Meriter for non-life-threatening emergency visits, there are 5 exam rooms dedicated to their care, along with a pediatric-only waiting area. There are also three inpatient beds which will be reserved for children 15 years of age and younger who require hospital admission for observation, further treatment or post-surgical care.

Outside of the Pediatric Center, children will continue to be cared for across the entire hospital for a host of other services, including outpatient surgical procedures, medical imaging procedures, and therapy visits. In addition, patients with severe illness and injury will continue to be cared for in the main emergency department. Children ages 16 and 17 years who require hospitalization will be admitted to the appropriate specialty unit, but will be cared for by pediatricians, surgeons or family medicine physicians.

I hope that you and your child never need the services of the Meriter Pediatric Center. But if you do, know that your child will be in the excellent hands of caring and professional staff who are all dedicated to providing the best care possible for children.

Have a Happy and Healthy Summer!

Dr. Nicole Baumann-Blackmore
Medical Director, Pediatric Hospitalist Program
Meriter Hospital
meriterkids.com

Fears in Toddlers

I was recently asked about a toddler who was afraid of her own shadow. Fears are common in toddlers, so I have included my response on our blog.

Developmentally, toddlers are becoming much more aware of what is around them and becaue of this, parts of everyday life that they didn’t notice before can become terrifying. In addition, toddlers are starting to develop a wonderful sense of imagination. They often struggle to distinguish between what is real and make-believe and they are still learning the concept of cause and effect. As a result, fears are quite common and normal in the toddler and preschool years. They become abnormal only if they develop into persistent and irrational fears that interfere with the child's normal activities. Some common fears in toddlers include fear of being separated from their parents, the vacuum cleaner or other loud noises, the bathroom drain, the dark, and yes ... even their own shadow.

For most common toddler fears, it is gentle reassurance and basic, truthful information that most successfully assuages a toddler's anxiety. For example, if he or she is afraid of shadows, don't bend over backward to avoid going outside. Make sure you acknowledge your toddler’s fear by mirroring their emotions, e.g. “the shadow is scary for you." In the case of shadows, expose him/her slowly to what he/she fears; some contact with what shadows (in a controlled setting with you right next to him/her or holding her while providing lots of reassurance will probably help). Gradually increase his/her exposure to shadows. Talk about the shadows in simple terms. Read books about shadows. You could do puppet shows on the wall. Silliness often helps. For example, you could make your shadows do silly dances. As she starts feeling more comfortable, you could play a game of “shadow tag” trying to “tag” each others shadows.

Chances are that once you have acknowledged your toddler’s fear and once your toddler senses that you are not afraid, they will follow suit.

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

Planting a garden with your child

Spring has sprung, and summer is on its way. This is a great time to plant something with your child. Flowers are fun, but vegetables can help a child learn that food doesn’t just come from the refrigerator. Even veggie-avoiding kids will sometimes try things that they grew themselves.

Many of the most delicious crops require full sun, but they don’t require a garden plot. Some can be grown in a pot! Every summer I grow five big tomato plants out in my main vegetable garden, but I also grow a cherry tomato in a half barrel that’s on our deck. I plant flowers all around the tomato and use a more decorative support structure since it’s visible right out the window. Last year my main task was trying to teach my two-year old that the tomatoes taste best if you wait until they are orange. (I planted Sun Gold, a very tasty variety that I highly recommend!)

Pole beans are green beans that grow on tall vines and taste delicious. If you have a sunny piece of ground, you can put up one 6 to 8 foot pole and bring strings down from a nail at the top to tent pegs in the ground in a circle that is 4 to 6 feet in diameter. Have the strings about a foot apart on the ground, and leave one area with at least two feet in-between strings for an opening. Then plant 4 beans at the base of each string. As the summer progresses, the vines will create a playhouse of leaves—a shady place with first flowers and then beans. If you have multiple poles available you can make a teepee of poles, tied together at the top. Then you could plant 6-8 seeds for each pole since they are further apart, as in this picture. Alternatively if there’s a window of your house with a southern or western exposure, you could set up strings in front of the window. By the hottest part of the summer, the beans will provide a nice leafy sun block.

Have fun with planting and add your suggestions as comments on our Meriter Facebook page. What have you grown with your kids in the past?

Dr. Julia Mason

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

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