Never say never. One of these days it will happen, guaranteed. You will be on the trip of a life time, the very trip you’ve been planning for months, when suddenly you hear that poorly timed comment “Mom, I’m not feeling so great”. You’ll freeze and immediately think: “this can’t be happening!”

We learned first hand just how paralyzing it can feel to have sickness strike on vacation just a few summers ago while visiting Disneyland in California. We should have suspected something was up as soon as we were heading out the door with the first comment of “Mama, I’m not feeling so great” but disbelief masked my ability to see illness close at hand. Pale, burning with fever, and complaining of a sore throat, by the second flight in midair there was no denying our daughter was sick.

Once at our hotel in Disneyland, we gave her what we could – ibuprofen, fluids, and expectorant. She slept well but by the next morning was not much better. The sleep took the edge off and she was clearly able to function better but being a pediatrician I strongly suspected she had strep throat and needed an antibiotic. Being a mom I knew she needed to see a doctor. But, where?

Being an East Coast doc, I was unfamiliar with the West Coast medical system and being a mom didn’t want to waste an entire day in an ER for a problem I knew was really an office based problem. Not really knowing what to do, we called the front desk who referred us to a house call physician service that would come to the hotel within an hour, see my daughter, and often provide medication on the spot if needed.

So, we made the call and as promised with in an hour a doctor from an on-call physician network, www.housecallphysicians.org, arrived at our hotel room, interviewed and examined our daughter, agreed with me that strep throat was likely the diagnosis, handed us a bottle of antibiotics for our daughter, whipped out his credit card machine (this is a pay now, submit to insurance later situation but much cheaper and convenient than a traditional ER visit at a grand total of $240.00), and went on his way. Within 12 hours our daughter was much better and by the next day she was riding Tower of Terror! So, in the end, we lost perhaps a day out of our vacation and had an experience that was reasonable and comfortable.

Even as a physician, I felt like a fish out of water during this entire ordeal. That was not my medical system and at that moment I was a mom and a tourist. Thankfully, we were in the continental US and not overseas. But, there are many resources you can call and use to get yourself and your family care. House Call Physicians is California based and there are similar groups emerging nation-wide and internationally to address the growing need of traveling and displaced families.

This can occur to any of us while visiting within the United States or over seas. While my brother was living in Vienna, Austria, their 2 year old son developed ear pain in the middle of the night while relocating to their new home. While a chronic problem for my nephew, they did not have any medications with them and were not familiar enough with the country to know what to do. The hotel they were visiting recommended a 24hour urgent care center which provided top-notch care and gave them the medications my nephew required. My husband and I had a similar experience a few years prior to that while visiting London. We both arrived not feeling so great and the hotel arranged for a doctor to come to our hotel room. Turns out we both had contracted a bacterial illness while traveling, not too surprising since it was the height of flu season at that time. Two cases in two different countries but with one very common and important similarity: the hotel staff was the conduit to medical care, and the medical care was able to come to us. The other avenue we could have each taken would have been to call our local US Embassy or Consulate. Those offices are always available to US Citizens while traveling overseas and are available to help find medical care when needed.

It is disappointing when sickness strikes on vacation and the person sick will likely feel horrible for any change of plans that need to occur – and plans will have to change a bit while the person is actively sick or if fever is present. Keep in mind that the same illness restrictions when at home apply for vacation sickness, too. The way to think about it is if you would be staying home from work or your child from school, you likely shouldn’t be going to a museum or an amusement park.

Out of the unexpected you’ll often find the most amazing moments of your vacation. For us, the hotel staff not only helped us get medical care for our daughter, they helped us shake the stress and enjoy our vacation. We couldn’t return to the room without a treat waiting for one of us: Balloons, cupcakes, cards from Mickey and pals. Totally unexpected and just the “medicine” our family needed.

So, when in doubt, call the front desk.

(Originally posted December 2007; Updated December 2009)

Technical Names: RSV Bronchiolitis

NickNames: RSV, wheezing virus

What it is: viral infection of the small airways of the lung; can cause a true viral pneumoniaas well.

Typical Ages for Illness: All ages; most severe in young and premature infants and children with heart and lung problems including congenital heart disease and asthma. Interesting fact: all kids become infected by RSV by the age of 2 and many of us get it multiple times throughout our lives.

Typical Symptoms:

adults: bad cold symptoms

older infants and children: similar to a bad cold

young infants: lethargy, trouble eating, fast breathing, cough, wheeze.

Etiology: Respiratory Syncytial Virus

Seasonal Issues: occurs predictably between November to March

How’s It Spread? Direct contact with secretions – person to person or on objects.

Incubation Period: 4-6 days but can range from 2 to 8 days

Diagnosis: Usually clinical – based on symptoms and high index of suspicion given out breaks in community. Rapid assay test available in many offices and emergency rooms – most useful if a child needs to be hospitalized to control infection.

Symptom Duration: 7-14 days, as with most viral illnesses with the most intense symptoms early in the illness.

Treatment:

• cold treatment: saline nose spray and bulb syringe, humidifier
• +/- breathing treatments such as inhalers or nebulizers
• fluids
• tylenol or motrin for fever and discomfort
• some children do need to be hospitalized due to severe respiratory symptoms such as trouble breathing and needing oxygen, or due to underlying heart and lung problems.

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance
• trouble breathing despite treatment
• blue or gray color to lips or fingernail beds

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets
• a medication called Synagis before RSV season is available for kids under 2 years of age that are high risk – premature babies younger than 35 weeks and congenital heart disease children. This is usually given starting in November as RSV season begins. Your pediatrician will alert you if your child falls into this group.

School and After school Activity Issues

• may return to daycare when fever free for 24hours and able to eat and drink normally, and breathing normally
• avoid large groups of kids if cough is not controlled to prevent further spread
• if on antibiotics, needs to be on them for 24 hours before returning to school
• activities should be curtailed until the child has the energy to participate without becoming winded or fatigued.

Internet Resources For Parents

General Info on RSV (KidsHealth)

General Info on Bronchiolitis (Kids Health)

How Lungs Work (KidsHealth)

There are times in life I’m reminded of the 1980’s Billy Crystal parody, “You Look Marvelous”. The skit was a paroday of Fernando Lamas and gave birth to the phrase “You look marvelous…it’s not how you feel, it’s how you look!!”

If you want a great pick me up, take the next 4 minutes and listen to the song:

What’s astonishing is that a song that was meant to be tongue and cheek has become a theme song for a generation of people who were infants and small children when the song was first aired. These folks are the folks who wear makeup to pick there kids up from school, wear designer clothes at the supermarket, and would never, ever think of admitting to illness when an appearance at an event is at steak, whether it be a playdate, a family event or a social gathering.

I’ve thought about this song a great deal lately as it seems we’re constantly finding ourselves in social gatherings where one of the children ends up being sick. Recently we were at on such gathering and a parent of a child casually told us that his son had been up all night vomiting. “But, he’s fine now – a real trooper. He’s not eating much but I can’t blame him for that.”  Given that many of the folks who had contact with this child came down with crud awfully similar to what he had, I’d beg to differ.

The reality is this scenario is frighteningly common. Parents are blinded to how contagious their children are to other people and how much time it takes to truly recover from these infections. The thought of not attending a social event is simply not an option more times than not and often met with comments such as:

“What if I give acetaminophen or ibuprofen?”

“What if she just doesn’t eat?”

“We’ll only stay a few minutes – he won’t even talk to anyone.”

“I promise she won’t cough or sneeze on anyone but me.”

The majority of illnesses we all get are viruses. They tend to come on very quickly and last a good 1-2 weeks. When any of us have a virus, a flu or stomach virus, or even a cold, we’re contagious right before we develop our symptoms and then for a few days after our symptoms go away.

So, take a stomach flu. Even if your child has one of those fast and furious ones that seems to come on out of no where and then goes away in a few hours, your child is still contagious for at least another day. Heading to a party a few hours after the last time your child threw up still exposes everyone at the party to the stomach bug.

When considering attending a party, or sending your child to school, the other issue, of course, is considering the other kids and adults at the event. Not knowing their health histories or those in their households, we could be placing them in enormous risk should they catch whatever our kids have. For example, someone could have an immune issue or be on a medication that suppresses the immune system. They could have someone at home who is under treatment for a cancer or other immune disorder that puts them at risk for battling even the most mild of infections. In other words, the decision to attend a part impacts not just our family but every family at the event.

So, as your child recovers from his next illness, just remember that looking marvelous is fantastic and a great sign your child is on the path to good health again. But, before you put your child back in the social spotlight again, make sure enough time has passed for your child to truly feel as marvelous as your child looks.

For more information:

When to keep kids home from school and daycare

The Stomach Flu

Do you follow your blood pressure at home, perhaps with a home monitoring device like the one shown in the picture? Does your blood pressure go up and down a bit?

What happens at the doctor’s office? Is it typically a bit higher than at home…or a lot higher.

Well, the reality is that all of us get a bit amped up heading to a doctor’s appointment – even us doctors. So, our blood pressures typically are about 5 mmHG higher at an appointment than at home. The trouble is, though, I’m finding that many times my blood pressure and many of my friends and relatives are ending up with blood pressure readings much higher than that at physician’s offices. Anxiety, sickness, medications all taken into account, there is one constant that’s at play in all these aberrant readings: improper blood pressure taking technique.

When I was in medical school, we had a few classes on how to properly take blood pressures. Taking a blood pressure isn’t very difficult but getting an accurate reading can be some simple steps are not followed, namely:
1. Ensuring proper cuff size for the arm. A cuff to large or too small will throw off the reading.
2. Making sure the cuff is placed on a bare arm and not over clothing as the reading will not be accurate over clothing.
3. Giving the patient a few minutes to rest before taking the reading.
4. Using the left arm, when possible.

Without fail, though, over the last year, few of these steps have been followed when I’ve had my blood pressure taken at amy of my doctor’s visits. The other day, in fact, I was at an appointment and I asked the nurse if I should take my arm out of the sleeve of my sweater and she said “no”. The reading for my blood pressure came back sky high at 150/100.  I wasn’t too worried because I know my baseline from taking it at home – but was surprised the nurse wasn’t more concerned and didn’t insist on rechecking it, perhaps with my arm out of the sleeve, because according to the Mayo Clinic, a number that high could have indicated stage 2 hypertension:

That night, at home, I did a little experiment. I took my blood pressure after I had been zipping about the house doing some housework, with the cuff over my sleeve. The initial reading was 140/88. After sitting for 10 minutes relaxing, the reading came back at 124/81, this time with the cuff on my bare arm.

I get that the health care groups are busy but are they so busy they can’t give us a few minutes to site and take our arms out of our sleeves so our blood pressures can be accurate??

You’re likely heard by now that some parents were ordering lollipops spit on – yes, I did type “spit on” – by children infected by chicken pop to attempt to infect their how children with the virus. Here are the issues, beyond the obvious “ick” factor, of course: this practice is unsanitary, dangerous and…illegal.

Maria Stephanos and I teased through this last night on Fox News 25 in Massachusetts and answered some questions viewers posted on Facebook that raise all the issues you need to know before you hunt for these virus-ladden pops:

Dr. Gwenn O’Keefe talks ordering chicken pox: MyFoxBOSTON.com

It never fails. One of your children gets sick when your spouse is away on business and you have a full schedule. The domino effect for a family with a sick child is enormous – home, work and school lives are all impacted and often at the least convenient times! To complicate matters, it can be difficult deciding when to keep a child home and when to forge ahead business as usual.

Sickness is a part of childhood, whether it’s a fever, sore throat, cough or just not feeling well. According to the Centers for Disease Control and Prevention, the typical child has 6 to 12 illnesses a year ranging from mild to severe. Illness can occur throughout the year, but tends to cluster in the winter due to flu season. These illnesses can seem to spread like wild fire affecting other students, teachers, and family members. Families and schools need to balance the child’s school attendance with the risk of spreading the illness to others in the school. Sometimes even minor illnesses require the child to stay home just to prevent the further spread of a contagious disease.

In addition to consulting your pediatrician and school nurse, these tips can help you decide whether to keep your child at home:

1. If your child complains of not feeling well but otherwise has no definite symptoms, your child can likely attend school. The school nurse will typically call you if something more develops. Be sure to contact your pediatrician if the complaints persist or other more definite sick symptoms develop.

2. Fever is a symptom of illness and not an actual diagnosis. Fever usually indicates that the body is battling an infection. A child with a fever greater than 100.5 degrees Fahrenheit needs to stay home from school until the fever is gone for at least 24 hours. If the fever does not resolve in 2 to 3 days, or if your child appears sick with any fever, call your doctor to have your child evaluated.

3. Many rashes will resolve spontaneously and are not reason alone to keep a child home from school. Any rash associated with symptoms such as trouble breathing or swallowing, fever, or ill appearance, should be evaluated by your physician. Rashes that are itchy or scaly may be contagious and should be evaluated before sending a child back to school.

4. Cough alone may not prevent your child from attending school unless it is interfering with a child’s sleep or ability to participate in school activities. If the cough is productive and has phlegm or is associated with fever or trouble breathing, keep your child home from school and arrange to have the child seen by their pediatrician.

5. Stool problems do sometimes require a child to stay home from school. This is especially true with diarrhea where the stool frequency is often many times an hour. Diarrhea that is bloody or associated with fever, abdominal pain, or vomiting should be evaluated by your doctor.

6. A child with vomiting, with or without diarrhea, needs to stay home from school. Your child can return to school when the symptoms have stopped and the child can tolerate a regular diet.

7. Children can attend school with mild sore throats if no other symptoms are occurring. Any child with a sore throat associated with fever, vomiting, abdominal pain, or difficulty swallowing should be evaluated by a doctor before returning to school. Call your child’s school and ask if strep throat is going around; if so, have your child tested. A child with a diagnosis of strep throat needs to stay out of school until on antibiotics for 24 hours.

8. If your child appears really sick, keep your child home and arrange an evaluation by your doctor that day. If you can’t get through to your doctor and you are really concerned, either call 911 or bring your child to the nearest emergency room for evaluation.

9. Call your doctor’s office for advice if you are not sure about your child’s condition or have questions about whether your child should stay home from school. Physicians have an answering service 24 hours a day, 7 days a week. So, even after hours, you will be able to reach someone for assistance.

Many illnesses can be stopped before they spread by reminding everyone to practice frequent handwashing, blowing noses into tissues, covering mouths when coughing or sneezing, and asking other parents about sick symptoms in their kids before arranging playdates and carpools. If only it were so simple – even the best hygiene practices can’t avoid the spread of all winter illnesses. Sometimes staying home is the only way to benefit our kids, ourselves and our communities.

Technical Names: Lyme Disease

Lyme Map: Lyme has a definite geographic distribution. According to the CDC you’ll find Lyme in these three areas:

• Northeast: Massachusetts to Maryland.
• North-central states: especially Wisconsin and Minnesota.
• West Coast: especially northern California.

Nicknames: Lyme Disease, Lyme

What it is: tick-borne infection from ticks of the Ixodes genussed by the bacteria borrelia borgoferi

Typical Ages for Illness: any

Typical Symptoms: Lyme Disease has three stages.

• Early: is a characteristic rash at the site of the tic bite called erythema migrans. Its main property is an expanding, red circle.
• The second phase is more disseminated: multiple erythema migrans patches occur in 15% of patients, other symptoms that can occur during this phase are arthritis, conjunctivitis, nerve palsies, headache and fatigue. Other uncommon issues can develop during this phase if untreated.
• Late disease is chronic arthritis of the large joints, usually knees. This is very, very uncommon in kids who have been treated.

Etiology: Borrelia burgdorferi , a spirochete bacteria

Seasonal Issues: spring and summer when tics are out; geographic distribution includes New England, eastern mid-Atlantic states, upper Midwest in Minnesota and Wisconsin.

How’s It Spread? Via tick bite of infected tic

Incubation Period: 1-55 days with a mean of 11 days. Late symptoms occur months to years later.

Diagnosis: clinical if rash present; quick lab assay that will remain positive for life – so it can be used for diagnosis but not to confirm if treatment was effective.

Prevention: REMOVE THE TICK if you remove the tic with in 2 days, Lyme will not get transmitted from the tick to the person its attached to. So, the sooner than better. How to remove? Take a tweezers and grab the tick on the head. Gently pull up and the tic will release. Don’t worry if the tikc’s small pincers stay attached to the skin – those don’t carry disease and will not cause harm.

Treatment:

Antibiotics for 14-21 days orally for early disease. More complicated disease and late disease needs to be treated longer and sometimes by IV antibiotics.

Call Your Pediatrician if your child has: A tick bite where a characteristic rash began to form.

School and After school Activity Issues: no restrictions. This is not contagious person to person.

Internet Resources For Parents

CDC Lyme Page

Tick Management Handbook

Tick Bite Prevention

Internet Resources for Kids and Teens

Lyme Info For Kids

Lyme Info For Teens

Technical Names: Allergic Rhinitis

Nicknames: Hayfever, Allergies

What it is: allergic reaction to something in the environment such as pollen, dust, molds, animal hai. It is an overreaction of the immune system – a “normal” reaction on overload. People can grow in and out of allergies throughout their lives. Genetics determines some predisposition but environmental factors can also overload the immune system.

Seasonal Issues:

Many people have season allergies particularly around season change times. Some people are allergen specific and others have year ’round allergies.

Symptoms:

Symptoms are different person to person but include some of the following:

• runny nose
• sneezing
• itchy skin
• watery eyes that may appear red
• wheezing or cough

Treatment:

Symptoms specific and may include:

• avoidance if possible of offending allergen (eg. if allergic to cats, avoid cats)
• antihistamines: over the counter and prescritpion
• expectorant for nasal congestion
• saline nose spray
• eye drops
• other medications as indicated by symptoms

When to Call Your Doctor

• symptoms interfering with activities
• symtpoms interfering with sleep
• trouble breathing
• worsening itchy rash

Internet Resources for Parents

All About Allergies (KidsHealth)

Internet Resources for Teens and Kids

For Teens

Two Steps Forward, One Step Back

In pediatrics medicine, we continuously strive to make kids healthier. But sometimes to improve one problem we inadvertently create another, as demonstrated by the American Academy of Pediatrics’ “Back to Sleep Campaign”.

Launched in 1992, the Back to Sleep Campaign has been a true success story, reducing the incidence of SIDS (Sudden Infant Death Syndrome) by nearly 50%!  The untoward consequence of the program, however, was a marked increase in flattening along the back of the head. While this problem is not life-threatening, like SIDS, it has become a source of anxiety to parents of affected infants. And, there is a lot of misinformation and confusion about what flat heads are really about and how, if at all, they should be addressed.

Ryan’s Story: A Common Tale

Ryan is a 6 month old baby boy from the North East United States who was placed on his back to sleep since birth. As he got bigger, his parents noticed a flattening develop on the right side of the back of his head which was very pronounced by 3 months of age.  Concerned, they consulted Ryan’s pediatrician who diagnosed Ryan with “positional plagiocephaly” and advised repositioning techniques, such as putting him down on different ends of the crib so his head will get used to turning in both directions.

Ryan’s parents attempted the repositioning for a month but saw little, if any, improvement.  They were also nervous to try this for too long fearing they’d lose their window for a helmet to be most effective.  To explore options, they consulted the large orthotic group in their area which was willing to make Ryan a helmet but they faced two hurdles. First, their insurance would not pay for the helmet, as this was a “cosmetic” problem. Second, the specialists were not convincing that the helmet was truly needed.

As their quest for information continued, Ryan’s head began to appear more round, not just to their eyes but to Ryan’s pediatrician and nurse practitioner as well.  So, with Ryan now 5 months old and moving around well in his crib, they opted to let nature take its course.

Ryan’s story has a happy ending but was it luck or something more?

Flat Heads: A Historical Perspective

Posterior head flattening, termed plagiocephaly (Greek “oblique head”) if it is asymmetric (only on one side), or brachycephaly (Greek “short head”) if it is symmetric (entire back flat), is not a new problem and has been in existence since ancient times. Many modern cultures, such as China and India, have practiced back sleeping for centuries. In these countries, moderate flattening is ubiquitous, well recognized, and more readily accepted.

In our country, however, flat infant heads are a relatively new phenomenon that we are not yet acclimated to. As a result, overwhelming attention has been focused on the diagnosis, prevention, and treatment of this deformity giving rise to an industry of unproven commercial devices and services that claim to treat or prevent the condition. Many simply don’t work, such as pillows and wedges, while others seem to work if initiated early enough such as the popular infant head helmets and bands, and the very new infant head cup, which is the only truly preventative modality available.

What is reassuring is that development and brain growth are not impacted by the myriad of head shapes that are developing with the Back to Sleep campaign. And, with more babies developing positional deformities, our definition of “normal” may be slowly changing.

A Postnatal Problem with a Prenatal Start

With the majority of babies sleeping on their backs, it is easy to imagine a future world of flat headed people. But, that is not the case at all. “Not every infant who lies on the back gets flat, and in fact, only about 20% actually develop clinically significant flattening”, notes Dr. Gary Rogers, plastic surgeon specializing in head shape abnormalities at the Children’s Hospital Boston.

According to Dr. Rogers, the problem starts before birth. If the baby’s head movement is restricted in utero, he or she may develop contracture of the neck muscles (torticollis). Like any muscle group, the neck muscles can become tight if they are not allowed to move freely. Once born, the tight neck will keep the infant’s head in a similar position to what it experienced while in mom’s womb. Other well established risk factors for plagiocephaly include: multiple births (e.g. twins), breech position, first born babies, male babies, low fluid in the uterus, and prematurity. It is no surprise that these are also risk factors for torticollis or neck muscle imbalance.

Once an infant is born, the head grows against a flat surface (bed, car seat, etc.). This is similar to a pumpkin growing in a field. If the pumpkin is not rotated during growth, it will become progressively flattened on the down side. But if the pumpkin is turned intermittently, the pumpkin will remain round.  This is the same for infants with poor neck mobility. If unable to move the head to both sides, their heads will become flatter as the head rapidly grows during the first few months of life. After 4 months, most infants, even those with tight neck muscles, have sufficient strength and neurologic development to reposition their head and the flattening usually stops getting worse.

What happens after this point has been a source of confusion for parents and physicians. There is little evidence to suggest that the flattening ever “pops out”. Whatever degree of flattening developed early on will persist but will look less pronounced as the head gets bigger.  “The improvement is relative to the increase in head size. Additionally, hair growth can act to camouflage flattening”, explains Dr. Rogers.  “It is analogous to comparing a one centimeter indentation in an apple (the 6 months old) vs. the same dent in a watermelon (the older child). The dent looks much less impressive on the later fruit, even though the actual size and depth of the indentation is identical.”

Diagnosing positional deformities is purely clinical. Radiographic studies are reserved for the very few times the head shape falls out of the range of what is expected from a baby sleeping on the back. And, even then, 99.9% turn out to be deformational. The remaining 0.1% are from a premature fusion of the posterior cranial sutures, called craniosynostosis.  While those situations do require further testing and surgery to correct, a baby can safely be diagnosed well into their first year of life. So, while specialists like Dr. Rogers are helpful for the few and rare cases of flat heads that are not typical, this is clearly a situation that can be handled by most pediatricians.

Beauty is in the eye of the beholder.

The Chinese still use swaddle boards to carry babies while they work. This results in the characteristic head shape of this culture. That is what their culture strives for.

In our culture, head shape is much more individual. This is truly a case where beauty is in the eye of the beholder. As long as you are comfortable with how your baby looks, whatever treatment you decide will be the right one.

(Acknowledgments: Dr. Gwenn would like to thank Dr. Gary Rogers from Children’s Hospital Boston for his time, input and contributions to this article, as well as for images from his picture collection.)

TYPES OF ORTHOTICS

Non-helmet Orthotic Devices and Resting Surface Alterations

Examples: memory foam, contoured pillows, cut-out surfaces, and slings.

What they claim to do: decrease focal pressure by increasing the area of contact with the supine infant’s occipital (the back of the head).

Why they don’t work: They do not expand to accommodate rapid head growth during infancy and do not provide for variable skull size. Soft or moldable surfaces, such as memory foam, are ineffective because the infant’s head, which weighs about 1 pound, cannot deform the surface into a concave, anatomically normal shape.

Repositioning Wedges

What they claim to do: they are intended to vary the point of contact between the surface and the infant’s occipital.

Why they don’t work: Most wedges only reposition the infant’s body, and many not change the head position at all. They also require constant adjustments by the parents who may be reluctant to continually awaken their sleeping infant. They are also relatively ineffective after about 4 months of age because most infants are mobile by this age and can easily slide off the wedge.

Molding helmets and headbands (cranial orthoses)

Background: described by Clarren and colleagues in 1981 (yes, flattening was treated well before 1992). Clarren founded the concept of helmet therapy on a simple premise: “If the pressure of a rapidly growing brain against a flat surface would flatten the skull, then pressure against a concave surface should round it back again.”

Do they work? Clarren and colleagues demonstrated improved cranial symmetry in all children treated with a helmet, but only 40% improvement when treatment was declined. There have been numerous subsequent reports that verify the effectiveness of helmet orthotics in managing deformational plagiocephaly.

Cups

What they claim to do: Developed by Dr. Rogers, these are concave cups that babies sleep in from birth to prevent flattening.

Do they work? Yes.

Downside: they need to be adjusted frequently by a licensed orthotist to allow for head growth.

How long are they needed? Once the baby rolls out of them they are not needed! This is a relatively new treatment and one that can be utilized well before there is a problem. And, it eliminates the development of the flattening to begin with.

Resources:

Cranial Technologies: Plagiocephaly and Helmet Informationl

Children’s Hospital Baby Head Suture Disorders

BACK TO SLEEP Campaign

(Originally posted March 2007; Updated December 2009)

How do you deal with medical “stuff” – tests, news, appointments? Some of us are laid back while others get anxious and uptight. For many, it depends on the circumstance. One thing we can count on, though, our kids will mirror their responses to “medical stuff” after us…a point I don’t think we consider enough, as recent celebrity headlines well illustrate.

Take the situation of Dr. Mehmet Oz’s colonoscopy, for example.

A well-spoken, otherwise healthy young physician who has been very outspoken about following a path of “good health”. Yet, his first routine colonoscopy turned up “something”. Instead of breathing a sigh of relief that the test preformed as it should and this “something” was caught early and was able to be handled before it became a true health crisis for him and his family, Dr. Oz essentially freaked out, going on every media outlet he could find expressing this sentiment to People Magazine: “This was a shakeup for me….I have done everything right. I don’t have any family history, and yet I’m high risk now….There’s a lot of tension…It’s frustrating. Why did this happen to me? It forces you to question the assumptions you make about life.”

Next up, Catherine Zeta-Jones’ reaction to her husband, Michael Douglas’s diagnosis of throat cancer.

As she told People Magazine: “It makes me furious they didn’t detect it earlier…He sought every option and nothing was found. I knew something was up. He knew something was up.”

Michael, on the other hand, had a more accepting response: “Without having to blame anybody, these things sometimes just don’t show up. I’m treating this as a curable disease….”

Both Zeta-Jones and Douglas reacted as we’d expect given the situation and they both ultimately showed their kids how to express some challenging emotions then quickly regroup in a way that is empowering and positive for the patient – Michael. While we only have glimpses of how the family is doing, it seems they are doing everything right for Michael and their kids. This is a solid example of how to handle a very challenging medical situation as a family.

Handling medical situations isn’t always easy and our emotions can quickly take over, as they did for Dr. Oz or even Zeta-Jones initially. Our job as parents is to help our kids understand the medical system so they know what it’s about and have a sense of what’s controllable and not controllable. This will help them if a parent or grandparent is the patient or when they become the patient.

All we can do is help our kids learn to live the healthiest life possible. What does that mean? To exercise, eat well, pursue activities that are fun and meaningful and to see their physician yearly.

As Dr. Oz’s boss and mentor, Oprah, loves to say: “live your best life”. Control what you can and deal with the rest as you have to…without Monday morning quarterbacking what you can’t control. If we teach our kids to do this with grace, courage and a good sense of humor, they’ll be ready to face whatever comes their way and be a lot healthier in their future tomorrows than any of us are in our best todays.