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Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Stay Sun Safe

Memorial Day weekend is the unofficial start to summer. Be sun smart all summer long.

With the long Memorial Day weekend here, it is another good time to discuss the importance of using sunscreen. Sunscreen labeling is about to undergo some changes which will probably make it easier for all of us to read labels and understand how to use sunscreen appropriately. The FDA has been working for over a decade on standardizing labels as to the amount of UVA sun protection each sunscreen product provides. UVA rays, are not the ultraviolet rays that lead to sunburn, but they are the rays that contribute to skin cancer and sun related skin aging. Many products have claimed to be waterproof, sweat proof, or even provide all day protection and these labels will no longer be allowed. At the same time labels promising over 50+ protection will also be pass
Daily Dose

Swimming Injuries On the Rise!

1.30 to read

Swim season is in full swing as the heat is on and the “dog day’s of summer” gripping the US. I have heard many news organizations reporting that there are more kids going to emergency rooms for swimming injuries than ever before.  Maybe the good news is that more people are swimming and therefore the rising statistics but the increase in injuries may also be related to parents who are not playing close attention to their children while they are swimming.

Researchers reveals an estimated 1.6 million swimming injuries reported in the U.S between 1990 and 2008.  The annual rate of swimming injuries among those children 7 years and older increased by 30% during the study period. Kids younger than 17 accounted for about 60% of swimming injuries.  That data correlates to about one swimming injury every six minutes (those lifeguards must be tired).

For every 100,000 people who swam yearly, 18 injuries occurred among kids ages 7-17 and 9 injuries among people 17 and older.  Research showed that 87% of the injuries happened in and around swimming pools, and 13% occurred in natural bodies of water.  

While most of the injuries were cuts, bruises and scrapes from the pool, others were more serious.  Children younger than 7 were more likely to require hospitalization and there were more deaths in this younger age group.  

Over July 4th weekend there were 7 drownings reported my area. There were 2 children who died and several young adults among those 7 drownings.  Parents need to be vigilant at all times when swimming with their children and should never be more than arms reach from a young child who is in the water.  

Additionally alcohol and water don’t mix!  Swimming and boating while drinking alcohol is as deadly as drinking and driving! Parents should never operate a boat while drinking.  Several teens as well as young adults recently died due to drowning in our area after they had been partying on boats and no one noticed that they had gone overboard.

Lastly, always wear lifejackets while boating or participating in water sports!Life jackets save lives and may have prevented several deaths had they been worn.

Safe swimming and stay cool!

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the vacation season here many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your childhas come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Your Teen

Summer Viruses Are Gearing Up

1.15 to read

Is it hot enough for you? Summer is here and will continue for a bit! Winter viruses are a distant memory (good bye flu and RSV), summer viruses which have been laying dormant are once again rearing their angry heads.

My office has been overflowing with really hot feverish kids of all ages.   I think the most likely culprit for much of the illness we are seeing right now is an enteroviral infection.  For some reason, it makes us parents feel better if we can “name that virus”, seems to help validate the illness.  

Enteroviral infections typically cause a non-specific febrile illness and with that you can see fairly high fever. In other words, just like the thermometer as summer heat arrives , 101-104 degrees of fever is not uncommon in these patients.  Remember the mantra, “fever is our friend”. I think it is almost worse to have a high fever in the summer as you are even more uncomfortable because it is already hot!

With that being said, if your child has a fever, don’t bundle them up with layers of clothes and blankets.  It is perfectly acceptable to have your younger child in a diaper and t-shirt, and older children can be in sundress or shorts rather than long sleeves and pants.  Bundling may increase the body temperature, even while you are driving to the doctor’s office. I often come into a room with a precious baby who is running a fever and they are wrapped in blankets, let them out! That hot body needs to breathe.

These summer enteroviruses may cause other symptoms as well as fever, so many kids right now seem to have sore throats and are also vomiting and having diarrhea. With this type of virus you also hear complaints of headaches and body aches (myalgias).  The kids I am seeing don’t look especially sick, but they do feel pretty yucky!  Just kind of wiped out, especially when their temps are up.

Besides treating their fevers, treat their other symptoms to make them comfortable.   If they are vomiting do not give them anything to eat and start giving them frequent sips of liquids such as Pedialyte (for the younger ones) and Gatorade or even Sprite or Ginger Ale. Small volumes are the key. 

I often use pieces of Popsicle or spoonfuls of a Slurpee to get fluids in kids. I always tried to pick drink colors for my own kids that were easier to clean up, in case they were going to vomit again, so no bright red!  The cold fluids may also help to soothe a sore throat. Once the vomiting has stopped, and it is usually no more than 12-24 hours, you can start feeding small amounts of food, but I would steer away from any dairy for a day or two. Again, nothing worse than thinking your child is over vomiting, fixing them I nice milkshake (comfort food) and seeing that thrown up!  Many a mother has come into my office wanting to strip after being vomited on, in a hot car no less.   I don’t think there is a car wash around that can fully get rid of that smell!

Most enteroviral infection last anywhere from 2-5 days. There are many different enteroviruses too, so you can get more than one infection during the season. This is not just a virus you see in children, so watch out parents you may succumb as well. Keep up good hand washing and your child should stay home from school, the pool, camp, day care etc. until they have been fever free for 24 hours. 

That’s your daily dose for today.  We’ll chat again tomorrow.

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

Summer Series: A Lesson in Pool Safety

1.15 to read

Every year, over 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. 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...so go take CPR class). 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!

Daily Dose

Traveling with a Toddler

1.15 to read

Summer is upon us and that means travel and family vacations. I think the hardest time to travel with your child is when they are a toddler.  While a 1-2 year old child is adorable, they are also like a teenager.  What do I mean by that?  A toddler is moody and temperamental, just like a teen. One minute they love you the next minute, not so much. They are prone to tantrums, meltdowns, and “going to the dark side” as we called it.  

If you are heading for a plane trip with a toddler, you just never know what to expect. A lengthy plane ride is somewhat challenging for sure.  While driving to the airport all I can think about is security lines with a toddler.  The lines are longer in the summer and trying to keep your child entertained while standing in a long line is akin to climbing Mt. Everest. It is even worse than sitting in the pediatrician’s office, at least we have toys!

So, once you get through security you still have to wait to board, get settled into your seats (holding a lap child is not easy) and then pray that your flight is not delayed on the tarmac.  I was fortunate as when my boys were little you could still get up and walk up and down the aisles with a child to entertain them. Even then it was difficult to keep your toddler’s hands to themselves. You cannot walk those precious toddlers up and down the aisles anymore, and sitting in that seat for hours is just not what a toddler wants to do. They want to MOVE!

One of my patients’ is getting ready for a move to Australia. This couple has a adorable 16 month old and they are getting ready for a 17 hour trip and asked my advice. I wish you could “Fed Ex” your child ahead. 

This cute little boy has a lot of words and during his check up in my office he kept pointing to the door and saying “OUT”.  Stuck inside a plane is not going to be his idea of fun...he would rather be at the park.

But parents do what they have to do......so I advised them to look for new toys and try to bring out something different throughout the flight. They are great young parents and have not yet introduced their child to the I-pad, so they can now “pull out” this new gadget to help entertain their toddler. I also told the mother to pack a ton of snacks and even “forbidden snacks like cookies and candy might be used to coerce the child to sit in his seat. I have a hard time sitting still, so it is reasonable for a toddler to be antsy as well. 

I just hope they have wonderful seat mates (on this journey) who want to help entertain a little boy who just wants “out”. They hope to have another baby while in Australia. The return trip could even be more fun.  

Daily Dose

West Nile Virus

1.50 to read

The temperatures are warming up around the country and “summer” iis only a few weeks away.  But the bugs are already coming out in full force and that includes those pesky mosquitos.  In Texas with warmer temperatures than other areas, I am already seeing lots of mosquito bites, which is already causing some anxiety due to the risk of West Nile Virus.

West Nile Virus (WNV) was first detected in the United States in 1999 and 2012 was the second worst outbreak of WNV disease (the worst was in 2003). WNV disease is a seasonal illness which typically is seen during summer and early fall, when mosquitos are at their peak.  

In 2012 there were a total of 5,674 cases of WNV in the U.S. reported to CDC and there were 286 deaths.  WNV has been reported in all 48 contiguous states as well as DC and Puerto Rico ( we can all head to Hawaii??). 75% of human WNV cases were reported from just 10 states, with Texas having the highest number. (1,868 cases and 89 deaths)

So....what do you need to know.  Number 1: WNV as the name states is a VIRUS, which means there is not an antibiotic used to treat the infection!! 

Secondly, about 80% of people (or 4/5) who are infected with WNV will NEVER show any symptoms of illness. Up to 20% of people who are infected will show symptoms of fever, headache, body aches , nausea or vomiting and some may also have swollen lymph nodes and a rash. These symptoms mimic many other viral illnesses so trying to decide if your child who has a fever and “the feel bads” has WNV or an enterovirus (like coxsackie) or and adenoviral infection is really not important.  

What do you do for all of these viral infections but treat the symptoms, right?  Give it a few days to see how your child is doing, treat the fever, keep them comfortable and hydrated and in a few days the illness will typically resolve and will be another unnamed nuisance viral illness.

About 1/150 people infected with WNV will develop severe illness with neurological problems including seizures, meningitis, and encephalitis. Those are the people who are at greatest risk of requiring medical care, which includes hospitalization and life support, which is most often seen in older people and in people who have other medical problems.

The best thing to do is to keep yourself protected from mosquito bites by using bug spray, closing windows and doors, draining standing water and avoiding peak exposure during the early morning and evening hours.  When you can wear long sleeves and long pants and socks to cover up from bites. For infants I would head out now to get some mosquito netting to cover strollers when a baby is outside (buy it now while available).

Lastly, don’t panic!!!  Some parents are already telling me they aren’t letting their children go outside!?  We have a long summer ahead and everyone needs fresh air and exercise.  Start shopping for bug spray....i am looking for buy one get one free deals! 

More on WNV as we get into the thick of the season although my zipcode in TX is already reporting WNV positive mosquitos.....maybe Hawaii? 

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