Twitter Facebook RSS Feed Print
Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

Daily Dose

Changes in Flu Immunizations for Children

Flu season is fast approaching and that means it is time to get your flu vaccine. Recently the Centers for Disease Control and Prevention and the American Academy of Pediatrics expanded the recommendation for flu vaccination to include all children ages six months to 18 years.

The previous recommended age group was 6 months to 5 years. "Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose," says pediatrician Dr. Sue Hubbard. That means the time is now for you to call and schedule a flu shot with your doctor and your child's pediatrician. Many offices block off certain times during the day in which they have "flu shot clinics." According to Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases there is an ample supply of the flu vaccine this year. He encourages people to start taking it now as there is no reason to wait. "There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective," says Dr. Hubbard. "Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits." Dr. Hubbard also recommends that you teach your child to practice good hand and cough hygiene to help prevent the spread of germs. More Information: The American Academy of Pediatrics More Information: Centers for Disease Control and Prevention

Your Teen

Teens Waiting Longer For Sex, But Still Taking Risks

"Fifteen- to 19-year-olds have the most sexually transmitted diseases. Even though they are waiting, they are having risky sex and not taking precautions," Weller said. According to Weller, it's important to provide sex education at a young age. "The younger one receives sexual education, the less likely you are to engage in risky sex," she said. Teenage girls in the United States are more likely than boys to have unprotected sex during their first sexual experience, new research indicates.

The finding was a surprise to researcher Nicole Weller, an Arizona State University graduate student working on her doctoral degree in sociology. "I'm looking at the interaction between sexual education and how it impacts young adolescent sexual behavior. This in particular was an interesting finding because males usually report that they are having more sex than females," Weller said in a university news release. Her analysis of data from the National Survey of Family Growth also found that young people are waiting longer than in the past to have a first sexual encounter, but they are contracting sexually transmitted diseases (STDs) earlier than in the past. "Fifteen- to 19-year-olds have the most sexually transmitted diseases. Even though they are waiting, they are having risky sex and not taking precautions," Weller said. According to Weller, it's important to provide sex education at a young age. "The younger one receives sexual education, the less likely you are to engage in risky sex," she said. But the type of sexual education provided in U.S. schools is inconsistent -- from abstinence to STD awareness, and from birth control to pregnancy awareness. "It varies in school districts and from state to state," she added. According to Centers for Disease Control surveys, Texas teens have unprotected sex far more often than the national average. In states and cities with "abstinence-plus" teaching policies, the rate of unprotected sex drops below the national average. Houston, for example, has an abstinence-plus teaching policy, and CDC surveys show Houston teens as below the national average for unprotected sex. Research also shows that younger children seek their parent's advice more than adolescents, who tend to depend more on their friends and the media. Take advantage of the opportunity to talk to your young children about issues of sexual health. Talking to your kids about issues like dating and relationships, STDs, and HIV can leave a lasting impression. This will help you provide your children with information that is accurate and reflects your personal values and principles.

Parenting

Health Official: Zika Outbreaks Likely in U.S.

2:00

The United States can expect to see outbreaks of the Zika virus says Dr.Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.

While the U.S. has already seen more than 350 cases of people who were infected abroad and returned to the country, there haven’t been any recorded cases of someone infected within its borders. But those days may be limited, said Fauci.

"It is likely we will have what is called a local outbreak," he said on Fox News Sunday with Chris Wallace.

Since being detected in Brazil last year, the virus has spread through the Americas. It has been linked to thousands of cases of microcephaly, a typically rare birth defect marked by unusually small head size, which often indicates poor brain development. The World Health Organization declared a global health emergency in February.

Zika, which is spread by mosquitoes and through sexual contact, can give adults the paralyzing Guillain-Barre syndrome. The Aedes aegypti mosquito, which primarily transmits disease, is already present in about 30 U.S. states.

While Fauci does expect someone to be bitten by the mosquito here in the States, he does not expect a large number of people to become ill.

"It would not be surprising at all - if not likely - that we're going to see a bit of that," he said. "We're talking about scores of cases, dozens of cases, at most."

He also raised the prospect that other neurological ailments could be eventually linked to Zika, which he called "disturbing."

"There are only individual case reports of significant neurological damage to people not just the fetuses but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," he said. "So far they look unusual, but at least we've seen them and that's concerning."

Fauci has pressed the administration’s case for budgeting $1.9 billion dollars in emergency funds to fight the virus.

"We have to act now," he said. "I can't wait to start developing a vaccine."

Still, Fauci refrained from recommending that U.S. women avoid becoming pregnant because of fear of giving birth to a baby with microcephaly.

"Right now in the United States they should not be that concerned. We do not have local outbreaks," he said.

According to the Centers for Disease Control and Prevention (CDC), no vaccine currently exists to prevent Zika virus disease. The mosquito that carries the Zika virus mostly bites in the daytime.

The CDC recommends following typical mosquito bite preventions such as:

•       Wear long-sleeved shirts and long pants.

•       Stay in places with air conditioning and window and door screens to keep mosquitoes outside.

•       Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

•       Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breast-feeding women.

◦       Always follow the product label instructions.

◦       Reapply insect repellent as directed.

◦       Do not spray repellent on the skin under clothing.

◦       If you are also using sunscreen, apply sunscreen before applying insect repellent.

•       To protect your child from mosquito bites:

◦       Do not use insect repellent on babies younger than 2 months old.

◦       Do not use products containing oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old.

◦       Dress your child in clothing that covers arms and legs.

◦       Cover crib, stroller, and baby carrier with mosquito netting.

◦       Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.

◦       Adults: Spray insect repellent onto your hands and then apply to a child’s face.

•       Treat clothing and gear with permethrin or purchase permethrin-treated items.

◦       Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last.

◦       If treating items yourself, follow the product instructions carefully.

◦        Do NOT use permethrin products directly on skin. They are intended to treat clothing.

Story sources: Diane Bartz, http://www.reuters.com/article/us-health-zika-usa-idUSKCN0XE0UV

http://www.cdc.gov/zika/prevention/

Your Teen

Headlines: Another Teen Suicide

On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years.The sad and desperate story of a college student who killed himself after a roommate secretly videotaped him having sex, and streamed it live on the web has made headlines across the world.

18 year old, Tyler Clementi, was embarrassed and humiliated by the invasion of his privacy. He jumped to his death from the George Washington Bridge. Unfortunately, Tyler is not the only teen who thinks suicide is the only way to end his suffering. On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years. Amazingly, suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The current headlines demonstrate that it is more important than ever that parents are aware of the symptoms of depression and substance abuse.  Suicides increase substantially when the two are combined. What symptoms should I look for? - Change in eating and sleeping habits - Withdrawal from friends, family, and regular activities. - Violent, rebellious behavior, or running away - Drug and alcohol use. - Unusual neglect of personal appearance - Marked personality change - Persistent boredom, difficulty concentrating, or a decline in the quality of     schoolwork - Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. - Loss of interest in pleasurable activities. - Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: - Complain of being a bad person or feeling rotten inside. - Give verbal hints with statements such as: “I won't be a problem for you much longer,”    “ Nothing matters,” “It's no use, and I won't see you again.” - Put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc. - Become suddenly cheerful after a period of depression - Have signs of psychosis (hallucinations or bizarre thoughts.) What should you do if you notice these symptoms in your child? If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide,"  always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a healthier mental outlook.

Your Teen

CDC: Summer Camp Flu Outbreaks Presage Fall Surge

The Centers for Disease Control and Prevention says outbreaks of the H1N1 flu (swine flu) among children attending U.S. summer camps foreshadow a surge in cases this fall as students return to school. "This is just a harbinger of what we will see in the fall," Dr. Richard Besser, who led the U.S. response to the virus outbreak last spring. He tells Reuters News that the outbreaks in summer camps have been in the hundreds. Dr. Besser predicts soaring numbers of H1N1 cases compared to those seen in April when the first U.S. cases were diagnosed in California and urges health officials to plan now for the possibility of crowded hospitals, swamped emergency rooms and overwhelmed clinics.

"The magnitude of the event in the fall will be much greater (than what was experienced last spring)," Besser said. H1N1 swine flu is now so widespread that the World Health Organization (WHO) has stopped counting individual cases. So far H1N1 is characterized by mild symptoms in most patients who go on to recover without treatment within a week. The median age of sufferers has been 14 to 17 years old, although the age is increasing slightly as the number of cases increases, according to the WHO, suggesting the virus is spreading from schools into the wider community. More Information: Centers for Disease Control and Prevention

Daily Dose

World Health Organization Virus Alert!

1.15 to read

An article in the news caught my eye today when I noticed that The World Health Organization (WHO) called an emergency meeting to discuss the infectious disease known as MERS (Middle East Respiratory virus, formerly known as nCoV).   This is only the second time that the WHO has called an emergency meeting, the first being in 2009 with the H1N1 bird flu virus.

While the name is complicated the biggest issue is that this VIRUS has only been identified in the past year. It was identified in 2012 as a “novel coronavirus” and is similar to the SARS virus from a decade ago.  This virus which also causes a respiratory illness has been confirmed in 55 patients mainly from the Middle East.  There have been a few cases reported in travelers from other countries ( France, UK, Italy and Tunisia) who had been to the Middle East.  Saudi Arabia has had 40 reported cases.  The alarming fact is that 31 of the 55 cases have died.

Now you may wonder why this really interests me???  I am always interested in emerging infectious diseases and how this infection might make its way to the U.S. as all doctors need to stay abreast about new infections.   But, coincidentally, I have just returned from overseas and 2 days later, I have an upper respiratory infection and cough. Now, I really do FEEL OKAY but as I have reminded people before infectious diseases are just a plane ride away.  You can never really know how you may contract a viral illness and the MER-S virus has been found to have human-to-human transmission. 

The WHO still does not know the original source or route of the virus that caused human illness.   This again reiterates the importance of vaccines and disease prevention!!!! While there is not a vaccine (to date) for MERS, there are plenty of vaccines that when given are working well to prevent communicable diseases.  (another reason to vaccinate your child!)

So.....I am going to be watching for further updates from the WHO and CDC about this virus......and in the meantime I will keep drinking fluids, and covering my mouth when I cough. I will say my trip was really fun!!    

Daily Dose

Dealing With Dog Bites

What should you do if your child is bitten by a dog? I received an email via our iPhone App from a mom who was very worried after her daughter had been bitten by a friend's dog.  This is a common concern/query to the pediatrician.  In fact, one of my own children was severely bitten by a friend's dog, but I had somehow forgotten that experience and the 20 stitches to his face!

Tincture of time is the best remedy for many things. At any rate, I looked at the CDC's website to find that there are over 5 million dog bites a year and about 800,000 require medical attention. No wonder the health care system is overflowing! This mother was concerned as to what was the appropriate treatment. Her daughter's bite was on the face (very common for a child) but small. It did break the skin. The first thing a parent should do is to stop the bleeding by applying pressure. Then, clean the area with warm water and soap. Dogs, like humans, have dirty mouths, so you want to wash and rinse well and even flush out the wound if it is deep. If the bite wound is small, it is usually not sutured, as this may increase the risk for infection. On the other hand, facial wounds, and larger bites have to be well cleansed and irrigated, and may require suturing. The sooner this can be accomplished the better. For a child with a dog bite that has broken the skin, most pediatricians would recommend a 7-day course of an antibiotic, typically Augmentin (unless the child is penicillin allergic). Rabies is usually not a risk in dogs that are family pets and in homes. If the dog is not known or their rabies status is unclear and you cannot find the dog, check with your pediatrician about rabies prophylaxis. Lastly, you want to ensure minimal scarring by using a topical vitamin E cream on the healed skin and sunscreen. The less the sun exposure, the less scarring, especially if the face is involved.  That really goes for all cuts and scars. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.