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Daily Dose

Kids & Cell Phone Use

Did your child get a cell phone over the holiday? Have you set rules, boundaries and limits? You should and here's why. I have been walking through my waiting room recently and noticing that a lot of my “younger” patients have their own cell phone. So, I have now begun to routinely ask all of my patients over the age of 8, if they have a cell phone. I must say I am surprised that some 8-9 year olds actually do!!

I'm not sure why a child in elementary school needs a cell phone. Who are they calling?  What happened to being able to either go to the office at school to make a phone call or I asking your teacher if you might use their phone to call a parent if necessary?  Is that not possible anymore?  I know that younger children are also texting on the cell phone and I am not sure how some of them can text when they are not yet fluent readers.  I digress. After learning if a patient has a cell phone, I have also started to ask about rules for the phone. Have the parents established rules for cell phone use?  When the phone may be used, how many minutes the child has (does everyone have unlimited minutes now?), who they may call and what time is the phone “put to bed at night”. I have always asked my patients about their bedtimes and bedtime routines, but I am now interested in when the cell phone heads to bed too and gets turned off.  I am not talking about high school juniors and seniors, I am really speaking more to the children I see in elementary, middle and early high school. The older kids are yet another story. Many of my patients seem to have very good rules about when the phone may be used, to whom they may call (especially the younger ones) and when the cell phones are turned off. But, just like those parents who still think that having a TV in a child’s room is a rite of passage, there are those parents who do not think it is necessary to set rules for the phone. I disagree. Children really do crave guidelines and need to have clear messages regarding the use of their cell phones. If you start off with “the rules of the phone” it lets a child understand that owning a cell phone is still a privilege, and that with that comes responsibility including when and how the phone may be used.  I do not think that a phone needs to be on once bedtime routines have started, and the phone should have a bed time too.  The easiest way to do this is by having a “family docking station” where the phones are put each night, turned off and charged. If this habit begins early on, it is easier to continue as your child gets older. Once again good habits are easier to make than trying to break bad ones. Having a middle school child on the cell phone in their room under the covers at 11 pm at night is not an uncommon occurrence and if the phones are put up each night it makes the temptation less likely.  The glow of the phone beneath the covers is a dead giveaway, as is the call record that shows use after the stated bedtime. Take the opportunity to review your child’s cell phone log on occasion. I was stunned at the number of calls high schoolers received after 11 pm when the phones were “supposed” to be off. Lastly, set rules about texts and let your child know that you will occasionally be reading their texts. They should be taught early on that anything they write should be fair game for a parent to read. Remind them that text messages never go away, somehow they may be retrieved from cyberspace even after deleted.  That amazes me, but we have all seen it in the news.  Discuss “sexting” too. If you don’t bring these things up they may find themselves in a situation they were ill prepared for, and make a poor decision. Being able to call your child when you need them is nice, but maybe we are all a little too connected at too young an age.  Like many things, once you let your child have their own cell phones it may be hard to go back. But remember, it is a privilege and the rules need to be followed or the phone may be taken away.  We parents just need to follow through. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

New parents often come in concerned about their baby spitting up.  They typically  ask, “does my baby have gastroesophageal reflux (GER)?”.  I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants.  Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time. 

GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”.  GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.  

For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.  

The best treatment for benign GER is lifestyle management.  Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas.  Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies.  It is always worth trying.

While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!

Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed.  Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.

For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary.  Talk to your doctor about options if lifestyle management does not seem to help. 

Daily Dose

School Lunches & Obesity

1.30 to read

Since we have been talking about healthier school lunches, I thought I would share with you an interesting article in last month’s Pediatrics which related to regulations on school snacks.  

While the nutrition standards for school meals changed for the 2012-2013 school year, the new guidelines do not effect foods in vending machines, snack bars or other venues within the school that are not a part of the regular school meal programs. These foods (typically snacks and drinks) are termed “competitive foods” as they compete with school breakfasts and lunches. 

This study looked at weight changes for 6,300 students between 2004-2007 and followed the students from fifth to eighth grade.  They found that adolescents in states with strict laws regulating the sale of “competitive foods” gained less weight over this 3 year period than those living in states without laws. 

As the childhood obesity epidemic continues (the CDC now estimates that 1/5 of American children are obese), public health officials continue to look at ways to improve a child’s eating habits during the school day.  The laws surrounding snack foods at school differ by state. There are no laws in some states, weak laws (where recommendations were made but there were no specific guidelines), and strong laws (where detailed nutritional standards were issued). 

The study did not conclude that strong laws were directly responsible for the differences in a student’s weight gain, but it did conclude that these outcomes tended to happen in states with strong laws.  That would seem to make sense to me as most children including my own, if given the opportunity, would at times choose vending machine snacks over a healthy school lunch. 

I also think that this is more common as the children become teens and seem to “snack” for lunch while multi-tasking rather than sitting down to eat a well balanced lunch. I continually hear this comment from adolescent patients of mine when I ask them about their lunch habits, and many of whom eat “off campus” if allowed, and choose fast foods over a healthy school cafeteria lunch.  Off school lunches seem to be another issue as well. 

One of the lead authors on the study stated, “competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent”. It seems like this might be a good cause to discuss with your own state representative.

Daily Dose

How to Treat a Baby With Thrush

2.00 to read

I have received some recent e-mails and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.I have received an email via our iPhone App and now an office visit regarding the possibility of a baby having thrush. Thrush is a yeast (fungal) infection that involves the mouth, and is most typically seen in infants.

The yeast infection usually involves the inside of a baby’s cheeks and lips and occasionally the tongue. It appears as white, almost cottage cheese like patches, and is often visible when a baby is yawning or crying. A baby who only has a white tongue typically does not have thrush, but just a milk coated tongue (see if you can wipe some of the milk off of the tongue, as yeast is usually more adherent). Thrush is fairly common as we all have yeast in our digestive tracts, and babies are often colonized with yeast as they travel through the birth canal. For unknown reasons, in some infants there is an overgrowth of yeast and thrush may develop. Many mothers feel guilty that they “gave their baby” a yeast infection. They worry that thrush has something to do with cleanliness (NOT) and somehow that maternal guiles thing is already beginning. (Dads have already cut to the chase and say, how do you treat it?!) Thrush can happen to any infant. In a breast feeding baby it may also cause a mother to have inflamed and tender nipples, and the baby and mother actually pass the yeast back and forth during feeding (no guilt, as breastfeeding is good!) In most babies thrush does not cause a lot of problems and may go away by itself. But if the infection becomes extensive it may become painful and cause an infant to be uncomfortable when nursing or taking a bottle. If you notice that your baby has white plaques in their mouth or under their lips it may be worth a phone call to your pediatrician. (This is not an emergency and can wait till office hours.) There are several prescription preparations that may be used to treat thrush. The most common being Nystatin, which is a liquid medication that is given to the baby after they have been fed, and is squirted into the mouth on the inside of the cheeks, to treat the yeast infection.  It is also beneficial to treat a nursing mother’s nipples with an anti-fungal agent. I usually tell patients to use the medications for at least seven days or until the white patches have been gone for several days before stopping treatment. It is not uncommon to get thrush again, so don’t fret if your baby develops another infection, at least you know what it is and how to treat it. A yeast infection in the mouth may often lead to a yeast infection in the diaper area (candidal diaper dermatitis), because as you know what goes in the mouth comes out in the poop. But that rash is for another day…. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Don't Touch The T-Zone!

A lesson from a 4 year old patient!Well, even though spring is officially here, we are still seeing a lot of coughs, colds and lingering RSV in our community. Thankfully, flu is on the way out!

While I was examining a child with upper respiratory symptoms, I was taught a very clever bit of information.  Mind you, I am always learning from my patients, but this time it was from a very precocious 4 year old little boy. He had been coughing and I noticed that he was coughing into his hand. I told him that another way to cover his cough would be to cough into his elbow. While we were talking about the benefits of this form of cough hygiene, I demonstrated how to do this. He listened attentively and covered his next cough with his elbow. Quick study and a good listener! After finishing examining him, I was talking to his mother about her child’s illness.  The little boy interrupted and said, “Dr. Sue, I have something to teach you too”.  “You need to tell everyone not to touch the T-Zone”. Now I am used to talking to teens about the T-Zone and acne, but why would this 4 year old know about the T-Zone?  Well, he quickly told me “you should not touch your eyes, nose or mouth; this is the T-Zone”. If you touch the T-Zone, you might get germs and then get sick”.  What a clever way to teach a child about keeping their hands off of their faces!  It was one of those “ah-ha” moments for me. So now, not only do I talk about coughing into your elbow, I have added don’t touch the T-Zone to my “shtick” about preventing colds and coughs. Out of the mouth of babes! Do you have any clever tricks you talk about with your kids?  Share with us! I would love to pass it on.

Daily Dose

Teaching Kids How To Swallow A Pill

Teach your child how to swallow a pillLife would be a bit easier (when your child is sick) if your child knew how to swallow a pill.

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies! So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned. I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home). We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down. When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing). For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!). Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow! I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger. Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

New Concussion Guidelines

1:30 to read

A really interesting study was published in Pediatrics online entitled “Benefits of Strict Rest After Acute Concussion”.  The guidelines for treating a concussion continue to be debated and that is what makes this study thought provoking.  

This was a “randomized controlled study”  which followed 88 patients between the ages of 11 and 22 years who had been diagnosed with a concussion.  45 of the patients were given instructions for 5 days of strict rest at home with no school, no work and no physical activity.  They were then allowed to have a “stepwise return to activity”.  The other 43 patients were told to “rest” for 1-2 days after which time they could  return to school also follow a “stepwise return to activity”.

Interestingly, there was no clinically significant difference in the  neurocognitive or balance outcomes between the two groups.  In fact the group that was “advised to rest for 5 days” reported more daily post concussive symptoms and slower resolution of symptoms than those who were told to rest for 1-2 days.  

This was a small study and does not mean that everyone should be treated the same way. In fact, when seeing a patient who has sustained a concussion each person seems to be a bit different.....as one could expect when discussing a “brain injury”.  No two brains are exactly alike...at least for the time being...who knows what will happen one day with genetics

In my own limited practice I have found that “very few” tweens and teens subscribe to the complete rest theory...that is no school, but also no TV, no computer and no videos or smart phones....WHAT??? No social media for 5 days?  You would have to put most of them on an isolated “post concussion island” to ensure they disconnect.  

The study authors also wondered if patients reported more symptoms after having strict rest recommended.  It seems plausible that I too might notice a few more symptoms when just sitting there wondering if my head hurts or if I seem to be more fatigued.

Subjective symptoms are always difficult to quantify...which makes treating a concussion more problematic.  I think erring on the conservative side and restricting “return to play” for a longer period seems to be of more importance than any other recommendation, including “5 days of strict rest”. In the meantime this is an interesting study....with more data to surely follow. 

 

Daily Dose

It’s The Season For Bug Bites & Stings

1:30 to read

Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss.It’s that time of year when insect bites and stings start showing up on your kids. Knowing how to prevent and treat common insect bites and stings, and knowing when to not overreact, can help keep your kids safe and healthy.

Babies and children may be more affected by bites or stings than adults. Let’s start with some common spring and summer insects. Spider bites Most spider bites do not actually penetrate the skin, and the majority of spiders found in the U.S are mostly harmless with the important exception of the black widow spider and the brown recluse spider, which are both dangerous to humans. Spider bites are fortunately uncommon. In many cases, presumed spider bites are actually due to another skin condition or an insect sting. The black widow spider is said to feel like a pin-prick, and some victims do not even realize they have been bitten. Sometimes you may notice double fang marks on the skin. The most common symptoms where the bite occurs are immediate pain, burning, swelling, and redness. Other symptoms may include chills, fever, nausea and vomiting, and severe abdominal pain. While black widow spider bites are hardly ever fatal, rare deaths have occurred from brown recluse spider bites and are more common in children than in adults. At first the bite of a brown recluse spider leads to a mild stinging, followed by local redness and severe pain that usually develops within eight hours but may occur later. Some reports of brown recluse bites describe a blue or purple area around the bite, surrounded by a whitish ring and large red outer ring in a "bull's eye" pattern. A fluid-filled blister forms at the site and then sloughs off to reveal a deep ulcer that may turn black. If bitten by a brown recluse or black widow spider - Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite. - Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg. - Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

Bee Stings In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. Most of the time the symptoms from a bee sting will be minor. Your child may experience a burning pain, a red welt, and slight swelling. Some children may have a stronger reaction with extreme redness and swelling that gets bigger over a couple of days. Children, adolescents, and adults who are allergic to bee stings may have a severe reaction called anaphylaxis. About 3% of people who are stung by bees quickly develop these anaphylaxis symptoms. - Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis) -  Difficulty breathing -  Swelling of the throat and tongue -  A weak and rapid pulse -  Nausea, vomiting or diarrhea -  Dizziness or fainting -  Loss of consciousness -  Convulsions -  Fever -  Shock may occur if the circulatory cannot get enough blood to vital organs. For most Bee stings you can apply an ice pack or cool compress, a meat tenderizer solution which can be made by mixing one part meat tenderizer and 4 parts water. Soak a cotton ball in the solution and apply to the bite for 15020 minutes. A baking soda paste works well or a topical anti-itch cream such as Calamine lotion. Talk to your pediatrician about ways to prevent bee stings and possible immunotherapy if your child is allergic. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems. If your child is allergic to bee stings always have an EpiPen available and use it right away as your pediatrician has directed. Wasps, hornets, and yellow jacket stings are similar to bee stings.

Fire Ants A bite that will get your child’s attention quickly belongs to the fire ant. Fire ants are so named because their venom induces a painful, fiery sensation. When disturbed, fire ants are very aggressive. To help children avoid fire ants, parents should regularly check their yards and their children's play areas for the presence of the ants and their mounds. Then they should either eliminate the ants or make sure children avoid them. If a child is stung, apply ice to the bite site for 10 to 15 minutes. Elevate the extremity where the child was bit. Clean and clip the child's fingernails to prevent any secondary infection that can result from scratching the bite. Check with the child's pediatrician for the correct dose of an oral antihistamine to reduce itching and inflammation A small percentage of children stung -- probably less than 0 .5 percent -- experience a severe (anaphylactic) reaction. These occur within minutes of a sting and vary in severity. A child who is stung and within minutes begins to experience hives, weakness, dizziness, wheezing, difficulty swallowing, shortness of breath or confusion should be taken immediately to the nearest emergency room. Watch the area for signs of infection over the next couple of days.

Ticks Ticks are common in grasses and wooded areas. If you have pets make sure they are tick free. Ticks are usually harmless but they can carry Lyme disease. To remove a tick begin by taking a cotton swab or cotton ball. Dip the swab or cotton ball in a small glass container that you will be throwing out after use. Place a small amount of rubbing alcohol in the bottom of your container. Use at least 2 tablespoons of alcohol. Dab on the site of the tick on the child or pet. Do not let it run, that is why you are dabbing it rather than pouring it on the site. If there is excess, dab it with another cotton swab or cotton ball. Let this cotton ball or swab sit on the tick for 3 minutes. This suffocates the tick and he will back out for retrieval with tweezers. If that method is unsuccessful, use the alcohol swab again and let the area dry. Then take a clean, unused cotton swab and glob a dollop of Vaseline petroleum jelly on the site where you see the tick. Let this stay on top of the tick for 3 minutes. You will then remove the tick and the Vaseline petroleum jelly.

Mosquitoes Probably the most common insect bite in the spring and summer come form mosquitoes. Ivillage.com has these tips for treating and preventing mosquito bites. The usual reaction is a local skin inflammation that is red, raised and very itchy. If your child scratches the bite, it may become infected as well. Here's what you can do for your children to help ease the itch and pain caused by mosquito bites. Treatments: Apply anti-itch creams like calamine as needed to help prevent scratching • Use anti-inflammatory creams like cortisone cream to help ease the inflammation and itching • If there is severe itching and multiple bug bites use antihistamines like Benedryl. Because they tend to make children drowsy, they work particularly well at night. •  Antihistamines like Claritin, Allegra, and Zyrtec tend to be much less sedating, buit check with your pediatrician about the correct dosage and whether these products are safe for children. Other Suggestions:
 Keep your child's fingernails cut short to prevent scratching • Apply cold wet compresses to the area to ease discomfort • Have your child wear long pants and long sleeves (if the temperature is bearable) • Make sure window screens are used if you keep windows open in your home • Use insect repellant to help prevent bites from occurring Choosing an Insect Repellant DEET is the best insect repellant in terms of effectiveness against flies, gnats, chiggers, ticks and other insects. The higher the DEET concentration the better it works. For children, however, the EPA recommends a concentration of 10 percent or less to prevent side effects and toxicity.

Scorpions Scorpion bites are painful but mostly harmless. The only dangerous scorpion in North America, probably the most venomous of all North American bugs is the bark scorpion. Bark scorpions are found in all of Arizona, extending west across the Colorado River in to California and east in to New Mexico. Scorpions are related to spiders, ticks and mites. Usually, they only sting to protect themselves or of they feel threatened. Scorpions can get caught up in bedding or crawl in to shoes so always check your child’s clothing and bed if you suspect scorpions may be around.  Scorpion stings without a serious reaction can be treated with ice on the sting and over-the-counter pain medication. Bark scorpion anti-venom is available only in Arizona. Any sting that shows signs of a bark scorpion needs to be treated at a hospital. Anti-venom has been shown to significantly reduce the effects of the sting. Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss. For pictures of several types of insects such as Black Widow and Brown Recluse spiders, check out http://www.webmd.com/allergies/slideshow-bad-bugs

Daily Dose

Treating Swimmer's Ear

Swimming is one of the best ways to beat the summer heat, but that may also mean that your child will develop a painful swimmer's ear, also known as otitis externa.Swimming is one of the best ways to beat the summer heat, but that may also mean that your child may develop a painful swimmer’s ear, also known as otitis externa. Swimmer’s ear is a common summer infection of the external auditory canal, in other words the part of the ear that connects the outer ear (where the Q–tip goes, but really shouldn’t) to the inner ear.

Swimmer’s ear often develops in school age children that spend much of their summer in the water, whether in a pool, lake or even the ocean. The ear canal just never gets a chance to dry out, and the constant moisture disrupts the skin’s natural barrier to infection. The skin may then develop micro abrasions, which allow bacteria to penetrate, and a painful infection develops. The most common bacterial infection is due to the bacteria Pseudomonas aeruginosa. A child with a swimmer’s ear usually complains when you touch their ear or tug on their ear lobe. They will often complain when they are lying down and roll over on that ear. Swimmer’s ear may be extremely painful and awaken your child from sleep. When you have an inner ear infection (otitis media) the ear itself is not painful to the touch. In severe cases the ear canal may be so swollen that it appears smaller than usual, and appears red and tender. At some times you may see discharge from the ear canal due to the infection and subsequent inflammatory response. The treatment of swimmer’s ear is to use an antibiotic drop instilled into the ear canal. I often use an antibiotic drop in combination with a steroid to provide anti-inflammatory effects too which will help to reduce the local swelling and irritation. In severe cases it may be difficult to get the dropper into the ear due to the swelling so the doctor may place a “wick” into the ear that will open the ear canal and allow the drops to enter. A child may also need pain control with either acetaminophen or ibuprofen. At the same time you are using topical drops the child needs to keep water out of the ear!! This is the hard part as they are such water creatures at this age. This also means not to get the ear wet when bathing or showering. I usually say for four to five days before returning to the water. To help prevent swimmer’s ear you can either buy a premixed solution called Swim Ear, at the pharmacy or mix up your own thrifty bottle made with 1/2 white vinegar and 1/2 alcohol. It is handy to keep this by the back door if you have a pool or in the beach bag. At the end of swimming apply a few drops to each ear and wiggle the ear around. This will help dry out the ear. Once your child is a “fish” and their heads are under water a good deal of the time, this a good time to start using this product. It is unusual to see a your-baby, toddler etc with swimmer’s ear, as they are just not under water all day. But prevention is the key, a painful ear is not fun and staying out of the pool just adds insult to injury! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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