Category Archives: Health tips

Preparing for school when your child has a food allergy

Missy Berggren’s preparation for her daughter’s upcoming entry into kindergarten started long before school supplies hit the shelves at Target.

Her daughter, 5, has severe food allergies to eggs, milk, peanuts, tree nuts and shellfish. Exposure can be deadly. So, Berggren, a parent advocate and board member of the Food Allergy Support Group of Minnesota, set out to safeguard her daughter beginning with researching school policies and practices before deciding on a school, and, then, partnering with the school administration and teacher.

“My goal is to empower my daughter to live as normal of a life as possible, with some extra planning to make sure she is safe and feels included. We always plan ahead to avoid a food allergy reaction but also need to be prepared if something happens,” Berggren said.

Berggren was most attracted to a school that does not use food in the curriculum and where there are wellness policies in place that limit or don’t allow treats on birthdays and holidays. Most schools in Minnesota still allow that, Berggren said. Her daughter will eat lunches packed at home at a peanut-free table, and will be reminded never to share food with other children.  

Berggren is working with the Kindergarten teacher to make sure classroom snacks are safe for her daughter. She also shared books from her personal library, such as the “Alexander the Elephant” series about food allergies, which the teacher plans to read to the class.

Her daughter recently spent four days at the school’s KinderKamp preparing for kindergarten. When Berggren dropped her off, she reviewed the allergy action plan and emergency medicines with the teacher. All the students washed their hands with soap and water when entering the classroom.

Before school begins in the fall, the family met with an allergist to review the child’s medical condition and to have the appropriate paperwork filled out for school. A special school meeting is planned with the principal, school nurse, teacher and other key staff to talk in detail about the child’s food allergies, how to spot and treat a reaction, and how to make sure she feels  physically and emotionally safe.

While food allergies are becoming more common — one in 13 kids has one, which equals about two kids per classroom – there is still the danger of being picked on or teased.

When other kids ask her about eating different food, she often says, matter-of-factly, that she has food allergies and needs her own food, Berggren said.

“In her mind, she’s a normal kid and she doesn’t want the emphasis to be on her food allergies and neither do I,” Berggren said. “I work really hard to make sure she feels included and that at this age, 5, she doesn’t feel treated differently.”

Here are some tips on how to navigate school with food allergies. Here are more age-specific tools to teach kids about food allergies. Here are suggestions on how to navigate the holidays with food allergies.

This post also appeared in the Star Tribune‘s kids’ health section.

Reminders to prevent flu at the Minnesota State Fair

With the Minnesota State Fair in full swing, we gathered information from the Minnesota Department Health to share reminders with fair-goers about preventing swine flu. Pigs are commonly infected with swine influenza (variant flu) viruses that are usually different from human influenza viruses. While rare, the flu can still spread from pigs to people and vice versa.

What you should know:

• Swine influenza viruses do not normally infect humans. However, sporadic human infections with influenza viruses that normally circulate in swine and not people have occurred. When this happens, these viruses are called “variant viruses.” Variant viruses are very different from human seasonal influenza viruses. Examples include H3N2v and H1N2v.

• Most commonly, human infections with H3N2v and H1N2v occur in people with direct or indirect exposure to infected pigs.

• H3N2v and H1N2v are not transmissible by eating properly handled and prepared pork (pig meat) or other products derived from pigs.

How to prevent it:

• Never eat, drink or put things in your mouth in animal areas. Don’t take food or drink into animal areas. Never take toys, pacifiers, spill-proof cups, baby bottles, strollers or similar items into animal areas. Avoid touching your eyes, nose or mouth.

• Persons at high risk for influenza complications should avoid swine exposure. Persons at high risk include: children younger than 5 years, people 65 years or older, pregnant women, and people with certain  chronic medical conditions (such asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions).

• Avoid close contact with pigs that look or act ill.

• Wash your hands frequently with soap and running water before and after exposure to animals. If soap and water are not available, use an alcohol-based hand rub. Always wash hands thoroughly after contact with farm animals, pets, animal feces, and animal environments.

Why you should protect your son or daughter against HPV

By Patsy Stinchfield, MS, CPNP

Patsy is a pediatric nurse practitioner and the director of infectious disease/immunology and infection prevention at Children’s Hospitals and Clinics of Minnesota.

The Centers for Disease Control and Prevention released a new report indicating that only about half of adolescent girls – and far fewer boys – received the first dose of the recommended HPV vaccine and only about a third  have completed the three-dose series.

As a parent and a practicing clinician, the fact that many of our children are missing an opportunity to get protected against HPV, short for the human papillomavirus (a common sexually transmitted disease) and related cancers concerns me. Since the introduction of the HPV vaccine, the number of HPV cases which leads to cervical cancer cases has been cut in half. In half. That’s monumental. We know this vaccine works, and we need to use it to the fullest extent possible.

The vaccine is safe, as well.  In the more than 56 million doses given thus far, no serious safety events have occurred.  The most commonly reported event is fainting, which happens with other vaccines given to teens, as well, leading to our usual practice of having teens sit for 15 minutes after vaccination.

HPV infects about 79 million Americans, 14 million of whom become infected each year. About 21,000 women are affected by cancer linked with HPV, and cervical cancer is the most common. More than 4,000 women, usually in child –bearing years, die of cervical cancer. It’s also associated with other cancers, such as those that affect the throat, tongue and tonsils, in men.  But, the infection that causes these cancers can be prevented with the vaccine series. What parent wouldn’t want his or her child to be protected against cancer?

The HPV vaccines are given as a series of three shots over six months to protect against HPV infection and the health problems the infection can cause, according to the CDC. Two (Cervarix and Gardasil) protect against cervical cancers in women. One (Gardasil) also protects against genital warts and cancers of the anus, vagina and vulva. Both vaccines are available for girls. Only Gardasil is available for boys.

I recommend to families that children – both boys and girls – get the vaccine well before they’re sexually active to offer the best protection. Typically, we suggest 11 or 12.  And, the full series – all three shots – need to be taken in order to be truly effective.

According to a recent blog post from CNN about the study:

“We don’t wait for exposure to occur before we vaccinate with any other routinely recommended vaccine,” CDC Director Dr. Thomas Frieden has said in the past.

I sometimes hear from parents that they’re worried their son or daughter will be encouraged to have sexual relations because they’ve been vaccinated. While I understand their concern, there is no link between getting vaccinated and increased sexual activity.

Unfortunately, I’ve seen first-hand the devastation that vaccine-preventable diseases cause in children who haven’t been immunized. Let’s work together to take HPV-associated cancers off that list. It’s the right thing to do.

Five Question Friday: Michael Scribner-O’Pray

Meet Michael Scribner-O’Pray, an RN in the Emergency Department at Children’s Hospitals and Clinics of Minnesota.

Michael Scribner O'Pray and his daughter, Grace

How long have you worked at Children’s? I started working at Children’s as an Emergency Medical Technician in the Emergency Department in 1998 while I was going to nursing school.  After graduating in 2000, I worked as a nurse on the float team for a year before coming back home to the Emergency Department in 2001.

What drew you to pediatrics? When our daughter, Grace, was admitted to Children’s as a toddler, I experienced, first-hand, what a difference great nursing care can make for a family. We were frightened by how sick our daughter had become and struggled to make sense of the storm of new information and emotions swirling around us in the Emergency Department.

Thankfully, the care providers we encountered (most memorably, Marie Koldberg, RN) were calm, confident and remarkably skilled.  They not only engaged our daughter directly, as the patient, they treated us, her parents, as the principal members of Grace’s health care team. During our four-day stay at Children’s, I realized that great nursing requires its practitioners to engage their entire selves – emotionally, intellectually, physically and spiritually.

What do you enjoy most about working in the Emergency Department? What could be better than getting paid to meet remarkable families every day and help alleviate suffering?

We have opportunities every day to build bridges with people from vastly different life experiences from our own. What a joy it is to see the look of surprise on people’s faces when they are greeted and asked genuinely about how they are feeling in their family’s own language! (Collectively, our staff can do this in at least 15 different languages: Amharic, Arabic, Cantonese, French, Haitian Creole, Hebrew, Italian, Mandarin, Ojibwe, Oromo, Polish, Russian, Somali, Spanish and Vietnamese)

Kids and their parents often arrive in the Emergency Department hurt and scared, and we get to play a role in helping them find relief. Sometimes our interventions are as simple as offering a kind word or warm blanket, and sometimes what we do is as complex and carefully rehearsed as a major theater production.  Although we encounter plenty to go home and cry about, more often than not, we also get to witness the transformation of pain and fear into relief and joy, of suspicion and anger into trust and understanding, of grief and powerlessness into hope and constructive action.

Do you have a favorite memory from working at Children’s? For more than a decade now, Mindy Teele, a a child life specialist in the department, has been encouraging us to find creative ways to make frightening procedures like laceration repairs and IV starts more child-friendly.

Many of my favorite memories are of times that we’ve succeeded in surpassing everyone’s expectations:  the 2-year-old with a 3-inch gash in her forehead who sat happily in her mother’s lap playing playdough and coloring with her dad while we put 30 stitches in her forehead…. the 1-year-old whose mother sang her to sleep in her arms while we closed a cut right next to her eye….  the 4-year-old boy who “never sits still” who sat up by himself in bed playing with water toys while we stitched up the back of his head…. all the times each week that kids (and parents) have left our Emergency Department feeling stronger, happier and more capable than they did when they arrived — these are my favorite memories.

How do you spend your time outside of work? My schedule working weekends in the Emergency Department allows me to do some extra things during the week including driving our teenagers around town, helping to provide in-home care for my mother-in-law who has Alzheimers, and volunteering one day each week as a farm hand on a small family dairy farm near Red Wing, Minn.

I also enjoy growing food, building and fixing things, canoeing, and learning primitive skills such as basketry and weaving, birchbark canoe building, hide tanning, bow building, and foraging for wild edibles.

6 tips for preventing, identifying and treating lice

During the summer, kids share everything. Pool towels, hats and, yes, even lice. It’s an itchy subject, but anyone can get lice! It’s totally treatable, and there are no long-term effects.

We spoke with Molly Martyn, MD, a pediatrician at Children’s Hospitals and Clinics of Minnesota, about how to prevent, identify and treat it.

1.  What are some signs of lice?

Lice are most often seen rather than felt.  Most children do not have symptoms when they have lice.  In some cases, they can develop itching from an allergic reaction to the lice saliva.

The head louse is about 3 mm long (about the size of a sesame seed) and is a grayish-white color.  Lice move by crawling, not by flying. Females lay eggs (commonly called “nits”) at the base of hair shafts.   The eggs hatch after a week and leave the remains of their white case in the hair. The eggs are firmly attached to the hair, so they move away from the scalp as hair grows.

The best way to look for live lice is to comb the hair with a fine-toothed nit comb. Hair should be wet with a conditioner. With a fine- toothed comb, start touching the scalp and comb through to the end of the hair, looking for lice or nits after each stroke.

Nits (eggs or the empty egg cases) can stay in the hair for some time even after active infestation is cleared.

2.  How do lice spread?

Lice spread through contact, most commonly from contact with the head of a person with lice. Lice can also transfer through shared clothing, hats, combs, hair brushes, headbands and hair ties, headphones, towels, pillows, beds, etc.

It is important to remember that lice can happen to anyone, and is not a sign of being dirty or having poor personal hygiene.

3.  What is the difference between dry scalp and lice?

This can be a surprisingly difficult thing to tell by just looking at a scalp.  Nits can be confused with dry scalp, residue from hair gels or sprays, or fungal infections of the scalp.  Nits are usually more firmly cemented to the base of the hair and are difficult to dislodge.  Your child’s pediatrician or family doctor can help you distinguish between dry scalp and lice.

4.  What are things parents can do to prevent their child from getting lice at summer camp?

Before your child goes to summer camp, it is a good idea to have a conversation about things they shouldn’t share such as hats, hair brushes, hair styling items, head phones, towels, and bedding.

If you are concerned, ask the camp about whether or not they have had issues with lice in the past.  Your child may be required to bring their own bedding.  If able, you should send them with their own pillow and towels.

You can also ask if children will be participating in activities requiring helmets and send your child’s own helmet if they have one that is appropriate for the activity.  Wearing appropriate head protection should never be avoided, even if it is shared.

5.  If a child acquires lice at camp, what should a parent do?

Dealing with lice can be a very stressful thing for families.  Given that it spreads by contact, many families end up treating not just one child, but multiple family members.

There are a number of different approaches to treating lice and you can always ask your child’s doctor for advice.  It is most often treated with a topical lotion or shampoo that helps to kill the lice when applied to the scalp.  The exact instructions on use will vary depending on the type of treatment used.  Some types of treatment are repeated at seven to 10 days because they kill only the adult lice, not the eggs.  Follow instructions closely, as the topical medications can have serious side effects if misused or overused.

Some families may choose not to use a topical medication and instead remove lice through processes such as repeated “wet combing.”  This is also a good option for children who are too young to use the topical medications.

If one member of your family is diagnosed with lice, it is important to check all family members.  Bedding, towels, and clothing should all be washed in hot water and heat-dried.  You should also vacuum your home to remove any hairs that were shed with nits attached.  Throw away combs and brushes used by the infected person or soak them in hot water greater than 130 degrees for 10 minutes.

We have many visits and calls to our clinic regarding lice, and have a standard way of helping families to treat and get rid of lice. We are happy to help!

6.  Where can I find out more about lice such as how to do the wet combing method?

The Centers for Disease Control and Prevention (CDC) has a terrific website with information on how to recognize, treat, and stop the spread of lice: .

A Q-and-A on emergency contraception, safe sex

News came out last week that the Food and Drug Administration approved the sale of the emergency contraceptive pill without a prescription to girls 15 and older.

Specifically, the agency approved Plan B One-Step, an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse – if another form of birth control like a condom was not used or failed, the FDA said. It’s a single-dose pill that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 72 hours after unprotected sexual intercourse.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, M.D. “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.”

This presents a timely opportunity to talk to your child about safe sex. Think your kid isn’t having sex? That may be true. But, that doesn’t mean you should avoid talking about it.

We spoke with Children’s physicians Dr. Dave Aughey, medical director of adolescent health, and Dr. Rachel Miller, a pediatric gynecologist, about safe sex.

How/when do I start talking about sex with my child? How often should I have the conversation?

Dr. Miller: A 2011 national survey of high school students found that 19 percent of female and 24 percent of male ninth-grade students were sexually active. The percentage increases to 51 percent of female and 44 percent of male high school seniors. Rates of sexual activity, pregnancies and births among adolescents have continued to decline during the past decade to historic lows, however many adolescents remain at risk of unintended pregnancy and sexually transmitted infections (STIs). The United States has the highest rate of unintended teen pregnancy of any industrialized nation and adolescents acquire half of all STIs in the country each year.

Dr. Aughey: Parents should look for every opportunity to talk and encourage discussions with sons and daughters about feelings, emotions, friendships and relationships. In general, boys have fewer of these opportunities and a lower comfort level than girls.  Use these discussions to reinforce expectations and values. Ground these discussions in their lives — their music, movies, games, schoolwork. Frequent conversations build comfort and trust. Mothers have a particularly strong influence on their daughter’s sexual attitudes and behaviors.

Realize that most teens have their first sexual experience between 16 and 18.  If the current generation of adolescents ends up marrying, it’s not likely to be until their mid- to late ’20s.  So, the “sex talks” need to include protecting oneself from Chlamydia, dating violence, exploitation, getting drunk, and using condoms in addition to the risks of unplanned pregnancy or fathering a child.  Scare tactics never work.  But being responsible includes all of this and more.  Young men, in particular, need to hear these messages more than ever.

Parents hope their children will delay these things as long as possible. But it won’t be forever. The longer your child knows someone, the stronger their feelings, the more in love they are, the more the bets are off. Rather than being scared about the physical aspect of sex, parents should prepare their children to be prepared emotionally, spiritually, and if needed, contraceptively.

My child says he’s not having sex. Should I make protection available anyway – just in case?

Dr. Miller: Condom education and availability programs improve use of condoms, delay sexual initiation of youth and reduce the incidence of STIs and pregnancy. It has been shown that an advanced prescription increased the use of emergency contraception and decreased time to use. No randomized study has shown an increase in sexual activity or decrease in ongoing contraceptive use in adolescents given advanced access to emergency contraception.

Dr. Aughey: Be honest with yourself. You’ve known your child for at least the last 15 years.  What do you think? When teenagers fall in love, everything changes.  It’s not hormones. It’s human nature. It pains me when a patient tells me her mother found her birth control pills and threw them away. Or threw his condoms away.  Really…is this logical? In 25 years, I’ve never encountered a teenager who, in this situation, has said, “I’ve seen the errors of my way…I will break up with my lover.”

What are the most effective forms of protection for my child?

Dr. Miller: It is not only the use of contraceptive method but also the type of method used that can significantly impact unintended pregnancy. Long acting reversible contraceptives demonstrate the greatest success in reducing unintended teen pregnancy. Examples are the subdermal implant and intrauterine systems. I always recommend dual use of a condom to protect against STIs.

Dr. Aughey:With few exceptions, contraception is safe for adolescents, much safer than is pregnancy, by comparison.  That’s not even factoring in all the economic and social perils of unplanned pregnancy or fatherhood.  Long-acting methods like the intrauterine device (IUD) or implant are best as it is difficult for anyone to consistently use pill, patches, rings or condoms.

Plan B is “emergency” protection.  It is never as good as an ongoing method of birth control.  It’s most effective taken as soon as possible.  It needs to be easily accessible to the teen for “emergency” use.  This doesn’t mean calling a clinic the next day, waiting for a prescription, getting it filled, finally taking it and hoping for the best. Ideally it’s taken within 12 hours.

I know my daughter is sexually active. If she needs emergency contraception, where can she get it?

Dr. Miller: Emergency contraception is available at most every pharmacy. One dose usually costs $40 plus tax. Comparatively:

  • Four months of oral contraceptives are $9 per month. Without insurance, it’s about $36 plus tax at some local retailers.
  • 120 Lifestyles Ultra Thin condoms (3 40-count boxes) are about $33 plus tax.

For more information on talking to your child about sex.

Five Question Friday: Dr. Dave Aughey

Meet Dr. Dave Aughey, MD, medical director of adolescent medicine.

What drew you to adolescent medicine? This will sound cliché, but I was quite ill as a pre-teenager.  My recovery overlapped with the magical time of puberty, and it was an emotional and a physical transformation.  From this time on, I knew I wanted to work with teenagers.  I couldn’t decide if I wanted to be a pediatrician or a psychologist.  I was drawn to Adolescent Medicine because I could do both.

Dr. Dave Aughey

Are there any trends you’re seeing right now in adolescent medicine and, if so, what are they? Nationally, about 600 pediatricians are certified as Adolescent Medicine specialists. In the last 10 years, only about 225 of these have gone through the three-year post-residency training and certification. Most of these pediatricians practice in academic centers and not in community settings. The field is struggling to find its niche and to attract new practitioners. The good news is that adolescents are now being recognized as having unique health needs, which are best served by a “psychosocial” care model.  This model embraces the “health” needs of adolescents and young adults, not just the physical dimensions. Many other primary care providers also now recognize these special needs and are effectively providing care and guidance.

What do you enjoy most about your job? I view myself as a pediatrician who specializes in being a primary care provider for adolescent and young adult patients and their families (and sometimes their friends). I have opportunities to be a dermatologist, counselor, gynecologist, sports medicine doctor, psychiatrist or pediatrician on any given day. I really enjoy being able to provide this range of care to patients. It makes relationships with patients and families very rich and gratifying.

What is your favorite memory from working at Children’s? After 25 years, it’s impossible to pick a favorite memory. I’ve had the honor of working with extremely compassionate and caring colleagues. Patients have been inspiring, especially those who overcame challenges and adversities that would have bewildered me. I remember patients who proudly shared their accomplishments with me.  Former patients who’ve brought their babies to show off. Patients who’ve stopped me on the street. “You don’t remember me, but….” These memories are all warm and heart-felt.

If you weren’t working in medicine, what do you think you’d be doing? My fall-back plan early on was going to be that I would run a hardware store. In retrospect, given the emergence of the big boxes, that would have not gone well. I still would love to teach high school and be around adolescents in another capacity.  In the deepest, darkest corner of my soul, I dream about being a woodworker or a dancer. Or a photographer. Or maybe an engineer…

Q-and-A with Dr. Troy: How to talk to children about death

During the past 12 months, we’ve been rattled by the tragedies we’ve read and heard about in the news.

In July 2012, 12 people were killed and 58 others were injured in an attack in an Aurora, Colo., movie theater shooting.

Twenty children and six adult staff members were shot to death in December 2012 at Sandy Hook Elementary School in Newtown, Conn.

Closer to home, an insanity trial is underway for a man who admitted to murdering his three daughters this past summer. Last weekend, a woman and her two children were found dead in their home after authorities say she drowned them and then committed suicide.

As parents, we want to protect our children from these horrors. It’s hard to comprehend discussing the unthinkable – a mother or father taking the life of their child – with our own kids. Do we bring it up? How do we respond when they come to us looking for answers?

We spoke with Dr. Michael F. Troy, Ph.D., L.P., our medical director of behavioral health services, in an attempt to answer some of those questions:

How do I explain death to my child in an age-appropriate way?

Dr. Michael F. Troy

There are important differences between explaining the death of an important person in your child’s life and talking about a tragic death in the news. The former is likely to be a challenging, but near universal, role for a parent.  Eventually, all families will face the loss of a loved one requiring parents to share sad news with their child. While it is typical for parents to find these junctures difficult, this does not mean that they are unable to do so with skill and sensitivity.  Parents are used to explaining things to children in developmentally appropriate ways. Whether it’s why they have to have a shot at a doctor’s office or why they need to move to a new community, parents generally know – by instinct and knowledge – how to do this. Talking about death, while less common and inherently sad, is not an entirely different kind of task. Parents should think of it as being like other kinds of sad or disappointing news they might have to discuss with their child.  The specifics, for example, the closeness of the person who died, whether it was an expected loss, and the age of the child, will determine what is communicated.  But the general point, that parents actually do have experience in talking about difficult things and that they should rely on that experience, is most important.

Talking about deaths reported in the news is a different situation. While there are always exceptional circumstances, it is generally best to wait and see if your child raises the issue.  Whether they are aware of a news story is likely to depend on factors such as their age, how routinely they are exposed to the news, and how direct the event in the news is to their day-to-day lives.  If they don’t have knowledge of the story, raising the issue with them is unlikely to be a helpful. If they do raise the issue, it’s important to first find out what they have learned and what specific questions they have (there is no need to respond with answers to questions they don’t have). Additionally, it is important to keep your feelings and thoughts about the news story separate from the actual, specific concerns your child has. Your job as a parent is to help your child understand the event in a way that’s consistent with their developmental level, as well as to reassure and comfort them as necessary.

How do I explain why a parent killed his/her child?

You can’t really explain what you may not understand yourself. If you find the news of a parent killing her children and then herself perplexing and distressing, then it is OK to say that you are confused and upset by it. At the same time, you can also provide reassurance of your child’s safety and, if necessary, of your own ability to take care of them. If you feel you have some understanding of the event, for example, if it was the result of the mother’s severe mental illness, do your best to explain this briefly and in developmentally appropriate ways and with an emphasis on how rare such events are. You might also want to communicate empathy for those most affected by the loss.

Should I talk about the mental health of the parent? How do I do that?

You should talk about the mental health of the parent if your child asks about it, or if you feel that it’s important and appropriate for you to include in your response to the specific questions your child has asked. It’s unlikely that we would actually know the mental health status of a parent taking the violent and tragic actions reported in these recent cases, especially in the immediate aftermath of the tragedy when it is most likely to be in the news. Consequently, you might note that questions regarding mental health issues have been raised – and what this might mean – without suggesting that you know for certain what led to act of violence. It may also be important for you to note that while mental health issues are sometimes linked to violent acts, the vast majority of people with a mental health diagnosis are not violent.

At what age is it appropriate to approach my kids about this topic? Should I always wait for him/her to bring it up?

Unless you have specific reason to anticipate your child encountering discussion of these issues, it is generally better to wait and see if your child raises such concerns with you. Of course, the older children are, the more likely they are to both hear about and initiate questions about news of a tragic event. Similarly, the older your child is, the more reasonable it likely is to bring up the issue.

Are there things I can say or do to make my child feel safe and at ease?

First, it’s worth remembering that our goal as adults caring for children is to help them feel safe without needing frequent reassurance. If such reassurance is necessary, then the most important thing to emphasize is just how incredibly rare these types of events (school shootings, parents killing their children) are. They are extremely upsetting to hear about, and terribly tragic for the families affected, but also quite unlikely to happen. Because they are so rare and so dramatic, they tend to receive intense media coverage. But it also this pervasive media coverage that can make it seem as if these tragedies are more common than they really are. Consequently, it is almost always reasonable to reassure children that they are safe and that there are many adults in their lives looking out for their wellbeing. Some children will have specific concerns requiring specific reassurance. Younger children are likely to need you to talk about the ways in which their own home and school are safe places, while older children might need help understanding the rarity of these events through comparison to other types of risks.  For example, you might point out that while there are people struck by lightning every year, the odds of any given individual beings struck is exceedingly low.

My child has a fever. What should I do?

By Erin Dobie, CNP

Fever is one of the most common reasons parents seek medical attention for their child or infant. All kids get fevers at some point. Studies reveal parents are most worried about fevers due to the fear that they can cause brain damage or even death. But, there is no evidence to support these concerns.

As a nurse practitioner in the Emergency Department at Children’s Hospitals and Clinics of Minnesota, I frequently see kids with fevers. The questions from parents are usually the same. I wanted to answer some of those questions here.

What is a fever? Fever is defined as a body temperature greater than 100.4°F (38°C). It is part of the body’s natural defense mechanism and a normal body response to fight infection. Fevers help the body fight infections by stimulating the immune system. Fevers slow the growth and reproduction of the virus or bacteria. They also increase production of antibacterial substances in the immune system.

Should I treat a fever? Otherwise healthy children and infants (3 months and older), whose temperature is between 100.4 and 102°F (38.0-38.9°C), do not require any medication to reduce the fever unless the child is uncomfortable. Consider how your child is acting before treating with medication. Is he/she still playful? Drinking and urinating? These lower grade fevers help the body fight off illness. Fevers greater than 102°F do not always indicate a more serious illness. Does your child have other specific symptoms or complaints that are concerning or need medical attention? It’s important to remember to treat the child, not the fever.

When should I call my child’s health care clinician? You should call your child’s physician or nurse practitioner if your child is:

    • younger than 3 months old with a rectal temperature of 100.4°F or higher
    • crying and can’t be consoled or extremely irritable
    • somewhat difficult to wake up
    • refusing to drink fluids
    • experiencing painful urination
    • not vaccinated

If your gut tells you something wrong or if your child has a chronic condition, then you should also call.

When should I call 911? Pick up the phone if your child has:

    • trouble breathing
    • purple spots on skin
    • extreme difficulty waking up

Which medication should I use to treat my child with a fever? Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil) are two fever-reducing medications recommended for children and infants. Do not give Ibuprofen to infants younger than 6 months. Do not give Aspirin to children of any age. Be aware that many other over-the-counter medications often contain acetaminophen. Therefore, please read the labels carefully to reduce the risk of overdosing your child. Medication dosages are unique for children based on your child’s weight.  See Fever Dosage Charts for more information.

Remember, treating the fever with these medications doesn’t treat the illness causing the fever so when the medications wear off, the fever will most likely return until the body is done fighting off the illness.

A night in the ED with a child life specialist

A 3-year-old girl needs her bottom lip sutured. A 2-year-old sibling is bored to tears – literally – while she waits for her brother to be released so they can go home. A 7-year-old needs an IV start for blood draws and medicine.

Who are you going to call? The child life specialist.

Mindy Teele, child life specialist

On a recent weekday night in the Emergency Department, Mindy Teele, a certified child life specialist at Children’s Hospitals and Clinics of Minnesota, is in demand. A patient is about to have an IV start, so an RN asks Teele to explain the procedure ahead of time. In another exam room, a patient is waiting for results, so Teele brings toys. A few minutes later, she returns to the patient with the IV start to distract the patient during the procedure.

“Child life specialists focus on the psychosocial and developmental needs of children to minimize their fears, clarify misconceptions, build coping abilities and enhance understanding when kids are in the hospital,” said child life manager, Sheila Palm. “Being better prepared improves long-term adjustment to medical conditions, increases cooperation and reduces pain during procedures.”

Children’s deploys certified child life specialists throughout the hospital – to the medical-surgical, pre-surgery, critical care, and cancer and blood disorders units. Child life specialists work in home care and hospice, too. Children’s also has child life associates who help on some of the units and in the Sibling Play Area. Philanthropy helps support child life specialist services; their work is not reimbursable.

In the ED, Teele helps reduce the stress of what can be a traumatic visit by providing age-appropriate information, coping strategies and parent coaching, Palm said. Gaining cooperation from the patient and family can reduce the time of the procedure, need for sedation and need for an extended ED stay.

A 2008 Children’s study in the ED compared parental satisfaction with their child’s experience during a laceration repair in the presence and absence of child life services. Overall, there was greater satisfaction when a child life specialist was involved.

Patients experienced less anxiety when they left the ED when a child life specialist was involved in their care. Child life specialists received a significantly higher rating than other providers in their efforts to relieve anxiety. Children’s also received a rating of excellent from families more often when a child life specialist was present.

“I find the presence of child life services in our ER to be a tremendous asset. The care that they provide in alleviating the apprehension and pain of the sick and injured children we care for on a daily basis is wonderful. I appreciate working alongside such caring individuals and see their effect in many of the patients I come across during my shifts,” said Dr. Mark Schnellinger.

Teele has worked at Children’s for 13 years, 12 of which she’s spent in the ED. “I feel like my personality fits this environment,” she said. “I like the instant gratification.”

In the ED, time is not on Teele’s side. She often only has minutes to explain and prepare patients and families for a procedure. So she relies on analogies to explain them. Instead of calling herself a child life specialist, she tells patients she’s a teacher – a term kids can understand.

“Anyone can go into a room and tell a child what’s about to happen,” Teele said.

But, a child life specialist is able to assess the child and take him or her through the experience on their terms, she said. If a child needs a CT and loves princesses, Teele might develop a scenario from “Snow White.” If the child is obsessed with video games, Teele explains the procedure like it’s a video game with various levels for advancing.

On this recent weekday night, a little boy is minutes away from having a needle inserted into his hand for an IV and blood draws. Teele explains that the RN will use a J-tip, which helps minimize pain with needles, to make the area feel soft. An RN will then use “soap” to clean the skin. Using the same tools for the procedure, she shows him what everything is supposed to feel like. She shows him the “straw” and explains that, unlike a juice box straw, it will give him medicine to make him feel better.

Later in the evening, she’s called in to help during an IV start with another patient. The ED has run out of J-tips. Armed with a Disney book, Teele holds it up for him and together they identify the characters while the RN inserts the needle, draws blood and then gives the boy medication. Distraction works. The patient remains calm the entire time.

“I think I have a very rewarding job,” Mindy said.

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