Many parents aren’t sure when to have their child’s vision screened. Is this something that pediatricians check during routine physicals, or do parents actually need to schedule a visual exam? We asked Dr. Kip Frizzell, a local pediatrician and director of Coordination of Care at Le Bonheur Children’s Hospital, to give our readers those answers.

“Pediatricians are looking for signs of vision problems with every exam.  Parents should be sure to let their doctor know if their child seems to have a squint, head tilt or if they see an eye deviate inward or outward.  Formal eye screening can begin as early as age 3. School-aged children can be tested with a Snellen wall chart, and most schools actually perform this screen,” said Frizzell.

According to the American Academy of Pediatrics (AAP), middle childhood is a common time for the recognition of vision problems, especially when children first have assigned seats in classrooms. Children may complain of having trouble seeing the blackboard or squints at the pages of a book while reading. He or she may also sit closely to the television in order to see clearly. All of these are signs of vision problems, says the AAP.

The AAP also offers these tips to keep in mind:

• Even though visual difficulties can sometimes cause headaches, this pain is most often associated with problems unrelated to the eyes.
• If your child wears glasses and participates in competitive sports, the glasses should be secured in place by attaching a strap that connects the two earpieces and stretches behind the head. Also, special sports glasses are available.
• Some optometrists recommend eye exercises to help treat learning disorders like dyslexia. However, carefully controlled studies have failed to demonstrate any benefits from these eye exercises—or from wearing colored lenses—to treat these disorders.

The hustle and bustle of summer months leaves little time for parents and their teens to think about much else, let alone vaccinations. But Dr. Kip Frizzell, a pediatrician and Le Bonheur’s director of Coordination of Care, stresses the importance of knowing when to get vaccinated, especially when preparing to go back to school or off to college. Here’s what Frizzell had to say:

“The best way to make sure you have the most current record of your child’s immunization history is to schedule yearly checkups with his or her pediatrician.

Your child, and you for that matter, should have the flu vaccine. Anyone over the age of 6 months can receive the shot version of the vaccine, and healthy individuals ages 2-49 can receive the nasal mist vaccine.

For young ladies, the HPV vaccine is available to protect against the virus that can cause certain forms of cervical cancer. Gardasil is recommended to be administered routinely to girls 11 to 12 years of age. A health provider’s discretion is recommended for girls and women between the ages of 9 and 26.

Any adolescent or college-aged individual should receive the vaccine for Meningococcal disease and meningitis.  It’s important for parents to be informed about this potentially fatal, fast-moving disease. It can easily be mistaken for the flu, and although meningitis can strike at any age, teens and college students are at a particularly increased risk, as they often live in close quarters, such as dorms or military barracks. Protect yourself and your family by having your child vaccinated.”

Take these tips from Frizzell, if you are concerned about administering a vaccine to your child:

• The risks from vaccines are exceedingly small;
• Vaccines are the single best way to prevent acquiring one of these significant and potentially life-threatening diseases;
• Parents should check with their pediatrician on any concerns regarding diseases or vaccines. The American Academy of Pediatrics also offers excellent information.

With many local schools currently holding outdoor football practice, it’s important to stay on the lookout for heat illnesses. Dr. Kip Frizzell, a pediatrician and Le Bonheur’s director of Coordination of Care, advises parents have their children drink fluids continuously throughout the day.

“These shouldn’t include juices, soft drinks or sports drinks – water is best. This is a very important rule to follow as the dangerous heat continues,” said Frizzell.

Frizzell also suggests parents and sports coaches know the symptoms of heat illness. 

According to The American Academy of Pediatrics (AAP), the most common types of heat injury are:

•  Heat Cramps – These are painful contractions of the muscles (most commonly leg muscles). Treatment is to stop exercise, gently message the involved muscle, and drink lots of extra fluids.

•  Heat Exhaustion – Symptoms include high temperature (up to 104°F), weakness, nausea, vomiting, dizziness, confusion, and fainting. Treatment is to stop exercise, either sit or lie down, and cool down (fanning, cool towels, ice bags, move to shaded or air-conditioned area). Also, giving lots of fluids is essential. If symptoms do not stop quickly, the athlete should be taken to an emergency room right away.

• Heat Stroke – This is a life-threatening emergency caused by extremely high temperatures (often higher than 107°F). Athletes can have seizures or go into shock or coma. They should be taken to an emergency room immediately.

If you see a child exhibiting any of these symptoms, he or she needs attention immediately.

When a player feels confused, dizzy, nauseated, sleepy, or otherwise seems ill during exercise in hot, humid weather, have the child cool down and start drinking right away, says the AAP. If you do not see quick recovery, take the child to an emergency room.

Is it normal for a toddler to hold her breath until she passes out? Is this behavioral or organic, and how should a parent respond? We asked Dr. Noel “Kip” Frizzell, director of Coordination of Care at Le Bonheur and local pediatrician, to answer this. Here’s what he had to say:

“Breath-holding spells are quite common in childhood, peaking at around 2 years of age. They are usually provoked by the toddler’s anger at being scolded or surprised, but they are occasionally brought on by painful events such as being hit on the head. The child may hold her breath until she loses consciousness, which is sometimes followed by jerking movements that mimic a seizure. These episodes are predictable in onset but are certainly frightening the first time they happen.

Once the child loses consciousness, they begin breathing spontaneously after a few seconds. After she regains consciousness, you should place her in a safe environment and ignore any further tantrum. If your child gets attention for these episodes, such as cuddling or playing with her afterward, they will often become more frequent. It can be difficult to remain calm after this happens, but doing so will reassure your child that she is safe and secure. See your pediatrician if these episodes are frequent.”

Dr. Kip Frizzell is the director of Coordination of Care at Le Bonheur Children’s Hospital. He took some time to give parents a good direction of action if their child is struggling with bedwetting. We also took an excerpt from the American Academy of Pediatrics on tips to keep in mind when dealing with the problem.

Frizzell says, “Bedwetting is frustrating for everyone, parents and school-age children alike.  As long as the child is not having any daytime symptoms that would include pain, burning, urinary frequency, dribbling or incontinence, it is usually not a serious problem.  I think it is more of a sleep disturbance than a kidney or bladder problem, or an issue resulting from an emotional or metabolic problem.  Since the child can not control it, harsh disciplinary measures are not helpful.  When it lasts beyond age 7 or so, it's a good idea to talk with your doctor to consider treatment options.”

Keep the following tips in mind when dealing with bedwetting:
• Be honest with your child about what is going on. Let your child know it's not his fault and that he will eventually be able to stay dry all night. Let your child know lots of kids go through this, but no one goes to school and talks about it.
• Be sensitive to your child's feelings. If you don't make a big issue out of bedwetting, chances are your child won't, either.
• Protect the bed. Until your child stays dry at night, put a plastic cover under the sheets. This protects the mattress from getting wet and smelling like urine.
• Let your child help. Encourage your child to help change the wet sheets and covers. This teaches responsibility. It can also keep your child from feeling embarrassed if the rest of the family knows he wet the bed. However, if your child sees this as punishment, it is not recommended.
• Set a no-teasing rule in your family. Do not let family members, especially siblings, tease your child. Let them know that it's not his fault.
• Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.
• Try to wake him up to use the toilet (1–2 hours after going to sleep) to help him stay dry through the night.
Reward him for dry nights, but do not punish him for wet ones.

Bedwetting alarms
If your child is still not able to stay dry during the night after using these steps for one to three months, your pediatrician may recommend using a bedwetting alarm. When a bedwetting alarm senses urine, it sets off an alarm so the child can wake up to use the toilet. When used correctly, it will detect wetness right away and sound the alarm. Be sure your child resets the alarm before going back to sleep.
Bedwetting alarms are successful 50 to 75 percent of the time. They tend to be most helpful for children who have some dry nights and some bladder control on their own. Ask your pediatrician which type of alarm would be best for your child.

Medicines
Different medicines are available to treat bedwetting. They rarely cure bedwetting, but may help your child, especially in social situations such as sleepovers. However, they are usually a last resort and are not recommended for children younger than 5 years. Also, some of these medicines have side effects. Your pediatrician can tell you more about these medicines and if they are right for your child.

Beware of "cures"
There are many treatment programs and devices that claim they can "cure" bedwetting. Be careful; many of these products make false claims and promises and may be very expensive. Your pediatrician is the best source for advice about bedwetting. Talk with your pediatrician before your child starts any treatment program.

Source: American Academy of Pediatrics

It’s midnight and your child feels warm to the touch. You take out the trusty digital thermometer and get a 103.5 reading. Frantically, you go straight to the medicine cabinet, pull out the Tylenol? and then dial your pediatrician’s office hoping to get reassurance that a trip to the emergency department isn’t warranted.  You’re scared, anxious and afraid that this is an indication of a serious problem.

For so many parents, this scenario is all too familiar. But in most cases, fever isn’t dangerous. The fear of fever is a myth that has been around for as long as there have been children. Although it is scary when your child’s temperature continues to rise, fever itself won’t cause harm and is actually a good thing. It is how the body fights off an infection.

A fever begins at 100.4 degrees Fahrenheit. A normal bodily temperature is usually around 98.6 and will fluctuate throughout the day being a little lower in the morning and higher in the evening. Fever occurs when the body’s internal thermostat raises its temperature above the normal level. Most causes of fever are benign, self-limited viral infections that are just a common part of childhood, especially if your child is in a child-care or pre-school setting.

According to Dr. Noel “Kip” Frizzell of Pediatric Consultants in Memphis, “The best thing that parents can do is get to know their child’s normal behavior and gauge the situation from there.”  He offers three general rules to ask yourself when your child has a temperature:
1. Is your child’s breathing labored?
2. Is he/she having any forceful vomiting?
3. Is your child crying inconsolably?

If you answer yes to any of these questions, he says it’s probably best to go ahead and call your pediatrician’s office. Dr. Kip says that he would rather see a child with a temperature of 99.9 accompanied with any of the three symptoms than a child who has a temperature of 103.5 and none of them. 

Dr. Kip stresses that if you have an infant under the age of three months with a rectal temperature of 100.4 you need to call your pediatrician immediately. Fever in newborns does require an exam to ensure that the infant does not have another potentially harmful condition.
The one thing you can do for your child when he or she has a fever is make them as comfortable as possible. You can provide them relief by administering a dosage of acetaminophen or ibuprofen if the child is 6 months or older. Most children with a temperature of less than 102 don’t need medication, but if you notice that your child is uncomfortable, it won’t hurt to go ahead and medicate them. You should also keep them dressed in light clothing, keep the house at a comfortable temperature, offer plenty of fluids and make sure your child is resting. 
 

Knowing your child’s normal behavior and the symptoms that are accompanying the fever is the most important information for you to consider. As long as you don’t notice any of the three red flags, a trip to the doctor’s office probably isn’t necessary. Just remember to stay on top of the situation and monitor your child closely.  “The majority of our after hours calls are about fever,” says Frizzell. “It’s a very broad concern for all parents, but in most situations, it’s not a result of something serious.”

Fever 101 - A Parent’s Guide
When does fever begin?
100.4 degrees Fahrenheit measured rectally;  99.5 degrees Fahrenheit measured orally and 99 degrees Fahrenheit measured under the arm.

What does fever mean?
Fever is the body’s natural defense against infection. Most causes of fever are benign, self-limited viral infections.

When should I call the doctor?
Call the doctor if you have an infant under three months of age with a rectal temperature of 100.4. or if your child is experiencing any of the following:
• Labored breathing
• Forceful vomiting
• Inconsolable crying
You should also call your doctor if you have an older child with a temperature higher than 104 degrees Fahrenheit.

What should I do if my child has a temperature of 104 but is acting fine?
If your child is not exhibiting any of the behavioral red flags, medicate your child with a dosage of acetaminophen or ibuprofen if your child is six months or older. Continue to monitor your child’s behavior and call the doctor if the fever has not gone down after 24 hours with medication.

What type of thermometer and method gives the most accurate temperature reading?
A digital thermometer administered rectally will give you the most accurate temperature.