The Last Time I Checked My Child’s Allergy Supplies Was…. ???

Usually when summer break gets closer, everyone is focused on vacation, spending time with their children and thoughts of school are left far behind. For our family, it means beginning a summer check up for our allergy needs. Especially since vacation time can also make us forget about other details, summer is a yearly reminder to clean out, update and refill.

Inhaler clean-out - smallCleaning Out A few months ago, something prompted me to check my son’s asthma inhaler. Upon examination, I was horrified. At some point, the inhaler must have discharged while it was enclosed in the holder and had “grown new friends”- yuck! Worse yet, I realized that my son had used the inhaler recently (which means all of what was hanging out in his inhaler was also having a party inside of his lungs too). In times of being a normal mom who worries about her son’s asthma, I was fast forwarded into dry-heave mode quickly followed by recycling the old case and getting a brand new one altogether. I sent the stretchy outer case through the washing machine and let it completely air dry.

The food allergy mom in me sent an email to the wonderful people at the Allergy & Asthma Network. With a tinge of embarrassment for feeling like I was the world’s worst allergy mom, I sent a picture and asked if they had any words of wisdom for me as well as to others on how to prevent a dirty inhaler from entering our lives again. They quickly responded with some helpful information from their Understanding Asthma Guide: “Clean your inhaler following the manufacturer’s instructions, usually once per week. Clean the actuator — not the metal canister — with warm water and leave time for it to air dry before another dose is needed. Holding chambers also need to be washed, especially when the unit becomes cloudy or filmy inside. Replace disposable parts as recommended to avoid bacterial growth. Talk with your doctor if there’s any uncertainty about cleaning your inhaler or holding chamber.”

Updating During my frantic summer allergy cleaning binge, I also noticed my son’s emergency contact paperwork was faded and torn. This is something that I consider to be an extension of safety for him in the event that he is unable to speak for himself. It contains a copy of my son’s Allergy Action Plan. I also updated his picture because, gosh, don’t all children seem to change overnight?!  This is also helpful when your child is with people they normally aren’t around (such as a substitute teacher) so that they have immediate confirmation that the person with the food allergy pack matches up with the listed allergens and contact information. Never assume, always overdue. Nobody ever died from too much information, only not enough.

I also checked expiration dates on his medications both inside his allergy pack and the extras that we keep on hand in the house and made sure our stock was full. It only took one bad asthma night with just a few counted doses available in his inhaler for me to realize that expiration dates on these life-saving medications are something that cannot be forgotten. Again, as a mom of an asthmatic child, the last thing that you want to tell your child who is gasping for breath is to not use their inhaler unless they have to because it might run out. I’m not proud of that moment but it happens to the best of us and teaches us new organization and safety techniques to avoid future repeats.

Early script refills - smallRefilling Because of the discount cards available the past few years, this is one area that is super easy and non-stressful. Both EpiPen and Auvi-Q have continued to provide a $0 copay offer, which means one less expense. Nothing can beat refilling a prescription for three twin packs of epinephrine and seeing a giant $0 on the receipt. Don’t get me wrong- my son’s safety is priceless and I would gladly pay to keep him that much safer at all times but not having to spend that money each year is a food allergy parents dream.

I do recommend discussing how to write out the prescription correctly with your child’s pediatrician or allergy specialist. This will ensure full benefit of the copay discounts, additional epinephrine to have on hand and for the next school year and ultimately, it will save you time going back and forth to the pharmacy for repeat refills. Also discuss correct dosages of medications for your child’s height, weight and age to prevent wasting a refilled prescription (ex: filling an Epipen Jr prescription and finding out after the fact that your child is now considered to be within the EpiPen adult dosage range…then what to do with the wasted medications?)

Allergies can be tricky but each year brings new techniques and better ways to come up with a strategy on what works best for your child and family. Just remember to be accepting of what might not work in the beginning, or even the year after and always give yourself more than enough time to be ready for school. The better prepared and calm that you seem, the less stressed your allergic child will begin another school year.

Tips for How a Child Can Stop Bullying Others

Editor’s Note: When it come to bullying, information is normally provided for children who are bullying victims. Here is information for a child who is the bully, but may want to stop and doesn’t know how.
People who bully others often find it hard to ask for help. They may be worried that they’ll get into trouble with their teachers or that they’ll be bullied themselves.

It takes courage to stop being a bully. Just because you’ve been involved in it doesn’t mean you have to continue. Help with bullying is not only available to those who’ve been bullied. Many anti-bullying support groups also help people who are involved in bullying.

Talk to a parent, teacher or an older pupil who you get on well with. If there’s any support system in your school for those who are bullied (such as a teacher who is designated to deal with bullying), they should be able to help you. Some schools have peer-support schemes, where older children are trained to help bullyingyounger children deal with bullying. Peer-support is usually available to children and young people who say they’re bullies.

If you’re worried about being judged, and don’t want to speak to anyone you know, you can get help anonymously by calling ChildLine (in the UK*) on 0800 1111 (in the US see the Get Help Now section of stopbullying.gov*). ChildLine advisers will listen to any child whatever the problem, and give advice.

Why Do People Bully Others?

There are many reasons why people bully others. It may be that they’re unhappy and taking it out on someone else. Many people who bully have low self-esteem, and bullying can be a way of coping with it. In some cases, people who bully are also being bullied themselves.

Others are encouraged by their friends to bully, and do it because they don’t want to be left out. Some people pick on others because they’re looking for attention or because they’re feeling jealous.

What Should You Do If You See Someone Being Bullied?

If you witness a bullying incident, it’s important to do something. Don’t just walk away and ignore it.

You can tell the bullies to stop doing it, so long as you’re not afraid that it will lead to a confrontation.

The best thing to do is talk to someone, such as a teacher, parent or friend. If you’re worried about doing this, leave an anonymous note for the teacher explaining the situation. Then the teacher will at least be aware of what’s going on.

Where To Find More Information About Bullying

ChildLine 0800 1111

ChildLine is a website and helpline for young people and children. You can call the helpline at any time of day or night to talk about any worries you have. Phone calls are free from landlines and mobiles, and they won’t appear on a phone bill. ChildLine’s website has information and advice on bullying.

GOV.UK bullying advice

The government website has a section on bullying, including information on what to do if you’re bullying someone or you’ve seen someone being bullied.

Editor’s Note: *clarification provided for our US audience.

US Bullying Websites / Resources:

Centers for Disease Control and Prevention (CDC) – bullying research and resources

Child Health & Safety News Roundup: 06-08-2015 to 06-14-2015

twitter thumbWelcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 10 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Living in an older house? What you may not know about lead poisoning. Lead Safe America Foundation http://t.co/Tqsa4sezLJ

Last Words on Kids and Water Safety…

Global Water SafetyIt is with sadness that I am ending my time as the water safety expert on Pediatric Safety.  I am working on a project to bring global awareness to the issue of water safety and have decided that I need to focus 100% of my time to that effort.  Over the last four years I’ve shared information designed specifically to keep your child safer.  Today I’d like to pull back and show you the bigger picture, in part so that you will understand why I am driven to create awareness on a global level, and in part so that you understand why teaching your child water safety now will keep them safer for their entire life, no matter where they live or travel.

  • Drowning is a leading cause of accidental death globally, but 90% of these deaths occur in low- and middle-income country.
  • Children under age five are most at risk for drowning and age two is the most common age for drowning.
  • In countries like the U.S., for every child that drowns, another five have a non-fatal drowning accident, often resulting in lifelong mental and physical damage. Most emergency room visits for children are for drowning.
  • We don’t have the data to count most drowning deaths in the world, so we know the problem is even worse than the numbers show. There is no global strategic effort to end drowning, relatively few programs in place to teach survival swimming and water safety, and virtually no funding.

Now for the good news.  Drowning is preventable and the actions are in your control.

Here is what you need to do to keep your child safer:

  • Install a four-sided fence around your pool with a self-closing and self-locking gate. Empty buckets, ornamental ponds, and splash pools when not in immediate use.
  • Supervise young children and non-swimmers around water, meaning you are close enough to touch them. Leave your phone in the bag – texting and water are just as dangerous as texting and driving. This means in the bath, at the pool, by the lake, or even the drainage ditch after a rainstorm.
  • Teach school age children basic swimming, water safety, and safe water rescue skills.
  • Learn CPR and safe water rescue skills.
  • Teach others – most people aren’t even aware drowning is an issue. All it takes is two minutes and two inches of water and drowning is completely silent. Don’t be afraid to speak up, you could save a child’s life.

Many thanks to the Pediatric Safety team for being willing to devote attention to the neglected issue of water safety and to children’s safety in general.  Additional thanks for their consistent and enthusiastic support of my work.  It has truly been an honor to work with them.  Finally, thank you for taking the time to learn about water safety.  Parenting is hard and time-consuming work and there are many days when adding one more thing seems overwhelming.  Thank you for keeping water safety on your ‘to do’ list – it really does make a difference.

For more information on the global issue of drowning:

Have Insomnia? The Risks of Mixing Ambien and Parenthood

If people can have no memory of driving, eating or having sex under the influence of Ambien, how can parents who use this medication limit risk to their children?

Have you ever suffered from severe insomnia? If you have you know just how critical regular, decent sleep is to normal daily function, mood, physical health, family dynamics….everything!  I suffered from horrible insomnia off and on for a few years. It started when my son was born – when my “mommy” senses kicked in and woke me up at the slightest noise. And then it got worse when I started traveling a lot for work and I developed a painful and chronic back problem. It got to the point where I could only function by using a rotating schedule of sleep aids…Tylenol PM, NyQuil, and prescription sleeping pills.

AmbienCR picOne of the most effective – at least in the short-term – was Ambien (also known as Zolpidem).  Ambien is part of a constellation of drugs called sedative-hypnotics. This grouping also includes other well-known medications such as Klonopin, Xanax and Valium (all of the benzodiazepine class).  Ambien and Lunesta are not “benzos” but are related types of sedative-hypnotics.  For someone suffering from insomnia, or traveling internationally across many time zones, Ambien can seem like a gift from the gods.  You fall deeply asleep almost instantly….at least at first….and even if you wake up before your alarm, you feel more rested than you have in a long, long time.

But after using Ambien for a while – admittedly for longer than the 7-10 days recommended by the FDA (Federal Drug Administration) and medical websites – I learned there are several downsides to using Ambien. First of all, you can develop tolerance to the medication through repeated use – which means it can take longer for the effect to kick-in and it may seem less effective if you’ve been using it for a long period of time. Also, according to the FDA package insert, you can develop a “drugged feeling” with use of around a month or more. But the most talked about issues with Ambien are what the medical community calls “abnormal thinking and behavioral changes”. This includes reports of “sleep-driving” and other behaviors reported while under the influence of Ambien, such as eating at night or having sex – with no memories of these activities in the morning.

risks-mixing-ambien-with-parenthoodSome of these odd sleep-behaviors can be comical. One woman found that she had painted her front door during the night, while another was experiencing unexplained weight gain that turned out to be caused by late-night Ambien-induced food binges (see this link).  My hairstylist told me of a male client that “cut” his hair under the influence of Ambien.  The result was terrible – with sections of hair cut so close to the scalp that it’s a wonder he didn’t badly injure himself.  He was mortified and she had to give him a buzz cut to fix the problem!

However, other reports of Ambien side effects are much more alarming.  There have been several reports of car accidents – most famously Patrick Kennedy’s 2006 crash – and people who wake up in police custody or the ER after Ambien-affected driving.  Plus Ambien-related ER visits have skyrocketed in recent years, with women much more affected than men.  Also a friend told me of her nighttime Ambien-fueled cooking sessions that resulted in bloody fingers from using her sharp kitchen knives under the influence.

But with all these issues, one thing really stood out for me….no one is talking about the risks of parents of young children using Ambien or medications like it.  If you can sleep-drive and crash your car under the influence of Ambien, what’s to prevent you from taking your kid along?  What about cutting your child’s hair or letting them help you “cook”?  And how might your kids cope if an emergency happens and they can’t wake you?  Even if these extreme situations may be rare, you might do or say some things you regret later. For example, I once took Ambien before putting my son to bed (remember that tolerance development I mentioned earlier??) and during reading time proceeded to explain how we needed to build a carousel in our bathroom! That might seem like a fun conversation for a toddler, but Elliott was old enough to know that Mom was behaving strangely….and it kind of freaked him out.  Another time, I told him my iTunes password….I had no memory of it later, but new apps/games (granted, mostly free) started showing up on my phone after I let him play on it.  His defense?  “But Mom, when I asked you for your password, you just told me!”  What can I say to that?

I’m in no way suggesting that people shouldn’t use Ambien.  That is a personal decision between you and your doctor – and Ambien can really help with insomnia, which I well know is a very real and serious condition.  Instead I think it could help if we (experienced Ambien users) started sharing the issues and challenges we’ve faced mixing Ambien use with parenthood and any advice we would have liked to have gotten when we started using sedative-hypnotics.  So here is my attempt:

  • If there are two adults in the house, plan for only one to take a sedative-hypnotic medication on any given night – and communicate when you are taking one so the other person is alerted
  • For women, make sure you are taking the lower dose of Ambien recommended by the FDA in 2013 (5 mg for immediate-release rather than 10mg for men, and 6.25 mg for extended-release rather than men’s 12.5 mg) – women clear the drug more slowly than men and studies have shown more next-day drowsiness and driving impairment in women
  • Skip the Ambien if you’ve had any alcohol or have taken other medications that can influence the brain – like narcotic pain relievers (e.g. medications including hydrocodone or oxycodone) or other anti-anxiety and insomnia medications – these combinations are associated with increases in Ambien-related ER visits
  • Even if you are finding the Ambien is taking longer to work….don’t take it until you get into bed, especially if your kids are still up – you may be surprised the next morning by what you did or said!…(see earlier)
  • Consider telling your children that you will be very sleepy that night – maybe because you aren’t feeling well – so they shouldn’t bother you in the night unless it’s an emergency (we didn’t want to tell our son that mom was taking a medication to sleep, although I did when he was older and understood my health and sleep challenges)
    • The one Ambien/parent story I found on the internet was about a mom whose son threw up on her while she was sleeping because he wasn’t feeling well but couldn’t wake her (even though Dad was also in the bed!) so make sure your kids know to ask the other parent for help that night
  • If you are the only adult in the house, think about asking a close friend or family member to be “on call” if something ever happens when you’ve taken an Ambien – you can tell your children to contact them in the night if something serious happens and leave a note with the number somewhere obvious on an Ambien night
  • If you can, limit how often you take Ambien, possibly by alternating other non-hypnotic sleep aids or by using alternative therapies – I was able to drastically cut my use of insomnia medication through acupuncture treatments and mindfulness meditation (though I know this won’t work for everyone)
  • And, finally, be kind to yourself…using Ambien on occasion doesn’t make you a bad parent – being severely sleep-deprived can though!

Physical Activity Guide for Children and Youth to Keep Healthy

How much physical activity do children and young people aged 5-18 need to do to keep healthy?

Keeping Our Bodies Fit.To stay healthy or to improve health, young people need to do three types of physical activity each week: aerobic, muscle-strengthening and bone-strengthening activity.

The amount of physical activity you need to do each week is determined by your age. Click on the links below for the recommendations for other age groups:

Physical Activity for Young People Aged 5-18

To maintain a basic level of health, children and young people aged 5-18 need to do:

At least 60 minutes (1 hour) of physical activity every day, which should range between moderate-intensity activity, such as cycling and playground activities and vigorous-intensity activity, such as fast running and tennis.

On three days a week, these activities should involve muscle-strengthening activities, such as push-ups, and bone-strengthening activities, such as running.

Many vigorous-intensity activities can help you meet your weekly muscle- and bone-strengthening requirements, such as running, skipping, gymnastics, martial arts and football.

What Counts as Moderate-Intensity Activity?

Examples of activities that require moderate effort for most young people include:

  • Walking to school
  • Playing in the playground
  • Riding a scooter
  • Skateboarding
  • Rollerblading
  • Walking the dog
  • Cycling on level ground or ground with few hills

Moderate-intensity aerobic activity means you’re working hard enough to raise your heart rate and break a sweat. One way to tell if you’re working at a moderate intensity is if you can still talk but you can’t sing the words to a song.

What Counts as Vigorous-Intensity Activity?

Examples of activities that require vigorous effort for most young people include:

  • Playing chase
  • Energetic dancing
  • Swimming
  • Running
  • Gymnastics
  • Football/soccer
  • Rugby
  • Martial arts, such as karate
  • Cycling fast or on hilly terrain

Vigorous-intensity aerobic activity means you’re breathing hard and fast, and your heart rate has gone up quite a bit. If you’re working at this level, you won’t be able to say more than a few words without pausing for a breath.

What Counts as Muscle-Strengthening Activity?

For young people, muscle-strengthening activities are those that require them to lift their own body weight or to work against a resistance, such as climbing a rope.

Examples of muscle-strengthening activities suitable for children include:

  • Games such as tug of war
  • Swinging on playground equipment bars
  • Gymnastics
  • Rope or tree climbing
  • Sit-ups, press ups etc.
  • Gymnastics
  • Football/soccer
  • Rugby
  • Tennis

Examples of muscle-strengthening activities suitable for young people include:

  • Sit-ups, press ups etc.
  • Gymnastics
  • Resistance exercises with exercise bands, weight machines or hand-held weights
  • Rock climbing
  • Football/soccer
  • Basketball
  • Tennis

Children and young people should take part in activities that are appropriate for their age and stage of development.

What Counts as Bone-Strengthening Activity?

Bone-strengthening activities produce an impact or tension force on the bones that promotes bone growth and strength.

Examples of bone-strengthening activities suitable for children include:

  • Activities that require children to lift their body weight or to work against a resistance
  • Jumping and climbing activities, combined with the use of playground equipment and toys
  • Games such as hopscotch
  • Skipping with a rope
  • Walking
  • Running
  • Gymnastics
  • Football/soccer
  • Basketball
  • Tennis
  • Squash
  • Martial arts

Examples of bone-strengthening activities suitable for young people include:

  • Dance
  • Aerobics
  • Weight-training
  • Water-based activities
  • Running
  • Sports such as gymnastics, football/soccer, netball, hockey, badminton and tennis
  • Skipping with a rope
  • Martial arts

Children and young people should take part in activities that are appropriate for their age and stage of development.