Think of your precious baby’s nose as a greenhouse:  It needs moisture, warmth, air filtration, ventilation, and greenery.  The mucous lining of the nose provides the moisture.  This lining has tiny glands that supply the wet, slippery mucus that keeps the nose from becoming a crusted desert, and allows air to flow freely.  The body temperature and the small dark space in the nasal cavity provide the warmth.  The filtering is accomplished by both tiny nose hairs and by the slippery mucus (greenery), so that dust and dirt are not breathed directly into the lungs.  The hairs and mucus catch and collect particles, filtering them out from the air your baby breathes.  Ventilation is provided by the open nasal passage that connects the outside world to the back of the nose.

When your baby has a stuffy nose, the best method of treating your miserable munchkin is nasal saline.  Any brand will do, but I prefer the type that comes in a cylindrical bottle, which allows for a more sizable amount of saline to do the job, with more air pressure pushing that saline to where it needs to go.  There is no dangerous chemical or medication in saline, so it is safe to use in newborns as often as is necessary.  To use the spray, hold your baby upright, so that he won’t feel like saline is going down his throat.  Place the nozzle in one side of the baby’s nose, and gently squeeze the bottle a few times. Aim the bottle ‘back’ (not ‘up’), as the nasal air passage is actually parallel with a line between ones nose and ones ear, not up towards ones forehead.  Repeat on the other side.  Most of the saline will drip back out, but some of it will go where it’s needed.  Most babies will hate this, and so, therefore, will you. But give it a few tries.  Many babies actually get used to this routine, and, when they get unstuffed, they feel better.  A cool mist humidifier in your baby’s room (or your room if he is sleeping there) may also help, especially at night time, to keep those linings moist.  Make sure you read the package insert instructions on how best to keep your humidifier clean, and avoid using any menthol or medicated additives to the water tank.

Most newborns leave the hospital with a few extra diapers, some travel-sized bath wash, and a suction bulb for nasal suctioning.  While these suction bulbs are great, I would discourage the immediate use of one for a stuffy newborn.  Most newborns are stuffy because their delicate nasal tissues are a bit swollen.  The suction bulb pressure will only cause more swelling, and more stuffiness. If you don’t see gobs of mucus coming out, steer clear of the suction bulb, and try the saline first.  If there is a lot of mucus that you can SEE, then gentle suctioning (quick, small puffs) will help your baby clear his mucus.  Follow the suctioning with a saline chaser.  This will ‘irrigate’ that runny nose, and flush out the mucus that the suction missed.

While newborns rely on those tiny nasal air passages for their breathing, and the snorting, grunting noises they make when there is some blockage may sound terrible, what is most important is how your baby is doing overall.  If your baby is making these noises, but is sleeping comfortably, and is eating and gaining weight, any nasal stuffiness will likely be short-lived and easily treated with over-the-counter nasal saline, a humidifier, and time.   If none of the treatments seem to be working, ask your doctor about considering a referral to a specialist for further evaluation.

- Nina L. Shapiro, MD

In the weeks leading to it, I had a few chats with my daughter about it.  I explained that she’d have a few shots near her teeth, but after that she’d just feel a little weird pressure. I’d be there the whole time, and she’d be back at day camp in time for archery. She was easy to convince.  Here’s why:  First of all, I know her.  Better than anyone else, except her, of course.  I knew she’d sail through.  Second, she knows what shots are for, and medicine, for that matter. Not because I’m a doctor, but because she knows that they’re necessary.  She also knows that they hurt, but just for a second.  No sugarcoating, because sometimes I don’t have a sugar cube with me at a doctor’s visit.   Just matter-of-fact.  No drama.

Am I mean and terrible?  Cruel to my kids?  Some may say so, but I really don’t think so.  There is so much controversy about vaccines, but the hype focuses on the risks and potential side effects.  The reality is that parents don’t like to feel guilty about allowing their kids to be hurt.  Point taken.  I hate when my kids are hurt.  I hate it when they fall, are ill, or, the biggest dagger of all, when their emotions are toyed with.  That pain is worse than any shot.   But shot crying never really gets to me.  For my generation and theirs, until ‘needle-less’ injections are the norm, those pinpricks are a necessary evil, in order to protect them, or even to ease their pain.

I think because I’ve always taken a pretty casual attitude about ‘shots at the doctor’, that my kids do the same.  They know it’s pretty likely that they’ll get at least one at each check-up.  They know that I get them too (flu shots and pertussis boosters), and I even try to have them come with me and hold my hand when I get a shot. I always make sure to say ‘ouch!’ really loudly, so they can give me an extra hug and tell me I’m brave.   And I never use shots as a threat.  Saying ‘if you don’t behave, you’ll get a shot’, is, first of all wrong, and second of all, well, wrong.  Shots aren’t a punishment. I think parents need to remind themselves of that.

Tooth-pulled girl did great. The whole thing took fifteen minutes, enough time for her to watch half an episode of “Gravity Falls”.  The dentist and her nurse were in awe.  I was nonplussed.  I suggested they try it with some other kids, even if they’re only yellow belts.  My daughter made it to archery on time, and the tooth fairy did double duty that night.

I left the office, musing about the cool surgeries I’ve seen and performed for infants and children with breathing problems.  On the other hand, the show-stopper was that cockroach.  Is that so interesting?

A kid is brought in to the emergency room in the middle of the night by his distraught mom, but not nearly as distraught as her child, screaming and banging his head to ‘get it out!’, and ‘stop the noise!’.   I’m called by the nurse to see him.  It was a one of those rare nights, where the emergency room was quiet.  The hall lights were dimmed, and most of the room lights were off, except for one, giving a fluorescent glow to his exam room.  This seemingly healthy young boy was thrashing about all over the room, barely able to sit still in the chair.  He was shaking his head back and forth as quickly as a wet dog. The nurse, his mom, and I coaxed him to hold still for just a second.  The two women held his head as I looked in his ear with a magnified ear light.  And there it was, as creepy as those old horror movies where bugs are magnified to look like monsters.  He had a monster in his ear, banging on his eardrum with its tiny legs, as if it were Ringo Starr.  Since cockroaches can’t crawl backwards (cool fact, I’m told), it couldn’t get out of his ear, and only crawled forwards, relentlessly trying to get somewhere, anywhere, but this kid’s ear.  After I took a gasp, thankfully small enough, and muted by the child’s screams so as not to alarm his mother even more, I found the nearest ear instrument and gave the monster a little pull.  And as any fearless, mature surgeon would do, I saw it squirming from the tips of my surgical tweezer, gave another little gasp (ok, this time it was a shriek), and dropped it on the exam room floor. Before it scampered away under the exam chair, the seasoned nurse squashed it with her foot, not missing a beat, as if she’d seen this countless times before (which she had).  The boy’s mom knew what it was, and gave the nurse and me thankful winks when she saw the cockroach demolished, but spared her 8-year-old the grim details. He was overtired, terrified, and most of all relieved that the noise was gone.  There was no need for him to know what had caused it– he’d never go back to his bed again, and nobody could blame him.

After the patient and mom left the emergency room, the nurse casually said, “First roach, huh.”  “Yup.”  I tried to seem nonchalant.  She knew me well enough to know that I was still shaking in my scrubs.  “Don’t worry. You did fine.  And there’ll be plenty more.  Now try to get some sleep”.

Come to think of it, I guess it was pretty interesting.

When my children received their immunizations (on the schedule recommended by both the Centers for Disease Control and the American Academy of Pediatrics, I might add), my pediatrician explained which vaccines they were receiving, what these vaccines would protect against, and what risks were possible with each vaccine: Some may cause fever, some may cause a rash or swelling, some may cause a minor flu-like illness. Some of them cause pain at the injection site for a day or two. The chicken pox (varicella) vaccine, in rare instances, may even cause the chicken pox. Are there potential serious risks? Yes. There are rare allergic reactions, dangerously high fevers, and other awful, sometimes life-threatening reactions that occur in less than 0.001% of those who receive protection against diseases that used to decimate populations. I then give my pediatrician informed consent. Each time.
What amazes me is that pediatricians and primary care physicians who do not immunize patients, or who casually comply with a parent’s choice not to immunize a child, DO NOT review the risks of NOT immunizing every child. I know a mom with three school-aged children whose pediatrician, by routine, does not immunize his patients. Recently, this concerned mother of children ages four to eight asked me, now that her kids are older and presumably less susceptible to immunization-related complications, which vaccines I thought were important to give her kids. Which vaccines I thought were important? Is this really a question we have to ask? “Has your pediatrician ever discussed this?” I asked. “No”. Okay, then. Let’s explore what the Flu, Pertussis, Measles, Mumps, and Polio, to name a few, have to offer the unprotected child.

Well, the flu is a drag. Every flu season, UCLA’s pediatric intensive care unit is filled with previously healthy children suffering from complications of the flu, ranging from high fevers to respiratory failure. Pertussis (whooping cough) is a bummer, and not just because of that noisy cough. It’s an epidemic in many states, including California, and can lead to severe coughing spells, to the point of the child passing out, turning blue, and vomiting every day for 3 to 4 months. If an unimmunized child develops pertussis, and exposes that five-month-old baby down the block, that baby can die. Measles is not pretty; this virus can lead to complications including bronchitis, pneumonia, ear infections, hearing loss, and in one out of 1000 cases even encephalitis (swelling and infection in the brain). Mumps can lead to permanent sterility. And polio, a viral disease that affects the nerves, is really no fun; it can lead to partial or full irreversible paralysis.
But it’s not up to this mom to know and understand all of this. It behooves her pediatrician to clearly state, at each visit, which immunizations her child is NOT receiving, why he is not receiving them, what he will NOT be protected against, what the risks of each illness is, and what the potential complications of each illness may be. Then she can make an informed decision. Informed dissent. Each time.

Apparently, a lot of people, in addition to the mom I mentioned, are asking about the necessary vaccines, because the California State Senate passed AB2109, which mandates that parents consult with a health care provider to discuss the pros and cons of immunization and that said nurse, physician’s assistant, nurse practitioner, or medical, osteopathic, or naturopathic doctor must sign a form attesting to the meeting, before the parent’s signed waiver will be accepted by a California school.

There shouldn’t have to be a law that parents have to meet with a doctor to get a waiver signed. The meeting should have occurred beginning at the baby’s two-month check-up, at the latest. It is the physician’s responsibility to explain to each family why he has chosen to treat their child differently from what the American Academy of Pediatrics and The Centers for Disease Control recommend every year for all children. Each time.

-Nina L. Shapiro, MD

“Nut-free”, “Peanut-free”, and the latest and greatest: “Nut sensitive”. The rage in preschools and elementary schools across the country is to protect our nut-challenged children from nut exposure, even if it means not exposing them to nuts in the same building or playground, to minimize their risk of life-threatening allergic reactions. Allergic concerns have expanded beyond nuts, to gluten and dairy, to the degree that some schools now prohibit ‘powdered cheese products’, to protect children who are especially dairy sensitive. Some schools are not ‘nut-‘ or ‘dairy’-free, but are merely ‘nut’ or ‘dairy’-sensitive. I hope that this means that they take special precautions, beyond just discussing the inner feelings and emotions of those ‘sensitive’ to certain foods.

Please don’t take any of this as sarcasm. I am fully aware that food allergies are bona fide, and when they occur to the point of danger, kids can die, or nearly die, from a severe food reaction. An elementary school girl recently died of a previously undocumented allergic reaction recently, while at school. So an institution’s decision to either ban or, well, ‘sensitize’, potential food allergens, for the greater good, becomes a public health issue, even on the small scale of a school’s microcosm. This is a good thing. By not sending your child to school with their favorite PBJ or cheese puff, you are protecting others. Not necessarily your nut-insensitive child, who happily gobbles powdery cheese products and peanut butter cups in the comfort of your BPA-free hybrid vehicle, but others. Your child’s sacrifice for the greater good is worth it; seeing a small friend go into anaphylactic shock can scar a tyke for life, not to mention the allergic child himself. And this protection of others is important. Equally important is teachers knowing and being re-certified in CPR (which, by the way, might have saved that elementary school girl, had it been initiated before paramedics arrived). Maybe even as important as getting immunized.

Is there a lunch table for the vaccine-sensitive? We promise not to serve nuts. I just wonder if schools would consider instituting ‘vaccine-free’ zones. You know, for the greater good? Just as we are protective of the nut-challenged from life-threatening reactions, what about protecting children from life-threatening illnesses? Public schools can mandate that all must be immunized, but do allow for exemptions, which are pretty easy to get. Many public schools report immunization rates of less than 50% of their students. Private and parochial schools can strongly encourage immunizations, but they cannot mandate that all must be immunized. Some private schools have immunization rates of less than 20%. Yes, that’s right a parent might pay $25,000 a year to a school where less than one in five of their classmates are immunized against life-threatening illnesses such as measles, polio, bacteria which cause meningitis, or pertussis (the one that causes whooping cough). In order for a school to be considered truly immunized, from a public health (or ‘greater good’) standpoint, that particular school’s immunization rate needs to be 90% or higher. Parents have varied reasons, primarily personal, why they choose not to immunize their children. Some parents are concerned about autism risk, even though all of the studies connecting the rise in autism with immunizations have been debunked. Some are concerned that their child’s body is too small to tolerate a large dose of so many vaccines at once, so they spread out the schedule recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) to create their own ‘tailor-made’ schedule. Some parents think that the illnesses kids are getting immunized against don’t exist anymore, so why bother getting immunized, since illnesses such as polio, measles, mumps, and tetanus have been eradicated anyway.

But here’s the reality: these diseases do exist, and we’re going to see more of them come back. I read about pertussis, the bacterium that causes whooping cough, when I was in medical school. We would learn about this horrible respiratory disease and how it afflicted and took the lives of so many of those poor shlubs from the 1930’s, who hadn’t figure out prevention yet. We would read about them as if they were some primitive Neanderthal tribe, barely able to put two sticks together to make fire. Occasionally a crusty old professor would tell tales of the ‘days of whooping cough’. Ho hum. Well, it’s back. Not so ho-hum anymore. The hundred-day cough, which became an outbreak in California and other states, resulted in many children dying. During the tail end of medical school, I saw H. flu infections, a bacterium that caused severe respiratory illnesses, meningitis, eye infections, and blocked breathing. The miracle of the vaccine for H. flu, which became widely used in 1999, nearly wiped it out. Until now. It’s back, too. Dr. Jonas Salk, the co-creator of the polio vaccine, spoke at my medical school graduation. Polio killed millions, and paralyzed millions more. Thank you, Jonas Salk, and your sidekick Albert Sabin. We haven’t seen polio outbreaks in the U.S. since the 1950’s, when Salk and Sabin’s vaccine began being given widely. Well, we haven’t seen outbreaks yet. We might have to wait until the immunization rates drop some more. But let’s hope not. Polio, whooping cough, meningitis, and measles, to name a few, are still out there – and they could once again be coming to a school near you.

The short answer to ‘when is a cold more than a cold’ is a parental gut feeling that ‘something is not right’.  You may not know exactly what that ‘something’ is, but the fact that you have that feeling that this time is different is reason enough to at least give your doctor a call.   Even if it is just to be reassured that your child has ‘that bug’ that’s going around (almost 99% of the time, there is a ‘bug’ going around), reviewing the exact nature of your child’s symptoms will help you and your doctor figure out whether or not your child needs to be seen.   From a practical standpoint, ‘different’ does have some cut and dry meaning, and can include any or all of the following:

1. * Fever greater than 102 F for more than one day
2. * Fever greater than 101 F for more than three days
3. * Few or no wet diapers for one day (or minimal urination if your child is potty trained)
4. * Ear pain
5. * Red eyes or eye discharge
6. * Cough for one week
7. * Green or yellow nasal discharge for more than two weeks
8. * Just doesn’t seem ‘right’
9. * Extreme lethargy, uncontrollable vomiting, fever that wont come down with fever medications, drastic behavior change, seizure, loss of consciousness, dusky skill color, trouble breathing (NOW IS THE TIME TO USE THAT EMERGENCY PHONE LINE, OR CALL 911)

Many of these signs can be indication of a ‘secondary’ infection, meaning, what was a ‘primary’ viral cold is now a ‘secondary’ bacterial infection—either an ear infection, a sinus infection, an eye infection, a throat infection, or a lung infection.  Your child may or may not need antibiotics, but he does need to be evaluated by his doctor.  If your child is seen, and your doctor still does not think antibiotics are needed, do not be disappointed! It still may be a viral infection, whereby antibiotics will do no good, and may actually do some harm.

As far as what your child’s ‘more than a cold’ may be, the most common infections are ear infections and sinus infections.  Ear infections are so common that they are actually the most common reason a child is brought to a doctor’s office.  Ear infections can often (although not always) begin with cold symptoms, and progress to ear pain, fever, irritability, poor sleep, temporary hearing loss, and overall misery.  Thankfully, ear infections are pretty easy to diagnose.  Your doctor is likely very experienced in looking at ears, and can tell a ‘hot’ eardrum from a normal one.  However, diagnosis of an ear infection, even a nasty one, does not necessarily mean that antibiotics are in the plans.  In fact, most ear infections are caused by viruses, and the American Academy of Pediatrics (AAP) recommends ‘watchful waiting’, with a day of pain and fever control before going straight to antibiotics.  The worldwide overuse of antibiotics has led to the need for stronger and stronger antibiotics and higher and higher doses of antibiotics to treat the run-of-the-mill ear infections, as, over time, the stronger bacteria have survived the run-of-the-mill antibiotics.

A prolonged or ‘nasty’ cold may also be a sign of a sinus infection.  These, however, are not so easy to diagnose.  First of all, the sinuses in most children under age 12 years old are barely developed, and each one is the size of a lima bean, or smaller.  A sinus X-ray, or even a sinus CT scan will show sinuses filled with fluid, in a child with a cold or a full-blown sinus infection. In fact, studies have shown that children undergoing head CT scans for reasons unrelated to a sinus infection will have sinuses filled with fluid, without any other signs of sinusitis or even a cold.  Sinus infections in children are diagnosed by a combination of symptoms, and possibly X-rays.   Symptoms of a child with a sinus infection can include:

1. * Fever
2. * Green or yellow runny nose for more than two weeks
3. * Cough for more than two weeks
4. * Facial pressure, headache, pain, irritability
5. * Foul-smelling breath
6. * Puffiness around the eyes
7. * Sticky drainage from the corners of the eyes
8. * X-ray evidence of sinusitis with all or some of the above symptoms

A visit to the doctor will be needed to determine whether or not your child needs antibiotics for a sinus infection.

Whether your child has a cold or ‘something more’, it’s good to keep on top of his symptoms with some home remedies.  These include:

1. * Nasal saline—the best stuff on earth.  Spray this into your child as often as he will humanly tolerate.  It’s really worth the battle on this one.
2. * Stay on top of fever control.  Make sure you have at least one thermometer in the house!  Keep notes on the time of your child’s fever, whether you gave acetaminophen or ibuprofen, and whether or not the fever broke with the medicine.
3. * Keep your child hydrated. Drinks with electrolytes work well—diluted apple or white grape juice, Pedialylte®, or even diluted sports drinks will help your child feel better.
4. * A humidifier, cool-mist is best, in your child’s room at night will prevent dry mouth in the morning if he goes to sleep with a stuffy nose.
5. * Ask your doctor about over-the-counter cold and cough medicines.  Most are now approved in children over age four years, but check with your doctor first, especially if it’s a new medication for your child.

Most of these remedies are all you need when your child has a cold—plus of course a little extra TLC and attention. These tried and true remedies may also prevent that run-of-the-mill cold from turning into ‘something more’.

Holiday travel with children is a bit like a game of Russian roulette. Or poker. Or even like playing the lottery. The numbers are never in your favor. Kids get up to ten colds per year, most of which are in the fall and winter months. Adults also get a few colds per year, most of which also occur during these seasons, and are well timed to kick in around the holidays. So you don’t need to be a statistics whiz to figure out that there is a decent chance that you and/or your kids may have a cold the week you plan to fly. That said, the BEST way to minimize your child’s chances of getting sick during travel is for him to be well before travel. This is no easy task. But this may be a time where you may want to decide not to bring your brand new bundle of joy or drippy-nosed toddler to the office holiday party, where he will be passed around like a fruit cake, kissed by strangers (or strange co-workers), and unduly exposed to everyone’s lingering or imminent cold virus. And remember, many of your co-workers either haven’t gotten around to, or have chosen not to, receive a flu vaccine. If you have an infant who is not yet immunized, he is at high risk to be exposed to and develop the flu virus in this setting.
It is critical, especially before travel time, that you and your family stay healthy, even if you are stressed by work, family, holiday shopping, weather change, or all of the above. Make sure everyone at home gets enough sleep, eats well, and stays hydrated. This is the time to take extra good care of yourself (and your spouse). If this means taking even part of a day off from work, missing a holiday event, or cancelling one soccer game, all in the name of sanity and wellness, do it.
Assuming that the stars are aligned, and you, your family, and your kids are healthy, now you all need to stay that way while you and 250 of your closest friends breathe in that lovely recirculated dry air at 35,000 feet. Here are some tips for health in the air:

1. If you can swing it, buy your child his own plane ticket. While children under age two years may sit on an adult’s lap, the safest and healthiest way for a child to travel is in his own seat. Your baby doesn’t sit on your lap in a car, so why should he on an airplane? He will have his own space (his infant car seat or booster), minimizing his ability to touch all of the seats and armrests around him, he will be able to sleep more comfortably, and you can still take him out from time to time. He will also be more sequestered from a neighbor’s seat. The FAA requires that babies and toddlers in car seats are given window seats. Since you will be next to him (and stuck with a middle seat for this and all foreseeable future flights), there is no chance that one of those sneezing passengers will be at his side.

2. Bring extra baby wipes. While these may not be as ‘eco-friendly’ as hand sanitizers, you can wipe down surfaces as well as body parts as needed.

3. Bring saline nasal spray. It cuts down on chances of getting a cold. (Don’t share these with family members—you should each have your own bottle, labeled with each person’s name). Spray your child’s nose once or twice before take-off, and every two hours (when he’s awake) during the flight. NOW aren’t you glad he’s restrained in his car seat?

4. Spray your own nose as well, every two hours. Feel free to use the airplane lavatory to do this in private.

5. Drink lots of clear liquids. This goes for everyone, and more so for moms who are breastfeeding.

6. Do not drink alcohol, especially if you are breastfeeding.

7. If you or your child is a bit congested before the flight, check with your doctor if it’s safe to use oxymetazoline (Afrin®). This is a nasal decongestant spray. It will help prevent congestion from turning into a sinus infection or a worsening cold. It can be used once before take-off, as directed by your doctor. It does not cause sleepiness, nor does it cause extra jitteriness.

8. Don’t forget to place all spray bottles in a 1-quart size clear plastic bag in your carry-on bag. These will need to pass through security as a separate item, and all bottles must be 3 ounces or less.

9. Bring acetaminophen (and ibuprofen for babies six months and older), and any prescribed medicines, in your bag of liquid carry-ons.

10. Wash your hands often, or use baby wipes or hand sanitizer. It isn’t just your kids and strangers who carry germs.

11. Happy travels! When you arrive at your destination, baggage claimed and all accounted for, breathe a sigh of relief! Now it’s that family dinner you need to get through. But that’s another story.

All of us know the good part about Halloween; I’ve never met a parent who hasn’t ‘shared’ in their child’s Halloween bounty, and many hope to snap an adorable kid-in-a-costume shot that may work for a holiday card photo. But we must remember the safety issues that arise on this holiday.

All of us rightly worry about losing our child on a dark, crowded street, errant cars injuring children who are running into the street, careless adults on cell phones, not paying attention to their children who are running into the street, or not being able to get our sugar-loaded children to sleep on a school night.

But here’s what I worry about, and, while Halloween day is often a quiet one, Halloween night can be frightful for an airway surgeon: Choking. I don’t mean choking on clothing that is too tight, or external choking by a teenage prankster. I mean choking on regular old candy. The kind your child brings home from preschool, receives from your neighbors, and likely the kind that you are giving out. Choking is the number one cause of accidental death in children under age three years. Yes, it’s true. One child dies every five days in this country from choking on food. Most of these kids are under age three, and most of the food items causing these horrors do not contain warning labels indicating the danger to the under-three crowd.

It’s that ‘magic’ age three, when kids cross the threshold and are allowed to play with toys comprised of ‘small parts’. But what about food with small parts, sticky bits, or unsafe fragments? What was the last food (or candy) label you’ve read with the commonly found toy warning “not for children under three”? Still thinking? Let me know, because those labels don’t exist. And now I’m here to rain on your Halloween parade; no candy is safe for children under three. Label or no label. This includes gum, even if it’s sugarless. Tots can chomp on a thin, plain chocolate bar, if they are seated (so don’t steal those Hershey® bars from your kid’s bag—that’s all they should be allowed to eat).

Children under age three years have neither the motor control, patience, nor airway reflexes to safely eat hard candy, chewy candy, caramel corn, popcorn, or nutty candy, especially on a busy, dark, Halloween night. Older children should be able to do so, but not while walking around trick or treating. Even kids over age four or five years are at high risk for choking on candy if they eat it while in action, and a choking event may go unnoticed if their face is hidden under a Darth Vader mask.

There is plenty of fun to be had on Halloween, while heeding these simple anti-choking tips. Awareness is the first and most important step, which is why I’m writing this. So, Happy Halloween! From your neighborhood airway doctor. Let’s meet up at a party or while trick or treating, not in the emergency room.

Preschoolers, new and seasoned, get excited for ‘big kid’ school, and may even get a cool princess backpack or a rockin’ superhero lunch bag to feel extra ‘big’. Older kids– from elementary school through high school– may have different ideas: anticipation of their new grade, new teachers, or even a new school. Some may even have some ‘new school-year resolutions’ regarding homework planning, staying ahead, (parents can dream, can’t we?) or trying out for the school play. But few, if any, are thinking about staying healthy. After all, they are invincible, are they not?

That’s where we come in. We, the party-pooper parents, not only make our kids do their homework, but we also try to ensure they stay well. But how can we do this? What’s that expresssion? An ounce of prevention is worth….? That’s right, a pound of….well, you get the idea. Prevention, prevention, prevention; it’s the back-to-school song parents and doctors in partnership sing at the beginning of each school year.

Prevention starts at home. For the littlest ones, personal hygiene is key. Wash your hands. With soap. Let’s go over that again. Wash hands. With soap. Teaching this to your kids before they can even stand on their own will go miles in the school years ahead. Hand-washing (with soap) should last as long as it takes to sing the ‘ABC song’, ‘Twinkle, twinkle, little star’, or any new ditty your child chooses. And the good news is that the hand-washer gets to pick the song. At a minimum, hands should be washed before and after meals, as soon as they come home from school, after playing outside, and before bedtime. This simple, easy to teach, yet admittedly annoying to enforce, habit has been shown to reduce the incidence of colds and coughs spreading from tot to tot (and even from teen to teen and parent to parent). Another preventative tool for the young ones: cover your cough (or sneeze)–but not in that hand you just washed!– in the crook of your arm. Teach your child to catch their cough inside their elbow, even if it means boogering-up a brand new school or sports uniform.

While it’s great that we can teach our young ones (and hopefully this basic hygiene skill carries on to the big kids) how to keep themselves clean, we cant teach our kids how to get immunized. That’s our job, not only as responsible parents, but also as responsible people. Despite that fact that the 1998 Lancet study linking vaccines to autism has been debunked countless times by the medical literature and leading medical authorities, some still choose not to immunize their children. While many think of this as a personal choice, indeed this is not the case. To underscore this, according to the American Academy of Pediatrics (AAP), one quarter of our nation’s pediatricians are now turning away patients who refuse to vaccinate their children. They are not doing this to prove a philosophical point, but to protect their other patients. If an un-immunized child is sitting in the same waiting room as a child who has a weakened immune system, either from cancer treatments or from chronic illness, or near a young infant who is not yet vaccinated, the ‘weaker’ and ‘younger’ child both have a high likelihood of contracting diseases such as measles, whooping cough, or even the flu. All of these may be fatal, or result in permanent lung or brain damage to those with immature or compromised immune systems. Un-immunized children can also put elderly folks as well as adults with weakened immune systems at risk for serious illness.

So while you’re helping your kids pick out their school supplies, washing their hands and finishing up summer reading lists, help your children, and those around them, stay healthy. Be their advocates. Don’t leave their health up to the medical profession alone. And certainly don’t leave it up to chance. Wash their hands and vaccinate your children for the good of your whole family and community.

Even the kids who are ‘water safe’ really aren’t, until they are old enough to lifeguard– mid to late teens for most. It’s not the swimming ability alone that makes a child safe, but the ability to reason, recognize danger, and watch out for the safety of others are what makes one truly safe in the water. Drowning is the second leading cause of accidental death in children ages one to 15 years in the U.S., and the highest risk group is boys under age five. Over half of these fatalities occur in home pools.

When we think of pool risks, we think of the big pools, complete with deep-ends, diving boards, and swim parties. But did you know that over 10% of pool-related deaths in young children occur in what are best known as ‘kiddie pools’? These include inflatables, plastic wading pools, and larger above-ground pools. I know what you’re thinking. It’s those large above-ground pools, with five to six feet of water that must really be the culprits. No. The average depth of water in which these kids die is 18 inches. That’s right: the average childhood drowning death occurs in one and half feet of water. And, yes, kids have drowned in as little as 2 inches of water.

A recent study in the journal Pediatrics, the most respected journal in the field of pediatrics, documented, for the first time, that shallow pool drownings are actually frighteningly frequent causes of infant and toddler deaths. Besides showing the obvious– that these drownings occur in young children, primarily in the summer months, and primarily at home, the authors also shed some very important light on these horrific scenes. It turns out that over half of these events take place when a child is either unsupervised, or has had a lapse in supervision. A lapse can be anything from the adult falling asleep, going in to the house to answer the telephone, doing chores, or chatting with a friend. Another startling fact: fewer than 20% of adults instituted CPR on the child prior to arrival of an ambulance.

Many of us can smugly think to ourselves: I would never let this happen to my child. Don’t be so smug. The study authors found that, while prevention is the number one way to save our kids from drowning, there is no sure fire method of prevention. The authors suggest that we consider ‘layers’ of prevention, since no singular method is fool-proof, not even eagle-eye supervision. If we consider implementing several of these measures, we are providing the safety our kids really need:

-All pools, even the above-ground ones, need pool fencing.

-Pool fencing should be at least four feet high, non-climbable, and have no opening under the fence.

-Pool gates should be self-closing and self-latching.

-Above-ground pool ladders should either be removed when the pool is not in use, or locked.

-Toys should be kept out of pools when not in use.

-Kiddie/wading pools should be emptied when not in use.

-CPR training is a plus, with refresher courses before swimming season for all adults.

-Emergency telephone numbers, CPR instructions, life-preservers, and life jackets should be available near pools.

-Life preservers are not to be used as pool toys.

-A telephone should be brought outside when children are swimming, in case emergency personnel need to be called. A land-line is better than a cell phone, making it easier for emergency personnel to track your location.

-Indoor high locks should be installed on doors, so that children can not go outside without an adult opening the door.

-Door alarms can alert an adult that someone, kid or adult, has gone outside.

As parents, our concerns about pool safety are always heightened in the summer months. This concern usually focuses on ‘deep’ pools in homes and in public. There is so little information out there in the media and consumer education campaigns regarding ‘small’ pool safety. But clearly these seemingly ‘safe’ pools can also pose a risk. There is no magic bullet to prevent these horrors, so stock your safety arsenal with layers of prevention, so that summer fun doesn’t turn tragic.

For more information, see: Pediatrics 2011;128:45-52.