Friday, December 2, 2011

“My tummy hurts!” - How to Tell When a Stomachache Is Real

“Mommeeee… my tummy hurts!” my three-year old complained as he came out of his room for the second time that night.  

“Show me where it hurts,” I said to him.

He pointed to an area around his belly button (where most children will point when asked this question).  My son was normally a great sleeper, so I was a little concerned that maybe he really was coming down with something.

I looked at him and went through my checklist.  Dressed in his dinosaur fuzzy footy pajamas, he had walked over to my room to report his distress (no signs of pain with walking).  He wasn’t bent over or crying (not severe pain).  He had come up with this reason after a previous unrelated reason for leaving his bed (not repeated or consistent pain).  He had eaten dinner well earlier today and went to the bathroom normally (no loss of appetite and no vomiting, diarrhea or constipation).  I put his hand on his forehead and he did not feel feverish (yes, we will always tell you to take your child’s temperature with a thermometer – but I’ll admit to using the mommy forehead test).

 “What do you need to make it better?” I asked.  I almost always ask my kids this question when they have a complaint.  They usually have a fix in mind and the “boo-boo” disappears magically.  My favorite was when my daughter told me that “chocolate candy” would fix her stomach pain.  (I didn’t give in on that one!)

“I need boo-boo penguin,” he answered promptly.  He was referring to our penguin-shaped ice pack that seems to cure almost all ailments. 

So, I said okay.  And within five second of boo-boo penguin’s magic, he was ready to sleep.

I wouldn’t recommend giving in to demands on repeated nights, but since this was a first request, I let it slide.  Sometimes it isn’t worth the battle!  (ummm - perhaps “do as I say, don’t do as I do” applies here also)

How do you know when a stomachache is the sign of real illness or when it’s just a behavioral ploy for attention or to get out of doing something (like eating vegetables or going to school)?

It can be difficult to tell sometimes.  However, there are certain signs that are red flags for illness.  Some of these require immediate medical attention.  Others can be treated first at home and then your child should be brought to your pediatrician if there isn’t any improvement.

When you call your doctor, think about the following so that you can have these answers ready.

Timing  - How long has the pain been going on?  How often does your child have the pain?  How long does it last? When does it happen?  Most simple pains only last a few minutes and happen only once or twice.  If the pain lasts for several days or several hours, call your child’s doctor.  Some pains only occur during school mornings.  Others happen only at bedtime.  These can all be clues as to the underlying cause (or motive as the case may be!)

Severity – Is your child running around and playing? Or is she rolled up in a little ball crying about her pain?  This will help you to determine the seriousness of the pain.  Asking young children if their stomach hurts does not always help since they will usually give the answer that they think you want (not how they actually feel).

Location – Where does your child point to when you ask where it hurts?  Tell them to point with one finger to where it hurts the most – otherwise, they’ll usually rub their entire belly button area and say “It hurts all over!”  Pain located in the lower right side of the belly is possible appendicitis and is an emergency.

Triggers – Does it occur after eating certain foods or drinking certain liquids?  Lactose-intolerance is fairly common and can be helped by eliminating lactose from the diet (your child can drink soy milk or Lactaid milk to get the needed calcium).  Also, food allergies can cause stomach pain or vomiting or diarrhea.  Celiac disease (or gluten intolerance) is a common food allergy that can cause ongoing stomach pain.  Bloating and gassiness can be associated with food-related allergies or intolerance.

Vomiting or Diarrhea – Stomach bugs can cause short-term belly pain along with vomiting or diarrhea.  However, if the vomiting/diarrhea is severe, lasts more than 24-48 hrs, contains blood, or your child is unable to keep fluids down, call your doctor.

Constipation – If your child’s pain is much better after having a bowel movement, then the pain may be related to constipation.  Increase water, fiber and vegetables in your child’s diet to see if your child’s pain improves with softer stools.  See my previous blog post on constipation for more information.

Urinary problems or groin pain – these can be signs of other medical problems like a urinary tract infection or testicular torsion.  Call your doctor immediately.

Rash – stomachache and rash can be signs of other types of illnesses, such as a Strep infection, call your doctor for guidance.  If your child has hives, then it may be an allergic reaction, seek help immediately.

Fever – fever usually means infection.  If the fever is low grade (102 or less), has been less than 3 days, and the stomach pain is minimal, you can likely treat your child’s symptoms at home.  However, if the pain is severe, your child is in distress, the fever is high, or any of the warning symptoms described above are present, then you should call your child’s doctor.

Weight changes or poor growth – if your child is not growing well or is losing weight, these can be signs of more serious diseases and your child needs to be seen.

What to do if you suspect the complaint is behavioral?

If your child is running around happily and is not ill-appearing, then the complaint of a tummyache may be a way of getting attention or a ploy to get out of an activity.  If you think this is the case, the best thing you can do is to ignore it.  The more you acknowledge it, then the more he will repeat the behavior (i.e. getting boo-boo penguin in the middle of the night – oops!) 

Instead, provide a distraction and move on to the next activity.  If there are no further complaints, then you know it’s just a clever way to get some attention.  Or if he insists on a cure, then give a placebo, like a medicine syringe full of colored water or juice and see if the pain improves.  If so, you know that there is nothing serious causing the pain. 

Shower your child with love and attention when he is not complaining of tummy aches and gradually the behavior will stop.  It may take a few weeks, but if you stick to it, then the imaginary tummy aches will be cured.  (and then they’ll move on to “Mommeeee…  my leg hurts!!!”)  (more on that later!)

Happy Holidays, and thanks for reading!

Saturday, October 22, 2011

Keeping Our Kids Happy and Healthy Through The Holidays

“Can I wear my gloves today?” asks my daughter holding up her new pink gloves decorated with snowflakes.  It’s the end of October and sixty degrees outside.  It’s been unseasonably warm this season, and we’re only just starting see some colder weather announcing the arrival of autumn.  

So I tell her, “Not yet, but soon.  It’s cold, but not cold enough for snow yet.”  She nods and puts them in her backpack for safekeeping.  “Maybe it will be cold enough tomorrow!”  

The she zips up her backpack, thinks for a second, and then asks, “Can I wear my boots?”

And so it goes…  in the end, we’ve compromised.  She can wear her boots this weekend, her hat now, and her gloves when she goes to the playground today if she wants.

Cold weather is here, and we are spending more time indoors sharing viruses and germs.  Kids and adults alike tend to get sicker in the winter months because of this.  Parents can take help prevent illness in their children by teaching them valuable skills that will prevent illness.

Regardless of age, one of the most important methods of prevention is good hand washing.  My kids are notorious for running their hands under the water for three seconds (maybe getting a little bit of soap if we’re feeling extra good today) and then quickly wiping their hands on a towel as they run out to get back to playing. 

To wash our hands properly, we should rinse our hands with water and soap for at least twenty seconds, or the time it takes to sing the alphabet song.  For children who are old enough, teach them how to wash correctly.  Show them how to clean the tips of the fingers especially well since children tend to put their fingers in their mouths often.

One of the most common ways that we pick up germs or viruses is by touching surfaces that someone else who has been sick coughed on, sneezed on, or touched.  Then we end up infecting ourselves or our children.

Many parents also notice how younger siblings seem to get sicker at a younger age or perhaps more often than an older sibling did.  This is because the older child brings germs or viruses home from school or daycare and infects the younger child.

Colds, flu, and vomiting/diarrhea diseases are some of the most common illnesses that children get from others.  If your child ends up with any of these illnesses, here are some tips to help you and your child get through them.

For colds and flu, it is important to give your child plenty of fluids.  Food is not as important while they are ill, and your child may lose her appetite while sick.  Hydrating your child with age-appropriate fluids is important.  Running a humidifier in the child’s bedroom and having her sleep in a more upright position will ease nighttime congestion and cough.  For children older than 1 year, giving 1 teaspoon of dark honey can quiet coughing episodes.   In general, over-the-counter cold medications are not recommended for children under the age of 6 years.  If your child has fever greater than 104, has prolonged fevers for more than 3days, has a severe cough, chest pain, wheezing, or seems lethargic, call your doctor immediately.

In the past, we were all told “cover your mouth when you cough”… and we did this with our hands.  However, when a child coughs and covers his mouth with his hand, the virus particles get all over that hand, spreading the virus to others as he touches various surfaces.    To help keep from spreading germs, teach your child to cough into the crook of his or her elbow.  And again, good hand-washing is key to prevention of spread.

Use antibacterial hand sanitizers when soap and water are not available.  These are effective for killing many of the germs that can cause illnesses.

For vomiting and diarrhea illnesses at all ages, it is very important to prevent dehydration.  This can be done by giving small frequent sips of an electrolyte solution, such as Pedialyte.  If your child refuses to drink or cannot keep large amounts down, then give 5 mL every 5 minutes using a medicine syringe.  This can hydrate a child successfully and will be less likely to trigger more vomiting.

You should avoid giving juice or sports drinks because the excessive sugar in these liquids can result in worsening diarrhea.  Giving water alone does not provide enough of the salts and sugars that the body needs to function.  Probiotics can also be very helpful with diarrhea illnesses.  These can be found in yogurt (if your child isn't vomiting) and in powder or chewable tablet forms in most drug stores and several grocery stores.

If your child shows signs of dehydration, call your doctor immediately.  Signs of dehydration include increased thirst, dry mouth, sunken fontanelle (for infants), doughy-feeling skin, decreased urine production, and lethargy or tiredness. 

Regardless of the type of illness, do not send your child to school if he or she has a fever.  Viral illnesses are the most contagious when the person has a fever.  Most viruses are spread by respiratory droplets or contact with fluids that contain virus, so even though the fever is gone, your child may still be contagious to others.  Use your best judgment when deciding when your child should go back to school.  

Teach your child not to share food or drinks with other kids since someone else might be ill or be contagious and not realize it.

Help your child stay healthy and ready to learn by taking precautions and use prevention methods.  Teach your child to wash his or her hands often and avoid direct contact with other sick children when possible.  By doing this, everyone can stay healthy and have a happy holiday season!

Happy Fall and thanks for reading!

Friday, September 30, 2011

Hyperactive - Or Just Being a Kid?

“Sit down!  Why can’t you sit still?” 
“Don’t touch that!”
 “I told you that it’s time to go?  Why aren’t you ready yet?”
“How could you forget your homework again?”
“Get off that ____!”  (sharp thing, dangerous high thing, major machinery that children shouldn’t be on, museum object with sign that says ‘Don’t Touch’, etc, etc)

Do you ever feel like a broken record?  Or think that your child is ignoring you?  Or perhaps that there is something wrong with your child, or your skills as a parent?

Well… I have.  As I watch one of my sons, yet again, be unable to keep his hands off of the items around him, or sit still for longer than a second, I wonder if there is more to him than meets the eye.

Now, my oldest is the calm, rule-following, responsible one who tends to obey and follow most of my requests.  While he’s not a robot, he seems to get what my husband and I are trying to say.

My second, however, is totally different (as he should be).  I love him to pieces, but he can drive me crazy at times.  Now, don’t get me wrong, he’s not a bad kid.  He’s actually very bright, very creative, and downright funny.  He will be the first one to help his younger siblings if they are in need.  He’s a pretty decent athlete and shines in many ways. 

However, he just can’t stop moving!  He gets frustrated easily and is very easily distracted.  He doesn’t appear to know when it’s inappropriate to grab things from other people, and has a very hard time waiting for his turn.

Part of me wonders if he is just so different from my first son, that I’m making comparisons that just aren’t realistic or fair.  But then, when I’m talking to parents and evaluating their children for ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder), I know in my heart that he may very well have it.

The good news is that ADD/ADHD is a treatable condition and that are many resources now available for parents and their children.  ADD/ADHD may affect as many as 10% of the population.  That means that in the average classroom of 24 kids, at least two children may suffer from the disorder.  But how do you know if your child has a disorder or if he is just being a kid… and since it’s more common in boys (five times more common in boys than girls) – how do you know if he isn’t just “being a boy”?

ADD/ADHD tends to run in families (hmmm, so maybe it is my fault!) and at least two genes have been associated with the disease.  Studies have shown the disease to be associated with brain chemical (neurotransmitter) changes, structural brain changes and is frequently found in children with other health conditions.  It is felt that ADD/ADHD may be partly due to developmental delay of the part of the brain that is responsible for executive functioning (which is the part that manages control and judgment).

As children get older, many of them are able to learn to manage their symptoms as they gain the maturity and develop the higher brain function needed to govern attention, planning and judgment.  Many adults who have ADD/ADHD do quite well and are able to multitask successfully.  Some may still require medications as adults, but that is not very common.

There are several standardized tests and tools that medical doctors and psychologists use to help to determine if a child has ADD/ADHD.  For the most part, it is recommended that you wait until your child is in school before testing is done.  Often, the very active preschooler does fine when he reaches the age of 5-6 years and starts attending elementary school.  

Treating the disease is important to ensure maximum success at school.  Treatment may involve behavior modification therapy, working closely with teachers, getting special services for extra time for classwork and homework, accommodations such as having an extra copy of textbooks at home, and sometimes taking medications.

The criteria for the diagnosis of ADD/ADHD include the following:
a.                   often fails to give close attention to details or makes careless mistakes
b.                  often has difficulty sustaining attention in tasks or play activities.
c.                   often does not seem to listen when spoken to directly.
d.                  often does not follow through on instructions and fails to finish tasks
e.                   often has difficulty organizing tasks and activities
f.                   often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
g.                  often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
h.                  is often easily distracted by extraneous stimuli
i.                    is often forgetful in daily activities

a.                   often fidgets with hands or feet or squirms in seat
b.                  often leaves seat in classroom or in other situations in which remaining seated is expected
c.                   often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings or restlessness).
d.                  often has difficulty playing or engaging in leisure activities quietly
e.                   is often "on the go" or often acts as if "driven by a motor."
f.                   often talks excessively
g.                  Impulsivity – has difficulty awaiting turns, interrupts or intrudes on others

If you suspect that your child may have attention or hyperactivity issues, take your child to your pediatrician for further evaluation and advice.

(Okay, so it’s taken me five tries to sit down and finish writing this as I got distracted by the phone, my emails, searching for food, putting away dishes, doing the laundry… so guess where my son got it from?  Oh well... hopefully he got enough good genes from my husband's side to balance him out!) 

Take care and thanks for reading!

Sunday, August 14, 2011

Back to School – Where did the summer go?!

As I sit in my kitchen sipping my morning coffee, I glance over at my kids.  Two are glued to Nintendo DS players.  One is stuck to our iPad.  And the fourth is still in bed.  It’s eight in the morning and this is how they are starting the day.  If they aren’t in camp, the default activity is something with a backlit screen (computer, video game, TV).  This drives me crazy.  

I think about going to back to school in two weeks (we go back before Labor Day).  This is not going to be an easy transition!  

Now, don’t get me wrong.  I’ve tried throughout the summer to stimulate their brain cells.  “Let’s do five pages of workbooks!”  Grumbles and groans, while I hear, “Mom, I have to save!” Then there are about ten-fifteen minutes of focused library-like quiet after they settle down with age-appropriate workbooks.  Then… they’re done.  “Can I play now?”

We’ve read books, gone outside (when it’s not 120 degrees and a wall of humidity out there), been to summer camps, played sports, visited museums, vacationed at the beach, and so on.

But, now it’s time for school again.  Hurray!  Summer can be exhausting (for the parents!).

So, starting next week, it’s back to normal bedtime and wake up times.  This will make the actual week of school a much easier transition.  I highly recommend requiring this for your kids the week before school starts, especially your teenagers who would much prefer to go to bed at 2 a.m. and wake up around noon.

You may have heard of the motto – “9-5-2-1-0” as a way to remember what is healthy for kids every day. 
9 - hours of sleep
5 - servings of fruits and vegetables
2 -  hours of screen time (max)
1 -  hour of exercise, and
0 - sugary beverages (like juice or soda)  

So, take a look at what your child is getting and see if there is any room for improvement.  This applies to kids who are in preschool, elementary, middle or high school. 

Buying school supplies is always a treat for my kids.  They love their new backpacks and cool lunchboxes.  If your child is new to school, or isn’t a big fan of school, this is a positive way to bring up the idea of heading back.

Starting school is also when germ-sharing begins in earnest.  Proper hand washing is the best way to prevent picking up viruses and bacteria that can make us sick.  Teach your kids how to wash their hands well while at school and when they come home from school.

To wash hands properly, your child should wash with water and soap for at least twenty seconds, or the time it takes to sing the alphabet song.  Try to clean the tips of the fingers especially well since children tend to put their fingers in their mouths or touch their faces.

Getting plenty of rest, eating a health breakfast and washing hands properly will help to make your child’s beginning of the school year a great one.  Best of luck with the back-to-school preparations, and pat yourself on the back for a job well done as you send your little one off to school for another amazing year!

Thanks for reading!

Saturday, July 2, 2011

Pooping on the Potty - Don't Make Me Go!

“Currently, our toddler is practicing willful control of her bowels - in a bad way. Potty training was going well for awhile, but suddenly she's refusing to let herself have a BM. (We made no changes to routine, diet, etc.) She's just flat out clenching and fighting for all she's worth to not have a BM, even when we add high fiber foods. After 3-4 days of a grumpy, constipated child, we finally pull out some PediaLax products, which then seems to *make* her go 1-2 days later. Then she'll be regular for 2-3 days, but after that, the cycle starts all over again. Any advice for me and/or your blog readers?”

Going poop in the potty is a common issue for toddlers.... something about pooping into that bowl really bothers some kids.  So they end up holding it in and get constipated.  Then it hurts to go because they are constipated, and they are even more afraid to go next time... so they hold it in.  Then they get more constipated... and so on.  It’s a painful cycle for your toddler and can throw a monkey wrench in what had been successful potty training efforts.

So... here's what to try if it happens to your toddler or child.  Buy some Miralax (an over the counter stool softener - very safe for kids, can use up to a year if you had to).  Other stool softeners can work, but often result in more cramping and cannot be used for long periods of time. Give 1 capful a day (17g) of Miralax mixed in liquid (if the stools are too soft, cut back a little).  But do this for at least two months - even if the stools are normal.  Stop pushing potty training temporarily while you do this.  She needs to forget that pooping hurts. 

Her colon needs to get used to normal-sized, soft stools for several months.  When constipation occurs, the colon gets stretched out of shape (think of how a woman’s belly gets all stretched after being pregnant – it takes time to get back to normal) (although I think mine will never get back to normal!).  The stretch of the colon sends a signal to our brain to tell us that we need to go.  If your colon is stretched out already, it takes even more stool to send that signal to your brain.  So, it’s important to give your child's colon time to shrink back to normal size before you stop the Miralax.  

It is very important to change your child's diet.  Avoid constipating foods (bananas, rice, applesauce, toast (white bread), cheese).  Give more fiber (oatmeal, bran, fresh fruits, vegetables), prune juice (if she'll drink it), prunes, and water.  For some children, too much milk or dairy can be constipating.  Toddlers need around 16-20 oz of milk to get enough calcium, but more than that can result in constipation and anemia (too much calcium can interfere with iron absorption which then leads to anemia or low red blood cells).  

Then in about two months, start trying to potty train again.  Don't remind her that she used to do it... just start from scratch... stickers, rewards, etc. 

Don't worry – there are very few kindergarteners still wearing diapers to poop or pee... so everyone gets it eventually!  Refusing to poop in the potty is very common and very normal toddler behavior.

If she hasn't poop in five days, has vomiting, has blood with stools, or severe stomach pain, call your doctor for help.  Do not use Miralax in infants.  If your baby is constipated, consult your child's doctor.

Hope this helps!  Thanks for reading and Happy 4th of July!