KV Healthcare

Pediatrics

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.

Bringing Music into Your Child’s Life

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Contributor Dr. Elise Herman

Children seem to love music right from the start, which makes sense since babies in the womb can hear sound beginning around the fourth to the fifth month of pregnancy. Research has shown the many positives of music for kids, so making music part of your child’s life will reap benefits over their lifetime. Music involvement includes listening to music, playing an instrument, singing, and dancing.

Music exposure for young children increases brain development, according to research done at the University of California at Santa Cruz in 2016. This was particularly noted in the areas of language and reading skills. Other research has shown that participation in music classes can increase IQ and standardized test scores along with achievement in English and mathematics. Involvement with music improves patience and listening skills and, therefore, school readiness for young children. Experiencing music and dance of different cultures expands a child’s world view and appreciation of other people.

Music has been shown to decrease stress hormones and anxiety, so much so that it is used in hospitals before surgeries and in dental offices. It increases positive emotions and encourages self-regulation and a sense of calm– obviously beneficial for children of all ages. Playing an instrument and dancing help develop motor skills and encourage self-expression and creativity. Being part of a music or dance class teaches kids how to participate in a group and work with others; kids learn valuable social skills in these settings.

It is never too early to bring music into your child’s life. Sing to your unborn child and continue this from infancy onward. Talent doesn’t matter, so don’t avoid this if you are not a gifted singer (few of us are). Sing lullabies to your infant, and attach certain songs to activates for your toddler, such as songs for cleaning up, nap time, and bedtime. Nursery rhymes and clapping along are delightful to young children. Preschoolers love silly songs and lots of repetition (think “The Wheels on the Bus”). Quiet background music (at times) is a great way to expose your child to music of different types.

Keep simple musical instruments in your child’s play area, like a tambourine and shakers. You can also make your own ‘instruments’, such as using a wooden spoon to beat pots and pans and putting beans in a childproof small plastic container for a shaker.

Older kids enjoy music classes in school and benefit from music and dance lessons outside of school as well. Watching dance videos with your child and trying to learn dances together is a fun musical activity. Going to concerts and dance performances connects kids with others and encourages attention and listening skills.

So, start early by filling your child’s life with music and dance of all types. Have fun, and let it awaken the child within you, too. Look online to find lots of local opportunities for music and dance, both for classes and live events. We are also fortunate to have the outstanding music department at Central Washington University, which offers many concerts which are family-friendly.

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.

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

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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

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.

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.

Curiosity in Children

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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

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.

Dr. Elise Herman Retirement Party

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May 15, 2022 @ 3:00 pm – 5:00 pm

Facebook Event

After 31 years of pediatric practice in our valley, Dr. Elise Herman has retired from her position at KVH Pediatrics.

She continues to remain active in the community, volunteering for local children’s organizations and blogging about healthy families.

On May 15, we’re throwing an informal celebration party for Dr. Elise, and we’re hoping you and your family will attend. She’s chosen to have it at North Alder Street Park, which offers plenty of space for active children.

Please plan to drop by the park between 3-5 p.m. to enjoy light refreshments and give Dr. Elise your best wishes. She will be glad to see so many of her patient families again.

North Alder Street Park

2400 North Alder
Ellensburg, Washington 98926 United States + Google Map