“What you forgot to tell the babysitter” and “When is my child old enough to babysit?”

 

babysitting cartoon

What you forgot to tell the babysitter

The first time my husband and I went out to dinner after our daughter was born, we walked out the door, got into the car, and sat in the driveway as my husband fretted over how our daughter was doing with the babysitter. “Did you see?” he said. “She looked sad when we left.” After a few minutes elapsed, he still had not started the car engine. Finally, to allay his fears, I told him to sneak back to the house and peek into the window. He came back amazed. “She’s fine,” he said with relief.

Finding someone to appropriately look after your child can be a difficult task. Even if you resist the urge to run back and check on your child when you leave the house, you may wonder as you pull away if there is anything you forgot to tell the babysitter. Chances are, you didn’t think of much beyond leaving your cell phone number and the name of your destination. Linda Miller, a nurse who taught a babysitting course for years for Child, Home, and Community (a United Way agency serving Bucks and Montgomery Country, Pennsylvania), shares with us the information she leaves her own babysitters:


Parents’ cell numbers

Kids’ names, ages and birthdays

House address (chances are, if your sitter lives down the street, she or he doesn’t know your house number)


The full name of the town you live in (is it Borough or Township?) In Nurse Miller’s case, there is a street of the same name in the neighboring township. Ever since the pizza delivery guy went to the wrong house one hungry night, her family is careful to be very clear as to where they live.

The nearest cross street. This important piece of information helps emergency responders confirm they are heading to the correct address. (It could also be helpful if your sitter is old enough to order pizza!)


Where you are going – name and address and phone number.


Phone number to call in an emergency: For most it is 911

Poison control center phone number : 1-800-222-1222

Height and weight of each child – for emergency medication administration

Allergies – to Foods and Medications


Since seconds count in an emergency, even if your sitter is a regular fixture in your home, it doesn’t hurt to point out the safety information each time, should he or she need it.

Remember to bring your sitter’s cell phone number with you so you can reach her, in case you cannot get through on your own house phone.

When is my child old enough to babysit?


Somehow the years passed quickly, and the tables have turned. My daughter herself is a babysitter. How will you know when your own child is old enough to babysit? First ask yourself whether he will be too scared to stay home without an adult. Then ask yourself if he can solve problems on his own. The age that kids start to babysit themselves or younger siblings varies. Ultimately parents need to judge their child’s maturity for themselves. Tweens can be mature enough to babysit themselves and a younger sibling for short period of time. In fact, the American Red Cross babysitting training course (which can be taken online) is offered to kids 11 years and older. Even if your child is not babysitting anyone else, but staying by himself at home, a course will give your child valuable self-care tips.

Outline specific Do’s and Don’ts for your child. Walk them through what to do if the doorbell rings or if the phone rings. What activities are they allowed to do? Are they allowed to eat? Cook? Can friends come over? What will they do in a power outage? What if someone gets injured or sick while you are out? Familiarize him with basic first aid.

Keep anything which is potentially harmful such as medications, guns, and alcohol inaccessible. Make sure you are comfortable with parental controls for computers and the television.

And of course…give them Nurse Miller’s list from above.

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




Calling Dr. Dads

 father's dayIn honor of  Father’s Day, we would love to hear your anecdotes of any “Doctor Dad” moments your children have experienced.  Tell us about how your child’s dad or any father figure in your child’s life helped your child through a tough time, an illness, or an injury. Send us your anecdotes to twopedsinapod@gmail.com by June 4 and we will include the top stories in our Father’s Day post. 

Thank you in advance,

Drs. Kardos and Lai   





The definition of happy: Mother’s Day 2013!

 

mother's day cartoonThis Mother’s Day we bring you definitions inspired by our children and our patients. Don’t think we’ll out-hip Urban Dictionary, but we’re moms…. by definition we are not hip. Enjoy your day.

 

Sleep walker: the daytime state of a new mom.

 

Sweater: a garment worn by a child when his mother feels cold.

 

Displacement:  a vacation with toddlers.

 

Sick: something moms are not allowed to become.

 

WOW: MOM upside-down.


Mommometer: a mom’s hand on a feverish forehead.

 

One zillion: number of times a mom says “wash your hands” to her children over the course of their childhoods.

 

Yesterday: when the sports/camp/school field trip form was due.
Today: when the child hands the mom the sports/camp/school field trip form.


Working mother: Every Mom

 

Water torture: a grade-school son’s interpretation of a mom’s announcement of “shower night.”

 

Boomerang: a mom’s realization that her child is acting like she did at the same age.

 

Happy Mother’s Day from your two Pediatrician Moms,

Julie Kardos, MD and Naline Lai, MD

©2013 Two Peds in a Pod®

 




Alcohol and drugs- what to say when your child tells you the truth about college parties


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.

John Gannon
Psychologist, Marriage and Family Therapist


Licensed psychologist John Gannon has over 25 years experience as a marriage and family therapist in the Philadelphia area. A father of a young adults, John Gannon has spoken both locally and nationally on family matters. He has addressed numerous teacher and parent groups, given advice on a radio call-in program, and has appeared on The Montel Williams Show.
___________________________

Information and tools to help prevent and treat drug and alcohol abuse by teens and young adults  www.drugfree.org

If you are concerned your child is addicted : to find treatment- U.S .Department of Health and Human Services- Substance Abuse and Mental Health Services Administration – Substance Abuse Treatment Facility Locator www.findtreatment.samhsa.gov 1-800-788-2800

Naline Lai, MD and Julie Kardos, MD
©2013 Two Peds in a Pod®
Modified from the original 12/3/2009 post


 




The effects of sugar on children … not so sweet

swimming in sugarToday’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:

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®




Allergy medicine: the quest for the best antihistamine


The antihistamine quandry

 Junior’s nose is starting to twitch
His nose and his eyes are starting to itch.
 As those boogies flow
You ask oh why, oh why can’t he learn to blow? 
 It’s nice to finally see the sun
But the influx of pollen is no fun. 
Up at night, he’s had no rest,
But which antihistamine is the best?

It’s a riddle with a straight forward answer. The best antihistamine, or “allergy medicine” is the one which works best for your child with the fewest side effects. Overall, I don’t find much of a difference between how well one antihistamine works versus another for my patients. However, I do find a big difference in side effects.

Oral antihistamines differ mostly by how long they last, how well they help the itchiness, and their side effect profile.  During an allergic reaction, antihistamines block one of the agents responsible for producing swelling and secretions in your child’s body, called histamine. Prescription antihistamines are not necessarily “stronger.” In fact, at this point there are very few prescription antihistamines. Most of what you see over-the-counter was by prescription only just a few years ago. And unlike some medications, the recommended dosage over-the-counter is the same as what we used to give when we wrote prescriptions for them.

The oldest category, the first generation antihistamines work well at drying up nasal secretions and stopping itchiness but don’t tend to last as long and often make kids very sleepy.  Diphendydramine (brand name Benadryl) is the best known medicine in this category.  It lasts only about six hours and can make people so tired that it is the main ingredient for many over-the-counter adult sleep aids.  Occasionally, kids become “hyper” and are unable to sleep after taking this medicine. Other first generation antihistamines include Brompheniramine (eg. brand names Bromfed and  Dimetapp) and Clemastine (eg.brand name Tavist).

The newer second generation antihistamines cause less sedation and are conveniently dosed only once a day. Loratadine (eg. brand name Alavert, Claritin) is biochemically more removed from diphenhydramine than Cetirizine (eg. brand Zyrtec) and runs a slightly less risk of sleepiness. However, Cetirizine tends to be a better at stopping itchiness.
Now over-the-counter, fexofenadine (eg brand name Allegra) is a third generation antihistamine.  Theoretically, because a third generation antihistamine is chemically the farthest removed from a first generation antihistamine, it causes the least amount of sedation. The jury is still out.

If you find your child’s allergies are breaking through oral antihistamines, discuss adding a different category of oral allergy medication, eye drops or nasal sprays with your pediatrician.
Because of decongestant side effects in children, avoid using an antihistamine and decongestant mix.

Back to our antihistamine poem:
Too many choices, some make kids tired,
While some, paradoxically, make them wired. 
Maybe while watering flowers with a hose,
Just turn the nozzle onto his runny nose. 

Naline Lai, MD with Julie Kardos, MD

©2013 Two Peds in a Pod®

Updated  from the original  post April 10, 2011




Confused omnivore? How to feed your vegetarian kid

vegetarian cartoonAfter 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 DThe 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®




Cooped up kids? Indoor exercise ideas

indoor exercisesLast week we all sat on the couch watching the Super Bowl. If your kids are still on the couch, this post on indoor exercises by Dr. Deborah Stack is for you:


Let’s face it, it’s hard to move when it’s cold and it’s freezing at my home.  I believe today’s high is 20 degrees Fahrenheit.  Now while this may not deter younger children from bundling up and going sledding, teen couch potatoes are busy whining that it’s “too cold.”  So there they sit.

 

What’s the secret to keeping them active in the winter months?  Have them schedule an activity, and be an example yourself.  Ideas for teens (and you) to do when it’s cold outside:

 

Have a 15-minute dance party

Have a Wii contest

Try swimming (indoors please!)

Dust off the treadmill or stationary bike in the basement and GET ON IT

Play ping-pong

Do a few chores

Jump rope

Jog during T.V. commercials

Pull out some “little kid games” such as hopscotch, hula-hoop or Twister

Let each child in your house choose an activity for everyone to try

 

Teens, like everyone else, need exercise to stay healthy.  Staff from the Mayo Clinic recommend kids ages 6-17 years should have one hour of moderate exercise each day.  Exercise can help improve mood (through the release of endorphins), improve sleep and therefore attention (critical with finals coming up), and improve cardiovascular endurance. Those spring sports really ARE just around the corner. 

 

Here are some numbers to get the kids moving:  All activities are based on 20 minutes and a teen who weighs 110 pounds.  The number of calories burned depends on weight.  If your teen weighs more, he will burn a few more calories, if he weighs less, he’ll burn a few less.  Below the table are links to some free and quick calorie calculators on the web so your teen can check it out for him self.  For those attached to their phones, there are web apps too.

 

ACTIVITY

CALORIES USED

Shooting Basketballs

75

Pickup Basketball game/practice

100

Biking on stationary bike

116

Dancing

75

Hopscotch

67

Ice Skating

116

Jogging in place

133

Juggling

67

Jumping Rope

166

Ping Pong

67

Rock Climbing

183

Running at 5 mph

133

Sledding

116

Treadmill at 4 mph

67

Vacuuming

58

 

 

What’s the worst that can happen?  You’ll have a more fit, better rested, and happier teen!  Or at least you’ll have a cleaner home!

 

Try these activity calculators:

 

http://primusweb.com/fitnesspartner/calculat.htm

www.caloriesperhour.com/index_burn.php

http://www.caloriecontrol.org/healthy-weight-tool-kit/lighten-up-and-get-moving

 

References:

www.mayoclinic.com/health/fitness/FL00030.   
www.caloriesperhour.com/index.burn.php

Deborah Stack, PT, DPT, PCS


With over 15 years of experience as a physical therapist, guest blogger Dr. Stack heads The Pediatric Therapy Center of Bucks County in Pennsylvania www.buckscountypeds.com. She holds both masters and doctoral degrees in physical therapy from Thomas Jefferson University.

modified from the original Jan 26, 2011 post

© 2013 Two Peds in a Pod®




“Mommy, I throwed up”: What to do when your child vomits

volcanopublicdomain

“Mommy, I throwed up.”
Few words are more dreadful for parents to hear, especially at 2:00am (my children’s usual time to start with a stomach bug).

In my house, I am the parent who comforts, changes pajamas and sheets, washes hands and face, and sprays the disinfectant. My husband scrubs (and scrubs, and scrubs) the rug. Little kids never throw up neatly into a toilet or into the garbage can. Sometimes even big kids can’t seem to manage to throw up conveniently.

What should you do when your child vomits?

After you finish cleaning up her and her immediate environment, I suggest that you CHANGE YOUR OWN CLOTHES AND WASH YOUR HANDS! The most common cause of vomiting in kids is a stomach virus, and there are so many strains, we do not develop immunity to all of them. And trust me, stomach viruses are extremely contagious and often spread through entire households in a matter of hours. Rotavirus, a particularly nasty strain of stomach virus, is preventable by vaccine, but only young babies can get the vaccine. The rest of us are left to fend for ourselves.

Stomach viruses usually cause several episodes of vomiting and conclude within 6-8 hours. Concurrently or very soon thereafter, the virus makes an exit out the other end in the form of diarrhea, which can last a week or so.

The biggest problem children face when they vomit is dehydration. Kids need to replace fluids lost from vomiting.  Pedialyte® or other oral rehydration solutions (ORS) such as Kaolectrolyte® or CeraLyte® are useful and well tolerated beverages for rehydrating kids. They contain salt, sugar, electrolytes and water, all substances that kids need when they throw up and have diarrhea.  For babies however, try to “feed through” with breast milk or formula unless otherwise directed by your child’s doctor. Most oral rehydration guidelines are based on diarrheal illnesses such as cholera, so you will find slight variations on how to rehydrate. Basically, they all say to offer small frequent amounts of liquid. I council parents to wait until no throwing up occurs for 45 minutes to an hour and then start offering very small amounts of an ORS (we’re talking spoonfuls rather than ounces) until it seems that the vomiting has subsided. In her house, Dr. Lai uses the two vomit rule: her kids go back to bed after the first vomit  and she hopes it doesn’t occur again. If vomiting  occurs a second time, she starts to rehydrate. Continue to offer more fluids until your child urinates- this is a sign that her body is not dangerously dehydrated.

Can’t immediately get out to the store? The World Health Organization has recommended home based oral rehydration solutions for years in third world countries.  Also, while the oral rehydration solutions are ideal, any fluid is better than none for the first hours of a stomach bug. You can give older kids watered down clear juices, broth or flat ginger-ale with lots of ice.  Now, some kids hate the taste of Pedialyte®. Plain, unflavored Pedialyte® splashed with juice often goes down better than the flavored varieties. For some reason, plain water tends to increase nausea in sick kids and copious amounts of plain water can lower the salt in a child’s bloodstream. So, offer a fluid other than plain water while  your child is vomiting.

Even if your child drinks the Pedialyte®, once the stomach symptoms have subsided, don’t forget that  Pedialyte®, while excellent at “filling the tank,” has no nutrition. The gut needs nutrition to overcome illness. Start to offer small amounts of food at this point. Easy-to-digest foods include complex carbohydrates such as rice, noodles, toast with jelly, dry cereal, crackers, and pretzels.  Additionally, give protein such as bits of turkey or baked chicken. Thicker fluids such as milk and orange juice do not sit as well in upset bellies, nor do large quantities of anything, food or drink. So offer small bits of nutrition fairly frequently and let kids eat as their appetite dictates. Warning- just when everything blows over, toddlers in particular, may go a day without vomiting and vomit one more time as a last hurrah.

Vomiting from stomach viruses typically does not cause severe pain. A child curled up whimpering (or yelling) on the floor with belly pain might have something more serious such as appendicitis, kidney stones, or a urinary tract infection. Call your child’s doctor about your child’s vomiting if you see any of the following:

  • Blood in vomit or in stools
  • Severe pain accompanying vomiting (belly pain,  headache pain, back pain, etc.)
  • No urine in more than 6 hours from the time the vomiting started (dehydration)
  • Change in mental state of your child- not responding to you appropriately or  inconsolable
  • Vomit is yellow/green
  • More fluid is going out than going in
  • Illness not showing signs of letting up
  • Lips and mouth are dry or eyes sunken in
  • Your own gut tells you that something more is wrong with your child

Of course, when in doubt, call your child’s doctor .

Hope this post wasn’t too much to stomach!

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

 

 

 

 

 




“Baby it’s cold outside!” all about frost bite

Breathless after a stint on the treadmill at the gym, I burst out of the building yesterday into the bitter cold. Startled by the frigid air, I reached into my winter coat pocket and pulled out… a pair of stinky socks. One of my kids handed them to me after swimming the other day and I had stuffed them into my pocket. Instantly all my visions of myself as a wonder-workout -woman dissipated as I scurried towards my car with my new sock-mittens. What would have happened if I hadn’t thrown on the socks? Probably not much beyond dry chapped hands. But if you live in a cold area of the world, and your kids refuse to wear mittens (or socks) on their hands in this chilly weather… this post is for you:

Three little kittens, they lost their mittens, and they began to cry.

Oh, mother dear, we sadly fear

That we have lost our mittens.

What! Lost your mittens, you naughty kittens!

Then you shall have no Xbox today. 

-the modern version of a traditional poem

It’s only January and already my kids’ mittens are missing some mates.

Prolonged exposure to cold can lead to injury in body parts with relatively less blood flow such as the ears, fingers and toes. In frostbite, injury occurs secondary to ice crystals which form within or between the cells in your body. Injury can be so severe that the tissue dies and infection sets in.

Early signs of frostbite include tingling or aching. Without treatment, the area will become pale and lose all sensation.


If you suspect your child’s hands are  frostbitten, first remove all wet clothing. Rewarm the area by placing immediately in warm water. Think opposite of a burn- where you use cold water. Do not massage the hand as this may cause further injury, but do encourage your child to move his hands. As very cold hands warm up, they will become blotchy and painful or itchy. Ibuprofen (brand names Motrin and Advil)or acetaminophen (Tylenol) will be helpful. Warm for at least half an hour even if it is painful.

 

Signs of actual frostbite are blistering, numbness, or color changes. As my sister, an emergency room doctor says, red is good. Black and white are not.

 

Head over to the emergency room if you think your child has frostbite. To avoid the risk of over-heating and to manage the pain of treating frost bite, thawing for frost bite should be medically supervised. Just as you would seek care for a burn, seek medical care for a cold induced injury. To rewarm properly, the frostbitten part of the body should be submerged in warm 37-to-40 C (98 -to-104 F) water. No higher because then it’s like trying to defrost a chicken. You will end up cooking rather than thawing the tissue, says my sister. Also a big no-no: starting to thaw but then not completing the thaw. Thaw-refreeze-thaw will injure tissue, same as it ruins a defrosting chicken. So again, seek medical attention for your child if you suspect frost bite has set in.

 

For an interesting but somewhat technical article with photographs on a case of frostbite, check out this New England Journal of Medicine article.

Naline Lai, MD with Julie Kardos, MD

© 2013 Two Peds in a Pod®

modified from original post on 1/20/2010