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Urinary Tract Infections in Young Children – Part I: Diagnosis

Urinary tract infection  (bladder, Kidneys)  is a very common issue in children and sometimes not the easiest to diagnose.  The symptoms depend on the age and sex of the child, and the location of the infection and these symptoms can vary across the board.  Urinary tract infections (UTI) are more common in females as a rule but during the first year of life, when it is most difficult to diagnose, the incidence is just about the same in males and females.

Sometimes there is an anatomical problem with abnormalities in the kidney or bladder or both that children can be born with, but most of the time these infections occur de novo.  An infection is defined as bacterial growth in the urine in the presence of appropriate symptoms.  If there are no symptoms, the presence of bacteria might only mean colonization, eg: there are bacteria in the urine but have not caused a body reaction yet.  Under certain circumstances even colonization needs to be treated.

During the first year of  life, one might only see a very irritable, cranky baby with or without fever and the source of those symptoms is “hidden” sometimes even to the best and most experienced physician.   Therefore, during the first year of life the suspicion for a UTI is very high and the urine might be checked more often than it would in an older child with the same symptoms.  As you can imagine, obtaining a “clean” urine specimen is very difficult so a variety of methods have been devised.  If one merely “catches” the urine as it is produced externally this stands a significant chance of being contaminated by bacteria living on the skin.  The best ways of obtaining a reliable urine specimen is somewhat invasive but at least your doctor can rely on the results of the evaluation.  These consist of either a bladder catheterization, where a small tube is passed up into the bladder and a urine specimen is obtained or a supra pubic needle aspiration where a needle on a syringe is passed through the lower abdominal wall and a  urine sample is obtained.  The urine sample is obtained by a reliable lab or sometimes in the Doctor’s office by means of a urinalysis and a culture of the urine to be sure there are bacteria in it and what kind it may be so as to choose the correct treatment.  This culture can take 2- 3 days to complete.

This is a very large and important subject so I will stop here and take on the topic of  treatment of UTIs and possible further diagnostic procedures in my next entry.

How to Keep an Eye on Your Children Online

Being careful…

Observing

Parenting

Investigating

Snooping

Spying

All of those words or phrases have similar meaning, at least in their denotative (dictionary or literal) form.  In their connotative (commonly understood) form, they come out very differently.  As a parent, it is our responsibility to look out for our children, even if they don’t always like it.  And let’s be honest, we didn’t like it much when our parents “spied” on us.

Ask yourself this question: If your child was outside playing, would you look out the window occasionally to check on them?  If you answered yes to that question, then you should also be willing to see what they’re doing online.

I’m not suggesting that you watch them 24/7.  Just as when they’re offline, the amount of oversight will vary from child to child.  It’s not about trusting your child to make the right choices.  At least, it’s not just about that.  According to the FBI, there are 750,000 predators online at any given moment.  This is what concerns me as a parent.

Why is it so important that parents become more involved here?  Because, as parent advocate and internet safety expert Sue Scheff reports, 57% of teens say that they know how to hide their online actions from their parents.  That’s how many admit to it, so I believe the real number is even higher.

So, how can you keep an eye on what your children are doing online?  There are several ways, many of which will be completely unknown to your kids.

1. Friending/Following Them

Many parents probably already do this.  They might think that it’s a great way to see what their kids are up to, but it’s actually one of the least effective ways to know what’s happening to them online.  The biggest reason why this is the case is because many kids are known to have multiple accounts on social media sites.

Smart kids continue to post to the accounts that their parents know about, while putting their private posts on another account.  A zombie phone is one that is no longer on a call/data plan, but can still access the Internet using WiFi, just like any tablet can do.  Really clever kids will use a zombie phone for their private accounts and stay signed into the accounts that their parents know about on their “active” phone.

On some apps, people may join groups to talk about shared interests.  On some apps, you can’t tell if a person is in any group.  On Facebook, they have Public, Closed and Secret groups.  Nobody can tell if a person is a member of a secret group unless they are already in the same group. The only way for a parent to know if their child is the member of such a secret group is to either be a member of the group themselves or to be signed into Facebook as them (which will be explained shortly).

2. Seeing What their Friends Do

A chain is only as strong as its weakest link.  Maybe your child is pretty adept at keeping you out of the loop, but maybe their friends aren’t as good at it.  Maybe their Instagram account isn’t set to “private”, which blocks most people from seeing what they post.  In that case, look at their friend’s accounts and see what they post there.  Maybe you’ll see pictures from a party that your child said they hadn’t attended, even though you clearly see them in several pictures!

3. Using Search Engines/Sites

Have you ever entered your own name into a search engine to see what would show?  I recommend it.  You might be amazed at what you’ll see.  Of course, it’s harder to find yourself or your family members if the name is fairly popular.  Still, it’s a start.

In addition to the usual search engines, here are a few specific tools that can help you:

  • Advanced Twitter Search – this feature on the popular app is really helpful and easy to use. Here’s the link: https://twitter.com/search-advanced.
  • Google Alerts are a way to have Google send you email alerts if content which might include your child gets posted in real time. You can get a lot of false positives, though.
  • Google Image Search is a great way to see if images are being posted online. I primarily use this to find catfish (online fakers), but it can also be used to see where images might be posted.

4. Third Party Monitoring Apps

There are many options here to choose from.  The features range from being very permissive to being very restrictive.  Those that are permissive tend to be more of a monitoring app that lets parents know if a child does something questionable online.  At the opposite end of the spectrum, some of the apps lock out certain apps or websites from a device.  Of course, these apps only work if the child doesn’t have a zombie phone. With so many options available, they allow parents to find the monitoring app that matches their parenting style.

5. Signing on as Your Kids

While this is the most time-consuming way to know what kids are doing online, it can be the most effective.  However, this assumes that the child doesn’t have accounts on sites that their parents don’t know about – either single accounts or multiples on the same site.  The same is true for kids who have unknown devices to use.

Those limitations aside, it gives full access to parents who want to see direct messages sent to their kids, what groups they may have joined and more.  When I speak with parents, I always ask them what would happen if they asked their child to hand over their phone without notice.  I’m always amazed at how many parents say that their kids would never allow that.

In most cases, the parents paid for the phone and probably pay for the monthly service.  So while the child uses it, the phone is not their property.  When we gave our daughter her first phone, we made sure that she was aware of this.  Like many teens, she put a PIN on her phone to avoid people using it without permission.  She is required to give us that PIN, as well as any logon credentials for any apps that she uses.

While we almost never use them, I actually did last night.  I found out that she had changed the PIN after one of her friends was able to guess her original choice.  It was a pretty easy code to guess if someone knew her, so she made it a more random number and harder to guess.  We have never had a reason to question her judgment online, but we made it clear to her that as her parents, we reserve the right to access her devices/accounts if we felt the need.  I didn’t check any of her emails or accounts, but if we couldn’t get past the PIN, we would not have even had the option to do so if we felt it necessary.

Takeaway

These methods vary in effectiveness and how invasive they are to the child, but the goal is always the same – to keep them safe and out of trouble.  Sometimes, it’s protection from others and sometimes, we need to protect others from them.  Kids may not like it when their parents “spy” on them, but we’re their parents, not their friends.  Our primary responsibility is to protect them from dangers that they may not even know exist.

One of the most important things to remember is that if you do see something happening online that requires you to intervene, avoid doing it online. 

We worry about what they might do online because it’s part of their Digital Footprint, otherwise known as their history and reputation.  But the truth is, that what parents do online can become part of their Digital Footprint.  We may not have liked it when our parents scolded us in front of our friends, but at least it was done and over with.  Scold a child online and it will have much longer lasting effects.

Senseez Pillows: Vibrational Therapy to Soothe Anxious Kids

senseez logo -smallMy name is Stephanie Mitelman. I am a Mom and I created the Senseez Pillows. The name Senseez means to ease the senses… Let me tell you the story of how Senseez was born…

When my son was 2, he was diagnosed with a special need. One of his difficulties was sitting in one place long enough to eat his meal, read a story, or sit for circle time.

I spoke to an occupational therapist who recommended a vibrating mat to help with this.I bought one for my son, and he instantly loved the sensations!

But one day, I wanted to take him to our local library for story telling, and though the mat would help… it was large, black, heavy, and had to be plugged in. I was also concerned about my son looking different or standing out with this large mat.

So I went on a search to find a small, lightweight, portable pillow that would offer the same sensations that he could take with him. I couldn’t find one!

So Senseez was born!

Senseez are colorful, lightweight, fun shaped vinyl pillows that offer a gentle vibration when they are squeezed or sat on. They operate on batteries and have a small pouch inside that can vibrate to offer sensations to relax, calm or soothe the body. They’re small enough to take anywhere and are made just for little bums!

Painting on a Senseez pillow

Kids that have trouble sitting for meals, stories, car rides, shopping trips, school work, movies, or anything else will be comforted by the vibrations of Senseez. Kids that have trouble falling asleep will enjoy the relaxing sensations.

The original prototypes were sewn in the basement of our home! We made about 25 pillows by hand, and distributed them throughout schools and therapy centers in our area. Since Senseez was created to be taken everywhere and to be used by multiple children, we used a vinyl material, since it is considered to be the most hygienic and easiest to keep clean. The vinyl is also water resistant. We also created a Senseez furry option for children who would like more tactile input.

After we got some feedback, we hired an engineer to perfect the vibrating mechanism we needed. Once that was complete, we had the pillows tested by Canadian standards for lead, small parts and flammability.

We then connected with an importer who handled the production. Our first order was for 600 pillows. Once the word started getting out, we sold out within 9 months!

In April 2013, we were also invited to do a taping on the Dragon’s Den television show. Today, we have 14 different distributors across Canada and the US, and the pillows are now being used across schools, therapy centers and many homes! The feedback we get is so positive, and the ways in which the pillows are being used is so inspiring. Here is an example:

I wanted to share a positive story regarding your Senseez Pillows. I gave one of the pillows to my client who is part of our deaf blind program. Although she is very fluent in hand over hand sign language as well as Braille, she struggles a lot with expressive communication. We have been working closely with her to initiate requests, preferences, feelings…..communication in general. The pillow was introduced during a session as a sensory aid with vibration. She immediately started hugging the pillow and placing it behind her back ……all while signing the word “happy”.

While her expressive communication still remains a struggle, she is now on a regular basis asking for the “vibrating pillow”. She has created a sign that meshes together the words vibrate and pillow, which she independently will communicate to others!

It’s a huge break through!!!!!! It is the first time that she has communicated a want.

Needless to say, we will be needing some more pillows 🙂

Research shows that vibrational therapy has been used for many years in many different forms. Some children require the vibrations to help calm their bodies, while other children just enjoy the way it feels!

We are thrilled that our pillow is helping children, parents, teachers and therapists!

HEALTHFUL HINTS

Tips for working with children who have difficulty sitting in one place for any length of time:

  1. Some children do best with time limits. Let the child know how long they will have to sit for. A start and finish time can help. i.e: sit for 3 minutes to finish snack.
  2. Sometimes using a visual timer can help. Visual timers are available at most special needs stores.
  3. When training a child to sit for a period of time, start small and the build it up. One minute, goes to two, then five etc…
  4. It is okay to use outside reinforcers during this process. Children respond well to rewards, like their favorite treats. You want to build in a reward at the beginning and it won’t be long before long they won’t need it anymore.
  5. It is also okay to use other distractors like TV or iPad in the beginning. We want to calm the child during this hard task. For some children, TV and iPad can help reduce the anxiety of staying one place may cause. After a while, the distraction won’t be needed either.
  6. And you will need to verbally prompt at the beginning. Prompting is giving a gentle reminder about what the child is supposed to be doing, and reinforcing it when they do.
  7. It is always important to reinforce the good behavior (when they do sit in one place), and not only discuss when they don’t.
  8. And lastly, some children enjoy different sensations to help soothe their senses. Vibrations are helpful. Other sensations could be a weighted vest or blanket, or something that offers compression.

Note: Each child is different and you will have to experiment with what works with your child!

This 4th of July, Keep Your Family Safe and Give EMS the Day Off

An evening of fireworksAs summer has rapidly arrived upon us and the kids have let out of school for the summer, the planning has already begun for the July 4th celebration that happens all over our great United States. It is unfortunate that those of us involved in the emergency field will see this happy day turned into a bad one by accidents having to do with Fireworks and a lack of Firework safety.  The numbers every year do not lie and neither do the stories we see and hear every year about fireworks. According to the American Pyrotechnics Association, National Council on Firework Safety the information from 2012 is as follows:

As you can see that the number of serious injuries and deaths from Fireworks in 2012 is pretty alarming and most could have probably been avoided with some simple safety preparations and precautions.

Fireworks safety chart 2012

In 2017 alone:

Some very basic and simple safety tips and precautions are:

  • Never allow young children to play with or ignite fireworks.
  • Always have an adult supervise fireworks activities. Parents don’t realize that young children suffer injuries from sparklers. Sparklers burn at temperatures of about 2,000 degrees – hot enough to melt some metals.
  • Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks.
  • Never try to re-light or pick up fireworks that have not ignited fully.
  • Never point or throw fireworks at another person.
  • Keep a bucket of water or a garden hose handy in case of fire or other mishap.
  • Light fireworks one at a time, then move back quickly.
  • Never carry fireworks in a pocket or shoot them off in metal or glass containers.
  • After fireworks complete their burning, douse the spent device with plenty of water from a bucket or hose before discarding it to prevent a trash fire.
  • Make sure fireworks are legal in your area before buying or using them.

If you see fireworks being used improperly or in an unsafe and dangerous manner around you or your home by unknown, underage people, or even neighbors, please do not hesitate to call 911 and alert the police or even the fire department.

These are just a handful of safety tips and precautions that should be taken BEFORE, DURING and AFTER using fireworks. Please feel free to consult your local fire station for more information if you feel the need. As always, a little preparation and safety can save a lot of pain and injury later and make this Holiday the celebration it should be for all of us.

Thank you and be safe!

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** Editor’s Note: Pounds of fireworks purchased each year in the APA chart above are in millions

Play-Dates: Making Sure Other Children Are Safe With Your Dog

Dog wants to be with childYou probably did quite a bit of work (maybe even before you brought your new baby home), to ensure the relationship between your baby and your dog was cultivated and nurtured into a beautiful lifelong friendship. But now, time has passed, and following the natural course of events, they are ready to establish friendships with other children.

You may have met some other parents at the park, or if you work and your child is in daycare, they may have already made some friends and you have met some of the other parents, and decide to get together for a play date. But there are a few very important things to be aware of here before making plans to host this at your house to ensure that other children are safe around your dog, and I will give you some advice on a way  to ‘test the waters’ without putting any child in danger.

To start off with, there are three very important questions you must answer:

  1. What is the breed (or the dominant breed if your dog is a mix) of your dog?
  2. How protective is your dog over your child?
  3. Does your dog tend to be a bit on the skittish side?

The first question is important because there are certain characteristic traits that each breed may have that may tell you what to expect in a given situation. But also please note that I said “may”.  Although knowing the breed of the dog can help you anticipate some possible behaviors, it is important to remember that most dogs have not ‘read the book’ on themselves, and therefore, do not always fall to ‘type’.  This is why questions two and three are equally important. You have to know your own dog’s temperament to ensure everyone’s safety.

Going back to the first question; here are some examples of why the breed of the dog matters: Some breeds, what people have termed the ‘bully’ breeds, such as the Rottweiler, Pitt, Akita, Rhodesian Ridgeback, German Shepherds, and several others, despite the general public’s fear of them, are usually great with children…. Where the problem comes in, is that they are great with ‘their’ children… the one’s they have accepted into their pack. But often they are mistrustful of ‘strange’ children (ones they don’t know) and the biggest problem; they do not understand how children play:

Prime Exampleyour young child is playing with a toy and another child takes it, and now they are arguing over it. Remember, dogs are instinctual animals, so they rely heavily on their senses, not rational thought. What you observe: two children learning to share and work out disagreements. What your dog observes: (sound) shouting or crying (sight) your child posturing and ‘guarding’ what is theirs. (smell) humans secrete different odors that dogs can detect for fear, stress, anger, sadness, happiness, etc. (I am sure you have heard the term “They can smell your fear a mile away”)

Now I want to add that I highlighted some of the breeds that people, in general, can be nervous around, but ANY dog can go into protection mode if they perceive their pack member in danger. And any dog that tends to be skittish is usually not a great candidate to be invited to the play date. Remember what I talked about in earlier articles…. Fearful dogs have two vices…. Fight or flight. If you are lucky, they will choose the latter, but I think it is better to remove them from the situation to avoid them having to make that choice at all.

So, how can you ‘test the waters’ on how your dog will react while keeping everyone safe? One way I have found that works well is to start on neutral ground (somewhere other than your dog’s home, where his job is to be the ‘protector of the realm’.) This is a two adult exercise, so please do not attempt to do this alone… you cannot be in two places at once.

The first step is to find a park where the children’s playground area is fenced in. There does not necessarily have to be a closed gate, but a fence needs to be there. Now plan a trip to this park with two adults, your child, your dog, and plenty of treats. handler holds dog at parkThe adult working with your dog needs to be the one with the strongest authority over him… the un-challenged pack leader.  To make the explanation of this exercise a bit easier, going forward, I will refer to this adult as ‘the handler.’ Double-check your dog’s equipment (leash and collar) before doing this as well. Do not trust a leash that has been previously chewed or that is frayed in any way, or a collar that could easily slip off.  Hint: If you typically use a Flexi leash®, now is NOT the time to use it. You need something with guaranteed control, not something that may or may not lock when you need it to.

Once you arrive at the park, the handler remains outside of the playground, behind the fence with the dog and the second adult brings the child in to play with the other children. Make sure your dog can see your child, but be aware that you don’t keep calling the dog’s name to make sure he is watching, as this will confuse him and make him want to come to you, and you will not know whether his reaction is stress from being away from the child, or not being able to come to you when called. Now comes the important job of the handler…. Watching. There are many ways to tell your dogs reaction long before they actually act. Body language is a clear give-away as to what they are feeling.

Here are some simple signs that can tell you your dog’s stress level:

Relaxed:

  • Ears forward
  • Mouth open with normal panting
  • Looking around at many things
  • Follows commands easily

Stressed and Reactive:

  • Ears back
  • Excessive panting
  • Pacing
  • Whining, crying, or barking
  • Scruff up on the back of their necks
  • Excessive yawning
  • Stare locked on your child
  • Difficulty following basic commands

If he starts to whine and cry as the child is walking away, a good way for the handler to tell the extent of the dogs reaction is by giving some commands. A dog that is very stressed and reactive may have a difficult time following even basic commands, such as SIT, DOWN and STAY. If he follows the commands easily enough, treat and praise.

If you had some mild difficulty (i.e. he is ‘locked in’ on your child and not listening), try refocusing him by simply walking him around in a few circles with some basic commands and plenty of praise and treats.  If you see him start growling at the other children and you have a difficult time refocusing him, I recommend walking further away, giving him a few commands that are treat-worthy so you end on a positive note, and try again another time (just try not to wait too long in between these sessions.)  Repeat this exercise as many times as it takes until your dog becomes relaxed and non-reactive consistently .

If your dog is aggressively growling at other children, trying to lunge, or exhibits behaviors that are very concerning, I would suggest not trying this exercise again until you consult with a professional trainer. *A good resource to find a trainer near you is the International Association of Canine Professions (IACP). Click on ‘find a professional’ and then enter your zip code for a list of local trainers. 

If your dog was relaxed (non-reactive) the entire time, it is a pretty good indicator that they may do well during play dates, but as an added ‘protection feature’ at the first play date after this exercise is successful, have your gates up, and the dog on a leash the entire time.  Remember, the handler’s job on that first play date needs to be focusing on the dog, regardless of how well it is going. If the adult in charge of the kids needs assistance, ask one of the other parents to help… you never know what action may set off the dog’s reaction, and things can go south very quickly, so now is not the time to ask the handler to help put out snacks.

I will end this with two last thoughts: The best defence is a good offense.

  1. Don’t over-react, but be vigilant and aware. And if neither of you is 100% convinced that you can handle any reaction, it is OK to start off using a muzzle. It is humane, and ensures the safety of everyone around.
  2. And lastly, as I always stress, no matter how great it is going, the children should ALWAYS be supervised around the dog.

An added bonus: You may have other parents there that have no experience with their children interacting with dogs. If they are nervous about there being a dog in your home, they will be impressed with the measures you have taken to ensure their child’s safety.

Hearing Loss In One Ear Can Cause Speech Delays

Children with hearing loss in one ear may seem to be hearing normally but may fall behind in speechMost babies are given a basic hearing test when they are born.  Usually kids don’t get another hearing test until they enter kindergarten.  A 2018 article by the Cleveland Clinic shows that hearing loss in one ear can go undetected and often goes untreated. The problem is that “these children are exhibiting speech and language delays and are at risk for education problems, including an increased rate of failing a grade, the need for educational assistance in the classroom, and perceived behavioral issues”.

If your preschooler is behind in speech or diction or seems to only pay attention occasionally you might want to ask for a hearing screening.  Being deaf or hard of hearing qualifies a child for special education.  Although that disability may not mean there are any cognitive impairments the condition may prevent the child from taking in or accessing the information being taught. Children with hearing impairments also benefit from speech therapy and other strategies.

More details on how to recognize unilateral hearing loss (UHL) in children can be found at the American Speech Language Hearing Association (ASHA), where you can also find information on testing as well as tips for helping your child hear and learn better at home and at school.

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Editor’s Note:  Links have been checked for accuracy and updated as needed