Friday, June 27, 2014

Summer!

Summer is upon us, even in the Pacific Northwest.  And with it come adventures and great fun.  But let's keep those kids safe, healthy, and intellectually stimulated also.

Keep Them Safe
A little caution goes a long way toward a great, safe summer.
  1. Drowning, Dry and Wet:  Drowning typically occurs quietly and with little commotion.  A child can simply slip under the water and not come back.  Also, drowning can occur hours after the initial scare; this is usually referred to as "dry" or "secondary" drowning.  If you notice that your child is coughing, has chest pain or difficulty breathing, is fatigued, or is acting strange, consider secondary drowning and call your doctor, 911, or go to the Emergency Room.  For more information on drowning or secondary drowning, see my post, or this WebMD article.
  2. Sunburn:  Sun damage, especially sun burns, in childhood increase the risk for skin cancer later.  Sun damage can be prevented with a few steps.  Use an adequate amount of sunscreen with an SPF of 30 or higher with "broad spectrum" protection (UVB protection as well as UVA), and be sure your sunscreen is not expired.  Apply at least 15 minutes before going outside and reapply frequently (time depends on the product).  Experts recommend staying out of the sun between 10 and 3, and wearing protective clothing and UV blocking sunglasses when you are in the sun.
  3. Hydrate:  It's pretty easy to get behind on fluids, especially when you're a kid on the run in the sun.  Be sure your children always have a water bottle them, and figure out a way to make sure they drink from it even when you're not around.  Push fluids first thing in the morning, and whenever you have the opportunity.  We do lose electrolytes through sweat, so be sure to replenish these too.  However, you do not have to use major brand name sports drinks (they are high in sugar, and contain high fructose corn syrup and other ingredients I don't love).  Coconut water, miso soup, vegetable and chicken or beef broth all have great electrolytes.  You can simmer carrot or celery chunks in water for 30 minutes to make your own electrolyte rich vegetable broth.  Finally, there are some natural products on the market that you can buy (effervescent tablets or packets, and liquids); just be sure you read the labels!
  4. Concussions:  Obviously this is one to think about all year long.  Anytime a child is on any sort of moving vehicle, whether it's a bike, a balance bike, a scooter, or a skateboard, he needs a helmet, fastened, at all times.  Of course, concussions can happen any time; with a simple fall, or an injury sustained despite the helmet, or while playing sports.  If your child sustains a head injury, even if it seems minor, go see the doctor.  Concussions can be very serious, and education is very important.
  5. More summer safety articles can be found on MedicineNet, Baby Center, and Parents


Keep Them Moving
Not everyone gets extra time off over the summer.  This can mean the kids are at home while parents are at work.  It can be challenging to keep the kids stimulated while you're concentrating on work just as much as ever.  As a result, many kids actually gain weight over the summer.  I firmly believe in the importance of keeping kids active and intellectually stimulated (see "Keep Them Learning," below) throughout the summer.  One of the best solutions here is to sign up for summer camps.  Parent Map has a good list of camps; I especially like the "Camps In a Class By Themselves." Seattle Parks and Recreation also offers a wide range of camps, as does the YMCA.  Other solutions are to exercise or play as a family after work and on weekends, to start a "get moving" program in the family, and to limit access to screens and cars or buses.  Fortunately, most day cares and summer camps do include physical activity in their programming, but if the kids are home with a nanny, be sure you set the expectation for physical activity with the nanny.

Keep Them Learning
We know that all kids who do not participate in educational activities over the summer experience the "Summer Slide;" they lose math and reading skills, and perform more poorly on standardized tests at the end of the summer.  Kids from lower socioeconomic brackets experience even more of a slide than those from the upper brackets (another volunteer opportunity).  So be sure you continue your daily routine of reading with your kids every day throughout the summer.  And find some time to add in museums, summer camps (see links in "Keep Them Moving," above), and visits to the library.  (The Seattle Public Library has great summer reading and education programs).  If you are feeling really ambitious, look at starting a summer learning program at your school through Horizons

Keep Them Eating
Unfortunately, summer is a time of hunger for countless children.  Their normal free meal programs are just not available over the summer.  Coincidentally, if your family is more fortunate, you can benefit greatly by volunteering.  Volunteering brings family together, strengthens family bonds, and exposes kids to the world of those less fortunate, along with empowering them to do something about it.  So, why not find a place to volunteer this summer?  Make it part of your weekly routine.  Here's a great Seattle's Child article with more information including volunteer opportunities, and how to access summer eating programs for your own family.

Happy summer!  Be safe, and have fun!

I have no affiliations to disclose.  This post does not constitute medical advice.  If you have medical questions or concerns, call your doctor or 911.

Thursday, June 26, 2014

My Top 10 Avoidable Physical Dangers for Kids

As a naturopathic doctor, I don't see a lot of emergency cases. Parents tend to know when they need to go to the ER, so I generally see kids for their follow-up care. But, as a mom who is also a doctor, I ponder questions such as: what do I worry most about for my child? Here are the physical dangers I worry about most for my baby, his buddies, and my patients, that are preventable, or at least whose damage can be mitigated.
  1. Drowning
  2. Accidental Gun Shots
  3. Unrecognized Respiratory Distress
  4. Accidental Marijuana Ingestion
  5. Alcohol Poisoning
  6. Accidental Over the Counter Medication Overdose
  7. Falls From a Window
  8. Obesity
  9. Car Accidents
  10. Vaccine Preventable Illness
Here are some suggestions for avoiding these, or mitigating their damage.

Drowning: a far too common cause of death and disability in children. Since it is entirely preventable, the onus is on us to beware the water. Remember, drowning does not only occur with swimming; it can occur in a few inches of water if the child is too young to move his head. Always supervise swimming and bath time. Do not leave buckets of water unattended around young children.  Keep toddlers away from the toilet unless they are supervised, or install a lock on it. Talk to your teenagers about drinking and swimming. Help them understand that drinking or doing drugs and swimming (especially cliff diving!), are not a good combination. Be aware of "dry" or "secondary" drowning.  If your child chokes on water, or has any sort of "near drowning" event," he is vulnerable to drowning at a later time.  Watch for coughing, trouble breathing, chest pain, changes in behavior, or fatigue.  If you notice anything unusual, even hours after the event, call your doctor or 911, or go to the Emergency Room.  If you do not already know CPR, take a class. You could be the one to save your own child's life, or someone else's. 


Accidental Gun Shots: if you decide to have a gun in your home, keep it locked in a safe, preferably unloaded. Ensure that the safe will not be accidentally opened by someone who does not know the gun is there. Hiding a gun is not sufficient to protect children. They are curious, persistent, and know no boundaries. There is no reason to think that your child, your child's friends, or your child's caregiver won't stumble upon it at some point. No matter your view on gun control, make 100% sure that your child and his friends are 100% safe.

When your child begins visiting other people's houses, especially if he will be there without you, ask the parents if there is a gun in the home. If there is, ask where it's kept and if it's loaded.

Unrecognized Respiratory Distress: respiratory distress is not always as obvious as you might think. Whether it's a viral infection in a baby, asthma developing in your older child, or a child with an inhaled foreign body, you could potentially miss it. Here's what to look for:

  • fast breathing
  • abdominal breathing: either the space where the ribs meet the belly or the V where the ribs, top of the belly, and xyphoid process all meet is sucking in with each breath
  • retractions: the muscles in between the ribs are contracting with each breath, or the spaces just above the sternum or clavicles suck in with each breath
  • nasal flaring: nostrils flare with each breath
  • shoulder shrugging: the shoulders move up and down with each breath
  • wheezing: this is generally only audible with a stethoscope, but you might hear it on the outbreath
  • leaning forward, open mouth breathing, drooling
  • unable to talk or walk normally
  • cyanosis: blue lips or fingertips 


Image and more information on respiratory distress available here

If you notice any of these signs, call 911 or your doctor immediately. For more information, read this article.

Accidental Marijuana Ingestion: recreational marijuana is licensed in Washington State and Colorado now. I would expect more states to follow suit. This means that marijuana is more widely available. People who never would have used it or possessed it before, now do. Which means that when you go to a party, you need to find out exactly what's in the cookies. And the brownies. And the lasagne. It brings a whole new meaning to the question, "Mommy may I have a cookie?" Be sure to speak with your child's friends parents about this one too: find out if they have it, and if it's kept away from the children at all times.

Alcohol Poisoning: people have different ideas about how to raise children with a healthy respect for and a reasonable relationship with alcohol. I won't get into that here. But I do want to make sure that your child, whether a toddler or an adolescent, never gets alcohol poisoning. For toddlers this may be as easy as keeping it out of reach. Until of course they can reach it, which will come sooner than you expect - on the day they learn to move a chair over and climb on it. Also when your child starts going to other people's houses for play dates, find out where their alcohol is.

Obviously this may be easier said than done for adolescents, but think about it, research the options, discuss it with the family, choose a strategy, and most importantly, address it. Do NOT think that because your child hasn't brought it up with you that she's not being faced with it at school. And do NOT think that because your child is: obedient, an athlete, a straight A student, etc; that she is not thinking about using alcohol. For more guidance, here's a good place to start.


Accidental Over the Counter Medication Overdose: kids are curious. They will get into medications, supplements, essential oils, you name it. Iron is a big offender here. Ensure that all of your medications are stored in their original child-proof containers. Supplements and essential oils can be harder to deal with as they usually do not have child-proof caps. Store them out of reach and periodically ensure that your child has not gained the height or skills necessary to reach them.

Adolescents and child care providers may get into these substances too, very much on purpose. Have an idea of how many pills you have in any given bottle. Keep especially attractive / addictive medications like pain killers locked in a safe. If you have left-over medications, especially pain killers, take them to a drug take back location; do not save them for "next time."

Falls From a Window: this may sound crazy, but it does happen. If a child can get to the window, he can climb out of it. So leave them either closed and locked or open only enough that he can't fit through (as long as you're sure he can't open it further). Remember to think and act like a child. It might not be obvious that he can get to it, but if he climbs that and scoots under this, he's there. Be especially careful of windows that are elevated, but remember that even if he doesn't hurt himself going out the window, he's still now on the loose without you knowing it. Finally, know that kids have flown out of windows after bouncing on the bed, or rough housing in some way.


Obesity: all too common these days, and not necessarily because parents are overweight. It's an epidemic; one with terrible consequences. And despite the fact that we know how bad it is, how rampant it is, and what contributes to it, we as a country do not change our practices. So it's up to us as parents to bring our children up in a way that fosters healthy weight and healthy body image. Here's what to do:

  • Avoid juice and sugary drinks (and artifically sweetened drinks - more on these in a future post).
  • Avoid sugar except for occasional treats.
  • Limit processed food, junk food, and white flour.
  • Encourage fruits, veggies, and whole foods.
  • Encourage physical activity. I don't use the word exercise with kids for 2 reasons: they naturally love to run and play outside in a very physical way; I think this wording encourages them to embrace that. I also think using the word "exercise" too much can make it sound like a boring adult activity being forced on them.
  • Promote outside time - because fresh air is important for physical health, for mental / psychological development, and because if you're outside, there's a good chance you're moving your body.
  • Foster good sleep. Poor sleep is an independent risk factor for obesity, so practice good sleep habits with your children.
  • Limit total screen time. Do not allow screen time within an hour of bed; do not allow any screen in the bedroom. 

Car Accidents: can be hard to avoid. I'm sure you already do everything you can to decrease your risk (avoid alcohol and drugs, don't drive tired, no fiddling with the radio, no talking on the phone or texting). But since accidents happen, consider how to mitigate the damage. Wear your seat belt and make all of your passengers wear theirs too. Every time. Place your child in his car seat and lock the harness. Every time. Ensure your car seat fits in your car properly and that your child fits in the seat properly. Ensure that you are using your car seat properly.

Vaccine Preventable Illness: I have many posts coming soon that address vaccines in detail. But for now I'll just make this plea: if you decide not to vaccinate, or to delay vaccines, be completely sure you understand the diseases your child is at risk for. I don't want any child coming down with meningitis or tetanus induced respiratory depression because of a lack of information. Be sure you are familiar with the course of the disease, the complications, and how it's contracted. Be sure you understand the risk you are taking by not vaccinating before you make your final decision.

Remember in medicine, the best policy is usually prevention.

I have no affiliations to disclose and no financial interest. This post does not constitute medical advice. If you have medical questions or concerns, call 911 or speak with your doctor.