Is your state breastfeeding-friendly?

I never thought twice about the laws surrounding breastfeeding in public. It was never an issue in New York, but I probably should have checked in Connecticut before I nursed my son in front of the dentist while my daughter was getting her teeth cleaned or while she was playing soccer on the field. Is it still considered indecency even if I use a hooter hider (yes, this is the real name for a designer cloth for breastfeeding)? Find out how your state compares to others regarding breastfeeding laws.

August is National Immunization Awareness Month

We've come a long way with vaccinations. Although most of the diseases (for example, polio) prevented by vaccines are no longer common in the United States, we still need to vaccinate our children to avoid outbreaks. Kids that are not fully vaccinated can become very sick and spread the disease to a community very quickly. As a parent, it is ok to have questions and concerns about vaccines. The Centers for Disease Control and Prevention (CDC) has valuable information about vaccines, including the most up-to-date vaccine schedules for both children and adults. With school starting next month, make sure your children are fully vaccinated to protect them and their classmates with this guide.

Medication Allergies - Know the answers to these questions

Just started giving your child a new medication and (s)he has developed hives, difficulty breathing, fever, swelling of the lips or eyes, an itchy rash, or anaphylaxis? Chances are your child has been exposed to this medication (or an ingredient of this medication) in the past. Note that sometimes it is the inactive ingredient (for example, the dye, preservative, filler of the tablet) that is the culprit. Medication allergies are rarely fatal, but they can be scary and do warrant immediate attention, especially if your child appears to be struggling to breathe. If your child has a history of severe allergies and has an Epi-Pen, use it as directed and call 911. If it is a mild reaction, a dose of diphenhydramine (Benadryl) is all that is necessary to relieve the symptoms. Be sure to contact your child's pediatrician or allergist beforehand.

To help confirm that the reaction was a true drug allergy, a detailed history is crucial. Be prepared to answer these questions: When did the reaction occur? What drugs were you giving your child? How soon after taking the drugs did your child have the reaction? What kind of reaction did your child have? How severe was the reaction, and how long did it last? If your child had a rash, did it blister, peel, or cause ulcers in the mouth, vagina, or rectum? Has your child since taken that drug or one like it without a reaction?

Sometimes a side effect (or intolerance to the medication) is mistakenly labeled as an "allergic reaction." For example, having an upset stomach, diarrhea, or rash to a penicillin are common side effects and they resolve on their own, even when the medicine is continued. Attributing these to an allergic reaction could pose problems in the future, especially if the best course of therapy involves a penicillin. Optimal therapy may end up being delayed as your child is being desensitized to the medication. So, talk to your child's doctor and pharmacist to clarify whether what your child is experiencing is a side effect or an allergic reaction. Also, if your child is allergic to shellfish, soy, eggs, cross-sensitivity to certain medications and vaccines is possible. Be sure to alert your doctor and pharmacist about these food allergies so that they can be updated on your child's medication profile.

Beware of hidden secrets in herbal supplements

Many parents give herbal supplements to their children in hopes of trying something natural. What's the harm? It's just an herb, right? It's not that I don't think herbal supplements work. I hesitate to recommend them because I don't really know what all of the ingredients are in a product or how much of each is in it. Sometimes they work too well, or worse, they interact with Western medicine in a negative way and cause severe complications. Lack of consistency and undiscovered active ingredients are my main concerns. Herbs can contain powerful chemicals and cause side effects, too. Furthermore, the FDA does not regulate herbal supplements the same way they do with prescription and nonprescription drugs. That's right, herbal supplements are not considered drugs. They are considered dietary supplements (along with vitamins and minerals) under the umbrella of "foods" and are covered under the Dietary Supplement Health and Education Act of 1994 (DSHEA). Basically FDA does not expect the herbal supplements to go through the same rigorous process of being approved as drugs. Thus, many products claim to help with a lot of illnesses. Note that these claims have not been scientifically proven. However, you will never see that the herbal supplement "treats, cures, or mitigates a disease" on the label; that's illegal. An even bigger problem is when there are undisclosed ingredients in the herbal supplement that require a prescription for consumption in the United States. The FDA intervenes when a product poses an "unreasonable health risk" or "imminent hazard to public safety" by compiling a complaint against the producer of the herbal supplement, and then filing it. Many times, the products are recalled by the companies. A recent example is the weight loss product that contains sibutramine, an appetite suppressant that can increase blood pressure and pulse rates. If not, the FDA will issue an advisory to the public. Here is more about herbal supplements from the FDA's perspective and a good article from the Discovery Channel. The FDA also offers tips on how to use herbal supplements safely. Because a lot is still unknown about the safety of herbal supplements, be sure to let the doctors and pharmacist know which herbal supplements or teas your child is being given. Check to see if your teenagers are on weight loss products, too.

A spoonful of sugar not needed, just a straw

Having and caring for your own children really has put things into perspective for me. Although I have shared many tricks with parents on how to give medicine to your children, I've had to be really creative with my own. Fortunately, the only medicines my daughter took as an infant were famotidine suspension for her reflux, which resolved before she turned 1, and one course of amoxicillin for sinusitis. The famotidine was quite the challenge because even at 8 weeks, she was already clamping down her lips when she saw me coming with the dropper. I ended up using an oral syringe instead and "shot" the medicine into the side of her mouth a little at a time. Now she only takes fluoride tablets, which are chewable and flavored, but after 3 months, she started resisting. Thankfully, the tablets we got with our refill were grape-flavored, and she is willing to take it again.

With my son, we've had a few pink messes when I tried to give him the amoxicillin for his ear infection. The first couple of times, he tolerated the oral syringe. Then he realized he could spit it out. I knew it was time for an old trick: the straw. Sometimes I use a straw like a pipette to get him to drink fluids. So, I measure the dose he needs with a medicinal spoon, then I use the straw to give him small aliquots until the entire dose is given. Yes, he knows what's going on, but he'll drink the medicine. I add water to the spoon to get what is left on the side. Yes, I do have to hold his hands down and we still get a little messy, but the dose is successfully given. We do this twice a day - only 6 more days to go!

What are some of the tricks up your sleeve?

Mom vs. RPh: the Inner Struggle

My son had a fever Sunday night that lasted until yesterday afternoon. He was cranky, lethargic, and woke up every hour. His rectal temperature was 99.8 degrees F at 10 pm, 101.8 at 3 am on Monday, 101.9 at 9 am, and 98.9 at 3 pm. He had a lot of mucus coming out of his nose and mouth, but other than that no other symptoms. His appetite was decreased, but was still willing to drink.

The mom in me wanted to medicate and make a doctor's appointment ASAP, while the RPh in me wanted to just wait it out; it's probably just a virus. Well, the mom won and gave him 2 doses of acetaminophen. The RPh helped figure out the dose since the label only offered contacting the doctor for children under 2. I used his weight in kg, calculated his dose, and adjusted slightly (he's 30 pounds and only 13 months=old). At 9 am, the mom panicked because the fever was high and a rash was seen. An appointment was made for later that evening. Until then, the pharmacist recommended giving a dose of ibuprofen and giving him a tepid bath.

The mom and RPh came to common ground at 4 pm when the fever broke. Both agreed that the appointment could be given to someone who needed it more. Unfortunately, the engagement could not be broken without a penalty, so I brought him anyway. It turns out he has a left otitis media. What I didn't tell you is that my son had fevers two weeks ago, so he probably had it then, too. In any case, amoxicillin was prescribed. The RPh was ambivalent about starting it, but the mom remembered the colored mucus and misery during the last several weeks. I just have to make sure he doesn't miss any doses and that he completes his 10-day course.

As a mom, I want what is best for my children, and I find that having a background in the health profession helps me make better decisions for them. You, too, can be an informed parent. The information is out there. In fact, many hospitals and general practices have their own web sites to provide you with important information about your child(ren)'s health. Your pediatrician might even have print resources in his office. Some centers have family-oriented libraries. Take a minute to get better acquainted with common illnesses in children and their management. Most of the time, you can treat them at home, but worsening symptoms or changes in behavior warrant a call to the pediatrician.