Fall 2012 Newsletter

To the families of the Northwestern Children’s Practice,

We would like to wish you a happy, healthy and joyful holiday season. Our entire staff is looking forward to continuing our tradition of offering compassionate and comprehensive health care to your family in this new year.

We look forward to seeing new patients, and to caring for our patients that are already part of our Northwestern Children’s Practice family. We are even fortunate enough to take care of children of our former patients, for which we are grateful. We are honored to be caring for your family.

Happy holidays to all.

Fondly,

Marc Weissbluth, Rebecca Unger, Priya Sharma, Daphne Hirsh, Scott Goldstein, Dawn Li, and Aaron King

AUTUMN AND WINTER WELLNESS WONDERLAND

By Rebecca Unger MD and Ben Stewart, MS3, Feinberg School of Medicine

Be Good for Goodness Sake

Play it safe. Prevent injuries with your winter pastimes:

Wear well fitting helmets while bike riding, skiing, snowboarding, and playing hockey. Use other protective equipment as appropriate (wrist guard, mouth guard)

Be aware of obstacles on your toboggan path.

Never ski, snowmobile or skate alone.

Avoid alcohol and other drugs before winter sporting activities.

Children under 16 years should not operate a snowmobile and children under 6 should not ride in a snowmobile.

Use sunscreen even in the winter to protect exposed skin. Wear at least SPF 15 and protective eyewear and lip balm.

Winter fashion tips:

Dress in layers. Use moisture wicking fabrics to help regulate body temperature.

Cover heads and necks to keep warm. Avoid long scarves and cords that can get caught and hoods that can block peripheral vision.

Food for thought:

Be sure to eat breakfast. It helps jump start your day. Quick, easy and well-balanced breakfast ideas include: smoothies (add your favorite greens along with milk, frozen berries and a touch of lemon); nut butter sandwich on whole grain bread (at least 3 grams of fiber /serving); cereal, berries with Greek yogurt (more protein than other yogurt); breakfast apple crisp with apples. Flour, cinnamon, oatmeal (made in a microwave).

Drink milk 2-3 times/day to keep those bones strong. For children two and older drink skim or 1 % milk (both low fat milks) and use that to make a nice steaming cup of hot chocolate.

Eat 5 servings of fruits and vegetables each day. Serve fruits and/or vegetables with each meal and snack. A well balanced diet can help you stay healthy.

Be fit:

Encourage daily physical activity. Children and adults should be active for an hour each day and engage in vigorous physical activity at least 3 days each week. Be active as a family as much as possible. Caregivers should be good role models. Try to incorporate physical activity into your daily lifestyle such as walking a dog, cleaning the house, carrying groceries and walking (at least part way) to activities, school and/or work.

Ideas for Chicagoland winter physical activities: Check out a museum passport from all Chicago Public Libraries. Explore Chicago Park District activities. Enjoy some Family Winter Activities and Outings. Get moving at Ice Skating Rinks and Roller Rinks

Home Safe Home:

Winter weather means more time spent indoors and increased used of artificial heating sources, which is a great time to make sure that you have working smoke detectors and carbon monoxide detectors on every level of your home.

Practice good fire safety by ensuring your family has a fire escape plan in place. Keep a Class ABC fire extinguisher which is graded for waste, electrical, and grease fires in your kitchen. For small grease fires, using pot lids to cover the fire (put on oven mitts first!) can be effective as can smothering the fire with baking soda. Putting water on a grease or electrical fire can be dangerous. For oven and microwave fires, turn off the appliance and keep the oven door closed. Visit the US Fire Administration for more information.

If you are planning on using your chimney this year make sure that you have it inspected before using it for the first time and never use flammable liquids or charcoal (which can produce dangerous amounts of carbon monoxide) for starting or maintaining an indoor fire.

Protect your family from scalding water burns by setting your water heater temperature to Clean hands save lives. Wash your hands, wash your hands, wash your hands. Sing Happy Birthday twice through to wash your hands thoroughly. Use hand sanitizer if soap and water are not available.

While decorating for the holidays, make sure that you keeping small items that may be choking hazards out of reach of children who are less than 3 years old. If you are decorating the outside of your home, take appropriate precautions for yourself by securing ladders and wearing shoes with good rubber grips.

Joy to the World:

When you are shopping for gifts for your friends and family this year, keep an eye out for ENERGY STAR-qualified labels on electronics and home appliances (http://www.energystar.gov).

For the electronic devices you already have, you can save energy by unplugging things that you are not using or are already charged. According to ComEd, consumer electronics account for 15% of household electricity use and 40% of that is spent while the devices are not turned on.

Encourage your children to turn out lights whenever they leave a room and to help remind you to do the same.

Whenever you leave your home for more than 4 hours, you can set your thermostat to 5-10 degrees cooler than normal to save energy. Turning your heating system off and back on again can INCREASE your total energy expenditure. Lowering your thermostat to cooler temperatures before you go to sleep at night.

Minimize the energy necessary to warm or cool your home by making sure your home is well insulated.

When incandescent bulbs in your house burn out, replace them with compact fluorescent bulbs. While fluorescent bulbs are more expensive, they also last longer and consume far less energy, leading to an average savings of over $40 over the life of the bulb. Similarly, replace old incandescent Christmas lights with LED lights which are more energy-efficient and pose less of a fire risk.

When shopping for the holidays, take the opportunity to dispose of old batteries and used ink cartridges at your local drug store. You can also return ink cartridges and old electronic equipment to office supply stores to be properly recycled. For a more complete list of recycling options, visit 1 800 Recycling.

NEW PARENT SUPPORT GROUP

The Northwestern Children’s Practice started a support group for new parents in April of 2010. The purpose of this group is to provide a forum for the concerns of new parents. Many of these concerns relate to feeding and sleeping. These are activities that require learning on the part of the baby and their parents.

Dr. Marc Weissbluth. Author of “Healthy Sleep Habits, Happy Child” attends weekly to share his expertise and answer your questions.

Nancy Nelson, who is a Certified Lactation Consultant, as well as a Pediatric Nurse, is also available to share information about breastfeeding and other baby care issues.

Many of the mothers and fathers who come to the meetings, return week after week. They begin to share their experiences with the parents of the new babies, who are there for the first time.

Anna Fazekas, mother of William writes:

“I came to the new parent group for the first 10 weeks of my son’s life. The advice I got from Dr. Weissbluth and Nancy boosted my confidence as a new mother and I credit what I learned at this group to my son sleeping at least 10 hours a night by seven weeks. I have returned to the group at different transition periods during my son’s first year. I always come away with valuable advice.”

Alina Slotnik also writes:

“The new parent’s group is really valuable. In fact I cannot overstate how essential the advice about sleep and eating was. The hour at the group is the most efficient time I can spend getting answers to issues and questions. You walk out with specific strategies to implement that day. My daughter is now 18 months old and has grown up to be an excellent sleeper and eater in no small part thanks to this supportive, helpful resource! Thank you so much!“

We provide light refreshments during the meeting and there is an opportunity for parents to informally share their experiences with each other. They are often surprised at how much they can help each other become better parents.

Many friendships have developed as a result of these meetings.

The meetings are held on Tuesdays from 12:30 PM to 1: 30 PM in the Lake Office, Suite 123. You do not need to pre-register. Call Nancy Nelson at 312-642-5515 ext. 125 for more information.

RACE YOU TO THE TABLE!

By Teri Kawalski, MSN, RN, CPNP

With the school, activity, and holiday calendars filling up, it’s easy to rush through dinner, eat in front of the television or in the car on the way home. However, take time this holiday season to sit down with your family and enjoy a meal. Eating together as a family can foster healthy and strong relationships. It also has been shown to protect against obesity, school problems, and substance abuse in children.

Several studies have shown that eating together as a family protects children from obesity and other nutritional health problems. In fact, one study found that children of families that eat five or more meals per week together were about 25% less likely to have nutritional related health problems when compared to their peers who ate one or less shared meal per week. There are several hypotheses as to why shared family meals are protective against obesity. Families who eat together are less likely to eat ready-made dinners or fast food and more likely to eat a home-made and nutritious meal. Family mealtime provides a time when parents can monitor their child’s intake, and even recognize disordered eating habits, including eating too little or eating too much. Removing the distraction of television, computers, or other electronic devices allows families to focus on eating and stopping appropriately when full (Hammons & Fiese, 2010).

Not only do family meals help protect children from obesity, they can also protect against high risk behaviors among adolescents. According to one study published in the Journal of Adolescent Health, sitting down and eating five meals or more per week as a family reduces the risk of substance abuse in adolescence, specifically cigarettes, marijuana, and alcohol, specifically among females. Researchers surveyed students between the ages of ten and twelve and inquired about family meal frequency, substance abuse, race, and socioeconomic status. They were also asked to rank the closeness they felt to their parents, or how comfortable they were with approaching their parents with a problem or concern. Five years later they were surveyed again. Researchers found that family meal frequency was inversely related to substance abuse. They also found that eating together as a family supports cohesiveness of the family unit and supports the parent-child relationship (Eisenberg, et. al., 2008).

The good news is that family meals have these important benefits. The bad news is that, for many families, it is still hard to find the time and space to sit down together for a meal. Here are a few recommendations:

Family meals do not have to be dinners. Try gathering together for breakfast, or a weekend brunch/lunch.

Prioritize family meals on the weekends if it is too hard during the weekday.

Reorganize your child’s routine at night to be able to make time for a meal together. For example, try moving a nighttime bath to another part of the day so you can have dinner together and still be able to put your child down for an early bedtime.

Dress up your family dinners. Try a special tablecloth or add some fun candles (fire fairies!) to your table.

Include your children in meal planning and preparation when age appropriate.

Because families come in all shapes and sizes, recognize that every little bit helps! It is a tough cookie to figure out how to put this all together and still take care of other responsibilities, like working, and enabling the whole family to get enough rest.

This holiday season (and beyond!) gather around the table and enjoy these moments just as you savor each bite of all of the healthy (and unhealthy!) holiday fixings.

References:

Eisenberg, M.E., Neumark-Sztainer, D., Fulkerson, J.A., & Story, M., (2008). Family meals and substance use: Is there a long-term protective association? Journal of Adolescent Health, 43, 151-156.

Hammons, A.J., & Fiese, B.H., (2010). Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics, 127, 1564-1574.

Effects of family meals, sleeping and screen time on obesity in preschoolers. HealthyChildren.org, American Academy of Pediatrics, February 8, 2010.

Fever

(Excerpts from “Pediatrics” and “AAP News”)

Fever in a child is one of the most common symptoms managed by pediatricians and is a frequent cause of parental concern. Fever accounts for one-third of all presenting conditions in children. Fever, however, is not the primary illness, but is a physiological mechanism that has beneficial effects in fighting infection. Fever slows the growth and reproduction of viruses and bacteria, and enhances the body’s immune response. Most fevers are of short duration, are benign and may actually be protective. Fever, in and of itself, is not known to endanger a generally healthy child; in contrast, fever actually may be of benefit. Some studies have shown that fever actually helps the body recover more quickly from viral infections. The degree of fever does not always correlate with the severity of illness. In addition, there is no evidence that fever worsens the course of an illness or that it causes long-term neurological complications.

A normal temperature range is 97-100.4 degrees. Many parents give fever medications (Acetaminophen or Ibuprofen) even when there is minimal or no fever because they are concerned that the child must maintain a “normal” temperature. Approximately 50% of parents consider a temperature of less than 100.4 to be a fever and 25% of parents would give medication for a temperature less than 100. The primary goal of treating a child with a fever should be to improve the child’s comfort rather than focusing on the normalization of the body temperature. The desire to improve the overall comfort of the febrile child should be balanced against the desire to simply lower the body temperature. Parents should focus on monitoring activity, observing for signs of serious illness and maintaining appropriate fluid intake to maintain hydration. Many physicians continue to encourage the use of antipyretics, believing that most benefits result from improved comfort and the accompanying improvements in activity and feeding, less irritability, and a more reliable sense of the child’s overall clinical condition. Sleeping children should not be awakened to take a temperature or to give fever medications. Treating with fever medication does not prevent febrile seizures.

Acetaminophen and ibuprofen, when used in appropriate doses, generally are regarded as safe and effective agents in most clinical situations. However, as with all drugs, they should be used judiciously to minimize the risk of adverse drug effects and toxicity. Studies provide some evidence that combination therapy may be more effective at lowering temperature. However, questions remain regarding the safety of this practice as well as the effectiveness at improving discomfort, the primary treatment endpoint. The possibility that parents will not receive or not understand dosing instructions, combined with the wide array of formulations that contain these drugs, increases the potential for inaccurate or overdosing.

From Healthy Children.org

A fever can’t always be detected by feeling your infant’s forehead. It’s usually necessary to take his temperature as well. Although there are numerous thermometers on the market that measure temperature in different areas, parents should use rectal thermometers with their babies for the most accurate reading. “The ‘gold standard’ measurement is still the rectal temperature,” says Dr. Vickers.

Once you’ve identified a fever, you can begin treating it if needed based on your child’s age and other symptoms. While you may instinctively want to bring your child to the doctor’s office, it may not be necessary, especially if the child seems fine once the fever is reduced.

“What I tell parents when they call me in the middle of the night is, ‘Don’t panic.’ Fever by itself is not something to panic about. I ask them how the child looks and how they’re acting—are they behaving normally?” says Dr. Huggins. “Then we focus on how to get the fever down. With the vast majority of viral infections, once you get the fever down, everything’s better.”

For More Information on Tylenol and Ibuprofen Dosing, click here.

How to Take a Rectal Temperature

Taking a rectal temperature is the most accurate way to measure a young child’s true body temperature. The American Academy of Pediatrics encourages parents to remove mercury thermometers from their homes to prevent accidental exposure and poisoning. Here are the steps for taking a rectal temperature:

Use a rectal thermometer (preferably digital) that has a round bulb at the end.

Clean the tip of the thermometer with rubbing alcohol or soap and water.

Lubricate the tip with a water-soluble lubricant.

Place your baby on his stomach across a firm surface or your lap. Or, if your child is more comfortable on her back, gently lift her legs and proceed to step 6.

Stabilize your child by placing one hand on his lower back just above the buttocks. If your child is wiggling, ask someone to help you restrain him.

Slowly insert the lubricated thermometer into the anal opening about one-half inch, stopping if you feel any resistance. Never force the thermometer.

Gently hold the thermometer in place between your index and forefinger while keeping your hand against your baby’s bottom.

Wait until your thermometer beeps or signals that it’s done. A reading of 100.4 degrees Fahrenheit or more is generally considered to be a fever.