Ask a Nurse: Treating Minor Cuts and Scrapes

What is the best way to care for my child's minor cuts or scrapes?

The two most important things to remember when treating your child's minor cuts and scrapes is to 1.) stop the bleeding and 2.) prevent infection.

You should wash and rinse the area with warm water and an antiseptic soap to remove dirt and germs and cleanse the wound. Then use a clean cloth and direct pressure on the wound to stop the bleeding. Once the wound is clean and the bleeding has stopped, apply a thin layer of antibiotic ointment (such as Neosporin) and cover the wound with a clean bandage.

Most minor injuries heal rather quickly. If, however, a wound does not heal or if you begin to notice signs of infection (redness, swelling, pus or watery discharge, and fever0,call your pediatrician.

Well-Child Exams

A huge part of keeping our children healthy and happy is practicing good preventative health care. Health care costs are lower and hospital visits are less frequent in children that have regular checkups with a pediatrician. We all know that we should take our children to the doctor when they are sick or have a problem, but what about when our children are well?

Well-child visits give the pediatrician a chance to make sure your child is healthy and is growing and developing normally and to do regular screenings and preventative care like immunizations. It is also an opportunity for you to ask questions that you may not have time to talk about during a sick visit. A lot of first time parents may not realize that a pediatrician is equipped to handle any question related to your child's care, even if it is not a "medical" question. So be afraid to ask about potty training, nutrition, safety, or anything else you are concerned about.

The American Association of Pediatrics recommends the following schedule for well-child visits:

3 to 5 days
1 month
2 months
4 months
6 months
9 months
12 months
15 months
18 months
24 months
30 months
3 years
And once every year thereafter

Ask a Nurse: Treating Nosebleeds

What is the proper way to treat a nosebleed? I never remember if I should tilt the head forward or backward.

There are many misconceptions about how to treat nosebleeds. Here’s a list of dos and don’ts.

Do . . .

1. Remain calm. While a nosebleed can be frightening, it is rarely serious.
2. Keep your child in a sitting or standing position. Tilt his head slightly forward and have him gently blow his nose if he is old enough. Tilting the head forward keeps the blood from running down the back of the throat.
3. Pinch the lower half of your child’s nose (the soft part) between your thumb and finger and hold it firmly for 10 minutes. Don’t release the nose during this time to check if it is still bleeding.
4. Release the pressure after 10 minutes and wait. If the bleeding hasn’t stopped, repeat this step. If after 10 more minutes of pressure, the bleeding hasn’t stopped, call your pediatrician or go to the nearest ER.

Don’t . . .

1. Panic. If you panic, so will your child.
2. Have your child lie down or tilt back his head.
3. Stuff tissues, gauze, or any other material into your child’s nose to stop the bleeding.

If you have a question you would like Nurse Brittany to answer, e-mail it to healthyhappychildren@gmail.com.

Vision Problems in Children

Middle childhood (ages 6 to right before adolescence) is the time when many children begin to develop problems with their vision. The most common visual problems are myopia, hyperopia and astigmatism.


Myopia is also called nearsightedness. This condition occurs because the eyeball is too long, which causes light that enters the eye through the lens to focus in front of the retina. As a result, these children can see close objects clearly, but distant objects appear blurry.


Hyperopia is farsightedness. In this condition, the eyeball is shortened, so light is focused behind the retina, causing close objects to be out of focus. These children can see street signs a mile away but may have difficulty reading or seeing clearly close objects.


Astigmatism is another condition that affects vision. This happens because the front surface of the eye has an irregular shape—it is shaped is more like a football than a basketball. This leads to distorted vision, both near and far.

All three of these conditions can be inherited, so children of parents that wear glasses are at greater risk for developing visual problems.

The good news is that all three of these visual problems can usually be corrected with eyeglasses. If your child complains of having difficulty seeing the board in school or reading the words in a book or if you notice your child squinting or sitting close to the TV, you should make an appointment with an eye doctor to get your child's vision tested.

Choking Prevention

Choking is a common form of injury and death among children. The risk of choking is high among children under the age of five, with children under one being at the greatest risk. Here are several things parents can do to help prevent choking accidents from happening:

* Food is responsible for most choking accidents, so supervise your children during mealtime. Encourage your child to chew completely before swallowing, and never allow your child to run and play while eating.
* Cut food, especially hard or round food, into small, bite-size pieces no more than 1/2 inch in size. Hot dogs are the number-one choking culprit among children.
* Don't give your young child hard, smooth foods like raw vegetables. These foods must be chewed with a grinding motion, and children don't develop that skill until around the age of 4. As a result, young children will often attempt to swallow these foods whole, therefore increasing the risk of choking.
* Keep your home clean. Remember that young children will put anything they find in their mouth. Small objects found around the house are often responsible for choking accidents.
* Beware of items associated with choking accidents: balloons, safety pins, coins, marbles, pen/marker caps, buttons, hard or sticky candy, chewing gum.
* Look at manufacturers' guidelines when selecting toys for your children, but also use your own judgment. If there are small parts associated with a play item, it could be a choking hazard. Select toys with parts larger than 1 3/4 inches, which is about the diameter of a toilet paper roll.

And because accidents can happen to anyone at anytime, I recommend that all parents take an infant/child CPR class, which includes instructions on what to do if a choking accident does occur.

Ask a Nurse

Today's Ask-A-Nurse question comes from Beckie in Orem, Utah:

How long does it take what I eat to transfer into my breast milk? It would be nice to know if what I am eating is causing odd behavior and gas.

Sometimes babies have reactions to certain foods their mother eats. Common foods that can trigger these reactions are spicy foods, gas-causing foods, or dairy products. If your baby has an allergy to something in your diet, you may notice symptoms like diarrhea, gas, fussiness, a rash, or dry skin. Usually if the mother can determine what food is triggering the symptoms and avoid eating it, the problem will go away on its own. If the problems persist, you may want to contact your health care provider.

It takes about two to six hours for your body to digest and absorb the food you eat and pass it on through your breast milk. So if your baby starts having reactions in the evening, think back to what you ate about four hours earlier. You may want to start keeping a record of what and when you're eating so you can see if there is any correlation between your diet and your baby's reactions.

If you have a question you would like Nurse Brittany to answer, e-mail it to healthyhappychildren@gmail.com.

10 Ways to Stay Active in the Winter

Your children need at least an hour of physical activity every day to stay healthy. Here are ten ideas for how to keep your kids active during the winter months:

1. In the spirit of the Vancouver Winter Olympic Games, have your own indoor Winter Olympics. You can find ideas for this here.
2. Try rearranging one room in the house so it resembles an indoor playground with areas for your kids to run around and climb on.
3. Play in the snow: create snow angels, build a snowman, have a snowball fight.
4. Organize a game of hide-and-seek around the house.
5. Go swimming at an indoor swimming pool.
6. Bundle up and take your kids for a nature walk outside around the neighborhood or in the park.
7. Have your children participate in winter league sports like basketball or hockey.
8. Check out activities for kids at your local recreation center.
9. Encourage your kids to play active video games like the Wii Sports or Wii Fit.
10. Set out mats and do exercises together with your kids, like marching in place, push-ups, sit-ups, and stretching.

Childhood Obesity: A Growing Problem

Childhood obesity is becoming a huge (no pun intended) problem. It is estimated that 17 percent of children are obese, a number that has tripled over the past 25 years. Doctors and scientists are concerned about the health implications of this ever-increasing number of overweight children. Some of the health-related consequences of obesity are the following:

• Cardiovascular Disease—Childhood obesity leads to increased incidence of high blood pressure, high cholesterol, and glucose intolerance, all of which are risk factors for heart disease. Among overweight children, over 60 percent have one of the above risk factors, and nearly 40 percent have two or more.
• Type 2 Diabetes—Type 2 diabetes used to be called adult-onset diabetes, but with the rise in childhood obesity, the rates of this disease are increasing among children and adolescents. Uncontrolled diabetes can lead to kidney problems, circulation issues, and visual deficiencies.
• Psychosocial Issues—Children who are overweight are at risk for various social issues including discrimination, which can lead to poor self-esteem and low confidence. Children with low self-esteem often have difficulty academically and socially.
• Although less common, studies have also linked childhood obesity to increased rates of asthma and sleep apnea.

The next post will discuss ways you can prevent obesity in your children by keeping them active during the winter months.

Ask a Nurse

I've heard of children having bad reactions to vaccines? What are the signs of a reaction? What should I do if I am concerned my child may be having a reaction?

Fortunately it is rare that a child has a reaction to a vaccine, but it does happen. Here are the signs you should look for. Call your pediatrician if your child has any of the following symptoms:
* hives
* difficulty breathing
* a fever greater than 104
* a generalized rash
* extreme irritability

It is important to note that it is common after getting vaccinated for children to experience a little pain, redness, or swelling at the injection site. Children may also develop a slight fever, but these symptoms should go away within a few days. Children's Motrin or Tylenol can help relieve any of these symptoms.

The Statistics Behind Vaccines

If you're like most, you know vaccines are important in keeping our children healthy and disease free, but you may not know exactly what diseases your children are being protected from. So what are the actual statistics on how various vaccines have prevented illness and death? Below are the disease and death rates from the Centers for Disease Control and Prevention since the introduction of various vaccines.


Vaccine: DTaP
Diptheria—In 1920 there were 147,991 reported cases of diptheria causing 13,170 deaths. In 2002, one case was reported in the United States.
Tetanus—Tetanus continues to kill 300,000 newborns and 30,000 birth mothers a year in areas of the world where the immunization is not available.
Pertussis (Whooping Cough)—Before the immunization, there were around 260,000 cases reported each year leading to around 9,000 deaths. Worldwide there were 9,771 cases reported in 2002.

Vaccine: HIb
Haemophilus Influenza type b (bacterial meningitis)—Before the vaccine, HIb killed 600 children a year and infected over 20,000. In 2005 only 34 cases were reported.

Vaccine: PCV
Pneumococcal—Since the vaccine was introduced, disease rates in children have declined 70 to 80 percent.

Vaccine: IPV
Polio—Before the vaccine 13,000 to 20,000 new cases were reported each year. In 2000 no cases were reported.

Vaccine: MMR
Measles—Measles continues to be one of the most infectious diseases in the world, and researchers estimate that if the vaccine were stopped, there could be some 2.7 million deaths worldwide from the disease.
Mumps—Before the vaccine there were an estimated 212,000 cases of mumps annually. In 2002 there were 270 cases reported.
Rubella—Before the vaccine it is estimated that rubella led to 20,000 infants born with severe disability, 2,100 neonate deaths, and 11,250 miscarriages.

Vaccine: Varicella
Varicella (Chickenpox)—Before the vaccine there were around 4 million cases annually, leading to 11,000 children hospitalized and 100 deaths each year. In 2002 there were 9 reported deaths from chickenpox.

Vaccine: HepB
Hepatititis B—In 1982, 22,177 new cases of the disease were reported. In 2002 only 7,996 cases were reported.

Vaccine: Smallpox
Smallpox—The vaccine for smallpox began to be widely used in 1900. At that time there were about 1,000 deaths caused by the disease each year. By 1977 smallpox had been eradicated.

In the News: MMR Vaccine

The question of whether vaccines cause autism has become quite a controversial topic related to children's health. However, the 1998 study that suggested a link between the MMR vaccine and autism was retracted last week, sending an important message to the health care community. The study was retracted after an intense investigation by a medical panel in Great Britain that concluded that one of the study's authors had been dishonest and violated basic research rules and ethics.

In response to the retraction of the study, Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, said, “It builds on the overwhelming body of research by the world’s leading scientists that concludes there is no link between MMR vaccine and autism.”

Richard Horton, editor of the medical journal that retracted the study, added, "I certainly hope that our retraction today will help to reassure parents that there really isn’t anything to be concerned about with the vaccine."

For more information on why the study was retracted, you can read the following articles from the New York Times:

http://www.nytimes.com/2010/02/03/health/research/03lancet.html
http://well.blogs.nytimes.com/2010/02/08/did-the-media-inflame-the-vaccine-autism-link/

Later this week we will post more information on the recommended vaccination schedules for your children so you can keep them healthy and happy.

How to Properly Take Your Child's Temperature

A digital thermometer is an essential item in every home with children. Fever is often one of the first signs of illness, and it is important to monitor and treat even a mild temperature. What most parents don't know is that in order to obtain an accurate reading, it is important to use the proper technique to take your child's temperature. Based on your child's age, the American Academy of Pediatrics (AAP) has given the following guidelines for checking your child's temperature:

Newborn to 3 months: rectal
3 months to 3 years: rectal
4 to 5 years: rectal or oral
5 years and older: oral

How to Take a Rectal Temperature
* Clean the end of the thermometer with soap and water.
* Put a small amount of vaseline on the tip to act as a lubricant.
* You can either 1) place your child tummy down across your lap with one hand on his/her lower back or 2) place your child face up across your lap and with one hand bring his/her knees to the chest.
* With the other hand, turn the thermometer on and insert it 1/2 inch to 1 inch into the anal opening. Be sure not to push the thermometer in too far. Hold the thermometer in place until it beeps (about one minute).
* Check the reading. Anything greater than 100.4 is considered a fever.

Note: Be sure to label the thermometer as rectal so it is not later used in someone’s mouth.

How to Take an Oral Temperature
* Clean the end of the thermometer with soap and water.
* Place the tip of the thermometer under the child's tongue and toward the back of the mouth.
* Hold the thermometer in place until it beeps (about one minute).

Note: To ensure accuracy, be sure the child has not anything hot or cold to drink for at least 15 minutes before taking the temperature.

Another Alternative
Although not as accurate, after your child is 3 months old, you can use the digital thermometer to check the axillary temperature (under the armpit). This may be a good option when you just need a ballpark idea of whether or not your child is getting sick. To check the axillary temperature, place the thermometer directly in the child's armpit and then hug his/her arm tightly against the thermometer. Hold in place for until it beeps (about one minute). Again, if your child has a fever, it is important to use either the rectal or oral method so you can accurately monitor his/her condition.

Even though there are other options available for checking your child's temperature (including ear thermometers), the AAP still recommends using a digital thermometer—it is the safest and most accurate method for home use.