sspcobb, Author at Stepping Stone Pediatrics

What is Dry Drowning?

The recent tragedy of a 4 year old Texas child has focused many parents on the issue of “dry drowning.” The heartbreaking story of the victim has not only generated sympathy around the country, but also fear in many parents’ minds about this unfamiliar danger to their own children. How much of a danger does “dry drowning” pose, what exactly is it, and what can you do to recognize it and protect your children?

First, it is very important to keep the risk in perspective: these events are very rare. In fact, Cook’s Children’s Hospital in Texas, one of the 12 largest children’s hospitals in the United States, has treated only one case of “dry drowning” in nine years!

Having said that, there are actually two separate and distinct types of events, true “dry drowning” and “secondary drowning”, that get lumped together by the lay press as “dry drowning.” It’s an easy mistake to make because both occur while the child is no longer in the water and have similar symptoms.

True “dry drowning” occurs when inhalation of water into the upper airway results in an excessive instinctive response that closes off the airway at the level of the vocal cords (called “laryngospasm”). While this keeps water from getting into the lungs, it also prevents air and oxygen from getting there as well. Episodes of true “dry drowning” tend to occur almost immediately with the child choking, sputtering and gagging within minutes of inhaling the water.

On the other hand, in “secondary drowning” some fluid actually gets into the lungs, but not enough to immediately overwhelm the child’s breathing. Typically the child has an episode of coughing/sputtering but seems to recover at the scene. Symptoms then begin to re-emerge anywhere from an hour to 24 hours later. Although, very rarely, this can occur as much as a week later. The water in the lungs causes inflammation and respiratory compromise and is often mistaken for an oncoming viral illness until the child is in severe distress.

How to Recognize Dry Drowning and Secondary Drowning

While reiterating that these are rare occurrences, it’s still wise to know how to recognize if/when this is happening. What can you do to prevent this from happening to your child? Supervision, Supervision, Supervision…..and knowing the symptoms to look out for.

The symptoms of both of these entities include:

Persistent Coughing/Chest Pain
Difficulty/Labored breathing
Sudden severe sleepiness/fatigue
Sudden irritability/changes in mental status
Vomiting

Should these symptoms occur, take your child to the Emergency Department immediately.

Finally, with all the publicity surrounding these unusual events, it is important to note that the more typical “wet drowning” is by far the greater risk. Please remember that drowning is a silent killer. Victims rarely thrash or scream—they’re too busy gasping for air to make a lot of noise. Signs to watch for include:

Head/mouth bobbing above and below water level
Head tilted back
Wall-clinging (crawling along the wall because the child is too tired)
Arms moving downward (“climbing an invisible ladder”)

It’s hard to find the right balance of vigilance vs. paranoia, but hopefully, this information will help you enjoy the water with your children safely and happily all summer!

Now Performing Maintenance Allergy Shots!

Tired of driving every few weeks to the allergist for allergy shots? We now offer allergy shots to our patients who are on maintenance injections or close to maintenance injections. Talk with your allergist to see if this option is available for your child. Call our office if you have any questions.

May is Mental Health Awareness Month

May is Mental Health Awareness month – and it couldn’t be more timely as teens finish up finals and AP exams! Because mental health is a big part of your child’s overall wellbeing, we screen all teens ages 13 and up for depression at every well visit. However, things can come up between annual checkups, and it’s important for parents and teens to know what to look for. While some emotional ups and downs can be very normal during adolescence, it’s important to know the difference between a “down day” and signs of depression.

Roughly 6% of adolescents are estimated to have depression; however, less than 20% of those affected ever seek treatment. Girls are at higher risk than boys, possibly due to differences in peer relationships and use of social media apps between boys and girls.

What causes depression?

Many things can contribute to depression in teens. Risk factors including:

Normal hormonal changes that occur during puberty
An imbalance of neurotransmitters (the messengers of the brain and nervous system)
Experiencing some kind of trauma
Stress (including academic stress!)
Trouble with self-esteem, including difficulty with grades, being self-conscious about weight, and peer problems
A positive family history or personal history of anxiety, depression, or other mental illness
“A history of a physical disability”
Identifying as gay, lesbian, or transgender
Using drugs, tobacco, or alcohol

What are the signs of depression?

Depression is different for everyone, and many symptoms of depression can mimic how teens feel on a “down day”. When teens experience these symptoms most days or every day, it’s time to seek help.

What to watch for:

Changes in a teen’s attitude or behavior
Feelings of sadness or hopelessness
Frequent irritability or anger, even over small things (maybe things that wouldn’t otherwise bother them)
A lack of interest in activities a teen usually enjoys (i.e: not wanting to spend time with friends and family)
Fixating on mistakes and criticizing themselves (i.e: over a poor grade, or self-criticism about weight)
Difficulty concentrating or feeling restless
Feeling fatigued or tired, or having difficulty sleeping (either too much or too little)
Changes in appetite or weight
Frequent complaints of physical discomfort or pain (i.e: headaches, body aches without any known cause)
Decline in typical school performance
Evidence of self-harm behaviors (i.e: cutting)
Frequent thoughts about death and suicide, or plans about suicide

Why is seeking treatment important?

Depression can be treated! Seeking treatment is important because depression is unlikely to go away on its own, and can get much worse. Depression puts teens at risk for abusing drugs and alcohol, strained relationships with friends and family, poor school performance, and self-harm and suicide.

Suicide is the 3^rd leading cause of death in children ages 10-19. Ninety percent of teen suicide is associated with a history of a psychiatric illness. Over 35% of teens with depression have or will make a suicide attempt.

Know the warning signs, and act! If your teen is experiencing signs of depression, don’t wait to get help. It’s as easy as scheduling an appointment. We offer a safe space for teens and parents to talk, and we can help facilitate what can be a tough conversation. Just as no two people are alike, no two situations are exactly the same. The mental well-being of our patients is always considered on an individual basis to help your teen achieve their best self.

If you or someone you know is in crisis, call the U.S. National Suicide Prevention Lifeline for 24 hour help at 1-800-273-TALK (1-800-273-8255).

Now Accepting Amerigroup and Medicaid Insurances!

FINALLY!!!

Stepping Stone Pediatrics is now accepting Amerigroup and Medicaid insurances!

(Wellcare patients, we are still awaiting approval but are told it should be coming soon!)

After many months of shepherding paperwork through the system and navigating the enigmatic state Medicaid bureaucracy, we are finally able to accept “straight” Medicaid patients and patients who have the Amerigroup (Medicaid CMO) insurance. We look forward to seeing some familiar faces again as well as being able to welcome new patients to the practice.

Keep watching this space for developments with regard to both Wellcare and the new Medicaid CMO product, CareSource, which unveils in July!

Spring Fever Is Here!

From Tanya’s Corner

Mark Twain once said, “It’s spring fever. That is what the name of it is. And when you’ve got it, you want — oh, you
don’t quite know what it is you want, but it just fairly makes your heart ache, and you want it so!” This is the time of year when the Earth’s axis tilts further towards the sun. The days are getting longer and warmer. As a result, colorful flowers are budding and blooming, and pollen counts are rising! It is a time filled with transformations and new beginnings … both in nature and in our own lives. We all start to feel that tug to get out of the “sloth mode” of winter with a fresh, healthy start. There is no better time than now to get out, get active, and jump-start your family’s health!

The family that plays together stays together! It is so true! I would like to challenge families to incorporate one small change into your weekly routine to start your family’s transformation to a healthier life. Once a week, choose one of the activities below to do together as a family – and yes, all family members must be present and participate. Feel free to set a time-limit initially so that members won’t feel as though they are “trapped with no means of escape” for an infinite amount of time. Soon enough, I think you’ll find that won’t be necessary as your family will be having so much fun, they won’t care about the time investment! Increase “buy-in” by allowing your kids to help plan these fun family activities. Don’t forget to put your own personal stamp on the activity to get creative with them!

Have a picnic – choose a theme like “Italy”. You must travel (preferably by hiking or biking), to “Italy”. When you get there, serve authentic Italian fare and engage in authentic Italian sports and activities.
If you have younger kids, host a “Bubble Fest” outside with games.
Go to the local zoo (be sure to pack a healthy lunch with plenty of water).
Plan a bike ride.
Host an art contest with sidewalk chalk.
Have a backyard baseball or dodgeball game.
Have a water balloon fight.
Host a Twister tournament outside.
Have a firefly catching contest.
Play hide-and-go-seek.

These activities will not only get your family up and moving their way to improved health, they will also cement family bonds. By actively playing together, rather than merely watching a screen, or passing by each other in silence, you can establish an empowering family relationship. Communication will increase tremendously as you and your children talk through the rules of the games. This type of negotiation is the same that they would use to solve problems throughout their lives. From involvement in weekly family games, children learn how to run, jump, ride a bike, catch, think, strategize, and learn about the triumphs of victory and the agonies of defeat! What better way to jump into spring and start your family’s transformation?

Sports and Camp Physicals

Who needs a Sports Physical?

Everyone playing sports or going to camp! Ideally athletes in need of a sports physical should schedule a visit 6-8 weeks before sports or camp start. This allows plenty of time for further screening and referrals (maybe to PT for a trigger point or knee pain from last season) BEFORE the season starts – making sure your athlete is in top shape to start, not starting behind.

How is this different from a regular check-up or a sports physical at a walk-in clinic?

Because your child is an established patient, we are able to pay greater attention to your child’s history (we know they broke their arm in 2014, or that they had asthma when they were younger). We also pay close attention to your family’s history, as sometimes family history is the only clue we may have that a child is at risk for sudden cardiac problems.

Some schools will organize sports physicals with “stations” where you see a different provider at each station for different parts of the sport physical. While this may be adequate for some, this is no replacement for a well visit with a provider who is familiar with your medical history that has time to put together the whole picture.

Do I need a separate checkup if I had my regular checkup already?

Not necessarily. If your child had a well visit with one of our providers in the past year, Stepping Stone Pediatrics will sign your child’s sports or camp form. We request 3-5 days for paperwork to be completed, as the provider your child saw must be the person signing your child’s form.

How do I schedule a sports or camp physical?

If it’s been more than a year since your child’s last physical, give us a call ASAP and let us know you need a sports or pre-camp well visit. Our spring and summer schedules can fill up quickly, and scrambling to get forms completed isn’t fun for anyone (especially for athletes and campers who may miss out as a result).

How to Celebrate Valentine’s Day in a Healthy Way

This Valentine’s Day, indulge your little sweethearts without causing/contributing to massive sugar overload by trying out some or all of the following tips.

For your child’s school Valentine’s party, send in colored pencils, cool erasers, stick on tattoos, or bubbles as tokens of their friendship.
Don’t tempt your child with sweets. Instead, write them a sweet note or poem (on really fancy paper) and hide it. Then, send them on a scavenger hunt to find it.
Your time is one of the most meaningful gifts that you can give. Plan a picnic (that involves a hike), gather wood together for an outdoor bonfire, or go to a rock-climbing wall.
Make your own Valentine’s Day treats together (recipe follows).

Valentine’s Day Sun Catchers

You will need:
Pony Beads
Muffin tin (of your choice)

Melt beads in tin in 400 degree oven. Once melted, remove from oven and allow to cool to room temperature and pop out. Punch a hole in the top, tie a pretty ribbon, and stick it to a card-stock paper with a Valentine’s message!

On a personal note (from recent experience), DO NOT use silicone baking cups/dishes as they will catch fire! However, my daughter will always remember the night we made a fire in the oven!!!

Asthma and Sports

Even though it is winter, children need to get out, play, and participate in sports. We often see children who are having symptoms of exercise induced asthma during the winter because the cold and the exercise can both be triggers. Children with asthma should be able to fully participate in the sport of their choice without asthma exacerbations or other symptoms of their asthma impacting their endurance or performance. If you feel like your child is not able to keep up with their peers, it might be time for an asthma tune up. Or if you are concerned that your child might have exercise induced asthma (EIA), it might be time to have them evaluated. Sometimes it is hard to tell the difference between your child not being in shape and becoming short of breath and exercise induced asthma.

Symptoms of exercise induced asthma are:

shortness of breath on exertion that is not caused by being “out of shape” and takes longer than 10 minutes to recover
chest tightness that develops while exercising
a cough or wheeze that develops while exercising
sore throat
decrease endurance
stomach ache

If your child has been diagnosed or you suspect they have EIA, here are some suggestions to help relieve symptoms of EIA:

Warm up with low intensity exercises for about 15 minutes before you start more intense exercise.
Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.
Try to breathe through your nose while you exercise. This helps warm the air that goes into your lungs.
2 puffs of their albuterol or rescue inhaler prior (15-20 minutes before) to practice or a game.

If they continue to have symptoms please call us and schedule an appointment. We might need to start your child on a daily medication to help prevent these symptoms.

Stepping Stone Pediatrics in the Hot Chocolate 5K

We are now well into the New Year, and we’re ready to share our resolution! This year, we will be participating in a variety of community events as a way of giving back to the community that continues to support us.

Our first community outreach will be participating in the Hot Chocolate 5k/15K benefiting the Ronald McDonald House Charities. While we always hope that our families are able to stay healthy and out of the hospital, we realize that a prolonged hospital stay can be difficult and taxing. We are raising money for this event by raffling off a hot chocolate basket – raffle tickets are $1 and can be purchased in the office now through the end of January. Our winner will be announced on Facebook on February 1st!

Several of our staff are also walking and running on the 22nd! It should be a pleasant weekend, so if you’re free and up for some morning exercise followed by lots of chocolate, come join us in Atlanta! Lots of pictures to follow.

Throughout the year, we will be participating in similar events that are near and dear to us in pediatrics. We look forward to sharing our outreach with you! If there is a pediatric cause that is near and dear to you, please let us know!

Did you know we offer easy Payment Plans?

With the New Year many of our families will see their deductibles reset – just in time for flu season!

Stepping Stone Pediatrics never wants our parents to worry about their children receiving needed medical care. To meet the demands of high deductibles we offer flexible, zero-interest, recurrent monthly payment plans. No questions, no qualifying, no hassles. It’s really that easy!

770-515-9000

Author: sspcobb