Ask the Experts: May 2020

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One thing we all have in common as parents are questions. Lots of questions. Whether it’s concerning how to save for your child’s college fund, best practices for dental care, or how to talk to your child about a death in the family, it can feel overwhelming at times. While Google is handy, it can also be confusing and most importantly, unreliable.

We are so excited to introduce a new feature on Charleston Moms called Ask the Experts where a team of local experts will answer your burning parenting questions in a monthly blog post. Our hope is that you get answers to some common questions that many parents have and connect with these amazing resources right here in our community!

Want to learn more about our team of local experts? Have a question? Ask it here and it will be answered in next month’s post! 

Children's Health

Q: What are the best ways to ease the pain of teething? My child has a rough time each time a tooth comes in: loose stools, mild fever, behavior and sleep changes, drooling and chewing always precede a tooth popping in.

A: Great question! Teething typically starts around 4-7mos and typically the front teeth (either upper or lower) come first followed by the opposite front teeth. The first teeth typically come in around 6-12mos. Babies may show signs of discomfort as teeth are coming in. Parents may consider easing the pain by massaging the baby’s gums with clean fingers, offering solid (not liquid-filled) teething rings, or a clean frozen or cold wet washcloth. Use teething biscuits with caution; they contain sugar and salt and can lead to choking.

Avoid using teething tablets and teething gels as they may contain ingredients dangerous for children. Also avoid amber teething necklaces as they can be a strangulation risk or choking hazard.

Babies should not develop a true fever (>100.4 F) due to teething so if your baby has a fever please contact your pediatrician. Parents may consider acetaminophen for discomfort associated with teething in consultation with their pediatrician.

Expert(s):
Elizabeth Mack, MD, MS
Division chief of pediatric critical care
MUSC Children’s Health

Women's Health

Q. What are the methods offered for pain management during L&D besides an epidural?

A: While epidural anesthesia provides excellent pain control during labor, there are other available options. In general, pain relief during labor can decrease pain without losing feeling or ability to move or can block pain. An epidural allows you to remain alert during labor but does decrease some feeling in your lower body. With an epidural, the loss of feeling is not so great that you cannot push.

Medications can be given that will decrease your awareness of pain. These medications can be given systemically, which would affect your whole body, or locally. Intravenous opioid medication can be given that will lessen pain however these medications do cross the placenta and can have a short term effect on your baby. Because these medications cross the placenta, they cannot be given within a few hours of delivery.

Another systemic medication is nitrous oxide. This is a gas that is mixed with oxygen and can be inhaled when you are having pain. While nitrous oxide does not eliminate pain, it will make the pain easier to tolerate. The woman in labor controls when she places the mask over her mouth and nose and inhales.

This medication is only offered at some hospitals. Nitrous oxide is an option for pain control for women delivering their babies at MUSC. If you choose to use nitrous oxide for pain relief during labor, you will meet with our Anesthesia team to discuss this option for pain control. The availability of nitrous oxide is impacted by SARS-COV2 and I would recommend that you discuss this with your provider.

An additional option for pain relief is local anesthesia, which is injected to control pain in the vagina, vulva, and perineum immediately prior to delivery or during the repair of a laceration.

There are other ways to control pain during labor that do not include medications. While these methods do not eliminate the pain, you may find that they help with your ability to cope with the pain. Relaxation and breathing exercises, listening to music, massage, and walking or changing your position during labor may be helpful. A labor support person can also be very helpful as you manage the pain during labor.

Please discuss these options with your obstetrical provider. Every labor is very different and you may find that your preferences change.

Expert(s):
Barbara Head, MD
OB-GYN Maternal-Fetal Medicine
MUSC

Oral Health

Q: My child has some severe crowding and it’s been recommended to have some permanent teeth pulled prior to starting braces treatment. Is there any way to avoid this and if not, how do I prepare my child for this experience?

A: Great question! Orthodontic treatment plans come in all shapes and sizes just like our children. When someone is very crowded, you have to create room for all of the teeth to fit safely and aesthetically within the arch (bone that holds the teeth).

I like to compare it to a crowded city parking lot. You only have two options: You can make the parking lot bigger or you can take cars out of the parking lot.

When making the parking lot bigger there are biologic constraints. You can only make the arch as wide as the bone structure will allow, but things like expanders can create a wider arch to fit the teeth. Additional space can be gained by the front teeth coming forward, but you certainly don’t want your front teeth coming through the door before you do!

Sometimes these outside factors push a treatment plan towards removing teeth. The teeth that are typically used to create space are called “premolars.” There are a pair of these premolars in each quadrant of your mouth so they are GREAT space creators and do not affect chewing function or smile aesthetics. In short, you won’t miss them! The only people who will know you are missing these teeth will be you, your orthodontist, and your dentist.

Bottom line is that extraction versus non-extraction is very case by case dependent. Ultimately, you want the healthiest, most stable, and most aesthetic smile possible for your child.

Prepare you child by letting them know WHY they are having teeth pulled. Assure them that there will not be any space when treatment is over- that is usually their biggest concern. Sometimes I will even put the braces on first so that the extractions aren’t noticeable… you get a hall pass once braces are on- PROMISE! They will be a little sore after the extractions, but most kids heal incredibly fast and are back to normal as early as the next day.

Final thoughts- pick a doctor you trust, ask questions, and make sure you understand the treatment plan. Sometimes this requires a few conferences with your doctor so that everyone is on the same page.

I hope this helps!

Expert(s):
Dr. Katie Bullwinkel
Board Certified Orthodontist
Bullwinkle Orthodontics

Financial

Q: Before meeting with a financial professional, what conversations or “things to consider” do my partner and I need to address?

A: When meeting with a financial professional it is important to think about what your goals for the future are. The conversation tends to focus on where you are now and where you want to be financially. It might be good to know things like how much you have saved in your 401k and what your debt balances are. The more detail you can provide, the better they can help you. It’s also important to think about things like what age you would like to retire at or if you want to pay for your children’s college education.

Some couples are on the same page when it comes to their future goals and some couples are on different pages. That is completely fine and something that a financial professional can help you navigate.

There is no such thing as the “right time” to talk to a financial professional. Usually the sooner, the better. With time on your side, it’s a lot easier to achieve those goals. A financial professional can help you create a plan to reach your goals and help hold you accountable.

Typically someone is what we call the “bill payer.” It’s important that the other spouse is still included in what’s going on and not left in the dark. Holding monthly reviews can help with that.

It’s important that both spouses are respected. If one earns more than the other, that is okay. You are both equal. Be sure that the “breadwinner” does not get to make decisions simply because they make more money.

If you are a newlywed or soon to be married, take the step to a better financial future by scheduling a financial review using the link below.

https://www.newyorklife.com/agent/ctmahoney01

Expert(s):
Caroline Mahoney, Financial Services Professional
Steven Fazio, Financial Services Professional
Riley Knudsen, Financial Services Professional

New York Life, Charleston

Education

Q: I am interested in learning about local private school options and am unsure how to start the search process. Can you share any tips on researching, interviewing, and finding the right fit for my family?

A. What an exciting time for your family! We know the school search process can seem daunting, but we encourage you to look at it as an opportunity – an opportunity to learn about the many educational options in our area and how each one might benefit your child. Just take the process step by step so that it doesn’t become overwhelming.

Determine Your Priorities
Think about what your family is looking for in a school. Some things you might consider include:
• Do you want a more- or less-structured program?
• How far are you willing to travel?
• Do you need after-school care/programs at school?
• What is your budget? Will you be seeking financial aid?
• Do you want a school that mirrors your family’s values?

Do Your Research
Next, visit each school’s website. It should give you a good idea of what the school offers, what the school considers important, and what life at the school looks like. This should help you determine which schools line up with the list of priorities you made.

Get First-Hand Knowledge
Ask friends and neighbors about their experiences at different schools. This first-hand knowledge can give you great insight into what being part of a school is really like. HOWEVER, be sure to remember your list of priorities. Understand that what another family’s child needs may not be what your child needs. What is important to your family may not be the same as what is important to another family. You want to use this input as one of many tools to help you with your decision.

Contact the Schools
Ideally, you would schedule time at each school to take a tour and see the school in action. During this time of school closures, however, this may or may not be possible. If an in-person tour is not an option, you can still speak with an admissions person on the phone. Many schools also offer virtual tours on their websites. Some things to look for or ask on a tour or over the phone include:
• What is the curriculum like? What special area classes does the school offer?
• What is the typical class size?
• How much time do students spend on homework each night?
• What are the lunch options? Is lunch provided by the school or delivered by vendors? Can students bring their own lunches?
• What can students do after school? Is there a program of optional after-school activities? Is extended care available, and for how long?
• What team sports are sponsored by the school and at what grade levels?
• What support systems are in place should a child begin to struggle at school, either academically or socially?
• Where do most students attend school at the next level? (High school or college, depending on the grade range of the school)
• Is financial assistance available for families who may need help with the costs of attendance? What is the application process like for financial assistance?

Make Your Decision
At this point, you have likely determined which school is the best fit for your family. Knowing that you have done your homework and made this decision based on what is important for your student and your family means that you can enroll with confidence, so go ahead and get excited about the year to come!

Expert(s):
Joanne Stemple
Director of Communications
Mason Prep School

Oral Health

Q: Do I need to floss my kid’s teeth if they have spaces in between them?

A: If you can confirm that the toothbrush is able to reach in between the teeth, then it is not critical to use floss yet. While there may be teeth in the front that do not touch, be sure that there are not ones that contact each other in the back. It is very common for younger children to have spaces in between some teeth while others are close together. These tight spaces are very susceptible to early cavity growth.

As parents ourselves, we know children do the best with developing habits at an early age. If they are exposed to flossing while they are young, even if it is to simply play with on their spacious front teeth, they will have already been introduced to floss so that it is not a strange thing in the future. As teeth do begin to touch, flossing nightly is definitely recommended.

Expert(s):
Dr. Mike & Dr. Will

Board Certified Pediatric Dentists
Kids Teeth

Adolescent & Family Therapy

Q: What are some effective ways to discipline and set boundaries and expectations for a toddler?

A: Thank you so much for your question. Boundary and expectation setting is often very difficult for parents during the “terrible two’s,” “threenager,” and “ferocious fours.” Here are a few strategies to help your child recognize and respect boundaries:

Set clear expectations

Before you impose expectations on your toddler, you and your spouse need to prioritize which ones are most significant. Your child will be more likely to remember a small set of expectations (three to five), so start with a short list. Posting them throughout the house ensures your child can see them as he or she moves from room to room. You can even take photos of your child in various situations to remind him how to behave in those circumstances.

Be a role model

Toddlers are very observant, and will watch what you, his or her siblings, and caregivers do. One easy way to teach boundaries is to consistently model desired behaviors. When your toddler is learning new concepts, you can reinforce these teachable moments by using words to describe your choices. For example:
• “I’m walking in the house to my body safe.”
• “I’m putting away my tools so I know where I can find it.”

Offer choices and consequences

One of the reasons it is difficult to discipline toddlers is that at their stage of development, they are learning to assert their independence and often want to do things by themselves. Offering your toddler two acceptable choices allows him or her to decide and can dissuade him or her from unnecessarily pushing her boundaries. Rather than enforcing a strict rule, giving options allows your child to feel empowered and independent.

Once we have defined our expectations, boundaries then must be consistently applied. When children understand boundaries, they can apply them in a variety of situations. As a parent, you will then be able to apply guidance with a much lighter touch. Through establishing and enforcing consistent expectations, parents can help their toddlers understand what is acceptable and what is inappropriate behavior.

Commend your child for obedience

It is very easy to focus only on negative behavior and forget to praise positive actions. If your child is making good choices, point them out! As you reinforce the desired behaviors, your expectations are also reaffirmed. Make your praise sincere and frequent. You want to let your child know you see and appreciate the positive choices he makes as you guide him toward wisdom, obedience, and respect for others.

Expert(s):
Ashlin Blum
Executive Director
Empowered Family

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