NURSE'S TIPS

TEETHING

When does teething begin?

A baby's first tooth will appear anytime between the ages of 3 months and 1 year. Teething usually begins with the incisors - the two central bottom and top teeth. The teething process continues through the next two to three years, until all 20 primary teeth have erupted. Teething patterns very among children and can be influenced by heredity. So if mom or dad were "late teethers", their baby might be also.

The most common pattern is:

• 6-7 months - central incisors, top and bottom
• 7-9 months - two more incisors, top and bottom
• 10-14 months - first molars
• 15-18 months - canines ("eye teeth")
• 2-3 years - second set of molars

What are the symptoms?

Most children go through the teething process without significant symptoms or discomfort. You will see your baby producing more saliva, drooling, and wanting to chew on things. Some babies will be fussy as the tooth erupts, but this should be for a brief period. Parents often associate many problems with teething - runny nose, fever, diarrhea, sleeping problems and diaper rash. There is really no research to support this, and if your child has any of these symptoms, please call and talk to a nurse or provider, as it may be an indication of illness rather than teething.

What can I do to keep my child comfortable?

Massaging the gums is probably the most soothing for the baby. You can do this by applying firm pressure with your clean finger. Teething rings often work well, especially when cold. A cold pacifier may also be effective.

Teething gel (Oragel) can help, but the effect is brief. Use only 2-4 times a day if needed. We don't recommend teething tablets (Hylands) due to the potential for side effects. Acetaminophen (Tylenol) can be used on occasion if needed.

If you have any further questions, please feel free to call our office and talk with our nurse practitioner, Ellen Castellanos, or one of our nurses at 805-466-6622.

FEEDING YOUR BABY

Ever thought about making your own baby food? It might be simpler than you think. Infants are usually ready for solids by about 4 to 6 months. They can start with one of the iron fortified baby cereals, and then move on to fruits and vegetables.

To cook for you baby – choose fresh fruits and vegetables, or you can use frozen. Wash the fresh foods well to remove any residual chemicals. Using a blender, food processor, or baby food grinder, puree the foods. To store, use ice cube trays, or individual small containers. If using the trays, after the food is frozen, store in zip-lock bags. Do not refreeze unused portions, and discard any unused defrosted food after 2 days in the fridge.

As your baby progresses through various foods, you can puree some of what the family is eating, such as pasta and chicken. Mashed potatoes are often a favorite, with sweet potatoes being especially nutritious. Adding texture is important as the baby gets older – such as adding cottage cheese to a pureed fruit – with the cottage cheese still soft enough for the baby to handle, but providing a little chewiness.

A few books available about feeding your baby:

• “Super Baby Food” Ruth Yaron
• “The Healthy Baby Meal Planner” & “First Meals” Annabel Karmel
• “The Baby Cookbook” Karin Knight

(Some information taken from The Tribune, “Better Baby Food” July 16, 2003).

CALCIUM & VITAMIN D RECOMMENDATIONS

Calcium and vitamin D are essential nutrients for strong healthy bones.

These nutrients play an essential role:

1. in assuring acquisition of peak bone mass in childhood and adolescence
2. in preserving skeletal mass in mature adulthood

Adequate calcium and vitamin D intake is essential to attaining adequate bone mass in childhood and adolescence, thereby preventing osteoporosis in later life.

What is needed?

1-3 years 500mg/day 200 international units/day
4-8 years 800mg/day 200 international units/day
9-18 years 1300mg/day 200 international units/day

Calcium content of some common foods:

SAFETY REMINDERS

CAR SEATS – infants need to be in rear facing car seats until they are 20 pounds AND 12 months old. If they reach 20 pounds before a year of age, they still need to be rear facing. When you are shopping for a car seat for your toddler, consider a seat that converts into a booster seat. By law, children need to be in a booster seat until they are 60 pounds or 6 years old.

The National Highway Traffic Safety Administration recently tested car seats with regard to assembly, clarity of instructions, ease of securing the child in the seat, and features which affected installation of the seat in the car. For the complete list of the car seat models and their ratings, go to:
www.nhtsa.dot.gov/CPS/CSSRating.

BIKE HELMETS – It is important to teach your child that a bike helmet is required each time he or she is on a bike. It is also very important that the helmet fit right. To insure a safe fit, pay attention to these tips:

• The helmet needs to rest low on the forehead - less than two fingers’ width above the brow.
• The straps should make a V around the ear - pull the chin straps snugly

For more information, go to the Consumer Product Safety Commission website: www.cpsc.gov.

PROTECT YOUR CHILD FROM POISONS

Keeping your child safe from poisoning involves awareness of his/her environment and some anticipatory action.

Take a look around your home and make sure all potential poisons are up and out of reach, both in the home and in the garage.

If you think your child ingested a substance that may be poisonous, the first thing to do is to call Poison Control, at 1-800-876-4766. The Poison Control Center can give you needed information instantly – which is why it is best to call them instead of your doctor or the emergency room. When you call, have the substance container available and know the child’s weight. Post the Poison Control number near your phone.

It is no longer advised to keep Syrup of Ipecac in the home – as it no longer plays a role in the treatment of a poison ingestion.

Don’t forget about the possibility of poisonous plants. It is important to know what is in your garden. These are some excellent Web sites with information:

Know Your Plants-Safe or Poisonous? http://envhort.ucdavis.edu/ce/king/PoisPlant

California Poison Control System at www.calpoison.org

INFANT SLEEP POSITION

It is important to put your infant down to sleep positioned on his/her side or back.

This has been the recommendation of the American Academy of Pediatrics since 1992, and has reduced the incidence of Sudden Infant Death Syndrome by more than forty percent.

When the infant has learned to roll over, between three and six months of age, then he/she can choose to sleep on back or stomach.

To avoid the possibility of the infant developing a flattened or misshapen head due to lying in the same position consistently, it is important to alternate the baby’s head position from left to right each night.

Give your baby some tummy time during the day when they are awake and you are around. This gives the infant the opportunity to use his/her neck and shoulder muscles and develop head control.

Position the baby in different directions in the crib or playpen so he/she has to turn in varied directions to see what is going on in the room.

If you have concerns about your infant’s head becoming flattened or misshapen, please discuss this with your health care provider.

CHILDREN NEED THEIR SLEEP

It is very important to establish good sleep habits in your child. A recent survey has shown that most children are not getting the number of hours of sleep they need.

Children under a year need 14-15 hours of sleep a day. Toddlers age 1 to 3 need 12-14 hours, preschoolers need 11-13 hours, and school age children need 10 or even 11 hours a night.

The bedroom should be reserved for sleeping, and eliminating the television from the room is one step in the right direction. If a child watches television before bedtime, it can serve as a stimulant – due to the broad light and content.

Try to establish a bedtime routine, giving children time to wind down before going to bed. Stick to a set time as much as possible. Perhaps have a bedtime snack – nothing with caffeine, such as soda or ice tea. Read a story, cuddle, then lights out!

A WORD ABOUT TANNING

With summer upon us, it important to think about sun exposure and the use of tanning booths.

According to a study done in Scandinavia and published in a recent Journal of the National Cancer Institute, sunburns and the use of tanning booths during the adolescent and young adult years significantly increases the risk of skin cancer. It was found that women of any age or skin tone who used a tanning booth one or more times per month had a 55 percent increased chance of developing melanoma. The risk was higher for women in their twenties.

Please discourage your teens from using tanning booths or “laying out”. Teach your children the importance of using sunscreen. Encourage the use of hats to protect the face. Most important of all, set an example, by trying to stay out of the sun, and when outside, protecting yourself from sunburn.

AVOIDING SUMMER STINGS

Along with summer comes insects, many of which will bite or sting if given the chance.

Here are a few ways to avoid those stings:

• Avoid using scented soaps and shampoos, as bugs are attracted to sweet scents.
• Avoid areas around water or blooming plants, as this is where bugs congregate.
• Try to keep food covered while eating outside, as bugs are attracted to food.
• Bugs are attracted to brightly colored clothing, so dress quietly!
• Use repellents that contain DEET, at a lower percentage for children, such as 7 to 10 percent. Try to apply only once in a day for children, so use it when the likelihood of exposure is high.
• If someone gets stung, remove the stinger by scraping horizontally across the area with a fingernail or the edge of a credit card.

(from American Academy of Pediatrics and Centers for Disease Control)

RATING MOVIES

Here are a few internet sites to help parents decide if a particular movie is appropriate for their children:

• www.mediafamily.com - The National Institute on Media and the Family offers KidScore, on which parents rate videos based on content such as violence, language, nudity and sexual content (free).
• http://movies.yahoo.com/moviemom/ -provides information on movies, DVDs and videos at Movie Mom’s Reviews (free).
• www.pluggedinmag.com - Focus on the Family’s (a non-profit Christian organization) film reviews (free).
• www.CQCM.org - the Coalition for Quality Children’s Media publishes a Kids First! Directory, which issues warnings about violence, sexual behavior, discrimination, and unsafe behavior in movies and media (membership needed)

(from Knight Ridder Newspapers)

DENTAL HEALTH

In a recent study published in General Dentistry, the journal of the Academy of General Dentistry, it was shown in addition to soda’s known risk to tooth health, non-colas, canned ice teas, and diet drinks can weaken and erode tooth enamel.

In addition to the damaging effects of sugar (a typical 12 ounce can of soda contains approximately 10 teaspoons of sugar), the acids in soda and other drinks are corrosive to the tooth’s protective enamel coating. The acids also draw calcium out of tooth enamel.

Another good reason to limit your children’s soda and sweetened drink intake!
So encourage your children to drink water. The earlier you start, the more likely the child will be a water drinker. And don’t forget brushing, flossing and regular dental visits.

PROTECTING YOUR CHILDREN FROM SEXUAL ABUSE

Many people who commit sexual crimes against children have common characteristics. The following are actions and behaviors which may be expressions of genuine warmth and affection, but may also be possible warning signs. A parent must be vigilant and be aware of adults who interact with their children
Some of these signs are:

• Adults who volunteer with children’s groups and activities even if their own kids don’t participate.
• Adults who buy expensive gifts or take others’ kids to professional sports events or concerts.
• Adults who frequently take others’ children on outings that will allow them to be alone with the child – such as camping trips.
• Adults who do not have children, but show an extreme interest in children’s activities or fads, and may have books, video games or movies for children in their home.
• Adults who insist on hugging, touching, kissing, tickling, wrestling or giving children back rubs or excessive physical attention.
• Adults who seem too available for babysitting or family functions.

So pay attention to your gut instinct about people who interact with your children. Talk to your children about inappropriate touch, emphasize that they can tell you anything that happens which makes them uncomfortable and they would never be blamed.

(Los Angeles Times)

NUTRITION TIPS

Here are some recent tips from the American Dietetic Association about infant and toddler nutrition:

• There is little room in a young child’s life for high-calorie, low-nutrient food – such as soda, sugary snacks, candy.
• Television is inappropriate for children under 2 years old because of its potentially negative effects on development and physical activity.
• It can take 10-15 exposures for a baby to accept a new flavor. But parents may give up on a new food too soon, thereby limiting the baby’s diet.
• Iron can be hard for babies to get in their diets. Iron-fortified infant cereals or pureed meats are good sources, along with iron-fortified formula or breast milk during the first year of life.

Dietary habits start young. Try to make mealtimes relaxed. Accept your child’s cues that he/she is full. Do not use food as a reward.

AVOIDING DOG BITES

Dog bites account for 80% of all animal bite wounds in the U.S. each year. It is important to teach your child how to act around dogs, and how to avoid being bitten.

• Do not pet a dog without first letting it see and smell you. Teach children to ask permission of the dog’s owner to pet it.
• Do not approach an unfamiliar dog.
• Do not scream and run from a dog.
• Remain motionless when an unfamiliar dog approaches you.
• If you are knocked over by a dog, roll into a ball and lie still.
• Avoid direct eye contact with a dog.
• Do not disturb a dog that is eating, sleeping, or caring for puppies.
• Do not allow children to play with a dog unless supervised by an adult.

If a child is attacked, try to loosen the dog’s grip by pushing your arm against its throat. Place something between the child and the dog, like a purse or jacket. Control the bleeding and wash the wound with soap and water, then get medical attention to determine the risk of infection or rabies.

INJURY FREE PARENTING

Here are some tips to reduce the likelihood of being injured while caring for children.

• Alternate the side on which you carry and nurse children.
• Slow down your movements and think in steps. For example, lift the child, then turn.
• Your little is pitching a fit? First take a deep breath – tension in the body can make an injury more likely. Then kneel or squat at the child’s level to soothe him. If you have to pick up the child quickly, you’ll be in a better lifting position.
• Take time to open a child-safety gate. Stepping over it can be hazardous, not only because of tripping but also because it can injure your back.
• Although it is convenient, try not to carry your baby in a portable car seat. If you must, alternate sides frequently.
• Talk to and hug your child as you lift – you’ll naturally exhale and bring your child’s weight closer to you body.

TAKEN FROM: “HOW TO RAISE CHILDREN WITHOUT BREAKING YOUR BACK” BY ALEX PIRIE AND HOLLIS HERMAN.

CUT BACK ON TELEVISION TIME

We are seeing an epidemic of overweight and obese children in our society. This problem is closely related to an inactive lifestyle during childhood, with a direct correlation to how much time children spend watching television. Here are some hints to cut back on your child’s television time:

• START EARLY – it is easier to avoid placing a television in your child’s room than to remove it once it’s there.
• PAY ATTENTION TO TIME AS WELL AS CONTENT – while it is important to monitor your child’s exposure to sexuality, violence and drug use in programming, studies show that it’s total viewing time that predicts overweight most closely. There’s a similar relationship between total viewing time and attention-deficit hyperactivity disorder.
• OFFER CHILDREN ALTERNATIVES TO TV – according to interviews with children, watching TV isn’t really regarded as fun. They regard almost any other activity as more fun than watching TV. Watching TV is regarded as a default behavior. Children can come up with more creative activities, given the opportunity.

So focus on family time, getting children involved in sports or other group activities. Make mealtime a time for family members to talk and interact; limit television time on weeknights; read a book before bedtime instead of watching TV.

PEDIATRIC NEWS January 2005

MERCURY IN FISH AND SHELLFISH

Research indicates that high levels of mercury in the bloodstream of unborn babies and young children may harm the developing nervous system. The FDA and EPA have issued an advisory that, if followed, should keep an individual’s mercury consumption below levels that have been shown to cause harm. It is important information for women who may become pregnant, pregnant women, nursing mothers, and parents of young children to be aware of..

Fish and shellfish are an important part of a healthy diet. A healthy diet that contains a variety of fish can contribute to children’s proper growth and development.

The following recommendations for selecting and eating fish and shellfish, if followed, will allow women and young children to receive the benefits and reduce the exposure to the harmful effects of mercury:

• Do not eat shark, swordfish, King Mackerel, or tilefish because they contain high levels of mercury.
• Eat up to 12 ounces (two average meals) a week of a variety of fish and shellfish that are lower in mercury. Five of the most commonly eaten fish and shellfish that are low in mercury are shrimp, canned light tuna, salmon, Pollock and catfish. Another commonly eaten fish, albacore (white) tuna, has more mercury that canned light tuna. So, when choosing two meals of fish and shellfish, you may eat up to six ounces (one average meal) of albacore tuna per week.
• Check local advisories about the safety of fish caught by family and friends in local lakes, rivers and coastal areas. If no advice is available, eat up to six ounces (one average meal) per week of fish caught from local waters, but don’t consume any other fish that week.

Follow these same recommendations when feeding fish and shellfish to young children, but serve smaller portions.

TIPS FOR BACKPACK WEAR

With school starting, now is the time to make sure your child’s backpack is the right kind and is being worn safely.

The best packs have two shoulder straps, wide and padded. Avoid the one strap “messenger” bags, which have one strap and go across one shoulder and the chest, as these do not distribute the weight evenly. A pack with multiple compartments will help distribute the weight evenly.

Some other tips:

• Make sure your child uses both straps and connects the waist strap if provided.
• Pay attention to your child’s posture. If the child is unable to walk without hunching or rounding the shoulders and back, the pack may be too heavy.
• Avoid overloading the pack. Take advantage of using a double set of textbooks if available, and make locker stops if possible to drop off textbooks or non-essentials.
• Work with your child to spread homework assignments over the week, avoiding leaving everything to the weekend. This will help avoid an overloaded backpack on Fridays.
• Keep your child active and in shape with exercise and sports activities. This will help keep the shoulders and torso in shape.

SAN LUIS SPORTS THERAPY

WHAT PARENTS NEED TO KNOW ABOUT RABIES

Rabies, a disease that attacks the nervous system, is caused by a virus. In the United States, the most common carriers of this virus are bats, skunks, coyotes, foxes and raccoons. In the Third World, dogs pose the biggest rabies threat.

• Keeping pets vaccinated and teaching children to respect wildlife are the keys to rabies prevention. Children should be instructed to never approach ill or strange-acting animals. Bats, especially those found in your home or on the lawn, should never be handled.
• A person who has been bitten by a potentially rabid animal should wash the wound with soap and water and seek immediate medical care. In the United States, treatment consists of one dose of rabies immune globulin and five doses of rabies vaccine.
• Rabies shots are relatively painless, but you need to act right away. The incubation period for rabies typically is four to six weeks. But once symptoms set in, the disease is nearly 100% fatal.
• Although rabies is uncommon in dogs, cats and ferrets, any domestic animal that bites a person should be confined by its owner for 10 days and observed. If the animal becomes ill, it should be evaluated for rabies and the person who was bitten should seek medical advice about the need for treatment.
• Families traveling to developing areas of Africa, Asia or Latin America should consult with a doctor about whether to receive pre-exposure vaccination against rabies.

2005 American Academy of Pediatrics

WHEN IS YOUR CHILD READY FOR AN ADULT SEAT BELT?

Auto seat belts are designed for adults. Most children are not ready to wear an adult seat belt until they are at least 8 years old. The child needs to be approximately 4’9”. The reasons for this are that until then, most children have not developed strong hip bones, and their legs and body are too short to allow for proper fit of a safety belt. Auto seat belts are designed for adults.

To be able to fit in a safety belt, a child must be able to:

• Keep his/her back against the vehicle seat back
• Sit with his/her knees comfortably bent over the edge of the vehicle seat
• Sit with the shoulder belt crossing the shoulder between the neck and the arm
• Keep the lap belt low and snug on the upper thigh
• Stay comfortably seated this way for the whole trip

If the seat belt does not fit properly, the child should use a belt-positioning booster seat with a lap/shoulder belt.

Always check belt fit on the child in every vehicle. Depending on the width of the vehicle seat, a belt-positioning booster seat may be needed in some vehicles and not in others.

Remember, all children under 12 years should ride in the back seat.