A shred of advice: how to remove splinters

Yow!

Although I first cringed when I saw this splinter, it is actually one of my favorite kinds. It’s obvious and relatively easy to remove.

Now that summertime is upon us, many kids will want to run barefoot outside. Have your children wear shoes, especially on decks and docks, in the woods, and even in grass and sand in order to protect their feet. In short, if they are not actually swimming, kids (and adults) should wear shoes outside. Even for those who are careful, splinters have a way of magically embedding themselves in bare feet.

If the splinter is very tiny (too small to grab with tweezers,) seems near the skin surface, and does not cause much discomfort, simply soak the splinter in warm soapy water several times a day for a few days. Fifteen minutes, twice a day for four days, works for most splinters. Our bodies in general dislike foreign invaders and tend to evict them. Water will help draw out splinters by loosening up the skin holding the splinter. This method works well particularly for multiple hair-like splinters such as the ones obtained from sliding down an obstacle course rope. Oil-based salves such as butter will not help pull out splinters. However, an over-the-counter hydrocortisone cream will help calm irritation and a benzocaine-based cream such as Oragel will help with pain relief.

If the splinter is “grab-able”, gently wash the area with soap and water and pat dry. Don’t soak an area with a “grab-able” wooden splinter for too long because the wood will soften and break apart. Next, wash your own hands and clean a pair of tweezers with rubbing alcohol. Then, grab hold of the splinter and with the tweezers pull smoothly in the direction opposite of the way the splinter entered. Take care to avoid breaking the splinter before it comes out.

If the splinter breaks or if you cannot easily grab the end because it does not protrude from the skin, you can sterilize a sewing needle by first boiling it for one minute and then cleaning with rubbing alcohol. With the needle, pick away at the skin area directly above the splinter. Use a magnifying glass if you have to, make sure you have good lighting and for those middle-age parents like us, grab those reading glasses. Be careful not to go too deep, you will cause bleeding which makes visualization impossible. Continue to separate the skin until you can gently nudge the splinter out with the needle or grab it with your tweezers.

Since any break in the skin is a potential source of infection, after you remove the splinter, wash the wound well with soap and water. Flush the area with running water to remove any dirt that remains in the wound. See our post on wound care for further details on how to prevent infection. If the splinter is particularly dirty or deep, make sure your child’s tetanus shot is up to date. Also, watch for signs of infection over the next few days: redness, pain at the site, or thick discharge from the wound are all reasons to take your child to his doctor for evaluation.

Some splinters are just too difficult for parents to remove. If you are not comfortable removing it yourself of if your child can’t stay still for the extraction procedure, head over to your child’s doctor for removal.

Now you can add “surgeon” to your growing list of parental hats.

Julie Kardos, MD with Naline Lai, MD

Limiting BPA and other potential toxins in your child’s environment

Guest blogger pediatrician Heidi Román returns to us today to give practical advice on how to decrease potential toxins in your child’s environment.

In today’s world we are surrounded by “stuff”. We touch it, we eat from it, we drive in it, and we wear it. Before becoming a parent, I have to admit I didn’t think all that much about whether this “stuff” was safe. I had passing thoughts about toxic chemicals in “stuff”. Mainly, the environmental toxin I worried about as a pediatrician was my little patients’ exposure to lead.

Suddenly, as a new mom, I started to think about toxins a lot. I did little things like get BPA-free cups and bottles and avoid plastic toys. But, sometimes it feels like a losing battle. I did all kinds of research and bought a car seat with great safety ratings, only to later read a report that suggested it was “toxic”. And, in many cases the science is not definitive. A product may be found to have a substance that is considered toxic, but it is unclear whether or not the exposure is sufficient to actually impact the health of children. It all feels a bit overwhelming.

So, I’m here today to offer a few practical tips to parents who want to make their home environment safer for their kids; and, to let you know about some important legislation that is coming up that may help us all out.

1. Reduce exposure to BPA (bis-phenol A). We don’t yet have all the answers about the impact BPA may have on our kids. But, we do know this. BPA is all around us- particularly in food containers and linings. And, we have emerging evidence that it is an “endocrine disruptor“. The endocrine system is a set of organs that controls everything from body temperature to puberty via complex hormonal interactions. So called “endocrine disruptors” are thought to somehow alter these interactions. There is enough evidence out there about potential detrimental impact of pre-natal and post-natal exposure in kids (including suggestion of impact on behavior of young children) that I think it is time to dramatically reduce our exposure to BPA. Many companies who market products to babies have already made the switch- so look for BPA-free bottles and the like. You can also reduce your own exposure. Switch to glass food containers. Try to eat less canned food.

2. Improve the air quality in your indoor environment. Bring a few plants into your home. Varieties like the peace lily and rubber plants have been shown to significantly improve air quality. Switch to less toxic household cleaners or make your own from simple ingredients like vinegar, lemon juice, and baking soda. “Conventional cleaners often contain volatile organic compounds whose fumes can trigger asthma attacks and irritate the eyes, nose and respiratory passages”, says Maida Galvez, a pediatrician and environmental health specialist at New York’s Mount Sinai School of Medicine. Not only that, they are a significant poisoning risk to children if swallowed.

3. Decrease the number of products (cosmetics, etc) you use on your hair and skin. Learn more about the safety of those that you continue to use. Definitely use broad-spectrum sunscreen, but consider switching to a zinc oxide or titanium dioxide based formulation, especially for young children. Avoid aerosolized skin products, as there is risk of inhalation. Keep all personal care products out of reach of children.

4. Support TSCA reform. The Toxic Substances Control Act is the federal law that regulates which chemicals are deemed “safe” for use. The problem is that TSCA was passed in 1976 and has never been updated. TSCA grandfathered in 62,000 chemicals that were “presumed safe”. It does not require studies of health impact prior to chemicals reaching the market. Instead of requiring industries to prove the safety of chemicals, TSCA leaves the onus on the consumer and public and environmental health agencies to prove that they are unsafe after they’ve been available for use. It ties the hands of agencies like the EPA when they try to limit exposure, even to chemicals such as asbestos that are known to have adverse effects.

The great news is that for the past few years a growing coalition has organized to tackle TSCA reform. The EPA put forth a list of Essential Principles for Reform of Chemicals Management Legislation. Most importantly, the Safe Chemicals Act of 2011 (SB 847), put forward by Senator Frank Lautenberg, is making its way through the early legislative process. This bill seeks to improve chemical safety and protect our health using the best science available. It aims to reward innovative companies that attempt to put safer products on the market. The bill still needs our help to push it forward. Call your Senator and ask him or her to sign on as a co-sponsor.

One last thought. Many products are actually very safe. The trouble is, right now it is really hard to know which ones are okay for children and which ones aren’t. Parents have enough to worry about. Let’s give some of the responsibility regarding unsafe chemical exposures back where it belongs- to the industries producing chemicals and the regulatory agencies designed to keep our communities safe. And, for now, a few easy changes at home can keep toxic stuff away from your kids and help keep them safe and healthy.Heidi Román, MD

Heidi Román MD, FAAP is a mother and pediatrician who practices in San Jose, California. She has special interest and experience in public policy issues and working with under-served families from diverse racial and socio-economic backgrounds. Find her thoughtful blog posts at

mytwohats.wordpress.com.

Special thanks to toxicologists Alan Woolf and Melisa Lai Becker for reviewing this post.

Add 7/18/12: The FDA announced on July 16, 2012 that BPA is banned from use in baby bottles and sippy cups. BPA use in other containers is still permitted. Click here for the New York Times article.

Mother’s Day: thoughts to nosh on

mothers day My youngest child clambered off the bus Friday afternoon with a fixed grin across his face.

“What are you doing here?” he asked curiously. Usually, I am not home in time to greet the afternoon bus.

“I came to walk you home from the bus stop and then go for a run,” I said beaming, and kissed him on the forehead.

As my son stiffly kissed me back, the strange fixed grin remained on his face. Then I noticed his hands were behind his back. With a sly glance, I saw he clutched a crinkled brown paper bag. I smiled. Hidden crumpled paper bags close to Mother’s Day mean only one thing — a “surprise” gift.

“Don’t you want to go running now?” my son asked as we walked up our driveway, carefully rotating his body so that he continued to face me.

“Yes, good idea” I said, and resisted the temptation to look back.

As I jogged through the neighborhood, I mused over the upcoming holiday and what it meant to be a “happy” mother on mother’s day. Last week I had gained some insights after participating on a panel at Brown University’s Women’s Leadership Conference. The topic of the discussion was “Happy Kids/Happy Parents: What’s the Secret Sauce?” The talk was lively, and since it was a women’s conference, discussion focused on motherhood. Ultimately the conclusion made by moderator Clare Hare was “There is not one right way to parent,” but, perhaps, some good guidelines. Here are some ideas to think about:

On the dilemma of working outside the house vs. working full time as a mom at home: As a mom it is easy to give, give, and give so much of yourself to others that you can lose a little (or a lot) of your own self-identity. By maintaining a self-identity you become a more confident mother. Some women draw confidence from forging a career outside the home. Others draw from organizing local community-based activities. A mom ultimately needs to feel at the end of the day that she raised her own child, no matter how she does it. Stop comparing yourself to others and do what is right for your own family. In an economy where it is often not financially feasible for one partner to stay at home, working outside the home may be less of a choice and more of an obligation; however, the crucial point remains— if you are not the person you want your child to see, then become the person you want her to see.

On helicopter parenting: Worried that you are too much of a helicopter parent? Know where to draw the line. Use the “cry now or cry later” philosophy. If you know your child will be crying in 30 years when he is obese and diabetic because you didn’t insist on a healthy diet with limited “junk”, stand your ground and let him cry now and you refuse him a second helping of cake. If you know your child will NOT be crying in 30 years because you didn’t insist that he continue piano lessons, let it go.

On keeping you and your child sane during the college admission process: Yes, statistically it’s tougher than ever to get into colleges- this is a matter of demographics. There are more college-bound seniors because of population growth, and hence more applicants per spot. But the pressure for students to overextend themselves in multiple activities is imposed by parents and the kids themselves, not by the admission offices. In the years preceding applying to college, encourage your child to concentrate on excelling in specific areas—think quality not quantity. Do what comes from the heart. When your child seems overwhelmed, as Dr. Kardos and I always say, insure basic needs are met — eat, sleep, drink, pee and poop. And don’t forget to leave time for play and relaxation.

On ignoring hype: Be willing to change your opinion in light of data. Use evidence, not hype, to drive your actions. Despite data showing teens naturally awaken later in the morning than younger children, one audience member recounted how she still encountered many difficulties when she advocated for later high school start times in her school district.

All thoughts to nosh on.

You never realize the soaring magnitude of your own mother’s love until you meet your child. No matter your approach to raising children, we wish you “happy” as you remember how you felt when you were the child who brought home a brown crinkled paper bag to surprise your own mom. And again “happy” as you feel gratitude and awe for the privilege of now receiving the surprise.

Dr. Kardos and I wish you a Happy Mother’s Day.

Naline Lai, MD

Special thanks to my fellow panelists: Clare Hare, Principle of Clare Hare Design; Jill Hereford Caskey, Director, Alumni College Advising Program, Office of Alumni Relations, Brown University; Judith Owens , Director of Sleep Medicine, Children’s National Medical Center; Peg Tyre, Director of National Advocacy, Edwin Gould Foundation, author of The Trouble With Boys and The Good School.

Are my teen’s vaccines up to date? Maybe not—HPV, pertussis, meningococcal meningitis and flu

Today we bring you more advice from the Atlantic Regional Osteopathic Convention 2012 Adolescent session, where Dr. Amanda Manning updated us about adolescent vaccines. As always, be sure to review with your child’s doctor any contraindications as well as reasons to vaccinate early with all of these immunizations.

Tdap : This vaccine, which prevents pertussus (whooping cough), tetanus and diphtheria, is given to 11- 12 year olds. But since the pertussis component of the Tdap vaccine was not recommended until six years ago, your teen may have received the formulation without pertussis protection (dT). If so, he should now get a dose which contains pertussis. Recent evidence shows teens and adults lose their immunity to whooping cough and can spread disease to vulnerable infants and young children.

The meningitis vaccine, or “quadrivalent meningoccal conjugate vaccine”: Pediatricians routinely give this vaccine to tweens. New recommendations add a booster dose at age sixteen years. If the first dose was not given until age sixteen, a booster dose is not needed. Read our earlier post for more information about this vaccine and the disease it prevents.

HPV vaccine: This vaccine protects against Human Papillomavirus (HPV), which causes cancer of the cervix, vagina, penis, and throat. HPV also causes genital warts. Most people who are infected pick up the virus unknowingly during their first two years of sexual activity. In fact, eighty percent of women by age 50 are infected with some form of HPV. Luckily, the majority of infected women do not develop illness. The Pap tests that women receive at their yearly gynecology visits screen for cervical cancer caused by this virus. Here are common questions parents ask about the HPV vaccine:

Is this vaccine safe for my kids?- it’s too new

No more need to “watch and wait” for more safety data before giving it to your teen. Health care workers have given over 40 million doses of HPV vaccine worldwide so far with no serious adverse events. The vaccine has a good track record of safety, despite what some internet sources as well as politicians would have you believe. The side effects of local soreness and mild fever are the same as those seen in all other vaccines.

Should both girls and boys be vaccinated?

Yes, but only the brand Gardasil is approved for use in males.

Isn’t giving the vaccine at 11 or 12 years old “too young”? My kid is not sexually active.

Younger teens make better antibodies from this vaccine than older teens. The vaccine is most effective before the onset of sexual activity, before kids could be exposed to the virus.

If my teen forgets a dose, does she need to restart the series?

Three doses complete this vaccine series. Fortunately, if you forget to bring in your teen for the follow up dose, your teen’s doctor can simply continue the series wherever your teen left off and the vaccine will still be effective.

Can my young adult aged children also get the vaccine ?

Yes, but for Gardasil only up through 26 years and for Cervarix through age 25. Cervarix is not approved for males. Last year, the FDA did not find there was enough of a decrease in disease to widen the age range for Gardasil after age 26.

FLU: The guidelines for the flu vaccine are the easiest to remember of all the vaccines. Give a dose of flu vaccine to every teen every year, before the start of flu season. In fact, EVERYONE should get flu vaccine every year, including adults. The mist-in-the-nose form is safe for anyone without asthma or other chronic health conditions, and now, safety data shows most everyone can receive the injectable form, even kids with egg allergy. Please see our earlier post for more information about the flu virus, the flu vaccine, and how to tell if your child has the flu.

Amanda Manning, DO, FAAP, FACOP, is the site supervisor of the pediatric group at Geisinger Medical Group in Bloomsburg, Pennsylvania. She is a graduate of Duke University and The University of Medicine and Dentistry of the New Jersey School of Osteopathic Medicine, and completed her pediatric residency at the Geisenger Medical Center. Dr. Manning has been practicing general pediatrics for fifteen years.

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

Chewing the fat: new cholesterol screening guidelines for all kids

cholesterol cartoon I have a confession to make. Two of my kids still have not had their blood cholesterol checked. You see, according to the National Heart, Lung and Blood Institute (NHLBI), kids with risk factors for heart disease (in my children’s case, a grandfather who had an early heart attack) should have their cholesterol level checked. But I’ll be getting my kids to the lab soon. New research shows that although heart attacks and strokes are rarely seen until adulthood, atherosclerosis (cholesterol plugs) in blood vessels, which is a precursor for heart disease, can be seen as early as during fetal growth. The concern is so great for heart health that guidelines were recently revised: EVERYONE, regardless of risk factors, should be screened twice during childhood.

For those WITHOUT risk factors, your child’s doctor can order NON-fasting total and high-density lipoprotein-HDL (aka “total cholesterol” and “good cholesterol”) levels for initial screening. Routine screening should occur sometime between 9-11 years and again between 17-21 years.

For kids WITH heart disease risk factors like mine, the American Academy of Pediatrics recommends a nine to twelve hour fasting “lipid panel.” Lipid panels usually measure low density lipoprotein (LDL) “bad cholesterol” and triglycerides in addition to total and HDL cholesterol. For kids with risk factors, screening should occur when the risks are discovered.

Pediatricians start asking for a family history of risk factors by three years old. Risk factors include: a parent, grandparent, aunt/uncle, or sibling with a heart attack or evidence of heart blood vessel damage less than 55 years in males or less than 65 years in females, or a parent with high cholesterol or triglycerides. Other risk factors for your child include having medical conditions such as diabetes, high blood pressure, obesity (Body Mass Index/BMI ≥95th percentile) and smoking cigarettes. Ask your child’s doctor for a full list of qualifying conditions.

The easiest way to time a “fasting” blood draw is to give your child dinner at his regular time, send him off to bed, and go to the lab first thing in the morning. Bring a snack with you so you can feed your child immediately after his blood is taken.

Because drinking water will not affect the lab results, have your child drink plenty of water before-hand and throw a sweater on him. The extra fluid will plump up the veins and the warmth from the sweater will dilate blood vessels, making it easier for the lab technician to draw blood.

Worried about calming down your kids’ nerves before a blood draw? Use techniques discussed in How to take the sting out of injectible vaccines.

For the full NHLBI report check out http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm . For guideline analysis look at this link from the American Academy of Pediatrics.

Naline Lai, MD with Julie Kardos, MD

The Jersey Shore: pediatric style

We’re back from a Jersey Shore medical conference where we moderated the adolescent session of the Atlantic Regional Osteopathic Convention. In the next few weeks, we’ll be posting you advice gleaned from talks on teen depression, vaccine updates, fatigue in adolescents and worrisome teen drug use trends.

Today we start with advice based on Dr. Melisa Lai Becker’s talk, Trendy Tox Teen Behaviors:

How do I know if my kid is high? Your tween or teen wanders in late on a Saturday night and acts like he is in slow motion. “I’m just tired,” he claims. Is he high, you wonder? To answer the question, have him look you straight in the eye as you talk to him. Even if he is lying, the truth will be in his eyes. More specifically, it’s in the size of his pupils (the black part of his eyes). Too big (nearly covers the colored part of his eyes) or too little (like pinpoints) is a sign he is currently high.

Alcohol: Parents, beware. The type of alcohol in your beer, ethanol, is the same type of alcohol in your morning mouth wash and perhaps in your medicine cabinet. The difference is that mouthwash contains more alcohol than beer. Beer typically contains up to 5 percent ethanol, wine up to 14 percent ethanol, and liquors usually up to 40 percent ethanol. Compare this to Original Listerine with 27 percent ethanol and Nyquil Nighttime Cold/Cough with 25 percent ethanol (and you wonder why it helps you fall asleep?!).

How can you tell if your kid is drunk? Again, look at his eyes- if he is drunk you may see pupils dancing in small circles. The dancing eyes give the sensation of “dizziness” to drunk individuals.

Pharming: We teach our children that medicine is not candy, and yet Pharming—consuming prescription substances to get a high—is a big problem among teens. Since 2003, according to the Centers for Disease Control, more overdose deaths have involved painkillers like Vicodin and Percocet than heroin and cocaine combined. Among teens, medications prescribed for Attention Deficit Hyperactivity Disorder are the most popular pharmed drugs. Don’t unwittingly contribute to a pharming party where kids raid medicine cabinets, deposit pills into big bowls and randomly ingest them. This upcoming week, April 28, is National Prescription Drug Take-Back Day . Make it a spring cleaning priority.

The most important phone number parents (and doctors) can know:

poison control: 1-800-222-1222

Melisa Lai Becker, MD, is chief of Emergency Medicine at the Cambridge Health Alliance at Whidden Memorial Hospital campus in Everett, Massachusetts. She also serves as Director of Medical Toxicology of the Cambridge Health Alliance and as a Harvard Medical School instructor.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

How can I motivate my child in school? — Creating the resilient learner

“What will happen if your grade drops from an “A” to a “C”?” I sometimes ask during a check-up.

Many kids shrug and say, “Try harder next time, I suppose.” Others look shocked and anxious about the possibility and are speechless.

Still others will point at their parents and say,”THEY would kill me.”

Observe a toddler learning a new skill. You will see him repeatedly try to fit a ball into a hole until he is either successful or wanders way. He is not anxious or afraid of failure. He is not “stressed” about trying to learn. Although all children start this way, too often toddlers become big kids who end up in my office discouraged and worried about school performance. Today’s guests Principal Mr. Leonard Schwartz and Vice Principal Michael Testani, based on the work of Dr. Carol Dweck, discuss ways parents can influence their children so that they embrace learning.

– Drs. Lai and Kardos

Researchers under the leadership of Dr. Carol Dweck conducted a survey of parents of school aged children. The majority of parents thought it was necessary to praise their children’s intelligence in order to give them confidence in their abilities and motivate them to succeed. Instead, this approach can lead to fixed mindsets in children. Kids with fixed mindsets believe “my abilities are what they are.”

Instead, the most motivated and resilient students demonstrate a growth mindset. They are the ones who believe their abilities can be developed through their effort and learning. These students are resilient and persevere when tasks become challenging.

A study of students’ brain waves revealed students with a fixed mindset were interested in whether they got an answer right or wrong, but when they were wrong, they paid little attention to the correct answer. Students who were praised for their intelligence later lied about their scores. They felt the errors were so humiliating that they could not own up to them. The students failed to persevere, believing they were no longer “smart,” and therefore unable to meet academic challenges.

Students with a fixed mindset typically think it is best if they:

Don’t make mistakes – “I’m too smart to make mistakes.”
Don’t need to work hard –”I’m smart and learning comes naturally to me.”
Don’t try to repair mistakes- “I was wrong, and that is the end of it.”

Students with a growth mindset generally:

Take on challenges
Work hard
Confront their deficiencies and correct them

How should parents talk to their children in order to develop a growth mindset?

Wow, you got 10 out of 10 right! What strategy did you use to get a perfect score?
What can you learn from this mistake that will help you do better next time?
I am proud of how hard you worked on this project and look at how your hard work paid off!
The strategies you used last time didn’t work. Let’s take a look at them so I can help you figure out better strategies to use next time.
You’re becoming such a good learner!
Smart is not something you are; it’s something you become. Let’s figure out how you can become smart at this assignment.

What is your child’s mindset? Ask yourself, what is your own mindset? Have a conversation with your child as you discuss your child’s report card. Use any upcoming parent teacher conference to examine outlooks, attitudes, and strategies that are or are not supporting your child’s academic progress.

Where applicable, praise your child’s positive skills and attributes. Celebrate instances you observed that contributed to positive indicators.

When necessary, examine areas of poor performance and strategize with your child about how he or she can turn a weakness into a strength. Again, you may revisit situations you observed this past grading period in which your child took shortcuts, provided incomplete work products, or did not do his or her personal best.

Make your expectations very clear in terms of why you value attributes or traits of resiliency, and how they can and will develop into habits that will serve your child well.

Grades are a distant second to the level of effort a child invests in personal learning in any setting.

Leonard H. Schwartz, Principal, Mill Creek Elementary School

Michael R. Testani, Assistant Principal, Mill Creek Elementary School

Mr. Schwartz and Mr. Testani are part of the Central Bucks School System in Pennsylvania. After fourty-three years as an educator in two school districts and five schools, Mr. Schwartz retires this year. This post was published in it’s full original form in the publication Principal’s Prose of Mill Creek Elementary School.

Some like it hot: Hot Tub Folliculitis

hot tub rash From the start, a family I know was suspicious of the hot tub sanitation at the resort where they recently stayed. As time went by, even though the water looked clear, the hot tub seemed less chlorinated, and the water more tepid. They dubbed the tub “the scuz tub.” After their return, one of the kids broke out in the rash of hot tub folliculitis pictured to the left. You could say, they figured out just what the “scuz wuz”.

Hot tub folliculitis is a skin rash caused by a bacteria called pseudomonas aeruginosa. The rash appears a day or two after soaking in a hot tub. A light pink bump appears around hair follicles (hence the name). As you can see in this photo, the rash is typically worse on areas of skin where bacteria was trapped under a swimming suit. The rash can cover all body surfaces, including the face, if your child dunked his head under water.

The rash can be slightly itchy but is not usually painful. No other symptoms develop such as fever or sore throat. The rash is not contagious, but often other people who swam in the same hot tub also break out.

Treatment is to wait it out. Typically by one to two weeks, provided your child does not go back into the hot tub, the rash resolves on its own. If your child feels very itchy, you can treat her with oral diphenhydramine (brand name Benedryl). Rarely, just like mosquito bites, the rash can become infected with other bacteria if your child scratches too much.

Pseudomonas thrives in warm wet places. In fact, it’s the same bacteria that causes “swimmer’s ear.” Tight control of chlorine and acid content of the hot tub water limit the growth of the bacteria. Unfortunately, you can not tell the pseudomonas content of water just by eyeing it.

May you bring back a better souvenir than this family did on your next vacation.

Julie Kardos, MD and Naline Lai, MD

Cinnamon Challenge = Potential Choking Calamity

Do not take the cinnamon challenge Beware. There’s another choking “game” out there. This time, kids try to swallow a teaspoon (or more) of cinnamon without water as quickly as possible without coughing or vomiting. The cinnamon usually forms a thick slurry in the back of the throat and causes gagging and coughing. Hence, the “cinnamon challenge.”

We first saw warning reports of the cinnamon challenge via recent emails circulated by principals in local school districts, but yesterday Dr. Lai heard about it directly from a kid and his mother in her office. Luckily, the teen and his friends who played it the other day were fine. However, everyone did cough after taking in the cinnamon and one kid in his group threw-up.

“Do you know why people cough?” I asked him.

“Why?” he said.

“It’s a sign your body is trying to protect your airway,” I said.

The trend is spurred on by kids trying to copy YouTube videos and Daniel Tosh on the television show Tosh.0

Current statistics for emergency room visits or deaths related to this particular “game” are hard to come by. But we do know in 2000, according to the Centers for Disesase Control, 160 children aged 14 years and under died from airway obstruction associated with inhaled or ingested foreign bodies. Food was associated with about 40% of those deaths. Especially for those who already have sensitive airways such as those with asthma, any substance which tickles the back of the throat can produce spasm in the lungs. Also, the substance itself can get into the lungs.

Tosh starts off the video above by saying, “The internet is full of challenges.” Well, we’re on the internet too, Tosh, and we challenge you to model the healthy behaviors – not the dangerous ones.

Naline Lai, MD and Julie Kardos, MD

How to treat bloody noses- nothing to sneeze at

Our fantastic Two Peds in a Pod photographer Lexi Logan recently put in a request for a post on bloody noses. I cringed, thinking any photo would not be pretty. “No problem,” she replied,” I’m thinking just a tissue and a top-of-nose shot… pinch angle.”

I was aghast. “Looks like you fell for the number one myth associated with bloody noses,” I said.”That’s the wrong spot to pinch.”

“See,” she told me,”that’s why I need the post.”

So, how does one squelch the fountain of red which spews from a bloody nose? Apply pressure to the SIDE of the nostrils—not up near the bridge of the nose. More blood vessels lay near the bottom of the septum, the divider which separates the nostrils, than near the top. Pinch the nose firmly. Since kids never seem to apply enough pressure on their own, go ahead and pinch for them. You’ll find it easier to pinch both nostrils simultaneously even if the blood is dripping from only one side.

Now hold. Hold. Hold. Hold in the middle of the night until you nearly fall back to sleep. Hold until the pot of spaghetti boils over. Hold for at least ten minutes before peeking in order to allow the blood to clot. If the nose is still oozing, pinch for another ten minutes. Have your kid sit up straight or lean slightly forward. Otherwise, blood will drip down the back of her throat and cause nausea and vomiting.

Do not be surprised after an episode if the next couple of nights bring more bloody noses. At night during sleep kids tend to rub their noses. Any scab that formed from a recent nose bleed gets sloughed off.

To prevent reoccurrence, protect those fragile blood vessels by keeping the inside walls of the nose moist. Once or twice a day, spritz saline into the nose, then apply a thin layer of petroleum jelly. Try running a cool mist humidifier in your child’s bedroom.

Prevent nasal irritation by decreasing environmental irritations such as cigarette smoke or dust. Teach your child to dab at his nose or blow gently when he has a cold. Ironically, some steroid nasal sprays, which treat runny noses caused by allergies, can irritate nasal passages.

Your kid is having too many bloody noses when you start to carry around tissues or your child sleeps with a box of tissues next to his pillow “just in case.” Go to your child’s doctor if this occurs. Also, go if there are signs of a clotting problem such as easy bruising, bleeding gums, or heavy periods. Likewise, if bloody noses take more than twenty minutes to clot, or if the nose bleed requires an emergency room visit or packing in the nose, make an appointment. Other reasons for more evaluation include if your family has a history of clotting disorders, your child gets speckled flat rashes that look like broken blood vessels (petechiae) which do not blanch (lose color for a second when you press on it) or if a nosebleed is caused by trauma.

Your child’s doctor may recommend sealing vessels with cauterization or investigating for possible blood clotting problems. Depending on your child’s age, she may also recommend a short course of oxymetazoline (eg Afrin). Be sure to use oxymetaxzoline according to directions- overuse can cause rebound symptoms.

Ultimately, you may find that your kid’s bloody noses are just the result of the perfect storm: dry air and a kid who picks his nose. In the meantime save that thirty percent-off Kohl’s coupon. You might be buying a lot of pillow cases.