Use the correct medicine device for children, never a kitchen spoon

photo of kid getting medicine

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A “spoonful of medicine” has long been the prescription for making sick children well. But “spoonful” is a highly inaccurate description and can lead to dangerous dosing errors when parents administer medicine to their children.

According to a study published in the Journal of Pediatrics, more than 40 percent of parents have made dosing errors and they are more than twice as likely to make mistakes when using teaspoon or tablespoon measures than when using millimeter measurements. The rate of potentially dangerous outpatient medication errors for children is three times that of adults due to the complexity of weight-based dosing, inaccurate measuring devices, incomplete instructions and inadequate education for care givers about the medication.

It’s difficult for parents when pharmacies put a teaspoon measurement on the package, but then supply an oral dosing syringe that’s marked in milliliters. Parents have to do a complicated math conversion that must also take their child’s weight into consideration. Because pharmaceutical companies base their dosing on weight (mg/kg), the dosage for each child will be different. The physician or pharmacist needs to calculate the correct dose and then educate parents or other care givers on how many milliliters to give to the patient.

It is also very important for parents to use the correct dosing device: an oral syringe, dropper or dosing spoon. Kitchen spoons come in many sizes and shapes and are not accurate for dosing medications. Their use should be discouraged by doctors and pharmacies.

In addition to correct dosing, there are a number of other things parents need to consider in order to safely administer their children’s medicines at home:

  • What time should the medicine be given? How often and for how long?
  • How should the medicine be administered: by mouth; inhaled; inserted into ears, eyes or rectum; or applied to the skin?
  • Should the medicine be taken with or without food?
  • How and at what temperature should the medicine be stored?
  • What are common side effects or allergic reactions?
  • Are there interactions with other medications your child may be taking?
  • What happens if your child misses a dose?
  • Do your doctor and pharmacist have your child’s correct current weight?

Remember that kids are not just miniature adults and are often more sensitive than adults to certain drugs. Getting the dose even slightly wrong can lead to serious problems. If unsure of dosing instructions, parents should always check with their pharmacist or their pediatrician!

Masoomeh Khamesian, Pharm. D. is the director of pharmacy for Howard County General Hospital. She is also a mother of two children and three step children.

 


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Six clues to observe in your child if he takes in too much water

secondary drowning photo

It’s every parent’s worst nightmare. One second your toddler is happily swimming in the backyard or neighborhood swimming pool. You look away for a few seconds and, when you turn back to the pool, he is struggling under water and then gasping at the surface for air. You get him out of the water immediately and, after a few minutes, hours or even up to two days, he seems no worse for his frightening experience. But suddenly he starts to have strange symptoms that require an emergency hospital visit.

A swimmer may inhale a lot of water or take in a rush of water after jumping off a high surface or coming off a water slide. A toddler can slip into water that is over his head. It only takes a few seconds in the water – just enough time for the water to get past the vocal chords before the body can react.

The majority of children, or anyone for that matter, who suffer the effects of secondary drowning, will survive. But a small percentage could have permanent brain damage and others may even die.

It is a rare condition – the syndrome occurs in less than one to two percent of near-drowning victims–but its onset is usually rapid and is characterized by a period of one to 24 hours of respiratory well-being. The swimmer seems fine at first, but water left in the lungs begins to cause swelling and diminished oxygen exchange to and from the blood. As the blood oxygen level drops, oxygen flow to the brain and other vital organs is reduced. Inhaling pool water can cause an additional condition called chemical pneumonitis, inflammation of the lungs due to harmful chemicals. An interesting observation is that children who develop secondary drowning syndrome after immersion in fresh water have a higher rate of survival than those who take salt water into their lungs.

Common symptoms of secondary drowning are persistent cough, shortness of breath, chest pain, lethargy, fever and unusual mood change. These signs can be difficult to spot in young children who are normally tired and fussy after a day a long day in the water. If symptoms are diagnosed early on, a physician can administer oxygen and remove fluid from the lungs. If not treated, the syndrome can progress to pulmonary edema (swelling) with a frothy pink discharge from the nose and mouth; partial or complete lack of oxygen supply to the brain, which can cause serious cognitive, physical and psychological impairment; respiratory and cardiac arrest; and death.

It sounds very scary, but none of this means parents should needlessly worry or forego the joys of family summer vacations at the beach or long days at the swimming pool. Just remember that vigilant monitoring of children when near the water is extremely important and water safety is the best prevention. If your child does have a near drowning experience, you should observe him or her in the following days and know what to look for. If you see any signs of secondary drowning, immediately take your child to an emergency department. Time is a critical factor in treatment – it could save your child’s life.

Dr. David J. Monroe is the director of the Children’s Care Center at Howard County General Hospital.

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Do you have little ones in your household? If you do there are a few issues that are unique to your kitchen. One is how to feed your children the most healthy food. Another is how to bring them up with the habit of preparing their own healthy food.

I sought out some books on this subject and found a few great ones to share with you.

First is Weelicious: 140 Fast and Easy Recipes (2012) by Catherine McCord. Her recipes grew from a blog she began when her first child was born. As her family has grown, the blog has blossomed into a polished website with amusing and instructive videos and advice. Her advice—as is mine—is to “turn passive eaters into active ones” by getting the kids involved in the preparation of their food. As soon as they are old enough to wash their hands they can wash vegetables. If they helped mix the salad they are more likely to enjoy eating it. McCord’s book covers foods from baby purees right up to casseroles the whole family will enjoy.

Jenny Flake is another food blogger who focuses on recipes that keep kids happy. Her book is The Picky Palate Cookbook: 133 Recipes for Even your pickiest eaters (2012). She is a happy mom whose adventures in cooking began when she realized she “didn’t know how to cook anything.” She dove right into her new kitchen and even entered cooking contests. Her enthusiasm is contagious and the photos make the food look scrumptious, but there is no promise of healthfulness and, as with McCord, above, no nutrition information. While both books cover a lot of the same ground, McCord’s is a little more child-oriented and Flake’s has more general family appeal.

The Mom 100 Cookbook: 100 recipes every mom needs in her back pocket is another 2012 publication by a blogger (—it was a very good year!). Author Katie Workman is founding editor in chief of a recipe website, as well as her own website. She has an engaging writing style and has arranged the book in 20 chapters, each headed with a “dilemma, a predicament, a head-scratcher.” Each dilemma has five solutions, accompanied by sidebars like “What the kids can do” and “Vegetarian notes.” Top all this off with a superb index (librarians like that!) and a list of suggested menus and you have a great cookbook—even though the recipes don’t have nutrition information.

If you want to get even more serious about your child’s nutrition, try Stacey Antine’s Appetite for Life: the thumbs-up, no-yucks guide to getting your kid to be a great eater (2012). Antine founded HealthBarn USA—part working farm, part classroom, part summer camp—on her family’s New Jersey farm in 2005. She is passionate about teaching children about food and fills her book with advice and ideas and recipes—each of which has nutrition information! Here is a book to learn from and to trust.

My last recommendation is The Cleaner Plate Club: more than 100 recipes for real food your kids will love (2010) by Beth Bader and Ali Benjamin. The authors share a passion for feeding children well. They “examine why children eat what they do—how their food preferences are created,” talk about shopping strategies and introduce vegetables alphabetically. If this sounds dull, you have not opened the book yet! Great illustrations, sidebars, a piece on converting recipes for the slow cooker, and one on varieties of oils. This is more than just a cookbook. You can sample more of Benjamin’s writing and recipes here.

I really enjoy browsing the new cookbooks at Howard County Library System branches! I hope you will too.

Barbara Cornell joined the Howard County Library System in 1993 as Assistant Branch Manager at the new Elkridge Branch. Since 2000 she has enjoyed a shorter commute to the Glenwood Branch.

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Pear-and-stethoscope_webI’m a pediatrician and a mom. The issue of childhood obesity, for me, is both professional and personal. Even if we’re not worried about our kids being obese, we want them to live a healthy, active lifestyle. Discussing this issue with my patients and their families is as important as writing a prescription when they are sick.

The obesity epidemic is rooted in environmental, genetic and cultural factors. Our culture makes it difficult to have a healthy lifestyle. Fast food restaurants can take a 10-calorie vegetable – the onion – dip it in batter, fry it and turn it into a 1,000-calorie snack! And portion control is off the charts. A typical bagel is now two times the size and calories it was 20 years ago. We’ve come to think of “more” as “better,” but, when it comes to food, that is not the case.

Children and teens spend too much time in front of TVs, computers and electronic devices that require no physical activity. And parents often worry about their children playing unsupervised outdoors, so they end up spending more time at less active, indoor activities.

The risks for overweight kids

Being overweight is a serious health problem for children. It can lead to diabetes, high blood pressure, hip and knee problems, and liver disease. If a child is obese early in life, they have a higher risk of being obese as a pre-teen or adult. The emotional consequences include depression, low self-esteem and lower academic achievement. But parents can reverse this trend by reinforcing a healthy lifestyle.

Body Mass Index

We use a tool called Body Mass Index (BMI) to determine if a child is overweight. For children and teens, it is age- and sex-specific; for kids aged 2 to 18, a BMI in the 85th percentile is considered overweight; in the 95th percentile obese; and in the 99th percentile severely obese. Although the BMI is not ideal, it is helpful for diagnosing at-risk children. Once we acknowledge there is a problem, we can develop a plan of action.

Eat less – do more

The short answer is fairly simple. If you take in more than you spend, you will gain weight. If you take in less than you spend, you’ll lose weight. The trend today of eating more but doing less puts our kids on the wrong side of this balance.

Children should, ideally, get more than one hour of physical activity every day. It doesn’t have to be a formal “exercise” or an hour at the gym. A walk or jog in the park is great, or playing their favorite sport. Anything that gets them moving is good.

They are what they eat

The best source for vitamins and minerals is not vitamin tablets, but fresh fruits and vegetables. Juices and sugary drinks are fattening and those pretty green and red drinks are not strawberries and kiwi; they are red and green dye and sugar. Water and fresh fruit is a better option. Get creative in your kitchen and let your kids try new foods. Don’t give up! It can take up to twelve times for a child to get used to flavors and accept new foods.

The role of psychology

Obesity is a chronic disease and addressing it is not about a quick fix or a diet. It involves a commitment to adopting a healthy lifestyle. Setting weekly goals can be helpful. Rewards are important, but don’t use food. Most important for us, as parents, is that we teach by example. Maintaining a healthy weight, eating well and getting exercise should start with mom and dad.

Rx for healthy living

It doesn’t involve pills. Here it is:

  • Five servings of fruits and vegetables every day
  • Less than two hours of screen time
  • Get out and play hard for one hour every day
  • Cut down or eliminate soda and juice

For more information, visit: healthychildren.org, choosemyplate.gov, letsmove.gov and healthyeating.org

To learn more, watch the HCGH Wellness seminar, “Weighing in on Your Child’s Weight,” at bit.ly/hcgh_child_obesity, presented by:

Edisa Padder, M.D., Pediatrician
Robin Toler, M.D., Psychiatrist
Ashli Greenwald, Dietitian
Suzie Jeffreys, Exercise Specialist

Edisa T. Padder, M.D., FAAP, is a pediatrician in private practice in Columbia, MD. who works with her patients and their families on these issues.
 


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Nutrition Label with circle CUYou love your child more than anything in the world. You want him or her to be happy and healthy. You have a pretty open relationship and can talk about almost anything. But when it comes to talking about weight with kids who are obese or on their way to being overweight, most parents are at a loss. They clam up and let the problem continue to get worse rather than confront the “Fat” issue, because it is such a loaded and complicated subject.

Most children are already self-conscious and sensitive about their weight and may be teased about it at school. Parents are often afraid they might compound the problem if they acknowledge a weight issue. Will my child develop anorexia if I mention her overeating? What if he thinks I don’t love him as much because he’s overweight? Is she overeating because of depression or some other problem?

Some ways to approach a touchy subject

So . . . how can parents bring up this difficult subject without hurting, alienating or making their child feel defensive? Here are some ideas:

Ask for help from your pediatrician. He or she has experience with this and can be neutral and bring up the topic of weight as a health factor, mentioning that the child has gone over the “healthy weight” line and that there are health risks involved. Talking about health, rather than social or cosmetic factors, can open the door to conversations about a healthy lifestyle and how important it is to overall well-being. You can continue the conversation by substituting healthy choices for fattening snacks and letting your child help with food shopping and preparation at home.

Put the focus on yourself. “Wow! Spring is just around the corner and I’ve really packed on some pounds this winter. Do you want to start an exercise program with me? Let’s try to lose some weight before summer.” Find an exercise you both enjoy and then be a partner rather than a superior. You can show, by your example, that regular exercise makes you feel better. You could even make it a family project.

Talk! Once the cat is out of the bag, it might be easier to address your child’s feelings about food. What is he feeling when he overeats? What is bothering her? Try to help them develop other ways to cope with their feelings and get them involved with activities they like rather than turning to food for comfort. Most of all, tell your child that you love them, no matter what.

Avoid isolation

Some kids with weight problems are treated differently by their peers. Encourage friendships; spend time together and let them know you have confidence in their ability to get healthy.

Depression and anxiety – when should you worry?

How do you know if depression is causing your child’s weight gain, or if weight gain is causing her depression? It can be a vicious cycle that’s hard to interpret. Emotional ups and downs are a normal part of growing up and all children will experience some degree of anxiety from time to time. But today’s social pressures are tough, and anxiety disorders and depression can lead to many devastating problems including suicidal thoughts and substance abuse. If you suspect serious depression or an eating disorder, consider consulting with a professional. Howard County Mental Health Authority (hcmha@hcmha.org) and National Alliance on Mental Health (NAMI) Howard County (info.namihch@gmail.com) are good resources for finding local mental health professionals.

To learn more, watch the HCGH Wellness seminar, “Weighing in on Your Child’s Weight,” at bit.ly/hcgh_child_obesity, presented by:

Edisa Padder, M.D., Pediatrician
Robin Toler, M.D., Psychiatrist
Ashli Greenwald, Dietitian
Suzie Jeffreys, Exercise Specialist


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Linger, even for one chapter in this massive book, and you will soon find yourself caught up in psychiatrist and National Book Award winner, Andrew Solomon’s comprehensive (albeit eloquent) and tender tribute to the myriad parents of “horizontal” offspring — that is, dwarfs, transgenders, schizophrenics, prodigies, those who commit criminal acts, and more.

Solomon’s all-embracing assertion (as a homosexual, and therefore, a horizontal child himself) is that the parents of such children, along with the children themselves, deserve voice and a raison d’etre. Even the ones certain to be defined as bad parents are given voice: Is it hard or easy to love a child that society has deemed imperfect? Does bearing a child with supreme challenges take us to the edge of an awful precipice? Or does it make us, as one mother says, “Deeper for it?”

Sue Klebold, mother of one of the two teens who committed the Columbine massacre, divested her soul to Solomon when the question was asked if it would have been better had her son never been born.

“I believe,” she said, “it would not have been better for me.”

Far From The Tree is the Camino Trail of epic reads. Take the journey anyway — if not for the privilege to walk in the shoes of some of the most diverse parents and children you will ever meet.

Aimee Zuccarini is an Instructor & Research Specialist at the East Columbia Branch. She facilitates several book discussions and writes the book reviews for The Maryland Women’s Journal.

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