Sunday, December 12, 2010

Coughs, stuffy noses, and fevers – Welcome to Winter!

“How can I help with the cough?” is one of the most common questions I get in the office during the winter cold season. 

When cold weather arrives, we all stay indoors and we share our germs.  Viruses love the winter season because it’s the best time to travel from one person to another and then to another.   Kids who are around many other people tend to catch more colds and viruses than ones who are not.   Common exposures come from daycare, school, and their brothers and sisters. 

Children build immunity by fighting illnesses from viruses.  Their immune systems learn how to fight these bugs, and then hopefully, will be more protected in the future as they encounter new viruses.  Any pediatrician will tell you that they’ve never been sicker than their first few years in training or in practice due to the large number of viruses that we’re exposed to.  If you’ve never been exposed to a virus, then your chances of catching it is much higher.  However, once you’ve battled the illness, then your immune system has a memory that will help it to fight future similar viruses.

So, when a baby is born, EVERY virus is new to his system.  It’s no wonder that babies will catch colds.  When a baby or toddler starts childcare, very often they have a new cold or illness every two weeks for a while.  Then when they reach elementary school, they are less likely to get sick because they’ve already had many of the viruses.

When a new virus emerges, like the H1N1 flu virus, we are all susceptible since none of our immune systems are prepped to fight it off. 

Most cold viruses can last up to two weeks.  Many people get concerned if their child is still congested or coughing a little after one week.  However, two weeks is still reasonable.  Fevers should be less than 103-104 F and should only occur during the first three days of illness.  If your child has a fever later, has a high fever, is breathing fast, or working hard to breathe, you should call your doctor immediately for guidance. 

Most coughs are protective.  The cough reflex is designed to protect your lungs from drainage that is trying to go down into them.  However, occasionally coughs can be more ominous and can be a sign of infection (bronchitis, pneumonia) or wheezing/asthma.  If your child seems to have a bad cough, has a fever with the cough or has difficulty catching his/her breath, call your doctor.

So, what to do when your child has a cold?  Well… it depends on the age of your child.

Young Infants (under 6 months of age):  At this age, colds can be especially miserable because they can’t clear their own noses.  If congested, it is hard for your baby to feed since your child has to breathe through his/her nose when drinking or eating. Putting a few drops of nasal saline in each nostril and then suctioning the nose will help.  Sleeping upright in car seat or elevating your baby’s mattress may be helpful (do not use a pillow).   A humidifier (cool or warm) next to where your baby sleeps will also help.  Hydration is important, so small frequent feeds are good if your baby can’t eat his/her usual amount.  While fevers may be part of a viral illness, young babies need to be checked if they have a fever to rule out other illnesses (especially babies under 3 months of age).   Call your doctor if your baby has ANY fever>100.4 (rectally), has trouble feeding, is breathing fast, has coughing fits, is vomiting or is not improving.   No over-the-counter cough medications are recommended at this age.

Older Infants and Toddlers:  Children this age also have difficulty when their noses are stuffy and they are coughing.  Sleeping is a challenge and often they will lose their appetites and drink less.  While eating less is okay, it is important that your child drink enough fluids and stay hydrated.  Clear fluids, like Pedialyte, will help to hydrate without increasing the mucous production like milk-products can.  Nasal saline is also useful to clear stuffy noses.   Suctioning your child’s nose will help him/her to breathe easier.  A humidifier (cool or warm) will help to quiet coughs and make nighttime easier to manage.   Sometimes, babies tend to collect mucous in their throats or upper airway and then vomit the mucous after coughing.  While messy, this can be normal and is their way of getting rid of the drainage.  However, if your baby has a high fever (>103-104), has difficulty drinking, is working hard to breathe, is vomiting other than with cough, or has a fever after the first three days of illness, call your doctor.  No over-the-counter cough medications are recommended at this age.

Preschool-aged children:   Kids aged 2-5 often have colds in the winter, especially if they are in preschool.  The sharing of viruses is inevitable when every child seems to have a runny nose in class!  For this age, you can help by taking care of the symptoms.  Again, nasal saline is useful and teaching your child to blow his/her nose is important to prevent secondary infections such as sinusitis or ear infections.  To help with sleeping, use a humidifier and have your child sleep upright on pillows.  A teaspoon of dark honey has been shown to be as effective as cough suppressants.  Over-the-counter cold medications are not recommended at this age.  If your child has high fever (>103-104), has difficulty breathing, or has a fever after the first three days of illness, call your child’s doctor. 

School-aged children:  For older children, it’s primarily night time that is difficult.  Run a humidifier, keep your child hydrated, and use nasal saline sprays to help.  A teaspoon of dark honey can be effective for quieting coughs at this age.  Over-the-counter cold medications can be used sparingly.  It is important to pick a medicine that specifically treats your child’s symptoms.  Multi-symptom cold medicines have active ingredients for each symptom – fever, cough, congestion, runny nose, and so on.  Do not give your child medication for symptoms that your child doesn’t have.  Also, while cough suppressant might make it easier to sleep, try not to use it during the day.  Cough has a purpose (to protect your lungs from drainage), so suppressing it may lead to further complications.  High fevers (>104), fever after the 1st three days of the cold, or difficulty breathing are all symptoms for which you should call your child’s doctor.

Hope you and your family have a safe and healthy holiday season!  Thanks for reading!

Monday, November 22, 2010

Flying With Kids

I awkwardly pulled my laptop out from under the seat in front of me while trying not to spill the little plastic cup of soda and bag of pretzels precariously balanced on my airplane tray table. My son across the aisle from me whined, “Mommy, I’m hungry!”  Then his brother said, “I need to go potty!”
Meanwhile, my two youngest children sitting next to me were impatiently waiting for me to start the Dora movie on the laptop.  “We want Dora!” they chanted.  They had not yet comprehended how computers are not instant satisfaction on startup.  At the same time, my husband (who was sitting next to the two older children across the aisle) had his eyes closed, resolutely ignoring the boys as they tried to get someone’s attention to feed them and take them to the bathroom.

Hmmm… Are we there yet?  

Thank goodness it was only a two hour flight.  The last flight we took as a family was over four hours and that was easily the maximum capacity for my two-year old for flying on a plane.  After that, I vowed no more long flights until he was older.

Flying with kids can be a challenge or it can be smooth-sailing.  Very much it depends on the age of your child, the length of your flight, and the time of day of your flight.  

I love to travel, and I really enjoy taking my kids places so that they can experience sights and adventures that I never had the opportunity to see and do as a child.  I even actually enjoy flying with my kids (usually).  However, I enjoy it more when they are older than three years of age and when I have enough adults around to help me.  Let’s just say it’s a little less stressful and a whole lot less to pack.

It’s amazing how much STUFF a baby needs.  I remember taking my oldest on a flight when he was five-months old.  He was a tiny little baby, and he had an entire full-size suitcase dedicated to him and his STUFF.  You know what I’m talking about – the diapers, the wipes, the bottles, the warmer, the clothes, and the backup clothes, the baby soaps and shampoos, the bibs, and the backup bibs, the blankets, etc.  Not mention the car seat, portable high chair, toys, and so on.  

So, how to survive a flight with your little one?  Here are some ideas (based on age):

Young Infant – the nice part of this age is that entertainment is not necessary.  Most of the times they are content to eat, sleep and poop as they normally do when not in an airplane.  The biggest issue will be helping them to “pop” their ears and equalize the pressure in them during the flight.  Generally, if your ears are popping, their little ears are trying to do the same.   To help your baby with this, make sure that he/she is swallowing during takeoff and landing.  You can do this by feeding your baby during these time periods.   Just make sure to pack extra clothes and diapers, including extra clothes for you in case of unexpected spit-up or diaper accidents.

Check the TSA website listed later in this blog post to familiarize yourself with rules regarding bringing formula or breastmilk onto the airplane.

Older Infant/Toddler – This is a challenging age for flying.  You can certainly fly successfully with a toddler, but timing is of utmost importance in this age group.  Choose your flight time by avoiding anything near naptime or bedtime.  Tired toddlers make lousy travel companions.  Pack plenty of snacks, favorite toys and distractions.   If at all possible, try to book nonstop flights to minimize the total travel time.  For really long flights, a break in the middle at a connecting city for a few hours may be ideal – however leave enough time so that you won’t be running for a connecting flight with a toddler in tow.  

Bring your stroller all the way to the gate and check it in at the gate just before you board.  It will make getting all your belongings and your baby to the plane easier.  Also, bring an empty sippy cup and then buy something in the airport to fill it, or ask them to fill it on the airplane with water or juice.
Some pediatricians recommend bringing along an weight-appropriate dose of Benedryl along in case your toddler is really having a difficult time with the trip.  Benedryl is an allergy medication that generally causes drowsiness as a side effect.  However, be aware that a small percentage of children actually get hyper on Benedryl.  Therefore, it is wise to test this at home before you discover that your toddler is wild after taking Benedryl on the airplane!

Children Ages 2-4 Years Old – This age group generally loves airplanes… at least they love looking at them.  Flying in them may be a different issue.  Reading about flying or going on an airplane is a good idea if this is your child’s first trip.

I usually try to buy a surprise activity for each child to do on the airplane – a new coloring book or new activity that travels well.  The fun of trying out a new coloring book and new markers will entertain most children for at least a portion of the trip.  Don’t give it to them until you are actually on the plane to enhance the surprise (and distraction) factor.

Also, while I don’t normally advocate video watching – a portable DVD player or laptop or ipod can work wonders to keep little minds occupied for a good portion of longer trips.   Taking a few walks up and down the aisle midflight helps to break the monotony of sitting in the seat.  Feeding children in this age group just before you fly, or bringing food on the plane, is also a great way to pass the time.

School-Aged Children and Older – Luckily, this age group tends to be able to entertain themselves.  Favorite activities include books, handheld games, and MP3’s make flying a more enjoyable and less boring experience for this group. Let them pack their own backpack and have them each carry their own carry-on.  It makes traveling much easier (especially if you can pack things for a younger sibling in their bag also!). 

Again, food is an excellent way to pass the time, so bring a meal onboard and give them something to do.  This will also ensure that they will not be hungry during the flight.

With the many travel rules these days from TSA, it’s a good idea to check out their website for rules about traveling with children.  They have a useful website at:

So, I hope this helps if you have little ones traveling by plane this holiday season!  If you tried some tricks for successful flying that have worked for your children, please share them by posting a comment!  

Thanks for reading and Happy Thanksgiving!

Wednesday, November 10, 2010

Time to Sleep – I wish!

“Mommy… can you cook my oatmeal?” said a soft voice.  I felt a small but insistent tug on my arm. 

Groggily, I opened my eyes and looked blearily at the little face peering up at me.  I looked at the clock, and it glowed, “5:45 A.M.”  I looked down at my almost-three year old son who was bright-eyed and alert, holding up a half-opened packet of instant oatmeal.  “I’m hungry… you cook my oatmeal?” he demanded much more loudly.  

Ughhh... I hate daylight saving time.

Daylight savings time was first conceived by Benjamin Franklin in 1784 and was designed to help us make the most of the natural sunlight variations of the seasons.  If we use natural sunlight most optimally, then overall we save on energy and electricity costs for lighting and appliances.  While this idea may make sense, it can be difficult to make that transition twice a year, especially for children.  

So, how can you help your child adjust quicker?
  1. Light-blocking curtains.  This is especially useful in the spring when bedtime is suddenly at a time when the sun is still bright and shining.  Every spring, we change the clocks forward.  Without fail at bedtime, one of my kids will say, “It’s not nighttime!” and show me how bright it is outside our windows.    So, I then show them the clock, reassure that it is indeed nighttime and then usher them rapidly into their bedrooms where they can’t see the sunlight because the curtains have light-blocking liners.  It also works for the fall time change so that the ones who wake up with sunlight, don’t wake up so early.  These types of curtains can be purchased at many home goods stores.
  2.  Change the clocks earlier in day.  Technically, we are supposed to switch at 2 a.m… but I don’t suppose that anyone actually stays awake to change the clocks.  Therefore, change it before your kids go to bed and keep bedtime at the “new” time.  For example, my children go to bed at 8 p.m.   So, I changed the clocks around 5 p.m. to reflect the new time (turned it back to 4 p.m.)  Then they slept at the new 8 p.m. (which was 9 p.m.) and then they were supposed to sleep the full ten hours (apparently my youngest son did not get the memo).  It just gives your family the chance to adjust on Saturday and Sunday, instead of just on Sunday. 
  3. Adjust nap times gradually.  For little children, adjusting naps by 15-30 minutes a few days ahead of the scheduled clock change helps to make the 1 hour switch less painful. 
  4. Shut off technology.  While it’s tempting to use that extra hour to watch TV, play video games, text, or surf the Web, it has been shown that all of these stimulate our brains, and interfere with our bodies to “shut down” easily.  Turn off all electronic devices at least one hour before you go to sleep.  This is true any time of the year.
  5. Calming rituals before bed.  Stretching, massage, lavender baths, stories, soothing songs, and so on.  Look for ways to relax your child so that sleep will come easily.  
  6. Eat healthy and exercise the next day.  One of the best ways to combat fatigue is to eat a good breakfast that is high in protein and fiber.   Then exercise sometime during the day to get the natural endorphins that fight fatigue.  Do this as a family and you’ll all feel better.
So, if you are still adjusting the time change, try some of the above to get back on track. 

Of note, when it gets dark so early, it can be very hard in the evenings to stay energized and alert.  Studies have shown an increased number of car accidents and pedestrian accidents just after the autumn clock change because it is so dark and we are more tired as we drive in the evenings.  So, please be extra careful as you are driving or walking around after dark these next few weeks.

Thanks for reading!

Saturday, October 23, 2010

Trick or Treat – I LOVE sweets!

“Can I please have candy?”  My daughter asks with an innocent big-eyed look with the most angelic smile.  She asks me just as I walk into our house after a long day at work. 

With my mind still transitioning from my work thoughts to how-to-be-a-mommy thoughts, I stammer, “Uhhh….. sure!” 

Then my heart is briefly happy when she cheers and jumps up and down.  She proclaims to her three brothers, “Yay!  Mommy says I can have candy!”

And then, my responsible parent brain kicks in when my sons start to clamor loudly (and less politely) for candy.   Ooops, what I have I done?  I didn’t have any idea how much sugar they had already eaten that day, and we all know candy just isn’t healthy. 

Candy -  it’s been around since ancient history.   The first candy confections were made from fruits and nuts rolled in honey.  Then around the middle ages, sugar was manufactured.   Initially it was very expensive so that only the rich could enjoy it.  However, by the 17th century, sugar was cheaper and hard candy became a popular treat.  In the mid-1800’s, there were over 400 candy factories in the US. 

When you add up our total sugar consumption, the average American consumes around 135 lbs of sugar PER PERSON in a year!  That’s about 2-3 pounds of sugar a week.  It’s not all straight sugar of course.  This amount includes dextrose and high fructose corn syrup which is found in many of our foods.  In the mid-1800’s, the average consumption per person was only 5 pounds a year.  It’s really quite sad how addicted we are to the stuff.

So, how to control the candy craving with Halloween just around the corner?  Here are few tips and tricks.

1.  Use a smaller bag/bucket.  If you allow your child to carry a pillowcase-sized bag, it not only allows unlimited amount of candy collection, but it encourages people to throw handfuls of candy into it, instead of just giving 1 or 2 pieces.  Older kids tend to go out later in the evening and tend to carry bigger bags.  At that time of night, people are trying to get rid of excess candy.  So, having the jumbo-sized bag just encourages people to give your child more candy.

2. Limit the trick-or-treating time.  If you trick-or-treat for hours, your children will get more and more candy.  Then you’ll have to deal with the ten gallons of candy that they’ve acquired.  Set a time limit and set expectations ahead of time.  Find other ways to celebrate Halloween that don’t involve candy.  Have some friends over for party or play Halloween games or watch a Halloween-themed movie.  You can make trick-or-treating just a small part of a fun day.

3. Allow them to eat it (at first).  Sometimes you create the craving by limiting it.  Imagine if I made you live in a room full of money and told you that you could only have one dollar each day.  Most people would really look forward to the moment when they got the chance to have a little more of the stash – at least at first.  And even if you didn’t care, it would likely be a part of your thoughts throughout the day since you could see it, but you couldn’t have it.  Halloween trick-or-treating is all about the candy.  So, let them have a chance to enjoy it. 

4.  After the binge, set a limit.  No one NEEDS candy.  So, consider it a treat.  Just like all sweets, you should limit it to once a day at the most.  If they want something sweet to eat, give them a piece of piece of fruit.  As your children learn to get their sugar fix from healthier options, then you will give teach them a lifetime skill that will pay off in the future.

5. Set a date for when you are going to throw the leftover candy away.  Very often Halloween would roll around and I would realize that I still had candy from LAST Halloween.  While some candy doesn’t ever seem to expire, it can go bad eventually.  Plus, if you don’t have it in the house, no one can eat it.  So, just toss it.

6. Consider a barter.  Let them “buy” fun things with their candy.  This way you don’t squelch their fun, but they don’t risk their health and their teeth.  Try five candy bars for a trip to the movies, or eight Tootsie Rolls for a pizza dinner.  Be creative.

7. Take it to work or to other events.  Get the excess candy out of the house.  If it’s in your house, your kids will find it.  Either give it away or throw it out. 

Have other ideas for how to limit the candy craziness?  Please share them!  For now, I need to find an apple or something – all this talk about candy makes me hungry!

Thanks for reading!

Saturday, October 16, 2010

Tantrums – Can I Throw One?


(pleading adult voice)  


(more pleading from the tired grownup) 

This is my two-year old son in his gymnastics class today.  I can hear them as I am sitting in the waiting area for the parents.  I feel bad for the coach.  I knew it was going to one of those mornings.

You know how you just know on some days that your child just woke up on the wrong side of the bed?  Everything is a battle.  From changing clothes (“I can’t dooooo it!”) and then to brushing teeth (“I don’t waaaant to!).  Eating breakfast is a mini-Congressional debate.  “Eat your oatmeal, you said you wanted oatmeal.”  “I want pancakes!”  “You told me you wanted oatmeal, now you have to eat it.” “I want pancakes!”…. and so on.

The “terrible twos” start somewhere around fifteen months and end around age 4.  This is a normal part of development and can be very trying for most parents.  Your cute, adorable sweet baby has turned into a seemingly stubborn little monster.  Tantrums are a normal part of this.  It’s caused by your child’s need for independence and inability to harness feelings that they are having. 

Approximately 20% of toddlers have at least two tantrums a day.  And most will have at least one a week.  They are emotional outbursts that help children express the feelings that they are having.  For young children, they revert to primitive behaviors that express their feelings – yelling, crying, hitting, kicking, and even biting.  Luckily, most are short-lived and children recover quickly from them once they are distracted.   

How to handle tantrums? 

1.)  Ignore them.  Tantrums require an audience.  Has your child ever thrown a tantrum when no one was around to watch?  Children naturally want attention, especially from their parents.  So, when you are paying attention to them because they are screaming and throwing themselves to the floor, you are just reinforcing to them that “Hey, this is a great way to get mommy to put that computer down (or that baby , or that book, or those dishes, etc) and, by the way, I should remember to do this again in the future.”

2.) Be sure your child is safe.  If the tantrum is happening somewhere unsafe (as you are crossing the parking lot), pick your child up and move to a location where they can flail and cry and dramatize the end of the world because you wouldn’t buy the toy that they suddenly need.  

3.) Avoid the tantrum.  If at all possible, avoid your child’s triggers.  Hunger, tiredness, overstimulation are common triggers for kids.  Make sure they are well fed, that you are avoiding activities during naptime or late afternoon, and that your child is prepped for the activities to come.  Every child has a different temperament.  If your child gets a little crazy every time you go into a crowd, it may be too much stimulation for him/her.  Go to the festival or the museum when there aren’t so many people around.  It will be better for all of you.

4.) Take deep breaths and count to ten in your head.  It’s easy to throw the adult version of a tantrum when you are frustrated with your child or embarrassed by your child’s behavior.  Losing your own temper in front of your child just teaches them that yelling is okay.  Spanking is a grownup temper tantrum , hurts your child, and teaches him/her that hitting is fine.  Don’t be surprised if your child hits or “spanks” other kids when they think the other child has done something wrong.  Child abuse happens commonly when adults lose their patience.  If you need it, make sure that your child is safe and give yourself a time-out. 

Well, apparently, this coach knows how to handle cranky frustrated two-year olds, because my son is now happily working his way through the mini-obstacle course in the gym.  Thank goodness.  Perhaps today will be a good day after all!

Thanks for reading!