Tag Archives: KC Parent Magazine

Picky Eater or a Feeding Disorder?

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NURSE MONDAYS

published in KC Parent Magazine – May 2012 issue

by Stacey Hatton

Most kids are picky eaters at one time or another—but determining if their finicky behavior is severe enough to be classified a pediatric “feeding disorder” involves an expert’s diagnosis. According to the September 2011 National Institutes of Health (NIH) report, “Up to 10 percent of infants and children have a pediatric feeding disorder;” however, many children are missed in this study.

Symptoms

“Professionals working with children with feeding difficulties sometimes classify children as ‘picky eaters’ rather than a ‘problem eater’ or a child with a ‘feeding disorder,’” says Marci Chmielewski, M.S., OTR/L, and clinical coordinator of the Occupational Therapy Department at Children’s Mercy Hospitals & Clinics.

“A picky eater is a child that does not have a wide variety of foods, but will typically eat 30 or more foods,” reports Chmielewski. “The picky eater may also have times in which he won’t want to eat that food, but will generally add it back into his food repertoire after a couple weeks.”

These kids usually are able to touch, look at or taste new foods, even if they refuse to eat them. They also will try one food from each food group.

“The ‘problem feeders’ are the children we treat in occupational therapy and typically have 20 or fewer foods they eat,” says Chmielewski. “A child with a feeding disorder will often never eat a food once they have “burned out” on that food—even after a break from it. These children may cry, try to get away from the table, be unable to tolerate smells of food or become very upset when a new food is presented. The problem feeder also often eats foods in only one or two of the food groups.”

Treatment modalities

“The treatments vary depending upon the underlying causes of the child’s problem or picky eating,” Chmielewski says. “A feeding  therapist will typically take a history to help determine if there are underlying physiological problems causing discomfort with eating, as well as evaluate for oral motor problems (inability to properly chew or move food in the mouth), swallowing problems or oral sensory problems (difficulty with tolerating various textures of foods).”

Working along with the parents, caregivers and treatment team, a goal-oriented plan will be initiated for improving eating and feeding techniques for the child. The NIH recommends the earlier the diagnosis and beginning of treatment, the better the results. If left untreated, feeding disorders can become more complex.

Stacey Hatton is a pediatric RN and Overland Park freelance writer.

Nighty-Night, Electronics: We Need Our Rest!

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published in KC Parent April 2012 issue

by Stacey Hatton

With both parents and children more dependent than ever on social media for entertainment and overall survival in the world, shutting off the noise and getting some restful sleep can be challenging.

“Sleep difficulties in children are on the rise—and this trend will get worse before it gets better. Estimates for the number of children with abnormal sleep range from 1 in 10 in the general population,” writes Victoria Dunckley, M.D., in her article “Wired & Tired: Electronics and Sleep Disturbance in Children,” published in Mental Wealth.

“Evidence shows video games and other electronics induce the fight-or-flight syndrome, putting the body in a state of stress. Studies show sustained increases in blood pressure and pulse, even hours after playing,” Dunckley says. “It doesn’t have to be a violent game or even a game at all! Internet surfing and texting will similarly put the brain and body in a state of stress, just from the high level of visual and cognitive stimulation.”

There needs to be a set bedtime routine for your tweens and teens – just like when they were infants! “Tween-dom” is a stressful place, with school pressures, relationships, hormones and expectations, so sleep can be challenging.

Nightly at a set time, have your family deposit all electronics in a basket in your room. This will be the point in the evening where all family members need to turn off the noise and concentrate on relaxing. (GASP!)  Are you saying parents should do this as well? Children learn better by example…that’s all I’m saying!

Northeast Kansas mom Karyn says, “For many reasons my boys have to ‘turn in’ their devices at bedtime, and they don’t get them back until the next day after their homework is checked. This rule has set my mind to ease.” She continues, “I know they are sleeping, or at least working on it, when they go to bed. It has also ensured they get right on task with homework when they get home from school.”

Computers, TVs and video games shouldn’t be in children’s rooms. Creating a sleeping place with fewer temptations for midnight “Google-ing” or television watching is imperative. Those are the kinds of interruptions that ensure your child’s never reaching stage 4 of REM sleep—which is the so-critical restorative stage.

Stacey Hatton is a pediatric RN and freelance writer.

Knock on Wood

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previously published in KC Parent magazine December 2011 issue

From fireplace wood to doors and splinters, read here for tips on keeping your kids safe and healthy this month.

Fireplace Safety

When temperatures dip into the freezing range, cuddling with your family in front of the fire hits the spot. However, the beautiful flames can be like a magnet, drawing your tike to those glass doors which can burn your child’s hands in seconds. Jonathan Kelly, manager at Fireplace & Bar-B-Q Center in Overland Park, says, “We carry Spark Guards that come in a wide range of sizes and prices. These will keep kids 8 inches away from the hot glass.”

Kelly states manufacturers are trying to make the glass itself safer, but until a product like that is on the market, these guards are instrumental in preventing serious burns.

Splinters

Q: How do I safely remove a splinter from my child?
A: Depending on how deep the splinter is in the skin, you might have to wash it with soap and water and let the body get rid of it on its own. If you think you can remove it with tweezers, first ice the area to numb it. Then take a pair of tweezers, which have been cleaned with rubbing alcohol, and, holding the afflicted area, firmly grab the splinter’s end and gently remove. If the splinter breaks in half, you are out of luck. Don’t go digging for it. You will only make the area irritated. Wash with soap and water and apply an antibiotic ointment and bandage. Keep an eye for signs of infection, like redness at site, red streaking from the area, pus or continual pain. Report these findings to the child’s medical provider.

Stranger Danger Knocking on the Door

Quick quiz: Answer each of the below with yes or no.

  1. If your children are left with a babysitter and someone comes to the door, should the babysitter answer the door?
  2. If your mother-in-law is watching the kids and someone rings the bell, should she open the door to a stranger?
  3. Your 13-year-old is watching her siblings while you run back to the store. Should she open the door to an unknown salesperson?

(ANSWERS: 1: N 2: N 3: N)

The caretaker should flash lights or elevate the TV or music so the person at the door knows someone is in the house, but unlocking the door is inviting trouble. No one needs to know your children are home with a babysitter or alone. Make sure this is clear to your children and every babysitter.

Stacey Hatton is a pediatric registered nurse and freelance writer.

Are American Girls Reaching Puberty Earlier?

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Previously published KC Parent magazine July 2011 issue

Puberty…ah, every parent’s favorite memory—and a time each can’t wait to get over with their children. It’s a challenging, hormonal, crazed time which is hard to decipher, harder still to predict—perhaps hardest yet when it finally hits your home.

The hormones should occur sometime during adolescence. The average age is 10 for girls, but no earlier than 7 or 8. Unfortunately, there is a different phenomenon occurring, according to a 2009 research study in Pediatrics journal: American girls are entering puberty much earlier than in the past.

Precocious Puberty (Very Early)

The American Academy of Pediatrics (AAP) says, “Precocious puberty, which can be manifested by the appearance of breast buds in a girl under the age of six or seven, affects approximately 1 in 160 otherwise healthy youngsters. No underlying disease is detected in about 90 percent of these girls.” Initial signs are:

  • Breast development
  • Pubic or underarm hair
  • Growth spurt
  • Menstruation
  • Acne
  • Body odor

Dr. Sherri Martin, a pediatrician with Shawnee Mission Pediatrics, says she sees numerous cases of precocious puberty every year. “What I sometimes see are 5-year-olds with breasts and 6-year-olds with pubic hair,” she says. “You need to perform a thorough exam. Do they have body odor, pubic hair, underarm hair, breasts, or are they growing in height too quickly? Then check their bone age, several hormone blood levels and their thyroid.”

A bone age test, which is an x-ray of the hand and wrist, determines the overall maturity of the child’s bones. If results are advanced, she will send the child to an endocrinologist for further testing and treatment.

“Our world is getting fatter and BMIs (body mass index) are going up,” says Dr. Martin. “Almost always (these patients) are overweight.”

Other Causes: (AAP)

  • Tumor, abnormality of the ovary or thyroid gland
  • Disorder of the central nervous system
  • Delayed effect of radiation therapy to the brain and/or spinal cord
  • McCune-Albright syndrome

Typically, these girls are referred to a pediatric endocrinologist who provides hormone suppressive therapy. This treatment prevents the child from having stunted overall growth, because when puberty finishes, growth in height ceases.

Treatment

If a girl’s height potential is not going to be reached because of early puberty and will cause physical or social problems, there are ways to temporarily stop the child’s menses. This allows the child to continue growing in height.

“Depo Lupron will not reverse the breast development or the pubic hair, but will delay the period and will allow the child to grow to their appropriate height while receiving the injection,” Dr. Martin says. Typically, the endocrinologist will monitor this carefully. As soon as the monthly shots are stopped, puberty will resume as before.

Early Puberty “There’s also thought to be a connection between obesity and early puberty, especially in girls,” says Nemours Foundation. “Overweight kids tend to grow faster and enter puberty earlier, and obesity might play a role in earlier onset of breast development, usually the first sign that a girl is entering puberty.” Kristi, an elementary school nurse in south Kansas City says she see quite a few students dealing with puberty in the 4th grade. While she doesn’t claim to know the specific causes, she suspects that obesity and inactivity are contributing factors. “They don’t go outside and just veg out to video games,” she says.

“Girls are getting breast buds in the third grade, too.” Another Kansas City, MO, suburb elementary school nurse, Kelly, says, “I see girls with breast buds in second grade – a good percentage of them. And I know of two third graders on their periods. In 4th and 5th grade, I expect it, but both girls are overweight.” Kelly says, “I do have concern over kids having such high fat diets, and there is some evidence it could be a link. Look at ballerinas and gymnasts who are so physically active and have delayed periods versus kids who are not active and start earlier.”

While some evidence may suggest a link between obesity and early puberty, there is not a proven link between the two.

Controversial Theories

Theories abound about the root causes of early puberty in American girls. And although various concerned groups passionately oppose different substances and products, direct links between any of them and the early onset of puberty remain unproven. Here are some of the main topics of study:

  1. Soy, a natural phytoestrogen, is present in much of our prepackaged food. It’s difficult to find food without some sort of soy product in it nowadays. Some research on mice has shown that accelerated mammary gland development has occurred, but the studies are inconclusive on humans, and there are no boys who are developing breasts from infant soy formula.
  2. Bisphenol A is used in the interior lining of food and beverage cans and has been shown to alter mammary gland growth in mice. Exposure to such agents has also been shown to advance pubertal development in animals. Still inconclusive – but interesting.
  3. Growth hormones in dairy and meat are often debated. These are given to the cattle and chickens to produce larger cuts of meat for the consumer, but is this hormone good for human consumption, especially children who have not gone through puberty yet?

We want to protect our children, but have no definitive answers about what causes early puberty. And research hasn’t yielded data that warrants any regulation changes. Nonetheless, AAP recommends “encouraging self-acceptance and downplaying the importance of physical characteristics.” By teaching children true beauty is a “combination of personality and how they treat others,” and that the media distorts images in the entertainment and fashion business, parents can give children a strong introduction to a healthy body image. Remember, too, that children learn by example and will model attitudes and lifestyle choices – good and bad. Incorporating healthy balanced meals and increasing daily exercise will also battle many potential health issues.

Stacey Hatton is an Overland Park freelance writer.

Hand, Foot and Mouth Disease

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KC Parent Magazine June 2011 issue

Just when you think your children are out of the woods with the cold and flu season behind them, a summertime disease called Hand, Foot and Mouth rounds the corner. It comes on with fever, muscle aches and painful blisters attacking your child’s mouth and throat, the palms of his hands and the soles of his feet.

Dr. Carlos Monzon, a pediatrician with Pediatric Associates of Olathe, says that during the summer and fall months, Hand, Foot and Mouth Disease is quite common. “You see the illness mostly in toddlers and young children,” says Dr. Monzon. “One child comes in; then you see two or three from the same place over the next few days.”

The virus is quite contagious and can spread from person to person on unwashed surfaces and hands contaminated by feces.

“HFM disease is spread by direct contact; however, there is no specific treatment,” says Dr. Monzon. “You treat the symptoms—the fever, the pain—and make sure to keep them hydrated. Sometimes the child is not drinking enough because of the pain (mouth ulcers).” If the pain is so severe that the child is not eating or drinking, a compounded medication called Magic Mouthwash, a combination of several drugs mixed together by a pharmacist, can have tremendous therapeutic outcomes. “Magic Mouthwash is a good way to alleviate the ulcers in the mouth and great to soothe mouth pain,” Dr. Monzon says.

Magic Mouthwash
They don’t call this one magic for nothing! As soon as this medication contacts the mouth and throat ulcers, pain relief is instant.

“Doctors write differing prescriptions for Magic Mouthwash, but most include equal parts of lidocaine, Benadryl and Mylanta or Maalox,” says Tracy Dryer, a pharmacist with Red Cross Pharmacy, Grain Valley, MO.

“The lidocaine works the best for the sores,” she says. “Mylanta or Maalox helps adhere the substance to the ulcerated area, and the Benadryl is an antihistamine,” which relieves the irritation of the sores.

Follow instructions carefully. “You want to make sure the child swishes and expectorates (spits out) the medicine. You don’t want a child to swallow a whole bunch of the lidocaine,” Dryer says.

Can My Kid Catch HFM from Petting Zoos?
Not unless your kid is a goat! Hoof and mouth disease is an often fatal viral disease, which affects only domestic and wild bovine animals. Hand, Foot and Mouth Disease is completely unrelated to this barnyard animal and livestock disease.

Stacey Hatton is a pediatric RN and mom to two kids, who are not goats.