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Daily Dose

Best Ways to Hydrate

1.15 to read

The temperatures across the country have hit triple digits and while your kids are outside playing and maybe sweating a bit they need to make sure to stay hydrated. But, do you really know when it is appropriate for them to have water? What about a sports drink?  Who picks?

While pediatricians have been effective in discouraging families from drinking full calorie carbonated beverages, and schools have phased out full-calorie soft drinks in cafeterias and vending machines, there has been huge growth in the sports drink market.   It seems that these sports drinks are now the third fastest growing beverage category in the US, after energy drinks and bottled water. Many of these beverages are being marketed towards children and teens and are not always the best beverage of choice.

Sports drinks are flavored beverages that contain carbohydrates, along with minerals and electrolytes, and they should be used specifically for hydration in athletes. Advertisements would suggest that these products may optimize athletic performance and replace fluid and electrolytes lost in sweat during exercise. For the average child who is just outside playing and participating in routine physical activities, the use of a sports drink is really unnecessary, good old water will do the trick.

It is important to teach children to hydrate with plenty of water before, during and after regular exercise.  If we doctors and parents are encouraging exercise as a means of improving overall health and wellness, providing sugary sports drinks seems counter intuitive. Some kids may not even burn as many calories with their exercise as they may receive from one bottle of a sports drink. In other words a child’s overall daily caloric intake may increase without any real nutritional value provided by a sports drink. Back to reading labels!!

For athletes who are participating in vigorous exercise, or in conditions of prolonged physical activity, blood glucose is an important energy source and may need to be replenished; in which case sports drink providing additional carbohydrate may be appropriate.  But, different sports drinks contain differing amounts of carbs, anywhere from 2-19 grams of carbohydrate per 8 oz serving. The caloric content of sports drinks is 10 – 70 calories per serving.  You must look at the labels and judge the intensity and duration of exercise to decide which drink to use. Children are not looking at calories, but rather the labels they recognize from ads, so pay attention.

With summer here it is good to know that sports drinks really are not indicated for use during meals or snacks, and are not a replacement for low fat milk or water. Turn on the faucet and cut down on calories and cavities!

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

Daily Dose

Summer Viruses Are Gearing Up


Is it hot enough for you? Summer is here 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

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 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

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

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

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

Make Your Backyard a Safe Haven

2.00 to read

Summertime means backyard time for kids. There’s forts, trampolines, swings, pools, trees –everything you need to spark the imagination and capture the energy of youth. While there is no sure-fire way to prevent all kids from getting injured, there are some strategies that are a good start to creating a safe haven for your kids.

Plants: Make sure there are no poisonous plants in your backyard. Little kids often put things in their mouth that they shouldn’t or crawl into spaces that could cause them to end up in the emergency room.

Keep an eye out for poison ivy, poison sumac and poison oak around fence lines and on trees.

A short list of common posionous plants includes Oleander, the most common toxic plant with every bit of the plant being harmful. Lilly of the Valley can cause nausea, vomiting, pain and diarrhea. Hydrangea blooms will cause stomach pain if ingested and possibly itchy skin, weakness and sweating as well as a possible breakdown in the body’s blood circulation.

You can find photos and more toxic plants at

Home playgrounds. Just like public playgrounds, home playgrounds need to be monitored and checked for loose screws, cracked wood and rusty metal. has a great list of precautions parents can take to help prevent injuries.

- Cover areas under and around the playground equipment with shock-absorbing material, such as sand, rubber, or mulch, 9-12 inches deep.

- Make sure swing seats are made of soft rubber, not hard wood.

- Don't suspend more than two swing seats in the same section of the equipment's support structure. Most home playground injuries can be blamed on swings.

- The equipment should have ladders with steps rather than rungs for easier access, or rungs with more than nine inches or less than three and a half inches of space between them, to prevent children from getting stuck.

- Cover all protruding bolts.

- Do not attach ropes or cords to the play set, which could become strangulation hazards.

- Plastic play sets or climbing equipment should never be used indoors on wood or cement floors, even if they're carpeted. All climbing equipment should be outdoors on shock-absorbing surfaces to prevent children's head injuries.

- Slides and platforms should be no higher than six feet for school-age children, or four feet for pre-schoolers.

- Platforms, walkways, ramps, and ladders should have adequate guardrails.

- Protect against tripping hazards such as tree stumps, concrete footings, and rocks.

- During hot summer days, check the temperature of the slides and swings, because they can become hot enough to cause burns to the skin.

Treated wood. Treated wood is a common product found in backyard fences and decks. Many treated outdoor wooden structures contain arsenic. The wood industry phased out production of this type of wood in 2003, but there are plenty of wood products around that were manufactured before then. Arsenic in pressure treated wood used in play sets and picnic tables pose an increase risk of cancer according to the EPA.

Pools and spas. Pools and spas pose their own special kind of risks. Drowning is a leading cause of death to children under 5. And many drownings  occur at home. Take these simple precautions:

- Always supervise children who are in and around a pool or spa.

- Have fences or walls at least four feet high completely around the pool. Gates should be self-closing and self-latching, with latches out of reach of children.

- Keep rescue equipment by the pool.

- Steps and ladders for aboveground pools should be secured or removed when the pool is not in use.

- Use a cover for the pool when it is not in use.

- Make sure drain covers are properly fitted and paired or have vacuum suction releases to prevent being trapped under water.

- Consider installing a pool alarm that can alert if someone enters the pool.

- Spa water temperatures should be set to 104 degrees Fahrenheit or lower to avoid elevated body temperature, which could lead to drowsiness, unconsciousness, heatstroke, or death.

- Keep a cell phone with you when you’re at the pool with your kids. Seconds count and you don’t want to have leave your child to find the phone.

These are just a few suggestions for helping parents create a safe backyard where kids can have fun and hang out. Have a great Summer!


Your Child

Have A Fun and Active Summer!

1.45 to read

With another school year wrapped up, many kids are looking forward to summer and lots of free time. You might think summer is when kids are more likely to drop a few pounds. But that’s not how it usually goes. Summertime is often when you'll see kids add pounds. Children who are overweight gain more and kids who are on the border of obesity, cross the line. Even children who are at a normal weight for their age and height during the school year tend to put on weight after school shuts down for summer break.

Why the weight gain?

Kids are not active as they used to be.  Instead of playing outdoors, too many kids spend hours in front of the TV or computer. You may have ridden your bike, played tag or hide and seek, climbed trees or splashed in the pool with friends until the sun went down, but a lot of kids today spend their time with friends on the computer or playing video games. It may be fun, but they’re not burning very many calories.

Kids tend to snack more when they are home. It’s easy to grab a bag of chips and a soda throughout the day when the kitchen is only a few steps away. Constant eating becomes a habit. Presently, US kids eat 27 percent of their daily calories in the form of snacks, typically eaten three times a day in-between meals. A yogurt here (110 calories), a freeze pop there (50 calories), a cookie (80 calories), a donut (200 calories), and another juice box. They all add calories above and beyond a child’s needs.

How can you help prevent summer weight gain? Make sure that there are healthy food snacks available. Get rid of sugary drinks in the house. Encourage your child to maintain a normal pattern of eating with breakfast, lunch, a healthy afternoon snack and dinner with the family rather than adopting a grazing style of eating.

Garden together. Besides being great exercise, gardening can be a way to introduced children to healthy foods. The experience of eating a fruit or vegetable they planted and nourished can help teach them about appreciating healthy foods for a lifetime.

Be a part of your child’s activities. Exercise as a family with bike rides, walking, sports, swimming and trips to the museums, parks, concerts, and recreation center.

Day camps may be a good option for some families. It’s probably too late to register for a stay-over camp, but many cities and local organizations provide day camps. These camps offer a wide variety of learning and fun activities for children.

Limit television, video/DVD and computer access to no more than two hours each day.

Maintain structure in your child’s daily schedule. While it’s good to let your child relax from a long 9 months of school, too much unscheduled time can lead to boredom, overeating and long hours on the couch or at the computer. Some kids do better than others with extra time on their hands, so knowing how your child handles unstructured time can help you create a doable schedule.

Having structure in the summer can also help kids make a more seamless transition back into school come fall. They will already be accustomed to meeting the demands of a schedule (and getting up in the morning), whereas if no summer structure was in place, the school routine could be a shock to their systems once the new semester rolls around again.

Summer should be fun. It should be a break from grueling routines and a time for families to enjoy doing things together. Too often it becomes about doing nothing. The best way to help your child (or you for that matter) avoid gaining weight during the summer is to live an active lifestyle throughout the year. Summer vacation offers many opportunities for families to try something new or different. Make this the best summer ever!

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!


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