Head Lice

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These are two words no parent wants to hear. Head lice infections are common and each year between 6 and 12 million US children between the ages of 3 and 11 years are infested with head lice. Household members of these preschool and school aged children are also at risk for infestation.
The biggest concern with head live is discomfort due to itching and secondary bacterial skin infections and further spread of the infestation to others. Lice do not transmit disease but the effects on the family in terms of days lost at school and parents being unable to go to work due to child care responsibilities are substantial.
Although hygiene and hair length are not the cause of head lice infection, an infestation often causes many families to be embarrassed and suffer social stress and isolation.
The rash that is seen with a head lice infestation is due to the body developing sensitivity to the saliva of the louse which is injected under the skin when it is feeding on the host. It may take up to several weeks for the sensitivity and subsequent itching to develop.
A louse is about the size of a sesame seed and has six legs. The louse can live for up to a month and lays up to 10 eggs per day. The eggs are attached to the base of a hair shaft. Eggs that are not at the base of the hair shaft are not viable. When the eggs hatch the casings (nits) are white and easier to see. Within 10 days after hatching a louse can begin to lay eggs and the cycle continues. Eggs cannot hatch at room temperature. Body heat is needed to incubate.
Lice will die if not on a host for 24 hours. They do not jump or fly. They crawl quickly and sometimes can be seen easier if you use a lubricant such as oil, hair conditioner or water to slow them down. They avoid light.
It is best only to treat children who have living lice. Over half of all children with nits do not have living lice. Prevention is difficult and depends on avoiding head to head contact. Children need to avoid the sharing of combs, brushes and hats. Prompt treatment of children with living lice is the best way to curtail an outbreak.
Various medications are available for treatment. Choice depends on patient age and medication availability as well as potential side effects. Lice have become resistant to certain medications and often another medication may need to be used if the first medication fails to eradicate the infestation.
Treatment includes OTC medication containing 1% permethrin (Nix). The hair should be shampooed with a non-conditioning shampoo and then towel dried. The medication is applied thoroughly to damp hair and left on for 10 minutes. It is then rinsed off with warm water and the process is repeated in 7-10 days if live lice are seen. Nix is the least toxic lice medication and rarely causes redness, itching or scalp swelling. Permethrin (Nix) does leave a residue on hair that kills newly hatched lice for several days. The use of hair conditioners and hair products with silicone based additives hinders this protection and should be avoided for several days.
Another commonly used medication is malathion (Ovide). It is available by prescription. It is applied to the hair and scalp while eyes are tightly shut. The hair should start dry and end thoroughly wet. Leave hair air dry and uncovered. Shampoo hair after 8-12 hours and use nit comb to remove lice and eggs. It appears to be more effective than Nix but has more side effects. It has not been studied in children under age 6 years and is not used in children under age 2 years. It is highly flammable and contains almost 80% isopropyl alcohol. Avoid high temperatures and open flames while the hair is wet.
Another medication is benzyl alcohol (Ulesfia). It is available by prescription. It is applied to hair to completely saturate scalp and hair. Short hair takes 4 ounces and long hair up to 24 to 48 ounces. Rinse off with water after 10 minutes and repeat in 9 days. It kills lice by suffocating them. It is approved for children over age 6 months and can cause eye and skin irritation. In children under 6 months it can cause severe metabolic disturbances due to skin absorption.
Spinosad (Natroba) was approved by the FDA in 2011. It is used in children 4 years  and  older. It is applied to dry scalp and hair to cover the entire area. Apply up to 120 ml depending on hair length and leave on for 10 minutes. It is then thoroughly rinsed off with warm water and repeated in 1 week if live lice are seen. It is derived from the fermentation of a soil bacterium and may be more effective than Nix. It can cause application site irritation due to benzyl alcohol in the product.
The most recent new product is ivermectin (Stromectol). It comes in a 0.5% lotion called SKLICETM) and is indicated for head lice treatment in patients 6 months and older. It is applied to dry hair to cover scalp and hair and left on for 10 minutes and then rinsed off with warm water. A nit comb is not necessary. The person who applies the medication should wash their hands thoroughly after application. Repeat treatment is not needed.
Lindane (Kwell) is no longer indicated for the treatment of head lice. It can cause serious neurotoxicity and seizures.
Occlusive agents like mayonnaise, margarine and various oils have been used with varying effects in an attempt to suffocate head lice. Head shaving is effective but is undesireable for cosmetic reasons. Frequent wet combing with a nit comb and shampoo or conditioner as a lubricant may also be effective.

When Would My Child See an ENT Surgeon?

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If your child has sleep disordered breathing or obstructive sleep apnea with a history of restless sleep, snoring, gasping and sleep pauses your child will be referred to an ENT for a tonsillectomy and adenoidectomy evaluation. A sleep study is usually not needed. Adenoid enlargement alone may be the cause of obstructive symptoms. Often a trial of nasal steroid spray is pursued if the tonsils are not enlarged. In cases of severe tonsillar enlargement do to infection that does not respond to antibiotics and systemic steroid treatment ENT referral may be needed. Another uncommon condition is a retropharyngeal or peritonsillar abscess that would require surgical drainage.

If your child accidentally swallows a small object and it is lodged in the windpipe he will need bronchoscopy to have it removed. General anesthesia is used in the operating room and a small endoscope with a camera is passed into your child’s windpipe and the object is removed. Small pieces to toys, peanuts or small objects like earrings are commonly aspirated. Coughing episodes are common and a foreign body should be considered whenever a previously healthy child has unexplained symptoms of airway obstruction that do not respond to routine asthma treatmentIf your child has a chronic middle ear fluid and is at risk for speech, learning or language problems he will be referred to ENT for tymanostomy (PE Tube) assessment. If your child is not at risk and has had no complications then he will be observed for 3 months before he is referred.
If your child has a suspected cholesteatoma he will be referred to an ENT. A cholesteatoma is a collection of cells that are in the upper anterior part of the eardrum. Although they are rare they are sometimes seen during ear examinations for children who have recurrent ear infections or hearing loss. They are congenital and can block the Eustachian tube opening causing Eustachian tube dysfunction and recurrent serous otitis media and otitis media and can cause other intracranial problems
If your child has a complication of otitis media called mastoiditis he will be referred to an ENT. Mastoiditis can cause brain infections and facial paralysis. Common symptoms include pain, swelling and redness behind the ear with protrusion of the ear.
If your child has a nasal fracture and a septal hematoma he will be referred to an ENT. Most nasal fractures do not require x-rays. If a septal hematoma is present then an ENT will need to evaluate your child for possible incision and drainage to prevent infection which is common several days after the injury.
If your child has orbital cellulitis he will be referred to an ENT. Orbital cellulitis is often a complication of sinusitis and can involve an infection around the eye or a more severe infection. Management is usually with intravenous antibiotics for younger patients with small infections and no complications. A pediatric ophthalmologist will also frequently be involved in the evaluation.
If your child has severe croup (Laryngotracheobronchitis) or stridor (an inspiratory sound due to airway structure collapse or impingement) an ENT referral may be needed. A fiber optic flexible laryngoscopy can be performed to evaluate for possible causes of stridor. All newborns with stridor will be referred to a pediatric otolaryngologist to evaluate for anatomic causes, such as vocal cord paralysis or subglottic stenosis. Older infants with stridor due to laryngomalacia are also frequently referred. In laryngomalacia, the supraglottic structures collapse into the airway during the inspiratory phase of respiration.
If your child has a rare newborn condition involving the ear, nose or throat regions such as a thyroglossal duct cyst, brachial cleft cyst, lymphatic malformation or dermoid cyst an ENT referral will be needed.
If your child has a neck abscess or enlarged lymph node that needs biopsy, drainage or excision an ENT referral may be needed.

Tonsillectomy

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A tonsillectomy is commonly performed to improve breathing and decrease sings of upper airway obstruction. Common signs include restless sleep, neck arching during sleep, snoring and difficulty swallowing chunky foods. It is also helpful for children who suffer from recurrent episodes of pharyngitis. The potential benefits of a tonsillectomy, usually in combination with an adenoidectomy, must be weighed against potential risks and the overall discomfort associated with having the procedure performed.
Children between the age of 3 and 6 years are at highest risk for tonsil and/or adenoid enlargement that is commonly called hypertrophy. Tonsil size generally decreases after age 8 years. This is why many children who snore prior to age 8 stop snoring by their teen years. If your child has upper airway symptoms with associated sleep apnea then the benefits of surgery clearly outweigh any risks. Snoring alone is not enough of an indication for the surgery. If the complaints listed above are present as well as other complaints including daytime sleepiness, academic difficulties, attention difficulty, enuresis or behavioral problems then surgery should be strongly considered. Children whose BMI is above the 95th% are considered severely overweight (obese). Their symptoms of nighttime upper airway obstruction are less often cured by adenotonsillectomy. Pre-operative sleep studies can often assist decision making on whether to perform surgery on these children.
In addition to the above upper airway obstruction indications children who have 7 episodes of severe recurrent sore throats in 1 year, 5 episodes in 2 consecutive years or 3 episodes in 3 consecutive years are candidates for surgery.
The greatest risk with surgery is the postoperative pain. Bleeding occurs in up to 5% of cases and the general anesthesia can cause transient post-operative disorientation, nausea and vomiting. A single dose of intraoperative dexamethasone has been shown to decrease postoperative nausea and vomiting.
The best way to prevent and manage any post-tonsillectomy problems is through good perioperative care. Make the doctor aware of any obstructive sleep issues or any accompanying medical problems including obesity, sickle cell disease, blood problems, heart problems, heart arrhythmias, craniofacial abnormalities or a family history of anesthesia problems.
After surgery a clot composed of fibrin, inflammatory cells and bacteria will coat the area where the tonsils were removed. This clot will come off after about 1 week and can be associated with delayed bleeding. The area will heal over 2-3 weeks.
Pain is usually intense on day 1 and decreases over the next week. There may be a period of increased pain on day 3 after surgery. This increase is associated with the intense healing and inflammation. The pain is usually gone by 2 weeks. Pain is worse if associated with anxiety. Age and prior experience with pain also affect the perception and severity of the pain. Ibuprofen is the present recommendation for pain management. Caution should be used with acetaminophen with codeine since some children over respond to the codeine and become over sedated. Rough foods and vigorous activity should be avoided after surgery. Your surgeon will give you instructions on returning to a regular diet and an active lifestyle.

Snoring

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Snoring is the sound of obstructive sleep apnea. It is a sound everyone is familiar with. Both children and adults snore. It is the sound produced by the forced flow of air through a reduced space and is caused by partial or complete airway closure. The term used to describe this is increased airway resistance. As everyone knows snoring varies throughout the night. It increases during dream sleep (REM) and causes sleep disruption not just for the person who cannot fall asleep due to the loud snoring (“Snoree”) but more importantly for the person who is snoring (“Snorer”). The results of this obstruction include an increased effort of breathing and secondary oxygen, carbon dioxide exchange abnormalities and subsequent physiologic changes.
Common risk factors for obstructive sleep apnea include adenoid and/or tonsil enlargement, obesity, craniofacial abnormalities, Down syndrome, neuromuscular disorders including cerebral palsy, and a family history of obstructive sleep apnea. The most common clinical signs include loud snoring, apnea and gasping sounds. Sleep is often restless with frequent moving, thrashing or awakening. Another common complaint is excessive sweating. For the younger child weight loss or poor weight gain are often seen. Due to the sleep disruption daytime sleepiness is common as is decreased cognitive performance at work or school and an increased incidence of bedwetting. Grades can decrease and frequent complaints include hyperactivity, distractibility and overall attention problems. Many of these children are diagnosed incorrectly as having an attention deficit disorder (ADHD).
The diagnosis is made by history and observation. A sleep study (Polysomnography) can be obtained to verify the diagnosis. In this study heart rate and breathing patterns are monitored in conjunction with the oxygen level in the blood.
Treatment depends on the cause. The most common cause is adenotonsillar enlargement. In this situation a tonsillectomy and adenoidectomy is required. If obesity is the issue then weight loss is needed and continuous positive airway pressure may be prescribed to alleviate symptoms while pursuing a weight management program. For neuromuscular and congenital causes intervention is specific to the cause. Chronic obstructive sleep apnea can lead to systemic and pulmonary hypertension which must be prevented.
If your child or teen snores seek help and advice. Snoring is never normal. If the snoring is associated with an acute illness patience may be the treatment of choice. If it is chronic then a thorough evaluation and subsequent intervention are required.

Generic Medication or Brand Name Medication – Is There a Difference?

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“Are generic drugs just as safe and effective?” This question is raised by most parents since out of pocket costs are almost always higher for brand-name medications. In addition, most doctors are required by insurance carriers to substitute a generic product for a brand-name product. Most parents prefer a generic medication due to the added cost of a brand-name drug. Generally, this substitution is both safe and reasonable. There are a few situations, however, when generic substitutions can cause adverse health effects. A few medications have a narrow therapeutic index (NTI) and substitution of a generic drug for a brand-name drug can cause a change in the blood level of the drug which can cause a worsening of a medical condition or new medical problems. This can be seen in medication used to treat depression, anxiety, seizures and for medications used for blood thinning or contraception. Specific drugs in this category include levothyroxine, warfarin, phenytoin and digoxin.

Approved generic drugs have demonstrated therapeutic equivalence. The Food and Drug Administration’s (FDA) Orange Book provides the latest information on generic approvals. A drug is considered bioequivalent if testing shows the drug has bioavailability properties that fall within the 80% to 125% range of the brand-name medication.
This substitution can also occur without the doctor being notified. Many health insurance plans request and allow pharmacists to substitute generic medication. Issues raised by this substitution relate to quality standards and safety controls for drug manufacture. Simple issues including a change in pill shape or color also add to the confusion and increase the potential for errors in pill administration.
Here are some helpful tips:
·         Ask the doctor or prescriber if it is safe to use a generic medication.
·         Ask if there is a difference between the brand-name medication and the generic medication.
·         Ask if your doctor would be able to monitor the generic medications effectiveness and increase the dose if more of the generic medication is needed due to a lower bioavailability.
·         Ask the pharmacist if a generic medication was substituted for a brand-name medication.
·         If you are being treated for one of the above described conditions be cautious.
Overall, the use of generic medications is safe and effective. Always discuss medication changes or medical issues that could be related to a medication change with both your doctor and your pharmacist.

Schedules and Elimination

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Every first time parent wonders how often their infant needs to be fed. Overall most infants thrive on feedings every 2-4 hours.  Frequent feedings every 2 hours will reduce the amount of time needed for a mother’s milk to come in. Studies show milk will come in a day earlier with an every two hour schedule rather than every 4 hours. The first 6 to 8 hours after delivery a mother may need to rest and allow the nursery staff to feed her infant due to the strenuous hours prior to delivery. Parents need to consider sending their infant to the nursery for the first 6-8 hours after delivery. This allows both parents to sleep. The nursery staff can bring the infant to the mother’s room for a feeding during this time for breast feeding and can feed the infant in the nursery if formula fed. Everyone must understand, the newborn feeding schedule should not exhaust the mother. Adequate sleep, nutrition and fluid intake are the first steps in maternal self-care.

Frequent nursing during the newborn period is associated with greater breastfeeding success as well as higher maternal prolactin levels which increases milk production and greater overall milk intake with greater infant weight gain by age 2 weeks.

Infants are born well hydrated. They have just completed one of if not the most turbulent day they will experience in their lives. Many are too tired to suck and others are slow to learn the latch and suck muscle routines. Breast milk does not come in for at least several days and during this time the colostrum production although important in terms of nutrients and immunity is low in terms of volume. Over half of all babies will lose at least 5% of their birthweight by day three after delivery. This weight loss is to be expected and infants are not stressed by this loss. If there is any sign of low blood sugar by history or exam, your infant will have sugar levels checked several times a day. This is done by pricking her heel for a small blood sample. If needed, early feedings with formula or breast milk will be given.

Many parents wonder if a feeding schedule should be used. Most grandparents were raised under the belief that scheduled feedings were best for infants. Interval feeding is no longer recommended. The American Academy of Pediatrics and the World Health
Organization do not support timed interval feeding schedules. The best approach
is to breastfeed an average of 8-12 times a day. If your infant is formula feeding the same advice is given. Feed frequently and watch for signs of hunger including rooting, restlessness, increased alertness or hand sucking and hand to mouth movements.

Feeding duration varies between infants. Try not to spend longer than 20 minutes for each feeding. Some infants eat faster than others. If your infant falls asleep during a feeding it is best to stop and restart when she shows signs of hunger. Feeding for extended periods will tire most infants and parents. A feeding schedule is a marathon and not a hundred yard dash.

The most important sign of adequate formula or breast milk intake is urine output and the character of the urine.  The urine color should be clear or pale yellow like dilute lemonade. Stool output is extremely variable and ranges from 1-2 times per day to 6-8 or more times per day. Breastfed infants frequently will have a bowel movement with each feeding. Formula fed infants tend to stool less frequently than breast fed infants. Breastfed infants may skip 1 or more days between bowel movements and show no signs of discomfort since the breast milk is absorbed so well by their digestive tract.
Formula fed infants who miss days usually will show some signs of gas and discomfort. The key is patience. No suppositories are needed and no medical intervention needs to be pursued as long as the infant is feeding well and overall doing well.  If your infant does not have a bowel movement in the first 24 hours of life she needs to be watched closely for any obstruction symptoms.

Stools in the first several days will be like black tar. They then change to transitional dark to yellow green seedy stools and eventually to wet mustard stools for breast fed infants. Formula fed infants have more formed yellow to brown stools. Breast milk stools are less odiferous than formula fed stools.  Infants who require soy formula due to milk protein or lactose sensitivity tend to have stools less frequently then infants fed regular
formula. Infants with lactose tolerance problems tend to have loose watery and at times explosive stools when given lactose containing formulas. Maternal diet will effect breast milk but rarely causes feeding and digestion problems for the infant. If specific food intake by the mother causes gastrointestinal issues for the infant then maternal diet adjustments should be made.

Temperament

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Each child is born with genetic predispositions for a specific behavioral style. Your child’s behavior style is described by her patterns of reactivity, regulation and flexibility. Reactivity describes how intense a response your child will show to a stimulus. Other components to reactivity include sensory sensitivity and overall motor activity level. Regulation describes outlook and how emotions are expressed.  Lastly, flexibility describes his ability to relate to change and transitions in terms of schedules, routines, rituals and social interactions. These patterns are commonly described as either happy, mellow or fussy babies. As a child grows older we describe more complex mood patterns as well as attention profiles, motor skill performance and sleep habits.

These genetic predispositions can be influenced by environmental stimuli, historical events and interpersonal relationships. The influence can either inhibit certain predispositions or accelerate and enhance patterns of response. The result is described as a layering of new circuitry within the brain. This circuitry allows new skills to develop. These new skills can reflect past genetic predispositions or not. The attention and stimulation you provide your infant and child will determine what response patterns are
expressed. Your responses may be positive or negative. Children respond to both. It is important you avoid negative or aversive responses. The greatest success is seen with a positive supportive focus based on love, safety and security. Without this support no alignment with or attachment to new patterns of behavior will occur.

One of the most important environmental stimuli is your own temperament. How you respond to your child depends not only on the sought after behavior but also on your own temperament. Take time to understand your own behavioral style. Examine your own mood patterns, attention span, flexibility and overall ability to control your own impulses even when you would prefer not to. It is this combination of temperaments that  determines the family environment which also provides a direct influence on behavior style.  In addition, your perception of your own parenting skills is strongly influenced by your child’s temperament and the family environment.

This reciprocal reaction between your temperament, your child’s temperament and the family environment are the prime determinants of the behavioral style your child will develop. Will he be agreeable, confident, happy, internally motivated and competent or will he be irritable, restless, unsettled, withdrawn, angry, easily frustrated overcautious, unpredictable and withdrawn. Your involvement in the development and support of these skill sets and new brain circuits is one of the most important duties of any parent. Your awareness of the complexity of these interactions allows you to influence your child to grow up with compassion and respect for himself and for others.

Self Regulation Profiles

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Your child is born with a genetically determined self regulation profile. Over the next five years of life she will express this profile. During these years you have the opportunity and responsibility to support her own . Many aspects of social, emotional and cognitive development are involved in self regulation. It is best described as an integration of emotion and cognition and results in the behaviors your child will express.

Self regulation includes a child’s ability to control their own impulses as well as the capacity to do somethig they would prefer not to do.  In order for her to do this effectively she must learn to recognize and understand her own feelings. This understanding will provide her with the skills she needs to manage her own emotions. This is the foundation of self regulation. Your child watches you. They learn more from what they see then what they hear. Your understanding and patterns of response effect their behavior. So, react wisely and choose the patterns you want to support while avoiding behaviors you do not want to see your child develop.

Many aspects of social, emotional and cognitive development are involved in self regulation. It is best described as an integration of emotion and cognition and results in the behaviors your child will express.

Self regulation develops over time and depends on your child’s developmental level. It is very important you understand developmental skills before you set your expectations about your child’s ability to self regulate. Infants rely on you for until six months or older. They have a limited ability to self regulate. They rely on you for food, comfort, sleep and social interaction. You must attend to their cues to understand their needs and wants. It is through this attention founded in love that attachment develops. This attachment provides the security your child needs to develop their own skills to self soothe and calm themselves. Toddlers have more skills and are learning how to connect their feelings and emotions to situations and events. They are newcomers to this skill and consequently their responses swing widely from happiness to sadness and tears to laughter. This self regulation growth is mirrored in their language development and as they grow older their language skills can be used to make their emotional outbursts and temper tantrums more manageable. By preschool your child will begin to understand the connection beween the feelings they have and the behaviors they express. This the crucial time for you to use shaping, modeling and emotional coaching techniques along with traditional limit setting to help them choose and implement self regulation strategies. Your involvement combined with realistic expectations and the anticipation of inappropriate behavior can help this time become less turbulent.

Choosing What is Best For Your Child

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When your child is born it is natural for you to feel vulnerable, fearful and anxious. You are concerned about doing the right thing, at the right time and in the right way. This concern is healthy and encourages you to obtain the best care possible for your new child. Concern becomes unhealthy and unhelpful, however, when it is replaced by fear and anxiety based on the concerns of others.  One of the skills you must rely on is the ability to gain control of your own experience.

As a parent you must learn to feel good about yourself and your child. You cannot rely on the expectations and feelings of others. To do so, causes you to loose your balance and in many ways encourages your fears to become real.  Everything in your life is responsive to you both in the way you think and the way you live your life. To allow negative thoughts to enter your life simply encourages them. Once negative thoughts are embedded in your mind they grow. Even though you mean well and only want to protect your child this fostering of negative thoughts actually causes you to loose control.

You and you alone have control over your life and your ability to inspire your child. It does not matter what others think or say about you or your child. Only your thoughts matter. Clean your mind of all negative anxiety and fear. Seek a contentment based on balance, understanding and acceptance. Trust your feelings about what is best for your child. Fill your mind with dreams, passions and inspirations about your child and by so doing you will prepare her to chase her own dreams.

Theses skills do not just happen.  They take time to grow. Give yourself time to develop the patience and understanding to deal with the negative thoughts of others. Such skills must be fostered and supported. The first step is a committment to this belief of self control. Experience will tell you and the way you live your life will show your child that each of you have control over your own futures. Certainly, unexplained and unwanted events will occur but most situations, events and opportunities are due to your thoughts, words and actions. In fact, most of the time you will be treated by others as you expect them to treat you. By finding, seeing and then listening to the positive harmony within your life and the life of your child you will understand life’s questions and answers are already within you and your child.

Death

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For every parent when their child is born thoughts of their child dying or becoming gravely ill or injured arise.This is common and expected.  As a parent you will find new emotions attached to words like meningitis, SIDS, autism, drowning, seat belts, car seats and immunizations. The need to address these negative thoughts is essential and has been discussed in previous blog entries.What should you do, however, when you are confronted by the death of a member of the family including a parent or a child? The answer to this question as with all others rests within you.

Although the departure of those you love may never be accepted it must be allowed. Death allows a person’s soul to be set free. The act of living allows each person to pursue the connection between mind and body, but, it is death that allows a person’s soul to be set free. This freedom is a freedom expected and long awaited since birth. Although the death of a child or teenager can can be understood through natural laws it
can only be accepted through the power of spirituality.

Souls are amazing. they are filled with equal parts patience and understanding mixed with a measure of joy and a touch of laughter. They never leave us no matter how much
we neglect them. They are social yet independent and never lonely. Their wisdom knows who and what we are. They listen even when not being listened to. Theirs is a world of questions more than answers and love unhindered by guilt or remorse. A world with no if ‘s or when but only now.

Your soul and the soul of your child are the keepers of understanding about all things eternal and those that are not. Ypur child’s soul is invisible save for its image reflected during acts of love and compassion. These glimpses are fleeting, yet their images are strong, narcotic and inspiring.  Living a life filled with compassion and forged from relationships is always at risk for pain and suffering. Yet, by living and dying each person, no matter what their age, is provided the opportunity of being and not just doing. For, a soul reveals itself most  and shines brightest in the eyes of your newborn and in the spirit and memories of the old and infirmed.

So do not Hide. Show no fear. Live life. Watch your child grow. Revel in every sound they ever utter or word they speak. watch their actions and reactions. Smile and shout about decisions whether right or wrong. Live a life without labels or bounds. Allow your child to live unencumbered by your fears, feelings and expectations. Empower yourself
and your child to make choices based on opportunity, love and compassion. There is no reason to fear illness and death. Each are part of life and will never touch your child’s soul. A child’s soul never sleeps. With unending patience it only watches and waits.