Guest Post: What is ORT?

Date posted: June 13, 2012

ORT stands for oral rehydration therapy. It’s something you can do at home to help prevent the dehydration that can be associated with vomiting and diarrhea.

Generally, what happens in the gastrointestional (GI) tract when it’s infected (either by a virus or bacteria) is that is get’s irritable. One strategy to help keep fluids down is to give very small amounts of fluid frequently. The stomach is more often able to handle these small amounts of fluid rather than just letting the child drink what they want. They’ll keep more down and you’ll be able to know exactly what they’ve taken in.

Pedialyte or equivalent is generally recommended for kids 2 and under. Sports drink preparations for kids 3 and up.

Sometimes, kids aren’t very fond of the commercially prepared flavors. One nursing trick for you to try at home is to get unflavored Pedialyte or an equivalent knock-off brand. Get a sugar-flavored drink mix and put just enough crystals in the fluid to give it a decent taste. It doesn’t take too much and mix only a small volume—a couple of ounces at a time. Then, if your child doesn’t like it, you haven’t wasted much of the Pedialyte which tends to be more expensive and you can try another flavor with the less expensive drink mix.

Once mixed, give small amounts every five minutes. For babies under 3 months—give 3ml. For 3mo-3yr—give 5ml. For 3+yrs—give 5-10ml to start. Once your child has tolerated this for 30-45 minutes, you can try to double the dose of the fluid.

What if they vomit? Give it 15 minutes and start over.

How long do I do this? It can be labor intensive as we’ll want to stay this route for several hours—like 4-8 hours of giving these small amounts of fluid frequently. Often times, parents will keep up the routine for an hour and if their child has done well, they’ll let them drink what they want. Sure enough, everything comes back up. Better to stick with the slow route.

When should see a doctor?

Concern for dehydration. Some of the signs are as follows: Dry, cracked lips. No tears when your child cries. Pale color. Listless. Lack of a wet diaper in six-eight hours. Vomiting will lead to dehydration more quickly and the younger the child the more at risk they are. An infant 0-12 months who continues to vomit even with the small amount of fluids frequently needs to be seen. There are some concerning gut issues (like obstruction) that occur in this age group that is worthy of an MD exam.
You notice blood or bile. Any time blood is noted in diarrhea or vomit, you should see your doctor. Bile looks either bright yellow or vivid green. Old blood can look like brown flecks. All of these should be evaluated.
Your child fails ORT at home. You’ve given it your best shot but your child continues to vomit despite giving the small amount of fluid frequently.
Abdominal Pain. This can be hard because stomach cramping is not unusual with gastroenteritis. This is at your discretion if the pain is worrisome considering your child’s normal baseline and how they handle pain.
They flat out refuse oral fluids. Here, you’re backed into a corner. Of the utmost importance is for your child to be drinking. They must stay hydrated. So, if they won’t take anything at all, you’ll need to be seen by your doctor or in the ED.

Have you ever tried ORT at home?

Jordyn Redwood has served the pediatric population and their families for many years. She has five years of experience in the pediatric ICU and ten years of pediatric ER nursing which is the area she currently works. Jordyn also teaches CPR and advanced resuscitation courses.

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: Humor Me

Date posted: June 4, 2012

by Jordyn Redwood

Don’t we need humor in life to make it through? Life is hard. I have two very serious jobs. I’m a real life pediatric ER RN and a suspense novelist. Those can be heavy days but they can also be fun days—by using a little humor to get through.

Marriage is no different, right? Humor is necessary. What are some of the funniest things that have happened between you and your spouse? To take a break from discussing serious subjects: like death, trauma, and writing suspense—I thought I’d take a humor break and share some funny highlights from my married life.

Do you find that opposites attract? That’s the truth with my husband and I. He’s the quiet introvert. I’m the more outspoken extrovert. He gets queasy at the site of blood. Obviously, I do not. What we have seems to work—as we’ve been married almost fifteen years.

During our dating years, we were set to see a movie. I drove to his place and let myself in—and then sat there fuming when he was nowhere to be found. This was before the age of everyone having a cell phone. Finally, his phone rings. I answer. He’s on the line. “Where are you?” He asks. “Where are you?” I ask right back. He says, “I’m at your place!”—“Well, I’m where you should be.”

Other funny moments? Let’s see—teaching kindergarten Sunday school with his ex-girlfriend. Well, we can laugh about that now.

My husband likes to trim his own hair. One day, he mistakenly forgot to put the spacer on the clippers and took a swipe. Without much introduction, he comes into the living room and asks me, “Can you fix this?” with one bald stripe down the middle of his head.

I burst out laughing so hard—I still crack up thinking about it. ER nurse honey—not hairdresser extraordinaire.

Then, add kids to the mix and the potential for a good laugh multiplies. We have two daughters age 7 and 9. When my youngest was perhaps 4 y/o—she was just in one of these pestering type moods. After several attempts at redirection, I finally just say, “Please, just get out of my hair!” In her sweet, innocent voice, she says—“But, I’m not in your hair.”

Sometimes, you need those lighter moments in life to get you through serious novels, too. I have a very dry sense of humor. My debut medical thriller, Proof, deals with some very serious subjects and I thought whilst writing the ms—I really do need some moments of levity.

Hence, the humorous pairing of my odd couple detectives, Nathan Long and Brett Sawyer. Nathan means business. He’s serious and organized—bordering on an undiagnosed case of OCD. A southern gentleman. Brett’s the laid back easy type—maybe plays a little bit loose with the rules to get the job done. Often, their interactions provide comic relief in Proof. Let me give one example: an elderly woman with some questionable underwear choices serving them tea with a heavy dose of liquor during an interview. You may think that would never happen. Well, just recently I had a 14y/o show up just in his skivvies—at the ER. That’s right—just the white cotton briefs. And let me say—he was not deathly ill. Plenty of time for that young man to get dressed.

What about you? What’s the most humorous thing that’s happened in your married/dating/writing life? I’d love to know—could end up in my next book.

Names withheld—of course.

Jordyn Redwood is a pediatric ER nurse by day, suspense novelist by night. She hosts Redwood’s Medical Edge, a blog devoted to helping contemporary and historical authors write medically accurate fiction. You can connect with Jordyn via her website at www.jordynredwood.net.

About Proof:

Dr. Lilly Reeves is a young, accomplished ER physician with her whole life ahead of her. But that life instantly changes when she becomes the fifth victim of a serial rapist. Believing it’s the only way to recover her reputation and secure peace for herself, Lilly sets out to find–and punish–her assailant. Sporting a mysterious tattoo and unusually colored eyes, the rapist should be easy to identify. He even leaves what police would consider solid evidence. But when Lilly believes she has found him, DNA testing clears him as a suspect. How can she prove he is guilty, if science says he is not?

Guest Post: Medications to Always Have On Hand

Date posted: May 23, 2012

It does surprise me, working in the ER, that often times parents don’t have basic medications on hand. So, in an effort to right this, I’m providing a list of medications, from an ER nurse’s perspective, that are good to keep in stock and make sure aren’t expired.

Acetaminophen: The fever reducer, pain medication appropriate for every age group. This is otherwise known as Tylenol. Here are a few things to consider. Check with your physician before treating an infant who is less than 2 months old with acetaminophen. Often times in this age group, we want to know what their actual temperature is and then once we know, we can give them a dose in the ER. Infants older than two months, you’re generally okay to give the recommended dose for pain/fever. Tylenol can be given every four hours.
Ibuprofen: Good as a fever reducer, pain medication and anti-inflammatory. This is otherwise known as Motrin and Advil. Ibuprofen should not be given to infants less than six months old. This is due to the concern for adverse effects in this age group. In the case of concern for sprain, strain, or fracture—Ibuprofen is the preferred drug of choice for its anti-inflammatory properties. The recommended dose can be given every six hours.
Diphenhydramine: Good to have on hand for simple hives and itchy rashes. Otherwise known as Benadryl. Often times, it’s okay to give Benadryl for concern of allergic reaction but they need to be seen in the ED if this is why you administered it. The recommended dose can be given every six hours.
Pedialyte/Sports Drinks: To have on hand for concern for dehydration related to vomiting and diarrhea. Pedialyte or generic equivalent is generally recommended for kids 2 and under. Sports drink preparations for kids 3 and up are okay. Better to have it on hand than have to worry about braving the weather. Isn’t there always two feet of snow on the ground when your child get’s sick?

One medication not to have on hand, unless specifically told by a physician to give, is aspirin. If aspirin is given during a viral illness, it increases the risk of your child having Reye’s Syndrome. You might be surprised at some medications that actually have aspirin in them—like the adult preparation of the thick, pink, chalky substance given for nausea. Check the label. If it says salicylate acid—that’s aspirin.

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: When Should I be Concerned About My Child’s Pain?

Date posted: May 9, 2012

Determining if your child’s pain is significant enough can be a quagmire for every parent. After all, kids can complain a lot about pain. Does this pain represent something I should truly be concerned about? Here are some things to consider to help determine whether your child’s pain is significant enough to be evaluated by a doctor.

1. It wakes them up in the middle of the night.

2. It stops their normal activities. They don’t want to play. You offer them ice cream and cookies and they turn their nose at you. If you have a teen, they stop texting.

3. It limits their normal functioning. Meaning, they can’t walk normally. They won’t bear weight on the extremity. They won’t use an arm. You ask them to touch their chin to their neck and they simply can’t. They lie on the couch all day.

4. You give pain medication and it doesn’t lessen or resolve the pain. Pain that doesn’t respond to over-the-counter analgesics is concerning and should be evaluated.

5. It’s associated with other symptoms. Fever, stiff neck, rashes, vomiting and diarrhea to name a few.

Children will often complain of headaches and stomach aches. Often times, nothing serious is going on but how can you be sure?

My youngest, who is now seven, used to complain about stomach pain a lot. How do I tell the difference between her wanting attention and something truly physical going on? At the time, she didn’t have any other symptoms… just the pain. After several of these episodes, I took her to her pediatrician for an exam. He didn’t find anything concerning. I think this should be done for headaches and other complaints of pain as well. Take them to their pediatrician first for an exam.

If the pediatrician is not concerned, here’s something to try to see how bothersome the pain is. This is done only if the child has no other signs or symptoms (injury, fever, vomiting, diarrhea, or funny rash). You have just the complaint of pain and the pediatrician has given the “all clear”. This is good to try around age 4-5 and up. Once adolescence hits, it may not be as effective.

Your child comes up to you. “Mommy, my tummy hurts.”

“Okay, sweetheart. I’m sorry you’re not feeling well. What I need you to do since you’ve told me you’re not feeling well is to go lie on your bed. No reading. No playing. No games. No TV (hopefully your five-year-old doesn’t have a TV in their room). I need you to rest for 30 minutes and then we’ll see how you feel.”

Fifteen minutes later. My daughter comes down. “I’m feeling better now.”

“Oh, honey. That’s great! But, since you told me you weren’t feeling well I do need you to lie down for the full 30 minutes. So, back upstairs you go and I’ll tell you when the rest of your time is up.”

Back up she goes. Time is up. The rest of the day there are no further complaints.

Next day:

“Mommy, my tummy hurts.”

Rinse… repeat.

Ten minutes later this time… my daughter comes down. Again, I send her back upstairs to lie on her bed doing nothing but resting. Have them rest the full 30 minutes.

Strangely, that curbed her complaints of abdominal pain and she remained a happy, healthy child.

What are your thoughts? Do you think a strategy like this could work for you?

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: Leading Causes of Abdominal Pain

Date posted: April 25, 2012

….In kids under 8. I’m going to focus on this age group because once girls enter the prepubescent phase; a whole new crop of issues can come up related to the reproductive system. So, let’s stick with younger children. I’m curious to know if this list surprises you.

1. Constipation. Shocked? Ask any pediatrician and this will likely be their response. Your child is full of poop. Pain associated with constipation can be excruciating, particularly when gas gets trapped. Children can have diarrhea and still be constipated. What happens in this instance is some liquefied stool leaks around the obstruction. A child can even have what appears to be normal bowel movements—and still be constipated.

2. Urinary Tract Infection. Girls are more prone to urinary tract infection than boys and this can present as lower type abdominal pain.

3. Strep Throat. A cluster of symptoms associated with strep throat are headache, sore throat, fever, abdominal pain and vomiting. So, don’t be surprised if your PCP tests for strep, particularly if the child has some of these other symptoms.

4. Stress. The stomach is highly innervated—meaning it has a lot of nerves. Stress, anxiety, and psychological issues can present as abdominal pain. It doesn’t mean your child doesn’t have pain; there just may not be a physical cause we can find.

5. Gastroenteritis. The “stomach flu”. These bugs can cause abdominal pain/cramping.

Are you surprised by what doesn’t lead this list? Appendicitis—sure, it happens but very rarely compared to these other diagnosis and is more common in older children. Obstruction? Again, a more rare diagnosis.

Does this list surprise you in any way?

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: Is Breast Always Best?

Date posted: March 21, 2012

Is Breastfeeding Always Best?

The topic of breastfeeding is always a hot one. I remember being pregnant with my first daughter and outwardly saying, “I’m not going to worry much about breastfeeding. If it works, great! If not, it’s no big deal.”

Little did I realize the emotional impact not being able to breastfeed my daughter would have on me psychologically. I simply could not get her to latch on. She would end up screaming and I would end up sobbing. My ideal just wasn’t meeting real life.

Why do medical professionals prefer breastfeeding? It’s what Mother Nature intended. It is easy and convenient—no need to pack bottles, formula, etc. Breast milk is easier for the baby to digest. More importantly, it provides the baby some extra immunity. The mother passes on antibodies for things she’s protected against to the baby. There are plenty of resources that talk about the benefits of breastfeeding. I’ll include this link: www.breastfeedingbasics.com/

So, yes, I’m on board with encouraging a mother to try breastfeeding first.

As a nurse, I’ve also seen breastfeeding not work and, in conjunction with your pediatrician, it might be worth having a conversation about stopping in these situations.

The baby is not growing. Sometimes, as in my case, the mother and baby never get in a good rhythm. Or, the mother is simply not producing enough of a supply. In this case, it might be worth having a discussion with a lactation specialist for some extra pointers. Paramount is for the baby to stay hydrated. You can tell that your baby is hydrated if they are having a good amount of wet diapers. If your infant hasn’t peed in approximately eight hours, there may be a concern for dehydration. There are additional signs to look for that I won’t go into detail today but if you’re interested in this, leave a comment and I’ll do a special post just on that. Bottom line is the baby needs to be growing and gaining weight. If they can’t do this nursing, you’ll need to supplement or switch to formula.
It doesn’t work for your lifestyle. I’m all about sacrificing for your child, but real life is real life. In the situation with my first daughter, I ended up having to pump the breast milk and give it to her via bottle. This was twice the work. Time spent pumping, then the actual feeding. I was blessed to be off work for about four months and had some extra breast milk frozen. Once I went back to work, I just couldn’t maintain that schedule anymore. I chose to do 50/50 breast milk and formula until my supply ran out and then we moved to formula.
Medically you shouldn’t. There might be some situations where giving the baby your breast milk could endanger the child. If you’re taking illegal substances, or too much of legal ones (like alcohol)—these can be passed to your infant. If you’re on any medications and breastfeeding, you need to check with your physician to see if it would be passed through your breast milk and if so, is that a concern for the baby.

For me personally, women get enough pressure when it comes to breastfeeding. I do encourage it, yes. However, in my opinion, as long as your baby is happy, healthy and growing, I’m fine with breastfeeding, formula, or a combination of the two.

What are your thoughts about breastfeeding? Is there a situation where you had to stop?

Jordyn Redwood has served the pediatric population and their families for many years. She has five years of experience in the pediatric ICU and ten years of pediatric ER nursing which is the area she currently works. Jordyn also teaches CPR and advanced resuscitation courses.

Jordyn Redwood has served the pediatric population and their families for many years. She has five years of experience in the pediatric ICU and ten years of pediatric ER nursing which is the area she currently works. Jordyn also teaches CPR and advanced resuscitation courses.

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: 3 Things You Should Never Say to Your Child While At the Doctor

Date posted: February 22, 2012

As promised, my friend Jordyn Redwood, ER nurse and writer extraordinaire is going to be posting common medical Q & A’s on my blog twice every month. I’m superexcited about this and think it will not only be a ton of fun but it will also be really informative. So, a huge thank you to Jordyn! And, if you want to know more about her, Jordyn is not only a novelist with a book coming out from Kregel in a few months, but she’s also a blogger who writes a superfun blog called “Redwood’s Medical Edge” where she discusses now novelists approach medical issues in their books. Check it out here.

Three Phrases Not To Say To Your Child

…while in the ER. That was supposed to be the whole title but I thought I’d run out of room. Dealing with children in the ER can be challenging. Unfortunately, parents can make it more challenging by some of the things they say.

Truth comes first. Even in pediatrics, we do not lie to children. If we don’t have the child’s trust, we’re not going to get very far. Parents can actually breech the trust we are trying to build with our patients by saying the following things.

You’re not going to get a shot. This is making a promise you may not be able to keep. Unless you know specifically what the proposed treatment plan is, I wouldn’t say anything about whether or not the child may get a stick. We may want to check a blood sugar, or some lab work for the presenting complaint. If you’ve told your child they aren’t getting a shot, and here we come with the needle, the person they’re likely going to mistrust first is me. It’s better to say, “I’m not sure, let’s talk to the doctor/nurse about it.”

This isn’t going to hurt. Unless you know for sure it’s not painful, don’t say it.

We’re very open with kids about what kind of pain they are going to experience and how long it should last for. Better to let the nurse describe to the child what the procedure is going to feel like. Experienced pediatric nurses are very good at this for every age group of children we deal with. Parents can be helpful by letting us in on terms you use at home or telling us ways you’ve used to aid your child in getting through something painful.

Oh, he’s not going to take that. This generally happens when we come into the room with an oral medication. First problem, you’ve set us up for failure. You’ve verbally given your child permission not to take it. Now, it’s probably going to definitely be a struggle. If you’re trying to let the nurse know that your child has difficulty taking oral meds—say, “We struggle with this at home.” The nurse can likely give you some pointers on getting the task done.

One tip always is to set the expectation of what you want your child to do. “Honey, will you take this for mommy?” Better is… “It’s time to take your medicine. Open your mouth for me.” See the difference?

What are your thoughts? Have you thought about the things you say to your child and how it can change the experience they have with their medical provider?

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

Guest Post: Ear Infections

Date posted: January 25, 2012

Last week, Jordyn asked my users for their own medical-related questions. Here’s one from Jennifer:

“Ear infections. It seems like I’m heading to the doctor every other day when my kids complain of ear pain… and half the time, they don’t have infections. But then, the other day, my 3-year-old was complaining and I ignored it (after 2 false alarms) and her ear drum ruptured. So, I guess my question is this: Is there any sure way to tell at home if it’s really an ear infection or just ear pain? And, does it hurt to just give my kids some Motrin and wait it out if I suspect an ear infection?”

Thanks so much for leaving a question!

The only way to really determine if it is an ear infection is to look at the ear drum. This requires direct visualization by a medical provider.

The second part of your question is interesting. Ear infections can be caused either by a virus or a bacteria. The concern is treating a viral ear infection with antibiotics and this contributing to strains of bacteria that become resistant—which we don’t want to do.

Some doctors are taking the watch and wait approach and prescribing an ear analgesic (Auralgan) and ibuprofen for pain control but seeing if the infection will clear without antibiotics.

I do think it’s worth having that type of conversation with your pediatrician.

You might find this article on waiting vs. treating link helpful.

Jordyn is also a suspense author. Her novel, Proof, will be published by Kregel June 1, 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.