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Daily Dose

Treating Sunburn

1.15 to read

Is it hot enough for you and your kids?  I bet every day you look at the weather map and try to figure out the best ways to beat the heat. 

With kids taking the plunge to stay cool, many forget to re-apply sunscreen and end up with a bad sunburn.  Sunburn is no fun and can cause significant problems. 

Sunburns may cause first-degree burns and you know it when you see it…your child’s skin turns pink and red and is uncomfortable, and itchy. 

Sunburn may also cause second-degree burns where the burn actually penetrates the dermis and causes blistering and a deeper burn and more cell damage. With blistering may come scarring and also an increased risk of skin cancer and skin damage later in their lifetime. 

Repetitive sunburns are cumulative and can put your child at even more risk for melanoma. Recurrent sunburns are often seen on the nose, ears, chest, and shoulders. 

You may not notice symptoms until 2-4 hours after the damage has begun. You’ll see redness over the next 12 -24 hours with pain, swelling and blistering. Some children will even develop nausea, fever, vomiting or dizziness after a significant sunburn and are at risk for dehydration. 

The best way to treat sunburn begins by moisturizing the burned area to cool down the skin and reduce inflammation. Try a cool bath or apply cool, wet cloths.  I like a product called Domeboro.  It’s very soothing when added to a bath or to cloths that you can soak in the solution. 

Keep your kids hydrated to replace fluids.  You can also give your child a pain reliever like Tylenol or Motrin/Advil to help with discomfort.  Some children also respond to an oral antihistamine to help with itching. 

Do NOT let your child back in the sun until their symptoms are improved and even then they should wear sun protective clothing as well as sunscreen. Remember, you can even get a burn in the shade, under an umbrella or on a cloudy day. Most of us heard that from our own mother's but unfortunately did not believe it until we ourselves had experienced a sunburn.

 

 

 

 

 

Daily Dose

Teen Pregnancies

1.30 to read

Did you know that May is National Teen Pregnancy Prevention Month?  I really think that this should be a topic of interest to parents year round, but this is a good month to be reminded of the importance of educating our children about their sexuality.

The good news is that the teenage pregnancy rate is going DOWN! The bad news is that 750,000 teens in the United States experience a pregnancy each year and 400,000 will give birth.  That means that 70 young women out of every thousand become pregnant.  To continue to reduce these statistics requires improved education and continued dialogue about the risk of teen pregnancy. 

Although some teens think that becoming pregnant is a way to escape their own situation, the reality is that teens who become pregnant are less likely to finish high school or enter college, and are more likely to experience poverty.  Being a parent is a hard job for any one, but trying to be a teen parent is almost impossible, even with good support systems.  The effects of teen pregnancy are far reaching for all of society.

Studies show that teenagers who receive comprehensive sex education are 50% less likely to experience teen pregnancy compared to those who were taught abstinence only sex education. Other studies have recently shown that the decline in teen pregnancy rates are due to increased contraception use. But, 39% of sexually active teens did not use condoms when they last had sex, and only 23% of teen reported that they or their partner used hormonal birth control.  

Parental involvement in sex education should occur in every home. This begins with that first, “birds and bees” talk with your child. A comment from a recent young patient after reading “ Where Did I Come From” with her parents   “DISTURBING” !  (cue my laughter). 

The conversation needs to continue during the tween years and is not only about development and physiology, but about family values and teaching your child that they can talk to you about anything. Let them know that although they may feel embarrassed this SEX stuff is part of normal growing up and you are there for ANY and ALL questions. 

Lastly, by the time you have teens in the house you realize that hormones are raging and with those hormonal changes come sexual feelings. This is time to reiterate values, expectations and at the same time to keep the conversation open.  Knowing that over 50% of high school seniors admit to having sex, it is crucial that parents have calm and rationale discussions about the importance of safe sex.  Just because you talk about safe sex does not mean that you condone it, but to ignore the subject may only mean that your child does not get the correct information or ends up being a statistic due to lack of education. No parent wants that for their child.

Daily Dose

Too Many Antibiotics Prescribed!

1.45 to read

What are the sounds of the season in my pediatric office? Coughing, sneezing and wheezing.  It's upper respiratory season and I'm seeing a lot of viral illnesses.  

With the winter season in full throttle, no one wants to be sick, so parents and patients still “want” me to prescribe antibiotics for a plethora of viral illnesses “because it is a busy time of year, we are traveling and can’t be sick."  

According to a recent article in issue of Pediatrics, pediatricians write more than 10 million antibiotic prescriptions unnecessarily every year. Antibiotics won’t help a viral upper respiratory infection and in many instances might be causing more harm than good. That is sometimes a hard concept to explain to parents. 

Everyone wants to be well sooner than later. Parents don’t want to be sick and never want their children to be sick or feeling cruddy, yucky, pathetic or pitiful. We are the parents so we can "fix it” right?

Unfortunately, a virus is bigger than any concerned parent, and even an antibiotic won’t “fix it”.  In many cases the only cure is “tincture of time” and that is often bitter medicine to swallow.

An antibiotic that is prescribed for a cough or cold is typically broad spectrum and will kill good bacteria that are beneficial to our bodies. An antibiotic is not very specific and by hitting everything in your body it may upset the normal bacteria and lead to symptoms such as diarrhea or abdominal cramping.  

In many cases of a viral illness it may be more appropriate to avoid an unnecessary antibiotic and to “wait and see” how the illness progresses.  If a child has worsening of symptoms or a change in symptoms it is better to re-examine the child than to just prescribe an antibiotic.   

Unfortunately, fall/winter URIs do not go away quickly. In most cases, it takes 7-14 days to get over the congestion, cough, and sore throat no matter what you do.   

I have patients who are seen at outside clinics with a negative strep test, then given antibiotics and do not get any better. That good old Z-pack just doesn’t do the trick!  By the time I see them the sore throat has developed into a classic upper respiratory infection and the antibiotic has not helped at all.  Good rule of thumb: if you are told you have a viral infection, you should not be getting and antibiotic. 

Viruses are also quite contagious so it is not uncommon for the entire family to succumb to the cold. Keep up hand washing and good cough hygiene and don’t assume and antibiotic will help, it may do more harm than good!

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

Daily Dose

Why Teens Need Curfews

1.00 to read

While talking to a mother of a teenage patient today the discussion of curfews came up. Does your child have one? They should!While talking to a mother of a teenage patient recently, the discussion heated up when we talked about curfews.  I remember growing up with the TV news coming on and saying, "it is 11 o'clock, do you know where your child is?" At the time I just hated that as it reminded my parents (who always watched the news) to come downstairs to make sure that I was home.

Maybe they would have remembered on their own, but I was convinced that it was the news that kept my parents checking on me. At any rate, the point of this is that I had a curfew and that they checked on me, enforced the curfew and there were consequences for not following the rules. So, the mother today was telling me that her son had a curfew (good for her and an appropriate time too) but that he had broken the curfew twice and he was now upset that she had followed through by having him come home earlier and had taken the car away for a week. Her son was angry that she "didn't trust him" anymore, and she explained that she had trusted him, by giving him a car to drive and a time to come home, but that he had broken the trust by not following the curfew. She then explained that he had to re-earn her trust, and he is just baffled by that. She is doing a great job of setting limits and boundaries, but we talked about how hard it is to follow through and not just give in. On the other hand, I also see a lot of parents of teens that do not have curfews for their kids, driving contracts for new drivers, and those who turn their heads when their teens are not making good choices. It is a hard job, but teens need limits, boundaries and consequences, just like when they were toddlers. If you have a teen keep up the good work and remember, it is 11:00 0'clock, do you know where your child is? Do you have a curfew for your teen? Share your comments & feedback. That's your daily dose, we'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

The Dangers of Using Baby Aspirin

1.15 to read

During a recent office visit, I saw a 4 year old child who is not one of my routine patients.  He had a fever and runny nose. His mother was giving me the child’s medical history during the time I was beginning to examine the little boy.  I had my back slightly turned from her. 

The mother was explained to me that her son had had a fever the previous evening and said, “I gave him some ASPIRIN before putting him to bed.”  I immediately turned around and with a stunned voice said, “you mean you gave him Tylenol or Motrin or Advil,” right? She really looked at me like I was crazy or that I had not been listening to her and she said, “No I said baby aspirin.”  “He likes the chewable ones.”  

I was shocked, as I had not heard of anyone giving aspirin to their children for a fever in over 20 years!! This very nice, young, concerned mother could not figure out why I was so worried about the aspirin.  I then had to explain to her about the risk of Reye’s Syndrome. She had never heard of Reye’s Syndrome and said that her mother had kept baby aspirin in the house for her, so that is what she bought to use for her own child.  

I know that they sell enteric coated baby aspirin for adults to take to help prevent a stroke. I guess I didn’t even realize that regular old baby aspirin was even around. There was so much publicity in the 1980’s about the link between aspirin or any salicylate containing medication and the development of Reye’s Syndrome, as well as warning labels about not giving aspirin to children that had a fever or chicken pox that I had not heard of anyone using aspirin for years! 

I explained to her that Reye’s syndrome affects the brain and liver and is a very serious disease, which may lead to death.  It occurs in children between the ages of 4-18 and causes recurrent vomiting, lethargy and coma and was often seen after a child had the flu or chickenpox. 

I saw several patients with Reye’s during my training, but have not seen a case since that time. This mother had never even heard of it, but was quite concerned that she had already given her son the aspirin the previous evening. 

This was a great lesson in the necessity of telling every new parent about the use of appropriate medicine to treat a fever. I typically have this discussion at the time of the first vaccines as I tell parents that prior to that time I don’t even want them to have fever reducing medications available. 

Many pediatricians, including me, had been in the habit of using “Tylenol” as the name for acetaminophen, in the same way as you say Kleenex. Since Tylenol was withdrawn from the market last year, we are now correctly saying that you should treat a child’s fever, which is usually due to a viral illness, with acetaminophen, and NEVER aspirin or aspirin containing products!! 

So as you prepare for this winter and lots of viruses with fever go stock up on acetaminophen of ibuprofen and leave the BABY ASPIRIN for ADULTS ONLY! 

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

Daily Dose

Prevent Common Injuries

1.00 to read

This week, I saw two of my little patients who sustained very common injuries which served as good safety reminders to parents especially new ones. 

A 4 month old little girl was sitting in her Bumbo chair after her dad placed the chair on the counter while he was unloading groceries. Somehow the baby managed to squirm and tip the Bumbo chair off the counter.  She cried for a minute but then seemed to be fine so the parents felt as if they were lucky and no major injury had occurred. 

The following day they noted that she would not bear weight on one of her legs when she was being held to stand. They also thought the leg looked a bit swollen. The little girl was still happy and playful if you left her leg alone.  After being examined I sent her for an x-ray which showed that her tibia had a small fracture. 

Because the fracture was tiny and not displaced, the pediatric orthopedist did not need to cast the baby. I just saw her again and she is already bearing weight on her leg and all is well.  The mother’s comment was the side of the Bumbo chair clearly says “do not place on counter, but I guess Daddy did not read that!”  Reminder to all, put the chair on the floor and not up on something where it might tip off! 

Another toddler was in for a head injury which he sustained after a TV fell over on him.  He had climbed up to grab the remote from the top of the TV which then tipped over. Luckily he was not trapped under the TV, but he did have a big knot on his forehead.

The CDC reports that an estimated 13,700 children were treated in ER’s between 20008 - 2010 due to being “struck by a television”. With newer front heavy TV’s, it seems as if these injuries are on the rise. 

The American Academy of Pediatrics recommends that televisions are placed on low stands and push the TV back on the furniture as far as possible.  Ideally the TV and stand should be secured to the wall with appropriate anchoring devices as well. 

Two cute patients, worried yet relieved parents and no major injuries made for a good week.

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

Daily Dose

K2: New Legal "Drug" For Teens?

1.30 to read

I was seeing patients the other day when I saw a teenage boy that I have taken care of since he was born (one of the perks of being a pediatrician).  He came in over lunch with his mother, as she had called me earlier that morning, and she wanted him to have a drug screen. She had found a “pipe” in some pants of his and she was concerned that he was smoking marijuana.  I am often asked to perform drug screens on kids, and I really think it is important to sit down with the child and parents to discuss their concern, rather than ruin the trust of the teen, and blindside them with the results of a drug screen obtained under false pretenses. So…the point of this is that the adolescent told me that he had been smoking K2.  He told me that it was a “legal” substance that you could buy over the internet or in smoke shops. K2 is a mixture of herbal and spice products that are then sprayed with a psychotropic drug.  When asked why he would smoke it, he told me that it had similar effects as marijuana with an overall feeling of feeling good, sleepy, and relaxed.   Seeing that I did not know anything about this new substance, I got my computer, brought it into the exam room and “googled” K2, only to see many different articles. The most interesting was an article in LiveScience written earlier this year, that explained how K2 had been developed by a research scientist who was studying cannabinoid receptors in the brain.  He had published articles about this substance (which when first discovered went by his initials, JWH-018),  and had found that that K2 binds to the same receptors in the brain as marijuana, and that it is actually much more potent than marijuana. K2 may be 10 times more active than THC (marijuana) and while it may have many of the same effects as the high with marijuana, it  has also been found to cause hallucinations, and seizures. Upon further investigation, I found that it is becoming a problem in many states with plenty of information on the internet. K2 has already been declared illegal in the state of Kansas.  There are concerns that this drug has caused adverse effects and ER visits due to hallucinations, vomiting, elevated blood pressure and heart rate, which are not typical symptoms seen with marijuana.  K2 does not show up on routine drug screens.  There is a researcher in St. Louis who is studying K2 and is seeking urine samples obtained from teens who have used the substance.  I called several private labs in my area and they did not have the capability of testing for it. The good news in my patient’s case is that he told me about K2, had not smoked it in the last several weeks, and his urine drug screen was negative for marijuana and other drugs. Oh the things we must learn to keep up with adolescents! How someone discovered the article written in scientific journals in the late 1990’s and extrapolated that this compound, which binds to the same receptors in the brain as marijuana, could be used “legally” for a high similar to “weed”  is beyond me.  But kids are really “smart and clever” and will do almost anything for a “high” especially in this case with a product that is easily obtained and is legal.  After a lengthy discussion with this boy and his mother I understand that K2 use is quite prevalent in his high school, even among the “non-drug” crowd. I am going to continue researching this topic and will keep you posted. But if you have an adolescent who you think exhibits odd behavior and may even require a visit to the ER for a suspected overdose, and the drug screen turns out to be negative, be aware of K2. Lastly, talk to your teens, they are probably already in the know. That's your daily dose.  We'll chat again tomorrow.

Daily Dose

Babies and Jog Strollers

I seem to get a lot of questions from new parents that are runners about using the jogging stroller with their newborn or baby. I have researched this issue in the pediatric literature and I cannot find a consensus statement discussing when it is safe and appropriate to use a baby jogger with a newborn. (Could this be a double blind controlled study waiting to happen?)

Intuitively, it seems that using a your-baby jogger to walk or run with your newborn would be safe if you are covering the same terrain that you would with a regular stroller, i.e. not climbing Mt. Everest or running down the side of a mountain, over rugged terrain or over pot-holes which seem to be the most common problem in our neighborhood. All of these activities would also seem detrimental to the mother in the post-partum period, and despite being avid joggers it is important that a new mother not overexert herself. Most OB's recommend that a postpartum mother limit her physical activity for the first four to six weeks and I agree. It may be important for a new mother's sanity to get some light exercise, like a walk around the block, but not a 5-mile jog until they have been given the go ahead by their OB. If you push yourself too quickly you will see that it does take a toll both on your breast milk production and overall energy level. Just give it a few weeks to catch up with you as your euphoria and the hormones involved fade and you realize that you really are exhausted. Use the first few weeks after have a your baby to lounge around in your nightgown, take a catnap and enjoy just staring at your newborn!! It is really the only time you will get that opportunity and the run will be there in a few weeks. This being said, the issue is really with the baby, and making sure that an infant's neck is supported while they are in the jogger. The manufacturers of many of the most popular baby joggers have come out with a car seat apparatus that fits into the jogger, for use with younger babies. This has head and neck support with cushioning and may be used until your your-baby develops more neck support at around 4 months of age. I have had many parents of infants who have started taking their baby on walks/runs at around four to six weeks of age gradually increasing the length of their exercise, while the baby seems to be quite happy snuggled in the jogger. Some parents say this is their  baby's best sleep and can always be assured that their infant will calm down once they get moving. Much more economical than driving the your-baby around in the car too, which also seems to be a good calming maneuver. The only other issue is weather related. Make sure that your infant is well hydrated in the summer, wears a hat and sunscreen and is also shaded with an awning. Sun can penetrate the stroller awning so do not assume that your your-baby is not getting sun exposure. If bugs are a problem use mosquito netting too. The rule of thumb is if you are hot (or cold, during the winter months) so is your baby, so dress them appropriately and don't overdue it. That's your daily dose, we'll chat again tomorrow. 

Daily Dose

Skin Rash: Fifth's Disease

Even though it already feels like summer across many parts of the nation, I’m still seeing typical spring illnesses like Fifth’s disease.  Fifth’s disease is a common viral illness seen in children, often in the late winter and spring.

Many of these children look like they have gotten a little “sunburn” on their faces as they often show up with the typical “slapped cheek” rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks. Fifth’s is also called erythema infectiosum and is so named as it is the fifth of six rash associated illness of childhood. Fifth’s disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa. In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of “not feeling well’ and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed. When I see a child with Fifth’s disease it is usually an easy diagnosis based on their few symptoms and the typical rash. Although children with Fifth’s are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you “never know” where you got this virus. (the incubation period is somewhere between 4-20 days after exposure). Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10 – 60% of students in a class may become infected. Most adults have had Fifth’s disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a “memorable” event during childhood. Fifth’s disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve. I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas.  Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a hot spring/summer day may work just as well too. Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth’s disease, so it is business as usual with school, end of year parties, and summer play dates! That’s your daily dose for today.  We’ll chat again tomorrow!

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