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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!

 

 

 

   

Your Child

Is MiraLAX Safe for Young Children?

2:30

Constipation is a common problem in kids. It can become a painful elimination process if not treated quickly. Children will sometimes “hold” their poop to avoid the experience, making the situation worse.

Pediatricians often prescribe MiraLax for treatment. MiraLax contains PEG 3350, which is not habit-forming and is easy to give to kids because it has no taste or odor. You can mix it in their beverages, and they typically won't complain.

MiraLax is not a natural product. It does not completely clean a colon out, like an enema does, but it works well enough to unclog a child. Over time, constipation can cause other serious health consequences, so the condition needs to be treated promptly.

While the majority of children do fine when given MiraLax, a group of parents have reported dramatic changes in their child’s personality after being given the laxative.

For the past few years, the Children's Hospital of Philadelphia (CHOP) has quietly been conducting an FDA-grant funded study into parents' reports of devastating side effects from their kids' use of the over-the-counter constipation relief drug.  

But until that study is completed, the hospital won't comment on the experiences of individual families.

A FaceBook page called, Parents Against MiraLax (PEG 3350) has been created, and more than 3,500 people have joined to organize and voice concerns about PEG 3350.

When the FDA grant was awarded to CHOP in early 2014, the federal agency disclosed that MiraLAX powder contains small amounts of Polyethylene glycol 3350 (PEG 3350), which may under certain conditions degrade into ethylene glycol or diethylene glycol — toxic ingredients found in antifreeze.

"The Food and Drug Administration has received a number of reports of adverse events in children taking PEG products," the FDA said in its grant description. "The Agency has conducted a review that documented a number of reports of neurological and psychiatric events associated with chronic PEG use in children. A number of these pediatric patients received an adult dose of PEG (17 grams) for a duration ranging from a few days to a couple of years."

MiraLAX, manufactured by Bayer, is not recommended for patients under the age of 17, but the FDA concluded that it is often suggested to parents in clinical practice.

Bayer has responded in a statement, referencing existing clinical studies confirming the long and short-term safety of PEG 3350 in pediatric patients, though the company acknowledged the product is not labeled for use in the pediatric population.

An article in the New York Times, published in 2015, reported that the FDA had raised questions about the safety of an “an adult laxative routinely given to constipated children, “ sometimes for years.

The article also mentioned that buried in the FDA’s brief to researchers, it had tested eight batches of MiraLax and found tiny amounts of ethylene glycol (EG) and diethylene glycol (DEG), ingredients in antifreeze, in all of them. The agency said the toxins were impurities resulting from the manufacturing process.

Those tests were conducted in 2008, but the results were not disclosed. Jeff Ventura, an F.D.A. spokesman, said batches were tested because “many of the reported adverse events were classic symptoms of ethylene glycol ingestion.”

Psychiatric illnesses like those reported in children taking the laxatives have also been observed in cases in which a child took substantial amounts of ethylene glycol. Some children taking MiraLax chronically (over long periods of time) also have developed acidic blood, according to F.D.A. records, which can be a consequence of ingesting EG.

MiraLAX primarily is recommended for short-term use up to seven days to relieve constipation. The FDA does not approve chronic use, although many use it regularly or even daily to treat severe issues with digestion.

The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and the American Academy of Pediatrics said in statement after the study began, that they welcome “an investigation into the safety of treatment through data and research in the prolonged use of PEG 3350.”

A timeline for the CHOP study results is not immediately known.

For many children, MiraLax works well as a short-term laxative. However, parents should discuss the dosage and the pros and cons of giving it to the their child with their pediatrician.

Story sources: Michael Tanenbaum, http://www.phillyvoice.com/chop-leading-fda-study-parents-alarming-claims-about-over-counter-drug-miralax/

Catherine Saint Louis, https://www.nytimes.com/2015/01/06/science/scrutiny-for-a-childhood-remedy.html?_r=1

Steve Hodges, MD, http://www.parents.com/blogs/parents-perspective/2015/01/07/health/is-miralax-safe-for-kids-an-expert-weighs-in/

Daily Dose

Teen Drivers

1.30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website www.youngdriverparenting.org was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

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.

Your Child

“Opt-Out” of Letting Schools Sell Your Child’s Personal Information!

2:00

If your child is in school, you may have unknowingly given the school the right to sell your child’s private information to data brokers and marketing companies. It happens every year and many parents don’t know they could have signed a form preventing the sale.

Schools are allowed by federal law to sell your child’s personal information to anyone unless you fill out an “opt-out “ form. If you don’t fill it out, personal information such as your child’s name, address, email, telephone number, age, gender, height and weight and photo can be sold.

Not only can your child be subjected to a ridiculous amount of advertising from marketing companies, anyone can use that information to locate your child if they really want to find him or her. They can also contact your child through personal emails or phone and have a picture to identify them.

"Directory information may sound innocuous, but it can include sensitive information about each student that is quite detailed," said Pam Dixon, executive director of the World Privacy Forum. "And after the school releases this data, it is considered to be public information and you've lost control of it. I don't think most parents know this."

Under the Family Educational Rights and Privacy Act of 1974 (FERPA), a student's directory information includes home address, email address, telephone number, date and place of birth, height and weight, the clubs or sports teams they've joined - even a photograph.

FERPA was written before the creation of the Internet, when a student's personal information was stored in a file cabinet and privacy was not such a big issue. Today, the data is just what a stalker, abuser or identity thief needs.

FERPA also gives parents the right to see what “directory information” the school has about their children. You have a right to block or limit access to that information. But, the window of time you can do that is short, sometimes just a few weeks after school begins. Once the time frame expires, you cannot stop the release of your child’s personal information until the next school year.

This is especially important for domestic violence survivors who are hiding from their abuser. Information that's released without their knowledge could jeopardize their safety.

"When there are situations where the survivor has left with the child and has custody of the child and they're living elsewhere, they want to know that their abuser doesn't know where they are living," said Kaofeng Lee, deputy director of the Safety Net Project at the National Network to End Domestic Violence. "If this information is available, the abuser could get access to where this child is going to school which will pinpoint exactly where the family is now living and make it possible to find them."

Many schools do not do a good job in letting parents know about the form. Some have even neglected to provide the form to parents and some schools have worded the forms in such a way as to discouraged parents from signing them.

It’s a battle for your child’s data and parents need to be aware that they have the right and the means to protect that information from getting out to marketing firms and individuals.

Congress is scheduled to review FERPA to see what further privacy protections are needed to keep students and families’ information private in the digital age. Until then, parents have to seek out and make sure that the opt-out forms are signed, sealed and delivered.

A warning to parents; this isn’t a one-time fix either. You must sign these forms every year that your child attends school.

Source: Herb Weisbaum, http://www.nbcnews.com/business/consumer/student-privacy-n423466

 

 

 

Your Child

Zip Lining Safety Tips

1:45

From the mountains of Costa Rica to over waterfalls in Hawaii, zip lining has become a vacation acivity destination. Zip lining operations can also be found in  summer camps, zoos, fields in the middle nowhere, people’s backyards and lots of other exotic and not-so- exotic locations.

Here’s how they work. A zip line consists of a pulley suspended on a cable, typically made of stainless steel and mounted on an incline. A rider sits in a harness attached to a pulley. At the top of the slope, the user propels forward and gravity does the rest. Depending on your location, it can be quite a thrilling ride to the base.

One of the keys to a safe zip lining experience is knowing something about the company and the operator of the ride. Before you harness your child into a zip line at camp or during a family vacation, ask the operator questions about the ride’s safety and look around. Not every company follows the same safety rules. Though there are currently no national standards for zip line construction and operation, many states have them, and any legitimate operator should also adhere to the standards set by the Association for Challenge Course Technology or the Professional Ropes Course Association.

Here are some questions you can ask:

·      If the operation is inspected, how often and by whom.

·      What is the company’s safety record?

·      What training the operators have.

·      Is a safety demonstration included?

Check the area out once you arrive. Do the operators look professional? Look at the equipment provided, including carabiners, ropes, harnesses and helmets. Are they well maintained? Look at the course itself. Do the lines look free from wear and tear? How about the platforms? Do they look sturdy? Do they have guardrails?

Once on the course, make sure you're strapped onto a safety line at all times — not just while you're zipping through space. (Some places require that you have two safety lines hooked on.) Many accidents occur by a simple step off a platform. So if you're on the course (which often means many feet off the ground), you should be safely attached to a line that will catch you if you fall. Also, watch out for other adventurers and the guides. Don't get in their way.

Make sure everyone in the family who is zip lining wears a helmet and has closed-toe shoes.

Nearly 17,000 zip line injuries were treated in emergency rooms from 1997-2012, and most of those injuries were in the last four years, according to a 2015 study by Gary A. Smith, M.D., Dr.P.H., FAAP, and colleagues at Nationwide Children’s Hospital. About half the injuries involved children under 10 years old. Another 33% involved children ages 10-19 years. The study noted that many zip lines are not regulated, and there are no uniform safety standards.

The increase in the number of zip line injuries in children is “an epidemic by any definition,” according to Dr. Smith, past chair of the American Academy of Pediatrics (AAP) Council on Injury, Violence and Poison Prevention.

“If kids are using them, you really need to make sure they’re using them in places where people are trained, they know what they’re doing and the zip lines have been constructed in a way that they’re not going to fail,” said Dr. Smith.

Backyard zip line kits sold online and in stores also have been linked to injuries. Earlier this year, the Consumer Product Safety Commission recalled a backyard zip line kit (http://1.usa.gov/1XoHrFs) because of a design flaw that made it easy for the cable to separate from the line, causing riders to fall. Riders suffered head injuries and bruises. Another recall was issued in 2014 for backyard zip line trolleys (http://1.usa.gov/1RT6uaY) that released unexpectedly. No injuries were reported. Authors of the 2015 study warned against buying and installing backyard zip lines.

The AAP does not have a policy on zip lines and children. However, Dr. Smith suggested the following safety precautions:

·      Requiring riders to wear a helmet, harness and gloves;

·      Training operators;

·      Inspecting and maintaining equipment regularly; and

·      Posting rules and requiring participants to follow them.

“If done correctly, these and other types of outdoor amusements that are there for the thrill … can be done in a safe enough way that it’s reasonable for children to use them,” Dr. Smith said.

Story sources: Trisha Korioth, http://www.aappublications.org/news/2016/07/07/ZipLines070716

John Donovan, http://www.mnn.com/lifestyle/eco-tourism/stories/6-things-do-you-go-zip-lining

Your Baby

Britax Recalls Car Seat Chest Clips Due to Infant Choking Hazard

1:30

Faulty chest clips on more than 100 models of Britax Care Safety car seats are being voluntarily recalled because the clips could break off and create a choking hazard for infants.

The company says that no injuries have been reported, but it has received complaints of chest clips breaking.

The recall will affect more than 200,000 car seats. However, Britax stresses that the car seats are still safe to use until a replacement kit is obtained. 

The chest clip is on the Britax B-Safe 35, B-Safe 35 Elite, and BOB B-Safe 35 infant seats.

The products were manufactured between Nov. 1, 2015, and May 31, 2017. To see the model numbers that are included in the voluntary recall, or to check the serial number of your seat, visit the company’s website set up for this recall at www.bsafe35clip.com. You can find the serial numbers on the "Date of Manufacture" label on the lower frame of the seat.

Britax is offering to replace the chest clip with a free kit that contains a new clip made from a different material. The kit comes with step-by-step instructions for replacement. Consumers are advised to routinely check their current chest clip until a replacement arrives.

Story sources: Alexandria McIntire, http://www.webmd.com/children/news/20170623/recall-britax-car-seat-chest-clip

Ashlee Kieler, https://consumerist.com/2017/06/21/britax-recalls-207000-carseats-over-chest-clips-that-can-break/

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