Back to Sleep, Tummy to Play - Check

Rear Facing Car Seat Until 2 Years- Check

Sunscreen Every Time- Ch….Well, most of the time, amiright?

You can click the link above to read the detail on sun safety, but I'll summarize them here:

Under 6 Months:

• Keep in the shade under an umbrella or stroller canopy - Dads, it's a good excuse for you to stay inside when it's hot and watch the World Cup this summer.
• It's OK to put sunscreen on small areas of the body (i.e. face) if shade is not available.

Over 6 Months:

• Sunscreen, sunscreen and then sunscreen again. If your child isn't annoyed by your frequency of sunscreen applications, you're not doing it right. Re-apply at least every 2 hours and listen to the chorus of, “But mom, not again.” It’s a beautiful sound.
• Pick a sunscreen with the highest SPF you can find-At least 15 but preferably higher; if you find 1000, let me know, because my wife loves you!
• Limit sun exposure between 10 AM to 4PM-Feel free to use the classic lunch, no swimming for 2 hours because of cramps wives tail, it's been working for generations.

OK, super-parents who would never forget above facts can stop reading…now.

And, for the rest of us.

3 Tips to Treat a Sunburn:

1. Use an aloe vera based gel or cool wet rag for comfort.
2. Treat with oral ibuprofen at the onset of pain and for 24-48 hours.
3. Neither of these are miracle workers so prevention is by far the best strategy.

3 Reasons To Seek Medical Attention:

1. Severe blistering.
2. Severe pain.
3. Other symptoms such as fever, vomiting, headache or signs of dehydration (no urine output for >6 hours or dry lips and mouth).

Let’s all keep our kids sunburn free this summer!  

Sunburn is not only very painful for your kids it is very dangerous for their future health as well. The incidence of melanoma (the most fatal form of skin cancer) is on the rise in the United States. Studies have shown that a sunburn in childhood or adolescence almost doubles your risk of developing melanoma as an adult.

moment. So, while you have a calm moment, we thought it would be a good idea to take a look at what’s an emergency and when you should go the ER. Otherwise, you probably should take your child to the urgent care center.

Kimberly Aaron, M.D., medical director of the Cook Children’s Emergency Department, gives us six things to check in helping make this decision.

Here are 6 signs your child may need to go to the emergency room. Is your child having:

1. Difficulty breathing
2. Poor skin color
3. Abnormal or altered behavior  
4. Major trauma
5. Severe pain
6. Persistent bleeding

When in doubt, always call 911. Cook Children’s has four Urgent Care Centers to treat your children, Fort Worth, Mansfield, Southlake and Northeast Hospital.

Related Links:

• Medical emergencies: are you prepared?
• Emergency contact sheet
• "What do I do?!" - First-aid and safety information
• Going to the emergency room
• Teaching your child how to use 911
• Is it a medical emergency?
• Poison first aid
• The well-stocked first-aid kit 

During my first meeting with new families, I also make sure to explain what I do and how it fits in with their other providers. Specifically, as a neuropsychologist, I assess a child’s development, thinking ability, and behavior, and I describe how those areas are affected by his or her medical history. 

My personal experience taught me that patients do not always know what kind of doctor I am or even why they have been referred to me. In addition, remembering how I felt, I try to be thorough without overwhelming my patients. I also assure them that it is normal to feel overwhelmed, especially soon after receiving a diagnosis, and let them know that I will be available for more clarification later, if needed.

While I knew more about all of the severe potential outcomes than most other parents, my professional background did provide me with the advantage of being able to escape my own emotions for at least brief periods of time. In medicine, especially when working with children, you cannot help but experience some emotion. 

However, using your best clinical judgment means that you must learn to focus on objective information without allowing yourself to become blinded by your own feelings. Although I could only manage it for brief periods of time, imagining this child as my patient instead of my son enabled me to think more clearly when my emotions became too intense.

Related Links

• A stroke at birth - part 1
• Stroke at birth - part 2
• Stroke at birth - part 3
• Stroke at birth - part 4

That’s around the time tonsillectomies, the surgical removal of the tonsils, begun. One of the most common surgeries today, tonsillectomies are a routine surgical procedure used to fix repeated infection of the tonsils or big tonsils that cause difficulty breathing, sleeping problems or block the food passage. Although it dates back to ancient times, the procedure still comes with risks. You may be worried about news reports of weight gain, pain and even anesthesia-related deaths after surgery. However, serious complications after a childhood tonsillectomy are actually quite rare.

It is better  to undergo the procedure as a child, as the risk of complications is dramatically less than that in adults; studies show about twenty percent of adults face complications after the surgery. Our kids consistently experience an easier recovery, so if tonsils are causing problems, it is recommended to get them removed sooner rather than later. According to Cook Children’s Otolaryngologist Dr. Natalie Roberge, the ideal time to remove problematic tonsils is between the ages of three and 12.

There are many different reasons one may consider scheduling a tonsillectomy for their child. Dr. Natalie Roberge says the most common reason tonsils are removed is for sleep apnea, when a child cannot breathe well at night. “This can slow down development and growth and even impact behavior during the day when the child is not well rested,” Roberge says. The second most common reason to remove the tonsils is recurring tonsil infections, such as six to seven in one year or four per year for three years in a row. Some less common causes include tonsil infections that do not respond to appropriate antibiotic therapy, a tonsil mass, tonsil stones and even bad breath.

“We could literally hear his snoring across the house,” explained mother of two Jennifer Creecy. Over the last year, Jennifer’s youngest son, Bradyn, has had chronic coughing and snoring, and needed at least 12 hours of sleep to feel rested. Jennifer’s oldest son experienced the same symptoms and previously received a tonsillectomy with Dr. Roberge. From past experience with her oldest son, mom knew something was up, so she packed up again to visit Dr. Roberge, this time with her youngest boy. Mom and Dr. Roberge decided surgery would be the best option for him, and although Bradyn initially said, “But I like my tonsils,” he is now experiencing a pleasant, speedy recovery full of milkshakes for dinner, all the Jell-O jigglers he can eat, movies and even swimming! Less than a week after surgery, Jennifer and her husband were happy to see Bradyn’s shining, rested face waking them up bright and early each morning. 

All surgeries come with their own risks and benefits, and a tonsillectomy is no exception. Not every child should have the surgery; those with a bleeding disorder should explore alternatives with their doctor. However, according to Dr. Roberge, complications for a tonsillectomy are rare, with the most common being bleeding after surgery. “In general, yes, there is a small risk of bleeding in the very few percentage points. It tends to happen a week or so after the surgery when scabs come off. In most cases, kids can gargle with ice cold water to shrink up the blood vessels and stop the bleeding; very rarely does a child have to go back to surgery.” Only in very rare cases are complications beyond discomfort, bleeding and infections seen. These are typically heavily publicized cases, giving the perception that a tonsillectomy is very dangerous. In reality, it is unusual to be out of school more than a few days.

If your child’s tonsils are causing problems but a tonsillectomy isn’t recommended for their particular situation, there are other ways tonsils can be removed or reduced in size. For example, intracapsular tonsillectomy is a technique used to remove the majority of the tonsil instead of the entire tonsil itself. This method can result in less post-operative pain and bleeding, but can also increase risk of infection or the tonsils growing back.  According to Dr. Roberge, what is most important is that the surgeon be experienced and comfortable with the tools used for the method chosen.

At your pre-operative appointment, be sure to ask questions until you are comfortable with the process. The day of the appointment, Dr. Roberge says “kids are given a dose of relaxing medicine and able to go off to sleep without any shots or needles.” After the 15-30 minute surgery, your child will wake up with you by their side and most likely be released within hours-- occasionally the next morning-- once any complications are ruled out and pain is under control. Overall, tonsillectomies are a very safe procedure. Your biggest challenge may just be coming up with two weeks of a soft food menu! (Dr. Roberge recommends Popsicles, Jell-O, soft noodles and mashed potatoes.)  

Did you know that Kohl’s allows you to combine multiple coupons and discounts per single purchase? Right now, Kohl’s is having what they call a GOLD STAR Clearance Event where items are 60 to 80 percent off the original price. Now, if that doesn’t impress you, how does saving an extra 20 percent when you apply for a Kohl’s charge, or free shipping everyday on purchases of $75 more sound?

Rush on over to Kohl’s and make sure you have all coupons handy and ready to use….

“Mrs. Jones wants to talk with you about something before you go in the room with Jimmy, want me to grab her?”

I overhear this conversation regularly between parents and nurses in my offices. Usually it leads to a long discussion between the parent and me. We discuss the pros and cons of a drug test, including the implications of a positive or negative test. It’s a conversation I would like to have with you who are reading this today.

Here are some signs that your teenager might be using drugs from the article Early Detection of Illicit Drug Use in Teenagers from the Innovations in Neuroscience:

• Change in behavior or mannerisms
• Change of friends/social circle
• Prefer to be alone
• Skip family time-daily family dinner or bigger events
• Impaired sense of judgment
• Sudden, unexplained drop in grades

On May 26, 2014, the American Academy of Pediatrics (AAP) released a statement against the involuntary drug testing of adolescents. I’m not sure how the rest of my fellow conservative Texas pediatricians will feel about this statement (they don’t always agree with the AAP on certain things), but I have to admit that I applaud this statement.  It's how I've addressed this issue since I started practicing and here's why.

There are a couple of instances where getting a drug test (even if it is not consented to) are critical:

1. A teenager who is not acting normal or having other symptoms that could be related to drug intoxication (seizures, abnormal heart rhythms). In these situations knowing what the adolescent has taken is critical in choosing the correct treatment plan.
2. A teenager has shown a change in behavior over time that could be consistent with drug use. This should only be done after careful conversation with and without the parents to see if the patient will admit to using in those contexts.

Some other situations where drug screens are commonly requested, but caution should be used:

1. Juvenile delinquency - We want to know if our adolescents are doing drugs but I'm not a prosecutor and it's not my job to report them should I get a positive screen. Thus, I need to have clear documentation of who is requesting the drug test and why before I'll do a drug test that I'm not requesting because of a clinical need.
2. Foster care - Again, I'm not in the prosecution business so if CPS wants a drug test because there were drugs in the house where a child lived, etc., I like to see who is requesting the test and why.
3. School requests or general screening - If there has been a history of drug use and the school is requiring for re-entry, I understand. Of course, if your child is balking at random drug screening, then there's probably a conversation that needs to happen anyway.
4. Just because - I actually get this request from parents more often than you'd think. This is the primary reason I thought commenting on this AAP statement was important.

4 Reasons Why "Random" Drug Testing for Your Teenager Could be a Bad Idea

Again, this is not to say that you should fight the school district if they are requesting for athletic participation or for other reasons. I am talking about going into your doctor’s office and requesting a drug test.

1. Trust - A request for a drug test commonly comes in the form of a little note handed to my staff or a hallway conversation outside of the context of the visit. In those cases, it seems that the parent is requesting that I check the urine for drugs without the child knowing. This sets up a scenario where we have violated the trust of your teenager on multiple fronts. What if the test is positive? How do you handle that information? "Son, remember that urine sample that you gave at the doctor’s office, that wasn't actually for a kidney test and, by the way, why are you smoking dope?"
2. False positives - This is rare, but can happen and imagine the headaches that it causes. Families end up chasing an unnecessary rabbit trail of therapies and other interventions because a test is imperfect.
3. False negatives - Even if a child shows all the above symptoms of drug use and everyone is sure they are using, sometimes the tests come back negative. Now the adolescent has a free pass (at least for a while) because they can refer back to their negative test for months when you are "bugging" them about their behavior.
4. Cheating the test - If a child is resourceful enough to get drugs and hide their use from you, they can probably find a way to cheat a drug test. This again provides a false sense of security to the parent and a free pass for the teenager for a while.

Six years ago, my life changed forever...

At that time, I was completing my postdoctoral fellowship in pediatric neuropsychology. I also became pregnant with my first child. Because I had some "inside" information about a few hospitals in the area after having worked in them, although a little farther from my home, I chose to deliver at a hospital with a competent staff and top-notch facilities -- a decision that likely saved my son's life and possibly my own. While in labor, I suddenly went into distress, and my son was quickly delivered via cesarean section. He was whisked away to the NICU before I was even able to see him.

Those of us in pediatric neuropsychology know the hundreds of things that can go "wrong" with a child even before they are born, and the downside of that knowledge is that it can give us very specific things to worry about. However, like everyone else who has experienced a similar situation, I did not really think it would happen to me. But it did. 

My son had a stroke during birth, he needed a ventilator to breathe, and he developed seizures. Unlike parents who question the role that their healthcare providers may have played in their child's condition, understanding that my son's stroke could not have reasonably been predicted brings me peace. I also know that I did not do anything to cause my son's stroke. This is different than the mothers of some of my patients who question every insignificant thing they did or did not do during their pregnancy because it might have played some tiny role in their child's condition.

Although most parents remember their baby's weight and length, the more important information for me was his Apgar scores and the location and extent of brain damage I saw on his imaging. Unlike most people in my situation, I did not have to ask about the potential future outcomes. I had worked with children who had severe disabilities, and I knew it was possible that my son could emerge with significant challenges. However, I was probably less frustrated whenever I was told that his future level of functioning was uncertain.

Having been on the other side of that conversation, I knew it is often difficult to predict what will happen several years in the future, particularly while a child is very young. Although some doctors like to be optimistic about a child's prognosis, others prefer to provide a more pessimistic assessment so that the parents may be pleasantly surprised by their child's better-than-expected outcome. I agree that most people prefer a definitive answer, even if it is one that they dislike, but "I don't know" is often the most honest answer to a parent's question.  

Related Links:

• Cook Children's Stroke and Thrombosis Program
• A stroke at birth - part 1
• Stroke at birth - part 2
• Stroke at birth - part 3
• Stroke at birth - part 4

About the author

Carla Hearl Morton, Ph.D., is a pediatric neuropsychologist at Cook Children's. She is a licensed psychologist with expertise in how learning and behavior are connected to the development of a child's brain structures and systems. At Cook Children's, neuropsychologists work closely with a team of neurologists and neurosurgeons to provide the best treatments and interventions that meet the individual needs of each child.

I began raising my two children by myself after getting a divorce. I’m sure like most single mothers; I had no idea how difficult my new journey in life would be. My hat goes off to all the mothers/caregivers of the world, especially those mothers who are making it on their own. I’ll admit that since getting a divorce, and having to solely depend on one income for two children, I became the most frugal person I know! Yes I said it, I’m cheap, and find great joy in paying little to nothing for high priced items.

But I know some of you hard working ladies out there; don’t have time to find those cost-saving deals. Moms, leave it to me. I can help and I will. So, let’s start with one of my favorites.            

Target

How many mothers out there shop at Target? If you’re anything like me, I prefer to get all my household toiletries from Target and Target alone. I recently found a savings feature called Cartwheel. Cartwheel allows you to save 5-30 percent on the things you already buy throughout the store! You can register online at www.target.com, scroll down to the bottom of the page and select coupons. Once you create an account it’s all there. Just click on the coupons of your choice, you can print or use your smart phone at the register to start your instant savings on your next visit to Target.

Target also has a debit card designed just for its most loyal customers. The card works just like a regular debit card you have with your bank, and it’s free of charge. It withdraws the money from your existing checking account, has no annual fee, your PIN is very secure and you can even withdrawal cash (up to $40) at checkout. Oh yeah, I forgot to mention, you will also save 5 percent on each purchase just for using.

Janeen Walls is not affiliated, associated, authorized, endorsed by, or in any way officially connected with Target. This blog is meant for entertainment and informational purposes only.

This video about the #WorldsToughestJob went viral last week.  If you haven't watched it yet, please do, it is worth your time.

In thinking about this video, I thought of #AnotherToughJob that I thought I would write a job description for:

• Able to deal with people when they are at the end of their stress level, operating on very little sleep and have been waiting to see you or talk with you for hours.
• Able to deal with a boss who has a strong personality and convince them to complete tasks (i.e. filling out forms) when they would rather be doing something else (i.e. playing golf).
• Able to let said boss take all the credit when something goes right but force you to be the bad guy day after day.
• Able to deal with very messy situations - no exemption from poop, pee or puke exposure.
• Able to skip lunch or go without a potty break for hours should "special circumstances" arise (like most days).
• Able to deal with very sad situations and be a person of support even when you feel very sad yourself.

It's not all bad though...

Perks include:

• Dealing with the coolest people in the world-our patients and their parents.
• Watching a child grow to be a young adult (and eventually a parent themselves).
• Watching children who are sick return to health.
• Working with other great people who love children as much as you do.

So, say a special "Thank You" to all of our amazing nurses at Cook Children's.  

From our primary care offices to inpatient to specialty to home health, we have some of the best nurses in the country!

Leave comments for your favorite nurses and we'll pass the message along!

When deciding about starting a medication as a breastfeeding mother, here are some questions that need to be considered:

1. Has the medication been studied in humans or other mammals?

2. How important is the medication to the mother?  For example, what would happen if the mother did not take the medicine?

Clearly if something is well studied, safe and very important for mom, go for it. If something has been shown to be unsafe and not important, then skip it. In my mind, everything I see is a gray area. If you are not impressed with the helpfulness of this “brilliant” analysis, here are some resources you can use:

1. Your pediatrician or obstetrician. I don’t memorize all the possible drugs, but I do know where to look them up.
2. Infant Risk -Dr. Hale from Texas Tech is one of the national leaders in medication use during pregnancy and while breastfeeding.
3. LactMed –The National Library of Medicine’s Drug and Lactation Database

A Special Consideration: Anti-Depressant and Anti-Anxiety Medications

Because of the relatively small number of breastfeeding mothers on anti-depressants, they are still mostly unstudied. Many have been found to enter the bloodstream at less than 2 percent of the dose (adjusted for the babies weight), but some do reach higher levels (near 10 percent).

Here are some of the ones that enter at higher levels:

• Buproprion
• Fluoxetine
• Lithium
• Venlafaxine
• Diazepam
• Citalopram
• Lamotrigine

Even though we know this, we still don’t know the effects of the medication on the baby is in many ways. The AAP statement highlights the fact that these medications tend to have a build up over time. It is important to note also that baby’s kidneys and liver function (the primary way the we get rid of medications) are not fully mature. Because of this, I evaluate each mother/baby combination by these 3 criteria:

• Benefits of breastfeeding
• Risk of the medication
• Risks of mom’s depression on the child

In summary, I believe we should use caution with all medications with breastfeeding mothers.  If you are breastfeeding, please consult with your pediatrician or obstetrician prior to taking any medication.