Category Archives: Parenting

Sleep tips from Children’s Sleep Center

Children's Sleep Center in St. Paul specializes in identifying and treating the full gamut of sleep challenges. (iStock Photo)

Children’s Sleep Center in St. Paul specializes in identifying and treating the full gamut of sleep challenges. (iStock Photo)

subscribe_blogKaren Johnson, APRN

Parents know good sleep is essential for healthy growth and functioning. Parents also know that good sleep can be hard to come by.

Families seek out the Children’s Sleep Center for our experience in treating rare and common sleep disorders in infants, children and adolescents. At Children’s Hospitals and Clinics of Minnesota, we specialize in identifying and treating the full gamut of sleep challenges, ranging from difficulties falling asleep, staying asleep, or with breathing during sleep, to difficulties waking up and staying awake.



SLEEP TIPS FOR ALL CHILDREN

Random bedtimes breed bad behaviors in kids

Many parents have learned the hard way that late bedtimes make for cranky kids the next day. In one study, children who went to bed after 9 p.m. were rated as having more behavior problems. During the day, later bedtimes affected the child’s school performance. Irregular bedtimes cause worse behaviors than short amounts of sleep. Behavioral problems improve when children have regular bedtimes.1

Sleep tips for a better bedtime routine

1. The bedtime routine should take place in the child’s bedroom where it’s quiet — a great time to read two to three books to your child, developing a love for reading, too.

2. Your child will be calmed when the routine is done in the same order each night.

3. Younger children may benefit from a visual schedule (pictures, words, or both) to remind them of the steps.

4. Determine which events are calming and which are stimulating. Calming events are required for bedtime. For example, if bathing is stimulating instead of relaxing, move the bath time earlier in the evening or to the morning.

Kids and electronics

Screen time can impact the quantity and quality of sleep. The American Association of Pediatrics recommends no more than one to two hours of screen time a day for children two years and older. The light from these screens suppresses melatonin, a hormone in the brain that signals sleep. Due to the usage of multiple electronic distractions (cellphones, computers, tablets) for tweeting, texting, social networking and entertainment, kids’ evenings are “lit up.” The light from these devices is keeping many kids awake long into the night, creating sleep deprivation. Losing one hour of sleep at night can negatively affect a child’s academic performance at school.

Tips for improving sleep

1. Implement an electronic curfew at least one hour before bedtime.

2. Remove all electronic devices from the bedroom.

3. Adjust your child’s schedule to accommodate for homework to be completed earlier in the evening when homework requires using electronic devices.

4. Consider doing homework in the morning, as the light from these devices helps your child wake easier.3,4

SLEEP TIPS FOR PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Can I get sick from my CPAP mask?

Unwashed CPAP/BiPAP masks may have an odor and harbor germs. Because you breathe through the mask for several hours each night — particularly if you use a heated humidifier in conjunction with the CPAP machine — you create a warm, moist environment inside your mask. Fungi, bacteria and viruses can thrive in this environment. These infectious agents then have direct access to your airway and can make you sick.

  • Wipe the CPAP mask clean each day with a mild detergent and allow it to air dry.
  • If you have any questions, call your equipment vendor or the Children’s Sleep Center for help.

Important things to know about CPAP/BiPAP and sleep

1. You should start to feel better during the day soon after you consistently start using your CPAP/BiPAP at night.

2. CPAP/BiPAP improves your health and well-being in many ways.

3. Not everyone finds CPAP/BiPAP easy, but there are things that you can do to make it easier. Ask your sleep specialist for ideas.

4. To succeed with CPAP, you need to be patient and stick with it. Since it generally will make you feel better the next day, taking a night off from using it is not a good idea.

5. It is not unusual to find your mask is off when you wake at night. What matters is being aware and putting the mask back on again when you notice it is off.

Treating sleep apnea in kids improves behavior, quality of life

Kids with untreated obstructive sleep apnea often are tired during the day, have trouble paying attention and other behavioral problems; these children are not getting enough quality sleep at night.

Obstructive sleep apnea (OSA) is marked by pauses in breathing while asleep. These pauses can occur through the night and disrupt sleep. Positive airway pressure machines help keep the airway open. The main message is that this treatment — although it may be difficult to tolerate — can result in a significant improvement in the child’s behavior and quality of life. One of the issues is that children may not want to wear the bulky mask while they sleep, but the study shows that even three hours a night is enough to make a big difference by improving attention, behavior, sleepiness and quality of life.5

PEDIATRIC PARASOMNIAS

Pediatric parasomnia refers to movement or experiences that take place during sleep as a child transitions from sleep to wake phases. A few common parasomnias include sleepwalking, sleep terrors and confusional arousals.

Parsomnias can be common in families and may be triggered by other sleep disorders, such as OSA and restless leg syndrome (RLS). Other triggers include certain medications, sleep deprivation, irregular sleep schedules, fever, sleeping in unfamiliar places, stress and separation anxiety.6

Sleep terrors occur during the first hours after falling asleep. The child wakes abruptly from sleep with loud screams, is agitated and frightened. The child is unresponsive to a parent’s efforts to calm and does not recall the event in the morning. It’s best to stand by during the event, observe and maintain the child’s safety. The terror is not traumatic for the child, only for the observer.

Nightmares occur at the last half of the night during REM sleep. They are disturbing dreams that wake the child, usually creating fears and anxiety. The child can recall the nightmare in the morning.

Sleepwalking occurs in about 15 percent of children, peaking between 8-12 years of age. Some may exhibit inappropriate behaviors at night, even urinating in strange places. Children have injured themselves by unconsciously carrying out dangerous behaviors such as leaving the house at night. Safety is the biggest concern in managing sleepwalking events. Second-floor bedroom windows should be locked and alarms placed on outside doors to alert parent if the child attempts to leave the home during the night.

Confused arousals may occur at any time during sleep. The child may sit up in bed, cry, whimper, moan and seem agitated and confused. Usually they do not respond to your interventions to comfort.

Home management

  • Maintain a regular sleep and wake schedule seven days a week. Getting the proper amount of sleep to feel well-rested will reduce the triggers for an event.
  • Precautions for safety during sleepwalking events need to be addressed. Alarms on doors and windows are advised.
  • Night terrors and confused arousals do not require the child to be comforted, as this will intensify the event. Parent should stand by to observe and maintain child’s safety.
  • Children will outgrow parasomnias as they get older.
  • If your child is having regular parasomnia events, an evaluation by your sleep provider may be required.

Karen Johnson, APRN, is a certified nurse practitioner at the Children’s Sleep Center in St. Paul. Get more information about the Children’s Sleep Center.

Resources
1. www.npr.org, 2003
2. Sleep for teenagers; www.nytimes.com, (2014).
3. Treating sleep apnea in kids improves behavior, quality of life; www.webmd.com, (2012).
4. Limiting screen time improves sleep, academics, behaviors, study finds; www.sciencedaily.com, (2014).
5. American Journal of Respiratory and Critical Care Medicine, 2012
6. Suresh Kotogal MD (2014). Sleepwalking and other parasomnias in children.

Cognitive-behavioral therapy for insomnia an option for kids with sleep trouble

Cognitive-behavioral therapy for insomnia (CBT-I) requires regular visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. (iStock photo)

Cognitive-behavioral therapy for insomnia (CBT-I) requires regular visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. (iStock photo)

Terese Amble, PsyD, LP

Insomnia is broadly defined as difficulty falling asleep, staying asleep and/or subjective, poor-quality (“non-restorative”) sleep.

Everyone has problems sleeping at times; however, a diagnosis of insomnia is made if sleep problems persist for more than one month and result in some degree of daytime impairment. Untreated insomnia can result in chronic sleep loss that can cause excessive daytime sleepiness and impact daytime functioning, which may range from fatigue, moodiness/irritability or mild cognitive or behavioral problems (difficulties with concentration/attention, hyperactivity) to significant effects on mood, behavior or school performance. Chronic insomnia also increases the risk of physical and mental illness.

Given the negative impact of chronic poor sleep, it is important to have sleep problems evaluated and treated. Behavioral treatments are the first line treatment for insomnia and involve improving sleep without the use of medications, as there are no medications that are FDA-approved for the treatment of insomnia in youth. Cognitive-behavioral therapy for insomnia, commonly referred to as CBT-I, is a safe and effective treatment that aims to help children and adolescents identify and replace thoughts and behaviors that cause or worsen sleep problems with thoughts and behaviors that promote sound sleep.

CBT-I requires regular (usually weekly or biweekly) visits with a sleep provider who will work with you and your child to help change the way he or she sleeps. The frequency of treatment may vary from as few as two sessions to as many as eight of more sessions, depending on the specific sleep concerns and progress. At the beginning of treatment, a comprehensive sleep evaluation will be conducted to determine factors that are underlying or contributing to sleep difficulties and to help develop an effective treatment plan. As part of this initial evaluation, you will be asked to keep a sleep log of your child’s sleep patterns for one to two weeks and your child may be asked to wear an actigraph, a portable wristwatch-like device which records and stores more objective information about body movements and sleep-wake patterns.

subscribe_blogAfter this initial evaluation, treatment is individualized and each session is focused on learning specific cognitive and behavioral strategies to improve sleep. The cognitive part of CBT-I involves teaching your child techniques to quiet his or her busy mind at night to relax and fall asleep. Your child will learn strategies to recognize, modify or eliminate unhelpful/negative thoughts or worries that interfere with his or her ability to sleep, including unrealistic beliefs and attitudes about sleep and the possible daytime consequences of poor sleep (e.g. “I’ll never be able to fall asleep tonight,” “If I can’t fall asleep, I won’t be able to get up in the morning and I’ll miss my test”).

The behavioral part of CBT-I involves identifying and changing behaviors that may keep your child from sleeping well and developing good sleep habits to promote quality sleep. Treatment is tailored to each child or adolescent and may include some combination of the following techniques:

  • Sleep restriction: This strategy involves temporarily restricting the total time in bed to current amount of sleep each night to decrease the amount of time spent in bed awake. Being extra-sleepy can help your child fall asleep quickly and stay asleep. Once sleep has improved, the amount of time in bed is gradually increased until desired bedtime is reached.
  • Stimulus control: This technique involves eliminating any activities in bed that are not conducive to sleeping to disrupt the association between being in bed and wakefulness (and strengthen the association between being in bed and sleepiness). Stimulus control instructions often include only going to bed when sleepy, leaving the bed (and possibly bedroom) to engage in a quiet activity if not asleep within 15-20 minutes and only using the bed for sleeping both during the day and at night (not watching TV, doing homework, worrying, etc.).
  • Sleep hygiene: This involves learning positive sleep practices and habits that are important for getting sound sleep, such as establishing an optimal sleep environment, implementing a developmentally appropriate and consistent bedtime and wakeup time (no matter how much sleep you got the night before!), avoiding naps, establishing a calming, consistent bedtime routine, decreasing stimulation near bedtime (caffeine, physical activity, conflict/stress) and removing electronics from the bedroom.
  • Relaxation training: Increased mental activity at night (such as worrying or not being able to “switch off” an active, busy mind) or stress about not being able to fall asleep leads to increased activity and tension in the body, which further interferes with the ability to unwind and fall asleep. Relaxation strategies, such as deep breathing, visual imagery, progressive muscle relaxation, autogenics, meditation and mindfulness can be used to help quiet the mind and calm the body at night and improve sleep.

Given the potential negative consequences of chronic sleep loss, it’s important to actively treat sleep problems. CBT-I is a safe and effective way to treat insomnia in children and adolescents without the use of medications. CBT-I is generally short term, but the skills learned during this treatment can lead to lasting, improved sleep if positive habits are maintained.

Terese Amble, PsyD, LP, is a pediatric psychologist in the sleep center at Children’s Hospitals and Clinics of Minnesota.

Prepare your child’s sleep for daylight saving time

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Karen Johnson, APRN

Preparation is the key to minimize the impact of daylight saving time on your child’s sleep patterns. It’s a good idea to get your child into bed a little earlier in the week leading up to the time change.

subscribe_blogChange the child’s body clock

Four days before daylight saving time starts — it takes place at 2 a.m. Sunday, March 8 — get your child to bed 15 minutes earlier the first night. Your child may not actually go to sleep earlier, but by getting him or her to bed sooner, you are encouraging the body to relax earlier than usual. This will lead to falling asleep earlier, too. Make the child’s bedtime progressively earlier by 15 minutes each of the four nights before daylight saving time until it adds up to an hour the night of the time change.

Daylight saving time sleep tips

Make sure that the bedroom is dark. The big challenge for parents during daylight saving time is having the child go to bed when the sun is out. Sleep is influenced by having a dark environment, as this allows for the natural secretion of melatonin that is needed to invite sleepiness.

Calm bedtime routine

Take extra care to ensure that the bedtime routine is calm and as relaxing as it can be. A calm and regular bedtime routine is best, without debates and arguing to promote sleep.

Waking too early

Ensure that your child understands that it’s not time to get up for the day. Encourage him or her to go back to sleep. Some parents put a clock beside their child’s bed and explain what time it has to be before the child can get up for the day. If you have a toddler or young child, use a sleep clock such as the Good Nite Lite. The light is a cue that informs your child to stay in bed until the sun shines on the clock in the morning. This isn’t just effective for time changes; it also can help you train an early riser not to wake Mommy and Daddy too early in the morning and may help with bedtime battles.

Get some sun

Besides making sure to get the proper amount of sleep, early morning bright light exposure also can help set a regular sleep-and-wake pattern called a “circadian rhythm.” Eating breakfast in a bright part of your house or going for an early morning walk outside in the sun will help you and your child wake easier as well.

Daily physical activity is recommended for all children, but don’t try to wear your child out in an effort to get him or her to sleep earlier. Overtired children often take longer to fall asleep and may even resist sleep completely.

Be consistent

While your child is getting used to the new sleep schedule, stick to your usual bedtime rules and routine.

Be patient during this time adjustment as you may have a tired and grumpy child on your hands in the days after the time change. It generally takes about a week after the clocks have changed to be in a new sleeping pattern. Prepare to feel unfocused in the days after you set clocks forward. You might want to keep your family’s schedule more open in the days after daylight saving time in case you aren’t well rested.

Other tips

  • Newborn babies usually are not affected by the start and finish of daylight saving time.
  • Change clocks Saturday evening before going to bed.
  • Check the smoke alarms. Changing the batteries as a good safety rule.
  • If your child has difficulty sleeping, please contact the Children’s Sleep Center.

Karen Johnson, APRN, is a certified nurse practitioner at the Children’s Sleep Center.

“Children’s Pedcast,” Episode 2: Dr. Keith Cavanaugh on sleep health

subscribe_blogDr. Keith Cavanaugh and Karen Johnson, APRN, of the Children’s Sleep Center in St. Paul talk about healthy sleep habits for kids from newborns to teens.

They cover children and schedules, sleep apnea, daylight saving time, teens and technology, and other sleep habits, both good and bad, providing information for parents and kids.

Listen to “Children’s Pedcast” on Podbean, iTunesStitcherYouTube and Vimeo.

Preparing yourself for your child’s surgery

Visiting the hospital ahead of time gives everyone a chance to learn more about what to expect and what’s helpful to do ahead of time or bring with you when you come to the hospital. (2013 file photo)

Jeri Kayser

When a child needs surgery, the focus of preparation usually is with the child.

That makes sense.

We want our kids to understand what’s about to happen so they aren’t overwhelmed or traumatized by the event. They’re kids, after all, and we adults have to deal with it, right? Or, perhaps, wrong.

After more than 30 years as a child life specialist, 20 of those in surgery, I have observed that the first person to be well-prepared should be the parent. Children respond most directly to how their parents are reacting emotionally to the event to gauge their own response.

Imagine you are 3 years old and about to get your tonsils out. This is scary because it’s hard to understand what’s about to happen and frustrating you can’t control it. Age-appropriate information and a supportive staff are helpful, but if you notice your mom or dad is anxious, nothing else matters. You got the message: You should be anxious, too, especially if your parents are trying to suppress their emotions – that is even scarier to a child. You can tell that they are upset, but you don’t know why, so you imagine the worst. If you’re a teenager, you might pick up on the message that we don’t talk about this and it will upset your mom if you bring it up to her. It’s hard to deal with the unspoken stress of your family as well as your own fears and concerns.

When I’ve observed kids coping successfully with the challenges of a health care experience, I have noticed that their families have prepared themselves with some or all of the following techniques:

Seek information

Find out what is happening and why. What are the expected outcomes?  What types of things can you as a family plan on doing to foster your child’s healing?

Attend a pre-admission tour

On our hospital’s website there is helpful information about surgery and how to sign up for a tour. Visiting the hospital ahead of time gives everyone a chance to learn more about what to expect and what’s helpful to do ahead of time or bring with you when you come to the hospital.

Make a list

Write down a list of questions to bring to meetings with health care providers. I remember one family kept an ongoing list in their kitchen for anyone to write down questions, and they all contributed, even the siblings. Everyone had a say, and the questions helped everyone feel a part of the event. Knowledge helps you be in control and having specific tasks you can do to support your child in his or her recovery provides focus and direction.

subscribe_blogBe honest with your emotions

As a parent, our job is to love and protect our kids and guide them towards being an independent adult. It can be overwhelming to have to make decisions for your child that includes any potential discomfort since we so desperately want to keep him or her safe from life’s struggles, but learning to deal with life’s struggles is what helps kids learn to be independent. We also carry with us our own memories and experiences with health care that may help or cloud our emotional response to our child’s experience. It helps to pay attention to where your emotions about surgery differ from your child’s. You each get to own your own perspective.

Kids do best when we are honest with them. When you label your emotions and show your child what you’re doing to help yourself, your child gets to experience some phenomenal role modeling on how to cope with challenging situations.

“I am sad that your tonsils need to come out, but I am glad that the doctors can fix this and soon you will be able to breathe better at night when you’re sleeping,” a parent can say. “Let’s think of some fun things to do while you are healing!”

Take care of yourself

You know yourself best. Helping your child through the experience of surgery can be exhausting. Think about what will help you be in your best place. Whom can you call on for support? Even small favors like having someone else pick up your other kids from school can be a great stress reducer.

Plan on something nice you can do for yourself while waiting for your child’s surgery to be done or when you get home. This also can help you and your child focus forward and be reminded of the time-limiting nature of the experience. It won’t last forever, and soon you’ll be looking back on this adventure.

Cut yourself some slack. There is no perfect person, so there can be no perfect parent. Your effort is what your child will notice and appreciate.

We grow as individuals and we grow as a family when we figure out what works best for us to deal with life’s challenges. This knowledge is precious and affirming and gives us all the more strength to deal with the next adventure.

Jeri Kayser is a child life specialist at Children’s Hospitals and Clinics of Minnesota.

Taking fear out of food-allergy diagnoses

(iStock photo)

(iStock photo)

Dealing with a food allergy diagnosis can feel daunting, especially for the uninitiated, due to its serious nature. But it doesn’t have to be — no parent or child has to face the new reality alone. There are doctors who specialize in food allergies, and there are groups and programs to educate and assist with how to live with food allergies.

The Food Allergy Support Group of Minnesota, founded in 2003, provides support to more than 650 members and is committed to guiding people through the confusion and fear that can come with a food-allergy diagnosis. Its mission is to empower families affected by food allergies by providing support, education and a community to build personal connections.

For the newly diagnosed, finding a board-certified allergist and learning what medications are commonly prescribed for food allergies are at the top of the list. Other actions include: knowing how to read food-ingredient labels, organize the kitchen and recipes, eat safely at restaurants, travel with food allergies, and partner with your child’s school.

All parents should know

It’s important for all parents and teachers to know about potential dangers and how to practice food safety, too. Kids with food allergies may encounter unsafe food or treats brought to school for lunch or holidays such as Valentine’s Day. Or a child’s friend visiting as a house guest may have a food allergy that requires consideration.

Preparing and taking precautions are not as difficult as you may think. Make sure you have the child’s emergency medications nearby and ask to review their Allergy Action Plan from their doctor. Here are some important steps to take if someone is showing symptoms of a food-allergy reaction:

  • Watch for symptoms, which may include hives, coughing or a tight throat.
  • Identify their symptoms on their Allergy Action Plan and determine if they are having a minor or severe reaction.
  • Give emergency medicine as directed, such as an epinephrine autoinjector (ex. EpiPen).
  • Call 911 for medical assistance and head to the hospital in an ambulance.
  • If possible, bring a smartphone or tablet to entertain your child during the wait.
  • Bring safe snacks.

Food or foe?

subscribe_blogEight foods account for more than 90 percent of food allergies in the U.S., according to the Food Allergy Support Group of Minnesota.

  • Milk (all dairy)
  • Eggs
  • Fish
  • Peanuts
  • Shellfish
  • Soy
  • Tree nuts
  • Wheat

The Big Quack

The Food Allergy Support Group of Minnesota (FASGMN) is hosting the ninth annual Big Quack, a family-friendly, food-allergy-safe event at the Water Park of America, from 4-8 p.m. April 19. Attendees will enjoy shorter lines as the park will be closed to the general public during this event.

The Big Quack event is a fundraiser to help support families who manage food allergies by providing special support groups and programming. Admission is $15 per person (if purchased in advance), which is roughly half of the usual price at the water park. No food allergies? No problem. All are welcome! For complete details or to order tickets, please visit FoodAllergySupportMN.org.

Food Allergy Resource Fair

The Food Allergy Resource Fair, which takes place on Oct. 12 at the Eisenhower Community Center in Hopkins, is an event open to the public that features allergy-friendly products and services from the U.S. and Canada. There are products for adults to sample and a safe trick-or-treat experience for kids with food allergies (all candy is free of the top-eight food allergens).

Find the Food Allergy Support Group of Minnesota at foodallergysupportmn.org,  Facebook, or email [email protected].

When to vaccinate against measles

Joe Kurland, MPH

Our infection prevention and control team has received questions about the measles, mumps and rubella (MMR) vaccine from a number of concerned parents since measles and vaccinations began dominating national news coverage. Here we highlight the number of recommended doses and the times to receive the vaccine.

I want to protect my child. What is the recommendation for the MMR vaccine in Minnesota now?

Children’s Hospitals and Clinics of Minnesota, like most medical centers, follows the guidelines for vaccination as recommended by the Centers for Disease Control and Prevention (CDC) and Minnesota Department of Health (MDH).

  • Every child should receive two doses of MMR vaccine, with the first dose given between 12 and 15 months of age and second dose between ages 4 and 6 years old. The second dose can be given earlier as long as it comes at least 28 days after the first dose.
  • If a child will be traveling outside of the U.S., he or she may be given a single dose of MMR if the child is between 6 and 12 months old. However, any dose given before the first birthday will not count towards the regular schedule, and the child still will need the two doses as outlined above.
  • If an older child is unimmunized and wants to “catch up” on his or her immunization schedule, the child will need two doses of MMR vaccine separated by at least 28 days.

subscribe_blogAs with all medical decisions, you should discuss your concerns and plan with your clinician. Currently, the CDC is not urging earlier-than-usual vaccinations, even for young children traveling within the U.S. or attending daycare. But as the measles outbreak changes, new guidance may become available. Please continue to check Children’s and CDC websites.

The Minnesota Department of Health reported an international-travel-related measles case on the University of Minnesota campus Jan. 28. To date, there have not been any additional cases in the greater community, and children are not at increased risk.

A few additional points to remember:

  • Two doses is all that is required, and after that the child is considered immune.
  • Blood testing for immunity (or titer levels) is not recommended by the CDC.
  • If adults are unsure of their vaccine status, they should get at least one dose of MMR.

If you have been hesitant to vaccinate your children, take this as a wakeup call. Vaccine-preventable diseases such as measles are active outside of the U.S. and may be just a plane ride away. You can and should protect your children; immunize them.

Joe Kurland, MPH, is a vaccine specialist and infection preventionist at Children’s Hospitals and Clinics of Minnesota.

Measles and how to protect against it

A rash forms three to five days after other measles symptoms start. (iStock Photo)

A rash forms three to five days after other measles symptoms start. (iStock Photo)

Joe Kurland, MPH

Something strange has been happening over the past few years. Infectious diseases are fighting back against the tools that have previously succeeded in protecting us all. In 2000, the U.S. announced that measles had been eliminated from the country. Our tools were so effective and some vaccine-preventable diseases were so rare, that they were all but unknown to a generation of parents and doctors. Sadly, these tools became a victim of their own success.

Measles

Measles is caused by a virus. Sometimes people say “it’s just a virus,” which ignores the fact that some of the most dangerous germs we know are viruses, measles included. It gets into your body when you inhale droplets sneezed or coughed out by someone who’s infected and is considered to be one of the most contagious diseases of which we known, with research showing that, on average, one sick person will infect as many as 18 people who are not protected. Nine out of 10 unimmunized people exposed will get measles because it is that easy to catch. This is partly because measles is an airborne virus; it can survive and infect other people who simply walk through the same room as an infected person. And the infected person doesn’t have to be in the room. The droplets are so small that the air in a room stays infectious for up to two hours after the ill person has left.

OK, measles spreads easily. But is it really that scary? What does it do?

After you’re exposed to measles, it takes between seven and 14 days to develop signs of the infection. The signs include high fever, cough, runny nose and red, watery eyes. You get a rash three to five days after those symptoms start. At first it looks like flat, red spots that show up on your head by your hairline and then spreads like a bucket of rash downwards. It covers your face, neck, chest, belly and finally your arms, legs and feet. The rash may be small, individual, raised, red bumps with flat tops, or they can join into large patches. Four days before the rash shows up, you can spread the virus to others.

For many people, the rash and fever go away after a few days, but for some there are complications. These can vary in severity from mild effects like ear infections and diarrhea to more severe symptoms such as pneumonia and swelling of the brain (encephalitis). Pneumonia is the most common (1 in 20 cases) cause of measles-related death in children, and encephalitis, while less common (1 in 1,000 cases), can cause seizures which may lead to deafness or mental disabilities. For every 1,000 children who get measles, one or two will die from it. Infections in pregnant women may result in premature delivery or a low-birth-weight baby.

You have my attention. What can I do if I’ve never had my shots and may have been exposed?

In the U.S., there are several factors working in a person’s favor:

A modern health system: Clinicians watch for measles and other diseases. If a case is found, they are required, by law, to report it to their local public health departments. The public health experts (epidemiologists) interview the sick person, notify anyone who may have been exposed and work to stop measles in its tracks by having people stay home while potentially contagious. 

Effective medication: There are no antiviral medicines available to treat measles. People exposed to the sick person can protect themselves if they act quickly. If the measles vaccine (MMR shot) is given in the first few days after exposure, it can stop the virus from making you ill.

Community immunity: This is perhaps the most effective tool we have. Community immunity (also known as herd immunity) stops a disease outbreak like a firewall by stopping the virus from reaching new hosts. If you surround an infected person with people who can’t get infected with measles — because they are immune, immunized or were previously infected — the virus cannot spread and the outbreak will end. Community immunity is especially important for families where someone is immune-suppressed or who have children younger than 1 year old who are too young to be immunized.

subscribe_blogSo, the vaccine is the best protection against measles. But some say the MMR vaccine is safe, while others say it is risky and may harm my child. What’s true?

All medical treatments have some risk. But after many studies examined MMR (measles, mumps and rubella) and other vaccines, the final word is the MMR vaccine is safe and rarely causes a severe allergic reaction.

And there is no link between the MMR vaccine and autism spectrum disorders. The association between the two repeatedly has been investigated, and no study has shown results linking the vaccine to the symptoms. In fact, newer research into autism suggests that it’s the result of unusual networking in the fetal brain in the weeks following conception.

What were you saying about our tools being a victim of their own success?

Because the vaccines and immunizations our medical system uses are so effective, the scary, deadly diseases they prevent are now rare. Paralytic polio, babies born with congenital rubella syndrome, tetanus, diphtheria are unknown and forgotten to an entire generation of parents. Because the effects of these diseases were forgotten, the tiny risks for side effects from the vaccines became the focus of concern. Combined with questionable sources in media and on the Internet, fear of vaccines grew. Pockets of underimmunized communities sprung up in cities across the U.S. and provided a foothold for vaccine-preventable diseases, imported from countries with lesser health systems, to resume their toll on a new generation of susceptible children.

But I heard the anti-vaccine community is pretty small and most people follow their pediatricians’ recommendations.

It’s true. Nationally, the number of parents electing to refuse vaccinations is low; however, in some communities, vaccine coverage is less than in war-ravaged Sudan. And this gives the diseases a chance to attack. Measles is so contagious that outbreaks may occur if any more than 5 percent of the community is unvaccinated. Some schools in Oregon and California have reported vaccine rates of 50 percent to 69 percent when anything less than 95 percent vaccinated has great potential for an outbreak.

Vaccines have been so effective that we lost our fear of the diseases they prevented. Amnesia created doubt and hostility towards the utility and need for protection. It is up to parents to protect not only our own children against measles, but in doing so, know that we protect others, too.

For more information:

Joe Kurland, MPH, is a vaccine specialist and infection preventionist at Children’s Hospitals and Clinics of Minnesota.

Introducing new podcast, “Children’s Pedcast”

Starting today, we’re happy to share with you our new podcast, “Children’s Pedcast,” a conversation about pediatrics.

subscribe_blog“Children’s Pedcast” — “Pedcast” for short — is a weekly podcast by Children’s Hospitals and Clinics of Minnesota about pediatric health information, issues and concerns, featuring guests made up of experts from Children’s, The Mother Baby Center, Midwest Fetal Care Center and other individuals connected to Children’s, including doctors, nurses, other health care experts, patients and patient families.

The show is conversational and loose with a goal of providing information and an enjoyable, entertaining listener experience.

A new episode is available for download each Monday and can be heard on iTunes, Podbean, StitcherYouTube, Vimeo, all of Children’s social media channels and everywhere podcasts are available.

Taking a proactive approach to preventing sexual abuse

Parents may become concerned about sexual abuse, particularly in younger children, due to behavior. (iStock photo)

Parents may become concerned about sexual abuse, particularly in younger children, due to behavior. (iStock photo)

Alice Swenson, MD

Parents worry about many things that might happen to their children when they’re in the care of others. Sexual abuse often is one of those concerns, so it’s important for parents to be aware of the risk of sexual abuse in young children and to take steps toward prevention.

  1. Teach kids from a young age that their bodies belong to them and that if someone touches them in a way they don’t like, they are allowed to say no. Model this behavior by allowing your child to say no to things like hugs.
  1. Children should be taught that the private parts of their bodies are just that, private, and that only specific people should be allowed to look at or touch those parts. This may include people who are changing diapers or helping with toileting, or, in older, more-independent children, only doctors or nurses who are making sure that their bodies are healthy. Children should know the proper anatomical terms for body parts so if something happens they can communicate to protective adults. Parents should have regular conversations under non-stressful circumstances with their children about who they can talk to if something happens to their bodies that they don’t like, naming specific people such as a parent, teacher, doctor or nurse.
  1. Talking to your children about secrets is important. Explain that families don’t keep secrets from each other and that if someone tells them not to say something to their parents they need to tell right away.

subscribe_blogThe most common way that sexual abuse is discovered is when a child discloses that it has occurred. When this happens, parents should refrain from questioning the child at length. At that point it is crucial that the concerns be reported to local child protection and law enforcement. Trained professionals can then investigate the allegations and help keep children safe.

Most children who are sexually abused have no physical findings on an exam, and exam findings that may cause concern for parents, such as redness of the genital area, are not necessarily associated with sexual abuse.

Parents may become concerned about sexual abuse, particularly in younger children, due to behavior. Sexual development begins in early childhood, and children by age 3 may express interest in their private parts and touch themselves to experience pleasure; this can be normal behavior. Other common sexual behaviors may include expressing interest in other children’s private parts, showing their private parts to others and trying to look at adults’ private parts.

There are, however, sexual behaviors that may be outside the “norm” (trying to put things into their private parts, simulating sex with other people), but these may indicate other problems such as exposure to pornography rather than indicating sexual abuse.

It’s the responsibility of everyone in the community to keep children safe and healthy and protect them from abuse. Children’s Hospitals and Clinics of Minnesota, including the Midwest Children’s Resource Center, is a community partner in this endeavor, offering services such as medical evaluation of child abuse and therapeutic resources.

Alice Swenson, MD, is a child abuse pediatrician at the Midwest Children’s Resource Center, a clinic which is dedicated to the medical evaluation of suspected child abuse and neglect.