Hot!

Pictured is a kid with a second degree burn.  No, this burn wasn’t caused by hot water or by touching the stove, but by the sun. A sunburn is still a burn, even if it was caused by sunlight.

Treat sunburn the same as you would any burn:

• Apply a cool compress or soak in cool water.
• Do NOT break any blister that forms- the skin under the blister is clean and germ free. Once the blister breaks on its own, prevent infection by carefully trimming away the dead skin (this is not painful because dead skin has no working nerves) and clean with mild soap and water 2 times per day.
• You can apply antibiotic ointment to the raw skin twice daily for a week or two.
• Signs of infection include increased pain, pus, and increased redness around the burn site.
•  A September 2010 Annals of Emergency Medicine review article found no best method for dressing a burn. In general, try to minimize pain and prevent skin from sticking to dressings by applying generous amounts of antibiotic ointment. Look for non adherent dressings in the store (e.g. Telfa™). The dressings look like big versions of the plastic covered pad in the middle of a Band aid®.
  
• At first, the new skin may be lighter or darker than the surrounding skin. You will not know what the scar ultimately will look like for 6-12 months.
  
• If the skin peels and becomes itchy after a few days, you can apply moisturizer and/or hydrocortisone cream to soothe the itch.
• Treat the initial pain with oral pain reliever such as acetaminophen or ibuprofen.

Preventing sunburn is much easier, more effective, and less painful than treating sunburn.

What is SPF? Which one should be applied to children?

• SPF stands for Sun Protection Factor. SPF gives you an idea of how long it may take you to burn. SPF of 15 means you will take 15 times longer to burn… if you would burn after one minute in the sun, that’s only 15 minutes of protection!

• The American Academy of Pediatrics recommends applying a minimum of SPF 15 to children, while the American Academy of Dermatology recommends a minimum of SPF 30. Dr. Lai and I both apply sunscreen with SPF 30 to our own kids.

• Apply all sunscreen liberally and often– at least every two hours. More important than the SPF is how often you reapply the sunscreen. All sunscreen will slide off of a sweaty, wet kid. Even if the label says “waterproof,” reapply after swimming.

Why does the bottle of sunscreen say to ask the doctor about applying sunscreen to babies under 6 months of age?

• Sunscreens were not safety-tested in babies younger than 6 months of age, so the old advice was not to use sunscreen under this age. The latest American Academy of Pediatrics recommendation is that it is more prudent to avoid sunburn in this young age group than to worry about possible problems from sunscreen. While shade and clothing are the best defenses against sun damage, you can also use sunscreen to exposed body areas.
• Some clothes are more effective than others in blocking out sunlight. Tighter weaves protect better than loose weaves. Cotton t-shirts are horrible for sun protection. Clothing uses a UPF rating. UPF measures the amount of UV light that reaches your skin. Higher numbers are better. For example, a rating of 100 means that 1/100, or one percent of UV rays reach your skin.
• Hats help prevent burns as well.
• Remember that babies burn more easily than older kids because their skin is thinner.

Which brand of sunscreen is best for babies and kids?

• For babies and kids, no one brand of sun screen is better than another. Dr. Lai and I tell our patients to apply a “test patch” the size of a quarter to an arm or leg of your baby and wait a few hours. If no rash appears, then use the sunscreen on whatever body parts you can’t keep covered by clothing.
  

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Yesterday morning we were aghast to read medical misinformation in the print edition of our local newspaper. Aghast, because we were the pediatricians interviewed for the content of a summer time tips article.

Although a more accurate online version appeared, the print version contained several inaccuracies.

How can you tell if the medical article you are reading is accurate? 

• Readers should always question what they read, and cross check to see if the information is consistent when compared with other credible sources. In this instance, we served as the “expert” sources of two articles for the same publication (print and online), yet the articles contain conflicting medical information. Cross reference our information with other experts in our field, such as the American Academy of Pediatrics, the Centers for Disease Control, and of course your own pediatrician.
• Look twice if the interpretation of the information is coming from a secondary source. The information we give on Two Peds in a Pod is “straight from the horse’s mouth.” We edit and publish our own material. In our office, we talk to patients directly. Remember that “telephone” game you played at birthday parties? The message changes the more intervening people are involved in relaying information.
• Medical information changes as new discoveries occur and more studies are conducted. There is a saying in medical school, “Even though half of what you learn in medical school will be inaccurate in ten years, learn it all, because you don’t know which half will be disproven.”  We keep up with evolving knowledge in pediatrics by reading journals, taking courses, reviewing cases with our colleagues, and retaking our medical boards on a scheduled rotation. Be sure you read information that is current as well as backed by credible sources.

Despite our dismay at the inaccuracies in the print version, you will find the online article helpful. In addition, please check our prior summertime posts about bee stings, Lyme disease, tick removal, poison ivy, splinter removal, and stay tuned for near-future articles about swimming and sunscreen.  

Whoever said, “You can’t believe everything you read on the internet,” was right… except perhaps this time.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

What would you do if your child told you he or she was drinking or using other drugs? Standing with one’s mouth gaping open is probably not the best response. As your child arrives back college, or if he’s about to embark on his first year, take the opportunity to discuss alcohol and drugs. Today, psychologist John Gannon talks about how to approach the subject. —Drs. Lai and Kardos

Okay, it happened. Your child went off to college and now he tells you his college experience is just as bad as yours was. Yes, he is doing well academically. But he is smoking pot and drinking alcohol– it is just about enough to push you over the edge. OMG!

I won’t tell you to relax about this, but remember for the most part, this is a transitional time and not necessarily a life changing scenario. After all, people have gone off to college for 100’s of years and survived. The likelihood that your child will be the exception is not overly high.  Most likely, the actions are unlikely to be life changing and isolated to college. If this scenario occurs and you comment about drug and alcohol use, you will be acting responsibly without necessarily condoning the behavior.

So what is fair to talk about and what is probably too much to talk about? First, if there is any family history for either drug or alcohol abuse, this should be discussed. The family secret needs to be revealed so that your child has a chance to minimize the impact of biology/genetics. Painful as it may be, your child deserves the chance to understand why his situation is somewhat unique and that he is at greater risk for drug and alcohol abuse issues than other students.

Secondly, if there is any family history of depression, anxiety, mood disorder, or other significant mental health issues, this also needs to be revealed. These disorders run in families. The presence of these disorders increases the likelihood a person self medicates with drugs or alcohol in order to combat mental illness.

Next, isolated events do occur. We always hear about them from our friends. We are grateful that the events do not happen to us. Although these events do appear random, your child has the potential to experience one of them. For instance, episodic binge drinking can be epidemic at some colleges. Chances are your child will participate at some point or another.

Did you ever have that talk about alcohol and drugs that you promised yourself you would have with your child before he went to school? Did you explain about mixing substances? Did you explain about how the body metabolizes alcohol? Did you talk about how alcohol and marijuana lower impulsivity and reduce judgment? Did you tell him how proud of him you are and yet you also feel scared? Did you set the stage to have a dialogue versus a lecture from parent to child?

So go on! Have the talk even if your child already started college. Sure you might be met with some eye rolling. Don’t forget, you rolled your eyes at your parents. What goes around comes around. Listen, if your child hears one thing from you that he remembers, that’s a win! With luck, your child’s events are not the ones others are talking about.

Today’s guest blogger, teacher and health coach Mary McDonald, teaches us how to understand the amount of sugar reported on nutrition labels and gives ideas for low sugar snacks —Drs. Lai and Kardos

Can you imagine packing lunch for your child and throwing a cigarette into the bottom of the brown paper bag?  Well, many Americans may not be packing cigarettes in their kids’ lunches, but they are packing something addicting: sugar.  As a family and consumer sciences teacher,  I see what the students eat and their food choices are alarming. 

In the past, my colleagues and our students worked together to bring awareness to drug prevention in a campaign called “Red Ribbon Week.”  This campaign asks individuals to take a stand against drugs and live a drug free life. I now challenge the organizers of Red Ribbon Week to include excess sugar to their list of drugs.  In 2008, Professor Bart Hoebel and his team in the Department of Psychology at Princeton University determined that mice given excess sugar demonstrated three qualities indicative of addiction:  increased intake, withdrawal, and cravings.  The subject of excess sugar has gained a lot of popularity over the past few years.  A recent article in the NY Times, “Is Sugar Toxic?” highlights the negative health effects of excessive sugar consumption.

If you don’t trust the reports coming in day after day from physicians and researchers, then test it out at home.  Tell your kids that you are going to skip dessert tonight after dinner.  I can almost hear the blood-curdling screams from here. The image may be funny, but the reality of what we are doing to our children is not.  Excess sugar causes weight gain, obesity, diabetes, heart disease, and many other deleterious conditions.  The President of the American Diabetes Association and a Pediatric Endocrinologist, Dr. Frances Ratner Kaufman, MD, reported in the fall 2012 Clinical Diabetes Journal that diabetes is no longer a disease of our grandparents, but instead it is a disease of our children. Type 2 diabetes is now considered an epidemic in the American pediatric population, up 33% in the past decade alone. Epidemic. If that doesn’t scare you, then think about the fact that our children’s generation is not expected to live as long as our generation.

Okay, enough about the depressing news. What can we do to stop these trends? My advice is something so simple, but not so easy. Turn over each and every label of your food and read the ingredient list and nutrition label. For this activity, focus in on the number of grams of sugar in each product. But what does a gram really represent? Well, here’s an easy conversion:

4.2 grams sugar= 1 teaspoon of sugar

So keep your life simple when you are reading labels and divide the number of grams of sugar by 4 to understand how much sugar you and your children are consuming. Take a look at a bag of Skittles®. Each 2.17 oz bag of original Skittles® contains 44 grams of sugar, or 11 teaspoons of sugar. Instead of reaching for that bag of candy, reach for something equally as sweet that contains far less sugar: an apple!

Here are some suggestions for snacks to substitute for sugar-filled junk food:

• Banana and Natural Peanut Butter Circles– great snack for energy too!
• Healthy Yogurt Parfait– a new twist on the “build your own” dessert.
• Cheerios n’ Fruit- grab the old fashioned yellow box of plain Cheerios and top it with fruit of your choice. This is a great way to start your day or a great snack at anytime.
• Trail Mix – it’s a satisfying treat with many health benefits.
• Fruit Kabobs–who doesn’t like a kabob?
• Homemade snack bars-this is a tried and true favorite in our house.
• Apple and Cinnamon– you cut the apples and let the kids sprinkle on the cinnamon.
• Fruit Smoothie– my favorite snack of 2013!

Mary McDonald holds a Masters of Education from Arcadia University and a health coach certification from Institute of Integrative Nutrition.  A mom of four daughters, she teaches family and consumer sciences in Central Bucks School District, Pennsylvania.  For more information on her health counseling services, please contact her at nutrition101withmary@gmail.com or visit her website at nutrition101withmary.com.

©2013 Two Peds in a Pod®