Author: Katie P. Tolley, RN, MSN, CPNP-PC

Leave the schedule behind & Enjoy Family Time!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

Over the Easter holiday, my family spent a long weekend with cousins in Charleston, SC. We had such a great time, and the kids just love spending time with their cousins.

Today’s families have so much on their schedules; work, school (parents and kids), homework, sports, music lessons, church, choir practice, birthday parties, appointments, etc., etc….

Sometimes we need to schedule unscheduled time! 

It is so obvious when we watch how our children react to unscheduled time that it is necessary, and a valuable must for all of us! Being able to enjoy the great outdoors, a family meal, or holiday memories is more special than many of us realize.  The over-commitment and over-scheduling of today’s society can create stress and anxiety. Having time to just relax and enjoy each other without the rest of life’s demands keeps us healthy in ways that we don’t even think about. These demanding schedules can raise stress hormones, such as cortisol. Increased cortisol levels can cause difficulty concentrating, obesity, depression, sleep problems, high blood pressure, thyroid problems and many other health issues. Many of today’s kids are over-scheduled, it is important to make sure that children have time to unwind and relax. Given time to relax, cortisol levels will decline.

Unscheduled time allows for creativity. I’ve mentioned it before, creating and accomplishing things builds self esteem. Kids learn to make up games, build forts, and just explore their surroundings. One thing that time playing outdoors can do is help regulate neurotransmitters such as dopamine and norepinephrine. These neurotransmitters are important for normal brain function, concentration, organization, retention of information and paying attention. There is no doubt that kids need all the help they can get with focus and attention, especially those ADHD kids I talked about in my previous post.

Josh and AK battling it out!

During our time away, our children didn’t have a schedule, they ran around outside playing, jumping, climbing, bouncing, swimming, building, and just doing things that kids do. One thing I noticed during this time is that their was no complaining, no crying, no battling over attention, and the kids worked together to help one another! What a bonus for everyone!! 🙂

G reading Drew a book on our way to dinner.

Another cool thing I notice about hanging with our cousins is how kids bond, and you just can’t predict these things.  Most of us, as I did, would would assume that the girls would play girl things, and the boys would play boy things, but that isn’t necessarily the case. What happened is that the oldest cousin, Garrett (13) and the youngest, Drew Elizabeth (5) spent time together, and Joshua (10) and Anna Kat (11) spent time together most frequently.  It has been this way ever since they were very young. It is so cool to watch Garrett try to teach and explain things to Drew, and help her learn new things. I even caught him reading to her on our way to dinner. This changed just a little on this trip because Cousin Garrett has a girlfriend. When G’s girlfriend was around, Drew had to share , but she didn’t seem to mind. Even adding another kid to the mix didn’t cause any problems, everyone got along great. Drew climbed right up in the paddle boat with G’s girlfriend, and he had to take care of both girls, it was pretty cute! He bucked up and met the challenge, I think it really got him some brownie points with the GF! 😉

Overall, I think the unscheduled time is good for everyone, kids and adults alike! Taking time out to relax and smell the roses is one of the best coping mechanisms we can teach our children! It never hurts, and always helps to let those cortisol levels go down every now and then! The hard part is leaving to go back to the schedule of day to day life. Both of our children were very unhappy when it came time to leave, Morgan and I were too. 😦 Joshua hid in my cousins Suburban so he didn’t have to leave, it took a few minutes to find him too, crazy kid. Drew Elizabeth was carried on the verge of tears, kicking and pouting to the car. You don’t have to be very old to know that unscheduled time is the best for everyone. 😉

I hope that you figure out how to balance your children’s time.  There are so many things we want our children to experience and enjoy as they grow up.  Don’t forget some of the best things in life are things that happen by chance, not by a schedule.

My wish for you and yours is that you find lots of opportunities for unscheduled time along your journey! 😉

Small Dose #8 – April Fool’s from Our “Out of the Box” Thinker!

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

(There was a picture here with about 15 toilet paper rolls inside my husbands pillowcase that said, “You just got pranked…”, I guess it was “inappropriate” because it has disappeared from my post) 😦

After tonight’s post about ADHD and how creative these “out of the box” thinker’s can be, I knew I needed to share this!!

Tonight, when my husband went to bed, this is what he found….

His pillowcase was stuffed full of toilet paper rolls with a note from Joshua…

“You just got PRANKED… April Fool’s!”

Hahahahahaha, I told you this kid keeps us on our toes!!!

Gotta love the creativity!!

Happy April Fool’s Day to you and your family!

I hope your journey is just as exciting as ours! 😛

Bullying Info from Child Psych Mom

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

BULLYING IS NEVER OK!

What most kids don’t realize is that most bullies really have low self esteem and need to pick on others to make themselves feel better.

Bullying is such a huge problem in our society! I am grateful that my children go to a school that is very in tune with the students and their interpersonal relationships. Not all children have an environment that keeps them as safe as we hope. Now that I have delved into the world of blogging, I have found a few really great parenting blogs, one of which is Child Psych Mom. I recently read a post by Child Psych Mom that dealt with Bullying that I wanted to pass along to my readers. She has some great references to check out too.

Parents, teachers, and all adults should be hyper-vigilant about how children interact with one another. Bullying can affect a child’s self esteem for the rest of their life. Growing up in this society is hard enough without having some bully make it worse.

Read Child Psych Mom’s post Bullying: How Do I Save Myself? to educate yourself. The more parents and other adults know about bullying, the better we can protect our children.

And, remember, your children watch what you do, and learn from what you do! Spread happiness and smiles! 😉

BE CURIOUS, NOT JUDGMENTAL – Walt Whitman

Small Dose #7 – A little TLC goes a long way!

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

When your child is sick, the most important thing you can do is be there!!

Last night when Drew Elizabeth was vomiting, even though I am a Pediatric Nurse Practitioner, I couldn’t do anything…..except BE THERE & LOVE HER! Just being there beside her between the bouts of vomiting made all the difference in the world. Most of the time, Children tolerate illness better than adults. Children don’t know what to expect when they are sick. If  parents can be brave, strong, supportive and loving, it makes their children brave and strong.

The one thing we all want to do when our children are sick is make them better. This usually isn’t possible, most illnesses will last a certain amount of time no matter what we do as parents.Trust that your support can fix it just a little bit. So, as you travel along this unbelievable journey, remember how important a little TLC can be! 😉

Just being there and holding their hand makes all the difference in the world!

The scoop on poop…Could your kid be constipated??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

From infants to teenagers, constipation seems to be a problem for so many kids! I had a visit with a 9 year old and her mom about her stomach pain related to constipation problems. As soon as I left the room I realized that Dr. M was seeing a 2 month old for ongoing constipation issues. Then, at the end of the day, Dr. T’s first call of the evening came in before we ever left the office, and it was about a 3 month old with constipation problems. So, you see, this is a daily problem in pediatrics. Anyone that works in pediatrics will tell you that we talk about poop everyday, sometimes all day. Inadequate nutritional intake and hydration is usually the problem. 

In my house, my kids are 2 for 2 on this topic. Drew Elizabeth has been as regular as clockwork until just a few months ago. I’m sure most of you remember my Paranoid Mom post about Drew Elizabeth’s chest pain. She has never had a problem in the past, but in the past few months she hasn’t been eating her veggies as she should, and as she used to for the past 5 years. Kids…I can’t always explain why they do the things they do… I usually have more problems with my own than with yours! 😉

My poor Joshua has had constipation problems since he was an infant.  Joshua is the child that taught me all about children’s constipation. Well, Joshua and a PNP GI specialist ;-)!  Joshua eats an apple almost everyday. He loves apple slices with cinnamon; I highly recommend this, it’s great for the bowels.  Even with adequate fruits and veggies, Josh still doesn’t drink enough water (hence, the importance of hydration) to keep himself regular.

Most kids do not eat enough fruits and vegetables. For proper nutrition information, you can check out Let Them Eat Cake…For Breakfast??  Not only do most kids need to eat more fruits and veggies, they need to drink more water. Yes, I’ve tried to cover that too, you can read more about hydration in The Importance of Hydration. If adequate amounts of fiber and hydration don’t help your child with their constipation problems, I would recommend an evaluation with your child’s medical provider. Ongoing constipation can cause the large colon to expand and cause nerve damage and leaky gut and multiple other systemic problems that don’t even seem related to the bowels, but they are. Our immune system is centered in our gut, a healthy gut really matters.

By definition, constipation is having 3 or fewer bowel movements in a week that are hard, dry, and usually hurt.

A few facts about constipation:

  • When kids are constipated, they usually eat less.
  • When kids are constipated, they will usually have stomach pain, and usually on the lower left side.
  • When kids are constipated, they may have nausea and vomiting.
  • When kids are constipated, they may have more urinary incontinence (accidents), urinary frequency, and bedwetting.

So, what can you do to help your child with constipation? 

  • High fiber foods: fruits and vegetables (the crunchier, the better), beans, fresh popcorn, baked potato w/skin, berries, oatmeal. (The one fruit to avoid with constipation is bananas, they can make stools harder.)
  • Drink more water!!
  • Decrease processed foods, like carbohydrates made with white and wheat flour.
  • Getting normal exercise can help with bowel movements also.
  • Do not rush potty time. Children will often not take the time that they need to sit and eliminate their bowels.
  • Infants will frequently have temporary constipation problems when they are transitioning to new foods such as cereal, or  from breastfeeding to formula feeding. Do not give cereal under 4 months unless instructed by a medical provider.
  • In infants, try a couple ounces of 100% apple or pear juice, if this doesn’t work, you can try prune juice. Baby juice does not need to be diluted, adult juice should be diluted with half water.
  • Abdominal massage. I recommend abdominal massage to all the infants I work with that have constipation issues as a first line treatment! Massaging clockwise around the belly button and then doing the I Love You massage can work wonders for infants. With the I Love You massage, start with a few strokes of the I (left of belly button), then the L is upside down (above and to the left of the belly button), and then the U (around the belly button). This helps massage the large bowel, and can be quite helpful. Be sure to use mineral oil and apply a moderate amount of pressure. Most babies will enjoy this once they start to relax.
I hope you found some of this information helpful! Constipation can definitely make this parenting  journey a little painful for you and your child!
The ‘I Love You’ massage works! Ask the massage therapist that taught me about it when Joshua was an infant. 😉

Small Dose #6 – Medication Conversions

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

I felt it was necessary to provide a resource of medication conversions based on my last post about Medication Safety. Children depend on their parents to keep them safe and healthy. Don’t let them down!

1/4 tsp = 1.25cc

1/2 tsp = 2.5 cc

3/4 tsp = 3.75 cc

1 tsp = 5 cc

1 tbsp = 15 cc

1 oz = 30cc

cc = ml (same thing, different label)

I urge you to take the administration of medication very seriously, your child’s life depends on it! Do not give medications frequently unless advised by your child’s health care provider.

There is just so much to learn and be responsible for on this Parenting journey! It really does take a village! 😉

Don’t eat that egg…You’re allergic to Ragweed…Huh??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 4 Comments

Why in the world would I be telling you not to eat eggs if your allergic to Ragweed?? Concomitant Food Allergies.

Did you know there are certain foods that can make your environmental allergies worse? There are also foods that can worsen food allergies and food intolerance. These are called Concomitant or Synergistic Allergies. When certain environmental allergens are blooming (like ragweed for instance), eating these foods (such as eggs or milk) can make the allergy symptoms worse. Avoiding these foods during the blooming season is very helpful.

I wrote a post last week with basic allergy information, symptoms and treatment options, Springtime & Sneezes…You might have allergies if…. This post will help you recognize and treat your allergy symptoms.

You may not know what you are allergic to, and that is why allergy testing can be helpful!! Treating allergies isn’t easy, and knowing which allergens affect you can make developing a treatment plan easier. I remember calling my friend Kathy, RN/Allergy Specialist and asking her about Joshua’s allergies. She is my saving grace when it comes to Joshua and his allergies. (If you haven’t picked up on it yet, Joshua is definitely one of those kids that needs the entire village!) 😉 I have mentioned that Joshua has allergies, but has a negative RAST test. RAST testing is done via blood draw with lab testing to identify specific allergens.

There are many different panels that can be ordered depending on what part of the country you live in. Joshua was unable to do skin testing because he reacted to the control test that contained only saline. 😦 How his RAST test was negative alludes me… But, I say kids don’t read and follow the books. 😉 Also, we can’t test for every substance under the sun, it’s just not possible. Every April since this boy was 2 months old he has had a clear runny nose, that, my friends, is allergies!! No doubt about it. Some doctors will tell you that infants can’t have allergies. I beg to differ, I live with that clear runny nose, morning cough and sneezing each April, and have for 10 years now. Joshua eats a lot of apples, this high fiber food is actually necessary to help Joshua with another of his problems, but we can talk about why kids need fiber another day. 😉 So in April, when all the trees are blooming, Joshua avoids apples.

Keep in mind that allergy symptoms can be cough, congestion, clearing your throat, sniffles, runny nose, sore/scratchy throat, itchy/watery eyes, headache, skin rash, dry skin, eczema and asthma.

So, I wanted to share a list of specific foods that compound allergy symptoms. The following charts are provided by Online Allergy Center, and list what foods make specific allergies worse.

As you or your children sneeze and cough your way though this allergy season, I hope this information helps you Enjoy the Journey and beauty of Spring a little bit more! 😉

Proven Concomitant Foods:
Rhus Allergy (poison ivy, oak, sumac)… Pork, Black pepper
Ragweed… Egg, Milk, Mint
Iva ciliata… Wheat
Sage… Potato, Tomato, Tobacco (chewing or snuff)
Pigweed… Pork, Black pepper
Grass… Legumes: Beans, Peas, Soybean, Cottonseed (cooking fats)
Cedar… Beef, Yeasts (baker’s, brewer’s or malt)
Elm… Milk, Mint
Cottonwood… Lettuce
Oak… Egg, Apple
Pecan… Corn, Banana
Mesquite… Cane sugar, Orange
Dust… Oysters (seafood)
Molds… Monilia, T.O.E., Cheese, Mushrooms, Truffles
Cystic breast disease… Caffeine foods (thoephylline): Coffee, Tea, Cokes, Chocolate

Questionable Concomitant Foods (to be proven):

Dust… Nuts
Influenza Vaccine… Onion
Iva ciliata… Tea
Chenopods… Egg

Proven Synergistic Foods:

Corn… Banana
Beef… Baker’s yeast, Brewer’s yeast
Cane Sugar… Orange
Milk… Mint
Egg… Apple
Pork… Black Pepper

Questionable Synergistic Foods (to be proven):

Wheat… Tea
Pork… Chicken
Milk… Chocolate

Small Dose #5 – Don’t just say it, live it!!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 4 Comments

Be an example for your children!

Children watch and learn from the adults in their life.

Do not judge other’s for their differences, but embrace what makes us all unique! 

SMILE!

Be kind to others, and teach your children to treat others the way they want to be treated!

Say “Hello” to passersby.

Encourage your children to help those in need.

We all need to come together in our own community to make it a better place for our children’s future.

Volunteer in your community and encourage your children to do the same!

SPENDING TIME with your child is the MOST VALUABLE thing you can do for them,

and the one thing they WANT and NEED most in this world!

Don’t just say it, live it! 


Paranoid Mom…. It happens to the best of us!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 7 Comments

Hi all! After the morning I had, I just had to share this one…. It’s alright to be a “Paranoid Mom” because the well being of your children is a HUGE responsibility! I thought you all would enjoy knowing that I can be that Paranoid Mom too! 😉

Drew Elizabeth told me last night that her chest hurt. Ok, no big deal, I was convinced that she just needed to burp, toot, poop, or all of the above. Very frequently children will have chest pain that is referred gas pains. She has complained of her chest hurting 2 or 3 times in the last month or so, but she also hasn’t been eating her veggies as well as she used to. She has decided after eating her veggies for the past 5 years that she just doesn’t like them anymore. She doesn’t get away with it, and I make her eat a little. Not getting enough fiber can certainly decrease the frequency of bowel movements and the consistency of said movements. She is displaying her independence, and this is something she can control. No biggie.

When she didn’t even want the ice cream I had taken her to get, I was a little more concerned, but still thought she probably needed to go sit on the potty for a few minutes. I decided I would grab my stethoscope and take a listen to make her feel better. She will tell me she needs me to take care of her like I take care of the sick kids at work, so I didn’t want to deny her. Well, I took a listen……

I think I have mentioned before that we shouldn’t go looking for problems, because we may not be prepared to deal with what we find. Much to my surprise, I found that my daughter’s heart sounded like it was skipping a beat. Naaa, I must be hearing things, or it is just fluctuating because of her breathing, or something….. It is not unusual for heart rate to slow or increase on inhalation and exhalation. I listened a little longer…..Yep, there was definitely a skipped beat every 3rd or 4th or even 8th beat!! WTH?!? Interestingly enough, I have a cardiac history, and both of my children have had an EKG (electrocardiogram) because of it, and they were perfectly fine! Drew has even had an echocardiogram because she had a benign (innocent) murmur when she was 1 year old. So, here I am listening to my 5 year old, and her heart is skipping a beat! Yes, I looked quite calm on the outside, but the inside kept thinking, “What the He!! is going on???” I am fortunate enough to be able to call my colleagues that are close by. The PA I used to work with lives one mile down the road, and our Pediatrician (that I used to work with) lives a mile away in the other direction. I knew I could take her to either of them for a second opinion. No, I am not my kids Pediatric provider, I am their Mom! As soon as something is abnormal with either of them, I second guess my assessment skills and diagnostic skills. It is unusual for a child to have chest pain that is cardiac related, actually only 4% of pediatric chest pain is cardiac.

I broke down and called our Ped, Dr. Denise. She is awesome!! I can call her anytime for anything! She is a wealth of information, like an encyclopedia of pediatrics. Denise gave me some advice, we didn’t think the pain was cardiac related, as I first assumed, but we concluded that Drew needed an EKG first thing in the morning, but she was probably alright. BTW- she pooped and tooted and the pains went away, but the skipped beat was still there. So, my plan was to take her to the office in the am, get her evaluated, and they would say, “Oh, Katie, you were over reacting, we don’t hear anything.” Well, that was my plan, I was ready to be the crazy paranoid mom! No problem, it was my lack of skill, not her heart! I was good with that!

Well, I went to the office, told them I needed an EKG and we got started.  I love my kids pediatric office, they are the best! I worked there for almost 8 years before I was a PNP. My friend, T.,RN did her vital signs and asked what was going on. I said to just listen to her heart and tell me what you think. I watched her listen and start counting Drew’s heart rate, she nodded as she counted, 1, 2, 3…1, 2, 3… T looked at me with big eyes and a strange face… I said, “So, you hear it too?” She did! Oh, $#!+! I didn’t want her to hear it, I would rather be crazy! So, we finished vital sign, height, weight, and I waited for Karen, my friend the PA. Karen is a great PA! I adore her and we take our kids back and forth the mile between each others houses when we need a second opinion after diagnosing our own children. Drew really likes Karen, and did whatever Karen asked. So, Karen listens….. She looks at me, and nods her head! Dammit!! I wanted her to tell me she didn’t her it! But, of course she did.

My girl with all of her EKG wires attached! She ROCKS!

Well, this started the procedure for the 1st of 2 EKGs and 60 second rhythm strip (which recorded and showed her heart beat for a full minute). The first EKG was at the office, and then Karen sent us to the Diagnostic Center for a repeat EKG and the rhythm strip. Drew was so good during all of this! My sweet girl, this was going to have to be OK, I couldn’t deal with anything being seriously wrong with my girl’s heart! I’m sure you all know exactly how I felt! During the 2nd EKG and strip, the tech looked at me and said, “I know exactly what you are looking at, it’s right here and here and here…” OK, now my heart rate was up a little, too many people are confirming that I am not crazy, I REALLY PREFERRED CRAZY at this point!! I looked at the results, normal QRS, that’s reassuring, each individual beat had the proper electrophysiology, the conduction controlling her heart beat was doing it’s job, there was nothing abnormal about how the heart was beating, but there were obvious pauses between some of the beats.

So, as soon as I left, I called Denise (she was home because she had been on call all weekend). She said this is probably ok, we talked about the details, and she told me what she thought we should do. I called Karen back at the office, and Karen put a call in to “The BEST” Pediatric Cardiologist in the the Mid-Atlantic region. I am so grateful to have friends that take care of my kids, and know how to get answers, and get answers from the Experts! Dr. Ruckman of Children’s National Medical Center is one of the BEST in the nation! Karen spoke to him 2 times before lunch and called me.  Dr. Ruckman confirmed without a shadow of a doubt that this was a “normal abnormality” in children Drew’s age.

 HALLELUJAH,  HALLELUJAH…..HALLELUJAH, HALLELUJAH, HHHHAAAAALLELUUUU-JAHHHH!!!!

I could hear the angels singing in the background with me! THANK YOU, GOD! 🙂

I know this is a pretty personal post, and rather specific situation that I hope NONE of you ever face. What are the odds of listening to your daughter’s heart, just to make her feel better, because you are convinced she just needs to poop, burp, or toot, and there is an abnormal heart rate…. Hopefully, never! Drew was a trooper and got 3-4 lollipops during the whole ordeal, and even a chocolate donut on the way to school. As for me, I went on to work, and had a normal busy afternoon. I was happy with normal, busy! 🙂 

I can do without another day like this morning for the rest of my life! I know it won’t be that easy, something else will come up that makes me worry about my kids, and I pray that it will turn out just fine.  I thought it would be nice to share so that you know even the professionals get a little worried every now and then! Today was one of the days on this journey that I could have lived without! I am thrilled that at the end of the day everyone is happy, healthy, and Drew has no idea of the stress that was going on inside her mother for a few hours as I waited to be sure she was ok.

So, today, I enjoyed the journey a little less than some days; but all in all, “It is a wonderful life!” 😉

“Spring Forward” without meltdowns…. Help your child adjust to the Time Change

/ Katie P. Tolley, RN, MSN, CPNP-PC / 5 Comments

If you have a baby or small child, it maybe painfully obvious that they don’t tell time! 

So, How can you help your little one adjust to the time change? 

Children have a difficult time changing schedules, especially by an entire hour. When babies in the hospital need schedule changes, the change is made in small time increments.

Try to change your child’s schedule by 15 minutes at a time each day.

For example, if dinner is usually at 6:00, keep in mind 6:00 is now 7:00. Waiting an extra hour for food is way too long for a little one. I’m sure I don’t have to tell you how quickly a hungry or tired child can have a meltdown. 😉 You could have dinner at 5:15 the first day, 5:30 the second day, 5:45 the third day, and by the fourth day, dinner is at 6:00 again. If you have the opportunity, spend a few days at each new time before moving on. Keep in mind, bedtime is now an hour later, which means they may wake an hour earlier than you plan if you don’t help them adjust. It may be that your child is off schedule enough that it is more difficult to wake them in the morning, small changes can help. If you have little ones that don’t go to school, this is much easier. If you have a little one that has to get up and go to school or daycare, you may have more of a challenge. If you need to be back on schedule by Monday (only 2 days away), you can force the change a little quicker by changing things by 30 minutes vs 15 minutes. It will not be as smooth of an adjustment, but it should be helpful.

Filling the time before meals with small healthy snacks such as fruit or veggies to help hold them over until the new dinnertime can be helpful too.

I learned early along my parenting journey that the time change can wreak havoc on a child with a good schedule. Good parenting involves schedules, so most kids will have some adjustment to make.  I hope this info makes “Springing forward” easier for your family! Good luck and I hope you are Enjoying the Journey! 🙂