Twenty One Things Every Parent Should Know

Twenty one things that every parent should know to help make parenting their kids a little easier and help them avoid common mistakes.

There is no need to use hydrogen peroxide on cuts and scrapes.
There is no need to use hydrogen peroxide on cuts and scrapes. Use soap and water instead.

You could just parent by instinct, but it is much better to supplement your instinct with a little helpful advice from some of the parents who have come before you.

While some of these things experts figured out through years and years of research, others are simply tips that folks figured out after making mistakes and understanding that there must be a better way to get things done.

  1. Vaccines are safe, necessary, and they work.
  2. Sleep is good. For everyone. Learn to help your baby sleep through the night by the time they are four to six months old.
  3. Three years is not a magic age at which every kid is potty trained. Some take a little longer. The main potty training mistake you can make is to push your kids when they aren’t ready.
  4. Some kids continue to wet the bed at night, even after they are potty trained.
  5. Don’t give aspirin to kids, even teens. It is a risk factor for getting Reye syndrome.
  6. If you still have them, safely dispose of mercury thermometers and syrup of ipecac.
  7. Experts don’t recommend that you use hydrogen peroxide to clean wounds any more. You can usually substitute soap and water instead.
  8. “Starve a fever; feed a cold” is an Old Wives’ Tale, like not drinking milk when your kids have a fever or diarrhea. It is not a real thing. If your child is sick and hungry, let them eat their regular diet. If they are sick and don’t want to eat, encourage them to at least drink a lot of fluids, and add bland foods, until they are ready to eat more.
  9. A green or yellow runny nose almost certainly means that your child has an infection, but unless it has been lingering for weeks or your child has a persistent high fever, then it is likely a viral infection that won’t respond to antibiotics.
  10. When your doctor prescribes antibiotics for your kids, think about whether the prescription is because your sick child needs it or because the doctor thinks you want it. Consider asking if your child might get better without antibiotics.
  11. Don’t force kids to “clean their plates” or eat foods that they really dislike. Picky eaters who are forced to eat are probably more likely to grow up to be picky adult eaters.
  12. Most kids, unless they are missing out on one or more food groups or have a chronic medical problem, probably don’t need a daily vitamin.
  13. Don’t just ask your kids if they are being bullied. Also ask if they ever bully  or see kids getting bullied. Someone is doing the bullying.
  14. All kids are different. Don’t compare them. Or at least don’t compare them too much. But talk to your pediatrician if your child’s growth and development really seems off-track compared to most other children.
  15. Some kids are harder to discipline than others. Try something else or get help if what you are doing isn’t working.
  16. Taking extra unnecessary risks, like hiding a loaded gun in the house, not having a fence around your backyard swimming pool, letting your kids ride a bike without a helmet, or letting them ride an ATV, etc., will increase the chances that your kids get hurt. Think about safety.
  17. Not every kid wants to play or is going to be good at team sports.
  18. Being on a “select” sports team probably doesn’t mean what you think it means. The selection process is just as likely to involve the fact that you can pay to be on the team and take extra lessons or classes, as it is to about your child’s skill level.
  19. For perspective, always remember that no matter how good or talented you think your child is, there is always another kid playing at a much higher level. That’s why so few end up playing in college or at higher levels.
  20. At some point, you child might say “I hate you!” Be ready, and understand that it almost certainly has nothing to do with you.
  21. The ‘free range kids’ movement is the opposite extreme to ‘helicopter parenting.’ Don’t fall for parenting fads.

And don’t believe everything you hear or read about parenting. Kids do come with instructions – good instructions, you just have to know when and where to get them. And who to trust.

Otherwise you could end up making all of the same mistakes that all of the rest of us have already made.

For More Information on Things Parents Should Know

Treating Hard to Control Nosebleeds

Don’t panic when your child has a bloody nose. Instead, encourage them to sit, lean, pinch, and wait and learn to prevent chronic nosebleeds.

Parents usually get scared when their kids get a nosebleed.

Fortunately, most nosebleeds aren’t serious. That doesn’t make them less scary when they are happening though, especially when it is your first or it doesn’t stop right away.

Nosebleeds

There are two things to understand about nosebleeds in kids. They are common and most of the things that you probably know about stopping them aren’t very helpful.

We no longer recommend tilting a child’s head back during a nosebleed, pinching the bridge of their nose, stuffing tissue into their nostrils, or holding a tissue lightly against their nostrils. Although your child’s nose will likely eventually stop bleeding with these methods, it will take a long time and it won’t be from any of those interventions.

Treating Nosebleeds

When your child has a nosebleed, the best treatment advice is to:

  • have your child sit down
  • encourage them to lean forward
  • pinch the tip of their nostrils firmly for five or ten minutes with their fingers or a tissue if it is available (don’t check every few minutes to see if it has stopped)
  • continue to pinch for another ten minutes if it is still bleeding (again, wait and don’t check every few minutes to see if it has stopped)
  • for persistent bleeding, some experts recommend blowing out the clot, spraying a nasal decongestant into your child’s nostril, and then applying firm pressure for ten minutes

If blood is still coming out while you are pinching the soft, lower part of your child’s nose, then you likely aren’t pinching firmly enough or may not be pinching in the right spot. Pinching the bony part doesn’t help.

Keep in mind that it takes at least a few days for blood vessels to heal, so your child  might easily get another bloody nose in the hours or days after a nosebleed. That’s why some kids might get a nose bleed without really doing anything to provoke it.

After a bloody nose, you might encourage your child to avoid blowing out the clot in their nostrils and leave their nose alone.

Treating Hard to Control Nosebleeds

What about if your child has hard to control nosebleeds?

If the nosebleed is hard to control because it just won’t stop after about 20 minutes, then you likely need to seek quick medical attention.

On the other hand, if you can stop your child’s nosebleeds, but they are hard to control because they keep coming back, then ask yourself these questions and share the answers with your pediatrician:

  • Are your child’s nosebleeds seasonal, which could mean that allergies are a trigger?
  • Have you been using a nasal steroid to treat your child’s allergies? Nosebleeds can sometimes be a side effect of using a steroid nose spray, especially if you don’t spray towards the outside of the nostril when you use them.
  • Does your child frequently pick his nose?
  • Have you noticed any other signs of heavy bleeding or easy, large bruising? If not, a bleeding disorder is almost certainly not causing your child’s nose to bleed.
  • Do your child’s nosebleeds increase in the winter, when it is dry in the house?
  • Does anyone in the house smoke? Second hand smoke is an irritant.
  • Has your child been using a nasal decongestant for more than a few days? That can dry out your child’s nasal passages and lead to nose bleeds.
  • Could your child’s head or nose have been hit recently?
  • Did your child stick anything in his nose?

In addition to treating uncontrolled allergies, things that might help chronic nosebleeds include keeping your child’s nails cut short, encouraging your child to not pick his nose, using nasal gel (or Vaseline) or saline spray to keep your child’s nostrils moist (can discourage picking too), using a cool mist humidifier (this can increase mold and dust mites and make allergies worse though), and avoiding second hand smoke.

A pediatric ENT can help your child with chronic nosebleeds when routine treatments don’t work. Although a little painful, cautery with a silver nitrate stick is an option to seal blood vessels in the nose for some kids who keep getting nosebleeds.

What To Know About Treating Hard to Control Nosebleeds

Don’t panic when your child has a bloody nose. Instead, encourage them to sit, lean, pinch, and wait and learn to prevent chronic nosebleeds.

More Information About Treating Hard to Control Nosebleeds

Treating Hard to Control RSV

RSV is never really easy to control for infants and toddlers, as there is no treatment or cure, but fortunately, most kids do not have severe symptoms that require hospitalizations.

With a cough, wheezing, and trouble breathing that can linger for weeks, all RSV infections probably seem like they are hard to control, especially since up to 2% of kids, mostly high-risk infants, with RSV require hospitalization.

Still, it’s important to remember that for many kids, RSV is just a cold.

Understanding RSV

Since there is no cure or treatment, it is best to learn to protect your kids from RSV.
Since there is no cure or treatment, it is best to learn to protect your kids from RSV.

The first thing to understand about RSV is that it isn’t a disease.

Instead, RSV, or the respiratory syncytial virus, can cause many different kinds of upper and lower respiratory infections, ranging from the common cold and croup to bronchiolitis and viral pneumonia.

And almost all kids get sick with RSV at some point during the first few years of their life, especially if they are in daycare.

Fortunately, although RSV can cause life-threatening infections, especially in high-risk infants, the great majority of  children get over their symptoms without any special treatments.

And infants who are the most high risk, including premature babies who were born at less than 29 weeks, can get five monthly doses of palivizumab (Synagis) during RSV reason to reduce their chances of getting sick. Infants with hemodynamically significant heart disease or chronic lung disease of prematurity can also get palivizumab.

Treating RSV

Many of the classic treatments for RSV have now fallen out of favor with pediatricians. In fact, the American Academy of Pediatricians now advises against using albuterol breathing treatments, epinephrine, steroids, or chest physiotherapy (CPT) for infants with RSV bronchiolitis.

What’s left?

Not much, except pushing your child to drink and treating cold symptoms as possible.

The AAP even advises against routinely testing kids for RSV. That makes sense, since there is no treatment, kids can sometimes be contagious for 3 to 4 weeks, long after they have returned to daycare without symptoms, and other viruses can cause similar symptoms.

Instead, if your child has symptoms of RSV, especially if she was around someone else with RSV symptoms about two to eight days ago or is simply in daycare during RSV season (usually November to April), then it is safe to assume that your child has RSV.

Also understand that antibiotics have no role in the treatment of uncomplicated RSV infections. RSV is a virus. Antibiotics do not work against viral infections.

Going to Day Care with RSV

Since many kids who get RSV are in day care, the million dollar question often becomes, when can my child with RSV go back to day care?

“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”

AAP Red Book 2015

Although I once had the manager of a day care argue with me that a child needed to test RSV negative before being allowed back into her day care, kids can usually go back, even if they still have cold symptoms, as long as they:

  • don’t have a fever for 24 hours
  • don’t have any trouble breathing
  • are not fussy or irritable

Since these kids will likely be contagious, the AAP recommends that “In child care centers, good hygiene practices should be used by the staff and the children, including frequent and thorough hand washing.”

Treating Hard to Control RSV

If your child has RSV symptoms and isn’t getting better, ask yourself these questions and bring the answers to your pediatrician or seek quick medical attention:

“Some youngsters with bronchiolitis may have to be hospitalized for treatment with oxygen. If your child is unable to drink because of rapid breathing, he may need to receive intravenous fluids.”

American Academy of Pediatrics

  • Do you think your child’s symptoms are hard to control, not because they are getting worse, but rather because they are lingering for several weeks, which can be normal when young kids have RSV?
  • Does your newborn or infant under two or three months have a fever (temperature at or above 100.4F/38C)?
  • Is your child having trouble breathing, such as breathing fast or hard, with chest retractions (chest caving in), nasal flaring, trouble catching his breath, or a non-stop, continuous cough?
  • Do you see any signs that your child isn’t getting enough oxygen, including that “his fingertips and the area around his lips may turn a bluish color?”
  • Is your child dehydrated, with less urine output, dry mouth, or no tears?
  • Does your child have any medical problems that put her at higher risk for a severe RSV infection, including extreme prematurity, having complex heart disease, chronic lung disease of prematurity, or immune system problems?
  • Is your child lethargic, which doesn’t simply mean that he is just playing less, but rather that he is actually hard to wake up and is maybe skipping feedings?

If your child with RSV is getting worse, although there aren’t any special treatments to make the RSV infection go away, supportive care is available to help your child through it, including IV fluids and supplemental oxygen. Those who are most sick sometimes end up on a ventilator to help them breath, and tragically, some infants with RSV die.

What To Know About Treating Hard to Control RSV

RSV is never really easy to control for infants and toddlers, as there is no treatment or cure, but fortunately, most kids do not have severe symptoms that require hospitalizations.

More Information About Treating Hard to Control RSV

Save

Tom Price as HHS Secretary – Good for Kids?

Tom Price is not going to support and improve the ACA (Obamacare), strengthen CHIP, or improve access to Medicaid services. He is basically against everything the American Academy of Pediatrics supports.

Many are describing President-elect’s choice of Representative Tom Price as the secretary of health and human services as “scary” and a “radical choice.”

To understand why, you should both understand what he believes and what his job will be.

The HHS Secretary

HHS Secretary Sebelius at a meeting of the Interagency Autism Coordinating Committee.
HHS Secretary Sebelius, NIH Director Dr. Francis Collins, and others, listen to a speech at the a meeting of the Interagency Autism Coordinating Committee, July 10, 2012. (HHS photo by Chris Smith)

Surprisingly, few people probably know the name of the current HHS secretary – Sylvia Mathews Burwell.

She succeeded Kathleen Sebelius, who resigned in 2014, mostly over problems with the healthcare.gov website and roll-out of the Affordable Care Act.

What does the HHS Secretary do?

As head of the United States Department of Health and Human Services, the HHS Secretary is a member of the President’s Cabinet and overseas the:

  • Administration for Children and Families (ACF)
  • Administration for Community Living (ACL)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

As you probably recognize at least a few of those names, like the FDA, CDC, and NIH, you likely know that these agencies “administer a wide variety of health and human services and conduct life-saving research for the nation, protecting and serving all Americans.”

That work can be seen in the current strategic plan of the HHS:

  1. To Strengthen Health Care
  2. To Advance Scientific Knowledge and Innovation
  3. To Advance the Health, Safety, and Well-Being of the American People
  4. To Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

And it can be seen in many of the current problems they are tackling, such as combating the opioid epidemic, lead poisoning hazards, the Zika virus, and continuing to get more people insurance coverage, etc.

Problems with Tom Price as HHS Secretary

So what might be the problem with Rep. Tom Price as HHS Secretary, after all, he is a doctor and has been endorsed by the AMA?

“The Association of American Physicians and Surgeons recommends a policy of Non-Participation to all physicians as the only legal, moral, and ethical means of concretely expressing their complete disapproval of the spirit and philosophy behind these amendments.”

THE PRINCIPLES OF MEDICAL ETHICS OF THE ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), an organization of doctors that was opposed to the establishment of Medicare and Medicaid and which tells its members that it is “legal, moral, and ethical” to not treat patients on Medicare and Medicaid.

The AAPS is also against birth control and pushes a lot of anti-vaccine misinformation that can scare parents away from getting their kids vaccinated and protected against vaccine-preventable diseases!

A Radical Choice

In describing Tom Price as a “radical choice” for HHS Secretary, the New York Times stated that he is “a man intent on systematically weakening, if not demolishing, the nation’s health care safety net.”

In addition to supporting the repeal of Obamacare, Tom Price is a climate change denier, and has been in favor of:

  • block granting Medicaid
  • turning Medicare into a voucher program, which many think is a step towards privatization
  • barring all federal funds for Planned Parenthood, even though the very great majority of their activities have nothing to do with abortion
  • limiting participation in Children’s Health Insurance Program (CHIP) and voting against expanding CHIP several times
  • cutting billions of dollars from the Supplemental Nutrition Assistance Program (SNAP or food stamps) as it was converted to a State Flexibility Fund in the 2015 GOP proposed budget
  • continuing to ban research on gun violence at the CDC as he did not sign a letter with a bipartisan group of 146 other members of Congress, led by Congressman David Price, calling for a lift of the de-facto ban on federal gun violence research

And although his nomination was supported by the AMA, the American Academy of Family Physicians (AAFP), and the Association of American Medical Colleges (AAMC), there are many doctors and medical students who think that “Price’s stances are incompatible with the values of the medical profession and with the stated missions of the above organizations.”

The AAP on the Nomination of Tom Price

What has the American Academy of Pediatrics said about Tom Price’s nomination?

“Above all, HHS should strive to implement an agenda with children at the core and ensure that all children have access to high-quality, affordable health care so they can thrive throughout their lifetimes. All children, regardless of their immigration status, should have affordable health care coverage, insurance with pediatric-appropriate benefits, access to timely and affordable primary and subspecialty pediatric care and mental health services, and receive comprehensive, family-centered care in a medical home.”

AAP’s Blueprint for Children

As is their style, they have not issued a statement, but reviewing the AAP’s Blueprint for Children, it isn’t too hard to figure out what they would say.

Members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.
Although they are not always successful, members of the American Academy of Pediatrics routinely volunteer to lobby members of Congress to support pediatric issues, like CHIP re-authorization.

The Blueprint, which “presents specific policy recommendations for the federal government to align its activities to promote healthy children, support secure families, build strong communities, and ensure that the United States is a leading nation for children,” states that they:

  • oppose block grants for Medicaid and other entitlement programs
  • support renewing and strengthening CHIP
  • support maternal and reproductive health programs
  • want to improve access to Medicaid services
  • support protecting and strengthening federal nutrition programs for children and families, including SNAP and WIC
  • support federally funded research to build the evidence base for a public health response to violence, including research on gun violence coordinated by the Centers for Disease Control and Prevention (CDC)
  • want the administration to aggressively addresses climate change
  • support the enactment of comprehensive immigration reform that prioritizes the health, well-being, and safety of children
  • want the administration to address factors that make some children more vulnerable than others, such as race, ethnicity, religion, sexual orientation or gender identity, and disability

And perhaps the thing that is most apparently in conflict with Tom Price’s nomination, the AAP states that they want the HHS secretary and Congress to:

Support and improve the ACA. The ACA has made important progress for children. Congress should improve upon this progress and enhance pediatric benefits in the marketplaces, allow families that are not eligible for CHIP to purchase CHIP plans in the health insurance marketplaces, improve affordability of plans for families (especially those with children with special health care needs), and strengthen rules to ensure that adequate pediatric networks exist in marketplace plans.”

Tom Price is not going to support and improve the ACA (Obamacare), strengthen CHIP, or improve access to Medicaid services. He is basically against just about everything the American Academy of Pediatrics supports and has been working for.

We don’t need a statement from the AAP to know what that means.

 

Treating Hard To Control Cold Symptoms

Perhaps the only thing more frustrating than having a cold, is having a child with a cold and feeling helpless that you can’t do more to control their cold symptoms.

There are many viruses that can cause a cold, which means that your kids can get a cold every few weeks or months, and year after year.

And unfortunately, there is no cure or vaccine to prevent your kids from getting these colds. That often leads parents to try and look for ways to help their kids feel better when they have a cold.

Cold Symptoms

Before trying to treat your child’s cold, you have to figure out when they have a cold.

Colds are often misdiagnosed as allergies, sinus infections, and even the flu.

That shouldn’t be too surprising when you look at the classic cold symptoms, which can include:

  • a runny nose – with clear, yellow, or green drainage (green doesn’t mean that it is a sinus infection!)
  • coughing – often from post-nasal drip
  • sore throat – often from post-nasal drip
  • sneezing
  • watery eyes
  • a low grade fever (usually under 102.2F or 39C) for the first few days
  • mild headaches
  • mild body aches

That’s right, you can have a fever with a cold!

Most importantly, understand that cold symptoms typically worsen over the first three to five days and then gradually get better over the next seven to ten days. So they can easily last for a good two weeks, although you can expect improvement in that second week.

Treating Cold Symptoms

Most cough and cold medicines should not be used in kids under age four to six years.
Most cough and cold medicines should not be used in kids under age four to six years.

So how should you treat your child’s cold?

A pediatrician I once worked with when I was a student used to recommend “soup, suckers, and showers.”

However, since treating the symptoms won’t help the cold go away, you could do nothing at all. While that might seem harsh, keep in mind that colds go away on their own and most of the things that we do to treat cold symptoms don’t actually work all that well.

Still, if your child has a cold and doesn’t feel good, some soup and popsicles (suckers) couldn’t hurt. Nor could some time in the bathroom with the door closed and a hot shower going, so your child can breath in the steam (while being supervised).

What about cough and cold medicines?

Because of the risk of serious, sometimes life-threatening side effects, since 2007, cough and cold medicines have carried the warning “do not use in children under 4 years of age.” So anything you find over-the-counter for younger kids now is either homeopathic (diluted to nothing) or just has honey as its main ingredient.

Treating Hard To Control Cold Symptoms

What else can you do to help control your child’s cold symptoms?

You could try:

  • Letting him continue with his usual activities, including going to daycare or school, if he doesn’t have a fever and isn’t overly bothered by his cold symptoms.
  • Encouraging your child to drink extra fluids.
  • Using a cool mist humidifier.
  • Spraying a saline spray or nose drops into your child’s nose.
  • Suctioning your younger child’s nose with a bulb syringe after using saline nose drops. Keep in mind that even with specialty gadgets, like the NoseFrida, you can’t do deep suctioning like they do in the hospital, so any benefits will be very temporary. And this type of suctioning is for symptomatic relief, it won’t help your child get better any faster.
  • Suctioning your younger child’s nose with a bulb syringe without saline nose drops.
  • Encouraging your older child to blow his nose, although since this is mainly to help him feel better and won’t help him actually get better any faster, don’t nag him too much or cause a meltdown if he doesn’t want to do it.
  • Giving your child an age appropriate dose of acetaminophen or ibuprofen to reduce fever and/or any aches and pains.

While there are cold and cough medicines for older kids, over age four to six years, and nasal decongestant sprays (like Afrin and Neo-Synephrine) for kids over age six years, there isn’t a lot of evidence that they work. They definitely won’t help your child with a cold get better any faster, so make sure they are at least helping him feel better if you are using one of them.

Even the popular cold and cough medicines with guaifenesin to thin mucus or long-acting cough suppressants probably don’t do much or anything to help your kids feel better and certainly won’t help them get better faster.

What about prescription cough and cold medicines? Most were forced out of pharmacies by the FDA several years ago because they were never actually approved or evaluated to treat cough and cold symptoms. And the American Academy of Pediatrics has long been against the use of cough suppressants with narcotics, such as codeine.

Most importantly, do see your pediatrician if your infant under age three months has a fever (temp at or above 100.4F or 38C), if your older child continues to get worse after three to five days, or isn’t at least starting to get better after 10 days of having a cold.

And avoid asking your pediatrician for an antibiotic when your child just has a cold. Antibiotics don’t help colds get better faster.

What To Know About Treating Hard To Control Cold Symptoms

Perhaps the only thing more frustrating than having a cold, is having a child with a cold and feeling helpless that you can’t do more to control their cold symptoms.

More Information About Treating Hard To Control Cold Symptoms

Multiple Layers of Protection Can Keep Your Kids Safe

A layers of protection child safety plan can help keep your kids safe from accidents and tragedies, such as falls and drowning.

Parents are well aware of the need to use protection to keep important things safe.

After all, we build our homes thinking about fire protection, with firewalls and smoke detectors, plug our computers into surge protectors, and use virus protection software on our computers.

The same type of protection, usually grouped into a layers of protection plan, can also help keep your kids safe.

Layers of Protection

Using a layers of protection approach to child safety means using more than type of child safety technique, barrier, or warning, as a protection against a specific hazard. That way, if one protective layer breaks down, then one of the other layers of protection will still be in place to keep your kids safe.

Of course these layers of protection aren’t meant to keep your kids safe forever. They can buy you some time though if your child gets away from you for a few moments.

“…parents ought to appreciate the importance of applying multiple injury prevention strategies to a single category of risk, to provide children with layers of protection.”

Mark Widome, MD

Although often used in connection with the pool safety campaigns of the Consumer Product Safety Commission, it was mentioned as early as 1992 by Mark Widome, MD, who is on the American Academy of Pediatrics Council on Injury, Violence & Poison Prevention.

Layers of Protection for Water Safety

The concept of using layers of protection is often easiest to see when you think about water safety.

Consider some common drowning scenarios:

  • A 23-month-old in Redford Township near Detroit, Michigan, drowned by getting out of the house (the family was visiting friends) and climbing a ladder into an above-ground pool that only had about two feet of water in it.
  • A 3-year-old drowned in La Plata, Maryland during a birthday party while several other people were in the pool. When some started to get out of the pool, they noticed the child at the bottom of the deep end of the pool.
  • An 8-year-old drowned in a busy community pool near Indianapolis, IN.

To help prevent these types of drownings, the CPSC and the AAP recommend a layers of protection plan for water and pool safety, that includes:

  • close, constant, direct supervision of small children near water, whether it is a lake, pond, in-ground pool, spa, large portable pool, small wading pool, bathtub, or even a large bucket of water, etc.
  • closer “touch supervision” whenever an infant, toddler, or older child who is a weak swimmer is in the water, meaning that you are within an arm’s length of the child at all times.
  • installing a climb resistant isolation fence (a 4-sided fence that doesn’t allow direct access to the pool from inside the house) around backyard pools with a self-closing and self-latching gate.
  • adding a door alarm so that you know if your kids get out of the house and into the backyard, especially if your house makes up one of the four sides of the fence around your pool. A gate or pool alarm might also be useful.
  • making younger children wear a coast guard approved personal flotation device if they don’t know how to swim well and not just air-filled arm floaties. They should wear their personal flotation device whenever they are by the water, even if they are not swimming.
  • teaching kids to learn to swim, especially once they are 4-years-old, keeping in mind that knowing how to swim does not make your child drown-proof.
  • learning CPR, having a flotation device, and a telephone by the pool in case there is an emergency.

Also be sure to empty buckets of water, the bathtub, small kiddie wading pools, and other things with water when you are not using them.

Layers of Protection Work

How do the layers of protection work to reduce the risks of a drowning?

Consider a house with a fully childproofed pool. It has a 4-sided fence with a self-closing and self-latching gate. The door leading to the backyard is childproofed so that the twin toddlers who live in the home can’t open it. During a recent pool party, they even have a designated adult watching the kids in the pool.

When that person has to go to the bathroom, she asks someone else to take over. The new watcher isn’t as responsible though and gets distracted when he gets a phone call (one layer gone). One of the twins who had been inside, decides she wants to swim again. She walks to the backyard right through the door that someone had left open (another layer gone), through the open gate (yet another layer gone), and jumps into the pool without anyone seeing her.

The gate to the pool had been propped open during the party because people got tired of opening it every time they went from the pool to the house, and unfortunately, this breakdown in pool safety is a common way that kids drown. Fortunately, because the parents were using a layers of protection plan, the child was still safe, as she was still wearing her personal flotation device (last layer intact).

Layers of Protection for Home Safety

How can the layers of protection protect your kids at home?

For one thing, you can simply get rid of some of the things that are unsafe around kids, such as poisonous plants, unused household cleaners or poisons, and recalled products.

Next, add a few extra layers of protection when childproofing the house, since you can’t be expected to supervise your kids every second of the day:

  • install child-resistant door knob covers so that kids can’t get into rooms that are hard to child proof, like the bathroom
  • set the temperature of your hot water heater to 120 degrees, so that if your child does get into the bathroom and turns on the water he won’t get burned
  • store household cleaners and other poisonous substances in a high, out of reach location and then put a child-resistant lock on the cabinet for an extra layer of protection
  • place TVs and other appliances on stable furniture that won’t easily tip over, but as an extra layer of protection, anchor both the TV and furniture to the wall
  • lock your car so that your kids can’t get back in (hot cars, especially getting trapped in the trunk, is a common hidden danger for kids), and then secure your keys for an extra layer of protection

The layers of protection idea can even apply to car safety, In addition to an age appropriate car seat, booster seat, or seat belts, and keeping your kids in the back seat until they are at least 13-years-old, you can add to your family’s safety in the car by not getting distracted talking on your phone or texting.

What extra layers of protection can you add to other risks in and around your home?

More Information On Layers of Protection

Low Fat Foods for Kids

While it is important to learn to identify low-fat foods and high-fat foods so you know what your kids are eating, your overall focus should be on helping your family eat healthy foods every day.

Although most kids get too much fat in their diets, there is one age group of kids for which you shouldn’t limit fat intake — infants and toddlers under age two years.

These children are still growing and need more fat in their diet than older kids. That doesn’t mean that you have to go out of your way to give your 18 month old French fries or have to avoid naturally low-fat foods, including most fruits and vegetables, but they shouldn’t drink low-fat milk, eat commercially made fat-free foods, or be put on a low-fat diet.

The only exception is toddlers who are already overweight or at risk of becoming overweight, who can switch to low fat milk before age two years.

Finding Low Fat Foods

As you learn to avoid high-fat foods for your children, it is just as important to learn to choose low-fat foods as part of your family’s healthy diet.

It is often easy to choose low-fat foods, as many clues are on the food label when a food is low, including nutrition claims that the food is:

  • fat free (less than 0.5g of fat per serving)
  • low fat (less than 3g of fat per serving)
  • extra lean (less than 5g of fat per serving and 2g of saturated fat)
  • lean (less than 10g of fat per serving and 4.5g of saturated fat)

Nutrition claims that are less helpful when choosing low-fat foods include the terms reduced, less, and light, since they only mean that the food has fewer calories or grams of fat than the regular version of the food.

For example, consider these chips:

  • DORITOS Nacho Cheese Flavored Tortilla Chips = 8g of fat and 140 calories per serving
  • DORITOS Reduced Fat Nacho Cheese Flavored Tortilla Chips = 5g of fat and 120 calories per
  • DORITOS Light Nacho Cheese Flavored Tortilla Chips = 2g of fat and 100 calories per serving

If you thought that the reduced fat chips were low fat, you would have been mistaken. They are not a bad choice, since they are not high in fat. You can find “potato chips” with even less fat though, including BAKED! LAY’S Original Potato Crisps, with only 1.5g of fat, and TOSTITOS Light Restaurant Style Tortilla Chips, which has only 1g of fat per serving.

Low-Fat Foods

Unfortunately, just because something is low in fat doesn’t meant that it is low in calories. So while you want to avoid high-fat foods, you also want to avoid foods that are high in sugar and calories. For example, most of the foods that rank at the top of the list for being low in fat in the United States Department of Agriculture National Nutrient Database for Standard Reference include candy, soda, and fruit drinks.

“Fat Matters, But Calories Count”

U.S. Department of Health & Human Services

Healthy low-fat foods can include:

  • Lettuce
  • Carrots
  • Tomatoes
  • Strawberries
  • Spinach
  • Egg whites
  • Baked potatoes
  • Grapes
  • Oatmeal cookies
  • Breakfast cereals (most brands, although some are high in sugar)
  • Watermelon
  • Air-popped popcorn (without added butter)*
  • Light tuna fish (canned in water)
  • Green peas
  • Wheat bread
  • Pancakes
  • Beans
  • Rice
  • Pretzels
  • Vegetable soup
  • Chicken soup with rice
  • Milk – 1% reduced fat and skim milk

In addition to the fruits and vegetables listed above, keep in mind that most raw fruits and vegetables, except for avocados and olives, are naturally low in fat.

What’s missing from the list of low-fat foods? Hot dogs, cheese burgers, French fries, milk shakes, chicken nuggets, tacos, and many other high-fat kids’ favorites.

Hidden Fats in Foods

Many low-fat foods become high-fat foods when parents unknowingly add high-fat or hidden fat ingredients to them, including:

  • oils, which are 100% fat and should only be used in limited amounts, with an emphasis on monounsaturated and polyunsaturated oils
  • butter and margarine
  • non low-fat cheese
  • mayonnaise (1 tablespoon = 10g of fat and 90 calories)
  • ranch dressing (2 tablespoons = 15g of fat and 140 calories)

Other foods made with hydrogenated vegetable oils, palm kernel oil, or coconut oil, are likely also high in fat.

What To Know About Low Fat Foods for Kids

While it is important to learn to identify low-fat foods and high-fat foods so you know what your kids are eating, your overall focus should be on helping your family eat healthy foods every day.

For More Information On Low-Fat Foods for Kids

Treating Hard to Control Obesity

Getting to a healthy weight is rarely easy, but there is help for kids who are overweight and with hard to control obesity.

Children aren’t just little adults, even big or overweight children.

So, it shouldn’t be surprising that obesity treatments might be different for children.

Childhood Obesity Treatments

The Let's Go! 5-2-1-0 message can help keep your kids at a healthy weight.
The Let’s Go! 5-2-1-0 message can help keep your kids at a healthy weight.

Most people know, even if they can’t get motivated to follow, basic treatments for obesity. They include eating and drinking fewer calories and being more active.

How are these treatments different for kids?

Kids are still growing, so calories shouldn’t usually be overly restricted. So we more often talk about healthy diets instead of dieting.

Remember that the goal for overweight and obese children and teens is to reduce the rate of weight gain while allowing normal growth and development.

CDC Tips for Parents – Ideas to Help Children Maintain a Healthy Weight

Treating Hard to Control Obesity

What do you do if your child continues to gain too much weight or just can’t seem to lose any weight despite trying?

Ask yourself these questions and bring the answers to your pediatrician:

  • Are other family members overweight?
  • Is your child physically active for at least one hour a day?
  • Does your child drink non-diet soda, fruit juice, or sweet tea each day?
  • How much milk and water does your child drink each day?
  • Do you eat out with your child one or more times each week?
  • Does your child get more than one to two hours of screen time each day?
  • Does your child have a TV and/or computer in their room?
  • Does your child frequently eat meals and snacks while watching TV?
  • How many fruits and vegetables does your child eat each day?
  • Do your child’s portion sizes at meal times resemble an adult portion size?
  • Does your child frequently get seconds at meal times?
  • What does your child eat at snack times?
  • How many snacks does your child eat each day?
  • How often does your family eat dinner together?
  • Are you waiting for your child to “grow into” his weight?
  • If physically active, what activities does your child do?
  • Do you know about how many calories your child should be getting each day?
  • Are you expecting a quick fix and for your child to lose weight quickly?

And perhaps most importantly, do you know why your child is overweight? If you don’t, or if you don’t really believe that he or she is overweight, then you will have a hard time helping get to a healthier weight.

A registered dietician can help teach you and your child more about healthy eating.

What To Know About Treating Hard to Control Obesity

Getting to a healthy weight is rarely easy, but there is help for kids who are overweight and with hard to control obesity.

For More Information About Treating Hard to Control Obesity

Treating Hard To Control Headaches

It can be frustrating when your kids have regular headaches, including migraines, but fortunately, there are many things you can do to both prevent and treat your child’s chronic headaches.

Does your child get headaches?

Are they easy to control?

Headaches

Headaches, including migraines, are much more common in kids than most parents imagine.  In fact, one study showed that up to 8% of kids have migraines, with many starting to have headaches by age 7 or 8 years.

Treating Headaches in Kids

In addition to treating headaches when they happen, it is important to teach your kids to get SMART and prevent their headaches:

  • Get plenty of Sleep each night.
  • Never skip Meals.
  • Be physically Active and exercise each day.
  • Learn ways to Relax and reduce any extra stress in their life.
  • Avoid things that you know Trigger their headaches.

If this doesn’t work and your child’s headaches are bothersome, you can consider treating them with a standard, age-appropriate pain reliever, such as acetaminophen or ibuprofen.

Treating Hard To Control Headaches

If your child has chronic headaches, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any signs of symptoms that might indicate that he needs immediate medical attention, including severe headaches that are getting worse, high blood pressure, a recent head injury, seizures, fever, or headaches that routinely wake your child up in the middle of the night?
  • Are your child’s headaches interfering with daily activities, including school, sports, or social activities?
  • Do headaches, especially migraine headaches, run in the family?
  • Does your child routinely have symptoms of allergies, in addition to headaches, with a runny nose and congestion, which could be a sign of allergy headaches?
  • How does your child describe her headache pain?
  • Does your child have any other symptoms with the headache, such as anorexia, nausea, vomiting, photophobia (light hurts their eyes), phonophobia (loud sounds bother them), or osmophobia (smells bother them)?
  • Can your child sense when a headache is about to begin, with with an aura, including symptoms like slow or slurred speech (dysarthria), vertigo (sense of spinning), or changes in their vision?
  • What does your child do during a headache?
  • Do you think that your child is having migraine headaches, tension type headaches, or allergy headaches, etc.?
  • Have you been giving your child pain medicines for her headaches on most days (more than 15 times a month), which can cause rebound or worsening headaches?
  • Have you been giving your child a triptan medicine for her headaches on most days (more than 10 times a month), which can cause rebound or worsening headaches?
  • If stress is a major trigger for your child’s headaches, have you considered seeing a counselor or child psychologist for extra help?
  • Have you tried keeping a symptom diary to try and identify headache triggers, such as caffeine, chocolate, weather changes, or stress, etc.?

What’s next if your child is still having bothersome headaches?

The FDA has approved a few medications (triptans) that can stop migraine headaches in kids, including:

  • Axert (almotriptan) – FDA approved for children between the ages of 12 and 17 years
  • Maxalt (rizatriptan) – FDA approved for children between the ages of 6 and 17 years

Zofran (ondansetron) can also be helpful if your child has nausea and vomiting with her headaches.

Lastly, a daily medication might help prevent your child from getting headaches in the first place. These preventative migraine medications can include Periactin (cyproheptadine), Elavil (amitripyline), Topamax (topiramate), Depakote (valproic acid), propanolol, or clonidine.

A pediatric neurologist can help manage your child with hard to control headaches. Other treatments for chronic headaches can include biofeedback, guided-imagery, cognitive behavioral therapy, and select nutritional supplements.

What To Know About Treating Hard To Control Headaches

It can be frustrating when your kids have regular headaches, including migraines, but fortunately, there are many things you can do to both prevent and treat your child’s chronic headaches.

More Information On Treating Hard To Control Headaches

Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

  • rotavirus – a vaccine-preventable disease
  • norovirus – the “cruise ship virus,” but very common elsewhere too
  • Salmonella, Shigella, E. coli – food poisoning, animals
  • C. diff – associated with recent antibiotic use
  • Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

  • continue breastfeeding on demand
  • continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
  • forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
  • take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
  • watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
  • Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
  • Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
  • Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
  • Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
  • Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
  • Has your child been drinking raw milk or other high risk foods?
  • Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
  • Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
    Have you tried giving your child a probiotic?
  • Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
  • Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
  • Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

More Information On Treating Hard to Control Vomiting and Diarrhea

%d bloggers like this: