Two Peds in a Pod

Starting out With Pearly Whites- infant and toddler dental tips

2010-03-06T14:15:00Z

My sister-in-law was startled when brown spots began to appear on her preschooler’s teeth. A trip to the dentist revealed that my nephew had eleven cavities, the result of constantly drinking juice as an infant and toddler. Unfortunately, time in the operating room was required to fill all the rotten spots. Today our guest blogger, Dr. Paria Hassouri, answers frequently asked questions on infant dental care. Starting care as an infant can prevent your child from ending up like my nephew with a mouthful of cavities. Dr. Hassouri is a board certified pediatrician who completed her training at the Cleveland Clinic Foundation. She has been in practice for seven years and is with Cedars Sinai Medical Group in Beverly Hills, California. She is currently writing abook about the experience of pediatrician moms across the United States. – Dr. Lai

When do I need to start brushing my baby’s teeth?

You should start brushing your baby’s teeth as soon as they come out. You can either use a clean moist washcloth or a soft baby toothbrush to do this. Before this point, many pediatricians advocate wiping your infant’s gums with a washcloth a couple times a day.

While plain water is enough to clean the teeth and gums, you can also use a small amount of fluoride-free toothpaste. Flossing should begin anytime there is tight contact between the teeth, particularly when the molars come in.

When will my baby get his/her first tooth?

While most babies will get their first tooth between 6 to 10 months, your baby may not get his/her first tooth until 15 to 18 months.

What is “baby bottle tooth decay” and how do I prevent it?

Baby bottle tooth decay is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. The sugar penetrates the gums and affects the teeth even while they are below the surface. Sugar-containing drinks include milk and formula (even breastmilk), fruit juice, and other sweetened drinks. Putting a baby to bed for naps or at night with a bottle increases the risk. And again, remember that your baby does not need any juice.

When does my baby need to first see a dentist?

While the American Academy of Pediatric Dentistry recommends dental visits starting at age one, you can ask your pediatrician when he/she thinks that your baby should first see the dentist. If you are already following a good dental care regimen which includes brushing your baby’s teeth regularly and not letting your baby fall asleep with a bottle, your pediatrician may say that you can wait longer for the first dental visit.

What to I do if my baby dislikes or refuses to let me brush his/her teeth?

Even if your child resists brushing, it is still very important to brush the teeth twice a day. You can try brushing in front of a mirror or taking turns with your child. You can also try having your child hold a larger, thicker handled toothbrush while you use a thinner handled toothbrush to brush the teeth. In this way, the thicker toothbrush acts as a “door stop” that your child can bite on to keep his mouth open while you follow through with the thinner toothbrush. Finally, you can try blowing bubbles or singing a special song while you are brushing your child’s teeth. That way your child associates this special activity with tooth brushing; but keep in mind that this only works if you reserve the blowing bubbles or other special song for tooth brushing.

What should we do if we don’t have fluoride in our water ?

If your water does not contain fluoride, ask your pediatrician or dentist about fluoride supplements starting at six months old.

Paria Hassouri, MD

Always something-those rubber bands

2010-03-03T03:57:00Z

The newest trend in kidville- trading rubber bands in various shapes. The kids wear the bands like bracelets and strut around with the colorful bands jutting out in all directions from their arms and wrists. The elementary school crowd is fascinated by them. Teachers, who find them a distraction, are not as enamored. Somewhere there is one teacher today who is particularly appalled. During a check up, a nine year old told me today that a classmate was sent to the nurse's office- the reason? The bands were on so tight that they were cutting off circulation to the classmate's arm.

Always something.

Naline Lai, MD

Holes In Your Head: Sinus Infections

2010-03-01T02:55:00Z

You have a hole in your head.

Actually, you have several.

You, your children, and everyone else. These holes are called sinuses.

These dratted air pockets in your skull can fill with puss and cause sinus infections. Scientists hypothesize they once helped us equilibrate water pressure during swimming. Now, sinuses seem only to cause headaches.

Sinuses are wedged in your cheek bones (maxillary sinuses), behind your nose (ethmoid sinuses) and in the bones over your forehead (frontal sinuses). When your child has a cold or allergies, fluid can build up in the sinuses. Normally, the sinuses drain into the back of your nose. If your child's sinuses don’t drain because of unlucky anatomy, the sludge from her cold may become superinfected with bacteria and becomes too thick to move. Subsequently, pressure builds up in her sinuses and causes pain. A sinus infection of the frontal sinuses manifests itself as pressure over the forehead. The pain is exacerbated when she bends her head forward because the fluid sloshes around in the sinuses. Since frontal sinuses do not fully develop until around ten years old, young children escape frontal sinus infections.

Another sign of infection is the increased urge to brush the top row of teeth because the roots of the teeth protrude near the maxillary sinuses. Bad breath caused by bacterial infested post nasal drip can also be a sign.

The nasal discharge associated with bacterial sinus infections can be green/yellow and gooey. However, nasal drainage from a cold virus is often green/yellow on the third to fourth day. If your child has green boogies on the third or fourth day of a cold, does not have a fever, and is comfortable, have patience. The color should revert to clear. However, if the cold continues past ten days, studies have shown that a large percentage of the nasal secretions have developed into a bacterial sinus infection.

Because toddlers in group childcare often have back-to-back colds, it may seem as if he constantly has a bacterial sinus infection. However, if there is a break in symptoms, even for one day, it is a sign that a cold has ended.

Hydrate your child well when she has a sinus infection. Your child's body will use the liquid to dilute some of the goo and the thinner goo will be easier for her body to drain. Since sinus infections are caused by bacteria, your pediatrician may recommend an antibiotic. The usual duration of the medicine is ten days, but for chronic sinus infections, two to four weeks may be necessary. Misnamed, "sinus washes" do not penetrate deep into the sinuses; however, they can give relief by mobilizing nasal secretions. When using a wash, ask the pharmacist for one with a low flow. Although the over the counter cold and sinus medicines claim to offer relief, they may have more side effects than good effects. Avoid using them in young children and infants.

Who knows. Someday we'll discover a purpose to having gooey pockets in our skulls. In the meantime, you can tease your children about the holes in their heads.

Naline Lai, MD
© 2010 Two Peds in a Pod

How to Help Your Bedwetting Child

2010-02-21T02:47:00Z

“Help, Mommy, Daddy, I wet the bed!”

As you wash yet another set of bed sheets and wet pajama bottoms, you may be wondering WHEN your child will stay dry at night and WHY your child still wets the bed when his friends, or worse yet, his younger siblings, are dry. This article will address primary bedwetting (doctors call this “primary nocturnal enuresis”), or kids who have NEVER been dry at night. Children who have had months or years of dry nights and then start bedwetting consistently need to be evaluated by their health care providers to rule out medical causes of new bedwetting.

Here are a few things parents of bed-wetters should know.

Most children master staying dry during the day BEFORE staying dry during the night. Only a small number of children actually wake up dry in the morning before they start potty training. Daytime dryness is under your child’s cognitive control. Night time dryness is not learned or controlled by your child’s rational brain, but rather is a function of your child’s bladder being mature enough to send a WAKE UP!! signal to your child. Quick hint here: nightmares can result from a full bladder. As you comfort your child from a bad dream, don’t forget to take him to the bathroom.

About 80 percent of children are dry overnight by age four. They sleep through the night and wake up dry or they wake up once to urinate in the bathroom and go back to bed. What about the other 20%? Each year after age four years, about 10% of kids who are wet at night become dry without any intervention. Genetics play a big role in this. If one parent was a bedwetter until age 7, for example, then the child has a 35% chance of bedwetting until this age. If both parents wet the bed until school age, then their child has at least an 80% chance of being just like Mom and Dad.

However, some kids just wet the bed even though their parents were dry at an early age. Regardless, parents can help.

· Do NOT punish your child for wetting the bed. It truly isn’t his fault.

· It is reasonable to limit fluid intake in the few hours before bed but do allow your child to drink water if thirsty or with teeth brushing.

· By all means let your child wear training pants at night or at least put some form of water repellant mattress protector on your child’s bed. These are not “crutches” or “enablers” but rather save you from having to wash sheets and mattresses.

· Not all kids are actually upset about bedwetting, but they can become very upset if parents let them feel that way. Reassure your child that someday “the pee pee will wake you up to go potty in the night” just like it tells your child to go to the bathroom during the day.

If your child is old enough to become self-conscious or to have his self-esteem impacted by his bedwetting (somewhere between the ages of 8 to 10 years, usually, because sleep-overs and camp gain popularity at these ages), there are a few ways to help your child approach potentially awkward situations.

1) Have the sleep-over at your house and have your child’s absorbent training pants already in the bed hidden under the covers. Your child can put them on after “lights out.”

2) Tell your child he does not have to share the reason for not wanting to sleep away from home.

3) Alternatively, he can tell his friends that YOU, the meanie parent, will not allow him to attend sleepovers yet.

If your child is motivated to try to become dry overnight, you can try a bedwetting alarm system. These systems work well over a period of several months. With alarms, both parents and child have to be active participants. Alternatively, you can talk to your child’s health care provider about medicine called DDAVP that can give a “quick fix." The medication can keep your child dry on the night he takes the medicine. The medicine comes in pill form and can either be used for sleepovers only or can be taken for a few months at a time to help your child feel better if self-esteem is becoming compromised by bedwetting. Note that even after months of dry nights on medicine, your child will likely bed wet if the medicine is stopped. However, there is also a chance that nature will have taken over and by the time the medication is stopped, your child will have reached the age that his body was programmed to stay dry at night.

Of course, your child’s health care provider can help ensure that your child merely has an immature bladder-to-brain messaging system and not any other cause of his bedwetting. Your doctor can also help evaluate if your child’s self esteem is affected by his bedwetting.

While not the most glamorous part of the parenting game, washing up after a bedwetting child and keeping a positive attitude for him are very important. The next time you will play this supportive role is when you become grandparents and your former bedwetter calls you for advice about his own bedwetting child.

Julie Kardos, MD
©2010 Two Peds in a Pod

Dry winter skin - guidance from a guru

2010-02-17T14:36:00Z

It's that itchy, scratchy time of year. Today our guest blogger, dermatologist Mary Toporcer MD, gives us hints on how to combat dry skin. For the past 21 years, Dr. Toporcer has practiced general medical dermatology in Doylestown, PA. She did her dermatology training at Hahnemann University and at St Christopher's Hospital, both in Philadelphia, PA.

Many patients suffer from severe dry skin (xerosis) in the winter when the air is cold and the humidity low. Those who are atopic (have a personal or family history of eczema, allergies, asthma, hayfever or sinus problems) are much more affected by their environment. A few MUST DO's include:

1. Moisture every day especially after bathing with Cerave Cream or Lotion. It contains ceramides which "waterproofs"the skin and keeps moisture in, but without that greasy feel.

2. Use gentle soaps such as Dove in the shower and keep the shower water luke warm, not hot. Hot water just irritates and ultimately dries the skin even more. It also increases itch.

3. Avoid irritants such as anti-static sheets in the dryer. Even if they say "free", they still put a coating on your clothing in an effort to prevent it from sticking together. This substance is very irritating to dry, sensitive skin. Liquid, fragrance-free fabric softener is much gentler on skin.

4. Lastly, for those terribly dry, scaly, fissured hands and feet, try vaseline or Aquaphor under the soft stretchy gloves and socks that you can buy at Bath and Body Works...they're often impregnated with aloe for extra moisture.

Mary Toporcer, MD

Count down the pounds: six simple guidelines to helping overweight children

2010-02-14T03:55:49Z

A common question that many parents ask us in the office is “How can I help my overweight child?”

Our newest podcast provides six simple rules for healthy eating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed your children, how to portion their foods, and how to change their behavior to help them lose excess pounds and maintain a healthy weight.

(If the podcast is not embedded in your RSS reader page, visit the www.TwoPedsInAPod.com home page directly.)

Julie Kardos, MD and Naline Lai, MD

Of body odor, UGGs and arm pits- your stinky tween

2010-02-11T16:00:00Z

Your nine-year-old sweetie pie still has baby fat on her cheeks and the changes of puberty have barely started, yet you find yourself in the aisles of a pharmacy scratching your head over the best starter deodorant. Yes, the dreaded body odor has started. Much to the consternation of parents in my office, adult-like body odor appears before periods and voice changes.

What to do about stinky armpits in tweens? Antiperspirants can be very irritating to skin. For a first deodorant, chose something like Tom’s of Maine- natural care, which does not contain antiperspirants. For some kids, a cornstarch powder works well.

For stinky feet, make sure the kids wash with soap daily-this can be tough for a kid who is just learning how to balance in the shower.

The bacteria which causes athlete’s feet can lead to an unpleasant odor. Add a half-cup of vinegar to a basin of water and soak the feet once a day to kill the bacteria.

Keep their feet well moisturized with lotion. Contrary to popular belief, the more dry and flaky the feet, the more pungent they are.

Yes, those UGGs are fashionable, and the UGG care kit comes with an anti-stink spray; however, sheepskin and warm feet in an enclosed boot leads to stinky feet. I know it’s counter UGG culture, but remind your kids to wear socks with their shoes. In general change socks often. Kids tend to go from school to a sporting event and into bed with the same socks.

Even with these hints, if your child’s body odor remains strong, reassure your child that nobody, especially the kid he has a crush on, really notices. Besides, if you have a stinky kid, at least you’ll never lose him in the dark.

Naline Lai, MD
© 2010 Two Peds in a Pod

Art Therapy : a picture is worth a thousand words

2010-02-06T14:32:00Z

Art therapy allows children a means to express themselves when they are unable to articulate their feelings. Art not only serves as a mode of communication, but the process of creating art is healing. Today’s guest blogger is Sarah Kutchta. She hold a masters in art therapy from Albertus Magnus and a bachelors in fine arts from the University of Connecticutt and will soon be a LPC (Licensed Professional Counselor) as well. Sarah specializes in working with students with learning, mood, and autistic disorders. Ms. Kutchta gives us ways parents can communicate with their children through art:

• Give children the space and permission to get messy. Put down painting plastic if cleanliness is an issue. Having the freedom to create whatever is needed can be very helpful for kids.

• When discussing artwork with kids and adolescents, it is better to say "Tell me about your artwork," than to ask "What is that?" Asking what something may imply that the child's drawing is unclear or not good.

• If a child or adolescent is having difficulty expressing emotions or has difficulty regulating emotions, it is better to have the child work with an art therapist than trying to work out the issue with the parents and art. The process of art creation can be very powerful emotionally and it is best to work with a professional who can provide a safe and supportive therapeutic environment.

• Art therapists can be found by contacting the American Art Therapy Association, arttherapy.org/, or Pennsylvania's Art Therapy Association, dvata.org/ (Delaware's is now based in Penn). Many are both LPCs and Art Therapists and accept insurance.

Sarah Kuchta, BFA, MAAT

Art Therapist

How do I know if my baby has autism?

2010-02-03T16:38:00Z

Autism is a disorder of communication. Autistic children have difficulty relating to other people. Many parents are concerned about autism and ask me questions about how to know that their child does NOT have autism.

Tools for autism screens exist for older toddlers. For example, the M-CHAT is a standard autism screening tool used as young as 16 months and can be downloaded for free: http://www.firstsigns.org/downloads/m-chat.PDF.One hallmark of autism is delayed speech. This sign makes autism difficult to diagnose before the age of one year because language development really takes off after a child’s first birthday.

Here are some communication milestones that occur during the first year of life. Problems attaining these milestones can be indicative of autism or other communication disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays:

By six weeks of age, your baby should smile IN RESPONSE TO YOUR SMILE. This is not the phantom smile that you see as your baby is falling asleep or that gets attributed to gas. I mean, your baby should see you smile and smile back at your smile. Be aware that babies at this age will also smile at inanimate objects such as ceiling fans, and this is normal for young babies to do.

By 2 months of age, babies not only smile but also coo, meaning they produce vowel sounds such as “oooh” or “aaah” or “OH.” If your baby does not smile at you by their two month well baby check up visit or does not coo, discuss this delay with your child’s health care provider.

By four months of age, your baby should not only smile in response to you but also should be laughing or giggling OUT LOUD. Cooing also sounds more expressive (voice rises and falls or changes in pitch) as if your child is asking a question or exclaiming something.

Six-month-old babies make more noise, adding consonant sounds to say things like “Da” and “ma” or “ba.” They are even more expressive and seek out interactions with their parents. Parents should feel as if they are having “conversations” with their babies at this age: baby makes noise, parents mimic back the sound that their child just made, then baby mimics back the sound, like a back and forth conversation.

All nine month olds should know their name. Meaning, parents should be convinced that their baby looks over at them in response to their name being called. Baby-babble at this age, while it may not include actual words yet, should sound very much like the language that they are exposed to primarily, with intonation (varying voice pitch) as well. Babies at this age should also do things to see “what happens.” For example, they drop food off their high chairs and watch it fall, they bang toys together, shake toys, taste them, etc.

Babies at this age look toward their parents in new situations to see if things are ok. When I examine a nine month old in my office, I watch as the baby seeks out his parent as if to say, “Is it okay that this woman I don’t remember is touching me?” They follow as parents walk away from them, and they are delighted to be reunited. Peek-a-boo elicits loud laughter at this age. Be aware that at this age babies do flap their arms when excited or bang their heads with their hands or against the side of the crib when tired or upset; these “autistic-like” behaviors are in fact normal at this age.

By one year of age, children should be pointing at things that interest them. This very important social milestone shows that a child understands an abstract concept (I look beyond my finger to the object farther away) and also that the child is seeking social interaction (“Look at what I see/want, Mom!”). Many children will have at least one word that they use reliably at this age or will be able to answer questions such as “what does the dog say?” (child makes a dog sound). Even if they have no clear words, by their first birthday children should be vocalizing that they want something. Picture a child pointing to his cup that is on the kitchen counter and saying “AAH AAH!” and the parent correctly interpreting that her child wants his cup. Kids at this age also will find something, hold it up to show a parent or even give it to the parent, then take it back. Again, this demonstrates that a child is seeking out social interactions, a desire that autistic children do not demonstrate. It is also normal that at this age children have temper tantrums in response to seemingly small triggers such as being told “no.” Unlike in school-age children, difficulties with “anger management” are normal at age one year.

As an informal screen for autism, children below one year of age should be monitored for signs of delayed or abnormal development of social and communication skills. Home videos of children diagnosed with autism reveal that even before their first birthdays, many autistic children demonstrate abnormal social development that went unrecognized.

Following the above guides and discussing your child’s development at all well child care check-ups will help you to pick out “red flags” that can prompt closer attention and further work up if indicated.

Julie Kardos, MD
©2010 Two Peds in a Pod

Speech and Language Milestones

2010-01-31T19:40:00Z

Remember Elmer Fudd from the Bug Bunny cartoons? He was the hunter who would say “Where’s the wascally wabbit?” instead of “Where’s the rascally rabbit?” Think how frustrated Elmer was as a kid when his parents and teachers didn’t understand him.

Unclear speech or lack of speech development can be a sign of hearing loss or an inability to communicate (autism, retardation or developmental delay). Amy King, MA, CCC-SLP with over 12 years as a speech therapist outlines important speech and language milestones to watch for:

Receptive Language Milestones- what your child understands (children should be doing these things by the time they reach the year marker)

By the time they are:

1 year: shakes head to respond to simple questions such as “Want milk?” and identifies some body parts

2 years: Follows 1 step directions- “Go get the ball.”

3 years: Follows 2 step directions- “Go get the ball and give it to daddy.”

4 years: Understands if/then- “If you pick up your toys, then you can help Mommy make a cake.”

5 years: Follows 3 step directions- “After you wash your hands, get the napkins and put them on the table.”

Expressive Language Milestones- what your child is able to say

1 year: 1 word

2 years: 2 word sentences- two words with one meaning such as “thank you” does not count. Expect phrases such as “mommy up” for “mommy, pick me up.”

3 years: 3 to 5 words—Dr. Kardos tells parents think Cookie Monster from Sesame Street: “me want cookie”

4 years: 4 to 7 word sentences with consistent correct use of parts of speech (nouns, verbs, adjectives, pronouns, prepositions, etc.): “I want to go to the park.”

Speech Milestones- phonetics (sounds should be produced accurately and consistently in words and phrases)

By the time they are:

3 Years: sounds of the letters: m, b, p, h, w, n, f,

4 Years: t, k, g, ng, s, r, sh

5 Years: z, l, v, y, th, wh, ch

6 Years: j, st, br, cl, r (by now if not before)

Speech Intelligibility -how well strangers understand your child

2 Years: at least 25%-50% of what your two year old is saying

2 ½ Years: at least 60%-75% of what your two and a half year old is saying

3 Years: at least 75%-90% of what your three year old is saying

4 Years: at least 95% of what your four year old is saying

Fluency- stuttering

Stuttering is normal in the preschool years. Be sure to give the child time to say what she is trying to say. Dr. Lai likes to think of a preschool stutterer as a child whose mind is thinking faster than he can move his mouth. If stuttering lasts more than 6 months and is accompanied by facial contortions, grimaces, or repetitive body movements, speak to a medical professional.

Red flags that always need further workup:

o Does not coo by 4 months of age

o Does not babble by 9 months of age

o Child does not respond to his/her name by 9 months of age

o Child does not look at you, others or objects upon request by 9 months of age

o Does not gesture (point, wave, grasp, etc.) by 12 months of age

o Child does not respond to your simple verbal requests (e.g., “Look!”, “Wave bye-bye”, “Come here”, “Give a kiss,” etc.) by 12 months of age

o Does not say single words by 16 months of age

o Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age

o Loss of any language or social skill at any age

Amy King, MA, CCC-SLP

More than meets the pink eye- the tale of bacterial conjunctivitis

2010-01-27T10:46:00Z

Pink eye. Yuck. More appropriately, pink eye, or bacterial conjunctivitis, should have been named “gooey eye.” Caused by bacteria, the thin layer over the eyeball becomes infected. Only after the gooey pus produced by the infection irritates the eye will the white of the eye turn red.

I call pink eye the goo that will not go away. When your child has a cold he may wake up with crusty eyes. But after you clean them up, the gooey discharge goes away until the next nap. If your child has pink eye, be on the lookout for other bacterial infections. When there is infection in the eyes, there may be infection in nearby parts of the body such as the ears or sinuses.

Antibiotic eye drops are the treatment for pink eye. After starting treatment, your child is contagious for 24 hours. Call your child’s school for their specific school/daycare exclusion recommendations. In general it is one day after starting treatment. Even if the infection is in one eye, to prevent spread into the other eye, place drops in both.

To prevent pink eye from spreading through your home, wash your hands before and after treating your child with drops, give your child his own towel to use, and in general try to prevent touching your own eyes after touching things your child has touched, such as toys.

If your child has pink eye, the infection may spread into the skin surrounding the eye as well as back into the eye socket. If there is swelling, redness, or tenderness of the upper or lower eyelids, the infection may be spreading. New high fever in a child with these symptoms can also herald a more severe infection.

A cold can predispose your child to pink eye. Bacteria love to brew in the nose during a cold and you don’t want to inadvertently place nasal discharge from the nose into the eyes. Teach your child to wash his face from top to bottom.Wash eyes, then nose, then mouth. Pictured above is one of my patients who had pink eye.

The next you see boogies coming from the eye, even if the white of the eyes are clear… think pink.

Naline Lai, MD
© 2010 TwoPeds in a Pod

Binge Drinking in College Students: What parents need to know

2010-01-23T15:35:00Z

Dr. Dave, a friend of Dr. Kardos, is a physician in a Student Health Center at a respectable college in a large city. Here is an alarming, yet typical, scenario involving binge drinking that Dr. Dave encounters on a too-frequent basis.

A 19 year old young man comes in to the Student Health Center very concerned because he had woken up that morning in an apartment in bed with a woman he did not know. He had been out with friends drinking at a bar (a frequent occurrence), vaguely recalls meeting a woman, but had so much to drink that he cannot even recall leaving the bar, let alone what happened afterward. His greatest concern is that he has no idea if he used a condom (he left before she woke up), and thus could have been exposed to HIV and other sexually transmitted infections.

Ironically, this student is worried about exposure to sexually transmitted diseases but not about the root of his problem: binge drinking. In other words, he is worried about sexually transmitted diseases but not about his drinking which caused his potential exposure to dangerous diseases.

Here is what Dr. Dave, a career student health doctor, wants parents of college students to know about binge drinking in college students:

Although alcohol use is often considered a rite of passage for college students, it is also one of the major health risks for this age group. Alcohol-related health problems can present in a variety of ways and do not have to involve any signs of dependency. Among college-aged students, the most common manifestation of alcohol abuse comes from the consequences of binge drinking.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports the following sobering statistics regarding annual health risks directly attributed to alcohol use among college students between the ages of 18 and 24. These statistics also serve as an important reminder that a person does not have to be drinking to be adversely affected by alcohol abuse.

· 1,400 student deaths from alcohol-related unintentional injuries (including motor vehicle accidents)

· 500,000 unintentional student injuries

· More than 600,000 cases of student-on-student assault

· More than 70,000 cases of sexual assault or date rape

· 400,000 students having unprotected sex and more than 100,000 students too intoxicated to remember if sex was consensual.

The first 6 weeks of the first semester of college is an important predictor of first year academic performance and is an important window period to monitor for any significant changes in a new student’s behavior and lifestyle habits. Parents can help by being aware of these issues and by being open to speaking with their children about the potential risks of alcohol use both before and during the college experience. A simple rule of thumb for parents is to stay involved, while still allowing their children the space necessary for learning, exploring, and maturing into adulthood.

If your child begins to exhibit unusual behavior, such as lower grades, mood changes, or a new unwillingness to talk to you, this behavior should prompt you to find out more.

Additional information is available at http://www.collegedrinkingprevention.gov/.

Dr. Dave, MD is a physician who has been working in college health since 2000.

“Baby, it’s Cold Outside” Frost bite: early treatment and when to seek help

2010-01-20T05:43:00Z

Three little kittens, they lost their mittens, and they began to cry.

Oh, mother dear, we sadly fear That we have lost our mittens.

What! Lost your mittens, you naughty kittens!

Then you shall have no Nintendo DS

-the modern version of a traditional poem

It’s only January and pictured here is a photo of my three kittens’ mittens (gloves) which are already missing mates.

Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.

Early signs of frostbite include tingling or achiness. Without treatment, the area will become pale and lose all sensation.

If you suspect your child’s hands are starting to become frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water. Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful. Warm for at least half an hour even if it is painful.

Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.

Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water. No higher because then it's like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.

For a recent interesting, but somewhat technical article with photographs on a case of frostbite, check out the New England Journal of Medicine, N Engl J Med 2009;361:2654-62

Naline Lai, MD

Friends of Children Disaster Relief Fund

2010-01-16T16:00:00Z

Haiti, one of the poorest countries in theWestern Hemisphere, was struck by a devastating earthquake last week.

If you are looking for a way to help the children, consider donating to the American Academy of Pediatrics Friends of Children Disaster Relief Fund. The American Academy of Pediatrics has used this fund in the past to respond to disasters that affect children in the US, such as hurricanes Katrina and Ike, and worldwide, such as recent earthquakes in China.

The fund provides emergency relief to pediatricians and the children they treat by:

• Addressing primary health care needs ofchildren;

• Supporting medical services (example: power generators for medical facilities, replacement of medical equipment damaged by the disaster);

• Supporting future disaster preparedness and response programs with a special focus on children.

http://www.aap.org/donate/fcfdonate.htm

Fever: What's Hot and What's Not, Part 2

2010-01-15T22:26:00Z

Here is how to tell if your child is VERY ill with fever vs not very ill:

Any temperature in an infant younger than 8 week old that is 100.4 (rectal temp) degrees or higher is a fever that needs immediate attention by a health care provider, even if the infant appears relatively well.

Any fever that is accompanied by moderate or severe pain, change in mental state (thinking), dehydration (not drinking enough, not urinating because of not drinking enough), increased work of breathing/shortness of breath, or new rash is a fever that NEEDS TO BE EVALUATED by your child’s health care provider. In addition, a fever that lasts more than three to five days in a row, even if your child appears well, should prompt you to call your child’s health care provider, who most likely will want to examine your child. Reoccurring fevers should also be evaluated.

Should you treat fever? Given the information from above and from Part 1 of this fever blog post, you may have concluded that fever is an important part of fighting germs, and in fact I do NOT advocate treating fever UNLESS the side effects of the fever are causing harm. Reduce fever if it is preventing your child from drinking or sleeping. If your child is drinking well, resting comfortably or playing, or sleeping soundly, then he is handling his fever just fine and does not need a fever reducing agent just for the sake of lowering the fever.

A note about febrile seizures (seizures with fever): Some unlucky children are prone to seizures with sudden temperature fluctuations. These are called febrile seizures. This tendency often runs in families and usually occurs between the ages of 6 months to 6 years. Febrile seizures last fewer than two minutes. They usually occur with the first temperature spike of an illness (before parents even realize a fever is present) and while scary to witness, do not cause brain damage. No study has shown that giving preventative fever reducer medicine decreases the risk of having a febrile seizure. As with any first time seizure, your child should be examined by a health care provider, even if you think your child had a simple febrile seizure.

I refer you to our “How sick is sick?” blog post for further information about how to tell when to call your child’s health care provider.

Fever: What's Hot and What's Not, Part 1

2010-01-12T02:04:00Z

So now that your children have been back in school, there has been plenty of opportunity for germs to circulate. In addition to washing hands, your child’s body has many ways to fight germs. I receive many worried questions about fever, so here is what every parent needs to know:

Fever is a sign of illness. Your body makes a fever in effort to heat up and kill germs without harming your body.

Here is what fever is NOT:

· Fever is NOT an illness.

· Fever does NOT cause brain damage.

· Fever does NOT cause your blood to boil.

· Unlike in the movies and popular media, fever is NOT a cause for hysteria or ice baths.

· Fever over 100 degrees F is NOT a sign of teething.

Here is what fever IS:

· Fever is a body temperature that is equal to or higher than 100.4 degrees F rectally in a newborn until the age of 8 weeks old.

· Fever is a body temperature of 101 degrees F or higher in anyone older than 8 weeks old.

· Fever is a very effective defense against disease.

To understand fever, you need to understand how the immune system works.

Your body encounters a virus or bacteria (germ) that it perceives to be harmful. Your brain sends messages to your body to HEAT UP and kill the germs. Your body will never let the fever get high enough to harm itself or to cause brain damage. Only if your child is experiencing Heat Stroke (locked in a hot car in July, for example) can your child get hot enough to cause death. This is because the heat source is EXTERNAL (a hot car) and not generated by your child’s body.

When your body has succeeded in fighting the germ, the fever goes away. If you “treat” the fever with a fever reducing agent (Tylenol, Motrin, etc) the fever goes away temporarily but WILL COME BACK if your body still needs to kill off more germs.

Symptoms of fever include: feeling very cold, feeling very hot, muscle aches, headache, and/or shaking/shivering.

Fever may be a sign of any illness. Your child may develop fever with cold viruses, the flu, stomach viruses, pneumonia, sinusitis, meningitis, appendicitis, measles, and countless other illnesses. The trick is knowing how to tell if your child is VERY ill or just having a simple illness with fever.

Stay tuned for how to tell.