My little grandson, Otto, struggles with carsickness, so this topic has been on my mind of late.

Carsickness, of course, is a sensation of dizziness, fatigue, restlessness, confusion, nausea or actual vomiting associated with car rides or other movements.  The actual mechanism is a dissociation of visual from spatial sensory input.  In other words, the eyes misperceive where the inner ear says the body is going (or vice versa). It can occur 1-18 years of age but is most common in 4-13 years, peaking age 6-9,  usually dissipating thereafter. Perhaps 30% of children have some symptoms, 5% have severe/prolonged/frequent symptoms.  10% even report problems on swings and slides.

What can we do? Some suggestions:

  1. Proper seat positioning–front facing is better than rear (but only if its safe–children should be rear facing until AT LEAST age 2, and sit in the back until > 90lb)
  2. Plenty of fluids before/during the drive. Adequate hydration will mitigate symptoms.
  3. Keep window down when feasible–fresh air also relieves some of the problem.
  4. If possible, warm the car up during cold months so the child can sit in their seat without heavy outer clothing, increasing comfort and easing symptoms during the ride.
  5. Distractions– as with seasickness better to look to the horizon, its best to focus out of the car.  ‘I spy” games are good; pointing out interesting sites like mountains, buildings, even road signs.  Anything requiring close looking is bad–movies/videos; video games are the worst(no surprise!). Nontechnical interactive games (“Madlibs”) can be a fun way to shift the child’s focus. Audio pass times, like singalongs, listening to music, audio books are another good strategy.
  6. Snacks before or during the ride. Light, “neutral” foods like crackers, ice pops, non-acidic fruits are good; heavy, fatty, greasy foods, or very salty, spicy fair with strong odors–not so much.
  7. Be aware of your child’s symptoms.  Poor color, change in demeanor, evidence of anxiety, and, of course, if your verbal child complains of symptoms–consider stop and take a brief walk for some fresh air.
  8. Patience and humor–car sickness certainly has a clear psychological component. An easygoing, approach to your child’s difficulties–to limit anxiety or negative feelings on their part–is essential.  Junior vomited in the car? Gross, but relax: wash it out and the odor is gone, tomorrow you will forget it and in a few years it’ll be a humorous family anecdote!
  9. If all else fails, try some anti-histamines. Dramimine for > age 2, benadryl can be used for younger kids.  These medicines may cause drowsiness which can be of benefit, if the child sleeps through some of the symptoms.  However, be aware of a “paradoxical reaction“–some children experience agitation, irritability, confusion, even transient hyperactivity from antihistamines which can be unpleasant or even worsen the underlying problem. So (as always!)  try everything else before considering drugs.

If your child struggles from car/motion sickness, please give me a call and let’s discuss it.  Thanks for following.

Kudos to the NY Times Parenting blog for some of the inspiration for this blog post.

Maternal Immunization

As we enter flu season , let’s review some important immunization information. Young parents, and in particular expectant mothers are an important population of citizens who should keep their immunization status current.  This involves in particular 2 shots–TdaP and, in this season, flu shots.  Children under 6 months old are ineligible to receive flu vaccine so their only protection comes from immunizing their contacts.  Under 2 months they also have not received whooping cough vaccine yet, so, again, prevention by keeping that infection out of their environment is essential to protect them.

But that protection goes even further.  Both vaccines provide antibodies that cross the placenta and provide good immunity to the baby from even before actual birth. As 80% of whooping cough infections occur before 2 months of age–before they have even received their first shot–and 70% of infant deaths occur in that age group, this early maternal conveyed immunity can be life saving.  In a typical year 20 infants < 2 months of age will die from pertussis. Studies demonstrate that hospitalization for pertussis in this age group is decreased 90% when mother’s receive prenatal TdaP. Therefore, it is recommended that women receive TdaP with each pregnancy between week 27-36.

Also note that infants <6 months of age are at greater risk for hospitalization from flu compared to older children, as well as many serious complications from that infection–pneumonia, secondary bacterial sepsis, or encephalopathy(brain swelling). If the baby has other health problems like prematurity, genetic or chromosome abnormalities like Down Syndrome, or heart disease, that merely ups the ante for this risk. Maternal prenatal immunization lowers infant hospitalization rates for influenza by 77.7%.

Influenza, of course, poses substantial risk for pregnant women themselves.  While approximately 9% of women age 15-44 are pregnant during flu season, 23-44% of women in that age group who require hospitalization are pregnant. Of additional concern is that influenza is an important risk factor for the pregnancy and is a frequent cause of complications like premature birth.  Studies indicate that maternal prenatal flu immunization lowers that risk by 40%.

Only 59% of pregnant women get flu shots and 55% get TdaP; only 35% get both. Both vaccines are recommended for all pregnant women (flu in season).  They are both safe and effective. The leading reason for not immunizing is not knowing the recommendation.

So I’m telling you now. Expectant Mom’s (and Dads!)–talk to your primary care physician (mothers to OB) about flu and TdaP vaccine.  Call me and let’s talk about it. It may very well save your baby’s life.

Thanks for following. Image credit from

Nightmares and Night Terrors

Every parent hates the experience of their young child waking suddenly with a bad dream. The child is terrified and everyone’s sleep gets disrupted. What’s going on? We just finished Halloween so time to “un-frighten” this issue.

Nightmares, of course, are scary, unsettling dreams that we all experience from time to time.  In young children, they tend to occur in early morning hours during rapid eye movement (“REM”) sleep. The child will wake up frightened and tell you their scary experience. It is not uncommon for the same scary dream to recur.  With night terrors , the child will begin terrible screaming, often with eyes wide open but not really awake, and will have no recollection of the dream or the experience upon awakening.  With the memory of the bad dream it may be difficult for the child to return to sleep but given that there is no such memory with night terrors, returning to sleep is usually less of a problem there.

Both conditions are common in toddlers and young children.  Unless they occur frequently there is no cause for alarm. Night terrors appear to occur in families.

The best treatment is prevention: a  good bedtime routine; avoid overstimulation–reading stories is better than vigorous physical activity; limit video entertainment–stop video games > 1/2 hour before retiring; avoid large snacks, especially high sugar snacks–a small cup of water or milk is better.

To help your child after a nightmare, keep it simple–hugs, reassurance that you are there and that dreams are not real.  Talk about pleasurable incidents from the previous day or anticipated ones in the days to come. Distract the child with whatever toys or happy objects are at hand.

Please note that if you take your child to bed to sleep with you after a nightmare  you likely will set yourself up for difficulty getting them back to their own room on subsequent nights. If you must, better to have your child sleep next to you on the floor with a pillow and blanket–no mattress, to encourage them to return to their own room when things calm down.

With night terrors, things are a bit different.  Gently wake the child up from the sleeping, shrieking fit.  Quickly reassure them that everything is fine; a quick trip to the bathroom or diaper change (as applicable), half a cup of water to drink, and back to bed.  In both situations, keep it short and sweet–dragging it out only disrupts sleep patterns further.

As stated above, if these episodes begin to occur on a more regular basis there MAY be some underlying issue–in health, lifestyle, or social situation– that must be uncovered and addressed. Give me  a call in that situation and let’s try and figure it out together.

Thanks for following.