This webinar is intended for all parents, with children of various ages (infant – older children), to learn about sleep guidelines, general sleep facts, common sleep issues, and much more! Our panel includes Allied Physician Group pediatricians, Dr. Kerry Fierstein (Pediatric Health Associates, Plainview, NY) and Dr. Janice Montague (Tuxedo Pediatrics, Suffern, NY), as well as Child Sleep Specialists, Seema Bhambri, and Zeenat Hameed-Zaman.
By Dr. Stephen Borchman
#1 asthma tip of the year- GET THE FLU VACCINE
Any parent with a child with significant asthma will naturally have an underlying fear that their child may have a catastrophic asthma episode. Their fears are well-founded, as every day in the United States between 3 to 5 individuals succumb to acute asthma. Approximately 1/3 of the victims are children. Acute asthma has a variety of triggers, and these triggers vary greatly from child to child. As I often tell parents, asthmatics are like snowflakes, no two are the same. They all have their own individual characteristics. One of the most common and potent triggers of acute asthma in children are respiratory tract infections. Fortunately, for the most dangerous of infections, we have vaccines. And of all dangerous infections, the one that is most common in our society is the influenza viruses. Influenza viruses change their characteristics every season, and there are at least a half a dozen strains that circulate the globe every year, with more evolving every year. The World Health Organization monitors the frequency and severity of influenza infections yearly and then will decide which strains to include in the annual vaccine. While not perfect, this is currently the best approach we have towards protecting people from the very potentially serious consequences of influenza infection.
Acute asthma occurs when the triggering agent, whether this is an infection, pollen, animal dander, or environmental pollutants causes a sudden inflammatory event in the child’s bronchial tubes. If this inflammation proceeds unchecked, it is often accompanied by airway spasms, resulting in respiratory distress. Any parent who has seen their child in respiratory distress knows exactly what this looks like. It is terrifying and any parent who’s been through a hospitalization with their child certainly never wants to experience that again. Influenza infection is a very potent trigger of airway inflammation. And although the vaccine may not stop every influenza strain from causing illness in your child, getting the vaccine will certainly improve your child’s chances of avoiding hospitalization. This was proven in a 2017 study. In that year, 171 children died of influenza infection in this country. Of those 171 children who died, only one had ever received an influenza vaccine, but not in the year that the fatal event occurred.
So please, on behalf of all the doctors at Allied Physicians group, please follow the recommendations of the American Lung Association, American Academy of Pediatrics, and every other medical organization, make sure your child receives influenza vaccination every year. In fact, everyone in the home should be vaccinated for influenza as well to increase the probability of keeping it out of your home. Every year your child receives the vaccine, his or her immune system acquires more information about influenza viruses and is better equipped to defend itself against these infections. Please also follow your doctor‘s recommendations as specified in your asthma control plan. Make sure you contact your practitioner if you feel your child’s asthma is unstable in any way. Lastly, please always keep your follow up appointment so your doctor can monitor and change your child’s medications as needed.
Click here to learn more about our Asthma Control Education (ACE) program.
By: Kerry Fierstein, MD, Pediatric Health Associates (Plainview, New York)
Mealtime should be fun – for you and your child! You can de-stress mealtimes by remembering some simple concepts.
#1 – Don’t really care if your child eats or not. Normal, healthy, neurologically-intact children will not starve themselves. The more invested you are, the more power you have given to your child and the more likely he is to use mealtime to manipulate.
#2 -Your job is to provide the food. Your child’s job is to determine which choice and how much. Make sure whatever you offer has some nutritional value. She doesn’t drive or shop. Don’t give her food you don’t want her to have. Don’t play waitress. If you make Mac & cheese whenever she doesn’t like what you give her, soon she will only be eating Mac & cheese.
#3 -Give them control – Make a buffet and let your child fill the plate. Create dips out of applesauce, tomato sauce, avocado, mayo, yogurt or ketchup. Put Parmesan cheese in a child-sized shaker.
#4 – Involve them. Use the IKEA principle. We are all more invested in things we make. Cooks are invested in their meals – so let your little helper prepare dinner with you.
#5 – Appeal to their sense of fun! Make plates colorful. Arrange foods in a happy face. Have pizza for breakfast or pancakes for dinner. Have a picnic in the den for lunch.
#6 – Have realistic expectations. From one year to puberty kids are just not growing that quickly. A toddler should eat 1/4 of what an adult should. That means one chicken nugget, 1/4 of a grilled cheese sandwich or 1/2 an egg.
One good meal a day is fine. So if your toddler eats two good meals today, he may not eat tomorrow at all!
#7 – Don’t sabotage mealtimes. Goldfish will fill up her little belly with no nutritional value, and no wonder she doesn’t eat dinner. Milk is not a substitute for eating. Don’t let him drink all day. Max out milk at 16 oz per day. Max out juice at 4 oz per day. Offer water liberally.
#8 – Give your child the gift of recognizing and responding to their hunger signals. Don’t you wish you only ate when you were hungry?
#9 – Go easy on yourself. Your value as a parent is not judged by how well your child eats at any given meal.
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York)
It has been a scary week for our country. First, days of hearing about bombs being sent to many of our leaders as well as people who broadcast the news. Then on Saturday, we hear about the senseless shootings at a house of worship in Pittsburgh.
Our thoughts go out to the families that lost loved ones in such a senseless way. We are humbled by our first responders, running into the gunfire to save the innocent. Our prayers go out to those who were injured and wish all a speedy recovery.
Our country was founded on the principle of political and religious freedom. It is simply unconscionable for people to be targeted during worship, and unthinkable that it would happen in the United States in this day and age. This violence occurs at a time when there is an increase in religious harassment on college campuses and online. But how do we this explain to our kids, how do we reassure them that their house of worship they will be safe? What’s next?
First thing is to reassure our children they are safe. Listen to their fears, validate what they are feeling, and let them ask questions. Keep your explanations age appropriate. Early elementary school need simple concrete answers. Take them to schools and houses of worships to show them they are safe. Ask principals, ministers, rabbis priest and imams to talk with them about the safety of the buildings. Schools are already doing drills to prepare students. Ask your house of worship if they are prepared as well. Suggest or run a program for students to make them comfortable.
Older elementary and middle school students need to ask more detailed questions. They are just developing opinions and are able to understand more. Ask them open-ended questions. Remind them they are safe and encourage them to talk with their school and religious leaders. Let them hear how the community is working to keep them safe.
Older middle school and high school students will have varying opinions and are developing political and religious views that might be different than their parents. Encourage the students to talk, if not to you but to people they respect. Listen and ask what can you do for them. They might have different views than you, validate them and discuss with them how to be civil with those that hold different views.
Observe your kids. Look for changes in behavior, appetite and sleeping patterns. Limit your younger children’s television viewing and try to limit their online news. Watch your conversations with your spouse and friends in person and the phone. Maintain your normal routines. The more normal life appears for your kids the better. Do enjoyable things as a family.
Martin Luther King said, “Darkness cannot drive out darkness; only light can do that. And hate cannot drive out hate; only love can do that.
By: Dr. Deborah Schwartz (Chester Pediatrics– White Plains, NY)
As your child is preparing to start or return to college, take time to discuss the stresses of college life. NAMI (National Alliance on Mental Illness), encourages families to start the conversation now about mental health challenges, including what the privacy laws are and how mental health information can be shared. Starting this conversation may not be easy, but it is a useful tool to keep channels of communication open between you and your child.
There are many colleges that require incoming freshmen to complete online courses about alcohol and drug use. There are also some families that have a family history of mental illness and substance abuse. Use this as a springboard to start the talk. These conversations may help your child to be proactive about their own physical and mental health.
The excitement of being out of the house for the first time, in a new environment with new people, may mean your child has not considered the other emotions they may experience. Not only are they having to deal with the pressures of living away from home, but they are navigating the task of that innovative but rigorous college academic schedule and the social pressures of fitting in with their new group of friends. This combined with poor eating habits, curtailed sleeping hours, and drug and alcohol use, all contribute to feelings of sadness. There will be days that they may feel down or overwhelmed. These feelings can be normal. However, sometimes these feelings of sadness can turn into more overwhelming emotions.
Mental health issues are common. NAMI reports that 1 in 5 young adults will experience a mental health condition. Thirty percent of college students report feeling so down the previous year that they found it difficult to function.
It is important that your child finds a good emotional outlet. When looking to unwind or clear their heads, they should try to take some time for themselves. Engaging in an activity that makes them feel good is always a great start. Whether it be taking a walk, going to the gym, FaceTiming a friend from home, or getting lost in a good book.
Sometimes it may be difficult to assess whether whatever your child may be feeling is an early sign of an emerging mental health condition or part of a normal response to a new situation. Make sure to educate yourself about the services that the school provides so you can help guide them to the best resources possible. Knowing that they have support at home and at school is essential and will provide ease to your family during this very exciting and new time!
By: Cindy Goldrich, Ed.M., ACAC (is a Mental Health Counselor, Certified ADHD Coach, Teacher Trainer, and Parenting Specialist. She works nationwide with parents, teachers, and related services professionals for the education, treatment, and support of children with ADHD and Executive Function Deficits. Cindy is an active writer, speaker, and contributor to the field of ADHD.)
Now that summer is finally upon us it’s a good time to take a break from the treadmill and breathe. While for many of us, our work day is no different, there is undoubtedly a shift in the daily routine now that the school bus no longer beckons and homework is not an ever-present stressor.
By allowing for some distance from our daily stressors, we can begin to view the challenges we face with our children through a more patient, reflective lens. Here is an exercise you can do to help you become more in tune with your wants and concerns for your children.
1. For each of your children, write a list of three or four situations that you want to be different regarding their behavior. Perhaps it has to do with the morning routine, or how they treat their sibling, how the way doing homework seems to be a battle each day. Don’t feel you need to write a comprehensive list of everything. Just the big ones that pop into your head that represent the ones that create the most significant stress or frustration.
2. Put this list away for a day or two, and then look it over to see if perhaps there are ones you want to add or eliminate. This will help you recognize if you were responding out of momentary feelings, or if the items are representative of genuine systemic challenges you or your children face.
3. For each of the situations, write down a basic sentence of why this concerns you. Then, ask yourself why that is a concern. And then a third time. Each time you are going deeper into understanding what is the core concern.
4. Now comes the moment of truth. Ask yourself what is the fear behind the why? What is truly making you nervous, anxious, sad, etc?
5. Now, take out a new sheet of paper and write down a new set of wants based on your reflections.
At this point, you may want to sit with these thoughts for a while. And when you are ready, see if you can use this deeper awareness to communicate your concerns to your children. Or, you may find that you want to let some of your concerns guide you in adjusting your parenting priorities, shifting what you are focusing on.
Sometimes, it can be constructive to stop, breathe, and reflect. Take in the scenery and put things in perspective. Parenting is a journey; we often learn as we go. As always, you are never alone – reach out if you want support, guidance, or tools.
Enjoy the moment.
Button Battery Injuries in Children: A Growing Risk
More than 3,000 button batteries are ingested each year in the United States. It may be as frequent as every three hours that there is a child in the ER somewhere in this country for a battery-related emergency issue.
Small, shiny and appealing to children, button batteries can result in a major injury and even death if ingested.
What Are Button Batteries?
Button batteries are the small round batteries found in small electronics, such as:
- Remote controls
- Games and toys
- Hearing aids
- Bathroom scales
- Key fobs
- Electronic jewelry
- Holiday ornaments
As more homes use these small electronics, the risk of these batteries getting into the hands of curious and crawling infants and young children increases.
What Should Parents Do?
Parents and caregivers should not assume that every battery-powered product that enters their home is safe for use by children. In many products, for example, the battery is easily accessible or can fall out when the product is dropped. Make sure that the battery compartments of all electronic items are taped shut and loose batteries are always stored out of children’s reach.
A button battery stops powering a device way before it runs out of a charge. So, what we think of as a “dead” battery still has the charge to harm a child should it get caught in their ear, nose, and throat or swallowing passage. The higher the voltage of the battery (3V vs. 1.5V), the faster the injury.
When a child ingests a button battery, their symptoms could be virtually absent or similar to those of a common infection. This makes it challenging for health care professionals who are evaluating the child.
- When a button battery is placed in the nasal cavity or the ear canal, drainage or pain may be noted, which is not unique to button batteries. Non-specific symptoms combined with an unwitnessed placement can lead to a delay in diagnosis and even greater injury. Batteries that are lodged in the nasal cavity can cause nasal mucosal injury, periorbital cellulitis, scar tissue formation and nasal septal perforation. Injuries in the ear canal include hearing loss, tympanic membrane perforation, and facial nerve paralysis.
- When lodged in the body, the electric current in a button battery rapidly increases the pH of the tissue adjacent to the battery, causing significant tissue injury even within two hours. Esophageal button battery injuries can include esophageal perforation, mediastinitis, vocal cord paralysis, tracheoesophageal fistula, esophageal stricture, or death caused by a significant hemorrhage of an aortoesophageal fistula.
Figure 1 (left): Endoscopic view of button battery injury to nasal septum in right nasal cavity of a child.
Figure 2 (right): Rigid esophagoscopy showing button battery injury extending into the muscular layer of esophagus in a child.
If You Suspect Your Child Has Ingested a Button Battery
If a parent or caregiver is suspects their child ingested a button battery, the child needs to be taken immediately to an emergency room.
Healthcare professionals in the primary care, urgent care, and emergency room setting need to consider that any metallic foreign body in the nose, ear canal, or esophagus is a button battery until proven otherwise.
The diagnosis can be confirmed on a two view x-ray, which from a distance can sometimes be mistaken for the more commonly ingested foreign body, a coin. See Figures 3 and 4 below. Note: The button battery has the double ring, or halo sign, as opposed to a single ring of the coin.
Figure 3 (left): Double ring, or halo sign, of a button battery in the esophagus of a child.
Figure 4 (right): Homogenous appearance of a coin in the esophagus of a child.
The treatment for a button battery stuck within the body is urgent removal in order minimize local tissue damage. Both immediate assessment of the area of battery contact and follow-up surveillance for long-term, delayed complications should be performed to identify acute or delayed injuries.
Awareness is Key to Prevention
Parents and caregivers need to be aware of the risk posed by button batteries in their home. Keep loose and spare batteries locked away and store any product that uses button batteries out of reach. A child’s curiosity can be dangerous. Take the necessary precautions to prevent these situations and be sure you are prepared.
Lead Exposure: Steps to Protect Your Family
The most important step parents, doctors, and others can take is to prevent lead exposure before it occurs.
- Test your home for lead. If your home was built before 1978, talk with your local health department about getting your home tested for lead. If you don’t know how old your home is, assume there is lead. In the United States, lead is in paint in 87% of homes built before 1940, 69% of homes built from 1940–1959, and 24% of homes built from 1960–1977. Homes in the Northeast and Midwest are most likely to have lead in paint. Ask the landlord about lead before you sign a lease. Before you buy a home, have it inspected for lead.
- Before any work is done on your home, learn about safe ways to make repairs. When repairs are being done, seal off the area until the job is done and keep your child away until everything is cleaned up. Be sure to use a certified contractor. Removing lead paint on your own can often make the condition worse. If work is not done the safe way, you and your child can be harmed by increased exposure to lead in dust. See the EPA’s Renovation, Repair, and Painting rule Web page for more information.
- Keep your children away from old windows, old porches, and areas with chipping or peeling paint. If it is in your home, cover it with duct tape or contact paper until it can be completely removed. If you rent your home, let your landlord know about any peeling or chipping paint. Landlords are legally required to repair lead problems found on their property.
- Do not allow your child to play in the dirt next to your old home. Plant grass over bare soil or use mulch or wood chips.
- Clean your home regularly. Wipe down floors and other level surfaces with a damp mop or sponge. Taking shoes off at the door can help reduce tracking in dirt.
- Teach your children to wash their hands, especially before eating. Wash pacifiers and toys regularly.
- Keep clean. If your work or hobbies involve lead, change your clothes and shoes and shower when finished. Keep your clothes at work or wash your work clothes as soon as possible.
- Use cold flushed tap water for mixing formula, drinking, or cooking. If you are in an older home, run the water for several minutes before using it in the morning and start with cold water for drinking or cooking.
- Eat healthy. Give your child a well-balanced diet that includes breakfast and food high incalcium and iron. A good diet can help your child absorb less lead.
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York) & Kerry Fierstein, MD, Pediatric Health Associates (Plainview, New York)
E-cigarettes or “vapes” have replaced traditional cigarettes as the nicotine delivery system of choice for teenagers and parents need to understand the appeal and the risk vaping represents.
Though marketed as a safer alternative to cigarettes, recent studies show that the vape liquid is laced with dangerous chemicals that build up in a teen’s body. Teens who smoke e-cigarettes have higher levels of cancer-causing chemicals in their bodies than nonsmokers, as a team at the University of California, San Francisco, recently published in the Journal of Pediatrics. Unlike what might be expected, the fruity flavors seem to produce the highest chemical levels. Although e-cigarettes do not produce smoke, breathing in the second-hand vapor is not harmless. The aerosol from e-cigarettes may contain many potentially harmful chemicals, including lead and other heavy metals.
In 2018, about 37% of high school seniors admit to vaping within the last 12 months with about 42% admitting to vaping at some point. Middle schoolers are getting into the act as well and vaping is a common occurrence in middle school bathrooms. Middle school use is rising. An increasing number of middle and high school students said they can obtain a vaping device ‘fairly easily” or “very easily” with this percentage as high as about 80% for high school seniors. In 2018, U.S. Surgeon General Jerome M. Adams officially declared e-cigarette use among youth an “epidemic” during a Dec. 18 press conference.
Our teens are using different types of vape pens with the JUUL being the hottest thing. JUUL pods hold the fluid and contain about as much nicotine as one pack of cigarettes. The JUUL looks like a flash drive so teens can carry it around openly and most adults have no idea what it represents. The JUUL device is rechargeable and can plug into the USB port of a teen’s computer. The device is about $35-$50 and each pod is about $4 and comes in flavors such as tobacco, mint, and fruit. Also, our teens are now vaping marijuana. This is quickly becoming an easy way to get high.
So what is a parent supposed to do? It is time parents and schools start educating themselves about vaping. Studies show that parental opinions on drugs will affect teen behavior. Include a talk on vaping as your child prepares for middle school. Teach your high schooler about the chemicals in vape. Talk to your children about vaping, but first, do your homework! Get involved. Nassau County is proposing a new law that would enact a new code regulating the advertisement of age-restricted vaping products within 1000 feet of schools, parks, playgrounds, and duly licensed day-care centers. Even if you live outside Nassau, contact your representatives, tell them we need to protect our kids.
By: Dr. Eric Levene, Chester Pediatrics (White Plains, New York)
The Tide Pod Challenge has become a viral social media sensation. Teenagers are eating these laundry pods and posting videos of themselves on social media. They are then daring one another to follow suit. There have been many discussions on how this trend developed, but the Tide pod meme has caught on.
In the first half of January 2018, there have been 39 reposts of intentional Tide Pod ingestions, which is an increase from 52 for all of 2017.
So, what happens when a teen eats a Tide Pod? The pods contain ethanol, polymers and hydrogen peroxide. First, there is a bitter taste and you may become nauseated. The pod’s coating dissolves in the mouth releasing the cleaning agents, causing a burning sensation. A chemical burn could occur in your mouth, lips, tongue and checks. In many cases the symptoms will dissipate in a few hours but you could end up hospitalized or worse. The burn could cause difficulty breathing and esophageal burns. These burns could require months of hospitalization and multiple surgical procedures. In the most severe cases patients may have had seizures and may require ICU care. As per Dr Michael Lynch a the Pittsburgh poison Center, the more you swallow the greater your risk.
In response, both YouTube and Facebook are trying to remove these posts from their sites. P&G, the makers of Tide, have taken to Twitter with a video of Super Bowl bound, New England Patriot, Rob Gronkowski to warn teens against this problem.
We recommend that you talk with your Tweens and Teens about this latest “Craze”. Review with them the possible injuries that can occur with eating laundry detergent. Discuss how to say “NO” to the challenge.
Please remember these laundry pods are attractive to younger children who think they are candy and they should be kept high or locked away or both.
If you may have consumed any toxic substance, call the Nation Poison Hotline 1-800-222-1222.