Published: Nov. 12, 2009
Updated: Dec. 7, 2010
Duke pediatricians William Lawrence, Martha Gagliano, and Michael Land talk turkey on school lunches, nasty noses, seasonal sneezes, and scabs.
School is starting again, and I'm afraid that when left to their own devices, my kids will subsist on cafeteria corn dogs and Tater Tots. How can I make sure they’ll eat healthy meals?
William Lawrence, MD: Whenever feasible, we encourage packing a breakfast or lunch to send to school. It really gives you control over content. Most children don't get enough fruits and vegetables in their day, so send things that are packable and won’t quickly spoil: apples, bananas, carrot sticks.
And for breakfast, try thinking beyond traditional foods like pancakes. A little bit of protein and a good carbohydrate source, like a stick of mozzarella and a piece of fruit, can make a healthy breakfast.
While packing meals is not always practical, simply knowing what's on the school menu [check your school's Web site] can help you steer your child toward healthier options.
Depending on your child's specific dietary needs, good everyday choices may include 1 percent milk instead of whole or chocolate milk, or opting for water instead of juice -- there are a lot of concentrated calories in juice, so cutting it out can really have a good impact.
At our house, we know it's autumn before the leaves change color because our child's sneezing and runny nose really ramp up. Can you recommend any natural remedies for seasonal allergies?
Michael Land, MD: There is not enough strong evidence to recommend the use of herbal supplementation, acupuncture, or "special diets" for the treatment of allergic rhinitis. Some patients benefit symptomatically from nasal saline rinse, which washes out debris and pollens.
Allergy shots are considered by some to be a natural way of dealing with allergies, although they are still a medical treatment given by a doctor. These injections actually expose your body to small amounts of what you’re allergic to. By starting with tiny amounts and gradually increasing regularly, these injections slowly change your immune system to be able to tolerate larger amounts of the allergens.
The best way to get rid of the symptoms of allergic rhinitis would be to avoid the allergen that is triggering them. Reducing exposure to outdoor allergens is important when the pollen count is high.
To avoid outdoor pollens, keep the windows closed in your home and car. Also, pollens are often emitted in the early morning hours (between 5 a.m. to 10 a.m.), so avoiding early morning outdoor activity can help extremely sensitive people.
Is it really better to "air out" a scab and keep it dry, or should you keep it covered and moist -- or does it make a difference?
Martha Gagliano, MD: Airing out scabs has fallen out of favor among dermatologists. Scabs itch and kids pick at them.
We'd rather keep it covered and not let it form that thick, itchy scab. Coat the scab in an antibiotic ointment like Polysporin, then bandage it to keep it moist and not let it get crusty.
My day-care provider says my child should probably stay home if he's got "green snot." Does that mean he has an infection? When should I take him to the doctor, and when can he just ride it out at home?
Gagliano: That's a myth -- the color of mucus is completely irrelevant. Kids don’t blow their noses very well, so the mucous turns green.
The younger a child is, the harder it is to know how serious an illness is. Both viral and bacterial infections can make very young children quite ill, so with infants it's best to be proactive and to follow your instincts: If your baby is listless, eating poorly, or just doesn't look "right" to you, call your doctor.
Any fever in a baby less than one month old is worrisome, and you should call your doctor immediately.
For older children, things are a little easier. In general, viruses cause lower fevers (less than 102.5º), are accompanied by symptoms such as a runny nose, hoarseness, vomiting, or diarrhea, and improve over three or four days.
The illness is more likely to be bacterial if the fever is high, if it lasts longer than four days, of if there is specific pain (like a sore throat or an earache).
Note that antibiotics don't work on viruses, only on bacterial infections. We have a huge problem with drug resistance because of the overuse of antibiotics, so you don’t want to use them unless they will really do some good.
For a virus, keep your child comfortable and hydrated and wait it out. Most viruses are at their worst for three to four days, so if it lasts longer, or if the fever is 103° or higher, go to the doctor.
While we're on the subject of fevers, is it better to let a mild fever go? If I bring down my child’s temperature with Tylenol or Motrin, for example, am I hampering the body’s ability to fight infection?
Gagliano: That's controversial -- maybe the fever's doing some good, but maybe not. If your child is uncomfortable, treat the fever. Most kids look terrible with a fever, so they're very difficult to assess.
Controlling the fever allows both the doctor and parent to assess how that child is doing. Also, kids get dehydrated easily; when they have a fever, they're losing water and need more, but they often won't drink as much, so they’re at higher risk of dehydration. My opinion is to go ahead and treat those fevers.