Published: Monday, 11 December 2017 09:35
Article written by: Samuel M. Libber, MD, Annapolis Pediatrics
The holidays are times of great joy, celebration, and sharing with family and friends. Our routines shift, our day-to-day patterns change, and life takes on a different pace. To a child, however, these changes can expose them to a number of risks both inside and outside of the house. Taking a few moments to remind ourselves of these risks may pay gigantic dividends....and maybe even save a life.
According to the Centers for Disease Control, transportation-related accidents rate highest in terms of risk to children. Motor vehicle accidents, in particular, are the most problematic. At holiday time, long car trips, drivers impaired by alcohol or sleeplessness, crowded roads, and poor weather conditions present hazards to kids and their families. Heightened defensive driving, proper seat-belt and car seat use, frequent breaks, and timing trips to avoid high-risk scenarios will all help to lower these risks.
Household injuries, such as falls and burns, also pose threat to kids (and their family members). While celebrating, adults may temporarily let their guard down when supervising their children. Kids can easily fall, harming themselves and potentially requiring emergency care. Candles, electric fixtures, and lit fireplaces can be especially intriguing to small children and can lead to contact burns, scalds, and fires.
Be careful, too, about ingestions. Little children may find their way into bottles of brightly colored pills lying on tables or countertops, or in purses left open from visiting family and friends. In only a short time, a child may consume enough to have a serious or even fatal ingestion. Watch out for mistletoe and holly, both of which have potentially disastrous effects when consumed. Poinsettias have had a bad rap, which has been largely disproven for humans...although not necessarily for pets.
Enjoy your holidays and treasure the time with your family and friends, but remember to be mindful of potential hazards. You will thank yourself for the extra few minutes you take to prevent possible mishaps from happening. Happy---and safe---holidays!
For over 60 years, Annapolis Pediatrics has provided superior healthcare to infants, children, adolescents, and young adults in Annapolis and the surrounding communities. In some cases, we have cared for three generations of families. We strive to provide high quality medical care, from excellent clinical care to a positive customer experience for our patients and their parents.
We have over 30 physicians and nurse practitioners in 5 locations: Annapolis, Crofton, Edgewater, Severna Park, and Kent Island. We also offer M-F walk-in hours at our Annapolis office for short sick visits.
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Published: Monday, 11 December 2017 00:00
Today I want to talk about some vital signs. These are important, right; they’re VITAL. And we need to have them all working (fairly) smoothly in concert to remain vertical, so I think it’s fair to give them some attention. Most of the time at work, before I even go into a room to examine a patient, I take a look at the vital signs as a way to frame up my assessment.
Let’s first say what the vital signs are:
• Pulse (or heart rate)
• Respiratory rate
• Blood pressure
One thing that I want everyone to know is that normal vital signs are different for different ages.
Kind of like in the animal kingdom, where little animals like hummingbirds have usual heart rates of over 200 beats per minute and elephants have rates of 40 per minute: the larger the creature gets, the slower the heart rate is. Same deal in humans. A heart rate of 145 in a baby is perfectly normal, but when I see that number for a teenager I get very concerned, or at least need a reasonable explanation for it.
Temperature and weight get addressed a lot, don’t they?
Between fever and obesity, many a blog has been written. Respiratory rate is a vital sign that usually makes itself known when there’s a problem: it’s hard NOT to notice when a child is in true respiratory distress. They’re breathing so fast that their chest and abdominal muscles are visibly moving in and out, and they can barely feed (baby) or speak (older child) due to that rapid respiratory rate. Blood pressure is a squirrely one in children: high blood pressure in kids is relatively uncommon, but as the childhood obesity epidemic grows, we are starting see more of it. See how vital signs interrelate?
Let’s get back to pulse.
That’s the number of times the heart beats in a minute. What I want to focus on today is on the heart rate, and specifically, a fast heart rate. The 25 cent word for this is tachycardia (pronounced ta-kick-ard-ee-uh), and it always gets my attention. I’m happy to say that most of the time in pediatrics it is easily explained by reasons OTHER than the heart, but that doesn’t diminish its importance. There are FIVE key reasons for the heart rate to be elevated in kids (adults too, for that matter):
Elevation of the body temperature alone causes the heart rate to increase. The chemicals in our cells that are associated with inflammation (due to whatever cause: infection, auto-immune reactions, etc.) produce a cascade of reactions that ultimately elevate our body temperature “set point”, and that’s why we have fever that hangs on until a fever-reducer medicine is given (acetaminophen or ibuprofen) or the infectious or inflammatory process goes away. Along with those chemical reactions come an increase in pulse, as the heart does its job to help pump along all the infection fighting inflammatory cells in the blood to the rest of the body where they are needed. Thanks, heart, for pitching in and doing your job.
When we exercise, our muscles need more oxygen to keep going, and as such, the heart rate increases to make sure the oxygen delivery is adequate. Simple as that. As we get better conditioned our muscles “process” oxygen more efficiently and that’s why athletes have lower resting heart rates. Totally normal.
When the body is low on fluids, the circulating volume of blood and plasma in your body decreases, and this causes the heart to pump faster in order to get that smaller amount of oxygenated blood to the other organs and tissues where’s it’s needed. Refer to the animal analogy from earlier: the smaller the body, the less volume reserve the body has. That’s why babies get dehydrated quicker than older kids. And it’s one of the MOST common reasons that the heart rate goes up. Again, thanks heart. See #1.
4. Actual heart problems
Kids can get abnormal heart rhythms, called dysrhythmias (diss-rith-mee-uhs...25 cents!) that cause the heart rate to increase. These are typically quite dramatic; I’ve had families say that they could see their child’s heart beating rapidly underneath their shirt from across the room! It’s not unusual for a rapid heart rate due to an actual cardiac cause to yield markedly high heart rates of over 200 beats per minute (BPM), compared to only moderately elevated heart rates due to other causes. Needless to say, a heart rate elevated over 200 BPM in ANY age group warrants an immediate and emergent evaluation, usually with heart monitoring and an ECG (electrocardiogram) tracing. I’m not gonna thank the heart for this one, since it needs to straighten up and act right.
Special shout out to THE most common medicine for causing kids to feel like their hearts are thumping away: ALBUTEROL, the friendly neighborhood wheezing medicine. Available in nebulizer or inhaler form, this medicine, while doing a beautiful job dilating and opening up the constricted airways, also has a direct effect on the heart to speed up the rate. In children, this is usually not a big deal and it goes away on its own after a bit of time, but it can be very annoying and distracting. I’ll take it temporarily though, if it means that breathing improves.
Other substances can cause the heart rate to increase: cocaine (yep, I’ve seen it in kids), and one that we always need to keep in the back of our mind- accidental ingestion of an adult family member’s medication. This happens more than we all think, even with our best intentions of keeping medicines away from children. Make sure you have the Poison Center’s phone number handy: 800.222.1222. Those folks are fantastic, and are available 24/7.
This list covers most of the important highlights of what goes through my mind when I see a child with an elevated heart rate. As you can probably conclude from a few of the points above, not every child who comes in with the complaint of “heart palpitations” needs a fancy ECG or X-ray. What they DO need is a full set of vital signs (and maybe a repeat set or two, to catch any potential discrepancies during the first set) and a thorough assessment by a solid clinician to determine the most likely cause. And now that YOU have some insight into what could be the explanation, you’ll be able to follow along the rationale without a stressful increase in YOUR heart rate as well.
Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from our highly skilled staff, with patients and families everywhere.
Follow Dr. Christina online for everyday health tips, insightful articles and more.
Published: Tuesday, 04 November 2014 09:09
Sponsored Editorial Courtesy of Historic St. Mary's City
What did it take to get through the winter 350 years ago? Forget a quick trip to the store—you needed enough food to last until the next harvest, a secure shelter that would keep out the elements, and clothes to keep you warm. At "Hearth and Home in Early Maryland", today’s families can explore the skills that allowed Maryland’s first citizens to weather the cold. Hearth and Home will take place on November 28 and 29, from 11 a.m. until 4 p.m. at Historic St. Mary’s City (HSMC).
Discover the 17th-century version of a refrigerator. Help put our gardens “to bed” for the cold months and assist as we tighten up our fences. See what’s cooking at each living history site – explore open hearths, food preservation, and more! Watch the trial of John Salter, pig thief, and consider what it took to preserve the peace in early Maryland. Lend a hand grinding corn, churning butter, and maybe stir a pot or two. Take home a free colonial recipe book and try some old-style cooking at home.
Hearth and Home in Early Maryland offers a welcome opportunity for family and visitors to get out of the house after Thanksgiving. All will gain a new appreciation for the comforts of our homes, and the convenience of modern appliances, utilities, and grocery stores!
Begin your visit at the HSMC Visitor Center at 18751 Hogaboom Lane, St. Mary’s City. Admission is $10 for adults, $9 seniors, $6 students, and free for those under 6 years and Friends members. Bring a non-perishable food item for the Southern Maryland Food Bank and save $1!
For more information, call 240-895-4990, 800-SMC-1634, or visit hsmcdigshistory.org
Published: Monday, 05 January 2015 10:50
A Homework Survival Guide for Kids with ADHD (or anyone who is tired of sitting!)
So your child comes home with homework; all day long they have been encouraged to sit still and be quiet and now you have to coerce your child to do the same. Quite often bribery, threats or even tears ensue. Well no more…here are some multi-sensory ideas to ease the pain.
An interesting thing to consider is that a major difference between the top performing education system (Finland) and ours, is the amount of time spent taking a break and moving around. Finland gives students approximately 75 minutes of recess daily, while many of our schools allow just 27 minutes of free time to move a day (this is outrageous but a discussion for another day). SO, building movement into homework kills so many birds with one stone; your child gets to move and using their whole body (multi-sensory learning) helps accelerate learning.
Need to work on spelling words?
Spell words out loud while:
- Bouncing a tennis ball
- Playing balloon volleyball
- Playing catch
- Jumping rope (Coupling a rhythmical movement with a memorization task actually improves recall)
Have ‘read aloud’ each night?
Read aloud while walking around the room. At every comma, you stop walking and pause in the reading for one second before resuming walking and reading. At every period, exclamation point, or question mark, you stop and pause in the reading for two seconds before resuming. (You can add other movements or features when you encounter different types of punctuation. Here the kids can become very imaginative!)*
Working on skip counting?
- Jump while counting on the trampoline
- Swinging while counting on a swing
- Choreograph a short dance routine that includes simple moves and count on the beat!
- Use chalk to make a big number line on the sidewalk or driveway. Do addition and subtraction by walking the line.
Silence is overrated!
How about some ’thinking’ music in the background? Choose carefully. Rhythmical drumbeats are very calming and organizing, and helps maintain attention. Some classical strings can tap into higher level thinking skills. DO NOT put on music with an irregular beat (this promotes inattention and distractibility).
Take it outside
How about interspersing answering some homework questions with 5 minute intervals on the playground/swing-set. Use a timer so you can stay on track.
Switch up the seat
As long as you are armed with a clipboard who says you need to sit on a chair and work at a table? Dig out an exercise ball and gently bounce while working through the worksheet. Lie on the floor propped up on elbows, or, my favorite for the serious mover is standing on a balance board and completing the assignment.
The most organizing and attention inducing activities are those that involve resistive or compressing actions on our major joints, simply put, pushing and pulling activities. These could include climbing a rope, ladder or cargo net, tackling the monkey bars, wheelbarrow walks, tug-of-war, push-of-war, riding a bike. These activities would be excellent to incorporate into homework time.
For personalized strategies to manage ADHD, and Sensory Processing Disorders at home, in school or in the community please call Katie on 240-421-3154 or visit us at www.blossomOT.com
Katie Ryzhikov M.S.,OTR/L is the owner of Blossom Pediatric Occupational Therapy which specializes in Sensory Integration therapy for children with ADHD, fine and gross motor delays and Autism Spectrum disorders
Content provided by Blossom Pediatric Occupational Therapy
Published: Wednesday, 24 August 2016 15:20
Sponsored editorial provided by Annapolis Pediatrics
The beginning of the school year is a stressful time for both parents and their children. Parents hurry through office supply stores to gather everything on those dreaded school supply lists, annoyed over the outrageous cost of three-ring binders while wondering whether their children will reach their academic potentials this year.