A Dose of Dr. Gwenn

My kids’ spring school vacation this year fell during TV Turn Off Week. I figured this would be a snap with the change in routine and the excitement of exploring new locales. I anticipated happily tired kids falling asleep at the end of each day before they even remembered we had a TV in our hotel room. Even without an “official” no TV week, vacations are low TV times for us – we’re just too much on the go.

However, I quickly faced one huge hurdle I didn’t quite anticipate: we were visiting The Big Apple – the city that never sleeps and that has a screen of some sort on just about everywhere you go: hotel lobbies, elevators, restaurants, bars, museums, Times Square, and even taxi cabs. Talk about TV tube over load complete with an instant failure of our attempt at TV Turn Off Week. My only solace was that none of us actually hit the “on” for those bigger than life screens.

With TVs also now available in refrigerators and cars, we do honestly have to ask ourselves when this will end, especially knowing the plethora of studies citing the risks to our kids and our society for too much tube time. And, that is what we are talking about: too much.

Kids who watch too much tv are at risk for obesity, inattention and even behavioral issues. And, a recent study in Pediatrics actually showed that teens without TVs in their bedrooms were healthier. They moved more, ate healthier foods and spent more time with their families.

But it is not just kids that fare better with less TV and technology. Adults do, too. I recently learned of a very creative day called “Shutdown Day”. Such a brilliant concept: be plugged in less and get outside to interact with the world more.

We all should be doing that a great deal more - unplugging. I often wonder if we emailed less and talked more, would we be better off and I have a feeling the answer would be yes. And, I can say that without citing a study and just by looking a what my life was like pre and post the email craze.

It may take time to niche away at the societal issues of being overly plugged in and with TVs at every turn, but you can do something about your own family's little piece of the world. Since returning from NYC, I've been reciting this to myself:

Spring has sprung; the grass has riz; I wonder where all the family time is??

Family time should be active and outside this time of year and not passive and in front of a tube. So, unplug your family and get everyone out on the same grassy field with some balls and just see what happens. One more thing - leave your cell phones in the car. This is a completely unplugged family experience - I have a feeling the first of many once you see how incredibly bonding with your kids like this can be!

Do your kids ever complain about stomach aches? How often? Do those aches seem to have a pattern to them or interfere with your child’s ability to get through the day and participate in school and social events? If so, your child may have IBS, irritable bowel syndrome. And, chances are other people in your family have this, too. This isn’t something many people talk about but it is much more common than you realize. Believe it or not, 6-14% of adults and kids have IBS so you are far from alone!

April being IBS awareness month is a great excuse for you to gather some information and really sort out if those “my tummy hurts” complaints deserve further attention. IBS isn’t your typical stomach ache – it is much more profound than that because it happens more frequently and more intensely than the typically upset stomach. While most people think of this as an adult condition, it actually affects more kids than you’d realize – in fact, to the same degree! And, from my own clinical experience, I can tell you this is very real in kids and teens and often comes in very predictable times – like State testing or moving or friendship issues or trouble at home. Just like us adults, the intestines of our kids are often the mirror of their minds and emotions.

The symptoms are often very, very uncomfortable with abdominal pain and sometimes bloating. The pain is often lessened when the child has a bowel movement. And, bowel movement patterns are often altered with some IBS patient’s having very hard stools or true constipation and others more loose stools. For these symptoms to be true IBS, they need to occur for 12 weeks during the year and not necessarily in a row.

What should you do if you think your child may have IBS? First, start keeping a log of your child’s symptoms and foods and stress. Second, call your pediatrician. There is a lot that can be done to help people with IBS but the first step is being open to the diagnosis, and getting your child to the doctor to get a diagnosis.

Keep in mind, that many kids have “nervous stomachs” that still warrant attention even if they end up not quite meeting the true criteria for IBS. So, still make that call if your child has symptoms that are interfering with any life activities at all. Even IBS- like conditions deserve attention and many kids have those as well. This is an unfortunate side effect of our busy life styles and perhaps even our unhealthy diets.

So, now you have some information to think about and can decided if you need to talk further you’re your child’s pediatrician. Better to call and have those tummy symptoms be nothing than to find out later there was actually something simple you could have done to help your child feel better. Act today so tomorrow can be a better day for whoever in your family has IBS.

For more information check out:
About IBS
About IBS Kids

It's becoming a tradition. Opening Day for the Boston Red Sox arrives and I find myself posting on youth sports safety. Why? Because of the 40 million kids and counting who are participating in youth sports leagues across our country who need us to wake up and pay attention to what they need as kids and developing athletes.

Last year I talked about the youth sports code of conduct and Opening Day for any new season affords a great opportunity to revisit that code and make sure all the adults involved with your kids' sports teams sign on to that code. And, I do mean all adults: parents, coaches, trainers. It's not just our kids who are on the team - we are as parents, too. We may be "just" the carpoolers and cheerleaders but that doesn't diminish our role to the functioning of the team.

Parents are not "just" cheerleaders at all. In fact, parents are really the gatekeepers of their own kids safety but to function in that role, parents need information. This is where Dr. Google can come in very handy!

Information helps not just in preparing our young athletes for each sport, but is your ultimate defense for ensuring your athlete is safe on the field. You don't need to understand each and every rule of the game. But, understand enough so if something looks off on the field, you'll be able to pick it up while on the sidelines cheering. Recent studies have shown that the number of intentional injuries on high school fields is much higher than we all realized. One way to help stop this madness, is for us as parents to know enough about game play to force the coaches and officials to do their jobs better.

There are many great websites for information, but for youth sports, there are only a couple I'd suggest you book mark. First, the American Academy of Pediatrics (AAP) always puts out handy tips each sports season that hit the highlights. In fact, the AAP just released the latest version of their Sports Injury Prevention Tips, reprinted here with permission:

"More American children are competing in sports than ever before. Sports help children and adolescents keep their bodies fit and feel good about themselves. However, there are some important injury prevention tips that can help parents promote a safe, optimal sports experience for their child.

Injury Risks

All sports have a risk of injury. In general, the more contact in a sport, the greater the risk of injury.

Most injuries occur to ligaments (connect bones together), tendons (connect muscles to bones) and muscles. Only about 5 percent of sports injuries involve broken bones. However, the areas where bones grow in children are at more risk of injury during the rapid phases of growth. In a growing child, point tenderness over a bone should be evaluated further by a medical provider even if minimal swelling or limitation in motion is appreciated.

Most frequent sports injuries are sprains (injuries to ligaments) and strains (injuries to muscles), caused when an abnormal stress is placed on tendons, joints, bones and muscle. As always, contact your pediatrician if you have additional questions or concerns.

To reduce injury:

* Wear the right gear. Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee, shin), helmets, mouthpieces, face guards, protective cups, and/or eyewear. Young athletes should not assume that protective gear will protect them from performing more dangerous or risky activities.
* Strengthen muscles. Conditioning exercises before games and during practice strengthens muscles used in play.
* Increase flexibility. Stretching exercises before and after games or practice can increase flexibility.
* Use the proper technique. This should be reinforced during the playing season.
* Take breaks. Rest periods during practice and games can reduce injuries and prevent heat illness.
* Play safe. Strict rules against headfirst sliding (baseball and softball), spearing (football), and body checking (ice hockey) should be enforced. Stop the activity if there is pain.
* Avoid heat injury by drinking plenty of fluids before, during and after exercise or play; decrease or stop practices or competitions during high heat/humidity periods; wear light clothing.

Sports-Related Emotional Stress
The pressure to win can cause significant emotional stress for a child. Sadly, many coaches and parents consider winning the most important aspect of sports. Young athletes should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition."

These tips are great but only hit the highlights. For more specific information on each sport, including the rules and expert insight, check out www.momsteam.com. MomsTeam is a comprehensive website dedicated to youth sports with the unique goal of "creating a safer, saner, less stressful & more inclusive youth sports experience". You can find a lot of youth sports information on the web, but not in one place and from actual youth sports experts.

There is one final element that you need to make sure is part of any youth sports season your child participates in: fun. Honestly, what's the point in playing if your child is not having fun. Childhood should be about fun, especially with sports. And, I'd argue fun and competition can co-exist on the playing field. In fact, for youth sports, a savvy coach with a developmental background, will be able to do just that.

When day light savings day arrived, I bet you changed all the batteries in your smoke detectors. You likely go through that ritual each fall and spring, right? You have to do a similar ritual with youth sports but with each and every sports season. Youth sports contain a number of burning ambers ready to ignite on many different levels from the leagues on down to the athlete. You are your kids best smoke detector for this fire and it starts with information, awareness and a willingness to speak up when you see something not quite right on the sports field. That is how you fit on your kids' teams - and how your kids need you to be involved.

Do your kids spend time on line? Do they instant message (IM), chat, surf websites? If they IM, do you know the people they chat with?

Instant messaging is a great way to communicate – it is quick and allows for a real time conversation via our computers. But, it is a step removed from true conversation so the “real” part is a bit diluted. My friends and family use IM to swap ideas quickly and confirm social engagements. But, our daughter and her friends have true conversations via IM. So far, she only IMs with people we know. How can we be sure? We check the log. We actually download the IM log regularly, go through it and if there is a screen name we don’t recognize we ask our daughter about it. You may think that our daughter would be angry with us for violating her privacy but not so. She’s 13 and this has been the rule since we allowed her to venture online. And, she knows the consequences if she violates the rule: out goes the computer and off goes the cell phone.

Speaking of cell phones, you may be interested to know we don’t allow texting. Don’t even have the service. The thought of her having that ability so young just worries us and does open the door to her chatting with people we don’t know. We just don't see the need for a young teen to be so connected to cyberspace so we keep all nonessential features off. We are very realistic that at her age, the temptation to use those features is just too great and, unlike the home computer, we are not around her all the times she uses her cell phone. Paranoid? This email sent to me by a friend may change your mind. Before you read this, though, you should know this tale is likely fiction but considered worthwhile by most parents and police who have read it due to the point it makes. In fact, this was sent to me by a police Chief's wife.

Here's the email story I received:

“After tossing her books on the sofa, Shannon decided to grab a snack and get on-line. She logged on under her screen name ByAngel213. She checked her Buddy List and saw GoTo123 was on. She sent him an instant message:

'I had a friend whose daughter was like you. Only she wasn't as lucky. The guy found her and murdered her while she was home alone. Kids are taught not to tell anyone when they are alone, yet they do it all the time on-line. The wrong people trick you into giving out information a little here and there on-line. Before you know it, you have told them enough for them to find you without even realizing you have done it. I hope you've learned a lesson from this and won't do it again. Tell others about this so they will be safe too?'"

I’ve shown this to a few people and they always have the same reaction – stunned silence. Talk about a wake-up call for all of us. The truth is, the only way we can truly protect our kids is to be active in their lives, on and off line. And, to talk to them honestly about the dangers of internet use if they are old enough to use the internet independently.

This vignette also raises other issues about teen life today. Today’s world is very different than the world we were raised in. Many of us walked to school while in elementary school. We can’t let our kids do that today. Same with middle school. We have to be more careful. The online world has opened a gateway to some dangers we just didn't have as kids. It is not being paranoid or an alarmist to take extra precautions when the dangers are out there. I'd call it being practical and a realist. We have to live in the world we have and today's world, sadly, has some issues that put our kids in harm's way. So, it may be we all have to take a moment or two extra out of our day to drive our child somewhere where even thought it seems silly because of how close to home that place is or our child's age. Perhaps we have to just enforce a better buddy system with our kids. Some parents and I do that with my daughter and her friends whenever they want to walk somewhere in our neighborhood. This gives them some freedom but all of us peace of mind that none of them are alone.

But, back to online safety. This vignette is a great way to help you talk to your kids about the dangers they could face online. This is a very tangible group and they learn better through stories and experiences of other kids their age. Hopefully this story will spark conversation, if not at that moment than over time. Some kids need some time to digest a story as intense as this one.

After reading this vignette with your child, here are some talking points you can use to prompt discussion:

1. Do you ever “chat” with people on line who you don’t know from school or an after school group?
2. What kinds of identifying information have you given out online?
3. What did this make you think about?
4. Has this sort of situation ever happened to anyone you know?
5. If someone every contacted you by IM that you don’t know, what would you do?

You can say something along the lines of: “We have no problems with you IM’ing people you know but we want you to be safe. Let’s make a promise that you’ll only IM people you know, OK? Can you do that? And, if someone you don't know contacts you by IM, can you let us know immediately?” Hopefully, your child will say “yes” after reading this vignette! If not, gently probe about the hesitation.

Another great way to spark conversation is during times your tween or teen is using the computer. Ask questions such as “who were you talking with just now?” or “that was a cool looking site. What was it about?” If nothing else, it will reinforce to your child that you are watching and noticing. Sometimes that is the only way we can show our kids were are there if they need them.

Finally, use the computer to reinforce what we are talking about today. Go on a "internet safety" information hunt and check out these sites with your inquiring teen or tween:

FEMA: online safety rules for kids
Get NetWise Safety Tips for Kids (covers all age groups)
A parents guide to online Lingo That Teens Use

Here's to safe surfing and a safe spring!

There has been a great deal of news recently that we are one big sleep deprived nation! Well, that is not really news. I think we know that. But, what we have to recognize is that lack of sleep doesn't just make us grumpy, it causes health issues. For women, just this week we learned that lack of sleep may be tied to heart health. For kids, we are all aware that lack of sleep is connected to poor school performance.

So, time to wake up and take action! How? Great question and the National Sleep Foundation has just the solution: The Great American Sleep Challenge.

Last week, the National Sleep Foundation actually hosted National Sleep Awareness Week ....and most of us missed it. I think I was just to darn sleep deprived to catch the news and Daylight Savings this past Saturday has only made the situation worse. Isn't it amazing how one missed hour of sleep can have such an impact on how we function? It is no wonder that we are all zombies most days! Clearly this is why the java and tea industries are thriving...and why for most major presents my family opts for coffee or coffee gizmos!

The Great American Sleep Challenge is really an awareness campaign and the information on the website is valuable whether you take the full challenge or not. But, if you do sign up for the challenge, there are incentives and prizes along the way to keep you motivated.

According to the National Sleep Foundation, “(b)y taking the Sleep Challenge you can:
• Improve the quality of your life! Sleep problems are far reaching – impacting relationships, health, productivity at work and even driving skills
• Get the most from your sleep – It's as important as diet and exercise (only easier!)
• Understand the causes of sleepiness and fatigue and how they impact your life
• Get help – if you think you may have a sleep problem, take the printable sleep journal to your physician or sleep clinic
• Win a prize! By joining the Sleep Challenge you'll be entered in a raffle with a chance to win!”

I found some interesting information on the site about the link between sleep and performance as well as sleep and health. Click here to learn more. .

So, whether you take the full challenge or just read a bit to get more informed, this site is worth spending some time on and can only benefit you and your kids. We have nothing to loose but gained sleep!

It is a very scary diagnosis for parents and doctors, meningitis. And, this time of year it seems to make headlines somewhere in the country. Last year some hockey players from New Jersey shared water bottles and contracted meningitis, and this week two Bentley College students in Massachusetts have been hospitalized with meningitis.

Parents often wonder when their children complain of symptoms if those symptoms are "meningitis". Viruses and bacteria can cause meningitis, which is irritation of the lining around the brain. Like all illnesses, there is variation and there can be mild to severe degrees of illness. But, bacterial meningitis, the type that is making news this week, makes people very, very sick and very quickly. This isn't the type of situation where you wonder if your child is sick - you know it. These kids look and act sick. They have fever, often very high. They feel lousy. They are tired and often very sleepy. Some may feel very sick to their stomachs . Some may seem confused to those around them. They have severe headache and their neck becomes so stiff they truly can't bend it without their heads hurting more.

Antibiotics help when begun early but it is a serious illness and, sadly, can claim lives and leave survivors with horrible problems once they recover. For this reason, close contacts are also treated, and a vaccine has been developed for preteens and close contacts. But, what is important to remember is that only close contacts need to be treated because bacterial meningitis can only be spread by sharing saliva - kissing, sharing food utensils or cups. This isn't the type of illness that spreads by casual contact which is actually reassuring. Your kids won't get bacterial meningitis by being in the same room as a person with the illness - there has to be that direct contact with saliva. Breathing air or touching isn't a risk factor.

So, what should you do next time your child has fever, headache and complaints of a sore or stiff neck? Don't play doctor, call your doctor for advice. Keep in mind that true, serious illness like the type bacterial meningitis causes doesn't hide for long so if your child looks well and is acting well that is always reassuring. But, if your child is becoming sick before your eyes, your child needs medical attention right away. In fact, if that is going on, call your doctor on the way to the ER or call 911 if your child is horribly ill to you.

Here are some links for more information:
CHOP Meningitis Information
CDC Meningitis Information

Did you catch the recent Eli Stone controversy? Regardless of where you fell on the issues of immunization and autism, there’s no denying that TV greatly impacts our ideas and how we think. The problem with shows that have medical content, however, is that if those shows become misguided, so too can their audiences. And, recent events should cause us all to pause and at the very least wonder about the thoroughness of medical review for TV dramas.

Why is this so important? Simple. It's essential to have solid background information on all TV dramas because of how real and believable the events portrayed can seem. The same is true for what you see, hear and read on the internet. Keep in mind that celebrities are actors but are not experts. They just play experts on TV or online.

If it hadn’t been for the medical community shedding light on the Eli Stone episode before it aired, many parents may have not known the facts and could have been too easily convinced that immunizations are harming their children. They may have been all too swayed by the power of the drama and their own emotional hot buttons and could have been misguided to not immunize their own children. The interesting irony with this episode is that even before it aired, a new study demonstrated that thimerosal, the element always cited as the culprit of vaccine harm, is innocent as charged.

Thanks to the outcry of medical experts, the producers of Eli Stone did post a disclaimer at the start of the show and some links at the show's conclusion. Those are often tried and true ways of alerting you to important medical information. In fact, question shows you see with questionable medical information that does not take those extra steps. A responsible show with a good message will include some sort of informational message at the end, if not question the reliability of the show and hold fast to your current health beliefs.

If you ever watch a show that raises medical questions about someone in your family, your family's pediatrician or internist are two wonderful resources available to you. Start there before you go too far online. The last thing any of us want is for a TV show to confuse you and if you are confused, others in the practice likely are, too. So, let someone know.

It used to be so simple – get an over the counter medication and fix a symptoms, in ourselves and our kids. Nowadays, however, there is concern in over the counter medication use in children under 6 years of age and many of the products we were given as children and may have used in our teens and tweens as infants and toddlers with colds have now been pulled from the shelves.

Knowing what over the counter medications to have on hand and when to use them can come in very handy for those unexpected illnesses, when on vacation and for those middle of the night ails!! If you have any doubt at all about whether a medication is appropriate for your child, consult your pediatrician.

Here are some rules of thumb to help you decide what to stock in your medicine chest at home:

1. Other than ibuprofen (Advil and Motrin) and acetaminophen (Tylenol), most over the counter medications do not work well in children under the age of 2 and are thought to be unsafe in this age group. With this in mind:
a. Most over the counter (OTC) cold medications for kids under 2 years of age have been pulled from the shelves for this reason.
b. If you notice a product on a store shelf, do not purchase it.
c. If you have an OTC product at home that was once on a shelf, toss it.

2. Medications are dosed by age until approximately 12 years of age and 95 pounds at which point “adult” dosing kicks in.
a. Medication dosing for kids under 12 years of age are typically given in a range on over the counter packaging but this range is not very accurate on the extremes.
b. For an accurate dose for your child, consult your pediatrician for a weight-related dose.

3. Never give over any counter medication if your child appears very ill to you. Consult your doctor first or call 911 if your child appears
a. distressed in any way
b. has labored breathing
c. has altered mental status (inability to recognize you or act normally)

4. Fever is an elevation in body temperature and the cut off for what is considered fever varies by age. The younger the child, the lower the cut off for what we consider fever.
a. 100.4 rectally is considered a fever in infants. Infants under 1 month of age should be seen very quickly for a fever but older infants may not need to be seen right away. Consult your pediatrician right away in this age group for advice.
b. Fever in older infants, toddlers and school age children is generally considered 101.5 or higher taken any way – orally, by ear, rectally, under the arm. For older infants, consult your doctor’s on call group if a fever develops and it is after hours
c. For older children with fever, fever may be the only measurable sign of illness and it can last for a few days. You can usually wait for 1-2 days before seeing your doctor unless your child has any specific complaints (such as ear pain or abdominal pain).

5. I would not recommend using anti-diarrheal medication without consulting your doctor first.

In addition to over the counter medications, there are a number of other items that are useful to stock and have on hand:

1. First Aid Kit: band-aids of all sizes, wound cleaner, antibacterial ointment (Bacitracin or Neomycin), ace wraps, ice packs, tweezers for splinter removaA
2. bug spray and antiitch lotions such as aveeno, calamine or the first aid antiitch sprays
3. Benadryl for hives and allergic reactions (consult your pediatrician for a dose)
4. Fever reducer: acetaminophen and ibuprofen. Acetaminophen also comes in a rectal suppository – Feverall is the brand
5. Humidifier – cool works for most coughs and congestion
6. Pain reducer: Tylenol and Motrin/Advil as well as over the counter ear pain drops for middle of the night ear pain
7. For girls: Uristat is worth having for pain with urination to buy time while waiting to see your doctor. Hydrocortisome cream and antifungal creams are useful (such as Lotrimin)
8. Potty issues: stool softeners, Dulcolax suppositories, swipes
9. Rashes: mild soaps, hydrocortisone cream, lotrimin, lotions – Aveeno, Eucerin, Lubriderm are my favorites
10. Saline nose spray – great for kids of all ages, and bulb syringe for infants

You may end up needing other medications at home depending on your child’s symptoms. Your pediatrician’s office will guide you to these as your child’s symptoms evolve.

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(image) For those of us in New England, we live for season changes, especially winter. However, the last few years have been quite disappointing with very mild temperatures and modest snowfalls creating rather unimpressive ski conditions. We honestly didn’t know what to do when the snow started falling just days into December and the deep freeze came shortly thereafter. Out came all the winter gear, hardly used for the last few years, and high hopes were set for a season filled with much anticipated winter fun: sledding, snow shoeing, skiing, and just basic outdoor snow fun!

But, where cold and snow are concerned, “fun” takes on new challenges if we are not adequately prepared and it is all too easy to get injured from the elements and the activities so unique and special to a snowy winter. Anything can happen in snow from concussions due to sledding accidents to sprained ankles or broken arms from falling on icy sidewalks or getting checked during a hockey game. Even building a snow village can be treacherous with frostbite and frostnip risks and lacerations and contusions occurring from snowballs containing hidden objects such as pieces of trees or ice.

According to SafeKids USA more than a quarter million kids are injured in winter sports each year. They report that more than 49,000 children ages 5 to 14 were taken to emergency rooms in 2005 for winter sports juries. Of these, 29,000 were from skiing and snowboarding, 20,000 from sledding, and 660 from snowmobile accidents. If you add to these numbers the amount of kids injured that were treated at home or by their pediatricians, these numbers go much higher.

Proper equipment is essential in minimizing risk for all sports but especially important for winter sports with the added elements of snow, cold and ice. Make sure the equipment is the proper size for your child and consult and outdoor store if you have any doubt as to the integrity of used equipment. For all winter sports, including sledding, a ski helmet is mandatory for kids and adults and can cut down the risk of traumatic brain injury by over 50%.

Kids often have trouble understanding how dangerous the cold can be because we dress them like Eskimos but fail to explain to them why. It is crucial they understand starting very young that without all those thermal layers, they would be at risk for hypothermia, frostnip and frostbite – even while just walking to and from school or while waiting in line for a ski lift. How do you decide how cold is “too cold”? In general, the further below zero the wind-chill falls, the shorter the time it will take for any of these cold-related injuries to occur. Massachusetts schools all follow very strict guidelines for outdoor recess. Children must have snow suits and boots to play in the snow. And, children are kept indoors during cold weather advisories and when the temperature drops below zero. Encourage your family to follow these same guidelines for home and recreational activities. So, if it's too cold for outdoor recess, than it's too cold to build a snowman or hit the slopes.

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Cold-related injuries can be very serious and early identification and treatment is essential. Hypothermia develops when the body's core temperature drops below normal. The body essentially freezes and major systems stop functioning normally. Symptoms result from the body's attempt to warm up and conserve energy. Early symptoms include shivering, clumsiness, and slurred speech. If you become concerned your child may be developing hypothermia, get your child in a warm environment and seek medical attention right away.

Frostnip and frostbite are two extremes of the same problem and result from direct cooling and freezing of the skin and underlying structures. Early on the skin turns white and becomes numb and is referred to as frostnip. Frostbite is an actual freezing of the skin and outer tissues. Fingers, toes, ears and nose are the most susceptible. They may appear pale, gray or blistered and the child may complain that the skin burns or feels numb. Frostbitten areas need to be warmed up with warm water. Wrap your child in a warm blanket and give hot cocoa to warm up the inside temperature. If the symptoms do not resolve in a few minutes, call your doctor.

I know my family is looking forward to finally having a winter worthy of schlepping all the ski stuff north for! At the same time, I know as a parent I have no hope in getting my kids to dress like an Eskimo if I don’t do the same. So, “all for one, one for all” will be our motto for winter dressing and should be your family’s motto, too. And, that includes on the slopes. Believe it or not, ski helmets do come in adult sizes!!

With all the talk of the flu shot this time of year and how “best” to combat the flu, it can be confusing to figure out who in your family should get the flu shot each year. The bottom line boils down to this: if you are a household with kids under 5, every grown up and child over 6 months of age should get the flu shot annually unless a person has an allergy to a component of the flu shot such as egg. And, even if you don’t technically fall into this list, you likely come into contact enough with someone who would be at high risk if they contracted the flu, so getting the flu shot is a good idea still.

The flu is a very strong virus and we know from clinical experience that it hits the extremes of ages hardest: the kids and the elderly. Among the kids, the youngest of the kids and kids with chronic conditions are at most risk but just being a kid is a risk for the flu because their immune systems are still developing.

As for kids, there are two flu vaccines available: FluMist nasal spray and the traditional flu shot. Both work just as well in kids over 2 years of age and cost the same. So, for parents wanting to avoid another shot, the nasal mist is the way to go and is very well tolerated.

One question that comes up every year is why do encourage everyone to get a flu shot yearly. The flu virus changes yearly so our vaccine changes yearly. Luckily, most changes in the virus are not huge so the vaccine, although based on last year’s flu season, still work fine.

Here are the official CDC recommendations for who should get the flu shot each year:

1. People at high risk for complications from the flu, including:
o Children aged 6 months until their 5th birthday,
o Pregnant women
o People 50 years of age and older
o People of any age with certain chronic medical conditions (primarily chronic heart and lung conditions such as congenital heart disease, respiratory conditions, and those people on immunosuppressive treatment)
o People who live in nursing homes and other long term care facilities

2. People who live with or care for those at high risk for complications from flu, including:
o Household contacts of persons at high risk for complications from the flu (see above) – i.e. parents of kids under 5!!
o Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
o Healthcare workers

Your pediatrician can help you figure out if your child would benefit from the flu shot and help answer any other questions you might have. For more information, the CDC website is a great resources, and I post frequent updates on Pediatrics Now as the flu season progresses.

Finally, talk to your kids about some simple flu-avoidance measures that can keep all of you as healthy as possible this winter:

1. Wash hands frequently
2. Stay away from sick people – cancel playdates if you have to, don’t go to school, work or activities if feeling sick. This self-exclusion is very important to control the spread of illness.
3. If you have to cough or sneeze, use the crook of your arm – and wash your hands if you cough/sneeze in your hands.

So, be wise, immunize…and when in doubt, wash your hands!