With an obesity epidemic in this country, the question of whether kids are being too active rarely comes into play. However, if your child is over-scheduled with sports leagues or is over-training in the same sport, he or she is at risk for an overuse injury. Here's some common questions/answers to this topic:
What is an overuse injury? Overuse injuries are chronic injuries that occur with repetitive stress on the musculoskeletal system over a course of time without allowing for adequate recovery. Pediatric athletes are prone to overuse injuries causes by stresses placed on growing bones.
What are common overuse injuries in kids? The most common overuse injuries in kids are tendinitis, stress fractures, knee cap pain (patellofemoral pain), and apophysitis (inflammation where muscles attach to bone).
How much is too much? The answer to this question differs for every child. It usually becomes clear when a child is over-training. Fatigue, pain, or disinterest in his or her sport are common signs that a child is developing an overuse injury. Generally, they do not have adequate rest between sports activities.
How do I make sure my child does not acquire an overuse injury? Make sure your child has built in rest days in the weeks of scheduled sports activities (don't forget that PE also counts as an activity). Also listen to your child if he or she complains of pain or fatigue.
What is the treatment for an overuse injury? Rest is the first line of treatment. Each overuse injury has more specific treatment, but generally the treatment includes physical therapy, ice, anti-inflammatories (like ibuprofen), and possible bracing or orthotics.
Every sport has common overuse injuries. For instance, young baseball pitchers are prone to acquiring "Little League Elbow" (a type of apophysitis). It is important that you are aware of what the most common injuries seen in the sport your child participates in. Included in the links and resources section is a website with sports specific resources and injury prevention information (STOP sports injuries).
Rachel Brewer, MD
Pediatricians for Parents. We pediatricians dedicated to sharing useful information with parents about common childhood ailments.
Friday, December 30, 2011
A Big Pain In The Bum ... Diaper Rash
Diaper rash is very uncomfortable for both babies and parents. It has many causes and is a problem that every parents has to deal with. The most common cause is contact with poop
and pee (especially diarrhea), but others like allergy to diapers,
yeast, bacteria, and viruses do exist. If the rash is due to contact with poop
or too long in a wet diaper, take these steps:
1) Stop using wet wipes - instead use cotton squares (like the kind you buy to apply makeup) and place in a sandwich bag, soak the cotton with mineral oil (baby oil without fragrance - often found in the laxative area), then you have handy, portable wipes that work fantastic to clean off a baby's bottom and leave a layer of moisture behind.
2) Start using Desitin Original Paste (40% zinc oxide) with every diaper change and LOTS of it. The entire diaper area should be white and stay white until the next diaper change.
3) Give your baby as much time out of a diaper as possible. A good time to do this is after bath time, on top of a towel (too avoid a messy floor).
4) After the diaper rash resolves, continue to use a barrier ointment to protect your little one's bottom - at this stage you can use any ointment that works best for your baby.
If the rash is due to an allergic reaction from the diaper itself, it
is usually the dye in the disposable diaper. It may get better, but
will not go away completely with conventional methods. The rash is
usually located away from the genitals and around the waist or on the
inner thighs. Try to switch diaper brands, because they all use
different materials or switch to cloth diapers. Cloth diapers are very
good for babies who are sensitive to diaper materials and the rash
will go away very quickly, if this is the problem.
If the rash is not going away with either of these methods, then it may be a virus, yeast, or bacteria. Yeast is very red appearing and spreads even with conventional treatments. You can try over the counter yeast cream, like Clotrimazole 2-3 times a day before applying the Desitin. If the rash is not going away with either of these treatments or develops drainage (like pus), then go in and see your pediatrician.
There are many methods for successfully treating diaper rash, this is just one that consistently works for me. If anyone else has another good method, then feel free to post in the comments section.
Heather Joyce, MD
1) Stop using wet wipes - instead use cotton squares (like the kind you buy to apply makeup) and place in a sandwich bag, soak the cotton with mineral oil (baby oil without fragrance - often found in the laxative area), then you have handy, portable wipes that work fantastic to clean off a baby's bottom and leave a layer of moisture behind.
2) Start using Desitin Original Paste (40% zinc oxide) with every diaper change and LOTS of it. The entire diaper area should be white and stay white until the next diaper change.
3) Give your baby as much time out of a diaper as possible. A good time to do this is after bath time, on top of a towel (too avoid a messy floor).
4) After the diaper rash resolves, continue to use a barrier ointment to protect your little one's bottom - at this stage you can use any ointment that works best for your baby.
If the rash is due to an allergic reaction from the diaper itself, it
is usually the dye in the disposable diaper. It may get better, but
will not go away completely with conventional methods. The rash is
usually located away from the genitals and around the waist or on the
inner thighs. Try to switch diaper brands, because they all use
different materials or switch to cloth diapers. Cloth diapers are very
good for babies who are sensitive to diaper materials and the rash
will go away very quickly, if this is the problem.If the rash is not going away with either of these methods, then it may be a virus, yeast, or bacteria. Yeast is very red appearing and spreads even with conventional treatments. You can try over the counter yeast cream, like Clotrimazole 2-3 times a day before applying the Desitin. If the rash is not going away with either of these treatments or develops drainage (like pus), then go in and see your pediatrician.
There are many methods for successfully treating diaper rash, this is just one that consistently works for me. If anyone else has another good method, then feel free to post in the comments section.
Heather Joyce, MD
Thursday, December 29, 2011
Hot Topic - Concussion in Young Athletes
Concussions are a hot topic in the media lately, and you can't watch the news or Sportscenter without hearing about an athlete who is affected by a head injury. Concussions not only affect pro athletes, but they are also common in kids who play contact sports. It is very important for parents to understand what a concussion is and how it is treated.
A concussion is a brain injury caused by a direct blow to the head. You don't have to lose consciousness to have a concussion. Even "getting your bell rung," or what you think is a mild bump to the head can be serious. The most common signs and symptoms of a concussion are headache, dizziness, nausea, confusion, behavior or personality changes, difficulty sleeping, and sensitivity to light and loud noises. There are many more symptoms of a concussion, and they can occur directly after the injury or days later. Bottom line - if you feel like your child is not acting like his or herself after a head injury, seek medical attention right away.
There is no simple test for a concussion. We use many tools to determine if a child has a concussion including neurocognitive tests, evaluation of signs and symptoms, and the physical exam. Getting a CT scan of the head is only indicated if we suspect a more serious diagnosis (such as a brain bleed or skull fracture) - a CT is normal with only a concussion.
Just like you rest any other part of the body when an injury occurs, a concussion requires "brain rest." This means limited stimulation with school, TV, computers, video games, texting, etc. When symptoms improve, the medical team, family, and school work together to get your child back to these activities gradually. The tests used to diagnosis a concussion are also used to determine when it is safe for a child to return to play. In general, kids take longer to recover from a brain injury than do adults (usually 3-4 weeks). Kids are not all the same in how long it takes them to heal, but each should be symptom free before returning to play.
There are definite risks for letting your child return to sports without letting a brain injury resolve, which include prolonged concussion symptoms, possible death due to more severe brain injury, or long term cognitive effects. Also, if a child sustains one concussion they are at higher risk of sustaining another concussion in the future.
Again, as a parent, it is important to recognize that a concussion is a serious diagnosis and that if your child is not acting like his or herself after a bump or blow to the head that you seek medical attention. Included in the links section is a great website by the CDC for education on concussions for young athletes, coaches, and parents.
Rachel Brewer, MD
A concussion is a brain injury caused by a direct blow to the head. You don't have to lose consciousness to have a concussion. Even "getting your bell rung," or what you think is a mild bump to the head can be serious. The most common signs and symptoms of a concussion are headache, dizziness, nausea, confusion, behavior or personality changes, difficulty sleeping, and sensitivity to light and loud noises. There are many more symptoms of a concussion, and they can occur directly after the injury or days later. Bottom line - if you feel like your child is not acting like his or herself after a head injury, seek medical attention right away.
There is no simple test for a concussion. We use many tools to determine if a child has a concussion including neurocognitive tests, evaluation of signs and symptoms, and the physical exam. Getting a CT scan of the head is only indicated if we suspect a more serious diagnosis (such as a brain bleed or skull fracture) - a CT is normal with only a concussion.
Just like you rest any other part of the body when an injury occurs, a concussion requires "brain rest." This means limited stimulation with school, TV, computers, video games, texting, etc. When symptoms improve, the medical team, family, and school work together to get your child back to these activities gradually. The tests used to diagnosis a concussion are also used to determine when it is safe for a child to return to play. In general, kids take longer to recover from a brain injury than do adults (usually 3-4 weeks). Kids are not all the same in how long it takes them to heal, but each should be symptom free before returning to play.
There are definite risks for letting your child return to sports without letting a brain injury resolve, which include prolonged concussion symptoms, possible death due to more severe brain injury, or long term cognitive effects. Also, if a child sustains one concussion they are at higher risk of sustaining another concussion in the future.
Again, as a parent, it is important to recognize that a concussion is a serious diagnosis and that if your child is not acting like his or herself after a bump or blow to the head that you seek medical attention. Included in the links section is a great website by the CDC for education on concussions for young athletes, coaches, and parents.
Rachel Brewer, MD
Wednesday, December 28, 2011
Winter Remedies for Every Parent
I am going to start this blog by giving a list of the most commonly prescribed remedies I give out during the winter, also known as cough and flu season. These are the items I ALWAYS have around my house and I recommend to every one of my patients.
Vaseline (petroleum jelly) or Aquaphor - Winter is a time for dry skin, diaper rash, runny nose and red cheeks. The best remedy for all of these is a great barrier ointment and Vaseline does the trick almost every time. It may be thick and greasy, but when your little one really needs protection, it does the trick. If you ever get around to checking out the ingredients on your body lotion, baby lotion, or beauty cream, one of the first ingredients is petrolatum (yes, the main ingredient in Vaseline). This is because it is the only ingredient that creates a barrier from the outside world. All of the other ingredients are added to make it feel better, absorb better or smell better, all of which your child does not need and may cause irritation.
Nasal saline and a bulb syringe - Nothing helps a runny nose and clogged sinuses in a child like saline. You can not use it too much. For infants and young toddlers (<2), I recommend nasal saline drops. Just put 2 drops in each nostril, let it sit as long as you can hold your child down (<10 sec for most parents), insert the bulb syringe, close the other nostril with your finger and suck. The hardest part is holding your child in a position to get this done! For older children, the nasal saline spray is much easier and kids don't seem to mind it near as much.
Cool mist humidifier - Place in your child's room, near the bed (but not too close to wood furniture - I learned that one the hard way) at the first sign of a cold, sore throat, or sinus blockage. Remember not to use the hot water humidifiers, they will burn your curious children.
Children's ibuprofen (Advil) or acetaminophen (Tylenol) - If your child goes out in public at all or anyone else in the house gets sick, then your little one is bound to get something during the winter months. Upper respiratory tract infections are very common and most of them have fever associated with them. The fever is your child's body fighting the infection, but fever can also cause your child to be very uncomfortable, with fussiness, flushed cheeks, fast breathing, and sleepiness. Our greatest weapon against fever is ibuprofen or acetaminophen, use as directed by your physician. Remember that both of these medications come in infant formulations and the dosage can be very confusing, so double check before giving. Please remember no ibuprofen for infants <6 months and never any aspirin for children.
Honey - Honey has been shown in several studies (and by personal experience) to calm a cough better than the cough suppressants that are FDA approved for children (only for >6 years). Dark honey seems to do the best job, but regular honey works and also tastes better. Just 1/2 - 1 teaspoon every 2 hours for children older than 2. Do not give honey to any child <1 year for risk of botulism.
Pedialyte or Gatorade - If your child is sick with an upper respiratory tract infection or gastroenteritis (also commonly known as the "stomach flu", it is very important to have an oral rehydration solution on hand. For children under the age of 2 or 3 (depending on when they refuse to drink the solution), Pedialyte is best. After that Gatorade will work. It can be warm, cold or frozen like a Popsicle. If your infant is just refusing to eat and drink because of a stuffy nose, try switching to Pedialyte, it goes down much easier than formula (the Popsicle trick also works with infants >4 months). If they are vomiting, try giving small amounts (5 ml or sips) of Pedialyte very frequently to keep them hydrated.
Influenza Vaccine - If you have children over the age of 6 months, please get them an influenza vaccine. I also urge all parents to get the vaccine, especially if they have children under the age of 6 months, who can not get the vaccine. Influenza is a very serious respiratory illness, especially in children. It causes high fever, runny nose congestion, cough, difficulty breathing and a very ill child for 5-7 days on average. The vaccine is the only weapon we truly have against this life threatening illness.
Heather Joyce, MD
Vaseline (petroleum jelly) or Aquaphor - Winter is a time for dry skin, diaper rash, runny nose and red cheeks. The best remedy for all of these is a great barrier ointment and Vaseline does the trick almost every time. It may be thick and greasy, but when your little one really needs protection, it does the trick. If you ever get around to checking out the ingredients on your body lotion, baby lotion, or beauty cream, one of the first ingredients is petrolatum (yes, the main ingredient in Vaseline). This is because it is the only ingredient that creates a barrier from the outside world. All of the other ingredients are added to make it feel better, absorb better or smell better, all of which your child does not need and may cause irritation.
Nasal saline and a bulb syringe - Nothing helps a runny nose and clogged sinuses in a child like saline. You can not use it too much. For infants and young toddlers (<2), I recommend nasal saline drops. Just put 2 drops in each nostril, let it sit as long as you can hold your child down (<10 sec for most parents), insert the bulb syringe, close the other nostril with your finger and suck. The hardest part is holding your child in a position to get this done! For older children, the nasal saline spray is much easier and kids don't seem to mind it near as much.
Cool mist humidifier - Place in your child's room, near the bed (but not too close to wood furniture - I learned that one the hard way) at the first sign of a cold, sore throat, or sinus blockage. Remember not to use the hot water humidifiers, they will burn your curious children.
Children's ibuprofen (Advil) or acetaminophen (Tylenol) - If your child goes out in public at all or anyone else in the house gets sick, then your little one is bound to get something during the winter months. Upper respiratory tract infections are very common and most of them have fever associated with them. The fever is your child's body fighting the infection, but fever can also cause your child to be very uncomfortable, with fussiness, flushed cheeks, fast breathing, and sleepiness. Our greatest weapon against fever is ibuprofen or acetaminophen, use as directed by your physician. Remember that both of these medications come in infant formulations and the dosage can be very confusing, so double check before giving. Please remember no ibuprofen for infants <6 months and never any aspirin for children.
Honey - Honey has been shown in several studies (and by personal experience) to calm a cough better than the cough suppressants that are FDA approved for children (only for >6 years). Dark honey seems to do the best job, but regular honey works and also tastes better. Just 1/2 - 1 teaspoon every 2 hours for children older than 2. Do not give honey to any child <1 year for risk of botulism.
Pedialyte or Gatorade - If your child is sick with an upper respiratory tract infection or gastroenteritis (also commonly known as the "stomach flu", it is very important to have an oral rehydration solution on hand. For children under the age of 2 or 3 (depending on when they refuse to drink the solution), Pedialyte is best. After that Gatorade will work. It can be warm, cold or frozen like a Popsicle. If your infant is just refusing to eat and drink because of a stuffy nose, try switching to Pedialyte, it goes down much easier than formula (the Popsicle trick also works with infants >4 months). If they are vomiting, try giving small amounts (5 ml or sips) of Pedialyte very frequently to keep them hydrated.
Influenza Vaccine - If you have children over the age of 6 months, please get them an influenza vaccine. I also urge all parents to get the vaccine, especially if they have children under the age of 6 months, who can not get the vaccine. Influenza is a very serious respiratory illness, especially in children. It causes high fever, runny nose congestion, cough, difficulty breathing and a very ill child for 5-7 days on average. The vaccine is the only weapon we truly have against this life threatening illness.
Heather Joyce, MD
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