Visiting Grandparents?

We understand that these have been really challenging times for families and that it has been very hard for people to remain physically distanced from their loved ones during the pandemic. Many people are starting to question when it may be okay to have grandparents visit their grandchildren or to travel themselves to visit family members. While social distancing and isolation are crucial to controlling the spread of the COVID-19, we recognize that mental health and family relationships are also critical during this strange “new normal.”

Evaluate your risk factors and risk tolerance

There is no single answer, but here are some things to consider when evaluating your family’s risk factors and risk tolerance. Do the grandparents have high risk medical conditions? In general, the risk of getting very sick due to COVID-19 is higher in older people, but medical conditions such as lung disease, heart problems and diabetes can place people at higher risk for a more serious infection. Consider how well each family member has been socially distancing – have any family members still been working outside the home on a regular basis? Some jobs may be riskier than others (for example, healthcare and grocery store workers) due to how much contact they have with other (potentially sick) people.

If you do visit, reduce the risk

If you decide to visit with grandparents, some options for reducing risk of the visit could be:

  • Spend the visit outdoors (studies show that transmission of COVID-19 is significantly decreased outdoors compared to a closed indoor space).
  • Do not share utensils or a family style meal together.
  • Consider driving instead of flying and minimizing public rest-stops.
  • Consider traveling to the grandparents instead of grandparents traveling to you if air travel is required for the visit.
  • If possible, both the grandparents and the visiting family should be diligent about socially distancing for two weeks prior to the visit to reduce the risk of any member of the group acquiring and even unknowingly spreading COVID-19 infection.
  • Consider meeting somewhere geographically neutral if family members live in a high COVID-19 prevalence area.
  • Consider pre-visit testing if this is available in your area. The nasal PCR test can accurately identify active COVID-19 infection; but, so far, none of the antibody tests can reliably determine immunity or confirm past infection.

As we continue to learn more about this new virus, please note that the above guidance may change. Lastly, remember that frequent hand washing, wearing a mask, while in public, avoiding touching your face, social distancing and sanitizing high-touch surfaces remain critical to controlling viral spread.

Multisystem Inflammatory Syndrome in Children (MIS-C)

If you’ve been keeping up with the news lately, you may have heard about a new illness called Multisystem Inflammatory Syndrome in Children (MIS-C) that’s affecting children. Doctors and researchers are still trying to learn about this new disease, but here’s what we know so far.

Symptoms of MIS-C

MIS-C is a condition in which different body parts become inflamed, such as the heart, lungs, kidneys, brain, gastrointestinal tract, skin or eyes. Children with MIS-C can have a variety of symptoms, including:

  • Fever
  • Abdominal Pain
  • Vomiting
  • Diarrhea
  • Neck Pain
  • Rash
  • Bloodshot Eyes
  • Feeling Extra Tired

If your child experiences the following more severe versions of MIS-C symptoms, you should seek emergency care immediately:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

What causes MIS-C?

We do not yet know what causes MIS-C, however many children with MIS-C have tested positive for the novel coronavirus (COVID-19).  We also don’t know if children with certain health conditions are more likely to get MIS-C than others. Fortunately, unlike COVID-19, MIS-C does not appear to be contagious. MIS-C is also a relatively rare condition – less than 10 percent of patients that test positive for COVID-19 contract MIS-C.

The link between MIS-C and COVID-19 is evolving every day, and pediatricians and researchers at Children’s National Hospital and the Centers for Disease Control (CDC) are working tirelessly to understand its current and long-term effects on children. For additional information, please visit the CDC page on MIS-C.

While MIS-C is a serious condition, with proper medical care most children are able to recover. If you have concerns your child is suffering from MIS-C, please call your primary care provider.

Bike and Walking Safety

In the midst of the coronavirus pandemic, it’s important to practice social distancing and stay in the house as much as possible to protect ourselves, our families and the health of others. However, we do understand that getting out for a bit to stretch and play is important for children (and adults). As you work to strike that right balance, here are a few simple safety tips to help your kids stay active and injury free.

  1. Teach kids to look left, right and left again before crossing the street. We know that many of you are now balancing working from home and supervising your children so at times they may be outside playing on their own. This is a great opportunity to reinforce this simple tip and practice a few times with the younger ones to make sure they know the right thing to do when an adult isn’t there.
  2. Make eye contact with drivers. Everyone is just a little more distracted nowadays so remind kids to make eye contact with drivers before crossing the street, and to pay full attention while crossing by putting phones, headphones and devices down.
  3. Wear a properly-fitted helmet. Taking a bike ride is always a great activity for kids, and it seems more and more kids are cruising around either by themselves or with their families. This is no time for a needless trip to the hospital so remind your children the importance of wearing a helmet every time they ride. And if you’re going with them, remember to be a good role model and wear your helmet as well. Kids look up to you.

Washing Hands

Colds, viruses and flu abound at this time of year, but there’s a very simple way to keep them at bay: wash your hands.

According to the Centers For Disease Control (CDC), a large percentage of foodborne disease outbreaks are spread by contaminated hands, and appropriate hand washing practices can reduce the risk of foodborne illness and other infections.

When should you wash your hands?

To help avoid illness, you and your children should wash your hands:

  • After using the bathroom
  • After sneezing, coughing or blowing your nose
  • After changing a child’s diaper or cleaning a child who has used the bathroom
  • Before, during and after preparing food
  • Before eating food
  • Before and after touching someone who is sick
  • Before and after treating a cut or wound
  • After working and playing with your hands

When in doubt. Wash your hands.

How to wash your hands

Washing your hands is easy. Just follow these five simple steps from the CDC:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

What about hand sanitizer?

Parents often give their children hand sanitizer because it is convenient and quick and many believe labels that say “kills 99.9 percent of germs” as fact, but hand sanitizer is not the best option for fighting infection.

If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol, but the bottom line is that washing hands with soap and water is the best way to get rid of germs.

Valentine’s Day Stress

Valentine’s Day is supposed to be a fun and festive holiday filled with giving and receiving gestures of appreciation and love. However, sometimes it has the opposite effect and makes us feel lonely or unappreciated. This is especially true for kids and teenagers who are particularly sensitive to what others think of them. As a parent, there are a few things you can do to help alleviate some of your kid’s Valentine’s Day anxiety.

For children and teens, Valentine’s Day celebrations may be filled with dread, as they worry about not receiving positive feedback from friends or peers. Teenagers in particular may become stressed around this time, either because they would like to be the recipient of a grand gesture but worry they won’t, or because they want to avoid such public displays.

Alleviating a child’s anxiety

  1. Listen to their concerns: Talk to children or teenagers to get a sense of how they are feeling about Valentine’s Day. If you sense they are anxious or concerned about whether or not they will receive cards from their peers, or if they are hoping for a gesture from someone in particular, ask them about it and listen without passing judgment or trying to solve the problem for them.
  2. Offer moral support: The next best thing you can do is to try to normalize their feelings. Let children know that it is okay to feel worried, anxious, or to even want to avoid the whole day altogether. Help them think about the situation more positively by reminding them that it is one day, and the events of that day are often quickly forgotten.
  3. Check in with your child’s school: For younger kids, touch base with a teacher to find out if there is a classroom rule that each student gives and receives cards so there are no hurt feelings. With older kids or teenagers, try not to get too involved aside from providing moral support. Encourage teens to set an example and be inclusive with their own gestures, whether it be cards or treats.
  4. Be sensitive: When children come home from school on Valentine’s Day, try to read their mood and demeanor before you decide how to react. Be supportive, understanding and ready with a listening ear and fun distraction if the day did not turn out how they expected.
  5. Give your child a Valentine: Make sure to give your children a Valentine, even if that just means an extra hug to let them know they are loved at home. Also, remind children that every day is an opportunity to show how you feel.

Fever

What is a fever?

A fever is a body temperature of 100.4º F and higher.

Body temperature is controlled by a small center in the brain called the hypothalamus.  It’s a little regulating center in the brain that can purposefully raise or lower body temperature in response to different stimuli. The most common reason the hypothalamus raises the body temperature is to help the body fight an infection, whether it’s caused by bacteria, viruses or something else.

In adults, the hypothalamus keeps the temperature tightly regulated, but children tend to swing up and down all over the place, so they can jump from low to high and back down again fairly quickly.

In most fevers, the temperature can go really high – kids can go up to 105-106º F very easily, and it doesn’t necessarily mean they are any sicker than if they were in the 102-103º F range.

How to treat a fever

There are two basic categories of medications you can give your child as a fever reducer: acetaminophen and ibuprofen. Both work slightly differently, and both work to stimulate the body to lower the temperature.

Your doctor, nurse, or pharmacist can help you figure out the correct dosing for your child. Both medications are available over the counter, meaning you don’t need a prescription for them.

When to seek medical care for a fever

If you have a baby that is three months or younger, you should take them to the doctor or emergency department as soon as they have a temperature of 100.4 º F or greater.  Fevers can indicate serious illness in young babies, and they definitely need a work up and evaluation by a physician immediately.

Babies in the 3-6 month range who received their two, and possibly four, month shots also need to be seen urgently for fever.

In older children who are fully vaccinated, fevers are very common. A fever can mean a simple cold or viral illness. It can also indicate ear infections, strep throat, influenza, pneumonia, urinary infections or vomiting and diarrheal infections like gastroenteritis. Some of those conditions require treatment, and some don’t.

You’ll also want to bring your child in if their fever isn’t responding to the appropriate doses of fever reducers, or if your child is showing any signs of difficulty breathing, decreased responsiveness or lethargy, changes in behavior, signs of dehydration or other concerns.

The truth is, kids get fevers. They just don’t regulate their temperatures the way adults do, and it’s perfectly normal for their temperatures to bounce up and down. Depending on your child’s age and the timing, you probably need a trip to the pediatrician to figure out the source, or if under 3 months, to your local hospital.

Children and Headaches

According to the National Headache Foundation, more than 10 million American children between the ages of 5 and 17 experience chronic headaches; this makes up 20 percent of all young people. So when your kid gets a headache, what should you do?

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches can be single or recurrent in nature, and localized to one or more areas of the head and face.

Headaches are typically divided into two categories: primary and secondary.

Primary headaches are due to the headache condition itself and not other conditions. For example, they can be caused by tight muscles, dilated blood vessels, changes in communication between parts of the nervous system or inflammation of the structures in the brain. There are three types of primary headaches: migraines, tension headaches and cluster headaches.

Secondary headaches are caused by problems in the structure of the brain, or by other health conditions and diseases. Secondary headaches are the least common type of headache and typically increase in frequency over time. They may be associated with other neurologic symptoms or signs, such as fever, excessive vomiting, double vision or periods of confusion that are otherwise unexplained.

How to treat your child’s headaches

The good news is that most kids don’t need lab tests or MRIs for headaches. Headaches can usually be treated at home with rest, quiet, plenty of fluids and over-the-counter pain relievers. An electrolyte-filled drink like Gatorade, Powerade or coconut water will help break the headache quickly. If you use ibuprofen, be sure not to use it more than three days in a week – people who overuse it can develop daily headaches.

If your child feels fine and wants to play outside or go to school, they can, even with a headache.

How do I prevent headaches?

Most patients with headaches respond to basic healthy lifestyle changes that reduce headache frequency and intensity. Common goals include drinking specific amount of fluids every day, avoiding caffeine and artificial sweeteners, daily aerobic exercise, regular sleep cycles and a healthy, well-balanced diet. In a study in the New England Journal of Medicine, more than 70 percent of children and adolescents showed improvement in their headaches when they performed these lifestyle changes for a period of several months.

When to see a Healthcare Clinician

If your child has headaches on a regular (or daily) basis, or their headaches are increasing in frequency, you should consult your healthcare clinician. Other reasons to consult a doctor are if the headache wakes your child up out of sleep or if their headache has lasted for longer than three days and it won’t go away.

If you have any questions about your child’s headaches or how to treat them, do not hesitate to contact your child’s healthcare clinician.

Internet Bullying

Children and teens spend much of their time online, which makes bullying even easier. Cyberbullying allows the bully to be bolder, due to the possible anonymity, and allows the bully to reach the victim at any time of the day or night, leaving the victim with nowhere to hide. Another reason cyberbullying can be worse than physical bullying is the fact that it spreads much more quickly. Cyberbullying has been used for many purposes, and often parents have no idea their child is being bullied because the child is hesitant to tell them.

Keeping bullies at bay

  • Block the bully from your child’s account, and do not respond to any messages from the bully.
  • Refrain from sharing contact information online, such as email address and phone numbers.
  • Take pictures of threatening messages for evidence.
  • Remind your child to report any bullying or threatening messages to an authority figure.
  • Visit sites such as stopcyberbullying.org and wiredsafety.org to learn about how to deal with bullying and other internet safety tips.

Besides internet bullying, another concern is internet crime, as offenders continue to become smarter and sneakier and are able to lure children in. Parents should be cognizant of the ease of accessibility to their children for internet predators, and be sure their children are aware of the potential online dangers.

Find other tactics parents should employ to protect their children, along with these:

  • Use parental controls to block certain websites, and monitor chat room use.
  • Maintain access to your child’s account, and monitor it regularly.
  • Tell your child to NEVER arrange a meeting with anyone they met online.

Parents that allow their children to be involved on the internet and on social networks should also have an online presence. Not only does this allow parents to monitor their child’s activities, it also provides a new means to bond with their children.

E-Cigarettes and Vaping

E-cigarettes are a growing concern because of their availability, addictiveness and attractiveness to teens. But what exactly are e-cigarettes and why are they so bad? And how should you talk to your kids about their potential dangers? Below are answers to some common questions many parents have about vaping, e-cigarettes and teens.

What are e-cigarettes?

Electronic Nicotine Delivery Systems (ENDS) – also known as e-cigarettes, personal vaporizers, vape pens, vaping devices, or by brand name, e.g., JUUL – are battery-powered devices that produce a vaporized mixture of liquid composed of flavorings (such as fruit, candy, peppermint or chocolate), chemicals and often nicotine that are inhaled by the user. The devices can resemble traditional tobacco products like cigarettes, but teens are more likely to use devices that pass as small common gadgets such as USB memory sticks or pens.

According to the American Academy of Pediatrics, e-cigarette use has sharply risen and is now the most commonly used nicotine product among youth. The vaping “epidemic” has infected 12 of every 100 high schoolers (who in 2017 endorsed use of an e-cigarette in the last 30 days), with use starting as young as 12 years old.

Why are e-cigarettes dangerous?

The harms from e-cigarettes come in at least three ways. First, the vapor itself contains toxic and carcinogenic chemicals and metals that harm the lungs short-term with inflammation (which may make youth more prone to pneumonia, asthma attacks and decreased sports endurance). Inhaling hot vapor also may temporarily cause dehydration and taste bud damage that results in decreased sense of taste or smell (“vaper’s tongue”), as well as nosebleeds. The long-term effects of vaping on the body are not yet fully known, so there is no known safe amount that can be recommended…even if it’s “nicotine-free.”

Second, the developing brain (up until age 25 years) is uniquely susceptible to nicotine. Even one inhalation of nicotine can alter the brain to crave more and start the cycle of vaping more often to get rid of unwanted nicotine withdrawal symptoms. Imagine what happens in the brains of teens who vape a whole JUUL pod per day (each pod contains about as much nicotine as a pack of cigarettes). If your family has a history of addictions, your teen is at higher risk of nicotine dependence when using ENDS.

The negative effects of nicotine on the body are cumulative and include increased blood pressure and heart rate and stomach ulcers. Youth may complain of heart racing, chest palpitations or abdominal pain, especially if they also consume caffeine from coffee, soda or energy drinks. Life threatening arrhythmias (abnormal heart rhythms) and heart disease may occur long-term.

Third, vaping poses risks to others. Accidental ingestion of the highly concentrated e-juice used to refill the e-cig devices is an increasing source of infant and child nicotine poisonings. While some e-cigarette devices have cartridges that are replaced as a whole, many have pods that require refilling with a dropper from a bottle of e-juice obtained online or from a vape shop. Adults should keep these products out of children’s reach. E-cigarettes that have substantial plumes of vapor also pose a health risk for bystanders who breathe in the polluted air. However, certain low-vapor devices are more popular with youth, e.g, JUUL, PHIX, and Suorin, possibly because fewer plumes facilitate undetected use on school grounds.

Although most youth hold negative views about traditional cigarette use that prevent them from uptake, they do not perceive harm in e-cigarette use. Unfortunately, kids who use e-cigarettes are more likely to transition to traditional cigarettes and suffer the better-known negative health consequences.

How do I talk to my teen about e-cigarettes?

It’s very important to communicate openly with your teen about e-cigarettes and vaping; ideally starting just before middle school. You can start a conversation with questions like “Do any of your friends use electronic cigarettes or vape?” Or “what are your thoughts about vaping?” Teens rarely identify themselves as “smokers” or “vapers” or “regular users.” One way to get around this is to ask them specific questions about behaviors, such as “Have you ever tried an e-cigarette?”

Teens respond better to specifics about the dangers of ENDS (see above), rather than being told “it’s bad” or “just say no.” Most young adults have a negative view of people who use traditional tobacco products, but that view doesn’t always transfer to e-cigarettes. By pointing out that e-cigarettes contain nicotine and still carry some of the same risks as other forms of tobacco, you can help them make that connection. You should also remind them that the contents of what they inhale may contain nicotine despite labeling, or may be spiked with cannabis extract without being able to tell (or smell).

You can also have a cigarette smoker in the family explain the challenges they’ve faced cutting down or quitting their nicotine addiction as a prevention message to youth. While adults already addicted to nicotine products may use ENDS as a harm-reduction or cessation strategy, it is important to point out that the use of ENDS by teens can lead to nicotine addiction since their brains are still developing.

If you don’t seem to be getting through to your teen, consider enlisting your pediatrician or adolescent medicine specialist to talk with them confidentially. Youth are more likely to engage in discussions about risk behaviors, like use of e-cigarettes, if they have time alone with their health care provider.

How can I tell if my teen is using e-cigarettes?

Unfortunately there is no easy way to tell if your teen is using e-cigarettes. Unlike traditional cigarettes, ENDS come in all shapes and sizes, may have small plumes of vapor that can be blown away discretely, and don’t have the odor associated with burning tobacco. It is definitely not a good idea to go through your child’s room or bag looking for e-cigarettes, cartridges, or containers of e-juice. Instead, opt for open and consistent communication, especially if you notice unfamiliar USB drives or parts in the trash bin. Warning signs that your child may be using nicotine products relate to the side effects, such as increased thirst or sudden avoidance of caffeinated products.

What should I do if my teen smokes e-cigarettes?

If your teen does smoke e-cigarettes, you should talk to them about their expectations. Ask them how often they think it’s okay to use cigarettes without long term health consequences. Then explain that vaping just once a week can easily increase to twice a week, then daily and eventually lead to addiction.

Emphasize that you want your teen to quit vaping, but don’t use commands, threats or ultimatums. Instead, ask your teen why they started using ENDS and what are the good and not-so good things about their use. Understanding what motivates them can help you address the situation and help them identify ways to cut down or stop. Once you set a quit date, co-develop a plan to help them distract themselves from cravings and have them write it all down. Encourage them to hang out with friends who don’t use ENDS or smoke cigarettes and practice how they might turn down offers to use by peers.

Your healthcare provider or school counselor can also provide support, or you can call 1-800-QUIT-NOW – a toll-free number operated by the National Cancer Institute that will connect you directly to your state’s tobacco Quitline. Quitlines offer free advice and counselling to teens and adults, information about nicotine replacement products, self-help materials and referrals to other cessation resources. Most teens should be able to quit nicotine use with the support of their family and friends, but your adolescent medicine specialist or pediatrician can help make decisions about whether to use nicotine replacement therapy.

Is My Child Too Sick For School?

According to the Center For Disease Control (CDC). the common cold is the main reason for school absences each year. Additionally, about 40 percent of children between the ages of 5 and 17, missed three or more school days this past year because of illness or injury.

It’s often hard to draw a line on when to send your kid back to school after he has been sick and when to keep him home an extra day.

“Kids should stay home, if they have fevers over 100.5 degrees,” say CDC officials. “Then, the child should stay home until 24 hours without a fever have passed.”

Children also need to stay away from school if they need regular, special attention, for example if they are throwing up, need to take multiple naps throughout the day, or are on a nebulizer treatment. Staying home from school when the child is experiencing the above symptoms, not only helps the child get better faster, but also spares fellow students from catching various bugs.

CDC officials point out symptoms that children can have and still attend school.

Safe symptoms: 

  • Have a cold, but no fever
  • Runny nose or cough is present: Just make sure to wash hands frequently!
  • Green snot: Contrary to popular belief, the presence of green mucous does not mean a child is sick, it actually is a sign he is getting better.
  • Eating normally
  • Child is energetic

“Of course there are tons of different types of illnesses, each with their own exclusion criteria, but they are so individualized. Just makes sure to ask your child’s healthcare provider if you have any questions,” say officials. “And make sure you ask when your child can go back.”