Recognizing Allergies in Children

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Allergies are very common. Over fifty million people in the US have some type of allergy and thirteen million adults and four million children have asthma.  If you have asthma you have an 80% risk of also having allergies. Most asthma symptoms begin after exposure to specific allergens and in children viral infections are the most common cause of an asthma episode.  Itchy and watery eyes or nose, sneezing, coughing and wheezing are the most common symptoms. Skin rashes including hives are common as are gastrointestinal symptoms. If one parent has a history of allergies a child has a 25% risk of also having allergies. If both parents have allergies this risk increases to over 60%.

In addition to general discomfort other consequences to allergies include an increased risk for infection, school absence and work loss. Life threatening consequences due to anaphylaxis although uncommon are also possible.

An allergy is caused by an overreaction of the body’s immune system. The immune system functions to fight off infection. In the case of allergies it becomes activated to a harmless substance called an allergen.  Antibodies (IgE) are produced that cause a cascade of events leading to the release of many chemicals such as histamine from allergy cells in the body. An allergy is not a disease. It is a reaction to something eaten, breathed, touched or injected.

The most common reactions include wheezing, skin reactions like hives, contact or atopic dermatitis, eczema, food allergy and hay fever. Common airborne allergens are pollens such as trees, grasses and weeds or molds, dust mites and animal dander. Food allergens include cow’s milk, eggs, soy milk, wheat, peanuts and tree nuts, seafood and shellfish. Medication, chemicals and the saliva from stinging insects are also common allergens.

The most serious reaction is anaphylaxis. After allergen exposure there is a rapid onset of skin, gastrointestinal, respiratory and cardiac symptoms that can lead to death if there is not rapid intervention with epinephrine. This is done through the use of an EpiPen or a Twinject.  An antihistamine like Benadryl is also given. In children the most common causes are peanuts, tree nuts, cow’s milk, soy, eggs, fish and shellfish. Insect stings from bees, wasps, hornets and fire ants can also cause anaphylaxis.

For mild to moderate symptoms avoidance and environmental accommodations are best. The best treatment is to determine the cause of the allergy symptoms and then to focus on avoidance measures. Options include vacuuming and dusting, carpet avoidance, the use of air conditioning, damp mopping, a HEPA filter and humidity control. Dust mites and molds thrive in a moist environment.  Indoor plants, smoke and pets can also cause allergy symptoms.  Working with your doctor and close observation are essential to develop the best action plan to treat your child.  Mild symptoms can often be managed with avoidance and over the counter antihistamines. For chronic or moderate to severe symptoms further allergy intervention including skin testing, prescription medications and immunotherapy (allergy shots) are often needed. Treatment is available. The proper intervention can alleviate or eliminate life threatening reactions and symptoms that make your child’s life very difficult.

Too Much

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I always rode a girl’s bike. My two older sisters shared two bikes. We called them red and blue. The red bike was much smaller and had solid rubber tires. The blue one had big balloon tires and was easier to ride with no hands.  Sharing bikes meant I always rode a girl’s bike and being smaller than my sisters I mostly rode the red bike. I loved that bike. Riding down the street doing tricks or leaving long rubber streaks on the concrete from spin outs were our X Games events. Two bikes and three children provided me some of my most important lessons about sharing. Deciding who would run next to the bikes, trading off riding and riding double is my first memory of taking turns.

Most of our friends shared bikes, and I was so happy we had two.  They were our magic carpets.  We spent our days playing board games, kickball, tag, climbing trees or building forts.  Many days we just rode our bikes.  We shared sandwiches for lunch and played on porches if it rained. Summer seemed endless.  Trips to the beach and drive-in movies were the salt and pepper of those magical summer days.

Playing together we learned how to give and share and although we never got everything we wanted, we did get everything we needed.  Summer was filled with games, new discoveries, smiles and laughter.

Many parents attempt to give their child everything they wished for but did not have. They fill their child’s life with objects, activities and opportunities they only dreamed of and forget the power of shared imaginative free play.  Schedules and responsibilities act as magnets drawing us in and tempting us to take control of the lives of our children.  Limiting our child’s independence hinders the development of free choice, imagination and sharing.  Driven by our own unconscious feelings of lack we are stealing from our children opportunities for acts of giving and sharing.

Is your child given more than he or she needs?  Are you fulfilling your own dreams through your child?  Are you the manager of your child’s schedule?  If the answer to these questions is yes, it might be time for a change.  By supporting exploration through unscheduled and independent free play a world of creativity and relationships is visible to your child. Act now.  It is never too late.

The Question

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I turned off my reading lamp and wondered if I had made a bad decision. It had been raining all day, and the room was lit by my reading lamp and two basement windows. The room was nearly empty except for a cot, a desk piled high with books, a suitcase and two old leather chairs my father had been given when he opened his law practice just before enlisting in the navy at the start of World War II. I remember saying to myself, “At least it’s cool.” Listening to the rain I was about to doze off when I heard a squeal of tires and a loud thud. Barefoot and wearing jeans and a white T-shirt, I ran up my back stairs and out into the street.

About fifty people were standing around a car stopped in the middle of the street. Several women were crying but mostly it was quiet. The synagogue across the street had just finished services, and I wondered if there had been an accident. I slipped through the crowd and saw an elderly man curled up on the ground. He was on his side moaning. His back was leaning up against the right front tire of an old sedan. I could see the driver pacing to the side and heard him telling some men: “I never saw him.” This is when I asked the question.

In the years since I have often wondered: “Which is more important, questions or answers?” The answer to this question is elusive since the power and success of an action often depends on questions asked. With experience I now believe the choices we make are fueled by the questions we ask, should have asked or could have asked.

I asked the man next to me: “Did someone call an ambulance?” He shook his head, raised his hands and said: “I don’t know?” This is when I asked the question. “Has anyone checked him for injuries?” “Who are you?” he asked. “I am a medical student.” I answered. With those five words my life changed. Everyone turned toward me and stepped back as if I had parted the sea. A woman kneeling next to the man waved me forward. I thought to myself, “I am in big trouble.” The only emergency medicine I knew was learned from television, movies and boy scouts. I had completed only three days of medical school and this woman was looking to me for help. Kneeling down, I checked his pulse and placed my hand on the woman’s shoulder. I asked her if she was his wife. She nodded and began to cry softly. I told her his pulse was strong and help would arrive soon. She thanked me and squeezed my hand against her shoulder.

The police had been called and an ambulance arrived after the two longest minutes of my life. I helped transfer him onto a stretcher and waved to his wife as she climbed into the ambulance. I turned and began to walk home. A woman touched my shoulder. I turned to her and she said, “Thank you.” Standing there, shoeless in my wet shirt and jeans, I shook my head and said, “I didn’t do anything.” She squeezed my hand and said: “Yes you did.”

That wet and rainy night, absent of knowledge and filled only with desire I discovered the meaning of comfort and why we should never stand quiet. The next time you have the opportunity to help someone check your pulse and follow your heart.

The Bus Pass

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Before cable TV, Wal-Mart, two car families and shopping malls, we had radio, corner stores, buses and department stores. We dreamed about landing on the moon, wore white T-shirts, PF Flyers and cutoffs, collected empty soda pop bottles for ice cream money, helped hang out laundry and rode the bus.

I will never forget the feeling of absolute freedom and adventure the first time I used my bus pass. The door opened and the driver looked down at me with his arm extended and his hand frozen on a worn chrome door lever. Walking up those curved stairs that day my life changed. I entered a world of exploration and discovery. The driver nodded as I proudly walked by the fare box and showed him my laminated bus pass and headed to the back of the bus. This simple piece of paper enlightened me. It allowed me to realize learning opportunities are everywhere and never ending.

Although that first solo ride was long ago it empowered me for many years thereafter. Learning how to read bus schedules and routes became a way of life for me. Bus transfers and trips to the public library were my enlightenment. I recognized the world around us is our greatest teacher.

Sitting in the treasured last row of the bus, I could see all of the other bus riders and take in the sights and sounds out the many windows. I was safe and actively in control of my life. Within seconds I could ring the exit bell and skip down the stairs to a new destination. Time became elastic and my only timetable was arriving home for dinner. Every Saturday was a caravan of discovery.

How and what we learn is more about acquisition and less about opportunity. Endless events and experiences entice us to hide behind patterns of behavior and expectation from ourselves and others. We cannot allow life to make us passive participants. We must engulf life or be engulfed. We cannot allow turbulent sensation to blindfold us and hide learning opportunities or encourage retreat into a world of unconscious behaviors and decisions. My bus pass taught me a new adventure is always within reach. All we have to do is step onto the bus and listen for the voice that tells us to get off the bus and always know another bus will come.

What are you and your child doing today to escape your cocoons? What bus routes will you choose? Will you be ready to ring the exit bell? Trust me, life is filled with transfers and the bus line called life is always running.

The Dream

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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

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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

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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

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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

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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.

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Household Safety

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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?