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Daily Dose

Pay Attention Around The Pool

With summer heat spread across the country, many families seek relief by a pool. The first thing to think of is safety!With the summer heat enveloping the entire country, it certainly is time for trips to the pool.  The first thing that comes to my mind when I think of swimming pools is safety!!

Knowing that over 900 children between the ages of 1–14 years die each year from drowning,  the discussion of water safety is a necessary part of summer.  Astoundingly, reports show that 9 out of 10 of those children who drowned were “under supervision”. The AAP has recently endorsed allowing children between the ages of 1-4 to take swimming lessons. It was previously thought that encouraging swimming lessons for children under the age of 4 years might actually contribute to increased drowning. In fact, recent studies have suggested that children ages 1–4 may be less likely to drown if they have had formal swimming instruction. The AAP has not gone so far as to routinely recommend mandatory swimming lessons for this age group, but does endorse swimming lessons in younger children who are frequently exposed to water and are emotionally and physically able to participate. Just as with any childhood milestone, different children will become more adept swimmers at different ages.  The AAP does not recommend formal “infant survival swimming lessons” for children under the age of 1 year. I have heard many parents discuss infant swimming classes and I believe that parent- child pool time is great, but infant survival swimming has not been proven to be beneficial. The AAP continues to recommend that most children ages 4 and older should learn to swim.  Swimming is a life skill that everyone should attempt to master, just like jumping rope, riding a bike and swinging. When I am discussing water safety with my patients and families, I emphasize that drowning continues to be the second leading cause of death for children ages 1–19.  Because I practice in Texas, many families have a backyard pool of some sort, whether it be in ground, above ground or even a very large portable inflatable pool. All of these pose the risk of drowning. I often have interesting discussions with parents who have a backyard pool who do not believe that it is necessary to have a barrier around the pool. They will say, “we never let our child outside alone” or “he or she is always being supervised by an adult”.  As you might expect, these are usually first time parents who have yet to experience the cunningness of a toddler. Just as our children watch us and learn how to feed themselves, or drink from a cup or climb out of a bed, they too watch us open a door, or take a stool out to reach something. A toddler is more than capable or figuring out how to reach a door handle even with a lock, or climb out a window to go outside and head straight for the pool. Drowning is also SILENT!!  It is not like the movies with screaming and yelling. The child quietly goes beneath the water and sinks.  It only takes minutes and the consequences of drowning are devastating. Even for a child who is found and resuscitated there may be a life-long brain injury and the worst case scenario, death.  All families with a pool should install a 4 sided fence that is at least 4 feet high to limit pool access. It must be difficult to climb and have a self-latching, self-closing gate. The arguments I hear about “landscape aesthetics” fall on deaf ears. Every family should also know CPR. So sign your child up for swimming lessons, and have fun practicing flutter kicks and arm strokes. Just do it with an adult within arm’s reach of all new and novice swimmers and a fence around the pool! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Toddler

FDA Targets Unapproved Eardrops

1:30

For years, physicians may have been unknowingly prescribing unapproved eardrops used to treat ear pain and swelling, to parents for their children’s ear aches. The drugs have not been evaluated for safety, quality and effectiveness says the U.S. Food and Drug Administration (FDA).

The agency notified the drugs' makers to stop marketing the drops following a few reports of local allergic reactions of the ear, eye, face, neck and mouth. The drops can also cause itching, stinging, burning and irritation of the ear, according to an FDA news release.

"If we don't know whether these drugs have any benefits, we should not accept any possible risk of side effects," said the FDA's Dr. Charles Lee in the news release.

The FDA did not release the names of the companies or the medications involved, but did note, "unapproved prescription otic [ear] drug products containing the following ingredients are covered by this action:

·      Benzocaine;

·      Benzocaine and Antipyrine;

·      Benzocaine, Antipyrine, and Zinc acetate;

·      Benzocaine, Chloroxylenol and Hydrocortisone;

·      Chloroxylenol and Pramoxine;

·      Chloroxylenol, Pramoxine, and Hydrocortisone.

“Taking enforcement actions against these unapproved products will protect patients from unnecessary risks,” said Cynthia Schnedar, director of the Office of Compliance in the FDA’s Center for Drug Evaluation and Research. “There are many FDA-approved prescription products to treat ear infections, so we expect little or no impact on patients from the removal of these unapproved and potentially unsafe products.”

The labels on these products do not disclose that they lack FDA approval, and health care professionals may not be aware of their unapproved status.  The FDA’s action does not affect FDA-approved prescription otic products, or legally marketed otic products sold over-the-counter.

Unapproved prescription otic drug products are frequently given to young children suffering from ear infections and other conditions that cause ear pain and swelling. Patients taking unapproved drugs may be at greater risk because there is no proven safety or effectiveness information. These products may be contaminated or manufactured incorrectly, which could result in patients receiving the wrong dose, even when administered according to the labeled directions for use, the agency said.

The FDA recommends that you check with your doctor if you think your child may have been prescribed one of these products or has exhibited side effects. You can ask for an alternative medication that has been FDA approved.

Sources: Margaret Farley Steele, http://consumer.healthday.com/general-health-information-16/doctor-news-206/unapproved-ear-drops-targeted-by-fda-700970.html

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm453348.htm

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.

Your Child

Lung Ultrasounds as Effective as Chest X-Rays for Detecting Pneumonia

1:45

Traditionally, when a child shows up at the ER or physician’s office with suspected pneumonia, a chest x-ray is ordered to verify a diagnosis.

A new report says that lung ultrasounds may offer a safer and equally effective alternative for diagnosing pneumonia in children.

"Ultrasound is portable, cost-saving and safer for children than an X-ray because it does not expose them to radiation," explained study leader Dr. James Tsung. He is an associate professor in the departments of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, in New York City.

Ultrasound, also called sonography, is an imaging method that uses high-frequency sound waves to produce images that lead to diagnosis and treatment of many diseases and medical conditions. Radiation is not used in ultrasound testing, but is used in x-rays and CT scans.

The study looked at 191 emergency department patients, aged 21 and younger, who were randomly assigned to either an investigational group or a control group.

Patients in the investigational group had lung ultrasound and, if additional verification was needed, a follow-up chest X-ray. Those in the control group had a chest X-ray followed by lung ultrasound.

The patients in the investigational group had nearly 39 percent fewer chest X-rays, with no missed cases of pneumonia and no increase in complications. The reduction in chest X-rays led to overall cost savings of $9,200 and an average decrease in time spent in the emergency department of 26 minutes, according to the study published April 12 in the journal Chest.

"Our study could have a profound impact in the developing world where access to radiography is limited," Tsung said in an Icahn news release.

Pneumonia is a leading cause of death among children worldwide. Chest X-ray is considered the best way to diagnose pneumonia in children, but about three-quarters of the world's population does not have access to X-rays, according to the World Health Organization.

Parents in the U.S. may want to request a lung ultrasound instead of a chest x-ray when that option is available, to avoid their child’s exposure to radiation.

Story source: Robert Preidt, http://www.webmd.com/children/news/20160413/lung-ultrasound-may-be-best-to-spot-pneumonia-in-kids-study

Your Baby

Exercising During Pregnancy

2:00

If you’re pregnant, you may be wondering if you should start or continue exercising. The answer is a resounding, yes!

Regular exercise throughout your pregnancy can help you stay healthy, improve your posture and help decrease common discomforts such as backaches and fatigue.

There is even evidence that physical activity may help prevent gestational diabetes, relieve stress and build more stamina needed for labor and delivery.

All of these benefits are good things.

If you were physically active before your pregnancy, there’s no need to stop. However, don’t try to exercise at your former level; instead, do what's most comfortable for you now. Low impact aerobics are encouraged versus high impact.

Check with your obstetrician for guidance if you are a competitive athlete, you may need specialized monitoring.

What if you have never been into exercise, should you start now that you are pregnant?  Absolutely!

You can safely begin an exercise program during pregnancy after consulting with your health care provider, but do not try a new, strenuous activity. Walking is considered safe to initiate when pregnant.

The American College of Obstetrics and Gynecology recommends 30 minutes or more of moderate exercise per day on most if not all days of the week, unless you have a medical or pregnancy complication.

While exercise is great for most moms-to-be, there are some women who should not exercise during pregnancy. They are women with medical problems such as asthma, heart disease or diabetes. If you have one of these conditions, check with your OB/GYN about your options and follow his or her recommendations.

Exercise may also be harmful if you have a pregnancy-related condition such as:

           ·      Bleeding or spotting

           ·      Low placenta

           ·      Threatened or recurrent miscarriage

           ·      Previous premature births or history of early labor

           ·      Weak cervix

Talk with your health care provider before beginning an exercise program. Your health care provider can also give you personal exercise guidelines, based on your medical history.

Most exercises are safe to perform during pregnancy as long as you don’t overdo it.

The safest and most productive activities are swimming, brisk walking, indoor stationary cycling, step or elliptical machines, and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth.

What about jogging, tennis and racquetball? All these activities require balance and coordination– which may change as you progress during your pregnancy.  If you’re healthy and have discussed these sports with your OB/GYN, go ahead and enjoy, but in moderation.

There are certain exercises that can be harmful during pregnancy. What exercises should be avoided? They are:

·      Holding your breath during any activity.

·      Activities where falling is likely (such as skiing and horseback riding).

·      Contact sports such as softball, football, basketball, and volleyball.

·      Any exercise that may cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction.

·      Activities that require extensive jumping, hopping, skipping, bouncing, or running.

·      Deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches.

·      Bouncing while stretching.

·      Waist-twisting movements while standing.

·      Heavy exercise spurts followed by long periods of no activity.

              ·      Exercise in hot, humid weather.

Stretching exercises can help make the muscles limber and warm, which can be helpful during pregnancy.

Kegal exercises can help strengthen the muscles that support the bladder, uterus and bowels. By strengthening these muscles during your pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.

Tailor exercises strengthen the pelvic, hip, and thigh muscles and can help relieve low back pain.

Many health providers have DVDs, websites or exercise pamphlets with instructions and examples available for their pregnant patients. There are also classes with instructors trained in leading exercise programs specifically for pregnant women.

What should a pregnancy program consist of?

A total fitness program should strengthen and condition your muscles. Don’t forget to drink plenty of water and never exercise to the point of exhaustion.

Exercising during pregnancy has many advantages, but there are warning signals you should look out for. Stop exercising immediately and contact your health provider is you:

             ·      Feel chest pain.

             ·      Have abdominal pain, pelvic pain, or persistent contractions.

             ·      Have a headache.

             ·      Notice an absence or decrease in fetal movement.

             ·      Feel faint, dizzy, nauseous, or light-headed.

             ·      Feel cold or clammy.

            ·      Have vaginal bleeding.

            ·      Have a sudden gush of fluid from the vagina, or a trickle of fluid that leaks steadily.

            ·      Notice an irregular or rapid heartbeat.

           ·      Have sudden swelling in your ankles, hands, face, or calf pain.

           ·      Are short of breath.

           ·      Have difficulty walking.

           ·      Have muscle weakness.

The big question many women have after delivery is – when can I start working off these extra pounds? It’s best to start fitness routines gradually and follow your health provider’s recommendations. Too often, women who have just given birth are inundated with images of celebrities who look as though they have dropped 50 pounds and returned to their former sleek selves within weeks after delivery. However they accomplish this (think spandex & a personal trainer that works you relentlessly), it’s not necessary or even healthy to try to capture your former body immediately.

Most women can safely perform a low-impact activity one to two weeks after a vaginal birth (or three to four weeks after a cesarean birth). Do about half of your normal floor exercises and don't try to overdo it.

Exercising during pregnancy is not a “one routine fits all” kind of thing. You can strengthen your muscles and reap the benefits of exercise while pregnant, just do it under the guidance of your health provider. He or she knows your limits, your medical history and will be able to help you achieve the best results.

Story source:

Traci C. Johnson, MD, http://www.webmd.com/baby/guide/exercise-during-pregnancy.

 

 

Parenting

Holiday Decorating Safety Tips

1:45

Millions of American families will enjoy the beauty and fun of decorating a Christmas tree and hanging lights this Holiday season.  Whether you choose an artificial tree or a fresh tree, there are steps you can follow to make sure that your tree and decoration space are safe.

Many house fires occur during November and December when Christmas lights and candles are pulled out and used. Not only are fires a hazard, but plenty of people end up in an emergency room due to injuries from falls, lacerations, back strains and children ingesting foreign objects.

The Consumer Protection Safety Commission has a great list of tips to help you make safety a priority.

1. Take special care with sharp, weighted, or breakable decorations. Lacerations were among the top reported decoration–related injuries last year.

2. Avoid trimmings that resemble food or candy that may tempt a child to mouth or swallow them.

3. Place decorations with small removable parts that can pose a choking hazard to young children out of reach.

4. Purchase only holiday light sets that bear the marking of a safety-testing laboratory. Fires sparked by holiday lights caused 10 deaths last year.

5. Examine new and old light sets for damage. Discard sets with cracked or broken sockets, frayed or exposed wires, and loose connections.

6. Keep burning candles in sight and away from places where kids and pets can knock them over. Between 2010 and 2012, candles were the source of an estimated 6,500 residential fires annually, causing 80 deaths, 650 injuries, and $237 million in property loss per year.

7. Place lighted candles away from items that can catch fire, such as trees, other evergreens, decorations, curtains and furniture.

8. Look for a label that reads “fire resistant” when purchasing an artificial tree. Check live trees for freshness. If the tree is fresh, the needles should stay in place and not break. It should be hard to pull them off the branches. Check the trunk to see if it is sticky. If so, it's definitely fresh. Check for loose needles by banging the tree up and down on the ground. Expect some needles to fall off but if a lot fall off, move to another tree. One that loses a lot of needles is no longer fresh and could be dry enough to be a fire hazard.

9. Place live Christmas trees away from heat sources, and keep trees well watered.

10. Read “Ladder Safety 101” for tips to prevent ladder falls this season. You may think you know everything there is to know about using a ladder, but even the “experts” can make mistakes and wind up in the ER.

It’s easy to get complacent when decorating for the holidays; it’s something a lot of families do year after year often using the same decorations. After a certain amount of time, these decorations can become worn and damaged. Make sure your holiday doesn’t turn into a visit to the emergency room or worse by brushing up on some simple safety tips.

Source: http://onsafety.cpsc.gov/blog/2015/12/07/tis-the-season-to-decorate-safely/

 

Daily Dose

Play It Safe While Playing on the Slide

Do you remember the first time your child went down a sliding board? Or do you have a toddler who is about ready to make their first trip down the slide?

I remember watching my child climb the ladder up a sliding board, and then looking back and saying, “Mommy, you come with me.” So, up the ladder you go, putting your child in your lap for that first sliding board experience. Isn’t that the safest and easiest way to teach your child about a sliding board? What a sense of accomplishment, for both parent and child. Such a fun day at the park!! Well, I was reading a study by Dr. John Gaffney in an issue of the Journal of Pediatric Orthopedics. Dr. Gaffney noted that he was seeing fractures of the tibia (shin bone) in toddlers, many of whom had a history of being on a slide. I must admit, I haven’t ever seen a fractured tibia from a sliding board accident, but he looked at medical records for all tibia fractures he treated over an 11- month period. Of the 58 tibia fractures he studied, eight (13.8%) were sustained while playing on a playground slide. The age range of these patients was 14 – 32 months, and the average age of the eight patients in the study was 20.7 months. All of the tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult or an older sibling. None of the eight children studied had been on the slide alone. Dr. Gaffney states, “if a toddler is riding by himself and gets his leg stuck against the side of the slide, he can stop himself fairly easily, but with a parent’s weight added in you have greater velocity and momentum and it is harder to stop and the leg may get wedged and subsequently break.” He advises that if a child cannot use a sliding board independently, you should look for another age appropriate piece of playground equipment. I guess that would mean the sandbox. Thank goodness that I was lucky enough that all of my children made it safely down the slide with their parents, as I know both my husband and I were on the slide numerous times. I am sure I have pictures of that event, but I will be telling my patients about this interesting study. Like many things, there are risks involved, so find a smaller slide that your child can handle alone, or just wait until they are bigger. It ironic that something that we think will make our children safer might actually cause more injury. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Your Baby

CDC Warning: Dangerous Germ Found in Powdered Infant Formula

2:00

The Centers for Disease Control and Prevention (CDC) issued a new warning about Cronobacter contamination in powdered infant formulas.

Because powdered infant formula is not sterile, it can sometimes contain Cronobacter — formerly known as Enterobacter sakazakii — a germ found naturally in the environment that can survive in very dry conditions, the CDC reports.

Cronobacter bacteria can cause severe blood infections or meningitis, an inflammation of the membranes that protect the brain and spine. If infected, infants two months of age and younger, are most likely to develop the infection.

Infants born prematurely and those with weakened immune systems are also at increased risk for serious sickness from Cronobacter, the CDC warns.

In infants, the sickness generally starts with fever and usually includes poor feeding, crying or very low energy. Very young infants with these symptoms should be taken to a doctor.

In some outbreak investigations, Cronobacter was found in powdered infant formula that had been contaminated in the factory. In other cases, Cronobacter might have contaminated the powdered infant formula after it was opened at home or elsewhere during preparation, according to the CDC.

Because Cronobacter lives in the general environment, it’s likely there have been other sources of this rare sickness.

Using current methods, manufacturers report that it is not possible to get rid of all germs in powdered infant formula in the factory. Powdered infant formula can also be contaminated after the containers are opened. Very young infants, infants born prematurely, and infants whose bodies have trouble fighting off germs are at highest risk.

The CDC offers these tips on protecting your infant:

·      Breastfeed: Breastfeeding helps prevent many kinds of sicknesses among infants. Almost no cases of Cronobacter sickness have been reported among infants who were being exclusively breastfed.

·      If your baby gets formula, choose infant formula sold in liquid form, especially when your baby is a newborn or very young. Liquid formulations are made to be sterile and therefore should not contain Cronobacter germs.

·      If you use powdered infant formula, follow these steps:

1      Clean up before preparation

Wash your hands with soap and water.

Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them.

Clean work surfaces, such as countertops and sinks.

2      Prepare safely

Keep powdered formula lids and scoops clean and be careful about what they touch.

Close containers of infant formula or bottled water as soon as possible.

Use hot water (158 degrees F/70 degrees C and above) to make formula.

Carefully shake, rather than stirring, formula in the bottle.

Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple.

3      Use up quickly or store safely

Use formula within two hours of preparation. If the baby does not finish the entire bottle of formula, throw away the unused formula.

If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows the growth of germs and increases safety.

When in doubt, throw it out. If you can’t remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.

Story Source: http://www.foodsafetynews.com/2016/04/125714/#.VyJvoat5ylA

 

Daily Dose

Summer Series: A Lesson in Pool Safety

Every year 900 children 14 years and younger drown in swimming pool mishaps. Unfortunately, most of these drownings are totally preventable.Swimming pool season is in full swing so it is a good time to reiterate pool safety. Every year, 900 children 14 years and younger drown in swimming pool mishaps. Unfortunately, most of these drownings are totally preventable.

Studies have shown that nine out of the 10 children over the age of 1 who died were “supervised”.  The best way to prevent any drowning is by having fencing surrounding all pools. That means four feet high on all four sides. It is amazing how even a young toddler can unlock a door, or climb on a chair and undo a latch or climb out of an open window into a yard with direct access to a pool. Children are clever, quick and quiet when they want to be. Drownings are silent, and many times the last place a parent looks for their missing child is at the bottom of the pool, long after it is too late. So, after fencing a pool with a locking gate, you also need to have the appropriate equipment at the pool while your children are swimming. The first thing that should always be nearby is a telephone. There should also be an appropriate rescue floatation ring available. Anyone supervising a child should be a “designated supervisor” so that they are totally aware that they are in charge and should be within arm’s reach of the “non swimmer” child at all times. Optimally, the supervising adult is also CPR trained (a good summer activity for all, go take CPR). Lastly, “The Virginia Graeme Baker Law” which is federal legislation passed in 2007, requires all pools to be retrofitted with new drains to avoid suction entrapment and drowning. Despite this act, it seems that not all pools, both public and private, have complied. It might be wise to inquire if your pool is updated, and new drains have been installed. At the same time it is a good idea to teach children to stay away from drains in general. Swimming is one of the highlights of summer for all ages, and safety is paramount to that. That’s your daily dose, we’ll chat again tomorrow.

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