13 Tips to Help Parents Address Prom Night

Written by Nelson Branco MD and Nell Branco, MPH, LCSW

PromProm season and graduations are here. Any adult who works with teens or has a teen in their life wants them to fully enjoy this big event while somehow managing to keep it in perspective.

The prom is a time to dress up for a fancy event planned just for them. Kids get to celebrate their friendships and the years they have spent together. We all have memories (good, bad or indifferent) from our high school years, and I’ll bet the prom picture is the first one grandma whips out when she’s trying to embarrass you with your kids.

High school juniors and seniors are young adults, and prom is another opportunity to build trust and foster their ability to be self-reliant. It’s also a good opportunity for parents to communicate clearly about your expectations. Here is a list of issues and suggestions for making prom night stress-free, safe and fun for all.

Planning for prom may be stressful or frustrating for your teen.

Try to be open and supportive through the ups and downs. There may be a logistical or social aspect of the prom that is worrying your son or daughter. Let them problem solve, using you as sounding board, but don’t try to fix it for them.

Don’t side-step the topic of drugs, alcohol, and safe sex.

If you have reasons to be concerned about these issues, bring them up. The emphasis should be on making responsible decisions in addition to having fun.

Discuss rules for the prom; your own rules, the school rules, and consequences for breaking them.

The goal is not to lecture. You want to have a discussion to set positive expectations for a fun and safe night. Tell your teen that you trust their ability to made good plans and reasonable decisions, and that you know they want the night to go well. Begin the conversation with “I know we’ve discussed this before…” or “I know you know this already but I think it is a good idea to review ….”

Make a plan with your teen that you can both stick to.

You might agree to one phone call check-in vs. multiple calls or texts through the night. For older, more independent students a check-in may not be necessary.

Ask who they are going to be with.

It’s reassuring to know your son or daughter’s date, and if they plan to go with a group of students you already know. Have the name and cell phone of one other person in the group as a backup contact.

If your teen is going to a pre-prom or after party, find out who is hosting and who is supervising.

You should feel free to talk to those parents beforehand if you have questions. There are lots of reasons to call each other; to thank them, to offer help, to arrange a pick up time, etc. Often, students and their parents have put a lot of planning into these parties and have rules and guidelines that guests are expected to follow.

Have a backup plan for getting home.

Even if your teen is going with a group in a limo or bus, make sure they have money for a cab or another ride if needed.

Does your teen know how to contact you throughout the evening?

Tell them where you plan to be and how they can reach you. Some parents and teens set up a code or agreed upon phrase that will cue parents to pick them up, no questions asked.

Plan for changes.

If their plans for the evening change (and they may) make sure they know to check in and let you know the new destination and who they are with.

Renting hotel rooms for students is not recommended.

Not only are there issues of supervision and cost, but a large group of teens may run afoul of hotel noise policies and have a negative impact on other hotel guests.

If you are hosting a party review your town’s Social Host laws.

Parent hosts are often responsible for the safety of their guests. For more information about social host laws, see http://www.socialhostliability.org or http://en.wikipedia.org/wiki/Social_host_liability

Driving safely.

Reinforce the message that they shouldn’t ever drive if they’ve been drinking or using drugs, and shouldn’t let their friends dot it either. It’s also worth reminding your teen that driving while tired can be just as dangerous as driving while they are intoxicated.

Most importantly – with all the excitement (and worry) don’t forget to say

“I love you and have a good time”

as they get ready to leave, and take lots of pictures.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP. Ellen Branco is a School Counselor and Health Educator in the San Francisco Bay Area. She has been working at independent high schools and counseling since 2001.

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Is Your Child Outgrowing Her Generic Concerta Dose?

Methylphenidate (also known as Concerta).

Methylphenidate (also known as Concerta). (Photo credit: Wikipedia)

Written by Kristen Stuppy MD. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.

Generic Concerta Not Working Like the Brand Used To? It might not be that you’re outgrowing the dose…

I used to be a huge fan of generics. They save money, right? They are equivalent to the brand name, right?

That’s what I’ve always been taught and what I teach.

I’ve been jaded by many problems and now disagree with the above. Generics aren’t always cheaper than the brand name. Some generics are not equivalent to the name brand.

A recent discussion on a psychology/pharmaceutical listserv I follow brought up the issue of generic Methylphenidate HCl not working as well as the brand name Concerta. Several members had some great insight into why this is.

The discussion peaked my interest in the issue and I started looking online for information earlier this week.

Ironically today I went to pick up a family member’s medicine. We have filled at the same pharmacy previously for generic “Concerta” and have always gotten the equivalent generic.

When I looked at the pills in the bottle today, I told the pharmacy tech they weren’t OROS (see below). She looked confused. She had no clue what I was talking about.

(Lesson to all: if you have any questions, ask to talk to the pharmacist. Hopefully they will understand the pharmacology better than the tech.)

Generics for Concerta (Methylphenidate HCl) might have the same active ingredient, but have a completely different time-release system, resulting in varying drug peaks in the bloodstream.

The original Concerta (from Watson pharmaceuticals) uses a special technology to time-release the active drug. This time-release technology is called OROS (osmotic controlled release oral delivery system). There are several other time-release methods.

The active ingredient may be imbedded in various substances from which the medicine must exit slowly or a gel cap is filled with beads that dissolve at different rates. With the technology used by Concerta, the capsule IS the time release. It doesn’t dissolve.

The medicine is slowly released through a small hole in one end of the capsule. The pill works like a pump, pulling in water from the intestines, pushing the medicine out of the tube slowly throughout the day. See this photo from Medscape.

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I have recently learned that not all generic formulations of Methylphenidate HCl are using this technology. This alters the time-release nature of the active medicine.  For some people this substitute might be just fine, or even preferable.

But if it seems like your medicine isn’t lasting long enough, has times that it works well followed by times it doesn’t until the next peak, or any other problems — check your pills!

You can tell the difference by closely looking at the capsules. The OROS capsules are a unique shape, a little more blunted than a standard capsule. If you look really closely at the ends, you will find that one has a “dimple” where there is a small hole covered by a thin layer matching the rest of the capsule. I just happen to have at least one of three dosages.

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So if any medicine doesn’t work like it used to, look closely at the pill itself to see if it is the same as previously. If you don’t have any left, ask the pharmacy for the company / maker of the medicines you’ve filled over the past several months.

Let your doctor know if you can’t use a substitution so they can specify “Watson brand only.”  If the new “brand” works better, be sure to ask for that manufacturer.

Do not ask your physician to simply increase dosing, because with the next prescription you might get the OROS pill, and the new dose will be too high.

Ask which manufacturer makes the generic for Concerta sold at your pharmacy. Watson Pharmaceuticals is the one that is approved by Ortho McNeill Janssen Pharmaceuticals to market the OROS system pills.

Mallinckrodt markets another type (not OROS) in the US. If your pharmacy doesn’t use your preferred pill type and you plan to shop elsewhere, be sure to let them know why!

 

Reporting Adverse Events: If you have an issue with the duration of action of a different brand of Methylphenidate HCl you should report it to the FDA. This will allow them to review cases and possibly stop the substitution of these non-equivocal products. Click on this link for the MedWatch Report.

Resources:

The Pre-MMA 180-Day Exclusivity Punt? What Gives? A legal blog explaining how medicines lose their exclusivity and can become generically available, specifically the Concerta dispute.

How To Tell The Difference Between Concerta and Generic Concerta A Canadian ADHD blog provided the picture of how to recognize the difference. Generic formulations have been available in Canada years prior to in the US.

Special thanks to the members of the Child-Pharm listserv!

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Why Feeding Your Child With A Spoon Is Better For Her Development

Written by Jesse Hackell MD

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Growing up in the sixties, outer space was truly the final frontier. We greedily devoured all sorts of arcane facts about the nascent space program, from the rigors of pre-flight training to the seemingly more mundane details of how, exactly, one managed to eat and drink in the zero-gravity confines of outer space.

We knew that the astronauts drank Tang, which no self-respecting parent today would ever mistake for fresh-squeezed, locally sourced, organic and pesticide-free orange juice.

And astronaut foods were freeze-dried, and provided in pouches. When water was added to the pouches, the food was rehydrated and reconstituted, and the space explorers “ate” by sucking the resulting slurry out of the mouthpiece of the pouch.

Fast forward fifty years, and pouches aren’t just for astronauts any more. All sorts of fruits, vegetables and combinations thereof, in flavors which would certainly have thrilled early spacemen, are now seemingly the food deliver mechanism of choice for today’s on the move infants and toddlers.

No longer does feeding your baby on the go require a high chair, bib, bowl, spoon and yards of paper towels for clean-up.

Just pop off the top (don’t hand the top to the baby, although the caps are ingeniously designed to prevent choking should the little one happen to get hold of it and have it lodge in the airway), hand the pouch to your child, and–slurp–4 ounces of highest quality, organic produce goes down the hatch.

That’s progress, no? One prediction of the future made in the sixties actually coming true in the twenty-first century!

But I am not so sure that this new feeding mechanism actually represents progress for babies. They are born knowing how to suck nutrition out of a “container”–breast or bottle.

Progress in feeding, for an infant, comes not only in learning about new tastes and textures, but also in learning about new, more mature means of getting their comestibles out of the container and into their mouths.

These pouches (along with so called “sippy cups” with spouts) are really just bottles in disguise. (They are also a whole lot more expensive than either store-bought jars or homemade baby foods.) We do not generally recommend putting puréed foods in baby’s bottle, so why create a new bottle substitute?

Let me make a plea for a return to the older, admittedly messier, mealtime, with the baby sitting upright, wearing a bib, and being fed with a spoon. It will encourage the baby to learn new mouth movements and new positions for eating. And it will provide lots of opportunities for those adorable, messy face baby photographs!

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

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Why don’t you have separate sick and well waiting rooms?

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Written by Suzanne Berman MD. Dr. Berman is a practicing general pediatrician in rural Tennessee.

We’re occasionally asked by families why we don’t have separate waiting rooms for sick and well patients.  It’s a good question, especially given that many pediatric offices are designed this way.  There are several reasons why we chose not to do this.

 What ‘s a “sick” visit vs. a “well” visit?  

The first problem is one of definition.   While some kids are very clearly sick and other kids are clearly well, many of the visits we do don’t fit nearly into one category or another.  Is a depressed teenager “sick” or “well” ?

What about a 4 year old with a possible urinary tract infection?   An infant who’s not gaining weight?  An 8-year-old with belly pain?   A better way to separate the waiting rooms would be a “contagious” waiting room and a “noncontagious” waiting room.

However…

Parents often don’t know whether a child is contagious or not when they check in.  

We don’t expect them to be – that’s our job.   If a child comes in with a new rash, it might be eczema (not contagious at all), chickenpox (very contagious), or ringworm (only very mildly contagious, and certainly not enough to keep them out of school or sports.)   Fifth disease is contagious and causes a rash – but once the rash appears, the child is no longer contagious.

Knowing whether the child is contagious (and how contagious, and for how long) first requires a medical evaluation – and that happens after the child has been brought back, not in the waiting room.

What about siblings? 

We often see double or triple appointments in a family.   If Dad brings in a 6-month-old baby for a checkup (a well visit) and his two year old sister for a cough (a sick visit), what side of the waiting room should the whole family sit on?

We could put the well baby on the sick side (since he’s already been exposed to the two year old’s illness, presumably), or we could put the sick child on the well side (to keep the well baby well.)   There’s no good answer.

And I can’t put a number on the times I’ve seen a well child who was accompanied by a parent who was coughing and sneezing uncontrollably.

It actually can make crowding in the waiting room worse.

Our office’s single large waiting area measures about 20 x 30 feet.   Let’s say we divided it in half, to create separate sick and well waiting areas, each about 20 x 15 feet.

In the summer, when 70 percent or more of our visits are “well,” our patients would be crammed in a much smaller room while our “sick room” would be underutilized.

The exact opposite would be true in the winter months –a crowded waiting room of sick children half as big as it could be.   When we have a single large area, we can make the most of our space; families can sit wherever they wish, near or far away from anyone else in the waiting room.

Parents are sometimes not honest about their child’s contagious condition.

I once reviewed a malpractice case in which the plaintiff contended that the defendant pediatrician didn’t recognize a baby’s sickness. The defendant’s attorney asked the plaintiff’s grandmother (who had brought the baby to the office) whether the grandmother chose the sick or well side.

The grandmother said, “We sat on the well side.”  The defendant’s attorney asked, “If the baby was sick, as you say, why did you sit on the well side?”   The grandmother replied, “Well, she wasn’t very sick at the time – just a little sneezing and cough.  And I didn’t want her catching something from the sick side.”

Honest parents will admit that they’re usually more concerned about keeping their own child away from other sick children, rather than worried that other well children will catch their child’s illness.

Our receptionists don’t want to police the waiting rooms.

Colleagues with separate sick and well waiting rooms tell me that their receptionists spend at least part of each day helping parents decide which waiting room to sit in, moving patients from one waiting room to another, or settling angry squabbles between two families who are convinced the other’s child is in the “wrong” area.

Our receptionists would rather check in patients quickly – validating insurance information, updating phone numbers, and processing questionnaires — rather than serving as “waiting room police.”

There’s no evidence separate sick and well waiting rooms make a difference in controlling the spread of infection.

The American Academy of Pediatrics’ statement on controlling infection in pediatric offices states, “No studies document the need for, or benefit of, separate waiting areas for well and ill children.”

We believe that other commonsense precautions are more effective – like making masks, tissues, and hand sanitizer available in the waiting room; bringing children suspected of having an extremely contagious disease in through the back door; bringing extremely fragile/susceptible children back as soon as they enter the office.

When Should You Allow Your Child to Have A Cell Phone

This is a very common question from parents. I know my wife and I had to answer this question not too long ago.

Funny thing is, that our parents, and our parents, parents, didn’t have to answer this question. I find that fascinating. But our world is different now.In more ways than one.

Makes me wonder the type of questions they will have to ask themselves as parents 20 or 30 years from now. I can’t even imagine.

In this video, Dr. Wendy Sue Swanson from Seattle Mama Doc talks about when we should allow our children to have a cell phone.

Dr. Swanson practicing pediatrician and the mother of two young boys. She sees patients at The Everett Clinic in Mill Creek, Washington. She is also on the medical staff at Seattle Children’s and am a Clinical Instructor in the Department of Pediatrics at the University of Washington.

Dr. Swanson is passionate about improving the way media discusses pediatric health news and influences parents’ decisions when caring for their children. Dr. Swanson blogs regularly at Seattle Mama Doc

Quick Tips To Avoid Health Issues Associated With Winter

Written by Richard Lander, MD

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Winter is here and as the song says, “baby it’s cold outside”. Here are a few quick tips to avoid some health issues commonly associated with winter.

First of all, make sure your children are dressed appropriately for the cold weather. That doesn’t just mean a warm coat or layering of clothes.

Since heat is lost from the top of our heads, have your child put on a hat on their head. Also, put a scarf or face mask and be sure to protect hands and fingers from getting wet and/or cold.

Gloves help protect the skin on  hands which tends to get dry.

When skin becomes too dry, your child’s hands may become cracked making the skin more susceptible to infection.

Be aware of frostbite. This is caused when the skin has become so cold that the circulation to the fingers is compromised.

The skin becomes pale or grayish in color and may blister. Next your child may lose feeling in her fingers. If your are worried that this has happened, place your child’s hands in warm water, about 104 degrees, which is average bath water.

Then carefully pat them dry and place them on dry warm cloths. If this happens to their nose, use warm, wet compresses initially,  but be careful not to rub and then use warm dry compresses.

Often playing outside in the cold weather leaves your child’s clothes wet. Take off the wet clothes as soon as they return inside, put on warm, dry clothes and drink warm liquids, such as soup, hot chocolate.

If you and your children are spending extended periods of time outside, remember to keep yourself hydrated; drink lots of fluids.

There are many outdoor activities to enjoy during the winter months, such as skiing, ice skating and sledding.

Make sure your equipment (skis, snowboards, blades on the ice skates or the runner of the sled) are in good condition and that your children have not outgrown them.

If they are taller this year you might need longer ski poles. Perhaps their feet have grown since last year and their ski boots or ice skates are too small.

Does their helmet still fit properly?

If the children are going to use a sled, make sure the the steering works and tell them to go down feet first, not head first.

Parents, when sending your children to the bus stop remember that it is dark and cold outside. Remind your children to stay on the sidewalk and look both ways before crossing the street.

A brightly colored scarf, hat or gloves is a great way to ensure that they are visible in the dark.

Winter is a fun time of the year. Be safe and be smart.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician

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Will Having a Baby Stand Make Them Bow Legged?

Written by Kristen Stuppy MD. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.

I am surprised how often I am asked if having a baby “stand” on a parent’s lap will make them bow legged or otherwise hurt them.

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Allowing babies to stand causing problems is one of those tales. If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs it will not harm the baby.

Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them. Supported standing can help build strong trunk muscles.

Other fun activities that build strong muscles in infants:

Tummy time: Place baby on his tummy on a flat surface that is not too soft. Never leave baby here alone, but use this as a play time. Move brightly colored or noisy objects in front of baby’s head to encourage baby to look up at it. Older siblings love to lay on the floor and play with baby this way!

Lifting gently: When baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. Baby will get stronger neck muscles by lifting his head. Be careful to not make sudden jerks and to not allow baby to fall back too fast.

Kicking: Place baby on his back with things to kick near his feet. Things that make a noise or light up when kicked make kicking fun! You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.

Sitting: Allow baby to sit on your lap or the floor with less and less support from you. An easy safe position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V”. When fairly stable you can put pillows behind baby and supervise independent sitting.

Chest to chest: From day one babies held upright against a parent’s chest will start to lift their heads briefly. The more this is done, the stronger the neck muscles get. This is a great cuddle activity too!

What were your favorite activities to help baby grow and develop strong muscles?