Wednesday, May 31, 2006


Dear Lisa,

I have eczema and now my baby's skin is becoming very dry. What are the chances that my baby will get eczema too? Is there anything that I can do to prevent my baby from getting it?

“Don’t want eczema in N.J.’’

Dear “Don’t want eczema in N.J.”

Atopic dermatitis (AD) or eczema is hereditary. “80% of the offspring of two parents with AD will develop AD, 60% will develop the disease if one parent has AD and the other parent has respiratory allergies and 50% will develop AD if one parent has AD”.(1) Therefore there is nothing that you can do to prevent your child from getting eczema because it is genetically determined who will most likely develop the disease. There are things you can do to control the factors that exacerbate Atopic Dermatitis.

With the correct environmental conditions you may help control your child’s symptoms. To avoid a flare up of the disease, you should eliminate anything that is irritating to your baby’s skin such as tight fitting clothing or clothing with rough textures. It is best to dress your baby in soft, loose fitting cotton clothes and avoid clothes made from wool, corduroy, jeans or items filled with decorations that rub at the skin.

The clothes that a caregiver wears are also important. A baby’s face and hands frequently rub against its caregiver's clothing during handling and feeding. Therefore you should avoid wearing fabrics with rough textures when handling your baby.

Avoid scented soaps, shampoos or bath gels or products that contain colored dyes or preservatives. A non-drying soap such as Dove is recommended because it adds moisture and it doesn’t contain additives which may trigger a flare of eczema symptoms. I recommend Dove liquid soap as a shampoo for babies because shampoos on the scalp may irritate the skin of the baby’s face as well as the rest of the body.

When you dry your baby after a bath, you should pat the skin instead of rubbing it. Within three minutes of bathing an emollient should be applied to your baby's skin . Vaseline Petroleum jelly or Aquaphor are both good moisturizers. It is a good idea to avoid moisturizers containing preservatives such as parabens because such agents could result in a flare up of eczema.(2) Newborn babies do not need to be bathed daily, bathing twice per week is enough. Otherwise the frequent bathing can strip the skin of its natural oils and lead to over drying which is a risk factor for a flare up of Atopic Dermatitis.

Lastly, certain foods may be linked to the development of atopic dermatitis. When introducing new foods, watch closely for sensitivities which may result in a worsening of your child’s skin condition. It is a good idea to avoid highly allergic foods such as milk, eggs, fish, and nuts until a child is older.

(1) Rosenthal, M. Pediatricians treating more patients with atopic dermatitis. Infectious Diseases in Children. 2006; April:56.
(2) Connelly, E., Eichenfield, L, Treatment Pearls for Managing Atopic Dermatitis. Children’s Hospital, San Diego and University of California, San Diego. Pediatric Skin Care. 2004:16-18.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents

Tuesday, May 30, 2006


Dear Lisa,

My neighbor’s child developed Campylobacter. What is Campylobacter and can my son catch it? How can I prevent my son from getting it?

“Need info about Campylobacter”

Dear “Need info about Campylobacter”,

Campylobacter is a diarrhea illness caused by the organism Campylobacter jejuni. It lives in the gastrointestinal tract of domestic and wild birds and animals. The symptoms of campylobacter include; diarrhea (usually bloody in nature), abdominal pain, fever and overall feeling of discomfort. Transmission occurs when a child ingests contaminated food or by direct contact with stool of an infected animal or person. Improperly cooked poultry, untreated water and unpasteurized milk are the main sources. Many times the infection is linked to travel outside the United States, living in a home with a sick pet, or a trip to a dairy farm where children drank unpasteurized milk.

Recent research showed infants and children developed Campylobacter after drinking well water, eating fruits and vegetables prepared in the home and riding in a shopping cart next to meat or poultry. (1) The cross-contamination is thought to occur when food infected with Campylobacter contaminates a surface such as a kitchen counter or shopping cart. Raw Poultry containing Campylobacter can contaminate the countertop during food preparation. Transmission may occur when a child’s food, such as uncooked fruit and vegetables is prepared on the same countertop or surface and then fed to the child. Contamination in the supermarket occurs when shoppers pick out poultry from the meat section and then touch the handle of shopping carts. Children sitting in the front of the shopping cart have direct access to the handle through touching or by putting their mouth on the handle.A child can catch Campylobacter if he comes into direct contact with another child’s infected stool, if he ingests contaminated food or comes into contact with items exposed to the Campylobacter germ.

You can prevent transmission by properly cleaning surfaces and utensils when cooking and preparing meat and poultry. Wash your hands with warm soapy water after cooking and before touching your child. Surfaces that come into contact with raw meat should be washed with warm soapy water or a chlorine based product. When shopping at the supermarket with young children, you can clean off shopping cart handles with disinfectant wipes or purchase a seat or cover which is designed to prevent young children from coming into contact with the cart. Your child should not have contact with a child with Campylobacter who is still in diapers or not potty trained.

(1) Rusk, J. New exposures linked to Campylobacter infections among infants. Infectious Disease in Children. 2006; March: 36.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Preventing Infections

Monday, May 29, 2006

Crystal Meth Abuse

Dear Lisa,

I was in the pharmacy the other day and at the cash register there was a sign reading: Sudafed is no longer available over the counter. It can only be purchased from behind the counter. Limit of one box per customer. You must be 18 years old to purchase. I asked the teenage cashier why Sudafed was not available over the counter and why there were restrictions. She told me that kids use Sudafed to make Crystal Meth. I never heard of such a thing. Are the kids today making their own drugs? I like to keep aware of what’s going on in the community because I have a 10 year old daughter who will soon be exposed to this and I would like to know what to watch out for.

“What’s going on with Sudafed?”

Dear “What’s going on with Sudafed?”

Yes it is true; Sudafed is one of the ingredients that drug dealers use to make a street drug called Crystal Meth. Methamphetamine (MA) is an addictive stimulant drug which exerts stimulatory effects on the central nervous system and cardiovascular system. It’s produced in many forms and can be smoked, snorted, ingested or injected. In 2004, in the United States 1.4 million people 12 years or older reported using MA in the previous year. (1) In the past MA abuse was more prominent in California and Arizona, but now it is spreading to other areas of the country. MA is not usually sold on the street like many other illicit drugs. It’s typically a more private sale, arranged by networking with those who produce the drug. It is often sold by special invitation at all-night warehouse parties or raves. (2).

MA comes from super labs located in Mexico and in California. There are also smaller home based labs located across the United States. Meth producers get recipes from friends and use Sudafed and common household products and equipment to make high –quality MA. Users experience euphoria, increased attention, increased libido, increased physical activity, visual hallucinations, aggression, violence, hyperthermia, and increased heart rate.(3) The signs of a home based Meth lab include unusual strong odors, blacked out windows, people coming and going at unusual times, excessive trash, stained coffee filters and an unusual number of clear glass containers in the home. (4). The best thing that we can do as parents to keep our children safe from drugs is educate ourselves about the drug use trends in our community. If we teach our children about street drugs and the negative effects of drug use it will better equip them to just “say no” when they are exposed to them when they are older.

(1)Substance Abuse and Mental Health Services Administration. Na
tional Survey on Drug use. Methamphetamine use, abuse and dependence: 2002, 2003, and 2004. SAMHSA Website. Available at: Accessed April 2006.
(2) National Institute on Drug Abuse. NIDA Community drug alert bulletin-methamphetamine. NIDA Website. Available at: Accessed April 2006.
(3)National Institute on Drug Abuse. Research Report Series: methamphetamine abuse and addiction. NIDA Website available at: methamp/methamph3.htm#long. Accessed April 2006.
(4)Koch Crime Institute. Is there a meth lab cookin’ in your neighborhood? KCI Website. Available at: htm. Accessed April 2006.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents

Friday, May 26, 2006

Crib Safety

Dear Lisa,

My husband wants to use on old crib that was passed down from his family. I’m worried that the crib doesn’t meet today’s safety standards. How do I know if the crib is safe?

“Need a safe crib in N.J.”

Dear “Need a safe crib”,

In order to prevent crib injuries the space between the slats should not be more than two and three eighths (2 3/8) inches apart. You can measure the space with a ruler. Otherwise a child’s limb could get caught in the space and the child could get hurt. When the side of the crib is lowered, it should be at least 4 inches above the mattress. The mattress should fit snuggly, with no more than two fingers fitting between the mattress and the crib. If you can fit more than two fingers, the mattress is too small.

If the crib is painted, I would be concerned about the toxicity of the paint. Years ago, paint contained lead. The paint could chip and the baby could inhale the paint dust or eat the chips which could cause lead poisoning. To be safe, you should remove the paint from an old crib. Sand the surface and repaint the crib with non-toxic paint. The work should be done in an area away from the child’s room and careful cleaning measures need to be followed in order to remove the paint dust from the home. The residual paint dust in the home from the repair may also cause lead poisoning. If the crib surface is wood, make sure the wood is smooth with no rough or sharp edges in order to protect the baby from splinters.

In general, the crib should be sturdy, the sides should move up and down smoothly, and the latches and locks should work correctly. There should be no sharp metal edges that can come into contact with the baby. Avoid cribs with ornamental balls or bells because they can become detached and become a potential choking hazard. You can never be too cautious when it comes to the safety of a baby’s crib. After all, that is where the baby will spend most of his time during the first year of life. It is important to remember, whenever you use second hand baby items passed down from relatives or purchased from a garage sale, you should call the manufacturer to check to see if there have been any recalls.

Good luck with your new baby.

Lisa Kelly, R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Healthy Babies

Thursday, May 25, 2006

Hay Fever

Dear Lisa,

My 7 year old daughter has allergies to grass and tree pollen. Even though she is taking her allergy medicine, she still has some days where she is suffering. Is there anything else I can do for her?

“Suffering with Hay fever in N.J.”

Dear “Suffering with Hay fever”,

There are some measures that you can take to help control your child’s exposure to grass and tree pollen. In order to avoid grass pollen exposure, refrain from playing outsdoors right after mowing the lawn. On high pollen count days, try to avoid outside activities early in the day; instead find activities to do indoors in an air-conditioned environment. By the end of the day a lot of the pollen will fall to the ground and less will be floating in the air. Late afternoon is a better time for allergic children to play outside.

The best time to spend time outside is after a good rain. When it rains outside, the raindrops wash the pollen in the air to the ground leaving less pollen floating in the air waiting to be inhaled. After spending time outdoors, have your daughter take a shower instead of a bath when she comes inside the house. Showering will wash the pollen off of her eyelashes and hair. This will prevent her from rubbing the pollen into her pillow or bedding and re-exposing herself to the allergen all night long.

At night it is better to sleep with the windows closed and with an air-conditioner on until allergy season is over. The air-conditioner improves air quality by filtering allergens from the air that enters the room. Closed windows prevent the wind from blowing pollen into her bedroom while your daughter sleeps.

If your daughter continues to suffer despite all of these efforts to adjust the environment you should contact your Doctor or Nurse Practitioner. She may need a change in her medication or the addition of a new type of medication in order to get her symptoms under control.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Ask Lisa Pediatric Advice

Wednesday, May 24, 2006

Bottle Weaning

Dear Lisa,

I just weaned my 15 month old son from the bottle and now he won’t drink milk from a cup. I am afraid that he’s not getting the nutrition he needs and I am tempted to just let him have the bottle back.

“Back on the bottle again in N.J.”

Dear “Back on the bottle again”,

Most toddlers react to the transition from bottle to the cup with some resistance. They usually show their disapproval of this change by refusing to drink milk from a cup. It is a very difficult time for parents and many do let their child go back to the bottle. If you do go back to the bottle, it will be more difficult to wean him when he is older because children learn from their behavior. When you try to wean the bottle the second time, most likely he will just put up more of a fuss, with the hope that you will let him have the bottle again. So the best advice is to stick to your decision to wean your son and know that your child’s nutrition should come from solid food, not from milk.

After watching your baby consume such large amounts of milk/formula during the first year of life, it is natural to think that a toddler needs to drink large amounts of milk too. Fortunately this is not the case. A 15 month old child only needs 16 ounces (or 2 cups) of whole milk per day. If your child will not take this amount you can give him solid foods that contain the same nutrients as milk. You can replace the milk with yogurt, frozen yogurt, pudding, cheese, or cottage cheese. Luckily, most children will eat a bowl of cereal with milk. It is also a good idea to add extra milk or cheese to recipes whenever you can. You can add milk to pastina or hot oatmeal to cool it down, put cheese sauce on vegetables or sprinkle grated cheese on macaroni. Many children love grilled cheese sandwiches or scrambled eggs with a slice of cheese melted on top. For those children who don’t take enough calcium and Vitamin D fortified foods, you can give juice with calcium. You will be able to find orange juice with calcium and many juice box brands with added calcium in your supermarket. The most important thing to do is not give up offering milk in a cup, because most children in time will begin to drink milk again.

Lisa Kelly, R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice -Keeping Kids Healthy

Tuesday, May 23, 2006

Refusing Medication

Dear Lisa,

My 8 year old won’t take liquid medication. It is very frustrating. Do you have any suggestions?

“Won’t Take Medication in N.J."

Dear “Won’t Take Medication” ,

A lot of children don’t like to take medication and it can be the most frustrating part of caring for a sick child. Here are some suggestions for older children who you can reason with. If your child hates a certain flavor ask your doctor or pharmacist if there is an equal medication with a different flavor. Some pharmacies will add a flavor of your choice to a medication at your request.

Another suggestion is to have your child suck on an ice pop or ice cube before taking the medication. The cold will numb his tongue and he won’t taste the medication or be bothered by its texture. A very popular alternative is to squirt Hershey’s Chocolate Syrup on the spoon with the medication. Chocolate hides the taste of the worst tasting medication. Just remember, always ask the pharmacist before mixing your child’s prescription with an additive to make sure there is no interaction.

You can reason with an 8 year old, and explain why he needs the medication and what will happen if he doesn’t take it. Children at this developmental age are very interested in how their bodies work and an explanation usually helps. It is important to let him know that he has no choice whether he will take his medication or not, but he has a choice “how” he will take the medication. If all else fails, teach him how to swallow a pill.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents with a Sick Child

Monday, May 22, 2006

Infant Sleeping

Dear Lisa

My newborn baby seems to have his days and nights mixed up. He sleeps for most of the day and after feeding goes right back to sleep. At night he is up every two hours and doesn’t fall asleep after feeding. What can I do to get some sleep?

“In need of sleep in N.Y.”,

Dear “In need of sleep"

Unfortunately many babies aren’t born with a circadian rhythm that is congruent with our lifestyles. The circadian rhythm or sleep cycle determines when a baby sleeps and when it is awake. It is mainly influenced by the timing and intensity of light. (1) Therefore if your baby seems sleepier during the day and more awake at night, you can help change the rhythm by the use of light.

Starting in the morning around 7 a.m. open all of the shades or blinds in your home and turn on all of the lights. Feed, burp, change, bathe, interact and play with your baby in a common area, where there is a lot of traffic (such as the kitchen or family room). Wake your baby every 3 hours if necessary by unwrapping him and changing his diaper, followed by feeding. Don’t let him nap in a dark room away from the activity in the home.

At night, starting at 9 or 10 p.m., put your baby in a dark room, in the “back to sleep” position, with blinds and shades drawn, away from all of the activity. When the baby wakes to feed, do not turn the lights on, but use a night light instead. The interaction should be limited. Only feed, burp and change the baby, avoid play time and too much interaction. For most healthy children, there is no need to wake a baby at night to feed, especially if it fed every 3 hours during the day. Your baby should wake on its own at night to feed, every 3 to 5 hours depending on the baby. If your child is a preemie, has jaundice, has a problem gaining weight, or other health concerns your Doctor or Nurse Practitioner may ask you to wake your baby more often at night.

By three months old an infant develops its circadian rhythm, begins to sleep more at night and has an established daytime nap schedule. (1) In order to help an infant establish its circadian rhythm you can institute measures that encourage light during the day and darkness at night. Most babies should be able to sleep through the night by 3 months of age. (2) Sleep through the night usually means about 6 hours of uninterrupted sleep.

In the mean time, you should nap during the day while your baby is napping and recruit help from friends and family so that you can get the well deserved rest that you need. You will be better equipped mentally and physically to care for your baby with the proper rest.

Congratulations on your new baby.

(1)Rosen G. General Overview of Neuroanatomy and Neurophysiology of Sleep. Presented at: Pediatric Sleep Disorders Conference;May 31, 2002:Edison.
(2)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:341-342.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Friday, May 19, 2006

Strep Throat

Dear Lisa

I’ve been exhausted and have a terrible sore throat. I went to my Doctor and he told me that I have strep throat. I’m worried about my 7 year old daughter because I’ve been kissing and hugging her. Now she tells me that her throat hurts too. I didn’t think anything at first because she’s been playing and acting normal. This morning she woke up with pimples around her mouth. Now I am beginning to wonder if she has strep too. Can pimples around the mouth be a sign of a Strep infection? She hates getting throat swabs and I don’t want to bring her to the Pediatrician and force her to get a strep test if it’s not necessary.

“Don’t want the stick in N.J.”

Dear “Don’t want the stick",

Throat swabs are very uncomfortable, and many children dislike them tremendously. Unfortunately, it is the only way to obtain a culture and determine if a child has streptococcal pharyngitis (strep throat) . Strep throat is contagious via respiratory secretions. Being that you had close contact with your daughter it is possible that she has strep too.

According to The Red Book, Report of the Committee on Infectious Diseases, transmission of group A streptococcal infection almost always follows contact with respiratory secretions. The exchange of respiratory secretions occurs when there is close contact such as kissing, hugging or sharing of food.

I am also concerned about the rash you are describing around your daughter’s mouth. Impetigo is a skin infection that may be caused by the same microorganism that causes streptococcal pharyngitis. It is common for a child to have strep throat and impetigo at the same time. Impetigo looks like pimples or vesicles which rupture and leave erosions with honey-colored crusts. Since your daughter was exposed to strep and has developed a sore throat and a new rash around her mouth, a visit to the Pediatrician’s office to rule out strep is a good idea.

Lisa Kelly R.N., P.N.P.C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Sick Children

Thursday, May 18, 2006

Testicular Self Exam

Dear Lisa

My 15 year old son was in the Pediatrician’s office for an annual examination and was told that he was supposed to be doing a monthly Testicular Self Exam. Isn’t he too young for this?

“Too Young for Testicular Self Exam in N.J.”

Dear “Too Young for Testicular Self Exam”,

Testicular Cancer is the number one cancer killer in young men aged 15 to 35 years old. Luckily it has a very high cure rate if caught early. It usually presents as a painless pea size mass which gives the sensation of heaviness in the testis. Other warning signs for testicular cancer include sudden accumulation of fluid in the scrotum, swelling in the groin, dull ache in the groin area, enlargement of the testicle, or lower back pain. Those at risk for Testicular Cancer include men with a history of an undescended testicle, a family history of testicular cancer, caucasian race and young age (teenagers and young men).

The American Cancer Society recommends that men with risk factors perform a testicular self exam (TSE) on a regular basis. They also recommend a testicular exam by a health care professional as a part of their annual physical examination. It is not only recommended but prudent for your son to perform a testicular self exam on a regular basis. It is recommended that young men start performing TSE at puberty or 15 years old. The Jason A. Struble Memorial Cancer Fund was named after a young man who died of testicular cancer. Its mission is to educate young men about testicular self exam. You can contact the foundation at for free information, including a shower card which illustrates how to perform a TSE.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Healthy

Wednesday, May 17, 2006

Migraine Headaches

Dear Lisa

My teenage daughter suffers from migraine headaches. About once per month she develops a migraine. They seem to come out of no where. I feel so bad for her and wish I knew what was causing them. My friend told me that certain foods may cause migraines. What foods should she stay away from? Besides food, what other things may be the cause of her migraines?

"Terrible Headdaches in N.J.”

Dear “Terrible Headaches”,

An important goal in the treatment of Migraine Headaches is the identification of Migraine triggers. Once a migraine trigger is identified, steps can be taken to avoid that particular trigger in order to decrease the frequency of episodes. The foods that are known to be common triggers for migraines include; food with MSG (such as Chinese food), food with Nitrates (such as lunch meats or hotdogs), foods containing tyramine (cheeses and chocolate), citrus fruits, fried foods, foods or drinks containing aspartamine (an artificial sweetener), bananas and alcoholic beverages (sometimes found in desserts or sauces). Other conditions such as lack of sleep, skipping meals, getting your menstrual period, anxiety, depression, anger or fear may also trigger migraines.

Since everyone is different it is important to keep a headache diary in order to identify your daughter’s triggers. In the diary include information in regards to her mental state, stress level, sleep pattern, food intake and time of the month. In time you may be able to determine a pattern and ultimately identify her triggers. The good news is that “30% of migraines are treated successfully with changes in diet.” (1).

(1) Stephenson, M. About 4% to 10% of children have migraine headaches, researcher says. Infectious Diseases in Children. 2006, May: 31.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice- Keeping Kids Healthy

Tuesday, May 16, 2006

Petting Zoos

Dear Lisa

A friend told me that there’s a recent outbreak of E.coli at petting zoos and I shouldn’t bring my child there. I don’t want to put my child at risk, but I do want him to have a normal life. Is it safe to go to petting zoos?

“Worried about germs at the zoo in N.J.”

Dear “Worried about germs at the zoo”

There have been some recent reports of children coming down with diarrhea illnesses such as Escherichia coli 0157:H7 after visiting petting zoos. The CDC released results of a case-control study of an outbreak of Escherichia coli 0157:H7 associated with two Florida petting zoos. Visitors who did and did not get sick were interviewed and the behaviors that were strongly associated with illness were feeding a cow or goat, touching a goat, stepping in manure and having manure on shoes. (1) Those that washed their hands after visiting the petting zoo and before eating didn’t get sick. It is not surprising that good old fashioned hand washing is needed to prevent the development of infection.

Other studies noted that a large percentage of people brought food and drinks into the zoo or ate and/or drank while at the zoo.(1) I can’t tell you how often I see a mother chasing a playing child, instructing him to eat; with one hand filled with fruit snacks and the other a juice box. This was not the practice 25 to 35 years ago when we were growing up. Our parents didn’t chase us around with snacks and drinks while we were playing. Following children around while they are playing and insisting that they eat gives them the wrong message. Children do not learn the concept of sitting at a clean table to eat with clean hands (not to mention the lesson learned from the delay of immediate gratification).

It is not surprising that today more children are developing diarrhea illnesses after visiting petting zoos. Zoos are dirty places and are meant for looking, learning and touching, not eating. I wouldn't worry about bringing your child to the zoo, just make sure he washes his hands with warm soapy water after leaving the petting zoo and feed him before you go. Oh, and don’t forget to clean off his shoes when you leave!

Have fun.

(1)Riley, Lauren. Common practices at petting zoos put people at risk for GI illnesses. Infectious Disease in Children. 2006;May: 54.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Monday, May 15, 2006

Urine Output

Dear Lisa

My 11 month old son has been diagnosed with gastroenteritis. He is having a lot of diarrhea. My doctor told me that he could become dehydrated and I have to count how many times he urinates. I use disposable diapers and it’s too hard to tell if they are wet. How do I tell if there’s urine in the diaper?

“Worried about dehydration in N.J.”

Dear “Worried about dehydration”,

Disposable diapers are so absorbent that it is very hard to tell if there is urine in them. One option is to put a folded paper towel inside the diaper, adjusting it towards the front of the diaper over the spot where your baby usually urinates. When you check the diaper for urine, the paper towel should be wet with urine.

Another option is to look at the inside contents of the diaper. When you change the diaper you can pull apart the inside of the diaper near the area where there is usually urine, using gloved fingers. The inside of the diaper will look like tiny balls of gel. If your child urinated the gel like beads will look wet, yellow and smell like urine. You might want to pull apart a dry diaper first so you have something to compare it to. The trick is to check the diaper frequently. If your child has diarrhea, it can mix with the urine and it will be too hard to tell what is urine and what is diarrhea.

Determining urine output is always a challenge for pediatric nurses in the hospital. One of the tricks that I learned was to weigh only the diaper, before and after a child is diapered, checking the diaper at least every two hours. I would take the difference in weight and convert it to milliliters. For example, if the diaper weighed 30 grams before diapering and 60 grams after diapering, I would subtract 30 from 60, and know that the child urinated 30 ml, which is equal to one ounce. Unfortunately, this technique may not work in the home setting because most bathroom scales are not that accurate and do not have the ability to measure such small amounts (most dry diapers only weight 30 grams).

In general, your child should urinate 6 times in a 24 hour period. If this is not the case or if you are not sure, you should bring him back to your doctor to have him checked for dehydration.

Lisa Kelly R.N, P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents with Sick Children

Friday, May 12, 2006

Tick Bites

Dear Lisa

I found 3 ticks on my 10 year old son after he was playing in the woods. I am worried about Lymes Disease. What signs do I look for?

“Tick bites in N.J.”

Dear “Tick bites”,

Borrelia burgdorferi is the organism that causes Lymes disease. The transmission of the disease usually occurs because of a tick bite, in which the tick remains attached for a period of time. Typically the rash appears 1 to 2 weeks after exposure, but has been known to occur as early as 3 days or as late as 31 days after exposure. Signs of early localized disease include erythema migrans rash, headache, fever, malaise, mild neck stiffness and joint pain. The typical erythema migrans rash appears as a red mark at the site of the tick bite and expands to a round, red, flat rash which is 5cm or more in size. The rash may also have partial central clearing, giving it a bull’s eye appearance.

If the signs of early localized disease are not detected then early disseminated disease followed by late disease may occur. Signs of early disseminated disease include multiple erythema migrans (which are usually smaller than the primary lesion and may occur in any location), cranial nerve palsies, meningitis, arthralgias and conjunctivitis. I recommend that you check your child for a rash and/or "flu" like symptoms over the next few weeks. If either of these develop, contact you Doctor or Nurse Practitioner for an evaluation.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Thursday, May 11, 2006

Microwaving Plastic

Dear Lisa

I received an email from a friend stating that a doctor on T.V. explained that microwaving with plastic releases toxins into our bodies that can cause cancer. Is this true? I am worried that I have been harming my kids because I microwave in plastic all of the time.

“Worried about cancer in N.J.”

Dear “Worried about cancer”,

It has been known for a long time that, “Hot food melts some plastics, such as margarine tubs, causing migration of package constituents. (1) “It’s true that substances used to make plastics can leach into food, but as part of the approval process, the FDA considers the amount of a substance expected to migrate into food and the toxicological concerns about the particular chemical.” The agency has assessed migration levels of substances added to regulated plastics and has found the levels to be well within the margin of safety based on information available to the agency. The FDA will revisit its safety evaluation if new scientific information raises concerns (2).

What we don’t know is what levels of which chemicals that are leached out of the plastic into the foods cause cancer in humans? How many years of exposure are needed in order to reach a level that puts someone at risk? What type of people are more susceptible to the accumulation of these chemicals? What other medical conditions may be caused by the accumulation of these chemicals in the body?

It is clear that future research needs to be done in order to answer these questions. In the mean time, parents can take one of two courses of action. Continue to prepare your child’s meals microwaved in plastic until it is proven that it is not safe or stop preparing meals microwaved in plastic until repeated research studies prove that it is safe. Before you make this decision ask yourself these questions; Are the misshapen, stained plastic containers that I use microwave safe? Does the plastic wrap that I buy state that it is safe to be used in the microwave?

The one thing that the experts do agree upon is that consumers should use plastics for their intended purpose and in accordance with directions. “Microwave-safe plastic wrap should be placed loosely over food so that steam can escape and should not directly touch your food.” (2) Rolf Halden, PhD, PE, assistant professor at the Johns Hopkins Bloomberg School of Public Health states, “If you are cooking with plastics or using plastic utensils, the best thing to do is to follow the directions and only use plastics that are specifically meant for cooking. Inert containers are best, for example heat-resistant glass, ceramics and good old stainless steel.”(3 )

(1)Farley, D. Keeping Up with the Microwave Revolution. FDA Consumer Magazine. 1992; December.
(2)Meadows, M. Plastics and the Microwave. FDA Consumer Magazine. 2002; November.
(3)Johns Hopkins Bloomberg School of Public Health. Public Health News Center. Researcher Dispels Myth of Dioxins and Plastic Water Bottles: 2006. Available at
Accessed May 10, 2006.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents

Wednesday, May 10, 2006

Burn Safety

Dear Lisa

I have three children and we are moving into a new home. My friend told me to check the water temperature in the house to make sure it is not too hot so my children won’t accidentally get burned. What temperature should the water be?

“Don’t want my children to get burned in N.J.”

Dear “Don’t want my children to get burned”,

It is estimated that a child exposed to water at the temperature of 130 degrees Fahrenheit will sustain a full-thickness burn with 10 seconds of exposure. At 140 degrees Fahrenheit, a full-thickness burn results from only 1 second of contact. (1). Therefore it is important to set the hot water heater in your new home to a temperature between 120 and 130 degrees F (49 and 54.4 degrees C). This way if your child is accidentally exposed to a splash of hot water it is less likely he will sustain a serious burn if he is removed from the water quickly. It is always a good idea to check the bath water temperature to make sure it is not too hot by using your elbow before putting your child into the bath. Sometimes calluses or the thickness of the skin on adult hands may prevent you from accurately determining the temperature. Good luck in your new home!

(1)Thompson, S. Accidental or Inflicted? Evaluating cutaneous, skeletal and abdominal trauma in children. Pediatric Annals. 2005;34(5):375-376.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Tuesday, May 09, 2006


Dear Lisa

My daughter is 8 years old and still struggling with bedwetting. Her Pediatrician recommended that I reduce the amount of fluids that she drinks in the evening and stop using the Pull-ups she was wearing at night. I followed these instructions and she still wets the bed every night. Is there anything else that I can do?

“Still Bedwetting in N.J.”

Dear “Still Bedwetting”

You are on the right track since you discussed this problem with your Pediatrician, eliminated fluid intake in the evening and stopped using Pull-ups. Nocturnal enuresis or “bedwetting” can be very frustrating, because it interferes with socialization, causes embarrassment and makes such a mess! Voiding disorders such as bedwetting occur in up to 6 % of children until the age of 7. (1) Some people take the “wait and see approach” which is okay in some circumstances because it is expected that “in about 15 % of cases, the condition resolves spontaneously.” (1) Since your daughter is 8 years old she should be mature enough and ready to use a bedwetting alarm. Bedwetting alarms are intended to alarm or make an irritating sound when the sensation of moisture is detected. It is connected to a child’s underwear or a pad placed underneath the child during sleep. The alarm is meant to disrupt the child’s sleep and cause a negative and unpleasant feeling when the child urinates.

The purpose of the bedwetting alarm is not to wake the child so that she can go to the bathroom, but to make her aware that she urinated and associate the bedwetting with a negative response. By doing this you train the brain to do what is “pleasant” which means hold the urine in until the morning. The process typically takes 6 weeks to achieve and commitment is necessary for success. You can purchase a bedwetting alarm from most pharmacies and submit the cost to your insurance company. If your daughter has daytime incontinence, incontinence of stool or continued symptoms at night despite a concentrated effort, I would contact your Doctor or Nurse Practitioner for further evaluation.

Good luck!

(1) Zacharyczuk, C. Psychosocial implications of nocturnal enuresis demand treatment. Infectious Diseases in Children; 2006, April: 72-73.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents Updated Daily

Monday, May 08, 2006

Hay Fever

Dear Lisa

My 7 year old daughter has a stuffy nose and itchy throat. I have really bad hay fever, so I’m wondering if her symptoms are from a cold or allergies. What are signs and symptoms of allergies?

“Wondering if my daughter has allergies in N.J.”

Dear “Wondering if my daughter has allergies”,

Although symptoms of a cold and allergies are similar there are some symptoms you tend to find in people with allergies or hay fever. Dark circles under the eyes, also known as “allergic shiners” are commonly found in children with allergies. Children with allergies typically perform the “allergic salute”, an upward rubbing of the nose which usually leads to the formation of the “allergic crease”. An allergic crease is a transverse skin line found below the bridge of the nose. Nasal congestion and rhinorrhea (a runny nose) can be found in both a child with allergies or in a child with a cold.

From my experience, children with allergies have more sneezing, more complaints of watery, itchy eyes and an itchy throat which many times presents with throat clearing. Hay fever or allergy symptoms worsen after exposure to the offending allergen; therefore worsening of symptoms after exposure to common allergens is a good indicator that your child is allergic. If you are not sure if your child has allergies or if the symptoms seem to be worsening you can discuss allergy testing with your Nurse Practitioner or Doctor which can aid in the diagnosis.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily

Friday, May 05, 2006

Waxy Ears

Dear Lisa

Every time I bring my child to the clinic to be checked they tell me that he has a lot of wax in his ears. Why does he have so much wax and how can I get it out?

“Waxy ears in N.J.”

Dear “Waxy ears”,

Wax in the ear canal is normal. Everyone produces wax, some more than others. In most cases the wax will come out on its own and there is no need to treat it. If your child has pain, complains of difficulty hearing or if the practitioners at the clinic cannot visualize the tympanic membrane (ear drum) because there is so much wax, then it would be a good idea to treat him.

To loosen the wax you can get a shot glass; fill it half way with warm water and half way with hydrogen peroxide. You should position your child on his side with his head turned and ear facing the ceiling. With a dropper take the solution and instill 4 to 5 drops in your child’s ear. He needs to stay still in this position for 20 minutes. Some children move too much and it may be easier to instill the drops when the child is sleeping. Alternate ears and continue this treatment until each ear receives drops for 5 nights. When you see brown wax on the outside of the ear you can remove it with a Q-tip. Avoid putting a Q-tip into the ear canal because this may push the wax in further and make it more difficult to get the wax out.

If your child has pain or if you don’t see any of the wax come out you should talk to your doctor about going to an Ear, Nose and Throat (ENT) clinic. In some cases, the wax builds up so much that it needs to be irrigated and evacuated by an ENT specialist.

*If your child has ear tubes you should not instill anything into your child’s ears without consent from your Doctor or Nurse Practitioner.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice -Keeping your Child Healthy

Thursday, May 04, 2006

Omnicef Dosage

Dear Lisa

I brought my 7 year old son to the Pediatrician three days ago because he complained of a sore throat and I noticed that he was sleeping more than normal. My doctor did a throat culture for Strep. I was told that my son’s throat didn’t look like Strep, but the Doctor gave me samples for Omnicef because he had swollen lymph nodes in his neck. I gave the Omnicef to my son once a day as prescribed, for the last three days. Today my doctor called and informed me that the throat culture was positive and that my son has strep. He called a prescription into my pharmacy for Omnicef. When I picked up the prescription from the pharmacy I noticed the directions read: give two times per day. Is this too much medicine? When my Doctor gave me the samples, he told me to give it only once a day and now the prescription reads twice per day. I don’t want to call my doctor because I don’t want to bother him and I don’t want him to think that I am questioning him.

“Don’t want to bother the Doctor in N.J.”

Dear “Don’t want to bother the Doctor”

I understand your confusion regarding the dosage of Omnicef. Like many antibiotics, Omnicef is indicated for many types of infections such as pharyngitis, ear infections, sinusitis, urinary tract infections and skin infections. Depending on the type of infection and clinical presentation, Omnicef can be given once or twice per day for a duration of 5 or 10 days. In my practice I prefer to give Omnicef twice per day for 10 days duration for Strep Pharyngitis because I find there is a better cure rate. Therefore just because Omnicef is prescribed to be given twice per day doesn’t necessarily mean that it is a medication error. Whenever you have a question about medication dosages or side effects you can use your pharmacist as a resource. He or she can tell you if a medication dosage is correct for your child’s weight. More importantly, I wouldn’t worry about bothering your doctor. Most doctors welcome questions about medication dosages and would not feel that you are questioning them. It is possible for medication errors to occur when a prescription is verbally telephoned into the pharmacy because of the potential for miscommunication and language barriers. Therefore, whenever you have a question about a medication dosage (especially a prescription that is telephoned into the pharmacy) it is best to call your doctor to double check.

Lisa Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice - For Parents with sick kids

Wednesday, May 03, 2006

Picky Eater

Dear Lisa

My two year old daughter is such a picky eater. How do I know if she is eating enough?

“Picky Eater in N.J.”

Dear “Picky Eater”

It is very common for Toddlers to be picky eaters. A two year old's developmental stage is centered upon their need for autonomy. They learn by touching; feeling new textures and temperatures. They gain a sense of accomplishment by trying new things and carrying out tasks by themselves. At this stage of development it is expected that a toddler will only sit for a short period of time for meals. They tend to enjoy small frequent meals which include finger foods or small pieces of food, tiny enough for their hand to pick up and feed themselves.

One general guideline to determine if your daughter is eating enough is to give her one teaspoon or bite of each food group per age. For example, a two year old should eat two spoons of chicken, two spoons of peas, two spoons of diced pears and two bites of bread. A three year old should eat 3 spoons from each food group and so on. Generally, our adult food portion sizes in the United States are too large and we as parents tend to envision our child needing a plate filled with food. Luckily this is not the case. My advice is to make eating an enjoyable time and not a time of reprimanding. This way your child will not learn to use eating or not eating as a tool to get your attention.

Lisa Kelly R.N., P.N.P, C.
Certified Pediatric Nurse Practitioner

Advice about Bringing up Healthy Children

Tuesday, May 02, 2006

Drug Abuse

Dear Lisa

My 14 year old son is really a challenge. Sometimes he acts so weird. I know that it is common for teenagers to experiment with drugs? How can I tell what is normal teenage behavior and what are signs that he’s doing drugs?

“Worried that my son may be doing drugs in N.J.”

Dear “Worried that my son may be doing drugs”,

Teenagers are definitely a challenge! You are not alone. Most parents of teenagers complain about their children acting really strange. Sometimes this strange behavior can be considered “normal” but there are some signs that are alarming and warrant further investigation. Chemical odors on your child’s breath, paint or stains on the hands or face and hidden empty spray paint containers or chemical soaked rags are all signs of inhalant abuse. (1) Red eyes, an increase in appetite (the munchies), impaired coordination, reduced attention span and lack of motivation are all signs of marijuana use. (2) Frequent chest pain, persistent nasal discharge, mood swings and declining school grades are signs of Cocaine use. (2) Pruritis (itchiness), constipation, needle marks, and chills may be signs of narcotic use such as Heroin.

Club drugs such as ecstasy and ketamine have gained popularity among youth. They are typically used at underground dance parties or “raves”. Their effects include high energy, enhanced bodily sensations and elevated body temperature which may be life threatening. In general if you notice a sudden change in your child’s personality, he develops problems with truancy or a drop in school performance or if he starts “hanging around” with a new crowd, I would confront him with your concerns. Parents with children involved with drug abuse need to recruit help from professionals who are trained in this area. Unfortunately, drug abuse is a problem which generally will not just go away on its own.

(1) Stephenson M. National Survey Reports Inhalant Use Among Aolescents Increasing. Infectious Diseases in Children. April 2006; 40.
(2)Nanda S, Konnur N. Adolescent Drug and Alcohol Use in the 21st Century. Pediatric Annals. March 2006; 35:3: 193-199.

Lisa Kelly, R.N., P.N.P, C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Healthy

Monday, May 01, 2006

Office Hours

Dear Lisa

I am so frustrated with my Pediatrician’s office. My daughter hasn’t been sick in two years. Now over the last two months she’s been sick three times and each time my doctor is not able to see her. First she had ear pain. I called my Pediatrician’s office and the secretary told me that my daughter could not come in until the next day. She was up all night in horrible pain. The next time I called, it was a Saturday morning. My daughter had pain with urination and they told me the office was closing in fifteen minutes and I could be seen on Monday. When I told the secretary that I was concerned that my daughter might have a urinary tract infection and I didn’t think it should wait until Monday, she told me to go to the Emergency Room. The other day I left work early because the School Nurse called. I called the doctor’s office multiple times and they didn’t call back. When I asked what time the office closed they wouldn’t even give me an answer and kept on telling me that the doctor would call me back at the end of the day.

"Feeling abandoned in N.J”

Dear “Feeling Abandoned in N.J.”

At very least a doctor’s office is obligated to tell you the office hours. I frequently hear the complaint that a child is sick and they can’t get an appointment. In some cases a child’s condition does not warrant an appointment that day. If this is the case, a healthcare professional, such as a Nurse or Nurse Practitioner should be available to explain what you can do for your child in the mean time, especially if there is pain involved. Many Doctor’s offices make arrangements to accommodate “add on” patients or parents who work and can't get to the office during the regular office hours. Some Pediatricians hire Nurse Practitioners in order to handle the addition of “add on” patients throughout the day. Other Pediatrician offices have contracts or agreements with “After Hours Centers” that will see their patients and answer their questions when the office is closed. The office I worked in offers “Walk-in” or “Open Access” hours to accommodate parents with sick children. During the designated “Walk-In” or “Open Access” hours, patients walk in with no appointment and do not need to telephone first. This prevents parental frustration and saves the nurses a lot of time on the telephone. The best way to handle the situation is to let your Doctor know how you feel. Don’t be afraid to talk to your Pediatrician about problems you are having. Sometimes the Doctor may not know how his staff is answering questions on the telephone. He may not be aware how frustrated you are and that changes need to be made in the system in order to keep you and his other patients satisfied. Good luck.

Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily