more pool safety

Its 50 years since I joined my local Y and became a competitive swimmer.  Proud to say that I’m still doing it, and my favorite thing about summer is being able to work out in my backyard pool.  Growing up I never had that, so every time I’m in my pool I remind myself how lucky I am to be able to do that now.  I’m reading a bit about pool hygiene safety so I thought I could make a quick comment for you all.

According to the Center for Disease Control, there has been an increase in the incidence of recreational water infections (RWI) in recent years.  There are a number of different bugs causing this problem: parasites like cryptosporidium(crypto) or giardia, bacteria like E.coli and shigella, and viruses like norovirus and hepatitis A.  These infections enter our bodies mainly when swallowed but also through eyes or nostrils as well.

There are 2 main areas of focus to control this problem: pool issues and body issues.  Keep your pool chemicals stable.  Chlorine levels of 1-3 parts per million are effective, but it takes variable amounts of time to kill these organisms: 1 minute for E. coli, 45 minutes for Hepatitis A, but 10 days for crypto.  And also be aware that these disinfectant times are increased by “chlorine stabilizers” like cyanuric acid.  But pH is also essential–7.2-7.6 is the ideal range for the chlorine to effectively disinfect recreational water.  It is very imprortant to regularly check and adjust these chemicals as their concentration is partially dependent on pool and air temperature,  are consumed by things like sunlight, and diluted by rainwater.

With respect to body issues, the most important things are the health and hygiene of those entering the pool.  Any non-toilet trained child should wear tight fitting plastic pants over diapers and their pool time should be kept brief to limit the risk of contamination from a soiled diaper as “its only a matter of time.”  Younger, more recently trained children–prone to “accidents”–should be encouraged to use the potty before playing in the pool and you should be sure to take regular bathroom breaks for kids in this age group (I’d say up to age 10).  Everyone entering the pool should absolutely take a shower using soap prior to and after using the pool.  Only people who are in good health should use the pool: in particular no one with open wounds and especially no one with any diarrheal illness.  Never purposely consume pool water and try and make sure that children drink plenty of fluids after playing in the pool as they so frequently do so without even thinking about it as they frolic.  This can help dilute out anything inadvertantly ingested and limit the risk of infection.

As I so frequently end these discussions, be careful but don’t get crazy:  its the summer, so have fun!!

Please post questions or comments, and thanks for following.

CT and appendicitis

Here’s an interesting article on appendicitis:

http://www.nytimes.com/2015/06/17/health/study-supports-antibiotic-use-to-treat-appendicitis.html?ref=health

Avoiding surgery would certainy be a positive development.  Appendicitis is another sometimes complicated diagnosis, fraught with many “side” issues.  I drive my friends and colleagues a little crazy sometimes going on about it.  And I will state up front that, as a pediatrician and not a surgeon, I should be careful in what I say and how I say it.  But that’s the point:  ultimately this diagnosis is best made by a qualified surgeon at the bedside–not be me, not by an emergency room doctor and, for heaven’s sake, not be a CT scan.

The use of CT scans in the evaluation of abdominal pain in the ER is a great concern of mine.  Now, CT is a great tool for us doctors in trying to diagnose many problems like the cause of abdominal pain.  LIke any tool, used properly it’s a great help; improperly it can just make a mess of things (like me using a hammer and screw driver to defrost the fridge–of course, I hit the freon line and destroyed it: wrong tool, bad outcome). The purpose of this tool(CT) when introduced into the abdominal pain evaluation algorithm was to assist the surgeon to avoid “false positives”–taking people to the OR who ended up not having appendicitis.  So, it’s purpose is not to allow me or the ER doctor to say “this guy has appendicitis and needs a surgeon and that guy just has a bellyache and doesn’t.”  Also note that CT’s power comes from the amount of radiation administered.  I have seen estimates of abdominal CT being equivalent to 650 chest xrays worth of radiation.  That’s a ot of rads for your kid to be carrying around in her guts for the rest of her life!

So please allow me to make several suggestions to keep in mind:

• Ask about doing an ultrasound.  There are lots of studies showing that US is very accurate in diagnosing appendicitis without the radiation
• Ask pointed questions about the radiologist’s report.  Did she clearly say she saw the appendix?  Did she say that she did/did not see inflammation? Or did she say something like “appendix not completely visualized?”
• Ask for a surgical evaluation.  If your child has an abdominal CT and no surgeon is available to evaluate your child at that time then perhaps she should be admitted for observation and the surgeon can come in later/the following morning.  If your child is sick enough to have a CT then she is sick enough to wait for the surgeon and the opposite also holds–if she isn’t that sick then she probably doesn’t need the scan.
• Have the ER call me.  As you can see, I am very passionate about this subject.  I want to help the ER make the best call for your kid.  Better yet, call me before you head to the ER.  Maybe I can help your child avoid the entire traumatic ER experience.

Please send questions or comments, and thanks for following.

Small thoughts on bigness

I read these 2 articles today and wanted to share them:

http://www.nytimes.com/2015/06/16/upshot/to-lose-weight-eating-less-is-far-more-important-than-exercising-more.html?ref=health

http://www.nytimes.com/2015/06/16/health/parents-denial-fuels-childhood-obesity-epidemic.html?ref=health

Obesity is much too large a topic to address in this forum.  Books are written, whole courses are taught and careers and fortunes are built around addressing its many facettes.

Pay particular attention to the message of the first article: exercize and weight control are related but still mostly separate topics.  Unless you start from a completely sedentary lifestyle you simply cannot work out your way to real weight loss.  You exercize for fitness and modify your diet (mostly cut caloric intake) to decrease your weight(mainly your body mass index, BMI).  Note that an average adult male must run 5 miles at a fairly brisk pace to lose 1 lb of body weight.

The second article goes to “state of mind.”  We need to be realistic about weight, health, meal and snack size and content, and, even, relationships.  I often point out that as we love our children and offer them sustenance–feed them–then the love and the food become somewhat psychologically linked.  If your child rejects the food then she rejects your love: painful, huh?  We must keep those concepts separated. We must feed our kids but not become too emotionally involved.

And its not just a “personal choice” issue but actually a national security challenge.  The number of recruits rejected as unfit to serve in the Armed Forces is becoming a real concern for military leaders.

So just a few thoughts.  I hope it inspires you, dear reader, to look again at this subject and how it impacts your family.  Pass questions and comments along, and thanks at following.

Swimming II

Last week I touched on pool safety. Now I want to speak about swimming and drowning prevention. On average 2 children drown each day and 10 more are treated in the emergency room for submersion injuries of varying severity( 80% boys).  So we are talking about a serious problem.  If there is one thing that I feel I can speak about as an “expert” it is this(so many years of my youth as a lifeguard).  So keep these points in mind:

1)  First and foremost, never leave a young child unattended by any standing body of water even for a second.  This includes toilets and large 5 gallon buckets–a toddler can fall in head over heels and be unable to pull herself out.

2) All adults should learn CPR.

3) Get your child swimming lessons.

a) There is some modest disagreement as to what age is ideal to start.  There are credible programs that begin as young as 6 months.  I think these classes are useful but they do not change numbers 1 and 2 above.

b) For  hygiene sake all noncontinent young children should wear tight fitting plastic pants when in the water.

c) By age 3 most chlildren can begin to get the basics of real swimming skills. Your child is not water safe until he can swim the length of a pool on the surface with an arm over arm elbow high stroke.  The more splash the weaker the swimmer.  Swimming under water does not qualify (easier to move under water without splash. That’s why those great swimmers in the Olympics stay under water after dives and turns-they go faster and it’s easier).  And remember : you are not “swimming” with swimmies , tubes or vests–you are floating.

4) No infant bathtub seats-they can easily tip over.

5) Everyone should wear a personal floatation device when riding in a pleasure craft sized boat regardless of swimming ability.  There are PFD’s for infants and young toddlers but personally I am not too much of a fan of their reliability.  I advise my patients to leave the littlest kids (<3 years) on the dock with Grandma for their boating excursions.  Should some serious accident occur and everyone ends up in the drink, those kids can not participate in their own rescue at all.  They won’t have any fun on the boat anyway.

As I said last time–it’s a summer so enjoy, safely.  Please forward questions and comments. Thanks for following.