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Daily Dose

Life Jackets!

1:15 to read

Summer is here and that means many of my patients are taking off to the beach or the lake to escape the heat and enjoy some water activities.  I recently saw a patient who told me that had just gotten a new boat and were looking forward to getting the kids out on the water.  This brought up the subject of life vests. 

When taking your children on a boat it is important that you have life vests for everyone. It is a law that all children under 13 years of age wear a “coast guard approved” life vest when on a boat that is being operated. This designation is very important, as many of the “life vests” that parents buy are not approved for boating…this includes “water wings” and some of the “cute” wearable t-shirts with life preservers sewn into them. 

Once you have found “coast guard approved” life jackets you might let your child help pick out the one they like the best and that is comfortable. This is important as it will ensure that they are both safe and comfortable. Children’s life jackets are sized by weight, so you might always have a few extras in case a friend or two comes along at the last minute.

Infants life jackets are are a bit different and have a strap that runs between their legs and extra flotation behind the head which guarantees that the baby floats face up at all times. I can attest to this important safety feature as my husband took our son on a little boat one summer day at a friends lake house. The lake was small enough that I could actually see them from the house as they rowed out to try to catch a fish. It was two men and a toddler on the boat…and I watched in horror as our 14 month old (now 32 year old) son leaned over the side of the boat to look at the fish and fell right into the dark murky Texas lake!!  Fortunately, we had followed the boating RULES and he was wearing his bright orange coast guard certified life jacket and bobbed right up to the surface…with a huge scared look on his face!  We have many pictures of our boys in the life jackets every time they set foot on a boat...including this one!

Lastly, get in the habit of applying sunscreen before you even set off for the dock and then have the children put on their life jackets. Kids can just as easily fall off the dock into the water as you prepare to get on the boat.  I would also encourage them to wear a hat for additional sun protection.

A day of boating is a great family activity and there is a lot a child can learn on board as well…how to navigate with a boating chart or GPS coordinates, how to watch for buoys or other water markings and all of the boating jargon.

Bon Voyage! 

Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

Daily Dose

Summer Viruses

1:30 to read

June….now seems like officially summer, although there are still some schools around the country in session, and even a couple in Dallas.  So, with summer here it is check up time in my pediatric office.  That means most days I am seeing very few sick patients, and most of the patients who come in for a visit other than a check up have a rash, a bug bite or maybe a swimmer’s ear.

 

But, with that being said there are also always some of those pesky summer viruses hanging around and many of them appear with just a fever. Many of the “sick” children I am seeing only have a fever, some of whom have a temperature as high as 103-104 degrees, with very few other symptoms.  Although these kids have a significant fever, once they are given an over the counter product like acetaminophen or ibuprofen they feel pretty well and even play for awhile. 

 

Fever is often just a symptom of a viral infection and these summer viruses have names…enterovirus, adenovirus, and even some left over parainfluenza virus.  We are definitely out of flu season….at least till next year.

 

Some of these summer viruses may have associated rashes which are more common with summer viral infections than winter viruses.

 

I have seen some kids with these summer viruses with prolonged fever, even 5-7 days which is a bit longer than a pediatrician and a parent want to see. But, with that being said, when I have seen these children they appear to look well and have not had any other physical findings.  I have often seen them again after having 5 or more days of fever, and it seems that many of them have adenoviral infections.  Adenovirus may also cause a myriad of other symptoms than just fever, including pink eye, sore throat, abdominal pain and vomiting and diarrhea and tummy cramps.  Rarely, some children will develop blood in their urine without having a urinary tract infection. 

 

Parents often ask me….where did they catch this? Remember that these are just viral infections and that there is not a vaccine for adenovirus. Once we see one virus in the community I know I will continue to see more and more children as it is “passed around”.  Best thing to do is to keep up good hand washing and keep your child home from the pool or summer activities if they have a fever.  

 

Daily Dose

Summer Slide

1:30 to read

School is out for everyone and that means lots of “down time “ for school children - all ages. I think that summer is really an important time for kids to get bored a bit.  In other words, fewer schedules, less connected to electronics, more play time and less stress….hopefully for all. I do know that as a working parent, I don’t think summer was as “unstressful” for me as it was for my children…as I had to continue to make sure that they had good child care and supervision - always challenging at times, but it all worked out and I would try to schedule a bit more time for me to be available for some fun outings.  

But, with fewer schedules and more time to “hang out” some children do experience what is referred to as “the summer slide”.  This can be defined as “the loss of academic skills over the summer break”. When children don’t read, work on math problems, or are not engaged in some sort of learning activity their skills and knowledge over the course of a 2-3 month summer vacation may regress. There is data to show that the loss in learning does vary with grade level,  subject matter and socioeconomic status - but most children show some negative changes when they are tested at the beginning of the summer vacation as compared to the end of the summer.  

The best way to try and prevent the summer slide is to have an idea or plan on how to keep your children interested in learning….but by doing different things than one might do during the school year.  

How about a summer book club or reading program that you might find either on line or through your public library.  There are book lists and fun reading projects for all ages…and if your child is older you might join them in reading one of the classics or even a new novel and discussing it together.  Even if your child claims to “not like to read” these programs are fun and reading a sports book or a scifi adventure may spark their reading.

Field trips:  Whether you live in the city or suburbs or even the country there are many FREE places to visit in your community. That might be a simple trip to the park to play while at the same time talking about why we have parks, and green spaces.  Museums typically have programs for children of all ages …and many are interactive with the parents. It is amazing how much “new” stuff there is to learn, for all of us.  If you are fortunate to live in driving distance to a national park or seashore take advantage of the many free events there. 

Mass transit: I know that when we finally got light rail in Dallas I took the opportunity to ride the rail with our young boys….all sorts of learning taking place as we read signs, and learned how to read a map of the rail system.   We also saw some local sites that we had never taken advantage of.  Inexpensive way to spend a day and the subway, light rail and bus systems in some areas are really growing.

This is also a good time of year to teach your children a few of the “basics”…whether that is how to pump a swing, or ride a bike with or without training wheels, how to tie their shoes, wash the car, or catch a ball …lots of life skills that may get ignored during the school year, and these are skills everyone should know. 

 

 

Daily Dose

4th of July Celebrations!

1:30 to read

The 4th of July weekend is here, which means many families will celebrate with a long weekend with other families and friends. Let’s remember the importance of making it a safe holiday!   

Of course the celebration includes fireworks which are definitely fun to watch, but at the same time, when they are used by consumers (many of whom are children and teens) rather than by trained professionals, there are many associated risks.  Being on call in the ER as a new doctor was one of the scariest and longest nights in my life...and I can remember seeing children with burns...several which were disfiguring. Burns remain one of my biggest fears.

In 2013 there were an estimated 11,400 people treated in emergency rooms for fireworks related injuries, and the risk of fireworks injury was highest for children ages 0- years, followed by children 10-14 years. I know that having fireworks in your backyard or on the beach is fun, but also dangerous. Although I was used to my boys saying, “ Mom, you tell us that everything that is fun is too dangerous...which not only included fireworks, but trampolines, and motorcycles.”  I am sticking to that.

The majority of fireworks related injuries were to the extremities followed by those to the head (eyes, ears, face).  The greatest number of injuries were caused by small firecrackers, sparklers, and bottle rockets. Did you know that a sparkler burns as hot as 1200 degrees F, while water boils at 212 degrees F and wood burns at 575 degrees F!! Even a left over sparkler may cause a significant burn to little hands.

Fireworks are best left to the “hands” of the experts. Fireworks are dangerous and can be unpredictable, especially in the hands of amateurs (including parents).  Public firework displays are equally enjoyable and are carefully planned and executed. Especially with drought conditions and fires already raging in parts of the U.S. it is especially important to be aware of the risk of inadvertently setting a small fire from a misguided bottle rocket.  That small fire may lead to an even bigger fire which destroys acres of land as well as puts firefighters themselves at risk. No one wishes for that scenario but there were over 17,500 fires caused by fireworks in previous years. 

Start planning your holiday fireworks viewing now....from a safe venue! Happy 4th!

Daily Dose

Don't Miss Out on Summer Fun!

1.00 to read

The lazy days of summer seem like the perfect time to engage in playtime activities. My summer months at the office are particularly busy doing check ups as everyone is out of school. This means that I seem to see a lot of children in the 5-12 year group, and I enjoy getting to talk to them about their summer fun. 

I have suddenly realized that many of the children in this age group seemed to have “missed” some key milestones in child development, which I think most of us adults learned during the lazy days of summer.  I think learning to ride a bicycle and learning how to swim are two MUSTS of child development. While not all children will want to one day participate in a swim team, or a bike race, being able to swim and pedal a bicycle are life long skills. Who knows, with the price of gas we may all be heading back to bicycles as preferred transportation, at least for short distances.  

At the same time I have noticed a fair number of parents who are concerned about their young children’s motor development.  This is the 2-4 year old group where I am sometimes amazed when the parent of a 3 year old tells me that their child “does not jump high enough”. What?  How about getting out the jump rope again, and drawing hopscotch on the sidewalk to practice hopping and jumping. These are free exercises that can help boost coordination while having fun together. What about learning to skip and to balance on a beam (doesn’t have to be at gymnastics) a two by four in the back yard or park works just as well. Learning to pump a swing is another. I can remember how proud I was when I mastered that skill (makes me smile, even today). 

So while the last days of summer are here, make a list of not only summer reading, or computer skills that your child needs to finish, but of some of those childhood milestones as well.  Hop, skip, jump rope, ride a bike, learn to swim. College applications might start asking about those milestones one day too?  Stranger things have happened.

Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

National Safety Month

1:30 to read

June is National Safety Month…just in time for summer! It is a good reminder for all of us to try and prevent any injuries in our children. I do know from my own pediatric office that we see more injuries during the summer months. Whether it is from falls, bike accidents, pool incidents, household poisonings or burns, our phones stay busy.

 

So..this is the perfect time to re-think child proofing your home. Make sure that stairs are gated, both top and bottom. Cabinets need to have child proof latches to protect children from getting into breakable or sharp objects as well as medicines or household products that may be poisonous.  Put the number for Poison Control in your phone….1-800-222-1222. I am often surprised that a parent calls our office about a child who has “gotten into “ a possible poison…the first call should be to Poison Control. Keep the number posted in the house as well so a babysitter may also have it if necessary.

 

Learning to ride a bike a is “life skill” for sure….but that also includes learning to wear your helmet. I see most young children in our neighborhood who are still under the eye of a parent with a bike helmet, but once they are older I often see kids without helmets. Just saw a neighbor’s child ride down the street this evening..no helmet!!  Bike helmets are like a seat belt…not optional. Many “tween” boys will “debate” with me during their check ups about the need for a helmet,  as they tell me “ I am a great bike rider and don’t have wrecks”. Teach your children what the word ACCIDENT means and that just like a car…you never know what “the other guy may do”.  Accidents are NEVER planned and a bike helmet protects the head and brain. We can “fix” the broken arm or stitch a leg…but cannot “fix” a brain injury.

 

Texting and driving is unsafe and may even be illegal in your state. Texas just passed a law prohibiting texting and driving….but teens (and adults)  need to be reminded on a regular basis that texting is not allowed!!  Texting while driving is a leading cause of accidents and I just saw a mother who is pregnant, and was in the office with her 1 year old…she had just been involved in accident that totaled her car.  She was hit from behind by a teen who had been texting and never slowed down.  Fortunately both mother and child were buckled up and were not seriously injured.  If your child is found to be texting while they are driving you should have some serious consequences with both revoked driving privileges and no phone for a while. 

 

Lastly, this is a good month to remember to check your medicine cabinet and throw away any expired or unused medication.  There are some pharmacies that are having events where you can bring in expired medications and they will dispose of them properly. The number one place that  teens find drugs is in the home…keep all narcotics locked up and dispose of any unused medications!! I have had more than several parents who have told me that “drugs” had disappeared from their medicine cabinets after their own kids had had a lot of friends over…and who knows who may be “seeking” prescription medications. Locks on medicine cabinets and liquor cabinets are a must for families. 

What about taking a family first aid course at your local YMCA or Red Cross and spend a day getting your own family first aid kit together.  This is a great way to spend some time together and a productive activity. Have a fun and safe summer!!

Daily Dose

Dog Bites

1:30 to read

I am a dog lover and we have always had a dog in our house….even before we had our children.  But, some dogs will bite and unfortunately there are more than 800,000 people every year who receive medical care for a dog bite…more than half of these are children.

 

Children are also more likely to be severely injured from a dog bite…and I was reminded of this today when I saw a very serious dog bite to a child’s face.  The child was brought to my office by his nanny after being bitten on his cheek by the family’s dog.  It was one of the worst bites I have ever seen! He was severely injured and should have actually gone straight to the ER….the good news is that he will ok, but he had to undergo surgery to repair the bite and will probably require another small surgery at some later date. 

 

In this case as in most, the dog bite occurs when a child is interacting with a familiar dog, and in this case it was the family pet. The little boy is a toddler with a twin sister and they were playing when he was bitten.  The dog had been around the children since they were born…and it is unclear what precipitated the bite.  Sometimes a dog becomes aggressive if they are bothered while they are eating or sleeping…and you know toddlers, they can “bother” anyone. 

 

One of my “boys” is also a dog bite statistic.  He was raised with dogs (my sweet lab Maggie is at my feet as I am writing), so I was totally caught off guard one night when the phone rang. My son had been spending the night at a friend’s house (he was about 10 years old) and the voice on the other end of the phone was the father of the friend (he too a doctor), informing me that my child had been bitten by their dog.  It seemed the boys were laying on the floor on blankets watching a movie and eating popcorn and for some “unknown “ reason the dog bit my son on his face.  The bite was not precipitated by anything…they had not been playing or rough housing with the dog and the dog had not been known to be aggressive. The next words out of the father’s mouth…”do you know a good plastic surgeon?” Not words you want to hear from another physician.

 

Thankfully, I did know a good plastic surgeon who I awakened after his long day in the OR….and he got out of bed and met us to suture my son’s face with over 20 stitches. Luckily it only involved his nose, cheek and chin, just barely missing his left eye. I am sure I cried more than my son.  He still has a scar across his nose..which only bothers his mother.  Incredibly, he never “blamed” their dog, went back to play at their house, and still loves his own dogs more than anything.  My brother who is a vet still thinks that any dog that bites without provocation should not stay in the home with children…but that is one vet’s opinion. 

 

It is especially important to teach your children never to approach a dog to pet it without first asking the owner if it is okay.  Children should learn to move slowly and let the dog “sniff” them first and to stay away from their face and tail. Teach your child how to gently pet an animal and to always be gentle.  If they are around a dog who is behaving in a threatening manner by growling or barking, they should slowly back away from the dog and try to avoid eye contact with the dog. If they are ever knocked over by a dog they should curl up in and ball and protect their face with their arms.

If your child is bitten and it is superficial it will probably just require care with soap and water. For bites that break the skin you should check in with your pediatrician.  Make sure you know the rabies vaccination status of the dog that bit.  You also need to make sure that your child is up to date on their tetanus vaccination. In some cases your child may also need an antibiotic.

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