Summer DivorceCare and DivorceCare 4 Kids program begins May 11

The summer session of DivorceCare and DivorceCare 4 Kids starts May 11 and concludes Aug. 3.

DivorceCare is a support group for adults who are divorced, separated or reconciling. Both adult and children (ages 5-12) sessions take place at the same time.

Participants are not required to attend every week, and can come at any time during the series since each week covers a new topic. The sessions are free, but the workbook that corresponds with the program costs $15. Other social activities are planned outside of the weekly meetings.

The summer support group has a new meeting time and location, from 6:30 to 8 p.m. Saturdays at Rose Street Community Center, 109 Rose Street, Union Gap. Several contacts are listed: Tom Burke, 509-930-7074; Tracy Johnson, 509-930-5855; Dan Whitney, 509-930-1420; Mary Whitney, 509-930-1421; or hhhcouncil@gmail.com.

You can also find out more information on the support group’s website at yakimadivorcecare.net.

Frugal Yakima Mom: Tips on producing healthy and affordable food for baby

By Aubrey Does, Frugal Yakima Mom

As new parents, we were absolutely filled with excitement when the doctor gave us the go-ahead to feed our son his first baby food. The initial joy wore off rapidly as we realized that it was not easy to get a baby to eat and it was majorly time-consuming. The “baby food stage” quickly became my least favorite and I longed for the day he could feed himself. Spending 50 cents on a jar of food was no big deal when I knew there was convenience involved.

Fast-forward to my second son. By the time he was ready to eat, I was much more budget-conscious. I also knew what feeding the baby involved and waited a full two months longer to start than I did with my first son. Around this time there were two big events that were a turning point in my decision to make my own baby food.

1. The “Baby Bullet” was invented.
2. A real-life mom friend of mine introduced me to the idea of using frozen food.

She explained how she bought bags of frozen fruit and vegetables and pureed them in her blender. Whaaaaaaat??? I had been picturing picking through fresh produce for the purest of the species and then taking them home for a cooking experiment that involved some sort of seven-pan medley on my stove top.

After discussing it with my hubby, I decided to purchase a Baby Bullet. You don’t have to have this item to make baby food, as any old blender will do, but I didn’t have anything so I went for the one that was cute and came with a ton of storage containers.

I’m sure that there are really attentive moms who only select the freshest organic produce for their baby’s sensitive belly. I just went straight for the store-brand bags of frozen veggies and tried to buy in bulk when they went anywhere lower than 75 cents a bag. For fresh produce that can’t be frozen (like bananas and avocados), he mostly ate what went on sale that week.

There are lots of different foods you can feed your baby, and it’s up to you to decide in what order you introduce those foods. One example is peas. These you can buy frozen and they were super easy to whip up. I just dumped the peas into a strainer in my sink and shot them with water until they weren’t frozen. You could also just leave them there to thaw. I put them into the blender with a little bit of water and pureed until smooth. Voila! One small frozen bag of peas made 4-6 servings of food. You basically use this same method for any kind of frozen veggies that are good for babies.

Another example is a fresh food like bananas. These I would just break into chunks, throw into the blender with a little water and puree until smooth. Voila! One banana is 2-3 servings of food. Bananas brown easily, so this is more of an “as-you-go” food.

Some of you may be thinking that you would rather use fresh produce. Or you’re thinking about your garden full of food that you want to use because it’s free and organic. If you have a baby young enough to just start eating solids and a garden that’s producing food, kudos. The general principle on using fresh produce (such as green beans, carrots or potatoes) is to boil until tender enough to puree and then puree with a little water until smooth.

The consummate resource for all things baby food is www.wholesomebabyfood.com. It has extensive info on feeding babies and exactly how to cook each type of food. It has way more than I can give you in one article, and you’ll find some really creative recipes!

Storing the baby food you make is easy. You can use any type of reusable container (for glass, make sure it’s labeled freezer-safe). Another popular method of storage is using ice cube trays. Pour a little of your prepared baby food into the wells of an ice cube tray, cover with plastic wrap and freeze. Then move the cubes into a plastic bag and store in the freezer until you’re ready to thaw and use.

I hope I have given some good pointers to get started. If you think this is something you want to try your hand at, make a small batch to start and see how it goes. The best-case scenario is that you’re on your way to making all of your own baby food for a fraction of the cost!

* When she’s not chasing two very busy little boys, Aubrey Does loves drinking coffee and blogging deals. You can read more of her frugal adventures at frugalyakimamom.com.

Second Opinion: Newborn skin conditions

By Dr. David Pommer

A recent photo from a relative of an infant suffering from a rash reminded me of how common skin changes are in newborns. Fortunately, most are benign. Let’s take a few moments to cover the most common rashes: erythema toxicum neonatorum, baby acne, heat rash, cradle cap, stork bites and the infamous diaper rash.

Erythema tocixum neonatorum (ETN) is fairly common, occurring in 40 percent to 70 percent of newborns. It shows up about two to three days after birth. These red bumps cause the baby to have a “flea-bitten” appearance. The rash covers the face and trunk and no treatment is needed. It tends to improve within one week.

Baby acne (acne neonatorum) occurs in about 20 percent of newborns. It may be due to high hormone levels in mom and baby. Focused on the forehead and cheeks, it tends to improve by four months of age without scarring; no need to purchase “zit cream” while buying your diapers.

Heat rash (miliaria rubra) is caused by a deep level of sweat gland obstruction. It appears on covered portions of the skin. Treatment includes removing excess clothing, cooling baths or avoiding situations that cause overheating.

Cradle cap (seborrheic dermatitis) involves redness and greasy scales on the scalp. This tends to improve over several weeks to months. You can use petroleum jelly to soften scales so they are more likely to comb out with a soft brush. Other treatments include use of a tar shampoo or soaking the baby’s scalp with vegetable oil overnight and then washing with shampoo in the morning.

Stork bites (nevus simplex) are a vascular (blood vessel) birthmark. These can be on the back of the neck and scalp. They are benign and most go away by 18 months of age.
Finally, diaper rash. I’m often asked by new parents for the best remedy. If it’s mild, frequent diaper changes and using a zinc oxide cream, such as Desitin, or leaving the diaper off for short periods of time (hopefully you don’t have new carpet) can treat it. If it doesn’t improve and there are distinct red spots on the diaper area, stomach and thighs, it may be time to see a doctor and to start a medicine for yeast infections, such as clotrimazole.

There are many possible rashes in newborns. Fortunately, these tend to be self-contained and don’t indicate a more serious problem. Don’t follow my example as a new parent and reach for your loofah. Just give it some time and most rashes will improve on their own.

Second Opinion: Exercise 101 — It’s more than chasing the ice cream truck

By Dr. David Pommer

As we ponder our New Year’s resolutions from a month ago and slowly consider coming out of hibernation, let’s take a moment to reflect on times we were physically active as youth.

Perhaps it was in organized sports. Or it was a weekly race to catch the ice cream truck before it got to the next block. If you were like me, it may have involved evading dodgeballs while trying not to shriek in terror and lose bladder control.

Whatever your experience, hopefully we can collectively promote memorable physical activity for our kids that will develop into lifelong habits.

Exercise (“physical activity”) recommendations from national groups may be more than you would anticipate. The American Academy of Pediatrics recommends 45-60 minutes of activity “as many days as possible” (healthychildren.org). The Centers for Disease Control recommends 60 minutes or more every day for kids.

So how can kids come close to making the grade? First, let’s talk about scheduled times for activity, then how to add or “sneak” more activity into other parts of their day.

Time outside is often advantageous. If snow abounds, consider building a snowman or snow fort, cross-country skiing, sledding (and walking back up the hill) or snowshoeing. As the weather warms, transition to playing tag, jumping rope and riding bikes.

Older kids might benefit from the camaraderie of team sports. Try to choose sports with a good aerobic component to them, such as swimming, cross country, soccer and basketball. Check out parks and recreation offerings and the local YMCA.

How can you motivate children without an ice cream truck? For younger kids, denoting times of activity through sticker charting might be a good start. Turning off TVs and all “screens” can be beneficial. Consider imposing a rule that before sedentary activity (i.e. video games or a movie) that there first must be meaningful physical activity. For teens and adults, use a pedometer to count steps (with a goal of 10,000 steps per day) or consider a workout partner. A friend participating in healthy activities can be a great motivator.

Next, how do you “sneak” additional physical activity into a day? My own kids’ preference is to follow a cheeseburger and soda with the accompanying Playland, but I think we can be more creative than that. Walk or bike to a destination rather than drive. If you have a dog, take it on regular brisk walks. Park farther away from the entrance in parking lots and use stairs instead of elevators. Stop by a park or the Yakima Greenway in the midst of errands during the day.

So what memories can you create with your children through healthy activity? What habits do you want to change? Let’s try to resist the lure of the ice cream truck together. Best wishes for an active 2013!

* David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.

Strict Avoidance: Living with the threat of anaphylaxis

Story and photos by Suzanne Voldman

“Your son is allergic to peanuts and tree nuts. You must practice ‘strict avoidance.’ He must have two doses of epinephrine with him at all times. He is at risk for anaphylaxis.”

Those are the words that changed our lives two years ago. Our pediatric allergist gave us a book, some pamphlets and a 5-minute Epi-pen training. He gave us a prescription for Epi-pens and sent us on our way.

By the time we made it to the parking lot, I was sobbing. The words were sinking in and I knew our life had changed forever. My husband, who was still not really sure what had just happened, seemed confused by my emotional reaction. I knew he didn’t really “get it” yet, but the scary reality of the situation sank in for him, too, over the next few weeks as we both educated ourselves on managing life-threatening food allergies.

The diagnosis was in such a matter-of-fact manner that it was hard to comprehend the profound impact it would have on all aspects of our life. The word “anaphylaxis” loomed heavy on my mind. Most people understand that anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death, but for me this word was very real.

The previous year I had seen my mother hospitalized after suffering an anaphylactic drug reaction. She was put on a ventilator for a week and despite the predictions of her doctors, she suffered no brain damage. She recovered, but the future for Abe, my then 18-month-old son, looked terrifying.

I read everything I could about food allergies. I found many online communities that shared valuable information and the empathy and support that none of my friends or family could really give to me. Most of all I desperately wanted to talk to someone personally who understood.

I contacted two friends I had known in high school who had children with food allergies. I wanted someone to tell me the secret to dealing with the fear and anxiety that a food allergy diagnosis brings. They gave tips and advice, sharing ideas about how to deal with birthday parties and pointing out “safe” restaurants and products.

Ultimately, each shared the same advice distilled in this way: “Your son deserves to live his life fully. Do the very best you can to keep him safe by educating yourself and everyone else around you. You will get tired of repeating yourself with friends and family, but that is what you need to do. Don’t let the fear rule your life. Pray.”

While I was still in the pit of grief, this advice seemed rather simplistic and it left me feeling rather helpless. Is this really all I could do? They had been dealing with this for a long time; surely there was some other secret to managing this new life? It took months and months for me to appreciate and understand the wisdom they had shared.

As I researched more, I began to feel somewhat lucky that the only allergies we faced were peanuts and tree nuts. I learned that many people deal with multiple food allergies that severely restrict their diets. Our diets were more limited than one would suspect, however, because although it is easy to remove nuts and nut butters from a diet, “cross contamination” from nut products during  the production process makes many more products dangerous.

Foods like ice cream, bakery items and most chocolate became off-limits because the cross contamination risk was too high.

I learned about the real risk of “cross contamination” when my son developed mild hives after eating a pancake mix. There were no nuts listed in the ingredients, but after a call to the manufacturer I discovered that the production line used for the pancake mix was also used for a trail mix containing almonds. “Cross contamination” had been a vague, unlikely concept before this. It is really difficult to imagine that such miniscule particles can be life-threatening, but that incident made it a very real and believable concept. This constant level of scrutiny and fear can make food feel like an enemy.

I was just starting to come to terms with our situation a month after the initial diagnosis when Abe had another reaction to tangerines. The next few months led to new reactions and more rounds of testing. Six months after our initial nut and tree nut allergy diagnosis, Abe had been diagnosed with allergies to peanuts, tree nuts, most legumes (including peas and lentils), peaches, pineapple, kiwi, oranges, tangerines and lemons. I was now one of the “multiple food allergy” moms I had felt sorry for only months before.

I researched obsessively. I talked to other families in online support communities. I read articles, blogs and books that gave tips about reading labels and cooking for children with allergies. I got a lot of answers, but for those six months I became obsessed with questions. Would his grandparents understand and be willing to keep him safe?  How will we ever have a playdate? Would we ever be able to leave him with a baby sitter? How will he ride the bus safely? Will I trust his teachers to understand and keep him safe? How will he go to school safely? When he becomes a teenager will he be able to protect himself? Will I make a mistake?

The questions I had were difficult and during that time felt overwhelming. Over the next year and a half I have come to terms with those questions. Most of them have no real answers. My friends’ advice has echoed in my mind. I get it now. This is what I have to do. I don’t like it. I wish it was different. A life of “strict avoidance” is not convenient, and it’s not fun sometimes. Our lives revolve around food, and almost every social situation will involve food.

There are lots of misconceptions about food allergies. I do get tired of repeating the same information and answering the same questions, but those questions are important because the answers I give keep my son safe. Awareness keeps him safe. Teaching others about food allergies is my responsibility now. Every day I work to let go of my anxiety and refuse to let fear rule my life.

My son is probably going to live with this condition for life. I am showing him how to ‘live fully’ with this challenge. I want him to be safe, not live in fear. We try to focus on the food we can eat instead of focusing on food we miss. We eat good, healthy food that makes us happy and is safe for all of us. As parents, we want to be the role models that show him how to advocate for himself without apology or shame. We need to show him how to manage social situations with grace so that as he enters adolescence he feels comfortable doing it himself.

I have also come to terms with the fear that I will make a mistake. I will. I have. It will probably happen again. Part of living with food allergies is knowing this fact and being prepared to deal with it effectively, and so I pray. I pray for the courage and strength to do all of this with grace for myself and others.

The simple advice my friends had given me months before was, in fact, my new strategy for life with food allergies: “Eat, Read, Teach, Pray.”

* Suzanne Voldman is the mother of two boys. She is is a food allergy advocate and runs a local non-profit group that promotes cloth diapering.

 

Food Allergy resources

Allergic Living magazine. First started in Canada, the U.S. version of Allergic Living kicked off in 2010, and features food allergy and asthma news, personal stories, tips, medical information and recipes. allergicliving.com

Food Allergies for Dummies. By Robert A. Wood, MD. An accessible, thorough book on food allergies. Part of the “For Dummies” series, published in 2007. $19.99 in paperback.

The Food Allergy & Anaphylaxis Network (FAAN). The website offers a wealth of information on all major food allergies and includes a link to a useful pamphlet called “The Peanut Answer Book.” A toll-free number is available any time of day or night if parents need to call to ask questions. foodallergy.org

Kids with Food Allergies. A nonprofit organization that promotes and develops plans for children with food allergies to live nutritious and healthy lives. The group focuses on educating the public about food allergies and providing networking to those with food allergies. kidswithfoodallergies.org

How to Manage Your Child’s Life Threatening Food Allergies: Practical Tips For Everyday Life. By Linda Marienhoff Cross. Another acclaimed and helpful resource book, first published in 2004. $16.95 in paperback.

Mayo Clinic. The website lists the eight most common food allergies and their symptoms. These food allergies are milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. The site also provides tips on reading labels properly and how to allergy-proof your house. mayoclinic.com/health/food-allergies/AA00057
The Nut-Free Mom blog. Jenny Kales runs one of the most popular and informative blogs on the subject of peanut and tree nut allergies. nut-freemom.com

WAFEAST — Washington Food Allergy, Eczema, and Asthma Support Team. Based in Seattle, WAFEAST provides networking, support groups and education for those dealing with food allergies, asthmas and other concerns. wafeast.org

Y-FAST — Yakima Food Allergy/Intolerance Support Team. Brand-new food allergy/intolerance support group in Yakima. Stay tuned for resources, events, and connecting opportunities. Playdate magazine will offer updates.

Second Opinion: How to maximize a visit with your health care provider

By Dr. David Pommer

As a physician, I get a lot of junk mail. I shudder at the number of rain forests that have been clear-cut so that I can receive glossy brochures of new medicines and esoteric conferences.

Most of the mail hits the recycling bin unread. As I skimmed one magazine recently before its inevitable freefall, I read about a consultant who explained how physicians can see 10 patients per hour. Ten patients per hour? I laughed out loud. I’m lucky if I can see three or four.

Fortunately, I have not had those kinds of expectations placed on me. But your doctor may be under pressure to see more patients and spend less time with each patient. How do you maximize the available time? Here are some tips to keep in mind for that next office visit.

First, let your provider know within the first minute or two what your priorities are. I don’t want to spend 15 minutes talking about toenail fungus, and then find out your child was in the emergency room last week for a seizure. Consider making a list of what you want to address, and share that early in the visit. Be flexible about having everything addressed. You and your doctor can determine the top priorities and hit the high points that day.

Second, bring outside records and prescriptions with you. What happened in the emergency room? And what exactly was that good-tasting pink medicine you were prescribed? This will also save time for nurses, so that they are not playing phone tag with other hospitals or clinics to get old records. By supplying your care team important information, the best decisions on future care plans can be made.

Third, use the art of paraphrasing. This is a two-way street. A good physician will briefly summarize what you’ve told him or her and “check for understanding.” As a parent, you should similarly try to paraphrase your provider’s diagnosis and treatment plan in a sentence or two at the end of the visit. This will give the provider an opportunity to clarify any element that wasn’t communicated clearly.

Fourth, be on time. I know what you’re thinking: why do I have to be on time, but the doctor is almost never on time? I try to apologize readily when I am running late, which is more often that I would like. But if you show up 10 minutes late for a 15-minute visit, that doesn’t provide us much time to address your needs.

Fifth, please limit technology. If you are answering a phone call or texting when we are talking, it makes it more difficult to obtain the information I need so we can make the best plan for your child.

Finally, and this should go without saying, try to see your own provider. Continuity of care is a hallmark of family medicine and makes for the best medicine. Do your best to see your own primary care provider whether it is for preventative care or an urgent visit.

That is, unless they happen to be at a nice conference in Hawaii. Now where did I put that glossy brochure, anyway?

 

* David Pommer is a family physician at Selah Family Medicine. He is married with three children. It did take him more than six minutes to write this story.

Turkey Trot scheduled for November 24

Now you can eat for two or three people at Thanksgiving and not feel quite as guilty about it.

That is, if you follow up those meals by participating in Camp Prime Time’s annual Leftover Turkey Trot, set for 10 a.m. Nov. 24 at the Yakima Greenway.

This 5K walk or run (or hobble-while-you-gobble … I don’t think anyone would really mind) will help you lose those calories while gaining funds for Camp Prime Time.

The cost is $20 for adults and $7 for children 10 and under. The fee includes a T-shirt. Call 509-453-8280 for more information, or visit campprimetime.org.

Second Opinion: “When Should I See a Doctor about a Cough?”

By David Pommer, MD

 

Allow me to present a familiar scene. Imagine you and your significant other are about to take a trip after months of planning. Tickets have been purchased, reservations have been made and bags are packed. The night before departure, your toddler develops a cough. You might be asking yourself, “Why now and what should I do?”

When I first see children with a cough, I often ask questions about other aspects of their health. Do they have a significant fever? How is their appetite? How is their energy level? If these areas are abnormal, my ears perk up: this child may be fairly sick.

Next, I may ask about duration of the cough. Did this start a day or two ago? If the answer is yes, I may lean toward this being a self-limited viral upper respiratory infection. If the cough has persisted for multiple weeks, I may give stronger consideration to pertussis, bronchitis, asthma or other maladies.

Let me walk you through some of the things I look for during an exam that you can look for at home without a stethoscope. Initially, I try to determine if a child is very sick (and perhaps needs to be in the hospital) or if he or she is just feeling a bit under the weather.

If a child is experiencing abnormal breathing, we call this respiratory distress. Here are some signs that your child may be in respiratory distress. First, their nostrils may be flaring in and out due to rapid breathing. The child also may grunt when trying to breathe. When you look at the skin between the ribs, it may move in-and-out quickly; we call these retractions. The fingers and toes may have a bluish hue, suggesting the child is not getting good oxygenation to the extremities. These are all reasons to be seen right away at an emergency room.

I mentioned earlier about appetite and energy level. If a baby or toddler can’t feed well because of difficulty breathing, that is a red flag. A significant decrease in wet diapers suggests dehydration. Finally, if a child is lethargic and difficult to arouse, that is another reason to be seen right away.

For kids with milder symptoms, a question I hear often is will cough medicine help? The answer will vary by physician, but I would say in most cases that cough medicines are not particularly helpful. You would think with the amount of over-the-counter medications available they would be very helpful, but that has not been found to be the case. And in toddlers, some cold medications are no longer made because of adverse reactions.

Sometimes a child can have a significant and persistent cough and when you take them to see a doctor you don’t leave with an antibiotic prescription in hand. That is because many causes of cough do not warrant an antibiotic. Viral upper respiratory infections, RSV (respiratory synctial virus), and bronchitis don’t respond to antibiotics. When you don’t receive an antibiotic, please resist the urge to think negative thoughts about your provider; medical professionals truly have your best interests in mind.

So let’s reconsider the article’s headline: When should you see a doctor for a cough? Long duration, fever, lethargy, poor oral intake and respiratory distress are good reasons to pay a doctor a visit. For less severe and mild symptoms, it might be wise to stick to ensuring adequate rest and good hydration for a few days. If the symptoms don’t improve on their own a visit may be warranted. And if you read last issue’s installment on immunizations, thanks for being immunized against pertussis and the flu; I won’t get to see you quite as much.

David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.

Don’t miss the point: Immunize

Don’t Miss the Point: Immunizations

By Dr. David Pommer

There remain many misperceptions about the benefits of immunizations. As a physician, I take responsibility for informing parents and patients on the importance of this public health defense. And as kids head back to school, I believe this is a good opportunity to readdress immunizations and dispel some of the more common myths.

In medicine, there have been few triumphs as great as immunizations. We have not conquered cancer or vanquished diabetes or obesity. But we do have fewer infections. How often do we see children suffering from polio, measles or meningitis — diseases that were commonplace and deadly for much of the 20^th century?

Fortunately, we witness these diseases rather infrequently. However, that trend is slowly changing in areas where fewer kids are immunized.

Here is some interesting data from the Children’s Hospital of Philadelphia (vaccine.chop.edu) about infectious disease in the 1900’s prior to vaccines being widely available. In one year, one could expect:

• Polio to paralyze 10,000 kids
• Measles to take the life of 3,000 children
• Haemophilus to cause 15,000 cases of meningitis — resulting in permanent brain damage for many.

We tend to have a short-term memory about the devastating effects of vaccine-preventable illnesses.

More recently, we have been bombarded with articles and studies trying to link vaccinations with various childhood diseases and disorders — most commonly, autism. In fact, a British journal recently retracted a study from the 1990’s that had fabricated data linking vaccination shots and autism. And what about mercury’s side effects on children? In vaccines, trace amounts of mercury had been used as a preservative. Today, mercury is used only in multi-dose flu shots and there have been more than six studies investigating mercury and autism, concluding that there is no evident link between the two. Vaccines and mercury do not cause autism.

There are also varying viewpoints on the best time to deliver immunizations. One viewpoint is that delaying shots may be better for a child’s immune system. In reality, infants are colonized with trillions of bacteria, and face more immunological challenges in their first week of life then they will from immunizations. Delaying immunization shots is not a recommended practice.

As a parent myself, I understand that many parents may view immunizations as a personal decision. It most certainly is. But the decision to skip or delay your child’s immunizations also affects our community and those around you too. As physicians, we refer to this as “herd immunity.” It is based on a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not yet developed immunity. I’ll provide a brief example to illustrate the importance of this concept:

On most days, my waiting room is filled with children of all ages. Some of those children may be too young to have received certain immunizations. When an older child who is behind or has skipped some immunizations comes into the room with pertussis or chicken pox, this could infect the younger kids (even if they weren’t licking the toys). In contrast, should most or all of the older children be up-to-date on their immunizations, the likelihood of the younger kids getting infected is diminished greatly.

I understand that this is a very short synopsis on immunizations, and I leave myself open to sharp and pointed attacks. But I am a promoter — or a booster if you will — of the immunization process.

Is your response, “ouch!”? If so, feel free to let me know if you see me in the clinic. Or email me at davidpommer@yvhm.org.

 

 

 

Second Opinion: Sweetened Beverages

Sweetened Beverages: Not Ideal for Thirst or Flying

By Dr. David Pommer

 

The marketers for Red Bull energy drinks use metaphors to depict the benefits of their sweetened beverage. The problem with their slogan — “giving you wings” — is that unlike birds, human bones are not hollow. And with the extra calories these sweetened beverages add to your waistline, any child or adult would find it difficult to “lift off.”

So as warmer weather approaches and kids leave the classrooms for summer break, they will likely find themselves with increased levels of thirst. The question is, what thirst quenchers will they choose? Hopefully this column will give both you and your child the information necessary to make an informed decision.

Sweetened beverages or any drinks that include sugar — such as soda pop, juice, chocolate milk, strawberry milk, sports drinks and energy drinks — pack a lot of calories.  And with a growing childhood obesity epidemic, these are not calories they need for a healthy developing body.

Let’s turn to our nutritionist friends for help in crunching some of these numbers:

 

 

 

It takes 3,500 calories to make one pound of fat.

• Your standard-issue juice box has about 110 calories. So, let’s say you had a juice box every day. Over a year, you would gain about 11 pounds.
• A 12-oz. can of soda has approximately 150 calories per can.  Over a year, you may gain up to 15 pounds.
• Drinking a large fountain drink or an energy drink could create upwards of 40 pounds of additional weight.

 

Not only do you need to be concerned about calories, but also about serving sizes. Actual drink sizes have gotten bigger over the years, even as the official “serving” size has remained constant.  Today, a “kids”-size drink from a fast-food establishment is about the size that an adult drink was decades ago. If you order a beverage and it comes with two handles and wheels, consider that a sign to send it back. [what comes with two handles and wheels?]

And what about those energy drinks? The truth is, while it may provide a boost of energy, many people consume these drinks for activities that don’t require a lot of energy. One of my colleagues commented on a patient drinking energy drinks to play video games longer. While that may benefit the folks at Red Bull, a sedentary lifestyle compounds the problem of the extra calories from this sweetened beverage. And as a side note, the other additives that give an energy drink its “kick” are not particularly healthy either.

So what can we do?  The American Academy of Family Physicians recommends that kids have no more than one sweetened beverage per day. If a child is overweight, this amount should be reduced significantly, preferably to none.

Recently my 11-year old asked to have some sweetened coffee, which reminded me how I can serve as a positive or negative role model. Whether we are aware of it or not, our examples influence our kids’ decisions and choices. (Note to self: put down my juice box.)

So I encourage you to let water, milk and other unsweetened beverages pass your lips this summer. Not only will you and your children drink more responsibly and quench your thirst, I won’t need to explain how weight influences aerodynamics in my waiting room.

–David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine.

Twin Miracles

By Tysa Kihn

 

My pregnancy was all about the numbers.

I was comparing early blood test results, discovering that my conception date was exactly two years after the date of my tubal ligation.

At that time, I learned that the chances of my pregnancy were 5 in 1,000.

Now, I saw that I was going to have two babies.

But the numbers that meant the most: our boys had a 100 percent chance of dying from Twin to Twin Transfusion Syndrome, if left untreated.  Treatment offered a 95 percent chance that one boy would survive, and a 70 percent chance that both boys would survive.

It began at the end of February 2009.  Something told me that, in spite of my tubal ligation, things weren’t right.  Two blue lines confirmed my suspicion.  The next two weeks were spent in and out of the lab and waiting for those numbers to tell us if it was a viable pregnancy.

Finally, an ultrasound confirmed that we were having a baby.  It was a big adjustment, and even more so when at nine weeks an ultrasound showed two babies.

Life became busy after my husband Dana’s eye surgery and recovery.  Distracted by caring for him, I ignored how my belly seemed to have grown rounder and heavier almost overnight.  Walking became difficult, and my back was so sore.  I attributed it to being over 30, and carrying two babies instead of one.  I reasoned that it wasn’t just because I was having twins; I was working full time, chasing around two older kids, so my body was complaining.

We went in for the big gender ultrasound at 18 weeks.  We couldn’t wait to find out whom we would be meeting that November.

It was during the ultrasound I began to realize something was wrong.  Baby A measured right on.  But Baby B was measuring behind in growth.  The ultrasound tech couldn’t get many measurements; my baby hardly moved.  She couldn’t even find his bladder.

With each measurement, the words Twin to Twin Transfusion Syndrome came to me.  I’d read that it was a risk in identical pregnancies, and that it wasn’t good.  I didn’t want to believe that’s what we were seeing, but when Dr. Rowles came into the room, I knew by the look on his face what he was going to say.

It was a Tuesday, the day before our ninth anniversary. All of a sudden the world seemed to be crashing down on us. The babies that we never expected, and never thought we wanted, were now so dear and we could lose them.

Two days later, we were at the University of Washington with a full day of examinations. I was scheduled to see Dr. Walker at Eastside Maternal Fetal Medicine in Kirkland first thing Friday morning, one of only a handful of doctors that perform the surgery to treat TTTS.  I didn’t know then how lucky we were not to travel several states away for surgery, like many parents.

TTTS happens only in identical twin pregnancies when the twins share a placenta.  Due to the shared placenta, there are often blood vessels in the placenta that cross each other.  In TTTS, one baby begins to get too much blood and becomes the recipient twin.  The other baby doesn’t get enough blood, and is called the donor.  The donor becomes malnourished, while the recipient begins to have heart issues from the stress.

The fear that we had for the lives of our sons lessened once we met with Dr. Walker’s staff.  They went through a huge binder explaining the surgery, and were very clear on the numbers.  He determined the boys were in stage 2.  Stage 4 means death.  Dr. Walker was committed to saving our babies, and surgery was scheduled for Monday, June 15, 2009.

I thought I would be a wreck that weekend, but instead I was filled with a calm spirit.  Monday morning, we watched on a screen as a fetal scope was inserted into my belly, and methodically each shared vessel was lasered.  Once they felt that they had separated all the vessels, and drained a liter of fluid from Baby A’s amniotic sac, they turned the camera on the boys.  We were able to see our boys’ faces and elbows and feet.  It was amazing.  The next day I could already tell how much lighter I was, and how much smaller my belly was.

The next few months were full of doctor visits in Seattle.  Once I had reached 32 weeks I was considered in the clear and my appointments were moved back to Yakima. On October 15, Bryce Walker (Baby A) and Brendon Quinn (Baby B) were born.  They were 6 pounds 3 ounces and 5 pounds 6 ounces, respectively. The delivery was a recommended C-section, and after the doctors and nurses checked out the placenta, still bearing the marks of surgery, it was packed up to be sent off for study.

Too many parents lose their twins to TTTS.  Their obstetricians don’t know what to look for. The moms don’t know what to look for. By the time it is determined something is wrong, it is too late. If I had known some of the warning signs, I may have been able to request an ultrasound earlier.

If you learn you are pregnant with twins, ask the doctor if they could be sharing a placenta.  If so, regular ultrasounds are a must.  The near overnight growth of my belly was a sign of TTTS. The extreme lower back pain and exhaustion were signs of excess amniotic fluid weighing my belly down.  I didn’t know that, and if I’d had another doctor, we may not have known until it was too late.  Instead we had the best medical care all around, and two fantastic boys to prove it.

Video of the surgery and the boys can be found on Tysa’s blog, dtkmkihn.blogspot.com.

Second Opinion: Autism

Autism: when a winter coat tastes like a marshmallow

By Dr. David Pommer

 

April is Autism Awareness Month. In this issue, I present a definition and a few issues regarding this disease.

Autism is becoming more and more common. Approximately one in 110 children has autism, affecting four times more boys than girls. And the challenges we face will grow right along with these children as they become adults who might require long-term assistance.

Defining autism is kind of like nailing Jell-O to a wall. In fact, the medical community will likely have a modified definition in a few years. With several different types of autism, it is actually a spectrum of diseases. Three core features characterize the spectrum: delays in social interaction, impairments in language, and restricted and repetitive behavior.

Perhaps because autism can look so different between people, there is still some disbelief. There are segments of society that feel that autistic children are products of poor parenting or a misguided medical community.

My wife and I are more aware of autism than we would like to be. Our oldest son, Josiah, has autism. I’ll use Josiah’s story to illustrate and explain the three core features.

First, his social interaction was different when he was a toddler. He had limited eye contact. Most children learn how to coordinate the use of eye contact, facial expression, gestures and language together as they grow up. This is nearly impossible for those with autism. Usually, when you point out something to a toddler, the toddler will look at the object. Josiah was more fascinated by the finger being pointed. He couldn’t develop peer-to-peer relationships well, which still affects him today.

Second, he has had language impairments. His first words were delayed. Normal speech development starts by age 1 with some words, growing to 10-20 words by 18 months. Josiah was still working with a small handful of individual words at age 2 while his peers were starting to combine words. He also has echolalia, evidenced by wanting to repeat words said by a teacher or a public speaker. This makes school, church and going to movies problematic.

Finally, he has restricted and repetitive patterns of behavior. He fixates on certain patterns (for example, he can only wear a particular article of clothing on a certain day of the week), which makes it harder for the household to function. Regarding repetition, he often asks the same question again and again and watches the same video over and over.

All of these traits combined to produce some interesting life moments, like when Josiah put his mouth on another student’s coat. Granted, I had not sat my son down to explain that we don’t eat inanimate objects, particularly other people’s coats. But as we got more information from him, we learned that he was hoping that the coat, which was made with a puffy white material, would taste like a marshmallow. No such luck. Lesson learned.

If you are concerned that your child shows signs of autistic behavior, your doctor can screen your child for autism by age 2. And if you are around parents of children with autism, please extend some extra grace. It will be appreciated.

 

Second Opinion: Co-sleeping

Co-Sleeping

I remember the tidal wave of emotions I felt after the birth of our first child. The fear and sense of responsibility driving home from the hospital. The sense of wonder watching him gaze at his surroundings. The joy in my heart seeing him coo or smile. Except for the times he had projectile vomiting, I wanted to be around this little guy all the time, awake or asleep. And so I was first confronted with the issue of co-sleeping.

Let’s first define what co-sleeping is in regards to this article.  Co-sleeping is when a parent sleeps next to his/her infant in the same bed. (Incidentally, my least favorite form of co-sleeping is in a motel room with family — usually because there is little sleep.)

What are some of the potential benefits of co-sleeping? Moms may not need to get out of bed to breastfeed. It may deepen the relationship between mother and child. And some may sleep better in this arrangement.

But studies indicate there are pitfalls to co-sleeping as well. The most important potential danger is SIDS (Sudden Infant Death Syndrome). Co-sleeping becomes more dangerous when parents use tobacco or alcohol or when a parent is overly tired or sleeps on a couch. The United Kingdom Department of Health advises that the safest place for an infant to sleep is in a crib in the parents’ room for the first six months of life. Similarly, the American Academy of Pediatrics, in a November 2011 report, recommends that baby can sleep in the same room as parents, but not in the same bed. Sharing a room is OK, but sharing a bed is not.

Let’s re-examine some of those purported benefits. If co-sleeping works while baby is small, fast-forward a year to when that toddler needs to graduate to his or her own bed — that could be a more difficult task. There are other ways to bond, as well: taking a walk, reading a book or playing games.

And on a related note, please place your baby on his or her back to sleep, and avoid blankets and toys in the crib (please see healthychildren.org for more information). The above AAP report also notes that immunizations and breastfeeding are associated with a lower incidence of SIDS.

Many mothers go the extra mile in pregnancy, avoiding over-the-counter medications, caffeine, soft cheeses and fish. Parents fill their homes with safety latches, gates and CO2 detectors. I would challenge parents to think of co-sleeping as a similar safety issue, where good choices can potentially save lives.

David Pommer, MD, is a family physician with Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He co-sleeps with his pager, and he is happily married with three children.

Second Opinion: Antibiotics

“But antibiotics taste so good”

It is a hassle to see the doctor.

The first battle typically involves the phone system. With carefully orchestrated options designed to keep you from reaching an actual person, it can be a minor miracle to reach the scheduler. Then, does your schedule match an opening for your doctor, if she or he has one?

Next up: the waiting room.

If your child wasn’t truly sick before arriving there, licking the waiting room toys might cinch the deal. When you are finally called back to the exam room, there is some momentary excitement, until you surmise that this is actually another smaller waiting room.

And don’t get me started on the redundancies of disclaimers and insurance paperwork.

—

I know what you’ve been through to get to see me. And I want to try to redeem the experience and make it as positive as possible. That doesn’t necessarily mean I’ll prescribe an antibiotic, however. Sometimes an antibiotic may be harmful rather than helpful.

Let’s take sore throats for example.

What percentage of sore throats are caused by strep bacteria and will benefit from an antibiotic? Only about 20 percent. The remaining are caused by viruses, and an antibiotic will not help.

And what about the color of mucous — is this important? I don’t like that green nasal drainage running down your child’s face either, but it turns out that whether it’s clear or colored does not matter. The color is caused by inflammatory cells, called neutrophils, that are present in both bacterial and viral infections.

Many bacterial infections are going to be self-limited. If a child is found to have an incidental ear infection, but is feeding well and not lethargic, he or she can probably get away with observation. A sinus infection should not be treated with antibiotics unless the patient has severe pain or symptoms have progressed past one week.

—

A study that affected how I prescribe was published in The Journal of Family Practice in 2000. It evaluated using a “backup” prescription, instructing families not to fill this unless the patient’s condition deteriorated or failed to improve. I may use this when an ear infection is mild, or if a sinus infection has not progressed beyond a week.

Sometimes people will request another antibiotic because the first one didn’t cure their infection, but it may be that the patient simply has a viral infection that just needs to run its course.

Why are physicians passionate about this topic? Possibly because contrary to the goal of the Hippocratic oath, they have done harm at times with antibiotics. Little Johnny may have had the sniffles before, but now with the help of antibiotics, he’s really got diarrhea and a diaper rash to boot. Antibiotic resistance (think MRSA) has proliferated with overprescribing. If you have a strong stomach, Google “Stevens-Johnson Syndrome” and you can see some of the dangerous rashes (and accompanying trial attorneys) that can rarely result from an antibiotic.

Now don’t get me wrong. I love the great taste of pink amoxicillin suspension as much as the next guy. But these medicines are a double-edged sword that need to be used at the right time in the right situation. So please don’t demand them.

And maybe I’ll see you in the waiting room with my own children, hoping to graduate to the next, smaller waiting room. We’ll try not to lick the toys.

 –David Pommer, M.D. is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

2nd Opinion: “Screen Time”

 

 

 

 

 

 

 

 

 

 

 

 

By Dr. David Pommer for Playdate magazine

OK, I confess. I have not been a perfect role model about “screen time” with my patients and my family. But I think this is important to discuss as summer comes to a close and many of us retreat indoors.

What is screen time? The American Academy of Family Physicians defines this term as “watching television or DVDs, playing video or computer games and surfing the Internet.” A few years ago with patients, I would primarily ask about TV and video games, but now I need to inquire about cellphone screen time as well. As I will detail below, more screen time correlates with worse health.

Let’s take a quick self-assessment to see if this may be an issue with your family.

1) Do you use television as a baby sitter so you can get other things done at home?

2) Have you misplaced your library card months ago? … Or do you first check out the video section at your local library?

3) Do your children feel that happiness comes at Redbox?

4) Have you heard your child repeat a phrase in conversation that they likely heard from TV (for example, when I heard my son state “it’s fun for the whole family” when he wanted my wife and I to buy something, I knew he had been sitting too long in front of the boob tube).

If you answered “yes” to any of the above, keep reading.

According to a 2010 Kaiser Family Foundation study, the average child spends 7 1/2 hours per day in front of a screen. Another study broke this amount into about four or more hours of TV, videos and/or DVDs, more than one hour of computer time, and almost one hour of video games. Two out of three children ages 8-18 have a TV in their bedroom. And those kids who have a TV in their room watch almost 1½ hours more television per day than those who do not.

The consequences of this excessive screen time are more sobering.

The more time kids spend in front of a screen, the higher their risk of obesity. Obesity rates are lowest in children who have less than one hour of screen time per day, while they are highest in kids with greater than four hours per day. Screen time may also negatively affect body image and school performance and may correlate with increased violent behavior.

What is our remedy?

The American Academy of Pediatrics recommends limiting screen time to no more than one to two hours of “quality programming” per day. If there is a TV in a child’s room, I would recommend removing it. Use parental controls on your computer so a child has a set limit before he or she is logged off. Establish a “token economy” where kids need to earn their 1-2 hours by chores or reading earlier in the day. Though your children will not thank you now, hopefully their brains and waistlines will thank you in years to come.

David Pommer, M.D., is a family physician at Selah Family Medicine. He is a graduate of Whitworth University and the University of Washington School of Medicine. He is married with three children.

MyPlate Dishes Up a Simpler Food Plan

Toss out the food pyramid, folks…there’s a new way to make sure we’re eating right.

It’s called MyPlate, which the USDA and Michelle Obama unveiled in June.

OK, so the content and distribution of food items on the new design isn’t drastically different; the transformation lies in the presentation. The idea behind the change is to simplify our food-making decisions to help adults — and kids — make healthier choices. It’s also part of a campaign to help fight obesity in the U.S., with a heavy emphasis on increasing our intake of fruits and vegetables.

Unlike the food pyramid, all it takes is one glance to recognize a plate divided into four parts to represent four food groups: fruits, vegetables, grains and protein. The fifth food group, dairy, rests on the border of the plate and resembles a drinking cup.

Each section is a different size to emphasize how much consumers should eat of each group daily.

You can find more information at choosemyplate.gov.

–Scott Klepach, Jr

Here are some tips from choosemyplate.gov:

Eat less and avoid oversized meals

Make sure half of your meal is made up of fruits and vegetables

Make sure at least half of your grains are from whole grain products

Drink fat-free or low-fat (1%) milk

Look at labels for sodium content—then choose the foods with lower numbers

Instead of sugary drinks, drink water!  

When Should Your Child First Visit the Eye Doctor?

Sure, some of us didn’t get glasses or contact lenses until we were teenagers or adults, and others still don’t wear them. But there are plenty of others who need corrective lenses at an earlier age.

In fact, according to the American Optometric Association, parents should plan on scheduling their baby’s first eye exam at 6 months of age.

That first eye exam can help detect any possible vision or eye problems early on. The association wants parents to view eye assessments as being just as important as visiting a pediatrician and a dentist, especially since many eye problems can develop with no symptoms.

Check with your eye doctor to see what he or she recommends and what you and your baby should expect for this first eye exam.

One program, InfantSEE, allows one no-cost eye and vision assessment for babies 6-12 months old.

 

Local InfantSEE Providers

 

Yakima

Dr. Christopher J. Babin: 1211 S. 40^th Ave. 509-966-2966

Dr. Roy W. Hinze: 5 S. 12^th Ave. 509-248-2020

Dr. Ed Labissoniere: 1121 S. 40^th Ave. 509-966-8801

Dr. Michael C. Noble and Dr. Donald T. Shute at Cascade Eye Center, 1211 S. 40^th Ave. 509-966-2966

Dr. Jeanette Marie Stromme: 111 University Parkway, Ste. 104. 509-966-0675

 

Union Gap

Dr. Seth Thomas Copeland and Dr. Benjamin C. Winters at Family Vision Care, located inside Costco. 509-454-5253

 

Selah

Dr. Dale K. Graf and Dr. Aaron D. Qunell at Selah Vision Clinic, 105 W. Orchard Ave. 509-697-6177

 

InfantSEE: 888-396-3937 or infantsee.org

 

 

 

Kids Seeing Hope, Progress

By Scott Klepach Jr.

 

Kids face enormous pressures when they start each school year, with new challenges coming their way every day.

Since we rely on our senses to meet these challenges and learn and grow, it’s important to understand potential developmental problems that may arise in school-age children.

Our eyes are no exception.

For many, prescription glasses take care of poor vision. But for others, eye problems might develop that glasses or contact lenses can’t completely solve. One option more people are turning to is vision therapy.

Vision therapy has been an option for some years now, but it has been gaining popularity as research and technology develops to provide new ways of recognizing the many eye problems that exist and how to treat them.

Consider it physical therapy for not just the eyes, but the brain as well, says Dr. Benjamin Winters, an optometrist at Family Vision Care at Costco in Union Gap. Winters also practices vision therapy with Dr. Seth Thomas Copeland at Washington State Vision Center in Yakima.

The center opened last year to treat kids and adults, but its particular focus has been treating vision problems in school-age children. Although some of the kids who receive vision therapy already have prescription lenses, others have 20/20 eyesight, passing school vision screenings. The common link is that they all still struggle with reading and school performance.

Vision therapy is made up of weekly sessions at the clinic with exercises at home four times a week. The amount of time varies with each child depending on their eye problems; many kids are there for at least six months.

When Teresa Obert noticed reading problems in her son, Henry, she took him to vision therapy.  After a few months in vision therapy, Henry, now 10, made improvements and gained confidence.

“He couldn’t control the lens that focuses the eye,” says Obert. “He’s had the most progress there. Like a camera, the eye has to focus and refocus, and he couldn’t control that.”

Jett Black became good at memorizing information at school, but he also struggled with reading. It turns out that he was using his memory to compensate for his eye problems.

“We had him at four different eye doctors,” says his mother, Angela Noel. “He has 20/20 vision with a slight astigmatism. But something wasn’t right with his vision.”

One of Black’s difficulties is the ability to look at a shape and remember it. In his case, reading is difficult because each letter is a shape.

“He’s phonetically strong, but sight wise he is remembering patterns differently,” Noel says.

Black, 11, is also working on tracking, which will allow him to smoothly read each line of text.

“It’s still bumpy,” says Black, but being in therapy for several months had made reading a lot smoother.

Black also experiences suppression, when one eye shuts down due to the stress of trying to work at reading or receiving information.

“When his left eye is stressed, it shuts off,” Noel says. “It’s tough in school all day long. He gets exhausted.”

Black, who is a fifth-grader at Naches Valley Primary School, recognizes that when this happens, he gets irritable and tired. His teachers and friends have detected a positive shift in his attitude since he started vision therapy, and his grades have improved.

Shelby DeVore has also struggled with reading since Kindergarten. Many doctors told her and her mother, Lynn DeVore, that her eyes were fine. Yet she was unable to see the words in front of her, especially if they contained more than five letters.

Shelby has become a tactile learner because of her difficulty seeing.

“When she holds her pencil, she pushes on the paper so hard to feel what she’s writing. She can’t see it,” says Lynn. “It all came down to vision problems.”

Lynn says the goal is to have Shelby’s eyes work together. “They’re trying to teach her brain to do things automatically,” she says.

Unlike Shelby, Dominic Urlacher could see the words on the page, but he used to read very slowly.

“He’s always been tired by mid-morning, and he’d go take a nap,” says his mother, Sharon.

Dominic, 10, also had trouble in math. He found some improvement when he was prescribed glasses for his far-sightedness a year ago, but “it didn’t cut down on his tiredness, or learning,” says Sharon.

Dominic’s self-esteem was affected by his challenges, which include suppression and convergence insufficiency – essentially, his eyes not working together.

But Dominic is the very first graduate of the center in Yakima. He has completed his therapy program and can apply what he has learned in the years ahead.

The goal is not to have children in vision therapy forever. Instead, says Winters, it’s about teaching them to be aware of their eye problems and giving them the tools to fix them after they finish therapy.

“We’re excited [about] the journey,” says Lynn DeVore. “And we’ll definitely be excited to see the finish line.”

We’re Off to See the Dentist!

We’re Off to See the Dentist!

Story by Scott Klepach Jr.

Photos by Amber Miller

Sure, going to the dentist is not exactly the same as a day at the playground, but it doesn’t have to be a scary experience for kids, either. In fact, there are a number of pediatric dentists in the Yakima area who are trained to work with babies, toddlers and infants.

But when should you first take your kids to the dentist?

Local dentists, as well as the American Academy of Pediatrics and the American Academy of Pediatric Dentistry, agree that kids should have their first oral check by their first birthday, if not before.

“They should be seen at age 1 at the latest,” said Dr. Tyrone Rodriguez, a board-certified pediatric dental specialist with Apple Valley Dental & Orthodontics of Yakima. “If they’re 13 months (without an oral check), they’re overdue.”

Carlos Dorantes, doctor of dental surgery at Summitview Pediatric Dentistry of Yakima, agreed with this timeline, and added that if parents missed that window, they should take their child for a visit no later than six months after the first baby teeth have come in.

And that first oral check is fast and easy, said Ashley Tercero, a doctor of dental surgery at Yakima Pediatric Dentistry, and usually involves the dentist brushing, flossing and examining your baby’s teeth, and then applying fluoride.

Rodriguez said the first visit is a knee-to-knee exam, and he covers recommended eating habits with parents, what they should expect to see as their child’s mouth matures, and accident prevention.

“It’s not a thorough exam,” said Dorantes. “It’s more of a sit-down with parents on what to do when teeth come in, how to keep the mouth clean, what to use, and what not to use.”

This early check will also help children avoid anxiety about visiting the dentist’s office.

One question that typically comes up is, why do baby teeth need to be checked and fixed, if kids are only going to lose them?

“Baby teeth are the fruit at the top of the bowl, so if they go bad, what’s going to happen below?” said Rodriguez. “There could be possible irreversible damage.”

Tercero said cavities impact speech, growth and development, nutrition, sleeping, learning and overall health. Decay can also cause pain and infection, which can damage permanent teeth.

It is recommended that after kids receive their first oral check, they should be seen about twice a year, or every six months. Sometimes they might be seen more frequently if the dentist detects poor oral hygiene.

Proper Cleaning and Brushing

Tercero said children start getting their baby teeth at different times.

“Some get their first tooth at three months, others at one year. Parents shouldn’t be concerned about timing of teething,” said Tercero.

Instead, she said parents should make sure their children’s gums and teeth are clean to help lessen the pain that comes with teething.

“If the gums are healthy,” Tercero said, “it doesn’t hurt as much when the teeth break through.”

Dorantes said some parents are surprised they can and should start cleaning their baby’s mouth even if no teeth have come in yet. He suggested using a small cloth or a piece of tissue to wipe the mouth clean.

“This allows the child to have a clean mouth, and gets them in the habit of learning they have to do it, no matter what,” said Dorantes.

Kids should have assistance with brushing until they are about 7 or 8, said Tercero, and she suggests following the rule of “twos.”

“Brush two times a day for two minutes each time,” she said, adding that flossing is only necessary once a day.

Fluoride-free toothpaste and water will be sufficient for infants, she said, adding that kids can graduate to regular toothpaste that contains fluoride when they can spit it out.

Don’t Sugarcoat the Situation

“Caries,” which is the disease of having tooth decay, can be much more than an annoyance.

“It’s the number one childhood chronic illness,” said Dr. Joe Wilson, a pediatric dentist at ViewCrest Pediatric Dentistry in Yakima. “It is five times more common than asthma in children.”

Caries has been shown to lead to other health problems that can cause kids to be absent from school or miss out on other activities.

But a lot of families aren’t aware of this problem.

Tercero said the biggest oral health problem in the Yakima area is the amount of sugar that families have in their diet. Yakima kids have a much higher decay rate than those in Seattle, for instance.

“Most of this is due to our lack of good oral health education and our higher-than-average sugar intake,” she said.

Juice, while tasty and containing some good nutrients, is something that needs to be controlled.

“Most families think of juice as being a healthy thing for kids, but really it is more like ‘liquid candy,’” Tercero said.

“Think like a cheap bartender, and water it down,” Rodriguez recommended. “You’ll save money and you’ll save your child’s teeth.”

Dorantes said parents don’t need to eliminate entire foods out of their kids’ diets.

“It’s not what you give, but how often you give it,” he said. “The higher frequency of carbohydrate ingestion, the more likely a child may be at risk for having problems with teeth.”

Dorantes noted parents should be aware that refined carbohydrates – the stuff that can contribute to tooth decay – can be found in cookies, french fries, pastas and breads.

“It doesn’t necessarily need to be sugar per se to be a problem,” said Dorantes.

Tercero said a prolonged session of snacking can contribute to tooth decay because the sugar contained in most snacks has time to coat our teeth. Snacking in short sessions is preferred, so our saliva can do its job to clean the sugar off our teeth, which usually takes 20 minutes.

Overall, maintaining a healthy mouth doesn’t just help kids avoid cavities.

“Oral health is tied into systemic health,” said Wilson. “You can’t have one without the other.”

Wilson added there are three ways a person can get cavities: you have to have teeth; you have to have a sugar source, and you have to have bacteria present in the mouth. This last point is largely unknown or overlooked, he said.

“Think of it as a cold, and how bacteria is transferred,” said Wilson.

When parents or primary caregivers test the temperature of food for a child, for instance, that bacteria can transfer to the child’s mouth. For this reason, Wilson said it’s necessary for adults to maintain proper oral health, and expecting mothers should have cavities or other oral health problems fixed as soon as possible.

“It should be in the planning stages of having a child,” said Wilson.

Cause for Concern?

Other common concerns parents have include pacifier use, thumb sucking and teeth grinding. But these behaviors don’t necessarily turn into a problem for all kids.

Tercero noted that pacifier use and thumb sucking is normal and comforting for many infants and toddlers, but they can quickly turn into bad habits.

Dorantes said he looks for three things to determine if using a pacifier will become a bad or damaging habit: how long a child has been using the pacifier, how often during the day, and the intensity of use. Depending on those questions, he might try to wean a child off the habit.

Dorantes and Tercero agreed that it might be time to stop the pacifier use once a child turns 3, because the habit can possibly damage not just the teeth but also the shape of the palate, or roof of the mouth.

Teeth grinding is just as natural for children, and for the most part it’s not something to be worried about unless it persists after their adult teeth come in. Excessive grinding can cause small fractures or other problems, though, and the activity can point to other health problems, such as obstructed sleep apnea, difficulty sleeping and snoring.

Brace Yourself: See an Orthodontist Early

Most people don’t think about getting their kids braces until they hit junior high, but be prepared to have them checked out by an orthodontist years before this age, said Dr. Todd Steinhart, an orthodontic specialist at Apple Valley Dental and Orthodontics.

“Most orthodontists like to see kids for their first assessment at age 7 or 8,” said Tercero, though this isn’t the age that they start wearing braces. Instead, this consultation “allows the family and the orthodontist to come up with a plan for the future.”

At that stage, orthodontists can detect if any early treatment is needed, or if jaw surgery is needed.

“Most dentists are trained to spot these problems and will refer the patient to an orthodontist when needed,” said Tercero.

Toothy Trivia

• Kids have 20 baby teeth
• The complete set of baby teeth are usually in place by 3 years
• Front teeth come in around 6 months, first molars by age 1, the canines follow at 18 months, and finally the second molars appear around 2 years
• Kids can start losing their baby teeth around kindergarten, or age 6
• Kids will probably get their first set of adult molars in at age 6, and then the lower teeth follow
• Babies should stop using a bottle at 12-14 months to avoid “baby bottle tooth decay,” according to the American Academy of Pediatrics. At that point, drinking from a regular cup or sippy cup with a straw is best.

Recommended Books

Sure, we all know middle readers and young adult readers love reading about teeth – the sharper, the better, what with all those vampire stories taking a bite out of the juvenile fiction market. But before they get to the age to become “Twi-hards,” you might want to check out a few of these books that explore the world of dentistry. These are some titles your kids can cut their teeth on:

• The Berenstain Bears Visit the Dentist
• The Night Before the Tooth Fairy
• Teeth are Not for Biting (Board Book), by Elizabeth Verdick
• The Tooth Book
• The Tooth Book: A Guide to Healthy Teeth and Gums

Resource:

There is a helpful parents’ section on the American Academy of Pediatric Dentistry’s website, aapd.org.

Living With Crohn’s

By Karri Wick Stagman

When Tyler was born in 1997, everything was normal. Ten fingers, 10 toes, one miraculous little cherub. Somehow, amazingly, she was a part of me. I was in awe; every part of me wanted to protect this tiny being. Young and idealistic, her father and I decided to give her strong name, so that she would always be regarded as such.

I had no idea how strong she would have to be.

It wasn’t until Tyler was in fourth grade that she began to show serious symptoms. No matter how hard she worked, she couldn’t keep up with the girls on the basketball court. She complained about the pain in her joints when she ran, which her doctors attributed to growing pains. She tried not to get discouraged, but her coach was increasingly hard on her. It was difficult to watch.

It was during this year that she got an infection, which progressed into pneumonia. By her third round of antibiotics, I was getting worried. Countless frustrating trips to the doctor, tests, X-rays and blood draws gave us no diagnosis.

Tyler eventually couldn’t keep food down. Between vomiting and diarrhea, she endured abdominal pain like I’ve never seen. From February to June in 2007, she lost 18 pounds and weighed in at a mere 78 pounds. She was wasting away.

Tyler and I had moved from Florida, where she was born, when she was just 2. Eight years later, I was a single mom working on commission in a new job I loved and struggling to support my small family with little to no help from her father. It became difficult to focus at work. I stayed home when she really needed me, but as a single parent I had to keep working.

My mom used all of her vacation and sick leave helping me care for Tyler. I alternated between feelings of helplessness, guilt and stress. Little did I know that both Tyler and I were learning valuable lessons: I learned how to be an advocate for my child. Tyler learned, at the tender age of 9, how to live up to her name.

In late May 2007, we were finally referred to Seattle Children’s Hospital, though we had to wait for weeks to get in. By this time Tyler, an intelligent, clever child, took another turn for the worse: On May 31, I saw a toilet full of blood without the presence of stool, and Tyler experienced pain that dropped her frail little body to the floor. We called Seattle Children’s and they said she needed to be seen immediately. Mercifully, it was the day her health insurance became effective.

After a colonoscopy and an upper GI, the diagnosis was Crohn’s Disease.

The disease was present in 11 areas the doctors could see, from her esophagus to her colon.

There is no known cause or cure for Crohn’s. It is a chronic condition, with some cases much more severe than others. Crohn’s is an autoimmune disease that acts as an opportunist: when the body’s immune system is weakened it attacks the digestive tract. In Tyler’s case, she had an infection, then pneumonia. Her Crohn’s had been there for years, but very mild, as evidenced by her joint pain and stomach troubles. When her immune system was compromised, her body could no longer fight it off.

Since that first trip, Tyler has also been diagnosed with Ulcerative Colitis (UC), which is closely related to Crohn’s, as well as Arthralgia, which is joint pain. Crohn’s and UC fall under the classification of Inflammatory Bowel Disease (IBD).

The diagnosis, however, brought little relief. There are myriad ways to treat Crohn’s, including special diets and a battery of medications, but the side effects can be brutal. We simply had to try each one and figure out which worked. Tyler’s youth complicates matters, since many medications aren’t even approved for use in children.

Finally, in December, after 11 months on the job with a chronically ill child, I had to leave work. The pressure was unbelievable. By that time Tyler needed full-time care. I took care of her during the day, and my mom would sit with her at night so I could take a part-time job. For most of her sixth-grade year, I home-schooled Tyler, because more often than not she could not attend classes. At that time, I was giving her weekly Methotrexate injections (which are also used to treat some forms of cancer).

The side effects made her miserably ill, and after several months she absolutely refused treatment. After stopping the Methotrexate injections, she was able to go back to school, though she missed about 40 percent of her classes.

Crohn’s is such a frustrating disease because it is isolating. The symptoms aren’t discussed in polite society. Our joke is that it’s not “dinner conversation.” Tyler was depressed in a way I couldn’t comprehend. She couldn’t understand why this had happened to her, and couldn’t find escape from the constant pain. Depression is very common in Crohn’s patients — I can see why.

In order to manage and treat Tyler’s Crohn’s, there were several things that had to be addressed. In order to stop the bleeding, we would have to control the inflammation, and give her intestines a chance to rest and heal. Since treatments vary, we have tried countless medications in various combinations, and her medications change based on her symptoms. With each medication there are factors to weigh, kind of a cost vs. benefit analysis. How sick is it going to make her? Can she stand it? There were pitfalls during treatment that we didn’t expect: Two years ago while receiving her seventh Remicade infusion at Seattle Children’s, she went into anaphylactic shock.

Tyler is currently taking injections of Humira, which is prescribed for patients with severe Crohn’s who do not respond to any other treatments. Tyler also has a restricted diet, has to get substantial rest and is supposed to avoid stress, which exacerbates her condition. That last one always makes me laugh — the irony!

After 41 months, she is doing much better and has learned to deal with her condition. She is still symptomatic every single day — some days much worse than others. She now only misses about 20 percent of school, which is a great improvement.

As her mother, I have seen her go through unspeakable pain. But I have seen the frailty of a 9-year-old replaced by the strength and sharp new wit of a 13-year-old who has been through more than most adults. She has a new determination that I never had.

I have also witnessed grace. The first time she had to receive a Remicade infusion in Seattle Children’s oncology unit, Tyler realized it could be worse. Following that treatment, I heard her singing a song she wrote about how beautiful all of the children were, though they looked different on the outside. I cried as I secretly listened outside the bathroom door. Her strength and compassion continually amaze me.

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