Child can’t tie shoelaces? Problem solved!

Posted August 28, 2014 by Dr. Roy
Categories: Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

For most kids, shoelaces are no big deal. But some kids have fine motor problems and just can’t seem to get a good knot. Velcro is great for younger kids, but let’s face it: bigger-sized Velcro shoes are just plain ugly. What’s a parent to do?

There is hope! There’s more than one way to tie a shoe. I do the traditional “loop around the tree and the bunny pokes his head out of the hole” method. Many kids seem to do better by tying two loops together. Here’s a third way—it’s really simple, and I think many kids may find it easier than any of the traditional methods. You tie a half-hitch (just an ordinary x-knot, whatever you want to call it), then another half-hitch, and poke the aglets thru the hole between the knots. The video makes it much more clear. There are loads of other “easy-tie” videos on Youtube worth exploring for the shoelace challenged.

Still too difficult, or just too much bother? Maybe you’ve got a child who can tie shoes, but is too lazy to do it. Here’s another option: shoelace replacements called “Lock Laces.” They look good, they come in all sorts of colors, and they’re really easy to use.

Or just stick with Velcro. They can’t all look bad

Contest Winners!

Posted August 25, 2014 by Dr. Roy
Categories: Medical problems

The Pediatric Insider

© 2014 Roy Benaroch, MD

Thanks for everyone for playing last week’s contest! The winners are all getting a copy of my Great Courses lecture series, Medical School for Everyone: Grand Rounds Cases!

First, the answers– What’s the name of the theme song of these TV shows?

Sanford and Son  – The Streetbeater, by Quincy Jones

Taxi  – Angela, by Bob James

M*A*S*H – Suicide is Painless, music by Johnny Mandel, lyrics by Mike Altman (the 14 year old son of the movie’s director, Robert Altman. It’s said that he made far more money by writing those lyrics than his father made from directing the film.)

The Benny Hill Show – Yakety Sax by Boots Randolph

The Dukes of Hazzard  — Gold Ol’ Boys by Waylon Jennings

 

Our winners are stuart, Sallie, Karen, Sheila, and Teresa! Woot! You all will be getting your courses in the mail soon, congrats!

If you didn’t win– please check out my lecture series over at The Great Courses. Feedback has been excellent! They have a 100% no-questions money back guarantee if you want to return your purchase, and the course is at special sale price right now!

 

 

 

Avoiding medication dose errors in children

Posted August 21, 2014 by Dr. Roy
Categories: In the news, Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

The thing about medicines: they’re real bio-active substances. They do stuff. Some good stuff, and some bad stuff too. Every medicine (or, really, anything you put in your body that has any biologic effect at all) is also potentially going to have side-effects or adverse drug effects, too. To maximize the good, and minimize the bad, you’ve got to dose medications correctly.

So it’s chilling and discouraging to learn that in a recent study of 300 parents prescribed children’s liquid medications out of Emergency Departments in Philadelphia and New York, about 40% of the time the dose was misunderstood or given incorrectly. That’s a huge number of incorrect doses, and probably contributes to the 10,000 poison center calls made about children’s medicine doses to poison centers each year. Doses were twice as likely to be incorrect if the instructions were given in teaspoons or tablespoons, because those units aren’t necessarily understood correctly by everyone.

The authors suggest that children’s liquid medicines always be dosed in milliliters, and that parents be given a correct-unit-dosing device (like a syringe) marked with the exact dose. Those are good ideas. Parents should not be ladling medicine into their kids from a kitchen spoon—that’s just too inexact, and depends too much on what kind of spoon and how high you fill it. Dosing syringes can be standardized to measure the right amount, and don’t spill medicine all over the place when you’re trying to get them into Junior’s mouth.

When your child is prescribed a medication, make sure you know the correct dose, and the correct way to give the dose. Any questions? Ask your doctor or pharmacist. If you’re going to give your child medicine, you ought to do it right.

Win a copy of my lecture series in a TV Theme Trivia Contest!

Posted August 18, 2014 by Dr. Roy
Categories: Pediatric Insider information

The Pediatric Insider

© 2014 Roy Benaroch, MD

My lecture series with The Great Courses is doing really well—so far, all 5-star ratings, and initial sales look great! If you’ve already bought a copy of Medical School for Everyone, thanks! If you haven’t, or if you want a second copy for some reason—here’s your chance to win!

The course is a series of 24, 30-minute lectures, all “medical mystery” cases that I hope will be fun to figure out. I’ll give you the clues, and you’ll try to figure out the diagnosis! Along the way, I’ll teach you about medicine, and about how doctors think. It was fun to write and tape the series, and I think you’ll have fun listening or watching it. You can get audio-only or video versions.

If you don’t want to buy a copy, here’s your chance to win a DVD copy! Below are the names of five TV series that I liked as a kid (I’m not apologizing for The Dukes of Hazzard. I liked the car jumping parts and Roscoe P Coltrane’s dog.) In the comments, give me the NAME of the matching theme song. Hint: these theme songs are NOT named “The Theme From Taxi”—they all have real names. If you’re the first person to name a show’s theme correctly (and you’ve given me an email address that works), I’ll get in touch with you to mail you a copy of the course. Cool!

Please only guess one show in one comment—once you’ve won a copy for yourself, don’t give away any answers for the other shows. The idea here is that 5 different people will each win a copy. If you give multiple answers I’ll delete your post. If you’re not a frequent poster here, your comment will be held in moderation—don’t worry, you’ll still win, I’ll give credit to whomever posted first.

 

What is the name of the theme song of:

1. Sanford and Son

2. Taxi

3. M*A*S*H

4. The Benny Hill Show

5. The Dukes of Hazzard

 

Rules: Only one win per person. I’ll pay to mail these in the USA, but if you live somewhere else you’ll have to pay your own postage. I am the final judge of the winners. If you win and you like the course, please post a review at The Great Courses or Amazon. Thanks for playing!

 

Another win for dogs!

Posted August 14, 2014 by Dr. Roy
Categories: Medical problems

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The Pediatric Insider

© 2014 Roy Benaroch, MD

Trying to decide whether to get a dog? Here’s more evidence that you should!

A 2012 Finnish study looked at about 400 babies from birth through the first year of life. Families kept diaries to track respiratory infections together with information about both dog and cat contacts.

Author and Misty, 1976

Children who lived with dogs had fewer colds and fewer ear infections; they were also prescribed fewer courses of antibiotics. The effects were dose-related, too—more time with dogs increased the health advantages. Cat exposures were much less beneficial.

Author and Lucky, 2014
Author and Lucky, 2014

Other research has shown that pet ownership decreases stress, increases life satisfaction, and may decrease the incidence of allergies. Dogs are also really fun to have around. Please consider a rescue pup from an organization like Furkids/SmallDog Rescue (they’re in Georgia—many other great non-profit rescues can be found all over the country. Look for your own local rescue via Google.) There are some great dogs out there who really need a home, and they’ll pay you back with love, companionship, and fun.

Cats are nice, too. I suppose.

Getting the most out of your child’s checkup

Posted August 11, 2014 by Dr. Roy
Categories: Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

In a recent post, I wrote about the value of a yearly checkup with your child’s doctor—it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips.

First, and most important at all, go to the visit. You’d be surprised how often children are brought by a cousin or aunt or sitter. Sometimes they bring a list of questions from mom—but what kind of a way is that to communicate? Even better: if both parents have questions, both of you should try to go to the physical. I like meeting both parents. And we’ll all get more out of the visit together.

Bring records of any visits with other doctors, Emergency Departments, and urgent care centers. If your child has been prescribed medications from other docs, bring those, too. Let’s use this as an opportunity to make sure all of the records and straight and all in one place.

Bring questions! A typed list, scribbled notes on a receipt, or a few words typed in a phone app—I’ve seen it all. Any kind of list is a good idea. You won’t get answers if you don’t remember your questions. Bonus pro-tip: put your questions in order, starting with the one you’re most concerned about.

If possible, don’t bring other children (especially young, distracting siblings). I know it’s not always practical, but if you can possibly set up a time for just the child, parents, and doctor to be in a room together, we can best focus on the star of the show. If you do have to bring siblings (and I understand, sometimes you just have to bring the whole family), try to bring something for them to do. Crayons, iPads, whatever you’ve got.

If for some reason you can’t make it on time, reschedule the visit. You’ll get more out of a rescheduled well check than a rushed well check. If you have to cancel, please call ahead of time—at my office, we always have a waiting list of people hoping to grab a cancelled slot. Do someone else a favor and call ahead of time if you can’t make it to your appointment.

Talk with your child in advance about what to expect. The doctor is going to check “down there”, which is OK for the doctor to do as long as mom or dad is in the room (when kids get older, I’ll ask mom and dad to leave—expect that by the teenage years.) We just want to make sure everything is OK, and that means everything. OK?

There may be some things you don’t want to talk about in front of the child. Maybe school problems, or bullying, or maybe there’s marital problems that are stressing your child out. These are all good questions, and sometimes it can be awkward to bring them up. If it’s a quick question, slip the nurse a note that you need a moment alone with the doc. If you think you need more private time with the physician, call ahead and ask how your doctor’s office likes to handle that. It’s unfair to leave a child alone in the room for a long time while you talk secretly with the doctor—and it makes the kids very, very nervous. It might be best to set up a separate time for parents to come in.

For visits with school-aged or other children, be prepared to let your child talk. I know you’ve got questions, too, and we’ll get to those—but I first want to make sure your child knows this is his visit. He gets to talk first. That drives some parents crazy, but that’s the way it works best.

A yearly checkup with your child’s doctor should be more than a time to get a form signed for soccer. It’s a chance to catch up and make sure someone is looking at “The Big Picture.” Parents and doctors both want to make sure that these checkups are valuable for the children and families. Be prepared, and you’ll get the most out of the visit.

Left your amoxicillin or Augmentin out of the refrigerator? It’s probably OK.

Posted August 7, 2014 by Dr. Roy
Categories: Pediatric Insider information

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The Pediatric Insider

© 2014 Roy Benaroch, MD

We get these calls a few times a month—a family, despite dire warnings that their child’s antibiotic MUST be refrigerated, leaves it out on the counter overnight. Can we call in a new prescription?

Sure we can. But we probably don’t need to.

Many children’s antibiotics come in liquid suspensions. Little ground-up particles of medicine (along with flavorings and colorings and stabilizers and other goodies, collectively called “excipients”) are mixed by the pharmacist with water, and the bottle is shaken. Voila, you’ve got a suspension. But the water can break down some molecules especially if the water gets warm. So some of these suspensions are supposed to be kept in the ‘fridge, especially amoxicillin and amoxicillin/clavulanate (commonly called Augmentin.) That’s in the product insert: “keep refrigerated.” And it’s on a little sticker the pharmacist puts on the bottle. But is it really necessary?

Trust science to find out!

From The Journal of Applied Pharmaceutical Science, 2012, comes a study using state-of-the-art liquid chromotography to determine the potency of amoxicillin/clavulanate stored in three ways: refrigerated, stored in a cupboard at room temperature, and with the bottle submerged in water at room temperature (to minimize fluctuations in temperature.) Both the amoxicillin and clavulanate components of the medication kept all of their potency for at least five days. After that, there was a drop off in potency no matter how the samples were stored, though the refrigerated sample stayed the strongest. The amoxicillin portion of the medication lost about 17% of its potency in the fridge after 10 days, versus 25% of its potency in the cupboard. The clavulanate portion was a little bit more sensitive, losing about half of its potency at room temperature by day 7 to 10.

The study was done in Nigeria, where frequent power outages make consistent refrigeration problematic, and where limited resources make it more difficult to easily replace medications. But the results should be applicable here, too: under ordinary household circumstances, both amoxicillin and Augmentin are stable if left unrefrigerated for 5 days, maybe even longer for amoxicillin alone. They considered up to 84 degrees ordinary room temperature—again, this was in Nigeria. I imagine in typical cooler American homes these medications might last even longer sitting on the counter.

Some factors might further influence unrefrigerated shelf life. Light, especially direct sunlight, could potentially break down medications faster; and if the liquid gets really warm, left in a car, that’s going to ruin the medication pretty quickly. And this study only looked at two penicillin-based antibiotics (amoxicillin and Augmentin.) I can’t vouch for other medicines that are supposed to stay in the fridge. But it’s nice to know that for these common antibiotics, a few days at room temperature probably makes no difference.


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