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

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

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

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

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

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