Geeklog Site

Croup

Thu, 24 Jan 2008 21:24:16 -0500

Definition

Croup is a viral infection of the vocal cords, voice box (larynx), and windpipe (trachea). It is usually part of a cold. Croup usually lasts for 5 or 6 days and is worst at night. It can change from mild to severe several times, and the worst symptoms are seen in children under the age of three. A hoarse voice and tight, low-pitched, barky cough occurs. In severe cases, a harsh, raspy, vibrating sound called stridor occurs during breathing, and inhalation becomes difficult.

First Aid for Attacks of Stridor with Croup

If your child suddenly develops stridor or tight breathing, try the following first aid techniques. Most children settle down after these treatments and sleep through the night.
Inhalation of Warm Mist. Warm, moist air seems to work best to relax the vocal cords and break the stridor. Have your child breathe through a warm, wet washcloth
placed loosely over the mouth and nose. Alternatively, fill a humidifier with warm water and have your child breathe deeply from the stream of humidity.
The Foggy Bathroom. Have a hot shower running with the bathroom door closed. Once the room is fogged up, take your child in for at least 10 minutes to help relieve the stridor.

Home Care for a Croupy Cough

Humidifier. Dry air usually makes coughs worse. Keep the child’s bedroom humidified if you have a humidifier. Run the humidifier 24 hours daily, or have wet sheets or towels hanging in your child’s room.
Warm, Clear Fluids for Coughing Spasms. Sticky mucus caught on the vocal cords often causes coughing spasms. Warm apple juice, herbal tea, or lemonade may help relax the vocal cords and loosen the mucus.
Avoid Smoke Exposure. Smoke can worsen croup, so do not let anyone smoke around your child.
Cough Medicine. Medicines are less helpful than either mist or swallowing warm fluids. Older children (over 4) can be given cough drops for the cough, and younger children can be given up to 1 teaspoon of corn syrup. Acetaminophen or ibubrofen can be used to relieve a fever.
Close Observation. Observe your child carefully, especially during sleep as croup can be a dangerous disease.
Contagiousness. The viruses that cause croup are contagious until the fever is gone or at least until 3 days into the illness. Since spread of this infection can’t be prevented, your child can return to school or child care once they feel better.

Call our Office IMMEDIATELY if . . .

Breathing becomes difficult when your child is not coughing.
Your child develops drooling, spitting, or difficulty swallowing.
Your child develops retractions (tugging in) between the ribs.
The warm mist fails to clear up stridor in 20 minutes.
Your child starts acting very sick.

Call our office during regular hours if . . .

A fever lasts more than 3 days.
Croup lasts more than 10 days.
You have other questions or concerns.

Constipation

Thu, 24 Jan 2008 21:15:54 -0500

Definition

Constipation is often due to a diet that does not include enough fiber. Drinking or eating too many milk products can cause constipation. It’s also caused by repeatedly waiting too long to go to the bathroom.

If constipation begins during toilet training, the parent may be applying too much pressure. Changes in the diet usually relieve constipation. Sometimes trauma to the anal canal during constipation causes an anal fissure. This is confirmed by finding small amounts of blood on the toilet tissue or on the stool surface. Symptoms include:

Painful passage of stools: The most reliable sign of constipation is discomfort with the passageof a bowel movement (BM).
Inability to pass stools: These children feel a desperate urge to have a BM, have discomfort in the anal area, but are unable to pass a BM after straining and pushing for more than 10 minutes.
Infrequent movements: Going 3 or more days without a BM can be considered constipation, even though this may cause no pain in some children and even be normal for a few. (Exception: After the second month or so of life, many breast-fed babies pass normal, large, soft BMs at infrequent intervals without pain.)

Common Misconceptions. Large or hard BMs unaccompanied by any of the conditions just described are usually normal variations in BMs. Some normal people have hard BMs daily without any pain. Children who eat large quantities of food pass extremely large BMs. Babies less than 6 months of age commonly grunt, push, strain, draw up the legs and become flushed during BMs. However, they don’t cry.
Home Treatment

Diet Treatment for Infants.

If your baby is under 2 months of age, try 1 teaspoon of dark Karo syrup twice a day.

If over 2 months old, give fruit juices twice each day (pear, prune).

If over 4 months old, add strained foods with a high fiber content, such as cereals, apricots, prunes, peaches, plums, beans, peas or spinach twice each day.

Strained bananas and apples are neither helpful nor constipating.

Diet Treatment for Older Children

Make sure that your child eats fruits or vegetables at least three times each day. Someexamples are prunes, figs, dates, raisins, peaches, pears, apricots, beans, celery, peas, cauliflower, broccoli, and cabbage.

Increase bran, because it is an excellent natural stool softener because it has a high fiber content. Make sure that your child’s daily diet includes a source of bran, such as unmilled bran, bran flakes, shredded wheat, graham crackers, oatmeal, or whole wheat bread or popcorn.

Decrease consumption of constipating foods, such as milk, ice cream, yogurt, cheese, and cooked carrots.

Increase the amount of fruit juices your child drinks. Orange juice is not as helpful as the others, like apple and prune.

Sitting on the Toilet. Encourage your child to establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast. Some children and adults repeatedly get blocked up if they don’t do this. If your child is resisting toilet training by holding back, stop the toilet training for awhile and put them back in diapers or pull-ups.
Stool Softeners. If a change in diet doesn’t relieve the constipation, give your child a stool softener with dinner every night for a week. Stool softeners are not habit forming. They work 8 to 12 hours after they are taken. Examples of stool softeners that you can buy without a prescription are Haley’s M-O, Metamucil, or Citrucel.
Measures for Acute Rectal Pain. If your child has acute rectal pain needing immediate relief, one of the following will usually provide quick relief: sitting in a warm bath to relax the anal sphincter, a glycerine suppository, gentle rectal stimulation for 10 seconds with a thermometer, or gentle rectal dilation with a lubricated finger.

Call our Office IMMEDIATELY if . . .

Your child develops severe rectal or abdominal pain.

Call our office during regular hours if . . .

Your child does not have a BM after 3 days on the new diet.
You have other questions or concerns.

Bronchiolitis

Thu, 24 Jan 2008 21:05:47 -0500

Definition

Wheezing: a high pitched whistling sound produced during breathing out
Rapid breathing with a rate of over 40 breaths/minute
Tight breathing (your child has to push the air out)
Coughing, often with very sticky mucus
Onset of lung symptoms often preceded by fever and a runny nose
Lots of sticky nasal mucus is a problem
An average age of 6 months
Symptoms similar to asthma
This diagnosis must be confirmed by a physician

Cause

The wheezing is caused by a narrowing of the smallest airways in the lung (bronchioles). This narrowing results from inflammation (swelling) caused by any of a number of viruses, usually the respiratory syncytial virus (RSV). RSV occurs in epidemics almost every winter. Whereas infants with RSV develop bronchiolitis, children over 2 years of age and adults just develop cold symptoms. This virus is found in nasal secretions of infected individuals. It is spread by sneezing or coughing at a range of less than 6 feet or by hand-to-nose or hand-to-eye contact. People do not develop permanent immunity to the virus.

Expected Course

Wheezing and tight breathing (difficulty breathing out) become worse for 2 or3 days and then begin to improve. Overall, the wheezing lasts approximately 7 days and the cough about 14 days. The most common complication of bronchiolitis is an ear infection, occurring in some 20 % of infants. Bacterial pneumonia is an uncommon complication. Only 1% or 2% of children with bronchiolitis are hospitalized because they need oxygen or intravenous fluids.

In the long run, approximately 30% of the children who develop bronchiolitis go on to develop asthma. Recurrences of wheezing (asthma) occur mainly in children who come from families where close relatives have asthma. Asthma is very treatable with current medications.

Home Treatment for Bronchiolitis

Medicines. Some children with bronchiolitis respond to asthma medicines; others do not. Your child’s medicine is____________. Give ___________________ every ________________hours. Continue the medicine until your child’s wheezing is gone for 24 hours. In addition, your child can be given acetaminophen every 4 to 6 hours if the fever is over 102°F (39°C).
Warm Fluids for Coughing Spasms. Coughing spasms are often caused by sticky secretions in the back of the throat. Warm liquids usually relax the airway and loosen the secretions. Offer warm lemonade, warm apple juice or warm herbal tea if your child is over 4 months old. In addition, breathing warm moist air helps to loosen the sticky mucus that may be choking your child. You can provide warm mist by placing a warm wet washcloth loosely over your child’s nose and mouth, or you
can fill a humidifier with warm water and have your child breathe in the warm mist it produces. Avoid steam vaporizers because they can cause burns.
Humidity. Dry air tends to make coughs worse. Use a humidifier in your child’s bedroom. The new ultrasonic humidifiers not only have the advantage of quietness, but also kill molds and most bacteria that might be in the water.
Nasal Washes for a Blocked Nose. If the nose is blocked up, your child will not be able to drink from a bottle or nurse. Most stuffy noses are blocked by dry or sticky mucus. Suction alone cannot remove dry secretions. Warm tap water or saline nose drops (nasal washes) are better than any medicine you can buy for loosening up mucus. Place three drops of warm water or saline in each nostril. After about 1 minute, use a soft rubber suction bulb to suck it out. You can repeat this procedure several times until your child's breathing through the nose becomes quiet and easy.
Feedings. Encourage your child to drink adequate fluids. Eating is often tiring, so offer your child formula or breast milk in smaller amounts at more frequent intervals. If your child vomits during a coughing spasm, feed the child again.
No Smoking. Tobacco smoke aggravates coughing. The incidence of wheezing increases greatly in children who have a RSV infection and are exposed to passive smoking. Don’t let anyone smoke around your child. In fact, try not to let anybody smoke inside your home.

Call Our Office Immediately if...

Breathing becomes labored or difficult.
Breathing becomes faster than 60 breaths/minute (when your child is not crying).
Your child starts acting very sick.

Within 24 hours if...

There is any suggestion of an earache.
A fever lasts more than 3 days.
You have other questions or concerns.

Blocked Tear Duct

Thu, 24 Jan 2008 20:59:10 -0500

Definition

Continuously watery eye
Tears running down the face even without crying
During crying, nostril on blocked side remains dry
Eye not red and eyelid not swollen
This diagnosis must be confirmed by a physician

Cause

A blocked tear duct is an obstruction of the channel that carries the tears from the eye to the nose. It is present at birth, but an onset of the symptoms is often delayed in babies until 3 or 4 weeks of age. This is a common condition, and often both sides are blocked. Over 90% of blocked tear ducts open spontaneously by the time the child is 12 months of age. If the obstruction persists beyond 12 months of age, an ophthalmologist can open it with a special probe.

Home Care for preventing eye infection

Because of poor drainage, eyes with blocked tear ducts become easily infected. The infected eye produces a yellow discharge. To keep the eye free of infection, gently massage the lacrimal sac twice a day to empty it of old fluids. The lacrimal sac is located in the inner lower corner of the eye. Start at the inner corner of the eye and press upward using a cotton swab. A small amount of clear fluid should come out. Always wash your hands carefully first. If the eye becomes infected, it is very important to begin antibiotic eye drops.

Call our office IMMEDIATELY if . . .

The eyelids are red or swollen.
A red lump appears at the inner lower corner of the eyelid.

Call our office during regular hours if . . .

Lots of yellow discharge is present.
Your child reaches 12 months of age and the eye is still watering.
You have other concerns or questions.

Anemia, Iron Deficiency

Thu, 24 Jan 2008 20:55:27 -0500

Definition

Anemia means that the number of red blood cells in your child’s body is below normal. The red blood cells carry oxygen in the bloodstream, and iron is needed for the body to produce red blood cells. Anemia is caused by too little iron in the diet. A physician must confirm this diagnosis.

Home Treatment

The iron medicine for your child is _______________. Your child’s dose is _____ mL, given _____ times each day for _____ weeks. This medicine contains iron and will need to be taken for 2 to 3 months to get your child’s red blood cell level back to normal. It can occasionally cause an upset stomach and should be taken with food to prevent this. Mix the iron medicine with a juice containing vitamin C to improve iron absorption and prevent staining of the teeth. (Note: If staining occurs, use baking soda to brush it off. The iron may
change the color of bowel movements to greenish-black, but this is harmless.) Too much iron can be dangerous and cause serious poisoning. Keep this medicine out of your child’s reach.

Diet

If your child’s diet is well balanced, he won’t get anemia again. Meats, fishes, and poultry have the most iron. Raisins, dried fruits, sweet potatoes, lima beans, kidney beans, chilli beans, and pinto beans, green peas, peanut butter, enriched cereals, and breads are also iron-rich foods. Milk does not contain any iron. Your child should not drink more than three glasses of milk a day, so he will have an adequate appetite for iron-containing foods.

Follow-up Visits

We would like to see your child in ______________ to ensure that the red blood cell level has returned to normal.

Call our office during regular hours if . . .

Your child refuses the iron medicine.
You have other concerns or questions.
Page 1 of 1Pediatric and Young Adult Medicine, P.A. - Baby Steps

Anal Fissure

Thu, 24 Jan 2008 20:49:29 -0500

Definition

An anal fissure is a shallow tear or crack in the skin at the opening of the anus. More than 90% of children with blood in their stools have an anal fissure. Trauma to the anal canal during constipation is the usual cause of anal fissures. The main symptoms are as follows:

The blood is bright red, and in streaks or flecks.

The blood is on the surface of the stool or on the toilet tissue after wiping.

Your child usually passes a large hard bowel movement just before the bleeding starts.

You may see a shallow tear at the opening of the anus when the buttocks are spread apart (this cannot always be seen).

Touching the tear causes mild pain.

Home Care

Warm Saline Baths. Give your child warm baths for 20 minutes, 3 times each day. Have him sit in a basin or tub of warm water with about 2 ounces of table salt or baking soda added. Don’t use any soap on the irritated area. Then gently dry the anal area.
Ointments. If the anus seems irritated, you can apply 1% hydrocortisone ointment. If the pain is severe, apply 2.5% Xylocaine or 1% Nupercainal ointment (no prescription needed) 3 times each day for a few days to numb the area.
Diet. The most important aspect of treatment is to keep your child on a nonconstipating diet. Increase the amounts of fresh fruits and vegetables, beans, and bran products that your child eats. Reduce the amounts of milk products your child eats or drinks. Occasionally, a stool softener is needed temporarily.

Call our office during regular hours if . . .

The bleeding increases in amount.
The bleeding occurs more than two times after treatment begins.
You have other concerns or questions.

Child Immunization Schedule

Thu, 24 Jan 2008 18:37:00 -0500

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of 11/1/00, for children through 18 years of age. Additional vaccines may be licensed andrecommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and itsother components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Infants born toHBsAg-negative mothers should receive the 1st dose of hepatitis B (Hep B) vaccine by age 2 months. The 2nd dose should be at least one month after the 1st dose. The 3rd dose should be administered at least 4 months after the 1st dose and at least 2 months after the 2nd dose, but not before 6 months of age for infants.
Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5mLhepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The 2nd dose is recommended at 1-2 months of age and the 3rd dose at 6 months of age.
Infants born to mothers whoseHBsAgstatus is unknown should receive hepatitis B vaccine within 12 hours of birth. Maternal blood should be drawn at the time of delivery to determine the mother'sHBsAgstatus; if theHBsAgtest is positive, the infant should receive HBIG as soon as possible (no later than 1 week of age).
All children and adolescents who have not been immunized against hepatitis B should begin the series during any visit. Special efforts should be made to immunize children who were born in or whose parents wereborn in areas of the world with moderate or highendemicityof hepatitis B virus infection.
The 4th dose of DTaP (diphtheria and tetanustoxoidsandacellularpertussis vaccine) may be administered as early as 12 months ofage, provided 6 months have elapsed since the 3rd dose and the child is unlikelyto return at age 15-18 months. Td (tetanus and diphtheriatoxoids) is recommended at 11-12 years of age if at least 5 years have elapsed since the last dose of DTP, DTaP or DT. Subsequent routine Td boosters are recommended every 10 years.
Three Haemophilus influenzaetype b (Hib) conjugate vaccines are licensed for infant use. IfPRP-OMP (PedvaxHIB®orComVax®[Merck]) is administered at 2 and 4 months of age, a dose at 6 months is notrequired. Because clinical studies in infants have demonstrated that using some combination products may induce a lower immune response to the Hib vaccine component, DTaP/Hib combination products should not be used for primary immunization in infants at 2, 4 or 6 months of age, unless FDA-approved for these ages.
An all-IPV schedule is recommended for routine childhood polio vaccination in the United States. All children should receive four dosesof IPV at 2 months, 4 months, 6-18 months, and 4-6 years of age. Oral polio vaccine (OPV) should be used only inselected circumstances. (See MMWR May 19, 2000/49(RR-5);1-22).
The heptavalent conjugate pneumococcal vaccine (PCV) is recommended for all children 2-23 months of age. It also is recommended for certain children 24-59 months of age. (See MMWR Oct. 6, 2000/49(RR-9);1-35).
The 2nd dose of measles, mumps, and rubella (MMR) vaccine is recommended routinely at 4-6 years of age but may be administered during any visit, provided at least 4 weeks have elapsed since receipt of the 1st dose and that both doses are administered beginning at orafter 12 months of age. Those who have not previously received the second dose should complete the schedule by the 11-12 year old visit.
Varicella (Var) vaccine is recommended at any visit on or after the first birthday for susceptible children, i.e. those who lack a reliable history of chickenpox (as judged by a health care provider) and who have not been immunized. Susceptible persons 13 years of age or older should receive 2 doses, given at least 4 weeks apart.
Hepatitis A (Hep A) is shaded to indicate its recommended use inselected states and/or regions, and for certain high risk groups; consult your local public health authority. (See MMWR Oct. 1, 1999/48(RR-12); 1-37). For additional information about the vaccines listed above, please visit the National Immunization Program Home Page at http://www.cdc.gov/nip/or call the National Immunization Hotline at 800-232-2522 (English) or 800-232-0233 (Spanish).

Air Bag Safety: Children in back!

Wed, 23 Jan 2008 18:40:02 -0500

Everyone Buckle Up!
An infant or child riding in the front seat can be seriously injured or killed by the inflating air bag.

An air bag is not a soft pillow. To do its important job, an air bag comes out of the dashboard very fast, faster than the blink of an eye. Many people’s lives have been saved by air bags, but the force of an air bag can hurt people who are close to it. Drivers can prevent injuries to adults and children from air bags by following these safety steps.

Air Bag Safety Steps

Infants in rear-facing child safety seats must never ride in the front seat of a vehicle with a passenger air bag.
Children twelve and under should ride buckled up in the rear seat. The should use child safety seats, booster seats, or safety belts appropriate for their age and size.
Everyone should buckle up with both lap AND shoulder belts on every trip. Driver and front passenger seats should be moved as far back from the dashboard as practical.
Infants under age one must face rearward and ride in the back seat. Parents should feel just as comfortable as when they put their babies down for a nap and leave the room.
If a baby has health needs and requires special supervision, ask another adult to ride with the baby in the back seat and travel alone as little as possible until the health problem is resolved.
Check your vehicle owner’s manual and the instructions provided with your child safety seat for information on air bags and safety seat use.

Why have children died in vehicles with air bags?

     In almost all cases in which an infant died, the baby was riding in a rear-facing safety seat in the front passenger seat. The back of the safety seat was so close to the dashboard that the air bag hit the safety seat with tremendous force. The force broke the back of the safety seat and caused a fatal brain injury. Child safety seats are NOT designed to protect against this extreme impact.
     In almost all cases in which a child over age one has died from impact by the air bag, he or she was “out of position” – either unbuckled or not wearing the shoulder portion of the safety belt. The child slid or flexed forward during pre-crash braking, so the head and neck were close to the dashboard at the time the airbag was triggered. Severe head or neck injuries occurred.
     If a child is sitting against the seat back, fully restrained by a forward-facing child safety seat or a lap/shoulder belt AND the seat is pushed all the way back, the danger from the air bag is reduced.

What about sports cars and pickup trucks?

If there is no rear seat and no air bag shut-off switch, a child is at high risk from an air bag. Some pickup trucks made since the 1996 models have switches to shut off the passenger air bag. Other vehicles may have them in future years. Turning off the switch is the best way to protect an infant riding in a rear-facing safety seat or an older child using a safety seat, booster, or safety belt.

What if you have no alternative except putting a child in front?
If there is no room in back, a child over age one may have to ride in the front seat. Here is how to reduce the
risk:

Make sure the child is correctly buckled up with the seat moved as far back as possible. A toddler/preschooler should use a forward-facing child safety seat; an older child should use a belt- positioning booster or lap/shoulder belt.
Fasten the harness or lap/shoulder belt securely.
Make sure an older child does not slip out of the shoulder belt or lean toward the dashboard.

Vehicle owners and lessees can obtain an on/off switch for one or both of their air bags only if they can certify that they are, or a user of their vehicle is, in one of the four risk groups: Infants in rear-facing safety seats, drivers or passengers with unusual medical or physical conditions, children ages 1 to 12, or drivers who cannot get back 10 inches from the air bag cover. To be considered eligible for an on/off switch, a NHTSA request form must be filled out and returned to NHTSA. Forms are available from state motor vehicle offices and may be available from automobile dealerships and repair facilities. Forms can also be requested by contacting NHTSA’s Auto Safety Hotline at 1-888-DASH-2-DOT or visiting the web site at
http://www.nhtsa.dot.gov.

Overweight: A Weight-Reduction Program

Wed, 23 Jan 2008 18:23:00 -0500

Definition

Your child appears overweight to an objective person.
Your child weighs more than 20% over the ideal weight for his/her height.
The skinfold thickness (fat layer) of your child’s upper arm is more than 1 inch (25mm), as measured with a special instrument.
More than 25% of American children are overweight.

Causes

The tendency to be overweight is usually inherited. If one parent is overweight, half of the children will be overweight. If both parents are overweight, most of their children will be overweight. If neither parent is overweight, the children have a 10% chance of being overweight.
Heredity alone (without overeating) accounts for most mild obesity (defined as less than 30 pounds overweight in an adult). Moderate obesity is usually due to a combination of heredity, overeating, and underexercising. Some overeating is normal in our society, but only those who have the inherited tendency to be overweight will gain significant weight when they overeat. It is therefore not reasonable to blame your child for being overweight.
Less than 1% of obesity has an underlying medical cause. Your physician can easily determine this by a simple physical examination.

Expected Course

Losing weight is very difficult. Keeping the weight off is also a chore. The best time for losing weight is when a child is over 15 years old, that is, when he/she becomes concerned with appearance. The self- motivated teenager can follow a diet and lose weight regardless of what the family eats. Helping children lose weight between 5 and 15 years of age is very difficult because they have access to so many foods outside the home and are not easily motivated to lose weight. It is not quite as difficult to
help a child less than 5 years old to lose weight because the parents have better control of the foods offered to the child.

How to Help Older Children and Teenagers Lose Weight

Readiness and Motivation

Teenagers can increase their motivation by joining a weight-loss club such as TOPS or Weight Watchers. Sometimes schools have classes for helping children lose weight. A child’s motivation can often be improved if diet and exercise programs are undertaken by the entire family. A cooperative parent-child weight-loss program with individual goals is usually more helpful than a competitive with individual goals is usually more helpful than a competitive program focused on who can lose weight faster.

Protecting Your Child’s Self-esteem

Self-esteem is more important than an ideal body weight. If your child is overweight, he/she is probably already disappointed in himself. He needs his family to support him and accept him as he is. Self-esteem can be reduced or destroyed by parents who become over-concerned about their child’s weight. Avoid the following pitfalls:
- Don’t tell your child he’s fat. Don’t discuss his weight unless he brings it up.
- Never try to put your child on a strict diet. Diets are unpleasant and should be self-imposed.
- Never deprive your child of food if he says he is hungry. Withholding food eventually leads to overeating.
- Don’t nag him about his weight or eating habits.

Setting Weight-Loss Goals

Pick a realistic target weight, depending on your child’s bone structure and degree of obesity. The loss of 1 pound per week is an attainable goal, but your child will have to work quite hard to maintain this rate of weight loss for several weeks. Have your child weigh himself no more than once a week; daily weighings generate too much false hope or disappointment. Keeping a record of weekly weights may provide added motivation. When losing weight becomes a strain, have your child take a few weeks off from the weight-loss program. During this time, try to help your child stay at a constant weight.
Once your child has reached the target weight, the long-range goal is to try to stay within 5 pounds of that weight. Staying at a particular weight is possible only through permanent moderation in eating and maintaining a reasonable exercise program. Your child will probably always have the tendency to gain weight easily and it’s important that he understand this.

Diet: Decreasing Calorie Consumption

Your child should eat three well-balanced meals of average-size portions every day. There are no forbidden foods; your child can have a serving of anything family or friends are eating. However, there are forbidden portions. While your child is reducing, she must leave the table a bit hungry. Your child cannot lose weight if she eats until full (satiated).
Encourage average portions and discourage seconds. Shortcuts such as fasting, crash dieting, and diet pills rarely work and may be dangerous. Liquids diets are safe only if used according to directions. If you have any questions, consult a dietician.
Calorie counting is helpful for some people, but it is usually too time consuming. Consider the following guidelines on what to eat and drink:
- Fluids: Mainly use low-calorie drinks such as skim milk, fruit juice diluted in half with water, diet drinks, or flavored mineral water. Because milk has lots of calories, your child should drink no more than 16 ounces of skim or low-fat milk each day. Since fruit juices and 2% milk have similar calories per ounce, keep juice consumption to 8 ounces or less per day. All other drinks should be either water or diet drinks. Encourage your child to drink six glasses of water each day.
- Meals: Serve fewer fatty foods (for example, eggs, bacon, sausage, butter). A portion of fat has twice as many calories as the same portion of protein or carbohydrate. Trim the fat off meats. Serve more baked, boiled, or steamed foods and fewer fried foods. Serve more fruits, vegetables, salads, and grains.
- Desserts: Encourage smaller-than-average portions. Encourage more gelatin and fresh fruits as desserts. Avoid rich desserts. Do not serve seconds.
- Snacks: Serve only low-calorie foods such as raw vegetables (carrot sticks, celery sticks, raw potato sticks, pickles), raw fruits (apples, oranges, cantaloupe), popcorn, or diet soft drinks. Limit snacks to two each day.
- Vitamins: Give your child one multivitamin tablet daily during the weight-loss program.

Eating Habits

To counteract the tendency to gain weight, your youngster must be taught eating habits that will last for a lifetime. You can help your child lose weight and keep off unwanted pounds by doing the following:
- Discourage skipping any of the three basic meals.
- Encourage drinking a glass of water before meals.
- Serve smaller portions.
- Suggest chewing food slowly.
- Offer second servings only if your child has waited for 10 minutes after finishing the first serving.
- Don’t purchase high-calorie snack foods such as potato chips, candy, or regular soft drinks.
- Do purchase and keep available diet soft drinks and fresh fruits and vegetables.
- Leave only low-calorie snacks out on the counter – fruit, or example. Put away the cookie jar.
- Store food only in the kitchen. Keep it out of other rooms.
- Offer no more than two snacks each day. Discourage your child from continual snacking throughout the day.
- Allow eating in your home only at the kitchen or dining-room table. Discourage eating while watching television, studying, riding in the car, or shopping. Once eating becomes associated with these activities, the body learns to expect it.
- Discourage eating alone.
- Help your child reward herself for hard work or studying with a movie, television, music, or a book rather than food.
- Put up reminder cards on the refrigerator and bathroom mirror that state: Eat Less.

Exercise: Increasing Calorie Expenditure

Daily exercise can increase the rate of weight loss as well as the sense of physical well-being. The combination of diet and exercise is the most effective way to lose weight. Try the following forms of exercise:
- Walk or bike instead of riding in a car.
- Use stairs instead of elevators.
- Learn new sports. Swimming and jogging are the sports that burn the most calories. Your
- child’s school may have an aerobic class.
- Take the dog for a long walk.
- Spend 30 minutes daily exercising or dancing to records or music on television.
- Use an exercise bike or hula-hoop while watching television. (Limit television sitting time to 2 hours or less each day.)

Social Activities: Keeping the Mind off Food

The more outside activities your child participates in, the easier it will be for her to lose weight. Spare time fosters nibbling. Most snacking occurs between 3 and 6pm. Help your child fill after- school time with activities such as music, drama, sports or scouts. A part-time job after school may help. If nothing else, encourage your child to call or visit friends. An active social life almost always leads to weight reduction.

Call our office during regular hours if . . .

Your child has not improved his eating habits and exercise after trying this program for 2 months.
Your child is a compulsive overeater.
You find yourself frequently nagging your child about his eating habits.
Your child is trying to lose weight and doesn’t need to do so.
You think your child is depressed.
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Skar, Duane C - M.D.

Tue, 22 Jan 2008 20:00:00 -0500

Full Name

Date & Place of Birth

Marital Status

Duane Charles Skar

October 20, 1952
Bottineau, North Dakota

Married with 5 children

Education	University of Minnesota, Minneapolis, MN Major: Biochemistry Degree: Bachelor of Science, 1974 Publication: Skar, DC; Rohrbach, MS; Bodley, JW "Limited Trypsinolysis of Native Escherichia Coli Elongation Factor G" Biochemistry 14 3992-3926 (1975). George Washington University, Washington, D.C. Major: Biochemistry Degree: Master of Science, 1980 Thesis: Skar, DC "Simultaneous seperation of three naturally occuring cyclic nucleotides: Application to studies of endogenous labeling of cAMP and cGMP in lymphocytes following mitogenic simulation" Thesis George Washington University (1979). University of Minnesota, Minneapolis, MN Years Attended: 1980 - 1984 Honors: Zagaria Fellowship Oncology Research
Internship and Residency	Pediatrics University of Minnesota Hospitals, Minneapolis/St. Paul Dates: July 1984 - June 1987
Board Certification	Pediatrics, October 1989
Memberships	American Medical Association Minnesota Medical Association Ramsey County Medical Association
Professional	Pediatric and Young Adult Medicine (1987 - present) Active Staff: Children's Hospital of St. Paul, MN Utilization Review Committee Courtesy Staff: St. John's Northeast Hospital St. Joseph's Hospital Midway Hospital St. Paul Ramsey Hospital University of Minnesota Clinical Instructor (1988 - present)