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Daily Dose

Stop Bugs from Biting!

1:30 to read

We are in the throes of mosquito season and with concerns about Zika, West Nile Virus and ckikungunya it is a good time to revisit insect repellents.  The mosquito threat from Aedes mosquitos is especially relevant in the southern and southeastern parts of the United States as these are the mosquitos which carry both Zika and chikngunya. The Culex mosquito species which carries West Nile Virus has been found in all of the continental United States. 

One of the best way to prevent disease is by controlling the mosquito population which means eliminating areas where mosquitoes breed. This means draining standing water!! I find myself outside draining flower pot saucers after watering or an unexpected summer thunderstorm. I am also always changing the dogs water bowl. I am trying to be vigilant about eliminating standing water.

It is also important to try and limit exposure to mosquitos during dusk and dawn which is the prime time for getting bitten, but with that being said, the Aedes mosquitoes seem to be around all day. Wearing protective clothing which is light in color with long sleeves and long pants is  helpful, but is hard to do when it is over 100 degrees everyday and your children want to play outside. 

So, insect repellents are an important part of protecting your children from bites and possible disease exposure ( although children typically do better with these mosquito born viruses than pregnant women, adults and the elderly). There are many products out there to choose from but the insect repellents with DEET have been studied for the longest period of time.

When picking an insect repellent you want to make sure they have been proven to work (efficacy), they should be non-irritating and non toxic and preferably won’t stain your clothes. Cost is also an important consideration.

DEET has been the most widely used ingredient and has been studied and has good safety and efficacy data. DEET works not only against mosquitoes but also ticks, chiggers, fleas, gnats and some biting flies.  Repellents contain anywhere from 5 - 100% DEET, but the AAP recommends that children use products containing up to 30% DEET. There is no evidence that DEET concentrations above 50% provide any greater protection. DEET has also been shown to be safe when used in pregnant women which is particularly important with possible Zika exposure.

Picardin is another repellent that has been widely studied. It comes in concentrations of 5-20% and is odorless, does not damage clothing and has low risk for skin irritation.  The AAP recommends using products for children that contain up to 10% picardin. 

Oil of eucalyptus has been shown to be effective in preventing mosquito bites but it is not approved for use in children under 3 years of age.

Citronella and other oils have shown very little efficacy against mosquito bites and are not recommended.

So, when choosing a product I would start with a lower DEET or picardin concentration depending on your child’s exposure and go up in concentration as needed. Typically, the higher the concentration of DEET or picardin the longer the protection. As you know, some people seem to be bitten more often than others (all sorts of hypothesis about this) so you may use different products on different family members depending on age, frequency of getting bitten and expected exposure ( i.e.. playing in the yard vs a camping trip).

Once again, start reading the labels and then apply the repellent to skin and clothing. Do not use a combination insect repellent and sunscreen, they should be applied separately.  After the kids come in from playing at the end of the day a good bath with soap and water is important  to wash off the repellent.

Daily Dose

It's Important To Check A Child's Blood Pressure

When you take your child in to the pediatrician for a check- up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked. In certain circumstances a younger child should have their blood pressure checked too.

With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height. When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure. If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

Swim Lessons Can Reduce Risk of Drowning

1:15 to read

Now that hot weather is with all of us, the issue of childhood drowning is an ever-present concern. The American Academy of Pediatrics recommends that after the age of five years, all children be taught to swim. The AAP does not recommend for or against swimming lessons as a measure to prevent drowning in children younger than five years. Between 2000 and 2005, 6,900 children died from non-boating accidental drowning. The rate of drowning was almost four times higher for children one to two years of age, and twice as high for those younger than five.

An article in Archives of Pediatric and Adolescent Medicine looked at the association between swimming lessons and risk of drowning specifically in the one to four year old age groups. Previous concerns had been raised about the potential for swimming lessons to increase the risk for drowning in younger children. This study provided good news that kids aged one to four who have taken formal swimming lessons have an 88% less risk of drowning. Researchers found that only three percent of the children who had drowned had taken swimming lessons. So with this news, it might be prudent to start swimming lessons at a younger age than previously thought.

But swimming lessons alone will not prevent drowning and even in this study, many of the older children who drowned were noted to have been proficient swimmers. It is still important to have other drowning prevention strategies in place including pool fencing (some parents with pools feel like their child will not be able to unlock a door and head to the pool and do not have a fence in place, and I totally disagree with that argument), constant and age appropriate adult supervision and training in CPR. Children are amazing at finding ways to unlock doors, and windows that lead outside and no parent can know where their child is for every minute of the day. If you have a pool and a child is missing always check the pool first, as a child can quietly slip into the water and lose consciousness in as little as two minutes and drown in five minutes.

That's your daily dose, we'll chat again tomorrow.

Daily Dose

How To Prevents SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito….. rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

Daily Dose

Summer Viruses Are Gearing Up

1.15

Is it hot enough for you? Summer is here for a bit! Winter viruses are a distant memory (good bye flu and RSV), summer viruses which have been laying dormant are once again rearing their angry heads.

My office has been overflowing with really hot feverish kids of all ages.   I think the most likely culprit for much of the illness we are seeing right now is an enteroviral infection.  For some reason, it makes us parents feel better if we can “name that virus”, seems to help validate the illness.  

Enteroviral infections typically cause a non-specific febrile illness and with that you can see fairly high fever. In other words, just like the thermometer as summer heat arrives , 101-104 degrees of fever is not uncommon in these patients.  Remember the mantra, “fever is our friend”. I think it is almost worse to have a high fever in the summer as you are even more uncomfortable because it is already hot!

With that being said, if your child has a fever, don’t bundle them up with layers of clothes and blankets.  It is perfectly acceptable to have your younger child in a diaper and t-shirt, and older children can be in sundress or shorts rather than long sleeves and pants.  Bundling may increase the body temperature, even while you are driving to the doctor’s office. I often come into a room with a precious baby who is running a fever and they are wrapped in blankets, let them out! That hot body needs to breathe.

These summer enteroviruses may cause other symptoms as well as fever, so many kids right now seem to have sore throats and are also vomiting and having diarrhea. With this type of virus you also hear complaints of headaches and body aches (myalgias).  The kids I am seeing don’t look especially sick, but they do feel pretty yucky!  Just kind of wiped out, especially when their temps are up.

Besides treating their fevers, treat their other symptoms to make them comfortable.   If they are vomiting do not give them anything to eat and start giving them frequent sips of liquids such as Pedialyte (for the younger ones) and Gatorade or even Sprite or Ginger Ale. Small volumes are the key. 

I often use pieces of Popsicle or spoonfuls of a Slurpee to get fluids in kids. I always tried to pick drink colors for my own kids that were easier to clean up, in case they were going to vomit again, so no bright red!  The cold fluids may also help to soothe a sore throat. Once the vomiting has stopped, and it is usually no more than 12-24 hours, you can start feeding small amounts of food, but I would steer away from any dairy for a day or two. Again, nothing worse than thinking your child is over vomiting, fixing them I nice milkshake (comfort food) and seeing that thrown up!  Many a mother has come into my office wanting to strip after being vomited on, in a hot car no less.   I don’t think there is a car wash around that can fully get rid of that smell!

Most enteroviral infection last anywhere from 2-5 days. There are many different enteroviruses too, so you can get more than one infection during the season. This is not just a virus you see in children, so watch out parents you may succumb as well. Keep up good hand washing and your child should stay home from school, the pool, camp, day care etc. until they have been fever free for 24 hours. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

An Infected Toe: Ouch!

iPhone App question for Dr. Sue: what to do for an infected toe?It's media office day and I just received an email via our new iPhone App (The Kid’s Doctor) from a parent who has a child with an infected toe.  I suspect that her child might be a ‘toenail’ picker which often leads to a local infection along the edge of the toenail.

This seems to involve the ‘great toe’ more often than other toes, due to the development of an ingrown toenail. I also seen it when a child or parent has cut the toenail too short and the toenail wants to grow down into the skin rather than ‘out’. Because the edge of the nail has penetrated the skin, and therefore there is a break in the skin, bacteria (remember our feet are dirty) can easily get into the skin and cause a local infection. The term for an infection of the toenail is a paronychia. But, regardless of the fancy term, it causes an infection which is painful. On occasion if the infection is minimal and you recognize it early you can treat it by using warm water soaks with an antibacterial soap and then applying a topical antibiotic such as Polysporin or a prescription called Mupiricin (many parents may have this from their doctor for a previous skin infection for a child after a bite or something). If the toe is getting more red, inflamed and tender then this will require a visit to your doctor. When I see a paronychia in the office I typically treat it with not only local care, but with an oral antibiotic that treats skin infections.  If there is a lot of “pus” at the site (some can get really bad before they are seen) then I like to take a culture of the pus to determine which bacteria I am dealing with in order that the appropriate antibiotic may be selected. It is always preferable to send a culture when possible as you not only identify the bacteria in question, but you also get the antibiotic sensitivities which allows you to select the most appropriate antibiotic for the infection. Often it seems that a paronychia will become recurrent, which will then require an appt with a foot doctor to remove the offending nail matrix. Best advice, don’t cut the nail too short and no toenail biting or picking!!  Easier said than done. That’s your daily dose for today. We’ll chat again soon.

Daily Dose

Pokemon GO

1:30 to read

My office is suddenly a bit more “interesting” after a 13 year old boy who was bored while waiting in an exam room took out his phone and started playing Pokemon Go!!  Who knew that there was a Pokemon in my office…or was there?  

If you have children between the ages of 8 -15 I bet someone in your house is playing Pokemon Go - and it is not just kids, many adults are also engrossed in the new game as well. I can remember my sons playing with Pokemon cards years ago, and I don’t think I understood the game then, but it was certainly entertaining for them and they spent hours trading cards with their friends…wonder where those cards went…maybe they are a valuable antique now?

At any rate, as I am trying to understand the game I am also seeing a lot of news coverage about the Pokemon Go rage that is sweeping the country.  There have been several interesting news stories about accidents that have happened while people are so busy looking for the Pokemon on their phones and not paying attention to their surroundings…they have fallen into water, run into walls and almost been hit by cars, fortunately no one has been seriously injured.

One mother of 2 boys who are engrossed in the game told me that her boys sit in the backseat of the car “screaming at her to slow down”!  She said she was not going fast and could not figure out what all of the commotion was about until they continued to ask her to slow down to a crawl….in order that they might see if they were passing any Pokespots??  Unfortunately, she informed them that she needed to go with the flow of traffic and they were out of luck for the moment. Who knew your “tweenage” children would ask you to drive slowly!

As I have been reading a bit more about Pokemon Go I am learning about “augmented reality” and how “an artificial digital world can be mapped onto the real physical world”. It seems that this is not new technology, but with the advent of Pokemon Go being available for free on every cell phone around the country,  it will not be long before we see this phenomena in other aspects of our lives. 

The game and the technology displays a Pokemon floating on your phone’s screen and it appears as if it is in the real world in front of you. (brings back the ad, “is this real or is this memorex?”).  I must say, I really don’t understand it and it is a bit scary how the digital and physical world seem to overlap.

In the meantime, I have found a new game to discuss with my patients, and my office has a new mascot….I just don’t understand how he got into the exam room and if he is watching me all of the time?  

Daily Dose

Pool Safety

1:15 to read

As you know, water safety is paramont this time of year so I want to make sure your children are safe this summer.  Drowning is the leading cause of death for children between the ages of 1- 4 and the second leading cause of unintentional death for children under the age of 14.  Over 390 children die each year in their own backyard pools...tragically drowning is typically a SILENT event.

The first thing all pools need is a at least 4 foot tall fence surrounding all 4 sides of the pool. Now is the time to make sure that not only is your pool fenced but that it also is “tuned up” after the winter. That means that the self latching gate is working, that all pool furniture and toys are  moved away from the fence in order that children cannot climb up and over a fence, and you might even add a pool alarm that goes off if anyone enters the pool without supervision. 

If you have a door from the house to the pool there should be an alarm on the door as well as having a fence around the pool…this ensures “layers of protection”..the more layers to keep your child away from an unsupervised pool the better!  Children are clever, fast and tenacious.

Now once you decide to enjoy a day poolside you need to have several things on hand which include a portable phone, a flotation ring or hook, and always an adult within arms reach of a toddler or young child who has not yet learned to swim.  If there are several “non swimmers” in the pool with only 1 adult,  it is best to put all of the children in an approved flotation device as well.  The adult who is supervising the pool should ideally know CPR. I think that all “pool owners” should take CPR.

The person in charge of watching a child or children in the pool need to be identified and vigilant. That means staying off a cell phone or any electronics that might be distracting. It is also not the time for adults to be partying and alcohol is discouraged.  

Most children over the age of 4 years are ready for swimming lessons, but the AAP does recognize that there are some younger children between 1 -4 years who may be ready for swimming lessons, especially those that are frequently around water ( home pool, lake , beach). Each child will develop at differently.  Even a young child who has had swim lessons should not be considered “drown-proof” and never be unsupervised.

Lastly, don’t forget the sunscreen and remember to re-apply frequently to both you and your child!

 

 

 

   

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DR SUE'S DAILY DOSE

Some kids are playing sports before they are potty trained? Yes! This is crazy!

DR SUE'S DAILY DOSE

Some kids are playing sports before they are potty trained? Yes! This is crazy!

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