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Pediatric News Tips - Home for the Holidays

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Duke Health News 919-660-1306

Battling the Gimme Gremlins Michael whines incessantly about
those Air Jordan sneakers he really, really needs. Sarah won't
stop begging for her 153rd Beanie Baby. Does it wear you down?
You desperately want to teach them to appreciate what they
have, and to stem the seasonal tide of greed. So you pull out
lecture No. 54: 'Tis Better to Give Than to Receive.

Think again. "The best way to stem greed is to turn off the
television," says Duke child and adolescent psychiatrist Dr.
John March. "We live in a culture that is greedy. Children have
a harder time stepping outside themselves and understanding
what greed is. They are bombarded by commercial messages. I
tend to suggest that parents not lecture on the moral evils of
greed. Teach by example instead." March advises parents to "do
the ordinary thing." If you're in a family which has just
bought a new house or have other financial issues, or where
someone has been sick, it may mean scaling back. Explain
without apology: "I wish we could do more, but Christmas is
going to be on the scanty side this year. That's the way it
is.

"Be straight up with your children - and show
them sincere affection," March says. "Kids will take all kinds
of difficult stuff if it occurs against the backdrop of
affection. If they feel loved, and care about their
relationship with you, the rest doesn't really matter very
much."

Invite Santa, Ms. Claus, and the Elves to a Meeting. But how
do you maintain some semblance of order, while indulging in the
spirit of the holidays?

March recommends Family Meetings. Well before
the holidays, parents should sit down with each other to talk
about how to set up the few weeks around the holidays so that
everyone has fun. The meeting should include your children,
even those as young as three or four. Make sure to listen to
what your children say, and address their concerns: Do they
feel comfortable with the routine changing? Do they understand
the situations to which they will have to adjust? Talk about
what everyone would like to happen during the upcoming
holidays, and get clear about what is in the realm of
possibility. That's also the time to curb the Gimme Gremlins.
Then make plans for special outings, as well as for low-key
play dates and other fun activities.

The same advice holds true for families with children who
have identified mental disorders. For example, children with
attention deficit disorder, or who are very anxious, are more
vulnerable during
the holidays, and can get a little disregulated, March says.
"The excitement of the holidays may make them more impulsive
and hyper, or more anxious. Parents should try to pick up on
their cues early. A family meeting will help them understand
the rules of the game and to learn to adapt. The holidays are
like a little life transition. Work with your child and his or
her mental health provider to figure out how to adjust things
so that you can all cope skillfully with the pending changes in
routine."

March says his take-home message to all parents is to
remember, in any given moment, that kids and parents are doing
the best they can do. "The trick is to be as kind as possible
to each other," he says. Do's and don'ts for parents include:
DO make sure you take care of yourself. DON'T try to protect
your children from all stressful or difficult situations. (You
can't.) DO try to set the world up so it runs well. (You
can.)

And finally, DO view the holidays not as a burden, but as an
opportunity to have some fun together. Is Your Goose Cooked? Of
course, food safety is a daily, year-round proposition, but
during the holiday feasting season, when we tend to let our
guard down a little, an extra word of caution is in order.
Children are at higher risk than adults for developing E. coli
infections, for getting salmonella from raw eggs, and for
having their holidays ruined by staphylococcal food poisoning -
all of which can be avoided if the grown-ups take
precautions.

The same bacteria that has set off alarms around chicken -
campylobacter - is found in turkey. Duke pediatrician Ross
McKinney advises parents to thoroughly cook their goose,
turkey, or any other fowl. And that delicious breading stuffed
inside the bird provides a great environment for bacteria. So
if the meat is pink, avoid the stuffing or cook the turkey
longer.

While it's worth something to use a thermometer to figure
your meat's internal temperature, McKinney says to use your
eyes, too. "Bacteria can survive rare conditions," he says. "If
the meat is pink, delay dinner and finish cooking the bird.
You'll be glad you did."

And what about all that leftover turkey? "It's okay to
re-warm turkey that's been promptly refrigerated," McKinney
says. "Warming it through thoroughly
the first time will kill the bacteria. But if you let it set
out for several hours before putting it in the fridge, don't
make cold turkey sandwiches with it - especially if the meat is
even slightly pink." McKinney thinks parents need to re-think
meal preparation to avoid food poisoning. "We tend to cook the
creamed onions ahead of time and set them on the counter while
we cook the rest of the meal," he says. "Anything containing
cream or milk that's left out of the refrigerator for any
period of time grows bacteria that can cause staphylococcal
food poisoning." The cramping, vomiting, and diarrhea that
result can ruin your child's holidays - and yours - in a big
way.

Ban Batter Licking? Baking cookies with grandma is a holiday
tradition for many. Do parents really need to spoil the fun by
banning batter-licking? When raw eggs are involved, and if you
want to be absolutely correct, the answer is yes. "If you get
the wrong egg, you're going to get sick," McKinney says. "Very
young children are at higher risk for salmonella poisoning. So
you need to weigh the potential risk with the enjoyment of the
activity."

The same salmonella risk applies to homemade eggnog. One
alternative is to buy supermarket brands, which are
pasteurized. Or look for pasteurized eggs in the dairy
department.

And while you're baking, McKinney reminds you to wash your
apples before putting
them in a pie or homemade cider. Apples which have fallen to
the ground and come in contact with fecal matter from cows
carry the same E. coli (0:157 H:7) as undercooked beef. Keeping
Kids Healthy No one wants to be sick during the holidays,
especially children. To help your whole family stay healthier,
get your child a flu shot.

Pediatric experts say the flu shot is more effective in
reducing the degree of illness in children than in adults. "The
perceived benefit of giving children flu shots may be low,
especially since many insurance companies don't tend to cover
the shots," says Dr. Dennis Clements, medical director of Duke
Children's Primary Care. "But as someone who does pediatric
infectious disease as a specialty, I can say it's a good idea
to get your children flu shots."

Not only are children the biggest culprits in the spread of
the disease, they also tend to stay contagious longer, and to
stay sick longer with the flu. They also suffer with
flu-related gastro-intestinal disease in a way adults do not.
Influenza changes each year, and children have the least
experience with the viruses. Children with asthma or other
respiratory disease who get flu shots can't help but be less
sick as a result. How much less sick they are depends on the
strain of the flu and how sick the child is otherwise.

If your child is under the age of eight and has never had
the flu or a flu shot, get him flu shots twice this year, one
month apart. By next year, he'll only need one shot.

Don't Overdose Your Child! If and when your child gets sick
this winter, find your reading glasses and read the fine print
on the medicine labels. Tylenol infant formula is three and a
half times the strength of Children's Tylenol because it's
designed to give a smaller, concentrated dose to infants.
Parents who have both on hand may unwittingly overdose their
children. "With so many preparations with different
concentrations on the market, parents can't afford to go by the
presumed dose," Clements says. "The trick is to do a little
math. It should be 10 milligrams per kilogram, which is about
five milligrams per pound."

Clements says it's fine to alternate between children's
acetaminophen (found in Tylenol) and ibuprofen (found in Motrin
or Advil), as long as you can keep the dosing straight:
acetaminophen is given every four hours; ibuprofen, every six.
Write down the type of medicine, dose, and time to avoid
overdosing, especially when Mom and Dad are both dispensing the
meds!

The Fever Debate Is it best to keep the fever down anyway?
Fever is the body's response to an illness or infection, and
can actually help shorten the length of time your child is
sick. "So do you want your child to feel sick and crummy for
two days, or somewhat sick and not too crummy for three?"
Clements asks.

"It's a judgment call. Fever is just one of several signs
you're sick, and should carry
the same weight as other factors and symptoms. A child with no
fever who is lethargic worries me more than a child with fever
who is playing Monopoly."

Think twice before investing in an ear thermometer. Although
they rarely record a fever that doesn't exist, Clements says
they sometimes give a normal reading when in fact the child has
fever.

Avoiding the Emergency Department Planning to serve
alcohol-laced punch at your holiday party? Pediatric emergency
medicine physician Dr. Karen Frush hopes you'll keep it out of
children's reach. "Children are very sensitive to alcohol, and
become very sick when they ingest it," she says.

Children are around more, schedules are hectic, and parents
tend to get distracted before and during holidays. Emergency
department clinicians say most holiday-related emergencies
could be prevented if parents paid closer attention. Frush's
list includes young children who swallow glass tree ornaments
or their older siblings' small toy pieces; who burn themselves
on fireplaces, heaters, and wood-burning stoves; who ingest
kerosene; or suffer kerosene chemical burns on their skin.

If Mommy insists on kissing Santa Claus underneath the
mistletoe, she might consider buying plastic. The real stuff is
toxic. Since it is hard to tell whether your toddler has eaten
one or many berries, Duke poison control expert Dr. Shirley
Osterhout advises you to call poison control or your doctor
immediately. What about poinsettias? While they are not
poisonous, Osterhout says the milky sap of the leaf can be very
irritating to the skin. If your young child gets into the
plant, use clear water from a shower head or sink hose to clean
all the sap off.

Worry-Free Winter Wonderland Enough of these indoor worries.
Send the kids outside to play! But wrap them up first -- head
to toe - to prevent frostbite. A lot of heat is lost through
the neck and wrists, where the blood flows close to the skin's
surface. So scarves, hats, and good long gloves are
important.

"Frostbite in children is a problem mostly because kids
don't tend to give you any hint that they're cold," says Dr.
Clements. "They're either fine, or they're screaming in pain
from the cold. Adequate, dry clothing is a must."

Frostbite's telltale sign is whitened skin. It most
frequently affects the extremities - toes, fingers, the face -
where circulation is decreased. "If you find a frostbitten area
on a child, warm it up very slowly over the course of an hour,"
he says. "Start with tepid water, not warm water. And give your
child a bullet to chew on. It's going to hurt."

Frostbitten skin has actually frozen. "First there's no
circulation in the area, and then the temperature continues to
drop," Clements explains. "With frostbite, you actually get ice
in the tissues. Lactic acid builds up, which causes the pain as
the ice thaws." If the skin persists in being white, or turns
black, get your child to a doctor.

One more thing before you send your kids out to play in the
snow: Talk over sledding safety rules. "We took care of some
children who had tragic accidents on sleds last year," Dr.
Frush says from Duke's emergency department. "One child was
being pulled on a sled behind a truck and then was struck by
the truck. Some other children being pulled in a similar
fashion were killed by an oncoming car."

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