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Daily Dose

Don't Miss Out on Summer Fun!

1.00 to read

The lazy days of summer seem like the perfect time to engage in playtime activities. My summer months at the office are particularly busy doing check ups as everyone is out of school. This means that I seem to see a lot of children in the 5-12 year group, and I enjoy getting to talk to them about their summer fun. 

I have suddenly realized that many of the children in this age group seemed to have “missed” some key milestones in child development, which I think most of us adults learned during the lazy days of summer.  I think learning to ride a bicycle and learning how to swim are two MUSTS of child development. While not all children will want to one day participate in a swim team, or a bike race, being able to swim and pedal a bicycle are life long skills. Who knows, with the price of gas we may all be heading back to bicycles as preferred transportation, at least for short distances.  

At the same time I have noticed a fair number of parents who are concerned about their young children’s motor development.  This is the 2-4 year old group where I am sometimes amazed when the parent of a 3 year old tells me that their child “does not jump high enough”. What?  How about getting out the jump rope again, and drawing hopscotch on the sidewalk to practice hopping and jumping. These are free exercises that can help boost coordination while having fun together. What about learning to skip and to balance on a beam (doesn’t have to be at gymnastics) a two by four in the back yard or park works just as well. Learning to pump a swing is another. I can remember how proud I was when I mastered that skill (makes me smile, even today). 

So while the last days of summer are here, make a list of not only summer reading, or computer skills that your child needs to finish, but of some of those childhood milestones as well.  Hop, skip, jump rope, ride a bike, learn to swim. College applications might start asking about those milestones one day too?  Stranger things have happened.

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Daily Dose

4th of July Celebrations!

1:30 to read

The 4th of July weekend is here, which means many families will celebrate with a long weekend with other families and friends. Let’s remember the importance of making it a safe holiday!   

Of course the celebration includes fireworks which are definitely fun to watch, but at the same time, when they are used by consumers (many of whom are children and teens) rather than by trained professionals, there are many associated risks.  Being on call in the ER as a new doctor was one of the scariest and longest nights in my life...and I can remember seeing children with burns...several which were disfiguring. Burns remain one of my biggest fears.

In 2013 there were an estimated 11,400 people treated in emergency rooms for fireworks related injuries, and the risk of fireworks injury was highest for children ages 0- years, followed by children 10-14 years. I know that having fireworks in your backyard or on the beach is fun, but also dangerous. Although I was used to my boys saying, “ Mom, you tell us that everything that is fun is too dangerous...which not only included fireworks, but trampolines, and motorcycles.”  I am sticking to that.

The majority of fireworks related injuries were to the extremities followed by those to the head (eyes, ears, face).  The greatest number of injuries were caused by small firecrackers, sparklers, and bottle rockets. Did you know that a sparkler burns as hot as 1200 degrees F, while water boils at 212 degrees F and wood burns at 575 degrees F!! Even a left over sparkler may cause a significant burn to little hands.

Fireworks are best left to the “hands” of the experts. Fireworks are dangerous and can be unpredictable, especially in the hands of amateurs (including parents).  Public firework displays are equally enjoyable and are carefully planned and executed. Especially with drought conditions and fires already raging in parts of the U.S. it is especially important to be aware of the risk of inadvertently setting a small fire from a misguided bottle rocket.  That small fire may lead to an even bigger fire which destroys acres of land as well as puts firefighters themselves at risk. No one wishes for that scenario but there were over 17,500 fires caused by fireworks in previous years. 

Start planning your holiday fireworks viewing now....from a safe venue! Happy 4th!

Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Your Child

Protect Against Heat-Related Illness and Dehydration

2:00

Think it’s hot where you are? Try spending a few minutes outside in the southwest part of the country. This year, several cities have already set records of the longest stretch of time with temperatures 115 degrees and higher, and we’re only half way through the summer.

Your family’s area may not be experiencing those kinds of extreme temperatures, but it doesn’t have to be that hot for a child to end up with a heat-related illness or dehydration when out of doors.

Kids are particularly vulnerable because a child's body surface area makes up a much greater proportion of his overall weight than an adult's, which means children face a much greater risk of dehydration and heat-related illness.

Longer daylight hours often means kids spend more time in the sun so it’s important to make sure your child doesn’t become dehydrated or over-heated.

The early signs of dehydration can include fatigue, thirst, dry lips and tongue, lack of energy, and feeling overheated. But if kids wait to drink until they feel thirsty, they're already dehydrated. Thirst doesn't really kick in until a child has lost 2% of his or her body weight as sweat.

Dehydration can cause three of the worse types of heat-related illnesses:

Heat cramps: Painful cramps of the abdominal muscles, arms or legs.

Heat Exhaustion: Dizziness, nausea, vomiting, headaches, weakness, muscle pain and sometimes unconsciousness.

Heat stroke: A child with heat stroke can have a temperature of 104 degrees or higher. Severe symptoms such as nausea and vomiting, seizures and disorientation or delirium can occur as well as a lack of sweating, shortness of breath, unconsciousness and even coma.

Any one of these heat-related illnesses requires immediate medical attention.

To prevent dehydration make sure your child drinks plenty of cool water and often. They should be hydrated before play and during – even if they tell you they are not thirsty. A good size drink for a child, according to the American Academy of Pediatrics, is 5 ounces of cold tap water for a child weighing 88 pounds, and nine ounces for a teen weighing 132 pounds. One ounce is about two kid-size gulps.

Dehydration can be a tricky thing to catch early. It is typically cumulative – meaning that it may take several days to reach a dangerous point.  If your child is 1% or 2% dehydrated on Monday and doesn't drink enough fluids that night, then gets 1% or 2% dehydrated again on Tuesday, that means your child is 3% or 4% dehydrated at the end of the day. "They may be gradually developing a problem, but it won't show up for several days," says Albert C. Hergenroeder, professor of pediatrics at Baylor College of Medicine and chief of the sports medicine clinic at Texas Children's Hospital.

One way to monitor your child’s hydration is to weigh him or her before and after a sport’s practice or game or playing outside. If his weight drops, he's not drinking enough during his workout.

A simple rule of thumb: if your child's urine is dark in color, rather than clear or light yellow, he or she may be becoming dehydrated.

If you suspect your child is getting over-heated, get him or her out of the sun and into a cooler place. Have the child start drinking plenty of cool fluids. The child should also take off any excess layers of clothing or bulky equipment. You can put cool, wet cloths on overheated skin. In cases of heat cramps, gentle stretches to the affected muscle should relieve the pain.

Kids with heat exhaustion should be treated in the same way but should not be allowed back on the field the same day. Monitor your child even more carefully, Hergenroeder says.

If your child doesn't improve, or can't take fluids, see a doctor.

Some children are going to be more prone to heat-related illness. The biggest risk is a previous episode of dehydration or heat illness. Other factors that can put your child at greater risk for heat illness include obesity, recent illness (especially if the child has been vomiting or has had diarrhea), and use of antihistamines or diuretics.

If a child has been indoors most of the summer, they may not have had a chance to adjust to the hotter weather. Kids should add a little more time out of doors each day until they acclimate to the heat. However, with some of the high temperatures we’re having, it’s best to schedule activities in the morning. It can still be 90 degrees with a humidity index of 107 at 9:00 pm in some places.

In a smart move, a growing number of athletic programs suggest that it is sometimes too hot to practice. In fact, many are restricting outdoors practice when the National Weather Service's heat index rises above a certain temperature. The heat index, measured in degrees Fahrenheit, is an accurate measure of how hot it really feels when the relative humidity is added to the actual temperature.

Kids need time out of doors and certainly time to play and have adventures. Parents can help keep their children from experiencing heat-related illnesses by making sure their child is hydrated and not spending too much time out of doors when the temperature or humidity index is high.

Story source: Roy Benaroch ,MD, http://www.webmd.com/children/dehydration-heat-illness#1

 

Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

Daily Dose

The Joy of Fun Summer Activities

1:15 to read

While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics like summer and all of the wonderful activities to do. We have talked about swimming and camps and staying abreast of academic work, but what about the basics of summer? The good, old-fashioned leisure time activities that we all used to do. While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics.

So here are the things that come to my mind: Basic summer skills for all of us to remember and to teach. All of this is free, easy and are really akin to life skills that all children should probably master at some point in their childhood.

  • Jumping rope
  • Riding a bike (of course with a helmet)
  • Skipping a stone
  • Pumping a swing
  • Blowing bubbles
  • Catching a ball
  • Throwing a ball (don't think I have still mastered this, wonder if it is too late?)
  • Turning a somersault
  • Playing hopscotch
  • Playing four square
  • Learning how to float on your back
  • Fly a kite
  • Catching fire flies

Don't feel pressured to do this all at once, as childhood is a long time. But enjoy the time spent with your children accomplishing these simple pleasures. Why don't you let me know things that you think of and that you feel are essential skills of summer? I am sure I have missed many. That’s your daily dose, we’ll chat again tomorrow.

Send your question or comment to Dr. Sue!

Daily Dose

Dry Drowning

1:30 to read

It seems that at least once a week this summer I have seen a child in my office with a concern of “dry drowning”. In each case the child (anywhere from 2-6 years old) has been swimming and has had not had any issues…just a fun day in the pool.  But, the following day they “seemed tired, and didn’t want to play”, but were content to watch cartoons or play video games. A few of the children I have seen were sitting on my exam table eating a lollipop and playing on their mother’s I-phones.Thankfully, none were having any difficulty with breathing!

 

So…their concerned parents have seen media reports and are worried that this “fatigue and lethargy” is the presentation of “dry drowning”. In most cases they have also searched “dry drowning” on the internet and the first thing they see is WebMD’s definition of “dry drowning” which would concern most parents!  The article at the top of the Google search includes this.. “putting your child to bed after swimming and they never wake up in the morning”???  Who wouldn’t be worried….

 

But, if you ask most doctors (certainly all of the ones I know) they do not understand what “dry drowning” is, and have never seen a case like the one described by WebMD.  This small survey of mine included pediatric ER docs as well.  Actually “dry drowning” is not even mentioned in pediatric textbooks, and it is difficult to find the term in medical literature when doing a journal search. It is more likely to be found in media articles. 

 

As I understand it, the term “dry drowning” was first discussed in animal studies from years ago, in which animals died after ingesting water and experiencing laryngospasm, and it occurred 1-2 minutes after the immersion in water. None of the articles discussed “dry drowning” in children….but articles did discuss drownings!

 

In a pediatric study looking at data from over 15 years and “immersion related deaths- drownings” it was found that most drownings occurred at home and over 90% were due to lack of supervision.  There were no deaths reported from “dry drowning”. 

 

I am not concerned about any of my patients and “dry drowning”, but I am concerned about drowning!! 

 

Take home message….take your children to swim but be vigilant in watching them…..and you will not need to worry about any immersions or drownings!!  Drowning is preventable. 

 

 

 

 

 

 

 

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