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Why parents should care about the latest Surgeon General report on smoking

Posted by Dr. Claire McCarthy January 30, 2014 07:58 AM
teen smoking.jpg

50 years after the first report warned us about the dangers of tobacco, the current Surgeon General has issued a new report, telling us it's even more dangerous than we realized.

If anyone needs to listen to the messages of this report, it's parents.

Our job as parents isn't just to bring kids into the world. It's also our job to raise them to be healthy, happy, positive contributors to society. That's why we need to do everything we can to stop them from starting smoking. Most (87 percent) first use of cigarettes happens by age 18, and nearly all (98 percent) by age 26. We have got to get the message to our children that tobacco is really dangerous. Along with the cancer, cardiovascular and lung disease we knew it caused, the latest report links it to:
  • eye degeneration
  • birth defects
  • a higher risk of tuberculosis
  • diabetes
  • ectopic pregnancy
  • erectile dysfunction
  • liver and colorectal cancer
  • rheumatoid arthritis
  • immune problems
There is nothing worse than losing a child--especially when the death was preventable. Since the first report in 1964, there have been more than 20 million preventable deaths linked to tobacco. It is the leading preventable cause of death in the United States.

Here's a scary line from the report: "If current trends continue, 5.6 million US youth who are currently younger than 18 years of age will die prematurely during adulthood from their smoking."

You really don't want your child to be one of them.

It's not just the smoke--nicotine is a problem too. The report talks about how it can affect the developing brain, including the brains of adolescents, in ways that may be permanent. This is particularly important with the rise of "e-cigarettes", many of which contain nicotine. While e-cigarettes might help some smokers quit, it's really important that youth not start using them. The use of e-cigarettes has doubled among middle-and high-school students, so we have got our work cut out for us.

Even if your kid doesn't smoke and you feel confident they won't start, you need to care about this report--because all of us get exposed, at some point or another (some of us more than others) to secondhand smoke. The report makes it very clear that secondhand smoke can be deadly. In children, it causes ear infections, lung problems (such as asthma attacks), pneumonias and sudden death in infants. In adults, it causes cancer, heart disease and stroke--and if pregnant women are exposed, it can cause their babies to be born small.

Bad stuff.

There are also real dollar costs associated with smoking. The annual costs attributable to smoking in the US are between $289 and 333 billion, when you include direct medical costs and lost productivity due to premature death (from both smoking and exposure to secondhand smoke). These are dollars that might have gone to your child's schools, to your community, to health care and other things that make a difference in your family's life. 

Here's what you can do:
  • Talk to your kids, early and often, about the dangers of all forms of tobacco and nicotine. Have rules and expectations--and consequences if they use any. Find out if their friends smoke, because it makes it more likely that they will start. For more information and for ideas on what you can do, visit the Smoking and Tobacco page of the website of the Centers for Disease Control and Prevention.
  • Support any legislation or initiatives that make it more difficult for people to smoke, especially youth.
  • Support funding for anti-tobacco initiatives. Whatever they cost, it's going to be way less than $289 billion.
This is about your children's future. Read the report. Take action.

Guns put 20 youth into the hospital every day

Posted by Dr. Claire McCarthy January 27, 2014 09:18 AM
gun.jpgDid you know that in 2009, there were 7391 hospitalizations due to injuries from firearms in youth less than 20 years old? That averages to 20 a day--almost one an hour.

That was the finding of a study just published in the journal Pediatrics. Researchers from Yale and from Boston Medical Center (including my dear friend and esteemed colleague Dr. Bob Sege) looked at data from the 2009 Kids' Inpatient Database. They looked at not just the number of hospitalizations, but whether the injuries were from assault, from an accident, or were a suicide attempt--and they looked at data about the youth being injured.

When they looked closely, they found that 85 percent, or 17 out of those 20, were between the ages of 15 and 19. Most of those teens were male, African-American or Latino, and most of the injuries were from assault. These are kids out to hurt each other with guns. 

The injuries in kids under 15, the 3 out of the daily 20, were mostly unintentional. These are the accidents. 

Six percent of the youth who were injured died--that works out to one every day. And the direct medical costs for all the injuries totaled more than $146 million.

Clearly, we need to do something. 

For the kids under 15, we need to do a better job of preventing accidents from guns. The American Academy of Pediatrics thinks that children are safer in a house without guns, and I agree--but if there is a gun in the home, everyone is safer if the gun is kept locked up, with the ammunition stored (and locked) separately. Just making sure that always happens can make all the difference when it comes to preventing injuries and saving lives.

For the kids older than 15, solutions are likely to be more complicated. It's still important to keep guns locked up; as the Sandy Hook shooting showed us, bad things can happen when youth (especially troubled youth) have access to their parents' guns. 

In general, we need to be doing everything we can to be sure that only responsible adults have access to guns. There are way too many loopholes and ways that guns end up in the hands of youth (and others who shouldn't have them) who use them on each other. We need to close those loopholes. It should be hard to get a gun--and we should know the background and mental health status of people who get them.

But it's just as important to find better ways to identify and help at-risk youth. We need to connect with them before they connect with a gun. We need to put real dollars into education, youth jobs, community programs, family support and mental health services. We need to teach nonviolent ways to resolve conflict. We need to look at all the social and cultural factors that might be contributing to youth violence, including media.

Each and every one of us can do something. Dr. Sege talked about a mother who found a gun in her son's jeans pocket--and turned it in to the police, because she didn't want to be saying at her son's funeral that she didn't see it coming. Whether it's locking up a gun or turning one in, volunteering at a school, talking to your legislator about funding for youth programming and mental health services, or making a donation, each of us can make a difference. 

This is a public health problem--one that is hurting the lives and futures of our youth. It's time to fight it like we fight the flu, or smoking, or obesity. Ultimately, this touches all of us.  

The latest, greatest, wonderfully simple way to prevent childhood obesity

Posted by Dr. Claire McCarthy January 24, 2014 07:53 AM
kid eating.jpgIf you want to help your children get to and stay at a healthy weight, here's what you should do:

Let them serve themselves.

As Maanvi Singh wrote in a terrific blog on, the Department of Agriculture and lots of nutritionists have been recommending that kids be allowed to serve themselves for quite a while now. The idea is to put out bowls of food, "family style" and let kids take what they want.

It turns out that when kids do this, they eat less--and they are more likely to try new foods. Makes sense. And yet--we don't do it very often. We are far more likely to serve children ourselves. We do it for good reasons: we want to be sure they eat enough, and we want to be sure they eat the foods we think are best for them. But giving kids some freedom--and control over the amount and types of foods they eat--may be better for them in the long run.

This may be the case with babies, too. In a study from New Zealand, babies who were spoon-fed were more likely to be overweight than babies that were allowed to feed themselves. In "baby-led weaning," instead of giving pureed baby foods with a spoon, babies only eat solids that they can pick up and eat themselves--when they are ready, and only as much as they want. The idea is the same: when you give children control, they get to listen to their own hunger cues--as opposed to listening to you tell them to finish up.

There are definitely some caveats here. It's not okay if the only thing your child serves himself is pasta (as a couple of my children would definitely have done if it were up to them); there need to be some ground rules about taking a variety of foods (including fruits and vegetables). And when letting babies feed themselves, it's really important to be sure that they can't choke on any of the foods you offer, and that they are supervised while they eat. 

But the basic premise is immensely sensible. What's also great is that serving food "family style" by definition encourages family dinners--which we know are good for kids and families. It might even encourage cooking. I love it.

We need more ideas like this one: simple, practical ideas that not only help keep children healthy, but help strengthen families too. 

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post. 

Thank you, Senator Markey, for calling out NBC on e-cigarettes

Posted by Dr. Claire McCarthy January 22, 2014 10:31 AM
JULIA-LOUIS-DREYFUS-618-618x400.jpgI'm really proud of Massachusetts' Senator Ed Markey for calling out NBC--and some irresponsible celebrities--for sending a bad message to our kids. 

At the Golden Globes, there were some celebrities (including Julia Louis-Dreyfus and Leonardo DiCaprio) puffing away on electronic cigarettes ("e-cigarettes"), and it was caught (featured) on camera. As Senator Markey and four of his colleagues pointed out in the letter they sent to NBC Universal, it was like having a celebrity endorsement of e-cigarettes.

Youth are impressionable. We already know that exposure to tobacco use in the media makes kids more likely to start smoking. Having footage of celebrities using e-cigarettes makes it more likely that kids will start doing the same.

Now, e-cigarettes may not be a bad idea for some people--specifically adults who are trying to quit, or adults who simply can't quit. For both, e-cigarettes could be a way of lessening their overall health risk. But they are a really bad idea for youth.

There is a real danger that e-cigarettes could be where some youth begin their relationship with tobacco, instead of where they end it. Besides the fact that we really don't know the long-term health effects of e-cigarettes (which obviously is crucial when you are dealing with people who have the rest of their lives ahead of them), the worry is that if they get hooked on nicotine or just on the idea of smoking, they will move to tobacco--and the myriad of health risks tobacco brings.

That's why we need to speak up, like Senator Markey did. Even more, we need to take real action to protect our youth from e-cigarettes. At the Massachusetts State House, Representative Jeffrey Sanchez (D-Jamaica Plain) has proposed legislation HB3726 that would do just that. It would:
  • Create a comprehensive definition of tobacco products. It's not just e-cigs--there are all sorts of "emerging tobacco products" that sometimes sneak under the legal radar.
  • Restrict sales to minors. Seems like a "duh" thing to do, but until you make the law, anybody can go buy the stuff.
  • Restrict manufacturers from distributing samples of tobacco products. E-cigarettes come in flavors like chocolate and bubble gum. Handing them out could be like handing out candy...and a bad habit is begun.
  • Prohibit the use of smoking and electronic cigarettes in places where the smoke-free workplace law applies. Let's get rid of the loopholes. And truly, we don't know that the vapor from e-cigarettes is safe, even if it isn't the same as regular cigarette smoke. For all we know, it's got its own set of toxins.
The legislation is currently in the Joint Committee on Public Health and needs your help to advance. Call Senator John Keenan (D-Quincy-617-722-1494) and Representative Sanchez (617-722-2130) and let them know you support it. You can also send an email to the State House by visiting the Children's Advocacy Network site of Boston Children's Hospital.

Let's send a clear message that there's no such thing as safe tobacco or safe cigarettes. 

Martin Luther King Day: A Day On, Not Off

Posted by Dr. Claire McCarthy January 20, 2014 06:52 AM

Did you know that Martin Luther King is the only non-president to have a day commemorating him? 

Not only that, he's the only person whose "day" isn't just meant to be a day to remember him and a day off of work or school. It's meant to be a day of service. 

King's life was one of service. He fought tirelessly for the rights of African Americans, the rights of the poor, for equality for all people--and he believed that the fight should be nonviolent. Despite multiple arrests, and violence around him, he stayed steadfast in that belief until he was killed in April of 1968. 

It's great to have a day off, especially now when it's cold and we're all still recovering from the holidays and spring feels so very far away. It's nice to sleep in and not have to get everybody up and organized for school. But this is an opportunity we really shouldn't miss: an opportunity to teach our children that they are part of something bigger, and that they should help whenever and wherever they can.

So do something today. There are service projects all over the country--the Martin Luther King Day of Service website can help you find them (there are some great ones in the Boston area). If you can't organize to do something today, plan a future service project with your family. 

And while you're at it, watch the "I Have A Dream" speech with your children. It will give you goosebumps.

Reality shows I'd like to see

Posted by Dr. Claire McCarthy January 16, 2014 08:15 AM
Thumbnail image for pregnant teen.jpgIt sounds so wonderful, having a baby. You have a beautiful child who is all yours, who loves you best of all, who everyone dotes on. You get to be a parent and do everything perfectly, better than your parents and people you know.

And then you have a baby, and find that you are sleep-deprived, never get a moment to yourself, can't do any of the activities you used to do and spend most of your time feeling incompetent. Oh--and babies aren't always cute. They scream and poop and rarely do what you want them to do at any given moment.

Any parent can relate to this--and therefore understand how it might indeed be possible that the MTV show "16 and Pregnant" has decreased teen birth rates. According to a study released by the National Bureau of Economic Research, teen birth rates dropped a lot when the show started in 2009. The authors of the study said that the show is responsible for a 5.7 percent drop in teen births. 

There's nothing like actual reality, actual facts, to pop a fantasy bubble--especially for teens. Let's face it, they know better than all of us. If a teen has an idea, it's really hard to shake that idea. I know this from experience both as a parent and a pediatrician.

So...I think we should run with this concept. How about these reality shows?

A show about young adults living on a minimum wage job. Not only would this be good for our politicians and policy-makers to watch (our minimum wage is disgraceful), it might help motivate youth to stay in school--and go to college--so that they could get a job that pays a bit more. So many teens I talk to think that school isn't so necessary--they will just get a job and everything will be fine. Yeah, right.

A show about people trying to make it in professional sports. For a bunch of teen boys I've seen in clinic recently, Plan A is playing professional baseball or basketball. School is secondary. I'm sure they are talented (actually, I'm not positive they are, but they certainly believe themselves to be), but the odds just really aren't in their favor. I think it might help to watch what life is like for people who try...maybe I could get them to at least come up with a Plan B.

Just think about it. There are so many possibilities.

There are three other shows that would be unethical to do as long-term reality shows, but maybe if they featured one story each episode it wouldn't be unethical--and it could be really effective:
  • A show about kids who smoke a lot of weed, drink, or use other substances. I have various patients who experiment with this stuff, thinking that they can handle it and that it's not such a big deal. I think it would be really useful for them to see how lives can unravel.
  • A show about teens who have experienced unhealthy dating relationships. I once saw a survivor of domestic violence talk to a group of high school students, and they were clearly mesmerized--and visibly shaken--by her compelling story of how what seemed like a perfect relationship with the perfect guy went terribly wrong. If we could get more teens to hear these stories, we could help them see the signs, and ask for help, before it gets dangerous.
  • A show about victims of bullying. Lots of teens think of bullying as drama, no big deal, and think that the victim should just, well, ignore it or get over it. Maybe if they could really see and understand what it feels like to be bullied, they would think twice before they made that mean offhand comment. And maybe they would be more willing to stand up to bullies.
I also desperately wish there was a way to do a time-lapse reality show about how it really can get better for teens who are different--because of sexual orientation, or cultural differences, or simply because for whatever reason they don't fit in with the mainstream popular kids. Those of us who have known those kids or been those kids know that high school does eventually end and that when you find your tribe and your place it's a whole different world--but it is really, really hard to make suffering teens believe this, especially when that different and better world may be years away.

Sometimes it takes living something, or getting a good look at someone else living it, to really understand. Media in general, and social media in particular, can reach so many people and help them understand things they didn't before. 

I'm guessing that the creators of reality shows aren't as interested in helping people as they are in making money--but that's okay, because as "16 and Pregnant" demonstrated, you can do both. Here's hoping that the producer of the next reality show keeps that in mind.

Study: kids are getting beat up at school

Posted by Dr. Claire McCarthy January 14, 2014 05:47 AM
Thumbnail image for fighting.jpgSchool is supposed to be a safe place for kids. Not only is it where we send them to learn, it's a place with rules--and supervising adults. Sure, there's always the possibility of falling off the swing or tripping over a chair--but we shouldn't have to worry about our kids being beat up.

A study recently published in the journal Pediatrics says that actually, we do need to worry.

Researchers looked at information from emergency room visits across the country. They found that between 2001 and 2008, more than 7 million children ages 5 to 19 were treated for injuries they got at school (about 12 percent of all injuries in that age group). But here's what's scary: 10 percent of those injuries were intentional--the kids were hurt by someone on purpose, not by accident.

The injuries aren't all minor, either. Some are just bumps and bruises, sure, but there were a significant number of fractures--and brain injuries.

These intentional injuries are more common in boys--and, what is particularly scary is that boys are more likely to get beat up at school than outside of school. (Girls are more likely to be hurt intentionally outside of school). This is especially true of middle school students--which reminded me of the time when my daughter's middle school friend was taken under the bleachers and beaten because he is gay.

We talk a lot about cyberbullying, and it's true that it's a dangerous thing and on the rise--but this study makes it clear that plain old schoolyard bullying is still happening.

So what can we do?

Well, all schools should have anti-bullying policies and programs--and good supervision on school grounds. If parents don't know what the policies, programs and supervision are at their child's school they should ask--and if they aren't in place, they should speak up and make sure they get put into place.

Parents also need to work with their own children to help prevent them from becoming either victims or bullies. A lot of that has to do with how children are doing emotionally and socially, and parents should always talk to their pediatrician if they have any concerns. But there are also strategies we can teach children to help them handle those dicey school moments. The American Academy of Pediatrics (AAP) suggests that parents teach their children to ACT CALM.

If they are mad, they should:

Acknowledge angry feelings
Calm down (breathe deeply, count to 10, listen to music)
Think and Talk (think about the problem and ways to fix it, talk with someone about how they are feeling)

If someone starts a fight, the child can be the one to stay calm:
Calm down (keep a safe distance away, take deep breaths, stay alert)
Avoid (avoid returning insults, avoid other kids who may want to fight)
Listen (to what other kid is saying, try to understand what they really want)
Move on (find a way to solve the problem without fighting, or just walk away)

To learn more about the study and for links to other resources about violence against children and keeping kids safe, visit

4 Things Many Parents Don't Know About Cyberbullying

Posted by Dr. Claire McCarthy January 10, 2014 09:36 AM
cyberbullying.jpgDid you know that according to the 2011 Youth Risk Behavior Surveillance System survey, 16 percent of high school students report being the victim of cyberbullying? That's one in six. Three or four out of every classroom. 

One of them could be your child.

Kids (and grownups) have been mean to each other since time immemorial. Bullying is hardly new. But the explosion of electronic technology has allowed bullies to victimize in ways that are easier to hide from adults--and at the same time more visible to peers. Not only is the bullying more visible to peers, it's visible to more peers, and more quickly. Cyberbullying is harder to control, harder to make go away--and its effects can be devastating, even deadly. 

How much do you know about cyberbullying? Here are four things many parents don't know:

Most parents of victims have no idea it's happening. Cyberbullying happens in a sort of parallel communication universe, one that most parents simply don't have access to. It happens in text messages passed between kids, on social media sites parents don't visit or in posts they can't see because of privacy settings. Victims often don't want to tell their parents about it; they may be embarrassed--or, quite simply, they may not fully realize that they are being bullied. They know that what is happening makes them feel bad--but may not connect with the fact that it is wrong and something that they should tell someone about. In part, that's because...

Many kids think of it as "drama", not bullying. If you talk to teens, many will tell you that drama is a fact of life for them and their peers. Some of what they see online or in text messages may make them squirm, but they don't necessarily think of it as wrong or bad, let alone something they need to react to or try to stop because of the damage it could do. Parents can play an important role here in helping their kids understand that whether you call it drama or bullying, it can hurt--sometimes very badly.

Bullies are often the popular kids--or are victims of bullying themselves. Bullies are not just big mean kids who beat up little kids for their lunch money. Popular kids may be particularly good at the social nuance that makes bullying particularly powerful--and may be particularly invested in it if they feel that it is somehow helping their social status. They also have an air of deniability; parents and teachers might find it hard to believe that a student who appears well-liked by peers, is an athlete or a good student, could be capable of being mean and hurtful. 

At the same time, it's important to be thoughtful, and ask questions, when bullying is discovered. Many bullies have learned the behavior from being bullied themselves--or are lashing out because they've been hurt. While bullies should be punished--it's behavior that must have consequences--they may also need real help.

Cyberbullying should never be ignored. Even seemingly "little" things, like a text message that makes fun of somebody, should get a reaction. What we need to teach our youth is that it's never okay to be unkind, and that words can hurt. Some cyberbullying should be reported to authorities, such as if it is threatening, stalking or sexually explicit; it should also be reported if it breaks school rules (parents should make sure that they and their kids know what the school rules are). But more than that, we need to teach youth to be good online citizens--and a big part of being a good online citizen is understanding the role of the bystander in bullying.

Bystanders can make everything worse when they encourage or just ignore bullying--and they can make all the difference when they refuse to encourage it, when they support the victim, and when they stand up to the bully. It's important for parents to talk to their kids about this, and empower them to make that difference.

To learn more about cyberbullying, and bullying in general, visit

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post. 

Quiz: How Smart Are You About Cold Weather Safety?

Posted by Dr. Claire McCarthy January 8, 2014 07:58 AM
thermometer cold.jpgEarlier this winter, during one of the cold snaps that are becoming way too frequent, I saw a whole bunch of kids walking outside my daughter's middle school without hats or gloves. One girl had on Capri pants and no socks. It was nine degrees out. Not very smart.

How smart are you when it comes to being safe in the cold? See how you do on this quiz:

True or False: When going outside in cold weather, it's best to wear multiple layers of loose-fitting clothing, rather than one layer of heavier clothing.

Answer: True (starting you off easy here). Layers help keep the heat in. For inner layers, wool, silk or polypropylene are better than cotton. Hats are key, mittens are better than gloves, and it's important to have a scarf or mask for your face.

True or False: If you are sweating when you are outside in the cold, that's good--it means you are nice and warm.

Answer: False. Perspiration is how your body cools off--you'll just end up colder. Ditch a layer.

Screen Shot 2014-01-08 at 8.21.53 AM.pngTrue or False: If your kids are bundled up, it's fine to let them play outside.

Depends--on the temperature, and wind chill. I'm all about getting kids outside, even in the winter. But frosbite can set in very quickly--and exertion in really cold weather can stress the body further. When the weather gets very cold (it's hard to give an exact temperature, because the wind chill affects it as well), you should really limit the time your children spend outside. If they go out, bring them in as soon as they start shivering--and if they get wet.

Which of the following are signs of frostbite?
a. Very red skin
b. White, gray or yellow skin
c. Numbness
d. Pain and stinging

b and c. Certainly if the skin is getting really red (or there's any pain) it's time to get out of the cold, but frostbitten skin is pale and numb. It's the numbness that can be a problem--sometimes people don't even realize they have frostbite!

Which of the following should you do if you suspect frostbite?
a. get somewhere warm immediately
b. rub the skin
c. use body heat to warm the area, or run it under warm (not hot) water
d. use a heating pad

a and c. Don't rub the skin, as it can do more damage--and using a heating pad when skin is numb can lead to burning. If you are worried about frostbite you should also call your doctor for advice.

Which of the following are signs of hypothermia?
a. shivering
b. drowsiness, less energy
c. confusion
d. slurred speech, memory loss
e. all of the above

e. Remember, it doesn't have to be extremely cold for hypothermia to set in, especially if a person gets wet. And the confusion/drowsiness part can make it hard for people to realize that they are getting into trouble.

If you suspect hypothermia, you should:
a. Get somewhere warm immediately
b. Take the person's temperature
c.  Stick the person in a tub of hot water
d. Use warm blankets and give them something warm to drink.
e. Warm up their hands and feet first.

a, b and d. Obviously, getting out of the cold is the first step. But for warming, think dry--which also includes getting the person into dry clothing if they are wet. So warm blankets are good (an electric blanket is great if you have one), maybe lots of them. While hands and feet may feel really cold, you want to warm the core first--and drinking something warm, like cocoa (stay away from caffeine) can help warm the insides too (one big caveat: don't make people who are extremely sleepy drink--they might choke). The reason taking the temperature is a good idea is that if the temperature is 95 or below that's dangerous--and a reason to get medical attention. If you ever aren't sure what to do, call your doctor.

To learn more about cold weather safety, including lots of great information about how to prepare for storms and keep your pipes from freezing, check out the Center for Disease Control and Prevention's Extreme Cold guide.

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post.

Could you have the flu?

Posted by Dr. Claire McCarthy January 6, 2014 08:38 AM

Thumbnail image for flubreak.jpgI saw a child with the flu in clinic last week. At the time I wasn't thinking too much about whether it was the flu or another viral illness; I was thinking more about whether to hospitalize the child, which we did. But when I heard about the positive flu test, I thought: of course.

I also thought: here we go.

According the the Centers for Disease Control and Prevention (CDC), the number of people going to the doctor for "influenza-like illness" (we don't test everybody--we go by symptoms, usually) is on the rise. During the week of December 22-28, twenty states reported high levels of flu activity, up from only six states the week before (Massachusetts was not one of the states, phew). That's a big jump. 

It's important to know the signs and symptoms of the flu. People can get very sick, like the child we admitted to the hospital--so being watchful and ready is key. And while we don't usually give medications to treat the flu, in some cases (especially in people who have health problems or for other reasons might get sicker with the flu) we do--and to be effective, the medication really needs to be given in the first couple of days of illness. If people aren't paying attention, they could miss that window of opportunity. 

It's also really important for anyone with the flu to stay home. The flu virus spreads quickly and easily; if you go to work sick, or send your child to school sick, or visit friends or family sick, well, you could make a whole lot of other people sick.

So here are the symptoms:
  • Fever, sometimes high (not everyone with the flu will have a fever, but most do)
  • Cough
  • Runny nose/stuffiness
  • Sore throat
  • Headache
  • Muscle aches
  • Feeling tired
  • Sometimes: vomiting and/or diarrhea
I know, those sound like the symptoms of a cold. It's not always easy to tell the difference. Usually, the flu feels much worse than your average cold. But at this time of year, it's a good idea to stay home even if it just seems like a bad cold--better to be on the safe side. If there is any fever, stay home until it has been gone for 24 hours.

Most of the time, you don't need to go to the doctor. The child I saw was having trouble breathing--if that happens, you absolutely need to go to the doctor. You also need to go if the fever is very high and isn't coming down with medication, if there is extreme sleepiness, the person isn't drinking, there is severe pain, if things are getting worse, or there is some other reason that you feel very worried (I really trust a parent's instincts!). If you aren't sure what to do, call your doctor. Definitely call the doctor if the sick person is under six months old, over 65 years old, or has any medical condition.

As for what to do at home: think fluids and TLC. Clear fluids like chicken soup or clear juice are best. Use a humidifier, and saline nosedrops, for stuffy noses and coughs--for children over a year, honey soothes coughs well too. Extra pillows can help with the post-nasal drip (no pillows for babies!). Lots of rest is key. Acetaminophen or ibuprofen can help with the fever and aches, but be sure to follow directions exactly, and only use them if truly needed. Stay away from cold medicines unless your doctor tells you to use them--they don't do much and can have side effects.

It's not too late to get the flu shot! That, along with lots of hand washing, is the best way to keep the flu away.

To learn more about the flu and what you can do for your family, visit the CDC's flu website.

Pregnancy and peanut butter: another example of information overload

Posted by Dr. Claire McCarthy January 2, 2014 08:53 AM
Thumbnail image for plum island 2005 084-2.jpgI am so glad that my first pregnancy was 23 years ago instead of now. I would go absolutely nuts now.
Speaking of nuts, the latest in the list of actually-never-mind bits of medical information is a study recently published in the Journal of the American Medical Association saying that it's totally fine for pregnant women to eat peanuts and tree nuts (assuming they aren't allergic to them). According to the study, it doesn't make it more likely that their babies will have a peanut allergy, which had been discussed as a possible explanation for why we are seeing so many children with peanut allergies. It turns out that eating peanuts and tree nuts during pregnancy may actually protect against allergy!

So, as so often happens, the medical advice changes. It is, I think, part of an information overload problem. 

Medicine is changing all the time; we learn new things every day. And each new discovery spawns more discoveries; there are times when I feel that what we know, and what we are learning, is literally exploding. I do a lot of reading to keep up, but I could read all day every day and not know everything. Medicine feels different than it did 23 years ago when I was pregnant with Michaela.

At the same time, we are in an age where access to information is exploding too. News travels nearly instantaneously. When I was pregnant with Michaela in 1990, the JAMA study would have been reported in the papers, where I might or might not have read about it. My obstetrician might or might not have heard about it quickly, depending on how much time he had to read journals. Information, especially medical information, moved more slowly and was less widely accessible. 

There were downsides to this, obviously. Getting good health information out to those who need it quickly can make all the difference, and well-informed patients can better advocate for themselves (and often get better care when they do). But there were upsides, too. Information had a time to sit, get put in context, get tried out, be interpreted and better understood. Sometimes, in the process, we realized that it didn't make sense. Doctors had a chance to explain things. We don't necessarily get that anymore.

So often these days, parents ask me questions that puzzle me. They puzzle me because I haven't heard anything about it (I am not the only doctor who has had to Google something because a patient heard about it before I did)--or because it would never have occurred to me to ask the question, let alone worry about it. But the way information get spun these days, it's hard not to worry--and react.

See, that's the thing: without medical training (actually, without specific medical training--even parents who are medically trained come to me with puzzling questions outside of their area of specialty) it's really hard to interpret information--and know if it has anything at all to do with you. And when information has to fit into the paragraph next to the picture on the website and be condensible into a 140 character Tweet, well, there's lots that gets left out.

Like nuance. Like the fact that so little in medicine is completely certain, that there is so much more gray than black or white.  Like the fact that risks are relative. Eating Brie cheese during pregnancy doesn't mean that you will get Listeria (the risk of contamination is 0.7%, or 7 per 1000 servings)--which is good, since I was blissfully unaware that I wasn't supposed to eat soft cheese during pregnancy and ate it nearly daily. We need to be aware of risks, but we need to keep perspective, too--after all, crossing the street or driving a car and other ordinary acts of daily life can get risky too. Sometimes the big picture is the most important one. 

And ultimately, each person and each situation is different.

I don't want to turn back the clock 23 years. I think that overall, things are better now. But we do need to be careful about anything we read or hear; it's important to take a deep breath and ask questions. And--this is really important--we need to talk to our doctors, and others with training and experience, as we sort through all that we hear and read. We need to understand that some significant percentage of the information we get will be reinterpreted or disproven in the future--and so be more thoughtful, less reactive.

We can never know everything, and there are never guarantees. Getting more information, and getting it more quickly, will never change that.

Is there something you'd like me to write about? Leave me a message on 
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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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