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

To fly or not to fly … with a toddler

A number of years ago, my wife and I decided to take a trip to California with our 22-month old daughter, Sophia. We reserved a hotel, arranged for a rental car, and booked the 4 hour flight to San Diego. Like anyone else, I was looking forward to vacation. I imagined showing Sophia the ocean, visiting the zoo, and just getting away from the every day routine. It was all good until a friend questioned my sanity, saying to me “Flying with a toddler is crazy. She’ll probably cry the whole flight.”

Happy visions of strolling along the beach were replaced with nightmare-ish visions of my daughter screaming the entire flight, or throwing sippy cups and toys at the heads of the passengers in front of us. Determined to get our vacation off to a good start, my wife and I came up with a plan. We made lists of what we needed to bring on the plane and armed ourselves with books, toys, games, food and plenty of diapers.

Finally the day came. Sophia ran from window to window looking at all the airplanes. I boarded first and installed the car seat, and my wife waited until the end to board, letting Sophia burn off a little extra energy. At first, things were great. Sophia sat happily in her car seat, drank some juice and ate cheerios. Then, about an hour in, she got squirmy and we read some books and colored. Two hours in, the fussiness started. We got out the toys and she played happily for a while. About three hours into the flight, we reached the level of desperation and brought out...the finger puppets. Yes, one for each finger. My wife sang songs and I made the finger puppets dance. Sophia laughed and all was right in the world. Of course, she fell asleep just as the pilot started the descent.

Overall, it was a successful flight—minimal ear pain for Sophia, minimal angry looks from fellow passengers (people around us were very nice) and minimal tears. Truly, flying with a child does not have to be stressful, especially if you set realistic expectations and plan ahead.

Here are a few tips on flying with babies and young children:

Dealing with ear pain: Babies and young children may cry in response to the sudden change in cabin pressure, which can cause ear discomfort. Usually this occurs during take-off and landing. The act of sucking, by nursing, bottle feeding, or using a pacifier, may help alleviate some of this pain.

Do not use Benadryl or cough and cold remedies: I often get asked about giving Benadryl or cough and cold medications prior to flying. I usually do not recommend them because 1) they are not approved for children under two years of age and 2) some children actually have the reverse effect and become “hyper.” Also, even if it does make your child sleepy, it may make them more irritable after they wake up. I highly recommend talking with your child’s doctor if you have questions about this.

Separate seat vs. lap child: If at all possible, purchase a seat for your infant or child (children under 2 years of age fly free as a “lap child” on most airlines). You’ll have more room to move, and more importantly, your child will be safer. When turbulence kicks in or an emergency landing takes place, it can be very difficult to keep the child safely in your lap, regardless of how tightly you hold them. According to the American Academy of Pediatrics, “Preventable injuries and deaths have occurred in children younger than 2 years who were unrestrained in aircraft during survivable crashes and conditions of turbulence.” Also, check with your airlines for discounted seats for infants. You can use a car seat on the airplane. Just make sure that is an FAA approved car seat.

Wait to board the plane: While many airlines allow families with small children to board first, this often means that your child will be sitting in the seat for quite a while before the plane actually departs. If you are flying with another adult, one can board first and get everything settled (including car seat installation), and the second can follow later with the child.

Keeping the seat belt on: For older children who have not flown before who will not be using a car seat, have a few play sessions at home, pretending to be on a flight . Use an old belt, or anything you have that can be buckled. Have a few discussion prior to the trip about the importance of keeping the belt on, and stress that the plane will not take off unless everyone is buckled up.

Be prepared. Flights are often delayed, so bring plenty of food and drinks (check the TSA Web site to see what is allowed), plenty of extra diapers and several changes of clothes (including a spare short for each parent in case of “accidents”). Also, bring familiar and favorite toys or games. While new toys might be a good distraction for older children, babies and younger children often prefer playing with the toys they use everyday.

Allow ample time: The process from checking in your bags to the arriving at your gate may be long. Allow yourself enough time to get through the security screening process as well. If you have older children, it is important to talk about the screening process ahead of time. Their personal belongings such as dolls, toys and games, will be placed under an x-ray screen, but will return to them after they walk through the security screen themselves.

Have realistic expectations: Your child will probably cry at some point during the flight. Accidents and spills may happen. You probably won’t have much time to read that magazine you picked up at the airport. But, with a little preparation and planning, you can make flying a great experience for the whole family!

More than 7 years later, my daughter is a seasoned traveler. She even packs her own carry on bag and entertains herself on flights by reading or drawing. I’ll admit, it’s nice to have some time to myself to catch up on reading during the flight, but there is a part of me that misses the songs and the finger puppets.

Safe travels……
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