Burn Prevention

Every parent lives in fear of burn injury to their child.  Here is a good, fairly comprehensive list of safety measures.  How many do you practice?

1. Do not let cooking appliance electric cords hang off of counter.
2. Do not leave hot beverages or foods unattended or near the edge of table.
3. Keep hot beverages away from children and do not have a child sit in your lap if you are drinking a hot beverage.
4. Teach older children how to safely remove hot food from microwave and stove top.
5. Minimize use of stove front burners.
6. When carrying hot food in kitchen make sure young children are not in your path.
7. Test bath and shower water temp with your hand for 30 seconds before using.
8. Never leave young children unattended in bath or shower.
9. Adjust water heater to no higher than 120 degrees.
10. Avoid leaving unattended pots on stove.
11. Keep children away form fireplace and wood stove doors.
12. Install smoke detectors on all floors of your home and test monthly.  Ideally, they should be hard wired with battery back up.
13. Replace smoke detector batteries at least annually.  Keep a schedule.
14. Practice home fire drills and make sure children know how to exit the house in the event of a fire and where to meet outdoors.
15. Keep fire extinguishers in kitchen, furnace room, and by fireplace.
16. Teach children to exit the house low to floor if their is smoke in the room.
17. Obtain a safety ladder if your home has a second floor.
18. Teach children to not use elevators to escape a fire.
19. Teach children to “stop, drop, and roll” if clothing catches fire.
20. Avoid smoking indoors.
21. Minimize storage of flammable liquids, keep them away from child play areas or from potential ignition sources.
22.  Minimize extension cord use.
23. Keep matches and lighters out of the reach of children.
24. Avoid use of fireworks.

Thanks to Robert L Sheridan MD from Shiners Children’s Hospital of Boston Massachusetts who’s article ” Burn Care in Children” is the source of the above list.

Please call with any questions or comments, and thanks for following.

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Your Teen’s Cellphone

Remember the “Blockbuster Bowl” on New Year’s Day;  video rental stores?  Where did they go?  An entire industry came and went in only a blink of an eye–a few years, really.  As a still new grandpa I marvel AND fear the rapid evolution of technology and its effects on youth.  This is probably most evident in the proliferation of smart cellphones over the last years.  This was mere science fantasy for my generation as teens, and was mostly in its infancy as my children went through high school.  But its a major part of young families’ worlds now.

Here are a few suggestions to consider:

1. BE A GOOD ROLE MODEL! Get off the phone yourself.
2. Set time and place limits for appropriate cell phone use, and stick by them yourself.  No cellphone use AT ALL during homework, family meals.  I think 1 hour/school day and 2 for weekends/vacation days is reasonable.
3. No phone overnight in child’s room.  This is key.  I cannot tell you how many kids I see complaining of fatigue, headaches, difficulty in school where I find that the likely root cause is poor sleep, as they are up till whenever on line or communicating still with friends (about the usual teen high school social issues and nothing more).  No–not mono, ADHD, or any of those things(at least often not). It’s the darn phone!
4. Other activities. Read books – take your family to a bookstore or library, especially now that summer is here. Read books yourself. Play sports together – tennis, have a catch, ride a bike, take a walk. No phones during these activities. 
5. Educate your child about the public nature of online communication.  These devices are NOT private but rather are a combination of billboard and megaphone, I tell young people.  Before posting/sending ANY information–verbal or pictorial–ask yourself this question, I say: do you want everyone, including grandma and/or your worst enemy, to see this?  Because they will.  REMEMBER THAT.
6. There are good apps out there to help manage your child’s phone use: OurPact, KidsLox and Google Family Link; cost: approximately $50/year. These apps enable you to shut the phone off at a scheduled time, limit the use (internet and text) and can enable you to keep tabs on sites visited. These apps even allow you to add time if YOU feel it’s necessary.
7. Know your limitations. Again, now into my 7th decade, much of this tech stuff is quite foreign to me. You younger parents mostly grew up in a computer/tech world. But unless you actually do tech for a living, you likely know less here than your kid. So be humble. There are few filters or monitors you can apply that your child cannot at least partially work around. So avoid over-confidence and remain vigilant.

Let’s face it – these tech options aren’t going anywhere, and given the many benefits they bring to society, nobody says they should. But be aware of their disadvantages as well as their advantages.

Thanks for following.

Sports Participation Readiness

With Memorial Day just a week away, what are for me the best 6 weeks of the year–to July 4–are upon us.  Children are now preparing for summer sports and we’ll even begin fall sports physicals soon.  Let’s take a moment to recall some important principles.

30 million US children participate in organized sports annually.  1/3 will sustain injuries serious enough to require formal medical attention at an annual cost of $1.8 billion.  There are important differences regarding youthful athletes that we should keep in mind:

• Large surface area to body mass ratio
• Larger head compared to body size
• Protective gear may be ill fitting
• Growing cartilage more injury prone
• Evolving motor skills

A few other considerations:

• Children are still growing
• Within competition groups the size, maturity, and ability level between participants can vary considerably
• Open growth plates (cartilaginous) are more injury susceptible

Adequate nutrition is essential:

• Calories–good meals before training or competitions
• Protein–essential for muscle growth and recovery
• Vitamin D and Calcium–one study of forearm fractures showed that almost 50% of those injured were clinically vitamin D deficient; 1/2 of them required surgery.  Get the kids out in the sun at least a bit, especially Black children in winter months (more melanin means less sunshine metabolized vitamin D conversion in the skin).  Note this is particularly important for girls
• Hydration–important to drink plenty of fluids before, during and after athletic participation, especially on hot days

Suggestions for  competition readiness:

• Be in good condition–GET YOUR SPORTS PHYSICAL.
• Wear all appropriate safety gear
• Know how to use all equipment and be sure that gear is properly tuned and in working order
• Warm up beforeheand
• Proper rest–teens need > 8 hours of sleep/night.
• Never play through pain. This cliche of “pain is weakness leaving the body” is dangerous nonsense.  Pain is your body telling you something is wrong.  Listen!

It is also essential for responsible adults to create the proper atmosphere:

• Proper coaching–Coaches should have knowledge of the sports commensurate with the level of competition (college varsity and summer rec league obviously not the same).  It should ALWAYS be fun.  Youth sports can teach a lot about life. But it is NOT life–it is recreation.  I cannot overstate how I abhor the hyper-intense “winning is the only thing” or “failure is not an option” mentality.  It is both physically and psychically destructive.  People fail–it happens all the time; the world doesn’t come to an end and learning to cope with it builds character at least as much as winning.  And losing is a thing too.  Nobody always wins.  Most of us know at least one person who feels that they can, must, or deserve to always win.  Just read the newspapers!  Mostly those are very unlikeable people.  Who wants to cultivate that mentality?
• Proper officiating and respect for those performing that function to maximize physical safety and a sportsmanlike atmosphere
• Know the rules

Lastly, a few thoughts on avoiding overuse injury

• Max training in hours/week should not exceed the athlete’s age in years
• By middle school only one team and one organized competition/season
• I strongly urge young athletes to take one season completely off from all organized competition and one season to play a completely different sport
• If a child misses time due to illness or injury, 1 day of practice for every 2 days missed before return to competition

The percentage of people in a given age cohort who reach Olympic or major professional sports league competition is ridiculously, laughably small.  Turning your family life or financial world upside down in pursuit of such an unlikely achievement is, overwhelmingly, a fool’s errand.  If it happens, it happens.  But mostly take youth sports for what it is.  You and your children will likely be much happier and fulfilled that way.

Thanks for following.

Bugged about bugs (not that one!)

Now that we can finally enjoy spring weather and anticipate summer sunshine, I’m seeing more insect bites of late.  Let’s review a few basic concepts.

First, generally one insect’s bite looks much like the next–red, itchy bumps; there are only a few species who confer a bite with specific appearance.  Often there is swelling initially that usually dissipates within 24 hours or so; swelling in that time frame usually does not suggest infection.  Typically cold compresses and benadryl for itch is all that is needed here.  Keep fingernails trimmed so any scratching is done by blunt fingertips and not sharp nails to limit promoting infection.  Infections are different–firstly, usually, they hurt.  Moreover, if we think about an infection “growing”–somewhat like a plant–then we can understand the GERMS as akin to SEEDS that must GERMINATE.  In other words, like a plant that takes time to grow after the seeds are planted, the infection will take some period of time to “grow”(incubate)–generally 3-4 days–for the infection to develop.  So the usual progression is bite, swelling, improving, then 3-4 days later renewed swelling, redness and pain at the site.  So the former usually does not require any medicine and the latter may well require a course of antibiotics.  Those lesions associated with fever, blisters, pus, or red streak growing towards the body may be more serious and could require IV treatment.

Tick bites are a special case. I have covered them before.  If you find an embedded tick it should be promptly pulled out INCLUDING THE HEAD with a tweezers.  Don’t waste time trying to cover it with vaseline, other caustic agents, or burning it with a match.  Clean the wound off with the best antiseptic in the house(for any open wound)–soap and water.  It is allowable, although not essential in my opinion, to have the live tick tested.  There are limited circumstances under which preventive treatment is indicated and they do not involve identifying lyme in the tick. Note that one does not have to develop the classic “bull’s eye” rash to develop lyme disease, and that the symptoms of lyme infection are specific and well defined–it isn’t just joint aches, headaches, and tired all the time

Finally–prevention.  The best approach is avoidance.  Stay away from standing water (chemically treated pool does not count here)or thick vegetation early or late on summer days when and where insects are most active. Avoid walking in high grass or thickly wooded areas and wear long sleeves and pants if you do; generally better to dress in long sleeves and pants outside anyway if weather permits.  Insect repellent on bare skin is fine; reapply every few hours for prolonged exposure–just wash it off as soon as possible.

But its the spring, so get the heck out there and have fun.  Thanks for following.

Window Blind Cords

Toddlers and cords don’t mix.  That is the message from a recent study published in the journal Pediatrics.  The study examined injuries in children<6 years of age caused by window treatment cords.  This has been a well known hazard among pediatricians, manufacturers, and safety engineers for many years.  Unfortunately, however, and despite numerous product modifications over the years, the rate of occurrence has not changed too much.

Between 1990-2015 there were almost 17,000 cord related injuries treated in US Emergency Departments.  Fortunately, the large majority–93%–were minor injuries that were treated and the patients discharged. Mostly children were just struck by hardware when they pulled too vigorously on the cord.  However, that doesn’t tell the whole story.  12% of all injuries were entanglements, 80% of those involved the neck.  as a result, there were 761 hospitalizations and, worst of all, 271 deaths in that timeframe.  The greatest risk was in 1-4 years but serious injuries were reported up to age 9.

These deaths occurred often during nap time when the child was, obviously, left unsupervised and became entangled in a blind cord close to the crib or bed.  Of course, naturally inquisitive kids often cannot resist experimenting with a newly discovered object, so the fact that that window treatment “has always been there” provides no safety assurance whatsoever.  As, in this scenario, the child’s neck is entangled and she is strangling, the danger is silent.  It is entirely possible that one would not even hear it over a room sound monitor.

Numerous technical innovations have been tried but, as we can see, they have not had much impact.  So what to do?

1. Examine all window treatments front, side, and back for accessible cords.
2. Use cordless or inaccessible cord window coverings only.  This goes for grandparents home as well, as seniors often find the old pull cord products to be easier to operate.  Where possible switch to shades.
3. Use open cord pulls–no loops (cut them if possible)
4. If you have such products and replacement cost is an issue, at least do so in the child’s bedroom and play area if possible.
5. If cost is prohibitive or replacement is impractical, keep blinds pulled all the way to the top and wrap up all cords and place out of reach whenever the child is in that room.  Try to never have such products used near the child’s crib or bed.

New safety initiatives under review by the American National Standards Institute should result in >80% of window coverings sold in the US and Canada to be cordless or cord inaccessible by the end of this year.  But there is no substitute for awareness and caution.  As always, the buck stops with us parents.

Thank you for following.

 

 

More on Cautious Use of Medicines

OK, back to one of my favorite themes: don’t over treat.  A recent study reviewed almost 800,000 infants receiving either antibiotics or antacids during the first 6 months of life.  They found a significant increased risk of allergic diseases in those children.  With respect to antacids, both “H2 blockers” like ranitidine (zantac) as well as “PPI’s” like omeprazole (prilosec) were associated with food allergies as well as chemical risk factors like elevated allergy antibodies (IgE) in the abdominal cavity.  There was a comparable increased risk with antibiotic treatment in this age group.  In that instance there was a 9-51% increase in problems like eczema, hives, contact dermatitis, drug allergies, anaphylaxis, and eye allergies.  The incidence of asthma increased > 2 fold and hay fever > 75%.

Significantly, this information corroborated the findings of other similar studies.  Numerous mechanisms have been proposed as the likely cause of such observed phenomena, all basically involve altering the natural bacteria colonization of the GI tract in some way specific to that particular drug.  In addition, animal models (mice) have been shown to produce similar outcomes.  So there is a large and growing body of evidence to support a more conservative approach to the use of these drugs in this age group, as I’ve discussed previously.

Now, a word of caution (as always). This shows an association, not necessarily a cause. Perhaps the symptoms that caused the infants to have the antacids prescribed were early and nonspecific demonstration of GI problems and allergies which was only clearly diagnosed later.  Likewise with antibiotic treatments in this age group: perhaps these infants were already more susceptible to respiratory infections requiring antibiotic treatment because of their allergies so they received prescriptions earlier and/or more frequently compared to children who did not go on to be diagnosed with those problems.  In other words, based on this data we have not clarified which is chicken and which is egg here, so to speak.  Did the medicine cause the problem or was it merely earlier evidence of which children were born with those conditions already?  There may be very good reasons why some of these children needed these medicines as infants.  But there are definitely risks with these drugs and in particular in this tender, delicate age group, so we must respect that and always act with caution.  I encourage my patients to call me so we can discuss proper use (and improper MISUSE) of these drugs in their babies (as well as in “children of all ages.”)

Thank you for following.

Adolescents and Social Media

When I first entered practice in 1985, the term “social media” wasn’t even a thing yet.  Now, of course, its a major issue in the lives of virtually everyone and in particular adolescents.  It is a frequent topic that I discuss with parents.

A recent study in a British public health journal demonstrated some very troubling patterns here.  They enrolled almost 10,000 children and followed them from ages 10-15 to > 16 years.  Initial surveys collected data on social media sites and amount of usage reported, then after several years standardized mental health questionnaires measuring both well being and negative emotions were completed by  the now young adult subjects.

In girls they found a clear and quite strong association of increasing media usage with more negative feelings and greater emotional difficulties in late adolescence.  Interestingly, they found no such correlation among boys.  Greater prevalence was demonstrated in homes of lower economic or parental educational achievement. Unsurprisingly, more social media usage increased sedentary lifestyle.  Racial differences were inconclusive.  Another non-factor was type of usage–“passive”(reading only) vs “active”(posting and responding)–girls did worse either way.

There may be several reasons for this observation.  Girls seemed to make a greater effort at online presence and often put greater emphasis comparing themselves to perceived online personality or situations.  “Likes’ and “hits” are viewed very directly as popularity in ways similar to public opinion polls.  Online, as opposed to in person, conversation is more “indirect,” allowing less emotional commitment to the relationship, less effort at properly expressing oneself, and no opportunity to learn to judge facial expression, voice inflection, or body language which may result in a person with more limited social development.  Needless to say, online interactions may increase risks of such negative interactions as stalking, bullying, or public shaming.

So–what’s a parent to do?  As always, I say “you are your child’s best teacher and best toy.”  Be a role model–don’t obsess with your phone and social media yourself.  Use only at specific times and situations.  Try not to walk into your home using the phone, no use of phone at meals or parent/child interactions interrupted(except true emergency, of course).  Endeavor to develop ongoing activities of interest for your adolescent and take an interest in their participation.  Spend time with them (a challenge–important part of adolescent development is to establish autonomy from parents, so don’t overdo it here; try to do things with them on their terms).  Also I believe it is fine–almost essential— to place concrete time limits on phone/social media use, particularly in the evening when it can most commonly be an impediment to a good night’s sleep. I always counsel that cellphones NOT be kept in the teen’s bedroom overnight but rather in some fairly distant location in the house to avoid that frequent problem.

Here are useful tools from the AAP that can help you manage your family’s social media in English and Spanish

 

Thanks for following.