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July 4th

Have a safe & fun July 4th!

Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

Daily Dose

Teens & Safe Driving

1.30 to read

Teenage driving and specifically driving safety is getting more and more traction in the news. The National Highway Traffic Safety Administration has just launched the 5 To Drive campaign to reinforce last week’s "National Teen Driver Safety Week".  All of these campaigns are encouraging parents to initiate discussions with their teen drivers about safety. 

I have long been a propionate of driving contracts and luckily my three sons  abided by the contract and never had a “significant” accident. There were a few of the “I backed into the fence”, or “I just didn’t see the car when I backed out of the parking space”, but beyond that we were blessed with accident free teen years.  I also believe that they were maybe a bit more cautious because they had to pay for 1/2 of their insurance premium each year, as well as having other perks (like gas) tied to their grades.  Having some of their own hard earned money in the game made them realize consequences for accidents would also mean higher insurance premiums and more money out of their wallets.  

The NHTSA safety topics for parents to discuss with their teens are: 

No cell phone use or texting while driving - no exceptions
No extra passengers - parents also need to follow their own state laws on this topic as graduated drivers licenses enforce different lengths of time before allowing teens any extra passengers (which are definitely distracting)
No alcohol
No driving or riding without a seat belt 
No speeding 

There were 2,105 teen drivers involved in fatal crashes in 2011 and 45% of the teens involved died in those wrecks as well. The topics for parents to discuss with their teens are on the list as all of these behaviors seen in adolescent drivers are known to contribute to the high death rate among teens. 

Another recent study from Children’s Hospital of Philadelphia in collaboration with State Farm Insurance found that “teenagers were 50% less likely to crash when parents set clear rules, kept track of their teens activities and did so in a supportive manner”.

Take the time to discuss the safe driver rules and model behavior while you are at the wheel as well. Distracted driving affects everyone.....as I continue to remind myself to stay off the phone in the car, even though I finally did get hands free for the phone.  

Daily Dose

Food Allergies at Halloween

1:30 to read

Halloween is just around the corner and for children with food allergies or sensitivities it is sometimes challenging to go trick or treating.  In the United States 1 in 13 children has a food allergy and for some children even the tiniest bit of their allergen can cause a severe reaction!!

So…have you heard about the Teal Pumpkin Project? It was introduced several years ago to enable children with food allergies to enjoy a fun and safe trick or treating experience….with no fear of being exposed to allergens.  

Nuts, milk, soy, wheat and egg are a few of the most common allergens in children  and adults). So many Halloween candies may contain many of these ingredients, and many of the miniature versions of popular candy that is given out on Halloween may not be labelled as to their ingredients. At times the “snack” size treat may even contain a different ingredient than the usual size candy bar.  Even with diligence it may be difficult for parents to determine if the candy in question is safe.

The Teal Pumpkin Project promotes having non-food treats available for children with food allergies. By putting a teal colored pumpkin on your front porch along with the traditional pumpkins and jack o lanterns, you let families know that you have special treats for a food allergic child, or for any child where candy may present a problem. In this way trick-or-treating is inclusive for everyone and the teal pumpkin ( or a poster with a teal pumpkin ) is an easy way for kids and parents to spot the houses that are participating.

Children love to get stickers, glow sticks, pencils, chalk and small toys are all suitable options for kids who have food allergies or intolerances, or for any child who prefers not to have candy. Kids get so much candy you may be the hit of the block by having a different basket for them to choose from.

Remember, if you are getting a food item for another child in your family to make sure that all candy has been unopened and to avoid choking hazards (like nuts and popcorn) for younger children

Be safe, have fun and look for a teal pumpkin….I am going to go buy some spray paint to turn one of my orange pumpkins into blue!!!  Fun project for a family and neighborhood to do together - a block of teal pumpkins!

 

Daily Dose

Car Seat Safety

1:30 to read

I recently received a text from a patient who asked if she could turn her 17 month old child’s car seat around and have it forward facing in the back seat. She said that her car seat instructions read “may forward face after the child weighs 20 lbs”.

 

Not long after that, another patient came in for her 18 month check up and during the course of the check up I always ask about car seat position.  I remind them that they should continue to have their child in a rear facing car-seat until they 2 years of age.  The child’s mother said that she had turned the car seat around to forward facing because the child “did not like rear facing”.  Interesting discussion with a toddler.

 

So, this just so happens to be Child Passenger Safety Week and National Car Seat Check Saturday as well. What a better time to remind parents that the safest way to restrain your child who is under the age of 2 years (depending on your carseat height and weight restrictions)  is in a rear facing car seat.  

 

In a recently published article in the journal Pediatrics, about 38% of 17-19 months olds were not following AAP recommendations to ride in a rear-facing car seat. The recommendations were changed in 2011 as studies found that young children in a forward-facing car seat were 5 times more likely to be seriously injured than those in a rear-facing seat. 

 

In the study many of the families involved who had their children forward-facing often said that they “thought their child was too tall or too heavy to be rear-facing”. Others commented that “their feet were touching the back seat and they looked uncomfortable”. 

 

Interestingly, your child has been in a rear-facing car seat since birth, so it is strange that they “prefer” to forward face.  Kind of like being in the middle seat of an airplane, if you have never been seated on the aisle you don’t know the difference in seats.

 

If you are concerned about the appropriate car seat for your child or how to install it, this is a good week to have a car seat expert help make sure that your child is riding in the safest car seat possible. If your child is under the age of 2…that also means rear facing!  

 

 

 

 

 

  

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Daily Dose

Summertime Can Mean Snakebites

1:15 to read

Due to wet weather, snakes are being oushed out into the open. What does it mean? There is a higher risk of being bitten by a snake. News reports have families on alert: snakes are being pushed out into the open.  More snakes mean the potential for more snakebites.  I have never treated a patient with a snakebite and thought they were quite uncommon. Unfortunately, a rattlesnake bit a friend of mine (they are out of the hospital and doing well) so upon review I have learned a lot more about venomous snakebites.

There are actually over 45,000 snakebites reported in the U.S. each year. The majority of these are due to non-poisonous snakes and often requires little or no treatment. The days of the old Cowboy movies showing rope tourniquets being applied to the area of the bite and the cutting and “sucking” of the venom are over! Don’t start practicing “movie medicine” if you find yourself dealing with a snakebite. There are about 8,000 venomous snakebites reported each year. Fortunately, with these large numbers and the advent of anti-venom, only six to eight people die each year secondary to a venomous snakebite. Unfortunately, due to their smaller size, children do not handle snakebites as well as adults, and the fatality rate is higher in children.

In the U.S. 99% of poisonous snakebites are by the subfamily pit viper, which includes rattlesnakes, copperheads and cottonmouths (YUCK). The other species of poisonous snake found in the U.S. is the coral snake. I am not going to detail the specific treatment for each type of bite, but if a snake bites your child the first thing to do is to determine if it was a poisonous snake. Non-poisonous snakebites cause minimal pain, no swelling and really only require local wound care with irrigation and antibacterial soap. If the bite is thought to be from a poisonous snake the child should be transported to the nearest hospital. Do not put a tourniquet around the bite, apply ice or suction the area of the bite as these are all thought to cause more tissue damage than benefit.

Pit viper bites typically cause symptoms of swelling, bruising and progression within minutes of the bite. Children typically have more severe symptoms with nausea, vomiting, sweating, muscle weakness and clotting abnormalities, all of which are a medical emergency. Anti-venom should be delivered within four hours of the bite and will be given until improvement in systemic symptoms is achieved. All of this is done in the ICU setting. That’s your daily dose, we’ll chat again tomorrow.

Send your question or comment to Dr. Sue right now!

Daily Dose

Water Safety

1:15 to read

I was reminded of the importance of pool safety after watching the news and hearing that 3 children were found in a nearby apartment pool, under water and unresponsive.  

There are about 3,500 fatal unintentional drownings per year, which is about 10 deaths per day.  Drowning is the second leading cause of death in children ages 1-14 years.  For every child who dies from drowning, there are 4 non-fatal drowning victims who suffer severe and life changing injuries.

Drowning is preventable!!  Although many people think of drowning victims screaming and yelling, drowning is actually quick and silent.  It only takes seconds (the time to grab a towel, or answer the phone) and a child may become submerged. Most drownings also occur in family pools.  Because I have always had a fear of drowning we did not build a pool until our boys were all older than 10 years and were excellent swimmers ( was I a bit over zealous with swim lessons and swim team, maybe...)?  Children as young as 2-3 years can safely begin swim lessons and begin the process of mastering how to tread water, floating and basic swim strokes. 

Another rule for safe swimming is “never swim alone!”.  Teach your children the importance of the buddy system when they are swimming, even in a backyard pool. Adults need to be designated “water watchers” and know that they are responsible for watching the children in the pool and will never leave them unattended. The “water watcher” should regularly scan the bottom of the pool, and will need to have a phone at the pool for emergency use only.  Adult water watchers have only 1 job...to watch the pool, no poolside chatting or distractions. It is a big job!

Anyone with a pool or who is a caregiver of children who are swimming needs to become CPR certified.  CPR skills can save lives and prevent brain damage.   

Lastly, if you have a pool you need layers of protection - which  means a barrier around your pool. I have heard many a family tell me that their child “could never get out the door to the pool, it has several locks and an alarm”.  Despite the best of intentions, no parent can watch their child 24 hours/day.  Toddlers have been known to push a stool over to unlock a door, or a door is inadvertently left unlocked or ajar. Remember, it only takes seconds for a child to become submerged. 

By the way, I am following my own advice and a pool fence is going up to protect our granddaughter...the bigger the better.

Daily Dose

Pool Safety

1:15 to read

As you know, water safety is paramont this time of year so I want to make sure your children are safe this summer.  Drowning is the leading cause of death for children between the ages of 1- 4 and the second leading cause of unintentional death for children under the age of 14.  Over 390 children die each year in their own backyard pools...tragically drowning is typically a SILENT event.

The first thing all pools need is a at least 4 foot tall fence surrounding all 4 sides of the pool. Now is the time to make sure that not only is your pool fenced but that it also is “tuned up” after the winter. That means that the self latching gate is working, that all pool furniture and toys are  moved away from the fence in order that children cannot climb up and over a fence, and you might even add a pool alarm that goes off if anyone enters the pool without supervision. 

If you have a door from the house to the pool there should be an alarm on the door as well as having a fence around the pool…this ensures “layers of protection”..the more layers to keep your child away from an unsupervised pool the better!  Children are clever, fast and tenacious.

Now once you decide to enjoy a day poolside you need to have several things on hand which include a portable phone, a flotation ring or hook, and always an adult within arms reach of a toddler or young child who has not yet learned to swim.  If there are several “non swimmers” in the pool with only 1 adult,  it is best to put all of the children in an approved flotation device as well.  The adult who is supervising the pool should ideally know CPR. I think that all “pool owners” should take CPR.

The person in charge of watching a child or children in the pool need to be identified and vigilant. That means staying off a cell phone or any electronics that might be distracting. It is also not the time for adults to be partying and alcohol is discouraged.  

Most children over the age of 4 years are ready for swimming lessons, but the AAP does recognize that there are some younger children between 1 -4 years who may be ready for swimming lessons, especially those that are frequently around water ( home pool, lake , beach). Each child will develop at differently.  Even a young child who has had swim lessons should not be considered “drown-proof” and never be unsupervised.

Lastly, don’t forget the sunscreen and remember to re-apply frequently to both you and your child!

 

 

 

   

Daily Dose

Importance of Booster Seats

The Texas Legislature is sending a bill to Governor Rick Perry that will change booster seat laws. The current law requires that children under five years of age and 3 feet 9 inches tall be in a car seat. The new law will require that children under the age of eight years or 4 feet 9 inches tall be restrained in a car seat. Car accidents are the leading cause of death for children in this age group and experts testified that changing the booster seat law would reduce the risk of life threatening injury by up to 60%.

The extra height provided by a booster seat allows the seat belt to be positioned correctly, across the child's pelvis. Without the booster the seat belt is often placed across the child's abdomen or neck, or even behind the shoulders and neck and puts them at risk for head, neck and abdominal injuries. Correct positioning of the belt is essential for maximum protection. Forty other states have similar laws requiring booster seat use. This bill will not go into effect in Texas until 2010, but don't wait until then to get your child a booster seat. Many parents already have their children in booster seats, but if not, put this at the top of your "to do list". If your children balk at the idea, tell them that it is for their protection and it is now a law! That's your daily dose, we'll chat again tomorrow.

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