A PracticalDad Look at Concussions

Guns don’t kill people, 90 mph free kicks kill people.

  Poster on door of Middle’s bedroom

It was during the second half of a mid-season Division II college soccer game with the ball rolling free in the visiting team’s penalty box.  Both Diane,a forward, and a defending fullback raced from opposite directions towards the ball and the defender reached it in stride about two steps ahead of Diane.  The fullback cleared the ball with a strong kick and it traveled perhaps five feet before it collided solidly with Diane’s face, connecting squarely in the forehead.  Diane dropped flat onto her back, propelled torso backwards by an object kicked with sufficient force that it instantly – violently – eliminated all of her own forward momentum.  According to her teammates, the coach was on the field and running towards her as soon as she hit the turf; after several minutes on her back – conscious the entire time – Diane left for both the remainder of the game and the season.  The subsequent diagnosis from the university’s medical staff was that Diane suffered a major concussion.

While it isn’t a certainty that it will occur, there’s a respectable chance that any active kid will suffer a concussion either through organized sports or the simple *boom* of an accident from hard play.  But what exactly is a concussion and what should you expect to see if your child suffers one?  And as a full disclosure, the PracticalDad household has had first-hand experience with the injury.

A concussion is the common term for a brain trauma, a sudden event in which the brain is jarred or shaken severely enough that there’s an acute injury to it.  The design of a person’s head is – like the rest of the human body – a wonderful bit of engineering.  This crucial organ is housed within the helmet-like skull, but there’s actually no contact between the brain and the skull.  Between the brain and the skull is a thin layer of fluid which cushions it from the movements and shocks of everyday activity.  But a concussion can occur when the body undergoes a physical that overwhelms the cushioning capacity of the fluid and the brain is severely shaken or actually comes into contact with the skull itself.  In Diane’s case, getting pounded by a 430 gram ball kicked around 60 mph is clearly beyond the body’s natural absorption capacity.

We used to call a concussion getting your bell rung and the old treatment was taking a few minutes to clear your head before returning to the practice or game.  But the bright light of publicity that began years ago with the tragedy of former long-time Steelers center Mike Webster and progressing most recently to San Diego’s Junior Seau have brought greater awareness to the insidious damage to the brain caused by concussions, especially if they’re repetitive.  The long-term toll of concussions is now being given greater attention so that there are improvements both in terms of treatment as well as prevention.  What the medical community is now aware of is that the risk of long-term brain damage rises with a person’s number of concussions.

Concussion Rates: Who and How Often?

For all of the attention being focused on football, a male sport, the reality is that females will suffer a significant number of concussions as well.  At the high school level, girls’ soccer players reported the next highest number of concussions for any sport after football and girl basketball players suffered concussions at almost the same rate as their male counterparts.  For soccer however, girl players suffered concussions at almost twice the same rate as their male counterparts; it’s unclear as to why but the prevailing opinion is that it’s primarily physiological as the female heads are lighter – lending credence to the many fathers’ thoughts that boys are boneheaded – and have weaker neck muscles to support the head when it’s hit.  The other thought is that culture plays a role as boys are taught to “suck it up” while girls are more likely to say when something is wrong.

For a chart of the concussion rates per common youth sports, by gender, see here.

Additional research has shown that the incidence rate for concussion is several times higher for those who have already had a concussion; the fact that there’s already been trauma creates a lower threshold for a concussion than if the individual had never had one in the first place.  In Diane’s case, this was her third concussion over a three year period.

There are two upshots here.  The first is that your daughter-athlete is as much at risk for a concussion as your son-athlete.  The second is that if your child has already suffered a concussion, there’s a lower threshold for suffering another from a head trauma than another child-athlete who has not yet had a concussion.

Concussion’s Symptoms and Diagnosis

What makes a concussion difficult to diagnose is that there can be interior damage to the brain even if there’s no actual sign of exterior damage to the body, such as a bruise or laceration.  This is compounded by the fact that the interior damage might not be immediately evident; while Diane was visibly groggy in the immediate aftermath of the injury, she never lost consciousness and two decades ago, might even have been allowed to re-enter the game if she appeared to have been able since there doesn’t have to be loss of consciousness with a serious concussion.

The symptoms that arise from a concussion can be classified into four different categories.


  • Inability to concentrate
  • Inability to retain new information
  • Inability to think clearly (“fuzziness”)
  • event amnesia, i.e. inability to remember what occurred for a period of time around the trauma
  • demonstrably slower thinking time
  • Physical

  • headache
  • impaired vision
  • nausea/vomiting
  • sensitivity to light and noise
  • issues with balance
  • dizziness
  • fatigue
  • Sleep

  • altered sleep pattern from usual
  • inability to fall asleep
  • Emotion and Mood

  • greater irritability and/or anxiety
  • periods of sadness
  • flat aspect to personality for period after the trauma
  • The takeaway for parents with active kids is this: if you child is struck in the head – by a ball or bat (been there on both), a hard impact with wall or ground (been there, too) – then there’s the prospect of a concussion.  Because there might not be an immediate sign, it’s best to begin the watch for these symptoms and that watch can last for days.  It’s not easy and the child’s age can make it more difficult, especially if they’re younger.  For small children – kindergarten or younger – take it as a sign of possible concussion if he or she is showing signs of a regression in skills that you might have considered already mastered beforehand.

    If you notice any of these, immediately contact your physician.  There are objective cognitive tests that can be performed and don’t be surprised if a scan is ordered to ascertain if there’s overt damage to the brain, such as bleeding inside the skull.  But even if there’s no overt sign on the scan, the cognitive tests can help ascertain if the child has been concussed.  The only objective examination that can help ascertain the severity of the concussion would be if the child had a pre-injury baseline impact test such as used by professional and college sports teams; it might sound far-fetched for a child – actually a teen – but more middle and high schools are having their student athletes undergo them prior to the season’s start.  The online test can be performed on youth as young as 11 years of age if they’re involved in sports and can be performed at the office of any medical professional which offers it.  In our case, Youngest – a baseball player – took an impact test a year ago at a physical therapy practice which offers the test and the results are now available to serve as a baseline for future reference.  After a concussion was suffered, periodic test re-takings would serve as waypoints on recovery when compared to the original baseline examination. 

    Treatment of Concussions

    There’s no overt treatment regimen – physical therapy, medication – for a concussion and the only help is what was once called the tincture of time.  That said, the tincture can be aided by a simple regimen of true rest; this is rest not only from strenuous activity or exercise which might continue to shake the brain, but also rest from the single activity that preoccupies the majority of the waking time of most adolescents, electronics.

    When the brain is concussed, the purpose of the recovery period is to avoid any physical stressors to the brain.  That certainly includes minimal physical activity and more sleep but what most don’t realize is that there are other stressors and these include light, noise and the constant input of watching the flickering of any kind of electronic screen.  When I spoke with Diane’s father, he commented that he was surprised to find that the treatment regimen for his daughter included as little screen time as possible as the flickering, combined with the constant eye movements, were stressors that aggravated the brain and actually lengthened the recovery period.  Other aspects of the treatment regimen included the wearing of sunglasses and a visored cap when outside to shade the eyes and the absolute minimum of traveling so that she couldn’t even attend away games with her team, if only to stand on the sideline.  In other words, she was to avoid any movement and sensory stimuli that typically cause the brain to work.  This treatment regimen was to continue for as long as she had symptoms and in Diane’s case, the symptoms continued for a full six weeks before she was finally cleared to return to play and by that point, the season was finished.

    The upshot for parents is this.  What provides the greatest entertainment for youth today – electronic media – is one of the activities that has to be minimized, if not completely avoided, if the kid is going to recover both the most fully and in the shortest time possible.  The small upside is that the kids at greatest risk of concussion are the athletes and are probably on the screens less that the six hour daily average.  Yet the kid will still have to avoid the screens as much as possible for the recovery and the stress in the household will be greatly elevated as parents have to take into account the mood and temperament of a child who not only suffers from concussion symptoms, but can’t even find respite in those activities which were previously entertaining.

    A concussion is a frustrating injury for parents.  It requires vigilance from parents to maintain the rest regimen for a full recovery but it cannot be easily judged as to how it’s progressing.  Likewise, the child should be kept away from the typical favorite pastimes and the stage will be set for potential conflict between child and parent.  The other issue for parents is that in their youthful sense of invincibility, the kids don’t always understand that they’re at an increased risk of reinjury when compared to their uninjured peers and many will balk at the notion that they might not be able to play their favorite sport again.

    The Virus Cocktail

    I must be slipping.

    This morning saw a quick early morning run to the grocery store for the ingredients of the PracticalDad family virus cocktail, apple juice and Sprite.  They are the ingredients that for years,I kept on the basement storage shelves precisely for the moment when I heard the night-time Siren’s call, I’m not feeling well and think that I have to throw up.  Which is what my wife and I heard from Youngest in the middle of last night as he entered our room.  We both got up with him and after settling him back into bed, I took disinfectant wipes to the touchable surfaces in the kids bathroom; I then settled into the Eldest’s vacant bed in the room next to his in the event that there were other issues. 

    Each family seems to have its own magic elixir for handling illness and ours is the virus cocktail.  We adopted it for multiple reasons, not least of which is an effort to at least keep the sick ones hydrated and away from an emergency room IV drip for dehydration and excepting one occasion amongst three kids, it’s worked.  The non-acidic apple juice contains much needed vitamin C to help bolster an ailing immune system and is supplemented by the Sprite so that the antsy stomach isn’t out-and-out assaulted by the juice; when we’re fixing it, we even stir it before delivery to remove the carbonated bubbles so that again, the stomach is spared.  The fact that it’s tasty also makes sipping it less of a chore than water, which an ailing kid is likely to look at with an unspoken blecchhhh crossing the face. We also kept a spare bottle of Pedialyte on the shelves to help correct the sick child’s body chemistry but found that the taste was simply unappealing and after a horrendous session years ago, coaxing a sick child to take in some nutrients only to meet them again within 15 minutes, the option was to stick with the cocktail.

    When the kids were very small and I knew that my better half was leaving on business, it was a point to assure that we had at least two bottles of each within the house.  We seemed to live under a curse that left one or more kids simultaneously – or sequentially – ill with one thing or another and with her gone, any sickness left me housebound to manage until their recovery or her return.  Within two days of either, it was a given that I’d be in the same boat as the now-healed children.  But as the kids have grown and learned to cope with the illnesses, the practice of stocking for the cocktail has fallen into disuse so that this most recent event left me ill-prepared. 

    It’s easier now that the kids are a bit older and not so physically incapable of caring for themselves.  There’s no panic with sickness and a sense of routine – okay, here we go again so just stay to my room, nap and let it run the course – and sure enough, when Eldest was sick the other week in college, my wife received a text announcing the stomach virus with the news that a roommate had already been dispatched to the nearby grocery for…apple juice and Sprite.  Eldest then took to her room with her cocktail and let it run the 24 hour course.  On the refrigerator door is a note to remind me to pick up the replacement ingredients for the cocktail on my next trip so that I’m not caught unprepared again.

    Which reminds me, I need to stock up on more hand sanitizer and disinfectant wipes.


    Kids and Pot:  Discussing the Long-Term Effects

    Listen to the kids and teens today and one of the arguments in favor of pot smoking is that it is supposedly a harmless drug, even less damaging than alcohol.  I’ve heard kids point to the medicinal uses for which pot is now legal in California – with a doctor’s script, I point out – and the political/budgetary arguments that we simply can’t afford to keep spending resources on the enforcement of marijuana control laws.  Frankly, they do have a point there and I’ve told the older kids that at some point in the next decade, at least one state will probably legalize marijuana – and then move to tax the living hell out of it.  But I’m a child of the 70s and knew more than a few guys who’d rather score a high than a decent grade and my sense was that it did have a long-term impact on their ambition and IQ, even if I couldn’t prove it.  Now there’s a long-term study that links IQ loss amongst adults to marijuana usage in their teens.  While it’s not anywhere close to certain that the information would have an effect – the teen battle cry is what could go wrong? – it’s worth a shot at sharing the information with them.

    The study was a collaborative effort between Duke University and King’s College London and actually began with interviews with teens back in the early 1970s in New Zealand.  Through the ensuing years, the study team kept contact with the participants and at intervals, administered IQ tests; to further evaluate the participants, they interviewed family or friends that the participants themselves suggested.  The upshot is that participants who began to regularly smoke weed in their teens suffered an eight point loss in their IQ levels by their adulthood; those who began later also suffered loss but there was some recovery in their adult years.  Given some of the kids that I knew in high school and college, this isn’t a surprise.

    So what to do with the information?  Short of locking teens in their rooms or homeschooling them and rigidly controlling their outside access, they’ll spend considerable time out of your sight and control and you can only hope that you’ve given enough information – and helped build enough character – that they make the right choice.

    • Obviously, mention the study and show the article.  In my household, the information came via the laptop on the kitchen island during the morning kitchen routine prior to school. 
    • As always, make a values statement and offer some moral component.  Yes, it’s factual information but some kids need to have it placed in the context of our values; you don’t have to beat them over the head and chant it’s bad, it’s bad, it’s bad!!! but some quiet commentary can be helpful.
    • I don’t know of any public schools that don’t do random drug testing of athletes and kids involved in activities, so remind them that one blown drug test can have major repercussions on their favorite activities.
    • Stay on message and be prepared to go back to it again and again and again, even when they roll their eyes at the old fart who just won’t shut up about it.  Work to find new avenues to raise the issue instead of simply preaching but understand that they’re actually listening.

    Like many other aspects of being a parent, there are no simple and straightforward rules.  But what is necessary is the willingness to go back and revisit the issue whenever possible.  Pay attention to the media for anything that supports your stance so that it doesn’t appear that it’s just the old man back on the soapbox for another fun episode of meaningless redundancy.  But hang in there and keep with it, because it’s certain that elements of the popular media – and their peers – are pushing the other side of the argument.


    Kids and “the Pill”

    I never let the facts get in the way of a good story.

                              – Tom, a friend of the PracticalDad

    Just like Tom doesn’t let a fact get into the way of a good story, so Rush Limbaugh didn’t get the facts straight in the face of an opportunity to once again provoke a conservative/liberal spitting contest.  The newest – and perhaps most costly – imbroglio arose when Limbaugh took a twenty-something female Georgetown University student to task when she appeared before Congress to press for government coverage of oral birth control, i.e. "the Pill", for all women.  Limbaugh looked at her age and student status, pronounced her a slut and the fight ensued.  Despite the wildly poor choice of words, his defenders are stating that the woman was herself disingenuous.  The fact lost in the newest skirmish of the culture war is that oral contraceptives actually have benefits apart from the prevention of pregnancy and that it’s not uncommon for its prescription to teenage girls because of these benefits.

    Guys truly don’t understand the discomfort and pain that comes with a woman’s period.  We can nod our head in sympathy but we’ll simply never get it.  That said, something with which fathers should become familiar is the set of facts and processes of the menstual cycle even though the typical father thinks about his daughter’s reproductive health with the same relish that he considers next week’s colonoscopy.  Females have dealt with their cycles and periods and your daughter will do the same as she grows and matures, and there are over-the-counter medicines available to assist with the discomfort and symptoms.  However, there are occasionally instances in which a woman’s menstrual cycle operates outside the normal Bell Curve in terms of bleeding and period length and in these instances, an oral contraceptive is actually beneficial in regulating the system.  In these cases, the medicine – which it is – is prescribed and the fact that the patient might be only fifteen years of age wouldn’t necessarily be material if it helps control the situation and alleviate the symptoms.  A man might be philosophically opposed to the idea of a minor receiving an oral contraceptive but that opinion will probably change if he finds that his own child is suffering unnecessarily.

    Certain things will jar a father and I suspect that the prescription of an oral contraceptive is near the very top of that list.  But what it means is that, even if Mom’s around to ride herd on the process and help the daughter, you need to be at least aware of the daughter’s reproductive health.  This doesn’t mean that you walk in and start asking about her reproductive organs – Eldest once commented to me that it felt odd that her father could actually talk intelligently about menstruation – but it does mean that you pay attention if the topic is raised, either by your daughter or her mother.  If there’s no mother around, then you simply have to swallow your discomfort and deal with it.  Anything that pertains to your child’s health is important to understand, even if you and your mate opt to have a particular sphere of influence by dint of your gender.

    Should the government be responsible for covering oral contraceptives?  At one glance, perhaps not since the most common usage is for something of convenience rather than necessity.  But what Limbaugh and the other pundits need to understand is that when you paint with a very large brush, you also slop over the areas that have no place being painted in the first place.

    For reference on the uses and other benefits of oral contraception, go to eMedExpert.com.


    Children and Milk

    When you have a child, you think back on how things might, or might not be, different.  And when it comes to giving your child milk, it’s something that is both the same and different.  How can that be?

    How is it the same?  Things haven’t changed in the years since you were a child in that children under the age of one year should not be given cow’s milk, or soy milk for that matter.  Babies, those under one year of age, require the nutrients that are found in breast milk or formula, if the child isn’t nursing.  Not only that, but the child’s stomach and intestines aren’t sufficiently developed to handle the digestion of these products and it can lead to significant distress for the infant.  The rule of thumb is that a child should be able to drink and digest regular milk after reaching the first birthday.  Remember  however, that you have to still take care and monitor how your child does with the new food to assure that there’s no allergy.

    And how is it different?  First, there are now alternatives to regular cow’s milk, specifically soymilk and almond milk.  Neither soy nor almond milks have lactose, which is a sugar in cow’s milk that can cause real intestinal distress for a child, let alone an adult.  Each of these alternatives has its own nutritional profile and some might decide that it’s better than cow’s milk.  The flip side is that soy and almond milks don’t have the calcium content of regular milk and calcium is important for a growing child.

    If you do decide to feed your child regular milk, the second difference is the question of whole milk versus lowfat or skim milk.  Most are unaware that toddlers do need the extra fat content of whole milk until two or three years of age in order to assist with additional development of the body and brain; this need diminishes after that time and it can be replaced with a lower fat content milk.  The reality is that many children receive a high fat diet and the whole milk fat content then only adds calories from fat with no added benefit to the older toddler.

    If you take anything away from this, it’s the simple notion that your infant doesn’t get regular milk.  Because it’s a mistake that you don’t want to make.

    PracticalDad and Growing Pains

    It’s the middle of the night and you’re as sound asleep as a parent can be but you awaken to hear your kindergartener cry out.  The crying continues so you conclude that it’s more than an isolated nightmare and you rise to check on him.  You enter the room and find him in tears, reaching down to grasp his leg.  Daddy, he says, it hurts.  You shake your head awake and proceed to try and figure out what’s wrong.  There are no visible marks – no blood, no scrapes, scratches or cuts from loose items in the bed, and no scratches or marks from a family pet that crawled under the bedclothes and startled – and you wonder whether it could be simple growing pains.  But isn’t that just an old wives’ tale?

    What are Growing Pains and are they real?

    Yes, Dad, growing pains are indeed real and if your child is anywhere from preschool to upper-elementary age (3 – 12 years), then growing pains are a possibility.  Despite the moniker, physicians and researchers actually don’t attribute the pain to growth at all; while there is no identifiable cause, the consensus is that the pain is emanating in muscles that have been heavily used through the course of the preceding day.

    Growing pains typically occur in one or both legs and will start in the late evening or sometime during the night.  By morning, the pain is resolved and there’ll be no reoccurrence through the coming day.  Because it’s difficult to get a good description from any small child – and it’s nigh impossible at 3:00 AM – you might conclude that it’s akin to a cramp or deep muscle ache.  Growing pains have no skeletal or joint components and sometimes the pain is resolved by helping stretch out the limb or massaging it until it feels better.  If those actions don’t help, applying heat and giving children’s ibuprofen can help relieve the pain.

    When should I consider another possible cause?

    It’s always helpful to keep a close eye on the frequency of occurrences.  You might want to make a quick note on the family calendar and follow this for a period to see if they’re relatively isolated or happening with frequent regularity.  If the pain is occurring several times weekly, then you might consider consulting your family physician.  What else might cause you to see the doctor?

    • The pain occurs not only at night, but also during the day.
    • There are other objective findings, such as skin redness or areas that are warmer to the touch than others, inflammation or swelling.
    • Pain that’s routinely isolated to only one spot instead.
    • Pain that’s occurring in areas other than the legs.

    In our case…

    One of our children has had intermittent growing pain for years.  It’s sporadic and only occurs in the feet and legs and even  happened last evening.  We were out later than usual to see another child’s play and as we were leaving, the first started complaining of pain in his legs and feet.  He’s learned to massage his own limbs and on arriving home, we gave him children’s ibuprofen to alleviate the pain that would interfere with his sleep.

    And as usual, there were no problems come this morning.

    This article is for information purposes only and not meant as medical advice.  If you have concerns or questions, please contact your family physician or pediatrician.

    For more information on Growing Pains, you can visit Probing Question: Are Children’s Growing Pains Real? 

    PracticalDad:  Do I Send a Queasy Kid to School?

    One of the children awakens in the morning complaining of an upset stomach, a condition of which he complained before bedtime last night.  Does he go to school or not?

    Physicians have what they call "objective findings", things that can be readily observed or verified.  In this particular case, there’s been no vomiting despite the upset stomach.  There’s no fever, no clammy skin and no appearing to be pale.  Kids have discernible energy levels and through familiarity with the child, you can tell if the energy level is off; this is what is meant by the term "listless".  In this household, each child has a different morning level – one is bouncy, one calm/level, one quiet/slow.  How is he moving in relation to other mornings?  Has he had drainage?  Kids are notoriously poor with blowing their nose – Blow! – and drainage through the night will wind up in the stomach as it’s swallowed, contributing to or causing queasiness.

    How is Junior’s appetite?  If he doesn’t get something in his system, he won’t last until lunch since a child’s body burns through a lot of energy.  Options for food are dry toast or dry cereal; if the stomach is sensitive, it won’t tolerate heavier foods such as dairy (butter/milk) or bananas.  I’m also ruling out citrus fruits because of the acidity.  The only fruit that I’d consider would be apple slices but even that’s taking a chance.  For a drink, I’m giving a mix of apple juice and clear carbonated, such as ginger ale or Sprite.  Then give the kid a chance to eat and see how his body responds to the food. 

    This is probably a morning that I don’t want to put him on a bus.  If there’s sufficient time to see how he handles food, let him rest quietly and then prepare to take him to school.  If things are proceeding well, then I’d probably let him go. 

    I’ll also consider activity.  The reality is that when kids are engaged and among friends/classmates, they simply don’t pay attention like they do when things are quiet and nothing’s occurring, allowing them to focus on their discomfort.

    There are no clear answers in this situation.  Kids can recover well and have no further problems, or they wind up coming home and I’ve had both outcomes occur.  What it does mean is that I do have to amend my schedule for the remainder of the day in the event that I have to return to school and bring a child home.

    Disclaimer:  This is a discussion about what I’m considering in my own situation and not medical advice.  If you have questions or concerns, contact your pediatrician or family physician to discuss them.



    Feeding the Kids:  Portion Sizes

    There are any number of factors in the increasing number of obese children:  lack of exercise; excessive snacking; poor choice of foods for meals.  But large food portions are a large portion of the problem.  Experts and writers point to fast-food restaurants but the reality is that the issue also occurs in the home.  And fathers, still new to the family management role, tend to overdo the food portions fed to the kids.

    Why Portion Size Matters

    Children have to be taught just about everything and much of that learning is absorbed through watching and repetition.  You won’t be able to lecture them on finding the right sizes – God knows I’ve tried that – but you can teach them by making sure that they repeatedly see the right thing being done.  If kids consistently note roughly the same amounts on their plate, then they’ll be set to take the appropriate amounts as they age.  They might still overdo it, but they’ll at least understand that what’s presently on the plate really is too much when you remind them.

    Portion Basics

    First, remember that they aren’t adults and don’t require the same amount as you.  Their plate might appear sparse to you, but it’s fine for their age and size and they aren’t going to go hungry.

    The portion sizes for children will vary by their ages, which means that you may have to do some additional mental gymnastics when feeding kids of different ages.  In the PracticalDad household, that means feeding two teenagers and an elementary schooler, so be prepared for grousing when the younger ones have less on their plate.  The following chart is adapted from one provided by Kaiser Permanente.


    Child Serving Sizes
    Food Group Daily Servings 1-3 years 4-5 years 6-12 years
    Grains and Breads <=5 1/2 slice or 1/4 cup 1/2 slice or 1/3 cup 1 slice or 1/2 cup
    Vegetables 3-5 1/4 cup 1/3 cup 1/2 cup
    Fruits 2-4 1/4 cup 1/3 cup 1/2 cup
    Dairy 2-3 1/2 cup 3/4 cup 1 cup
    Meat and Protein 2-3 1/4 cup or 1 ounce 1/3 cup or 1 1/2 ounce 1/2 cup or 2 ounces

    Children bring chaos.  Kids are sick or have colic, schedules change and activities intrude, and there are meals that won’t come close to what’s recommended for nutritional requirements.  But the goal is assure that the kids have the necessary foods for the large majority of meals.

    Finding the Right Portion Size

    It’s simple to get the right portion size for children who are still on baby foods and cereal but that changes when they start to eat the same things that are on your plate.  So how can you find the right portion size?

    • Use a small scale or measuring cups to measure appropriate amounts.  This can continue until you are comfortable that you can reasonably estimate the right amount visually.  That said, you should consider occasionally still using them just to check yourself.
    • Learn some comparable amounts.  For instance, an adult serving of meat is four ounces which is comparable to a piece of meat about the size of your palm.  A one ounce piece of meat would consequently be a quarter of the size of your palm.  Likewise, a serving of peanut butter (a protein) is about one level tablespoon.  A good reference article for portion sizes can be found at Meals Matter.
    • If things are too chaotic in the moment, just consider what you would find appropriate and then cut it by one-half to two-thirds.  Trust me, it’s not a perfect approach but there will be meals like that.

    Final Comments

    The upshot of all of this is that meals require planning and forethought that goes beyond deciding what foods to serve.  You have to leave yourself sufficient time to prepare and then be ready to leave your own food while you tend to the kids.

    And don’t let them load you with guilt because you or older sibling has more on the plate.

    Sources:  www.permanente.net/kaiser/pdf/40863.pdf




    When A Kid Wakes Up With the Flu

    Even when your kids follow through on all of the right precautions, a virus can make it through and this morning, Middle awoke complaining of feeling feverish.  So what to do? 

    • Obviously, take his temperature and sure enough, he has a fever high enough to call for ibuprofen to help control it.  Bear in mind that for most people, their body temperature is lowest when they arise and if sick, will rise appreciably throughout the day.
    • Because taking ibuprofen on an empty stomach can cause nausea, assure first that he isn’t nauseated.  Then prepare dry toast and make sure that it’s eaten so that there’s some bland food in the stomach before the ibuprofen is given.
    • Provide a large cup of apple juice/water mix for him to drink and keep it filled through the morning.  Keeping him hydrated is essential.
    • Immediately pull the disinfectant wipes and start wiping down all of the bathroom handles and surfaces before the other kids arise.  Wiping down with disinfectant might seem like closing the barn door after the horse is out, but I may as well make the effort.
    • Then take the disinfectant wipes to other household surfaces, especially electronic remotes, telephones and door and faucet handles.
    • Banish him to his room to sleep and periodically check on him.

    Now I have to settle in for the long haul as these cases can last for days.  That also suggests that I have to start looking at the calendar and if necessary, make changes in what’s scheduled.

    Please note that this is not intended as medical advice.  If you have concerns or questions, contact your pediatrician or family physician.



    Does Youngest Require Stitches?

    Even after dealing with the illnesses and injuries of three kids over fifteen years, I’m never certain if a cut of any kind requires only a simple bandaid/gauze pad or actual stitches.  And Youngest today cemented his family title of Stitch King with an injury that initially scared the hell out of me:  an inch long laceration under the left eye.  And it begged the question of whether or not he needed stitches or just some antibiotic cream and a gauze pad over the eye.

    Why Stitches?

    Stitches, also called sutures, are simply used to assure that the edges of open wounds are held together long enough to permit the skin to heal itself.  The principle is the same as stitching fabric together, except that in time, skin can heal over an open wound.  With the edges held together closely enough, the wound is also provided further protection again an infection and scarring is minimized.

    In this instance, Youngest was in the side yard tossing a piece of PVC pipe in the air like a baton when an end landed on his face.  Because the pipe had been cut, the striking edge of the pipe was rough and caused a laceration of about one inch below the left eye.  Most specifically, the crease where the cheek meets the pouch of skin beneath the eye.  He came around to where I was cutting bushes with his hand covering the eye and my stomach turned when I saw the wound.

    Stitch or Not?

    Physicians use several criteria for deciding whether to use stitches or not.

    • The amount of blood emanating from the wound isn’t necessarily an indicator of stitches.  In this instance, Youngest had very little blood loss, especially since many wounds around the face and head can bleed heavily.
    • Are the skin edges of the wound so far apart that they can’t be easily pinched together?  Youngest’s wound looked like a typical laceration in that there was an obvious cut but the wound wasn’t gaping.
    • Can you see the deeper layers of flesh – called subcutaneous – beneath the top layer of the skin itself?  When I dabbed the wound with a clean, wet washcloth, I saw that the top edges of skin were peeled slightly back so that I could see deeper layers of tissue despite the narrowness of the wound.
    • Is the location of the wound such that scarring might be an issue?  A physician might be more likely to suture a wound in the face or other visible area to minimize scarring.  Youngest can’t avoid the coming shiner and sutures, but we can minimize the scarring over the long-term.
    • Is the wound located where there’s a lot of body movement?   A similar gash on the knee would certainly require stitches simply because the constant stress of skin movement at the injury site would delay healing because of persistent stress on the wound edges. 

    In Youngest’s case, the visibility of the subcutaneous tissue and our desire to minimize facial scarring led the ED physician to use six stitches to close the wound.