Conjunctivitis: The Pink Eye

Anna Tielsch-Goddard CPNP-PC

The most common causes of pink or red discoloration in the conjunctiva (the clear membrane which covers the sclera, the white part of the eyes) are bacterial, viral, or allergic conjunctivitis. This condition is also known as "pink eye."

If your child has pink or red eyes, complains of itchiness, and has any sort of crust or drainage around the eyes, you should make an appointment with your child’s primary care provider (PCP) for diagnosis and treatment. Your PCP, a pediatrician, nurse practitioner, or physician assistant, will be able to determine whether or not the pink eye is most likely caused by a bacteria, virus, or allergies.

Pink eye usually causes sleepy crust or "a glue" in the eyes, upon awakening. If your practitioner determines that the pink eye is caused by bacteria, he or she will prescribe a topical antibiotic, usually in the form of eye drops, which will reduce your child’s symptoms, shorten the duration of the illness, and reduce the risk of contagiousness.

If your child has cold symptoms, such as a cough, runny nose, or nasal congestion, the cause of the pink eye is most likely viral. If your PCP thinks that the pink eye is caused by a virus, he or she will recommend cold compresses, artificial tears, and other symptomatic treatment.

Another type of conjunctivitis, allergic pink eye, is usually affiliated with allergies, eczema, and asthma. This type of pink eye causes itchy eyes and watery discharge. Treatment involves avoiding exposure to allergens and using artificial tears or prescription eye drops to alleviate the red eyes.

Other causes of red eyes include subconjunctival hemorrhages and blepharitis.

Subconjunctival hemorrhages are caused by broken blood vessels in the eye that cause redness in the conjunctiva. They are caused by minor trauma such as vomiting or prolonged coughing, are painless, and usually resolve on their own in 2-3 weeks.

Blepharitis, a more severe inflammation of the eyelid, may also make the eyes appear red and will usually be accompanied by a swollen eyelid or crusting in the eyelid margin. Treatment, including warm compresses and a topical antibiotic, is necessary to help with healing. In severe cases a referral to an ophthalmologist is necessary.

In all cases of pink eye, you must teach your family to practice strict hand washing and avoid sharing any personal items that might spread infection. Any time your child touches or rubs the eyes, he or she should wash hands right away or use an anti-septic hand sanitizer. Avoid sharing wash-clothes and other cleansing objects.

Contact lenses should not be worn until the infection clears up. If your child wore the lenses during the course of the pink eye, discarded them and obtain a new lens case. Cross contamination usually subsides after 24 hours of antibiotic therapy.

If you child’s red eyes do not get better in a couple of days after seeing your primary care practitioner, you should make another appointment for a re-evaluation in case there is a re-infection or another cause for the red eyes.

References:

Cronau, H., Kankanala, R., & Mauger, T. (2010). Diagnosis and management of red eye in primary care. American Academy of Family Physicians, 81(2), 137-144.

1. Hovding, G. (2008). Acute bacterial conjunctivitis. Acute Ophthalmologica,86(1): 5-17.

1. Leibowitz, H. (2000). The red eye. The New England Journal of Medicine, 343 (5): 341-345.

1. Sethurama, U., & Keepak, K. (2009). The red eye: evaluation and management.Clinical Pediatrics, 48 (6): 588-600.

ANNA TIELSCH-GODDARD CPNP-PC Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy. She practices on the Perioperative Surgery teams in both presurgical assessment and pediatric-surgery.

Winter Safety

Monika Pis, PhD, CPNP

Winter is here, so is the snow, ice and frigid temperatures, and while winter activities may seem mundane, they can be dangerous. Winter wonderland offers plenty opportunities for various outdoor activities than can be fun, but may present all of us with safety challenges. 

Accidents are the most obvious safety issue of winter outdoor activities. However, let’s not forget frostbite, hypothermia, and heart attack. I always tell my patients that prevention is the best medicine. In agreement with this principle, I have outlined important safety measures below that you should take this winter to keep yourself and your family safe.

Before You Head Outside
- Dress in light layers, paying special attention to your nose, ears, hands, and feet.
- Wear a hat, as the most heat escapes our bodies through the head!
- Wear gloves and thick/warm socks.
- Cover lips/cheeks with a thin layer of Vaseline or Eucerin to prevent excessive skip drying and chapping.
- Check out these safety tips for sledding: Winter Sledding Safety Tips
- Check out these safety tips on ice safety: Danger Thin Ice

Getting Ready To Shovel
- Snow shoveling increases heart rate and blood pressure, so if you have a heart condition or are out of shape, do not shovel unless your health care provider says that you can.

- If you are over 40 years old, or physically inactive, check with your health care provider before trying to shovel your driveway.

- Snow shoveling is aerobic activity, so warm up before you grab the shovel.

- Pace yourself! Take frequent breaks and drink fluid to prevent dehydration.

- If you experience chest pain, shortness of breath, or other symptoms of heart attack, stop shoveling and immediately seek emergency care!

- Pushing snow in front of you is easier on your back than lifting and throwing it.

- If you have to lift, use proper body mechanics: squat, bend knees, and lift with your back straight. Scoop some snow, and walk to where you want to dispose of it. Throwing snow with a shovel, especially if you twist your body, puts too much stress on your back.

- Before you operate a snow blower, read the instructions. The most important thing to remember: Never stick you fingers in the snow blower to remove impacted snow! Use a stick instead.

When On The Road 
Have these emergency items in the car with you at all times in winter:
- Cell phone
- Flashlight
- Jumper cables
- Snow scraper/brush
- Small shovel
- Blankets
- Flare
- Sand or cat litter for traction

For long car trips, pack water, energy bars, food, extra blankets, and necessary medications.

When you stay outside on cold winter days, come inside every half hour to warm up. Every couple of hours drink a cup of hot cocoa or broth. Do not drink caffeine. Warming up will prevent hypothermia.

What is hypothermia?
Hypothermia is a term to describe low body temperature that results from extended exposure to cold temperatures. Each year over 700 people die from hypothermia, so it’s important to be aware of it and know how to prevent it. About half of deaths due to hypothermia occur among people younger than 65 years of age. However, anybody is at risk in wintertime, so take steps to prevent it!

How to prevent hypothermia?
- Dress in light layers.
- Wear gloves, hat, thick/warm socks, and water proof shoes.
- Go indoors every half hour to warm up.
- Every couple of hours, have hot cocoa or broth.
- If you are cold, stay indoors, and do not venture out again until you warm up adequately.

What is frostbite?
Frostbite results from exposure to freezing temperatures. It most often affects the nose, ears, cheeks, chin, fingers, and toes. Frostbite causes a loss of feeling and color in the affected area, and it may settle in as little as 20 minutes! Frostbite can lead to permanent damage of the affected area, and if severe, may lead to amputation. 

Signs and symptoms of frostbite: numbness, waxy white or grayish-yellow skin. If you see these signs, seek medical care right away. If you cannot see a health care provider immediately and have no signs of hypothermia, get into a warm room right away, do not walk on frostbitten toes as it may increase damage, immerse the affected area in warm water, do not rub it, do not use a heating pad. If hypothermia settles in, seek immediate medical attention!

Weight Loss

Dr. Hillary 

The beginning of a new year means (for many) a fresh start, new opportunities, and a chance to make things better or “right." We vow to eat less, exercise more, spend more time with loved ones, spend less money, etc. 

Since weight loss is a popular New Year’s resolution, I would like to encourage those who want to lose weight to start making permanent changes in their lifestyles. Since it took time to put on extra pounds, it will take time to lose the excess weight. Don't fall for weight loss programs that claim immediate results. There are no shortcuts to weight loss. Weight loss is a lifetime project that requires commitment and perseverance.

Weight loss and gain are directly related to the energy we supply our bodies by eating food and the energy burnt in daily activities. For weight maintenance, there needs to be balance between energy supply and demand. When there is more supply, the energy surplus turns into fat cells. It is only when there is more demand for energy that weight loss can begin.

The only goal of weight loss should be losing excess body fat. Losing water or muscle is not healthy and it does not improve appearance or performance! The two most important habits that anybody trying to lose weight should adopt are: developing healthy eating and getting enough physical activity. 

Developing Healthy Eating
Three square meals a day and nutritious snacks in-between are necessary for performance in our daily activities and overall health. Be mindful of your portion sizes and select foods high in fiber and low in fat and sugar. Here are some ideas to consider:

 Replace soda and juice with water.
 Broil, steam, or bake foods instead of frying.
 Eat whole-grain cereals, breads, etc.
 Replace full-fat dairy with low-fat equivalents.
 Decrease fast food intake to once a month.
 Remove temptation--Do not keep high-fat and high-sugar foods at home.
 Always eat breakfast.
 Select healthy snacks.

Healthy Snacks
Pop corn (no butter)
Graham crackers
Fruits (fresh or dry)
Raw vegetables with cream cheese or peanut butter
Low-fat frozen yogurt

Get Enough Physical Activity
Physical activity helps with weight control by using energy in our bodies that otherwise would be stored as fat. Everything that we eat provides our bodies with energy. On the other hand, everything that we do utilizes that energy. The more things we do, the more energy our bodies burn and the math is simple: our body fat starts to melt away!

Many of us come up with multiple excuses not to exercise simply because most of us don't enjoy it! Personally, I prefer to engage in physical activity with a purpose other than exercising. I like to garden, thus every spare moment in the spring, summer, and fall I spend outside planting and weeding. I even decided not to hire a yard clean-up crew this past fall so that my husband and I could get some exercise raking. In the winter we shovel our driveway, make a snowman, have a snowball fight, or go for walks in the woods to watch birds and deer. Here are some ideas to boost your physical activity in a “user-friendly” way:

 Decrease sedentary behaviors. By doing this, you’ll increase your chances of being more active. So, limit TV/Computer/Video game time to 1-2 hours per day.
 Walk your dog daily. If you don’t have a dog, borrow one from the neighbor.
 Play tag with your kids.
 Park your car as far from a store’s entrance as possible.
 Take the stairs instead of an elevator.
 Get a jump rope and jump with it twice a day for 5 minutes.
 Check out a yoga or other exercise tape or CD from your local library and exercise with it a couple of times a week.
 Team up with your family members or friends and go on 30-minute walks around the neighborhood 2-3 times a week.
 Get up to change the TV channels instead of using the remote.
 Have a dance party with your kids.
 Don’t forget that gardening is an excellent way to burn calories!

Benefits of Regular Physical Activity
To get the most benefits, you should exercise at least 20-30 minutes every day. Aerobic activity such as brisk walking, jogging, bicycling, dancing, and swimming should be a part of your exercise routine. Here are some tips to make sure you have an enjoyable and effective experience:

 Choose activities that you enjoy.
 Build up an exercise routine gradually.
 Exercise at a comfortable pace.
 Wear comfortable shoes and clothes.
 Exercise in a safe environment.
 Hydrate your body before, during, and after exercise.
 Challenge yourself!

Examples of Aerobic Activity
Brisk walking
Jogging
Bicycling
Dancing
Swimming

Tips for Effective & Enjoyable Physical Activity
 Choose activities that you enjoy
 Build up exercise routine gradually
 Exercise at comfortable pace
 Wear comfortable shoes and clothes
 Exercise in a safe environment
 Hydrate your body before, during, and after exercise
 Challenge yourself!

Preparing Your Child for Tonsillectomy

Anna Tielsch-Goddard CPNP-PC

A tonsillectomy and adenoidectomy, often referred to as a "T&A," is one of the most common pediatric surgeries. 

The tonsils and adenoids are gland tissues that are found in the throat. These glands are part of the body’s immune system and help fight infection. Sometimes, the tonsils and adenoids can become infected and cause problems, such as bacterial infections known as tonsillitis or strep throat, or they can become so enlarged that they cause airway obstruction.

The tonsils are located in the back of the throat, and the adenoids are higher in the throat behind the nose and the roof of the mouth. The tonsils can be seen by shining light into the mouth and looking at the back of the throat. The adenoids are not visible through the mouth or nose and special pictures, such as an X-ray or CT scan, must be used to look at them.

If your child has any of the following, he or she may need to be evaluated by an ENT physician (an Ears Nose and Throat specialist) to assess whether your child may need to get his or her tonsils and/or adenoids removed:

• mouth breathing
• noisy breathing throughout the day
• recurrent ear infections
• snoring every night
• restless sleeping
• breath pausing while sleeping
• frequent throat infections, and/or abscesses (pockets of pus) on the tonsils

Just having large tonsils alone does NOT necessarily mean that your child must have their tonsils removed. Each child should be evaluated individually.

Prior to surgery

Your child’s physician may want to order a blood or urine test prior to surgery. Most hospitals will call you to let you know when they want your child to stop eating and drinking, usually on the night before surgery. Do not let your child eat or drink anything after these times or most likely the surgery will be canceled the next day. This precaution is to reduce the possibility of complications from anesthesia, such as aspiration pneumonia, which can be caused from having liquids in the belly while being put to sleep. You should talk to your child about his or her hospital visit. Have your child pick out a familiar toy or blanket to bring along to the hospital.

Surgery

Your child will be asleep under general anesthesia for their T&A, and he or she will not be able to feel anything during the procedure and will not be in pain. The pediatric ENT surgeon will remove the tonsils, and the throat will be able to heal naturally without any stitches. The tonsils are removed through the mouth and there is no cuts or incisions into the skin. Most children are able to go home several hours after their surgery as long as they are breathing without difficulty, are able to swallow and have something to drink.

In some cases, your child will need to stay overnight in the hospital for observation. Your medical provider should let you know before the day of the procedure if this might be the case. Children that need to stay overnight after a T&A are usually younger then 2-3 years old, have prior sleep apnea symptoms, or have chronic diseases, such as seizures, and need to be closely monitored after having surgery.

After your child’s T&A 

It is important to be with your child or have a caregiver come to the hospital for the next few days after a T&A. An upset stomach for a few hours after surgery and feeling sleepy after the anesthesia are normal. Your ENT specialist will prescribe pain medication to give your child after the surgery. It is important to follow these guidelines and give your child the pain medication after the tonsillectomy.

Good fluid intake and no "horse play" after surgery are very important. Any surgery comes with risks and possible complications, even though these complications are very rare. Watch your child for any type of throat bleeding after the surgery. If there is throat swelling, throat bleeding, or your child is having difficulty breathing, this is an emergency, and you must bring them to the ER or call 911 for immediate treatment.

Most children are absent from school between 5-10 days after a tonsillectomy. They should not participate in gym or any type of strenuous physical activity for 14 days (or 2 weeks) after their surgery. Make sure your child is drinking adequately. Sometimes the throat can be sore and your child might not want to take fluids. It is important to make sure you give your child the prescribed pain medication, so that he or she will maintain appropriate fluid intake.

If you have any questions or concerns after your child’s tonsillectomy and adenoidectomy, you should contact your physician or nurse practitioner who is involved with their care.

References:

The American Academy of Otolaryngology- Head and Neck Surgery: Tonsils and Adenoids. Available at: http://www.entnet.org/HealthInformation/tonsilsAdenoids.cfm

Drake, AF., Carr, M. (2011).  Tonsillectomy. eMedicine Available at Medscape at: http://emedicine.medscape.com/article/872119-overview

United States National Institute of Health. Tonsillectomy. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm

Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 380

ANNA TIELSCH-GODDARD CPNP-PC Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy. She practices on the Perioperative Surgery teams in both presurgical assessment and pediatric-surgery.

Homemade Baby Food

Monika Pis, PhD, CPNP

Preparing baby foods at home helps to integrate preparation of your infant’s meals into preparation of meals for the rest of the family. By making baby foods yourself, you will be in control of the quality of nutrients that your child eats, and you will also be able to provide her diet with a greater variety of healthy foods that taste much better than any jar baby food available at your local supermarket. While having a tremendous sense of satisfaction from having an impact on your baby’s health, you will also save money!

Essentials you need:

 food processor or blender
 veggie/fruit peeler
 stainless steel saucepan and steamer (avoid copper as it robs food from vitamin C)
 paring knife
 colander (for rinsing and draining)
 fine mesh strainer
 ice cube trays or muffin tins
 pen and labels or masking tape
 small freezer bags
 instant-read meat thermometer


Fruits & Vegetables
With the exception of bananas and avocado, all fruits and vegetables have to be cooked. Cooking tenderizes them and kills bacteria that may be present on their surfaces. While cooking in water is the easiest way to prepare fruits and vegetables, it’s not the healthiest, as it depletes many nutrients. To preserve all or most vitamins and minerals, steam your fruits and vegetables instead. Other healthy ways to prepare your foods are roasting and baking. You may roast or bake apples, winter squash, broccoli, cauliflower, and sweet potatoes. Dry heat will preserve all their nutrients and bring out their natural flavor.

Meat & Poultry
Roasting or baking meat or poultry are healthier methods than frying, broiling, or grilling. Frying leaves the food too greasy and fatty, while broiling and grilling can cause formation of carcinogens, the cancer-triggering substances. Always check if your meat is done with the meat thermometer.

You do not need to add salt to your baby’s food. Also, refrain from adding spices in the baby’s first year of life, as her delicate digestive system may not ready to handle them.

Freezing
Spoon your cooked and cooled baby food into a clean ice cube tray (~ 2 Tbsp of food), or muffin tin for older infants. You want to leave room for fluid expansion during freezing. Cover tightly with plastic wrap and place in the freezer. When frozen, transfer baby food cubes into small freezer bags. Label them with the name of food and the date of preparation. You may store the frozen cubes up to 1-2 months.

Thawing
Defrost the desired amount of baby food in the fridge overnight. You may microwave it for ~30 seconds per cube if you need the food right away. However, check the food’s temperature before you serve it to your infant to prevent burns! Discard leftovers. Also any baby food left at room temperature for an hour or more needs to be discarded.


Sample Recipes

BANANA

1 small ripe banana
breast milk or formula

Break banana into pieces. Blend with a blender or food processor. Add breast milk or formula to thin it out.


CARROTS

½ lbs peeled and washed carrots
breast milk or formula

Steam carrots until tender (~10 minutes). Cool for ~ 10 minutes. Blend. Add breast milk or formula to thin it out.


MEAT/POULTRY

2 oz cooked and chopped chicken, turkey, beef, or pork
breast milk or formula
Blend the meat. Remove chunks. Add breast milk or formula to thin it out.