How To Get Kids To Swallow Pills

It seems like more and more, I’m seeing older children and teenagers, fully adult-sized patients, who refuse to take medication in tablet form.  “I can’t swallow pills.”  “They make me gag.”  “I’m going to choke.”  I talk a lot with parents about how to get kids to swallow pills.

The problem with older kids and adults that won’t take pills is that a ten-day course of antibiotics for an adult can be quite a lot of liquid.  Some medications just aren’t made in a liquid because they aren’t meant for children, and sometimes they can’t be crushed or cut into pieces to make them easier to swallow.

Before we go into how to work with your kids to help them achieve this adult skill, I want to be very clear on how we use words.  I hear “I can’t” a lot, both from patients and parents.  If your child is eating solid food, he or she CAN swallow pills.  It is physically possible to do so.  A single bite of food is MUCH larger than any tablet that is made to be swallowed intact.

So what is the problem?  Your child (and maybe you as well) has bought into a self-limiting belief.  They BELIEVE that they are unable to swallow pills and if they try, something unpleasant will happen.  Maybe they half-swallowed a piece of hard candy once and had a choking sensation that scared them.  Maybe they DID swallow a piece of ice from their drink or a piece of hard food they didn’t chew well, and it hurt a little going down.  Whatever the reason, they firmly believe that swallowing something intact will hurt.

Your job as their parent is to help them prove to themselves that they CAN swallow it and it WON’T hurt.

How do we do that?  Candy to the rescue!  (Yes, you read that right, Dr. Jen is actually advocating you giving candy to your child.  In this instance, though, the candy isn’t candy but a training tool and a necessary evil, LOL!)

Start with a small package of really tiny candies.  Some examples are Tic-Tacs, M&M Minis, and Mini SweeTARTs.  You know your child, what would they like?  It just has to be really small.  Get one small package and tell your child if they are able to swallow the first (insert small number, like 3 or 5 or 10) whole, they can have the rest of the package to eat.  Use milk or juice to wash the candy piece down.  Watch them to make sure they don’t chew them first (and if they do, that’s OK, it just doesn’t count) and apply liberal amounts of praises and atta-boy/girl.

Gradually work up to larger and larger pieces of candy until they are able to swallow pieces as large as an average medicine tablet.  Examples are Skittles, plain M&Ms and Reese’s Pieces.  Once they are able to confidently swallow these, they should be ready for an ibuprofen or acetaminophen tablet in case of a headache or minor injury.  Be sure to use the correct weight-and-age-based dose for your child.

Also, since children’s supplements are usually formulated to be chewable and to taste good, they often contain sweeteners and flavors that really aren’t good for your child.  Not to mention that they are EXPENSIVE!  I recommend to parents that they move their child to a high-quality adult supplement as soon as they are able.

I started my children learning to swallow pills when they were five years old.  The first pill they took was Shaklee’s Optiflora probiotic, which is so tiny that if you drop it, you won’t find it again unless your flooring is really dark:

Shaklee OptiFlora

After the probiotic we moved on to Shaklee’s OmegaGuard which is also small.  (Plug for those of you who don’t like fish oil because they’re horse pills – OmegaGuard is little!)

Shaklee’s OmegaGuard

And now both my boys, at 15 and 10, take Shaklee’s Vitalizer Men.  I laugh when people ask me what I’m feeding my 6’2″ teenager who has sprouted up about 8 inches in the last 2 years.  He’s my Shaklee kid!

Shaklee’s Vitalizer Men

Your child CAN take pills, if he or she is able to swallow solid food.  It is physically possible.  It’s your job to help him or her past the fear and get the confidence to learn this adult skill.  Like so much of parenting, it just takes patience, persistence and lots of positive reinforcement.

They can do it!  And so can you 🙂

QUESTION: How did you help your kids learn to swallow pills?  Do you have a child that can’t or won’t do it yet?

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New HPV Vaccine Recommendation

Just this week, the CDC released a new recommendation about the HPV vaccine.  Since 2006 a vaccine protecting against the human papillomavirus (HPV) has been available for girls aged 9-26.  In 2011 this vaccine was also approved for boys.

Human papillomavirus is the virus that causes cervical cancer in women, penile cancer in men, and genital warts and head and neck cancers in both men and women.  It is sexually transmitted and can be transmitted from mother to baby during birth.  It is estimated that up to 80% of women who are sexually active will contract the HPV virus.

In 2013 (the latest year for which statistics are available) almost 12,000 women were diagnosed with cervical cancer and over 4000 women died from it.  About 19,000 cancers in women and 8000 cancers in men per year are caused by HPV.  Cervical cancer used to be the leading cause of death from cancer in women, but the use of the Pap smear has dramatically decreased the impact of cervical cancer on women over the last 40 years.

Now we have a vaccine that even further reduce the cases of cervical and other cancers and the number of women and men who lose their lives.  Since the introduction of the vaccine, cases of HPV infection with the strains of virus covered by the vaccine has decreased by 56%.

Unfortunately, according to research published in 2013, only about 1/3 of girls between 13 and 17 had been fully vaccinated.  Other countries, such as Rwanda, have vaccinated over 80% of their teenage girls.  However, even with such low vaccination rates in the US, infection rates went down from 11.5% to 5.1%.

In order to increase the percentage of teenagers who are vaccinated and further reduce infection rates, researchers have been studying a two-dose vaccine schedule for the HPV vaccine.  They have found that two doses is as effective for younger teenagers as the traditional three-dose schedule.

The new recommendation for teens who start the vaccine series before their 15th birthday is to have two doses 6-12 months apart.  If the patient starts the series at age 15 or older, they should receive the traditional three doses with the second and third doses 2 and 6 months after the first shot, respectively.

It is important to realize that we don’t have to restart the vaccine schedule at any point.  So if your teenager had the first shot and didn’t get back for the last two, we just continue at whatever point we started.

For instance if a parent had their teen get their first shot at 12 years (which is when we typically recommend the vaccine) but then had second thoughts and didn’t continue, that’s OK.  We would simply give a second dose and call it a day, no matter how old the patient is, as long as they are under 26.

The two-dose schedule for HPV vaccination should make it easier to get our teenagers protected against a preventable, cancer-causing infection.

QUESTION: Do you think the new two-dose vaccine schedule will improve HPV vaccination rates in American teenagers?

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Raising Teenagers

I’m feeling thoughtful today.

Last night I drove my son and three other teenagers from our church youth group to drop them off at a weekend retreat.  Four teenagers half-yelling over each other in my car was quite an experience.

Most of the ride was spent discussing music.  They have a wide range of interests, some of which I share (and some of which I sincerely don’t).  Scanning through radio stations and stopping at songs one or another wanted to hear.  At one point someone broke out with “Is this the real life?  Is this just fantasy…”

Someone is raising their kids right.  All four of them knew every word to Queen’s “Bohemian Rhapsody.”  There was a very enthusiastic five-person a cappella rendition.  I think I’m a cool mom now, LOL!

When we got to camp and unloaded the pile of bags and pillows and sleeping bags (and food!) from the back of the truck, Chris grabbed his stuff and took off towards the boys’ cabins without a backwards glance.

Finding myself asked to move my car so other parents could unload, I figured the best thing to do was just to head home.  On the one hand I couldn’t be happier that my son is comfortable enough with 100 other teenagers and a few harried (but very dedicated) adults to head off on his own.

A tiny part of me, though, watched as time did that weird telescope thing that time does for parents as their children grow.  I saw myself prying him off my leg when he was two and didn’t want to stay at the day care.  And I wondered, when did this happen?

My son is growing up.  He is 14 now and a freshman in high school.  He tops me in height by several inches.  His hands and feet are bigger than mine.  He is learning things in school that I never learned and never will.

A very large part of me is intensely proud that Chris is doing this growing-up thing so well.  He is smart and caring and occasionally as awkward as a half-grown puppy, all arms and legs that don’t always do what he wants them to do.

He is also beginning to prepare for Confirmation and to try to figure out what path God wants him to take in his life.  Since my primary job as a parent is to get my kids to heaven, this discernment is a very important process to me, but I can’t do it for him.  All I can do is pray for him and encourage HIM to pray and listen for the whisper that will show him the path meant for him.

What I wish all you other parents out there could tell me is, do all parents raising teenagers feel this way?  99% terrified pride and 1% sadness that I will never again be as central to his life as I was when he was two?  Happy excitement that his world is getting bigger by the day paired with fear about all the dangers he will be navigating soon?

Is it normal to want to kiss one more boo-boo?  To tuck him in and try to find his head under the pile of blankets for one more good-night kiss?  To have him reach to hold my hand in the parking lot one more time?

When my mom was my age she was a new empty-nester.  Both her daughters had left for college.  I’ve got quite a few years before both my boys will be out of the house, but this weekend I can all too easily look forward to the day when my firstborn will head off to college and spread his own wings.

I think I need to call my mom.

QUESTION: If you have kids, did you feel this way when they were teenagers?  Any advice for me?

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Do Hands-On Dads Have Healthier Kids?

If you’re reading this article, I’d like you to take a moment and think about your own father.  Was your father present in your life when you were small?  Did your dad change diapers and give baths and play games in the backyard?

When comparing fathers of the past and present-day dads, it’s clear that fathers today take a much more hands-on role in the lives of their children and in management of their homes.  With so many mothers working outside the home, dads have more responsibility for meals and child care and household tasks.

Do these changes have an impact on their children’s health?  Do hands-on dads have healthier kids?  New research suggests that yes, they do.  As reported at Obesity Week, in at least one very important measurement, kids whose fathers are involved in their day-to-day lives ARE healthier than children whose fathers are absent or stick to a more traditional fatherly role.

There is an enormous study called the Early Childhood Longitudinal Study Birth Cohort which investigated all sorts of social, economical, health and educational parameters of 14,000 American children born in 2001.  Researchers looked at surveys filled out by the fathers of children in the cohort and found an interesting correlation.  (This research specifically looked at fathers who lived in the same household with their children.)

When dads were physically involved in the care of their babies, toddlers and preschoolers, the children were less likely to be obese.  Physical involvement means that fathers changed diapers, bathed and dressed and fed their children.  They were hands-on with their kids!  Dads being more involved with meal preparation was also correlated with lower risk of obesity.

No one really knows what the basis of this correlation is.  It is possible that households with hands-on fathers are more stable and, therefore, happier places to grow up.  15% of the homes studied were below the poverty line.  Fathers worked an average of 46 hours per week and mothers worked an average of 18 hours per week.

It has been thought that dads’ role in the prevention of obesity was limited to encouraging physical activity.  Getting kids involved in sports and encouraging their efforts was thought to be in the father’s sphere.  However, this new research suggests that fathers’ opportunity to promote health in their children may extend to menu planning and meal preparation and the deeper bonding that happens when a dad participates in the nitty-gritty tasks of raising a child.

As a doctor, this research has made me rethink the questions I ask about a child’s father at well-child visits.  In the vast majority of cases the child’s mother brings him or her to the doctor for a checkup.  I will need to be more curious about Dad’s role in taking care of the child, and encourage a more hands-on role for him.

If you have a small child or children at home, whether you are Mom or Dad, please think about the typical tasks you and your partner take on.  Do you split jobs on traditional gender lines?  Or do you switch off?  Taking turns with diapers, baths, dressing and mealtimes will allow deep bonds to grow between a small child and BOTH parents.

Deep and stable bonds with both parents make for happier kids.  It’s interesting that they may make for healthier kids as well.

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What Parents Need To Know About E-Cigarettes

You see them everywhere.  Adults walking in no-smoking zones exhaling huge clouds of white with ball-point-pen-shaped devices in their hands.  My patients often tell me they’re switching to e-cigarettes when I remind them that they need to quit smoking.

Are e-cigarettes safer than regular cigarettes?  Do they help smokers quit?  What impact are they having on our teenagers?

As parents, we need to understand the appeal of e-cigarettes to our teenagers and what the health risks are.

E-cigarettes are electronic devices that provide a vapor that contains carrier chemicals, nicotine and flavorings.  They don’t contain tobacco and therefore don’t expose the user to the carcinogens and other harmful additives in traditional cigarettes.  They are seen as a safer alternative to traditional cigarettes.

But are they really safer?

According to the American Lung Association, the chemicals in e-cigarettes are largely untested.  Because they are usually marketed without drug claims, companies don’t have to disclose or test their ingredients for safety.  One chemical, called diacetyl, is associated with a lung condition called popcorn lung.

Nicotine itself is NOT safe.  It doesn’t matter whether a user gets nicotine from patches, gums, lozenges, e-cigs or traditional cigarettes, it is harmful to the brain and to the circulatory system.  Nicotine is harmful to developing fetuses and therefore pregnant women should NOT smoke or use e-cigarettes.

Newer research shows that the brains of young people continue developing far longer than was previously thought.  (This is not a surprise to those of us raising teens, right?)   Use of nicotine is associated with problems of working memory and attention in adolescents.

Do e-cigarettes help smokers quit?

There was a survey done in North Carolina of middle- and high-school students about the use of cigarettes and e-cigarettes.  It found that use of e-cigarettes increased 4-fold between 2011 and 2013.  Those who used both cigarettes and e-cigarettes were actually LESS likely to quit (and less likely to try to quit) than those who smoked cigarettes alone.  Teens who use e-cigarettes are more likely to start smoking traditional cigarettes as well.

There has never been any evidence that e-cigarettes help smokers quit.  They cannot be marketed as a smoking cessation aid, but that doesn’t stop people from believing they will help.

As parents raising teenagers it is important we talk to our kids about e-cigs.  They will hear that e-cigs are safe, that they are just a fun, tasty way to get a little nicotine buzz.  E-cigs are heavily marketed to the adolescent age group.

The truth is that they are addictive, dangerous drugs that can be considered a gateway to traditional cigarettes.  They hurt teenagers’ ability to learn and process new information.  They are harmful to the lungs and circulatory system just as traditional cigarettes are.

When we’re talking to our kids about smoking, alcohol and drugs, we can’t forget to cover the dangers of e-cigarettes because marketing messages and their friends certainly won’t give them the whole story.

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Staying Healthy In High School

Here we go!  High school is definitely the biggest adventure our teenagers have ever had.

Credit: http://travelingmom.com

Credit: http://travelingmom.com

However, it is also the time when they have the most opportunity to get in trouble that they have ever had.  My son started high school this week and I am TERRIFIED!

Well, excited and terrified.  Proud, excited and terrified.  I know he’s going to be pushed to grow beyond anything he thinks is possible.  Expected to perform academically and personally at the highest level.  Held to the highest ethical standards.  He will gain skills he will need to succeed as an adult.  I wouldn’t want anything less for him!

I also know he will have much more opportunity to do unhealthy things.  As parents our teens need us to continually encourage them to take better care of their bodies and minds.

There are 3 main things we can do to give our teens the best shot at staying healthy in high school and building good habits they can take into college and beyond.

Sleep

Teens are teens, they are NOT adults.  They still need 9 hours of sleep or more per night.  I know it’s not cool but they really need a strong bedtime in order for them to have the energy and mind power to learn and perform at the highest level.

Sleep deprivation not only makes people tired and irritable but it interferes with learning and retaining new information.  It slows reaction time (like when driving!) and interferes with good decision-making.  And it suppresses the immune system and promotes weight gain.

The most neglected health measure in teenagers is sleep.  There is no substitute for it, no pill you can take to replace it, and no single thing you can do to help your teen succeed than make sure they get enough sleep.

Nutrition

No one can perform without good fuel.  It’s not realistic to expect that teenagers aren’t going to eat pizza, drink soda, and indulge in other junk foods especially when they’re out with their friends.

However, encouraging them to get their fresh fruits and vegetables, whole grains, fatty fish, nuts and seeds whenever possible is very important.  Also making sure they take a good quality multivitamin is smart.

There are other nutritional supplements that can help manage stress such as B complex, magnesium and fish oil.  Shaklee’s Stress Relief Complex is awesome for extra stressful times.

Connection

Teens have opportunities to get into all kinds of trouble in high school.  Drugs, alcohol, smoking, sex.  Studies have shown that they are much less likely to engage in risky behavior if they have strong social connections.

Whose opinion matters to your child?  Who would they NOT want to explain themselves to if they wind up in trouble?  It doesn’t have to just be you.  Keeping them involved in church and youth group, a sport, a volunteer organization or a job that is very important to them gives you leverage to help them think twice before taking dangerous risks.

The old adage that “It takes a village to raise a child” is very true.  You don’t have to do all the heavy lifting.  Engaging your teens with strong positive role models will help reinforce the messages you’re giving them at home about responsibility, safety and making good healthy choices.

Imagine you’re going to ride a roller coaster, the biggest and fastest one in the world.  When that restraint bar comes down, you push at it, right?  You don’t push at it hoping it will give way, do you?  You push at it to make sure it’s secure, that it will hold you safe when the ride turns you upside down.

Please remember that you are your teens’ restraint system.  They just climbed onto the biggest, fastest, most dangerous roller coaster they have ever ridden.  When that ride turns THEM upside down by throwing new decisions and dangerous choices at them, they depend on you to hold them safe.

Pushing at your rules is teenagers’ way of testing the restraint.  Don’t give.  They depend on you to keep them safe, even when they act like that’s the last thing in the world they want.

QUESTION:  Any words of wisdom for me as my baby climbs onto this roller coaster?  What helped you help your teen negotiate the joys and perils of high school?

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Supplements in ADHD Treatment

If you know any families that have children with ADHD you know how difficult it is to manage.  The medications have side effects, are expensive and difficult to use, and don’t always control symptoms well.  Is it any wonder there is such a big demand for supplements in ADHD treatment?

Families of kids with ADHD are desperate for treatments that work and are safe.  Fortunately there is good evidence for two supplements in ADHD treatment.

There is a well-written review I came across while looking up something for a patient.  Since I have so many readers with family members struggling with ADHD I thought I would summarize the review for you.

Basically there are only two supplements whose use has been proven to help children with ADHD.  Many, many supplements have been promoted for use to help with ADHD but the evidence is thin to nonexistent about their benefit.  Let’s talk about the two useful ones, then I’ll quickly go through the ones that need more investigation.

OMEGA-3 POLYUNSATURATED FATTY ACIDS

Omega-3 supplements have very good evidence to show they help children with ADHD   The American diet is very heavy on omega-6 fatty acids and when the ratio of omega-3 to omega-6 fatty acids isn’t properly balanced it can interfere with lots of different body functions.  Omega-6 fatty acids tend to be pro-inflammatory and omega-3 fatty acids are anti-inflammatory.

The component of fish oil that seems to be effective for ADHD symptoms is eicosapentaenoic acid (EPA).  Fish oil supplements vary widely in their content of EPA.  For instance, Shaklee’s OmegaGuard contains 363 mg EPA per two-capsule serving.  Nature Made’s burpless fish oil capsules have 180 mg EPA per two-capsule serving.  Carlson’s lemon-flavor liquid fish oil supplement contains 800 mg EPA per teaspoon.

I’ve written elsewhere that fish oil is healthy for everyone to take.  If you have a child with ADHD this is definitely one to add to their daily regimen.  Make sure to get as much EPA as possible, since that seems to be what is helpful for ADHD.

MELATONIN

Melatonin is used to help patients fall asleep.  It is a hormone produced in the pineal gland.  Production goes down when it is light out, and goes up when it gets dark.  It regulates our sleep-wake cycle.

Sleep disturbances are common in children with ADHD.  Melatonin has been studied for its ability to help children with ADHD fall asleep, sleep longer, sleep better, and manage their ADHD symptoms better.

Melatonin has been shown to be effective for helping children with ADHD fall asleep more easily.  However, the evidence for helping them sleep longer and better is not very strong.  And there is no evidence for melatonin helping kids with ADHD symptoms other than trouble falling asleep.

I found mention of a concern about children taking melatonin regularly having trouble with delayed onset of puberty.  It is known that in other mammals like rats, melatonin plays a role in the onset of sexual maturation, and administering melatonin to young animals can delay this onset.  However I was not able to find any studies addressing whether children using melatonin regularly are more likely to start puberty later than children who don’t take melatonin.  There certainly is no evidence of an ABNORMALLY late start to puberty in such children.

OTHER SUPPLEMENTS

Many other nutritional supplements are promoted to be helpful with managing ADHD.  Supplements such as iron, zinc and magnesium may be helpful in patients with documented deficiencies or dietary problems like malabsorption.  Ginkgo biloba has a modest effect, much less than that of medications, and has some serious side effects such as increased bleeding tendency.  Carnitine and St. John’s Wort are no better than placebo.

In summary, in spite of all the marketing hype around supplements for ADHD, there is really very little evidence that any but a few are effective.  If your child has ADHD they should definitely be on a high-quality fish oil supplement that gives them plenty of EPA.  If they have trouble falling asleep then a trial of melatonin would be reasonable with the approval of their doctor.

Until more research is published to show effectiveness of other supplements, unfortunately there is little reason to spend money on other supplements specifically to address ADHD.

QUESTION:  Do you have kids in your life struggling with ADHD?  Was this post helpful for you?

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Syrup of Ipecac

Guess what?  A patient’s grandmother taught me this week that something I learned in residency is completely obsolete.  AWESOME!

When I was a resident I was taught to advise parents to have syrup of ipecac in the medicine cabinet in case their child swallows a poison.  I was taught to tell parents never to USE it unless told to do so by Poison Control, and to have the Poison Control phone number posted by the phone and easy to find.

What is syrup of ipecac?  It is a liquid medicine that reliably makes people vomit.  The point of having it ready in the house is that if you need it, that’s not when you want to be heading to the pharmacy to buy it.  If you need it, you need to use it NOW.

My patient’s grandmother listened carefully to my advice and then headed to the pharmacy to buy syrup of ipecac.  Guess what she found?  It’s not on the market anymore.  Not produced anymore.  Hasn’t been available for years.

What?!  Well I’m nothing if not willing to admit I might be wrong.  However, before changing the advice I give parents I wanted to look and see what the rationale was behind the change, and find out what I AM supposed to tell parents to do in case their child swallows a poison.

There are 3 main reasons why the use of syrup of ipecac is no longer recommended.  First of all it is not very effective.  It is pretty reliable at causing vomiting, but it generally does not completely empty the stomach.  If your child has swallowed a poison you want to get rid of ALL of it, right?

Second, it could cause more damage if used improperly.  There are poisons that do as much or more damage coming up than they did going down in the first place.  I would always tell parents NEVER to use syrup of ipecac without specific instructions from Poison Control, but I can see how a panicky parent might just reach for ANY remedy without making that all-important phone call.

Third, syrup of ipecac has the potential to be abused.  Patients with bulimia are known to use it to make themselves vomit.  Repeated abuse of ipecac can cause heart problems and trouble with the salts in the bloodstream.  Also, there is a terrible (but thankfully rare) mental illness called Munchausen syndrome where people deliberately cause themselves to be ill.  Some people are seeking attention or malingering.  In a truly horrible variant of this called Munchausen syndrome by proxy, parents or other caregivers cause illness in those under their care.  Ipecac was one substance frequently used to cause illness in these cases.  Taking it off the market takes it out of the hands of those who would choose to use it to hurt themselves or someone else.

So what should parents do in case of an accidental poisoning at home?  Please remember that the most important aspect of treating poisoning is not letting it happen in the first place.  Keep all cleaning products, household chemicals and medications locked up and secure.  Even vitamins should be kept out of children’s reach.

If your child gets into something and swallows a substance, and you’re not sure if it might be poisonous, the first thing to do is to call the National Poison Control number at 1-800-222-1222.  The experts will help figure out what your next step should be.

I just called and double-checked the number is still right (and it is).  I also have my own Poison Control story.  My oldest child got into his father’s underarm deodorant when he was a toddler and took a couple of bites.  (Why he didn’t stop after one bite is a mystery, that stuff CAN’T taste good!)  The Poison Control guy was so nice and supportive.  I suppose they get a lot of calls from moms who feel like they’ve lost their chance at Mother of the Year, right?

After looking up the active ingredient and making sure it wasn’t toxic, he laughed with me gently and reassured me that they get lots of those calls and mine certainly wasn’t the first child to develop a taste for deodorant.

What do you do if you have a 13-year-old bottle of syrup of ipecac sitting in your medicine cabinet?  Give that bottle the honorable burial it deserves, in the trash can.

Thank you Connie for letting me know what the pharmacist told you when you went looking for syrup of ipecac at the drugstore.  You’ve given me a great chance to improve my practice and give my patients the most up-to-date information.

They told me in medical school that 50% of what they were going to teach us was wrong.  It’s up to us to keep reading, keep researching and keep learning to figure out which 50% it is!

QUESTION:  Do you (or did you) have syrup of ipecac in your house?

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Vaccination Recommendations: An Update

Sudden fever.  Terrible headache and body aches.  Dry, hacking, painful cough.  Stomach upset and loss of appetite.  Overwhelming fatigue.  Yep, it’s the flu.  You can expect 7-10 days of this misery, and the only medicine available doesn’t do much and may give you diarrhea to boot.  What’s the best way to deal with the flu?  Don’t get it in the first place.

Last year I wrote about ways to avoid colds and flu.  While this is all still good information, this week I want to focus on vaccination as a method of preventing illness.

There have been a number of recent changes to the vaccination recommendations for children, adolescents and adults.  This week, since we’re heading into the flu season and everybody seems to be talking about shots, I thought I’d review them.  It’s a good reminder for me, too!

Since we’re talking about the flu, let’s start with the flu vaccine.  Not much has changed, except that there are both 3-strain and 4-strain versions available (my office gives the 4-strain version without preservatives).  Children receiving their first dose ever should get 2 half-doses a month apart.  All healthy adults and children 6 months of age and older can be vaccinated;  the vaccine changes every year because new and different vaccine strains keep popping up (darn bugs!!).

Speaking of the little ones, the major change to the primary vaccination series (birth to 18 months of age) is the addition of the rotavirus vaccine. This is an oral vaccine given at 2 and 4 months of age.  It prevents a horrible diarrheal illness that just about every baby got before they turn 2.  Both my boys had it.  As a resident doing my inpatient pediatric training, rotavirus season would see an endless parade of exhausted parents and listless, dehydrated babies admitted to the hospital for IV fluids.  The vaccine has dramatically decreased hospitalizations and deaths from diarrhea and dehydration not just in the USA but around the world.

For the adolescents, most of them know they have to get a shot before they start 7th grade.  What they DON’T know is that they actually need FIVE shots (insert evil laugh…)  At age 12 kids get a TDaP (which is required in the state of Ohio), their first meningitis shot, and the 3-shot Gardasil series.  Meningitis gets an booster at age 16 to hold them through college.  High school and college-age people (particularly if they live in a dorm) are at risk for meningococcal meningitis, a thankfully rare but extremely contagious and devastating disease.

Debating about the merits of vaccinating against a sexually transmitted disease is outside the scope of this post.  I strongly encourage all parents to discuss with their children the dangers of sexually transmitted diseases (I have the “cootie talk” with my teens and preteens in the office too) and advocate chastity until marriage.  This is the healthiest choice both physically and emotionally.  However, I also expect my teens to drive safely but to wear their seatbelts every time they’re in the car as an extra safety measure, and I consider Gardasil the “safety belt” for HPV.  The science suggests the HPV vaccine is one of the safest and definitely one of the most effective vaccines ever developed.

In adults, the recommendations haven’t changed much.  We still need a TDaP shot every 10 years or sooner if we hurt ourselves.  Unfortunately it still causes pain, redness and swelling at the injection site (I know because I just got my booster in August, ow!).  We need annual flu shots, of course.  Adults with chronic illnesses like asthma, diabetes, and COPD should have a shot for pneumococcal pneumonia.  At age 60 anyone who has had chickenpox should get the shingles vaccine.  If you know anyone who has had shingles, you know how miserable it is.

This is just an overview of the general recommendations and some changes that have been made in the last few years.  You should discuss with your own doctor what your specific vaccination recommendations are.

Vaccinations are one of the reasons we enjoy the health and long life we have in the United States.  In other parts of the world illnesses like measles, polio, hepatitis and pertussis are major causes of illness and death.

QUESTION:  Are you and your family up to date on shots?  Have you ever refused a vaccine?  Why?

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Back To School Health Concerns

It’s that time of year again!  Have you got kids going to school this fall?  Me too!  We’re shopping for school supplies and clothes and shoes just like everybody else.

Are your kids ready to go back?  There are a couple of back to school health concerns I want to discuss this week.

1.  Sleep

Did your kids get off their school sleep schedule this summer?  Don’t worry, if they did you should have plenty of time to get them back on-track before school starts.

Elementary school children need about 10 hours of sleep per night.  For instance, our kids’ bus came at 7:30 AM last year.  Since they got up between 6:30 and 7:00, that made our bedtime about 8:30 so that they were asleep by 9.

You will want to give plenty of time to adjust a child’s sleep schedule.  Move bedtime by no more than a half-hour per night, every few nights, to let your child adjust.  If they’ve become accustomed to sleeping in, start instituting a set wake-up time.  In the adjustment period if they need a nap let them take a nap

There are plenty of things to adjust to in the first few weeks of school.  Fatigue and sleepiness and battles over going to bed and waking up are things you just don’t need to deal with.

2.  Doctor’s visits

Are your kids playing sports this school year?  Summertime is a good time to get their sports physicals out of the way.  Don’t worry, the physical is good for a year and is covered by health insurance.  Make sure to bring along any medication administration forms (for asthma or other meds your child will need to take at school).

If your child will be heading into kindergarten or 7th grade, they will need vaccines prior to starting school.  You should have gotten paperwork from the school already if your child is affected.  Remember that although your rising 7th grader is required to have the DTaP, the meningitis and HPV vaccines are also recommended at this age.

I get a lot of questions about the HPV vaccine and should probably devote a whole blog post to that topic.  Please discuss the vaccine recommendations with your child’s doctor in detail.

After the 7th grade shots, your child will be done with tetanus shots until after college (unless she hurts herself, gets bit by a dog, etc) but she will need a meningitis shot booster at age 16.  Other than annual flu shots those are all the shots your child will need.

3.  Nutrition

My kids participated in a summer day program this year that did not provide lunch.  We were a little concerned that packing lunches would be a big hassle (since we hadn’t done it before except for field trips).  To our pleased surprise, it was a very positive experience for our boys.

Our lunch planning guidelines for the boys were that they needed to make a sandwich (with deli meat and cheese) and choose a fruit, a vegetable, and a starch for their lunch.  We read labels and used a food scale to explore portions for the starch (often pretzels, corn chips or a granola bar).  Here’s a website with interesting school lunch ideas.

Now at the end of the summer both boys are making their own lunches like pros.  Even better, when we go to the market and they want to try a different snack food for their starch (like barbecue potato chips) we can look at ingredients and talk about what’s in there, portion sizes and how they’re manipulated, price versus value, and other good topics.  We’ve even gotten them to try some new vegetables!

Nick says he wants to continue packing his lunch (unless they’re serving something he REALLY likes).  Chris is more noncommittal.  I have decided I like having them pack their lunch.  That way we have control over making sure they’re not eating junk food and that they’re getting enough to eat.  With the new school lunch regulations there were times our boys reported the lunches were awful AND too small for the bigger kids.

From a health standpoint, heading back to school can be stressful from a health standpoint.  With a little planning your youngsters can transition into the school year happy and healthy.

QUESTION:  What back to school health concerns do you have that I didn’t discuss?  I can always talk about them next week, LOL!

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