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Daily Dose

No Need for Stitches?

1.45 to read

OUCH!! I was just heading out to grab some lunch when a patient of mine, who happens to have 3 young sons (brings back memories) walked in with her youngest son who had been jumping on the bed and bumped his head!

As you can see by the picture, there was a nice little laceration right in the middle of his forehead. This was the perfect wound that would have previously required a stitch or two, but can now be closed with a liquid adhesive called Dermabond.

Fortunately, this experienced mother of 3 boys had already become a fan of Dermabond and instead of going to the ER; she came by the office for a fairly easy procedure to close the wound.  Smart Mom!

When Dermabond was released in the early 2000’s it took me awhile to get used to how easy this made wound closure.  Dermabond is a liquid skin adhesive that holds wound edges together. The best thing is that it is painless and can be used on small superficial lacerations. Even for a wiggly toddler in most cases the laceration can be closed even while the parent is holding a child still. This is certainly not the case when having to suture!

Dermabond forms a polymer which causes adhesion of the wound edges so it is perfect for “clean, straight, small” lacerations that I often see among my patients.  The classic ones are on the edge of the eye, the chin, the forehead or even the scalp. In studies the cosmetic outcome was comparable to suturing, and in my opinion for those small lacerations it is preferable.

So, we cleaned the wound up, laid him right down (he was perfectly still too) and within 5 minutes the head wound was closed and a happy 2 year waltzed out of the office. Not a tear to be found, but I did have a little residual glue on my finger!

The Dermabond will wear off on its own in 5 – 10 days. Once the adhesive comes off I always remind parents to use sunscreen on the area, which also helps to prevent scarring.

Happily this little guy left while singing “Dr. Sue said, no more little boys jumping on the bed!”

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

Daily Dose

Paying Attention to the Road

I am always talking to my own children about paying attention to the road and having no other distractions in the car.As I was driving to work today, I routinely go through a school zone. Today was the day that they had motorcycle police using radar and ticketing those drivers who were not following the school zone speed limit. There were a lot of people pulled over getting tickets and a line waiting for the police officer.

This is the same school zone that my children walked through on their way to school, and therefore I am always aware of the speed limit as it is closest to my home. I am always amazed at the number of cars that go speeding by oblivious to the flashing yellow lights. But, I am also sure that I am not as aware of other areas of the city and those school zones. We all get preoccupied while driving and it seems to be related to other things going on in the car. Whether it is children fighting in the back seat, or the noise from a movie on the car DVD player, or the cell phone or blackberry, there are too many opportunities to have our attention diverted. I am always talking to my own children about paying attention to the road and having no other distractions in the car. I even went as far to have the radio disconnected when our oldest started driving (that didn't go over well!) Well, I think "us" parents need to heed the same advice. Stay off the phone in school zones, no texting while driving, and let's not have kids watching TV on their way to school. Instead, how about talking to the children in the back seat. Whether it is weather, sports, spelling words or quizzing math facts, talking to our kids is far better than any thing else we can find to do on the way to school. And if you find yourself in a school zone, and don't have kids in the car, just pay attention to the rules and enjoy the quiet. That's your daily dose, we'll chat tomorrow! Send your question to Dr. Sue!

Daily Dose

Swim Lessons Can Reduce Risk of Drowning

1:15 to read

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

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

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

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

Daily Dose

Fire Safety Month

October is 'National Fire Safety' month and a great opportunity to review fire safety within your own home.October is ‘National Fire Safety' month and a great opportunity to review fire safety within your own home. I did not realize that fire and burns are the third leading cause of injury related deaths in the home. I do remember having a fire in our own home when I was a child and how frightening it was. Because of that, I have always been "freaky" about fire in my own home. Fires happen quickly, quietly and studies show that you only have about 3 minutes to get out of the house after a fire breaks out.

So... this month you should have a family fire drill, which requires a plan in case of fire. Where will you meet, how do you get out of the house if you cannot get out of your room, crawling out of the house on your hands and knees if necessary etc. Rehearsing what you will all do makes it second nature if a fire ever really happens. We do this in the hospital and the office too, kind of like a "mock code" for cardiac arrests. Preschool children learn about STOP, DROP, and ROLL if there is a fire and their clothes should be involved. Review this with your children. Install smoke alarms in all bedrooms and make sure the batteries are checked. Changing batteries with the clock changes each year is a great reminder. Talk to your kids about 911 and how and when to call, and teach them their address once they are between thee and five years of age. Prevention is the key, and planning ahead is the best remedy to prevent a disaster. That's your daily dose, we'll chat tomorrow. More Information: Home Safety Council

Daily Dose

No Need for Stitches?

1.45 to read

OUCH!! This week, I was heading out to grab some lunch when a patient of mine, who happens to have 3 young sons (brings back memories) walked in with her youngest son who had been jumping on the bed and bumped his head!

As you can see by the picture, there was a nice little laceration right in the middle of his forehead. This was the perfect wound that would have previously required a stitch or two, but can now be closed with a liquid adhesive called Dermabond.

Fortunately, this experienced mother of 3 boys had already become a fan of Dermabond and instead of going to the ER; she came by the office for a fairly easy procedure to close the wound.  Smart Mom!

When Dermabond was released in the early 2000’s it took me awhile to get used to how easy this made wound closure.  Dermabond is a liquid skin adhesive that holds wound edges together. The best thing is that it is painless and can be used on small superficial lacerations. Even for a wiggly toddler in most cases the laceration can be closed even while the parent is holding a child still. This is certainly not the case when having to suture!

Dermabond forms a polymer which causes adhesion of the wound edges so it is perfect for “clean, straight, small” lacerations that I often see among my patients.  The classic ones are on the edge of the eye, the chin, the forehead or even the scalp. In studies the cosmetic outcome was comparable to suturing, and in my opinion for those small lacerations it is preferable.

So, we cleaned the wound up, laid him right down (he was perfectly still too) and within 5 minutes the head wound was closed and a happy 2 year waltzed out of the office. Not a tear to be found, but I did have a little residual glue on my finger!

The Dermabond will wear off on its own in 5 – 10 days. Once the adhesive comes off I always remind parents to use sunscreen on the area, which also helps to prevent scarring.

Happily this little guy left while singing “Dr. Sue said, no more little boys jumping on the bed!”

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

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

Daily Dose

Summer Means Head Lacerations

Parents are often frantic (as we all can be) when their child falls and you see blood coming from the head and face.Last weekend I had several phone calls about head lacerations. Summer is the season for accidents and it seems the weekends are always the busiest.

Parents are often frantic (as we all can be) when their child falls and you see blood coming from the head and face. Luckily, in most cases there is more blood than one would expect for the size of the injury, as the head is well vascularized and therefore even a small laceration will cause a lot of bleeding. The first thing to do is to get the child calmed down (and you too) and try and wash the area to really get an idea as to how large the laceration is. The patient who called could not get her child to let her look at her head (which showed that her child was okay if she could put up that much of a fight) so we had the idea of taking her toddler to the shower with the mother and to wash off there. That worked wonderfully and by then both mother and child had calmed down. Once you can see the cut, try to establish how deep and wide it is, and then see if you can stop the bleeding with pressure to the cut. If it is a scalp wound and you can stop the bleeding and it is not too deep I often do not put a child through stitches as their hair will cover the scar. That is the antithesis to a facial laceration when we are all concerned about cosmetic appearance and even a smaller cut might get one or two stitches in order to have the best cosmetic result. If in doubt, take your child to the doctor or run them by your pediatrician's house (that works great for me on weekends) in order to decide if stitches are needed. Some clean cuts may be closed with a wonderful product called "Dermabond" which is almost like "super glue" for skin. Do NOT use super glue which one of my own children thought about using for an injury while they were at college. Thank goodness they called home first! Just remember that a lot of blood does not always mean a huge injury. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Drowning Is Silent!

1:15 to read

Summer is coming to an end, and many families will create memories this holiday weekend at the beach, lake, or pool. The first thing that comes to my mind (when I think of water) is safety!!  

Knowing that over 900 children between the ages of 1–14 die each year from drowning, the discussion of water safety is a necessary part of summer routines. Astoundingly, reports show that 9 out of 10 of those children who drowned were “under supervision”. The American Academy of Pediatrics has endorsed allowing children between the ages of 1-4 to take swimming lessons. It was previously thought that encouraging swimming lessons for children under the age of 4 years might actually contribute to increased drowning.   In fact, recent studies have suggested that children ages 1–4 may be less likely to drown if they have had formal swimming instruction. The AAP has not gone so far as to routinely recommend mandatory swimming lessons for this age group, but does endorse swimming lessons in younger children who are frequently exposed to water and are emotionally and physically able to participate.  

The AAP does not recommend formal “infant survival swimming lessons” for children under the age of 1 year. When I discuss water safety with my patients, I emphasize that drowning continues to be the second leading cause of death for children ages 1–19.  I often have interesting discussions with parents who have a backyard pool who do not believe that it is necessary to have a barrier around the pool. They will say, “we never let our child outside alone” or “he or she is always being supervised by an adult”.

As you might expect, these are usually first time parents who have yet to experience the cunningness of a toddler.  Just as our children watch us and learn how to feed themselves, or drink from a cup or climb out of a bed, they too watch us open a door, or take a stool out to reach something. A toddler is more than capable or figuring out how to reach a door handle even with a lock, or climb out a window to go outside and head straight for the pool. Drowning is SILENT!!  It is not like the movies with screaming and yelling. The child quietly goes beneath the water and sinks.  It only takes minutes and the consequences of drowning are devastating.  Even for a child who is found and resuscitated there may be a life-long brain injury and the worst case scenario, death.

All families with a pool should install a 4 sided fence that is at least 4 feet high to limit pool access. It must be difficult to climb and have a self-latching, self-closing gate. The arguments I hear about “landscape aesthetics” fall on deaf ears.  Every family should also know CPR. Sign your child up for swimming lessons, and have fun practicing flutter kicks and arm strokes. Just do it with an adult within arm’s reach of all new and novice swimmers and a fence around the pool!

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

Daily Dose

Kids And Choking Dangers

There are so many foods that can cause choking in your children. Dr. Sue tells you which ones.It has been a difficult week for my group practice as we have had a small child sustain a terrible accident after choking on an apple.  As a pediatrician, I talk about choking with parents beginning at the first visit, and encourage all new parents to take a CPR course.

When you discuss this with young parents you never dream that they will actually ever have to perform CPR. Choking hazards in young children are very real. A toddler’s airway is about the size of their “pinky” finger and there are many ominous objects just waiting for an active toddler to put into their mouths. Children like to explore with their mouths, so nothing is off limits!  With that being said, child proofing the house from choking hazards such as small toys, and objects is imperative. It is also important that when beginning to offer a toddler table foods that parents and caregivers think about choking hazards.  Parents worry about a child choking if they are beginning table food and don’t have teeth. It is not commonly known that teeth really have nothing to do with a toddler eating table foods, as even toddlers with a full mouth of teeth do not know to chew.  They just take big bites and swallow. So, think about foods being mushy and well cooked, in order that chewing is not necessary. It is like older folks, who often do not have a lot of teeth to chew with, so their food is all well cooked and cut into small pieces, which does not necessitate chewing. Every food that is offered to a toddler needs to be well cooked and think about being able to mush it up with a fork or between your fingers. The concerns about food allergies and the risks of giving a child a food “too soon” are no longer thought to be valid. The biggest concern about new foods for toddlers and children is really more about choking risks. With that being said, think about some of these foods.  Peanut butter is fine, but never a peanut or other nut that could easily cause airway obstruction. Melons that are mushy and given in small pieces would be fine too, but never a melon ball. Chips, popcorn, hard candies and hot dogs are a no-no too. So are uncooked carrots, celery sticks, apple slices, and chunks of meat like steak or pork.  Remember, can you mush it between your fingers? Well cooked peas, carrots, squash, eggplant, this list goes on and on and well cooked food are usually okay. So too are ground meats, shredded lunch meats and flaky fish.  It is important for toddlers to have a well balanced diet, while at the same time being aware of the risks of choking. Grapes should be cut into pieces, strawberries too.  Don’t let a toddler take a “bite” out of a hard fruit, rather cut it all up and give them small mushy pieces, several at a time. Lastly, remember to have your child sitting at a table for meals and snacks and do not allow them to walk around the house carrying food that might cause choking. It may be something that takes a little thought and reminding in the beginning, but your child will quickly learn that they eat at a table, rather than while “cruising”. It’s a really a good rule for all of us! So if you have a young child, and do not know CPR, call and sign up now!  At the same time be aware of choking hazards and the rare but deadly accidents that may occur. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

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