Bronchiolitis or “Wheezy Bronchitis” and Kids

One of the more common illnesses that is encountered during the winter months in infants and young children is a respiratory problem referred to as Bronchiolitis or “wheezy bronchitis”. This is a condition caused by a viral infection that attacks the respiratory tree, both upper (nose and throat) and lower (the smaller airways leading to the air sacks in the lungs). It is most commonly caused by RSV or Respiratory Syncitial Virus. It can also be caused by other winter time viral infections but the exact cause is relatively unimportant as the symptoms are nearly the same.

Your child will usually develop signs and symptoms of a regular cold with sneezing, runny nose, mild cough, and sometimes a low grade fever. At this stage it will be impossible to tell if this will progress to bronchiolitis, but most of the time this will remain a cold and your “cures” are limited as your doctor will tell you. In a certain number of infants and young children, after a few days of the cold, the cough might progress to a more significant stage and the infant or young child may show some signs of having difficulty breathing; more rapid breathing rate than normal will usually be the first of such signs, but fever alone can raise an infant’s rate of breathing, and if you are unsure call your baby’s Doctor and he/she will help you figure that out.

Because the primary problem with bronchiolitis is swelling in the respiratory passages (lower and upper), air might have to begin to squeeze through narrower passages in the lungs and similar to what we have presented about asthma in the past, this may lead to wheezing. Wheezing is a whistling (musical) type of noise when your child breathes out versus noisy breathing in noticed in those infants with the upper airway cold. Admittedly this may be difficult to see by non- medical parents, but you can ask your Doctor how to do this in a reliable and repeatable manner.

Most infants and young children will remain in this stage and, as long as he/she is feeding well , does not have fever over 103, and seems fairly cheerful with his/her usual skin color, you do not need to worry, and all the symptoms will resolve as the cold goes away.

Occasionally, the situation can worsen with more difficulty breathing, now showing itself by your child using more muscles of his/her body to help force the air through the small airways in the chest: those muscles might include the abdominal, neck and intercostals (muscles between the ribs). At this stage your child should certainly be under the care of a physician, who might, depending on the appearance of your child admit him/her to the hospital so that more intensive care can be used to help him/her breathe.

The illness is self limited in that between 3 and 7 days normal resolution will take place. The worsening progression that I outlined above will generally not happen very fast and you will have time to see that your child is getting worse. Anywhere along the way, should you have doubts about your ability to adequately monitor your child’s status you should be talking to his/her Doctor.

I would like to stress once again that most bronchiolitis illnesses in infants and young adults remains mild and in fact may be indistinguishable from a normal cold.

If you would like to hear more about bronchiolitis please leave me a note in the comments below

Be Ready, Be Buckled: Create Lifetime Seatbelt Wearers

In past articles I have written about various programs sponsored by the federal government that help to promote safety in kids. My most recent post was about distracted driving. For this post I have found a new program and site that I think is perfect to highlight and to showcase on this blog.

The program is called “Be Ready, Be Buckled”. Among its sponsors are the DOT, the National Highway Traffic safety administration and others. One aspect of the program is to encourage kids, K through 6th grade or age 5-12 to submit original artwork which focuses on the theme and supports the use of seat belts.

Some suggested questions or discussions to help inspire young artists include:

• Why is it important to buckle up every time while driving or riding in a bus, truck or car?
• How does the motto Safety Belts Save lives apply to bus and truck drivers as well as Kids and families.
• What would happen if a truck or bus driver did not buckle up on the job?

Two grand prize winners will be selected by the American Society of Safety Engineers (ASSE). The top 12 will complete the 2011 calendar. The picture at the top of this post is last year’s winner.

Even if your child does not win they and the family will share a bonding experience over safety and will hopefully create lifetime seatbelt wearers and champions. Please feel free to submit a copy of your child’s artwork here: info@pediatricsafety.net – we would love to post it on Pediatric Safety and to help encourage everyone to buckle up. For more official information and for the contest entry form please go to:
http://www.fmcsa.dot.gov/documents/safety-security/2011-ArtContest.pdf

Special Needs Kids, Dentists, Insurance, Oh My!

February is Kids National Dental Health Month. For some special needs children, everyday activities like getting a haircut or visiting a dentist can be a big challenge. My daughter recently needed to have a tooth extracted. Like many kids with special needs, she has been poked and prodded and now has a huge fear of anyone in a lab coat. She is less than cooperative. Her dentist decided it would be better to put her under anesthesia, so she would be relaxed and have no bad memory of the event.

Our insurance company didn’t agree with him, claiming it was a simple extraction for which they do not cover anesthesia. We ended up paying the anesthesiologist’s hefty fee out of pocket, even though the dentist’s office sent a letter explain the circumstances.

Looking back on the ordeal, I wonder if it was really even necessary. I think that when our special needs kids are concerned we are too quick to jump through hoops and get things done. Really, I don’t think would have been any terrible consequences in our case. Of course, this was not a medical emergency.

Learn from my bad mistakes – call your insurance company and discuss any upcoming procedures. Find out what is and isn’t covered. Until insurance companies understand the needs of special needs children, we must be their advocates.

For more information on dental care and special needs kids, check out another article I wrote here: http://www.examiner.com/special-needs-kids-in-los-angeles/dental-health-for-special-needs-kids

S.A.F.E.R. Child Car Seat Cover

To clean most child car seats covers requires complete removal of the car seat from the vehicle. As a result, there are two groups of parents, those who are constantly taking their child’s car seat out of the car for cleaning and those who never remove it from its secure position in the vehicle.

My husband (an award winning pediatrician) and I used to fall in the first camp. Then we came up with a solution. The S.A.F.E.R. Child Car Seat Cover provides a washable cover that doesn’t require removal of the child seat from the car.

Here’s our story:

We spend a lot of time in our car. Whether it’s taking the kids to school, afternoon or weekend activities or the long drives to grandma and grandpa’s house. All that driving often equals hungry and restless kids. The Cheerios® that used to pacify our kids at a younger age, soon turned into sticky apple slices, crumby granola bars, and drippy drinks. These snacks didn’t always make it into our kids’ mouths. More times than not, we’d find the leftovers in the child car seat. And after playground dates, our worn out kids mixed their dirty bottoms with this flavorful mess.

The only way to try and return their car seat to “like new condition” was to unfasten it from the vehicle, unhook the harness straps from the back of the seat, and then peel away the manufacturer’s car seat cover. Into the wash it went and if we were lucky, some of the stains disappeared. Then we’d reverse the process to put the seat back together. This process is not easy and takes plenty of time. When we’d go to put the child car seat back into our car, we could never quite get it right and would have to venture to our local Division of Motor Vehicles (DMV) for a trained technician to properly resecure it.

Sitting and talking with other parents, we knew we weren’t alone. Our frustrations were echoed amongst our friends. Some told us stories of leaky diapers and potty training accidents. Others, had kids who easily became carsick and frequently vomited. We’ve all experienced runny noses and drool that finds their way onto sleeves and nearby surfaces.

Searching the shelves at our local baby and toddler store, we found all sorts of mess-preventing items, like sippy cups, bibs, and high chair mats, but we couldn’t find something that would protect our child’s car seat cover from the inevitable every day dirt and grime accumulation. How could we create a better way to clean our children’s car seat covers while keeping them safe?

We turned our frustrations into action. Once we put our children to bed, we turned “together time” into “brainstorm time”. We carefully looked at both outgrown and current seats and we tried to figure out how to remove a car seat cover without having to disassemble the seat. We put our ideas on paper. We drew car seats and cut out the paper models. We did the same thing with scrap fabric. We even cut apart the manufacturers car seat cover to fully explore some options. Our late nights led to creation of specially designed release elements for a child car seat cover…5 years and many prototypes later, the S.A.F.E.R. Child Car Seat Cover was born!

The S.A.F.E.R. Child Car Seat Cover – (Secure And Fast, Easily Removable) – allowed us to remove and wash an otherwise disgusting car seat cover without having to jeopardize the car seat’s secure position in our car. It took less than 1 minute to remove and put back the cover. Our kids could now sit in a clean seat and we could eliminate removing the entire seat from the car, and avoid additional trips to the DMV. And, since proper hygiene is the first line of defense in keeping your child well and safe from illness, we now had an easy way to ensure our car was as safe an environment as our home!

But there were other ways we wanted it to be “SAFER” too. During the manufacturing process, we made sure the S.A.F.E.R. Child Car Seat Cover underwent lab testing that included checking for absence of specific toxins and against flammability. The testing also included proper washability, ensuring that it will hold up to multiple washes in the washing machine. In the end, we came up with a cover that was <1/8 inch thick and slipped easily on top of an existing car seat cover.

Once we were comfortable with our solution we knew we wanted to market it so kids like yours could be S.A.F.E.R., too. We were granted two patents for our designs and received a “Gold Medal” at INPEX 2008- America’s largest invention trade show.. Most important of all we received numerous comments from parents like you that their child’s car seats were a mess and they hated cleaning them…the S.A.F.E.R. Child Car Seat Cover made all the difference.

HEALTHFUL HINTS:

Car Seat Safety

• Always check that your child car seat is tightly secured in your vehicle by pushing and pulling it side to side. It should not move more than one inch in either direction. We encourage a child car seat to be installed at least initially by a certified child passenger safety technician. Locate one in your state here
• Shoulder harness straps for children in a forward facing car seat should always sit at or above the child’s shoulders. The S.A.F.E.R. Child Car Seat Cover has 3 levels of slots, designed to line up with a manufacturer’s original design.
• Harness straps should be pulled tightly against your child and the chest clip should be at armpit level. Do not wear winter coats in a child car seat.

Keeping your child seat cover clean:

• When washing a child seat cover, wash it in a mesh bag on a gentle cycle to minimize damage (the S.A.F.E.R. Child Car Seat Cover can be washed in the mesh “wash me” bag in which it was originally packaged).
• Since the cover needs to maintain its shape to function properly, hang it to dry overnight – do not put it in a dryer. This will reduce the possibility of shrinkage.

Top 3 Kid-safe Social Networks

When Rachel Sarah of Oakland, Calif., first heard about Club Penguin, a social networking site for kids, she had no idea what it was. “My daughter kept asking me if she could use it”, recalls Sarah. Not sure whether her daughter, who’s under 13, was too young to be on the Web, Sarah decided to check it out herself. “There aren’t any ads, and the site seems really fun and innocent”, says Sarah.

But how can you be sure a site is really what it seems? We’ve done the legwork for you and found the top three social networks for kids. Here’s how they keep kids entertained while making their safety a top priority:

CLUB PENGUIN

Kids are given a penguin avatar that can interact with the other penguins on the site, play games and earn coins to buy accessories for their penguin or furniture for their igloo. Membership is $5.95 per month for premium access, which allows kids to customize their penguins.

• Age group: 8 to 14, although older kids can join too. Parents register kids who are under 13.
• What kids love: The penguins are simple and cute. Kids can get creative when customizing the look of their penguin and igloo, and meet other penguin friends for coffee or tea.
• Privacy and safety features: Parents can choose between the Standard Safe-Chat, which allows kids to type their own chat messages, or Ultimate Safe-Chat, which restricts them to prewritten words or phrases, like “Hello” or “What’s up?”. “Club Penguin has really strong filters, so you won’t need to worry about kids swearing or going crazy”, says Anastasia Goodstein, author of Totally Wired: What Teens and Tweens Are Really Doing Online.

WEBKINZ

To enter the Webkinz world, you need to buy an actual Webkinz stuffed animal (store info is available on the website; teddy retails for around $14). Each animal comes with a code that grants access to the site.

• Age group: 6 to 13, although adults can log on too.
• What kids love: Their stuffed animals come alive online. Kids can buy food for their pet, decorate its room and win KinzCash by playing arcade games.
• Privacy and safety features: Parents can choose KinzChat Plus, where users are restricted to words or phrases listed in the site’s dictionary. Children must have their parents’ consent to access this area (kids need to provide their parents’ email address and must wait for their parents to reply to Webkinz’s request before they’re let in). Check out the Parents area.

WHYVILLE

After creating their avatar, kids can travel through Whyville’s beaches, boutiques and clubs, chatting with friends.

• Age group: Although the site’s cartoon design mainly attracts kids, anyone can register at Whyville. In compliance with the Children’s Online Privacy Protection Act (COPPA), children under 13 are required to get their parents’ permission before signing up (this is true for any website that solicits personally identifiable information from kids).
• What kids love: Whyville users can earn “clams”, the site’s currency, by starting their own business, playing games or accomplishing tasks (like sorting food or recycling in the cafeteria). “Whyville is great for kids with imagination”, says Goodstein.
• Privacy and safety features: Whyville offers what it dubs “communications tools”, which it says helps increase safety. For example, if a user is behaving badly, kids can create a 911 report about them. Individuals called City Workers also police the site — though not 24/7 — to make sure no one’s getting out of line.

No matter which site you pick, be sure to read the privacy policy, parents’ section (if they offer one) and keep tabs on your child’s usage. Sarah, for one, limits her daughter’s Club Penguin use to a couple of hours a week, but overall she’s happy to have found a website that’s both fun and educational. “My daughter is improving her math skills because she’s learning to save money to buy things and she’s typing notes to the other penguins”, she says. Plus, she’s developing her online skills in a safe way.

Code Adam…Because You Don’t Have Eyes in the Back of Your Head

Sometimes, as a parent, you have to give yourself a break. Even mothers have to heed the call of nature. But with a headstrong and mischievous three-year old in tow, a parental potty break in a public building can become an exercise in surprisingly emotional fear and guilt.

I mean, we are supposed to be able to keep our children safe. We aren’t supposed to lose them! But what can any reasonable parent do wedged in a tight bathroom cubicle with a toddler and sitting in a very compromising position when the wiggle worm decides it would be the height of fun to crawl out under the stall door and run out of the bathroom? I can still feel the brush of his jeans across my fingers as I just failed to grab hold….

Thankfully, with Code Adam, a nation-wide program administered by the National Centre for Missing and Exploited Children (NCMEC), my anxiety in our local children’s museum was contained by a very orderly and confident process. Code Adam, created and named in memory of 6-year old Adam Walsh who went missing while shopping with his mother and was later found murdered, is a simple but powerful search process focused on marshaling employees of public buildings, such as stores, libraries and museums, in a systematic search for lost children in the crucial moments immediately following their disappearance.

My Code Adam Experience:

• As soon as I could make myself decent and get out of the bathroom I approached nearby museum staff who were manning the entrance to the exhibit space we had just visited, and learned that my wayward son had not decided to return to the water or sand tables
• The staff then asked me very specific questions to compile a detailed description of my child – including his clothing and shoe color/style (I remember he was wearing those shoes with a light that flashes when he walked)
• A “Code Adam” page including this description was then given within the venue and designated staff immediately began a systematic search
• All potential exits other than the front doors were either closed or closely monitored and a member of the security staff escorted me to the front entrance to ensure my son, Elliott, did not leave the premises. I spent what felt like a wretched eternity desperately scanning the sea of kids, choking back tears, and constantly affirming to my security pal that I’d never lost my kid before…honest!

If my son wasn’t found within 10minutes, the next step would have been for security to call law enforcement. If he had been found in the company of someone other than a parent or legal guardian, the procedure would call for reasonable attempts to delay their departure until the arrival of police, without putting anyone in danger.

Thankfully, I was reunited with my wiggle worm within that timeframe, a staff member having found him obliviously and happily playing on a computer screen in another area of the museum. When he was back within arms’ reach I didn’t know what I wanted to do to him (or what would be considered the politically correct behavior)…wrap him in my arms and say “Thank God”…or berate him for running off from Mommy? So I fudged and did a little of both!

Making Use of the Code Adam Program

Code Adam originated in Walmart stores in 1994 but is now one of the largest child-safety programs in the U.S., used in around a hundred thousand establishments around the country and, since the Code Adam Act was made law in 2003, in all federal public facilities (click here for list of participants). Use of the program in a venue is proclaimed by a Code Adam decal at the building entrances. Thanks to NCMEC and its sponsors, the program is free to participants, who can apply online for a Code Adam kit, including:

• A training video for employees
• A break-room poster explaining the program steps
• Two decals to put on entrances announcing participation in Code Adam

So what can parents and safety advocates do?

• Check building entrances for the Code Adam decal. Know whether Code Adam is used in that venue before you and your children enter.
• Know the Code Adam procedures. I’d like to say my story above is the only example of our use of Code Adam in the past eight years, but my son has triggered 2 other experiences in large retail stores. In one of these venues, the staff I located did not know the Code Adam process. Thankfully I did…and suggested they call security and institute a Code Adam page….missing child quickly found. Lesson: Don’t rely on the quality of any given store’s staff training.
• Make sure caregivers know. Even if you are very familiar with Code Adam and its procedures, what about babysitters or grandparents? How often are they out with your children in a public venue? Be sure that they also know about Code Adam and how to ensure it is appropriately implemented.
• Suggest Code Adam to local venues. If a local store or establishment with a focus on families or children does not display the Code Adam decal, consider finding the manager and suggest that they participate. They can find everything they need at www.missingkids.org (search “code adam”). Additional information can be obtained by calling 1-800-THE-LOST (1-800-843-5678) or emailing codeadam@ncmec.org.