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Bronchiolitis or “Wheezy Bronchitis” and Kids

Last updated on November 3rd, 2018 at 05:42 pm

One of the more common illnesses that is encountered during the winter months in infants and young children is a respiratory problem referred to as Bronchiolitis or “wheezy bronchitis”. This is a condition caused by a viral infection that attacks the respiratory tree, both upper (nose and throat) and lower (the smaller airways leading to the air sacks in the lungs). It is most commonly caused by RSV or Respiratory Syncitial Virus. It can also be caused by other winter time viral infections but the exact cause is relatively unimportant as the symptoms are nearly the same.

Your child will usually develop signs and symptoms of a regular cold with sneezing, runny nose, mild cough, and sometimes a low grade fever. At this stage it will be impossible to tell if this will progress to bronchiolitis, but most of the time this will remain a cold and your “cures” are limited as your doctor will tell you. In a certain number of infants and young children, after a few days of the cold, the cough might progress to a more significant stage and the infant or young child may show some signs of having difficulty breathing; more rapid breathing rate than normal will usually be the first of such signs, but fever alone can raise an infant’s rate of breathing, and if you are unsure call your baby’s Doctor and he/she will help you figure that out.

Because the primary problem with bronchiolitis is swelling in the respiratory passages (lower and upper), air might have to begin to squeeze through narrower passages in the lungs and similar to what we have presented about asthma in the past, this may lead to wheezing. Wheezing is a whistling (musical) type of noise when your child breathes out versus noisy breathing in noticed in those infants with the upper airway cold. Admittedly this may be difficult to see by non- medical parents, but you can ask your Doctor how to do this in a reliable and repeatable manner.

Most infants and young children will remain in this stage and, as long as he/she is feeding well , does not have fever over 103, and seems fairly cheerful with his/her usual skin color, you do not need to worry, and all the symptoms will resolve as the cold goes away.

Occasionally, the situation can worsen with more difficulty breathing, now showing itself by your child using more muscles of his/her body to help force the air through the small airways in the chest: those muscles might include the abdominal, neck and intercostals (muscles between the ribs). At this stage your child should certainly be under the care of a physician, who might, depending on the appearance of your child admit him/her to the hospital so that more intensive care can be used to help him/her breathe.

The illness is self limited in that between 3 and 7 days normal resolution will take place. The worsening progression that I outlined above will generally not happen very fast and you will have time to see that your child is getting worse. Anywhere along the way, should you have doubts about your ability to adequately monitor your child’s status you should be talking to his/her Doctor.

I would like to stress once again that most bronchiolitis illnesses in infants and young adults remains mild and in fact may be indistinguishable from a normal cold.

If you would like to hear more about bronchiolitis please leave me a note in the comments below

Children’s Pajamas and Flame Retardants

Last updated on November 3rd, 2018 at 05:37 pm

Brothers in Pajamas

Brothers in Pajamas

As we head into the holiday season with cold weather, you might be considering buying your children new pajamas. When buying children’s pajamas, you are faced with a choice. A choice as to whether you want to buy pajamas treated with flame retardants or not. Whether that matters to you is a decision you’ll have to make for yourself. But at least  you should understand the options.

First, let’s understand that pajamas for children need to meet certain flammability requirements to prevent the risk injury from fires. For the most part, the risk is a loose sleeve or pant cuff catching an open flame, such as a candle. So, sleepwear intended for children between the ages of 9 months and 14 years must meet specific flammability requirements. Note that sleepwear for children under the age of 9 months is not subject to the requirement. This is because babies have limited mobility, are not expected to be unsupervised for long, and are not likely to catch a sleeve or pant cuff on an open flame.

If you are buying sleepwear for children between the ages of 9 months and 14 years, whether you have chemical flame retardants depends on what you buy. The Consumer Product Safety Commission (CPSC) considers flame retardant treated pajamas to be safe. Generally, the chemicals used on pajamas or pajama fabrics include chlorinated and brominated flame retardants, inorganic flame retardants such as antimony oxides, and phosphate-based compounds. In the 1970s, the CPSC banned brominated Tris and removed chlorinated Tris from being used on children’s pajamas after they were found to mutate DNA and identified as probable human carcinogens. These chemicals were removed from children’s sleepwear after it was found that children were exposed from their treated sleepwear. So, these two particular chemicals won’t be used, but what is actually used on pajamas is difficult to discover: just try asking a retailer what particular flame retardant is used on any particular item of sleepwear.

Unfortunately, chlorinated and brominated flame retardants are contaminating the environment and accumulating in the human body. For example, polybrominated diphenyl ethers (PBDEs) have been linked to damage to the nervous and reproductive systems and impairing thyroid function. And you generally can’t tell what flame retardant is being used on any particular clothing item. And you can’t really wash the flame retardants out. The regulations require that the fabrics demonstrate their flame resistance after being laundered at least 50 times.

But you can avoid flame retardants in pajamas and still have pajamas that are safe from the risk of fire.

To meet the regulatory flammability requirements, children’s sleepwear must either pass certain flammability tests, or be tight fitting and meet certain specifications as to dimensions. This means that your child’s pajamas either have flame retardants added or are snug-fitting and probably free of flame retardants. So, you can have snug fitting pajamas without chemical flame retardants and be safer from the risk of fire.

To tell the difference check the fabric content. Look at the label and see what is identified as the primary fabric used. If the item is sleepwear and it is made of a synthetic fiber, it has flame retardants. All synthetic materials have flame retardants added. The issue for synthetic fabrics is whether the sleepwear is “chemically treated” or not. Only some sleepwear is “chemically treated” with flame retardants. Chemically treated fabrics have a chemical flame retardant added to the sleepwear. These sleepwear items include nylon and acetate fabrics.

However, most synthetic fiber sleepwear has a flame retardant inserted into the fabric fiber, including most polyester fabrics, as opposed to the fabric being “chemically treated” with a flame retardant. Fiber with flame retardants inserted into the fabric fiber are considered chemically stable. These manufacturers may claim that the sleepwear is not treated with a chemical flame retardant, and that’s true. The sleepwear is not “chemically treated.” But that doesn’t mean it is free of flame retardants. If children’s sleepwear is synthetic, flame retardant is present, whether the fabric is treated with flame retardant or the flame retardant is bonded to the fiber.

To avoid flame retardants in children’s sleepwear altogether (other than making your own) you can purchase snug fitting natural fiber pajamas, such as cotton. (And to be green and avoid pesticide residues, buy organic natural fiber cotton with low-impact dyes.) Sleepwear that is snug fitting meets flammability standards by being tight enough to a child’s body that no stray sleeve can catch fire, and also by not allowing extra air between the fabric and the skin to promote the fire’s growth if accidentally started. How can you tell if the cotton sleepwear in question is flame retardant free? Look for the hang tag that says “must be snug fitting” and “not flame resistant.” Last year, Costco had some fabulous organic, snug-fitting, flame retardant free pajamas. Snug fitting natural fiber pajamas are also available at Target, Gymboree, New Jammies, and many others. (The author has no relationship whatsoever with any of the previously mentioned companies…other than she has shopped at them.)

But be warned. It isn’t enough to just look for natural fibers. Some natural fibers are actually treated with chemical flame retardants. These are generally sold as “flame resistant cotton” and generally do not have the hang tag that says “must be snug fitting.” Instead, these pajamas will generally be labeled as flame resistant cotton.  You may see cotton sleepwear advertised as containing Proban, which is made from tetrakis(hydroxymethyl)phosphonium chloride, or THPC. Studies have shown low migration from sleepwear, but the chemical used in the process is associated with genetic abnormalities and damage to the liver, skin and nervous system. Securest is another name for Proban-treated fabric. If you see flame-resistant 100% cotton, then that cotton has flame retardants. If you don’t want flame retardants, then always look for the specific key phrases “must be snug fitting” and “not flame resistant.”

Teaching Your Child The Fine Art of Swallowing Pills and Capsules

Last updated on June 16th, 2018 at 12:07 am

For any parent, getting children to take their medication can be a frustrating experience. The flavor of a liquid such as Prednisone may be off putting to a child. You worry about spilling liquid medications or dosing accurately. That’s why I find that teaching children as early as possible to swallow a pill or capsule to be a wise idea.

You may wonder “Why worry about teaching my child how to swallow a pill or capsule now?”

First, some medications only come in solid form. To be honest, there aren’t swallow a pill 3many but there are a few.

Second, pills and tablets are much easier to travel with and don’t require refrigeration. Think about toting around that bottle of antibiotic next summer on your trip to the Bahamas. Not fun!

Third, you will never have to worry about spilling or dripping a liquid again. Plus the dosing on a pill is accurate. How many times have you gotten to the bottom of the bottle of liquid medication and not had the full teaspoon?

In my experience, children as young as age 3 or 4 can learn to swallow a pill. I taught my own daughter who was not yet 3 to swallow pills. While a few teens can’t seem to master the skill, children are quick learners and repetition and patience along with some simple tips can help if you start children young.

It’s also a good idea to teach your child these techniques before they really need them. A sick little child is not great student!

WHAT YOU WILL NEED

  • Multi-colored round candy balls called mixed decors found in the cake-decorating section of a supermarket
  • Tic Tacs (I think the fruit flavor works best)
  • Mini M&M’s
  • Reese’s Pieces or M&M’s

THE TECHNIQUE

  • Start with the smallest candy ball from the cake decorating kit. Explain to your child that you are going to teach him a simple way to learn to swallow pills and that it starts with learning to swallow candy balls. (Now is a good time to explain that medication is NOT candy but that you are using candy because it is an easy substitute. Explain that you should NEVER take medicine without permission of Mom or Dad.)
  • Parent should demonstrate by putting a single candy ball as far back on your tongue as possible, use the straw technique, and take three gulps of water.
  • Tell your child it’s their turn. Also tell them that if the candy doesn’t go down the first time, they have to try at least two more times. If it doesn’t go down by the third try, they can chew the candy ball and take a break before trying again.
  • Repeat this until they get comfortable with a candy ball, usually about three successful tries. Then move up to a slightly larger candy (I like to use the bigger cake decorating sprinkles, then move up to mini M&M’s) and repeat the procedure until there is success at this level.
  • After three to five successes with the mini M&M’s, move up to a larger candy like an M&M or Reese’s pieces. After they have mastered that, compare it to a pill size wise. At this point they should be able to swallow most pills with minimum problems.
  • Remember to limit the “session’ to 15 minutes. This will be a Process that requires days, perhaps weeks depending on your child.

SOME TIPS

  • Have your child take a few sips of water before beginning. It is very difficult to swallow a pill or tablet with a dry throat.
  • These tips works best if your child is thirsty. He/She may be drinking quite a bit, practicing their pill swallowing technique.
  • Session should last no more than 15 minutes and be fun.
  • Room should be free from distractions. Leave toys in another room and turn of the television.
  • Stay calm and positive.
  • Be patient, this is a task that will require some time.
  • Demonstrate pill swallowing to your child in matter of fact way. When they see you do it calmly they will want to emulate you.
  • Use lots of Positive Praise! Avoid negativity. This is not going to motivate your child to learn to swallow pills/tablets.
  • Be consistent.
  • Have your child put the pill on his/her tongue. Then using a straw, suck down three big gulps of water. With a straw there is no pill floating around in your mouth like there is if you just try to swallow a pill with a big mouthful of water.
  • If water isn’t working try milk, a fruit smoothie, Pediasure, a milkshake, or fruit juice or nectar. Thicker fluids create more bulk, making it harder for the pill to separate itself from the fluid during swallowing.
  • Always end with a success. If your child has difficulty swallowing a large piece of candy, end by having him swallow a smaller piece or even a gulp of liquid. Always end on a positive note.
  • When swallowing a pill, have your child tilt their head back slightly. With capsules (which float), you do just the opposite. Have your child look down at the floor and swallow the capsule while still looking downward at the floor. The capsule should just float to the back of his mouth and slide down his throat with his drink.
  • Make sure you have your child place the pill or capsule in the center of their tongue rather than to the right or left, especially if they are going to be swallowing an oval-shaped pill. An oval-shaped pill should be placed so that the length is parallel to their throat. Otherwise, the pill may go into the throat “sideways” and create discomfort.

DON’T

  • Don’t break a tablet in half if it is too large. When you do this the rough edges can be scratchy and even more difficult to swallow than a larger smooth tablet.
  • Don’t take pills with a dry mouth. It’s more difficult to swallow when your mouth is dry, and capsules and tablets may even stick to a dry tongue.
  • Don’t bargain or bribe your child. After all you don’t bargain or bribe your child to brush his or her teeth or comb their hair. This is a skill they WILL learn. It just takes time and patience.

The techniques I shared with you should help you, help your child become proficient at swallowing pills and tablets. This is a skill that is a necessary part of life and when learned early can really be a very handy tool for a child to possess.

Remember to be consistent, patient and use positive praise and these techniques will have your child swallowing pills, tablets and capsules in a reasonably short time!

Preventing a Medication Mix-Up

Last updated on June 15th, 2018 at 11:12 pm

With the number of prescriptions that are handwritten and dispensed by pharmacies across the country each year, it should be no surprise that errors can occur. Even with the most careful doctor writing legibly and pharmacists double checking dosages, when humans are involved no amount of carefulness is error proof.

LaRowe med signRecently my 10 month old daughter was given a prescription from the local pharmacy with an incorrect label, instructing us to give her 5 times the amount of medication that was prescribed by her doctor. The doctor had written the prescription for 3 cc (cubic centimeters) three times per day, but the label instructed us to give her 3 teaspoons three times per day. To make matters worse, the technician at the drive-up window reiterated the incorrect instructions to my husband and showed him how to draw up the medication using a 5 ml syringe.

Fortunately, when my husband came home from the pharmacy and told me the instructions he was given I immediately knew what he was telling me was wrong. I grabbed the bottle to prove to him that he had misheard the instructions, but to my surprise, the instructions he was giving me were written clearly on the label.

When it comes to medications, errors will happen. It’s your job as a parent or caregiver to be sure that the errors don’t make it in your front door. While it’s great to have confidence in doctors and pharmacies, confidence isn’t a substitute for being an educated parent or caregiver.

When it comes to kids and medication, always follow these three rules:

  • Listen to the instructions of the prescribing doctor and repeat back to the doctor the medication name and dosing instructions. If your doctor seems rushed or if you’re preoccupied with the kids, ask the doctor to slow down or to write the instructions out for you.
  • Look at the label. Be sure it’s yours and confirm that the label matches the instructions the prescribing doctor gave you. Always check your prescriptions before leaving the store.
  • Ask for clarification. Speak up if things don’t make sense and take advantage of the pharmacist consult that most pharmacies offer. Be sure to speak to the pharmacist, not the technician if you do have questions. If you are given a syringe to administer medication and the units on it don’t match the units on your label, ask for a different measuring tool or for the conversion.