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Fighting fever phobia: The facts about fever for parents

This seems like an appropriate time to spend a few minutes focusing  on the subject of fever, in part because it’s one that effects (and therefore interests) just about every parent I know, and also because we happen to be right in the middle of cold and flu season – a time of year during which children inevitably experience far more than their fair share of fevers.  It’s also because fever phobia amongst parents is usually far more pervasive than it is warranted. That’s not to say that fever is inconsequential, but rather that we should all take the time to brush up on exactly what fever is, what it represents, when it does (or doesn’t) need to be treated, and how to do so appropriately. Fortunately,  the American Academy of Pediatrics just pulled together all of the latest expert thinking on the management of fever in children and released it in a clinical report entitled Fever and Antipyretic Use in Children.

Given the importance of the subject,  I figured it would be particularly helpful to review just what these latest fever recommendations tell us about fever.

A healthy respect for fever.  It’s important to understand that fever is not an illness, but rather a common and normal response to infection. While fevers can in some instances signify a more serious underlying infection, they are unlikely to endanger generally healthy children.

It’s a matter of degree – or is it?  According to the AAP’s report, the use of fever-reducing medications should be focused on making children more comfortable, rather than getting rid of fevers altogether. It’s certainly useful to own a thermometer and to know how to accurately measure your child’s temperature. But all too often, parents unnecessarily focus on using fever-reducing medications to fight their child’s temperature back down to normal and keep it there.

The benefits of fever. While I know it may be hard to recognize any benefits when you’re home caring for a sick child, the report reinforces that fever is actually thought to have a  beneficial effect when it comes to the body’s efforts to fight infection.

Fighting fever phobia. The most common fear that parents, caregivers and even health care providers often share is that high fevers, if left untreated, will result in seizures, brain damage, or worse. In fact there is no evidence to support this fever phobia, as there is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications.

Treat with care. Acetaminophen products (like Tylenol) and ibuprofen products (such as Motrin or Advil) are considered equally safe and effective for use in the treatment of fever for children 6 months of age and older. That said, it is especially important for these fever-reducing medications to be dosed accurately and given no more often than necessary or recommended (every 4-6 hours for acetaminophen and 6-8 hours for ibuprofen). As for giving them in combination or alternating them, as is often discussed, it may be effective but shouldn’t be done unless absolutely necessary since it increases the risk of making dosing errors.

Originally posted on Omaha World Herald’s Live Well Nebraska

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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

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An alternative to Valentine’s Day chocolate: reasons to dance your heart out!

Valentine’s Day is undeniably all about love and sweethearts. It’s also defined by the heartfelt gifts of chocolates, sweets and (candy) hearts so plentiful this time of year. Now it’s not that I think we need to do away with all of these sweet gifts in lieu of a more heart-healthy approach to Valentine’s Day. But it has occurred to me that this holiday could mean so much more when it comes to finding ways for our loved ones to have happy hearts.

To get you one step closer to achieving this goal, I’d like to suggest that you, your kids, and your sweetheart all get up and dance. That’s right…dance! There are several reasons why you and your family should put your best foot forward and get up and start dancing.

It’s Fun. Regardless of age, who doesn’t like putting on some music and just letting loose? The good news is that regular physical activity throughout the day (which could easily include dancing), improves sleep, reduces stress, and overall makes people feel better about themselves. So just break out those dancing shoes (and your toddler’s skid-free socks and tutus) and start dancing. For some added fun – grab your video camera and capture the moment(s). No rules, just fun.

It’s Exercise. I imagine you don’t need me to tell you that we’re in the middle of a nationwide childhood (and adult) obesity epidemic. The beauty of dancing is that it’s not work, it doesn’t require committing to regular trips to the gym, and it doesn’t cost a thing to break a sweat. Yet don’t let this lack of requirements deceive you into thinking it’s not exercise. In fact, First Lady Michelle Obama’s national Let’s Move! Campaign actively promotes the need for kids to get 60 minutes of moderate to vigorous active play every day. After all, when they (and you) simply get moving (or dancing!), it all adds up to building and keeping healthy bones, muscles and joints and achieving a healthy body weight.

It’s Quality Family Time. Whether you opt for a daddy-daughter dance, a dance contest, or a more freestyle approach to your family’s dancing, it all adds up to the potential for quality family time. With the hectic pace of parenthood and often over-scheduled childhood that defines the times, I would argue that protected quality time with the family – at the dinner table, during conversations with your child in the car, and when sharing fun family activities like dancing together – is invaluable.

And now for my timely and heart-warming news. As many of you may already know, in addition to being a pediatrician, I also own an educational childcare center – Primrose School of Legacy – located in West Omaha. As one of over 200 franchised centers across the country, I am particularly proud to share with you that from February 1st through March 19th, all your heart-felt family dancing can be for a very worthy cause! That’s because Primrose Schools is hosting the 2nd Annual National Family Dance-off Contest. This fun family-oriented dance-contest is open to all families and benefits the Children’s Miracle Network Hospitals. By simply uploading a 30-second video of your family’s most creative, unique, or amusing dance moves at www.FamilyDanceoff.com and/or making sure that you and everyone you know votes each day for your favorite Omaha video, you could be one of 14 weekly contest winners who receive a flip video camera and up to $5000, while also winning Children’s Hospital and Medical Center a chance at receiving a $15,000, $20,000, or even $30,000 donation from Primrose Schools!

Simply put, I want to see Omaha families and children getting healthy by eating healthier, getting up and moving, and dancing. And through March 19th, I more specifically hope you all will be dancing to win, not only for yourselves, but for Omaha’s Children’s Hospital and Medical Center. I guarantee you it will do your body, your family, and your heart some good!

Originally posted on Omaha World Herald’s Live Well Nebraska

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I have to say, it’s a good thing I have the opportunity to talk to lots of parents on a regular basis, if for no other reason than because I’m able to reassure myself that I’m not the only parent having conversations like this one:

Me:     “You can’t wear shorts today.”

Child who shall go nameless: “Why not?”

Me:     “It’s winter, and it’s too cold outside for shorts.”

Child (still wearing shorts):    “So?! I’m not cold.”

Me:     “It’s not just a little cold. It’s frigid outside. As in snow temperature. As in it’s sub-zero wind chill and like the arctic tundra outside. Now go change!”

Child (still not changing):        “But mom, WHY?!”

Me:     “Because I give people parenting advice for a living, and if you don’t, you’ll make me look bad, so end of discussion – go change!”

I have to admit that there’s some irony to me telling my children to change into long pants or go put on a winter coat. After all, I grew up in the Midwest and I was actually known all throughout college for not wearing a coat – even when walking outdoors between classes during winters spent at the University of Michigan. In fact, last winter I passed a college friend on the streets of NYC who I hadn’t seen in almost a decade. He later told me that the only reason he hadn’t stopped me to say hello was because I was wearing a coat, so he figured it couldn’t possibly be me!

Okay, so now I’ve owned up to my own history of dressing inappropriately for the cold weather. But that doesn’t change anything when it comes to the parenting advice I’m about to share with you. The fact of the matter is that cold weather (like what we get here in Nebraska) can be dangerous, young children are especially susceptible to the cold, and it’s our duty as parents to insure our children’s health and safety in warm and cold weather alike. While it’s not actually true (except in more extreme instances) that being cold makes you “catch a cold,” there are definitely instances such as hypothermia and frostbite that most certainly can result from being inappropriately dressed for the weather.

With this in mind, the following information, excerpted from the American Academy of Pediatrics’ Winter Safety Tips, will hopefully help you better determine which cold-weather clothing battles are worth fighting. Don’t let it deter you if your children try to give you the cold shoulder after you lay down the law. Instead of resorting to “because I said so,” you too can feel free to justify your “request” that your child go put his shorts away until at least March (if not May) by simply saying, “Because Dr. Laura and the American Academy of Pediatrics say so!”

  • Dress infants and children warmly for outdoor activities. Several thin layers will keep them dry and warm. Don’t forget warm boots, gloves or mittens, and a hat
  • The rule of thumb for older babies and young children is to dress them in one more layer of clothing than an adult would wear in the same conditions
  • Hypothermia develops when a child’s temperature falls below normal due to colder temperatures. It often happens when a youngster is playing outdoors in extremely cold weather without wearing proper clothing or when clothes get wet. It can occur more quickly in children than in adults
  • Frostbite happens when the skin and outer tissues become frozen. This condition tends to happen on extremities like the fingers, toes, ears and nose. They may become pale, gray and blistered. At the same time, the child may complain that his/her skin burns or has become numb.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Life-Saving Safe Sleep Tips for All Parents & Caregivers

Of all the topics I routinely discuss with parents, sleep has to rank right at the top of the list. This shouldn’t come as a big surprise, given that a good night’s sleep (or the lack thereof) can have a significant effect on just about everything else we do. When it comes to children’s overall health and well-being, it’s hard to sleep through all of the studies that reinforce that teenagers need more sleep (9 hours a night as compared to 8 for adults) in order to perform well at school, and that plenty of nighttime sleep (on the order of at least 10 hours a night) appears to be as important for keeping obesity at bay in young children as diet and exercise.

What I want to discuss today, however, isn’t just children’s need for an adequate amount of sleep, but the importance of safe sleep. While there are certainly aspects of safe sleep that apply to older children (bunk beds spring to mind), safe sleep has held a particularly prominent place in the national parenting consciousness every since the 1990s when the identified link between belly sleeping and Sudden Infant Death Syndrome (SIDS) led the American Academy of Pediatrics to recommend back sleeping in 1992. This was followed in 1995 with the official launch of the Back To Sleep Campaign.

While over a decade of subsequent parent education efforts have resulted in a dramatic increase in the number of back-sleeping babies (from 25% in 1992 to 85% in 2008), recent years have brought no additional increase in back sleeping. In fact, we may have started to backslide when it comes to insuring babies’ safety while sleeping. In the course of little over a single devastating month back in Feb/March of 2008, six babies died in Douglas County alone – all classified as SIDS attributed to bed sharing and suffocation.

While any increase in infant deaths is concerning, to say the least, the good news is that we know a great deal about what we need to do to keep babies safe while sleeping and reduce their risk of SIDS. The much larger task at hand is simply to make sure that all new and expectant parents and infant caregivers know the most effective ways to create safe sleep environments for babies.

This is the challenge being addressed in a new National Safe Sleep Education Campaign by the US Consumer Product Safety Commission, the American Academy of Pediatrics and Keeping Babies Safe. Their latest recommendations for providing a safe sleep for all babies include:

  • Place infants to sleep on their backs
  • Use a firm, tight-fitting mattress
  • Never use extra padding, blankets or pillows under baby
  • Remove pillows or thick comforters
  • Do not use positioning devices – they are not necessary and can be deadly
  • Regularly check cribs for loose, missing or broken parts or slats
  • Do not try to fix a broken crib
  • Place cribs or playpens away from windows and window covering cords to avoid fall and strangulation hazards
  • Place baby monitor cords away from cribs or playpens to avoid strangulation

These life-saving safe sleep tips can also be found in the campaign’s newly released 7 minute video, narrated by renowned journalist Joan Lunden and available for viewing or download on the AAP’s HealthyChildren.org and on the Keeping Babies Safe website. Additional information about safe sleep can also be found on in the newly revised 2nd Edition of my book, Heading Home With Your Newborn (AAP, Sept 2010), and on the Nebraska Department of Health & Human Services Website.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Coughs, Kids & Vaccines: Why parents are the key to silencing the sounds of pertussis!

You really don’t have to listen very hard to hear the sounds of the season – the rustling of fall leaves, the weekend cheers of husker fans, and lawnmowers out for one last run before being swapped out for snow blowers. But if you ask me, the most noticeable sounds this time of year are all of the coughs, sniffles and sneezes that predictably make their annual show of force during cold and flu season. For parents and pediatricians alike, these are familiar sounds that we learn to live with and treat as needed. This year, however, we are hearing a lot more than usual about another sound – a sound for which we should all be listening carefully: the sound of pertussis.

Perhaps you’ve heard of pertussis – also commonly referred to as whooping cough – from your pediatrician. Some of you may remember reading about it each time you received the standard set of vaccine information sheets describing each of your child’s scheduled immunizations, since the DTaP (the “P” part referring to pertussis) vaccine is routinely given.

Chances are that if you’ve been following the national news lately, however, you may have also heard that there’s a pertussis outbreak in California. In the world of infectious diseases, let me assure you that California isn’t very far away from Nebraska, and this outbreak is not just another news story about an isolated incident hundreds of miles away. The spread of pertussis in California is, in fact, proving to be the worst outbreak in 60 years, having already claimed the lives of 10 infants under the age of 3 months. If that’s not a reason to stop and take notice, I don’t know what is.

The fact of the matter is that pertussis is caused by one of the most contagious bacteria we know. The infection can start out seeming like a common cold, but over the course of a couple of weeks manifests itself as an escalating cough which then turns into coughing episodes sometimes severe enough to result in vomiting or the characteristic “whoop” sound that represents the dramatic effort to draw air back into the lungs.

While adults typically experience weeks (if not months) of a cough that just won’t go away, they don’t often “whoop” like kids do. Neither do babies under 6 months of age – a fact that increases their risk of life-threatening illness or death at a time when they can’t yet be vaccinated (under 2 months) or haven’t developed full immunity (under 6 months of age). Unable to draw air back into their lungs, babies may gasp, gag, or simply stop breathing altogether – making them the most vulnerable at a time when they are also the most at risk.

As someone committed to helping insure the health and well-being of all children, I’ve therefore pulled together some very important facts about whooping cough, who is at risk, and what each of us can do to prevent the spread of pertussis in hopes that we protect all of Nebraska’s children and adults against a sound you never want to hear at any time of the year….the sound of a young child with pertussis.

Make sure your child is up to date on his/her shots. DTap is recommended at 2, 4, 6 and 15-18 months, and again at 4-6 years. The best time to get your child protected against pertussis is the first day your child becomes eligible for each recommended immunization.

Get your adult tetanus booster. Immunity to whooping cough doesn’t last forever. Any adult (or teen) who doesn’t remember getting a pertussis booster shot, or hasn’t had one since they were immunized as a child needs to get vaccinated. The fact of the matter is that babies too young to be protected by the vaccine rely solely on all of us to not expose them. Sadly, an estimated 3 out of every 4 babies with life-threatening pertussis infection got it from a loved one. Prevent this from happening by rolling up your own sleeves, getting an adult booster shot, and doing your part to limit the spread of pertussis.

Be on the lookout for pertussis and contact your doctor or your child’s pediatrician with any concerns. It’s all too easy to mistake pertussis for the common cold at the outset of the infection, and while people are contagious for up to a month, antibiotics are of little benefit after the first week or so. Half of babies with whooping cough end up needing to be hospitalized.

Listen to the sound of pertussis. If my blog hasn’t already convinced you, or you simply want more information, watch my recent pertussis-focused CNN interview with Kiran Chetry on American Morning, go to www.soundsofpertussis.com and let Jeff Gordon of NASCAR fame convince you, or simply listen to what a baby with pertussis sounds like .

Now let’s all commit to doing everything we possibly can to silence the sounds of pertussis.

Originally posted on Omaha World Herald’s Live Well Nebraska