Parenting

Big HUGS for Valentines and everyday!

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

The most important thing you can give your child is YOU!!

Your time, attention and love are the number one thing that can make your child happy!!

So, everyday, but, especially today be sure to squeeze your kids extra tight and let them know they are a priority in your world!!

It’s a great journey – ENJOY!

Happy Valentines Day!! 

Yuck, the “throw ups”…Do I need to be worried because my child is vomiting??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 1 Comment

Well, tonight’s post wrote itself when friends of mine called to make sure they were doing the right thing for their daughter that had been vomiting all day. I saw kids of all ages today that had nausea, vomiting and diarrhea.  So, it sounds like the best parenting advice right now would be on managing that nasty stomach virus also know as gastroenteritis.

Poor little Maddie has been vomiting all day.  Her brother had vomiting and diarrhea a few days ago, and now it sounds like it’s her turn.  One question her Dad had; could it be something else? Well, maybe…but, probably not.  Dad told me he had been giving Maddie about a 1/2 ounce of Gatorade every 20 minutes or so.  She had been doing fairly well, then started having really bad stomach cramps. It seems that Maddie took a big drink of Mom’s tea, which wasn’t a good idea, but who can blame her, she was probably really thirsty.  Maddie probably had more than her stomach was able to tolerate.  It probably didn’t help that the tea had caffeine in it, which can be irritating to an empty stomach.  Drinking too much or eating or drinking the wrong thing can cause the pain and vomiting to start again. With rest and small amounts of fluids, Maddie will probably get throght this stomach virus just fine.  Slowly staying hydrated, and then eating small amounts of bland foods.  No doubt, she will be back to her happy playful self, and keeping up with that brother of hers.

Most vomiting spells will usually last 8-12 hours, but can come and go for a few days.  If your child vomits for more than 24-48 hours, you might want to consider having them evaluated by their pediatric provider.

Most children will have diarrhea with or after vomiting. This is just another way for the virus to exit the body.  Do not give children medication to stop the diarrhea or vomiting.  If this is necessary, medication should be prescribed and supervised by your provider.

Dehydration is usually the worst complication of gastroenteritis. Keeping your child hydrated after the initial vomiting spell is very important.  If your child is vomiting, don’t give anything by mouth the first couple hours; then give small sips of pedialyte or Gatorade (1/2 oz.) every 15-20 minutes.  For young children, Pedialyte popsicles can be really helpful.

If children tolerate fluids after several hours, try bland foods such as saltine crackers and toast.  Slowly, increase the diet with bland, salty foods over the next few days.  Do not give your child milk products, acidic products, or greasy foods. French fries and chicken nuggets are NOT a good idea.  Yes, too many parents of 3 or 4 years old children will come into my office and say, “Well, she said she would eat chicken nuggets” (or hot dogs, you can fill in with either)…. I want to scream “Are you kidding me?”   Fortunately, I learned to bite my tongue a few years back.  Trust me, it took some practice, I usually say what I think, but have learned that I just can’t do that sometimes.  Those of you that know me are smiling and laughing right now, no doubt. 😉

So, What else could it be??

  • Some people are concerned that their child could have appendicitis.  Believe me, that is the first thing I want to make sure a child doesn’t have either.  Appendicitis does need to be ruled out if a child is having severe or ongoing abdominal pain.  Appendix pain is usually in the lower right quadrant of the abdomen, but the pain can radiate elsewhere.  If you are worried your child may have signs of appendicitis, please see your provider.  This is not an easy diagnosis to make, even with physical exam.
  • Sometimes children will have vomiting, with a fever, sore throat and headache; beware, this can be strep throat.  Some children with strep throat will vomit.  My poor Joshua is one of these kids.  He has only had strep twice in his life,  first, with pneumonia.  Then, a few years ago he presented as fever, nausea and sore throat.  The poor kid vomiting for over 8 hours, he was pitiful.  If I hadn’t seen the positive strep test myself, I would have really thought it was a stomach virus.  It’s always safest to check if you have any doubt.  Strep throat cannot be confirmed without a throat culture, and MUST be treated with an antibiotic.

Again, I want to stress the importance of HYDRATION! Slow but steady hydration is the key to avoiding dehydration. If your child does not urinate at least once in 12 hours, please have him evaluated for dehydration.  Fever, along with vomiting and diarrhea can increase the risk for dehydration.  For more advice on fevers or hydration, please see my related posts.

Remember, sick kids need a little more patience, understanding, and TLC.

At some time or another, a vomiting child is something we all deal with….kind of like a rite of passage. Every Mom or Dad has a gross vomiting story to tell. Good luck with the vomiting thing when you experience it along your parenting journey.

Let them eat cake…for breakfast??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 3 Comments

Two thumbs up for cake for breakfast!! I was lucky enough to spend the morning taste testing wedding cake with my brother and future sister-in-law, Yummmm!!! We laughed about having cake for breakfast.  Sarah said, “this would be a good one for your blog”…I think she was right.  The smart one was Sarah’s mom, who ate an egg before our mini cake marathon.  Eggs are a great source of protein, so that was a good idea.  So,  when I thought about today’s daily dose of helpful hints, I figured I would write a bit about some nutrition basics.

So, is it really OK to eat cake for breakfast??  Not regularly, but I believe anything and everything is acceptable in moderation. Cake for a special occasion, birthday, or on vacation is no big deal no matter what time of day as long as we follow healthy eating habits and live a healthy lifestyle most of the time.

I usually let the kids go a little overboard when we are on vacation…why not, it is vacation. BTW-That’s how I get away with eating Key Lime pie for breakfast! Have you ever heard the song Kenny Chesney wrote about Key Lime Pie? Great song, it used to be the theme song in the Pilates class I taught. A little encouragement while we were exercising. 😉  My, My, My, Key Lime Pie…. (if you want to hear the song, http://www.youtube.com/watch?v=jle9Pe2NWFg)

So, now that I have you thinking about cake and pie (sorry), I’ll tell you about some Daily Nutrition Basics for everyone:

  • Eat 4-5 servings of fruits or vegetables daily.  Fruits and vegetables have essential vitamins and nutrients that our bodies need for good health.  Fruits and veggies add daily fiber, which is necessary for a healthy gastrointestinal system.  Notice this is servings per day, a large bowl of fruit or a large salad may give you multiple servings at one time.
  • Eat 2-3 servings of protein daily.  Protein builds muscle.  Muscle burns fat.  Eating protein and exercising daily can help increase lean muscle mass.  Protein comes from many sources, such as: fish, meat, eggs, beans, nuts, and peanut butter.
  • Drink your milk,  and chocolate is fine with me!! Calcium is crucial for good bone growth and development, and maintaining good bone density.  Milk and other dairy products are an excellent source of calcium.  For optimal bone health, the Institute of Medicine (IOM) recommends:  1 to 3 years old — 700 milligrams of calcium daily, 4 to 8 years old — 1000 milligrams, 9 to 18 years old — 1,300 milligrams.  One 8oz glass of milk or calcium fortified OJ has about 300mg of calcium.  For more information on Calcium intake and sources of calcium, visit. http://kidshealth.org/parent/growth/feeding/calcium.html#.
  • When eating carbohydrates, eat whole grains vs. white flour products.  Whole grains are healthier and better for our digestive system than white flour.
  • Meals should be equally balanced with protein, fiber and carbohydrates.
  • Control your potion size.  An adequate portion is the size of your fist or palm.  Keep in mind, for children, it is the size of THEIR fist or palm.  If your child wants second helpings, encourage seconds of protein and veggies before seconds of carbs.
  • And, of course, if you read any of my post, you know daily water intake is a must for proper nutrition. Check out my post on hydration for more details.

I tell my patients that they should follow these basic rules, everything else is alright in moderation. Living a healthy lifestyle consists of healthy eating habits, as well as staying active and getting regular exercise.  Yes, it’s ok to have sweets, but not all the time.

I hope these basic rules will help you keep your family happy and healthy.

So, while you enjoy the journey…. Let them eat cake!!!  😉

It’s just a “cold”…so now what??

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

We have all suffered with colds throughout our lifetime.  A cold or URI/upper respiratory infection can be miserable. URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), sore throat, decreased appetite, disturbed sleep and overall just miserable feeling.  If fevers accompany the cough and congestion, a day off to rest isn’t a bad idea no matter what your age. If there is no fever with the cold symptoms,  most people just continue on through their daily routine.

I know what you are thinking… Yes, children do get colds more frequently than adults!  Fortunately and unfortunately, childhood is a time of building  immunity; good in the long run, but growing pains along the way.  It is true that the more organisms you are exposed to, the stronger your immune system gets.

So, what can you do to make life a little less miserable for your child with a cold??

There are a few simple rules….

Rule #1 – HYDRATION, HYDRATION, HYDRATION!!!  Drink plenty of fluids.  Adding Pedialyte or Vitamin water can help, this helps to replace any loss of electrolytes, salts, sugars, etc. from the cold and fever.  I’m not a fan of Gatorade, too much high fructose corn syrup. If you learn nothing else from my post, you will learn about how important it is to be hydrated! 🙂

Rule #2 – Blow your nose.  This is hard for young children, but can be accomplished with continued practice and effort. For babies, use saline drops and a bulb syringe to help with the nasal drainage.

Rule #3 – Increase your Vitamin C intake.  I recommend 500-1000mg to my young patients, 1000-1500mg to the adolescents.  Vitamin C is great for boosting the immune system into gear, helping it fight off the cold.  We like the chewable Vitamin C in my house, they taste like sweet-tarts, just a little more tart.  Josh ate 8 of them one day (500mg each x 8 = 4000mg), and then told me how good they were!  I told him that he really shouldn’t have that many, although Vitamin C is not toxic.  Crazy kid! (You will start seeing a pattern with this kid, he keeps us on our toes around here.)

Rule #4 – Use a cool-mist humidifier in your child’s room while they are sleeping.  Don’t forget to pull the door closed, leaving a few inches for ventilation. Keeping the child’s head elevated is helpful too. Infants should have their mattress elevated on an angle, a pillow should never be used under an infant to elevate his head.

Rule #5 – Get plenty of REST! Children and adults need to take time to rest and let their body fight off the cold.  Our bodies heal during sleep, sleep is so important to maintaining good health.  (I will address sleep soon.)

All of the above can help your child be more comfortable.  There are some other helpful hints that may or may not be useful for you.  Keep in mind, all children are different, and have similar but different needs.  Some children will be more clingy and want to be with you 24/7.

Some children just need you to hold and love them because they don’t feel good.  It makes them fell better to have your hugs and kisses.  There is nothing like the love of a parent to make you feel better!

Other helpful hints:

  • Take Motrin (Ibuprofen) for comfort.  It can also be helpful with the swelling and inflammation in the upper respiratory tract.  Nasal congestion is not just a runny nose.  Most of the little noses I see are so swollen inside,  some of them hardly have any room to breath, and many are breathing through their mouth.   I’m sure this sounds familiar, most children will breath through their mouth when they have a cold, and this is exactly why!
  • The latest research shows that giving a spoonful of honey is more helpful than a spoonful of cough medicine!  I advise my patients to use Honey for that daytime cough.  Honey tastes good, isn’t full of chemicals, and you cannot overdose on it!  I think it is great that we are getting back to natural vs. chemical!! 🙂
  • Taking an antihistamine or decongestant is helpful for some people.  I frequently recommend Benadryl (Diphenhydramine) at bedtime. I think this helps the child get some sleep and also helps to dry up some of the congestion. I think Benadryl is too sedating to give more than 1-2x a day, and don’t recommend daytime dosing unless the child is home and can nap. For Drew Elizabeth I use Claritin (Loratadine) instead of Benadryl. I do this because she has mild allergies and takes Claritin on a daily basis anyway. Also, I can give her the Claritin in the morning and it doesn’t make her sleepy. DO NOT use 2 allergy medications at the same time! Some decongestants such as Dimetapp and Robitussin can be helpful, but usually do little more than treat the cough for a few hours. DO NOT give Dimetapp Cold and Allergy with another allergy medication.  Dimetapp makes a Cold and Cough and a Cold and Allergy. Please read labels carefully!!
  • I think cough drops can be helpful too. I personally like Ricola.  No, I don’t get paid by Ricola. Do you hear the horn in the background, Riiicooolaaaa ;-)! The natural herbs just seem to be helpful for the sore throat and cough that accompany most colds.  Please keep in mind any hard object like cough drops can be a choking hazard for young children.
  • Another helpful tip that a friend reminded me of after I wrote the cough post, was sinus rinses.  Thanks, Ami Jo! 🙂 If you have never tried it, don’t knock it.  Most people will say yuck, until they have tried it.  A sinus rinse is a great way to help with a cold or allergies. I have parents that report back to me and swear by them.  Sinus rinses can be really helpful for allergy sufferers.

Please visit your child’s pediatric provider if they have a high fever, are uncomfortable when laying down (can be a sign of an ear infection because the pressure increases when they lay down), aren’t drinking and eating, or exhibit any signs of breathing problems.  Colds should get worse for a few days (3-5), then start to gradually get better.

Well, that is enough information for now, this was supposed to be a short post! Oops.  Too many helpful tips, I guess.

Keep in mind, all children are different!!  Some need more intervention then others while they suffer through yet another cold along this journey we call Life. Hope this information is helpful for all of you Moms and Dads out there! (Yes, this one’s for you, Ryan!) Thanks for reading.

I hope you are taking time to enjoy the journey!

Parenting is NOT EASY!!

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

PARENTING IS NOT EASY.  Being a good parent takes time, hard work and endless energy.   When it seems just a little too tough, take some time to read Mom’s Daily Dose.   My goal is to provide you with advice to make parenting easier and educate you a little on why kids do what they do.  Along the way, I will probably share some funny moments from my personal parenting experience and the world of pediatrics.  Hopefully, my professional knowledge and parenting experience will help you enjoy the journey that is parenthood.

We love to explore the museums in DC, especially the "Dinosaur Museum!" Drew Elizabeth fell in love with dinosaurs at the Museum of Natural History when she was 3 years old....the rest is history!