All the Answers about Sunscreen: Why? Which one? How much? How do I pronounce Octocrylene?

little cute girl near the pool with a circle for swimming

Octocrylene. Octo (like the lady with 8 kids) – cry- lean.

Hmm.

Sunscreens have been around forever, mostly in the form of plants and dirt people rubbed onto their skin. Not terribly effective, sadly. Ancient Egyptians used aloe vera, extracts of rice, and pounded out calcite and clay to protect their skin. In the Philippines borak was used – made from water weeds, rice and spices. Zinc oxide has been around for thousands of years.

The first synthetic sunscreens were created in the 1920s, and were made commercially available by L’Oreal in 1936.

Sunscreen became more popular after WWII, when we sent a bunch of pale skinned soldiers to the Pacific Islands. Ouch.

These original sunscreens are estimated to have had an SPF of about 2. Also not terribly effective.

 

Why do we use sunscreen?

We use sunscreens to prevent sunburn, skin cancer, wrinkles, and hyperpigmentation.

The incidence of melanoma has increased in the 15-39 year age range by 3% per year since the 90’s. It is the 2nd most common cancer for women in their twenties, 3rd for men. Dr Sophie J. Balk (Former Chairperson, AAP Committee on Environmental Health) writes that this was caused by the thinning ozone layer, the fact that people are wearing less clothing, intentional tanning, and tanning beds.

Skin cancers like squamous cell carcinoma, melanoma, and possibly basal cell carcinoma can be prevented by using sunscreen – if you use the right one in the right way.

 

Who should use sunscreen?

Everybody.

It is especially important for children and people with fair skin, fair eyes, freckles, sun sensitivity, moles, or a family history of melanoma.

But really, everybody.

 

The Science: What Does the Damage?

Sunlight has wavelengths between 290-3200 nm; the light that we see, or “visible light” runs between 380 to 740 nanometers. Wavelengths in the top, violet part of the rainbow are 380-450 nm, so the wavelengths shorter than violet are called “Ultraviolet.”  UVB rays are the 290-320 range (about 5% of the total); UVA rays are 320-400 (95% of the total).

UVB rays burn, leaving you with redness and pain, and these were traditionally the rays we tried to block. UVB does contribute to skin cancer but since it does not penetrate as deeply as UVA it seems to not be the cause of the most deadly of skin cancers, the melanomas.

UVA light does not cause reddening or pain, and most conventional sunscreens do not block it. It does however penetrate deeply into the skin to cause the damage to DNA in cells (melanocytes) that can lead to melanoma.

UVB is more intense midday (from 10AM – 2PM), in the summer, closer to equator, and at high altitude. UVA light is constant through the day and year.

Window glass absorbs UVB, not UVA.

Both reflect off water, sand, snow, and concrete to increase exposure.

UVB and UVA penetrate water to a depth of about 60 cm (about 3 feet).

 

How to protect yourself from these evil rays?

Best, of course, is to avoid them. Stay out of the sun, especially between 10AM and 4PM.

Cover up. Light weight, long sleeved shirts and long pants are protective while they are dry. There is a UPF rating for fabrics, from UPF 15-50. Above 30 is considered sun protective, and more is better. There are swim shirts for kids that are protective even when wet.

Wear a hat with a brim.

Wear sunglasses with 99% UR protection.

Use sunscreen. Sunscreens absorb or reflect the sun’s ultraviolet rays, depending on the ingredients.

  • Sunscreens come in lotions, gels, or sprays.
  • They generally last about 3 years on the shelf.
  • SPF should be 30 or higher.
  • The words “broad spectrum” should be on the label, since only these have UVA protection that is proportional to the UVB protection.
  • The only chemical sunscreens available in the US that protect from UVA are avobenzone (which can be irritating and allergy producing) and Mexoryl SX and XL, available only from L’Oreal (they have a patent). Outside of the US, Tinosorb S & M and Uvinul A Plus block UVA. Mineral sunscreens also block UVA.
  • Look for “water resistance” on the label as well, especially if you will be swimming or sweating.
  • Apply sunscreen 20 min before exposure so that it has time to form a thin, even, protective film.
  • Apply 2 mg/cm2: this is about 2 tbsp for the average adult (about a shot glass, per the Dermatology Association), and about 1/4 tsp for the face. If you put on less, you get proportionately less protection.
  • Reapply sunscreen every 2 hrs or if you sweat, swim, or rub it off; stronger sun screens do not last longer and while newer sunscreens are very photostable, they do still rub off.

Sunscreens come in two basic forms, and combinations of the two forms.

Mineral (physical, inorganic) sunscreens include zinc oxide and titanium dioxide. They are usually better for sensitive skin, but they can leave a white cast and tend to be thick. They work more by reflecting sunlight, although they do absorb some. They do block UVA as well as UVB – zinc oxide more effectively than titanium dioxide.

The second type is Chemical or Organic sunscreens. They apply more like moisturizer and don’t leave a white cast. They work by absorbing sunlight’s high energy rays, although they do scatter and reflect some in the same way as mineral sunscreens.

Common Chemical/Organic sunscreens in the US:

  • P-Aminobenzoic acid
  • Padimate O
  • p-Aminobenzoic acid
  • Cinoxate
  • Dioxybenzone
  • Oxybenzone
  • Menthyl anthranilate
  • Octyl methoxycinnamate
  • Sulisobenzone
  • Trolamine salicylate
  • Avobenzone
  • Octocrylene
  • Octyl salicylate
  • Ecamsule
  • Homosalate
  • Mexoryl SX & XL

Common questions about sunscreen:

For much of this information I have to thank LabMuffin, because I am no chemist. She is a PhD chemist who educates on the chemistry behind skin and beauty products. She is amazing, and I highly recommend checking her out!

Don’t kids need sunshine to make vitamin D?

Yes, but they only need 5-30 minutes in the sunshine about twice a week, depending on their skin tone. Also, vitamin D is in milk and comes in pill form.

Should we worry about nanoparticles from mineral sunscreens?

The nanoparticles made from grinding up the mineral sunscreens (so they don’t look white on the skin) are too big to penetrate the stratum corneum and get to live skin cells.

What ingredients are the most irritating or allergic?

  • Avobenzone
  • Octocrylene
  • Oxybenzone
  • PABA
  • Padimate O
  • Enzacamene

Which ingredients are the least likely to break down in sunlight?

  • Tinosorb S and Tinosorb M (not in the US yet, hopefully soon!)
  • L’Oreal’s Mexoryl SX and Mexoryl XL
  • Mineral sunscreens

But don’t sunscreens have hormonal effects?

Yes, some of the chemical/organic ones do, but very little. One of the worst is oxybenzone, and to have a hormonal effect we would have to use it continuously for 277 years. Enzocamine, Padimate O, octinoxate, and homosalate also have hormonal effects in minuscule amounts.

Don’t some medicines make people react more to sunlight? 

Yes. A short list of meds on which you should avoid sunlight:

  • NSAIDS (ibuprofen, naproxen)
  • tretinoin (retinols)
  • tetracyclines
  • phenothiazines
  • psoralins
  • sulfonamides
  • thiazines

Aren’t there plants that make people burn more easily?

Yes. Plants that produce furocoumarins, like limes, can cause a burn and hyperpigmentation when exposed to sunlight.

Can I use a sunscreen/insect repellent combination product?

The AAD recommends purchasing and using these products separately — sunscreen needs to be applied generously and often, whereas insect repellant should be used sparingly and much less frequently.

Are sprays safe and effective?

Current FDA sunscreen regulations do not apply to sprays, so I don’t know. They should not be used near heat or open flame (no smoking!), and should not be inhaled.

What will the UV index for tomorrow be? Check out www.weather.com.

 

What those labels mean:

SPF stands for “Sun Protection Factor,” and measures sunburn producing UVB rays. The number is how much burning radiation penetrates through the sunscreen. An SPF of 20 means that 1/20th of the rays reach the skin. Above an SPF of 50 you don’t see any real difference.

SPF Equivalence requires UVA protection of at least 1/3 the SPF for UVB. This labeling is seen more in Europe.

PPD is “Persistant Pigment Darkening.”

Star ratings are used in UK and Ireland, between 1 and 5 stars.

PA is “Protection Grade of UVA”, used in Asia, between PA+ to PA++++.

If “Water resistance” is on the label, it should say whether it is resistant to swimming or sweating and for how long.

 

If you can, please share this blog. The sun is shining outside and sunscreens can be very confusing!

 

Summer Activities to Enrich Your Child’s Learning

Today’s blog is brought to you by Sam Casteris, a freelance writer in Phoenix, AZ:

little cute girl near the pool with a circle for swimming

When school gets out and parents are on the hunt for kids’ activities that encourage learning (while still encouraging fun, of course!), there are tons of enjoyable, enriching things to do, from being outside and going on trips as a family to enrolling your kiddos in camp or other special summer programs. Here are some of our favorite activities to enrich your child’s learning in the summertime.

1. Get outside and learn about the great outdoors

Today, many school-age kids have jam-packed schedules that allow for little to no downtime spent outdoors (it’s school, extracurriculars, homework, rinse, repeat!) This is why one of the best, most enriching activities you can do as a family is to simply get out in nature. Go for a family hike, go camping, and just enjoy being outside together. Or, if you live near one of our country’s national parks, you could enroll your child in a Junior Ranger Program. The NPS Junior Ranger program is designed for kids between the ages of 5 to 13; by completing a series of activities, kids can earn a Junior Ranger badge and certificate. This is a fantastic (and fun!) way for youngsters to learn more about their environment.

2. Sign the kids up for music lessons

If your child has shown an interest in music, summer is the perfect time to sign them up for music lessons. The benefits of learning music from a young age are astounding, really. Learning an instrument can improve a child’s memory and concentration, expose them to culture and history, and nurture their creativity and self-expression. Most of all, though: Music brings kids (and everyone!) joy.

3. Head off on a road trip

Road trips are wonderful for seeing the world, yes…but they’re also a wonderful way to learn about cars! If you want to teach kids the ins-and-outs of car mechanics and care, a family road trip is a prime time to do so.

4. Grow plants in a garden and learn about the natural world

It’s never too early, or too late, to teach children about the beauty of the natural world. One of the best ways to encourage a kid’s inherent curiosity and interest in nature is by growing a garden together. Giving children the opportunity to grow and harvest their own food has all kinds of benefits, from improving academic results (talk about a great way to learn about plant science!) to improving their overall health and well-being. Plus, this is such a fun activity to do as a family.

5. Enroll in a summer camp

The sky’s the limit when it comes to summer camps. Is your child interested in science, horses, making movies, art, writing, math, music, or any number of other activities? Enroll them in a summer camp that aligns with their interests. If they’re not sure what they’re interested in or they’d prefer something a little less specialized, there are dozens of traditional camps out there to pick from—ones where kids can do water sports, land sports, arts and crafts, performing arts, and other broad-based activities. No matter which type you choose, sleepaway camp is always a great way for kids to explore, make new friends, enjoy a little independence, and have fun.

6. Volunteer and be an active citizen

It’s crucial to instill a sense of civic duty and gratitude in your child, and there’s no better way to do this than through volunteering. Getting involved in their community helps kids to understand that their world extends far beyond what they see and know, and to appreciate what they have. Pick a cause that your family holds dear and sign up for a few volunteer slots this summer—not only will you be teaching your kids an important lesson, but you’ll truly be making a difference together.

 

FREE St. Patrick’s Day Wordsearch

Spring is here, with St Patricks Day!

Add a little fun into some St. Patrick’s day learning with this word search. You can find more challenging and creative educational activities at Education.com. The site was built with the contributions of thousands of teachers, and they have FREE activities for kids from preschool through 6th grade–activities that help them succeed in science, math, reading, writing, and social studies.

They teach with games, songs, worksheets, interactive exercises, hands-on activities, and more.

For example, Education.com let me use the printable word search below for this blog. Doing word searches helps kids with reading and writing skills, which are at the heart of learning–they apply to all other aspects of education whether that be understanding analytical math texts or practicing creative expression through poetry. Kids learn while they think they are just playing a game.

Check out Education.com for great resources for every age child, from helping kindergarteners create stories to geography challenges for sixth graders.

And no, they are not paying me to write this–it’s just a great site.

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Free Summer Break Activities! (Don’t Tell Them They’re Educational)

boy with baloon2-01Summer break has been going on for quite a while now.

Running out of things to do? Counting the minutes until school starts again?

Help is here!

One of my favorite sites for kid’s activities is Education.com. The site was built with the contributions of thousands of teachers, and they have FREE activities for kids from preschool through high school–activities that help them succeed in science, math, reading, writing, and social studies.

They teach with games, songs, worksheets, interactive exercises, hands-on activities, and more.

For example, Education.com let me use the printable maze below for this blog. Doing mazes helps kids learn problem solving, fine motor control, visual motor skills and confidence–all while they think they are just playing a game.

Also check out Education.com for great summer break learning resources for every age child, from helping kindergarteners create stories to geography challenges for sixth graders.

And no, they are not paying me to write this–it’s just a great site.

kindergarten_maze_kayaking

kindergarten_maze_kayaking_answers

 

Why Don’t Immigrants Just Become Legal? And Do They Get All Kinds of Public Benefits?

Sad child on black background. Portrait depression girlI am not an immigration lawyer; I am no expert in immigration. But I know that we cannot resolve our immigration crisis without dealing with actual facts rather than just making up stuff that fits with what we already believe. And we do need to fix this, because abusing children is just not acceptable.

So here is a blog by Eric Pavri, who is an immigration lawyer. He studied law at the University of Arizona (bar #44591 on the Supreme Court of Colorado website if you want to verify) and is currently Director of Immigration Services for Catholic Charities of Central Colorado. He wrote the following to “simply provide correct information so that people can decide for themselves what is right and best.” So:

Why Don’t Immigrants Just Become Legal?

“First, I want to acknowledge that asking why people don’t just become citizens, or whether people without legal status can get public benefits that U.S citizens cannot, are legitimate questions. If they are asked in good faith, no one should mind you asking them.

“Therefore, let me answer your questions.

“First, as to why young people who have DACA haven’t just become citizens: To become a U.S. citizen (other than by birth), one must first become a Lawful Permanent Resident (“green card” holder). Only after five years as a Permanent Resident can you apply to become a citizen. Thus, the obvious next question: how does a person become a Permanent Resident? There are three primary options to do so:

  1. Family-based petitions. This means that a U.S. citizen or Permanent Resident parent, spouse, adult child, or sibling files a “petition” for you. Depending on the category that you fall into, the wait will be anywhere from 1 – 22 years (yep) before you can use that petition to take the next step – applying to become a Permanent Resident (background checks, medical exam, more fees, etc.). That works for people living outside the U.S., but for those who have been here, it may not be possible if they entered the U.S. illegally, even if they were minor children when they did so.
  2. Employment-based petitions. A U.S. employer can similarly sponsor you, but generally only if you are in a profession requiring an advanced degree or unique skills (doctors, software engineers, world-class athletes to coach professional sports teams, etc.). Even then, the potential employer must generally also prove that they made good-faith efforts to hire a U.S. citizen for the position, but no qualified applicants applied.
  3. Diversity visa lottery. Every year, the U.S. government selects 50,000 people worldwide who enter a lottery and pass background checks to come to the U.S. as Permanent Residents. This lottery, however, is only available to people from countries that traditionally send few people to the US – so, for example, people from countries such as Mexico, the Philippines, China, Guatemala, India, El Salvador, and other countries that send larger numbers of immigrants to the U.S. do not have this option.

“Extra note: The current Administration has actively sought to eliminate or dramatically limit Options #1 and #3. The new term being used in the attempted re-branding of Option #1, family-based immigration, which has been the basic principle of U.S. immigration law for over a century, is “chain migration”. If those two options are in fact eliminated or curtailed, legal immigration to the U.S. will be significantly reduced.

“The KEY POINT to all of the above: If you do not qualify for one of these 3 options, then there is no “line” to get into to legally become a Permanent Resident and eventually a U.S. citizen. So, if you are not fortunate enough to have, say, a U.S. citizen spouse or a graduate degree in computer science, you very likely can never become a citizen of the United States.

“Second, one commenter above asked why President Obama, when he established DACA in 2012, did not just create a path to citizenship for these young people at that time. The answer: earlier that year, Congress had for the 11th year in a row failed to pass the Dream Act, which would have done exactly that. The President acting through his authority as head of the Executive Branch cannot create a path to Lawful Permanent Residency (and eventual US citizenship). Only a law, passed by Congress and then signed by the President, can accomplish that. So President Obama on June 15, 2012 created the more limited DACA program through Executive Action – which is why President Trump, as the new President, was able to end the program, also without an act of Congress, last fall.

Do They Get All Kinds of Public Benefits?

 

“Finally, as to the question of immigrants receiving public benefits, only a U.S. citizen or a Lawful Permanent Resident (green card holder) can receive almost all types of public benefit – including Medicaid, Medicare, SSI disability, Social Security payments for seniors, TANF, and food stamps. The irony: most undocumented immigrants work under made-up Social Security numbers and so receive a paycheck from which Social Security, federal income taxes, and state income taxes are withheld, and of course they pay the same local sales and property taxes as anyone else through retail purchases, pass-through costs of apartment leases, etc. Same of course goes for the 800,000 current DACA recipients, who are authorized to legally work in the U.S. But none of those employees, despite paying IN to the system, will ever receive those public benefits listed above, that are paid for by the money withheld from their paychecks. So they are propping up our federal and state government entitlement programs because they pay in but won’t ever take out.

“The following are the public benefits that undocumented immigrants can receive in United States:

  1. Public education for children in grades K-12. This was definitively established by a 1982 Supreme Court case, Plyler v. Doe. The Supreme Court in its reasoning explicitly stated that it would not serve the overall public good of the U.S. to leave many thousands of children uneducated.
  2. Emergency room services, but only to the point where the patient is considered “medically stable”, at which point he/she is released. These services are not free, however, as in my job I meet hundreds of immigrant families who sacrifice over years to slowly pay off high emergency room medical bills.
  3. WIC assistance. This is for milk, food, etc, and available only to pregnant mothers. The rationale is that the children in the womb will be U.S. citizens when born, and therefore it is in the long-term economic best interests of the nation to ensure that they receive adequate prenatal nutrition to improve their chances of being productive citizens in the decades to come.
  4. Assistance from police if they are the victim of a crime and call for help. To their credit, the vast majority of our Colorado Springs law enforcement officers take their duty to protect all people seriously. Chief Carey of the CSPD and Sheriff Elder of the EPCSO have made clear that their officers can’t do their most important job – keeping us safe by getting dangerous criminals off our streets – if a whole class of people (undocumented immigrants) is afraid to call 911 to report crimes that they witness or are victim to.
  5. Assistance from a fire department. Rationale, besides the obvious moral one: If your house was next to that of an undocumented immigrant family, would you want the firefighters to let that house continue to burn, putting yours at risk of catching on fire too?

“And that’s it. Those, to the best of my knowledge, are the only public benefits that an undocumented immigrant can receive in just about any part of the United States. As someone who directs a small office that works with hundreds of low-income immigrant families per year, know that when I see the precarious economic situation of many of these families, I’d help them access other benefits if they could. But they simply can’t. Now, children of undocumented parents, born in the U.S., are U.S. citizens under the 14th Amendment (the one that declares that all human beings born on U.S. soil are citizens – this was passed immediately after the Civil War to forever end the legal argument that African Americans were not U.S. citizens). As such, those children can qualify for the same public benefits as any other U.S. citizen, if they qualify through economic need or disability. But their parents or undocumented siblings cannot.

“I hope that this information has been useful to those willing to read through this long explanation. Please know that even this long summary leaves out a ton of detail — there are tens of thousands of pages of statutes, regulations, internal federal agency procedures, and court decisions guiding how all of this is interpreted and implemented. But please take my word that I honestly believe that no detail I omitted for conciseness changes the basic points above. And I’d be happy to answer questions if you have them. Like I said, I don’t mind honest questions, and I believe that legitimate questions asked in good faith deserve well-informed, accurate answers. If all of us in the U.S. would be willing to actually listen to each others’ sincere concerns and do our best to answer each others’ questions, instead of just yelling at each other or retreating to our corners of the internet (left OR right) where everyone already agrees with us – well, I think we’d move our nation forward a lot more effectively.”

4th of July: 10 Tips to Stay out of the ER

Sunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket.

All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.

What’s the Deal with Family Separation?

Why Pediatricians Worry about Family Separation:IMMIGRANT-CHILD-CRIES-06-18

Sadly, we have lots of data about the damage done to children when they are separated from their families.

  • In Romania during his tenure as communist leader Nicolae Ceaușescu felt that the Romanian economy would improve if there were simply more Romanians, and so he pushed people to have children that they did not have the resources to care for. As a result, there were many Romanian children who grew up in orphanages.
  • In Australia, about 1 in 10 Aboriginal children were removed from their families to be raised by white Christians between 1910 and 1970.
  • In China right now many children, known as “the left behind,” live in outlying villages while their parents move away to work.

When children are separated from their families, their bodies suffer a stress response and secrete cortisol and adrenaline. These molecules initially damage and in the end can kill brain cells. Brain cells cannot repair themselves, so this kind of toxic stress can destroy both the white and gray matter in the child’s brain, resulting in permanent brain damage and lower overall brain activity.

Kids who are separated from their parents at a young age – those Romanian kids, the Aboriginal kids in Australia – have lower IQs, suffer the long term effects of PTSD, and their fight or flight response can be permanently broken. Their brains have trouble distinguishing what is safe from what is dangerous, so they will be scared of things that they should normally know are safe.

Those stolen Aboriginal kids have twice the rates of criminal arrests and gambling, and 60% more alcoholism.

Separated kids have more aggression, tend to withdraw from normal relationships, and have significantly higher rates of anxiety and depression. They are more likely to have high risk behaviors, get pregnant as teens, and commit suicide. It can affect their emotional development, which can lead to less resilience and adaptability later in life.

They are also at higher risk for long term physical problems including hypertension and cardiovascular disease, diabetes, and obesity.

To quote Dr. Hansa Bhargava at WebMD,  it can even potentially change their DNA, “affecting how their body and brain function for the rest of their lives.”

There is no doubt that separating kids from their families is as much child abuse as beating them, even before you add in how they are treated while being held in cages in constant light, noise, and cold, without the watchful eyes and comfort of their parents.

How Did This Happen So Suddenly?

First, some background. Entry into the US without a visa was perfectly legal (with an entrance fee) until 1929, when it was made a misdemeanor. Thousands of Mexicans were prosecuted for illegal entry between 1930 and the beginning of WWII (85-99% of the inmates in the booming border prison business were Mexican). Mostly white people got a pass.

World War II hit and suddenly we desperately needed those Mexican agricultural workers. We said “come on in!” and didn’t prosecute much again until 2005.

In the early 2000s life is places like El Salvador, Guatemala, and Honduras became a lot more dangerous. Gangs proliferated, and people came to our borders in increased numbers seeking a safer life for their families. Between 2003 and 2005 the number of illegal entries at our southern border went from 4000/year to 16,500/year; in 2010 it was 44,000; it peaked in 2013 at 97,000.

Recently the numbers overall have gone down but the number of families coming through has increased.

The immigration crisis is here.

So we reacted. A 1997 court had ruled that the government is must release children from detention in not longer than 20 days (Flores vs Reno) to either the parents, an adult relative, or a licensed program. In 2015 they expanded this to apply to children arrested with their families, not just unaccompanied minors.

Since we did not have enough beds for so many, this resulted in the practice of “catch and release.” Immigration aimed at prosecuting people who were dangerous to our national security, gang members, and criminals who had committed felonies rather than simple misdemeanors, and let families go.

On 4/6/2018 Attorney General Sessions announced a new policy of “zero tolerance.” This required every adult crossing the border illegally to be arrested and prosecuted for the misdemeanor offence of illegal border crossing, leaving their children stranded alone.

Not wearing a seatbelt is a misdemeanor. Do we expect to lose our kids forever if we are caught not wearing a seatbelt?

These kids – more than 2300 as I write – are now being housed in cages. We’ve seen pictures only of the older boys; the government will not allow any photos other than the ones they release themselves. The babies and toddlers are apparently being housed in “tender care” facilities, where the staff care for them but are not allowed to touch or comfort them. Hitler did this to babies as an experiment, to see how babies would do with food and care but no love. They all died.

They currently have no plan for returning these kids to their families. Some parents have been told they will never see their kids again. Some have already been deported to their home country without their children; other parents have been looking unsuccessfully for their children for weeks.

So when the head of HHS says we are not separating families, she is lying. When our president says he is merely following the Democrat’s laws, he is lying. There is no law, just a new policy that he could reverse with one order. When Sessions defends this with the Bible… I just can’t.

Session’s says he hopes that knowing this will happen will keep people from coming – an experiment, on babies. Trump says if the Dems sign his Immigration Bill (fund the wall, disavow the Dreamers) he will end it.

Yesterday the UN’s Human Rights Council criticized the practice of family separation, saying “The thought that any state would seek to deter parents by inflicting such abuse on children is unconscionable…People do not lose their human rights by virtue of crossing a border without a visa.”

So today we left the Human Rights Council.

So What Can We Do About  It?

First, we must stop separating families now. There is a bill in the House right now – S.3036 – to stop it. 100% of the Democrats have signed it, 100% of the Republicans have not. Our reps are playing political games while children suffer. Call your rep and let him know you want this stopped. Here in Alabama that rep is Senator Shelby at 202-224-5744.

Donate to KIND (Kids in Need of Defense).

What can we do long term?

  • We can help South American countries to become safer places, so families can stay in their homes.
  • We can aim better. Prosecute the people who have committed felonies, who might be a danger to our national security, and who are gang members.
  • we can require that employers who hire foreign agricultural and construction workers get the proper visas, pay reasonable wages, and don’t allow child labor.
  • We can allow asylum claims for domestic violence and gang violence.
  • We can streamline the path to citizenship so that it is accessible to all.
  • We can better fund our court system so that it does not take 2-3 years to work through an asylum claim.
  • We can use ankle bracelets to make sure the adults show up for their court dates, but can work and care for their children in the interim.
  • We can get big brains who know a lot more about immigration than I do to work on a bipartisan solution, instead of using these kids as pawns in a political game.
  • We can work together, Democrats and Republicans, to solve problems instead of acting like toddlers fighting over a prize.

We as Americans are abusing and damaging children to win political points. It must end. We have to be better than this.

 

 

 

It’s Allergy Season! What To Do For Your Child?

sneezing boy-01Allergies happen when a body’s immune defenses overreact to something in the environment. They decide that a molecule of pollen or mold is a dangerous invader and it needs to be killed. Queue the mucus, swelling and itching.

If your child has the tendency to wheeze, queue the airway spasm as well.

If he or she has sensitive skin, also expect an outbreak of dry itchy patches.

If they keep the mucus, swelling and wheezing for a while, they can develop secondary infections like earaches, sinusitis and pneumonia.

Allergies suck.

What triggers allergies?

Kids can be allergic to a multitude of things. They can react seasonally to flowers in the spring, to grasses in the summer and fall, or to wood fires and Christmas trees in the winter. Year round allergens include molds, mildews and dust mites (tiny bugs that live in dust and upholstery, feed on flakes of skin. and leave behind their poop). Many children are allergic to pets–especially cats and birds–and react to the pet’s feathers, fur, saliva or skin scale. The poisons in cigarettes are common triggers, as are fumes like perfume and air pollution. Scents and dyes in soaps and detergents can cause allergic reactions. Some kids react to contact with latex or metals like nickel.

Food allergies are different–a whole blog in themselves.

How do we prevent an allergy attack?

We can’t cure allergies–all we can do is try to keep them under control. If possible, avoid the allergen:

  • If your child is allergic to cats, don’t buy him or her a kitten. Ditto for birds, dogs, hamsters…
  • Never smoke in your house or car.
  • If the allergy is to pollens, keep your air conditioner on seasonally and buy filters that catch allergens.
  • Dust mites? Cover your child’s mattress and pillow with zip up covers designed to contain them.
  • Don’t use curtains in his or her room, or wash them weekly.
  • Limit stuffed animals to those you can wash in hot water with their bed linens once a week.
  • Vacuum daily (sorry).
  • Dust with a damp cloth (also sorry).
  • Molds? Fix any damp areas in your home. Use that bathroom vent – timers that shut off automatically work great, and are easy to install.
  • Clear out vegetation close to the house, and discard any dead plant bits.

Medicines can help prevent allergic reactions.

If avoidance is not enough, your munchkin can take an antihistamine as needed to block the allergic reaction. Try to stick with the newer, non-sedating antihistamines: claritin, zyrtec or xyzol, allegra and their generics.

If an exposure is inevitable (“We have to go to Grandma’s and you know she has that cat!”) you can give them an antihistamine about an hour before.

If they are going to be exposed to their allergy trigger every day for a while (springtime pollen?), they can take the antihistamine every day, if you buy the non-sedating type.

If their allergies are chronic, a daily steroid nose spray or a preventative medicine called Singulair (montelukast sodium) can also help prevent the symptoms.

Offer them lots of water to wash the allergens out of their system.

Allergy Testing

If they still have symptoms, allergy testing can help to pinpoint exactly what they are allergic to, so you know what to avoid or clean up. Knowledge is power. It does no good to find a new home for the cat if the child is only allergic to mold. Poor kitten.

Last, if avoidance and medication are not enough, your physician will bring up the subject of allergy shots to desensitize your munchkin to the allergen. He or she will not be thrilled.

Allergies are miserable, but there are things you can do to make your child more comfortable. Prevent the exposure if you can, and give medication if you can’t–either a short term antihistamine or longer term preventative nasal sprays or montelukast sodium. Consider allergy testing and shots when those simpler therapies don’t work. And hydrate. Soon, the season will change.

It’s Not Too Soon. It’s Too Late. Ask Their Parents.

Today’s blog was written by a fellow pediatrician, Dr. Chad Hayes. I could not have said it better.

Florida has some of the most lax gun laws in the country: anyone over 18 can buy  a semi-automatic weapon with no license, no firearms registration, and often without a background check. This is the state that, for a while, made it illegal for pediatricians to council parents on gun safety. If a pediatrician told a parent their guns should be in a safe, unloaded, without a bullet in the chamber–that doc could be arrested and charged with a crime.

The NRA owns our country and our politicians, and it is indeed too late for us to save the 17 children who died today. It is not too late to make rational gun laws that will save the kids who are sitting beside you doing their homework tonight.

The American Academy of Pediatrics recommendations for gun control:

  • Enact strong, effective assault weapon ban
  • Eliminate the gun show loophole, require mandatory background checks and waiting periods
  • Ban on high-capacity magazines
  • Enact strong handgun regulations
  • Require safe firearm storage under federal law

 

ChadHayes-01This afternoon, after spending a few minutes in my office, watching live coverage of our country’s most recent school shooting, I was talking about the tragedy with my nurse, who grew up in London: “You didn’t have a lot of school shootings in England, did you?”

“No, we didn’t. Nobody had guns. All people had were batons.”

I’ve not heard of many school batonings.

Among similarly-developed nations, frequent school shootings are a uniquely American problem. In fact, they are so common that many occur without drawing significant media attention. There have been several in 2018, and we’re only in week 7.

I’m writing this just a couple hours after the mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida. Reports from the scene are still fluid. From what I’ve heard so far, the shooter is in custody, and there are multiple fatalities (update: 17 so far). Those details, no doubt, will change. We will learn the true number of people injured and killed. We will see the faces of children who spent their last Valentine’s Day bleeding out on the floor of their school. We will learn the shooter’s identity (Nikolas Cruz, a 19-year-old former student), the weapons used (an AR-15 rifle), and possibly a motive.

But my intent is not to provide these details. I’m not a reporter.

What I am is a father that cannot imagine losing a child.

I am a pediatrician that cares very much about the safety and well-being of children. One that believes that no child should live in fear of being gunned down at school, that no parent should have to bury a murdered child, and that the number of times this has happened without any significant action to prevent the next tragedy is unacceptable.

I am a physician that has resuscitated children with gunshot injuries, and tried to resuscitate others. Some were suicides. Some were accidents. Their stories are powerful, but they aren’t mine to tell.

I sent out a tweet after heard about this shooting, essentially saying that maybe this time, after thisround of children is murdered, we should do more than “thoughts and prayers” and perhaps start taking actual steps towards preventing similar events in the future. It was long until I received a reply: “We don’t know anything yet and you’re [sic] attempt at politicizing this is pretty awful.”

And that seems to be the response every time this happens: “It’s too soon.” “Don’t politicize this.” “You’re using the victims to promote your agenda.” It’s the same response I heard after, just seven miles from my house, nine people were murdered in Emmanuel AME Church. It’s the same response I heard after 58 people were killed at a concert in Las Vegas. It’s the same response I heard when twenty 6- and 7-year-old children were murdered at Sandy Hook Elementary School.

So, yes. I’m using the victims to promote my agenda. And I feel like their families would probably be alright with that, because my agenda is to minimize the future victims.

Here’s the thing: There is no simple solution. There is no single solution. There is no perfect solution. There isn’t one change we can make and magically make gun violence disappear.

As with many issues, the answer—if we find one—will likely be found somewhere in the middle of two extremes. Firearms are so ingrained into American culture that to think it is at all feasible to ban them altogether is asinine. And to pretend that there are no steps we can take to work towards a safer environment for ourselves and our children is equally absurd.

The Second Amendment was written over two centuries years ago. The men who wrote it would not recognize and could not have anticipated the weapons available today. What they did anticipate was that the future would look remarkably different from their present, which is why they built into the Constitution a means to amend it in the first place. The Second Amendment, despite what the NRA would like you to believe, is not immutable.

At the time the Bill of Rights was signed, the most common weapons were muskets capable of firing a single shot before a rather complex and time-consuming reloading process.

Today’s weapons are far more accurate, far more powerful, and unbelievably fast. The term “semi-automatic” means that a round is fired with each pull of the trigger. This is to distinguish it from other types of firearms that require an additional action, such as the movement of a lever or bolt, to load and fire another round (and also from “automatic” firearms which continue to fire until the trigger is released or there is no more ammunition).

But while the term “semi-automatic” is frequently used in such a way as to demonize the weapon, the reality is that’s just how firearms work today. Just as most modern vehicles  include automatic transmissions and power windows, semi-automatic handguns and rifles are pretty much the standard. And in most states, anyone over 18 years of age (21 for handguns) and without a criminal record can walk into a store and purchase one.

A common example of a semi-automatic firearm is the AR-15 used in the Parkland massacre. These rifles are made for one purpose: to kill people quickly. Because in combat, that’s the goal. But these firearms are not restricted to the military; they are widely available to the civilian market. Certainly, most people that own them do not intend to murder their innocent neighbors; most people that own firearms are law-abiding citizens that simply enjoy shooting them at the range or keep them in case of some real or imagined catastrophe.

There are better firearms with which to hunt. There are better weapons with which to defend oneself or one’s family. But there is no better type of firearm (at least, not one available to civilians) with which to kill a lot of people very quickly. And the teenage murderer in Parkland, Florida knew that.

It is clear to me, and I think most people would agree, that there are some weapons that should not be available to the general public. At some point on the continuum from a baseball bat to a nuclear bomb, there’s a point at which one’s right to self defense is outweighed by the risks that a particular weapon presents to the rest of us. We can argue about where that point is. And we should.

We should argue about where to draw that line. We should talk about what further steps we can take to prevent people who shouldn’t have guns from obtaining them. We should talk about ways to encourage safe storage of firearms and ammunition. We should talk about preventing sales of firearms without background checks at gun shows or by individuals. We should talk about the education, training, and licensing that should be required to own a firearm. We have a lot to talk about.

I am not the expert in this field. But there are experts in this field. We should listen to them. Because while a good guy with a gun may occasionally stop a bad guy with a gun, it would be far better to have bad guys without guns.

As emotionally charged as mass shootings are–especially those involving children, they account for only a small percentage of the 30,000 or so gun deaths each year in the US. Far more people are killed by firearms in less spectacular situations like suicides, accidents, domestic disputes, or gang violence. And while we will not be able to prevent every firearm death, we can make a difference.

The thoughts and prayers aren’t working. It’s time to do something.

Because it’s not too soon. It’s too late. Ask their parents.

Fun, Free Printables from MyraMakes.com

Today’s blog is brought to you by MyraMakes.com. Myra Makes is a creative education company based in Boulder, Colorado. Their mission is to empower kids with a love of learning and inspire them to embark on their own creative adventures. They approach education in a kid-centered way–they believe that by introducing opportunities for kids to express their natural creative potential, they can help cultivate the generation of forward-thinking innovators that we so critically need.

They brought the adventure to life with their first product, the creative learning adventure book Journey to Cloud City, available on Amazon, and they have allowed me to put some of their printables on the blog. (Reprint only for non-commercial purposed only, please!) Designed to make problem solving, empathy, and teamwork fun, their first interactive storybook was created from over a year of feedback from parents, kids, and educators.

They introduce problem-solving through adventure, in which children follow their main character Myra as she meets new friends and creates solutions to the challenges that come up along the way.

The activities below are selections from Journey to Cloud City.

  • Extend the activities by using arts and crafts supplies to build the environments, solutions, and characters in real life after you’ve drawn on the printable!
  • Use pipe cleaners, pom-poms, building supplies such as Legos.
  • Re-use materials such as bottle caps and scrap cardboard.
  • Parents, work with you kids on the activities–they’re often just as much fun for adults as kids!
  • Remember to be as open-ended as possible when offering suggestions or asking your kids questions when they’re working on the activities.

The crew at MyraMakes is always interested in connecting with others who share their passion for inspiring kids as problem solvers, and would love to hear from parents, teachers, and others with collaborative opportunities or interesting stories to share at support@MyraMakes.com.

Enjoy the activity pages below!

Myra1

Myra2

Myra3

Myra4

Myra5