Heat illness

What a scorcher we had early this week.  We’re really in the “dog days of summer” now.  And I write about this as most fall sports teams, including youth football, are beginning pre-season training.  So be aware of heat related sports injuries.

There are several factors that put especially younger children at greater risk for this problem:

  • Children’s body proportions are different–the younger the child the greater the head:body size ratio.  That means children expel more heat from their heads compared to adults.  Put a helmet on that kid’s head and he holds more body heat compared to an adult.
  • Children sweat less so have more difficulty dissipating internal heat.
  • Conditioning–young children tend not to prepare with off season training as much so are more prone to difficulties early on.
  • Experience–young athletes often may not understand their own limitations and may not have the insight or ability (or courage) to recognize their own distress and communicate this to coaches.
  • Obesity–obese adults may exercise but they tend not to be on teams as much so they have less peer pressure to keep up (and note that peer pressure is a much bigger issue for children and adolescents)
  • Medications, like anti-histamines, increase the risk of dehydration.

There are 4 levels of heat injury

  1. Dehydration–symptoms are dry mouth, thirst, fatigue, headache, cramps.  Treat with rest, fluids, move to cool place.  Child may resume play when symptoms resolve
  2. Heat cramps–intense abdominal or limb pains and knotted muscles.  Treat as above with high sodium fluids (like gatorade) and stretching.  Again, may return when symptoms resolve.
  3. Heat exhaustion–pale skin, profuse sweating, dizziness, fainting, severe nausea and cramps.  The child should stop playing, all extra clothing and equipment removed, cooled and treated aggressively with fluids.  If symptoms do not quickly improve seek prompt medical attention.  No return to sports until the next day at the earliest and a modified schedule at that, especially if it’s a hot day (dehydration tends to recur).
  4. Heat stroke–high fever, dry skin, altered consciousness (confused, agitated, combative, even seizures) plus the above cramps, nausea, headache, etc.  Frankly, if this occurs, somebody screwed up pretty badly.  Heat stroke is a medical emergency and the child should be transported to the nearest ER, preferably by ambulance.

Principles of treatment involve prevention mostly.  Lots of fluids during practice, adequate rest periods, proper equipment for weather conditions (no helmets or pads during hot, humid days), good supervision and communication with young athletes during practice/games.  Having a certified athletic trainer on site is best.

Lastly, be sure that your child has had a recent physical so we can review current health status, any changes or new risks, and anticipate ongoing issues.

Please post questions or comments and thanks for following.

screen time

I come from the first generation of children for whom “screen time” was an issue for parents.  Our video technology was limited to “the idiot box” as our parents called the TV.  But now there is so much more: smart phones, tablets, ipods, laptops, apps.  These innovations certainly can offer many advantages, but they are like oxygen: some is now absolutely necessary for modern living: too much and you get burned.

Some trends:

  • In 1961 children began watching TV by age 2.8 years.  Now its 9 months.
  • In 2005 children typically started using consumer electronic devices by age 8.1 years; today it’s 6.7 years
  • 52% of children < 1 yr watch TV and videos > 2.5 hours; 60% of 1 year olds and 71% 2 year olds watch > 3 hours
  • Average screen time 7.5 hours/day; 6.5 hours in 2005
  • 2 hours more on mobile devices
  • 70% of children have TV in their rooms
  • Video games are $2.1 billion business in the US

(Above statistics are from bluemanateebooks.com)

All of these screen time issues can have some significant deleterious effetcs on your child’s development and well being: sleep disruption, disrupted learning. obesity, even emotional development.

Please note that the evidence of educational or language development benefit from video media use among toddlers and young school age children, at best, is variable.  As I’ve mentioned previously, you will get much more education “bang” for your effort “buck” by reading to your kid as opposed to using most computer technology or apps.

And we pediatricians harangue you young parents with brilliant ideas to enlighten you(or make you nervous) about what to do: no screen time < age 2 years, max 1 hour screen/time/day, no TV in the kid’s room, no internet in the kid’s room(how do you even do that in the days of household wi-fi?)

Why do I bring this up now?  A recent article addresses this very topic and makes a  very important point: “physician, heal thyself.” Quite literally, as I am very much as guilty as the next guy here, so I am no one to lecture.  But please check out the link and read the article.  To summaraize: if you want your child to have a healthy interaction with these media options, especially as the technology evolves and advances, we–their adult role models–must do a better job ourselves.  So pay attention to your media usage, and endeavor to practice what “I preach.”  I will, too!

Please send along questions or comments, and thanks for follwoing.


It’s summertiime, and, hopefully, your “livin’ is easy.”  Like most parents, I bet, you strive to find activities to fill your child’s time and enrich their lives–sports training, Bible study, camp, vacations.  Please allow me to share 2 thoughts.

First, don’t overdo.  There are clear advantages in children having free form, unstructured time.  Lying in the grass and looking at the sky to imagine what shapes they see in the clouds above is beneficial and fun.   Adult supervision of this tiime should be modified to allow for maximum freedom within your judgment of your child’s age and temperment appropriate safety needs.  Sometimes try and let them “just be” with their friends.  It is not so good to have every minute of every day of your child’s summer planned out by you.

Conversely, when planning your child’s summer schedule be sure to include a very generous portion of yourself. Summertime is such a great time to reconnect with your children after the busy school year.  Now that my own kids are grown so many of my happiest memories are of our summers together–biking and swimming, basketball with my boys and jogging with my daughter, camp family days and plays, vacations.

Family fun need not be expensive:

  • Family meals together. Outdoor barbecues are great.  Most township parks have great picnic areas with barbecue pits for family enjoyment.  Don’t forget to include lots of fresh healthy summer fruits and vegetables in your child’s meals.
  • While you’re at it, how about planting a family vegetable garden so you can grow the food together?
  • Read together.  Check out Ocean County Library for acitivities for every age group.
  • Lots of free fun at Ocean County Parks.  Check out Ocean County Carousel of Music for a schedule of free outdoor concerts throughout the summer.
  • Play sports together–take family walks and bike rides(everybody with a helmet!!), shoot baskets or play tennis at public courts, throw footballs/baseballs and “shag flies” together at neighborhood ball fields.  You don’t need to be in a league and you don’t even need to be any good.  You just need to be there.
  • Water sports–pools are nice but not necessary.  Area seasonal beach passes are still very modestly priced.  You can even just use the garden hose–lots of inexpensive toys can make this even more fun for you and your kids.

Remember your time and positive attention is the best gift you can give, the best salve for their ills and the best method to instill good discipline and promote positive behaviors.  Everything else that I may do with you about those things is secondary.

Lastly, summer is a great time to schedule your child’s yearly physical and catch up on needed immunizations.  Give me a call and we can set that up.  Send along questions or comments, and thanks for following.

pertussis (again)

I guess I go on a bit about pertussis–“whooping cough.”  With almost 50,000 cases annually, including 20-30 deaths(mostly in infants and very young children) this infection is never very far from the thoughts of any pediatrician.

Keep some of these statistics in mind when you read some anti-vaccine sources.

Pertussis isn’t “coming back.”  It never really “goes away.”  Rather, it is commonly carried in the nasopharynx of perfectly healthy adults.  And that’s the problem: immunization rates among adults are abysmally low–26% of adults wiith young children at home and only 16% overall.  Public health authorities consider a rate of at least 90% necessary to convey adequate “herd immunity” (where the risk of random infection is sufficiently low to protect vulnerable little ones just by limiting exposure).

Another concern is the effectiveness of the modern “acellular” vaccine.  Introduced in the 1990’s as the answer to the higher incidence of unpleasant side effects from the older “whole cell” precursor, there is an unfortunate price to pay for this milder post-vaccine course.  Immunity from the acellular vaccine appears to wane after 2-4 years as opposed to the whole cell’s record of 5-10 years.  And the acellular vaccine is only 80% as effective as opposed to the whole cell’s record of > 90%.

Bottom line: if you want to protect your children and those of your friends, neighbors and extended family you should immunize your child and your self.  That means keep your shot records updated.  Check with your doctor to be sure.  Note that as a service to my patients I can look over your shot record and we offer “catch up” shots where indicated.  Please keep in mind that, as the saying goes, “certain restrictions apply.”

But give me a call and let me help out.  That’s why I’m here.