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!

 

Doc’s 7 Tips for a Safe & Happy Holiday Season

Cute Kid Girl In Glasses Thinking About Gift On Christmas HolidaMy daughter the anthropologist tells me that celebrations solidify relationships between people within a community, give them hope for the future, and serve as rights of passage.

These are excellent goals to keep in mind as you enter into the holiday insanity. What you want this season to mean to your children throughout their lives?

Do you want them to be involved in your community with its rich heritage and history? Emphasize that. Tell stories, act out events and celebrate your history. Help out people who are less fortunate.

Do you want holidays to strengthen family bonds? Put family first. Limit the decorating and shopping and work events, and hang out at home. Make gifts for each other, bake cookies and play games.

If you want holidays to be about joy, be joyful. Foster realistic expectations, appreciation for what they have and genuine values. Develop traditions that are more about time together as a family and less about how much stuff they get. The memories they keep forever will be the little things: sharing a bowl of popcorn while watching an old movie; reading a book while Mom or Dad runs fingers through their hair. Few people remember what they received for Christmas last year. They do remember that walk on Christmas Eve admiring the sparkling lights, tasting cookies straight out of the oven, and the look on Grandpa’s face when he got that homemade penholder.

Gifts

It’s tempting to get your children all the things they want for the holiday just to see them smile, but where do you go from there? Maniacal happiness is not joy. It cannot be sustained over time. Add to that that you have created unrealistic expectations for all the other holidays in their future. And the storage needs!

Restrain yourself. If holidays are about family time, board games, and baking cookies it is possible for holidays later in life to be happy. If holidays are about how much money was spent and how many new toys they received, how can real life ever work out? Bigger and better toys every year? That was not the goal.

If you can afford it, get them one or two of the things on their lists. Make them the ones they can create with, the ones that make them use their brains and bodies and talent. Add on some little things that are fun to open. Let little ones play with the boxes and bubble wrap. Then focus the day on family.

The Insanity

Don’t let holidays overwhelm you. There are so many expectations that no one can possibly meet them all and have any joy left. There are special foods that need to be prepared, special clothes that need to be bought, decorations, gifts, traditions to be followed, parties, travel, family… eeek! Weed out the excess so there is room left for joy, relaxation and rejoicing in whatever you were celebrating.

Before you decide to spend money on gifts or travel, be realistic about what you can afford. What did you get for your last birthday? Don’t remember? No one does. What people do remember is the conversation, the hugs and the warmth. Those are free. Take dollars out of the experience as much as possible and you won’t end up with a credit card bill for a present that was discarded six months ago. Don’t try to keep up with the people who have that bill and you won’t be laying awake at night and fighting with your spouse instead of relaxing snuggled up with hot chocolate.

Tune down the stress. Not spending more than you can afford will eliminate a huge amount of stress. Next, stop worrying about what other people think; they’re too busy worrying about what you think to care anyway. Keep to routines as much as possible. Sit down for meals; take some time to focus on each other. Step back from the hysteria and think about whether your progeny will actually play with that new doll or just stuff it in a corner, and whether you really need to travel or attend all the parties. Take some quiet time and relax. The world will not collapse if you skip a party or miss the line for the “it” gift. It will collapse if your child is so exhausted and stressed that he or she has a melt down.

Health

Keep healthy. The week after a holiday is always busy at my office. I make lots of money from airplanes crowded with sick people and stores packed with germy carts. Get enough rest, and hydrate. Use hand sanitizer. Eat as healthfully as possible–avoid fast foods, throw in some fruits and vegies. Hide the caffeine and limit alcohol. Get a flu shot. Nothing can destroy a holiday quicker than a trip to the ER.

  • Avoid injuries. Most holiday injuries have nothing to do with the particular holiday, but everything to do with people 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 holiday injuries are from everyday activities and household objects made dangerous by the holiday craziness.
  • Chokings and poisonings are popular. 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 a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.
  • Toddlers will put anything in their mouths. Unfortunately this means that everybody needs to pick up their stuff. Items over 1¼ inch in diameter are generally safe. Smaller items than that can go straight into their gut or lung. The most dangerous items to swallow are 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!
  • Holidays also provide a banquet of things to irritate children’s allergies. Live trees indoors, foods, cigarette smoke, wood fires and other people’s homes and pets come to mind. Avoid them if your child has allergies.
  • Fires and electrical injuries are especially common during holidays. Decorations can be flammable, old Christmas trees will be dry, and space heaters, candles and fires are commonly nearby. Frayed and loose wires easily start fires. Keep your eyes open for dangers.
  • Use your common sense during celebrations. If it doesn’t seem safe, don’t let people pressure you into it. 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, or her.
  • 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.

Remember that the point of celebrations is to solidify relationships and give hope for the future. Get there by focusing on your history, rejoicing in your present and not sabotaging your future. Don’t go crazy with gifts: they don’t teach your children anything you want them to learn and the financial stress will eat away at that joy and hope you were dreaming of. Pick fewer things to do, and do them together. Be safe and stay healthy.

Nutrition Facts: What to Grow in Your Kid’s Garden

girl with plantIn Anna Karenina, Leo Tolstoy wrote “Spring is the time of plans and projects.” Plans and projects keep children out of trouble–or at least involve them in safer, more manageable trouble.

What could be better than digging in the dirt and playing in a spray of water on a hot summer day? What more creative than an adventure in the wilds of your back yard? Add in sunshine, fresh air and exercise, and planting a garden becomes the springtime activity of choice.

One of the best ways to coax kids into eating what is good for them is to involve them in its preparation. They are far more likely to eat the lunch they prepared with their own two hands than one you slaved over. If they help you peel and cut up carrots for dinner they will try them, and brag about their contribution while chewing.

Extend this a bit and you reap the miracle of children eating their vegetables because they grew them in their very own garden. They planted the seeds, watched over them, watered them, and cared for them. They will proudly eat the fruits of their labor and proclaim their tastiness.

Children need a variety of vitamins and minerals in order to function and grow, and the best place to get those nutrients, along with carbs for energy and fiber for bowel function, is in fruits and vegetables. Some, like beans and peas, are even excellent sources of protein. Many of them can be grown in small plots or in containers on a porch.

Carrots can be grown easily from seeds bought in your local garden store, and are very high in Vitamin A. Vitamin A helps with eyesight–especially night vision–which is why your mom always told you to eat lots. Watermelon, peas, peppers, beans, and tomatoes also have bunches of Vitamin A.

Tomatoes, peppers, and beans are high in B complex vitamins. B vitamins like riboflavin, niacin, thiamine and folic acid are tiny machines that allow your body to function. They help with everything from making blood cells, to generating energy from carbohydrates, to scavenging free radicles and protecting you from cancer.

Strawberries, raspberries, and blackberries are high in Vitamin C, which is necessary for collagen synthesis and wound healing and is an effective antioxidant. Without Vitamin C, people get scurvy.

Minerals are also easily come by on the plant side of your plate.

Calcium to build strong bones can be found in beans.

Potatoes, beans, corn, and mushrooms are high in iron, which helps carry oxygen around your body.

Potassium, necessary for muscle contraction and to maintain your heart rhythm, is present in potatoes, berries, peas, beans, and peppers.

Essential minerals like magnesium, phosphorus, copper, and zinc are all available in fruits and vegetables.

I’ve never seen a child turn down a pea fresh from the pod, or a strawberry plucked from the plant. Find a plant catalogue, pour through it with your child, pay attention to what will grow in your area and how much room the plants need to grow, and choose. Consider what you have room for: will these be container plants on the porch, or can you spare a patch of yard? Do you have space for a tree, or are we looking at a mushroom kit in the closet?

Some of my favorite kid friendly plants are peas, beans, peppers, tomatoes, and the ever popular carrot. Melons, pumpkins, and cucumbers are great if you have a little more room. Berries come in all sizes, from tiny strawberry plants fit for containers with pockets down the side, to raspberry vines best grown on trellises, to fat thorny blackberry bushes. Tires can be stacked up and filled with dirt in a tower as potato plants grow, then harvested by taking off one tire at a time.

Growing a few plants allows you to spend time with your children, get some exercise, and build some vitamin D of your own from all that sunshine. Have a conversation about science and nutrition while you are digging in the dirt. Money can be earned and financial lessons taught by naming the watering and weeding of those plants “chores.” Other lessons can be taught without any conversation: responsibility for life, the fruitfulness of hard work, and pride of accomplishment. Don’t miss this opportunity for spring plans and projects!

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Zika Virus: An Update

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. Evidence shows that these babies may also have eye abnormalities that will  effect their vision. There have been links to serious deformities in the joints in the arms and legs of affected babies. A report published August 30, 2016 noted that 6% of the babies affected by Zika also have hearing loss. According to the AAP as of November 4, 2016, their are five main birth defects: severe microcephaly with partially collapsed skull, decreased brain tissue with subcortical calcifications, extreme muscle tone, eye damage with macular scarring and increased pigment, and limited joint motion range.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 0 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
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Summertime Rashes

little cute girl near the pool with a circle for swimmingWhen the days warm up, pediatric offices see a lot of summer skin problems. Kids aren’t often ill during the summer, but they do get sunburns, bites, jellyfish stings, and rashes.

Sunburn

No one thinks about sunscreen on that first glorious sunshiny day, so sunburns are usually our first evidence that summer is here. Remember to use sunscreen, of course, and don’t forget to reapply it every hour.

If your child does burn, give ibuprofen immediately – it helps with the inflammation and can actually reduce the depth of injury. Use aloe generously: it lessens the pain, moisturizes the skin, and helps heal the damage. If the burn is bad, call your doctor. Prescription steroids and burn creams will help.

Bug Bites

Bug bites are also very popular in the summer, from mosquitos, fire ants, yellow flies, and fleas. Insects inject toxins into children’s skin when they bite; how much a particular child reacts depends on how sensitive he or she is.

Cover up little arms and legs when you can, especially if you are going to be outdoors around twilight. There are excellent clothing treatments available that will keep bugs away and last through several washings, protecting your child indirectly.

If your child is older than 2 months, use insect repellant with DEET on exposed skin, even though it’s nasty. It works and it’s a whole lot better than getting insect borne encephalitis. 10% DEET lasts about 2 hours; 30% lasts about 5 hours. Don’t use anything stronger than 30% on a child. Don’t reapply in the same day, and do wash it off when you go back inside.

Creams with pramoxine or calamine will help with itchiness. Cortisone creams help itch and also swelling and redness, but can only be used a couple of times a day. If there are lots of bites, an antihistamine by mouth will also help with swelling and itch.

Never use antihistamine creams (benadryl is the most common), because children can react to the topical antihistamine and actually get worse instead of better.

Bee stings

Bee and wasp stings are treated much the same way, after making sure to remove the stinger and apply a cool compress (and yes, Grandma’s idea about the wet mud does help).

Poison ivy, oak, and sumac

If your child is a forest dweller, he or she will at some point get poison ivy, oak or sumac. These plants produce a poison called urushiol in their sap and leaves, causing redness, itch and blistering.

The severity of this reaction also varies depending on your munchkin’s sensitivity. My brother’s eyes would swell shut if someone burnt it a block away; I could pull it up and throw it away with no reaction.

Wash both the child and his or her clothes as soon as possible. No lounging on the furniture! The toxin can stay on surfaces for months. Once the toxin is either absorbed into the skin or washed off, the rash is no longer contagious. Blister fluid does not contain urushiol.

The rash will develop first where the most toxin was deposited, in streaks and patches. It can spread for a week or so to the areas where less toxin landed, then take another two weeks to clear.

If the rash is mild, you can treat it at home with cool compresses, baking soda or oatmeal baths, the same creams you used for those pesky bug bites, and that antihistamine by mouth. See? Grandma was right again.

If the rash is not mild, or your child has it on their face, around their eyes, or on their genitals (and how did that plant get there?) call your doc. We can put them on steroids, which help enormously.

Jellyfish stings

If you harbor a small mermaid or man in your home, she or he may get stung by a jellyfish. There are some extremely dangerous jellyfish, so if your child has any trouble breathing, is weak or nauseated, has pain away from the sting, or has sweating, cramping, or diarrhea, call your doctor immediately.

If it is a simple sting, first remove the barbs by scraping it with a towel or a credit card. Don’t rub. Put suntan oil or salt water and hot sand on the sting; heat will deactivate the poison.

Do NOT wash the sting with fresh water – it will make the nematocysts (poison sacks) explode and release more poison into the skin. Your child will scream and not love you anymore. Put only fluids with lots of particles in them on the sting: sting-away, vinegar or steak sauce, for example. Ibuprofen will also help the pain and inflammation.

Allergic rashes

Last, we see allergic reactions to everything from sunscreen to henna tattoos to jewelry to pool chemicals from fun in the sun. Kids with sensitive skin or eczema will rash out in the summer from the heat, humidity and sweat.

By now you can probably sense a common theme (or you could just ask Grandma): give your itchy red bumpy child a cool bath with mild soap. Moisturize and apply topical steroids or give antihistamines by mouth.

If any of this doesn’t work, call me! It gets lonely in a pediatric office during the summer when all the kids are healthy.

DomesticatedMomster
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Summertime Injuries: Preventing the Scary Stuff

safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

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. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

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.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

Domesticated Momster
The Blogger's Pit Stop

4th of July Safety: Tips from the Doc

safety signSunshine, 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.

Top 10 Tips for Successful Summer Vacations

little cute girl near the pool with a circle for swimming

School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have a top ten from the Doc:

10. Pack a simple medicine kit: don’t waste a day of vacation at my office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

Why Did My Kid React to That Food?

Little chief-cook tasting the carrotKids can have reactions to food for many different reasons. They can be allergic, sensitive, intolerant, or have problems because the food contains poisons or has drug effects.

Food allergies are caused by a child’s immune system reacting to a food, similar to the way they can react to pollen or bug bites. Allergic reactions are usually to the protein in the food rather than the sugar or fat, and are usually immediate. The most common severe reactions are to tree nuts, peanuts, and shellfish. Less severe reactions are most common with cow’s milk, eggs, soy, wheat, and fish.

Celiac disease is in this category. People with celiac are allergic to the gluten protein in wheat and react with their immune system if they are exposed to even a tiny amount. Gluten allergy was worth a whole blog all by itself: A Gluten Free Blog.

80-90% of the time, kids will outgrow allergies to eggs, wheat, milk, and soy by 5 years of age. They outgrow peanut allergies only 20% of the time. (Do NOT experiment with this!) Fewer will outgrow allergies to tree nuts and seafood.

Symptoms of an allergic reaction include:

  • Skin rashes. Hives, or whelps–itchy raised patches with pale centers and red rims. Hives move around, fading in one area to reappear in another. Antihistamines like Benadryl (diphenhydramine) help the symptoms.
  • Breathing problems. Food reactions can make kids wheeze, make their throats feel tight, and give them sneezing fits.
  • Gastrointestinal symptoms like nausea, vomiting, and  diarrhea.
  • Circulatory symptoms like paleness, lightheadedness, and loss of consciousness.
  • Severe reactions can involve several of these areas, and are called anaphylaxis.

Food sensitivities and intolerances are not allergies. Some children can be sensitive to the common effects of a food and react strongly. For example:

  • Apples, pears and bananas contain pectin and can be constipating (useful if your child has diarrhea). Some children can get stopped up if they eat too many.
  • Dairy products can also constipate–some kids will never poop again if they eat a lot of cheese. (This may be a slight exaggeration.)
  • Sugar can cause diarrhea, so children may have problems if they drink a lot of juice. (Interestingly, we have never been able to prove that sugar makes kids hyper.)
  • Kids can react to dyes and preservatives in foods–they will feel nauseated or tired, and we have proven that red dye can make them hyper.
  • Lactose intolerance is an reaction to the sugar in milk. People who are lactose intolerant are missing the enzyme (lactase) that breaks down the sugar in milk (lactose). They get bloating, gas, and diarrhea.

There are certainly plants that contain toxins (poisons) in themselves–poisonous mushrooms, apple seeds, and belladonna are examples–but most poisonings are accidental, usually from foods that have spoiled:

  • C. Botulinium bacteria grows in improperly canned food and in cans that have rusted through.When we used to give Karo syrup for constipation, the bacteria would grow in Karo left on a cupboard shelf and children would die, paralyzed by the neurotoxin (nerve poison) that the bacteria produced.
  • Staph Aureus can grow in spoiled food and produce a toxin that is usually self limited in its effect, giving kids cramping, diarrhea, and vomiting.
  • Clostridium perfringens produces a similar toxin, and is frequently the villain in cafeteria incidents and contaminations in soil and sewage.
  • Salmonella can grow in spoiled meat, eggs, and milk and give your child diarrhea, vomiting and fever.
  • E. coli is more likely to grow in beef, but can be found in mishandled produce. Same unpleasant symptoms.
  • Shigella is common in daycare outbreaks. It causes the same nausea, vomiting, diarrhea, and fever, but has the added risk of seizures from the toxin it produces.

Foods can also have drug effects. The best examples of this are drinks (coffee, tea, energy drinks) and food (chocolate) that contain caffeine. Caffeine makes kids restless, shaky, and interferes with their sleep. In large doses, as with energy drinks, it can produce a rapid heartbeat, muscle tremors and seizures. There were 20,783 emergency room visits from energy drinks in 2011; 5 people died after consuming them. The youngest was a 14 year old girl.

Foods can also be irritants. For example, babies can get rashes around their mouths or diaper rashes from acidic foods.

People do not react to a food solely because it is a GMO (genetically modified organism)–GMOs are not something you need to avoid unless you have a reaction to the particular item. GMO wheat produces the same allergens as non-GMO wheat; if you are allergic to one, you will be allergic to the other. Also the subject of an entire blog: What’s the Deal with GMOs?

In conclusion, not every food reaction is a food allergy. Avoidance or treatment of the food reaction varies with the actual cause. If a child has an anaphylactic allergic reaction to peanuts, he or she never needs to be around peanuts again. They may outgrow other allergies. If they get gassy from a lactose intolerance, they can take lactase tablets when they eat dairy. Kids who become constipated with apples or cheese need to limit the number they eat. It is always important for every child to not be fed spoiled food or energy drinks.

Knowing in what way your child reacted to a food determines what you do about it in the future. Knowledge rules.

Domesticated Momster
Rhyming with Wine
Rhyming with Wine

Nutrition Facts: What to Grow in a Kid’s Garden

girl with plantIn Anna Karenina, Leo Tolstoy wrote “Spring is the time of plans and projects.” Plans and projects keep children out of trouble–or at least involve them in safer, more manageable trouble.

What could be better than digging in the dirt and playing in a spray of water on a hot summer day? What more creative than an adventure in the wilds of your back yard? Add in sunshine, fresh air and exercise, and planting a garden becomes the springtime activity of choice.

One of the best ways to coax kids into eating what is good for them is to involve them in its preparation. They are far more likely to eat the lunch they prepared with their own two hands than one you slaved over. If they help you peel and cut up carrots for dinner they will try them, and brag about their contribution while chewing.

Extend this a bit and you reap the miracle of children eating their vegetables because they grew them in their very own garden. They planted the seeds, watched over them, watered them, and cared for them. They will proudly eat the fruits of their labor and proclaim their tastiness.

Children need a variety of vitamins and minerals in order to function and grow, and the best place to get those nutrients, along with carbs for energy and fiber for bowel function, is in fruits and vegetables. Some, like beans and peas, are even excellent sources of protein. Many of them can be grown in small plots or in containers on a porch.

Carrots can be grown easily from seeds bought in your local garden store, and are very high in Vitamin A. Vitamin A helps with eyesight–especially night vision–which is why your mom always told you to eat lots. Watermelon, peas, peppers, beans, and tomatoes also have bunches of Vitamin A.

Tomatoes, peppers, and beans are high in B complex vitamins. B vitamins like riboflavin, niacin, thiamine and folic acid are tiny machines that allow your body to function. They help with everything from making blood cells, to generating energy from carbohydrates, to scavenging free radicles and protecting you from cancer.

Strawberries, raspberries, and blackberries are high in Vitamin C, which is necessary for collagen synthesis and wound healing and is an effective antioxidant. Without Vitamin C, people get scurvy.

Minerals are also easily come by on the plant side of your plate.

Calcium to build strong bones can be found in beans.

Potatoes, beans, corn, and mushrooms are high in iron, which helps carry oxygen around your body.

Potassium, necessary for muscle contraction and to maintain your heart rhythm, is present in potatoes, berries, peas, beans, and peppers.

Essential minerals like magnesium, phosphorus, copper, and zinc are all available in fruits and vegetables.

I’ve never seen a child turn down a pea fresh from the pod, or a strawberry plucked from the plant. Find a plant catalogue, pour through it with your child, pay attention to what will grow in your area and how much room the plants need to grow, and choose. Consider what you have room for: will these be container plants on the porch, or can you spare a patch of yard? Do you have space for a tree, or are we looking at a mushroom kit in the closet?

Some of my favorite kid friendly plants are peas, beans, peppers, tomatoes, and the ever popular carrot. Melons, pumpkins, and cucumbers are great if you have a little more room. Berries come in all sizes, from tiny strawberry plants fit for containers with pockets down the side, to raspberry vines best grown on trellises, to fat thorny blackberry bushes. Tires can be stacked up and filled with dirt in a tower as potato plants grow, then harvested by taking off one tire at a time.

Growing a few plants allows you to spend time with your children, get some exercise, and build some vitamin D of your own from all that sunshine. Have a conversation about science and nutrition while you are digging in the dirt. Money can be earned and financial lessons taught by naming the watering and weeding of those plants “chores.” Other lessons can be taught without any conversation: responsibility for life, the fruitfulness of hard work, and pride of accomplishment. Don’t miss this opportunity for spring plans and projects!

Domesticated Momster