Water Fears

Whether it’s on the beach or at the pool, many kids spend time engaged in water activities over their summer break. For most children, this is cause for celebration. But for some, these activities can cause a lot of anxiety. A fear of water can develop for many reasons, including:

  • A naturally anxious temperament
  • Seeing parents or friends who are afraid of water
  • A bad experience
  • Exposure to news of events like shark attacks or other children drowning

It is important to foster a healthy sense of respect and regard for water in your child, as there can be some risk of injury or death to children around water.  How do parents do this without creating fear in their children that prevents them from enjoying water sports and other activities? And, how can parents help a child who is afraid of the water?

First of all, it is important to talk to kids about how water can, and should be, a lot of fun, but that it can also be dangerous if kids don’t follow basic rules. Have a family meeting about rules around the water. Rules can include: always letting an adult know when you are going in the water and checking in when you get out of the water. You should emphasize that the pool rules (no running, no diving, etc.) should always be followed or the child must leave the pool immediately. For parents, make sure your kids are properly supervised to their level of ability in the water. Even with all these rules, it is important to convey to your children that they can have fun and be safe around the water.

If you have a child who is scared of water, don’t belittle them or tell them “not to worry.” Ask them what they are afraid of and let them know their feelings are okay.  It can be helpful to teach kids that their fear levels sometimes get out of whack, like a smoke alarm. If their fear (or what I call a “danger detector”) is set to go off too easily, they may miss out on some things that are actually safe and fun. This can happen with a fear of water. Let your child know that as a team, you can reset their danger detector.

To do this, encourage your child to get used to the water gradually and together. For instance, start with putting toes in. Praise them for trying! Next, put feet in, and so on. Keep praising, reassuring, and helping your child calm his or her fears through breathing or distraction. Sometimes it helps to remind them that the scary feelings, such as their heart beating fast or butterflies in their stomach, is just their danger detector going off and they have to use their brain to remind their body that it is okay! Tell them what a great job they are doing. Little by little, they may be able to work through their fear. If you need to use rewards, that can work too. For example, if they can stand in knee-deep water in the pool for a minute, they can get a nickel, or be allowed to play a favorite game for five minutes.

If your own efforts are not working and the child’s fear of water is getting in the way of family fun, a psychologist with expertise in treating specific phobias may be able to help.

Is My Child Ready For Camp?

Lots of kids love sleepaway camp. But how do you know when your child is ready for camp?

Generally, children are ready for an overnight camp between 8-10 years of age. Parents know their children best and should know if they are mature enough to handle it. A shorter, “trial” camp is often a good route for first-time campers.

Some indicators that your child may be ready:

  • He can get himself dressed, teeth and hair brushed and show some independence during daily routines
  • She has had a successful sleepover at a friend’s house
  • Your child is able to verbalize concerns to an adult comfortably

Benefits of summer camps

  • Provide opportunities to develop maturity and independence
  • Promote flexibility, problem solving and social skills (in a fun setting)
  • Specialty camps – for specific sports, interests or children with specific diseases – offer a way for kids to gain new skills with kids who have similar interests.

Talk with your child about camp

Include him in the decision-making process to find a camp that’s right. Schedule a tour of the camp ahead of time if you can.

Another tip is to talk with your child about specific scenarios and how to handle them. What if she doesn’t like the food one day? Or if she’s feeling sick? Counselors are trained to handle these situations so encourage them to confide in a camp counselor.

Manage your own expectations – and emotions!

Many children have a great time at camp and often forget to call or write home every day. And if they do, you should be prepared to hear a range of emotions. If your child is upset, be supportive – but don’t give him an easy out to come home. Everyone has bad days, and learning to cope with them is part of the experience.

Telling your child that you have confidence in them to succeed at camp is also important. Also, kids pick up on adults’ social cues, so if you’re anxious about camp, try not to show it!

Button Batteries

As we all know, young children have a tendency to put random objects in their mouths. They are particularly drawn to colorful and shiny objects, including button batteries which are about the size of a small coin. Unfortunately, these tiny batteries can cause major injuries, or even death, if ingested.

Due to advances in technology, lithium button batteries are becoming more and more prevalent. They are commonly used in everyday household items such as car remote controls, hearing aids, calculators, children’s toys, scales and television remotes. This has led to remarkable rates of button battery ingestions – over 3,000 are reported in the U.S. annually.

When swallowed, button batteries pose a high risk for injury and complications – including death – because of the chemical reaction they can cause in the esophagus, or food pipe. The esophagus is located near several other important structures in the body, like the aorta (main blood vessel leaving the heart) and the trachea (windpipe), and the chemical reaction caused by the battery can cause the lining of the esophagus to erode. If the battery is not removed promptly, the erosion can cause the esophagus to connect to the trachea or aorta leading to bleeding or difficulty breathing.

What can parents do about button batteries?

Like with most health issues, prevention is key. Button batteries may seem relatively harmless; however they must be kept securely away from children. In the event of an accidental ingestion, you should first call 9-1-1 and then poison control (1-800-222-1222).

There are also some things you can do to reduce the risk of serious injury while waiting for the ambulance.

Recent studies have shown that a coating substance can protect the esophagus from the damage caused by the chemical reaction from the battery. A medication called carafate can provide this protection, but unfortunately it is only available from physicians. However, honey is a common household product which has similar protective properties.

If possible, and if the child is able to swallow, give 10 mL (2 tsp) of honey by mouth to children older than 12 months every 10 minutes, up to 3 doses. Children under 12 months of age are at risk for serious infections from unpasteurized honey and should not be given honey.

Do not give honey if the battery was possibly in the esophagus for more than 12 hours. Honey administration is not a substitute for emergent battery removal. It can slow tissue damage, but it does not completely prevent it from occurring. Battery removal should not be delayed because a patient has eaten recently or because a patient was given honey or carafate by mouth.

Remember: swallowing a button battery is a medical emergency, and it should be dealt with immediately.

Healthy Eating and the Immune System

You can probably feel it coming: A scratchy throat, a cough that just won’t quit and that tired, achy feeling. I work with families every day to guide them toward healthy choices that help children grow up stronger. One of the most common questions parents ask me throughout the winter months is, “How can I keep my children from catching a cold or the flu this season?” While warding off sickness requires a daily commitment to healthy choices beyond just nutrition – such as staying active and exercising, getting enough sleep and washing your hands regularly – eating a well-balanced, colorful diet can also help you avoid common pitfalls.

Channel your inner Bobby Flay or Julia Child

By including children in snack and meal prep, choosing healthy foods can be fun. Set up a make-your-own smoothie station for kids to invent new smoothie flavors using low-fat dairy yogurt and their favorite fruits and vegetables. Strawberries are loaded with vitamin C and are easy to grab from the frozen section of the grocery store. Or pretend to be a famous Italian chef, cooking up mini-pizzas made with whole grain English muffins or pita bread, sauce and low-fat cheese. Top with veggies like spinach for vitamin E or red bell pepper slices for vitamin A.

Turn water into a sweet treat

Water is the cornerstone of a healthy immune system. It transports nutrients and oxygen to cells throughout the body, and it carries away waste products and toxins. But getting children to drink the recommended amount of water each day – approximately 5 to 10 cups based on age – can be daunting. Turn up the flavor and make water a sweet treat by freezing strawberries, blueberries and other fruit into ice cubes or using an infuser.

Be on the lookout for these missing colors

Many families don’t have trouble getting enough starchy vegetables such as potatoes and corn, but as the U.S. Department of Agriculture’s MyPlate tool points out, we all need to focus on eating more dark green, red and orange vegetables. These veggies give us fiber, vitamins, minerals and other nutrients to keep our bodies and immune systems healthy. For example, dark green vegetables can provide vitamin K, folic acid, potassium and omega-3 fatty acids. Red and orange vegetables also can be great sources of powerful antioxidants, such as lycopene and beta carotene. Turn capturing these nutrients into an activity by making a veggie skewers workshop and encouraging kids to assemble the most colorful mix of vegetables possible.

Avoid chugging orange juice

Unfortunately, a mega-dose of a nutrient won’t have a magical effect on the immune system. If you don’t have deficiencies, there is no evidence that taking extra amounts of any vitamin will protect you. Instead, take small steps every day to keep your family healthy and make sure you’re getting the recommended servings of fruits and vegetables. It’s likely more enjoyable than chugging orange juice and will help keep your immune system strong.

Putting Your Baby To Sleep

Sudden Infant Death Syndrome or SIDS, is one of the leading causes of death in babies from 1 month to 1 year of age. Here is some advice on safe sleeping for your baby and possible risks leading to SIDS.

It is important for parents to know, particularly with infants under 4 months old, that bed-sharing is a factor in sudden infant death syndrome.

What’s the difference between co-sleeping and bed-sharing? 
Some people use them as synonyms but they are actually different. Co-sleeping is when the parent and baby are within sound sight, and/or touch. Bed sharing (sharing the same surface) is a subtype of co-sleeping. What we recommend is a type of co-sleeping within arm’s reach but on a separate surface.

How common is bed-sharing?

It is very common. If you look at surveys, they will tell you anywhere from 25 to 75 percent of parents bed share any time at night. That’s what people are telling us, but actually numbers are probably much higher.

Suppose parents balk at the idea of not having their infants in the bed with them at night – whether for bonding, convenience, or economics?

My goal is to make sure you have a child to bond with at the end of one year. The bottom line is this: Is it worth the risk to take that chance? Even if you are doing everything right, your baby is at five times the risk of dying when you bed-share.

You can also bond with your baby when you are awake. Bonding when everyone’s awake is probably actually more productive and more useful in the long run.

Safe sleeping tips

  • Always put baby on his/her back for sleep
  • Don’t smoke around the baby
  • Use a crib with a firm sleep surface and place it next to your bed
  • Remove loose or soft bedding including blankets, pillows, bumper pads and stuffed animals from where your baby is sleeping
  • Use proper sleep clothing such as blanket sleepers
  • Avoid bed sharing and do not place baby on any soft cushiony surfaces to sleep
  • Use a pacifier, which protects against SIDS
  • Don’t overheat the room and don’t overdress your baby
  • Breastfeed your baby. If you nurse while sitting in bed, when you’re ready to go to sleep, put your baby in his or her own crib.
  • Make sure anyone who watches or takes care of your baby knows sleep safety protocol recommendations that you’re following

Winter Tips

When temperatures dip and snowflakes begin to fall, I – like many – am eager for the chance to dive under some cozy, warm blankets and spend the day curled up on the couch. Yes, I do love those restful days, but I also know that staying active and exercising throughout the frosty, snow-filled months is just as important.

As a pediatric nurse practitioner, I encourage families to take small steps every day toward ensuring their children grow up healthy and strong. During the winter months, getting enough exercise is one of the first areas we tend to overlook, but it’s critically important for strengthening growing hearts and lungs and preventing obesity. Choosing outdoor activities also can help limit the spread of colds and flu germs, which easily spread through close proximity and in enclosed spaces.

Parents often have concerns about how to keep their children safe and healthy while still being active outside during the winter, so here’s a list of answers to commonly asked questions to guide the way. As always, for specific questions related to your child’s health, I encourage all parents to seek advice from their pediatricians.

1.      Is it ever too cold for kids to play outside?

In our region, generally the answer is no. If the temperature is above 10 degrees Fahrenheit, it is safe for children to play outside as long as they are bundled up appropriately to stay warm. Extremities – hands and feet – are particularly vulnerable to overexposure from cold temperatures and wind. Be sure to dress children in warm gloves or mittens, a hat and thick socks. Wool socks are preferable.

2.      Is it safe to take my young child or baby out into the cold?

Parents are often hesitant about taking babies outside into the cold. However, families can enjoy outdoor activities together as long as the child is dressed appropriately, such as bundled in a warm snowsuit. For very young babies, I also recommend that moms use wearable baby carriers so little ones can snuggle up against a mom’s body for additional warmth.

3.      What if my child has asthma? Should I still encourage him/her to play outside in the winter?

For families with children who have asthma, parents often are wary of physical activity – particularly in colder temperatures. All exercise is beneficial for these children. If you know that cold air can trigger your child’s asthma, using a scarf to loosely cover the mouth and nose can warm and moisturize the air the child breathes. If your child is having trouble with wheezing and other asthma symptoms, seek help from your healthcare provider so therapy is optimized and your child can enjoy playing outside.

4.      Do kids need a winter skin care regimen?

Keeping the skin moisturized and protected with a layer of thick, fragrance-free moisturizer can help prevent chapping and keep skin from drying out. Be sure to target vulnerable areas, such as hands and cheeks.

5.      Kids don’t always keep their gloves and mittens on.  How do I know if their skin is overexposed? What should I do?

The fear of frostbite or overexposure is something many parents worry about. A warning sign of overexposure is if the hands don’t return to their normal temperature and pinkish color upon returning inside. If this happens, parents should warm their child’s hands between their own hands or place them under warm, but not hot, water. If hands still don’t return to their normal temperature and color, seek medical attention.

6.      Should I be worried about winter sports injuries?

Parents should always ensure that their children are wearing well-fitting protective gear that each sport requires. One critical area of importance is preventing head injuries. Children should always wear a helmet while skiing and playing ice hockey. I recommend wearing a helmet during ice skating and sledding as well. If your child is in an incident involving a forceful blow to the head or body that results in rapid movement of the head, check for symptoms of concussion. Contrary to popular belief, a child does not have to lose consciousness to sustain a concussion. In fact, nine out of 10 children do not lose consciousness. Parents should watch for any change in their child’s behavior, thinking or physical function. A more detailed list of concussion symptoms can be found on the Children’s National website. If your child has any of these symptoms, seek medical care immediately.

7.      My child really doesn’t like to play outside in cold weather. What should I do?

The aversion to outdoor winter activities can be caused by a variety of factors. For example, a child’s motor skills could be slightly behind, which could deter the child from wanting to participate in complex group activities, such as skiing or ice skating. The advice I typically give is to match the activity with the child’s interests and make it a family affair. If your children see you exercising and enjoying colder temperatures, they are more likely to as well.

Does My Kd Need Antibiotics?

When your child is sick, it is without a doubt that you want to do everything that you can to help them feel better. However, it is important to understand that antibiotics are not always the answer. Antibiotics are strong medicines that may come with side effects and other risks that you might not be aware of. When a patient needs antibiotics, the potential benefits that the antibiotics will deliver outweigh these risks.

When is it appropriate for my child to receive antibiotics?

Most infections are caused by two kinds of germs: bacteria or viruses. Antibiotics can cure bacterial infections only. Some examples of bacterial infections are strep throat and some types of pneumonias. Some examples of viruses are the common cold, most coughs and the flu. Yellow or green mucus does not necessarily mean that your child has a bacterial infection; it is normal for mucus to get thick and change color during a viral cold. Using antibiotics for a virus will not cure the infection, help your child feel better or keep others from catching your child’s illness. Viral illnesses are typically self-limiting, meaning that your child can fight the infection without targeted medicine against the virus.

What’s the harm in giving antibiotics anyway, even if my child might not have a bacterial infection?

Antibiotics can cause some bacteria in your child’s body to become resistant, or unable to be killed with certain antibiotics. This can become a problem later for future potential infections and can also be spread to others. Generally speaking, many common infections are becoming resistant to antibiotics. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are main drivers of resistance, with an estimated greater than half of antibiotics being unnecessarily prescribed to children in doctor office settings for cough and cold illness.

Antibiotics can also cause side effects, such as diarrhea, nausea, skin sensitivity and even Clostridium difficile-associated diarrhea. These side effects and allergic reactions cause 1 out of 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year.

What should I do when my child is sick?

The Centers for Disease Control and Prevention (CDC) suggest three important questions to ask your healthcare provider when your child is sick:

  1. What is the best treatment for my child’s illness?
  2. What do I need to know about the antibiotics that you’re prescribing for my child today?
  3. What can I do to help my child feel better?

When your provider prescribes an antibiotic to treat a bacterial infection, be sure to ensure its use as directed. If your provider thinks that your child has a virus, symptom management with pain relievers, fever reducers, saline nasal spray or drops, warm compresses and increasing liquid intake should help your child on the road to recovery.