I found it ironic when I came into work today and ready this article about the dangers of binkies, bottles and sippy cups (I know – seriously, what next).

So of course, I feel like that bad mom who still have a 15 1/2 month old using a binkie, not just walking but running through the house.

This article brings up some good points – kids shouldn’t be running or walking with things in the mouths, including food, and probably a good time to start weaning is as they begin walking.  Food for thought.

Every maker of infant acetaminophen products is changing the amount (concentration) of acetaminophen in their medicines. This means there will be new directions for these products.

These changes are being made to standardize dosing for infant and children’s acetaminophen products to help reduce medication errors.

What’s changing?

• The amount (concentration) of acetaminophen is changing.  The new concentration is 160 mg per 5 ml.  This is the same concentration as the Children’s acetaminophen products.
• The dosing device is changing.  Along with the new infants’ suspension comes a new measuring and dosing device called a “dosing syringe”.
• The dosing directions are changing.  For children under 2 years of age, your doctor or pharmacist can give you the right dose for your baby.

What you need to know

• There may be a time when infants’ acetaminophen products with the old and new concentrations are in stores and in your medicine cabinet.
• The old infants’ acetaminophen drops are three times stronger and need a smaller dose (amount) than the new infants’ suspension product.
• Using the directions from the new infants’ suspension product with the old product (concentrated drops) could result in serious overdose and cause liver damage.

What you need to do

• Always read and follow the label instructions on the product you are using.
• Give the amount of medicine listed on the label for your child’s weight.
• For children less than two years of age, only your healthcare professional can give you the right dose for your baby.
• Talk to your doctor or pharmacist if you have any questions.

Read the label directions carefully and always call your healthcare provider with questions!

By Stacy Roehrs, Clinical Pharmacist at Dayton Children’s

Stacy has been at Dayton Children’s for 11 years. She graduated from Ohio Northern University with a B.S. Pharm and then from the University of Cincinnati with her Pharm.D.  She did a pediatric residency at Columbus Children’s Hopsital. Stacy has 4 children ages 10, 8, 4 and 2 and enjoys reading and running.

Anecdotal stories are helpful in bringing serious problems to our awareness, but they can also give us a misleading impression as to the emotional health of our children. The facts are much friendlier.

• Lowest teen birth rate in history. Kids having kids is bad for the parents and their children, and typically results in all kinds of negative educational, social, and behavioral outcomes. The National Center for Health Statistics recently reported that 2010 was the lowest rate of teen births since the mid-40s, dropping to an all time low of 34.3 births per 1,000 teens. In 1957, the rate was 96.3 births. This significant accomplishment appears to be due to an increase in the use of contraception among teens, not in a decrease in sexual activity.

• Decreasing divorce rate, dropping by 5 percent since 1996.  Divorce puts kids at a substantial risk for long term problems. Happy marriages are more likely to raise happy kids.

• Decreasing cigarette smoking among kids, dropping by about a third to one-half of the teens who smoked in 1996-97.  We have a long way to go in trying to convince the 11 percent of 12^th graders who smoke daily that this stupid habit will cause them serious health problems and premature death. Cigarettes remain the most deadly drug used by our kids.

• Decreasing heavy drinking among teens, dropping to 23 percent in recent years for 12^th graders compared to 32 percent in 1998.  This decrease was also evidenced among younger children.

• Decreasing involvement in violent crimes. In 1993, kids between 12-17 years of age committed serious crimes at a rate of 52 crimes per 1000 teens. In 2009, that rate fell to 11 crimes per 1000 juveniles.

• Child sexual abuse rates have decreased by 38 percent in the time period from 1993 to 2006, due to aggressive prosecution and the efforts of parents to educate and empower their children about speaking up about uncomfortable situations.

• Increasing attendance at college, with 70 percent of our high school students enrolled in higher education, compared to around 50 percent about 30 years ago.

We have a long way to go in making our communities safe and healthy for our children. We don’t want any of our children sexually abused, committing violence crimes, smoking cigarettes or abusing alcohol. We’re not perfect, but we are getting better thanks to caring, committed, and loving parents.

Forgotten?  You may ask.  How could someone forget their child in a car?

When I first learned about these hyperthermia deaths I asked this question – how could you forget your child.  It’s quite simple to chastise these parents – right?

But then I think about my mornings. My scatter-brained trip to work. The juggling of a baby, early meetings and planning out the day. And I come to the realization – the hard realization – that I have to be more mindful if I’m taking Mary to Day Care. I have to be intentional. Because I can understand how a child could be forgotten. I believe that this acknowledgement is the start of preventing this tragedy. I could forget my child – so what am I going to do about it?

Around 9am my husband calls me nearly everyday – to make sure that Mary got to Day Care.  I don’t know if he’s just calling to talk to me (isn’t that sweet) or if he’s also keenly aware that I’m scatterbrained before my first cup of coffee. In either case – I don’t mind. I’ve heard that some people set their outlook calendar or phone to remind them to drop off the kids at Day Care.  Some Day Cares will call. With dozens of children killed each summer there has to be an answer.  I’m interested to hear your thoughts.

Visit the Dayton Children’s website for more information.

P.S. SafeKids even has a Baby Reminder app created specifically for this purpose! Check it out here!

May 6-12, 2012 is National Children’s Mental Health Awareness Week

Stacy Flowers, PsyD, a pediatric psychologist at Dayton Children’s discusses the issue of trauma symptoms in children with chronic illnesses.

When people hear the word TRAUMA, they typically think about an individual who has been in an abusive situation, been through a natural disaster or perhaps military personnel who have experienced the intensity of combat.   What pediatric psychologists and health care providers know is that children with chronic illnesses and/or life threatening injuries can also experience trauma symptoms.

Who is at-risk for developing trauma symptoms?

Children receiving painful or invasive medical procedures or long-term treatment as a result of chronic illness, accidents, or injuries are at a higher risk of developing post-traumatic stress symptoms. Research has also indicated that children’s perceptions of the event are critical- if children perceive the event as extremely frightening, life-threatening, sudden, or extremely painful they will also be at greater risk for developing post-traumatic stress symptoms.

According to the National Child Traumatic Stress Network:

Childhood injuries and illnesses are common:

• 5 out of 100 American children are hospitalized for a major acute or chronic illness, injury, or disability.
• 20 million children in the US each year suffer unintentional injuries.
• Over 11,000 children are diagnosed with new cancers each year in the US, and there are an estimated 250,000 children who are cancer survivors.
• More than 1,000 children have organ transplants each year and several thousand more are awaiting transplants.
• Research has indicated that 25 – 40 percent of children develop some post-traumatic stress symptoms as a result of life-threatening chronic illness, accident or serious injury.

These experiences can lead to traumatic stress reactions in children, their parents, and other family members.

Post-traumatic stress symptoms:

Children who have post-traumatic stress symptoms generally experience:

Impact of development

The way children cope and deal with symptoms of medical or other trauma also vary based on the child’s developmental level.

• Preschool children who have experienced a trauma may have more difficulty separating or may regress behaviorally (i.e., begin having accidents, become more clingy, or start using baby-talk).
• School-aged children may experience significant guilt or believe that they caused the trauma to occur (i.e., I did not wear my helmet like my mom told me and now I’m being punished).  They tend to become more concerned for their own and loved one’s health and safety. School-aged children are also likely to have increased somatic complaints following a trauma (i.e., headaches, stomachaches, general pain) as they show their emotional pain through physical symptoms.
• Adolescents often struggle with trying to “fit in” and may feel self-conscious about their experience. They may isolate themselves more and struggle with ways to be more independent in the face of a medical condition requiring them to be more dependent on parents and caregivers.
• Preschool, school-aged children, and adolescents may all have difficulty concentrating and learning once they return to school following the experience of a medical trauma.

The intensity of post-traumatic stress symptoms experienced in combination with the child’s developmental stage have the ability to greatly impact academic, emotional, social, physical, and behavioral functioning.

How parents can help:

The first thing parents need to do is recognize that their child is having difficulty or impairment in some area of functioning as a result of medical trauma.  Once parents are aware, one of the best ways to manage these symptoms is to talk to your child about how they are feeling or what they experienced.  Younger children tend to have more difficulty describing what they are experiencing emotionally but may benefit from drawing a picture, playing out the experience, or telling a story.  Regardless of age or developmental level, family support and involvement is essential.

The good news is you do not have to deal with this alone.  The psychology staff at Dayton Children’s has specialized training to treat children of all ages and developmental stages who are dealing with frightening or life-threatening illnesses, injuries, and/or accidents. We can work with children and their families to teach specific coping skills that will decrease post-traumatic stress symptoms.  Talk to your doctor if you think your child might be experiencing post-traumatic stress symptoms.  Also, remember you do not have to wait until symptoms significantly interfere with your child’s functioning, often times long-term impact can be reduced by getting treatment early.

For more information and a list of resources please refer to the National Child Traumatic Stress Network at:  http://www.nctsnet.org/trauma-types/medical-trauma

About Stacy Flowers, PsyD

Dr. Flowers is a pediatric psychologist who works with children and families dealing with issues related to chronic medical conditions. Her clinical and research interests have been in the area of children’s psychosocial functioning, specifically adjustment, coping, and long term outcomes of children and their families in response to being diagnosed with a chronic medical condition.

Check out some of the pictures from the event and make sure to follow their blogs! Thank you to each of the mommy bloggers who joined us today! We greatly appreciate your input!

Dance Love Sing Live
Adventures in Motherhood
Biz e-Mom
Domestic Debacle
Evan Has Landed
Savings Lifestyle Dayton
Inside That Head of Mine

Regardless of the number of wheels they have, children love to play with things that move. From the time they can walk, they’re pushing around a stroller. Once they grow into their walking legs, they graduate to a big wheel. Once in school, it’s rollerblades, skateboards, scooters and finally a bicycle.

In 2010, more than 800 children were treated in the Soin Pediatric Trauma and Emergency Center at Dayton Children’s for injuries suffered on nonmotorized wheeled vehicles including bikes, scooters, skateboards, Big Wheels and rollerblades.

As a pediatric neurosurgeon at Dayton Children’s, I know that a helmet is one of the most important tools we have to help prevent brain injuries to kids.

Helmets could prevent an estimated 85 percent of severe head injuries and up to 45,000 head injuries to children who ride bikes each year.

As your child takes to the road, make sure they have a properly fitted helmet.  Here are some things to look for:

• CSA, ASTM, CPSC or SNELL label must be attached inside the helmet
• The pads touch the child in the front, back, sides and top of his or her head
• The helmet sits level, about two fingers above eyebrows
• The chin straps are snug and meet just below the ears
• Eyes and ears aren’t blocked

The most important thing to do when sizing and fitting a helmet is to explain each step to the child so that they can learn how to do it for themselves. Teaching children about helmet use early and wearing one yourself will set a good example for your child to follow in the future. Together, with our partners at Kohl’s Cares, we can keep kids safe at play!

Guest Blogger:

Laurence Kleiner, MD, is director of the department of neurosurgery at Dayton Children’s. Dr. Kleiner received his medical degree from Temple University. He completed his fellowship in pediatric neurosurgery/CFS physiology at Brown University School of Medicine. His specialty interests include brain tumors and endoscopy with hydrocephalus.

These findings are consistent with decades of research in the discipline of Positive Psychology that an optimistic attitude results in all kinds of emotional, behavioral, and physical benefits. Research has documented that optimism is not an immutable trait determined by one’s genetic code, but rather a skill that you can teach your ten-year-old child.

An optimistic style is not based upon the mechanical repetition of positive statements, or the silly efforts to enhance children’s self-concepts. According to Dr. Martin Seligman in Learned Optimism, the focus should to teach children how to think differently about stressful events.  In Dr. Seligman’s ABC model of behavior, Adversity is a normal experience that happens daily to most people. The Beliefs that we hold determine the Consequences, or how we behave in response to some unpleasant situation.  We can change our response to stress by altering the way we think about the world.

Optimistic people have a different explanatory style for understanding good and bad events and children acquire such belief systems around the age of seven.

Three keys to a positive attitude:

• Permanence.  People with a positive outlook view adversity as generally temporary. Negative people will frequently use terms like “never” and “always” to describe their situations. If a child has a bad day at school, you are more likely to hear “My teacher is always picking on me” from a pessimistic child.

• Pervasiveness. When confronted with failure in one part of your life, do you generalize that to all other areas?  When a teen gets turned down by a girl for a date, does he think “no one likes me” or “this one girl doesn’t like me.”  People who catastrophize tend to develop universal explanations for their misfortune whereas positive people look for a specific cause.

• Personalization. Positive people tend to view the causes of good and bad events as more internally determined, and thus within their control. After winning a basketball game, does your child refer to luck (pessimistic style since that is beyond her control) or the skill of the team (internal cause, and a positive explanatory style)?

Your belief system is in the key factor in influencing whether you have a positive or negative attitude. A pessimistic attitude results from a belief system that interprets adversity as being permanent, pervasive, and due to external factors. You can change your life by altering the way you think. You are not the helpless victim of your genes, parents, or life’s circumstances. Change the way you think, and positive behaviors and feelings will follow.

Her teachers at day care made a wonderful point. They are teaching her how to bite and chew – so if she happens to put something dangerous in her mouth she would bite before she swallows and hopefully spit it out or give us a little more time to discover what she has done.

My husband has a different approach…cut everything up into itty bitty pieces.  And I’m talking itty bitty…I prefer to tear into pieces (and follow what day care is doing) but Daddy is on a mission to see how small he can cut up fig newtons, green beans and noodles. Or in the case of the photo above – those are French fries and quesadillas!

I guess we all have our safety hang-ups!

Too early the alarm clock rings and I have to wake her up to go to school. We are both exhausted from an interrupted night’s sleep. She is grumpy but she chats my head off on the way to school and claims that her ear feels better. She does not eat nor drink much for breakfast however she seems to be doing okay, so I drop her off after telling her teacher about her pain complaints and I remind them to call me if there are problems.

Sure enough at about 10:30 am daycare calls me. Audrey has been lying down for the past 45 minutes complaining of ear pain and she is very tired. So I go to school to pick her up and because I have the luxury of being a doctor, I check her over and look into her ears.  Sure enough her left ear is infected. Not good news but not terrible news because this is only the forth ear infection in her 3 year life, the last one was about 4 months ago. Now I have a dilemma… to treat or not to treat with antibiotics.

I decide to wait for now on the antibiotic treatment and focus instead on treatment of her pain.  After all, viruses cause fevers and ear infections more often than bacteria and we do not treat viruses with antibiotics. I review the American Academy of Pediatrics Clinical Practice Guidelines on acute ear infections. Because she is an otherwise healthy child, over the age of 2, who feels bad but is not running a fever over 102.5 F and is drinking fluids, I feel I can give her body a chance to do its thing to fight this infection..

Why wait you might ask? A majority of children will improve within 24 hours by treating symptoms with acetaminophen or ibuprofen whether they receive antibiotics or placebo. If I do not need to give her an antibiotic then that will lessen her risk for side effects from the antibiotic. It will also limit the use of unnecessary antibiotics which we know is related to increasing antibiotic resistance. Furthermore studies have shown that by treating her ear infection with antibiotics I may only reduce her illness by one day if her infection is indeed caused by bacteria.

When do I worry?

• If she has a fever higher than 102.5 F,  especially if the fevers do not reduce with Tylenol or Motrin.
•  If she is not drinking and not peeing as often
• If her symptoms get worse such as pain or swelling behind her ears.

Because her fevers are responding to treatment and she is drinking fluids I will wait 48-72 hours to see what happens.

I know, I am a doctor but what should you do?  Discuss the “what if’s” with your child’s doctor because they know your child’s medical history.

In an otherwise healthy child over the age of 2 years here is what I typically recommend for my patients:

• Treat fevers with acetaminophen or ibuprofen (fever reducers) – I typically treat my children when their temperatures are over 102.5F or if they feel so bad that they are not drinking fluids. Remember, fevers help the body fight off the infection; it is one of your body’s natural defense mechanisms and is not necessarily something to get anxious about.
• Give your child LOTS of fluids, rest, and a little time
• Seek medical attention from your doctor or urgent care if:
• Your child is not drinking fluids well
• Your child’s fever has lasted more than 3 days or is not coming down with the  fever reducers
• Your child’s symptoms appear to be getting worse
• Go to the emergency department if:
• Your child is having trouble breathing
• Your child does not urinate for more than six hours while awake
• You are concerned enough and you feel it cannot wait until the morning to call their physician.

Well, I hope to report back that all is well and we did not need a course of antibiotics. Wish us luck and good health!

Follow up: Audrey had fevers for 2 days, ear pain off and on for 3 days, and otherwise did well without antibiotic treatment! Next up for her, her 3 year old well child checkup.