By producing Health Tips For Success, we hope to help you and your family find solutions to those little ups and downs in life that tend to keep all of us from being as successful as possible. If you find this issue of Health Tips for Success to be useful in some small way, please pass it on to a friend. Our goal is to reach 10,000 families by the end of the year. All articles are derived from published materials, educational sources and years of experience for each author. Of course, in times of need, no e-newsletter should ever take the place of your family doctor or professional counselor. If you have comments or questions, please drop me a line at drfrank@drhuggiebear.com .

The U.S. Food and Drug Administration has finally approved an oral contraceptive that women take daily for 91 consecutive days and therefore only experience 4 periods per year.

The new birth control pill, Seasonale, should be available by late October or early November and offer women more control over timing of their menstrual periods. Cost should be similar to three packs of regular birth control pills, with each Seasonale pack containing 84 active pills and 7 “sugar” pills.

There were some concerns that “shutting off “ a woman’s cycle may cause hormonal imbalances, but this has not been found true. In fact, doctors have often allowed women to skip their “sugar-iron” pills and go right into the next pack of pills in order to accomplish similar results.

Side effects of Seasonale include a higher rate of breakthrough bleeding and compare to Depo-Provera and Norplant. Even though menses are delayed for longer intervals, the failure rate or risk of getting pregnant is still about 1%.

Likewise, the manufacturer has included a warning that Seasonale exposes women to a yearly higher total amount of hormone and may cause additional risk of blood clots, heart attack, stroke, and breast cancer. This is especially true of women smokers over the age of 35.

Choosing the perfect daycare provider for your child should involve more than price, convenience, location and hours of availability. Most larger daycare centers are inspected frequently by state or federal agencies and this practice tends to help them adhere easier to functional guidelines. Unfortunately, home based daycare providers are not always held to the same schedule of inspections and may slip in their desire to provide the same level of care.

As more and more moms become working parents, it is essential that parents feel comfortable with those who are taking care of their child when they are at work. The peace of mind you get knowing that your child is properly cared for and in a safe environment is priceless.

In this session, we’re going to discuss how you can visit a daycare and decide if it is suitable to provide care for your child. Keep in mind that the old adage “you get what you pay for” is as true in daycare, as in anything else.

• Their health and immunization status, as most states require workers to be in good physical and mental health and have all immunizations including hepatitis B up to date.
  
   
• Is the staff required to have hepatitis A immunization
  
   
• Whether the staff is required to take flu shots
  
   
• How the center screens workers prior to employment
  
   
• How the center insures the personal hygiene of the workers
  
   
• Guidelines for sending sick staff members home
  
   
• What is the age and education level of the person providing care for your child
  
   
• What is the provider to child ratio
  
   
• How has the staff been educated to detect serious or contagious illnesses in enrolled or visiting children
  
   
• What are the hand washing and soiled or dirty clothing guidelines for staff members

• Is food preparation on site or brought in already prepared
  
   
• Food handling areas and how the staff is trained to avoid contaminating food
  
   
• Use of disposable plates, cups, diapers, changing table papers, and towels
  
   
• Where children consume their food
  
   
• Diaper and dirty or soiled clothing change areas should be clearly separate from food handling and storage areas
  
   
• How the center handles potty training and the use of individual potties
  
   
• There should be a clearly marked exit door from each and every room in the facility
  
   
• Where are smoke-fire alarms and fire extinguishers
  
   
• How often are fire drills and evacuation plans reviewed and practiced
  
   
• Number of bathrooms to child ratio should not be in excess of ten kids per bathroom
  
   
• Are there handicap equipped bathrooms in case your child has special needs
  
   
• How often are bathrooms, the kitchen, and service areas cleaned
  
   
• What type of disinfectants are used, diluted bleach is the standard, additional Lysol is great, but not by itself as bleach kills HIV, TB and most infections
  
   
• How are toys cleaned and how often, plush toys should be washable and washed every day
  
   
• How are cribs and walkers cleaned and how often
  
   
• What areas are carpeted and how often are carpets cleaned
  
   
• Is the diaper-changing table cleaned after each use or do they use waterproof changing table pads that are disposed after each use
  
   
• Security risks and how the center ensures your child will remain there safely until you or a designated person picks them up
  
   
• What is the protocol for finding a lost child, “we’ve never had one” is not an acceptable answer

• About the age grouping of children in the daycare so that multiple ages do not tend to be placed in the same classes
  
   
• If the center has immunization and health records on each and every child
  
   
• What criterion does the center use in determining when to send a sick child home
  
   
• How are runny noses and children with dry coughs handled
  
   
• Are a lot of the children out sick on the day you visit
  
   
• How are cases of head lice and scabies handled
  
   
• Do all children have changes of clean clothing in case of soiling
  
   
• How are kids clothing and articles of need separated and stored
  
   
• Will the center give kid’s medications

A seizure disorder, Petit mal seizures, may actually cause staring episodes, what appears to be excessive daydreaming, and momentary lapses in concentration leading parents and teachers to believe a child has the inattentive type of ADHD.

Petit Mal seizures can be so short that even the child doesn’t realize they have occurred. The shortest may be as little as five seconds and if these episodes occur often, the child’s concentration and ability to learn will be severely compromised.

As a parent, sometimes you have to be just as much a detective as your family doctor. When a teacher or family member suspects your child is inattentive ADHD, ask what they observe immediately before and after periods of daydreaming or inattentiveness. It may be worth mentioning this “diagnosis trap” to your family doctor if your child is currently being treated for ADHD. Unfortunately, ADHD medications do not protect kids from the effects of seizures and this is one of the reasons ADHD drugs do not work in some kids.

“I just don’t know what to do doctor!” The anxious mom said on her first office visit with her son. “His teacher tells me he daydreams or seems spacey most of the time he’s in class or she finds him asleep with his head on his desk.” “His grades can’t go much lower or he will fail this year.” “His father and I have tried everything we can do to make him get a better night’s sleep or focus on his school work.” “We had his pediatrician start him on ADHD medications to help his concentration, but it’s still not working.” Most parents don’t realize sleep apnea can occur in children, and for the same reasons as in adults.

This ten year old was a perfect example of a sleep apnea affected kid. He was only four foot six inches in height, but weighed 137 pounds. His neck was very thick, he had a large abdomen, was short of breath just from walking down the hall, and his entire nasal-throat-upper airway passages were narrow and clogged with clear mucous. His mother was surprised when I asked if he snored at night. Her answer was quick, “So does his father!” “He got that naturally”. Further questions revealed what I suspected; he ate a lot of junk food, watched television and played video games during his awake hours, and avoided exercise like the plague. He was irritable when asked to do chore or homework and kept a bad attitude. Mom had blamed his weight problem on heredity and avoided enforcing the need for good nutrition and exercise in order to keep family peace.

The obesity epidemic we’re currently seeing in children is probably responsible for most of the obstructive sleep apnea (OSA) diagnosed in kids. When a short child gains weight, it tends to cause neck, throat, and nose tissues to grow very thick, thus decreasing effective airflow through these areas. A large abdomen pushes up on the diaphragm and breathing muscles, further decreasing the child’s ability to move air in and out of his lungs.

Kids can suffer from central sleep apnea (CSA) just like adults and some studies show that the brain breathing control centers in overweight kids may not function properly in the face of obesity. CSA can likewise occur in kids of normal weight and height and losing weight will not help these children’s sleep apnea.

• Shows excessive daytime sleepiness
  
   
• Sleeps poorly at night with frequent awakening
  
   
• Experiences a lot of nightmares
  
   
• Seems to daydream or act spacey a lot
  
   
• Can’t concentrate or focus at school or work/grades are worsening
  
   
• Is irritable most of the day or complains of frequent headaches
  
   
• Avoids exercise and complains of being tired a lot
  
   
• Has rapid weight gain and complains of shortness of breath
  
   
• Has developed “asthma” without a cause
  
   
• Develops bedwetting not previously noted
  
   
• Has unexplained seizures

So, once you suspect the disorder what should you do? In all cases, a parent should discuss these symptoms and the concern about possible sleep apnea with the child’s doctor. At that point, blood studies may be necessary to rule out other diseases and a sleep study to confirm presence of sleep apnea.

What about treatment in kids? For obese kids, weight loss is critical, along with control of symptoms of asthma, allergies and correction of air flow problems. Some children get a little relief from the use of allergy medications and antihistamines. It is very important for overweight children to receive a diet that promotes weight loss and start an exercise program.

CPAP or continuous positive airway pressure can be used to treat sleep apnea in children from birth into adulthood. Rarely do children require laser surgery on the soft tissues of the throat, but having adenoids and tonsils removed can help in select cases. For further information, please see our articles “ Tips on using CPAP to treat your sleep apnea” and “ Snoring, chainsaws and sleep apnea”.

Helping your kids overcome their sleep related problems at a young age would improve their quality and length of life.