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Avoiding Picky Eating in Kids

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Contributor Dr. Elise Herman

Most parents are familiar with the ‘picky eater’- the child who is suspicious of new foods, has strong favorites, and may refuse to eat what the rest of the family is eating. Picky eating is very common in young children, but usually improves by age 5 years. This behavior occurs in part to exert some control over mealtime (and parents) in a way that is often attention-getting.

Regarding feeding your child, it is a parent’s job to offer healthy foods and decide the time and place for eating; it is the child’s job to decide what to eat and how much. Remember that children will eat when they are hungry, and with enough opportunities (it may take 15 ‘exposures’ to something new), will accept and eat most foods. Pressuring a child to eat creates conflict and can make mealtime stressful actually resulting in the child eating less. It is OK if your child occasionally misses a meal because they refuse to eat what is served.

There are things parents can do to minimize “picky eating” and encourage good eating habits that last a lifetime:

  • Offer a variety of foods including vegetables as soon as your child starts solids in infancy.
  • Have set mealtimes and decide how long meals will last; most kids can sit at the table for about 15 minutes for breakfast and lunch, and 20-30 minutes for dinner.
  • Sit down for meals and do not allow kids to come and go from the table; if they are ‘done’, the plate and any uneaten food is removed.
  • The kitchen is ‘open’ for planned meal or snack time and otherwise is ‘closed’; no other eating or drinking (except for water) as it may decrease the appetite for the next meal. Kids need 3 healthy balanced meals and 1-2 small snacks daily.
  • Get your child involved–gardening, preparing food/ helping with cooking (keep this age appropriate), planning the meal, or setting the table.
  • No separate meals; you are not running a restaurant! You can have a ‘boring’ option available (for example, plain bread) occasionally, but ignore whining or tantrums about food.
  • Give new foods in very small amounts so it is not intimidating.
  • Do not offer crackers, cookies, chips, etc. to get your child to eat ‘something’; if they are truly hungry, they will eat some of what is served.
  • Do not use dessert as a bribe to eat a meal.
  • Model healthy eating habits and keep discussion of eating neutral; no elaborate praise if they eat ‘well’ and no criticism if they refuse to try a new food. Keep conversation light and upbeat so mealtimes are positive.

If you have concerns about your child’s ability to eat or swallow normally, or if you worry they may not be getting enough nutrition, talk to your child’s health care provider.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Pedestrian – Vehicle Accidents

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Contributor Dr. Elise Herman

Walking is a great way to exercise for adults and kids alike, but there is a concerning 11% increase in child and adolescent pedestrian fatalities in the US in the last 10 years, resulting in about 600 deaths per year. In response to this, the American Academy of Pediatrics (AAP) released a new policy statement in June 2023. It discusses not only what we can all do to keep our kids safe while walking near cars but addresses how communities can change roads and driving to help prevent pedestrian injuries.

There may be multiple reasons for this spike in pedestrian accidents involving children and youth. Both drivers and walkers tend to be more distracted than in the past, mostly by cell phones. Wearing earbuds makes walkers less aware of their environment. More kids are also walking to school (a good thing) but need to do so safely.

The risk of being hit by a car or other vehicle is greatest in rural areas, according to the AAP, and boys are more likely than girls to be victims. Vehicle speed is the most important factor. In general, the faster the vehicle is going, the greater the risk of a collision with a pedestrian and the more severe the injury. For this reason, it is recommended by the American Academy of Pediatrics that communities change policies and planning regarding roads. Speed bumps, roundabouts, and lower speed limits all work well to slow vehicles down. Photo speed limit enforcement, particularly in school zones, is very effective. Simply extending curbs is an easy way to help protect pedestrians.

There are steps we can all take to help kids be safe when around cars, both in advising our children and being safer drivers ourselves.

  • Pedestrians should be on a path or sidewalk if at all possible; if walking on the shoulder, walk facing oncoming traffic
  • Hold your younger child’s hand when crossing the street, cross at designated intersections or crosswalks, and always observe traffic safety laws. You are a role model– no jaywalking!
  • Teach your child to cross the street: look left, right, and left again, and keep looking around while crossing
  • Kids should not play in driveways or areas next to driveways
  • Children 10 and under should have adult supervision when walking near traffic
  • Pedestrians should not wear earbuds or look at smartphones
  • Increased visibility is important; brightly colored clothing, hats, and backpacks help anytime, and a flashlight or headlamp is crucial at night
  • Drivers should not be distracted by smartphones or interacting with the touchscreen on the dashboard
  • It is the law to allow walkers to cross a crosswalk completely before beginning to drive
  • Use the rear-view camera in addition to car mirrors when backing up and keep the camera clean and ice-free

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Wildfire Smoke Exposure and Children

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Contributor Dr. Elise Herman

As climate change causes a longer and more severe wildfire season, exposure to wildfire smoke in children is an increasing problem. Wildfire smoke is felt to be more dangerous than typical air pollution and kids (especially those under 5 years) are more vulnerable for multiple reasons. Children’s smaller airways are more adversely affected by swelling and inflammation from smoke. Kids also breathe more rapidly than adults, thereby taking in more of the dangerous particles. Children who have underlying lung problems including asthma are at increased risk and are more likely to need medical care.

Children typically have coughing, sneezing, and increased congestion with wildfire smoke exposure. They may also have burning or discomfort of their eyes, nose, and throat. If there is more serious exposure, a child may become lethargic or have shortness of breath. Signs of trouble breathing in kids include breathing rapidly, the ribs sticking out with each breath (“retractions”), and the abdomen moving a lot with breathing (“belly breathing”). Babies may also have head bobbing and grunting as signs of respiratory distress.

Being aware of the air quality can guide your actions. Airnow.gov is a good site to check; if the AQI (air quality index) is over 150, avoid any outdoor activity if possible. Kids 2 years and over can wear a mask to somewhat reduce smoke exposure. NIOSH N95 or KN95 masks are 80-95% effective at reducing smoke exposure (depending on the fit of the mask) but do not come in sizes for younger kids. Surgical masks are only 20% effective and therefore are not ideal. Cloth masks really do not help filter smoke.

Here are steps child you can take to protect your child if there is wildfire smoke in your area :

  • Ideally, temporarily relocate to an area free of smoke
  • If the AQI is over 150, stay inside and close windows and doors
  • If possible, use a HEPA air filter or MERV13 filter (this is a rating for a filter’s effectiveness) on your air-conditioning unit; the Environmental Protection Agency (EPA) also has information on creating a DIY air cleaner that is effective
  • Set your air conditioning to ‘recirculate’
  • If you do not have air-conditioning and the weather is very hot, consider going to a cooling center (a place with air conditioning to provide temporary respite from the heat)
  • Avoid lighting candles, vacuuming, or using a gas stove which can worsen indoor air quality
  • Rinse your child’s eyes with water if they are stinging or itchy
  • If your child has a lung condition like asthma, make sure you have enough medication, especially a rescue inhaler
  • Call your healthcare provider if your child feels short of breath, or complains of dizziness or chest pain
  • Seek emergency care if you see signs of shortness of breath as listed above or if your child seems less alert or very lethargic

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Vehicular Heat Stroke in Children

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Contributor Dr. Elise Herman

As summer approaches and the outdoor temperature increases, a danger looms for children- vehicular heatstroke (VHS), which is heat injury due to being in a hot car or other vehicle. These deaths are so preventable, and as a parent you may wonder how such a thing could happen, but vehicular heatstroke claims an average of 38 children’s lives a year in the US, with almost a thousand deaths since 1998.

Heat stroke is the most severe heat-related illness and occurs when the core body temperature is over 105.8 degrees Fahrenheit with signs of nervous system injury including confusion, seizures, and coma. Dehydration along with heat exposure can cause deadly heat stroke. Children are more at risk because they sweat less than adults and can overheat more quickly.

Vehicular heatstroke most often occurs when an adult ‘forgets’ a child in a car, often when the adult is on the way to work, intending to stop at childcare first. A change in routine such as a different parent doing the drop-off can also increase the risk. Parental stress or sleep deprivation can be contributing factors. Vehicular heat stroke can also occur if kids are playing in a car and accidentally lock themselves in.

The outside temperature does not need to be extremely high for vehicles to become dangerously hot. VHS has happened with outside temperatures as low as 57 degrees. A car can heat up 20 degrees in 10 minutes on a sunny day, and 72 degrees outside can become 117 degrees in a vehicle within 1 hour. Cracking the window or parking in the shade make little difference in term of the car heating up. Climate change also means more hot days and more extreme heat.

There are steps we can take to minimize the risk of this tragedy:

  • Never leave a child in a vehicle unattended even briefly
  • Make it a habit to open the back door of the car when you park, just to check the backseat.
  • Put some important item you need for your day- purse, iPad, employee badge, etc. in the back seat near your child.
  • Keep a stuffed animal or something similarly eye-catching in the car seat when empty and move it to the front passenger seat when the car seat is in use as a reminder.
  • Remember the phrase “Look before you lock”.
  • Instruct your childcare provider to contact a parent if a child is not dropped off as scheduled.
  • Keep car keys out of reach of kids, and teach them to never play inside cars, trunks, etc.
  • Teach your child to honk the horn if they are trapped inside a car.
  • If a child is missing, check all vehicles and trunks immediately.
  • If you ever see a child alone in a locked vehicle, call 911.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Gun Safety and Your Child

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Contributor Dr. Elise Herman

Parents want to keep their children safe, and an increasingly important part of this relates to gun safety. The leading cause of death in the US for kids (those 18 years old and under) is now firearm-related injuries. There were 301 unintentional shootings by kids in 2022, which caused 133 deaths and 180 injuries. Regardless of opinions on gun control, we all want to prevent these tragedies, making proper storage of weapons and ammunition crucial. Whether you have guns in your home or not, there are important steps you can take to keep kids safe.

Home safety

If you decide to keep a firearm in your home, make sure all guns are locked and unloaded, with ammunition stored separately and securely. Store weapons in a gun cabinet, vault, safe, or storage case. Keys and combinations for these need to be hidden. Fingerprint lock technology is another way to prevent children from gaining access to the safe. Consider a trigger lock as well to prevent the gun from firing. If firearms are in a vehicle, they should also be in a locked safe with ammunition stored and secured separately.

Studies have shown that contrary to what parents may believe, children generally do know where guns are in the home, can get access to a loaded weapon in minutes, and many have handled them without adult supervision.

Safety out of the home

Over one third of accidental shootings of children happen in other people’s homes. It is vital that you discuss gun safety with the parents of your child’s friends when arranging get togethers. Just as you would go over other safety information such as food allergies, adult supervision, or bike helmet use if appropriate, you need to ask about guns- in their home and vehicles. Without any judgement, ask if the other family has guns and if so, how the guns and ammunition are stored. You could also volunteer how you secure weapons at your house. If guns and ammunition are not stored appropriately by the other parents, you can suggest that they be secured but if the situation does not seem safe, have the playdate at your home instead. Think of how you would handle the situation if the other family had a pool without safety measures in place. Have similar discussions with family members or caregivers where your child spends time. These conversations may feel awkward at first, but it is your child’s safety on the line.

Talking to your children

Remind kids that if they see a gun that is not locked up, they should refrain from touching it, leave the area and tell an adult right away. Children should be taught to always assume a gun is loaded. Gun safety and hunter responsibility classes are recommended but are not a guarantee that a child will be safe around unsecured guns.

Mental health concerns

If someone in the home has depression or suicidal thoughts, firearms should be removed from the home while there is an active concern. Guns may be stored temporarily with local law enforcement (check on-line) or with a friend or family member living outside the household.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

RSV in Kids

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Contributor Dr. Elise Herman

We are definitely in the sick season and Respiratory Syncytial Virus (RSV), a common fall/wintertime virus, is very prevalent right now. Most kids have had RSV at least once by age 2 years and usually it just causes a mild cold. In some children, especially preemies, young infants, and those with heart, lung, or immune system problems, RSV can be more serious. It can cause pneumonia (lung infection) and bronchiolitis (inflammation of the small airways). Adults also get RSV, though as with most kids, they usually just have mild cold symptoms. Elderly adults or those with compromised immune systems or underlying health problems can develop more severe RSV.

RSV spreads by direct contact with the virus by kissing, sharing drinks, or touching a contaminated surface). Airborne droplets from a cough or sneeze are also infectious. People are contagious for a day or two before signs of illness and then for 3-8 days after becoming sick.

RSV symptoms include runny nose, cough, sneezing, fever, and decreased appetite. There may be mild wheezing, which is a high-pitched musical sound heard with breathing out. RSV typically lasts 1-2 weeks.

If RSV is more severe, there may be signs of difficulty breathing such as rapid breathing and sucking or pulling in between the ribs or just below the neck (“retractions”). Other warning signs include grunting respirations, and the lips or tongue appearing pale or bluish. Trouble breast or bottle feeding and pauses in breathing are worrisome signs sometimes seen in young infants.

Testing for RSV (done with a nasal swab) is not needed if your child is mildly affected. If the illness seems more severe, RSV testing may be ordered.  Kids can test positive for RSV for days to weeks, even once they appear recovered. There is no need to do testing to see if a child is “over” their infection.

There is no cure for RSV and most kids just need basic at-home care. Ensuring your child gets enough fluids is important. Small frequent feedings may be better tolerated and using saltwater nasal drops and suctioning prior to infant feedings can help. Breast milk can be expressed and put in a cup or bottle if feeding at the breast is too difficult.

Tylenol (over 2 months) or Advil (over 6 months) for discomfort is fine, but do not worry about “getting a fever down”, as the fever may be helping your child fight the infection. Severely ill kids may need oxygen and IV fluids in the hospital to treat dehydration, but this is uncommon and usually is just for a few days. Only 1-2% of infants under 6 months of age need to be hospitalized with RSV.

To decrease the risk of kids and adults getting and spreading RSV, practice good handwashing with soap for 20 seconds. Teach your child to cover coughs and sneezes with tissue or their elbow. Avoid sharing drinks and utensils.  If your child is at high risk of severe RSV, you may want to avoid childcare and crowded settings if RSV activity is high. Masks in kids over age 2 years are effective at decreasing spread of the virus. Avoid smoke exposure which is harmful to lungs in general.

There is no vaccine for RSV yet, though some are in the works. If your child is 6 months or older, it is vital to vaccinate them against influenza and COVID-19 since these can make RSV more serious. There is an injected monoclonal antibody medication to prevent severe RSV only in very high-risk kids.

Remember that most kids with RSV will have a mild illness. You should call your child’s provider, however, if there are signs of dehydration (not drinking well, poor urination, or looking pale or weak), extreme fatigue, or difficulty breathing.

Find more information on our RSV resource page: kvhealthcare.org/rsv

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

How to Talk with Your Teen

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Contributor Dr. Elise Herman

We all want to feel connected to our kids, but as they become teenagers, it may seem harder to engage them in conversation. Between their appropriate need to become more independent, their frequent use of their phones and social media, and all of life’s distractions, how can you create opportunities to have an honest conversation with your teen? Here are some suggestions that might help:

Be a good listener: Ask open-ended questions, avoiding those which would have a short “yes” or “no” answer. Do not interrogate but ask with a desire to learn- about their school day, friendships, and interests. Avoid lecturing and try to reserve judgment unless there is a real safety issue. If you disagree with what your child says, ask why they feel a certain way; try to see things from their point of view. Often, teens want to chat about a concern but do not want you to “solve” it. Ask if they like your advice or help before offering. Remember to listen without the distraction of phones or computers.

Empathize: Your teen has a lot going on with social media, relationships, and school pressures. Life is likely more complicated for them than it was when you were their age. Listen and empathize; don’t discount their feelings and struggles.

Please respect their privacy: Do not share your conversations with others. You want your teen to feel safe and comfortable being open with you.

Location counts: The dinner table is an excellent place to chat casually about school, activities, etc. (research has shown that regular family meals decrease risky behavior in teens). Start the family dinner habit when kids are young and keep it going as much as possible through the teen years. Even if they are quiet at the table (don’t force anyone to talk), connecting as a family is essential. When driving, it is also a great time to chat, especially if it is just the two of you. Frequent brief conversations are more accessible than longer, more formal ones and can make you both feel connected..

Let your teen lead:

  • Be open to discussing things they care about, such as social media, music, trends, etc.
  • Try to be aware of what teens are viewing and discussing online.
  • Don’t try too hard to be “hip”; aim to be curious and informed.

Encourage confidence: You know your teen and their strengths. Let them know you believe them to be capable of handling challenging situations but that you are always there for them, too, to be a sounding board or assist if it is appropriate.

Having regular, non-judgmental chats with your teen can maintain open lines of communication and increase your emotional connection. In addition, this will make it easier if they need to come to you to discuss important issues such as relationships, sexuality, mental health, or substance abuse.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Respiratory Virus Season and Children

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Contributor Dr. Elise Herman

As cooler weather approaches, the “sick” season does, too. For kids, this usually means respiratory illnesses, ranging from cold to croup or pneumonia. While these sicknesses are usually mild, more severe cases are rapidly increasing, with more kids going to the ER and being hospitalized. The viruses responsible include Respiratory Syncytial Virus (RSV), rhinovirus, adenovirus, and enterovirus. To complicate things, influenza season typically starts in October, and with COVID-19 currently spiking in Europe, a surge is predicted to hit the US soon.

Children are walking in nature, fall leaves.

This earlier and more severe start to the respiratory season for kids is felt to be related to gathering again (without masks) in schools and social settings. Kids do not have much immunity from last year when the respiratory season was milder due to social distancing and other anti-COVID measures. Wildfire smoke exposure may also be a contributing factor.

Most kids who contract these viruses will get a simple cold (“upper respiratory infection”), nasal congestion, mild cough, and mild fatigue. A low-grade fever is common for the first three days of illness. Kids may be sick for 1-2 weeks but remain fairly active with good fluid intake though overall eating is often decreased.

Younger or premature infants and children with lung problems like asthma are at increased risk of more severe illnesses like pneumonia. General warning signs include the pale or dusky color of the lips or skin, and increased work of breathing—rapid breathing with the ribs showing on inspiration (“retractions”). Unusually noisy breathing, such as wheezing (high-pitched musical noise with breathing out) or stridor (crowing noise with breathing in), is concerning. An infant who cannot feed well from a breast or bottle is worrisome. Extreme lethargy or limb weakness at any age is very concerning.

For mild respiratory illnesses, the diagnosis is usually based on symptoms and examination alone. Checking respiratory rate, heart rate, and oxygen level are routine when the child is seen by a medical provider. Testing for viruses with a ‘respiratory panel’ can be done but is expensive and usually reserved for those more severely ill since there are few specific anti-viral treatments available. Specific testing for COVID-19 and RSV may be done, given that the implications of having these viruses are more significant regarding attending school, childcare, etc.

If your child has typical cold symptoms, it is essential to ensure they stay well-hydrated; solid food intake is less important. Offer infants extra breast milk or formula. Saltwater nose drops and nasal suction for infants can be helpful in terms of clearing mucous which interferes with breathing through the nose. Fever control with Tylenol (over age two months, though talk to a provider first) or Advil (over age six months) is primarily for comfort since fever, as part of the immune response, may help fight the virus.

No cold medications are recommended under the age of four years and should be used with caution for those 4-6 years old. These meds are usually not helpful and may have harmful side effects in younger kids. Honey (1/2 to 1 tsp by mouth) may help to cough but is safe only for those over one year of age.

To help prevent respiratory illnesses, keep up the frequent handwashing we have all gotten good at during the pandemic. In addition, kids should be reminded not to touch their faces and not to share food or drinks. Although not easy, masking (especially if your child will be in a large group) does help prevent illness. Lastly, it is vital to get your child vaccinated against those respiratory viruses for which we have safe, effective vaccines—COVID-19 and influenza.

Resource / HealthyChildren.org

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Mindfulness for Children

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Contributor Dr. Elise Herman

We live in a busy and often stressful world. Mindfulness is a simple concept that can help parents and kids be calmer and enjoy life more. Mindfulness means being present, paying attention to what is happening, and accepting it non-judgmentally. This technique is helpful at all ages but learning this when young means children will carry it forward as they grow up. Kids’ brains are still developing, including the prefrontal cortex, which directs focus and control. Mindfulness targets this part of the brain, so it is an excellent opportunity to encourage these skills while the brain is actively growing. Research has shown that mindfulness helps decrease anxiety and improve attention in school-age children. As a result, many schools include mindfulness in their curriculum.

Like so many other things in parenting, modeling behavior is very influential. Practicing mindfulness also helps you parent more effectively. Slowing down, noticing the ‘little things’, making good eye contact, and eliminating distractions (e.g., phones) will help you be present for your child. Start this mindful practice early, beginning with feeding your newborn. Put your phone out of reach (or turn it off), so you won’t be tempted to be looking at it instead of your child.

You can promote mindfulness with your toddler by engaging in activities encouraging focus, such as looking at books, going on walks, and coloring. Just looking closely at grass or flowers (and maybe you’ll find a bug!) teaches patience and calm. Toddlers can also learn to take slow breaths when upset or frustrated. You can demonstrate this, too, and be an excellent example of handling difficult emotions.

Preschoolers can practice mindfulness and focus by being quiet for a short time and increasing this as their patience and ability to “be” increases. Some parents do this at bedtime, starting with kids having eyes closed, being quiet and calm for 15 seconds, then working up to several minutes or more. Your child may then be able to calm themselves more quickly at other times, such as when upset. Taking walks in nature and being attentive to clouds, leaves, birds, etc., encourages your child to be present and focused. Notice and discuss the five senses as you go about your day. What is your child aware of in terms of seeing, hearing, touching, tasting, and smelling? You can include mindfulness in eating– enjoying food slowly and being aware of taste and smell instead of just eating in a rush without truly paying attention.

Older kids can understand more about the concepts of mindfulness and master mindfulness techniques. By learning to observe something with curiosity and acceptance instead of having an immediate emotional reaction, your child will be better able to handle complex and stressful situations. By fully paying attention to the present, it is easier to let go of regrets about the past and worries about the future. A simple technique is focusing on the breath; counting each breath up to 10 (‘one breath’ equals breathing in and out) helps with this. Imagining each breath as a gentle wave can also be very calming. Mindful breathing is a form of meditating and can be done for just a minute or more throughout the day. This really does train the mind to focus and be more grounded.

There are lots of helpful online resources. “Smiling Mind” is an Australian website and free app with good info about kids and mindfulness, regulating emotions, and how to promote empathy and connectedness. Other apps have fees but can be very valuable including “Headspace for Kids” and “Calm.” Your child is always learning from you, so the more ‘present’ you are with your child (this means putting down phones), the more both of you can be mindful, calm, and enjoy life.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Kids & Allergies

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Contributor Dr. Elise Herman

Spring is here, the weather is improving and it’s great for kids to be outside, unless your child is itchy, congested, and miserable due to allergies. Seasonal allergies are rare under age 2 years but very common after that, affecting up to 40% of children. If your child struggles with allergies, there are strategies and treatments that can have them happily outside and relatively symptom-free this spring and summer.
Allergies are the immune system’s response to things such as pollens, grasses, dust, cat dander, and more. The immune system makes antibodies called Immunoglobulin E which then cause the release of histamines, chemicals in the body which cause allergy symptoms.

The typical culprits for seasonal allergies are flower and tree pollens (like cottonweed) which cause symptoms from spring through early summer. Grass pollen starts to cause problems in the spring and lasts the entire summer. Ragweed and mold spores (often found in hay) are typically problematic in late summer to fall.
Itchiness is the ‘hallmark’ of allergy and can involve the nose, eyes, and skin. Runny or stuffy nose, sneezing, throat clearing, and itchy pink, watery eyes are common. Children do not develop a fever with allergies. Kids can get raised pink itchy bumps called hives if their skin is exposed to something they are allergic to, like grass. Allergies can make asthma worse, causing wheezing, cough, and shortness of breath.

Allergies are often diagnosed by simply recognizing the symptoms and when they occur. Classic symptoms, which occur in spring and summer and worsen with outdoor exposure, do not need testing to make the diagnosis. Testing is indicated if allergy symptoms do not improve with typical treatments or if symptoms are severe or confusing. Skin testing is usually done in an allergist’s office with results in about 15 minutes. Allergy meds need to be stopped for at least 5 days before skin testing. Blood testing, which is best for kids who cannot stop their allergy meds or who have a skin condition like severe eczema which would make skin testing difficult, looks at the amount of Immunoglobulin E for certain allergens.

So how to help your itchy, allergic kiddo?

  • Rinsing off from head to toe and changing clothes helps, both when they are having lots of allergy symptoms and routinely before bed.
  • They should also wash their hands and face when they come in from playing outside to remove pollens.
  • Cool moist compresses to those itchy eyes provide relief, too.

There are multiple long-acting over-the-counter antihistamines which are safe and effective. Cetirizine (Zyrtec) is for kids 6 months and older, and Loratadine (Claritin) and Fexofenadine (Allegra) are approved for those 2 years and up. Loratadine and Fexofenadine are non-sedating; Cetirizine may cause mild sedation in a small percentage of people. Benadryl is not ideal since it only lasts 6 hours and typically is sedating.

If an oral medication is not adequate treatment, there are other options including nasal sprays such as Flonase and Astelin, and eye drops such as Zaditor and Pataday. Young kids may resist these at first but become more accepting as they get older. If allergies are severe, allergy immunotherapy (injections) may be recommended by the allergist. For kids 5 and above with severe grass or ragweed allergies, the allergist might prescribe immunotherapy pills that are placed under the tongue daily.

Every kid deserves to be able to get outside this spring and summer! Discuss your child’s allergies with their health care provider for more information.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.