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Tuesday, September 3, 2013

Getting Ready for Back To School:

The end of summer is here and the excitement of a new school year is upon us. Along with picking out that first day of school outfit, take some time to prepare and talk with your children about the upcoming year 

Be Prepared:
Make a Homework Plan:  Discuss when you expect homework to be done.  For many kids, it is better to have a little free time when they get home from school before they sit down to do homework. However, that short respite can drag on all afternoon, if there isn’t a pre-arranged plan.  For example, your after school plan may be when you get home from school you can have snack and play outside for an hour, but then you need to come in and do your homework. When that is done, you can go back to playing.

Discuss screen and phone rules:  No screen time until homework is done is pretty straightforward and easy to enforce. Have a drop box next to the door where phones can be left until homework is done. Keep screen time to no more than 2 hours a day.  Set a device curfew for when computers and phones need to be turned off for the night and choose a location that is outside your child’s bedroom for charging devices.

Choosing the right backpack:  A backpack should not exceed 10-20% of a child’s weight. If your child needs to carry more than this to and from school, consider a roller bag. Wearing a backpack over one shoulder increases muscle strain, so take the time to adjust the straps to ensure that the bag sits comfortably on BOTH shoulders.

Physicals and Vaccines:  Check with your children’s doctor to see if they are due for their annual health physical and if they are up-to-date on vaccinations. Since most doctors get flu-shots delivered in the fall, you may be able to get their flu shot while you are there.

Review the Rules for Getting to and From School:
Repeating safety information is critical with children. Don’t think that just because you told them once to never get in someone’s car, that they won’t do it. Back to school is a great time to review safety information.

Bus Safety:  Talk to your children about waiting for the bus to stop before approaching the curb, looking both ways when crossing the street and never running into the street to wave the bus down.  It is better to be late to school, than to be hit by a car. Also, remind your children that if the school bus has seat belts, they need to wear them.

Bike Safety:  Check that your child’s bicycle helmet still fits and adjust the straps as necessary.  A bicycle helmet is less effective if it is not fitted properly.  Remind your child to always ride with the flow of traffic, not against it and to follow the rules of the road. If your child will be riding home at dusk or in the evening, make sure he is wearing clothes that will help him be seen by drivers.

Walking Safety:  Discuss the route your child will take to school and where they will be crossing the street. Try to arrange for your child to walk with other children in the neighborhood.  For younger children, consider walking with them until you are certain of their ability to navigate the route and cross the streets safely. 

For more information on preparing for going back to school, check out my radio interview on RadioMD,Healthy Children or on the American Academy of Pediatrics, HealthyChildren website. 

Tuesday, May 10, 2011

Keeping Kids Rear-Facing - The New AAP Policy

For those of you who read my blog, you may recall a post about a year ago entitled Rear-Facing Car Seats Until At Least 2. A little over a year later it is official. The American Academy of Pediatrics now advises that children stay rear-facing until at least two years old and even once they reach two years of age, they should only begin riding forward-facing when they outgrow the weight and height limitations of the rear-facing position. This means you may very well have smaller 3 year olds still facing backwards.

In an article discussing the new AAP car seat policy statement, Dr. Hoffman, a member of the AAP's committee on injury, violence, and poison prevention stated, "Parents are really viewing these transitions as graduations. There is a perception that this graduation is a positive thing. It's not. In these transitions, you lose protection every step of the way. Therefore you need to delay these transitions for as long as possible." This is a wonderful point and something pediatricians need to explain to their patients. The fact is children are safest facing backwards. Facing forward is not something that should be rushed but rather something that should be put off for as long as possible.

Thursday, September 23, 2010

Similac Recall

Similac announced a recall of certain lot numbers of its powdered infant formula due to "the remote possibility of the presence of a small common beetle in the product." According to the FDA, "the formula containing these beetles poses no immediate health risk, however, there is a possibility that infants who consume formula containing the beetles or their larvae, could experience symptoms of gastrointestinal discomfort and refusal to eat as a result of small insect parts irritating the GI tract." The FDA advises parents to seek medical attention for any child who has GI symptoms which persist for more than a few days.

This recall applies only to powdered formula and does not include any of Similac specialty formula lines: Similac Expert Care™ Alimentum®, Elecare ®, Similac Expert Care™ Neosure ®, Similac® Human Milk Fortifier.

To find out if your canister of formula has been recalled, visit the Similac website and enter the lot number, which can be found on the bottom of the product.

Monday, April 26, 2010

Clogged Tear Ducts - Proper Preventative Care

Clogged tear ducts, a.k.a. nasolacrimal duct stenosis, is a fairly common problem among newborns. The tear duct's opening is located on the inner portion of the lower eyelid. The duct runs from the eyelid to the inside of the nose where it drains into the nasal cavity. For a small percentage of children, the inferior portion of the duct remains closed after birth and does not allow tears to properly drain from the eye into the nasal cavity. For these children, tears flow over the lower lid and down the cheeks.

Children with nasolacrimal duct stenosis often have small amounts of discharge from the duct coming out of the opening on the lower eyelid. This drainage is not cause for concern and can be wiped away gently with a warm cloth.
However, a blocked nasolacrimal duct does increase an infant's risk of infection of the nasolacrimal sac (dacrocystitis) and of the skin under the eye. Parents should seek medical attention for their infant if there is copious discharge from the duct's opening into the eye, if the eye is crusted shut in the morning, if there is any redness in the white of the child's eye, or if there is any redness or swelling of the skin under the eye or around the duct's opening. These infections have the potential to become very serious and require prompt medical evaluation and treatment with antibiotics.

Most children with congenital nasolacrimal duct stenosis will outgrow the problem. As the child grows, the duct also grows and the inferior opening located within the nasal cavity dilates relieving the stenosis and allowing the duct to function properly. By 2- years-of-age, over 95% of children with nasolacrimal duct stenosis have improved on their own.

For the small percentage of children who continue to have a problem after their two-year-old birthday, they should be referred to a pediatric ophthalmologist. Some pediatricians will refer a child after one-year-of-age. However, most pediatric ophthalmologists will give the parents of younger children a choice between watchful waiting and surgery. For children who have not had any severe infections of the duct, a simple surgical procedure in which the surgeon uses a probe to dilate the nasolacrimal duct is all that is needed to rectify the problem. For children who have had an infection of the duct, they may need both a probing of the duct as well as the placement of a temporary stent inside the duct to keep it open while the duct heals.

While watchful waiting is an appropriate decision for the child without a history of infection, children with a history of infection warrant an early referral to a pediatric ophthalmologist as their chances of resolution without surgery is very low.

Proper care of the nasolacrimal duct can mean the difference between an uncomplicated course of stenosis that is self-resolving and one that is complicated by infection and surgery. While many parents are told to simply massage the duct and sac by rubbing their finger in tiny circles in the inside corner of the eyelid this is actually not the proper technique. The massage is not being done to open the duct, as the closed portion of the duct is located within the nasal cavity, and not up by the eye. The massage instead is done in order to relieve the pressure within the duct and facilitate drainage of any discharge within the sac and duct into the eye. If the discharge material is allowed to remain inside the sac and duct, pressure within this area will increase and cause stretching of the inner lining of the nasolacrimal duct and sac. This stretching would allow normal nasal cavity bacteria to escape the confines of the duct and seep into the surrounding skin causing an infection.

Thus, proper massaging technique is essential to drain the nasolacrimal sac and duct and prevent infection. The correct way to massage the duct is to press your finger into the crevice between the inner eyelid and nose, right below the nasolacrimal duct opening and then move your finger up, milking out any discharge through the opening on the lower lid and out into the eye. This should be done a couple of times a day depending on how much drainage the child is experiencing. With this proper technique, the risk of infection is greatly reduced and the chance of the child requiring a surgical correction is less than five percent.

Nasolacrimal duct stenosis is a fairly common problem among newborns. Learning and using the proper massage technique is essential in order to avoid infection and subsequent surgery. By diligently massaging the discharge out of the sac and duct, parents can reduce the pressure and bacterial build up within the system and buy their children time to outgrow this problem naturally.