Pediatrician to Parent

Beat the Heat – Preventing Heat-Related Illness in Children

Carol Green, M.D.
Kelsey-Seybold Pediatric Hospitalist
St. Luke's Episcopal Hospital

With our recent weather heating up to daily temperatures of 100 degrees and higher, heat illness has become a rising concern for parents and pediatricians alike.

I have treated patients with heat illness in the emergency room and the inpatient ward at Texas Children's Hospital – thankfully not many.

During heat illness, the body’s ability to cool down is impaired and body temperature increases. Initial symptoms of heat illness include thirst, fatigue and cramps. Later headache, dizziness, nausea or vomiting, pallor, clammy skin and increased heart rate can occur.

If your child shows these symptoms, seek a cool place for them to rest, cool down them down with water spray, fan them, and call 911 for help. 

Children and elderly are most vulnerable to the effects of high temperatures, but there are a few things you can do to try to prevent heat-related health problems:

• Stay inside and use air conditioning during the hottest times of the day, usually between 2 p.m. and 5 p.m.
• Reduce strenuous activity and schedule exercise for the early morning or evening during the cooler times of the day.
• If your children are involved in outdoor sports or activities, they should wear light, loosely fitted clothing and drink plenty of fluids before, during and after their activity.
• Be cautious of playground equipment, such as slides and monkey bars that can become very hot on a sunny day.

As a last word, never ever leave your child in the car on a hot day, even for a few minutes, as cars can heat up quickly like an oven.

How is your child eating?

By David H. Barry, M.D.
Humble Clinic 

At every well checkup, one of my questions to parents is: “How is your child eating?” Many parents will answer that he or she is a picky eater.
 
Most commonly, these picky eaters are toddlers or preschoolers and their growth charts show that they are growing quite well. Parents can be assured that if they provide nutritious food, and are patient, their child will grow out of it. 

The United States Department of Agriculture has established dietary guidelines for people ages two years and older. The guidelines include foods that many children do not like, such as vegetables, fruit, meat and milk.  

Unfortunately almost all children enjoy sweets, chips and sugary drinks, and if left to their own devices, would only eat them instead of the food they really need. 

The best solution to the junk food problem – don’t buy it! Children will eventually come around to eating what their parents eat, but a food may have to be offered 10 times before a child will take it. 

Bribery and threats end up making kids worse eaters. Youngsters are more likely to eat a food that mom says “tastes good” rather than a food presented as “good for you.” 

Children of all ages like to learn. Taking them to the grocery store to choose food and involving them in preparing it will make them more likely to try something new. Try reading to them about food and eating.

A special word in favor of milk: It tastes great, but the soda and sports drink industry has crowded it off the diets of many children. The effects are seen in the health of their bones and even their height. Children 2 to 8 years old need two cups of low-fat milk or an equivalent dairy product per day, 9 to 12 year olds need three and adolescents four!

 

Don’t Let Swimmer’s Ear Keep Your Children Out of the Water this Summer

By Dr. David Weed, M.D.
Kingwood Clinic 

With all of this summer’s heat, swimming is a great pastime to keep cool and to exercise at the same time. However, the combination of heat, water and humidity can cause an acute otitis externa, commonly known as swimmer’s ear.

Here are some easy tips to follow to prevent and treat swimmer’s ear:

1. Use a bathing cap, ear plugs, or ear molds to keep the water out of the ears.
2. Dry your ears thoroughly after swimming or bathing.
3. Use a commercial product, such as Swim Ear, or make your own drops with a 1-to-1 mixture of rubbing alcohol and white vinegar. Put two or three drops in the ear canals before and after swimming for the day.  
4. Do not use drops if you have ear tubes, damaged ear drums or there is a possibility of ear infection. 
5. Don’t remove ear wax. It helps protect your ears from swimmer’s ear.  

Signs of a swimmer’s ear may exist if you have: 

• Ear drainage 
• Pain in the outer ear when you touch it
• A swollen ear
• If your ears are itchy or flaky

If any of these symptoms occur, be sure to call your pediatrician so you can be treated appropriately.
Treatment usually consists of prescription antibiotic ear drops for several days. It is not recommended that you go swimming while being treated for swimmer’s ear unless you wear well-fitted ear plugs.  

These helpful tips will insure that you have a fun time in the water this summer without the hassles of a swimmer’s ear.

 

 

 

The ‘What’ and ‘How’ of Fevers

By Dr. Anjana Dhingra
Pediatrics – Fort Bend Medical and Diagnostic Center

Your child has a fever. So what do you do? When should you call your doctor and what could be causing this escalation in temperature?

Let’s look at the basics of fever.

Normal oral temperatures can range from 97.5 to 99.5 degrees Fahrenheit. A rectal temperature of 100 degrees or less is considered normal. Any temperature equal to or greater than 101 degrees taken orally or rectally is considered fever.

Temperatures of 104 degrees or greater is considered high fever and requires treatment. Most lower degrees of fever are treated to reduce the discomfort associated with fevers. 

It might be an infection.
Raised body temperature or fever occurs when there is an increase in body metabolism, which is sometimes caused by inflammation. Most inflammation in children occurs due to infections.

Other reasons for increased body temperatures, such as a heat stroke, noninfectious inflammation, such as in rheumatoid diseases and cancer, are rare in children. So a child with a fever can be presumed to have an infection.

Is the fever due to a serious or non-serious illness?
If the child looks sick even after giving them fever medicine and the fever has been reduced, it is time to take them to their pediatrician. Other serious symptoms can be excessive cough, breathing difficulty or pain that isn’t reduced with medicine.

Medications – When and How much should I give?

Medications containing acetaminophen (10-15 mg/Kg) can be given every four hours or those containing ibuprofen (5-10 mg/ Kg) can be given every six hours to reduce fever.

Only one or the other should be used, but if fever is not coming down with ibuprofen alone, acetaminophen can be added in between the doses of ibuprofen, such as ibuprofen at 9 a.m., acetaminophen at noon, Ibuprofen at 3 p.m. and so on.

Ibuprofen is better at night because it lasts 6 to 8 hours and can help relieve severe pain such as ear aches or any musculoskeletal injury pain. It can also help reduce high-grade fevers (between 103 and 104 degrees. Caution - do not use ibuprofen for children under 6 months old.

The Dreaded Stomach Virus

By Sophie Lung
Pediatrician - The Woodlands

Everyone has suffered from the stomach virus at some point or another. Even worse than experiencing it for yourself is watching your child experience it.

Typical symptoms of stomach viruses include vomiting, diarrhea and abdominal pain. Some children also experience fever with these symptoms.

Most of the time, you can manage stomach viruses at home if you can keep your child hydrated. While your child has an upset stomach, encourage clear fluids such as water or Pedialyte. Avoid fruit juices and milk because these fluids can worsen diarrhea. 

If your child is able to eat, give them bland foods. You may have heard your doctor refer to the BRAT diet - this stands for Bananas, Rice, Applesauce and Toast. These foods will be less irritating to the stomach than your child's usual favorites. This is not the time to be eating pizza and fried chicken, so don't feed them anything too heavy or greasy! 

You should call your doctor if your child has severe vomiting, bloody vomiting, bloody stools, severe abdominal pain or appears to be getting dehydrated. Signs of dehydration include dry mouth, dry eyes, or decreased urination. Check with your doctor if you have any other concerns.

Breast Feeding: Education Benefits the Doctor-Parent Team

By Dr. David H. Barry 
Kelsey-Seybold - Humble Clinic

As doctors, we’re continually learning about advances in medicine and technology. We use this knowledge to educate our patients.

Last fall I attended an educational meeting at the Woman’s Hospital of Texas for nursing and medical staff titled “Supporting Breast Feeding When Challenges Occur.” The meeting was part of a global effort sponsored by the World Health Organization and the United Nations Children’s Fund that began in 1989 to promote breast feeding.

Such meetings are a requirement for the Woman’s Hospital of Texas, an affiliate of Kelsey-Seybold Clinic, to be certified as a “Baby Friendly Hospital.” 

Other requirements include:

• Prenatal education about breast feeding.
• Helping mothers start nursing within half an hour after birth.
• Showing mothers how to nurse and maintain lactation, even if they are separated from their infants.
• Not giving the baby any drink besides breast milk unless medically indicated.
• Co-bedding and feeding on demand.Not giving babies any pacifiers.

The goal is to get all babies started on nursing and staying with it more than half-time for six months.

I’ve had the opportunity to see these methods implemented first-hand in my own family. In the past two-and-a-half years, our daughter and daughter-in-law have successfully nursed their babies. The one thing that has made it easier for them, than it was for their mothers to breast feed when they were babies, is the wide availability of electric breast pumps. 

Breast pumps come in handy when the mother can’t breast feed directly. 

Whenever we watch our grandbabies, the refrigerator has an ample supply of little plastic bags of milk with dates on them. They last a week in the refrigerator and can be heated in a hot water bath. The babies do settle for the bottle and mom gets a break!

Getting Them Out of Your Bed

By Dr. Felicia Workeneh
Kelsey-Seybold - Silverlake Clinic 

Most of us know that babies should sleep in a bassinet or a crib from the time of birth. It is safer for the child, since many moms are sleep deprived and fall into a deeper sleep than usual.
 
This can result in moms rolling over on the child without realizing it. Also parents’ beds are usually more cushioned than advised for an infant and are strewn with comforters, blankets, etc., which increase the risk of suffocation.

Despite recommendations many families find themselves co-bedding with their infant, either due to the child crying excessively while in the crib, or because it’s easier to tend to the child when they wake up in the middle of the night.
 
For whatever reason, co-bedding is a common occurrence and parents may find it difficult to transition their child back to the crib when they are finally ready.
 
If they are old enough to walk or climb, this becomes a difficult task because they can leave their bed at will. However, if you train them early as small infants, it can be easily accomplished with an excellent success rate.
 
This usually just takes resolve on the parents’ part. Assuming the child is old enough to go a whole night without a feeding (about 3 to 4 months old), the infant will learn it is pointless to continue crying if the parent lets the child remain in the crib. In one week, the average child will usually be trained to sleep in their own crib.

One of the most frequent questions from parents is “How do I know if something is wrong with the child?” My answer to this is to equip the baby bed with a monitor, or discreetly take a peak in the room to make sure the child is not hurt. However, the parent should not pick the child up even if they are checking on them.

I also forewarn parents that they should mentally prepare themselves for this task by setting a date in which to begin a seven-day trial. The parent needs to know the child may carry on for a few hours with the screaming and expect this.

Both dad and mom have to be on board with the plan. They also need to take on the challenge during a time of low stress. Adding sleep deprivation during a time of high stress is a recipe for disaster.

As long as you follow these steps, you will more than likely have a child that is sleeping soundly in their own crib without fuss and you will start to experience more restful sleep.

Important Sunscreen Facts for Fun in the Sun

By David Weed, M.D.
Pediatrics - Kingwood Clinic 

Spring is here already in Southeast Texas and summer is soon upon us. With outdoor sports, trips to the beach and just more fun time spent outside come more chances for sunburns.

Here are some helpful suggestions to keep you and your children safe from those painful sunburns and possible skin damage.

1. Don’t apply sunscreen to babies under 6 months of age. The effects of sunscreen on babies less than 6 months old has not been thoroughly tested enough to know if there are any harmful effects. It is best to keep them in protective coverings or in the shade.
2. The best sunscreens and sunblocks contain zinc oxide or titanium oxide as the active ingredients because they sit on top of the skin and are not absorbed into it.
3. Sunscreens and sunblocks should contain active ingredients that block harmful UVA and UVB radiation.
4. The SPF (sun protective factor) should be at least 30. This means that you can be out in the sun 30 times longer. 
5. To get the best protective value of sunscreens and sunblocks, you should apply them correctly. The sunscreen should be applied about 30 minutes before going outdoors. For adequate coverage, about 2 tablespoons should be used with each application. It should be applied every 2 hours, and even more often if you have been swimming or sweating heavily. 
6. Don’t forget to use lip balm that contains sunscreen to help prevent damage to your lips. 

No sunscreen or sunblock can completely protect you or your loved ones from sunburn or skin cancer. But by following these easy guidelines, you can go a long way in preventing them.

Have Kids, Will Travel

Jakeen W. Johnson, M.D.
Kelsey-Seybold Clinic - Kingwood

As we approach spring break and summer, most of us are excitedly planning family vacations. However, meltdowns, screaming at restaurants (or on airplanes) and flat-out refusals always seem to become a part of our “perfectly planned vacation.”

There is no simple recipe for a smooth vacation with young children, but there are a few simple tips that will guarantee you a better time.

Recognize the age of your child. This is one of the most important things to remember when planning a vacation. Will your 6-month-old truly enjoy a Disney vacation? Will a walking tour of Washington, D.C. be what your 3-year-old wants?

When making plans for family vacation, choose activities that are age-appropriate to ensure everyone has a fun time. And if mommy and daddy want to tour European, maybe try this one by yourselves and take your toddler to Sea World at another time (more fun for all involved, trust me).

What schedule? We’re on vacation, right? Wrong – especially if your young child remembers the importance of adhering to their home schedule. This includes meal time, snack time, and yes, nap time.

Adults can rip and run all over the place with a smile on their face, but young children can’t. You will be left with a screaming, hungry, exhausted toddler and cranky parents. Not a good combination.

After breakfast, try a short-lasting activity such as water play (don’t forget sunscreen). Follow up with lunch in a cool place and then settle down for nap. After nap time, try another activity. Short vacation activities scheduled around naps and meals are a perfect fit for small children.   

Have fun! It is so easy to get wrapped up in the excitement of planning a family vacation. So remember that some of the most rewarding events of parenthood can’t be planned.

Traveling with small children definitely presents some challenges and we’ve all been there. But following the above simple tips will allow more pleasant memories so you can enjoy your vacation and your children too.

Make Hand Washing A Healthy Habit

By Asma Siddiqui, M.D., F.A.A.P.
Kelsey-Seybold Clinic at The Woodlands 

Washing hands is one of the most important steps we can take to avoid getting sick and spreading germs. If clean running water is not accessible, use soap and available water. 

Can’t See Germs!
Germs hide on remote controls, keyboards, door handles, faucets, countertops, and bathroom doors. Many diseases are spread by people not washing hands properly Keep in mind that anti-bacterial soap is not as effective as regular soap at killing germs. Also keep in mind that anti-microbial wipes or towelettes are another option although they are not as effective as alcohol based sanitizers.

Use of Alcohol Based Hand Sanitizers
Alcohol based hand sanitizers, which don’t require water, are an excellent alternative to soap and water. If you choose to use a commercially prepared hand sanitizer, make sure that the product contains at least 60 percent alcohol.Kids Need Clean HandsChildren can stay healthy by encouraging them to wash their hands properly and frequently. 

To help prevent rushing, teach your children to wash their hands as long as it takes them to sing the “Happy Birthday” song twice. 

Hand washing reminders, such as a chart by the bathroom sink at child’s eye level ensures consistency and a daily routine. It is the parents’ responsibility to help their child learn good hand washing technique. 

Young children in childcare settings are at greater risk at respiratory and gastrointestinal diseases, which can easily spread to other family members. Washing hands several times a day by the caretakers can help prevent spreading of illnesses.

Remember!
Hand washing does not take much time or effort but it offers great rewards such as preventing illnesses and the spread of infections. Adopting this simple habit plays a major role in protecting your and child’s health.

Happy Washing!


Wash Hands the Right Way!

How to Wash Your Hands?

• Wash your hands with clean running water, warm or cold, and apply soap.
• Rub your hands together to make a lather and scrub the back of your hands, between the fingers, and under your nails.
• Rub your hands for at least 20 seconds.
• Hum the “Happy Birthday” song from beginning to end twice.
• Rinse your hands well under water.
• Dry your hands using a clean towel or air dry.

When Should You Wash Your Hands?

• Before eating
• After using the restroom
• After blowing your nose, coughing, or sneezing
• After changing diapers
• After touching garbage
• Before and after treating a wound
• After handing animals or animal wastes
• Before inserting or removing contact lenses
• After touching sick or injured people