Why Children Should Always Wear A Helmet When Riding Their Bikes

Written by Joanna E. Betancourt MD., FAAP

Recently, two patients of ours had accidents when they were hit by a car while riding their bikes. Both suffered head trauma because they were not wearing their helmets.

The American Academy of Pediatrics reminds us that head injuries can occur on sidewalks, on driveways, on bike paths, and in parks as well as on streets. You cannot predict when a fall from a bike will occur. It's important to wear a helmet on every ride.

Below are four suggestion that could help you get into the habit of telling your kids to wear a helmet.

Are you wearing a helmet? We’ve all heard the saying, “…do as I say, not as I do.” But the truth is, children learn best by observing you. Thus, whenever you ride a bike, set a good example and put on your helmet. Not only will this reinforce the message, but you will be setting a good example.

Start Early. If your kids are small, have your kids wear a helmet as soon as they start to ride a tricycle or when they are riding as a passenger on the back of an adult’s bike. If your children learn to wear helmets whenever they ride tricycles and bikes, it becomes a habit for a lifetime. 

No helmet; no bike riding. Don't let children ride their bikes unless they wear their helmets. Being consistent is a big part of the process.  If you allow your children to ride occasionally without their helmets, they won't believe that helmet use really is important. 

Use professional athletes as examples. My husband likes to watch the X-Games. For those that don’t know, X-Games are a yearly competition where athletes perform extreme sports such as skateboarding, roller-blading, motorcycle jumping and various other high risk, death defying stunts. All of those athletes wear helmets at all times. Thus, using professional athletes such as those on the X-Games as an example, drives the message home of how important the use of helmets can be.

Your child needs to wear a helmet on every bike ride, no matter how short or how close to home. Many accidents happen in driveways, on sidewalks, and on bike paths, not just on streets. In fact, the majority of bike crashes happen near home. A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

Thankfully, both patients are doing fine. But these incidents are a sure way to remind parents that helmets are very, very important and should always be worn when bike riding, roller-blading or playing hockey. No exceptions!

For information on how to select the right helmet, clink on the link

Four Ways to Get Rid of Your Child's Pacifier

Written by Natasha Burgert MD

Are you stressing out at the mere thought of getting rid of your child’s pacifier?  Most parents dread this topic!  Here is some advice on how to get rid of the pacifier with confidence and success.

Pacifiers are an effective soothing mechanism for infants and have been shown to decrease the rate of SIDS during infant sleep.  For older toddlers, I think pacifiers help the stress and pain of teething.  After two years of age, however, most kids should be ready to transition to an alternative soothing item (stuffed animals, “lovies,” and other blankets.)

At the age of 2, the jawbone is still very pliable and changing.  Changes in the position of the teeth due to pacifier use (an “open bite,” or malocclusion) can still self-resolve.  And, removing a foreign object from a child’s mouth during a period of extensive language development is just a good idea.

I know some parents delay this transition because of the fear that their child will be “mad at them” for taking away their trusted friend. So, why not take yourself out of the process (figuratively speaking) and have them get rid of it?  If your child can actively get rid of the pacifier him or herself, then you are not the one to be blamed.  You are the one providing comfort.  So, how do you do it?

Here are my four effective ways for your child to get rid of his or her pacifier.

1.  Go shopping. Is there a toy, book, or treat that your kiddo would love to get his hands on?  Have your child “pay” for this item with all the pacifiers that he collects around the house.  When you are at the store where this item is sold, find a helpful face at the customer service desk.  Explain to the service clerk that your child would like to “pay” for a special item with his pacifiers.  As you pay the clerk for the item, allow your child to place all his pacifiers on the check-out counter in exchange for the new toy.  It is a quick, effective way to get the pacifiers out the house and provides a new item of distraction.  In addition, it is a tangible reminder of what the child accomplished.

2.  Go to Build-A-Bear Workshop. Have your child grab all of her pacifiers and head to the mall!  Have her pick out a new “best friend” from the Build-A-Bear collection.  Before the stuffing is placed in the bear, have her put all her pacifiers in the bear.  Now, she will have a new friend to sleep with, and her pacifiers will also be there! (I have no vested interest in Build-A-Bear.)

 3.  Pick a night for the Pacifier Fairy. Have your child collect all of his pacifiers and place them in a special sack near his bed.  Let him know that the Pacifier Fairy is going to leave a special treat in the morning in place of his pacifiers.

4.  Bring them to me! Bring along all the pacifiers to your child’s 2-year-old checkup along with a new “surprise” for your child.  Give the surprise to my nurse as you are checking in.  During the visit, I will be happy to take all the pacifiers from her in exchange for the new surprise.  You can remind her later that Dr. Natasha is using the old pacifiers with her patient babies who did not have a pacifier.  Promote the example of “big kid” generosity.

Some more quick tips:

• Any behavior modification with a 2-year-old works best when the message is simple and clear.  That is why these techniques work.  The pacifiers are gone.  Period.  This is why “weaning” a pacifier becomes so difficult.  The message is not clear from day-to-day, and this leads to confusion.  Stay firm with your decision, and don’t talk or “explain” too much.  Once the pacifier gone – it is GONE!  No turning back – no explanations needed. This is just something that happens to all big kids, and the time is now.
• Make sure that your child has not hid any pacifiers around the house.  Nothing is worse than getting through this process, only to find a formerly-hidden pacifier in your child’s mouth.
• You know your child best, but I would argue 20-22 months is the sweet spot for most kids to successfully make this transition.
• Regardless of how, where, or how much the pacifier was used; be prepared for 3 bad days.  That is the average time it takes to dissociate the pacifier from your child’s lifestyle.  Consider those 3 days short-term inconvenience for tremendous long-term gain.

My son loves his pacifier.  Just looking at his cheeks swell as he smiles behind that piece of plastic – I can’t help but smile myself.  I know our day to get rid of the pacifier will come soon.  Until then, let me know if these suggestions were helpful to you, or if you know of any other successful methods.  I would love to hear.

Good luck.

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

How Should I Prepare For Long Flights With My Child?

Written by Joanna E. Betancourt MD., FAAP

"We are planning on taking a trip to Hawaii this summer and I'm dreading the long flight with my children. What can I do to minimize the stress and help my kids cope with the long flight? "

A mother asked me this question yesterday. Flying with children can be very, very stressful. Not to mention uncomfortable. Especially when you feel everybody on the plane is wishing you had taken another flight while your baby is screaming at the top of her lungs.

There are a few things however, that you can do to make you trip a bit more pleasant. Remember, though, many babies never show the slightest signs of discomfort. But until you know that your own child (and you) will be spared, the thought of a baby screaming because of ear pain, boredom hunger or whaterver else may be huring her  is easily and understandably one of the most dreaded aspects of air travel. And from firsthand experience, we can tell you it tends to be all the more disconcerting when that baby happens to be your own.

Fly when your baby's tired – I know this isn’t always possible, but if you can help it, try to schedule the flight when your child is due for a nap. The caveat is that a tired baby may also be extra crabby due to the distractions of flying.

Take along the car seat – Taking along the car seat means you’ll have to purchase a seat for your child, but for long flights, I think it is worth it (depending on the cost of the ticket of course)

Keep diapers and wipes handy - Put wipes and a few diapers in a seat pocket. It'll be easier to have those items accessible when you need them.

Pack Snacks – Lots and lots of snacks. Not only to keep the child busy while takeoff and landing, but also to help with chaging air pressure which may hurt a baby’s ears. Lastly, it is important to account for delays when packing snacks. You don’t want to be stuck on a tarmac with a hungry baby.

Changes of clothes – For the baby and you. Trust me on this one.

Plastic zipper bags - Great for wet, messy baby clothes—and wet, messy grown-up clothes

Bring plenty of toys, books, coloring books and games – Anything that will keep your baby distracted

Keep your cool – Yeah, you may get a few nasty looks from inconsiderate people, but try to keep you cool. Keeping your own cool can go a long way when you're trying to soothe your baby and have to remain seated.

Other tips - Offering a bottle, breast, or pacifier during the times when the pressure changes in the cabin are likely to be greatest-during takeoff and initial descent

Out of Earshot -Airplane cabin noise hovers around 100 decibels, and is even louder during takeoff. Using cotton balls or small earplugs may help to decrease the decibel level your baby is exposed to, and as a result make it easier for her to sleep or relax

What if my baby or child is sick?
If your baby has a cold or ear infection, discuss with your pediatrician whether you can give him an infant pain reliever, some decongestant (which some pediatricians do recommend and some parents swear by, but which nevertheless has not been clearly proven to help), or whether it's best to postpone flying. In most instances, travel plans are not flexible enough to cancel because of a cold, but be aware of your increased odds of dealing with ear pain when you do hop aboard.

In my experience, the biggest challenge is with crawlers and toddlers who get antsy and upset when they aren’t allowed to move around. Younger and older kids tend to be easier. Either way, it is always best to prepare and to think about traveling with the baby. After all, you know your baby better than anybody else. So I’m sure you’ll make the right choices.

Photo Credit: http://www.rookiemoms.com

My Kid Has Lice. What Should I Do?

I still remember the face my mom made when she saw me at my grandmother's house. "What happened?" She cried out. My grandmother had shaved all my hair earlier because of head lice. She insisted that shaving my head was the only way to get rid of it all. I guess it does makes sense. But my mom, of course was furious. She wasn't buying it.

That was last week; and my mom still hasn't gotten over it... just kidding. I was around 5 years old when this happened. But my mom still hasn't gotten over it (nearly 32 years later). Fortunately, we don't have to take on the drastic measures my grandmother took. 

Dr. Jennifer Gruen from Village Pediatrics wrote for us a simple yet effective piece about head lice and how to get rid of it. Below is what she had to say: 

Lice is a very common childhood nuisance. If you child has been diagnosed with head lice, don't despair - take a deep breath, clear your calendar for the day, and read on.

Treatment of head lice is a two-pronged approach; you need to treat the live lice, and remove the eggs, or nits, that cling to the hair shaft. Unfortunately there is significant resistance to over-the-counter lice treatments, thus we recommend a secondary from of treatment as well if this is your second bout, or you want to be ultra-cautions.

You way want to review an excellent video prior to treatment; go the www.headliceinfo.com and watch "Head Lice to Dead Lice." Then proceed:

• Examine the whole family carefully for lice and nits. Even just one nit indicates infestation.
• Shampoo all those affected (or just the the whole family) with NIX - available over-the-counter and can be effective at killing both lice and eggs. Alternatively you can try LiceFreee!, a sodium chloride treatment that doe snot contain pesticides but will only kill live lice. Rinse with a dilute white vinegar solution. This will help loosen the protein that holds the nits in place of the hair shaft.
• Comb out any nits you may see. It may be worthwhile to invest in a fine, metal nit comb. This work is tedious, but a thorough removal of nits will ensure no recurrence. 
• Change pillowcases and sheets before treatment and one day following
• Use a vacuum and lint roller on couches, chairs, and car seats.
• Any items that have come in contact with your child's head should be washed on a hot cycle and dried on high heat OR dry cleaned OR put away in a bag for two weeks (i.e. stuffed animals). Lice cannot live without a live host.
• Check your child's hair daily for one week, then every other day for another week. Repeat treat at one week if you continue to find nits, and/or continue on to the "5 step olive oil battle plan" (based on smother head lice with olive olive at HeadliceInfo.com).
• Children may return to school once they have been treated and are free of live lice. Remaining nits should be removed as seen. But many represent dead eggs that were missed at the first comb-thur and do not pose a risk to other children. If you find live lice after treatment, you need to retreat prior to sending your child back to class. 

Thank you Dr. Gruen for this easy step-by-step approach to getting rid of head lice. If only my grandmother would have had this advice.

Dr. Gruend opened her practice, Village Pediatrics, in 2009. She is a contributor to the Survivor Pediatrics blog. But she prefers spending time creating fantastic kids birthday parties. 

Practicing Pediatrics Overseas

Written by David Sprayberry MD

I recently spent 3 weeks serving at a mission hospital in Kenya. It was a highly challenging time, with a much greater severity of illness and greater limitation of resources than we have here, but it was the most rewarding thing I have ever done as a physician. The work I did was needed, difficult, and stressful, but I did not have to fight an insurance company once and I did not have to constantly worry about my documentation meeting the minutiae of coding regulations that, if not followed precisely, might lead to accusations of billing fraud. I was able to focus on taking care of patients who needed help without significant intrusions by insurance companies. I was able to document what was important to the care of the patient, not what the insurance company or government wants to see on paper. It was demanding and refreshing at the same time.

In Kenya, I was able to perform procedures and take care of rather complex patients because I was the most qualified person available. In the U.S., I am forced to refer patients to subspecialists for problems I can handle, because I would have great liability if a patient had a poor outcome and I had not referred them out. In Kenya, I took care of premies who required intensive care, I intubated and ventilated babies, and I set up and changed ventilators. I managed kids with severe hypoglycemia, severe malnutrition, severe dehydration, meningitis, sepsis, tuberculosis, malaria, and congestive heart failure, most of whom I would not have had an opportunity to care for here in the U.S. because a subspecialist would have had to be involved.

Despite the limited resources we had to work with and despite the heartbreaking events that occur when practicing medicine in the Third World, I must say that my experience in Kenya is why I went into medicine. It is comforting to know that I can go practice there if our government and our insurance companies ever make practice here unbearable. In fact, I could practice there now.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.