Friday, July 16, 2010

yummy gummys


My little Ella has struggled with constipation since she was 2 months old. As a pediatrician, I know all things you are "supposed" to do (lots of fruits and vegetables, lots of water, Miralax if needed) but in the real world it doesn't always work. Some days I just plain forgot to feed her the 4 prunes she needed to stay regular! But there is nothing sadder (and more guilt-inducing) than watching your child cry and struggle when you know you could have done something about it. Thank heavens for Fiber gummies. I discovered these a few months ago, and they have been life changing. They have loads of fiber, and best of all Ella asks for them by name (she never did that with the prunes!)

Now, they are not perfect. They can be a choking hazard for children who are too small (I actually buy the kind from Costco and cut them in half so she can chew them). Also, like any gummy, they can promote tooth decay. I try to brush her teeth after, or at least give her an apple slice. And they don't replace a healthy, well-balanced diet.

But in our home, the benefits outweigh the risks, no question.

Sunday, July 4, 2010

healthy children

The AAP (American Academy of Pediatrics) has launched a new website to help parents.


The site contains all kinds of useful information, from colic to toilet training to (gasp) dating.

One of the cool features is the Symptom Checker. It's great for those "Do I really need to go in for this?" kind of questions.

Here's an example. Say your child has a fever and looks okay, but don't know if you need to call or go in. You can pick "fever" from the list of symptoms and here's what you get:

Call 911 Now (your child may need an ambulance) If

  • Not moving or very weak
  • Unresponsive or difficult to awaken
  • Difficulty breathing with bluish lips
  • Purple or blood-colored spots or dots on skin

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Not alert when awake
  • Any difficulty breathing
  • Great difficulty swallowing fluids or saliva
  • Child is confused (delirious) or has stiff neck or bulging soft spot
  • Had a seizure with the fever
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do not give your baby any fever medicine before being seen)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Very irritable (e.g., inconsolable crying or cries when touched or moved)
  • Won't move an arm or leg normally
  • Signs of dehydration (very dry mouth, no urine in more than 8 hours, etc.).
  • Burning or pain with urination
  • Chronic disease (e.g., sickle cell disease) or medication (e.g., chemotherapy) that causes decreased immunity

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Age 3-6 months with fever
  • Age 6-24 months with fever present over 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.)
  • Fever repeatedly above 104° F (40° C) despite fever medicine
  • Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • Fever with no other symptoms and you don't think your child needs to be seen

Cool, huh? So say you decide you don't need to call, but you still want to help your child. Click on the care advice link, and you get this:


  1. Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for sick children and help the body fight infection. Use the following definitions to help put your child's level of fever into perspective:
    • 100°-102°F (37.8° - 39°C) Low grade fevers: beneficial, desirable range
    • 102°-104°F (39 - 40°C) Mild fever: still beneficial
    • Over 104°F (40°C) Moderate fever: causes discomfort, but harmless
    • Over 105°F (40.6°C) High fever: higher risk of bacterial infections
    • Over 106°F (41.1°C) Very high fever: important to bring it down
    • Over 108°F (42.3°C) Dangerous fever: fever itself can harm brain
  2. Treatment for All Fevers: Extra Fluids and Less Clothing
    • Give cold fluids orally in unlimited amounts (reason: good hydration replaces sweat and improves heat loss via skin).
    • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling). (Caution: overheated infants can't undress themselves.)
    • For fevers 100°-102° F (37.8° - 39°C), this is the only treatment needed (fever medicines are unnecessary).
  3. Fever Medication:
    • Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).
    • Give acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil). See the dosage charts.
    • The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2° to 3° F (1 - 1.5° C).
    • Avoid aspirin (Reason: risk of Reye's syndrome, a rare but serious brain disease)
    • Avoid alternating acetaminophen and ibuprofen (Reason: unnecessary and risk of overdosage)
  4. Sponging:
    • Note: Sponging is optional for high fevers, not required.
    • Indication: May sponge for (1) fever above 104° F (40° C) and (2) doesn't come down with acetaminophen (e.g., Tylenol) or ibuprofen (always give fever medicine first).
    • How to sponge: Use lukewarm water (85 - 90° F) (29.4 - 32.2° C). Do not use rubbing alcohol. Sponge for 20-30 minutes.
    • If your child shivers or becomes cold, stop sponging or increase the water temperature.
  5. Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
  6. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101° and 104° F (38.4° and 40° C) and last for 2 or 3 days.
  7. Call Your Doctor If:
    • Fever goes above 104° F (40° C) repeatedly
    • Any fever occurs if under 12 weeks old
    • Fever without a cause persists over 24 hours (if age less than 2 years)
    • Fever persists over 3 days (72 hours)
    • Your child becomes worse
There are all kinds of symptoms to choose, as well as dosing guides for common medications (Benadryl, Motrin, Tylenol, etc). While it's not going to cover every question (that's why we are here), it's a great starting place and you can trust all of the information you find.