Making the Right Medical Decisions for Your Child

Making the right medical decisions for your child isn't always simple or clear cut. Yet we as parents are faced with these decisions everyday. And as a pediatrician I'm also faced with answering these questions. Just today I spent extra time with a family. They were having a hard time making a decision for their child. Finally I just printed out some info and told them to go think about it. I trust that they will research the topic and come back with more questions and then we can really get down to understanding what needs to be done.

As parents we presumably want the very best for our child and in this day and age there's a lot of doctor mistrust. Gone are the days of paternalistic medicine -where what the doctor say goes. Now, everyone has an opinion from guy at the walk- in Urgent Care site to Cousin Betty who is a nurse and her daughter the dental assistant. Between all the varied opinions it can be hard to sort it all out and make a well informed decision.

Make sure you gather all the information available and make the decision that you feel is the best for him, not just the one that makes you feel less squeamish.

This is what I recommend-

• Know every step of what is being done. This ranges from getting vaccines to antibiotics.

• Try not to get caught up in the anecdotal data that is floating around. "I once knew a friend whose brother's sister got sick that way!" isn't substantial enough evidence to avoid a procedure.

• Don't try to assume that your doctor will know everything. If you really need the opinion of a specialist then make sure you get to talk with one.

• If it doesn't seem right say so.

• Do your research.
  

• Ask your friends.

• Keep an open mind.

• Ask the right questions such as:
  

1. What would be the consequence of not getting the procedure/treatment?
2. Is this the standard of care?
   
3. Would the results change our management?
   
4. Are there other alternatives?
5. What are the risks?
   
6. Can I have a second opinion?
   

ADHD and Poor Weight Gain

Dr Cason,

I have a 5 year old boy that has ADHD and has been on Focalin XR 15mg. The meds aren't strong enough but they are scared to up his meds more because he is 35 lbs. They want me to put him in a day treatment program. Do have any tips for me to get him to eat and to listen to me because I'm starting to get really depressed about things.

- SM

Dear SM,

Unfortunately loss of appetite is the side effect of stimulant medication that can't really be avoided. Consider a holiday from the medication on weekends to get his appetite back or give a dose just after breakfast. You could also try to increase the caloric count of his foods so that he'll get more calories in a smaller amount. Such as milk shakes, grilled cheese sandwiches, peanut butter on crackers. Also you can have his doctor prescribe Pediasure- a nutritional supplement. It's available over the counter but some insurances will pay for it if it's considered medical treatment.

Try your best not to get into power struggles over his food and lack of interest in eating. You'll only lose and in the end drive him further away from eating. A thin but otherwise healthy child is ok. Be sure your pediatrician is comfortable with this.

Also I encourage you to look into the day treatment program. I've seen great success with some kids whose behavior was able to be managed with certain "Behavior Modifications" such as positive feedback and specific rewards for specific behavior.

Finally- it sounds like you still have some concerns that need addressing. 5 years old is young to be on medication but not completely unheard of. There may be some other issues that can be addressed. Also make sure your child's psychiatrist is willing to work with varying doses of stimulant medication. The idea is to keep going up incrementally as long as the ADHD behavior is still present and the side effects are not too unpleasant or risky.

I hope this helps. Don't despair, your pediatrician can find some local resources that will help you connect with some support groups. It's often very helpful to meet other parents who have gone through what you are going through!

Sheila Cason MD

Coin Ingestion

What’s the most common foreign body ingestion in kids? Coins!! And yep you guessed it: my little 16 month old swallowed a penny a couple of weeks ago. As a pediatrician I’ve seen this plenty of times but of course when it’s your own child it’s different!! I watched it go into his mouth and instead of politely asking if I could have it -like I have always done - I said NO! And I then tried to go after it. After much screaming and then choking and then coughing he gulped it down! I just froze. I thought now what do I do?

You go to the ER. Regardless whether a child has symptoms or not an x-ray needs to be obtained. The x-ray will show whether it passed into the stomach or got hung up somewhere! Occasionally the coin can hang out in the esophagus and cause problems such as esophageal erosions if they are not removed. If the coin is in the stomach then it will likely pass without incident. Most children will pass the coin in a few days. Examine the stool to make sure it has passed! If it hasn’t passed you’ll need to get follow up x-rays.

What about inducing vomiting? Good question. I wouldn’t recommend it. The baby could then choke on it again and this time he can get it into his lungs!! Just get the x-ray. My child happened to keep that coin in his stomach for a good two weeks and then got a hold of some Chamorro hot sauce. – I swear we really do watch our child! We happened to have an ER doctor friend with us. Who, after our baby was frothing and vomiting from the hot sauce, peered into the mess on the ground. He softly inquired, “Do you see a penny in there?” It wasn’t there but it did successfully move it from the stomach down to the intestines!! It passed two days later!

This was a trying incident to be sure, but one that reminded me to keep all small things away from young children. If it can fit inside an empty toilet paper roll then it’s too small. Ironically I was ridding the house of all teeny weeny things when the coin incident occurred! When something does happen make sure you’re ready. Get CPR certified. And if something does happen and if your child is having difficulty breathing or looks likes he’s in distress, call 911!

p.s. Check out the coin in the photostream. I cleaned it all up and saved it! What can I say…I’m a packrat at heart!!

Sheila Cason MD