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®

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®

After reading Charlotte’s Web, by E.B. White, when I was eight, I became a vegetarian. It was the first time in my life  I thought seriously about the source of my food.  My vegetarian diet only lasted only a week in my carnivorous family, but other kids stick to their convictions for much longer. Let’s say that your child is one of those kids. Below is a general guide on how to fulfill your child’s nutritional needs with a vegetarian diet:

Meat provides protein.  “If you give up meat, choose at least two other protein sources,” says Dr. Lai.

Consider alternative protein sources such as:

                Dairy products

                Beans

                Soy products

                Nuts and nut butters

                Seeds

                Eggs

Iron is another important nutrient found in meat, but can be found in other foods as well.  Menstruating females are particularly at risk for iron deficiency. Intake  guidelines can be found on the Centers for Disease Control website.

Iron-containing foods include:

                Iron fortified cereals

                Beans

                Dark green leafy vegetables

                Eggs

                Enriched breads, rice, and pastas

                Soybeans

                Dried fruit

If your child also stops eating dairy, he will also need to find  additional sources of calcium and vitamin D. The American Academy of Pediatrics and the Institute of Medicine
recommend a daily intake of 400 IU per day of vitamin D during the first
year of life, and 600 IU for everyone
over age one. Older kids should get 700 to 1,300 milligrams of calcium daily. 

Sources of calcium (other than cow’s milk):

                Soy, almond, or rice milk

                Soy yogurt

                Calcium-set tofu

                Fortified breakfast cereals

                Leafy green vegetables

                Broccoli

                Almonds, sesame seeds, and soy nuts

Foods containing vitamin D :

                Fortified soy, rice, or almond milk, or items made with these products

                Some brands of orange juice

                Eggs

Direct sunlight on the skin also stimulates vitamin D production, but because of the risk of skin cancer and skin damage, obtaining vitamin D through sun exposure is not recommended. Consider giving your child a daily vitamin D supplement.

Kids on a vegan diet take ALL animal products out of their diet—no meat, no dairy, and no eggs.  In addition to the above recommendations, these kids need an alternative source of vitamin B12, which is found naturally only in animal products. One good alternative is to eat B12 fortified breakfast cereals—read the labels and look for those that contain 100% of the RDA (Recommended Daily Allowance) for B12. The other way is to take a B12 vitamin (cobalamin).  According to the National Institute of Health, the RDA of Vitamin B12 for kids is:

                Ages 4-8 years:  1.2 micrograms (mcg)

                Ages 9-13 years:  2.4 micrograms (mcg)

                Ages 14 years to adult:  2.8 micrograms (mcg).

While vegetarian diets are fads for some kids and teens, they become a way of life for others. Encourage your vegetarian child to help you shop and cook, and to experiment with preparation methods and flavors. In a Vegetarian Kitchen with Nava Atlas has numerous vegetarian recipes.  

For vegetarian meal and snack guidelines as well as general information about nutrition, please visit the American Dietetic Association’s site.

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