Parentelligence Blog

Increasing Your Child’s Comfort with Nitrous Oxide

Deborah Worthington, RN, CPN

Deborah Worthington, RN, CPN
Registered Nurse, Swedish Pediatric Specialty Care

You may be familiar with “laughing gas” as something you find at the dentist’s office but did you know it can also be used when your child is a patient at Swedish? Laughing gas is a mix of nitrous oxide and oxygen, but you might hear your pediatric nurses just call it “nitrous.” In pediatrics, we use it to help a patient relax and feel more comfortable during certain procedures such as IV placement or urinary catheterization.

Once your doctor or nurse has determined that your child is a good candidate for nitrous (without any contraindications such as conditions where air may be trapped in the body, pregnancy, or impaired level of consciousness), your nurses and certified child life specialist (CCLS) will explain the process: Your child will choose a flavor for the inside of their mask used to administer the gas. They will be on a stretcher or bed and have a saturation probe attached to a finger to monitor their oxygenation. One nurse will administer oxygen, then the nitrous, gradually increasing the amount until your child is suitably relaxed for the procedure, while remaining responsive to directions. Another clinician will perform the procedure, e.g., place the IV. A doctor is also available.

As a parent ...

Picky Eaters - Tips for Establishing Healthy Eating Habits

Tarynne Mingione, RD

Tarynne Mingione, RD
Registered Dietitian

Picky eaters. We all know at least one, have a child that’s proud to be one, or heck, might have a history of being one (gulp). Every child is unique, hence the approach to picky eating needs to be highly individualized, but here I will outline some general tips on how to establish healthy habits for picky eaters!

The Basic Rules...

Introducing solids to your infant

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

As your baby grows, you’ve probably started wondering when and how to start feeding your infant solid foods. Here are some general tips to consider:

Is there a safe age to start feeding solid foods to my infant?

Yes, most infants this is between four and six months of age.

Why is there a ‘safe’ age to start feeding solids?

There are a few reasons why this age is safest. The first reason is because prior to four months of age, an infant is not developmentally ready to safely eat from a spoon.

To be able to swallow solids safely, an infant needs good head control; to be able to sit well with support; and to have lost the “extrusion reflex” (the reflex which enables newborns to tightly latch and suck from a nipple, but makes them shove a spoon out of their mouth).

The second reason an infant should be fed solids between four and six months is something many families are not aware of: it is also a strategy to prevent common food allergies. This is one of the strongest reasons I passionately advocate for infants to be exposed to as many foods as possible during this crucial three-month window.

Starting solids and preventing food allergies:

In the past, healthcare providers have advised parents to avoid potential allergens such as peanuts, eggs, and milk. New evidence is now showing that this practice might have played a role in the increased incidence of childhood food allergies in the U.S

Why might this occur? The ...

Flu vaccine for children

Hema Nirmal, MD, FAAP

Hema Nirmal, MD, FAAP
Pediatrician, Snoqualmie Primary Care

A lot of parents have questions about the flu vaccine and many parents refuse the vaccine as they feel it does not very effective. Some parents are concerned about vaccines in general and refuse vaccinating their child as they don’t want to administer “another vaccine” to their child. The best way to prevent getting flu is by vaccination.

What is flu (Influenza)?

Flu (influenza) is not just a common cold or a stomach virus as most people think. Influenza usually occurs during the winter in our region although it can occur all year around in other parts of the world. It can be a serious respiratory illness that can lead to complications especially in children and older adults. Symptoms are generally similar to any other common cold infections and can vary from fever, runny nose, nose congestion, cough, body aches and headaches. The body aches and headaches are mostly reported by older children and adults. Children may not be able to explain their symptoms and may just be fussy.

Most children get over the flu without any complications. In some children and adults, however, it can lead to serious complications including pneumonia.

How to prevent the flu:

Influenza is ...

Hernias: why are some watched while others are repaired?

Robert L. Weinsheimer, MD

Robert L. Weinsheimer, MD
Pediatric General Surgeon

The most common thing that I see as a pediatric surgeon is a child with a lump that is thought to be a hernia. A hernia is a bulging of tissue through an opening in the muscle layers that isn’t normally present. In children, these openings are usually the result of a developmental process that just didn’t quite reach completion. Some hernias need surgery emergently, while others are observed for years with the expectation that they will close on their own.

Here are some pointers to help understand this wide range of approaches to hernias:

Location is very important in considering how aggressive to be with hernias. Belly button (umbilical) hernias are...

Constipation during infancy

Robert L. Weinsheimer, MD

Robert L. Weinsheimer, MD
Pediatric General Surgeon

As a pediatric surgeon with a special interest in intestinal issues, I am often contacted by worried parents regarding their baby's infrequent bowel movements. This can be caused by a variety of
problems such as blockages of the intestines or abnormal intestinal function (including a condition called Hirschsprung's disease); but most frequently babies are just efficiently absorbing and thus not needing to poop very often. This is especially true for breastfed babies. So, how can a parent tell the difference?

I would offer the following "red flags" as issues that may indicate a problem needing further medical evaluation:

Fixing Chest Wall Deformities: A Minimally Invasive Option

Robert L. Weinsheimer, MD

Robert L. Weinsheimer, MD
Pediatric General Surgeon

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

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Top Authors

Jennifer Wojciechowski
Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

Robert L. Weinsheimer, MD

Robert L. Weinsheimer, MD
Pediatric General Surgeon

Elizabeth Meade, MD

Elizabeth Meade, MD
Pediatric Hospitalist

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