Dr. Elise Herman

Baby, It’s Cold Outside- But Get Out There Anyway!

Elise Herman , MD · January 3, 2023 ·

Contributor Dr. Elise Herman

We know how important it is for our kids to get outside regularly; all that fresh air and running around has numerous benefits. When it is cold, parents sometimes hesitate to let their kids out for fear that colder weather will make them sick. But it is actually the exposure to sick people and the viruses they carry that causes problems this time of year.

Winter play boosts physical and emotional wellness, builds muscle mass, and improves sleep. It means getting away from electronics and the temptation for unnecessary snacking. It also means avoiding crowded indoor spaces which can make it easy for viruses to spread. Vitamin D absorption is another bonus, especially if it is sunny. Exploring the outdoors in winter gives kids important exposure to nature which can lower stress. Getting outside when it is cold, blustery, snowing, etc. builds grit and toughness- in kids and parents!

Remember your childhood and what you loved to do in winter- maybe building a snow fort or creating a silly snowman. Sledding, cross-country skiing, and just going for snowy walks are terrific activities to do with kids. A scavenger hunt in winter helps kids slow down and pay attention. Can they find a bird’s nest in a tree or animal tracks in the snow? There are lots of suggestions online for outdoor play, but often children will just make their own fun without us adults “scripting” their activity.

To help keep kids warm out there, remember to dress them in multiple thin layers. Boots and gloves should be insulated and ideally waterproof. A hat and neck gaiter (safer than scarves, especially on younger children) really help on cold days. Infants and babies should wear one more layer than an adult would as a rule of thumb. If clothing gets wet, kids should come in quickly and change to avoid hypothermia.

There are some recommendations in terms of when it is too cold for kids to be outside safely. Pay attention to both the temperature and even more importantly the wind chill (what the temperature ‘feels like’). If the wind chill is 32 degrees and above, outdoor play is fine. If it is 13-31 degrees, just remember to take breaks to warm up perhaps every 30-60 minutes. Below 13 degrees windchill, outdoor play may not be safe for most kids though older kids may be OK for a limited time if they are dressed appropriately. Infants and babies tend to get cold faster since they are not playing actively and may also not complain of being too cold. Watch them carefully for signs of hypothermia- shivering, red cold skin, and decreased energy level.

Admittedly, it is easier to get outside on a beautiful spring day, but outdoor exercise in these colder months is equally important. Try to get your kids outside regularly this winter and lead by example. Your whole family will benefit by embracing winter in all its beauty and opportunities.

The local Kittitas Environmental Education Network puts out a seasonal kids’ newsletter and has some great info and ideas for wintertime fun with kids of all ages:https://www.ycic.org/_files/ugd/fbe211_0fb63dcb09744990994f0d205f32cb52.pdf

more about The contributor

Dr. Elise Herman

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

Elise Herman , MD · December 6, 2022 ·

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

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

Elise Herman , MD · November 18, 2022 ·

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

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

Elise Herman , MD · October 22, 2022 ·

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

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.

Curiosity in Children

Elise Herman , MD · September 21, 2022 ·

Contributor Dr. Elise Herman

There are characteristics we hope to see in our kids such as kindness, intelligence, and perseverance. We may not put ‘curiosity’ high on this list, but in fact it is crucial to a child’s success in learning and school—and maybe, even in life.

Research has shown that those who are curious tend to be happier, less anxious, and have a greater sense of well-being. In children, studies connect curiosity to higher academic performance, and in adults it is tied to greater achievement at work. When people are highly curious about a subject, they are more engaged with it and more likely to remember what they have learned. General memory is also improved for information unrelated to the original area of interest. It seems curiosity primes the brain to absorb and retain new information better.

Being curious has been shown to improve one’s patience. Those who are very curious seem willing to do the work themselves to figure something out as opposed to needing an answer immediately. Curiosity can lead to increased creativity, more original ideas, and a willingness to ‘think outside the box’. It also translates into greater empathy and stronger interpersonal relationships.

So despite the sometimes endless “why?” questions from our kids that can be a bit much, curiosity is a very good thing. There are lots of ways we can encourage this important trait:

Express curiosity and wonder yourself, e.g., “I wonder why the moon looks so big tonight?” Have a back-and-forth discussion about possible explanations. Together with your child find resources to get answers (and not just online) such as books, the library, and knowledgeable individuals.
Ask your child questions about things from the everyday to the more fantastical and encourage them to go deeper with their theories and ideas.
When your child asks you questions, avoid the “just because” response and research together if you don’t know the answer. You do not need to know everything, and it is valuable to show your child that you are still learning, too.
Encourage your kids to be aware and mindful, to be thinking about what they experience, and to use their full senses to engage completely.
Limit “screens” including TV, smartphones, and social media which generally are passive entertainment, though quality programing such as nature shows can encourage curiosity. Watch educational programs (on PBS and National Geographic for example) together so you can have discussions about the content.
Explore new things such as ethnic food, museums, and new cultures either through travel or online resources. This promotes not just curiosity but an openness to people different than us.
Encourage books about subjects that inspire curiosity such as history-making individuals, exploration, and science fiction.
Help your child to follow their interests and learn more about what they are naturally intrigued by.
Embrace outdoor activities, especially in nature such as walking in a park, hiking, birdwatching, and camping. These immerse us in the natural world and foster curiosity and wonder.

And enjoy being a bit of a kid yourself as you marvel and explore the world we live in with your child!

more about The contributor

Dr. Elise Herman

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.

Parent Advice / Back to School

Elise Herman , MD · August 11, 2022 ·

Contributor Dr. Elise Herman

As summer winds down, parents and children are well aware of the approach of the new school year. Some kids are very excited about learning and seeing their teachers and friends again, while others have more reservations. COVID and recent school shootings complicate this often emotional transition. There are steps parents can take now to make this go more smoothly.

Sleep

If sleep schedules got lax over the summer, start now to get back on track. To make bedtime earlier, adjust the wake-up time, moving this up by 15 minutes a day. Kids ages 3-5 years need 10-13 hours total sleep daily, those ages 6-12 years should get 9-12 hours, and teens need 8-10 hours. Remember, no ’screens’ of any kind for at least one hour before bedtime. Reading to your child before bed (or kids reading on their own) aids in falling asleep and is an excellent habit to develop now.

Nutrition

Ensure your child gets up early enough to have a healthy (not sugary) breakfast, improving attention and mood. If your child is taking lunch to school, review what they would like to bring—plan on including fruits and veggies and avoiding processed foods. Water is much better than juice; if they drink milk, nix the chocolate milk, which has as much sugar as soda. Family dinners are a great way to connect during the school year and have been shown to improve nutrition and emotional health. Although it can be tricky to have family dinners with kids’ sports and activities, try to make this a priority.

School Prep

For younger kids, being able to go to school and play on the playground now is very reassuring. Some schools will allow a visit to the classroom and a brief meeting of the teacher as well. You and your child can look at their school online, where they can see photos of the building and the school staff. Review transportation plans and always spend 10 minutes of “getting ready” time on school mornings so your child can be on time with less stress.

School Supplies

Look at the list for your child’s school and classroom (schools often post this on their website) and buy supplies early. Have your child practice packing their backpack and designate a place at home where it goes at the end of the day. All papers and notebooks should come out of the backpack daily so homework gets done and other things don’t accumulate. Pack the backpack with completed homework and any needed items the night before to help mornings go smoothly.

School Safety

In view of recent events, your child may have questions or concerns about school safety. Reassure them that a school is a safe place and that you are comfortable having them there. Although there may be a spike in COVID this fall, we have good tools (vaccines, treatment, etc.) to help. As tragic as school shootings are, they are rare, and schools continue to work on security to help prevent such violence. We must display confidence in our child’s safety at school, even if we are concerned.

Back to school “nerves”: If your child feels a bit nervous about the return to school, let them know they are not alone. This is common, especially if they are going to a new school (as will be true of many kids in Ellensburg with the new attendance zones). Talk up the positives of learning new things, making new friends, and meeting their teacher. If you recall feeling the same way, share that with them and how your nervousness dissipated over time.

Going back to school in the fall is a big deal for you and your child; let them know you have confidence in their ability to rise to this challenge. Planning a fun post-school activity and a special family dinner after that first day will give them something to look forward to and be a terrific way to celebrate this transition.

Local School Districts

Below is a list of Kittitas County school districts and their Facebook pages. Schools often post supplies lists, drop-off/pick-up info, scheduling, and other important information for parents and students.

more about The contributor

Dr. Elise Herman

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

Elise Herman , MD · June 28, 2022 ·

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

smilingmind.com.au / Explore mindfulness through creativity (activity templates)
headspace.com/meditation/kids
www.calm.com

more about The contributor

Dr. Elise Herman

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.

Update: Talking to Your Child about Traumatic Events

Elise Herman , MD · May 31, 2022 ·

Note: This article was first published in 2017 after the Las Vegas mass shooting. Other than updating the location of recent mass shootings, little else was changed. A sad statement that these horrific tragedies continue.

Contributor Dr. Elise Herman

In the wake of the most recent mass shootings in Buffalo, New York and Uvalde, Texas, we all feel sad and stressed. Parents also wonder if they should discuss traumatic events such as this with their children, what they should say and how to best reassure their child. Depending on the age of the child, how to do this will vary.

Under age 2 years, kids do not understand exactly what is happening but often pick up on the emotions of the adults around them, and may cry more often, be fussy and be less social. Preschoolers may have some understanding that something bad happened and will look to their parents for reassurance and a sense of normalcy. Kids in elementary school may develop fears depending on the trauma (especially a school shooting) and not want to go out to school or other activities. Regressive behavior and wanting more help from their parents are normal.

Preteens through teens, often very informed due to their exposure to media, may feel very worried and overwhelmed. They may minimize their feelings, withdraw, or not want to talk about the event. Their stress could come out in being more argumentative or they may have more physical complaints such as headaches.

Parents are crucial in helping their kids through a traumatic event such as a mass shooting. For the child old enough to express themselves who asks about the event, find out what they know or have heard. Keep your discussion age appropriate, and don’t volunteer additional details that may add to your child’s distress. For a preschool child, a simple explanation that a bad person hurt people but can’t hurt anyone anymore is enough. Of course, reassurance that they are safe is vital.

With their access to the news via their phone or computer, older kids may have more specific questions and worries. They may have heard misinformation from their friends and social media. Give them your full attention and listen carefully. Address their concerns and correct misperceptions. Remind them of the plans in place to help prevent these events and plans that go into action if /when such events occur- and that as tragic as a mass shooting is, it is very rare.

Kids of all ages benefit in these situations from parents being very available, whether it is for questions and conversation or just warm hugs and time together (take your lead from your child). Keeping the family routine including school, activities, and family meals is important.

It is healthy to express your emotions and encourage your child to do the same but process your own feelings before addressing the event with your child. Seeking help from a counselor, health care provider, or clergy member is appropriate for anyone feeling distraught and overwhelmed weeks later, or if you are worried about how your child is coping.

We have ‘screens’ everywhere and younger children may think every photo or video is actually another tragedy happening. Children with Internet-connected devices should avoid overexposure to the event- the same goes for parents. Younger kids (some say under age 11) should not watch the news or news videos online at all because the visuals can be too overwhelming.

In the face of such incomprehensible tragedy, we can remember PBS’ Mr. Rogers recalling what his mom told him:

Look for the helpers. You will always find people who are helping.

Good advice for all of us. Highlight the bright spots—the first responders, the heroes, average people doing what they can, be it donating blood or giving money to help. Tweens and teens may want to get involved to help promote social change; the non-profit website DoSomething.org is a fine place to start. There is a lot of the good in the world, and we can be the good and an example to our children. Be extra kind, help your child do something nice for someone else, and make your corner of the world a reassuring place for your child.

Resources:

DoSomething.org
National Child Traumatic Stress Network (NCTSN)
HealthyChildren.org (American Academy of Pediatrics)

more about The contributor

Dr. Elise Herman

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

Elise Herman , MD · May 6, 2022 ·

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

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.

Nature & Children

Elise Herman , MD · March 28, 2022 ·

photo courtesy of KEEN

Contributor: Dr. Elise Herman

Many of us recall childhoods filled with lots of outdoor time, whether it was playing in the backyard, going to parks, building forts, or just running around. Our kids, however, are having very different childhoods, with most spending less than 30 minutes a day outside and up to 7 hours daily in front of some type of technology. The negative physical and emotional effects of this shift are far-reaching and concerning. Rising obesity rates and more mental health issues are huge problems in kids and too much time inside and on electronics are felt to contribute. Research shows that simple outdoor time in nature (recommended to be at least 60 minutes a day) can help reverse these trends.

The benefits for children of getting outside in nature are well documented:

Increased physical activity, decreased snacking, and therefore decreased obesity
Increased imagination, creativity, and focus
Improved distance vision (kids without much outdoor exposure are more likely to have nearsightedness)
Increased Vitamin D levels (important in bone and immune system health)
Decreased stress, depression, and anxiety
Better behavior with less anger and aggression
Boost in confidence and self-reliance
Improved sleep

So what does outside nature time look like? It could be exploring the backyard or park, hiking, gardening, riding bikes, or just sitting under a tree daydreaming. Unstructured time, without a specific plan, encourages a child to get creative and be independent.

There are some terrific opportunities in our community for kids to get outside this summer. We have wonderful city parks and lots of hiking trails, including the Palouse to Cascades Trail (formerly called the John Wayne Trail) which is easily accessible and great for all ages.

We are fortunate to have nature/outdoor camps as well. Lazy F Camp and Retreat Center in the nearby Manastash Canyon offers day, overnight, and family camps. Kittitas Environmental Education Network (KEEN) provides nature-based education for all ages year round and will once again hold the “Windy City Park Rangers” day camp program in local parks this summer for kids in kindergarten through 8^th grade (more information coming mid-April). KEEN also has the Pond to Pines nature-centered summer camp for children in pre-K through 10^th grade which is based at Helen McCabe Park. KEEN has been awarded substantial grants and is able to provide 80 full scholarships for kids from families in need.

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KEEN Summer Camps 2022
June 20 through July 29

So get your kiddo out regularly in nature now and make summer plans for more of the same. Enjoy the benefits of turning your child into a nature-loving, active, outdoor enthusiast!

More summer camp info at:

more about The contributor

Dr. Elise Herman

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.