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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

How to Treat Swimmer's Ear

1:30 to read

The entire country seems to be experiencing the “dog days of summer”.  That huge high pressure system has covered most of the weather map, so the only thing to do for the next month is to head to any water you can find…swimming pool, lake, ocean, river or fountain!  But, with swimming comes swimmer’s ear or otitis externa.

I rarely see a child with an otitis externa except during the hot summer months.  Swimmer’s ear is a frequent problem for children who “live in the water” all day long. They are just like a fish. They head to to the pool first thing in the morning and don’t come in until they are water logged…and their ears stay wet all day long and into the night….then back to the water again.  When the ear canal cannot dry out it becomes the perfect dark, damp breeding ground for bacteria to take root.

The most common complaint with swimmer’s ear is pain!! I have seen big stoic teenage athletes in tears from the pain when you just touch their ear.  The pain is due to the inflammation and infection of the ear canal..not the ear drum (an inner ear infection).  So, if you tug on the ear lobe or push the area in front of the ear at the jawline, this causes pain.  Rolling over in bed and laying on that ear will cause pain.  Many people also feel a fullness and complain that they don’t hear as well as the ear canal is so swollen.

The treatment for a swimmer’s ear is not an oral antibiotic, it is rather for ear drops that contain an antibiotic to treat the infection topically at the source. Many of the ear drops used to treat otitis externa also contain a steroid that will help with the inflammation (and swelling) of the ear canal.  Pain control is also important with a combination of acetaminophen and/or ibuprofen.   Keeping the ear canal dry is imperative in order that the ear drops stay in the canal and are not “washed out” right after you put them in the ear. I try to keep the patient’s ear canal dry for several days and have them pain free before getting their ear wet again.

BUT, the best treatment for swimmer’s ear is actually prevention.  Little children who are just learning to swim really do not spend enough time under water or during a bath to have their ear canals become infected.  It is typically seen in children over the ages of 5 or 6 who are now great swimmers and spend a great deal of time in the pool, lake or any body of water.  For these children I recommend putting in “home made” ear drops made with half alcohol and half white vinegar. It is easy to make a bottle and buy a dropper and leave it by the back door to the pool or by the dock…..in this way as the kids come in at the end of the day, everyone tilts their head and gets several drops instilled into both ears before heading inside for the night.  You can also buy “Swim Ear” over the counter if you aren’t “into” making the frugal ear drops.

On occasion, for an extremely swollen ear canal you may need to see an ENT to have the ear canal cleaned and treated…..but if treated early this is uncommon. 

Stay cool, hydrated and avoid swimmer’s ear by using those ear drops routinely!! I learned my lesson the hard way one year….prevention is the key to avoiding a painful otitis externa.

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

Remember the Rules of Boating Safety

A tragic boating accident in our area during a Boy Scout outing to the lake has reminded me and many other parents of the necessity of following safe boating rules. While summer is here many families may have the opportunity for a boating outing. The best time to discuss boating safety and rules with your children is prior to even going on a boat.

Then another review of boating safety, (I would include jet skis in this too) should happen just before launching the boat on the water. Children of all ages should be taught boating safety and there should never be assumptions that they have heard all of the rules before. With the excitement of the day, many children and adolescents need to be continuously reminded of safe boating rules to ensure an accident free experience. All children and adults should have a Coast Guard certified life preserver (personal flotation device, PDF) and children should wear them at all times. In my opinion, adults should too, and model behavior for the kids. Whistles

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

Burns From Hot Surfaces!

1;30 to read

With the ongoing heat wave across many parts of the country which has hit Texas exceptionally hard, I have a new warning for parents (and kids).  My community has seen seen extremely high temperatures between 100-106 for the last two weeks. These temps have made everyone miserable and there have been many warnings about heat exhaustion and heat stroke, and ways to stay hydrated on the news.

Who knew that you needed to worry about burns other than sunburn? It seems that outdoor furniture, metal pool drain covers, and playground equipment have heated up with these unrelenting temperatures!  

So…what is this alluding to?  A patient just called me yesterday totally “freaking out” that her toddler had gone out to play in the backyard with his 3 year old brother. It was morning and not yet terribly hot, so she thought “best time to get out of the house and get some fresh air”.  The boys were climbing on their outdoor fire pit (as children often do) and he stepped on the edge, and immediately started to scream and cry. His mother, who also happens to be a pediatric nurse, initially thought something had stung him? When she picked him up he continued to cry as if in pain, but she could not see anything at all….until she looked at his feet. He had stood on the metal on the edge and immediately burned his feet, to the point of blistering on contact!  And, as you probably know, toddlers feet are typically flat (arches come later) so his “baby feet” had full contact with the metal and he sustained second degree burns to both feet.

When she got him to the ER they immediately started to treat his burns and pain (as burns are incredibly painful).   She said she did not know who was crying more…she or her child. Once things settled down she asked the ER doctor at Children’s Medical Center if this had ever happened before!  Unfortunately, the answer was yes.  They had seen several other serious burns to children who had come into contact with metal on playgrounds and around metal pool drain covers.

This precious little boy will ultimately be fine…..after many days of oral pain medication and routine bandage changes (some of which will actually be done as an outpatient at a burn unit). He will also never remember this.

So… this is a new warning for parents: watch out for the possibility of burns secondary to outdoor metal objects.  This photo is quite telling and painful to look at!  His mother called me today and sent a few new pictures with him smiling!

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

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

Hot Car Deaths

1:30 to read

Did you know that heat stroke is the second leading cause of non-traffic fatalities among children, with the first being backover deaths.  As the summer temperatures are rising these tragic accidents become all too frequent.  

My home state of Texas leads the country in child vehicular heat stroke deaths, followed by Florida and California.  But children who are trapped in vehicles have died in milder climates as well. The temperatures outside may be as low as 60 degrees, but the inside of a car heats up quickly, with 80% of the increase in temperature happening in the first 10 minutes. The reason for this is due to physics.....the sun’s short-wave radiation is absorbed by dark dashboards and seats...the heated objects including child seats then emit long wave radiation which heats a vehicle’s interior air.  All of this leads to tragedy.

A child’s thermoregulatory system is not the same as an adult’s, and their body temperatures will warm 3 -5 times faster.  When a child’s body temperature rises to about 107 degrees or greater, their internal organs begin to shut down.This scenario can then lead to death. If you see a child who has been left in a hot car call 911...every minute matters.

The greatest percentage of these tragic deaths are totally unintentional.  These parents are not “bad parents” or “child abusers”, they are loving, good parents who simply forgot that their child was in the car. On average there have been around 37 deaths per year due to vehicular heat stroke and in most cases this is not due to reckless behavior but simply to forgetfulness.  Parents and caregivers both admit to “just forgetting” a child was in the car.  It truly can happen to anyone.

So, how can you remember that your precious, quiet, sleeping child is in back seat. Make it a routine to always look in the back seat before you lock and leave the car.  Try putting your purse, briefcase, or cell phone in the back seat as a reminder to look for your child. Lastly, if your child is in childcare, have a plan that the childcare provider will call you if you have not notified them that your child will not be coming to school,  and they don’t show up.

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DR SUE'S DAILY DOSE

Can you use homeopathic products to relieve your child's illness?

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Can you use homeopathic products to relieve your child's illness?

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