How Much Do You Know About RSV?

Earlier today I got to spend some time with a friend and her baby girl. It was fascinating to see how a six month-old could "work" the room with her smiles and big blue eyes fixing on the face of one guest after another. She was the picture of health and beauty. So hard to imagine that just a month ago, she was taken to the emergency room in the middle of the night and hospitalized with breathing difficulties and a dangerously high fever.

It turned out she had an RSV infection. RSV stands for respiratory syncytial virus, and infection with this virus is the most common cause of infant hospitalization, leading to about 125,000 hospitalizations of young children each year in the U.S. Tragically, one to two per cent of these children die from the infection.

The baby's mom told me about the frightening night when she realized that her daughter had more than just a bad cold. The then five month-old began wheezing and having problems with her breathing. Her temperature soared, despite administration of the maximum allowed dosages of ibuprofen and acetaminophen throughout the day. The little girl became increasingly lethargic and pale, and her mom noted that she was even difficult to rouse. A phone call to emergency services led to the child's being taken to the hospital at once, where she was admitted and treated. I'm happy to say she recovered rapidly without complications and was home in a couple of days.

More than half of all infants are exposed to RSV by their first birthday. While any child is at risk for RSV infection, babies born prematurely have the highest risk for developing severe disease with the infection. The virus itself causes mild respiratory infections such as colds and coughs in adults, but in young children can produce severe pulmonary diseases including bronchiolitis and pneumonia. Many infected children have few or no symptoms, but some infants with RSV become very ill. After childhood, RSV causes repeated infections throughout life that are usually associated with cold-like symptoms.

A survey conducted by the National Perinatal Association (NPA) revealed that 90% of parents whose babies have been hospitalized with RSV infection believe that parents need more information on RSV and prevention of infection. RSV is highly contagious and is spread by respiratory secretions from an infected person. While it is impossible to completely prevent the infection from occurring, parents can reduce their child's chances of an infection by:

• Frequent handwashing, especially before holding your child. RSV is unstable in the environment and survives only a few hours on environmental surfaces. The virus is readily inactivated with soap and water and disinfectants.
• Never sharing personal items such as cups, pacifiers, towels, etc.
• Frequent washing of clothes, bedding, toys, and play areas.
• Keeping babies away from people who have colds or the flu, and avoiding crowds during peak RSV season (usually from November to April).
• Never allowing people to smoke around your baby.

I believe it is doubly important to recognize the signs of RSV infection. Be sure to call your pediatrician if your baby's cold is worsening, he/she has breathing problems or wheezing, worsening cough, high fevers, or develops blue lips or fingernails (signifying low levels of oxygen in the blood). As with any potentially serious illness, if in doubt about anything, call your health care provider.

Related Topics: RSV Season: It's Here, Common Childhood Virus Burdens Elderly Health

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Fruit Juice - Too Much of a Good Thing?

Fruit juice is one of those good-for-you-sounding things like vegetables, fresh air, and getting enough exercise. Like most kids, my kids love any kind of juice, anything made from juice, and any type of sickly sweet juice-resembling beverage (often labeled "juice drinks"), no matter how improbable the color.

But I'm talking here about true, 100% fruit juice without added sugars. While it shouldn't have to be a bad, forbidden, avoid-at-all-costs food, fruit juice also isn't always a wise nutritional choice. The reason is that it's packed with sugar and calories. According to the U.S.D.A. National Nutrient Database, a one-cup serving of apple juice has over 27 grams of sugar. That's about the same as the sugar content of a regular-sized Snickers bar.

Consumption of sweet beverages including fruit juice has been linked with an increased risk of childhood overweight and obesity, even when other factors, like the amount of fat in a child's diet or the total number of daily calories consumed, are taken into consideration. A child who regularly consumes fruit juice with meals and snacks can be slurping up hundreds of calories per day from the juice as well as reducing his consumption of nutritious foods because he feels constantly full.

What about the vitamins? True, some fruit juices are loaded with vitamin C, but in most cases, you can get the vitamins elsewhere- for example, from real fruit. Substituting real fruit for the liquid variety also provides you with a needed serving of fiber, and there's less of a tendency to over-consume. You can also get vitamin C from peppers, tomatoes, broccoli, and spinach. Plus, many breakfast cereals are fortified with vitamin C and other vitamins.

I'm not suggesting a ban on juice. Nor do most pediatricians oppose juice for children- it's just the quantity of juice and other sweet drinks consumed by many kids that concerns doctors. The American Academy of Pediatrics recommends limiting preschoolers to four to six ounces of juice per day (that's less than one cup). My own house is certainly not a juice-free zone, but I try to limit the kids' juice consumption to one glass per day. One thing I've taught my kids is that all juice needs to be mixed with water to make it "healthier", so they're getting only about half the sugar with the diluted stuff and - hopefully - acquiring a taste for less-sugary drinks.

How I Learned About Love and Logic™ Parenting

"Would you like to feel more comfortable as a parent?"
"Would you like to have more fun parenting?"
"Would you like to feel more relaxed at the end of the day?"

These three questions were printed in bold at the top of a flyer that one of my children brought home from school. It was a sign-up form for a parenting course called Becoming a Love and Logic™ Parent. After reading that third question, I had checkbook in hand. I have to be there. Sign me up now!

Actually, the class was almost free - we paid only for handouts - and was taught once a week in the school by an excellent team of two guidance counselors and a social worker. Based on the parenting techniques described by Jim Fay, a former school principal; Charles Fay, Ph.D., a child psychologist; and child psychiatrist Foster Cline, M.D., the course taught us techniques and solutions we could use starting right away to help solve parenting's little (and not so little) dramas.

The idea behind the Love and Logic™ theory is this: parents should provide an atmosphere of love, acceptance, and empathy, while allowing the natural consequences of a child's behavior and actions do the teaching. This should happen in the early years, when the consequences of the inevitable less-than-perfect choices are not too severe or damaging. By the time the child reaches adulthood, he or she is equipped with the decision-making skills needed for adult life. The method also teaches insight into parenting styles and how our own parenting styles can, inadvertently, sometimes rob a child of the ability to grow up making good decisions for him- or herself. It's applicable to all children, whether you have toddlers or teens.

Don't worry - Love and Logic™ isn't about letting three year-olds decide if they want to play in the street or the fenced yard and letting them suffer the dire consequences of a poor decision; your child's health and safety are never compromised. Rather, the method focuses on offering children the chance to choose from a range of choices that you, the parent, can live with, in order to experience the teaching value of their decisions.

An example of the theory might be allowing your child to decide how much he or she prepares for a second-grade test. If he says he doesn't need to study and ends up with a poor grade, that's a teaching consequence. When he is upset about the grade, you, the parent, step in as a source of empathy ("gosh, I'm so sorry that happened") without any sarcasm or proclaiming "I told you so". This way, you're not the bad guy, and hopefully your child learns the importance of preparing for tests before he is away at college when there's no mom or dad to goad him into studying. One could argue that the bad grade on one test in second grade is an affordable consequence, while a failed course at college is not. Using Love and Logic™ to help your kids learn decision-making lets them learn from consequences of their actions before the consequences become too big and far-reaching.

Of all the parenting books and advice I have read, I like this approach the best. It makes sense to me. I'd encourage any of you to check out this method if you believe that you're sometimes stressed out by parenting. You don't have to take the course, although the seven-week course was actually very fun and entertaining - never dry or dull. There are also books, tapes, DVDs and videos available to help you learn what this method is all about. You can find out much more than I can ever explain here at the Love and Logic™ Web site.

Let me assure you I am not affiliated with the program, nor did they or anyone else ask me to promote it here. Did it make me a better parent? I can't really judge that, but I have learned to spot some of my own parenting mistakes, and I certainly profited from the course. I hope I'm getting better and better at putting Love and Logic™ parenting into practice.

Do You - or Your Kids - Need "Hypoallergenic" Products?

Take a look at your shampoo label. Or read the label on any cosmetic product you buy for yourself or the kids. There's a good chance that your product carries the label "hypoallergenic." This sounds great, especially for "baby's delicate skin" or for your own "sensitive" skin. Hypoallergenic products certainly sound better for you- after all, who wants to risk getting hives or other signs of an allergic reaction?

Most people I have talked with don't understand exactly what they're buying when they purchase "hypoallergenic" products. According to the U.S. Food and Drug Administration (FDA), there are no federal standards that govern the use of the term hypoallergenic. In other words, if you develop a cosmetic product and want to label it "hypoallergenic", you can. You don't have to submit a list of ingredients to anyone, you don't have to prove that the product causes fewer allergic reactions than others, and you don't even need permission from any regulatory agencies to use the term.

Since any manufacturer can market any product as "hypoallergenic", it essentially renders the term meaningless for the consumer. Years ago, when the term became popular, the FDA attempted to regulate use of the term by requiring that companies selling "hypoallergenic" products submit proof that their preparations actually led to fewer allergic skin reactions than others. U.S. courts subsequently overturned the regulation, allowing for free and unrestricted use of the term.

In the early days of cosmetic manufacture, certain ingredients were used that did sometimes lead to skin reactions. With advancing time and technology, these harsher ingredients have been essentially phased out of the cosmetic manufacturing process, according to the FDA.

You can think of the "hypoallergenic" label, then, as a marketing term. (like my favorite marketing term, "European" - as in "a blend of European botanicals tested in leading European salons". Is something "European" necessarily better?)

It's really impossible to guarantee that a specific product cannot provoke an allergic reaction in anyone. However, since the FDA does require that ingredients be listed on cosmetic labels, if you have had allergic reactions or problems with a specific substance in the past, you can avoid purchasing products that contain these substances.

Related Topics: Hypoallergenic Hype, Allegies and Cosmetics

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Kids' Sports - Stay Smart, Safe, and Sane

The beginning of the second semester of school means, for many, that it's again time to sign the kids up for sports and extracurricular activities. If you have children, especially more than one child, you'll know what I mean when I compare scheduling the kids' after-school activities to planning a semester course load at college. How many "hours" should they take? Will we have adequate time in between back-to-back activities to get to the next one? What if two things they want to do very badly just happen to overlap, time-wise?

I'm somewhat of a newcomer to the extracurricular sports scene. During my own (pre-soccer league) childhood, girls could take dance lessons and boys could play little league baseball, and that was about it. And my husband and I celebrated the arrival of our own babies while living in Europe, where kids' lives were less pressured - and scheduled - than in America. Organized sports for little kids where we lived was pretty much limited to swim lessons (minimum age: five and a half) and mini-gynmastics lessons of the roll- and -tumble (rather than balance beam and pommel horse) variety.

Moving back to the U.S. presented an overwhelming array of organized activities for children. Not only could most five year-olds already swim, but the two- and three-year-olds were already perfecting their strokes in beginner classes. The range of sports lessons offered to preschoolers included dance, gymnastics, soccer, basketball skills, inline skating, swimming, equestrian sports, and various martial arts. The "older" elementary school set can mix it up by adding football, baseball, hockey, rock climbing, diving, cheerleading, tumbling, softball, archery, golf, ice skating, skiing, lacrosse, or tennis (and I'm probably leaving something out).

It's hard to know how much is "too much". Teaching kids to like and enjoy sports and physical activity is an important step in combating the escalating problem of childhood obesity (and related disorders such as Type II diabetes). For me, an interest in being physically active and fit is a value that I want to share with my kids, but I don't want to be a pushy mom or end up with stressed-out kids. I tend to follow a general rule of allowing each child to participate in one or two sports at a time. But since children all have different needs, wants, and capabilities, the "perfect" number of sports and activities for your daughter might be absolutely wrong for her best friend.

Learning to read your child's nonverbal cues can help you decide what activity level and type of activity are right for your child. Sometimes kids can't identify stressful feelings or articulate that they feel overwhelmed by too many activities. Instead, you might see behavior changes, sleeping problems, excessive tiredness, moodiness, frequent complaints of illness, or any number of symptoms that might mean that they're experiencing stress from overscheduling.

Parents and coaches of kids who are involved in sports also need to know how to best prevent and manage sports-related injuries, since active children can and will become injured. Data from the NIH show that children aged five through 14 sustained an estimated 2.38 million sports and recreational injuries per year from 1997 through 1999. Since children's bodies are still growing, the potential for damage to bones, tendons, muscles, and ligaments is greater than that for adults. Take the time to learn about your kids' sports, including the types of protective gear and equipment that are used, and the types of injuries that may occur. Preparedness and advance knowledge can help your child by increasing your ability to recognize and respond appropriately to a potential sports injury.

Related Topics: Keeping Kids Playing Injury-Free, The Stress of Youth Sports

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Myths and Anecdotes in Medicine

Everyone has likely heard their share of medical myths. Myths are untruths that spread throughout a culture by word of mouth and in some instances, become ingrained in our perceptions of reality and determine our behaviors.

Myths abound in the field of medicine. The one that comes first to mind, perhaps because I grew up spending summers on a lake, is that you must wait 30 minutes after eating before you can swim if you don't want to risk drowning. As children, we religiously watched the minutes tick off the clock, waiting to hit the water at the magic 30-minute mark. In reality, there has never been a documented case of drowning from muscle cramps brought on by a full stomach, and neither the American Red Cross nor the American Academy of Pediatrics recommend any specific guidelines about waiting to swim after eating. (For more information, see my article on Debunking Summer Health Myths).

Another widely-circulated myth is that the Christmas poinsettia plant is toxic if consumed by children or pets. Again, not true. Or the myth that you can't get pregnant the first time you have sex. And there's the one about what happens to the watermelon seed you swallowed by accident...

Anecdotes, on the other hand, are true accounts of some phenomenon or event. These may or may not provide medically sound or useful information. Anecdotes can be of benefit in medicine when they serve to alert doctors and researchers to possible new or interesting findings. Consider a fictional example: A doctor notes that several patients taking Drug A, which was prescribed for the treatment of seizures, have lower cholesterol levels than they had prior to taking the drug. Does this mean that Drug A should be used to fight high cholesterol? Absolutely not. Only supervised, controlled, double-blinded clinical trials can prove or disprove the safety and effectiveness of any drug or treatment. However, if the doctor shares her observations with others - and it turns out that other doctors have observed the same thing - the anecdotal findings might be strong enough to warrant investigation (including clinical trials) into other possible uses of Drug A and its effects on cholesterol levels. The anecdotes may ultimately lead researchers to discover yet unknown benefits of, and uses for, the drug in question.

You'll hear about "anecdotal evidence" that a particular treatment or drug is effective for certain conditions. But doctors are reluctant to base decisions on anecdotal evidence, since we're trained to look for scientific proof. Anecdotes are simple observations made outside of formal studies that often do not hold up under scientific scrutiny. We also don't want to do anyone a disservice by making decisions based upon what, in some cases, is no more than hearsay. Look at another example of a medical anecdote: "My wife's uncle Joe smoked two packs a day for 50 years, and he never got cancer." Would you accept this as proof that smoking is safe?

Related Topics: Medical Myths Debunked, Medical Myths Remain Even in This Age

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Curing Medicine Cabinet Chaos

Last night my five year-old daughter had a fever. Not a particularly high fever, I thought, when I felt her forehead at 3 a.m., but nonetheless, she felt warm - and she was miserable. She was coughing and complaining of pain with swallowing. OK, this seemed a logical occasion to give some children's ibuprofen - I didn't need my medical training to recognize that. And, I thought, I probably should measure just how high her fever is.

I stumbled in the dark into the closet where we keep the medications - on the only shelf in the house that is so high that even three curious (and resourceful) children can't reach even while standing on a chair. Standing on a step stool, I tugged down the zipper bag where I'd (cleverly, I believed) sorted all the children's medications, to keep them safely separate from those for the adults in the family. Steadying myself with one hand, I rummage through the medications and find nasal spray, liquid antihistamine, and antibacterial ointment. Oops, antibiotic ear drops from last year, better dispose of those. No thermometer. No ibuprofen liquid. Am I overlooking them in the dim closet light? Or have I, during a previous child's illness, relocated them to the "secondary" safe medication depot (i.e. the top kitchen shelf)? Or are they somewhere else?

Aha. Here's something - "children's ibuprofen cold preparation". Well, she does have a cold. This should do the trick. Looking at the dosage information (how much does she weigh again?) I find and administer the correct dose. Soon she is sleeping soundly and wakes up in the morning begging me to watch her cartwheel across the room.

In the clarity of daylight, I find the regular ibuprofen - on a high kitchen shelf. And there's the digital thermometer - in the bathroom drawer. Why didn't I realize where these things were last night at 3 a.m.? The answer is simple - we're not always in peak form when we're looking in our medicine cabinet. Awakened from sleep by a sick child or possibly feeling ill yourself, combined with suboptimal organization of the medicine cabinet, you've got a medication error waiting to happen.

Approximately 1.3 million people are injured annually in the United States following so-called "medication errors". In an FDA study of fatal medication errors, the most common error involving medications was related to administration of an improper dose of medicine. Giving the wrong drug and using the wrong route of administration for a drug were other common types of errors involving medicines. While it's unlikely that anyone will make a fatal error when dispensing children's ibuprofen, the potential for administration of the wrong medicines always exists, especially if your medicines aren't well-organized or kept cluttered with out-of-date preparations or prescriptions for several different family members.

Organizing the medicine cabinet to help prevent medication errors (and make it easier to find what you need!) would be a great, easy-to-accomplish resolution for the New Year. I'm going to do this too, and I think I can get my own medicine cabinet in order in under an hour. Here are some tips to get you started:

1. Keep over-the-counter meds and prescriptions in their original packaging. Keep prescriptions for different family members separated. I like to keep the children's meds apart from those for grown-ups, too. Some pharmacies are now offering color-coded bottles for different family members. You can also label bottles with different color markers or tape.
2. Discard expired medications - there's really no point in saving old prescription meds. Drugs can lose their potency over time, and you know better than to share the rest of your prescription with another person, anyway. The same goes for over-the-counters. Get rid of the antiques and schedule a trip to the drugstore to replenish anything you feel you cannot be without.
3. Don't just put old medications in the trash or flush them down the toilet if you can help it. Find out if your pharmacy offers a safe disposal or take-back program for unused drugs. According to the Harvard Health Letter, drugs of every type are being found in the nations' water sources. Some cities and states also offer drop-off services for unused medications and hazardous wastes.
4. Finally, find a safe, dry place to store your meds that is inaccessible to young children and pets. If you've done a thorough clean-out of your stash, you won't need as much space as you imagined. And keeping everything in one place is something I'm going to stick to from now on.
   

Related Topics: Kids Vulnerable to Medicine Mishaps

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