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Sportsmanship

Sportsmanship with Drew Pearson

Daily Dose

Pool or Trampoline? The Safety Debate

1:15 to read

Do you have a pool or trampoline in your yard? Both pools and trampolines are fun for children, and both pose dangers as well. I saw a patient today who asked me my opinion of trampolines. It seems that she and a friend, both of whom have elementary school age children, are having a "discussion" about trampolines. My patient is totally against having a trampoline in her yard, although she has a pool. Her friend says that it is safer to have a trampoline than a pool. And so their debate continues.

Both pools and trampolines are fun for children, and both do pose dangers. But as my own children often told me "according to you Mom, everything that is really fun, is dangerous!" The biggest issue surrounding children playing in pools and jumping on trampolines is parental supervision. When children are taught safety and are given rules to follow that are then enforced, they may have fun and be safe at the same time. Pools are fenced, and gated. Parents watch their children swim. This is usually the party line. But trampolines also require the same amount of supervision and many parents don't realize this.

Most trampoline injuries occur when children are unsupervised. Many serious trampoline accidents occur when children of disproportionate weights are doubling jumping and the smaller child becomes a missile and is thrown from the trampoline when serious neck injuries may occur. Trampolines are also safest when they are buried in the ground or have safety nets on the side. Letting children jump unsupervised is as dangerous as swimming alone.

So, I can't resolve this friendly discussion, but I do know that both pools and trampolines require parental supervision and strict safety rules to ensure the safest possible experience. And yes, they are both fun! That's your daily dose, we'll chat again soon.

Your Child

Doctors May Unknowingly Discourage HPV Vaccine for Preteens

2:00

The majority of physicians say that the HPV vaccine given to preteens, before they become sexually active, can help prevent infections with viruses that can cause cervical, penile and anal cancers as well as genital warts.

However, about 27 percent of doctors may inadvertently discourage parents from having their preteens vaccinated against human papillomavirus (HPV), according to a new study, because they don’t recommend the vaccine strongly enough.

Pediatricians and family physicians deliver the bulk of HPV vaccines. Some of these physicians do not offer the vaccines as strongly as they do when urging parents to vaccinate against meningococcal disease or to get tetanus, diphtheria, and pertussis booster shots, the study reported.

The study, which is based on a national online survey of 776 doctors, found a quarter did not strongly endorse the need for HPV vaccination with the parents of the 11- and 12-year-olds under their care.

Nearly 60 percent were more likely to recommend the vaccine for adolescents they thought were at higher risk of becoming infected — perhaps because the doctors knew or suspected they were sexually active — than for all 11- and 12-year-olds.

“You kind of get the sense that some [health care] providers see this as a somewhat uncomfortable situation,” said lead author Melissa Gilkey, a behavioral scientist in the department of population medicine at Harvard Medical School.

Many parents don’t like to think about the possibility of their child having sex, particularly when they are only 11 or 12 years old. The vaccine is actually meant to provide protection for when they are older. That’s why it is recommended before a child typically begins engaging in sexual activity. Studies have also shown preteens get the best immune response to the vaccines.

Evidence generated by one of Gilkey’s earlier studies suggests it’s not necessarily parents that are squeamish about the vaccination, but physicians that overestimate a parent’s response when the vaccination is urged. 

 “It’s not necessarily that physicians always are negative about it. But it’s kind of that HPV vaccine may get damned with faint praise, if you will,” Gilkey said. “Compared to the way that they recommend these other vaccines, parents may suspect that there’s something wrong with it.”

The aim of the research is to help figure out why HPV vaccination rates remain disappointingly low. The CDC reported that in 2014, 40 percent of adolescent girls and 22 percent of adolescent boys had received the recommended three doses of HPV vaccine. The agency says girls and boys should have all three doses by their 13th birthday.

According to the study, how the information is presented has an impact on how well it is received. Doctors who started conversations about the HPV vaccination by telling parents the vaccines protect against cancers and genital warts gave stronger recommendations than those who opened saying HPV viruses are sexually transmitted.

The study was published Thursday in Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Although Gilkey declared no conflicts of interest, the senior author of the study, Noel Brewer of the University of North Carolina, has received research funding and speaker fees from companies that sell HPV vaccines.

Source: Helen Branswell, https://www.bostonglobe.com/lifestyle/health-wellness/2015/10/21/study-says-doctors-inadvertently-discourage-hpv-vaccines/LuJaMFoEupeOeYrrUOlYRN/story.html

 

 

 

 

 

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Your Baby

Alert! 180,000 Baby Pacifiers Recalled Due to Choking Hazard

1:30

Munchkin is recalling their Lightweight Pacifiers and Clips. The clip cover can detach from the pacifier’s clip, posing a choking hazard for young children.

his recall involves Munchkin’s Latch lightweight pacifiers and clips sold as a set. The pacifiers were sold in five styles: designer, rattle and heartbeat clips with 0m+ natural shape pacifiers, and designer and rattle clips with 6m+ orthodontic pacifiers. The designer pacifiers and clips 0m+ and 6m+ are in three color patterns: blue and white strips, orange and with white polka dots and pink with white polka dots. The rattle pacifiers and clips 0m+ and 6m+ are green with beads in the pacifier cover to make a rattle sound and have a polka dot strap. The heartbeat pacifiers and clips have a red, heart-shaped pacifier cover and red and white polka dots on the strap.

About 180,000 of the pacifier and clip sets have been sold. They were available from Babies R Us, Target, Wal-Mart and other mass merchandisers, juvenile product, baby boutique and discount stores nationwide and online at amazon.com, munchkin.com and other website from March 2014 through March 2016 for between $11 and $15.

The firm has received 10 reports (5 in the U.S. and 5 in Canada) of the clip cover detaching from the pacifier clip. No injuries have been reported. 

Consumers should immediately take the clip away from young children and contact Munchkin for a free replacement Lightweight Pacifier pack with two pacifiers or a full refund.

There is a toll-free consumer hotline available for more information at 877-242-3134 from 7 a.m. to 5 p.m. PT Monday through Friday or online at www.munchkin.com, click on Help at the bottom of the page and then Recalls for more information.

Story source: http://www.cpsc.gov/en/Recalls/2016/Munchkin-Recalls-Latch-Lightweight-P...

Daily Dose

Bathing Your Baby

The end of summer baby “boom” is still going on and new parents are coming in with all sorts of questions…including how do I bathe my baby?  As many mothers and their babies are being discharged from the hospital after 24 hours, they really don’t have the opportunity to “practice” new parent skills, including giving their baby a bath.

Bathing your baby is really fun and is a good bonding experience for parent and child.  The bath also keeps your baby clean and smelling “sweet”.  I was convinced that it would also help them to relax and to sleep longer (not scientific at all - but it works for us right?).  At any rate, you can bathe your baby every day or every 2-3 days, or even once a week. It is really personal preference…but that wonderful “after bath smell” makes me smile.

Many people buy infant bath tubs and there are tons to choose from. I like the the “Puj Tub” or the “Tummy Tub” as you can easily put them in the kitchen sink (grandparent friendly), but you want to make sure that there are no sharp edges or places where a baby might get bumped or injured when you put the tub in the sink.  Some people use a folding tub (be careful not to pinch the baby) or inflatable tub  these may collapse), because they are easier to store if you have limited space.

The number one rule for a bath - NEVER leave your baby alone in the tub, not even when they can start sitting up. A baby may drown in an inch or two of water…so never even turn around to check your phone or check an email.  You should also make sure that the water temperature is correct and every new parent should check the hot water heater and lower the temperature to 120 degrees F, so prevent burns. Regardless, always check the water temperature before you put the baby into the tub.

I am also a fan of using mild soaps..including Cetaphil, Cerave, Aveeno, and Aquaphor  baby wash. If your child tends to have sensitive skin it is best to avoid fragrances and harsh chemicals.  I also like to moisturize the infant after a bath with baby lotions from these same companies. New data is showing that frequent moisturizing (twice a day) may also be important in preventing allergies later in life…. so why not enjoy some baby massage…and keep watching for more information on this issue.

 

 

Daily Dose

How to Swallow a Pill

1:15 to read

I have always been a proponent of teaching children to swallow a pill.  In fact, I think I taught my boys to swallow a pill before they were 5 years old, mainly because I was tired of trying to find the measuring cup or syringe for the liquid medicine, which often didn’t go down “like spoon full of sugar”, even though we would sing the song during dosing. 

By the time one child had learned to swallow a pill the other two boys, as competitive as they were, decided that they too could do it, even the 2 year old.  So, based on that experience I have been encouraging young patients to swallow pills, and even teaching them in the office with my stash of mini M&M’s and Tic Tacs!  I also know that if you wait too long it becomes a huge ISSUE.

Well, who knew that someone would actually study “pediatric pill swallowing”?  In an article just published in the May issue of Pediatrics the authors looked at different pill swallowing interventions.  They found that up to 50 % of children were unable to swallow a pill.   Problems swallowing pills included a variety of reasons including fear, anxiety and intolerance to unpleasant flavors. 

The authors reviewed 5 articles published since 1987 which found that behavioral therapy, flavored throat sprays, specialized pill cups and verbal instruction with correct head and tongue positioning all helped children to swallow pills. They also found that pill swallowing training as “young as 2 years helped increase the likelihood of ease of pill swallowing”.

So, like many things....jump in with your young child and master the art of pill swallowing sooner than later. It will make everyone’s life easier.

Last caveat, I always tell my patients who are older “non-pill” swallowers, “you cannot possibly operate a motor vehicle if you can’t swallow a pill”! This is usually a huge motivator for the “late swallower” and they conquer the challenge. 

Daily Dose

Sick Child? Have Patience

1:30 to read

I just got off the phone from texting with the mother of a 3 year old patient of mine. It was late in the afternoon and her son had just started crying that his mouth hurt.  I was texting her from the back of a car en route to the airport..the wonders of technology!

She was concerned because the pain had come on so abruptly, but she text me that he did not have a fever, had not had a fall or trauma to hurt his mouth, and that when he opened his mouth she could not see anything that would cause “obvious pain”.  

I asked her a few more questions via text and recommended that she might try giving him a dose of ibuprofen and see if he calmed down and felt better, but I did not hear back from her for awhile.

It was then that I realized that pediatrics and parenting have quite a bit in common…one of the similarities being patience.  

While she was concerned that her child had suddenly started crying due to some sort of pain, much of pediatrics is about watching and waiting.  We parents all want to keep our children pain free, but sometimes things will hurt both physically, and as your child gets older, emotionally (which may be even worse to watch).  A parents first instinct is to find the cause of the pain and “fix it”.  Whether that means a band aid, a kiss on a boo-boo, or medicine.. “just make it better”.

But in many cases in pediatrics and actually all of medicine, it is about watching, following, and waiting, which is not as easy as it may sound. Doctors, parents and patients often have to “be patient” and see what evolves.  Not all tummy aches are cases of appendicitis, not all falls cause a concussion and not all boo-boos result in broken bones (thank goodness!).

But for a parent to hear “let’s see what happens in an hour or so” may sound like a lifetime and waiting just seems crazy when there is a “doc in the box” on every corner.  You may see where I am going with this.

So, by the time I heard back from this concerned mother, she was already at the nearby “doc in the box” waiting for a doctor to see her son, who by now had stopped crying.  She had already put him in the carseat for the drive to the clinic before she read my text, so he had not even had any ibuprofen.

According to the clinic doctor (or nurse), the child “had an ear infection causing his pain” and she was given a prescription for antibiotics.  Once the mother was home and I could talk to her I asked if they had prescribed medication for pain relief, such as ear drops and/or ibuprofen. She said she only had the antibiotic prescription which she had filled, but her child had stopped complaining of pain.

So, I was not there, and did not see her child, but I wonder if ibuprofen might have done the trick and alleviated his pain..and also kept him off of an antibiotic until he could be seen the following day in the office?

But in this age of “quick” medicine and a clinic on every corner,  a patient/parent may not need to wait and see what evolves. I wonder if this “quick” medicine may be one reason we see antibiotic overuse . I’m just saying….  

Daily Dose

Bump on Your Child's Leg?

1:15 to read

I recently saw a young adolescent patient who had noticed a “lump or bump” on her leg which she had noticed for some time and she had now wondered what it was. She said that she had initially thought she had bumped her leg,  but she had continued to watch it and noticed that it did not seem to be going away. So, after many months of watching it and wondering what it was she decided to come ask me.

On her exam she had a notable “bump” or mass on her lower leg, about the size of a half dollar. There was no surrounding bruising and the mass was non-tender. She told me it really did not bother her, and she was more concerned as she thought it was noticeable and a friend had asked her about the “bump”.  Other than cosmetic concerns, it did not cause any problem.

The most common reason for this bump is an osteochondroma, which is a benign bone tumor. The most common time to find this type of tumor is during periods of rapid growth during adolescence. They are usually found in the leg (femur, tibia) or the upper arm (humerus). 

So, I sent her for an x-ray which was compatible with the diagnosis of a benign osteochondroma. She then had a CT of the area which confirmed the diagnosis.  Most osteochondromas are solitary and the chance for malignant transformation is rare (less than 1%).  So, after discussing her case with a pediatric orthopedic surgeon it was decided to just watch it.  

She had mixed emotions about her diagnosis, as she was happy to know what caused the “bump” but was concerned that her friends would continue to ask her about it. Of course her parents were relieved to find out that it was benign and would likely never require any treatment.

We all decided to watch it for now…..as the tumor typically stops growing after an adolescent has completed their growth spurt and the growth plates of the bones are closed.  

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