Ask a Nurse: Stomach or Back?

My mother insists that babies sleep better on their stomach, but my pediatrician says I should always place my baby on her back to sleep. Is this true? And what is the reason for this?

The American Academy of Pediatrics fully recommends always placing healthy infants on their backs to sleep. Although they don't understand the exact reason why, there is evidence to show that babies that sleep on their backs are at a lower risk of dying from SIDS (sudden infant death syndrome). SIDS is the number-one cause of death in the United States for babies in the first year of life.

In the News: Choking Hazard Labels on Food

Choking hazard labels on food now too? That's what the American Academy of Pediatrics is recommending. Just like toys have to be labeled if there are small parts that may be dangerous for small children, pediatricians recognize that certain foods also pose a huge risk and should have similar labels.

Choking injury and death is largely preventable. To read the entire article in the New York Times, click here. To learn more about choking prevention and safety for your kids, read our previous post.

10 Ways to Promote a Healthy Self-Image

1. Lead by example—if a parent is always on a diet, it will affect the children
2. Provide healthy meals and snacks for your kids
3. Encourage activities that will keep children physically fit
4. Compliment your children regularly
5. Avoid placing an emphasis on people's weight, instead talk about being healthy
6. Never tell your child she/he is fat or ugly.
7. Limit exposure to negative media
8. Encourage communication with your kids—studies show that children that have healthy relationships with their parents tend to have better self-esteem and a more positive body image
9. Help your children see that beauty comes in all color, shapes, and sizes and that everyone can be attractive
10. If you begin to notice any signs of disordered eating, seek help

Types of Eating Disorders

Anorexia Nervosa is an eating disorder in which the child thinks she/he is fat and thus restricts eating to just a few hundred calories a day. These children have a fear of gaining weight, a very distorted body image, and often will sneak or hide food avoid eating it. They will appear extremely thin, their hair becomes dull and brittle, and girls will often stop menstruating.

Bulimia is another eating disorder characterized by periods of binging and purging. These children also have a distorted body image, but instead of starving themselves, they will engage in a junk food binge and then feel so guilty that they make themselves throw up. These children may not be super thin, so it is harder to detect.

Restrictive Eating is a less serious form of eating disorder in which children are obsessed with weighing themselves, trying fad diets, and losing weight.

Eating Disorders on the Rise

Did you know that 50 percent of girls between the ages of 11 and 13 see themselves as overweight?

We live in a society that has become obsessed with beauty and with having the perfect body. You are probably aware that the incidence of eating disorders has risen drastically over the past 20 years. But now studies are showing the kids as young preschool age are affected by disordered eating. It starts with a preoccupation with weight and being thin, that leads to dieting to try to lose weight—studies show that 80 percent of 13-year-olds have tried to lose weight. There are serious physical and psychological implications if this obsession continues.

This week I will focus on the different types of eating disorders and their signs and symptoms, as well as ways you, as parents, can promote healthy self-image in your children.

Some Sobering Statistics

42 percent of 1st to ­3rd grade girls want to be thinner.

Over one-­half of teenage girls and nearly one­-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.

40 percent of newly identified cases of anorexia are in girls 15 to ­19 years old.

In the United States, as many as 10 million females and 1 million males are battling an eating disorder.

(Source: NationalEatingDisorders.org)

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.

Top 10 On-the-Go Breakfasts

Breakfast is the most important meal of the day, and unfortunately more than half of kids in the U.S. go to school each day without eating breakfast. I know how busy mornings can be trying to get everyone ready and out the door.

Here is my top ten list of ways to prepare a healthy breakfast for your kids that they can take on the go:

1. Yogurt and granola
2. Breakfast shakes
3. Bagel with peanut butter
4. Leftover pizza
5. Hard-boiled eggs
6. Portable fruits like bananas, apples, oranges, pears
7. Breakfast bars
8. Fruit and nut trail mixes
9. Sandwiches
10. Cinnamon raisin bread

Fact or Fiction: The Five-Second Rule

You have probably heard kids talk about it and may have even used it yourself as the excuse for still eating that M&M you dropped. The five-second rule states that if we drop food on the floor, as long as we pick it up within five seconds, it's safe to still eat.

Now I'm not sure where the five-second rule came from, but as a nurse, I was dying to know if there was any research on the subject. And to my surprise there are numerous studies.

So is the popular five-second rule fact or fiction? Well, it's a little bit of both. Studies show that food that drops on tile or hard wood DOES pick up large amounts of bacteria. Food that drops on carpet, however, DOESN'T pick up many germs but can pick up dirt and carpet fuzz (which in my opinion is just as gross).

The Art of Healing

One of the greatest blessings of being a nurse is the opportunity to participate in the art of healing. I see miracles every day, and I am always touched by stories of children who are overcoming all odds with the help of modern medical science.

I saw this story recently on CNN. Freddy Turihuano is a 15-year-old from the countryside in Bolivia who was born with a condition that prevented him from being able to walk. Thanks to an orthopedic surgeon, generous people who donated time and money, and Freddy's courageous spirit, he is now accomplishing what some thought was impossible. And Freddy's response? He hopes to grow up to be a soccer player . . . or a doctor.

Smoothies with a Twist

Smoothies are a great, healthy snack for your kids. And here's my little secret to make them even more nutritional for your kids (and you for that matter).



Just throw a handful of fresh spinach into the blender with your other smoothie ingredients. Even though it will turn the smoothie green, your kids will not be able to taste the difference. By adding spinach to your smoothies, your kids will get all the nutritional benefits of eating a large bowl of greens, which I know is hard to get most children to do.

Spinach is a super food: it is rich in antioxidants, a good source of iron, calcium, folic acid, vitamins A, C, E, K, B2, and B6 as well as magnesium, potassium, copper, protein, phosphorus, zinc, niacin, selenium, and omega-3 fatty acids, all of which are essential for keeping our kids healthy and happy.

In the News: Children's Medicine Recalled

The following is from a May 1 New York Times article:

"A unit of Johnson & Johnson has voluntarily begun a recall of certain children’s over-the-counter liquid medicines because of manufacturing deficiencies, the Food and Drug Administration said on Saturday. . . .

"Consumers should stop using certain lots of infants’ and children’s Tylenol, Motrin, Zyrtec and Benadryl products because some of them may contain more of the active drug ingredient than specified, the Johnson & Johnson unit, McNeil Consumer Healthcare, said in a statement late Friday. Other products involved in the recall may contain foreign particles or inactive ingredients that may not meet testing requirements, the company said."

Read the entire article here.

Also provided in the article is a Web site with a list of the recalled product lots.

Please check your medicine cabinets to make sure you are not in possession of any of these recalled products.

Treating Seasonal Allergies

The best treatment for children who suffers from seasonal allergies is to avoid the allergy-causing agent. If your child is allergic to pollen, this would include environmental modifications like keeping windows closed in your home and in the car and limiting your child's outdoor activities when the counts are the highest, like early morning for pollen.


If allergy symptoms are mild, your child may benefit from an over-the-counter allergy medication. These drugs can be found at your local pharmacy and should be taken on an as-needed basis. However, keep in mind that doctors do not recommend taking allergy medications with antihistamine for longer than 3–5 days at a time because they generally cause drowsiness.

Prescription allergy medications include decongestants, antihistamines, and steroids. Your child's pediatrician will be able to determine the type of medication and the dosing that is best for your child. There are many newer non-sedating antihistamines that work well to control allergies and have few side effects. It is important that your child take these prescription medications exactly as prescribed; they are less effective if taken intermittently or on an as-need basis.

Symptoms of Seasonal Allergies

Spring can be a miserable time for infants and children who suffer from seasonal allergies. Allergic rhinitis, or hay fever, affects nearly 40 percent of children in the United States. The symptoms may at first seem like a cold, but they are actually brought on (and worsen) with exposure to allergens, including tree pollens, grasses, and weeds.

The most common symptoms of allergies include:
• stuffy or runny nose (drainage will be clear)
• sneezing
• itchy, watery eyes
• sore throat
• morning cough
• allergic salute
• allergic shiners—dark circles under the eyes caused by nasal congestion


It is important to recognize and treat allergy symptoms in your kids, because uncontrolled allergies can lead to secondary sinus infections, ear infections, and asthma attacks. Uncontrolled allergies also can lead to irritability and poor concentration in school.

Seasonal Allergies: The Allergic Salute

The weather is getting warmer, the grass is turning green, and for many of our kids, it is also allergy season. One of the common signs of allergies in children is a small crease in the skin in the lower part of the nose that has been named the "allergic salute." The allergic salute is a result of a child suffering from an itchy nose consistently rubbing the nose upward.


Check back next week for more information on signs/symptoms and treatments for seasonal allergies in kids.

Ask a Nurse: Newborn Vision

I heard that a newborn's vision is blurry, but I feel like my baby recognizes me. When do babies begin actually seeing?

It is true that it takes about six months for your baby's vision to completely develop. Newborns see only in black, white, and gray, and they lack accommodation (or the ability of the eye to adjust to focus on near/distant objects). Despite these limitations, doctors say they are still able to recognize familiar shapes, including their mother's face.

Over the first several month's in an infant's life, visual abilities develop rapidly. By six months of age their visual acuity has progressed from 20/400 at birth to 20/25. By this time they begin to coordinate eye movements and are able to focus on distant and near objects. They also are able follow moving objects. Color vision is fully developed by six months of age.

In the News: Study on Spanking

This is by no means a parenting blog, and I'm not here to tell you how to discipline your children. But I thought this study on the effects spanking has on kids was interesting. The study found that kids who were spanked more than twice a month at age 3 were 50 percent more likely to be aggressive 5-year-olds.

http://www.time.com/time/health/article/0,8599,1981019,00.html

The American Academy of Pediatrics does not endorse spanking or other forms of corporal punishment for any reason and, based on other evidence, states that spanking is not effective in promoting long-term behavioral changes in children. Instead the AAP recommends other forms of punishment, particularly time out, as it helps a child to understand what and why a particular behavior is inappropriate. The recommended time for a time out is 1 minute for every year of your child's age.

What are you thoughts on this study? What methods of discipline work with your children?

Ask a Nurse: Is My Child Eating Enough?

How do I know if my child is eating enough?


As a general rule of thumb, children will eat when they are hungry and stop eating when they are full. If your child is growing well (progressing along the normal height and weight chart), he is probably getting adequate nutrition.


Here are two important things to remember when it comes to your child's eating habits:

1. Children have small stomachs and, therefore, need to eat small meals frequently. They should eat every three to four hours, which means about three meals and two or three healthy snacks every day.

2. Child-size portions are not the same as adult-size portions. Children need about 1/4 to 1/3 of an adult serving portion. An easy way to remember this is that a child portion is about 1 tablespoon for every year of life. For example, if you want to serve your 3-year-old toddler some peas, he only needs 3 tablespoons.

For the healthiest (and happiest) children, try to encourage your kids to eat a variety of foods from each food groups.

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

Fact or Fiction: Butter on Burns

You may have heard the old home remedy to put butter on a burn. Is it fact or fiction? This one is actually fiction, and while those who have tried it say it helps ease the pain, putting butter on a burn can actually lead to bacteria growth and infection.

So what is the best way to care for minor burns? Here are a few tips:
• As soon as possible, run cool water over the burned area. This not only cools the area and stops the burn from getting worse, but it also will ease the pain.
• Lightly cover the area with sterile gauze to protect the area and prevent infection.
• Do not rub the area, put ice on the burn, or put butter or grease on the burn.
• For more serious burns, your pediatrician may prescribe a medical ointment to promote healing of the wound.

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: Calcium Intake

Today's question comes from Tiffany in Ithaca, New York:

My toddler doesn't like milk. I can only get her to drink it if I put flavoring in it. What else can I give her to make sure she is getting enough calcium?

When it comes to your child and nutrition, calcium is an area parents should be concerned about. Recent research shows that nearly half of the children in the U.S. are suffering from a calcium insufficiency. Calcium is essential for developing strong bones and teeth. Although milk is the best source of calcium, parents of children who don't like to drink milk have many other options for making sure their child gets the recommended daily calcium requirement:

• Low-fat milk products are the best sources of calcium. But besides plain milk, this category includes yogurt, cheese, and, yes, even ice cream! Like Tiffany is doing, parents can also try adding chocolate or strawberry flavoring to milk if it will get their child to drink a glass. (Although remember the flavoring adds calories and lots of sugar, so it should be limited to one glass a day.)

• Other foods that are good sources of calcium include dark green leafy vegetables and broccoli. Tofu, chickpeas, lentils, and split peas can also be added to favorite recipes to boost the calcium content.

• Many juices and other foods today, like cereals, are fortified with calcium. Check the labels. One cup of calcium-fortified orange juice has the same amount of calcium as a glass of milk

Bowel Patterns: What Is Normal?

I got a call the other day from a mother whose infant had recently been discharged from the hospital. She was concerned because her baby girl had not had a bowel movement since they arrived home, which by this time had been over 24 hours. In my time as a NICU nurse, I've noticed that there are two things new parents seem to worry most about: breast-feeding and their child's poop!

So what is normal when it comes to your child's bowel patterns? How often should they go? This can be tricky for parents to figure out, because the frequency of pooping varies widely from child to child. For some children, it is normal to have several bowel movements a day; others will only need to go once every two to three days. The key is to watch your child and determine what is normal for him/her. A deviation from your child's normal pattern or marked signs of pain or discomfort in your child are the main clues that there may be a problem, and you will want to talk to your pediatrician.

Here are some important tips to support your child's overall gastrointestinal health:

• Feed your child a well-balanced diet, including foods that are high in fiber like whole grains, fruits, and vegetables.
• Make sure your child drinks plenty of fluids.
• Encourage regular exercise and physical activity. A sedentary lifestyle leads to slow-moving bowels as well as other health issues.
• Never give your child laxatives, suppositories, enemas, or stool softeners unless recommended by your pediatrician.

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.

In the News: Vitamin D Deficiency in Infants

A new study is showing that a majority of infants, even those on formula, aren't getting enough vitamin D in their diet. Vitamin D is important for for strong bones and overall health. Read the following article to learn more about this study:

http://www.cnn.com/2010/HEALTH/03/22/vitamin.d.babies/index.html

As the article suggests, parents should talk to their pediatrician about vitamin D supplements and other ways to ensure their infants and children are getting enough vitamin D.

FAQs on Food Allergies

With food allergies in children becoming more common, I thought it would be useful to answer some of the most frequently asked questions parents have about food allergies.


What is a food allergy?
When someone has a food allergy, their body actually believes that a particular food is harming them. As a response, the body tries to attack the food by setting off an allergic response. Responses can be mild, from a rash to an upset stomach, or severe, which is actually called an anaphylactic reaction and can be deadly.

What causes food allergies?
It is hard to tell exactly what causes food allergies, but we do know that they tend to run in families. Parents that have any form of allergy are at higher risk for having children with food allergies.

What are the symptoms of food allergies?
There are a wide variety of symptoms related to food allergies ranging from mild to severe.

Some examples are:

• cramps, upset stomach
• nausea or diarrea
• itchy skin
• rash or hives
• tingling or swelling in the lips
• stuffy/runny nose

Symptoms usually begin within a couple of hours of eating the problem food. As a rule of thumb, the sooner the symptoms appear, the more severe the reaction.

The most serious symptoms are those related to anaphylaxis.

These symptoms include:

• throat and tongue that swell quickly
• wheezing and difficulty breathing
• vomiting
• fainting

If your child begins to experience these symptoms, call immediately for medical help.


What are the most common foods that children are allergic to?

The most common causes of food allergies in children are:

• eggs
• milk
• wheat
• soy
• peanuts

The good news is that many kids outgrow food allergies before the age of five. An estimated 80 percent of children with allergies to egg, milk, wheat, and soy will outgrow them. However, only 20 percent of children outgrow a peanut allergy.

What is the difference between a food allergy and food intolerance?
Many people confuse food intolerance with food allergies. Food intolerances are actually very common and can cause some of the same symptoms as a mild food allergy, such as upset stomach and diarrhea. A food intolerance is much less serious and does not involve the immune system like an allergy does. The symptoms of a food intolerance are digestive only and generally don't appear until several hours after a food is eaten.

How are food allergies diagnosed?
Your pediatrician will probably start with a simple history. He or she may have you keep a log of what the child eats and when certain symptoms occur to determine what food may be causing problems.

If your child has a serious food allergy, the pediatrician will probably do an allergy skin test. The doctor puts a little drop of liquid on the skin and then pricks the skin to see if the area swells and reacts to the liquid. The doctor may also do a blood test to look at chemicals in the blood that are triggering the allergic reaction.

How are food allergies treated?
The best and most common treatment is to quit eating foods that cause the allergic reaction. However, this can be difficult for parents who have to start reading food labels and readjust their family meals to accommodate the child. If the food is eaten, some children benefit from an over-the-counter antihistamine like Benadryl.

If your child has a severe food allergy, the pediatrician will often prescribe an allergy kit that contains an EpiPen. The pen gives the child a shot of epinepherine, which can slow down or stop the severe allergic reaction from happening. Children with serious food allergies should wear a medical alert bracelet and have the pen available to them to all times.

Can food allergies be prevented?
Research is showing that the only possible prevention is to hold off on introducing all solid foods until your baby is at least 4 to 6 months old. Your pediatrician can give you a schedule on when and how to introduce solid foods into your baby's diet, but it is important to remember to introduce foods one at a time, so that you are able to recognize if there are any foods that may cause problems.

Raising a Child with Food Allergies

The number of children being diagnosed with food allergies is rising. Adapting to daily life with a child who has food allergies can be a challenge for many parents. Today's post comes from Christine George, who shares her personal experience with raising a son with food allergies. Our next post will focus on diagnosing and treating children with food allergies.

I looked at the doctor with wide eyes as he pulled out an EpiPen without the needle and demonstrated how to use it on his own thigh. “If you know he has eaten a peanut, you give him the EpiPen right away and take him straight to the ER. If he doesn’t have any reaction, or if his symptoms subside, you can wait outside the ER for up to an hour to be sure he’s okay before you take him home.”

Three years ago I never thought to ask someone if they had food allergies before I brought over a plate of cookies or gave some kids a snack. It wasn’t until our first child was 7 months old that I was introduced to the world of food allergies. Our baby screamed and broke out in bright red hives when we tried to give him milk-based formula. The same thing happened on another occasion the first time he tried eggs. We decided to visit an allergist. Tests indicated he was allergic to milk, eggs, peanuts, and several tree nuts. The allergist told us to avoid these foods entirely.

I remember walking out of the allergist’s office feeling overwhelmed. I didn’t even know where to start asking questions. What on earth was I supposed to feed this child?? I spent a lot of time on the computer researching food allergies and trying to understand how to work with our new family challenge. While there was a lot of information about what food allergies were and what foods to avoid, it was much harder to find helpful information about what foods were okay for my son to eat.

As our son got older, family meals became more of a problem. He began eating more and was very interested in whatever we were eating. I didn’t have time to cook two different meals every day, and I didn’t have the heart to tell him no every time he asked for something. I started searching for recipes that would accommodate his existing allergies but would also work for the rest of us. While it was fairly easy to find recipes that were free of dairy or nuts, it was very difficult to find recipes free of dairy, eggs, and nuts. I resorted to vegan recipes for a while, but my family wasn’t very fond of tofu or cheese alternatives—they just don’t taste good! Over time we learned to alter our own recipes and adopted new ones that passed the family test. It has taken a lot of effort, but we’ve finally found enough recipes that we can eat together as a family.

Eating out is still a challenge. We don’t go out to eat very often because of the difficulty in finding allergy-free food for our son, especially since he’s a picky toddler in addition to his food allergies! However, many large restaurants have recently created menus for people with food allergies so you can easily find something without having to ask the waiter about every ingredient in the dish.

Social eating has been our biggest struggle. In nearly every gathering, event, or celebration, there is food. Our son is now three and doesn’t quite understand why he can’t have what everyone else has. In many cases I am able to find out ahead of time what food will be at a social event we are going to attend, and I make the same item and bring it with us. It is a lot of work, but it’s worth it for him to feel included.

My husband and I have spent so much time trying to understand our son’s food allergies and learning how to deal with the social implications. I wanted to share what I have learned with others so maybe a few parents out there would have an easier time adjusting to the lifestyle change required by a family member with food allergies. We developed a Web site called EatAllergyFree.com, where you can share recipes, look up allergy-free products, get ingredient substitutions, find allergy-free menus for many restaurants, and share comments and ideas with others in the same situation. It’s a resource we wished we had since the beginning, and we hope it will be of use to others struggling with adjusting to a food-allergy life.

Ask a Nurse

What do I do if my baby has bad breath?

Halitosis (bad breath) is not a problem we expect to find in our little ones. Thankfully, it is usually not an indication of a serious medical condition. In kids, bad breath is most often caused by bacteria in the mouth or in the nasal cavity. Poor dental hygiene causes bacteria to feed on stagnant saliva and food particles in the mouth.

Many parents are unaware that good dental hygiene actually begins before your child's first tooth ever comes in. Even before your baby’s teeth come, in you should start cleaning his/her gums twice a day using a clean, soft cloth. Good times to do this are after a morning feeding and before bedtime. When the child’s first teeth come in, you should continue cleaning with a cloth or use a baby’s toothbrush and water.

For age-appropriate tips on how to take of your child's smile (and breath), check out our post on oral hygiene.

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

Diaper Rash

The term is pretty self explanatory. Diaper rash is an area of redness or small bumps in the diaper region—the genitals, the buttocks, upper thighs, and lower abdomen. The rash is almost always caused by leaving a soiled diaper on for too long. The moisture and chemicals in urine irritate the skin and cause it to break down. Stool is even worse because the digestive agents in the stool attack the skin. Once the surface of the skin is damaged, it is even more susceptible to diaper irritation. As a result, it is much easier to prevent diaper rash from ever developing than to treat it. Proper care is essential in protecting the integrity of your baby's skin.

Proper care includes the following:
• Always change your baby's diaper immediately after a bowel movement. Make sure the skin is thoroughly cleansed, and take special precautions if your child has diarrhea.
• Be sure to change your baby's diaper frequently (every 3-4 hours). You may change it less often during the night if your child's skin tolerates it.
• Assess your baby's skin every time you change a diaper. If you notice any redness or irritated areas, apply ointment and make a note to change diapers more frequently. It is much easier to remedy a problem when it is small, and regular assessments are key to noticing the development of a rash before it gets too serious.
• If your child does develop a rash, keep the area as clean and dry as possible. Apply a thick layer of ointment or cream, like Desitin. This acts as a barrier and helps protect the skin.
• Call your pediatrician if the rash does not go away in 2-3 days or if you feel like it is getting worse.

Fractures

Our kids can be very active, and, unfortunately, accidents do happen. One of the most common injuries in school-age children is fractures. Broken bones in children are generally not too serious (bones in young children are more flexible and have a thicker covering than bones in adults), and they generally heal quickly with proper diagnosis and treatment.

It can be difficult to tell whether or not your child has a broken bone. As a general rule of thumb, if the bone is broken, your child will experience pain and will be unable/unwilling to move the affected limb. However, some children are too young to tell you they are in pain, and just because a child is able to move the limb, doesn't always mean the bone isn't fractured. If you suspect the bone is broken, it never hurts to take your child to the doctor to have it examined.

The first thing the doctor will do if a fracture is suspected is order x-rays in order to see the extent of the injury. Most of the time a simple cast that immobilizes the area is all that is needed for the fracture to heal. If the fracture is more serious, bones that are displaced may need to be realigned by an orthopedic surgeon.

Here are a few tips if your child does appear to have a fracture injury:
1) Try to immobilize the area with use of a sling or splint.
2) If your child is older, place an ice pack on the area to reduce swelling and relieve pain. Never use ice with babies or toddlers because their skin is delicate and the extreme cold can cause injury.
3) Don't give your child anything by mouth; no food, drink, or medication for pain.
4) If your child has a broken leg, don't try to move him/her yourself. You may cause further injury. Instead call for medical help.
5) If bone is protruding through the skin, use firm pressure on the wound to control the bleeding, and then cover the area with clean gauze to help prevent infection.

Ask a Nurse

Today's ask-a-nurse question is a follow-up on last week's vaccine question:

How do I know my baby isn't getting too large of a dose of a vaccine?

Vaccine doses for infants are different from the doses for children and the doses for adults. It is important to note that it requires at least 10 years of FDA testing before a vaccine can even be licensed. Before they are even in use, vaccines are thoroughly tested for proper dosing, safety, and effectiveness, so you can be certain that the right amount is being given to your child to provide immunity to the disease without causing serious adverse effects.

Once a vaccines is licensed, the Centers for Disease Control and the FDA continue to monitor for safety and effectiveness of the vaccine. Any hint of a problem will lead to an in-depth investigation and appropriate actions will be taken including even revoking the vaccine's license if necessary.

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

In the News: Bath Toys

Recently I was watching The Today Show, and there was a segment on children's bathtub toys that I knew I had to share on the blog. As I watched the segment, I was appalled. The topic was something I had never thought about before, but it makes perfect sense—the combination of stagnant water, warmth, darkness, and an already-prone-to-bacteria bathroom setting is the perfect breeding ground for bacteria growth on and in your child's bath toys.

Watch the video here or read the news story here.

Scoliosis

You may remember getting a scoliosis health screening in junior high school—the one in which you bend over and touch your toes while the examiner looks at your back. Scoliosis is a common condition that develops during adolescence. One in 25 teenage girls and one in 200 boys are affected. It is called scoliosis because the person’s spine, which runs in a fairly straight line down the back in a normal individual, instead curves in an s-shape.


Most cases of scoliosis are idiopathic, meaning there is no known cause for the curvature. Researchers have found, however, that there does seem to be some familial tendency associated with the condition, which suggests there may be a genetic component. They have also found that scoliosis is more common in tall, thin women and tends to develop during rapid periods of growth.

Symptoms of scoliosis you should look for in your children/adolescents are:

uneven or rounded shoulders
curving of the upper body
leaning to one side
complaints of back pain


Scoliosis screenings are usually done in school, but your pediatrician can also do it during your child's yearly visit. A curvature greater than 10 degrees is considered scoliosis and is often referred for evaluation.

Six out of seven people with diagnosed scoliosis never receive treatment. In fact, it is only when the curvature gets severe (around 25 degrees) that the doctor will suggest either bracing or surgery. The purpose of bracing is not to fix the curvature of the spine but to prevent it from getting worse, so the brace is usually worn full-time until growth is complete. The only way to actually correct scoliosis is through spinal surgery.

Ask a Nurse

Today's ask-a-nurse question is from Angie in Michigan:

Is there still mercury in vaccines?

In the 1930s thimerosal, an organic compound containing mercury, started being widely used in vaccines and other drug products as a preservative. Although there was never evidence that the small doses of mercury in the preservative caused any harm to patients, in July of 1999 the American Academy of Pediatrics, along with several other public health organizations, began working with vaccine manufacturers to reduce or eliminate the use of thimerosal in vaccines simply as a precautionary measure.

To date, thimerosal has been removed or reduced to trace amounts in all vaccines recommended for children under the age of six. For older children and adults, there are now many vaccines that are available in thimerosal-free formulas.

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 Dawn in Michigan:

About what age do periods start? What are the signs that indicate a girl's period may be coming?

Puberty is a complicated topic because what is considered "normal" development will vary from girl to girl. However, growth and development do tend to follow a certain pattern. An adolescent girl will typically have her first period somewhere between the ages of 9 and 15 (the average age is between 12 and 13).

There are several changes that will begin to happen to a girl's body before the onset of menses. The first visible change, which starts about 2 to 2.5 years before the first period, is the development of breast buds. Following the start of breast development, girls will begin to develop pubic hair. The last indicator that a girl's period may be coming is a growth spurt. This growth pattern begins in the extremities and then moves to the trunk. Hence the reason why people say an adolescent is all hands and feet. Most girls reach their peak height about 6 months before they start their period.

Remember to talk to your daughter about these physical changes that are happening and will happen as she progresses through puberty.

RSV

Most children have been infected with Respiratory Syncytial Virus (RSV) before their second birthday. It’s very common and similar to a bad cold. Although it is usually nothing to worry about, it can lead to more serious infections like pneumonia, so it is important for parents to know the symptoms and treatment.

RSV causes the same symptoms as the common cold:
• stuffy/runny nose
• sore throat
• cough
• earache
• fever
• lack of energy
• fussiness in babies

RSV usually gets better with home treatment: control your child’s fever with acetaminophen or ibuprofen, promote rest and comfort, and make sure your child’s airway is clear (you may need to suction) so he/she can breathe well enough to eat and sleep. It may take a week or two before a child with RSV is fully recovered.

However, if the symptoms get severe or lead to pneumonia, you need to call your pediatrician. Babies under 6 months, children with immune problems, or children with heart or lung problems are especially susceptible to complications and should be seen by a doctor if RSV is suspected.

And as always, the best prevention is to practice good health habits. Make sure your child washes his/her hands often, don’t be around or share food/drinks with other children who are coughing/sneezing, etc. And, as always, make sure you child gets all the recommended vaccines.

In the News: Team Sports and Your Daughter's Health

Besides the health benefits of regular physical activity, a recent study is showing that a girl's participation in sports is associated with numerous benefits, including lower teen pregnancy rates, better academic success in school, and higher self-esteem.

Just 40 years ago Title IV mandated that schools and colleges receiving federal funding offer the same opportunities for girls to play sports as for boys. This legislation opened the door for girls' participation in team sports. In the 1960s only about 4 percent of high school girls participated in team sports, but today that number has jumped to nearly 1 in 3 girls playing sports.

Several economists and researchers have studied the numbers and the significance of this legislation and conclude that the increase in girls' participation in sports has led to about 20 percent of the increase in women's education and a 40 percent increase in career advancement for women.

The research also found that a girl's participation in sports is associated with a 7 percent lower risk of obesity later in life. It also showed a decrease in health issues related to obesity like diabetes and heart disease.

For more information on this topic, you can read the full article in the New York Times:
http://well.blogs.nytimes.com/2010/02/15/as-girls-become-women-sports-pay-dividends/?em

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.

Ask a Nurse

Today's ask-a-nurse question comes from Shanon in Colorado:

My 10-month-old isn't crawling yet. Should I be concerned?

Each child develops at his/her own pace, so what is “normal” for one baby may not be “normal” for another. However, children tend to follow a generalized pattern of growth and development, and for this reason, developmental milestones for each age group were established.

The developmental milestones are general task markers so parents and health care professionals know what to expect for children in each age group. According to the milestones, babies usually learn to crawl between the ages of six and ten months. It’s important to note that some babies don't crawl but instead learn to move in other ways like bottom scooting, tummy slithering, or rolling and that some babies skip crawling completely and go straight to standing and walking. If your baby is 10 months old and is not crawling yet, you should probably not worry too much. Some ways you can encourage your baby to start crawling are with daily tummy time (placing your baby on his/her stomach for at least 30 minutes each day) and by placing toys and other objects just outside your baby's reach.

If, however, by the age of 12 months your child is not showing an interest in becoming mobile, you may want to discuss this with your pediatrician. Your doctor will be able to accurately evaluate your child's development and recommend further testing if necessary.

The Basics on Car Seat Safety

Thousands of people, including children, are killed every year in automobile accidents. For parents, the proper use of car safety seats is the best way you can help protect your children. In fact, the research is so strong in support of car seats that parents are not even allowed to take their child home from the hospital without one.

But with all the information out there about car seats, parents can become overwhelmed. Below are the basic guidelines for proper car seat use for your child:

Infants: Infants should ride in either an infant car seat or a rear-facing convertible car seat. They should ride rear facing until they are at least 1 year old and weigh 20 pounds.

Toddlers/Preschoolers: It is best to keep your child in a rear-facing car seat as along as possible. However, once your child has outgrown the rear-facing seat, you should place your toddler in a front-facing seat with a harness. Most of the seats will fit a child from 20 to 40 or 80 pounds.

School-age Children: After your child has reached 4 years of age and can no longer fit in a car seat with a harness, you will need to place him/her in a booster seat. Booster seats are designed so a regular seat belt will fit properly across your child’s shoulder and lap. Your child should continue to ride in a booster seat until the adult belt fits properly, usually when the child is 4’ 9” or from 8 to 12 years old.

Here are some additional tips for car seat use:
• Always follow the manufacturer’s guidelines for proper use of the car seat. Each seat is slightly different, and each one has different height/weight recommendations for use.
• Don’t use a car seat that is old, cracked, missing parts, or has been in a moderate/severe crash before.
• Children should always ride in the back seat until they are at least 13 years old.
• Be a good example by always wearing your seat belt in the car.

The Children of Haiti

I have been glued to the television and Internet for the past two weeks, deeply saddened by the devastating effects of the earthquake in Haiti. Today's post is a tribute to the children of Haiti. It will take a long time to rebuild the country, and these children will undoubtedly continue to endure so much pain and suffering along the way. But despite all the tragedy, when I look at the faces of these children, I can't help but believe in the childlike qualities of faith and hope and their spirit of determination and resiliency that will pull them through this crisis.

The following article provides a brief look at the the struggles these sweet Haitian children are facing:

http://www.nytimes.com/2010/01/27/world/americas/27children.html

Ask a Nurse

Today's post will answer a question from one of our readers. Darbie in New Mexico asked:

What advice can you give for when to take your children to the doctor when they have a fever? My mother-in-law would take her children to the doctor if they were a bit warm, but I don't think that ONLY a fever with no other symptoms is a problem and wouldn't take my child to the doctor.

Unfortunately there is no exact formula for when you should take your sick child in to the pediatrician, but here are a few tips to help guide parents in determining if they should call the doctor:

* The best indicator of your child's health status is his/her behavior. Your child may have symptoms of a cold, but if he/she is running around and playing like normal, a doctor’s visit is probably not necessary. If, however, your child is not acting normally, is very sleepy, refuses to eat or drink, doesn't want to play, and is irritable, these are probably signs that the illness is a little more serious.

* Fever is a common response to infection and should always be monitored. But fever alone is not a reason to take your child into the doctor. Many fevers can be managed at home with antipyretics like Tylenol or Motrin. However, if your child is less than 3 months old and has a temperature greater than 100.4, you should call your pediatrician. An infant's immune system is less developed, and what would be considered a mild illness in a child or adult can be serious in a newborn. Also, if you are unable to manage your child's temperature with medication at home, you should call your doctor.

* If your child has a cough or cold that does not get better within a week, you should take him/her to the doctor.

* A child that will not eating or drinking for more than 12 hours or one that has severe vomiting or diarrhea should see a doctor. Dehydration is a major concern in these cases.

* Ear pain accompanied by a fever is usually indicative of an ear infection. This may be a bacterial infection, and your doctor will generally prescribe an antibiotic.

Remember, you as parents know your children best and are usually the best judge of their health status. If you are at all concerned, you should never hesitate to call your pediatrician's office.

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.

Spinach for Kids

Spinach is a super food—it is low in calories; rich in antioxidants; high in iron, calcium, and folic acid; and a good source of vitamins A, C, E, K, B2, and B6 as well as magnesium, potassium, copper, protein, phosphorus, zinc, niacin, selenium, and omega-3 fatty acids.

But if your kids are like most I know, getting them to eat spinach is practically impossible. Adding spinach to juices is a fun and easy solution to incorporating spinach into your child’s diet without altering the taste of their favorite drinks (although it does turn the juice green). Add a handful of fresh spinach leaves to orange juice, apple juice, or any other 100-percent fruit juice and blend it in the blender. You can even put the nutrient-rich juice into your toddler’s sippy cup.

Another alternative for your kids (or for you busy parents) is to make a spinach and fruit smoothie. You can use whatever fruit you want in the smoothie, but I typically use frozen strawberries and blueberries, part of a banana, spinach, and orange juice. The result is a perfectly healthy treat for your family!

Expected Stages of Play Development

As parents and health care professionals it is important for us to know normal child growth and development and what to expect of children in each age group. Play is such an important aspect of normal development because it is how children learn about the world around them. As they play, children pass through three distinct stages of development:

• Exploratory Stage (0–1 years old): Infants look around, hold objects, put objects in mouth, and begin interacting with the world around them.
• Imitation Stage (1–7 years old): Children use toys to imitate adult activities, e.g., playing with dolls, cars, cooking sets, or toy tool sets.
• Games and Hobbies Stage (8–12 years old): Children start developing their own interests and become involved in organized activities.

Play is also critical for the development of social skills in children. Experts have identified four stages of social play development.

• Solitary Play (infancy): Babies play alone but do enjoy the presence of others. They are interested in playing with body parts, sucking on fingers and toes, and smiling and squealing,
• Parallel Play (toddler): Toddlers play alongside but not with each other. An example of this is a child coloring at the table while the child next to him is playing with a toy car.
• Associative Play (preschool): Children in this stage begin playing together but often with no group goal and no rigid rules or organization. They often participate in imitative play.
• Cooperative Play (school-age): By this time children have learned to organize themselves in play activities. They establish rules and learn to conform. Leader/follower relationships develop in this play phase.

Parents should encourage age-appropriate play activities for their children.

Oral Health

You may be surprised to learn that the most common chronic childhood disease is tooth decay. According to the Centers for Disease Control and Prevention (CDC), more than 40 percent of children have tooth decay by the time they reach kindergarten, making dental cavities five times more common than asthma and seven times more common than hay fever in children. Health care professionals know, however, that this is one disease that is very preventable. Here are some tips for giving your child a healthy, happy smile:

• Start with good oral care habits early—Even before your baby’s teeth come in you should start cleaning his/her gums twice a day using a clean, soft cloth. Good times to do this are after a morning feeding and before bedtime. When the child’s first teeth come in, you should continue cleaning with a cloth or use a baby’s toothbrush and water. All baby teeth should be in by age two, and around this time, you can begin to use a pea-size amount of fluoride toothpaste on the brush. Don’t start using toothpaste until your child is able to spit instead of swallow after brushing. All children should brush at least twice a day and floss once a day.
• Avoid sugar—Sugar reacts with bacteria in the mouth to form acid, which then causes tooth decay. Limiting the amount of sugar your children consume and feeding them fresh fruits and vegetables instead of cookies, candy, and soda is much healthier for their bodies and smiles!
• No bottles to bed—Milk, formula, juice, and other sweet drinks have sugar in them, and when a child sucks on a bottle filled with these liquids right before bedtime or a naptime, the liquid pools in the mouth and the sugars react and destroy the front teeth (known as baby bottle tooth decay or BBTD). If you do need to put your baby to bed with a bottle, fill it with water.
• Fluoride—Fluoride is a mineral that is beneficial to oral health because it actually strengthens tooth enamel and works to prevent tooth decay. Fluoride is found naturally in many foods and is added to drinking water in most cities and towns. Fluoride is also added to toothpaste (however, to avoid fluoride toxicity in young children, it is recommended children don’t use toothpaste with fluoride until they are old enough to spit it out after brushing).
• Regular dentist visits—Your child’s pediatrician should check your child’s general oral health at every visit. It is also important that you take your child to see the dentist regularly starting around the first birthday or six months after the first teeth come in.