Tag Archives: Dr. Christina Johns

December 14, 2017 · 8:28 am

Guest Post: Your Child is Having a Panic Attack by Dr. Christina Johns


[Note: This is a sponsored guest post contributed by Dr. Christina Johns, Senior Medical Advisor at PM Pediatrics. This was originally published on her blog, Dear Dr. Christina.]

I hear a lot of people toss out the phrase “panic attack” in very dramatic fashion when describing events that are stressful or frightening. Of course most of the time these aren’t real clinical panic attacks, but I hear it enough that I think the topic is worth spending some time on, especially for kids, who can have a really hard time sorting through these incredibly difficult episodes. And children do get panic attacks. Yes they do… that look a bit different than your average neighborhood adult panic attack. So let’s get to it.

A panic attack is…
when a child experiences what seems to be a random, brief episode of intense fear and upset that can be accompanied by actual physical symptoms. The attack usually doesn’t last for more than 10 or so minutes and goes away on its own. The child may complain of rapid heartbeat, nausea, chest pain, shaking, sweating, or feeling dizzy. He/she may even state that (s)he feels like (s)he is going to die. There’s no real trigger for a true panic attack, but children may trace it to something concrete, and if it happens repeatedly it can negatively affect many aspects of their lives, from wanting to go to school or out in public to coming into contact with things or experiences that they associate with the panic. These panic attacks feel very real to the child experiencing them, and likely represent an adrenaline-like rush (in a bad way) that he/she can’t control.

I’ve had exactly 2 panic attacks in my life, and my symptoms were textbook.
My heart was beating a mile a minute; I was dizzy and sweaty, and I felt a sense of overwhelming doom that I cannot explain. I had no reason to feel that way. Sure enough, the feeling gradually went away, but during the episode I felt HORRENDOUS. I am 100% sympathetic to people who undergo this routinely, no matter their age.
The initial trick is to make sure that there’s no actual other organic cause for the symptoms. As an example, we need to make sure that the rapid heartbeat isn’t from an actual ARRYTHMIA (abnormal heart rhythm). Once that’s all squared away the focus should be on counseling and biofeedback and behavioral techniques to help the child recognize when a panic attack is coming on and give them tools to help manage through it. In severe cases some children may need medicines like anti-depressants to help with the symptoms.

What can you do if you know a child with panic attacks?
1. Be calm & a good listener

2. Comfort and encourage

3. Praise for efforts to recognize and “get through it”

4. Help with relaxation and biofeedback techniques.

Lots of sensitivity required here, obviously, but I think it’s time we draw a little more awareness to this issue and help kids out so that maybe, just maybe- there’s a little less of a panic going around.


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Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician, and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from their highly skilled staff, with patients and families everywhere.


Follow Dr. Christina online for health tips, insightful articles, and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/

This post is sponsored by PM Pediatrics, however, I only promote services, programs, and places that I genuinely believe in and think will appeal to KFDC readers.

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November 13, 2017 · 9:01 am

Guest Post: Treating Children with Special Needs in the Emergency Department by Dr. Christina Johns

[Note: This is a sponsored guest post contributed by Dr. Christina Johns, Senior Medical Advisor at PM Pediatrics. This was originally published on her blog, Dear Dr. Christina.]

Anyone who likes going to urgent care or the emergency department, raise your hand!
Anyone? No one?

That’s right. Nobody likes it for any reason, anytime.  It’s stressful, often unplanned and disorganized, and can be a frustrating experience.  I put my doctor head together with a few parents who live this firsthand, and we came up with some ideas that might help make the journey just a little easier.

One of the most helpful things you can do takes place before an emergency ever happens: that is PREPARE for the “just in case.” Make a detailed list of your child’s medical and surgical history, including all medicines with strength and dose.  I can’t tell you how many times a parent will forget to mention their child’s underlying diagnosis when I meet them for the first time. This is not because they want to keep something from me. It’s just not the first thing on their mind in an emergency.  A child with a brain shunt may have stomach pain and vomiting that doesn’t SEEM related to the shunt, but it may very well be. So having a handy and complete summary of your child’s medical “story” is a godsend to most clinicians, and can help your child and save time, too.  Same thing goes with any medical equipment or special dietary items (like liquid nutrition).  Bring these.  Just in case.

Also, I want to empower all you caregivers out there to remember that you have as much expertise about your child as the medical team.  After all, YOU live with your child every day, so don’t be afraid to speak up. Tell the doctor about the details that are unique to your own child, and tell them what you think, even if it “goes against” the medical convention.  It’s a team effort, friends, and just as I’ll ask you to be patient and flexible with the medical team, the clinicians need to LISTEN to you and incorporate your input as well.  This is a big deal.  If you feel like you aren’t being heard, then by all means speak up and say just that.  If you do this in a collaborative and respectful way, any solid medical provider should pause and redirect their focus to make sure you are being heard.

You are your child’s best advocate!

It nearly always helps to have your doctor give a “heads up” phone call to the urgent care or emergency department staff to let them know that you are coming in. Getting all the doctors’ brains on the same page really can make the visit go smoother. So please call your doctor if you can before you head on in to urgent care so that this communication can take place.

I wish you every good vibe as you navigate what can sometimes be a very tricky road!
That being said, if you can try to be as well prepared as possible for an unexpected trip to the emergency department, it will help you to focus on what’s really important: comforting your child.

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Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician, and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from their highly skilled staff, with patients and families everywhere.


Follow Dr. Christina online for health tips, insightful articles, and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/

This post is sponsored by PM Pediatrics, however, I only promote services, programs, and places that I genuinely believe in and think will appeal to KFDC readers.

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October 12, 2017 · 7:06 am

Guest Post: Controlla, Controlla by Dr. Christina Johns

[Note: This is a sponsored guest post contributed by Dr. Christina Johns, Senior Medical Advisor at PM Pediatrics. This was originally published on her blog, Dear Dr. Christina.]

You know what?  There are a lot of different respiratory medicines around–seems like a lot of people have trouble breathing.  And I’m not really talking about coughing; mostly I’m talking about being short of breath or wheezing. If you’re confused about keeping all these medicines straight, you’re like many of the patients that I’ve seen recently, and you aren’t alone. I’ve left work these past few times feeling like lots of folks are using their medicines incorrectly, and as a double whammy, the packaging looks alike.  And—sort of a true confession—I was also inspired to write on this topic when I heard that Drake song “Controlla.”  Alright.  You got me.

See, breathing medicines for people who wheeze regularly are divided into two categories:  rescue medicines and controller medicines (see recent Drake tune).

What I’ve noticed is that many people stop taking the controller medicine when they or their child aren’t having breathing difficulty, then start it up again when the wheezing or chest tightness begins.  Well, folks, that’s an excellent way for that medicine NOT to work.  The controller medicines are typically inhaled steroids (not anabolic steroids, rather an anti-inflammatory kind) that only go to the lungs and when given regularly decrease acute wheezing flares.  This means you have to use these medicines DAILY to achieve the desired effect.  They come in both inhaler form (like a pump spray) and nebulizer form (aerosolized via a machine).

In contrast, the RESCUE medicines are the bronchodilators.

These run the gamut from short acting medicines (albuterol is the most common one) that can be given frequently to long acting formulations that only need to be given once a day.  For MOST people, daily use isn’t needed, and these medicines are only effective when the airways are in spasm, which is part of what happens with wheezing/asthma.
So how do you know if you need a “controlla” medicine? (I kill myself! Haha.)  If your child needs to use the rescue medicine more than a few times a week and has regular nighttime awakening from symptoms, then it’s probably time to talk to your doctor about starting one.  Another day we should probably address the details on this, because it’s fairly well outlined.

During an acute flare, I like to tell my patients that if they are having to use the rescue inhaler more often than every four hours at home, then it’s time to get looked at.  In the monitored clinical setting these bronchodilators can be given continuously if needed, but I emphasize the word MONITORED here—it’s just not safe to be giving the rescue medications so often at home.

We could talk for hours about wheezing/asthma action plans and different nuances of medications, but mostly I wanted to write CONTROLLA a few times plus get the message out to everyone that you really need to know which medicine is which.  To review:

Inhaled steroid = CONTROLLA, needs to be used daily to be effective. 
Inhaled bronchodilator = RESCUE medicine, during an acute flare.
 
If everyone could do a little bit better job at the discipline part of keeping this sorted, then my guess is we’d all have a little more time for some groovy music, since we’d be spending less time dealing with our respiratory exacerbations.  I’ll jam to that.

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Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician, and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from their highly skilled staff, with patients and families everywhere.


Follow Dr. Christina online for health tips, insightful articles, and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/

This post is sponsored by PM Pediatrics, however, I only promote services, programs, and places that I genuinely believe in and think will appeal to KFDC readers.

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September 15, 2017 · 8:24 am

Guest Post: Cough vs. Codeine by Dr. Christina Johns

[Note: This is a sponsored guest post contributed by Dr. Christina Johns, Senior Medical Advisor at PM Pediatrics. This was originally published on her blog, Dear Dr. Christina.]

I love it when I get emails like this in the early innings of the day:

Good morning, I am attaching an article about codeine. On several occasions this past week parents have requested prescribed cough medicine. The Dr did a great job explaining why he does not prescribe them, right on point with this article in today’s Newsday.

Have a great week.

Catherine

It’s blog day and sometimes I‘m not totally hooked on a topic.  I was starting out with:

–Zika.  Nooooooo, not today. The legislators are being too annoying.

–Flu.  Meh.  I’ve done some posts about that already and in a few weeks I’mma be all over that like a bad rash.

And THEN I got the email above from one of my colleagues.  Along with an article.  And I thought: yep, gonna go there.  Gotta talk about cough medicine, everyone.
 
If you haven’t heard by now, prescribing cough medicines for kids and suggesting over the counter cough and cold remedies for that matter, are NOT recommended.

via Newsday:
The one medicine that has recently been specifically called out by the American Academy of Pediatrics is codeine, an opiate (yup!) that really can have bad effects on slowing down breathing, especially in the subset of people who, by mere genetics, happen to be rapid metabolizers of the drug. The codeine works by being broken down inside your liver and turning into morphine, which is another controlled substance and pain reliever.  Not too long ago, codeine was thought to be useful as cough medicine.

There’s been a lot of research done on this, concluding that there’s just no solid evidence that they work, and they can have potentially harmful side effects, like abnormal heart rhythms and depressed breathing.  Breastfeeding moms who are using codeine may also potentially increase opioid toxicity in your baby — speak with your doctor if you have concerns. Codeine used to be found in over the counter cough remedies but has been removed due to its negative effects.   Then for awhile, physicians would prescribe codeine syrup to help with cough.  No more.  Just not worth the risk.  Better to cough than to NOT BREATHE AT ALL. I also like to remind patients and parents that the cough is the body’s way of getting RID of an infection, so an effective cough is actually your body takin’ care of business.  Let’s not suppress that.

I totally get that when your child is coughing a lot they are uncomfortable, you are uncomfortable, everyone is uncomfortable and we all want to do something, anything, to help it get better.  But let’s respond to the data and do the best and safest thing for our kids.  No cough medicine.  And definitely NOT an opiate like codeine.

So what CAN you do?
• Give pain reducers for those sore chests and throats, like acetaminophen or ibuprofen.  A lot of people think that if there’s no fever then these medicines don’t help.  They do!  They make kids feel better.
• For kids over a year old, a little bit of honey (2-3 tsp) has actually been shown to have some benefit (research!).  Many people recommend mixing it in with a little decaffeinated tea (not too hot).
• Make sure the air in the environment isn’t too dry.  Sometimes a walk outside or a humidifier in the bedroom or sitting in a steamy bathroom can help break that annoying cough cycle.
• Try to be patient. The hardest one of all.
 
So, Cathy and I hope you’ll join the bandwagon of folks who don’t give or request cough medicine for their kids, even though it’s tempting.  We want everyone to get well soon, and we know you do, too! But first and foremost, we want to DO NO HARM.

* * * * *


Christina Johns, MD, MEd is the Senior Medical Advisor at PM Pediatrics. As a parent, pediatrician, and pediatric emergency physician with a master’s in education, she shares her own expertise, plus the wealth of knowledge from their highly skilled staff, with patients and families everywhere.


Follow Dr. Christina online for health tips, insightful articles, and more.
Blog: https://www.pmpediatrics.com/dear-dr-christina/
Facebook: https://www.facebook.com/DrChristinaJohns/
Instagram: https://www.instagram.com/deardrchristina/
Twitter: https://twitter.com/DrCJohns
Pinterest: https://www.pinterest.com/deardrchristina/

This post is sponsored by PM Pediatrics, however, I only promote services, programs, and places that I genuinely believe in and think will appeal to KFDC readers.

1 Comment

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