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