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Daily Dose

Water Safety

1:15 to read

I was reminded of the importance of pool safety after watching the news and hearing that 3 children were found in a nearby apartment pool, under water and unresponsive.  

There are about 3,500 fatal unintentional drownings per year, which is about 10 deaths per day.  Drowning is the second leading cause of death in children ages 1-14 years.  For every child who dies from drowning, there are 4 non-fatal drowning victims who suffer severe and life changing injuries.

Drowning is preventable!!  Although many people think of drowning victims screaming and yelling, drowning is actually quick and silent.  It only takes seconds (the time to grab a towel, or answer the phone) and a child may become submerged. Most drownings also occur in family pools.  Because I have always had a fear of drowning we did not build a pool until our boys were all older than 10 years and were excellent swimmers ( was I a bit over zealous with swim lessons and swim team, maybe...)?  Children as young as 2-3 years can safely begin swim lessons and begin the process of mastering how to tread water, floating and basic swim strokes. 

Another rule for safe swimming is “never swim alone!”.  Teach your children the importance of the buddy system when they are swimming, even in a backyard pool. Adults need to be designated “water watchers” and know that they are responsible for watching the children in the pool and will never leave them unattended. The “water watcher” should regularly scan the bottom of the pool, and will need to have a phone at the pool for emergency use only.  Adult water watchers have only 1 job...to watch the pool, no poolside chatting or distractions. It is a big job!

Anyone with a pool or who is a caregiver of children who are swimming needs to become CPR certified.  CPR skills can save lives and prevent brain damage.   

Lastly, if you have a pool you need layers of protection - which  means a barrier around your pool. I have heard many a family tell me that their child “could never get out the door to the pool, it has several locks and an alarm”.  Despite the best of intentions, no parent can watch their child 24 hours/day.  Toddlers have been known to push a stool over to unlock a door, or a door is inadvertently left unlocked or ajar. Remember, it only takes seconds for a child to become submerged. 

By the way, I am following my own advice and a pool fence is going up to protect our granddaughter...the bigger the better.

Daily Dose

Weird Skin issue?

1:15 to read

Have you ever heard of dermatographism??  This is the phenomena that occurs in some individuals when you scratch their skin and it seems to “welt” up? .I remember doing this at slumber parties and writing people’s names on their back..we thought it was really weird and cool at the time.  Never expected that I would go on to be able to “name that tune” later in life.

Dermatographism is actually a form of hives which occur when you simply stroke or scratch the skin, and it affects about 5 percent of the population.  It is typically a benign reaction, and most people are otherwise healthy.  It is also known as skin writing, because people realize that when they write letters on their arms, chest or back that within several minutes the skin has become raised and red (hives) and the writing is visible.  The hives usually fade within 30-60 minutes, although on occasion may last for hours.

It is really unclear as to why this occurs, but seems to be some type of allergic reaction and histamine and other inflammatory mediators play a role.  In some people this reaction may also occur when exposed to extreme cold or heat.

Although some parents have recognized dermatographism in their younger children, it is actually more common in females and teens….maybe that is why I have the memory of slumber parties and experimenting to see who might have this “interesting” skin.  We didn’t have cameras to take pictures of the art work we drew, but there are even artists now posting all sorts of pictures of their “skin art” on websites.

In most cases there is no need to be concerned and the condition may not be life long.  It seems that moisturizing the skin may help a bit as you are less likely to scratch your skin. It may also  help to take an antihistamine such as benadryl (diphenhydramine) or zyrtec (cetirizine) which may help to block the reaction.

But, if you or your child is lucky enough to have dermatographism, it makes for a good show and tell and party conversation.  

Daily Dose

Teen Driving

1:30 to read

 It’s funny that I often find myself reading articles in the newspaper or online, or even watching a TV segment, only to find that an “issue” that I have thought was important for years is “newsworthy” again.  The most recent example being on the topic of teenage drivers and the importance of parental involvement.

I feel like it was not too long ago that I was talking to my own sons about driving….and at that time Texas did not have a lot of rules around getting your driver’s license, besides being 16 an enrolled in school. (thankfully the laws in Texas have changed since then).  So after much discussion about the perils of teenage driving and knowing that the death rate due to an automobile accident topped the list for teens,  my husband and I  came up with a driving contract (which I have shared with too many to count), which clearly outlined the rules and expectations for our sons when they began to drive. I can also remember the oldest looking at the 3 page typed contract and announcing, “ I am not going to sign that!”.  If I remember correctly my husband’s calm reply was, “OK - then don’t drive”. He is a man of few words..but very convincing. 

Fortunately for us, all of our sons did sign the contract, knew the consequences and started off driving our family Suburban…and never had a serious accident (so many prayers as they pulled out of the driveway).  One son did back into a fence, and another hit a car in a parking lot….but I felt fortunate that that was the extent of their accident history.  

According to a recent article in the NY Times there is a time to be a helicopter parent, and that is when your “child” begins to drive.  “In 2013, just under a million teenage drivers were involved in police reported crashes, which resulted in 373,645 injuries and 2,927 deaths”.  These statistics are probably under-reported, and it is estimated that “one in four teens are going to be in a crash in their first six months of driving,” and one would hope that these would be minor “fender benders”, which as we told our sons, do count as an accident.

The biggest risk for a new teenage driver occurs when you add passengers to the car.  According to Dr. Nicole Morris at the University of Minnesota  “adding one non family passenger to a teenager’s car increased the rate of crashes by 44%, and that risk doubles with a second passenger and quadruples with 3 or more”. If your teen is not distracted by their passengers they are likely to be using their phones to stay in touch with their friends….either by text, talking or by checking their various social media sites….all while driving. Although teens state, “ I barely take my eyes off the road”, anything more than 2 seconds can be deadly. Better to turn off the phone and all notifications before your teen hits the road.

Teens should be reminded that driving is a privilege, and parents of teenage drivers need to have ongoing discussions surrounding expectations for obtaining the privilege of driving. Parents need to be knowledgable about teenage driving and their states’ laws - and enforce those, (too many parents of my patients seem to ignore some of the laws - such as limiting passengers in the car). Even if your state does not have laws regulating a step wise progression to full driving privileges (so called graduated driver’s licenses), parents may adopt their own to help ensure their teens safety. Earning more and more independence can be proven with time and a good driving record and the adage, “nothing good happens after midnight still stands”.  

If ever there is a time to be a hovering involved parent it when your child begins to drive - it has been proven to save lives.

 

     

Daily Dose

How to Treat Swimmer's Ear

1:30 to read

The entire country seems to be experiencing the “dog days of summer”.  That huge high pressure system has covered most of the weather map, so the only thing to do for the next month is to head to any water you can find…swimming pool, lake, ocean, river or fountain!  But, with swimming comes swimmer’s ear or otitis externa.

I rarely see a child with an otitis externa except during the hot summer months.  Swimmer’s ear is a frequent problem for children who “live in the water” all day long. They are just like a fish. They head to to the pool first thing in the morning and don’t come in until they are water logged…and their ears stay wet all day long and into the night….then back to the water again.  When the ear canal cannot dry out it becomes the perfect dark, damp breeding ground for bacteria to take root.

The most common complaint with swimmer’s ear is pain!! I have seen big stoic teenage athletes in tears from the pain when you just touch their ear.  The pain is due to the inflammation and infection of the ear canal..not the ear drum (an inner ear infection).  So, if you tug on the ear lobe or push the area in front of the ear at the jawline, this causes pain.  Rolling over in bed and laying on that ear will cause pain.  Many people also feel a fullness and complain that they don’t hear as well as the ear canal is so swollen.

The treatment for a swimmer’s ear is not an oral antibiotic, it is rather for ear drops that contain an antibiotic to treat the infection topically at the source. Many of the ear drops used to treat otitis externa also contain a steroid that will help with the inflammation (and swelling) of the ear canal.  Pain control is also important with a combination of acetaminophen and/or ibuprofen.   Keeping the ear canal dry is imperative in order that the ear drops stay in the canal and are not “washed out” right after you put them in the ear. I try to keep the patient’s ear canal dry for several days and have them pain free before getting their ear wet again.

BUT, the best treatment for swimmer’s ear is actually prevention.  Little children who are just learning to swim really do not spend enough time under water or during a bath to have their ear canals become infected.  It is typically seen in children over the ages of 5 or 6 who are now great swimmers and spend a great deal of time in the pool, lake or any body of water.  For these children I recommend putting in “home made” ear drops made with half alcohol and half white vinegar. It is easy to make a bottle and buy a dropper and leave it by the back door to the pool or by the dock…..in this way as the kids come in at the end of the day, everyone tilts their head and gets several drops instilled into both ears before heading inside for the night.  You can also buy “Swim Ear” over the counter if you aren’t “into” making the frugal ear drops.

On occasion, for an extremely swollen ear canal you may need to see an ENT to have the ear canal cleaned and treated…..but if treated early this is uncommon. 

Stay cool, hydrated and avoid swimmer’s ear by using those ear drops routinely!! I learned my lesson the hard way one year….prevention is the key to avoiding a painful otitis externa.

Daily Dose

Codeine & Children

1:30 to read

I order to keep us all safe, the FDA is constantly monitoring drugs and their side effects.  For many years codeine was prescribed for children for pain relief as well as to suppress coughs.  Over the last few years there has been more and more discussion about limiting the use of narcotics in children, but I continue to see some children who come from seeing other physicians and have received a prescription that contains codeine.

 

The FDA just issued new warnings against using prescription codeine in children and adolescents. The FDA reviewed adverse event reports from the past 50 years and found reports of severe breathing problems and 24 deaths linked to codeine in children and adolescents. Genetic variation in codeine metabolism may lead to excessive morphine levels in some children.

 

The FDA also performed a literature review which noted excessive sleepiness and breathing problems, including one death, in breast-fed infants whose mothers used codeine.

 

Due to these findings the FDA is now recommending that “codeine should not be used for pain or cough in children under 12 years of age”. They have also issued a warning that codeine should not be used in adolescents aged 12-18 “who are obese or have conditions associated with breathing problems, such as obstructive sleep apnea or severe lung disease”. In retrospect, codeine was prescribed to more than 800,000 children younger than11 years in 2011. Amazingly, codeine is currently available in over-the-counter cough medicines in 28 states.  

 

Lastly, the FDA “strengthened the warning” regarding codeine and breast feeding. They now recommend that breast- feeding women do not use codeine…which may change the post delivery pain protocol. Nonsteroidal anti-inflammatories (Ibuprofen) and acetaminophen (Tylenol) are preferred and are effective for mild to moderate postpartum pain. As a pediatrician it is important that I discuss this with new breast-feeding mothers as well. 

Daily Dose

When To Worry About Stuttering

1.15 to read

I received an e-mail today from a mother who is concerned about her 2 1/2 year old daughter who has started stuttering in the last week. She asked ”is this something to be worried about or just watch it and see?”

This is a common question from parents with preschool aged children, and is typically most frequent between 18 months and five years of age. Stuttering at this age is called disfluency or pseudo stuttering and is quite common as children learn to speak and develop more complex speech patterns.

In many cases the stuttering occurs out of the blue, and may last for several weeks, and resolve, but may return off and on during the preschool years as a child is learning more and more language. In a preschooler who is stuttering the parents usually note that the child repeats an initial sound such as l-li-like or s-st-star or may have frequent pauses with “um” and “er”. It is not uncommon to see this happen when a child is excited, or anxious or tired.

They may stumble or words or sounds and after a good night’s rest you may see an improvement. They often don’t seem to realize that they are even stuttering as their brains and mouth try to keep up with one another. Remember they have a lot to say!

The best medicine for stuttering is for a parent to reassure their child that it is okay to slow down as sometimes it is hard to make the words correctly. A hug from Mom or Dad while they are reassuring their child is also helpful. Practice slow and relaxed speech when you are talking to your child and try not to rush them when they are talking, even if the stuttering is bothering you. When your child asks you a question, pause before answering to also model behaviors with speaking. Reading aloud with your child in a slow and normal manner is also beneficial (I remember nights of trying to rush through those early books to try and get everyone in bed!).

The best person to emulate is Mr. Rogers, think of how relaxed he always was when speaking. He never seemed as if he was hurrying for anything! In most cases a child’s stuttering will not last more than weeks to several months and will resolve on its own.

If you think the problem is increasing in severity or is causing stress and anxiety for your child it may be time for a discussion with your pediatrician.

Do you have any tips?  Feel free to share them with us!

Daily Dose

Time-Out for Toddlers!

1.15 to read

I love talking to parents about behavior modification and that includes beginning to discipline their children. I really think this is one of the most important jobs for parents and it is hard to believe that your most “precious, perfect” child will at times misbehave.  It happens to all of us!

I would recommend to start using time out as a means of behavior modification when a child is somewhere between 15-18 months of age.  For those of you who watch Super Nanny, she coined the word “the naughty step” which is her version of time-out chair.

When you begin time out, pick a small chair in the house which you can use consistently for time-out. Never use a child’s crib or bed, as you do not want them to think that “bed is for misbehaving”.  After a child gets used to doing time out you can use all sorts of chairs and do time out anywhere. Like many things it just takes practice.

When putting your child in time out get down to their eye level, explain why they must sit in the chair, and hold them from behind (with your arms wrapped around them like you are a rope). I use a timer even at this young age so your child begins to understand how long they will be sitting in time out.  Time out is typically one minute per year of age.

After time out is “finished”, get back to eye level and explain that the next time you ask them to mind you, “they may choose” to listen and they will not have to go to time out.  These are such important words for a child’s entire life, as they need to understand that they are making choices for their behavior.  In other words, taking ownership of making a bad choice and knowing that there will be consequences.  You will use these words over and over, “you made a bad choice therefore....the consequence is....for a young child it is time out, for older children it may be no TV, or no going to a party, or even no driving. All versions of time-out.

One of my patients is a cute family of 5 and the mother has her version or time-out. She says “nose and toes in the corner” for a minute----her kids started doing that at 12 months! Impressive.

Daily Dose

Selfies Cause Lice?

1.30 to read

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

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