Loli-O’s and Kids: Puts the Treat in Breathing Treatments

Have you ever received a breathing treatment, either in an ambulance or in the hospital? It can be uncomfortable and you might be a little hesitant if you haven’t done one before. Now imagine you’re a child…

A lot of children in the pre-hospital setting as well as clinics, offices, homes and urgent care facilities tend to become very anxious and uneasy when you try and place a mask over their face or get them to hold a tasteless plastic mouthpiece in their mouth to receive breathing medications. Anxiety causes symptoms to increase and that is certainly where you do not want to go. Loli-O’s helps children from the ages of 3+ receive breathing treatments while enjoying a sugar free and dental friendly lollipop. Using Loli-O’s allows the child to focus on something that is comforting and enjoyable other than “I’m getting medicine”. And if used as directed, it delivers the medication at nearly the same equivalence as a mouthpiece nebulizer with ZERO anxiety and a happy kiddo in the process because let’s face it…… kids love lollipops!

I came up with the concept that is now Loli-O’s while transporting a 4 year old girl from a rural hospital to a metropolitan hospital in Nashville, TN. I am a 23 year veteran paramedic and have run across this scenario many times in my career. The child was ordered by the physician to receive continuous breathing medication during the over 1 hour transport. The child was already very anxious because I was a stranger and she was scared not knowing what was going to happen. During the transport, she would become more excited and upset during the treatment attempts, which in turn caused the shortness of breath to increase, her heart rate to increase and the oxygen level to decrease – the exact opposite of where we wanted to be. Despite many attempts to administer the treatments as ordered, I was unable to effectively give the treatment.

After arriving at the receiving hospital, care was released to the staff and the report was given. The staff was attempting to give the breathing treatment as we were leaving but were having the same problems I had faced in the back of the ambulance. After leaving the hospital we stopped at a convenience store to get a soft drink for the ride back home. While standing in line to pay, I noticed an older gentleman with what I assumed was his grandson standing at the counter. The little boy was about the same age as the little girl I had just transported. While at the counter, the little boy grabbed a whole handful of lollipops and put them on the counter. The grandfather asked him “so you want a lollipop huh?” The boy jumped up and down and said “yes yes yes!” That was it! Kids love candy, especially lollipops! There is something comforting to a child about having a sweet treat that I knew could work with helping receive breathing treatments.

I jotted down some rough drawings and came up with a plan. I bought a candy kit at Hobby Lobby and some cpvc fittings from Lowe’s and went to work. In just a couple of hours I had a working prototype right there in my kitchen. I shared this idea and prototype of mine with a long time physician friend and he was just as convinced as I that we had something worth pursuing here. 3 years later, our team consists of 4 top physicians as well as an accomplished ACNP (acute care nurse practitioner). Loli-O’s is ready to help children get that treatment they need with a little less anxiety and a whole lot more fun. We like to say that with Loli-O’s we put the “treat” in treatment. Loli-O’s uses lollipops that are sugar free, gluten free, dairy free, have no added dyes and are manufactured in a peanut free facility. In fact, the lollipops are considered “dental friendly” and the best part is they taste amazing and come in 5 different flavors.

Until Loli-O’s, there have basically only been 2 delivery methods for breathing medications. One being a mask that is strapped to the child’s face and the other is a plastic mouthpiece that the child has to hold in their mouth while they are breathing the medication. Loli-O’s is not trying to replace these devices because they are very effective for children who are already used to receiving treatments or are old enough to understand the reasoning behind that particular treatment device. But for the child who has to have a breathing treatment for the first time, or who might be scared and anxious, or who is younger, or for any reason at all, Loli-O’s is here to help the child, the parent and the provider. We have spoken with countless EMS professionals, ER physicians, pediatricians, nurses and respiratory therapists and have all concluded what we have thought from the beginning……. Loli-O’s can help!

Loli-O’s is set to hit the consumer market in July 2017. It already has commitments from EMS agencies and emergency departments in our area and will eventually make its way to ambulances, emergency departments, acute care clinics and pediatrician offices all over the US. In time, our goal is to see Lolio’s become a go-to among the already established nebulizer options. Another tool in the toolbox is always a good thing.

HEALTHFUL HINTS:

• Anxiety with children during doctor visits is all too common. Children, especially at a younger age have certain “comforts”. A parent/guardian is of course a big one but there are other comforts that can help make that trip to the doctor a little easier on the child as well as mom and dad.
  • First start off simple and if possible bring that stuffed animal or action figure that your child loves to play with. You would be surprised what a little “toy time” can do to alleviate some of that anxiety.
  • Next, let the child hold the stethoscope and let them hear their own breathing and heartbeat! I’ve seen more smiles from kids who hear their own ticker working than you could imagine.
  • Unfortunately, sometimes at the doctor the child has to get a treatment or injection that is either frightening or painful. In these circumstances, I’ve found that a little soft talking and explanation of why they are receiving it is very helpful.
• There are many respiratory conditions that effect children. From simple occasional allergies, to bronchitis, to asthma, to cystic fibrosis and etc., not every child will have the same symptoms or the same diagnosis which only proves that just 1 treatment device/medication is not the answer. Pay attention to your doctor and more importantly your child. Children have the ability to compensate very well when it comes to illness and injury but when their compensating mechanisms have run their course, children can and will become severely ill very quickly. When it comes to respiratory problems, there are a few tell-tale signs that let you know that your child is getting worse.
  • The first would be to watch your child’s posture. If you find your child setting uncharacteristically straight or in a position known as “tripod” where the hands are propped on the knees and leaning forward, then this would indicate a more severe respiratory distress.
  • Also watch for flaring of the nostrils. This indicates a forceful respiratory pattern that the child involuntarily does in order to move air in and out of the lungs.
  • You can also see what is referred to as “retractions”. This is where the child is having so much difficulty that the muscles between the ribs and other areas of the chest are sucking inward with inspiration. This is usually a sign of severe respiratory distress.
• As proactive parents and guardians, it’s a good idea to be prepared for health situations that could arise.
  • Have your child’s general and medical information written down on an index card and kept in a safe location.
  • Include your child’s name, date of birth, any allergies to medications, any current prescription medications they are taking and a thorough medical history. Having this card on hand will help so much if you should have to call an ambulance or if your child is being taken by someone other than yourself to receive medical treatment. When your child is severely ill is not the time you want to have to remember these important details.

Kids Can Fidget in a Vidget: Seats that Inspire Natural Movement

Healthy movement. Healthy learning. Healthy minds. Healthy spaces.

As I explored many different topics for my MFA Thesis in Industrial Design at RIT back in 2009, my mind and soul kept taking me back to my childhood experiences and how connected I was to the mystery of nature. Living in a rental property in an urban area, I didn’t grow up around fields of green grass but what I did have, I treasured. My backyard was cement but in the front of our house, there was a narrow bed of dirt with bushes, probably about 3 feet wide. This narrow bed of dirt became my haven for exploration and inspiration. As I explored my feelings of nature, I was directed by one of my advisors to read the book, Last Child in the Woods, by Richard Louv.

While in nature, Louv points out that children will “use more fantasy play, and their social standing became based less on physical abilities and more on language skills, creativity, and inventiveness” (Louv, 2008, p. 88). As I thought about this, I thought what better place to impact children than the classroom environment.

Do you remember sitting in chairs like this as a child? When you look at this picture does it bring back memories of cold, hard and uncomfortable chairs that were too small or too large?

As a student, I remember feeling confined, trapped and limited. I had so many ideas, questions, and my imagination was wild, yet I was told to “sit down, be quiet and not to move.” I remember being very distracted, frustrated and, what teachers called back then, a “satisfactory & fidgety” student. Who wants to be “satisfactory? I wanted to be great, express myself and share my ideas and imagination; I instinctively needed to be creative, but the classroom demands took precedence over mine. I felt like I was different because my body needed to naturally move.

Not much has changed from this picture in today’s classrooms until recently. Reflecting on this time of my life, I remember wondering… could the classroom objects take on a “life” – that inspired natural movement we find in nature?

As part of my user research, I started observing classrooms from kindergarten – 6th. I found the teachers inviting and interested in my thesis topic, especially how to provide children with a way to move without too much disruption in class, finding that balance between control and natural movement. I observed classrooms using all traditional type chairs and alternative chairs that move like the exercise ball. While the ball provides proven benefits such as core muscle strengthening and better posture control, it is dangerous, disruptive and difficult for classroom management. Teachers were very reluctant to bring the ball into classrooms but at this time, it was the only “dynamic” seating device on the market.

Research proves that sitting for more than 10 minutes at a stretch reduces our awareness of physical and emotional sensations and increases fatigue. Playing, running, jumping and feeling a sense of freedom is not only a desire but a human need.

When children are locked indoors all day within a controlled environment, stress and tension build, and learning suffers.

I wanted to provide a seating device that allowed kids to move but in a discreet way so that it didn’t stigmatize the child with special needs. ALL children need to move, but some kids with ADHD, Autism and Sensory Processing Disorder need more movement. I needed to design something for the inclusive classroom or environment as a way to allow for more integration.

In July 2010, the Division of Adolescent and School Health at the U.S. Department of Health and Human Services issued a research report, The association between school based physical activity, including physical education, and academic performance, to better understand the changing needs of students and teachers. Children’s’ bodies are meant to move, even if it is just standing.

As the ideas for the Vidget® started to take shape, I decided on the following design elements:

• children feel safe to be free & explore (both physically and cognitively safe)
• modular system that inspires natural movement.
• fun yet functional with many possibilities
• reduce feeling of confinement
• inspire children & teachers to build their own environment based on individual and group changing needs
• simple, inviting, flexible, and intuitive
• organic, flowing

I used clay as a way to start building the form of the Vidget®.

As I played with the shape, I had the “aha” moment that if the bottom surface could be shaped like an arc, it would rock side-to-side, similar to the stability ball. I turned it over and realized the cut-out for the feet could be used as a stool and turned the other way, the child could use it as a desk! Now I was on to something very special and it met my design elements – safety as the first goal!

After several more full scale models and user testing – taking about 3 years and additional design expertise – we finalized the dimensions of the 5 sizes (toddler – teen/adult). We took our prototypes and started sharing with local school districts and parents for feedback and more user testing, especially parents with special needs children like ADHD and Autism who had a much higher sensory need. During this process, we learned that Special Education Teachers and Occupational Therapists put Velcro underneath tables and chairs for kids who have more sensory needs. We thought, how can we add this type of feature into the Vidget®? Another “aha” moment was to add recessed handles in the sides with sensory bumps on the top surface – kids fidgety fingers naturally find the bumps which provide a temporary sensory input some children need to promote calmness and focus.

I also wanted children to embrace the idea that a chair doesn’t have to be just a chair and inspire them to use their imagination. Parents and teachers are focused today on how to create “innovative thinkers” but they are still using the same old chairs and desks that are more of an obstacle vs. adding a benefit to the learning process.

In 2012, we were fortunate to meet the Chairman of our Board, Dick Kaplan, who invested in our company allowing the manufacturing of the Vidget® to begin. Since launching the design in 4^th quarter 2015, we’ve sold more than 2,000 to parents, educators, health care providers and many more users across the country. We’ve attended 10 conferences in education and healthcare and received a number of positive reviews about how it is helping students in so many ways:

• “My oldest son is on the spectrum (ASD, high functioning) and has ADHD. The rocking feature helps him stay seated but allows him to rock & move when needed. His OT even ordered two for her office! Great product!”
  Trisha, ​Mom
• “Since incorporating the Vidget in our classroom, I have noticed an improvement in attention span, participation, and regulation in my students. They are happy and engaging in classroom routines and activities. The Vidget’s bright colors make it fun and attractive to use, and the kids love the versatility of the seat.”
  Tara, PreK Teacher & Occupational Therapist
• “After only having the Vidget chairs in my room for less than a week, I have observed a noticeable increase in on-task behavior from students who use them. Students who sit in the chairs participate more and demonstrate greater self-management. I am extremely excited and grateful to have these “tools” as part of my classroom.”
  Dan, 6th Grade Teacher (integrated classroom)

Fidgeting improves focus, releases energy, and promotes calmness. Vidgets create a healthier environment by providing a safe and quiet way to release some of the endless energy kids, teens, and adults have. Teachers who have incorporated flexible seating in their classrooms have noticed positive results such as longer attention spans, less disruptive behavior, and higher quality work. And for special needs, fidgeting and movement helps children with ADHD focus and problem solve. So rather than tell students to sit still, teachers are encouraging quiet fidgeting to help students learn.

With the Vidget®, we are not just moving our bodies, we are changing the way we look at the learning environment. Creating healthy and flexible spaces that inspire collaboration, creative and critical thinking, is what builds innovative spirits and ideas. The Vidget® is just one tool that helps in the process.

HEALTHFUL HINTS:

• If you are looking at seating devices that move for your special needs child, consider your child’s typical movement needs and ask the following questions: (Note: there are several seating options that provide movement, some with a lot of movement and others with less; Wobble Seat, Stability Ball, ergoErgo, and Vidget).
  • Does my child require sensory input
  • Does my child have issues with tipping back in their chair
  • Does my child benefit from being allowed to move naturally
  • Does my child have balance or mobility challenges
• If you are purchasing a seating device for a school environment:
  • Consider getting a couple different models to try. For schools, we encourage a universal design approach by offering several options to let the student decide based on needs.
  • When having students choose their seats, be sure that legs are 90 degrees when seated and feet are flat on the ground. It’s estimated that 83% of students are sitting in chairs that are not the correct height leading to increased fatigue, poor posture, and loss of attention.
  • When possible, have different sizes in the classroom to accommodate all students as they grow throughout the year.

The WarmMe: The Safe Car Seat Winter Coat Alternative

Just over four and a half years ago (Winter 2012), I found myself as a first time mom of a beautiful 6 month old baby girl and I had a problem. We had moved my daughter out of her infant car seat and into a convertible car seat, she was just too heavy to carry around in the infant seat. The problem was it was winter and I didn’t know how to keep her warm while also keeping her safe in her new seat. I had read many articles and seen many graphics online about the dangers of using a winter coat under the straps of car seat harness.

A winter coat is too bulky to safely and securely use under a car seat harness. We did the quick test suggested in multiple articles, put the child in their coat and secure the harness straps, tightening them until they feel snug, then take the child out of the seat and remove their coat, put them back in and buckle the straps. We were shocked by the results, we were certain the straps had been tight when the coat was one, but once the coat was removed there was so much slack in the straps! In the case of a car accident, the force from the accident would cause the child’s winter coat to compress against the straps and the result would be gaping, loose straps that a child could slip through. More recently (February 25, 2016), Consumer Report issued a report and video on this exact danger. They suggest removing the child’s coat and putting it over them like a blanket once they are secured in the car seat, or using a blanket to cover the child.

So, how would we keep our little girl warm throughout a cold Michigan winter? We tried multiple options including putting her coat or snowsuit on in the house and removing in the car then putting it over her once she was buckled. We tried layering blankets over her once she was buckled. We tried lightweight sweatshirts under the straps. None of these options were convenient or warm, taking the coat on and off was probably the most time consuming, the blankets didn’t stay on, and the sweatshirts just weren’t warm enough. That’s when I knew there had to be a warm and safe alternative to the winter coat. I decided to make something as warm as a blanket that would stay on without the need for removing in the car. I thought that something like a poncho would work the best, and so the first version of the The WarmMe was born.

The first version of The WarmMe was very basic, it kept my daughter warm and safe in the car, so it served it’s purpose but I felt there were improvements that could be made. The WarmMe had a single button on the front to secure it and made opening the front simple and easy for securing the car seat harness underneath. The first WarmMe was made of a fleece lined sherpa material that was cute and cuddly, but pricey plus very limited on color selection. The WarmMe worked well that first winter, so the next winter I made an identical one that was just a bit larger to fit my quickly growing daughter.

This second winter my daughter was becoming more independent and always wanting to walk rather than be carried, even on cold and windy winter days. I noticed that on a windy day her WarmMe would blow open when she was walking around outside. I decided to add something special that sets The WarmMe apart from other ponchos and kept my little girl warm even on windy days-by a special feature, interior pockets. The pockets on the inside allowed my daughter to keep her hands warm and also wrap The WarmMe around herself when she was wearing it outside of the car. Her second winter, my daughter loved her new and improved WarmMe with the added pockets. This was also when I decided to change the material from the sherpa to fleece. Fleece is much easier to work with especially when adding the pockets, has endless color and print combinations available, and is easily washable (a definite bonus when creating something for little kids!).

People stopped us all the time asking where were got The WarmMe and when I said I made it they started encouraging me to sell them. At this point in time I had two young children and was working part time as a school social worker, adding to a small business to my already full and busy life didn’t seem to make sense to me. Plus, my whole goal was to keep my daughters safe in the car, how could I put a price on that?

In October 2015 my life changed. I suffered a traumatic miscarriage. As our dream of adding a 3rd baby to our family was crushed and I was left in the most physical and emotional pain I have ever experienced, I found myself needing something I was passionate about to get me out of the dark place I was stuck in. At this point I had made a couple WarmMes as gifts for friends and family and the feedback was great, they loved how much easier it made everyday life. That’s when I went for it, I decided to take a chance and put them up for sale, as I realized I could reach a lot of parents and caregivers who were looking for a safe way to keep their little ones warm. The business started very small, just a couple postings on my personal Facebook page that were then shared by my family and friends.

Each WarmMe has always been custom made based on the child’s clothing size and the print or color preference, so I just focused on completing each order as it came in. People soon started asking for added features such as an attached hood. After asking around and doing a little experimenting I decided a hood is just too bulky to be comfortable behind a child’s head and neck while riding in the car. I decided to start offering matching hats and they’ve been a hit! The next request was for matching scarves for the mom or dad and that option was quickly added in what I like to call the “Mommy and Me Set.”

In February 2016, The WarmMe was featured on a segment called “Moms a Genius” on WXYZ Detroit and the business picked up from there. I could no longer keep up with orders on my own, so my wonderful and supportive husband stepped in to help. This year The WarmMe made the news again on my local news station WLNS 6 out of Lansing, MI and has been picked up by other stations in states such as South Carolina, North Carolina, Wisconsin, Indiana, Minnesota, Ohio, New York, and Virginia. This holiday season The WarmMe has been sent to cold states all over the map. The best part of the increased business has been the feedback from happy customers. Almost daily I receive messages stating how much parents and children alike love The WarmMe and how it has made life easier by keeping little ones safe and warm! It is amazing knowing that my product is making life a little easier for parents, while keeping their precious little ones safe! I’m very happy to say that both The WarmMe business and our family are growing as we are expecting the newest addition to our family in January 2017!

HEALTHFUL HINTS:

1. While the WarmMe is designed to young children safe and warm in their car seats, there are also products designed to fit safely over infant seats while not interfering with the ability to securely buckle the harness. These products are ones that do not go between the child and the car seat or buckles, but go over the seat similar to a shower cap.
2. If taking a long road trip or traveling far from home when road or weather conditions are really bad (remember, I’m talking Michigan winters!) take along coats, snowpants, or snowsuits. If something were to happen and you ended up stranded these items would definitely help keep your little one warm until help arrived.
3. Remember safe sleep precautions when using The WarmMe, similar products, or blankets to keep your child warm in the car seat. Always be sure the fabric is away from their face allowing for an open airway. If transferring a sleeping child from the car into their bed always remove The WarmMe.
4. Here is the official Consumer Reports recommended “simple way to check if your child’s coat is too big and bulky to wear under their harness”

• Put the coat on your child, sit them in the child seat and fasten the harness. Tighten the harness until you can no longer pinch any of the harness webbing with your thumb and forefinger.
• Without loosening the harness, remove your child from the child seat.
• Take the coat off, and put your child back in the child seat and buckle the harness straps, which are still adjusted as they were when he was wearing the coat.
• If you can now pinch the webbing between your thumb and forefinger, then the coat is too bulky to be worn under the harness.

The NuRoo Pocket: Skin-to-Skin Closeness for Mom + Baby

My name is Hope Parish, and I fell in love with the practice of Skin-to-Skin after being introduced to the benefits by my nurse midwife following the birth of my third baby. I thought I was pretty savvy in terms of how to provide best care for baby, but yet I had never heard of holding baby Skin-to-Skin. I will forever be grateful to her for taking the time to walk me through the incredible value that this simple holding technique offers. Initially I had seen Skin-to-Skin as a time for mom + baby to bond, but in reality, that is a secondary gain. There is over 30 years of evidence-based research that scientifically proves the benefits the practice offers. Some of the benefits for baby include accelerated brain development, less crying and colic, better heart rate, breathing and sleep as well as weight gain. For mom, benefits include increased milk production, faster recovery time and reduced risk of postpartum depression.

Bringing my baby home from the hospital to an already busy house with two toddlers, didn’t allow for the time to lay with baby Skin-to-Skin. After searching high and low for a product that offered coverage and a hands-free option to allow me to be on my feet and coming up empty handed, the idea for the NüRoo Pocket was born. I was thirsty for more information and knew I had a desire to bring more awareness to the practice. Given my background in medicine as a Physician Assistant, I needed to dig deeper and learn the science behind the physiologic benefits, and learn how and why this practice works. I buried myself in research articles and also found an opportunity to take a Kangaroo Care course that offered a certification that would allow me to teach and instruct on the best care practices for Skin-to-Skin.

When it came to taking the first steps to start the design process, to say I was overwhelmed is a bit of an understatement. I didn’t even know how to sew! I had shared the idea with my husband who couldn’t have been more supportive, as well as a handful of friends. In my mind this would be a “pet project” and I would find time for it when feeling creative. But, what happened is that I woke up thinking about it and carried the idea around all day. I found myself writing notes on random papers all over the house; scared I would forget the percolating details by the time I had a moment to work on it when the kids went to bed.

The passion for Skin-to-Skin was my driver, forcing me to find a way to bring this idea to fruition. I knew the Pocket needed to perform in both the hospital and home setting. I had a feel for how I wanted it to look and knew it needed to be an open panel design, allowing for easy access and positioning of baby. I picked up a pattern at sewing shop of a wrap shirt and hunted around for a soft, stretchy fabric. I found a seamstress who constructed the shirt from the first pattern and I went on to tweak it from there. Little did I know the work that it would take to launch this idea…. I was never so thankful for meeting Daniela – which was a total game changer. I first met Daniela and her new baby during a test fitting for my first Pocket prototype. The practice of Skin-to-Skin also resonated with her and she felt the challenges of carving out time for her + baby in a house of 7!

Our meeting turned into something more than a test fitting. I quickly learned that she was a marketing guru, along with her own personal desire and motivation to bring innovative designs to market. Since that fateful day, we became ‘mompreneurs’, and created + co-founded NüRoo in 2012. Together, we have implemented dozens of design tweaks and mastered the process of manufacturing, to perfect the NüRoo Pocket. We launched at retail, but always had our eye on bringing this product to the hospital setting, offering a safer way to practice Skin-to-Skin, as well as help grow that critical time mom + baby need to spend together.

When I finally had the opportunity to meet with the medical community at large conventions and conferences, I quickly learned three very valuable concepts from speaking with Nurses, Midwives, Lactation and Developmental Care teams: 1) Skin-to-Skin can help increase milk supply but only if baby was positioned properly: baby’s cheek to mom’s chest, or belly to belly while breastfeeding doesn’t elicit the same response; 2) We could overcome the perception that baby lying Skin-to-Skin on mom’s chest increased the risk of falls or drops with a Pocket that held baby snug and 3) With all the visitors in the hospital, wanting a chance to hold the new family member, the Pocket provided a great antidote to the ‘pass the baby’ experience many new moms are faced with in those precious and fleeting days after delivery.

NüRoo began in Rhode Island, with us working from home, side by side with our young families. We put in three years of early mornings and long nights, traveling all over the country, learning so much as we went along. Our vision and goals for NüRoo were growing and we quickly realized we needed help to achieve them. NüRoo found that help in Brownmed, a medical device manufacturer with over fifty years of experience bringing products to market. NüRoo was acquired by Brownmed at the end of 2014. We’ve combined talents + abilities and have been hitting our stride ever since!

Every NüRoo product fosters the bond between mom and baby, and is backed by scientific evidence. We are inspired by our children and have learned the benefits, both for mom and baby, of keeping baby close. Our mission is to offer mom and baby optimal time together in those first few months, allowing for every early advantage. Simply put, Closest to Mom. Best for Baby.

HEALTHFUL HINTS

1. When using any sling or carrier, baby should always be “visible and kissable.” This means you should be able to see your baby’s face at all times and be close enough to smooch that sweet forehead. Keep baby’s head and neck supported, and make sure baby’s chin isn’t resting on his/her chest. You should be able to easily slide one or two fingers between baby’s chin and chest.
2. Baby’s legs should be “frogged” in a shape that resembles the letter M, meaning baby’s knees should be higher than their bum. This helps to prevent hip dysplasia and ensures baby will be comfortable in the carrier.
3. Look and listen while you wear your baby. Watch for baby’s lungs to expand and contract and listen to their breathing. If anything sounds labored or unusual, take baby out and reposition.

DistrACTION Cards: Because Kids Already Know Shots Hurt

As a pediatrician, I have a confession to make. I’m ashamed to admit that in residency I was amused when kids ramped up the drama getting shots. I’m not talking about a sadistic pleasure watching a 4 year old get poked repeatedly, I’m talking about an artistic appreciation of the wailing, screaming, and ninja-like thrashing performance when the nurse brought in the tray and….cleaned the child’s arm. With cotton. Gently. Yep, it was hard not to restrain a snicker when you alerted the child that, far from being near death from pain, the procedure hadn’t started yet. See? Cotton.

As a pain researcher, I now know that fear dramatically increases pain perception. Not only that, but focusing on the site where you expect pain naturally enhances your body’s perception of pain. Just like focusing on bite of gourmet food enhances your perception of nuances of the flavor (“Oh, cilantro!”) focusing on a painful procedure enhances that pain to occupy your entire consciousness. Not great if you don’t want pain.

Pain relief has become a major focus of medical professionals and children’s hospitals in recent years. While topical anesthetics have been around for decades, only 7% of pediatricians use methods to decrease the pain of needles. Recent innovations to address pediatric pain have been introduced, in part due to the realization that needle fear has jumped from 25% to 63% of children. This 252% increase is theorized to result in part because there are five times more live-saving vaccines that are now routine, and the realization that some vaccines need to be given at older ages to work well. Older age means kids remember the event, have greater cognitive powers to focus on the event, and thus can develop ongoing issues with needles when they experience vaccines as traumatic..

One physiologic way to deal with pain has been spotlighted here before, putting the cold and vibration unit Buzzy “between the brain and the pain”. The body feels sensations of cold and massage, and has less bandwidth to perceive pain. The sensation can even be disrupted, just like cold running water eliminated the pain of a burned finger. What I realized soon after developing Buzzy, however, was that a kid who is bound and determined to let you know how much they hate shots can feel pain from an alcohol swab. For a highly anxious kid who hasn’t seen Buzzy before, the explanation of “how this is going to make it better” might even focus them more on the procedure. I realized I needed something to help the child who is already afraid…something to decrease the fear AND take the focus off the poke.

Fortunately, kids have amazing imaginations, and — Ooh, look at that! —are pretty easy to distract. An easier, faster, and less expensive way to address pain and even boredom comes from the delightful curiosity kids have about new things, especially when they’re brightly colored. The very trait in kids that can be frustrating in long lines or car trips can actually be a huge advantage in managing pain. In fact, some of the more traditional hospital distractions (blowing up a balloon, etc.) had been proven to decrease children’s distress with medical procedures consistently by about 50%… But for this situation – for the child walking in terrified – we needed something more…but what? And thus, the DistrACTION cards were born….

What we’d learned was that controlling pain wasn’t enough for anyone – Fear, Focus on the procedure, and Pain all contribute to the experience.

To optimally pull a child’s attention away from a painful procedure, Child Life therapists use a variety of techniques, from blowing out (pinwheels, balloons, deep breathing) to visual distractions, both passive (videos) and active (Where’s Waldo??). Pulling from the distraction pain literature, I distilled the elements that seemed to be most helpful. In a stressful situation, too much difficulty (math problems) can be counterproductive. This is why “Where’s Waldo”, while a good active distraction, is actually less effective for most medical situations: he’s just too hard to find. The concept, though, is useful – visual active tasks like finding work well. Adding rote elements like counting can be good, but it depends on how hard it is to find something. “How many of something can you find” can be too easy if they’re right there – you could stop after one. “Find 6 of something”, however, is a concrete task which adds visual input to the cognitive task and gives the comfort of rote familiarity. The trick is distracting effectively for the right situation, giving just the right amount of challenge with the comforting ritual of counting. It’s that simple.

DistrACTION cards have 10 questions on the back of each one, stratified by age groups.

They include questions that require simple finding for younger kids (Where is a purple cow?) with some questions that only adults could get (Can you find all the suits in a deck of cards?) Classic counting, how many cows?, was found to be too easy for older kids, so questions add difficulty by asking “How many cows are wearing a costume?”)

After creating the DistrACTION^® Cards for medical procedures, investigators around the world started testing them.

1. First, Buzzy plus Distraction was tested for IV access in Turkey. Used correctly, Buzzy decreases needle pain 50-80%, and has been highlighted in Phlebotomy Today as a way to help draw blood in anxious patients. When DistrACTION is added, both together reduce pain from IV insertion 88%.
2. Investigators then started evaluating the DistrACTION cards alone. In the first study, pain was reduced 50% with the “Monkeys” set of cards alone; even cooler, 97% of kids said the procedure was better than previous times they’d had blood drawn.
3. Subsequent studies comparing other Child Life techniques found that DistrACTION cards decreased pain more than playing with a kaleidoscope; another study found the cards more effective than blowing a balloon, or playing a singing cartoon game.

The DistrACTION cards have now been clinically proven in three studies to be even better than other distractors in hospitals

Beyond pain management though, we found a terrific secondary benefit. When you can distract a child well enough to reduce pain in an unfamiliar environment, adding DistrACTION cards to a situation that is “merely boring” is extremely effective. From a 2 hour junior high concert recital to (one emergency nurse admitted) sitting through Mass, the cards have been extremely helpful for everyday behavior support. They’re waterproof, so they even work on the beach. No batteries, no screens – who knew?

I think the coolest thing for me has been that now, I get amused when a child seems very anxious, starts to ramp up the drama… and then is told “It’s already done!” As kids learn how distraction helps them deal with their own pain, the lesson sticks, even when there are no cards around. At a recent doctor visit for HPV vaccination, my older son said “Wait! You don’t have DistrACTION cards? Ok, ok, no problem…” he looked around the room and found red, blue and yellow speckles on the tile floor.” “No problem. When I need the shot, I’m counting confetti!” When he didn’t even flinch with the poke he was almost as proud of himself as I was!

HEALTHFUL HINTS

1. Distraction is an extremely effective parenting technique for multiple situations quite apart from pain management. Trouble starts brewing when children get bored, but a child who learns how to entertain themselves will have that skill their whole lives.
   • It’s critical to not depend on a battery powered source for distraction – whether it’s a small book, Distraction cards, or a small pot of play-dough, props help avert a boredom-induced meltdown. Once you learn the level of difficulty that keeps a kid engaged, the world around becomes a perfectly good distraction. “OK, I spy with my little eye…”
   • YOU are the best distraction for your child. While older kids can ask each other questions or read the questions on the back of the cards themselves, human interaction keeps a distraction interesting.
2. For injections and medical procedures, there’s a difference between offering distraction and forcing a kid not to watch. Let the 20% of kids who prefer to view the procedure do so – it may be it’s own distraction for them, or a way for them to feel in control of the situation so they’re less afraid.

Coughy Cup

Imagine a coffee cup that’s not for coffee and it has no bottom. It’s my latest invention. I turned a coffee cup into a cup for coughing and sneezing. It’s called a Coughy Cup as in coughing cup. It’s a play on words but hardly child’s play.

The Coughy Cup looks like a standard Starbucks’ paper coffee cup with a plastic lid but it’s the inside that matters most. The Coughy Cup captures, contains, filters and kills 99.9% of germs and viruses. This means the germs and viruses stay in the cup and not in the air, on your hands, body or others. How? By using an antiviral and the same face mask filters used by doctors during surgery.

My name is John Delatorre. I was once a TV weatherman for ABC in Sacramento, California, Corpus Christ, Texas, El Paso, Texas and a few other cities. I spent much of my time visiting schools teaching kids weather and encouraging them to stay in school and away from drugs. Today I’ve taken on a whole new role in my efforts to help children.

A few months ago, my wife and I were watching Shark Tank; the ABC reality show. Out of the blue, my wife says to me, “You need to invent something to help children.” My initial reaction was to say it’s not easy to think of things to invent and that it takes time. My next response gave way to its creation. I told her that I would pray about it and see what God had to say. I did not pray at that moment nor later that night but 24 hours later I did. My wife was out of town that night so before I went to sleep I closed my eyes and my exact words were, ‘Okay God. You heard her. What do you got?’ A half second later I pictured two words; Coughy Cup. I immediately knew what it would be. There was no doubt in my mind. I was blown away. I was sure God had blessed me with an amazing gift. That night I began my research and the next day I started writing my fifth patent application. When my wife returned the next day, she agreed God had given me a great idea.

My initial reaction was to draw up every crazy complicated cup I could think of. Thank goodness that thought process didn’t last long. I quickly understood that I had to manufacture each cup for as little as possible and I had to be sure my cups would be socially acceptable. So, what is the cheapest form of a coffee cup? Paper, right?

Paper coffee cups and plastic lids can be made for pennies and people are very comfortable walking around holding them. They’re seen everywhere from meetings to work and play. I also understood that the name Coughy Cup easily described how the cup should be used so that was a huge advantage.

With this new knowledge, I set out to design a common coffee cup with a plastic lid. The only difference would be my cup would have no bottom, a bunch of holes in the lid and a filter. But, the cup was the easy part. The key to the success of the Coughy Cup would be the filter or as I like to call it, Coughy filter.

My journey began with understanding how to avoid germs and viruses. I found myself studying how surgical face masks worked. I knew there were a lot of face masks; some better than others. I soon found out that some materials used in face masks make breathing more difficult. My filters had to make breathing easy.

Consider what it’s like to cough. You expend a tremendous amount of air after each cough and immediately your body requires you to inhale deeply. The breathability of my Coughy filters makes it easy to inhale after each cough.

It also turns out the best face mask filter has a bacterial filtration efficiency of 99.9% and a particle filtration efficiency of 99.9%. But I didn’t want to only trap the bacteria. I wanted to kill it too. I knew other products were killing 99.9% of germs & viruses. So, I figured I’d find a way to apply this same technology to my cups. I am happy to say I found a solution, one that will remain a secret for now.

Soon after, I introduced the cups to the world of social media using Facebook, Twitter, YouTube and launched two sites of my own: www.CoughyCup.com and http://coughyt.wordpress.com. The response to the Coughy Cup has been amazing! In a few short weeks, thousands of teachers, parents, doctors, nurses and even Howie Mandel are following my work and appear to be my greatest advocates and why not? They know germs and viruses better than most.

So now the word is out! One of the first questions I often get is people wondering whether I expect them to walk around coughing into a cup. The question always makes me chuckle. You can certainly use my cups while walking around but that’s not how I expect people to use them. My cups are primarily for confined areas where people are expected to sit for long periods of time. Places like schools, school buses, airplanes, daycare centers, nursing homes, prisons, doctors’ waiting rooms and hospitals.

Imagine you’re on a road trip and someone in the vehicle gets sick? Would you prefer they be given a Coughy Cup to reduce the chance of others in the vehicle getting sick? Imagine you’re on a plane and the person next to you can’t stop coughing. Would you prefer the flight attendant hand the passenger a Coughy Cup? I’ve had people tell me they plan to buy my cups to give away to anyone around them who start coughing and sneezing.

My primary goal is to first get my cups into the hands of young school children. They represent a major line of defense in battling the spread of germs and viruses. If my cups can help reduce germs & viruses in schools, that means fewer kids and teachers missing school and healthier parents who don’t miss work.

Studies show that, on average, 40 percent of teachers in New Jersey’s Camden City Public Schools are taking sick days compared to only 3% absenteeism among the average American worker.

I believe the CDC will one day consider the Coughy Cup to be a huge help in so many ways. The Centers for Disease Control (CDC) and the National Institute of Allergy and Infectious Diseases (NIAID) are constantly seeking ways to better understand, treat and ultimately prevent infectious diseases. The numbers of people affected in the U.S. alone are staggering.

• The average child can catch between 6 to 12 colds every year.
• Colds cause children to miss 22 million days of school every year.
• More than 1 billion colds and more than 30 million flu cases occur every year.
• Almost 1 million people have died related to influenza in the U.S. in the last 30 years.

Ultimately, I would like to see a dishwasher-safe, reusable Coughy Cup in every child’s book bag. Teachers would be able to use the cups as a way of instructing children to perform one common behavior and a way to monitor who’s sick in their classrooms.

They would always have their cup at the ready. The shelf life of my Coughy filters is more than two years and they’re in air tight sealed envelopes. The child would simply take the filter out of the envelope, snap it to the lid, place the lid on the cup and cough or sneeze. It’s that simple.

So what’s my plan for getting my cups into schools? I’m hoping to recruit the help of pharmaceutical companies, cough syrup manufacturers and the makers of tissues. It’s a win/win. They get good PR and the kids get free cups.

I also hope to convince the airline industry to offer my cups to their passengers, especially international passengers. Consider the Middle East virus. The bird flu is only a plane ride away. The U.S. government is very concerned about the likelihood of a pandemic flu. It’s why they are stockpiling needles and syringes to be shipped to 10 receiving stations throughout the U.S. The purchase order can be viewed on their FedBizOpps.gov website.

But getting the cups into the hands of children and airline passengers unfortunately won’t be possible this flu season because I still have a lot of paperwork to do. Believe it or not, the U.S. Food and Drug Administration (FDA) consider the Coughy Cup to be a medical device. The FDA requires what they call Pre-Market Approval. This means any claims I make (i.e., kills 99.9% of germs & viruses) must pass an FDA evaluation before I can sell my cups. It’s a whole lot of government paperwork and a min of $9,500 to get there.

Still, I have no doubt the FDA will certify my cups. The Coughy Cup might sound too good to be true but it’s not because the science and technology works. In the end I expect the Coughy Cup to be by far my most successful invention.

That success may include winning the right to sit on the shelves at Wal-Mart and Target. I recently entered Wal-Mart’s “Get on the Shelf” and Target’s Simplicity Challenge contests.

• Wal-Mart gives Facebook users a chance to vote for which products they like best. I am happy to say my Coughy Cup made it through round two. Get additional information here
• Target’s contest is just getting underway. Target is using doctors and healthcare industry experts as judges. The winner gets $25,000 and a chance to partner with Target. Details can be found here

If all goes as planned, the Coughy Cup should begin showing up in schools and airplanes by next cold and flu season. I believe once people begin seeing the Coughy Cup in use, it will become better understood and more socially acceptable.

So, pass the cup not the germs, because NOT sharing is caring.

HEALTHFUL HINTS

I. Tips to Avoid Germs

• Don’t put personal items like backpacks, book bags, books, coats or similar items on the floor, especially public restroom floors or on kitchen counters or tables at home as this may further spread germs.
• Leave your phone in your bag or pocket when entering restrooms either at home or public.
• Try not to multitask (i.e., talking on phone, working on computer) when cooking. This could spread germs from one surface to another
• Children should never share food in school, especially during cold and flu season. If it’s necessary to share books, remember to never touch any portion of your face until you wash your hands and even then try to not touch your face.

II. Cold vs. Flu

• Colds usually go away on their own in 3 to 5 days.
• Colds are usually contagious in the first 3 days.
• A cough that last more than 5 days may be a sign of a sinus infection or pneumonia.
• Pay serious attention to a cough that lasts more than 7 days. A chest x-ray may be needed.
• If a cold does not go away after 7 days, your child may have a bacterial infection and need an antibiotic.
• Cold and flu symptoms can mimic one another but the common cold rarely includes a temperature over 101 degrees.
• If your child’s fever is over 101 degrees, keep him home. A fever is a sign your child is fighting an infection.
• The American Association of Pediatrics (AAP) recommends giving a child plenty of fluids and increasing the humidity in the room as the best way to relieve a child’s cough. Hydrate with popsicles, watered-down juice, flat ginger ale and chicken soup. Open a stuffy nose with 2 to 3 drops of saline solution in each nostril.
• Don’t worry about a child’s daytime cough. Coughing helps dislodge phlegm and reduce congestion.
• Persistent coughing, especially at night can be a sign of asthma.
• Honey has been shown to be a natural way to soothe a cough. The risk of botulism makes honey unsafe for children under one.
• A coughing child having difficulty inhaling may be a sign of whooping cough (pertussis).
• Rest may be the best medicine to prevent sickness but a sick child needs even more sleep. Normal sleep for children is 8 to 12 hours every night.

*****************************************************************************************************************

Editor’s Note: Pediatric Safety readers were first introduced to Coughy Cup in September, 2013. John is continuing to develop and sell his product, with a folding cup due out soon. Check out his Facebook and Twitter page for updates.