Flu & You: Protecting Your Family During the Flu Season

Originally posted on my US News & World Report parenting blog (Feb 16)

THIS YEAR’S flu season is officially reaching its peak, and this year’s strain of influenza virus is cause for considerable concern, striking with a vengeance not seen in decades. It’s causing more severe illness, more hospitalizations and even more children’s deaths, as parents do what they can to try to protect their kids.

In reality, the strategies being recommended to combat this year’s flu are essentially the same as those employed in years past. While you’re likely to have heard about many of these strategies before, it’s nevertheless useful to remind ourselves of the importance of washing our hands and covering our coughs; getting everyone in the family who is 6 months or older vaccinated; and being on alert for and recognizing early the signs of the flu – such as fatigue, body aches, cough, sore throat and fever – and it’s potential complications, from sinus infections and pneumonia to heart problems, particularly in more vulnerable individuals, like the very young and very old or those with compromised immune systems.

Now that’s easy to say, and it sounds like easy enough advice to follow. Yet each year I’m left wondering why it is that, as parents, we don’t always feel confident in our approach to fighting the flu. In large part, it’s the fault of the virus responsible for causing the flu. The influenza virus is cunning in its ability to change from year to year, which makes it all the more difficult to protect against.

But I would also suggest that there are some parenting practices and commonly held parenting beliefs that, despite our best intentions, stand to get in the way when it comes to protecting our children, and ourselves, from flu’s wrath.

It’s useful to start with a clear understanding of what “the flu” actually is, and what it isn’t….

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The truth about American Idol’s “Idol Bug”

I recently got around to watching a recorded episode of American Idol. Aside from all the melodrama associated with stress, sleep deprivation, and watching people who dream of living life in the spotlight compete against each other, I was struck by the fact that the episode was impressively reminiscent of the opening scenes from the movie Contagion. For anyone who hasn’t seen the movie, suffice it to say that the storyline is focused on the ensuing devastation invoked by the uncontrolled spread of a dangerous new virus.

Okay, so no one died on American Idol’s Hollywood Week episode. But I did experience the same sense of foreboding. Idol contestants shaking hands, exchanging frequent high-fives, offering each other lots of hugs, and just generally partaking in a whole lot of close contact also known as germ-sharing behavior. Worse yet, there was a clearly identified “Patient Zero” in the mix – runny nose, fever, fatigue and all. If germs were visible, I’m pretty sure any viewers who somehow missed the not-so-subtle foreshadowing by the shows producers would have been cringing along with me long before contestant after contestant proceeded to fall ill.

Hmmmm…If only germs were visible…Now there’s a thought. I majored in cellular, molecular biology, so I’ve admittedly had more opportunities to visualize germs than most. But the concept of helping people – even young children – be visually reminded of the presence of germs isn’t out of reach. In fact, there are even cool (and relatively inexpensive) soaps and science  kits that help children (and adults) visualize just how effective (or ineffective) they are at washing germs off their hands.

It is my sincere hope, however, that it won’t take actually visualizing germs for all of us to take stock in what simple measures we already know are effective in preventing the spread of germs. For a quick refresher, let me spell them out for you so you will have them at your (hopefully clean) fingertips! After all, the truth about the “Idol Bug” is that it was likely just another (admittedly nasty and poorly timed) virus making the most of making people sick.  More than just another virus, however, it was also a really good, attention grabbing reminder for the reported 19 million  that we’re still in the middle of cold and flu season, and that the sharing of germs that happened in Hollywood while the cameras were running could happen anywhere – especially to those who neglect to take the following actions!

Wash your hands with soap and water. Handwashing is particularly important not only before eating and after using the bathroom, but any time you or your children are sick or come in contact with people who are sick (or germy surfaces like grocery cart handles). And don’t just settle for a quick rinse. Lather up the soap and be sure to get all areas of the hands – both front, back and in-between fingers.

Cover your cough. I can tell you from lots of child-care-owning experience that it’s entirely possible to teach even very young children to not only cover coughs, but to do so with their arms rather than their hands. They may not get it right early on or every time, but over time they’ll pick up on this very important form of prevention. The fewer illness-causing germs that are coughed into one’s hands, the fewer that stand to contaminate surfaces or get shared directly with others.

Vaccinate. I often get asked longingly in interviews about whether or not we’ll ever discover how to prevent the common cold. I agree that this would be nice, as the symptoms associated with the common cold can certainly be quite pesky. But the severity of the common cold is nothing compared to all of the vaccine-preventable diseases (think measles, mumps, rubella, diphtheria, tetanus, polio) we are now able to effectively prevent. Simply put, vaccination is deserving of its recognition as one of the biggest public health success stories of the past century.

Avoid contact with those who are ill. Within reason, that is. That means that when you’re sick, it’s best to limit contact with others whenever possible – especially in the first days of an illness, when you have a fever, the flu, or other significant symptoms likely to spread germs and infect others (such as a lot of coughing).

Disinfect contaminated surfaces. Think snotty tissues on the nightstand, door knobs, telephone receivers, or any other high-traffic surfaces that are likely to have come in contact with unwashed, germy hands.  Germs can live for hours (and in some instances, days), so don’t forget to disinfect contaminated surfaces.

Originally posted on Omaha World Herald’s Live Well Nebraska

Starfish & Mittens: Helping Teach Our Children Kindness and Empathy

As you are probably well aware, my focus is and always has been on kids, parenting, and families. Quite often – whether in the books I write or at my childcare center – this translates into helping parents better understand, educate, and guide children towards happier, healthier futures.

Today is no different. In fact, I was halfway done writing my Live Well Nebraska blog in honor of National Children’s Dental Health Month, a topic I truly believe should be hugely important for all parents – perhaps more so than many are even aware.

As is often the case when I’ve promised myself I’m not going to be distracted while writing, however, I’ve found myself distracted. As soon as I opened my web browser with what I swear was for work purposes only, I saw a top-of-the-page CNN video entitled Children of the Trash Dump. These kind of titles always lure me in, and I’ve never been able to keep from clicking on the links and watching the videos. When I do, it inevitably solidifies my desire to do more to improve the lives of children and their families. Today, my conviction was made stronger than ever.

You see, I’m fresh on the heels of a very powerful trip to S. Africa, during which I had the opportunity to tour the makeshift shantytown of Dunoon just outside of Cape Town, where I witnessed firsthand both the terrible poverty and incredible resilience of its women and children. I left there more determined than ever to do something. I imagine watching CNN’s story about the plight of Vietnamese children living on a trash dump and at great risk of falling prey to child trafficking may have nearly the same effect on some of you.

The question that often arises, however, is what can one really do to tackle such a huge problem or even make a dent in such desperate situations as poverty, child trafficking or illiteracy. In the case of S. Africa, I joined about fifteen other members of the Global Hygiene Council to see firsthand the incredible power of teaching basic handwashing. Sure, I talk about handwashing all the time, and yes – we teach the students at my childcare center this basic life skill on a daily basis. But calling it a “life skill” has a way of taking on a very different meaning when one is teaching handwashing in a community with little running water and barely able to scrape together the dollar per week it costs to buy one’s family a bar of soap.

The hopeful news in Dunoon is that the four-year handwashing study conducted in the face of both poverty and health illiteracy yielded very promising results – on the order of reducing diarrheal illness by 30-50 percent! Those results would be great even here in Omaha, where parents inevitably are plagued by diarrheal illness and fret over the accompanying need to keep their children from becoming dehydrated. Now consider the fact that diarrheal disease worldwide is one of the leading causes of death for children . That’s why I’m now dead serious about finding a way to donate to the Dunoon community as much soap as I can get my hands on (along with books and beads). If you’re interested in helping me make this happen, by all means let me know.

But back to the children in Vietnam. The “hope” part of the story promised in the video’s promo is based on one woman’s vision to set up a non-profit to fight trafficking in Vietnam. This small organization is currently educating 200 of these poorest-of-the poor girls in hopes of giving them a chance for a better future and a better likelihood of avoiding predatory child traffickers. The visionary founder interviewed in the segment not only refers to the hugely important focus on “saving” girls through education, but also touches on the importance of improving the community’s reported illiteracy level from it’s staggering 99+ percent.

Let me just say that I couldn’t be more touched, or more in agreement. I thoroughly agree that education and literacy is fundamentally important and the key to helping people out of poverty and lead more successful lives. I’ve also become increasingly convinced with the notion that the education and empowerment of girls is absolutely key to solving not only poverty, but quite honestly – a good many of the world’s problems.

If you don’t believe me, then maybe you’ll believe Oprah. Or Hillary or Bill Clinton. Or pretty much anyone who has ever read Nicholas Kristof’s powerful book Half the Sky. Those who read it are likely to be permanently changed in the way they view the importance of girls, ready to join this global movement, and all but insist that everyone needs to read this book.

And finally – I am a huge believer in the power of doing something over nothing. You may have heard the anecdote of the boy and the starfish. It goes like this: a man and a boy are walking on a beach littered with washed-up starfish. Boy picks up starfish and throws it back in the ocean. Man sees this and applies the all-too-common viewpoint when he tells the boy that there are far too many washed up starfish to possibly save them all. Boy responds, “Well, I made a huge difference to that one.”  I love this story. I try to live by it. Clearly, so do the people whose far nobler efforts are recounted in Kristof’s book and CNN’s poignant video. The point is, every human being counts, and each and every one of us can do something to help those less fortunate than ourselves.

At Primrose, my teachers have t-shirts that state, “No matter how big or small, we all stand to make a difference in the world.” My husband and I were convinced to move to Omaha nine years ago in large part because we believe that here in Omaha, we are not alone in our belief that teaching even our youngest children to be involved in the community and help others is fundamental. And our Helping Hands curriculum isn’t just about the actual dollar amount the kids raise to donate, or about how many mittens, books or cans of food they collect “for kids who don’t have them” (although I’ll tell you that I couldn’t be more proud of the students for their selfless and impressive accomplishments). It’s that they’re learning the lifelong lesson that we really can make a difference if we all just take whatever opportunity we have to throw starfish back into the ocean.

With that said, I hope all of you will consider what you might do. Start big or start small. Think globally or act locally. Get your kids involved and I promise, the world will be a better place for it.

On that note, I’ll get back to writing about getting kids to brush their teeth. After all, teeth are really important too. And even pink princess toothbrushes can play a part in the grand scheme of oral health promotion.

Originally posted on Omaha World Herald’s Live Well Nebraska

Parenting a sick child: When a child’s cough is cause for concern

I was recently asked by a concerned parent, “When is a kid’s cough something you should worry about?” As a pediatrician, I feel obligated to point out from the outset that, in most instances, this is a question that really needs to be discussed directly with one’s own pediatrician. There are, however, several general cough concepts I can share with you that will hopefully help you gain a better big picture perspective.

It’s first worth pointing out that a cough, at the most basic level, is simply a reflex that exists to help keep things out of the airway. Even though it may not seem like it when your child is up and coughing in the middle of the night, a cough (like a fever) can actually serve a useful purpose.

As for considering the various causes of a cough, some of the most common in children include infections, asthma, choking or having something stuck in the airway, croup, habit coughing, and certain medical conditions (usually ones children are born with). Some are easy to identify, while other causes can take a bit more sleuthing. Even when you have identified the underlying cause, it may not always give you a definitive answer as to whether to be concerned. In the case of cough-inducing infections, plenty of common colds can cause an inconvenient, annoying cough. Pertussis, on the other hand (also caused by an infection and referred to as “whooping cough”) is known for it’s nagging cough…and the fact that it can prove deadly to infants.

When it comes right down to it, figuring out when to worry about a cough needs to be treated as a problem-solving venture. The following are some of questions most worth considering and the symptoms you’ll want to be on the lookout for.

Age matters.  Any cough in a baby three months or younger warrants a visit to the doctor’s office.

At a loss. It’s one thing to cough. It’s altogether another when the cough takes one’s breath away and is accompanied by more concerning signs such as troubled, noisy, and/or fast breathing.

Time of day. Taking note of how much, how often, and even when during the course of the day and/or night your child coughs can provide some telltale clues. Mucus drainage, for example, typically tends to trigger an increase in nighttime coughing. Habit coughs, on the other hand, tend to go away during sleep.

Persistence counts. More than 2 weeks of a cough definitely warrants a check-up. Coughs associated with run-of-the-mill colds don’t usually last this long, while pneumonia, sinusitis, and other causes of persistent cough often do.

Describe the circumstances. Any history of a sudden cough – especially following a gagging or choking episode – is particularly concerning for a foreign object in an airway.

Over-exposure. Consider if your child’s cough matches that of his siblings, his preschool classmates, or others he’s recently come in contact with. While I’m on the subject, let me also take this opportunity to add that while it’s a very wise idea to take advantage of practical and effective measures to stop the spread of germs – think hand washing, vaccines, and basic disinfection of contaminated surfaces – it’s unnecessary and, more importantly, unrealistic to think that you can (or should) keep your child away from all germs.

Wet or Dry. A mucusy cough is often referred to as a “wet” cough, whereas a cough without mucus is more likely to be called a “dry” cough. While determining whether a cough is wet or dry doesn’t automatically determine the underlying cause or inherently tell you how concerned to be, it can prove to be useful information.

For better or for worse. It’s fairly straightforward but worth saying that taking note of what triggers your child’s cough and what makes it better can be key in figuring things out. Croupy coughs tend to be worse at night and better with moist air. Asthma coughs can be caused by known allergens, may worsen with exercise and respond well to albuterol or other asthma medications.

Additional warning signs. Any time a child has other accompanying symptoms of concern such as a high fever, coughing so hard they are vomiting, coughing enough that they refuse (or are unable) to drink, or cough up blood, it’s time to head to the doctor. to the doctor.

Originally posted on Omaha World Herald’s Live Well Nebraska

The Benefits of Breastfeeding

There sure has been a lot of discussion about breastfeeding in Nebraska lately, and for that I’m glad. But I have to cringe every time it’s brought to my attention that Nebraska is one of only two states without legal protection for “the practice” of breast-feeding. To put it bluntly, as a pediatrician I find this quite embarrassing. Even more than embarrassing, I find it completely baffling. As much as I try to understand the opposition to LB 197 and the right to breast-feed in public, I simply can’t.

After all, you can’t convince me it’s based on concerns about over-exposed breasts. Not in this day in age. Not when Katy Perry flaunts her assets on Sesame Street, Lady Gaga’s outfits leave little to the imagination, and everything from billboards to Superbowl ads bombard us (and worse yet, our children) with nearly bare-all images of women’s breasts. Let me also point out that there’s a huge difference between the pervasive and highly sexualized imagery our society has discouragingly come to tolerate, and breast-feeding. Quite frankly, breast-feeding shouldn’t even be discussed in the same breath. Sure, it involves the breasts, but that’s as far as the connection goes.

I also think that anyone who opposes protecting the rights of women to breast-feed in public is missing the hugely important fact that promoting breast-feeding is one of the single best ways we know to improve the health and well-being of babies (and their mothers). It’s no coincidence that the U.S. Surgeon General, Dr. Regina Benjamin, recently  launched a nationwide campaign to encourage breastfeeding by removing barriers that discourage it. I applaud well-respected pediatricians Dr. Laura Wilwerding (the American Academy of Pediatrics’ breast feeding coordinator for Nebraska) and Dr. Tom Tonniges (former Associate Director at the American Academy of Pediatrics and now Medical Director at Boys Town) for their recent and ongoing efforts to insure that Nebraskans don’t lose sight of just how important breastfeeding is.

I join them in closely watching what’s happening with LB 197 and hoping Nebraska will soon catch up with the rest of the country in better supporting every new mom’s noble efforts to successfully breast-feed her baby –in the hospital, at home, and yes…even in public.

On that note, I figured it would be most compelling to leave you with a few simple but powerful reminders of just why breast-feeding and LB 197 are so important.

  • Breast milk contains infection-fighting antibodies that provide babies with protection against everything from diarrhea and the common cold to ear infections and pneumonia
  • Breastfed babies are less likely to have asthma
  • Babies who are breastfed for at least six months are less likely to become obese
  • Breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS)
  • Moms who breastfeed not only return to their pre-pregnancy weight faster, but experience less postpartum bleeding and are at reduced risk of breast and ovarian cancer.

Obstacles such as lack of support, instruction, and accommodation to breastfeed at work and in public all contribute to the fact that while 75% of moms in the U.S. start breastfeeding, only 43% are still doing so at the end of six months (and only 13% exclusively, as recommended by the American Academy of Pediatrics).

Originally posted on Omaha World Herald’s Live Well Nebraska

Giving Thanks: Things the Whole Family Can be Thankful For

I bought my turkey this past weekend. Not only did I buy it, but I even took a moment to think about how thankful I am for it. Sure I’m thankful because I love turkey, but also simply because I am fortunate enough to be able to afford a turkey. As a parent, I know full well that taking a simple weekend task like grocery shopping and turning it into a shared reflection on what our family has to be thankful for is likely to lead to some eye-rolling from my tween- and teenage children.

But the fact of the matter is that there’s no better time than the present (i.e. Thanksgiving week) to take a few moments – whether waiting in line at the grocery store or gathered with family and friends around the Thanksgiving table – and reflect on those things in your life for which you’re truly thankful. While trips to Disneyland, ipods, and the latest greatest toddler toys will understandably spring to mind first, I suggest you challenge your children, and yourself, to dig deeper. As a pediatrician and parent, I figured I’d get you started by sharing some of my own, all-too often taken for granted things to be thankful for.

Breathing through your nose. Spoken like a true pediatrician, right? But years of tending to snotty nose colds (my own, my children’s, and others’) has taught me that it’s hard to take time to stop and smell the roses if you can’t breath through your nose. You may think I’m kidding, but I’m not. Just think how many times your child’s (or your own) stuffy nose cold has kept you up at night and caused you misery. Instead of being frustrated by the annual average 6-10 colds that kids catch each year and the fact that we still don’t have a cure for the common cold, I suggest that we all remember to be grateful for each day that we wake up healthy.

Shots. I figure while we’re on the subject of waking up healthy, I’d take this opportunity to give my thanks to modern medicine and all of the medical pioneers that have given us vaccines. No, I’m not a huge fan of needles, and neither are my children. But I have such a healthy respect for the dreadful diseases we are now able to prevent by simply making sure that our children’s (and our own) immunizations are up-to-date that I count each and every shot a blessing, needles and all.

Car Seats. As someone who had 3 kids in just over 3 years – the youngest of whom only just outgrew the need for a car seat at age 10 – I am certainly aware of the parental challenges inherent in the purchasing, installing, and juggling of car seats, especially during holiday travel season. Yet despite having spent every day of the past 10 years overseeing the use of numerous seats of my own, I’m exceedingly grateful for the fact that car seats even exist, much less that they are so incredibly effective in protecting kids from harm. With nothing more important than my children’s health and safety, car seats (and all those who contribute to making sure that children are secured safely) deserve my thanks.

Cell Phones. Yes, I do have tween- and teenage children of my own. And yes, I do face the daily parental challenge posed by a world now dominated by texting tots and teens and threatened by everything from cyberbullying to sexting. But having just returned from a mobile health summit in Washington DC, I am now very, very grateful for cell phones. World thought leaders the likes of Bill Gates, Director of the National Institutes of Health Francis Collins, and the president of the Rockefeller Foundation joined over 2500 attendees from around the world who all share the belief that cell phone technology is the tool by which we will be able to reach the world’s poorest and provide them with access to better health.

Here in the United States, innovative programs like text4baby are making use of the ubiquitous nature of cell phones to put valuable health information and access to local resources right at the fingertips of pregnant women and new moms.

While I will absolutely not be thankful for any cell phones that make their way to my family’s Thanksgiving table, I will nevertheless be grateful that they exist, not just to make my life easier, but improve the health and well-being of those less fortunate than me.

Originally posted on Omaha World Herald’s Live Well Nebraska