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

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

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

Keeping Summer Fun

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

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

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

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

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

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

When April showers bring more than May flowers

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

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

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

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

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

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

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriter.com/pediatrics

Sun Safety Tips

It's spring, or at least it is starting to feel like it! With this, comes children playing outside more and many families traveling over Spring Break to places much warmer and sunnier than Madison this time of year. Some of us are more prone to sunburns than others, but all skin types need to take steps to prevent damage from the sun. UV rays can damage the skin and eyes and result in skin cancer that can be deadly. For many that develop skin cancer, the sun damage occurred in childhood.


Sun Protection Tips
- Wear sunscreen
- Try to avoid prolonged sun exposure between 10 a.m. and 4 p.m. when the sun’s rays are the strongest
- A cap with a bill to protect the face and sunglasses with UV protection (at least 99%) for the eyes is a good idea
- Remember that UV rays can bounce off water, sand, snow and concrete
- It is best to keep babies under 6 months out of the sun by staying in the shade of a tree, umbrella, etc.
- Set a good example. Like everything else, kids learn best from their parents’ example.

Sunscreen Basics
- For any new type of sunscreen, test on a small area to test for an allergic reaction. Apply carefully around the eyes, avoiding eyelids.
- Okay to use on anyone over 6 months. If sun exposure is unavoidable for babies under 6 months, it is okay to use sunscreen on sun exposed areas. (I recommend giving the baby a bath when you get back inside to decrease possible skin irritation.)
- Want at least sun protection factor (SPF) of 15
- Want “broad-spectrum” so that it screens out both UVA and UVB rays
- Use a generous amount of sunscreen on all sun exposed skin and rub it in well. Apply at least 30 minutes prior to going outdoors, after getting wet, and every 2 hours while in the sun.
- Sunblocks with zinc oxide and titanium dioxide are great for sensitive areas like the nose, cheeks, ears, and shoulders. They often stay visible even when being rubbed in, so some come in fun colors.
- Applying sunscreen is protection - not a reason to stay in the sun longer

Contact a doctor, if a baby under 1 year develops a sunburn or an older child develops blistering, pain or fever with sunburns.

The above recommendations were adapted from the American Academy of Pediatrics “Spring Break Safety Tips” at http://www.healthychildren.org/ and “Fun in the Sun: Keep Your Family Safe” handout.

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

What is Homeschooling?

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

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

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

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

Dr. George Idarraga

Pediatrician

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

The Truth about Meningitis

By now, you may have read or heard about the young University of Madison senior and the Mt. Horeb High school girl who recently died from bacterial meningitis. It’s pretty scary to hear of such stories in otherwise healthy young people. The good news is, you don’t have to panic. Fortunately bacterial meningitis is very rare. There is also a vaccine available to help prevent the most common type of bacterial meningitis that occurs in teenagers and young adults.

So what is meningitis? It is a disease caused by the swelling or inflammation of the protective covering of the brain and spinal cord known as the meninges. This inflammation is most commonly caused by an infection of the fluid surrounding the brain and spinal cord usually by a bacteria or a virus. Symptoms of meningitis are fever, severe headache, stiff neck, sensitivity to light, altered mental status, nausea and vomiting.

Meningitis caused by viruses is the most common type of meningitis. It usually tends to be less severe and it clears up on its own without any specific treatment. There are usually no long term consequences. Bacterial meningitis, on the other hand, can be quite severe and can cause long term damage and even death if not treated immediately with antibiotics. Although it can be serious, routine vaccinations given to all children has reduced the numbers of three of the most common types of bacterial meningitis.

The type of bacterial meningitis most commonly seen in teenagers and young adults is caused by a bacteria called Neisseria meningitis and is what the two young girls mentioned above had. This type of meningitis is not spread by casual contact. It is spread by direct contact with oral secretions. So just being in the same school or just breathing the same air that a person with meningitis had been would not give it to you. On the other hand, kissing; sharing the same utensils or toothbrush; frequently having slept in the same dwelling as the infected person; or sitting very close to a person (such as in airline travel) for more that 8 hours could put you at risk for getting Neisseria meningitis. If you have had this type of close contact within seven days with someone who developed meningitis, you should talk to your health care provider about getting antibiotics to prevent illness.

In order to prevent infection with Neisseria meningitis, it is also recommended that all all pre-teens between the ages of 11 to 12 get the meningococcal vaccine which prevents against most, but not all strains of Neisseria meningitis. It is also recommended for all college freshmen living in a dormitory or if you are a military recruit because this disease is more common in young adults and infectious diseases tend to spread quickly wherever larger groups of people gather together. There are also other high risk groups in which the vaccine is recommended such as in people who have problems which affect their immune system.

So, remember, bacterial meningitis is rare but can be very serious and even life-threatening. It can be treated successfully if dealt with promptly. It is important to get routine vaccinations. Know the signs of meningitis and if you suspect that you or your child has the illness or has been exposed to the illness, seek medical care right away.

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