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Kids and adults these days eat way too many simple sugars. I believe sugar is “The Great Evil” and we should limit it in our diets. Here are some basic rules:

1)  Do not drink soda, lemonade, Kool-Aid, or flavored milk – unless at a party.

2) Do not drink juice – unless constipated.

3) Do not drink Gatorade or Powerade – unless exercising in over 90 degree weather for more 2 hours.

4) Drink water and white milk.

5) Eat fruits/veggies/Greek yogurt/cheese/nuts/nut butters for snacks, not crackers, cookies, chips, fruit snacks, candy.

6) Eat 2 fruits and 2 veggies a day, minimum.

7) EAT MORE PROTEIN:  kids need 0.5 grams of protein per pound of body weight per day.
a. Toddlers 30 to 40 pounds need 15 to 20 grams a day

b. Kids 50 to 80 pounds need 25 to 40 grams per day

c. Teens more than 90 pounds need 45 grams for girls and 55 for boys

8) FAT IS NOT BAD:  We all need fat to live.  We need to be smart about what types we eat.  Limit trans fats found in foods such as fries, chips, cookies, donuts, cakes, chicken nuggets, etc.

9) Forty percent of your calories should come from protein, 30 percent from fats, and 30 percent from carbohydrates.

The reason for all of these is that simple sugars get broken down in your system very quickly, get used or stored very quickly, which leaves you hungry very quickly. Eat protein and fat and you will feel full longer and keep your blood glucose levels lower and steadier overall.


This booklet provides some ideas of meals and/or entrees that contain less simple sugars and more protein and fat. If sides are needed, add in fruits or vegetables. Use less simple sugars like bread, rice, potatoes, chips. If your child is hungry after a meal, eat something with protein in it, or a fruit or vegetable. Not simple sugars like cookies, candy, fruit snacks, cereal, cake. 


1. Steel cut oats: NOT instant oats. Prepare in the AM or the night before. Top with berries, chopped nuts, cinnamon, milk, peanut butter, granola or yogurt.

2.  Eggs: Hard boiled eggs, soft boiled eggs, scrambled eggs, quiche, omelets, over-easy eggs, sunny side up eggs, “Toad in a hole” eggs, poached eggs. Keep trying different kinds until your kids will eat them. Top them with cheese.  Put them in a tortilla.

3.   Bacon/sausage/ham

4.  Natural peanut butter – this means no sugar added. My favorite brand is Smucker’s Natural Creamy. Put it on toast, a waffle, or apple slices.

5. Greek yogurt. FULL FAT, NOT THE EVER-PRESENT LOW FAT VERSIONS. Top with berries, cherries, cinnamon, honey, granola.

6.  Cold cereal. Be sure the following criteria are met so you aren’t feeding the equivalent of a bowl of sugar:

a.“Whole Grains” listed as the first ingredient

b. Sugar (or corn syrup, high fructose corn syrup, etc) is NOT listed as one of the first 2 ingredients

c. 4 grams of fiber per serving.

7.  Last night’s dinner. Some kids just don’t like breakfast foods. Serve them leftover chicken, steak, pizza, enchiladas, a BLT, etc.

***Try to serve a fruit (NOT  JUICE) with breakfast and milk to drink.***


Lunch Pack your child’s lunch on days the school lunch is nasty or nutritionally deficient. Oh wait, that might be every day!

1. Sandwich. Only use “Whole Grain” bread. Even better is “Stone Ground” or “Whole Kernel”. Don’t be fooled by “wheat flour” or “unbleached wheat flour” or “enriched wheat flour”.  These last 3 digest way too fast.
a. Or use “Whole Grain” tortilla, English muffin, or pita bread. Add chicken, turkey, salmon, tuna or egg salad

b.  Add lettuce, tomatoes, onion.

c.  Add hummus, ketchup, mayo, mustard, relish, salsa.

2.  PB and J. This can be a healthy lunch if “Whole Grain” bread is used and natural peanut butter is used. For the jam or jelly, be sure the first ingredient on the label is fruit, NOT sugar. You could replace the jelly with a sliced banana.

3.  BLT with cheese. Use five pieces of bacon to make it more filling.

4.  Soup. Choose one with real ingredients, not chemicals. Pack with cheese wedge and whole grain crackers. Send in a thermos so it will stay warm.

5.  Any leftovers from dinner the night before.

See the next page for more lunchtime info,

6.  Chili. Send in a thermos with shredded cheese and whole grain bread or crackers.

7.  Turkey Club Skewers.
Prep time 15 minutes. Makes 8 skewers


·  8 slices whole grain bread (toasted & cut into fourths (3 pieces per skewer)

·  16 slices cheese (2 slices per skewer), any type is fine

·  8 slices bacon, cooked and cut into fourths (4 pieces per skewer)

·  16 slices of tomatoes or 16 grape tomatoes (2 per skewer)

·  16 small pieces of lettuce (2 per skewer)

·  16 slices of avocado, cubed (2 per skewer)

·  Sauce, if desired (Thousand Island dressing)

·  8 large skewers


If using sauce, spread sauce on bread and skewer the piece with the sauce side facing down.

Next slide on a piece of turkey (folded into fourths), a piece of cheese, a piece of bacon, a slice of tomato, a piece of lettuce, slice of avocado, piece of bacon, slice of turkey.

Slide on another piece of bread and repeat steps above, finishing with a slice of bread with sauce side facing meat.  



1. Crockpot Chicken Tacos.

Serves 4

Use “Stubbs Hatch Chile Cookin’ Sauce”. Cook on low in crockpot according to directions for 6 to 7 hours.  Serve in tortillas with lettuce, cheese, tomatoes, and avocados. DELICIOUS!

2. Pecan Crusted Chicken.
Prep time 10/Cook 45 minutes.

Serves 4


·  1/2 cup spicy brown mustard

·  2 Tablespoons raw honey

·  1 cup pecans, crushed

·  4 boneless, skinless chicken breasts


Pre-heat oven to 350 F. In medium mixing bowl, whisk mustard and honey.

Pulse pecans in food processor until finely chopped. Pour into large bowl.

Blot chicken dry with paper towels. Roll chicken one breast at a time in mustard-honey mix, coat both sides.

Transfer coated chicken into pecan bowl and coat both sides.

Place crusted chicken into greased glass baking dish & sprinkle with sea salt. Bake 45 minutes or until juices run clear.

3. Paleo Chicken Fingers.
Prep time 10/Cook 16 to 18 minutes.
Serves 4


·  1 pound chicken tenders

·  1 egg, beaten

·  1/2 cup almond meal

·  1/2 teaspoon salt

·  3/4 teaspoon paprika


Heat oven to 425 F. Line large baking sheet with parchment paper.

Combine almond meal with spices on shallow plate. Place beaten egg in separate dish.

Dry chicken with paper towel.  Dip in egg then almond meal mixture coating both sides. Place on baking sheet. Bake 16 to 18 minutes, turning over halfway thru, until internal temp is 180.

4. Bacon Lettuce Tomato sandwich

5. Turkey Club Skewers (See recipe with Lunch)

6. Bacon, eggs, fruit

7. Slow Cooker Cilantro Lime Chicken.
Prep time 10 minutes/Cook 6 hours
Serves 6-8


·  24 ounce jar medium or mild salsa

·   1 lime, juiced

·   1/4 cup fresh chopped cilantro

·   1.25 ounce packet taco seasoning

·    2 jalapeno peppers, finely chopped (optional)

·    4 to 6 boneless skinless chicken breast halves


In crockpot mix salsa, lime juice, cilantro, taco seasoning, peppers.

Add chicken and coat with mixture.

Cover and cook on low for 6 hours.

Serve with sour cream, crushed chips, rice, or in tortillas or tacos

8.  Oven Baked Ranch Chicken Tenders

Prep time 8/Cook 16 to 18 minutes.  Serves 3 to 4


·  12 chicken tenders

·  4 tablespoons olive oil

·  1 cup ranch dressing

·  1 tablespoon milk

·  1 cup Bisquick

·  1/2 teaspoon black pepper

·  1/2 teaspoon paprika

·  1/2 teaspoon salt


Preheat oven to 475. Line large baking dish with foil.  Drizzle 2 TBSP oil over bottom of pan.

In large Ziploc, pour in ranch and milk. Add all tenders, zip back (get all air out), and shake or massage bag until all tenders coated. Marinate 15 minutes.

In large Ziploc add Bisquick, paprika, salt, pepper. Add marinated tenders to bag, zip up and shake until all tenders are coated.

Place chicken flat in baking dish, being sure they don’t touch each other. Drizzle 2 TBSP oil over top of chicken.

Bake 8 to 10 minutes (until underside golden brown), then carefully flip over and bake another 9-10 minutes.

Serve with extra ranch, BBQ sauce, etc.

9  Pizza.
Prep 10/Cook 10 – 15 minutes. Serves 2-3


·  Flatout Light” Flatbread -- 6 carbs per flatbread - available at Hyvee, Walmart, Target, Hen House

·  9 ounces tomato paste

·  3 Tablespoons Italian seasoning

· 3 Tablespoons Italian seasoning

· 4 Tablespoons shredded parmesan cheese

· 1/2 cup shredded mozzarella cheese

· 1/2 cup shredded cheddar cheese

· Any veggies or meats you would like.



Preheat oven to 425 F.

Place flatbread on pizza pan.

Combine tomato paste and seasoning in bowl, then spread over flatbread

Sprinkle cheese evenly over pizza

Add any veggies or meats you’d like

Bake for 10 to 15 minutes

       The recipes in this book came from:

  • Dr. David Ludwig’s book Always Hungry
  • Cookingclassy.com from Pinterest
  • A Latte Food from PInterest
  • ThePaleoMom.com
  • Pip and Ebby from Pinterest-Sarah Fragoso’s book Everyday Paleo
  • Amy Kyle – mom of four who feeds her kids “keto” diet.

February 23, 2017/March 3, 2017 / Bert Fulks 
Visit Bert Fulk’s web site

Friends, as most of you know, I get to spend an hour each week with a group of young people going through addiction recovery. Yes. Young people. I’m talking teenagers who are locked away for at least six months as they learn to overcome their addictions. I’m always humbled and honored to get this time with these beautiful young souls who have been so incredibly assaulted by a world they have yet to understand. This also comes with the bittersweet knowledge that these kids still have a fighting chance, while several of my friends have already had to bury their own children.

Recently I asked these kids a simple question: “How many of you have found yourself in situations where things started happening that you weren’t comfortable with, but you stuck around, mainly because you felt like you didn’t have a way out?”

They all raised their hands.

Every single one of them.

In the spirit of transparency … I get it. Though in my mid-forties, I’m still in touch with that awkward boy who often felt trapped in the unpredictable currents of teenage experiences. I can’t count the times sex, drugs and alcohol came rushing into my young world; I wasn’t ready for any of it, but I didn’t know how to escape and, at the same time, not castrate myself socially. I still recall my first time drinking beer at a friend’s house in junior high school—I hated it, but I felt cornered. As an adult, that now seems silly, but it was my reality at the time. “Peer pressure” was a frivolous term for an often silent, but very real thing; and I certainly couldn’t call my parents and ask them to rescue me. I wasn’t supposed to be there in the first place. As a teen, forcing down alcohol seemed a whole lot easier than offering myself up for punishment, endless nagging and interrogation, and the potential end of freedom as I knew it.


For these reasons, we now have something called the “X-plan” in our family. This simple, but powerful tool is a lifeline that our kids are free to use at any time. Here’s how it works:
Let’s say that my youngest, Danny, gets dropped off at a party. If anything about the situation makes him uncomfortable, all he has to do is text the letter “X” to any of us (his mother, me, his older brother or sister). The one who receives the text has a very basic script to follow. Within a few minutes, they call Danny’s phone. When he answers, the conversation goes like this:

“Danny, something’s come up and I have to come get you right now.”
“What happened?”

“I’ll tell you when I get there. Be ready to leave in five minutes. I’m on my way.”

At that point, Danny tells his friends that something’s happened at home, someone is coming to get him, and he has to leave.

In short, Danny knows he has a way out; at the same time, there’s no pressure on him to open himself to any social ridicule. He has the freedom to protect himself while continuing to grow and learn to navigate his world.

This is one of the most loving things we’ve ever given him, and it offers him a sense of security and confidence in a world that tends to beat our young people into submission.

However, there’s one critical component to the X-plan: Once he’s been extracted from the trenches, Danny knows that he can tell us as much or as little as he wants … but it’s completely up to him. The X-plan comes with the agreement that we will pass no judgments and ask no questions (even if he is 10 miles away from where he’s supposed to be). This can be a hard thing for some parents (admit it, some of us are complete control-freaks); but I promise it might not only save them, but it will go a long way in building trust between you and your kid.

(One caveat here is that Danny knows if someone is in danger, he has a moral obligation to speak up for their protection, no matter what it may cost him personally. That’s part of the lesson we try to teach our kids—we are our brother’s keeper, and sometimes we have to stand for those too weak to stand for themselves. Beyond that, he doesn’t have to say a word to us. Ever.)

For many of us parents, we lament the intrusion of technology into our relationships. I hate seeing people sit down to dinner together and then proceed to stare into their phones. It drives me nuts when my kids text me from another room in our house. However, cell phones aren’t going away, so we need to find ways to use this technology to help our kids in any way we can.

Since first publishing this piece, I’ve seen an incredible amount of discussion about the pros and cons. Here are some of the questions folks have had:

Doesn’t this encourage dishonesty?

Absolutely not. It actually presents an opportunity for you as a parent to teach your kids that they can be honest (something DID come up, and they DO have to leave), while learning that it’s okay to be guarded in what they reveal to others. They don’t owe anyone an explanation the next day, and if asked can give the honest answer, “It’s private and I don’t want to talk about it.” Boom! Another chance for a social skill life-lesson from Mom and Dad.

Does this cripple a kid socially instead of teaching them to stand up to others?

I know plenty of adults who struggle to stand up to others. This simply gives your kid a safe way out as you continue to nurture that valuable skill.

What if this becomes habitual?

If you’re regularly rescuing your kid, hopefully your family is having some conversations about that.

If you don’t talk about it or ask questions, how do they learn?

If you’re building a relationship of trust with your kids, they’ll probably be the ones to start the conversation. More importantly, most of these conversations need to take place on the FRONT-side of events. Ever taken a cruise? They all make you go through the safety briefing in case the boat sinks. They don’t wait until the ship’s on fire to start telling you about the lifeboats. Talk with them. Let your kids ask questions and give them frank answers.

If they’re not where they’re supposed to be, shouldn’t there be consequences?

Let’s be honest. A kid in fear of punishment is a lot less likely to reach out for help when the world comes at them. Admitting that they’re in over their heads is a pretty big life-lesson all by itself. However, don’t get so caught up in all of the details. This isn’t a one-size-fits-all scheme. Every parent, every kid, and every situation is unique. What it might look like in your family could be totally different from mine—and that’s okay.

I urge you to use some form of our X-plan in your home. If you honor it, your kids will thank you for it. You never know when something so simple could be the difference between your kid laughing with you at the dinner table or spending six months in a recovery center … or (God forbid) something far worse.

At the end of the day, however, the most important thing is that you’re having some open, honest discussions with your kids. Keep building a relationship of trust. This isn’t the same world we grew up in. It’s not like sneaking a beer at Billy’s house anymore. Our kids face things on a daily basis that—given one bad decision—can be fatal. Don’t believe me? I’ve been to funerals for great kids from awesome families.

Friends, it’s a dangerous world. And our kids are out in it every day.

Prayers for strength and compassion to the parents out there as we all try to figure out this whole parenting gig—it never gets easy.

I beg you to share this piece. Talk about it with your kids. If this somehow gives just one kid a way out of a bad situation, we can all feel privileged to have been a part of that.

By Christine P. White, MD, FAAP
July 11, 2017
Category: Uncategorized
Tags: Untagged

– A question I hear regularly from parents of my patients.  Their child may be 2 weeks old or 20 years old.  The majority of the time the answer is, “No, your child does not need any vitamins”.  I can almost always tell parents that because their child is growing well, eats a well-balanced diet with a good mix of fruits and vegetables, animal protein sources such as chicken, turkey, beef and fish and consumes a healthy amount of calcium-rich foods he or she does not require a vitamin. Over the course of the next few weeks I’ll discuss some cases where these criteria may not be met, and it may be advantageous for your child to take a supplement.

The first group we’ll discuss are newborns and infants up to one year of age. Vitamin D is one supplement required by all members of this group. Our bodies must have vitamin D to absorb calcium and promote bone growth.  Too little vitamin D can result in rickets, a softening and weakening of bones.  Vitamin D also helps regulate the immune system as well as helping with nerve and muscle function. 


Vitamin D is so important our bodies can make it –but only after skin exposure to sufficient sunlight.  If you live north of a line drawn from Los Angeles to Columbia, South Carolina, you probably aren’t getting enough sunlight for vitamin D production throughout the year.  Kansas City is definitely north of this line.  For more information on how to get enough vitamin D through sunlight alone, click here.  Of course, this can put you at risk for skin cancer if you get too much sunlight. 

The other way to get vitamin D is through food or supplements.  Many Americans don’t consume enough foods high in vitamin D – such as salmon, mackerel, mushrooms, cod liver oil, tuna, sardines, or cow’s milk/yogurt/cheese fortified with vitamin D – to keep from becoming deficient in vitamin D.  A study in the journal Nutrition Resource in January of 2011 showed 42 percent of Americans were vitamin D deficient – which they defined as a vitamin D level less than 20 ng/ml.  This means 42 percent of new moms are likely vitamin D deficient, and this leads to a newborn deficient in vitamin D. 

Breast milk has everything a newborn needs – except vitamin D.  Babies born to mothers who are NOT vitamin D deficient are still at risk for becoming deficient, seeing as they definitely don’t eat enough of the above vitamin D rich foods.  They need to be given a supplemental form in a dose of 400 International Units (or IU) per day.  D-vi-sol™ and Tri-vi-sol™ can be found at most pharmacies and grocery stores.  They contain 400 IU vitamin D per 1 ml.  They taste decent and are really free of side effects.  They can be given alone or mixed with breast milk, formula or food.
So, if your baby is exclusively breast fed, he should start vitamin D supplementation with 400 IU in the first few days of life and continue it for the first year.  If your baby is fed both breast milk and formula, she should start 400 IU vitamin D in the first few days of life and continue for the entire first year, or until she is consuming 32 ounces of formula.  This is the amount of formula required to provide 400 IU of vitamin D.  Therefore, if your baby is fed formula from birth, he should receive 400 IU vitamin D supplementation until he is taking 32 ounces of formula a day.  This may not happen until around 3 to 4 months of age for some babies.
Recently there has been more evidence (Pediatrics, September 2015) that maternal supplementation with 6,400 IU of vitamin D per day will provide her breast-fed infant with 400 IU vitamin D per day through breast milk alone.  This is an alternative to supplementing the infant.  However, mothers should check with their health care providers to see if this dose is safe for them to take, as many references recommend the highest dose an adult should take is 4000 IU of vitamin D per day.  Side effects of too much vitamin D include weakness, fatigue, loss of appetite, dry mouth, metallic taste, nausea and vomiting. 

The other supplement needed by infants is iron.  Iron is important for brain growth and development.  It is also required for making red blood cells. Healthy, full-term infants (at least 37 weeks gestational age) have enough iron stored up from their time as a fetus to last them the first 4 months of life.  After 4 months of age, they need 10 mg of iron per day to prevent iron deficiency.  Symptoms of iron deficiency anemia may include:  pale skin, fatigue or weakness, irritability, shortness of breath, and inflammation of the tongue. Often babies with anemia show no symptoms at all.  Long-term iron deficiency can lead to decreased attention, reduced alertness and learning problems in children. 

Infant formula (with the exception of low-iron formula – which should never be used) contains about 2 mg of iron per 5 ounces of formula. Therefore babies who are exclusively formula-fed will get plenty of iron.  Babies who are fed both breast milk and formula who get at least 25 ounces of iron fortified formula a day do not require a supplement.  Those infants taking less than 25 mg of formula a day or who are exclusively breastfed should take a supplement.  The easiest one to find is Poly-vi-sol™ with Iron.  This provides 10 mg of iron per 1 ml of supplement.  It also provides the 400 IU of vitamin D these babies need each day. 

Cow’s milk formula should not be started until after 12 months of age as it doesn’t contain iron, so be sure to continue formula feeding up until 12 months of age, or to continue iron supplementation until 1 year of age if you are breast feeding. 

Another way to add iron to an infant’s diet is to feed your baby foods high in iron such as iron fortified baby cereals and leafy green vegetables such as spinach.  As she gets older feed her beans, chickpeas, lentils, eggs and eventually chicken and red meat.   
Premature infants (born before 37 weeks gestational age) should receive iron supplementation from birth.  Much of an infant’s iron stores are accumulated in the last few weeks of pregnancy, so these premature babies need the supplement from day one.
If you have any questions about vitamin D or iron needs for your child, please discuss them with your pediatrician.

By Christine P. White, MD, FAAP
July 11, 2017
Category: Uncategorized
Tags: Untagged
  • How you care for your baby’s teeth will set the stage for their oral health for the rest of their lives. That’s a big deal. Baby teeth are the place holders for the permanent teeth. If they decay, they may have to be removed. The gums may develop gingivitis. Permanent teeth will be affected by more pathologic bacteria.
  • From the time your baby’s first tooth comes in, you should be brushing that tooth, and any others, TWICE a day. With toothpaste. (See number 4.)

Once your baby has a tooth, you should not give him/her any milk or food at night. Feed the last bottle or breastfeeding before bed; brush their teeth, then no more “milk” until 6 or 7 AM. Night feeds lead to baby bottle caries.

  1. Before your child is old enough to spit the paste out reliably, use only a rice-sized dot of paste on the toothbrush. It is OK if they swallow this tiny amount of fluoridated paste.
  2. Once your child can spit, use a pea-sized amount of paste.
  • Once your child is 4 or 5 years old, she can brush her teeth once a day after breakfast. YOU, the parent, must continue to brush your children’s teeth for them at bedtime until they reach the age of 10 years. Yes, that is old. But until that age children lack the fine motor control to brush efficiently.
  • Once ANY two of their teeth are touching, those teeth must be flossed. Daily.
  • Your child should see a dentist once they have 6 to 8 teeth. This is usually around age 12 to 15 months. Yes, that is young.
  • Don’t share your oral bacteria with your baby/child. Don’t put their pacifier in your mouth before giving it to them. Don’t share utensils with them. Your bacteria are likely nastier to teeth than their new naïve bugs.
  • YOUR CHILD DOES NOT NEED TO DRINK JUICE. IT IS NOT HEALTHY. At any age juice should only be used as medicine – to help with constipation.
  • Your child’s snacks should usually consist of fruits/vegetables, cheese sticks, Greek yogurt sticks, lunch meats, etc. NOT Goldfish and other crackers, pretzels, puffs, veggie straws, etc. These simple carbs stick to their teeth and provide a buffet for the bacteria.
  • Your children will NOT remember to brush twice daily and floss each night. No matter what their age, YOU have to remind them to brush and floss. Then you have to remind them again. Then you have to go feel their toothbrush to be sure it’s wet. And you have to do this every night.
  • As long as you live in the city limits, use tap water for any of their water needs: to make formula, to brush teeth, to drink. They need the fluoride in the tap water to strengthen their enamel. The recommended level of fluoride in drinking water is 0.7mg per liter of water, or 0.7 parts per million. Check with your water provider to see if your children are getting enough fluoride in their water.
By Christine P. White, MD, FAAP
July 11, 2017
Category: Uncategorized
Tags: Untagged

"Ummmm, I think he has a brown one, but he only uses the red one now."

This is a common answer I hear when I ask a parent which inhalers their child is taking for their asthma flare. "The brown one" is likely Qvar – an inhaled steroid or anti-inflammatory inhaler. "The red one" is likely ProAir – a bronchodilator or rescue inhaler.

This blog doesn't go into what asthma is or how to diagnose it. This blog will try to explain what the different medications are that are used to treat asthma, how they work, and when they should be used, etc. I think this information is misunderstood by the majority of parents who have kids with asthma. And I don't blame them. It can be confusing to know what to start and when, and how long to continue it. But I think if you understand WHY you are using something and WHAT it does at the cellular level, then you will understand WHEN to use which inhaler and for how long.

I'm using the term "asthma". But you should take this to encompass a diagnosis of recurrent "wheezing" as well as "reactive airways disease". Infants or kids that have only wheezed once or twice in their lives (like with bronchiolitis) don't necessarily need to be on these medications. Sometimes you just get a bad bug and it makes you wheeze for the duration of that cold – but you never do it again. Kids with asthma wheeze and cough with almost every cold they get – and they cough for weeks with most colds.

Asthma is the most common chronic disease of childhood. The prevalence of asthma is increasing. This is also the case with other allergic conditions, including eczema, seasonal allergies, and food allergies. According to recent CDC data, asthma affects approximately 8.5% of the pediatric population in the U.S., or more than 7 million children. Asthma accounts for more school absences and more hospitalizations than any other chronic condition in this country.

Before we go over the main meds we use to treat asthma, lets look at what causes the cough and wheeze – at the cellular level. There are two main things that occur: the muscles around the tiny airways constrict which tightens the airway or closes them off somewhat. And inflammatory cells along the airway release chemicals and mucus into the airway. When you have asthma, you have to treat BOTH of these components to adequately treat the problem.

Medications that relax the muscles around the airways are called "bronchodilators". Albuterol (brand names ProAir, Proventil, Ventolin, Maxair, and Xopenex) is an example of a short acting bronchodilator meaning it's effect on the muscles lasts about 4 to 6 hours. There are some longer acting bronchodilators (salmeterol, formotorol found in Advair, Symbicort, and Dulera for example) that can be used for more persistent cases of asthma.

The most commonly used anti-inflammatory asthma meds are inhaled steroids. Examples of these are Qvar, Flovent, Pulmicort, Asmanex, and budesonide.

For the sake of this article, we are going to consider the most common type of asthmatic seen in an outpatient clinic or the ED: that is the infant or child who does totally fine with their breathing when they have no cold or viral illness, but as soon as they get a cold they start to cough and possibly wheeze. This is the kid whose parent knows the kid is supposed to be taking some inhalers when they get sick, but they don't exactly know which one to start first, when to start it, or how often or long to use it. Now, there are a few of you out there that have this figured out, so don't be offended and scream at your computer, "Hah! Dr. White, I know how to use the inhalers!" You are the minority, and I'm proud of you.

For the rest of the world, here's a simplified way to use your child's inhalers. The second he even has a hint of a cold – you start the inhaled steroid. That's your Qvar or Flovent inhaler or Pulmicort/Budesonide (in the nebulizer). You do it the second you get them home from daycare or school that day. You don't wait 2 to 3 days to see how bad this cold is going to get. You don't wait to see if they'll get a cough. You do it if they sneeze a few times and they have a touch of nasal congestion. The reason you jump on it so soon is because these inhaled steroids are going to act on those inflammatory cells in the airways to keep them from releasing all their chemicals and mucus that fill up the airways during an asthma flare. If you wait until the cold is in full nasty mode you have missed your chance to really shut those cells down. You will use the inhaled steroid twice a day for the duration of the cold plus three more days. You have to keep this one going until you haven't heard any cough or seen boogers for 3 days!!!

Now the albuterol you will use when you start to hear a cough. If the cough is mild, infrequent, not interfering with play, sleep, daily life – you can probably do the albuterol twice a day – like AM and PM when you are doing your inhaled steroid. If the cough picks up in frequency, your child coughs with play, coughs during sleep you need to increase the frequency of the albuterol, perhaps to every 6 hours. If the cough is severe, almost constant, keeping the child from playing or keeping him up at nite – you should do the albuterol every 3 to 4 hours. If you are needing to use the albuterol more often than every 3 hours, that child needs to be seen. Once the cold/cough have peaked and things start to improve, you can start to wean down the frequency of albuterol doses. About every 2 days you can take a way a dose as long as you feel symptoms are improving.

Anytime you use an inhaler, you should use a spacer (except with breath activated inhalers such as ProAir Respiclick or Pulmicort Turbohaler for example). If you try to do your inhaler without a spacer you will end up getting the majority of the medicine deposited on your tongue or throat because the medicine shoots out so fast. If you use your spacer the majority of the medicine will make it's way to your lungs. It doesn't matter if you're 4 years old, 14 years old, or 40 years old – USE YOUR SPACER.

The proper way to do inhalers is to shake up the medicine, insert in the spacer, do one puff and take 5 normal to big breaths. Wait one minute and repeat. If you just did your inhaled steroid you should get a drink to rinse your mouth so you won't get thrush.
This information is generalized and you should check with your pediatrician to see if your child needs this plan tweaked. If you have more persistent or severe asthma, you will likely have a more aggressive asthma plan to follow.