Welcome to the Family Health Page Archives!

Here you'll find an excellent selection of helpful articles on family health.

With cold weather here for a few months, use caution when playing in freezing temperatures, wind, dampness and cold. Children love playing in snow and cold, but prolonged exposure to such conditions can cause fatigue, reduce sensations of cold and increase the risk of hypothermia.

Hypothermia happens when the body can't maintain its normal temperature. Symptoms to watch for are slurred speech, abnormally slow rate of breathing, cold pale skin and lethargy or apathy.

If your child is showing these symptoms, move the child out of the cold and remove any wet clothing as soon as possible. Don't apply direct heat. Instead, use warm compresses to the neck, chest wall and groin. Don't warm the arms and legs. This actually will force cold blood back to the heart, lungs and brain causing the core body temperature to drop. Your family doctor will also have advice for treating a child who shows symptoms of hypothermia.

Frostbite is also a factor in cold weather. The places most likely to be affected are hands, feet, ears and nose. First degree frostbite causes numbed skin that has turned white in color with underlying tissue feeling warm and soft. Second and third degree frostbite are serious medical conditions and need to be treated by a trained medical professional.

If you suspect a portion of your child's skin has frostbite, first, get out of the cold as soon as possible, warm the affected area by covering it with dry, gloved hands. Get emergency medical help if numbness remains during warming. If medical help isn't available, warm severely frostbitten hands or feet in warm - not hot - water.

Dress children in warm waterproof layers to prevent such conditions, and head inside when they start to complain of cold. Individual layers are easily removed if your child becomes overheated.   

Sadly, there is no miracle cure for a cold. They tend to last between one and two weeks and the only sure cure is to wait it out. However, you can shorten the length and severity of your child’s common cold with natural remedies, which are possibly available in your kitchen right now! Try this home cough syrup recipe from www.naturalfamilyonline.com:

Honey Onion Cough Syrup

• In a small saucepan, mix together 1 cup processed honey; 1 medium, yellow onion, chopped; and 1 tablespoon thyme leaf (more, if you use it fresh).
• Cook the above ingredients until the onion is softened.
• Serve warm by itself, eaten by the teaspoonful, over mashed potatoes or with your child’s favorite vegetable, meat or chicken.
• Small amounts may be eaten several times a day, if desired.

With the first days of school fast approaching, here are some general safety guidelines for keeping your children safe this fall:

Remind children to wear a helmet if riding their bicycles, scooters or skateboards to school. Walkers must obey traffic signals and walk only in crosswalks. Fall is also a good time to make sure your child’s car seat is installed properly – try calling your local fire department for car seat safety regulations. Car seat safety information including laws is available at www.actsoregon.org.  

Car seat safety classes are available monthly in the Hood River County Courthouse.  Call WIC (Women, Infants and Children - 541-386-6882) for times and registration.  Classes are free and open to the public.  Car seats are available to participants for $25 each for those who meet WIC income eligibility guidelines.For older kids, going back to school can include being alone at home after school. Be sure to discuss with children when and how to answer the phone or doorbell. Create a handy first aid kit and teach children how to use it. Establish a regular check in schedule for your kids to let you know what they’re doing.

For children playing sports, it’s a good idea to have a general health exam before starting a new season of activities such as soccer, football or lacrosse. If your child has ever had a concussion through sports or other activities, check with your family physician about tests to make sure your child has fully recovered before returning to his or her sport.Fall also means time on the school playground. Parents can help make sure the equipment is safe and teach kids to play on equipment correctly and safely. For more info on playground safety, visit the www.healthinschools.org safety checklist.

Make sure your child is up to date on immunizations by checking our immunization schedule. If you have questions about immunizations, call the Hood River County Health Department, 541-386-1115, or your family’s healthcare provider.  Related Links

The Columbia River Gorge is a great place to play with your children. Here are some basic safety tips to help make sure your family activities are as enjoyable as possible:

Children and Sun
For babies, avoid direct sun exposure and dress infants in lightweight long pants and long sleeved shirts with brimmed hats. A minimal amount of sunscreen can be applied to small areas such as the face and back of hands.

For young children, apply sunscreen at least 30 minutes before going outside, even on cloudy days. Your sunscreen’s SPF should be 15 or higher.

For older children, the best line of defense is sunscreen and hats and sunglasses that block 99-100% of harmful UV rays. Light cotton clothing with a tight weave works well to keep out harmful UV rays. Reapply sunscreen every 2 hours.

Children and Heat
Heat stress is a real possibility as temperatures rise in the Gorge. Keep intense activities to a minimum when temperatures are high. Make sure children are well hydrated by encouraging them to drink at least 5 ounces of cold water or sports drink every 20 minutes (average for a child weighing about 88 pounds).

Children and Insect Bites
To avoid bug bites, don’t use scented soaps, perfumes or hair sprays on your child. Also, avoid places where insects nest, such as stagnant pools of water, uncovered food and gardens where flowers are in bloom. To remove a stinger from a child’s skin, gently scrape it off horizontally with a credit card or your fingernail.

Insect repellants with DEET are most effective, but should not be used on children under 2 months of age. Also, do not apply DEET under the clothing or on the hands of young children. Don’t use DEET around the eyes, nose or mouth, or over cuts, wounds or irritated skin. The concentration of DEET varies with each product. For more information on DEET, go to http://www.aapnews.org/cgi/content/full/e200399v1.

Children and Poison Oak
Poison Oak is also a problem in our area. To identify poison oak look for its three-leaf pattern. As the old adage goes, "If a plant has leaves of three, let it be!" Poison Oak can change with the seasons, looking bright red or russet brown during the spring and fall, turning yellow green with pinkish colors on some of the leaves in the summer.

If you suspect that you or your child has touched poison oak, wash it off of your skin as soon as possible, preferably in a hot shower using a special soap such as ‘Technu,’ available in most drug stores. Bringing wet wipes and Technu along on hikes can be very helpful.

For a really bad case of poison oak your doctor may prescribe steroids to reduce the itching and swelling. Some helpful over-the-counter remedies are Benadryl gel, Rhuli gel, and Calidryl lotion (available at most drugstores) or tea tree oil (available in health food stores).

For more on these safety tips, and for tips on swimming, boating, fireworks, and bicycle safety, visit the American Academy of Pediatrics Website.   

The urge may be upon you – to clean out cobwebs, dirt and a winters worth of dust and grime! Spring cleaning is something you don’t ordinarily think of as dangerous for your children, but here are a few precautions you can take to make the house a safer place this spring.

Consider choosing nontoxic products for your spring cleaning. For example, vinegar and water is an inexpensive and effective window cleaning solutions. Always store other cleaning products safely out of children’s reach.

If you’re moving furniture, be sure to place cribs, playpens and other furniture away from the window or potentially dangerous drapery cords.

It’s also a good time to check your home for recalled and banned children's products. To find out about recalled products, go to www.recalls.gov.

If you’re having trouble with pests such as ants, contact the National Pesticide Information Center at 1-800-858-7378. They will help you figure out the best and safest product to use for the pest you want to control. Pesticides can be harmful if not used correctly. After you've purchased the correct pesticide: Stop! Read the Label. It's the most important thing you can do. "The label will tell you how to use the product, what protective clothing to wear and what to do if there's an accident," suggest OSU Extension Agent Steve Castagonoli. "Whenever using pesticides, be sure to read, understand and follow the label instructions. If you are applying pesticides inside the home, make sure the product is labeled for indoor use." (See our Pesticides Article in the Family Health Page Archives)

Spring is also a great time to check all of your smoke alarms to make sure they’re working properly. It’s also a good time to develop and practice a family fire escape plan in case of emergency. 

If you’re working in the yard, be sure to choose non-toxic fertilizers and insecticides. Check your play areas for poisonous plants such as poison oak. Keep dangerous lawn tools such as shears, rakes, weed-eaters, etc. away from children’s reach. Gardening tools made especially for children are a great way to keep kids involved in gardening safely.

With cold weather fast approaching, use caution when playing in freezing temperatures, wind, dampness and cold.

Children love playing in snow and cold, but prolonged exposure to such conditions can cause fatigue, reduce sensations of cold and increase the risk of hypothermia.

Hypothermia happens when the body can't maintain its normal temperature. Symptoms to watch for are slurred speech, abnormally slow rate of breathing, cold pale skin and lethargy or apathy.

If your child is showing these symptoms, move the child out of the cold and remove any wet clothing as soon as possible. Don't apply direct heat. Instead, use warm compresses to the neck, chest wall and groin. Don't warm the arms and legs. This actually will force cold blood back to the heart, lungs and brain causing the core body temperature to drop. Your family doctor will also have advice for treating a child who shows symptoms of hypothermia.

Frostbite is also a factor in cold weather. The places most likely to be affected are hands, feet, ears and nose. First degree frostbite causes numbed skin that has turned white in color with underlying tissue feeling warm and soft. Second and third degree frostbite are serious medical conditions and need to be treated by a trained medical professional.

If you suspect a portion of your child's skin has frostbite, first, get out of the cold as soon as possible, warm the affected area by covering it with dry, gloved hands. Get emergency medical help if numbness remains during warming. If medical help isn't available, warm severely frostbitten hands or feet in warm - not hot - water.

Dress children in warm waterproof layers to prevent such conditions, and head inside when they start to complain of cold. Individual layers are easily removed if your child becomes overheated.

Making sure that your child’s vaccinations are up to date before school starts will prevent a last minute rush to the doctor’s office before classes begin. Check out the vaccination requirements for infants, children and adolescents below.

Requirements for children attending schools in Oregon are found on the Oregon State Department of Human Services website. For Washington, check the Washington State Department of Health website, which includes requirements for preschool and childcare as well as school age children, adolescents and adults.

No doubt, the Gorge is an ideal place for family hikes, whether you're backpacking with a group of older children or doing a short hike with babies or toddlers. Trails exist for all ages and abilities. Providence Hood River Memorial Hospital offers the following suggestions for a safe & fun adventure. 

It was a cold and damp evening last year when "Sarah" arrived at the Providence Hood River Memorial Hospital Emergency Department, distraught, dazed and confused. The night seemed to reflect how she felt inside, and she communicated this only through her tears. Not knowing where to go for help, she ended up at the emergency room. The doctors and nurses asked lots of questions and checked her vital signs. She talked about feelings of depression, and how hopeless she felt. The care team knew they wouldn't be able to offer much help, since our ER, like most in the country, is not set up to provide emergency mental health care. They called a local mental health clinic for help, but because of funding cuts, the small, exhausted staff is only available during office hours and for serious emergencies. Sarah was given their phone number to call the next day and given medication to help her sleep that night. Everyone involved felt frustrated. 

"Unfortunately, stories like Sarah's are growing in our community and across the nation," says Ted Chase, former PHRMH nursing supervisor and newly licensed psychiatric mental health nurse practitioner. "The demands being placed on emergency departments to provide mental health care continues to increase, and with limited psychiatric resources, ER personnel face a tremendous challenge." 

Thanks to a community needs survey, sponsored by Providence Hood River, many people in Hood River County alerted us last year to the growing and unmet need for access to psychiatric services. This set in motion a much-needed change in how the hospital handles these types of situations. "PHRMH has a strong sense of mission and commitment to the community," Ted added.

Access to mental health services, along with several other needs from the survey, helped form Providence Hood River’s Mission Imperatives for 2004. PHRMH laid out a plan to expand mental health services in two areas of need: 1) Psychiatric consultation and connections to community resources for patients who are in the hospital for a physical ailment, but who have mental health ailments, too 2) Expanded outpatient psychiatric services, to include older people. The plan led to a decision to hire Ted Chase. "If Sarah's issue came up today, we would provide up-front treatment, develop a care plan and prescribe and manage any needed medications. We are now able to provide a better continuum of care," continued Chase. 

Other Needs Discovered Other needs being addressed include access to healthcare for those without insurance, services to the frail and elderly, and medical assistance. Our 2004 community needs assessment is currently being conducted in Hood River County. PHRMH, in conjunction with a professional research firm, will continue to identify services and programs lacking in our community. 

"We want the community to tell us what needs are out there and what we can do to make a difference," says Gary Young, Director of Mission Integration and Spiritual Care. "By communicating directly with our community, we no longer assume which programs are appropriate. They tell us what's needed and what's not." 

This year's survey began in October with a dozen community leaders being personally interviewed, followed by 300-500 random phone surveys to community households, asking their opinion on a variety of topics ranging from housing concerns to racial and ethnic discrimination. To ensure the diversity of Hood River County was represented, local social service agencies delivered surveys to people without a telephone and conducted two focus groups among members of the Latino community. 

"The process proved to be in-depth and incredibly thorough," continued Young. "We are encouraged by our community's willingness to participate and look forward to seeing the end results early in 2005. We will look closely at them and use them to develop new programs, expand existing programs, and look for ways to work with other community organizations." 

Providence Hood River's goal is to help put needed programs in place to serve our diverse population. The community needs assessment has proven to be an effective beginning. For more information, contact survey coordinator Gary Young at 541-387-6450.   

According to the Centers for Disease Control & Prevention, recent tracking of positive flu tests from around the country has found overall low influenza activity in the United States as of mid-November.

Still, many people are concerned about the recent shortage of flu vaccines this year. Susceptible people include women who are pregnant during flu season, young children between the ages of 6 and 23 months and anyone with underlying chronic medical conditions. 

Armanda Mason, RN, BSN, CIC, Providence Hood River Memorial Hospital’s Infection Control Practitioner, says there are a few simple things people can do to stay healthy during flu season. “To prevent sickness and keep it from spreading, wash your hands regularly, cover your mouth when sneezing and avoid close contact with people who have symptoms of an illness,” says Armanda. 

Common flu symptoms include fever, headache, extreme fatigue, dry cough, sore throat, runny nose, and muscle aches. When symptoms appear, stay home to avoid spreading viruses. Get plenty of rest, drink plenty of liquids and avoid using alcohol and tobacco. Taking medications to relieve symptoms also helps. There are also anti-viral medications available with a prescription. These simple measures go a long way in preventing sickness during flu season. For more information, the CDC website features more tips on preventing the flu on their website. If you have any questions, Armanda recommends calling your doctor.

Chances are you’re busy checking things off of your back to school list. Items on your list may include immunizations and back to school supplies. Immunizations required for the State of Oregon include those listed on the family health page. In addition, school districts may request a physical examination for entering kindergarteners and first graders prior to being admitted into school. TB testing is also required for students enrolling for the first time in Oregon who were born in a developing country.

Many families struggle to pay for school supplies in addition to their regular expenses. There are several organizations in the area that can help, and donations to these programs are greatly appreciated. 

• Hood River Valley Christian Church is accepting school supply donations at their location on 975 Indian Creek Rd. in Hood River. Donated supplies are distributed to needy families throughout the county. All supplies are welcome, including pencils, glue, paper, crayons, calculators, markers, etc. Bring your donations Monday through Friday from 10am to 1pm. If you have questions, call Cathy at 541-386-2608.
    

• The Hood River County School District Office is also accepting donations for needy families. Bring supplies to the District Office or Community Education Office in the Coe Primary Building on 1009 Eugene St., Hood River.
   

• The Salvation Army is also giving away backpacks full of school supplies to families in need. Cash donations are needed for this program and can be mailed to:
  
  ‘Salvation Army Back to School’
  P.O. Box 682
  Hood River, 97031
   

• Project Pencil is a program in cooperation with the Oregon National Guard that will provide school supplies to children in approximately 650 schools in Iraq. Local students will also receive a share of donated supplies. Any school-related donations are welcome excluding crayons. For more information, call the National Guard at 1-800-452-7500. 
  

Little Emma's whimpers woke her parents in the middle of the night.  Her body was hot to the touch and listless.  Frantically, they wrapped her in a blanket and drove the few miles from their home to Providence Hood River Memorial Hospital's Emergency Department (ED), where the team was ready and able to help.

Seasonal allergies are common among children, and can definitely interfere with a child's ability to learn and enjoy one of the most beautiful times of year in the Gorge. Seasonal allergies can appear anytime after a child reaches 3 years old. Symptoms include a clear runny nose, stuffiness, sneezing, coughing, red, swollen & itchy eyes, as well as headache. When symptoms don't clear up within a week and are not accompanied by a fever, this is a good indication that you may be dealing with seasonal allergies instead of a cold.

Parents can help decrease exposure to allergens by:

Can’t get rid of that stuffy nose? Are your ears ringing more than your telephone? Has someone had it with your snoring? Did you lose your voice and not get it back? These “above the collar bone” health problems are just what our two new ENT (ear, nose and throat) specialists can help. 

Gorge area patients can now be diagnosed and treated locally for ear, nose and throat concerns ranging from tonsillitis to facial cosmetic and reconstructive surgery.

Dr. Mendy Maccabee recently opened Providence Hood River ENT Clinic where she specializes in adult and child ear, nose and throat disorders, sinus and allergy problems, thyroid and parathyroid management. She also specializes in facial cosmetic and reconstructive surgery, including scar revisions, cleft lip/palate reconstruction, face lifts, eye and brow lifts, chin tightening, light facial peels, and “nose jobs.”

Dr. Maccabee attended the University of Washington Medical School and completed her Ear, Nose and Throat residency at OHSU in Portland. To augment her specialty, she also holds a fellowship in rhinology (medical treatment of disorders of the nose). Dr. Maccabee and her husband, general surgeon Dr. David Maccabee, arrived in Hood River following a year-long teaching fellowship in New Zealand. Dr. Mendy Maccabee sees patients at the ENT Clinic in the Providence Health Services Building, 1151 May Street. Call 541-387-6125 for an appointment. 

Dr. Leigh Anne Dew and Dr. Charles Ford work together at the Columbia Gorge ENT & Allergy Clinic. Dr. Dew moved to Hood River from Portland where she worked in private practice and as medical director of the OHSU Voice and Swallowing Disorders Clinic. 

“I love the recreational opportunities and the quality of life in the Gorge, but it’s not such a good place if you have allergies.” She speaks from experience, as she has allergies herself and works compassionately to help other sufferers. She provides complete ENT services, including allergy testing and education about allergy management in addition to medication therapies. Contact her at the Columbia Gorge ENT & Allergy Clinic, 1790 May Street, 541-386-5119.

When this writer/parent had children in day care and pre-school, the colds began in November and lasted until April. It seemed like there wasn’t a single day when somebody in the house did not have a runny nose!

According to Medline, a service of the National Library of Medicine and the National Institutes of Health, there is “some degree of increased health risk” for children in daycare, primarily due to the exposure to other children who may be sick. Kids in daycare are more likely to get viral infections of the nose, throat, mouth and voice box, as well as common colds, ear infections and diarrhea.

Can you prevent your child from becoming sick at a day care center or pre-school? In a word, NO. It is virtually impossible to prevent them from “catching” the same illness, particularly the common cold, from other kids. The average child will still get eight to ten colds per year, but you may be able to reduce the severity and number if you take precautions. Here are some things you can do:

1. Children with a temperature of 100 degrees or more should STAY HOME. 

2. Keep your child home if he or she is vomiting, has diarrhea, is unable to take fluids, seems weak or lethargic, has sunken eyes, a depressed soft spot on the top of an infant’s head, is crying without tears or has a dry mouth.

3. Children taking antibiotics should be kept at home until they have taken the medicine for one or two days.

4. If you know another child at the center has a contagious infection (chicken pox, strep throat or conjunctivitis) keep your child at home.

5. Teach your child to wash his or her hands before eating and after using the toilet. 

6. Check your day care’s hygiene practices. Infection is often spread when children put dirty toys and hands in their mouths.

7. Before enrolling your child in day care get a complete physical exam on your child, especially to look for ear inflamma- tion (an indicator of future ear infections), review for allergies and examine tonsils to make sure their size is not impairing your child’s sleep.

"These ideas are all good," says Hood River family practice physician Janet Sjoblom, MD. "I would add the importance of using paper towels or giving each child a personal hand towel to use. And wait for their immune systems to get stronger as they get older." By the time they are in second or third grade they won’t spend the winter with the sniffles.

Source: www.entnet.org/KidsENT Kids E.N.T. (Ear, Nose and Throat) Health is a public education campaign presented by the American Academy of Otolaryngology – Head and Neck Surgery.

The Sandwich Generation
Is the stress of the 'Sandwich Generation' eating you?

Pesticides can be harmful if not used correctly.  Before buying or using any pesticide, contact the National Pesticide Information Center at 1-800-858-7378.  They will help you figure out the best and safest one to use for the pest you want to control.

After you've purchased the correct pesticide: Stop!  Read the Label.  It's the most important thing you can do.  "The label will tell you how to use the product, what protective clothing to wear and what to do if there's an accident," suggest OSU Extension Agent Steve Castagonoli.  "Whenever using pesticides, be sure to read, understand and follow the label instructions.  If you are applying pesticides inside the home, make sure the product is labeled for indoor use."

• Protect Yourself and Those Around You.  Pesticides can be irritating to the skin, eyes, throat and lungs, especially for children.  Be sure to wear the appropriate protective clothing when spraying or applying pesticides.  Mix only the amounts needed and make sure to mix them outdoors in a well-ventilated area.  Keep children and pets away from the mixing and spraying areas.  Always wash your hands thoroughly after working with pesticides.

• Poisoning is one of the biggest dancers of pesticide use.  Children are especially vulnerable, since they often eat, drink and play in areas such as the lawn or floor where pesticides have been sprayed.  If you think someone has been poisoned, call Poison Control at 1-800-222-1222.

• Store pesticides safely out of children's reach.  Chemicals of any kind should always be stored out of reach of children and pets.  Always store pesticides in their original container and away from food, medicine and feed products.  Locked storage is a good idea.

• Dispose of pesticides and containers safely.  Don't put unused pesticides directly in the garbage our pour them down the drain.  Follow the label instructions for disposal and never use pesticide containers for other purposes.  Hood River and Wasco County residents can dispose of up to 35 gallons per trip of household  hazardous waste FREE at Portland's Metro Region two collection facilities.  One is at 2001 Washington St., Oregon City.  The other is at 6161 NE 61st St., Portland.   Call Metro at 1-800-234-3000 for times and days they're open  Their website at www.metro-region.org, has lots of helpful information on dealing with hazardous waste, too. Washington residents, call your county solid waste departments: Klickitat County, 509-773-4295, or Skamania County, 509-493-3313.

Summer's here and as the song says, "the livin' is easy." But emergency room doctors think of summer as "trauma season." Why is summer more dangerous? Kids are supervised less, spend more time outdoors and engage in riskier behavior like playing with fireworks.

To keep your kids safe this summer here are ten summer safety tips from Children's Hospital and Medical Center in Seattle, WA.:

STAY SAFE THIS SUMMER AND HAVE FUN!!!!
Your friends at the PHRMH Emergency Department

Do you have a child between the ages of 10 and 14? They're too young to have a paying job but they could have too much time on their hands this summer. What's a parent to do?  Here are some fun summer activities kids can do without a lot of assistance from grownups.

Busy kids won't have time to get in trouble so keep your active tween occupied instead of sitting home. As always, make sure you know where they are at all times. Use a pager or cellphone to keep track of their movements or have them phone you whenever they move to a different location. Have a fun and productive summer!

The following article is re-printed from Providence Hood River Memorial Hospital's 'Health Currents'.   Family Practice physician Kristen Dillon, MD answers questions about expecting a baby.

Q.  We're expecting a baby soon, we've attended childbirth classes, but we're still terrified.  What do you recommend?
A.  Many people read and attend classes to prepare for childbirth, but I also encourage them to spend some time getting ready for parenting.  After all, birthing typically involves several trained nurses and a midwife or physician.  One or two days later you're at home, and it's just you and the baby.

Q.  How do we get ready?
A.  Spend time with friends or relatives who have a baby to learn basics like diapering, feeding and bathing.  Also, there are many useful books on the topic.  My favorite authors are Penelope Leach and William & Martha Sears.  You can look through the parenting section of the library or bookstore and find one that echoes your approach.  I also loved reading Operating Instructions, a Journal of My Son's First Year, by Anne Lamott.  Anne takes a loving look at the joy, stress, exhaustion, despair, and humor of those first few months.

Q.  My mother wants to come and help out for a few weeks.  Is that a good idea?
A.  Absolutely yes, usually.  A new mom needs help at home for several weeks, so that she can just focus on taking care of herself and the baby and healing from pregnancy and birth.  The need is even greater if birth was by cesarean section, because then mom is trying to recover from surgery as well.  Often her partner can take care of the household, but it could be great to have an experienced hand (mom, grandpa or auntie or...) to help cook, clean, do laundry and hold the baby when you need a nap.  Occasionally, having a relative or friend isn't helpful.  Someone who doesn't support your decision to breastfeed, for example, or who makes you feel nervous or self-conscious, would best be invited for a short visit when you and your baby are more settled.

Q.  We're planning to breastfeed.  That comes naturally, right?
A.  I highly recommend reading about breastfeeding, watching a video, attending a breastfeeding class or doing all of these.  While nursing is nature's way, many moms and babes find it difficult to get started, and the challenges can be even greater if birth is difficult or there are medical problems.  I also think it's a good idea to have a plan ahead of time about whom you'll consult if problems arise, resources include the hospital nursing staff, your or your baby's doctor, or your midwife.  

Q.  Anything else?
A.  Yes, practice saying out loud several times, "Thank you, that would be very nice."  No matter how independent and private you may be in day to day life, people with a new baby at home will benefit from all the help they can get.  Someone offering dinner?  To do your grocery shopping?  To wash your bathroom floor?  Now that you've practiced, it would roll of your tongue, "Thank you, that would be very nice."

Kristen Dillon, MD is a board-certified Family Physician who practices at Columbia Gorge Family Medicine. l She provides family-centered prenatal care and childbirth services, as well as primary medical care for all ages. 

Parenting a child is a huge responsibility.  As a parent you are responsible for your child 24 hours a day, seven days a week, 365 days a year for eighteen years or more!  Fortunately, many of those hours are joyful and full of laughter.  But no one raises a child to adulthood without at least some conflict, tears and heartache.

Like all good workers, parents deserve occasional breaks and rest periods, particularly when your child is in one of those difficult phases such as adolescence or the 'terrific twos.  The most effective parents know that they cannot do it all by themselves.  The recognize when they need a "time out."

For some parents, that means turning the child over to grandparents or other relatives for a few hours or even a week during school breaks.  For others it means taking turns handling a colicky baby over to a babysitter or to your spouse for an hour or two.  Preschool is often a welcome milestone for parents of active 3 year olds.

Whether you are thinking about starting a family, parenting your first child or have a house full of teenagers, you NEED a break from your parenting duties.  A little time away from your child or children will make you a better parent.  You come back to your daily chores refreshed and maybe with a new way of looking at a regular problem you and your child have had.

Ideally, you can organize your schedule so that you have several break times every day.  In fact, making small children take naps and have an early bedtime in the evening can give you much greater coping skills for their awake, active hours.  Other parents make sure they get up an hour or more before the children do so they can exercise or have some quite time to themselves before the chaos begins. 

It's best to find the routine that works for you and your child so that you both have some time away from each other.  The time you spend apart will increase your patience and your tolerance for mistakes and misbehavior.  Try re-arranging your schedule to avoid those stressful situations such as long grocery checkout lines at 5pm with two hungry toddlers.  If you're calm and relaxed, chances are you'll be able to handle your child's stressed out moments a lot better than if you're all at your wit's end!

At least once a week you should have an activity or outing that's just for you or for you and a partner if you have one.  Don't have a granny nearby who can babysit?  No problem!  Just trade babysitting duties with another family or parent who has kids around the same ages as yours.  Check out the GorgeKids.com Local Babysitter List.  Sometimes caring for four children who play well together is less stressful than being only with your own one or two.  The best part is that after you babysit for your friend's kids, you'll have time to go to the movies, a party or out for a hike while your kids are at your friends house!

Diaper Rash: Almost every baby develops some form of rash or skin irritation from wearing diapers. Most of the time diaper rash is not serious and can be prevented by changing baby's diapers as soon as they are soiled and using ointments that contain zinc oxide.  If baby develops bright or pus-filled sores, you'll need to talk to your doctor for recommendations on anti-fungal or other medications.

Eczema: Eczema is red, very itchy dry patches of skin that often appear when children are infants. Over half the infants with this condition grow out of it by age two, but flare-ups can occure throughout life.  Because it is a chronic conditions, it cannot be cured buy can be treated and controlled with proper guidance from a doctor.  Here are some tips for children with eczema:

• Avoid long, hot baths that dry the skin.
• Apply fragrance free lotion after bathing
• Keep your house somewhat cool & humid
• Dress your child in all-cotton clothing
• Use very mild laundry soap and make sure to rinse clothes well
• Watch for skin infections and consult your doctor quickly if an infection develops
• Do not rub or scratch the rash

According to the American Lung Association, asthma is a "reversible obstructive lung disease, caused by an increased reaction of the airways to various stimuli."  Asthma can become life threatening if it is not treated.  About 24.7 million Americans have asthma and nearly a third of them (7.7 million are children under 18.

Most children have mild to moderate problems and can control their asthma with medicine at home or at the doctor's office.  For some children, however, asthma means many visits to the emergency room and sometimes an overnight stay at the hospital.

Help is on the way for people with asthma: the U.S. Environmental Protection Agency Administrator Christine Whitman recently announced a plan to find out how much pollution in the air adds to asthma problems.  The American Lunch Association is supportive of the EPA's new approach.

Have you seen kids riding, skating, snowboarding or skiing without a safety helmet? It's a fact that helmets help kids avoid major injury, even save their lives. Because of this, PHRMH emergency/trauma nurses and docs offer a helmet for $5 to any child who needs one. They also fit helmets for kids who have them, but don't know how to wear them properly.

Here's what you can do to help:

• Pick up some coupons from the ER Admitting Desk at Providence Hood River Memorial Hospital.  Anytime you see or know of a kid who doesn't have a helmet or know how to fit it properly, give him or her a coupon for a brand-new helmet for just $5. 

• Encourage kids and their parents to come in and get a helmet and/or a free fitting.

• Donate a few dollars to help buy more helmets. 

• If you or someone you know is planning to give a bike, motorbike, scooter, skate board, snowboard or skis as a holiday gift, remind them to buy a helmet, too. 

• If you'd like an emergency room nurse to come and speak to your school, church, or other group about helmet or seat belt safety, call Jane Burke, 541-387-6184. 

Sponsored by Emergency Department/Trauma Nurses
Providence Hood River Memorial Hospital and 
The Oregon Traffic Safety Division
Cash donations gladly accepted to help buy more helmets.

It's not easy to find the right words to talk to your kids about drugs and alcohol. But if you don't have this tough talk early and often, your kids may think it's not that important. Talk to your kids frequently about how dangerous drugs and alcohol can be. Here are some excellent tips from the National Youth Anti-Drug Media Campaign, sponsored by the Office of National Drug Control Policy, available free in English at www.TheAntiDrug.com and in Spanish at www.laantidroga.com.

For more tips and information, download "Keeping Your Kids Drug-Free: A How-To Guide for Parents and Caregivers at www.TheAntiDrug.com or call 1-877-SINDROGAS

Other resources: Make a Difference: Talk to Your Child About Alcohol at www.niaaa.nih.gov or call 1-800-487-4889.

Keeping Youth Drug-Free, US Dept. of Health and Human Services, Center for Substance Abuse Prevention. www.samhsa.gov. or call 1-800-729-6686.

For a safe and fun hiking trip, follow these "Hiking Safety" guidelines from Providence Hood River Memorial Hospital:

Enjoy the woods this summer, but beware of poison oak. It is extremely common in the Pacific Northwest and grows from sea level to 5000 feet altitude, appearing in various forms - as spindly plants, bushes or even as climbing vines. Poison oak is a plant to be avoided, since it often causes unrelenting skin itching, possible infection and spreads easily from one part of the body to another.

The best way to identify poison oak is from its three-leaf pattern. As the old adage goes, "If a plant has leaves of three, let it be!"

Teenage Depression is more than a day or two of the 'blues.' It is a continuous, overwhelming feeling of sadness and helplessness. Instead of talking on the phone or hanging out with friends, teens with depression may refuse to go out of the house. Some turn to drugs or alcohol. Teenage depression is both painful and debilitating. Unfortunately, it can also be fatal.

Life stresses - loss of a family member through death or divorce, problems at home, a move to a new area, a breakup with boy/girlfriend, problems at school, or ongoing rejection by other students are heightened for teens and can trigger mild to serious depression.

Children and adults can experience a brain chemistry imbalance that affects both mood and behavior. This imbalance can cause depression, even when there are no huge stresses in life at the time.

The best way to tell for sure if your teen is depressed is to get an evaluation from a mental health professional. A qualified expert can properly identify and treat both depression and substance abuse issues.

It's a myth that people who talk about suicide do not actually attempt it. If someone shares suicide plans or thoughts with you, listen with concern and get them to professional help immediately. Seventy-five percent of all suicidal teens and adults give some warning to a friend or family member. Let the person know you care: tell them they are not alone, that suicidal feelings are temporary, that depression can be treated. Call the police, a health care provider or local emergency room for help.

Where can you get help? Gorge Counseling and Treatment Services, part of Providence Hood River Memorial Hospital, has psychologists, a psychiatrist and a licensed professional substance abuse counselor on staff. Call them. They can help...(541) 387-6138 or 1-800-955-3911, ext. 76138.

Signs of Teen Depression: Increased moodiness, irritability, arguing Poor concentration, slowed thinking Changes in grades/school performance Sleep and appetite changes (overeating, excessive sleeping or no appetite, lack of sleep) Increased self-criticism (excessive guilt, "I keep messing up") Despair, sadness, emptiness (feelings of worthlessness, excessive crying) Loss of energy, or at times, hyperactivity Lack of interest in usual activities and friends, withdrawal Increased talk of death and dying Physical complaints and pains Behavioral problems: drug use, steeling, lying, fighting with family and peers, running away Talking/threats of suicide

January 2001; by Kris Wilhelm
Physicians Interviewed: Dick Virk, MD; Phil Chadwick, MD 
(PHRMH Emergency Physicians)

Childhood fever: Common causes and treatments
Fever is very common in childhood. Most often, fever is caused by infection, and is a normal part of the process of fighting that infection, but may also result from some other illness. When the body detects infection, macrophages, which are the “janitors” of the body, find something that doesn’t belong, such as a virus, bacterium, or fungus, they mop up what they can, and at the same time, signal the brain to raise the body’s temperature. The fever is usually secondary to the infection, but should not be allowed to rise unabated.

Infections are caused by either bacteria or viruses. Antibiotics are only effective against bacterial illnesses. A medicine has not yet been developed that will kill cold or flu viruses, so you have to follow your body’s own defense system to fight the virus. Most common colds and flu are caused by a virus, not a bacteria. What causes fevers? Babies and children can sometimes get fevers following immunizations; a fever may also accompany a cold, flu, sore throat, ear infection, pneumonia, croup (which are most often viral illnesses), or urinary tract infections. Teething has also been known to cause fevers.

A fever is usually defined as a rectal temperature of at least 100.4 F. Normal body temperatures in a well child can range from 97.7 F to 100 F. If you want the most precise reading, rectal thermometer readings are recommended. To use a rectal thermometer, turn your child onto his stomach and gently insert the bulb about one inch into his anus (a little petroleum jelly helps). Hold it there for about a minute. Auxiliary thermometers are less accurate, however, can be used for most purposes. Hold the end of the bulb in the child’s armpit with his elbow against his side for about five minutes (the newer digital thermometers beep when they have finished the Measurements.) Underarm measurements register 1-2 degrees lower than rectal readings. Don’t use an ear thermometer until your child is over 2 or an oral (mouth)thermometer until your child is at least 3.

What should I do to treat a fever? In general, your child will feel more comfortable if you treat his fever immediately. To treat a fever in a child, you can do the following:

• With a fever over 101 degrees F, give your child a dose of acetaminophen (Tylenol). Follow dosage and frequency instructions carefully, and talk with your doctor first if your baby is under 3 months old.
• Do not give aspirin, which has been linked to a potentially rare fatal illness called Reyes Syndrome. Your doctor may also recommend Ibuprofen instead of acetaminophen.
• Don’t over-bundle your baby to “burn out” the fever. This may raise his temperature even further. Dress your baby in light, comfortable clothing. In general, dress the baby as you are dressed to stay comfortable in the room you are in.
• Don’t overheat or overcool the room he is in. Use only a sheet or a light blanket for covering.
• Hydrate your baby by giving them lots of fluids. In addition to fluids they already drink, you can offer gelatin flavored water, ice pops, clear soups, or diluted fruit juice.
• For high fevers, 102 degrees F and up, you can try a sponge-bath. Put your child in a shallow tub of lukewarm water, and rub his body, one area at a time, with a lightly wrung washcloth. Let the water evaporate, don’t dry him off—this can help the fever reduce within 10 to 20 minutes.

Local child psychiatrist Dr. Liz Chambers talked with writer Jean Sheppard about the pros and cons of letting children cry themselves to sleep. They refer to the book, "Solve Your Child's Sleep Problems" by Richard Ferber, MD, a pediatric sleep researcher.

New parents are often surprised and disappointed when their sweet little baby doesn't drift off to sleep every night listening to Brahms "Lullaby." In fact, bedtime in some households seems more like a battlefield than a tranquil nursery scene with Bo Peep and her sheep.

Parents complain about bedtime rituals lasting for hours, or endless nights of interrupted sleep. What can parents do?

In his book, Dr. Ferber recommends children learn to go to sleep without parental assistance. He claims "self-comforting" is a lifelong skill essential not only for restful sleep, but also for coping with frustration and other difficulties. His research shows children with good sleep habits do better in school and are more cooperative at home.

Dr. Chambers wisely cautions you check with your child's physician before starting any sleep training program. She also suggests starting the program no earlier than four to six months of age, when most babies are ready to sleep through the night.

Some parents believe it is cruel to ignore a baby's cries. True, research shows newborns are happiest if their needs are met promptly. But as they grow, babies can learn to comfort themselves for increasingly longer periods.

However, if you don't mind frequent sleep interruptions or if you enjoy longer bedtime rituals, your personal choice is best. Dr. Chambers encourages parents to stay consistent, whichever approach you use at bedtime. When we are inconsistent (i.e., we encourage a prolonged bedtime ritual one night and punish the child for doing the same thing the next night), children get confused and everybody gets frustrated.

Want to learn more about Dr. Ferber and his sleep research? You can check out his book at the Hood River County Library or other area public libraries and bookstores. If you'd like to talk to Dr. Liz Chambers, she can be reached at Gorge Counseling & Treatment Services, 541-387-6138. Sweet dreams!   

Is your child easily frustrated? Does he or she get unusually upset when unable to complete a task or when losing at games or sports?

It is quite normal for very young children to become angry when they cannot master things like zipping their coat or finishing a puzzle. Adults who share their lives with pre-schoolers need to stay calm and provide firm guidance and support when children act out.

If your child rips off his coat or knocks the puzzle to the floor in frustration, before you lose your temper, calmly say you know he's upset. Let him calm down, then encourage him to say how he's feeling (mad, stupid, frustrated). If he continues to yell or scream he may need to be sent to another room until he's calmed down.

After the child has regained control, you can tell him it's time to pick up the puzzle or try putting on his jacket again. Talk about other ways people have of expressing their feelings. Using the "Columbo" approach can help. Ask the child questions such as, "What else could you have done when you couldn't zip your coat?" Keep asking for other possible solutions. Let the child be the one to realize he could have asked for help, or could have taken the coat off and tried again later, or worn a sweater instead. Helping children come up with their own solutions is a great way for them to learn. It helps them understand that we all have choices and some choices are better than others.

When school-age children pitch a fit if they lose at a board game, or miss a shot in basketball, their friends will usually let them know they don't like it. When a friend says, "I don't want to play with you because you're a sore loser," children who are poor sports might change their ways. But, parents and other adults still need to remind children to use words and not hit people or throw things when they get upset. Teach them to recognize their anger before it gets out of control so that they can say to their friends, "This game is making me mad. Let's do something else."

As they grow, children can control their tempers better. Showing them how to make positive choices at a young age is an important developmental milestone.
By David Wade, Psy.D., Gorge Counseling & Treatment Services   

If you are a new or expectant parent, we hope you’ll spend the first two years of your child's life visiting the Health Department to complete your child's immunizations. Many young parents do not remember a time when children routinely suffered and/or died from polio, measles, mumps, whooping cough and rubella. Even chicken pox, which is typically not a serious illness for most children, is a fatal disease for 100 -200 American children a year. Use the table below to schedule your child’s vaccinations. All of these immunizations have been approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians. These physician groups have reviewed and evaluated thousands of children and this immunization schedule is based on their conclusion that these vaccinations are safe for children.

One of the biggest challenges expectant and new parents face is whether one parent can stop working indefinitely to stay home and take care of the baby. There is no simple solution to this gut-wrenching dilemma.

For many parents, the only answer is try and work alternating shifts and fill in with child care in an attempt to blend family time and financial security. For other parents, the need to build a career or business must be included in the decision.

The good news is that there are ways to achieve a satisfying balance for everyone. It's best to start planning long before baby arrives. In fact, young people who want to become parents should consider career options that allow for part-time work, a home-based business or flexible schedules. If you save for a few years before babies arrive, one income will stretch farther.

Deciding which parent works and which one stays home, either part-time or full-time, depends on the unique skills and personalities of each family. Expectant parents should set aside lots of time for uninterrupted brainstorming during the months before the baby arrives. Ideally, these discussions should include not only paper and pencil budgeting sessions, but also each person's feelings and opinions about what's best for baby and what feels right to each parent. Hopefully, with lots of loving talk and compromising you can find the solution that's right for you. Whatever option you choose, make sure both parents accept and support this decision. In healthy relationships each partner feels that their contribution to the family's well being is valued by the other person. Good luck!

by Jean Sheppard, Providence Hood River Memorial Hospital