Childhood Asthma: Part II

In Childhood Asthma: Part I, I presented ways in which Asthma can present and exactly what was the nature of the disease. Today we will deal with the diagnosis and various means of treating asthma.

Asthma may present in early infancy but is very difficult to diagnose for the reasons mentioned in part one. Also the signs and symptoms of asthma in the very young child can be caused by many other issues. So it is when the symptoms are very severe or they continue beyond two to four years of age that one begins to suspect asthma.

Let’s assume for the purpose of this article that all the other causes have been ruled out and that it appears that your child indeed has asthma. The first thing to realize is that the symptoms may vary from very severe to extremely mild requiring daily close control or only occasional use of medications and treatments to keep your child comfortable and active. The goal in treatment is twofold: first to allow your child to remain active, socially oriented, and happy. The second is to prevent the permanent secondary changes in the lungs from longstanding uncontrolled asthma.

Early in the course of treatment, a child who presented to the emergency room or physician’s office with symptoms of acute asthma usually needed to be admitted to the hospital for a few days in order to get the symptoms controlled. As time went on, newer systems such as nebulizer treatments that could be performed at home were implemented and admissions to hospitals dramatically diminished. Today it is not uncommon at all to see a nebulizer machine in the home of a child with asthma. The other issues that were improved upon were the level of education of a family in which there is a child with asthma, and the greatly improved medications available to treat asthmatic symptoms with fewer side effects and greater efficiency.

As more becomes known about asthma, through research and observation, the efficiency of treatments increases dramatically. Since we know from the previous article that the underlying problems causing symptoms of asthma are related to constriction of the small airways, mucus production and inflammation, there was a body of research that tried to find out which of these causes were more important, and which specific medications could be used for each symptom. At one point or another each of them were implicated but recently the inflammatory process seems to be very important. Also inhaled medications seemed to give the best results without some of the bothersome side effects, both long term and short term.

With the development of better mobile delivery systems for these medications and the increase in knowledge that families now have about the disease, the disease can now be managed very efficiently at home. Fewer and fewer hospitalizations have been the result with a greatly decreased cost of delivering medical care to these children.

Your Doctor is very familiar with the armamentarium of medications available to use for children with various degrees of the disease. The two main issues with the treatment of asthma is the immediate treatment of the acute problem, breathing difficulty, and then the long term control of the recurrence of those symptoms. There are many medications, or combinations of medications, available to gain and maintain control over the symptoms of asthma and your child should be able to live a perfectly normal life style.

You as parents will shortly become, with the help of your Doctor, the “expert” when it comes to asthma in your child.

Are Your Children At Risk for Dehydration This Summer?

Welcome to summer, the kids are out of school, summer camps are in full swing, family trips all over the country have begun and just in case you haven’t noticed, it’s hot outside. It is turning out to be one of the hottest summers on record with temperatures reaching triple digits in many parts of the country. As it heats up, summer safety becomes a serious issue. With all this fun and traveling going on please don’t forget to ask yourself one very important question, “are my children hydrated well enough to handle this heat?” the answer is most likely no.

Thousands of children each year are admitted to hospitals with heat-related illnesses and most go home, but there are the cases every year where children end up overheating and dying because they were not hydrated properly. As I write this, it’s a beautiful 94 degree Saturday here in Miami with all the humidity you can handle and that means one thing for us here at the fire department. A huge increase in the amount of heat illness related calls we are going to run and most of them will be on children.

As parents when we think of dehydration, we think of our children being sick and having a bout of diarrhea and or vomiting, and the doctor tells us to keep them hydrated with plenty of fluids. That is all well and good and as good parents we make sure our little campers get plenty of fluids and are back healthy A.S.A.P., But the kind of dehydration I am talking about is the kind we as parents tend to overlook in the rush of our day to day lives and that is the everyday dehydration of our very active children. By the time a child says he is thirsty, he is already dehydrated, and with studies finding that 50% of children participating in sports activities were already dehydrated we need to be hydrating our children before, during, and after physical activity as well as keeping an eye out for the signs of heat-related illnesses.

Recommendations for hydrating children ages 6 to 12 include:

• 4-8 ounces 1 to 2 hours before activity
• 5-9 ounces every 20 minutes of activity
• After activity, replace lost fluids within 2 hours

Recommendations for hydrating young athletes ages 13 to 18 include:

• 8-16 ounces 1 to 2 hours before activity
• 8-12 ounces 10-15 minutes before activity
• 5-10 ounces every 20 minutes of activity

Being able to recognize the signs of heat-related illnesses is critical and should be done by us the parents as well as the coaches. A basic awareness of the signs of heat-related illnesses could make all the difference, so here are some key points to be on the lookout for as recommended by Susan Yeargin, PhD, ATC.

Types of heat illnesses

Athletes who exercise in hot or humid weather are particularly at risk of heat illnesses:

• Heat cramps
• Heat exhaustion
• Heatstroke

Symptoms of impending heat illness

In addition to educating young athletes about both the importance of hydration and the dangers of heat-related illness, ensuring that they are drinking enough fluids, and taking precautions to reduce the risk of heat injury in children in hot and humid weather, you need to watch your child for symptoms of impending heat illness:

• Weakness
• Chills
• Goose pimples on the chest and upper arms
• Nausea
• Headache
• Faintness
• Disorientation
• Muscle cramping
• Reduced or cessation of sweating

A child continuing to exercise when experiencing any of these symptoms could suffer a heat illness.

Heat cramps

Symptoms:

• Thirst
• Chills
• Clammy skin
• Throbbing heart
• Muscle pain
• Spasms
• Nausea

Treatment:

• Move child to shade
• Remove excess clothing
• Have child drink 4 to 8 ounces of fluid with electrolytes (sports drinks) every 10 to 15 minutes

Heat Exhaustion

Symptoms:

• Nausea
• Extreme fatigue
• Reduced sweating
• Headache
• Shortness of breath
• Weak, rapid pulse
• Dry mouth
• Rectal temperature less than 104?F.

Treatment:

• Move child to cool place
• Have child drink 16 ounces of fluid containing electrolytes for every pound of weight lost
• Remove sweaty clothes
• Place ice behind child’s head
• Seek medical attention, if no improvement

Heat Stroke

Symptoms:

• No sweating
• Dry, hot skin
• Swollen tongue
• Visual disturbances
• Rapid pulse
• Unsteady gait
• Fainting
• Low blood pressure
• Vomiting
• Headache
• Loss of consciousness
• Shock
• Excessively high rectal temperature (over 105.8F.)

Treatment:

• Call 911
• Remove sweaty clothes
• Immediate and continual dousing with water (either from a hose or multiple water containers) combined with fanning and continually rotating cold, wet towels on head and neck until immersive cooling can occur.

As parents we tell our kids to study and do their homework so they will be prepared, well we as parents need to do our homework as well when it comes to recognizing the signs of heat-related illnesses and staying on top of hydration. Luckily for those parents who live and breathe on their iPhone there is help. iHydrate is an app that reminds you to hydrate yourself and your children before, during and after activities. App or no app, stay alert, keep those children hydrated and please remember, when in doubt call 911.

Who is The REAL Lifeguard at Your Kid’s Pool This Summer??

I was doing the usual mom chit-chat at Scouts while my son worked towards his water safety badge and fielded the inevitable question from the Scout leader, ‘what do you do?’. My answer, “I’m a global activist working to end child drowning. One child drowns every minute.” And then came the typical response, “Wow, I didn’t know it was such an issue, but it is certainly needed, the lifeguards need to do a much better job.” She then related a story about how she and her husband were at a pool with their baby and 3-year old son. She was sitting at the side holding the baby, her husband was in another area, and the 3-year old suddenly went past his depth and was bobbing up and down under the water, drowning. She screamed for the lifeguard, her husband screamed for the lifeguard but also managed to get to their son before any serious injury occurred. She related the story in harrowing detail and emphasized several times how the lifeguard had clearly not been doing his job well since her son had almost drowned in a crowded pool, so she understood why drowning is such a problem.

What is your initial reaction? Quite possibly the same as hers, the fault was with the lifeguard, if he had been paying attention her son never would have almost drowned. It’s an incredibly common belief, but the reality is quite different. These are excellent, diligent and concerned parents, and they believe, just as most people believe, that if you go to a pool or beach with a lifeguard on duty, you and your children will be safe. Yes, that’s true, if you swim in an area with a lifeguard, your chance of drowning is reduced to 1 in 18 million. That’s very good odds, even better when you consider that 75% of open water drownings occur when a lifeguard is not present. There is no two ways about it, if you swim in an area with a lifeguard, you are much safer, but it’s not just the lifeguard’s job to keep you safe. I do place the blame for that misconception squarely on the shoulders of those of us in the drowning prevention field, we haven’t explained what the true role of a lifeguard is, so let me start now to change how we view lifeguards.

When it comes to water and children, especially young children or non-swimmers, you, the parent, are the first lifeguard on duty. You need to be touch distance from your young or non-swimmer, meaning you can reach out and grab them at any time. Why?

• First, a child can drown in 2 minutes in 2 inches of water. Even the best lifeguard, diligently scanning a crowded pool can miss seeing a small child under water, especially if the sun is glinting off the water or there are many people in the pool obscuring visibility under the surface. Plus, most people don’t even recognize someone is drowning since it’s not like in the movies, there is no flailing of arms or screaming. Click here to see what it really looks like – and don’t worry, the boy is rescued.
• Second, you don’t want your child to be in a situation where they need to be rescued. You know how hard it can be to spot a small child in a crowded place. Even the fastest lifeguard will take precious seconds to spot the danger and make their way to the victim, and that can be a really frightening few seconds for a child.

Lifeguards are like police and firemen, their job is to prevent accidents by watching for dangerous behavior and educating the public, and to perform rescues when things do go wrong, but it’s not their job to babysit or watch just one child, much less the 100 children in the water on a busy summer afternoon. Think about it, you don’t let your 3-year old walk 3 blocks to preschool just because your town has police whose job is to keep people safe, do you? The good news is that having a lifeguard on duty is like having a firefighter stand in your front yard just in case a fire breaks out. 95% of a lifeguard’s job is preventing an accident in the first place and only 5% is actually rescuing someone in distress. With you on guard, hopefully it won’t ever be your child in distress.

Now that you’re thinking, ‘great, so much for relaxing at the pool this summer’, I have some very good news. Taking a baby or young child to the pool is better than having a personal trainer and Weight Watchers combined if you take advantage of the time in the pool with them. Trust me, I worked off two pregnancies swirling my children around in the water. Next month I hope you’ll check back for my tried-and-true ‘fun for kids, great easy workout for mom’ plan!

7 Solutions to Turn Pessimistic Kids Into Optimistic Thinkers

“Why should I bother? You know they won’t choose me.” “What’s the point? I’ll never make the team.” “Why are you making me go? You know I won’t have fun.”

Let’s face it: Kids with pessimistic attitudes are among the most frustrating breeds. They give up easily, believe anything they do won’t make a difference, and assume they won’t succeed. Sadly, they rarely see the good, wonderful things of life. They dwell instead on the negative, bad parts, and often find only the inadequacies in themselves: “I’m so dumb, why study?” “Nobody’s going to like me, why bother?” (Beware: the trend is increasing: a child today is ten times more likely to be seriously depressed compared to a child born in the first third of this century.) So what’s a parent to do?

First, do know I empathize if you have one of these little critters. I know this is troubling stuff, and at times even heartbreaking. After all, one of the hardest parts of being a parent is when your child isn’t happy. But there is one point you must keep in mind: Kids are not born pessimistic. Research shows a large part of this attitude is learned along the way. So take heart: research at Penn State University concludes that parents can help their kids become more optimistic. Doing so will dramatically increases the likelihood of your son or daughter’s long-term happiness. So roll up your sleeves, and let’s get started. Here are secrets to help make a real difference on your child’s life from The Big Book of Parenting Solutions.

1. Eliminate the negatives you can. Start by doing what you can do: Cut the sources that might be exacerbating your kid’s pessimism. Possibilities? Why not reduce the terrifying news on CNN; stop talking about the bad stuff on the front page; listen to your own negative talk and curb it; monitor the cynical musical lyrics your kid is hearing? Where once those tragic and terrifying world events seemed so far, far away or only printed words in the newspaper, they are now 24/7 on our TVs and Internet screens. So be more vigilante and turn off what you can control. Enough!
2. Look for the positive. Next, consciously stress a more optimistic outlook in your home so your child sees the good parts of life instead of just the downside. For instance, start nightly “Good News Reports”: each family member can report something good that happened that day to him or her. Or share optimistic stories. The world is filled with examples of individuals who suffered enormous obstacles, but don’t cave into pessimistic thinking. Instead they remained optimistic, and kept at their dreams until they succeeded. So look for examples to share with your kids.
   • Institute goodness reviews. Each night start a new ritual with your child of reviewing all the good parts about her day. Your child will go to sleep remembering the positives about life. If you do it often enough, it will become a routine that your child will do on her own.
3. Confront pessimistic thinking. Don’t let your child get trapped into “Stinkin’ Thinkin’. Help him tune into his pessimistic thoughts and learn to confront them. You could point out cynicism by creating a code–such as pulling on your ear or touching your elbow–that only you and your kid are aware. The code means he’s uttered a cynical comment. Encourage your kid to listen to his own cynical comments. Suggest an older kid wear a watch or bracelet. The watch reminds her to tune into how often she is pessimistic. Or even help your kid count their pessimistic comments for a set time period: “For the next few minutes listen how many times you say downbeat things.” A young kid can count comments on his fingers. An older kid can use coins moving one from his left to right pocket.
4. Balance pessimistic talk. One way to thwart your kid’s pessimistic thinking is by providing a more balanced perspective. If you use the strategy enough, your child will use it to help counter pessimistic talk. Suppose your child won’t go to her friend’s birthday thinking no one likes her. Offer a more balanced view: “If Sunny didn’t like you, you’d never have been invited.” Or if your kid blows her math test exclaiming that she’s stupid. You say: “Nobody can be good at everything. You’re good in history and art. Meanwhile, let’s figure out how to improve your math.”
5. Deal with mistakes optimistically. Pessimists often give up at the first sign of difficulty, not recognizing that mistakes are a fact of life. Tips to help kids keep a more optimistic outlook to setbacks are: Stressing that it’s okay to make mistakes. Give kids permission to fail so they can risk. Admit your mistakes. It helps kids recognizes mistake making happens to everyone. Or even call it another name. Optimists call mistakes by other names: glitch, bug, etc., so rename it!
6. Encourage positive speculation. Help your child think through possible outcomes of any situation so he’ll be more likely to have a realistic appraisal before making any decision and less likely to utter a pessimistic one. You might: Asking “what if?” kinds of questions to help your kid think about potential consequences. List pros and cons of any choice to help your child weigh the positive and negative outcomes. Or name the worst thing that could happen if he followed through so he can weigh if it’s all that bad.
7. Acknowledge a positive attitude. Do be on the alert for those times your child does utter optimism. If you’re not looking for the behavior, you may well miss those moments when your child is trying a new approach. “Kara, I know how difficult your spelling tests have been. But saying you think you’ll do better was being so optimistic. I’m sure you’ll do better because you’ve been studying so hard.”

Face it, this is a troubling time to be growing up, and cynical kids tune into the bad times often seeing only the downward side of any situation. The world really is a wonderful and hopeful place. We just need to take the time and point out all the goodness in it to our kids. After all, this is their world, and the habits they learn now will last them a lifetime. Let’s make sure that one of those habits is the optimistic thinking and recognizing the wonder and beauty in life.

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Dr Borba’s new book The Big Book of Parenting Solutions: 101 Answers to Your Everyday Challenges and Wildest Worries, is one of the most comprehensive parenting book for kids 3 to 13. This down-to-earth guide offers advice for dealing with children’s difficult behavior and hot button issues including biting, tantrums, cheating, bad friends, inappropriate clothing, sex, drugs, peer pressure and much more. Each of the 101 challenging parenting issues includes specific step-by-step solutions and practical advice that is age appropriate based on the latest research. The Big Book of Parenting Solutions is available at amazon.com