Parents Talk Back with Aisha Sultan
IP address: 18.215.98.188
User Agent: Mozilla/5.0

Parents Talk Back with Aisha Sultan

Live parenting chat with a Children's Hospital pediatrician

    Everyone's back in school, and Parent Chat will be tackling a wide range of questions about school pressures, parent-teacher conferences and Halloween tricks and treats. Our noon live Parents Talk Back chat with pediatrician Dr. Kathleen Berchelmann will address these and any other questions
    submitted.

    Whether you have a question about your child's social, academic or physical health, you can post in our chat here, and we'll try to help find some answers.

    Dr. Berchelmann is a homeschooling mom of five children and works as an ER pediatrician with St. Louis Children's Hospital.

    You can post your questions here before or during the chat or email them to asultan@post-dispatch.com.
    Comment ()
    Welcome to our monthly Parenting Chat after a brief hiatus last month. Dr. B. is just logging on now.
    Comment ()
    Hello! Glad to be here.
    Comment ()
    Is it flu season already? Should I get a shot for my 14 year old, even if she never gets sick? What are the best ways to prevent getting the flu in the first place?
    Comment ()
    Yes! The flu shot is essential for all infants and children, age 6 months and up. Influenza can be a fatal disease, especially in the young and the immunosuppressed. Our best hope at controlling the spread of the flu is the vaccine.
    Comment ()
    I always have this debate with myself at the start of flu season, of whether or not to get a flu shot for one of my children who rarely gets sick. (Thank God) I do get the shot myself because I can't take the risk of getting the flu, as does my husband. I also get the nasal mist vax for another child who catches viruses much more easily.
    Comment ()
    The flu virus is common and unpredictable, and it can cause serious complications and death, even in healthy children. Immunization each year is the best way to protect children.

    Each year, on average, 5 percent to 20 percent of the U.S. population gets the flu, and more than 200,000 people are hospitalized from complications. At least 145 children died from the flu last year, although the actual number is probably much higher since many flu deaths aren’t reported. If you choose not to vaccinate your child, you not only endanger your own child but also others.

    Although influenza can be treated with antiviral medications, these drugs are less effective than we would like, expensive, and have a lot of side effects.

    The American Academy of Pediatrics and the Center for Disease Control strongly recommends annual influenza immunization for all people ages 6 months and older, including children and adolescents. In addition, household contacts and out-of-home caregivers of children with high risk conditions and all children under the age of 5 especially should be vaccinated.

    Young children, people with asthma, heart disease, diabetes, weakened immune systems, and pregnant women are at high risk for complications of influenza, such as pneumonia.

    About half of all Americans get vaccinated against the flu each year, including 50 percent of pregnant women. This number needs to get better. Ask your child’s school, daycare center, or sports coach, “How are we promoting the flu vaccine for these children?”
    Comment ()
    Aisha, you mentioned the nasal mist vaccine.
    Two types of influenza vaccines are available for use in children. The inactivated influenza vaccine (IIV) is given by intramuscular injection and is approved for children 6 months of age and older. It is available in both trivalent (IIV3) and quadrivalent (IIV4) forms.

    The quadrivalent live attenuated influenza vaccine (LAIV4) is given by intranasal spray and is approved for healthy patients 2 through 49 years of age.
    Comment ()
    If you are healthy, it doesn’t matter which form of the vaccine you get:

    The quadrivalent influenza vaccines for the 2015-2016 season contain the same 3 strains as the trivalent vaccine, plus an additional B strain. Although this may offer improved protection, the AAP does not give preference for one type of flu vaccine over another.

    Last flu season, the nasal spray vaccine (the live attenuated quadrivalent influenza vaccine, or LAIV) did not offer greater protection than IIV against the predominant strain of influenza virus. Some people with illnesses that affect the immune system can only get certain forms of the vaccine, which is why the different vaccines are available. If you are healthy, either vaccine is appropriate.

    Please don’t delay vaccination in order to wait for a specific vaccine. Influenza virus is unpredictable. What’s most important is that people receive the vaccine as soon as possible. Remember, influenza is already here!
    Comment ()
    Overall, I think we all have to become so much more vigilant about hand washing during this season of flu. It's one of the best ways to prevent getting sick.
    Comment ()
    Yes! The flu has already hit St. Louis this year!
    Comment ()
    So, when will we know if how effective this year's vaccine is against the strain that will go around?
    Comment ()
    This year’s flu vaccine is expected to work better than last year’s vaccine. Here’s why:

    Last year’s flu season was particularly severe because the predominant strain was an influenza A called H3N2, which was not included in the vaccine. The vaccine for the 2015-16 season contains the H3N2 strain.

    There should be plenty of vaccine for everyone this year:

    For the 2015-16 season, manufacturers have projected that they will produce between 171 and 179 million doses of flu vaccine. At least 40 million doses have already shipped.
    Comment ()
    If you catch the flu and are vaccinated, you will get a milder form of the disease:

    We know that flu vaccines are about 60 percent effective– yes, I wish that number was higher. The good news is that vaccinated people who contract influenza get a mild form of the disease, basically just the sniffles, according to a recent study. People who are not vaccinated will be in bed with fever and miserable.
    Comment ()
    That's great to know. Thank you, Dr. B.
    Comment ()
    What are the most common injuries you see during Halloween for kids?
    Comment ()
    I've worked in the pediatric ER many Halloween nights, and mostly I see kids who were really too sick to go out for Halloween but tried to make it anyway. I see a LOT of asthmatics, kids with fevers, and vomiting kids.
    Comment ()
    We also see a lot of teens that are up to no good. There is a lot of alcohol use and drug use on Halloween.
    Comment ()
    We have had this problem in past years...A child has a cough but no fever and really wants to go trick or treating. It's really hard to say no. But I think it's better to limit the time outside in the cold if you child is starting to show symptoms of a cold.
    Comment ()
    And I also see a lot of lacerations from people using knives to open candy packages and cut up candy. I also see a few twisted ankles and abrasions from kids who trip on their long costumes while running.
    Comment ()
    By 7pm on Halloween the little ones appear, gasping for breath. When we get our first asthmatic, we know the night has just begun. The cool night air full of fall allergens will set off even a mild asthmatic. Every Halloween I hand out pediatric dragon-decorated masks that attach to nebulizers and blow smoking albuterol into little asthmatic lungs. We give grape flavored orapred, a steroid to reduce lung inflammation. It seems more like a trick than a treat.Kids with asthma will often push it too far while trick-or-treating, trying to make it to a few more houses before they go home for their inhaler. If you have a child with asthma, be sure to give all their maintenance medications before you go out and bring your inhaler with you. Coughing won’t stop? Asthma shouldn’t keep kids from activities like trick-or-treating. Sounds like your little creature needs an asthma action plan.
    Comment ()
    So, here are things to look out for to keep your child out of the ER on Halloween: children with asthma need to have taken all their meds before going out; find out your teens plans and where they will be; be careful with long costumes that can cause falls and knives.
    Comment ()
    Hello Aisha and Dr. B! Glad you're back. My oldest recently started kindergarten. She's pretty shy in some situations but can be very outgoing in others. But the shyness part is making it hard for her to connect with classmates and make many friends right now. She doesn't necessarily sit alone at recess but I don't think she has one or two good friends that she regularly plays with. She more or less runs around in with the large packs of kids. I know emotional and social growth is a large part of what kids learn in kindergarten but how do we make this easier for her as parents. I'm less worried about her making close friends at this age but it's harder on my wife. Should we worry? Should we get involved? Help!
    Comment ()
    Being shy in Kindergarten is common and normal. At this age it is important for parents to teach and encourage social skills and relationships. It's OK fo talk to another parent and plan a play date or two. Also, teach your daughter how to talk to friends, ask them how their day is going, etc. Get to know the other families in her class, not just the children. The best childhood friendships are the ones where the parents are also friends.
    Comment ()
    It's very common for parents to worry about whether their child is making good friends and about the quality of those friendships. To be honest, these concerns don't stop even when they are in their teens. I hear from plenty of parents who worry about their child's social development. We all recognize how essential friendship is to a good quality of life.
    Comment ()
    It really helps if you find another family, in which you genuinely enjoy being around the parents, who also have children your children's age. You should try to make a point to get together with your friends with your children present, so they can also see how adult friendship work.
    Comment ()
    And asking her about her friend's interests and families is another low-pressure way to encourage sociability.
    Comment ()
    Ask the teacher if she has any peers she really gets along with and try to plan an outing with that family one-on-one.
    Comment ()
    It comes up every year at Halloween...why do manufacturers make girls costumes so trashy???
    Comment ()
    This is such a good question. I think the 'sexy' nurse/pirate/witch/pizza rat/whatever costumes are terrible, too.
    Comment ()
    Immodest Halloween costumes are just an extension of the adult clothing styles that are now commonplace for our pre-pubertal daughters. After almost ten years of practice as a pediatrician, I’ve witnessed a decade of kids’ underwear trends and styles. Sexy underwear are appearing on younger and younger girls, from Victoria’s secret satin, to thong, to fluorescent string bikinis. Their child-like, curve-less hips aren’t made for sexy underwear. So why do moms let their daughters wear adult-styled underwear?

    I’ve heard all the arguments:

    “Thong underwear are for preventing panty lines—they are functional, not meant to be sexy.”

    “Pretty underwear help girls feel good about themselves. They’re important for self-esteem.”

    “She has to change for PE, and everyone sees her underwear. She doesn’t want to wear regular cotton underwear anymore.”

    “Shopping at Victoria’s secret with my kids is a great time to talk about why sex is a normal, healthy thing.”

    Here’s what I think: childhood is getting shorter—our daughters are growing up too soon. Our daughters are trying to look like grown-ups before they have grown-up bodies. Tweens wearing sexy underwear is just another example of all the other adult trends that have worked their way into childhood. According to the American Society of Plastic Surgeons, More than 326,000 18-and-unders had plastic surgery procedures in 2004 to correct something that made them self-conscious. Kids as young as 10 and 12 go to tanning salons, in many states without parental permission. One woman in New Jersey was arrested for bringing her six year old into a tanning device with her. And clothing styles for girls over seven look more like ladies clothes than kid’s clothes. Most moms I know struggle to find summer clothes for their daughters that cover their thighs.
    Comment ()
    Most companies wouldn't make trashy Halloween costumes unless there was a market for them.
    Comment ()
    Up until a certain age parents have control of the pocketbook. Even if it makes you unpopular or uncool for that night, just say no.
    Comment ()
    I totally agree, Aisha, companies make these costumes because parents buy them.
    Comment ()
    But I would also try to explain why dressing like that, even in a costume, is not a good idea, rather than just saying it's trashy.
    Comment ()
    Also, talking about ideas for costumes a little earlier in the month gives you and your child a chance to come up with some alternatives rather than just waiting for the last minute, when it becomes a battle of wills.
    Comment ()
    Getting started on the costume earlier also gives you the time to pull together something creative and modest, so you don't have to buy a pre-made costume.
    Comment ()
    I agree with Dr. B that hypersexualizing young girls is not healthy for their development. I want my daughter to be able to have fun without feeling pressured to dress a certain way.
    Comment ()
    Any ideas how to fight the constant sugar-pushing during the month of October? From classroom parties to trick or treating to candy overflowing at the stores and banks, I feel like it's harder to keep things in balance this month, especially.
    Comment ()
    Amy, you are correct, there is all together too much sugar in the last two weeks of October. This is also why most schools give kids the day after Halloween off! Halloween is (mostly) a secular holiday, so everyone seems to make it a big deal, with Halloween parties at school, dance class, in the neighborhood, etc.
    Comment ()
    Here are 6 tips to reduce the sugar:

    1. Limit the route and do something else with the rest of Halloween night: We will focus trick-or-treating to one or two blocks in our neighborhood. By keeping the number of houses that we visit down, the amount of candy that we acquire will be less. My son will join me for the remainder of the night sitting on our front porch handing out candy to other trick-or-treaters. There are a number of fun family activities for Halloween night that can keep the time spent trick-or-treating limited while still having fun such as watching a Halloween-themed movie, reading scary stories by flashlight, or turning one room of the home into a haunted house.

    2. Limit the size of the pumpkin: My children have multiple pumpkins and other receptaclesHalloween to use to collect their candy. I will have them take the smallest of these candy carriers with us when we go door-to-door. A small container will fill up faster and helps the child feel as though he or she has taken in a huge haul. I am always amazed by the number of trick-or-treaters who put their candy into a plastic shopping bag or pillow case. It would take a lot of candy to feel that one of those was full and it was time to go home.

    3. Write down your five favorite candies before you leave: Before leaving for trick-or-treating, children can write down their five favorite types of candy. When they get home, they can then keep anything that is on the list and get rid of anything that is not on the list. Making the list of favorites ahead of time may make the sorting process easier at the end of the night.

    4. Find a candy buy-back program: Many dentist offices and other organizations participate in candy buy-back programs that allow children to sell their candy for a per pound price or to trade the candy for other non-food prizes. Visit www.halloweencandybuyback.com to find local dentists and organizations that buy candy and then donate it to Operation Gratitude, which includes the candy in care packages sent to US military personnel as well as veterans, Wounded Warriors, and first responders. If your local area does not have a candy buy-back program, you can offer to buy some of your child’s candy. Let them use the money for a non-food treat and find somewhere in your community that might accept the candy as a donation such as a local food pantry, soup kitchen, or domestic violence shelter.

    5. Develop a pieces-per-day rule: Portion control is neither original nor exciting, but it works. We use a two-pieces-per-day rule in our house to limit how much candy our children eat. We keep the candy stash on a high shelf in the cupboard to keep it out of sight of our young ones (and to make it harder for us to “steal”). It may be helpful to pick an “expiration date” for the candy stash and agree to throw out any pieces that have not been eaten while following the piece-per-day-rule (which may prevent you from having to combine Halloween candy with marshmallow Peeps come spring).

    6. Get creative: I found several ideas for using Halloween candy creatively online. Ideas include baking with the candy such as using pieces of chocolate bar instead of chocolate chips for making cookies, creating candy art by using Skittles® and other small candies as mosaic “tiles,” and getting a head start on the holiday gingerbread house.
    Comment ()
    Here are some things I've done in the past: 1. Put most of the candy in the freezer. It's hard to binge on frozen candy. 2. Bring most of it to your work the next day. 3. Donate to troops overseas or hospitals. 4. Offer to buy your child a small toy in exchange for most of the candy.
    Comment ()
    Mostly importantly...Don't overbuy for trick or treaters!! This is always my downfall. Those mini Twix and Kit Kats.
    Comment ()
    What are the most important questions to ask during a 15 minute parent-teacher conference? With the new standards, it's hard to tell how well my child is doing overall.
    Comment ()

    Dear Kirkwood Mom, I am also a KIrkwood mom that struggled with this exact same issue. I would walk out of my 10 minute parent-teacher conference feeling like I had no idea how my child was actually doing. I also felt like any issues I brought up were never addressed. I ultimately left public school and started homeschooling my kids. I know that seems like a big move, but it was motivated by many more factors than those unhelpful parent-teacher conferences. I will link to my article, "18 Reasons Why Doctors and Lawyers Homeschool Their Children" at the end of this chat.
    Comment ()
    In short, though, I would ask the teacher how your child compares to other kids in the class by specific subjects. For example, how does your child do compared to peers with math? Ask what you should focus on at home to enrich your child's curriculum. Then get in the classroom and volunteer.
    Comment ()
    Here are some ideas: What subjects could my child use some extra practice in? How does my child compare to the rest of the class in reading, writing and math? Is my child able to follow your instructions, stay on task and get along with all other students? Have you noticed any special skills or strengths my child has?
    Comment ()
    Clearly, Dr. B and I have been in the same situation as you, Kirkwood Mom.
    Comment ()
    I would also ask what the teacher's goals for your child are for the year. Specifically, not just the classroom goals. Try to get specifics.
    Comment ()
    Lastly, if you attend conferences with a spouse, ask him in advance to limit small talk as not to take up any part of that valuable 10 minute conference time. Speaking from experience here.
    Comment ()
    Ask how the teacher enriches curriculum for kids who need more challenge in specific areas but may not qualify for the gifted program.
    Comment ()
    My elementary-school-aged son wants to play football. I keep seeing studies about brain injuries and long-term health risks from this sport, specifically. Would you let your son play? Is there a way to make it safer for him to be on a team?
    Comment ()
    I would not let my young child play tackle football. There are a lot of other sports out there.
    Comment ()
    That said, there are coaches and leagues that prioritize safety more than others. Talk to other parents whose children play to find out which ones have the best reputations and safeguards in place.
    Comment ()
    Things are changing in football, and there is a growing recognition of the frequency of concussion and the need to be removed from the game. That said, there are many more football players who cannot finish the season due to injuries, especially head injuries.
    Comment ()
    My editor, who has two very active sons who play hockey, says she would not let them play football. She doesn't believe there are enough safeguards in place yet. And study after study points to too many injuries.
    Comment ()
    My colleague, Dr. Lee, has some good thoughts about kids and football:

    A brain is a high-functioning complex living supercomputer and like your smart phone, they don’t like to be dropped. Maybe the first few times you get lucky and don’t notice much, but then one day, it is just so slow, or you can’t make a call, or check e-mail, or even turn it on.

    Concussions are like this. The more you have, the worse they are. Most kids will recover pretty well after some period of time, which may be days to months (yes months). They may suffer from headaches, dizziness, nausea, confusion, fatigue, vision changes, difficulty with sleep, changes in personality, mood swings, difficulty with concentration and falling grades. You don’t have to be “knocked out” to have a concussion. Kids who are still recovering and get reinjured are at even greater risk for permanent damage. Kids who have multiple concussions will have measurable changes on cognitive (intelligence) testing. How hard a hit and how many it takes for this to happen vary by person and situation.

    So what can I tell you for sure:

    1) Concussions are serious and common and will cause permanent damage over time. Football is a major contributor for recurrent concussions because of the way the game is often played, but concussions also occur in soccer, gymnastics, horse related sports, basketball, cheerleading, lacrosse and many others.

    2) Parents, coaches, trainers, and the general public need to understand the risk we are asking and allowing our kids to take.

    3) Younger players have greater risk and less personal understanding of that risk.

    4) There is no place for a “tough it out/shake it off/get back in the game” attitude with brain injury.

    5) Players need significant time to heal prior to returning to play and physicians knowledgeable about concussions should be involved in that decision and in the recovery care of these children.

    I don’t know what my final decision will be on this issue. I have several years before I will have to decide. There are no easy answers for kids and families who love the game. Participation in organized sports is extremely beneficial for our children, but we also need to make sure they stay as safe as possible while doing so.
    Comment ()
    Thank you everyone for the questions this week. Have a wonderful Halloween and see you here next month!
    Comment ()
Powered by Platform for Live Reporting, Events, and Social Engagement