parenting

Praise & Encouragement go a long way…Be your child’s cheerleader!

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

Kids need to know that they are doing the right thing, and they depend on Mom and Dad to keep them in check!  We all have had our moments when our children are definitely not acting the way we raised them, or so we thought.

Remember, much of our teaching is by example, and much of what kids learn about behavior is observed.

I find myself raising my voice more often than I like, it is a bad habit that I am trying to stop.  There are days that Joshua just makes me lose it, and if I don’t walk away, I could turn into a Drill Sargent. When I say do something, I expect it to be done, you know what I’m saying??? I don’t want to have to repeat myself 2, 3, 4 or more times!! It definitely takes a lot of patience to be a parent, more than I ever imagined!

The louder I get, the less they hear…. The longer I talk, the less they hear…. 😦

It’s not that I have chosen to parent this way, there are just those days that I’m on the go and/or stressed over something, and I have less patience. On days like this, I am grateful for a husband that can balance me.  Fortunately, we balance each other well! 🙂 When he has his days, I have to call him down too. We talk about it, and know we need to keep our cool and address the issue at hand.  Instead of focusing on what Josh has done wrong, focusing on the behavior and how to change it is the key. I mention Joshua, because he IS the reason James Dobson wrote the books, Raising the Strong Willed Child and Bringing Up Boys! Which I highly recommend! Good info, and fun to read!

Consequences are the best answer to unacceptable behavior!! I have tried to chose my words carefully with my children.  It is important to mean what you say, and follow through! Don’t give empty threats; like Santa won’t bring you any toys……Really? I doubt it! I do tell Josh that I can take those toys Santa brings and put them in the basement!!  😉 This is the ultimate consequence for Josh. If we take a toy that he is currently obsessed with, he straightens right up.  We have started to take some of the toys and electronics away during the school week.  It makes for better focus, and actually more “creative time”!!  I’ve talked about the importance of what I call “creative time” for a child’s self esteem. Win – Win!

Praise is one of the most effective mechanisms of good parenting. Praising a child makes them feel good about what they have accomplished…making them feel good about their self… building self esteem! When children feel good about an accomplishment, it creates drive and ambition to create something else that mimics that ‘feel good’ feeling.

Encourage your child to reach for the stars!! Children are limited or unlimited by their surroundings. An environment that is negative and lonely can severely limit a child. Children want to be loved and accepted, it is a basic human need. If a child feels neglected, they will do whatever it takes to seek the attention they so desperately crave. These attention seeking behaviors can be acting out, crying, throwing toys, and in adolescents drug use and sexual promiscuity, just to name a few.  Encouraging a child to take that next step, like singing that song in front of the church congregation, or playing a sport, or building a lego house….. Whatever it is that they want to do, encourage it! 

Basically, if you praise and encourage your children for their positive actions and behaviors you will get positive behavior in return. Be your child’s cheerleader! Tell them they have nice manners.  Encourage them to do well on that test and on the playing field. Cheer them on! Be an example of happy, positive behavior!

Pick your battles. Let them express themselves! Encourage pink or purple hair, if that is what makes them happy, it’s only hair, long, short, or different colors, what’s the big deal (unless there is a special or formal event).  I saw two kids yesterday, one with pink and one with purple streaks. I thought it was a fun way for them to express themselves. BTW- Drew Elizabeth wants purple hair, we settled for a couple feathers in her hair the for the first time, but I’m all for the purple hair.  I’ll definitely keep you posted on this one!

I ask the teenagers that I see in the office what they want to do when they grow up, some know, some don’t.  I ask them what they like to do the most?  When they have free time, what is it they are doing? I tell them to take whatever it is that they like the most, and think about a career that is similar. I tell them they can take whatever it is they like the most in the world and use their imagination to find a way to make a living doing it. They look at me, smile a little bit, and I can see the wheels start turning.  Teens are a different bunch, they torment their parents, I’m not looking forward to the teen years.

SO, Praise your children & Encourage them to reach for the stars….It makes for happy healthy kids!! Happy, healthy kids are what this journey is all about, ENJOY!

Happy Birthday Baby Boy…A whole new world!!

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

Babies make the world a happier place

At 5:46am, I will have been riding this train called Parenthood for 10 years! Oh My, What a ride it has been so far… 😉 If anyone thinks it’s easy, I beg to differ!!  I remember 10 years ago I started having contractions at the beginning of NYPD Blue. For those of you that remember, NYPD Blue was on Tuesday nights at 10, well, I contracted about every 8 -15 minutes throughout the show.  I called my best friend, who was so excited. She was going to forget about her fear of blood (I’m talking pass out kind of fear 😉 ) to be there when this new little bundle was going to enter this world. My husband didn’t quite get this was the real deal, and thought he was going to take a Benadryl and go off to sleep. I had to explain that I thought it was going to be a long night, and Benadryl was not a good idea! Well, it wasn’t too long, I was having contractions every 2 minutes as we were on our way to the hospital at midnight.  And, wouldn’t you know it, we pulled right up on a cop half way there. Morgan was so excited, he wanted to throw on the flashers, and speed past him.  I dared him to pass.  That was the last thing I wanted to deal with… This baby wasn’t coming quite that fast.

I wasn’t at the hospital for more than 4 hours, before my Joshua made his entrance, Thank GOD it was quick!! There are a few things that needed consideration during this birthing process….DRUGS!?!? I needed to decided if I wanted an epidural, or no epidural, this $#!+ hurt!!!  I’m not going to bore you with all the details of my birth story, we each have our own….and, each is definitely a Rite of Passage!

Speaking of Epidurals… a topic for any of you still in the baby making phase of parenthood.  I think women should decide if they want an epidural with no persuasion from husbands, mothers, in-laws, etc.  This is a personal decision!! There is nothing wrong with having an epidural, each person tolerates pain differently, and has different philosophies about pain. If labor is long and difficult, an epidural can be quite beneficial for mom and baby.  If mom is too stressed during labor, baby can be stressed during labor.  One thing to remember is that it takes time for the epidural to wear off after the baby is born. If a woman is induced, she should consider that the contractions induced by Pitocen (the hormone used to stimulate uterine contractions) can cause some really powerful and painful contractions.  Now, don’t get me wrong, contractions are a 15 on a pain scale of 1-10 with or without Pitocen, but with your body being forced into something it isn’t quite ready to do naturally, it just seems to make the contractions more forceful.  I’ve had friends that have had babies and needed Pitocen, and had no epidural. My hats off… it is an amazing feat, just plain amazing! I had no Pit, and my contractions hurt like He!!, No ifs, ands, or buts about it…Any woman that gives birth and doesn’t have an epidural can tell you, CHILDBIRTH HURTS!

When to go without an epidural?? I went without an epidural because I was blessed with quick labors.  Joshua was born 4 hours after I got to the hospital. This baby wasn’t waiting for the sun to come up or an epidural, he was in a hurry to get out and see what this world was all about.  Believe me, I thought about it, I have some back problems that made things a little iffy, and helped make my decision. If labor is quick, then, my personal opinion is suck it up, and get it over with.  The movie Fast and Furious was in theaters, that was what Joshua’s birth reminded me of…  He was 3.5 weeks early, 6#4oz, and 21.75″long, born in less than 8 hours from my first contraction. 1.5 hours of that was pushing…ughhh!!  All I could say, that was the hardest thing I have ever had to do in my life! At least that’s what I thought at the time, but the actual parenting thing is much harder!  All that pushing causes the baby to spend longer in the birth canal, causing a nice little cone head… it usually returns to normal within 24-48 hrs.  The little hats they have in the hospital are necessary to keep their body heat in because babies are learning to regulate their body temp, but the hats are perfect to cover up that little cone head until it is a little cuter. One of the best things in the world is the downy softness of a babies head! Enjoy it when you can, it only lasts a few months.

Aunt Shell made it and thought it was an amazing experience; and there actually wasn’t all that  much blood…We love Aunt Shell, she’s tops! 🙂 Aunt Kathy also made it in time, and was the first to say It’s a Boy!! (yes, we impatiently waited to find out). She was also the first to notice that Joshua looked just like his Daddy! Well, I do love the daddy, so that’s ok, I guess!

Another question that comes with babies – Breastfeeding or Bottlefeeding. This too is a personal decision for parents, but I am going to have to say the decision does have to weigh Mom’s feelings the most.  Breastfeeding takes dedication! It can be one of the most rewarding things you ever do (it was for me!), but for some women, it can be very difficult.  Breastfeeding can provide so many benefits to a baby, such as: increased immunities through breastmilk, help with allergies, management of cholesterol later in life, help with lifelong management of a healthy weight, help decrease ear infections, more easily digested by immature GI system, and the bonding experience is priceless, and there are so many more….  Yes, I am  an advocate for breastfeeding, I am also a lactation consultant.  As a practitioner, I support whatever decision Mom makes, no questions asked! I have helped so many moms and babies through their breastfeeding difficulties.  For the mom that is dedicated, breastfeeding can work out.  There are some women that are not capable of producing an adequate milk supply for their child.  This happens when women have insufficient glandular tissue for adequate lactation. This is real, I have friends that have had this grueling experience.  I enjoy a blog by a female pediatrician that expresses the distress from a mother that was unable to produce an adequate supply for her child.  Check out her struggles, at Confession of a Dr. Mom.  The information I have read so far on her blog has been awesome!

My Joshua, in Gryffindor tie with wand in hand! LOVE HIM!!

My Boy has changed my world, he has taught me that there are rules to parenting that don’t always fit every kid. Just when you think you know what you’re doing, the kids forget to read the book and respond appropriately….ugh! So, Fast and Furious has been going on for about 10 years….and hopefully will continue for many, many, many more!

All I really wanted to say was Happy Birthday to my Joshua! The catalyst that started this unbelievable journey called parenthood!

I LOVE YOU JOSHIE!! 🙂 

Find some “creative time”…don’t let Life’s stressors get to your kids!!

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

Childhood is a time of creativity, free thinking, and discovering oneself in this great big world.   As parents it is our responsibility to provide an environment for our children to have fun, smile, laugh and run around just being kids. Kids should have the opportunity to explore and play with smiles on their faces while laughing with friends.  This is the beautiful mental image of childhood, but not everyone’s childhood….

Creating an environment that allows for exploration and creativity allows children to learn by maneuvering and managing through their world.  Children discover new things about the world just by exploring  every day situations.  As a child grows older and their world expands, they are exposed to more of the “real world”.  Children depend on their parents to protect them from the stressors life in this “real world” has to offer.

Recently, I have been seeing children that have stomach aches, headaches, are acting out in school, having anger issues, suffering from bullying, and/or are dealing with dysfunctional family issues.  Most of these children have one thing in common, they don’t know how to cope with the hurdles that life is putting in front of them.  Parents have a  responsibility to help their children learn how to navigate and cope with the world they live in.  

Did you know that 5% of all children and adolescents suffer from depression or anxiety problems, that’s 1 out of every 20 children.  That is one child out of every classroom! WOW!  Another unfortunate statistic I’m going to share with you is that only 25% of these children get help for their mood disorder. This is sad, and leads to problems not only for the child, but for his family and possibly others.

So, what causes mood disorders like depression and anxiety??  Chemical (neurotransmitter) imbalances in the brain are the organic cause of depression and anxiety.  These chemical imbalances can be caused by genetics, environment, and negative thought processes.  A child that is constantly surrounded by negative will have a negative thinking pattern.  A child that is surrounded by positive feelings and actions will grow up with a more positive outlook.  Children at risk for mood disorders are children that are in high stress environments.  Children worry about  peer acceptance, pressure to try drugs/drinking/sex, bullying, parental expectations, family dysfunction (arguing, divorce, etc.), normal development, school/grades, acne, and future plans, just to name a few. This is an awful lot for children to deal with while they are still learning who they are.  Teaching children to cope helps them deal with all of the stressors that they encounter.  Children that are unable to cope with stressors may act out, feel anxious, depressed, worried, down, hopeless, angry, irritable, overwhelmed, burnt out, causing  difficulty thinking, problems sleeping, headaches, and stomach aches.  This unhappiness frequently leads to depression, anxiety, substance abuse, sexual promiscuity, anger issues, violence, obesity and other health problems. So, how do we teach kids to cope??  It doesn’t happen overnight.

Coping skill for you to share with your children:

  • talk about what is going on in their world and about their thoughts and feelings
  • developing a support network of family and friends
  • live a healthy lifestyle by eating healthy, exercising, and getting enough sleep
  • write in a journal
  • change negative thoughts to positive
  • approach obstacles with small steps
  • help your child anticipate events that may cause anxiety, discuss ways to help your child feel better during these times before they happen

Helping your child build good coping skills will help to build self-confidence and increase self-esteem. Allowing children time for free thinking is important. I’ve started calling this “creative time” in our house, as this unstructured time allows creativity.  When left to explore their environment, they imagine something, and they create it. Job accomplished! It’s all about baby steps…. My kids get 30-90 minutes of free time before bed most nights.  They play in their room and do whatever they want.  Joshua is expected to find time to practice his guitar and drums, and likes to find time to read as well.  My kids love their free “creative time”.

Setting goals, formulating a plan to meet those goals, and accomplishing those goals is one of the best self esteem building experience for anyone. Accomplishment feels great!  It provides feelings of capability and confidence, and it is motivating as well.

If you have concerns that a child or teen close to you is depressed or having trouble coping, please help them get help. Sometimes listening and helping lead someone in the right direction is the most important step to helping them see a brighter future.

As you continue on this parenting journey, create goals, follow through, enjoy the feeling of accomplishment, and be an example for your children!

Remember, to succeed, you must first have a plan…

I will explore more issues with child and teen depression and anxiety in future posts.  Please click on the FOLLOW button on the right side of my page to receive updates.

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!

What’s that cough all about??

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

Hi all! I hope you are doing well, ’cause there are lots of sick kiddos out there.  I have been so busy in the office, I haven’t had time for a post, so this one is going to be full of info for you.

So many kids are coughing!  I’m sure you are nodding your head in agreement right now.  What I’m noticing is a common goal: Most parents just want the cough to go away!  Well, of course they do, so I…. it’s the same in my house.  Drew Elizabeth has been coughing on and off for months; but, that’s life in Kindergarten.   Joshua coughs and sneezes and clears his throat every morning, which has got to be disturbing to him, it is to the rest of us.

With all of this coughing going on the real question is WHY IS MY CHILD COUGHING?? 

A cough is the body’s way to protect itself.  The real goal for parents and pediatric providers is to determine what is causing the cough? Is it post nasal drip, congestion from a cold, asthma, croup, pneumonia??   Figuring out what is causing the cough is the first step in figuring out how to treat the cough.  Treating a cough with a cough suppressant is not a good idea, the cough is there for a reason.

If your child has a cold (upper respiratory infection or URI), the congestion may be causing the cough.  URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), decreased appetite, disturbed sleep and overall they feel kind of miserable. The congestion from a cold usually runs down the throat, causing the body to cough.  Coughing is the body’s defense mechanism to keep the congestion from travelling down to the lungs.  Colds are caused by viruses, rhinovirus, adenovirus, etc.

Some viruses cause Croup.  Croup is caused by inflammation of the airway and vocal cords during a URI.  This causes a “barky” sound that is SCARY the first time you hear it. I freaked out the first time Josh had croup, at 2am my first thought was asthma attack because he looked like he couldn’t breath and his eyes were as big as eggs! He looked terrified, which terrified me!  If this happens to you in the middle of the night, do the tried and true steamy shower trick. As soon as you can, take a trip to the doctor for a dose of steroids and that cough won’t sound so scary.

Antibiotics will not get rid of a virus, antibiotics kill bacteria, not viruses.  Viruses typically last 7-10 days, with symptoms worsening over the first 3-5 days.   The best way to treat the cough is by trying to dry up the congestion.  I usually recommend an antihistamine or decongestant to help.  Check with your medical provider to see if this is proper treatment advice for your child.

Specific treatment options should be discussed with your primary care provider (PCP).  Children that do not start improving within a week should be evaluated for ear infections, pneumonia or other complications.  Children with symptoms that get bad quickly should be evaluated sooner.   Infants with lots of congestion and runny nose should also be evaluated sooner.  Babies are at higher risk for complications from viruses that older children and adults can easily fight off.

Pneumonia, a lower respiratory infection, can be a serious complication from ongoing cough and congestion. Children that have pneumonia will often present with symptoms other than cough, but not always.   These children will typically have little energy, and tire more easily when playing. Children with pneumonia will often have difficulty taking a deep breath, or doing so may be painful and will cause lots of coughing. These children are often compensating by doing lots of shallow breathing, and their breathing may be faster than usual.  Keep in mind fevers can also cause fast breathing and rapid heart rate. Children with pneumonia will often run a fever, but not always.  Another red flag with pneumonia is a cough that went away, or you thought it went away… The cough that is wet, thick and sounds bad, and then just disappears, may be a sign that there is fluid in the lungs that is inhibiting the child’s cough.  These children often look sick and have little energy, but again, not always.  If your child has a cough for more than a week that doesn’t get any better, but continues to linger, please have your child evaluated.  Children of all ages get pneumonia. I’ve treated just as many teens with pneumonia as younger children this winter.

Vaccinate against Pneumonia: You can help protect your children under the age of 5 years old with a vaccine.  Please check with your doctor to be sure that your child has had all of their pneumonia vaccines; this vaccine protects against 13 different organisms that cause pneumonia.  Children over the age of 2 years old with asthma or other chronic health conditions should consult with their doctor to see if they should have an additional pneumonia vaccine that is for people of all ages; this vaccine protects against 23 different causes.

Coughing can be a symptom of asthma.    Children with asthma will cough because of inflammation and secretions in the airway.  Children with asthma may not look like they are having difficulties breathing because they will breath more shallow to compensate.    Frequently, parents and children do not even realize this is happening.  I treated a little girl (8 yrs old) yesterday for asthma that was flaring because she has a cold.  The child’s symptoms were cough and congestion.  When I evaluated her, I discovered she was moving very little air in her lungs, but didn’t look bad at all.  Mom had not realize she needed her asthma treatments because her symptoms were so mild.  After giving her a nebulizer treatment in the office, she was able to move air in and out of her lungs more easily.   URI’s frequently cause children with asthma to have increased breathing problems.  Even if the child has not needed daily treatment in the past, they may while they have a URI.  Without a proper physical assessment, it is not possible to determine if a child is coughing because of asthma.  Please consult your provider to create an Asthma Care Plan for your child.  This plan should include treatment for mild, moderate, and severe asthma symptoms.  Asthma symptoms are often exacerbated by allergies, this should be addressed by your provider. Children cannot be diagnosed with asthma with one visit or one incidence of breathing difficulties.  Asthma is a diagnosis of chronic/ongoing incidence. 

If a child has allergies, they usually have a nighttime cough, but this cough goes away during the day.  These children will often cough, sneeze, and clear their throat for a while in the mornings.  Yes, this does sound like Joshua.  Zyrtec is often helpful for him, but at almost 10 years old, I let him chose if he is going to take it.  Recently, he has chosen no; so, the morning sneezing continues.  As April approaches  his allergy symptoms will get worse, and I will strongly encourage 😉 him to take his Zyrtec every night.  Joshua’s allergies are tricky to say the least, but that’s for another day.  If you think your child has allergies, check with your doctor to see if your child displays other silent allergy symptoms.  Allergy medication can be helpful, but you should always consult with your pediatric provider before starting a chronic medication.  I’ll talk about allergies in a future post, the season is not too far off.

I enjoy sharing my advice, and encourage you to consult with your pediatric care provider about all of your child’s healthcare needs and concerns.  Think of your Doc, PA, or NP as your partner in parenting and caring for your child. That is what I hope I am for all the families that I work with.  The journey is a challenging one, the more we stick together, the better parents we can be!

I hope you enjoy the journey, even with the coughs and runny noses! 😉

Are you thirsty? The Importance of HYDRATION!

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

Tonight’s dinner table conversation landed on the topic of how much water Joshua is NOT drinking during the day.  Drew Elizabeth isn’t much better (but got a reprieve because she was at Bible study).  When Joshua and Morgan asked me how much water he (Joshua) should be drinking.  I told them that he should have at least 60-80 ounces every day.  A surprised Josh said, “What? How is that even possible?”   I took a deep breath….  Then, I told him if he actually drank the water bottle he kept on his desk at school, it wouldn’t be hard at all.  I explained that if he drank one full water bottle at lunchtime, after morning recess and again at afternoon recess he would probably drink most of his daily requirement.  I reminded him this would be the perfect time to have a big drink of water.  After being outside playing for 15-20 minutes, there is no doubt he is thirsty.  The rest of his fluids could be obtained through milk, lemonade, juice, fruits, etc.   “Oh, yeah!?!” was his only response; translation to my ears, “YOU WIN, MOMMY!”  🙂

Encourage your children to drink water starting at a young age.  School aged children should drink approximately 60-80 oz of fluid a day.  Fluid intake can include any fluid that does NOT contain caffeine or carbonation.

Please give a sippy cup of water to your toddler. My children always had a sippy cup of water with them when they were little, even when they went to bed.  Once they outgrow the sippy cup stage, get them their own water bottle.  Kids love to have their own things, and a reusable water bottle is good for our planet!

Newborns should not have water.  They need 100% of their intake to contain calories for proper growth and development.  Children do not need extra water during the first few months of life, they get all they need from formula and/or breastmilk.

During the hot months of summer and during exercise, you need extra hydration. For every hour that you sweat, you should add 16oz to your daily intake.

In future posts I’ll address the importance of hydration for constipation, dry skin, allergies, headaches, and other health issues.

Thanks for enjoying the journey with me!

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!