My Head Hurts

Published on July 30, 2010 in Prevention, Uncategorized and illness. 0 Comments Tags: .

Children are no different than us grown-ups when it comes to getting headaches. By that I mean that some children get them often and it is nothing to worry about. Most of the time when I see a child for headaches in clinic, the parents underlying fear is that their child has a brain tumor so I put that on the table for discussion right away. I have seen children complain of headaches as early as they can verbalize and localize symptoms, but during the teen years, headaches are much more common.

The way I explain headaches in clinic is that it is often a spectrum with tension headaches on one end and a full blown migraine on the other. It is a continuum where sometimes you have more symptoms than others.

Headaches in general can be triggered by a variety of things including:

  • Illnesses
  • Stress
  • Dehydration
  • Not enough sleep
  • Certain foods like chocolate, hard and aged cheeses, pizza
  • Food additives
  • Certain drugs (birth control pills, tetracycline, too much Vitamin A)
  • Caffeinated beverages
  • Eye strain or sun glare
  • Pain medication (taking analgesics too often can lead to rebound headaches)

A classic tension headache is a squeezing or band like sensation around the head or pain in the back of the head and neck. They often come on as the day progresses into the afternoon. They are very common in the teen years and no surprise, stress is often a trigger.

Migraines are also common and occur in about 10 percent of teens. Even preteens can get migraines. They often run in families. With migraines, children can have an aura consisting of things like flickering lights or visual distortions. The migraines can also lead to nausea and vomiting. Triggers are often stress or certain foods. Quite often sleep is the solution for a migraine.

Certainly there are times when parents should worry and seek evaluation right away. Some of the warning signs would be severe sudden onset of the worst headache ever, worsening daily headaches with or without vomiting, confusion, clumsiness or weakness to name a few.

When it comes to treatment, typically earlier is better. With a tension headache, encourage your child to sit down and relax. A hot bath or shower can help sometimes, as can a hot or cool compress on the neck or forehead. For migraines, a dark quiet place seems to be best for most people with sleep being the ultimate treatment. Medications have a role as well. Tension headaches respond well to a single dose of an analgesic such as acetaminophen or ibuprofen. This is often the case for migraines as well, but occasionally other medications are necessary such as the triptans which work via a different mechanism.

I am a fan of headache logs. Often by writing things down a trend or trigger can be identified and used to prevent the headaches from happening in the first place. Things that can be tracked include the following:

  • When it occurred
  • How long it lasted and how severe
  • What they were doing when it started
  • What they ate that day
  • How much sleep they had the previous day

In summary, headaches are common and most often nothing to stress over. It might give you a headache.

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The Scoop on Sunscreen

Published on July 27, 2010 in Safety. 0 Comments Tags: .

My wife would be the first one to tell you that I use a lot of sunscreen whether it is here around Seattle or on vacation in Maui. Many of my patients have heard me tell them to use it if they do not want to look like a thick brown piece of leather when they are older. Having said that, kids do like to have fun in the sun, which is why we have sunscreen.

These days there are so many sunscreen options out there it is hard to know which one to pick. They are all the same, right? The answer is no. Some have better  protection than others and some are safer than others. When it comes to higher SPF ratings, at some point it becomes a numbers game. Most people do not apply enough sunscreen nor do they reapply it often enough. Ideally it should be applied 30 minutes before sun exposure and reapplied at least every 2 hours and following excessive sweating or swimming.

Besides using sunscreen it is also important to cover up, hang out in the shade, and avoiding the noontime rays, as these are some other great sun protection methods. I love the protective SPF rash suits for that day at the beach as regular clothing gives a false sense of security.

The best sunscreens contain zinc or titanium. “They are the right choice for people who are looking for the best UVA protection without any sunscreen chemical considered to be a potential hormone disruptor.” as stated on the Environmental Working Group Web site.

Avoid sunscreens with retinyl palmitate, a form of vitamin A, which studies indicate may speed the development of skin tumors in the presence of sunlight.

When sunscreen gets in the eyes as it commonly does, rinse them with lots of water. If the irritation continues despite this then it may be time to go see the doctor.

Don’t get burned. The goal is to prevent sunburns 100% of the time. A sunburn represents significant skin damage. The earliest sign of sunburn is redness of the skin. Once the damage is done, there is no quick fix as the treatments just ease the discomfort. Typical treatments include cold compresses and applying aloe. If blisters are present, the best advice is to leave them alone and let them rupture on their own as they serve as a protective covering.

Sunscreen does prevent Vitamin D production. Even knowing this, most of us will still get enough Vitamin D during the summer months but clearly living in the Northwest, most of us need a little extra Vitamin D from September to June.

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Eating Healthy is a Family Thing

Published on July 22, 2010 in Healthy Eating. 0 Comments Tags: .

I have always thought of our household as one that tries to eat healthy. Being the primary chef of the household, I do most of the shopping and tend to spend most of my time grocery shopping in the produce and meat department. Typically, my children are with me at the grocery store. A few months ago I randomly starting picking up vegetables at the store and asked my daughter what each one was. I was happy that she got them all right, except cauliflower. I asked a preteen patient in clinic a few months ago where French fries came from and was not overly shocked to learn that he did not know. Sad, but true.

We recently joined a local, organic farmer’s cooperative and get a produce shipment every other week. I never would have thought my children would get so excited to go pick up our box and see what things are inside. It has made them more willing to try things and expanded the repertoire of menu items we now all eat at home as sometimes the box contains something I would not have bought.

Obesity is a big problem in this country. The fast food industry is so ready to provide easy options but most of the time; the choices people make are not the healthy ones.

Here are some striking statistics:

  • Since the 1970s, childhood obesity (defined as a BMI at or above the 95th percentile for children of the same age and sex) has more than tripled, according to the Centers for Disease Control and Prevention.
  • About 12 to 18 percent of 2- to 19-year-olds are obese, putting them at higher risk for high blood pressure, high cholesterol, and Type 2 diabetes.

One of the ways Group Health is trying to tackle this epidemic is via the Family Wellness Pilot Program led by Dr. Sarah Rudnick, our Bellevue Pediatrician. The pilot is cited in the 2009 annual report. As one can imagine, the change involves getting the entire family involved.

Much credit should also be noted for First Lady Michelle Obama and the “Let’s Move!” campaign to promote family wellness has guidelines for healthier family eating.

Don’t be afraid to grab a new veggie next time you are at the grocery store- you can find hundreds of ideas and recipes online.

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What Does the “End of Men” Mean for Boys?

Published on July 20, 2010 in Parenting, Uncategorized and school. 0 Comments

Having both a son and daughter, I took interest in a recent article in The Atlantic that is getting a lot of press: “The End of Men.” It is an interesting look at the evolution of roles that men and women play in society. The world around us is changing. Earlier this year, women became the majority of the workforce for the first time in U.S. history. The attributes that seem most valuable today—social intelligence, open communication, the ability to sit still and focus—are, at a minimum, not predominantly male.

Some facts they point out are the following:

  • Most managers are now women.
  • For every two men who get a college degree this year, three women will do the same.
  • Three-quarters of the eight million jobs lost during the Great Recession were lost by men.

Meanwhile, boys are struggling in school. PBS cites the National Center for Educational Statistics:

  • Boys are 30 percent more likely than girls to flunk or drop out of school.
  • Boys are four to five times more likely than girls to be diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

Boy traits are often portrayed as more energy, curiosity, and a need for movement. I certainly hear this again and again in clinic. These can often be things that lead to them getting penalized in school as it can be challenging to find a way to channel that energy into positive ways. Girl traits are thought of as ability to sit still and focus and listen–all things that are typically rewarded and praised in the school setting. The problem with stereotypes is that they do not always hold true. Certainly in my household my son is the one more calm and able to sit still and focus.

It’s great to see a balance achieved, but this article points to a role reversal. What’s going on here? What can we do as parents to boost academics, opportunities, and self esteem for boys? I think it starts with modeling and teaching social and emotional intelligence for all kids. The days of saying “it’s a boy thing” or “it’s a girl thing” need to end. Schools and parents can look to being accepting and working with kids no matter what their characteristics are. Teaching emotional intelligence will help both genders.

When it comes to school, a parent cannot stress the value of education enough. As quoted in the PBS article, “The odds are that if you come from a family that values education, your boy will be successful in school and will go on to college. Most boys do. However, the average American boy is struggling in school” says Michael Thompson. This can be challenging especially for parents that clearly value education but find that their child is still struggling for whatever the reason. There are no easy answers here.

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Obesity and Gastric Reflux

Published on July 14, 2010 in Uncategorized and illness. 0 Comments Tags: , .

I came across an interesting article today regarding yet another health concern that today’s overweight children are facing, gastroesophogeal reflux disease or GERD. Most of us are aware of the more obvious health issues such as diabetes or high blood pressure, but as one would expect there are others as well. Let’s face it, being overweight as a child is associated with some serious health concerns that were once thought to be only adult related diseases.

GERD  is quite common in babies and typically goes away. The problem is that for older children, a recent study from Kaiser Permanente found that overweight children and teens were 30 percent more likely to have GERD than those at a normal weight. The problem with having GERD for many  years is that the constant reflux puts those at a higher risk of developing esophageal cancer. This is just another health issue that can have some more long term health implications as children get into adulthood.

The growing list of health related issues related obese children all the more illustrates the importance of helping overweight children lose it and the need to better educate families so that we can prevent obesity in the first place.

If your child is already overweight then it is time to take a serious look and make some changes. Part of it involves modeling good exercise and eating habits. Often this is much easier said than done but well worth the effort. Limiting screen time is a good place to start. a recent study published in the Archives of Pediatric and Adolescent Medicine found that teens with more than 2 hours of screen time a day had twice the risk of higher insulin levels suggesting insulin resistance. Insulin resistance is associated with diabetes.

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The Heat is On

Published on July 8, 2010 in Parenting, Prevention and Safety. 2 Comments Tags: , , .

It is hard to believe that just a few days ago it was raining on the Fourth of July as fireworks went off. To my surprise, I got called in to work on the Fourth at the Group Health Urgent Care. I am happy to report that I did not see any firework related injuries on that day.

With the hot weather, many of us will head to the outdoors to play in the sun but it is important to take some precautions. Smaller children can be much less tolerant of the heat than us grown ups due to the greater body surface area in proportion to their weight. They also may not drink enough liquids to keep up. This can lead to heat stroke or dehydration, so it is important to pay attention.

Some tips:
1. Drink liquids frequently throughout the day and especially during periods of exercise in the heat. They should be drinking liquids before, during and after an activity even if they are not thirsty.

2. Allow time for acclimation to the heat. If your child is not use to exercising, starting now in this heat is not the best idea.

3. Take advantage of shade or other opportunities to cool off.

4.  Watch for signs of dehydration or overheating. The signs can include irritability, fatigue, being flush, or nausea and vomiting just to name a few.

5. Use sunscreen along with protective clothing like hats. Apply the sunscreen frequently. Most people do not apply enough so be generous with it.

Have fun and be safe

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Happy 4th of July

Published on July 2, 2010 in Uncategorized. 0 Comments

Holidays are always fun. I can recall back to my childhood going to watch the fireworks on the Tacoma waterfront and being amazed by the huge explosions in the sky. I also remember shooting off my own fireworks. Like most children, I look back now and say I was lucky that I did not cause bodily harm in the process.

The facts are that children do indeed get injured from fireworks and that often it is best to leave it them to the experts. Unattended, older children often tend to get creative and do things with fireworks that can put them at risk for injury. It is interesting how my perspective has changed since becoming a pediatrician and having to work in the ER or urgent care on the holiday and seeing the injuries that occur and were preventable.

Have a safe Fourth of July.

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Running for Fun

Published on June 30, 2010 in Out and About and exercise. 1 Comment Tags: , .

This last weekend I was supposed to run the Rock and Roll Marathon in Seattle as I have done quite a few marathons over the years. Things did not work out as planned because about two months ago I developed an overuse injury that is slowly getting better. Having learned the lesson the hard way that my mind is stronger than my body on more than one occasion, like tearing muscles, for the first time I actually made the decision to let my body rest and not put it to that level of stress. It was the right decision.

This can be a hard thing for the teen athlete as well as there is so much pressure to compete. Often athletes can play through mild injuries but if things are getting worse then at some point rest is often the solution along with a hard look at what got them to that injury in the first place.

My wife and I both get out and exercise often as it helps to set an example for our children. They both enjoy going “jogging” around the block or taking walks. Our children see us both being active and want to engage in the activity as well. We also try to find activities to do as a family to get us all moving. Our latest new family activity is geocaching. Basically we use our GPS device to walk around parks and find little hidden treasures put there by other players. The kids really enjoy it.

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Keep Learning Going While Having Fun Over the Summer



Published on June 24, 2010 in Parenting, Uncategorized and school. 0 Comments

School is out and summer is here. This means lots of fun play time for the kids but it also means finding things for them to do that stimulate continued learning during the summer months. My family has already made its first trip of many to the Redmond library to check out some books for my daughter to read and for us grown ups to read to my son. My daughter was very excited to learn about the summer reading program at the King County Libraries and is progressing along well in the goal for  summer reading.

As difficult as it can be, we do try to find time every day to sit down and either read to them our encourage them to read on their own. It was not that surprising to me a few days ago when my daughter came and asked me to help her with her “math homework” which is really something she just wanted to learn more about on her own initiative.

Most of us want to raise children that can satisfy their own desires. Many children will say they are bored and no matter what idea we throw out there, none are sufficient. These days my answer to our daughter is that “we raised a bright child and I am sure you can find something constructive to occupy your time.”

There are lots of other creative ways that I am sure many of you use to help your children learn while having fun this summer. I would love to hear them.

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Start Kids Early with Good Oral Hygiene

Published on June 22, 2010 in Prevention. 2 Comments Tags: , .

As a pediatrician and a parent, I realize that it can be challenging to get some children to brush their teeth. It was a big battle in our household for both of my children when they were younger as they would kick and scream. This is one battle that is worth the fight as there are long term consequences of losing.

Oral disease is the single most common chronic childhood disease — Continue reading ‘Start Kids Early with Good Oral Hygiene’

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