The Dream

We all have our own stories about the importance of sleep. The time we stayed up all night or slept through an alarm. I thought with summer here and the days getting longer it is the right time to pause and talk about our great healer, sleep.

I will never forget my first emergency code as an intern in Pediatrics at the University of Virginia. Although I was used to long hours of study and late nights nothing prepared me for the sleep deprivation of my internship. One night after just falling asleep at 4am in the on-call room I awoke to being stat paged to the emergency room. I jumped out of bed, grabbed my stethoscope and coat and ran for the door. Somehow I knew a young girl in the emergency room needed my help. I ran down the hall, and hit the stairway to the floor below, jumping three steps at a time. I kept saying to myself: “I hope I make it in time!” Arriving in the ER I ran over to the charge nurse and out of breath asked for the room number of this little girl who needed my help. The nurse looked at me, smiled and turning to the other nurses said: “We have another one.”  My head and shoulders sagged under the weight of considerable laughter as I realized it was all a dream. Humbled, I walk slowly back to the bed I so desired and the sleep I so needed.

We fall asleep for one of two reasons. Either we are following nature’s cues or we have a sleep debt. Most people live with a sleep debt. Just as you run out of money at the end of the month and rely on a credit card to get you through to the next month our bodies run on credit. Just like with credit cards, however, payment is always demanded.

Sluggishness is not the only payment sleep debt exacts from each of us. Our bodies pay for sleep debt by going into overdrive and working double and triple shifts. This overtime leads to inflammation and causes heart disease, cancer, obesity and type-2 diabetes. Sleep debt also impairs your brain’s ability to perform and alters the actual function of your brain. Sleep fosters the development of long-term memories, improves our cognitive performance and improves our emotional state and ability to cope.

Without the restoration that sleep provides our bodies pay a price. We live shorter, less healthy and unhappier lives. We are unable to process the physical and emotional toxins that build up throughout our day and our body suffers. Without adequate sleep our emotional and spiritual lives are impaired and undeveloped. Without dreams to process the events of our daily lives we greatly lesson our ability to achieve and cope with the world that so easily can engulf us.

What can you do? Follow the rhythm of the sun. Get up and go to bed at a consistent time seven days a week. Aim for 8-9 hours of sleep a night and try to wake without an alarm clock. Naps are powerful but keep them under 30 minutes and avoid naps within 4 hours of going to bed. Never exercise before bed and make sure when you climb into bed you are a little chilled.  Use the power of natural sunlight and exercise to get your body back on schedule. Be consistent in your sleep schedule and avoid alcohol and caffeine. Don’t eat anything after dinner and be aware some foods help you sleep and others do not. Try an elimination diet. Prepare for sleep by fading light for several hours before going to bed and making sure your bedroom is dark and all electronic devices are turned off. Send your brain a clear and consistent message. Sleep is coming. Get Ready!

The next time events, responsibilities or opportunities tempt you to pull out your sleep credit card remember sleep debt does accumulate and there is interest to be paid every time you try to pay later rather than sleep now.  By saying no to sleep deprivation and yes to your sleep rhythm you will become renewed and discover a renewable healing energy that is only one yawn away.

Sun or Rain

How often do you second guess yourself? We live in a society where others constantly question rather than support our actions.  Increasingly, adults and children are being raised on a diet of self-doubt and the wishes and opinions of others.  This environment is risky for both parents and children. Children raised under this shadow of doubt often lack the emotional and decision making competency to explore the world. Led by fear not encouragement, children often lack freedom fueled by hope and expectation. Under this emotional harness we often become our own harshest critic.

During grade school our end of the school year picnic was our yearly highlight. Excitement would grow as June approached, and we would cross off the days in May. Chaperones, cake sales and talk about games, rides and cotton candy filled recess and lunch conversation. Finally, June would arrive and a countdown and prayers for a sunny day would begin. Every June day we would place a statue of the Blessed Virgin Mary in our classroom window. She would be looking out the window, and we would ask her to bless our school picnic with sun and fun.  I did not want to take any chances so I looked for a statue of Mary at home. I could find no statue.  I knew I was in trouble. On my dresser I had a statue of my namesake Joseph.  Why not use him? After all he was her husband. I put him on my window ledge and my worries were gone.

The day before the picnic the thunderstorms started. Gutters overflowed and basements were mopped.  My hopes were dashed. Why had I used Joseph and not Mary? I was to blame. Riding to school on picnic day the rain hid my tears. In class I sagged into my chair and looking up saw sister standing next to me. Seeing my tears she walked me back to the cloakroom. She knelt beside me and asked what was wrong.  I said: “It is my fault. I didn’t use a statue of Mary.” She smiled, gave me a hug and asked whose statue I had used. I told her Joseph. She said: “Mary would have been proud you chose Joseph.” She pulled a starched white linen handkerchief out of her habit sleeve and wiped away my tears. Placing her hands on my shoulders she said: “Maybe this storm needed both Joseph and Mary?”

Back in class we lined up for the bus. As we walked out of school the rain suddenly stopped and the sun chased the dark clouds across the sky. Pulling off our raincoats we screamed with delight and dashed around a parking lot of puddles. For some reason I suddenly stopped and turned around to look back at the school.  A few feet away I saw sister standing with her hands folded looking up at the sky.  Her lips moved silently. She turned towards me and our eyes met.  She pointed to the sky and said one word: “Joseph.”  We both began to laugh.

That day I learned about trust, love and acceptance.  Sister made me believe my best is always enough. She taught me why fear, anxiety, shame and guilt hide the sun.  Today, as a pediatrician I realize self acceptance allows parents, children and teens to pursue lives filled with confidence and happiness. I now know the greatest gift each of us can give to ourselves and another is the limitless power of choice. The power to choose, unhindered by the judgment of others, who we are and who we wish to become. That day in second grade I learned how to bring out the sun and chase away the rain.

Last Day of School

When was the last time you thought about elementary school and those last few days before the start of summer vacation?  Open classroom windows, sorted textbooks, empty desks and bulletin boards and clean chalkboards signaled what was about to come. Even the noise on the playground seemed louder. Waking on that last day and riding the bus to school was wonderful. The bus was roaring with talk about summer fun to come. The last bell of the day would ring and everyone poured out of the school chasing one another and the days to come.

I have always loved seeing the small pranks graduating 8th graders and high school seniors would play. Seeing ties lining entrance hand rails or forks filling the front lawn of the school signaled graduation and an earned rite of passage.

Every year as June arrives I feel an excitement matched only by snow days. The coming summer seems as endless as the opportunities for fun and exploration. Visiting friends and family, car rides, vacations, amusement parks, cookouts, baseball and soccer games, bike rides, visits to the library, boat rides, fishing trips, kites, go-carts, camp outs and sleeping in all seem new and real. Possibilities are endless and days never seem to end. Sleep and meals become pauses to gain strength and replenishment for the next day and every day becomes a weekend day.

This year when your child finishes school take time to revel in the way he or she sees the world. The end of school signals the arrival of summer. A summer filled with limitless choice bordered only by imagination. A place where dreams come true and opportunity and laughter fill the air. Don’t sit back and watch. Jump up out of that chair. Grab a sandwich and a cooler and discover the world with your child. Ask about their dreams and join them in the freedom this summer will provide. By giving your child encouragement and entangling yourself in their fun and excitement you will not only see the world through their eyes but also find and relive all the joy of past summers. Don’t waste a minute! Sit down or go for a walk with your child tonight and start planning all the rituals, rites of passage and absolute fun you want to pass on to your child and to your child’s child for this summer and every summer to come. Hear the bell. Summer is here.

Crib and Playpen Safety

Are there any safety tips to follow when selecting a crib?

  • Choose a crib with corner posts less than 5/8 inches height. This will help prevent choking injuries your child may receive from catching a cord or necklace around the post.
  • Avoid bumper pads if there are any safety concerns
  • When throwing away any plastic wrap that the crib mattress came in, be sure to tie it in knots to help prevent any suffocation injuries. Keep all plastic away from your infant.
  • Do not use plastic garbage bags as mattress covers. These are too thin and may cling to your child’s face causing suffocation (inability to breathe).

If I am using an older or second hand crib, what should I look for to make sure it is safe?

Check all the openings in the headboard and rail structure to make sure there are no openings big enough for a child’s head to become caught. Make sure the corner posts are flush with the headboard and footboard.

Are there any mattress safety tips?

Make sure your mattress sits snugly. This will prevent your infant from being wedged between the mattress and the sides of the crib.

Are there any tips on what crib is best to prevent my child from trying to crawl out?

Choose a crib with as large distance as possible between the top of the side rail and the mattress. Adjustable settings are also helpful and allow the mattress height to change as your infant grows.

Are there any tips when painting a crib?

Use only high quality household enamel paint and allow it to dry thoroughly so there are no fumes. Do the painting in a location away from the baby. Do not use old paint since it may have been made before lead paint limitation went into effect in February 1978. Also check the label to make sure the manufacturer does not recommend the paint to be used to paint object such as cribs.

Are there any crib safety tips?

  • If the crib is near a window beware of drapery or venetian blind cords.
  • When your child is old enough to stand or sit up make certain the side rail is always locked in its most raised position. Also make certain the mattress is set down to its lowest position.
  • When your child is climbing out of the crib or reaches about 35 inches in height he should be moved to a bed.
  • Check the crib periodically to see that there are no loose hooks, screws, or bolts.
  • Remember: a crib is not a playpen.

Are there any toys which should not go in a crib?

All toys large enough to be used for climbing should be removed. Use caution with any toys or mobiles with dangling cords. Cords should be less than 10 inches in length and out of reach of the infant.

How can I use my playpen safely?

When a child is able to move around, avoid toys or playpen attachments with strings, ropes or wires attached which could cause your child to become trapped and strangled. Always keep the playpen properly set up unless it is periodically for any loose connections.

Gate and Highchair Safety

Where should gates be used?

Gates should be used at the top and bottom of stairwells and at any place you do not want your child to come in contact with a suspected danger.

What type of gates should I have?

Gates that are V-hatched and collapse together look an accordion should be avoided. They can trap your child’s head, arms, legs, or fingers. A solid mesh screen is the best. It must be high enough that your child cannot climb over it.

How should gates be fastened?

Gates should be securely fastened or bolted to the doorframe. They must be attached in a way that cannot be dislodged unless desired by an adult.

What type of highchair should I buy?

Buy a chair with a solid base. Make sure it can’t be easily tipped over and one that has safety hardness straps around the waist (which prevents standing up in the chair) and between the legs (to prevent slipping under the tray). Follow all instructions for assembling, and check it periodically for any loose connections.

What safety rules should I follow?

  • Never allow your child to stand up in highchair.
  • Always use the safety straps.
  • Do not place highchair close to table, counter-top or wall which could allow your child to kick off the top or knock the chair over.
  • Always supervise your child when he is in a highchair.


Household Safety

Are there any questions I can ask myself to decide if my home is safe?

Yes, think about your home in terms of the danger areas.  Remember, there is no substitute for direct and immediate supervision of your child.

What can I do to make my kitchen safe?

  • Do all harmful products in the cabinets have child resistant caps?  Certain products such as drain cleaners and oven cleaners should have safety packaging and removed from any location where children can find them or reach them.
  • Are all potentially harmful products in their original containers with original labels?
  • Are harmful products stored away from food?
  • Have all potentially harmful products been put up high and out of reach of a child?
  • Are sharp knives or other sharp objects secure from my child’s reach?
  • Do I have child safety latches installed in areas where my child has access to cabinets and drawers?
  • Are chairs and stepstools away from the stove or tabletops where my child could easily get hurt?
  • Are pot handles on the stove top pointing inward out of reach of my child where he night easily get scalded from boiling water?
  • Are electric cords kept out of reach of my child and hidden away?
  • Is there a fire extinguisher for grease fires installed in the kitchen area?

What can I do to make my bathroom safe?

  • Do medicines and other potential harmful products have child resistant closures?
  • Have you discarded all out-of-date prescriptions?
  • Is all medicine in their original containers with original labels?
  • Are all medicines stored out of reach of my child?
  • Are safety latched installed on cabinet doors?
  • Have I installed a non-skid bathmat on the floor and in the bathtub?
  • Is the hot water temperature lowered to 125 degrees to prevent potential scalding injuries?
  • Are curling irons, electric razor, razor blades, and hairdryers kept out of reach of my child, when in use and out of use?

What can I do to make my garage or storage area safe?

  • Did you know that many things in your garage or storage area that can be swallowed are terrible poisons?
  • Do all of these poisons have child resistant caps?
  • Are potential poisons stored in their original containers with original labels?
  • Are original labels on the container?
  • Have you made sure no poisons are stored in drinking glasses, pop bottles or other “drinkable” container?
  • Are potential poisons in locked cabinets or safely out of reach?

What can I do to make my stairwells safe?

  • Are stairs carpeted to prevent head injuries in case of falls?
  • Do stairwells have gates or door locks installed?

What can I do to make my windows safe?

  • Does your child have easy access to windows to crawl through and fall?
  • Are window locks installed on windows and screens?
  • Is there peeling or chipped paint on window sills that my child could easily ingest or swallow?

What can I do to make my other living areas safe?

  • Do all electrical outlets not in use have outlet covers installed?
  • Have all furniture with sharp edges been removed from the room or have corners protected with covers?
  • Are electrical cords well hidden out of view of children?
  • Have matches and lighter been placed out of reach of children?
  • Are small objects out of reach that your child may choke on, for example, candy, gum, toys plastic bag or coins?
  • Has access to fireplaces or space heaters been prevented by some type of barrier?
  • Are drapery cords out of reach of children to prevent accidental choking or strangulation?

What can I do to make my bedroom safe?

  • Are safety pins out of reach of my child?
  • Do I avoid baby powders that my child could easily inhale or swallow?
  • Does my changing table have safety straps and high side boards to prevent falls?  (Never leave your child alone on a changing table).
  • Have smoke alarms been installed in the bedroom hallways and checked at regular monthly intervals for battery charge?

Infant Walkers, Swings or Bouncy Seats

Are there any potential dangers in using infant walkers?

A potential danger of infant walkers is that developmentally, infants are not able to properly control them.  Infants are unaccustomed to the speed to which they can be propelled. They are also unable to protect themselves if the walker is tipped over.

Potential hazards include:

  • Entrapment of arms, legs, hands, or feet.
  • Head and other injuries from tipping over the walker, running into objects, or falling down stairwells.
  • Damage to feet and/or ankles from the walker running over the infant feet.

Are there any benefits in using an infant walker?

Children do not learn to walk any faster by using infant walkers.  It may actually delay walking by interfering with your child’s own motivation to walk.  Although your child may be more stimulated by being positioned upright and able to “bounce,” infant walkers should never be used unless under close supervision.

Other infants propelled toys may expose your child to similar dangers. They should also be used only with strict supervision.

Are bouncy seats and swings safe?

Yes they can be. Use them in moderation and make sure there are no safety issues. Use them when your child is developmentally ready to use them safely. They need to be assembled correctly and must have adequate support. Make sure there is not risk for an arm or leg being entrapped and as always be cautious about choking risk.



What should I do if my child ingests a poison substance?

Prevention is the best treatment, but be prepared in case an ingestion occurs.  The best preparation is to have a Poison Control Center telephone number and your doctor’s telephone number written down close to your telephone.

Who should I call first in case of poisoning?

You should always call you Poison Control Center immediately without delay.  Do not call your physician or the hospital emergency room until after you have contacted the Poison Control Center.

What information should I have available when I call?

  • An accurate description of the product swallows (read the label).
  • An estimate of how much of the poison was ingested or how many pills were swallowed
  • Your child’s age or size in pounds or kilograms.
  • An estimate of how long it has been since the ingestion.
  • Current medicines your child had taken in the past 48 hours.
  • Current illness or chronic medical problems present.
  • Describe any reactions or symptoms suffered from the ingestion (i. e., choking, gagging, vomiting, sleepiness, seizures, unconscious, etc.)

Remember: If any poison is spilled on the skin or in the eyes, rinse thoroughly with luke warm water. Call your Poison Control Center immediately thereafter.

TV Toppling Injuries

Between 2000 and 2010 169 children died from injuries sustained from television sets tipping over on them. Front heavy televisions can topple over on children and cause severe injuries. Children frequently are around television sets either reaching for a toy or a remote controller on top of the set or watching the television. They also can become tangled in or tug at TV or cable cords causing the TV to topple. These deaths are caused by severe trauma to the head or body or by suffocation. They do not need to happen and can be easily prevented.

An estimated 13,700 children were treated in emergency departments between 2008 and 2010 after being struck by a television. Younger children suffered greater injuries and were injured more frequently. The most common injuries were head injuries. Since this is the time of greatest neurodevelopmental change head injuries at a young age have dramatic and lasting effects.

To protect your child from such injuries follow these tips from the American Academy of Pediatrics:

  • Place your television on allow stand or base and push the television as far back from furniture as possible.
  • Make sure the stand is sturdy and can handle the weight of your TV.
  • Do not place your television on a piece of furniture that is not designed for this use.
  • Secure your TV and its stand to a wall stud with anchoring devices.
  • Check packaging to make sure the anchoring device can support the weight of your TV and the piece of furniture. Make sure the anchoring device is designed for the kind of TV you own. Older TV sets that are not flat screen are especially heavy and can injure your child severely.
  • Always follow manufacturer’s instructions on anchoring your TV.
  • Do not place toys, remote controls or other items that might attract your child’s attention on top of the stand or the TV.
  • Keep TV and cable cords out of sight and out of your child’s reach.
  • Be especially careful when you are at another person’s house with your child. Make sure their TV is anchored properly and all the safety issues discussed above have been dealt with. If there are concerns then do not allow your child near the TV.

Sun Damage

When your skin is exposed to sunlight that contains ultraviolet or visible light photosensitivity reactions can occur. The one you see most often is sunburn. Sunburn is seen on sun exposed skin surfaces with red areas and if severe swelling and blistering can also be seen. Pain and itching are also common. During the healing process skin peeling is often seen. The best treatment for mild injury is patience and cool compresses.

Acetaminophen can help with the pain. If there are more severe symptoms including blisters with associated fever, chills, headache and feeling sick then call your pediatrician. Severe sunburn needs to be treated like any other burn to the skin. Hydration is very important.

Other reactions include sun poisoning or sun allergy where a variety of skin changes can be seen. Skin changes begin within hours to days of exposure and can vary from redness and swelling to raise red areas with blistering. Another name is PMLE (polymorphous light eruption).

Skin rashes are also associated with the ingestion of various photosensitizing substances in combination with sun exposure. These are commonly due to drugs that induce photosensitivity reactions. These include antibiotics (sulfa/ tetracycline/ doxycycline), phenothiazines, griseofulvin (used for ringworm), thiazide diuretics and acne medication (retinoids).

Topical agents applied directly to the skin can also cause skin reactions with sun exposure. These include various fragrances, non-steroidal anti-inflammatory medication and various antimicrobial agents including hexachlorophene.

Photo allergic reactions are also seen due to skin contact with various plant substances during sun exposure. Limes and citrus fruits are common culprits. These skin changes are often delayed and appear 24 hours after sun exposure. The areas are not itchy but may be painful and after the redness fades an area of increased pigmentation is seen and can last for a long time.

If your child develops skin changes after sun exposure and it is not typical sunburn call your pediatrician.