Why can't they be like that at home?

Wednesday morning I barely get home from dropping the kids off at school and the phone rings. It's the school. "Mommy, I forgot to tell you last night, I'm out of lunch money and my teacher said I have to call. " Also my son couldn't find his gloves and has taken the good ones to school which I only like him to use for skiing. After morning naps and finding the other gloves I pack up the two youngest and go to school. After dropping off the money for lunch, I go to my son's classroom and find he is currently at lunch. He begs me to stay, so I buy Imogen a lunch. My oldest's class comes while we are sitting there and she and here friends sit with us too. They are all so excited to sit together. After a bit my son show his 4 year old sister where to take her tray and then leads her by the hand out to recess. When I catch up with them, he is trying his hardest to lift her onto the swing. He only weighs 5 lbs more then she does, so is not very successful. Once I lift her on he insists on pushing her and then takes her up the slide and reassures her that it's not too scary and even defends her against kids who just want to push her down the slide because she is holding up the line. They were both sad when he had to go back to his class. These of coarse are my same two children who fight about everything when they are home.

It's heeerrrre!!!!

Those three little letters that strike fear in the heart of parents everywhere are here: RSV. Bronchiolitis which is the symptoms that RSV can often cause come around every winter. Usual symptoms include breathing fast, having lots of nasal secretions, wheezing and decreased appetite. Lots of different viruses can cause bronchiolitis, but RSV is the most common. You or older children can have RSV but have basic cold-type symptoms, in young babies it can be much worse. Bronchiolitis is definitely a spectrum, you can be just a little bit more sick then your normal cold or really bad and need to be in the hospital. How bad your child's symptoms are can change at anytime. Bronchiolitis symptoms can last up to a month. Antibiotics do not help the symptoms of bronchiolitis. The best thing to do is keep a humidifier going in the room the child spends the most time 24 hours a day. I recommend cool mist, the warm mist humidifiers are fabulous breeding grounds for bacteria. I recently heard something from a patient about the cool mist humidifier will make the room too cold and make kids sick. That is not true. The other thing to do is nasal saline spray and suctioning. I give my own kids a squirt of saline and suck them out with the blue suction bulb whenever they are having a hard time sleeping or eating because they are congested. There is not medication that is safe in young children to make congestion go away. I know they hate being sucked out. I know they cry like you're trying to kill them. Do it anyway. Do use gentle suctioning, don't do it so hard that they are bleeding.

Good reasons to see the doctor:
1. Your child is breathing faster then 60 times a minute if less then 1 or greater then 40 times a minute if greater then 1. Take off their shirt and watch their chest for a full minute and count. Don't count for 15 seconds and multiply. Best to count when they are as calm as possible.
2. They are having more nasal secretions then you can handle with the bulb suctioning. I know around where I live there are several respiratory clinics in hospitals that are open around the clock where you can take your child to be deep suctioned if needed. Ask you doctor. The clinics most likely need an order first.
3. Your child has any signs of dehydration; making less then 2-3 good wet diapers a day, not making tears when they cry, when you look in their mouth it is tacky instead of moist.
4. They are having any signs of respiratory distress. Flaring their nostrils when they breathing, using their stomach muscles to breath or pulling in between their ribs with breathing, otherwise known as retractions.

The beginnings of adolescence

Last Sunday after my oldest, Giselle, gets out of the shower. She is normally my very obedient, helpful, no attitude child. I tell her she needs to blow dry her hair before going to church. " But I don't like to blow dry my hair!" "Well I'll do it" I say. She protests loudly, so I say, "If you want to have the stacked hair cut, you have to blow dry it." She says "I didn't want my hair cut like this, you made me get it" "What did I say when they asked me how I wanted your hair cut? However she wants it, it is her hair." "Oh" she says. 1 point for mom. She tries again. "I didn't want to take a shower this morning, you told me I had to." " No honey, what I said was, 'If you are going to take a shower this morning you should probably do so, so that you have enough time.'" another "oh".

Hopefully this is not a pattern of things to come, but I dare say it probably is. And thank you to whomever invented the stacked bob haircut that has to be blowed dried or it looks awful.

I torture small children

My life became a lot easier the day I realized my job is to torture small children. I was the supervising resident one evening when I was called down to the Emergency Department for a consult on a 5 year old with alteration of consciousness and fever. The patient had been at school when it was observed that he was lethargic ( see previous post) and febrile (fancy for has a fever). The patient had been seen by the resident in ED and had had blood work, urine and spinal tap and a CT scan (CAT scan), all of which were normal. I went to look at the patient and really had to fight him, he was no longer lethargic, to get a good look at his ears and throat. Mom was not happy with me because she didn't want me to hurt him and did not assist at all with holding him still for the exam. His throat was nasty looking. I swabbed him and went to talk to the resident who had already seen him. I asked her what she thought of his throat and she said " Well I didn't get a good look at it because the mom was upset." The patient's strep came back positive. Here's what happened: The patient had a febrile seizure that was not witnessed and then was post-ictal. After seizures people are usually quite out of it. The poor kid had been put through a whole battery of tests for something really quite simple. I concluded that my job was to make sure I got a good look at kids ears and throats regardless of how mad I make a parent. Especially in pediatrics a lot of infections are in the upper respiratory tract. I don't try to hurt kids and I try to make the exam as fast and fun as possible, but my job is essentially to torture small children.

But he's got white stuff in his throat.

Currently we are seeing a lot of strep going around. It is most of the time a very easy diagnosis and treatment. I tell my MA she gets a raise everytime she has a postive strep. Of coarse I have actually nothing to do with her salary, but it makes her happy. Beta-hemolytic Group A Strep (Strep throat) is treated with antibiotics for one purpose; to prevent Rheumatic Heart Disease. Sorry, but you feeling better pretty fast is just a added bonus. There are other bacteria that sometimes come back postive on throat culture but they don't cause Rheumatic Heart Disease and usually they are not treated. There is some evidence that Group C strep and a couple of other "groups" might also need antibiotics so if it one of those it is treated. Contrary to popular belief exudate or white stuff on the tonsils are not very consistant with strep. They are alot more consistant with adenoid virus which is very good at mimicking strep. Having petechia on the soft palate and tonsilar pillars, the skin in front of the tonsils, is more consistant with strep. Usually cough and runny nose do not accompany strep. Sometimes people have headache and stomachache. Unless you have a strep rash the only way me or any doctor can tell if you have strep is to do a rapid strep antigen test or culture. The rapid test is about 93% accurate which is remarakably good as far as rapid tests go.

My complaints about common complaints Day 3

I work pediatric urgent care on evenings and weekends mostly so that I can be home with my kids during the day. I want to go home at the end of my shift cause my kids don't really care how late I was up the night before. There are a lot of times when I am there quite a bit later then we close for legitimate reasons. I don't mind staying with a child who has bad croup or lacerations or dehydration. What I do mind is a parent who brings in their kid right at closing because their child has had abdominal pain for a week, or anything that has been going on for a while and is not acutely worse tonight. Then frequently after I've stayed to see a patient after closing and I given them a prescription for their ear infection or strep or whatever, the parent says "great I'll fill this tomorrow" There are 24 hour pharmacies, 2 within 10 minutes of where I work. If your childs problem is serious enough to keep me late, then at least have the decency to fill the script and start the medication tonight.

My baby is messing with my head.

While I was pregnant with my fourth child, I told anyone who asked that I WAS fanatically done with having children.  She was to be my last.   Here's the problem; she is so darn cute!  I find my self thinking all the time "Maybe I should have another one".  She is barely six months old.  I hate being pregnant.  Hate,hate,hate.   So what is wrong with me?  Why can"t I think like a rational human being?  Granted she has her moments, but seriously my baby has made my brain turn into a pile of baby-loving mush.