Vitamin D during pregnancy could prevent RSV in infants

 This week a study was published online from the American Academy of Pediatrics that found that a deficiency of Vitamin D in cord blood is associated increased rate of RSV in infants. So it stands to reason that if an infant is not starting out Vitamin D deficient, they are decreasing their chances of catching RSV. The study suggested that if pregnant women increased their Vitamin D intake, it would decrease the rate of RSV by about 20%. That is AMAZING! And not only would it decrease the number of cases of RSV, it would decrease the severity, meaning fewer deaths, fewer tiny babies on CPAP and vents, and fewer infants being held down by nurses like me so they can have boogers sucked out through a tube in their noses. I may be jeopardizing my job security by proclaiming this information to the world, but I'm OK with that. But seriously RSV is a HUGE part of what I do and I would be glad to see fewer kids come down with it.
 The point is, if you are pregnant I recommend that you make sure that you are getting enough Vitamin D. Start today.  Not only does it reduce rates of RSV, your body needs it for cardiovascular health, a thriving immune system and strong bones. One may ask how much is enough Vitamin D and where do I get it?- The latest recommendations (as of November 2010)  for daily intake is the same for men and women under age 70, 600 international units, and 400 IU for children. Now there is debate that because of these new study findings, perhaps pregnant women should get more than that. It remains to be seen. The caveat with Vitamin D is that if you take too much it can lead to toxicity. (Vitamin D poisoning can lead to dehydration, vomiting, loss of appetite, constipation, muscle weakness, irritability, fatigue and kidney stones. Pregnant women have enough issues with those conditions without taking a vitamin supplement that would make them worse.) Vitamin D toxicity is actually pretty rare. It only happens when too much is taken over a period of time, usually months, and when an adult is taking 50,000 IU or more per day. Vitamin D from food has never resulted in an overdose.

  Of course you can get your Vitamin D from a prenatal vitamin or a Vit D supplement, but if you are looking for an answer that doesn't come in a pill form, here are a few good places:

• sunshine- not that the sun actually contains Vit D, but our skin has the power to turn ultraviolet light (UVB rays) into Vitamin D. (Aren't our bodies amazing?)
• fish- especially fatty varieties like catfish, salmon and tuna
• eggs
• fish liver oils- I suppose this proves that my grandma was right, or at least partly. Eating a tablespoon of cod liver oil a day can prevent illness. One tablespoon contains 1360 IU. That doesn't mean you can convince me to take it. It smells ghastly.
• mushrooms- I recently learned that a serving of button mushrooms contains 100% of the Vitamin D that you need for a day.
• In the United States milk is fortified with Vitamins A&D, because they help with the absorption of calcium. (Many people find it surprising that "Vitamin D milk" or whole milk has no more vitamins than skim or 2% milk. The only thing that it has more of is saturated fat.)
• Most cereals, butter and dairy products are also fortified with Vitamin D.

 Now I'm asking you to do me a favor. If know someone who is pregnant, share this information with them. Making sure that you're getting enough Vitamin D  while you're pregnant is a simple way to make a huge difference. If 20% fewer children in the United States came down with RSV each year, that's roughly a million children. And think how many families that would effect if there were that many children who weren't coming down with RSV. The thought makes me happy. So please, please, if you are reading this, spread the good news to your friends and family so they can keep their families happy and healthy.

Strep Throat vs. Spinal Meningitis

 Once when I was in the fourth grade I had a fever, headache, nausea and I felt lousy. My mom tried to get me to touch my chin to my chest. I couldn't/wouldn't. My mom rushed me to the emergency room because she was sure that I had spinal meningitis. As it turns I wouldn't touch my chin to my chest because I had a nasty case of strep throat. It hurt too much. Now it was great that she took me to the doctor, but it didn't really didn't merit an ER visit. (Of course I don't remember what day or time it was, that may have been the only option.) Complications of untreated Strep can include scarlet fever, rheumatic fever, and glomerulonephritis, but those are less likely to happen if antibiotics are started in a timely manner (and don't forget to take the whole course of antibiotics, not just until the symptoms go away.)
  It was years later when I was in nursing school that I realized what my mom was looking for. She was looking for a positive Brudzinski's sign, however it isn't based on whether a child can voluntarily touch their chin to their chest. To test for Brudzinski's sign, have a child lay flat on their back on a firm surface. (A floor or table will work.) Then firmly push their chin to chest. A positive sign will result in their legs and hips flexing involuntarily. If you see this, I would recommend taking your child to the emergency room, pronto. (Of course, you may be ok, going to a clinic first, if you can get in quickly and are admitted from there. Sometimes that's faster than going through the ER (and generally significantly less expensive). Where you should go to depends on where you live, how far the hospital is from you and your average ER wait times. But don't deliberate about the matter for too long.) The point is that this is serious business. Not to say that a negative Brudzinski's sign rules out a diagnosis of spinal meningitis, because it doesn't. But a positive Brudzinski's will not be seen in any other disease.

Symptoms of spinal meningitis include headache, fever, nausea, vomiting, irritability and lethargy. (See how the two can be confused?) Although the symptoms in meningitis are often more extreme than what will be seen in strep throat and also sometimes include muscle rigidity, bulging soft spots in infants, cold extremities and abnormal skin color. Of course you don't need all of these symptoms to have spinal meningitis. Small children sometimes only have fever and irritability, which can make a "phone or internet diagnosis" difficult. The surest way to diagnose spinal meningitis is with a lumbar puncture or spinal tap. I know that sounds really scary to a parent, to think about multiple people holding your child down while a doctor puts large needles into your child's spine, but if there is a chance that your child has this disease, you need to know. Not only that, you need to know what is causing it, whether it be bacteria or virus and what kind, so the doctor can pick the most effective medication.
 Meningitis is an inflammation of the meninges, which are the protective coverings of the brain and spinal cord. If those tissues become infected, because of their location, it can lead to serious problems. Complications can include permanent brain damage, deafness, epilepsy (a seizure disorder), sepsis (wide spread systemic infection), gangrene of limbs, shock and death. Does this mean that if your child has meningitis that they are going to die or have these complications? No. I have cared for many, many kids with this diagnosis, and I have never seen one die and I can list on one hand the kids I have seen who have had serious complications. But if your child does not get immediate treatment, their risk greatly increases. Bottom line, if you remotely suspect that your child has spinal meningitis, get it checked out as soon as possible.

Thoughts about Vaccinations

Last week it hit the news that the research study that claimed that there was a link between the MMR vaccine and autism had altered facts and statistics. So the MMR vaccine does not in fact cause autism. Wow, that's embarrassing. Because of the MMR/Autism scare, there are thousands of kids who didn't receive their vaccines, and as a result measles are actually becoming endemic in parts of Great Britain.
 Now I have a few mixed feelings about vaccinations. I believe that vaccinations can be a wonderful thing. Vaccinations have saved millions of lives. However they are not without their faults. If you read the information sheets that come with your vaccinations they list some pretty daunting possible side effects including seizures, neurological problems, permanent brain damage and death. These side effects are very rare and it is more likely that your child will be afflicted by the disease by not getting the vaccine (which for some of the diseases can also lead to neurological problems and death) than that they will be affected by rare severe side effects. Severe side effects are not as common as they once were, as vaccinations have been developed and improved through the years. But those risks are still there and every parents should be aware of them.
  Another thing that many people don't realize is that vaccinations are not 100% prevention. Even if you get all of your vaccinations you can still contract the disease they are trying to prevent, it's just not as likely. I had all of my vaccinations and I still came down with the measles when I was six. It stands out as the most physically miserable experience of my childhood. (I remember having sores every where and feeling too weak to even scratch them. And I remember all of my joints aching like I have never since experienced.) But if most of a population has been vaccinated against a disease, it makes it difficult for the disease to spread. (On a side note because I actually had the measles, my antibody levels against the measles are more than six times what the average immunized person has. I only know this because my doctor's office, high school and county health department all lost the record of my booster shots and I had to lab work done to prove that I have in fact been immunized before they would let me start my first Pediatric nursing job.)
  I personally have had my kids vaccinated for everything except the flu. (Flu vaccines have proven to not go over well in my family, hospitalizing multiple relatives. For us it's easier just to deal with the flu.) It's something that I prayed about long and hard before deciding. I felt that the benefits outweighed the risks. But I can't speak for every parent. Every child is different and their reactions may not be the same. I have an aunt that when she took her daughter into get her standard vaccinations and a strong spiritual experience that told her that she should not get her child vaccinated. No one know what would have happened if she had ignored that prompting, but she didn't and her children have all been remarkably healthy. As a parent it's part of our job to determine what is best for our own children, and if we follow the Lord, He will help us along the way. I believe that for the vast majority of people vaccinations are a great thing and I highly recommend them. They have helped to decrease the incidence of many diseases that have been known to maim and kill untold numbers of children. But if a parent told me that they had prayed about it and strongly felt that their child should not be vaccinated, I would not argue with them.

Anti-Itching Bath

This weekend my daughter woke up with itching bumps from head to toe. Chicken pox? It looked close, but not quite. She'd had the vaccine, but it is possible to still get the illness if you have had vaccine, the chances are just much lower. So we went to the doctor, just to see. (For the next few weeks we happen to be double covered on our insurance, so luckily it didn't cost anything.) As it turns out it's not chicken pox, but had an allergic reaction to her antibiotic. I swear I heard a dozen times in nursing school that antibiotic reactions usually happen in the first 24 hours, but as it turns out it is fairly common for children to develop an allergic reaction to amoxicillan 8-10 days after they start taking it. Sometimes even 3-4 days after they finish a 10 day course. Chicken pox or allergic reaction, the itchy bumps have to take their course and the best thing to do is ease the itching. I found this effective and simple recipe for a bath that eases the itching. (Some Benedryl helped too.) Supposedly it works for poison ivy, poison oak and any kind of itchy rash. I don't remember where I got it to give credit to.

Anti-Itching Bath
For each tub of water add
2 cups of oat flour
1 cup of baking soda


If you don't have oat flour handy, just throw some rolled oats in the blender or food processor and grind until powdered. I will warn you that this stuff makes a yucky film in the bath tub.

New reasons why you should have fish oil in your diet

So we've all heard that we should have more fish in our diets. Studies have shown that it can help to reduce inflammation, regulate cholesterol, treat clinical depression and bipolar disorder, slow cancer growth and increase rates of survival. This week I read an article in a nursing journal that discussed two new studies about the benefits of fish oil. In the first study they gave 13 ICU patients with an inflammatory response fish oil mixed with their tube feedings. 10 similar ICU patients received the standard solution. The patients who received fish oil had improved lab values and shorter hospital stays. The researchers believe that the omega-3 fatty acids reduce the inflammatory response.
The second study involved 81 adolescents and young adults who were at "ultra high risk" of developing a psychotic disorder. Some took fish oils, the others a placebo. After 40 weeks, on 5% who took fish oils developed a psychotic disorder, whereas 28% did from the placebo group. Those who took the fish oil also showed an improvement in symptoms with no adverse reactions. Omega-3's are crucial to brain function. The researchers conclusion was the fish oil is a safe way to prevent progression of psychotic symptoms. Moral of the story: Fish oil can can help you to heal faster and save your sanity. That's reason enough for me to start taking a supplement on a regular basis. (Right now there's a coupon for $2 off the Omega-3 gummy supplements at Costco if you're looking for a way to do this that doesn't give you fish breath.)

If you were my friend, this is what I would tell you...

 Let's say that we're friends. Your child is sick and you call me for advice. Most likely I will tell you to take s/he in to see the paediatrician. He says that he thinks that the child needs to be hospitalised. Now here is where my advice will help you. I'm going to tell you right now to "pay attention and ask questions". I think I tell almost every parent that I work with to speak up and ask questions. But sometimes because of the stress of the situation, parents just go along with what is happening. Don't be afraid to make waves!  You don't have to be rude, but this is your child we're talking about, and ultimately you are the one that has to deal with the consequences. Ask what is happening. Ask why. Ask if this is the best option. Ask what possible the side effects of a procedure/ medication are. And don't be satisfied until you get some answers.
 Now I wish that this weren't the case, but sometimes medical decisions are not based on the best interest of the patient. Sometimes they are based on politics or the best interest of the doctor, availability or insurance coverage. And the details vary from case to case, doctor to doctor and hospital to hospital. The best way to make sure your child is getting the best care that they need, is to speak up, pay attention and do not be afraid to ask questions.

Chicken Soup

So I'm at home with my sick kids and what makes this even more thrilling is that I have no voice. I feel like I'm screaming to barely be audible. And frankly right now I just want a nap, but I'm waiting for the munchkins to fall asleep. So while I wait I'll blog about what I made for lunch. I found this recipe on the foodnetwork, but I modified it to make it easier and a little healthier. (Does anyone out there actually make their own chicken stock? Who has that kind of time? Does it really make that much of a difference?) I feel like this recipe really hits the spot when you're sick. (And when you and your family are sick, do you really want to spend your whole day in front of the stove? I didn't think so.) The combo of chicken broth, garlic and cilantro does wonders.

Easy Chicken Soup

1 medium onion
3 garlic cloves
2 medium carrots
2 celery ribs
2 T fresh cilantro
2 T olive oil
1/2 tsp dry thyme
2 qts chicken stock/broth
1 1/2 cups cooked chopped chicken
8 oz dry whole wheat noodles

1. Throw first 5 ingredients in food chopper.
2. Sauté in olive oil in a soup pot for about 5 minutes. Add chicken stock. Bring to a boil.
3. Add remaining ingredients and cook until noodles are tender.

Ginger- Not just for cookie houses and Thai food

Currently there is some nasty horrendous gastro virus epidemic running through my extended family. While my in-laws were visiting us today, they started having symptoms too. I pray and hope that my kids don't come down with it as well. Anyway, it brought to mind a simple recipe that a co-worker once shared with me. It's fabulous for upset tummies and morning sickness too.

Orange-Ginger Smoothie
1 dreamsicle, stick removed
1/4 tsp powdered ginger
2-3 canned peach halves
1 T vanilla yogurt
Blend all ingredients in blender until smooth.

Besides decreasing the motility of the GI tract (it helps with diarrhea and cramping as well as nausea), ginger has many other benefits. It is useful for treating heart disease because it thins blood and lowers cholesterol. (So don't go overboard with it if you are on any kind of blood thinner.) In many countries, it is used as a treatment for the common cold. And the FDA has determined that is safe with no notable side effects.
Research in rats and mice have found that it prevents skin cancer, kills ovarian cancer and helps to treat diabetes, but it will probably be quite awhile before they can determine if it is potent enough to fix those problems in humans.

What to do when your kids are sick

First of all any advice that I dispense here does not replace seeing a medical doctor. (And whenever taking over the counter medication, use as directed.) There are times when you just need to suck it up and admit that this is beyond your scope and go to see a doctor at a clinic or hospital. Having said that, as a pediatric nurse there have been countless times that I have seen kids come into the hospital that would have been ok staying at home. They say better safe than sorry, however in this case, safe can make you sorry when you see that medical bill.

When your child is throwing up...

• Pepto-Bismal can do wonders. Give it a try, it won't hurt anything.
  
• It is important to keep them hydrated. However, if you give them too much to drink at once, that can cause them to throw up, which will make them even more dehydrated. Start with an ounce, if half an hour later s/he has kept it down, give another. Do this for a couple hours before increasing the amount.
• Don't give them anything too acidic (like orange juice) to drink and whatever you do, don't give them milk. Try pedialyte or half strength apple juice.
• If they can't keep anything down when trying an ounce at a time, and it has been 12 hours since they have been able to eat/drink anything, call your doctor. S/he may give you further advice, or let you know it is time to come in an see him.

When your child has diarrhea...

• Again try the Pepto-Bismal.
• Keep them hydrated, but this time you don't have to be quite as stringent as above, unless they have both symptoms.
• Give them yogurt. It has bacteria in it that can help replace the normal flora that they are losing with the diarrhea.
• If they are crying, but have no tears, they are too dehydrated. Call your doctor.
  

When your child is running a fever...

• If they are over a year old, try children's Motrin (Ibuprofen) & Tylenol (Acetaminophen). They do wonders for bringing down a fever, especially when you alternate them.
• If they are under a year, just give Tylenol.
• Make sure that they are getting enough to drink.
• Check the environment. Where's the thermostat? How many layers are they wearing?
  
• If their fever is still 100.4 F or higher, call your doctor.

What is most important is to listen to your kids and look at the overall picture. Are they behaving different than what is normal for them? Are they complaining of pain in an odd place? If things aren't right, don't ignore them. Watch them and if they don't get any better, take them to see a doctor.