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Daily Dose

Q-tip Injuries

1:30 to read

I know I am asked on a regular basis, “how do I clean my baby’s/child’s ears?  I have replied for years with something that I know I was taught many years ago, maybe even by a grandparent? “Nothing smaller than your elbow should go in your ear”. Who knows where that saying came from but it is a good visual that you should not “stick a Q-tip” or anything into the ear canal.

 

Now an article published in the journal Pediatrics sure makes that adage seem timely, as about 12,500 children younger than 18 are treated in emergency rooms annually, which translates into about 34 children per day.  The study also showed that about two out of three patients were younger than 8 years and children younger than 3 accounted for 40 percent of all injuries. 

 

Cotton swabs are really intended to clean the outer ear and should not be placed into the ear canal…even though most people put a q-tip right into the canal which may cause injury when pushed too far.  The study showed that about 30 percent of injuries caused by the cotton swabs were feeling as if there was a foreign body in the ear, while 25 percent of injuries were a perforated ear drum and 23 percent were soft tissue injuries. WOW…talk about expensive health care costs related to one little cotton tipped swab!

 

Ear nose and throat doctors (otolaryngologists) will tell you that the ear canals are usually self cleaning and using a cotton tipped swab to clean the ear only pushes the wax further down the canal and closer to the ear drum. If in fact the wax becomes impacted by using a q-tip, it is even harder to get the wax out. There are over the counter drops that you can instill in the ear canal to help soften wax and then use a wash cloth to clean the outer ear.

 

So..resist the urge to put a Q-tip into your ear canal and simply use them to take off makeup, paint small places or any of the millions of other uses…just NOT in the ear!

 

 

 

 

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Your Baby

AAP: No Fruit Juice for Children Under 1 Years-Old

1:45

Kids under the age of 1 should avoid fruit juice, older kids should drink it only sparingly and all children should focus, instead, on eating whole fruit, according to the American Academy of Pediatrics.

A 2006 AAP policy recommended no juice for children younger than 6 months of age, 4-6 ounces daily for children ages 1-6 years and 8-12 ounces for children 7 and older. Since then, however, considerable concern has been expressed about increasing obesity rates and risks for dental decay.

The new policy advices against giving children under the age of 1 any fruit juice at all unless there is a strong clinical basis for it in the management of constipation. For older children, maximum daily intakes of 100% juice products should be 4 ounces for children ages 1-3 years, 4-6 ounces for children ages 4-6 years and 8 ounces for those 7 and older.

When juice is served to older toddlers, it is important that it not be sipped throughout the day or used to calm an upset child. 

Instead of juices, the AAP recommends fresh fruit in children’s diets. Fruit generally contains additional fiber compared to juices. Consistent with recent AAP recommendations, water and cow’s milk are preferred as primary fluid sources after breastfeeding or formula ceases.

The policy clarifies that there is no reason to give juice during the first year of life and that expensive juice products marketed specifically for infants have no value.

The guidelines also strongly discourage unpasteurized juice products, which can carry pathogens such as E. coli.

As far as which juice is better for kids, the AAP does not favor one juice over the other, but does recommend 100 % fruit juice and not fruit drinks – which contain less than 100 % juice and have added sweeteners.

"Some juices naturally have certain vitamins or minerals in them," Abrams said, noting that orange juice has lots of vitamin C. "But that doesn't mean that apple juice doesn't provide vitamin C, because it's usually fortified."

Story sources: Steven A. Abrams, M.D., FAAP, http://www.aappublications.org/news/2017/05/22/FruitJuice052217

Katherine Hobson, http://www.npr.org/sections/health-shots/2017/05/22/528970924/pediatricians-advise-no-fruit-juice-until-kids-are-1

Parenting

Teaching Your Child Healthy Hair Care Habits

1:45

Teaching your child good hair care practices can help him or her maintain healthy and shiny locks throughout their life. It can also help prevent hair damage and skin conditions such as dandruff.

You’ve probably been washing your hair more years than you can remember by now, but there was a time when you had to learn what to do with shampoo and water.

If your child has reached the age where he or she can start washing their own hair, here are some tips to help them develop good hair care habits.

You’d be surprised how many kids think that washing their hair means just that – washing only their hair. Healthy skin and hair requires washing the scalp and the hair.

How often should your child wash his or her hair? The answer to that question depends on several factors. For example, during the summer, when kids are more likely to be playing outdoors or involved in sports, they may need to wash their hair as often as every other day. In the drier winter months when kids typically spend more time indoors, the schedule may be pushed back a day or two.

You also have to consider your child’s hair type. Does it tend to be dry or oily? Is it fine, curly, thick, thin or coarse? Different hair types require different care programs.

On an average, kids around 12 years old or who have started puberty and have fine, straight or thin hair, might need to shampoo as often as every other day. At this age, many kids are beginning to experience hormonal changes, causing their hair and scalp to be a little oilier.

For younger children, once or twice a week is sufficient – again, if they haven’t been doing something that would cause their hair to be excessively dirty.

For children with dry, curly or very coarse hair, washing their hair too often can be drying to the scalp and the hair. African American children often have at least a couple of these hair types. Washing their hair once a week or once every two weeks is sufficient if their hair isn’t too dirty. They may also benefit from using a moisturizing shampoo made especially for their hair type as well as a conditioner.

Healthy hair care begins with learning how to wash the hair without damaging it. When your child is ready to start shampooing, follow these steps to help your child develop healthy hair-care habits.

•       Wet hair and scalp with warm water. Shampoo works best on wet heads and hair.

•       Pour a quarter-size drop of shampoo in the palm of your child’s hand. Putting the shampoo in the hand first makes it easier to apply.

•       Tell your child to massage the shampoo gently into the scalp. When shampooing, it’s important to wash the scalp rather than the entire length of the hair. Washing only the hair often leads to flyaway hair that is dull and coarse. Rubbing shampoo into the hair can break hairs, leading to unhealthy looking hair.

•       Rinse well with warm water until the hair is suds-free. Rinsing well washes away shampoo and dirt.

•       Cover hair with a towel. Help your child wrap a towel around the wet hair. This helps to absorb the water. Rubbing hair dry with a towel can damage the hair, causing it to break.

•       Comb out damp hair gently. Use a wide-tooth comb, especially on curly hair. Don’t yank or pull the comb through the hair because that can pull out hair or break the hair.

•       Sometimes a de-tangling spray can help smooth out the hair and keep it from forming little tight knots.

To help kids develop good hair-care habits that help prevent hair damage, dermatologists give parents the following tips:

•       Make braids and ponytails loose and use covered rubber bands.

•       Consider styles that don’t require heat and chemical treatments.

•       When using heat on the hair, lower the heat.

•       Understand that chemicals in relaxers, dyes, and other hairstyling products often damage the hair. The longer the time between treatments, the better it is for your hair. 

•       After your child swims, make sure to wash away pool chemicals. If your child’s hair is normal to oily, shampooing works best. Children who have very dry or African American hair should rinse well and apply conditioner. Pool chemicals that are not washed away can damage hair.

•       Use a wide-tooth comb more often than a brush.

•       When outdoors, wear a wide-brimmed hat to protect the scalp and hair from the sun.

All hair needs to be treated gently, especially when it’s wet. Brushing or combing hair too frequently or in the wrong way (such as using a fine-toothed comb on very thick, curly hair or teasing hair) can lead to breakage. Hair extensions and braids can also cause breakage. Leaving them in too long or pulling them out without professional help can cause hair and scalp damage or even hair loss.

The condition of our hair can also tell us about our general health. Sometimes hair breakage and dry, brittle hair are signs of a medical problem, such as hypothyroidism or an eating disorder. If your child’s hair is breaking or falling out, even though he or she doesn’t treat it with chemicals or other styling products, tell your pediatrician.

Healthy hair doesn’t just happen; it’s the result of proper care and maintenance. Starting your child on healthy hair care habits early will most likely be how they think about and care for their scalp and hair the rest of their lives.

Story sources: https://www.aad.org/public/skin-hair-nails/hair-care/healthy-hair-habits-for-kids

http://naturalhairkids.com/basic-regimen/

 

Your Child

New Flu Vaccine for 2015-2016

1:45

Last year’s flu vaccine wasn’t as effective as previous vaccines, but this year’s vaccine should be a much better match according to Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention.   

Typically, the vaccine is 50 to 60 percent effective, making your chances of getting the flu reduced by as much as 60 percent if you get a flu shot.

This year’s flu vaccine contains the H3N2 strain, Frieden said. Last year's vaccine was only 13 percent effective against the H3N2 strain. As a result, "more seniors were hospitalized for the flu than ever before."

What's more, 145 children died from the flu, Frieden said, adding that the actual number was "probably much higher since many flu deaths aren't reported."

About 50 percent of the American population gets vaccinated every flu season. That includes pregnant women. More people, including pregnant women, need to be vaccinated, Frieden said.

The CDC recommends that everyone 6 months of age and older get the flu shot every year.

Frieden said there's an adequate supply of flu vaccine this year. Companies are expected to make 170 million doses of vaccine, of which 40 million have already been distributed, he said.

People at risk of flu-related complications include young children, especially those younger than 2 years; people over 65; pregnant women; and people with chronic health problems, such as asthma, heart disease and diabetes, as well as those with weakened immune systems, according to the CDC.

Most seasonal flu activity typically occurs between October and May. Flu activity most commonly peaks in the United States between December and February.

Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months of age you should get a flu vaccine to help protect them from flu.

It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

The CDC encourages people to get a flu shot preferably by October. Those children aged 6 months through 8 years who need two doses of vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart.

During this flu season:

•       Intramuscular (IM) vaccines will be available in both trivalent and quadrivalent formulations. (High dose vaccines, which are IM vaccines, will all be trivalent this season.)

•       For people who are 18 through 64 years old, a jet injector can be used for delivery of one particular trivalent flu vaccine.

•       Nasal spray vaccines will all be quadrivalent this season.

•       Intradermal vaccine will all be quadrivalent.

The quadrivalent flu vaccine is designed to protect against four different flu viruses; two influenza A viruses and two influenza B viruses.

It’s hard to believe that we’re about to head into the flu season, particularly with so many states still experiencing summer like weather. But we are, and getting a flu shot early can help protect you and your family from a virus no one wants to get.

Sources: Steven Reinberg, http://consumer.healthday.com/infectious-disease-information-21/flu-news-314/no-embargo-this-year-s-flu-vaccine-better-match-703392.html

http://www.cdc.gov/flu/about/season/flu-season-2015-2016.htm

Your Child

Never Use Q-Tips to Clean Your Child’s Ears

1:45

Parents and caregivers seem compelled to clean their child’s ears with a cotton swab. Despite repeated warnings to not put anything smaller than one’s elbow inside a child’s ear, more than 263,000 U.S. children had to be treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010, according to a new study.

Almost three-quarters of the cases — 73 percent — involved ear cleaning. About two-thirds of the patients in the study were younger than 8.

"There's this misconception that people need to clean their ears in the home setting and that this is the product to do that with," Dr. Kris Jatana, senior author of the study and a pediatric ear, nose and throat specialist at Nationwide Children’s Hospital, told TODAY.

"The ears themselves are typically self-cleaning... It is risky to use cotton-tip applicators in the ear canal across all age groups, and certainly we are seeing way too many injuries as a result of this practice."

The most common incident in the ER was the presence of a foreign body, such as part of the cotton swab and a perforated eardrum, researchers said.

"It's difficult for people to gauge how deep they're putting [the swab]," Jatana said. "Sometimes, it just takes a small movement to puncture the ear drum."

Physicians specializing in ear and throat diseases say that Q-tips and similar products should never be used for cleaning the ears. Not only can they cause ear canal injuries, but can also push ear wax deeper into the canal causing it to become trapped.

Studies have found 90 percent of people believe ears should be cleaned and say they regularly clean their ears or their children’s ears, according to the American Academy of Otolaryngology—Head and Neck Surgery Foundation. Kids also apparently learn to stick Q-tips into their ears by watching their parents: about 77 percent of the injuries in the study happened when the child was handling the swab himself.

If you see earwax on the outer part of your child’s ear, you can clean it with a washcloth or wipe, Jatana suggests. In most cases, earwax is actually beneficial for the ear. It protects, lubricates and cleans the ear canal. Occasionally, children and adults have excessive wax build-up, but a doctor should be consulted about removal.

Hearing loss, a feeling of fullness in the ear or ear pain are symptoms that should be checked out. An ear, nose and throat doctor can remove more stubborn excess wax.

Story source, A. Pawlowski, http://www.today.com/health/cotton-swabs-are-causing-ear-injuries-thousands-kids-t111296

 

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

Daily Dose

Diabetes On the Rise

1:30 to read

Diabetes continues to be a growing problem among our nation’s children.  Did you know that every year there are over 25,000 children diagnosed with diabetes?  

 

To begin with there are two different types of childhood diabetes, type 1 and type 2 and while both cause an elevated blood sugar, they also differ in many ways.

 

Type 1 diabetes was formerly called juvenile onset diabetes and is typically diagnosed in children and adolescents. Only 5% of those with diabetes have type 1 diabetes. Many parents worry that their child may develop diabetes because they eat too much sugar…and while eating sugar is not good for you, it does not directly cause type 1 diabetes.  Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the beta cells ( insulin producing cells)  of the pancreas. Scientists are not exactly sure why this occurs, but it seems to be a combination of genetic and environmental factors, and actually has nothing to do with diet. 

 

Type 1 diabetes comes on suddenly and causes dependence on insulin for the rest of the child’s life. The symptoms of type 1 diabetes usually include extreme thirst, frequent urination (day and night), increased appetite and sudden weight loss. Children who develop type 1 diabetes appear tired, thin and sick. I tell many a parent who worry that their child is diabetic, that they really cannot miss the symptoms and just drinking a lot of water will not be the only symptom. 

 

Fortunately, the ways in which insulin is given continues to improve and most children now use an insulin pump which delivers insulin in a more consistent manner than in previous years.  But, even with new insulin delivery systems and the hopes for pancreas transplants, type 1 diabetes is challenging for a family to manage. 

 

Type 2 diabetes which was previously called “non insulin dependent diabetes” differs in that it was previously typically diagnosed in adults, but it is now rising in children.  In type 2 diabetes the body isn’t able to use insulin in the right way and the glucose in the blood stream is less able to enter the cells. This is called insulin resistance.  So, the pancreas tries to produce even more insulin to keep blood sugar levels normal. Over many years the pancreas may wear out completely. Type 2 diabetes is sometimes controlled with an oral medication rather than insulin.

 

Type 2 diabetes seems to develop more frequently in those children who are overweight, less active and often have a parent with diabetes. As more children in this country have developed obesity, the number of cases of type 2 diabetes has also continued to rise.  In many cases if a child changes their lifestyle and eats a healthy diet, loses weight and exercises the body may be able to restore normal insulin balance. In this way type 2 diabetes differs from type 1 diabetes.

 

If you are concerned that your child is showing any signs of diabetes make sure to consult your doctor.  Continue to promote healthy eating habits and daily exercise for all children!

 

 

Your Teen

Why Do Teens Use E-Cigarettes?

2:00

Why do teenagers give e-cigarettes a try? Because these products are easy to obtain, not terribly expensive, come in lots of different flavors and their friends use them. All very adolescent associated reasons.

If they continue using e-cigarettes, it’s because of the low cost and the promise that they can help them quit smoking regular cigarettes, according to senior researcher Suchitra Krishnan-Sarin. She is a professor of psychiatry at Yale University School of Medicine in New Haven, Conn.

Teens who initially tried e-cigarettes because of their low cost had significantly stepped up their use of e-cigarettes by the time researchers checked in six months later.

In addition, teens who tried e-cigarettes to quit smoking were more than 14 times more likely to keep using e-cigarettes than those who did not consider this a reason to try the devices, the findings showed.

Unfortunately, researchers found that e-cigarettes did not help the kids quit smoking. Four out of five teens that were smokers, were still smoking regular cigarettes six months later even though they were using e-cigarettes to quit, the investigators found.

E-cigarettes don't produce tobacco smoke, but they do contain nicotine. And researchers fear they'll create a new generation of smokers, with kids hooked on nicotine turning to tobacco for a stronger fix, Krishnan-Sarin said.

"That is the huge public health debate," she said. "Are kids going to start with e-cigarettes and then move on to cigarettes? Is that going to be the start of nicotine addiction?”

As part of the study, Krishnan-Sarin and her colleagues’ surveyed 340 e-cigarette users in two middle schools and three high schools in 2013, asking them why they first tried e-cigarettes.

Most cited reasons for first trying e-cigarettes as curiosity (57 percent), good flavors (42 percent), use by friends (33 percent), healthier than cigarettes (26 percent), can be used anywhere (21 percent) and does not smell bad (21 percent).

Six months later, researchers checked in with the teens and asked if they were still vaping and if so, why. They then compared the answers to the teens’ reasons for continued use with their previous reasons for starting e-cigarettes.

Kids who cited the low cost of e-cigarettes or their potential help to quit smoking wound up vaping more days on average than those who cited other reasons, the study authors said.

Teens who cited low cost, used e-cigarettes two out of every three days during the previous month, and those who wanted to quit smoking wound up vaping nearly that often, according to the study results.

Other reasons also predicted continued use of e-cigarettes: they don't smell bad; they come in good flavors; friends use them; they can be used anywhere; they can be hidden from adults; and they are healthier than tobacco.

But for kids who kept using e-cigarettes, "the most robust predictors were the low cost and trying e-cigarettes to quit smoking," said lead researcher Krysten Bold, a postdoctoral fellow in psychiatry at Yale School of Medicine.

Krishnan-Sarin said these findings reveal several different means by which policymakers could make e-cigarettes less attractive to teenagers.

Earlier this year, The U.S. Food and Drug Administration (FDA), announced new regulations for e-cigarettes. Anyone under 18 years of age cannot purchase them and they must show a photo I.D. if they appear to be younger than 27. Retailers cannot give out samples and cannot sell them in vending machines unless the machines are in adult-only facilities. These new rules went into effect August 8th.

The Food and Drug Administration will have to approve all e-cigarette products that have been available since February 2007. That means nearly every e-cigarette product on the market must go through an application process to deem whether it can continue to be sold.

However, the FDA did not address the issue of different flavors.

Federal officials also could ban the use of flavors in e-cigarettes, as has already been done in traditional cigarettes except for menthol, said Dr. Norman Edelman, senior scientific advisor for the American Lung Association.

"Despite recommendations from the American Lung Association and others, the final rule did not ban flavorings as they have in ordinary cigarettes," Edelman said. "We continue to believe all the measures that have been applied against ordinary cigarettes should be applied to e-cigarettes."

The study was published online in the journal Pediatrics.

Story sources: Dennis Thompson, http://www.webmd.com/parenting/news/20160808/why-teens-choose-e-cigarettes

Aamer Madhini, http://www.usatoday.com/story/news/2016/08/07/e-cigarette-regulations-set-go-into-effect/88362926/

Parenting

Is Your Child Becoming an Emotional Eater?

2:00

You may be tempted to appease your child with food after a fall or tears for short-term relief, but this could actually set your child up for long-term unhealthy eating patterns.

What happens is that children begin to identify eating with self-comforting or relieving boredom instead of nutrition or eating when they’re actually hungry.

Almost all children, teens, and adults may engage in emotional eating at one time or another.

Hunger associated with emotional eating comes on quickly and feels urgent. It's often triggered by a specific event or mood. It's not like typical physical hunger, which gradually builds and is a result of an empty stomach. Physical hunger can be satisfied by a number of different foods, but cravings usually involve particular foods. Examples might be ice cream or candy after a fight with a friend or a tough day at school.

Why is emotional eating unhealthy? Emotional eating isn’t really about hunger or nutrition; it’s about filling an emotional need. It can lead to overeating and over time, lead to extra weight gain or obesity. It also sets up a pattern of handling uncomfortable situations by eating instead of by learning how to solve social and psychological problems.

There are lots of reasons kids may seek out food for comfort such as:

  • Anger
  • Boredom
  • Change
  • Confusion
  • Depression
  • Frustration
  • Loneliness
  • Loss
  • Resentment
  • Stress

Even positive emotions such as excitement and happiness can result in emotional eating once it becomes a go-to as a reward. 

If you notice signs of emotional eating in your child, talk to him or her about your concerns. Be gentle. Stay positive. Helping your child might be as simple as having a warm and loving conversation.

Help your child develop a healthy response to his or her problems, such as focusing on solutions. Encourage your child to talk about the emotions that trigger his or her emotional eating. Brainstorm other ways to deal with those emotions. For example, your child could exercise or become involved in sports when he or she feels stressed out, or call a friend when he or she is bored.

Emotional eating can be learned, so your influence as a parent or primary caregiver is one key to prevention. Be sure to model healthy eating habits for your child. Also, avoid using food to celebrate occasions or to reward your child for good behavior. Instead, use verbal praise and give other types of rewards (for example, stickers for a young child or a fun activity with an older child).

There are signs you can look for in children to let you know if your child is an emotional eater. They are:

  • Eating in response to emotions or situations, not to satisfy hunger
  • Feeling an urgent need to eat
  • Craving a specific food or type of food
  • Eating a larger amount of food than usual
  • Eating at unusual times of day (for example, late at night)
  • Gaining excess weight
  • Feeling embarrassed or guilty about eating
  • "Sneaking" food during high-stress times
  • Hiding empty containers of food

A recent study from Norway found that kids offered food for comfort at ages 4 and 6 displayed more emotional eating at ages 8 and 10.

Also, the researchers found signs that kids who felt more easily comforted by food were fed more by parents for that purpose.

Emotional eating typically starts early in life but can really begin at any age; it seems like an easy fix for anxiety at the time, but can lead to health problems if not brought under control.

Story source: https://familydoctor.org/emotional-eating-in-children-and-teens/

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DR SUE'S DAILY DOSE

Can q-tips harm your baby's ear?

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