Archive for the 'Prevention' Category

Concussions on the Rise among Child Athletes

Published on August 31, 2010 in Prevention, Safety and Uncategorized. 0 Comments

girls playing soccerSchool is starting up and this means a return to school sports. A hot topic related to this is that of concussions, which has gained a lot of press recently due the awareness that head injuries occur more often than we have realized in the past. Just this month, the journal Pediatrics published a clinical report on the topic. The passage of the Lystedt Law in May of 2009 has also helped with recognition of the problem at hand. It requires schools to have guidelines and informational forms to educate coaches, athletes, and parents about head injuries and concussions. It also requires the parents and athlete sign a form regarding informed consent about the risks of head injuries. It mandates that any athlete suspected of having a concussion or head injury be removed from play and requires that the athlete have written clearance from a health care provider prior to returning to play.

What is a concussion? A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a ding or “getting your bell rung” or what seems to be a mild bump or blow to the head can be serious. Concussions can also result from a fall or players colliding with each other or with obstacles.

The signs of a concussion can range from very mild like being a little confused or forgetful, such as not turning in an assignment or not being able to recall events before or after the impact. Symptoms can consist of headache, pressure in the head, nausea, vomiting, dizziness, balance problems, blurry or double vision, light and noise sensitivity, feeling slowed down or in a fog, drowsiness just to name a few.

Some sports have higher rates of concussions than others. At the top of the list is football but beyond that, girls sports have higher rates of concussions than boys in similar sports. For example, girls basketball has a three-fold greater risk of concussion than boys basketball. In order of decreasing frequency the top five are below:

  • Football
  • Girls Soccer
  • Boys Lacrosse
  • Boys Soccer
  • Girls Basketball

Don’t think that concussions only occur in the high school athlete. The recently published study in journal Pediatrics found that the rates of concussions in children as young as eight years of age nearly doubled for the top five sports even though the total number of children participating in those sports decreased.

The takeaway message is to recognize that any concussion is serious and not to be ignored. The days of saying “they got their bell rung” and then being sent back out to play are over.

Girls Entering Puberty Earlier?

Published on August 11, 2010 in Healthy Eating and Prevention. 0 Comments Tags: , , , .

It has been in the news recently that girls are now reaching puberty earlier than compared with studies done long ago. Typically, the first signs of puberty are breast bud development. A new study that was recently published showed that more girls are entering puberty at age 7 and 8 than previously. Caucasian girls showed the largest increase but in total numbers, more Hispanic and African American girls start puberty earlier. The study is done by Dr. Frank Biro at the University of Cincinnati. For the study, Biro and colleagues examined data on 1,239 girls between the ages of 6 and 8 from East Harlem in New York; the greater Cincinnati metropolitan area; and the San Francisco Bay area in California.

The results also showed that:

  • 10.4% of white, 23.4% of black non-Hispanic, and 14.9% of Hispanic girls had reached breast stage 2 or higher at age 7.
  • At age 8, these figures were: 18.3%, 42.9%, and 30.9%, respectively.
  • The proportion of girls who had reached breast stage 2 also varied by site and BMI (body mass index), with more obese girls reaching puberty earlier.

Biro and colleagues warned that their study was not representative of all girls in the US, and they will continue to follow this population to see what happens with the girls and what other factors might affect their development.

The first question that most parents are going to have is what is going on and the next being what can we do about this? The short answer is that nobody knows for sure. The theories range from genetics and obesity to environmental triggers. It would be very easy to jump to conclusions and blame hormones in milk or food but we really just do not know. We certainly can say that as a society our children are getting more and more overweight.

The problem with entering puberty earlier is that it puts that child at a higher risk for breast cancer later in life and they are more likely to engage in risky behavior.

Where Did I Come From?

Published on August 5, 2010 in Parenting, Prevention and Uncategorized. 1 Comment Tags: .

Daily in my practice I ask preteens where they came from or how did their mom and dad make them? Some look perplexed, others get quiet or shy and some start talking about an egg and a sperm. Most children are hearing about sex on the playground in the elementary school years. I recall one 11 year old telling me he learned about this in school and the teacher told them not to talk about it at recess but everyone went right out and told the other children what they learned. Quite often parents are under the impression that they do not need to discuss this topic until the teenage years but that is really way too late.

Even  some younger children have some idea that something happened to make them. I asked my 6-year-old daughter that question a few weeks ago and loved her answer. She initially sat there for a few seconds thinking and then said “when two people love each other a lot and they stare into each others eyes for a really really long time… babies happen”. My response to her was that I did not want her staring into peoples eyes “like that” for a really long time!

My Head Hurts

Published on July 30, 2010 in Prevention, Uncategorized and illness. 1 Comment Tags: .

Children are no different than us grown-ups when it comes to getting headaches. By that I mean that some children get them often and it is nothing to worry about. Most of the time when I see a child for headaches in clinic, the parents underlying fear is that their child has a brain tumor so I put that on the table for discussion right away. I have seen children complain of headaches as early as they can verbalize and localize symptoms, but during the teen years, headaches are much more common.

The way I explain headaches in clinic is that it is often a spectrum with tension headaches on one end and a full blown migraine on the other. It is a continuum where sometimes you have more symptoms than others.

Headaches in general can be triggered by a variety of things including Continue reading ‘My Head Hurts’

The Heat is On

Published on July 8, 2010 in Parenting, Prevention and Safety. 2 Comments Tags: , , .

It is hard to believe that just a few days ago it was raining on the Fourth of July as fireworks went off. To my surprise, I got called in to work on the Fourth at the Group Health Urgent Care. I am happy to report that I did not see any firework related injuries on that day.

With the hot weather, many of us will head to the outdoors to play in the sun but it is important to take some precautions. Smaller children can be much less tolerant of the heat than us grown ups due to the greater body surface area in proportion to their weight. They also may not drink enough liquids to keep up. This can lead to heat stroke or dehydration, so it is important to pay attention.

Some tips:
1. Drink liquids frequently throughout the day and especially during periods of exercise in the heat. They should be drinking liquids before, during and after an activity even if they are not thirsty.

2. Allow time for acclimation to the heat. If your child is not use to exercising, starting now in this heat is not the best idea.

3. Take advantage of shade or other opportunities to cool off.

4.  Watch for signs of dehydration or overheating. The signs can include irritability, fatigue, being flush, or nausea and vomiting just to name a few.

5. Use sunscreen along with protective clothing like hats. Apply the sunscreen frequently. Most people do not apply enough so be generous with it.

Have fun and be safe

Start Kids Early with Good Oral Hygiene

Published on June 22, 2010 in Prevention. 2 Comments Tags: , .

As a pediatrician and a parent, I realize that it can be challenging to get some children to brush their teeth. It was a big battle in our household for both of my children when they were younger as they would kick and scream. This is one battle that is worth the fight as there are long term consequences of losing.

Oral disease is the single most common chronic childhood disease — Continue reading ‘Start Kids Early with Good Oral Hygiene’

Water Fun, Water Safety

Published on June 10, 2010 in Prevention and exercise. 0 Comments Tags: , .

Summer is approaching and, for most parts of the country, this usually means warm weather and time to play in the water. I was shocked last weekend when I saw people swimming in Lake Whatcom. I can only imagine how cold the water must be right now, as at least for me, here in the Puget Sound area, it is not quite swimsuit time yet. I know the time is coming, though.

For most children, playing in the water is one of the most enjoyable and free-spirited of summer activities. It’s also great exercise. That’s why it’s so important to teach kids about water safety and how to swim. Without question, it’s one of the most important skills they’ll ever learn. Swiftly moving rivers pose obvious hazards, but parents don’t always realize that children can drown in the shallow end of a backyard pool, even in a few inches of water. Never leave a toddler or non-swimmer alone near water. This includes wading pools, buckets of water, or the decorative pond at a friend’s house.

The American Academy of Pediatrics recently changed their policy about swim lessons for children. The prior statement discouraged lessons for children under four years of age. This never really resonated well with my practice as even with my own daughter, we started swim classes much earlier than this. The new statement says “new evidence shows that children ages one to four may be less likely to drown if they have had formal swimming instruction. The studies are small, and they don’t define what type of lessons work best.” So the AAP is not recommending mandatory swim lessons for all children ages one to four at this time, but they ask you as a parent to consider whether to enroll your child in swim lessons based on your child’s frequency of exposure to water, emotional development, physical abilities, and certain health concerns related to pool water infections and pool chemicals.

The Frightened Toddler
Lots of kids are afraid of water at first, and some carry that fear longer than others. Telling them to “be brave” or “act grown up,” forcing them to jump into the water, certainly won’t help. The answer is trust. Talk with your child about what will make them feel safe in the water, and don’t press them before you’ve earned their trust.

Boats Afloat
If you plan on boating this summer, remember that Coast Guard-approved life jackets are not just a smart idea, they’re required by law. Your child’s jacket should be snug, but not constricting. Keep the straps fastened at all times.

If your older child wants to try water -skiing or tubing, be absolutely certain you have the safety equipment, keep a sharp eye out, and use good judgment at all times. It takes only a second of inattention or carelessness for disaster to strike.
Keep in mind that every child has different strengths and levels of coordination and that children of similar age and build may have completely different abilities.

My Tummy Hurts

Published on June 8, 2010 in Prevention, Uncategorized and illness. 0 Comments Tags: , .

These last few weeks I have seen quite a few children with a stomach bug otherwise known as gastroenteritis. This may surprise many parents because one would think we are just getting out of cold and flu season and it should be smooth sailing form here, right? This is not the case.

Late spring and summer is a common time for some of the viruses that cause intestinal symptoms. The symptoms typically consist of vomiting, diarrhea, abdominal pain, fever, and sometimes rashes.

It is never fun to see your child throw up. I recall one such episode last year when my daughter proceeded to burst into our room at 2 a.m. to declare she just threw up. When I went to investigate, I quickly realized that she must have been running down the hallway with her mouth open as there was quite a bit of cleaning that needed to get done after we took care of her.

Gastroenteritis is generally self-limiting, meaning that it will go away on its own without treatment or medication, but the symptoms can range from a few days to longer sometimes, especially if we are talking about resolution of the diarrhea.  It is also very infectious, as most of the viral causes can live on surfaces for quite a long time. Good hygiene is critical.

Foodborne illnesses are a different entity that can cause similar symptoms. Most are also self-limiting. As a general rule with foodborne illnesses, many people tend to get sick in a very short time period after ingesting something. The symptoms are often quick to resolve as well.

The treatment for both tends to be supportive care, which means keeping your child hydrated. Us pediatricians always tend to recommend Pedialyte but it seems that many children just won’t drink it, so half strength Gatorade or other sports drink can serve as a substitute. Slow and steady is a good guiding principle as putting too much into the stomach at once can lead to not so pleasant results. As your child feels better it is reasonable to have them try to eat some solids.

Historically we use to recommend the BRAT diet to help with diarrhea (consisting of bananas, rice, applesauce, and toast) but evidence based medicine does not support this as it is unnecessarily restrictive.

The new recommendation is for the child’s usual age appropriate diet realizing that giving lots of fruits or fruit juice may exacerbate the problem. Giving lactobacillus can also be helpful to help speed up the resolution of  diarrhea as this is the good bacteria that lives inside of our intestinal tract. By all means, if something does not seem right with your child or they are not urinating at a reasonable interval, something is wrong and they need to be seen.

Sports Physicals, Sports Injuries

Published on May 18, 2010 in Prevention, Safety and exercise. 0 Comments Tags: , , .

Summertime is rapidly approaching and for a pediatrician, this means lots of well visits as parents bring in their children to get a check up. Sometimes parents will call it the sports physical which is fine, but it is really an opportunity to assess the child and cover a variety of topics ranging from nutrition and injury prevention to discussing high-risk teen behaviors and depression. Quite often this is the one time a year I may see a healthy teenager, so there is a lot to cover.

Certain injuries and ailments are much more common than others and they vary by the sport the child participates in. During the growing years, a child’s bones grow faster than Continue reading ‘Sports Physicals, Sports Injuries’

National Infant Immunization Week

Published on April 29, 2010 in Parenting, Prevention and Vaccine. 0 Comments Tags: , , .

This is national infant immunization week. Many, including myself,  view immunizations as one of the greatest advances in medicine as they have clearly saved countless lives from diseases such as pertussis, measles, and haemophilus. Vaccination is the single most important thing I do on a day-to-day basis to prevent illness and protect children.

Our State, like many others, finds itself facing a rising number of school-aged children whose parents are choosing not to immunize their child and Continue reading ‘National Infant Immunization Week’