Guns Or Dogs?

The dog had bitten the child in the face, and the dog’s owner was angry.  The child’s parents thought the owner was going to shoot the dog.  This worried me because we needed the dog alive to see if it developed rabies.  I called the Sheriff’s department, who patched me through to the deputy on scene. “Did he shoot the dog?” I asked.  “Yes, in the head,” replied the deputy.  Oh no, I thought, shooting in the head is the worst, because second best to a live dog is having enough brain tissue to test for the rabies virus.

“How’s the dog then?” I asked tentatively.  “Well, when I pulled up,” the deputy replied, “he ran out, jumped up, and started licking me!”  Turns out the dog had been shot with a pellet gun, not the shotgun I imagined, and the pellet didn’t penetrate his thick skull.

This dog was lucky, because 9 times out of 10 dogs are shot with bigger weapons than pellet guns, and firearms are everywhere.  People are afraid of police because every cop carries a gun, and police are afraid because there’s so many guns among their constituents, who sometimes brandish them during routine traffic stops or domestic disputes.

Firearms are inherently dangerous.  They’re designed to kill. They’re present in at least half of all Louisiana homes, and our state is one of the top states with gun-related deaths in adults, and children. In fact, guns in the home are far more likely to injure or kill a family member than an intruder.  Exploring toddlers and children can accidentally shoot themselves.  Despondent teenagers use them to commit suicide. Angry spouses, in the heat of an argument, shoot each other. Guns stolen out of houses and cars are used in further crimes.

I have a shotgun for duck hunting (or more usually, given my aim, “duck scaring”).  However, when my kids were growing up, my gun was stored at my father-in-laws’. Like swimming pools, when there’s kids around, it’s best just not to have them at the house.  If you feel you must have a firearm, keep it locked up, unloaded, with ammunition stored separately.  For home protection, barking dogs are much more effective, and (mostly) safer.  Get one that doesn’t bite!

While pellet guns aren’t great at dispatching larger animals like our dog above, they’re effective against smaller pests.  When rats infest our yard, eating from the bird feeders and freaking out my wife, I’ll phone my brother-in-law.  “Hey, ‘Murder Incorporated,’” I’ll say, “come over with your pellet pistol.”  We’ll swagger around the yard like mafia hit men, and then “cap” the offending rodents.

While in my wife’s book the dirty rats have it coming, firearm threats to humans are another story.  As we mentioned above, guns’ sole design is to kill.  Having one in the house with kids is unsafe.  Depressed teenagers are one high-risk group. Teens are impulsive, one minute rational, the next minute ready to end their misery permanently.  Gun suicide is too easy, too quick, to give teens time for second thoughts.  When in the Emergency Department we see despondent teenagers, we advise removing guns from the home.

Toddlers and school-age children are also high-risk.  These kids are explorers.  When they find a new “toy,” (which they will, no matter how well you hid it) they’ll play with it. My worst encounter was when a DEA agent came home from an overnight stake-out.  Exhausted, he tossed his pistol on the kitchen table and fell in bed.  His five-year-old son woke up soon after, and you can guess the rest.

Regardless how you feel about the National Rifle Association, the NRA has good safety advice for gun owners.  First, if you must have a gun in the house, keep it locked up, unloaded, with the ammunition locked up separately.  When children are old enough, teach them about guns to take away the mystery, and so they learn safety rules.  The NRA advises teaching children that if they come across a stray firearm, they shouldn’t touch it. Instead, they should run away from it and tell a responsible adult.

Some argue that, if my gun is unloaded and locked up, how can I get it out in time if someone invades my home?  The answer: that gun is statistically much more likely to kill the owner or another family member than an intruder.  If you want real home protection, get a dog.  Dogs are much more effective stranger deterrence, and are cuter too.

Heavy Sleepers

This week’s guest columnist is Dr. Dylan Poche, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I had the same dream every time I wet the bed: I’d be at summer camp, walking out to the camp flagpole, and I’d urinate on it.  When I woke up, the bed was wet.  As I got older, I realized the connection between the dream and wetting, and in the dream would struggle to awaken before peeing on the pole.  About age 9 I I’d wake up as I was peeing on the pole, and go finish in the toilet.  Finally, by 10 years-old, I’d wake up as soon as the dream started and keep dry.

Bedwetting, “nocturnal enuresis” in doctor-talk, is common, and troubling for both children and their families.  It’s defined as involuntary bedwetting in kids otherwise potty-trained by age 5.  Up to a quarter of kids wet at age 5. These kids seem to be deep sleepers, not awakened by the urge to pee. There’s a genetic component, possibly involving maturation of the nerve pathway from bladder to brain.  When I was in medical school and learned this, I asked my parents about it.  Sure enough, dad wet the bed until he was 10, as did my grandfather!

The good news is that it usually resolves on it’s own, but can be alleviated sooner with  treatment.  However, kids who wet after having been dry for awhile might have something else, like urinary tract infections (UTI).  In other words, children who’ve been dry for months or years, and then wet, could be getting sick.  Sometimes it’s something like a stomach virus.  If your child has burning or belly pain with urination, it could be a UTI.  Other signs of infection are fever, foul-smelling urine, or extra frequent urination.  See your doctor for a urine test, since UTIs require antibiotics.

If it’s simple bedwetting, there’s lots of ways to approach this problem.  The easiest thing is restrict your child’s fluid intake in the evening.  This means not drinking a lot with dinner, certainly nothing sugary that kids will chug because it tastes good.  After dinner, minimal water, and have them pee just before bed.

I know of an old Cajun, Uncle Jim, who wet the bed as a child.  He grew up in the 1930s, sharing the attic bedroom, and beds, with six brothers.  When a brother pulled “Jim duty” and shared Jim’s bed, he also shared getting wet.  Finally the brothers, being clever Cajun-types, solved the problem: they propped up their side of the bed with bricks, so that the bed angled down towards Jim.  The high brother stayed dry.

Nowadays there’s better solutions to bedwetting.  Like we mentioned above, the vast majority of kids outgrow bedwetting, usually by around age 7.  A few kids wet into their teen years, but eventually stop.  In Uncle Jim’s day, it was sometimes seen as a psychological problem (Uncle Jim was mean, after all), but now is recognized as a benign issue.  These kids are simply heavy sleepers who aren’t awakened by the urge to go.

There’s things you can do to alleviate this issue sooner.  Like we said above, limiting fluid intake in the evening can make bladders less full.  Often the child needs to drink more during the day, so at night they aren’t drinking to catch up on hydration.  Also, making the child urinate just before bed, and even waking him up to pee soon after he falls asleep, can help make dry nights.  You can buy bedwetting alarms that have a sensor in the child’s pants.  When the sensor gets wet, the alarm wakes the child.  It takes time, but eventually he’s trained to wake up when he’s about to urinate, so he can use the bathroom.

Wetting the bed is of course embarrassing.  Punishing the child for wetting the bed only makes things worse.  It’s best to de-stigmatize the situation by calmly telling the child it’s normal, and decrease his guilt by having him help wash the bedclothes. Encase the mattress in a water-proof cover to prevent permanent urine smell.  Enforce a strict no-teasing policy with siblings.

Occasionally, doctors prescribe medicines to prevent bedwetting, like desmopressin or imipramine.  First the doctor needs to see the child to ensure there aren’t other medical reasons for the bedwetting, like urinary tract infections or constipation; and that the more benign interventions haven’t worked.  Including bricks under the bed.

Kids Don’t Float

My cousin has three daughters, and a pool.  He and his wife knew the drowning risks, so when they had kids they made this rule: no going in the backyard without a life jacket on, whether the girls were going in the pool or not.  So to tell their parents they wanted to go play outside, they’d chant “Jacket? Jacket?” with their arms held up, looking like chicks in the nest peeping for worms, waiting to have it slipped over their arms and buckled up.

This time of year beaches, lakes, and bayous become populated by vacationing families.  Home pools get big use: kids swim and splash around, and teens and parents host parties there.  Pools are also drowning hazards, a leading cause of death in children.

Toddlers are at particular risk.  They’re explorers, often escaping parents’ attention, scooting out into the yard.  If there’s a pool, they’ll bend down to touch the water, and tumble in.  Toddlers don’t know how to get their head above water; security videos invariably show that they don’t thrash about and get attention; they just sink quietly.  Pool parties are notorious for child drownings. The adults are drinking and distracted by conversation, it’s dark, and multiple kids are horsing around.  The toddler or older child slips under unnoticed.  Even for a designated watcher, the temptations to look at more interesting party events, or at the phone, are great.  In Germany, their Lifeguard Association noted more child drownings due to parents watching their phones rather than their kids.

The best drowning prevention is not to have a pool.  If you must have one, or live by a lake or river, fence the pool on all 4 sides, or fence your kids in from the bayou.  Pools  accessible by the patio door are particular trouble.  Pool alarms and covers also aren’t fail-safe.  Swimming lessons may buy your child time to shout for help or get out, but statistics haven’t proven their benefit.

Thus my cousin’s solution to having toddlers and a pool- jackets all the time.  Also, one time he visited Alaska and noted that all boat docks have a rack with child life jackets for anyone to borrow.  The sign above the rack: Kids Don’t Float.

In 2017 I almost drowned at Grand Isle.  I was swimming out to an inflatable island anchored off shore.  The waves were up and slapping me around, and I wasn’t a strong swimmer- “suck” best described my aquatic prowess.  Fortunately, already lounging on the island was my friend Dayle, a former lifeguard and collegiate swimmer.  As I began to flounder and panic, I called out to Dayle, who in seconds was buoying me up and towing me to the float.  Since then I’ve taken lessons, and added swimming to my work-outs.

Grand Isle is Louisiana’s only beach resort island.  If you like your water and your beach brown, Grand Isle is your vacation destination!  Seriously, it’s quite nice there, but they’ve had a spate of recent drownings.  The town had constructed some rock breakwaters off the beach.  These prevent beach erosion and attract fish, making them great for anglers.  Unfortunately, breakwaters also make riptides, dangerous currents that sweep unsuspecting swimmers out to sea.  If swimmers panic or aren’t strong, they drown.  Two of the drownings involved kids who were fishing from the rocks and fell in.  Parents who jumped into save them likewise were lost.  Then most recently a family  was swimming by the breakwaters, and several of them drowned.

When a swimmer is in a riptide, he’ll try to swim back to the beach.  After several strokes, he looks up and notes he’s farther away.  Instinctually, he will paddle harder to get to safety.  He burns energy swimming harder, only to look up and be even farther. Time is running out.

After the first drowning, Grand Isle installed life rings and rope on posts by each breakwater.  Thus if someone falls in, you throw them the ring so they can float, and haul them back in.  But this must happen immediately, before the victim gets too far.  The posts are 20 yards behind the breakwaters.  How long does it take to climb off the rocks, run to the post, run back with the ring, climb back up?  And what if you miss on the throw?

Thus kids on these breakwaters should be wearing lifejackets.  They should wear them in boats, around pools during parties where everyone is drinking and attention wavers,   or anytime they’re in a backyard with a pool.  After all, kids don’t float.

Blood Suckers

Lately I’ve focused this column on consequences of all that time we’re spending outdoors. In the Pediatric Emergency Department we’ve seen lots of related injuries and skin problems.  Now let’s talk about wild beasts your kids might encounter, especially the deadliest animal known to man.  Causing the most fatalities world-wide every year, this animal kills far more people than sharks, snakes, hippos, crocodiles, lions, tigers, or bears.  Way more than murder hornets or killer bees.  This vicious scourge is that blood sucker, the mosquito.

The mosquito kills so many people by transmitting disease when it bites.  Fortunately for us in the United States, it’s bloated world-wide death toll is mostly from malaria, a tropical illness in Africa, Asia, and Latin America.  However, mosquitoes are beginning to spread other tropical diseases from the southern hemisphere to us, like Zika, Dengue fever, and Chikungunya.  Then there’s diseases that mosquitoes already carry locally, like Eastern Equine Encephalitis and West Nile virus.

Mosquitoes often hit and run before you know they’ve come.  They land, stab you with their needle-like nose, suck up blood while simultaneously injecting anticoagulant to prevent clotting in their nose, and lift off with a belly full of your blood, all within a minute.  Only after your body reacts to the anticoagulant, causing that ferocious itch, do you realize you’ve been a victim.

In my practice, that itch does the most damage to kids.  They scratch those bites with dirty fingernails and cause localized skin infections.  I see West Nile or other encephalitises maybe once every five years.  I see infected mosquito bites daily.

In spring I like a beer on my patio as the sun goes down, the temperature’s the nicest, and unfortunately when mosquitoes are most active.  I spray repellent on myself and clothes and put out citronella candles.  I also keep my grass mowed, because long grass hides water that mosquitoes like to breed in.  I also make sure there’s no standing water, like in gutters or buckets.  The one water feature in our yard, the birdbath, has a dripper fountain- mosquitoes don’t lay eggs in rippling water.  Do the same with your yard and your kids.  And keep those nails clean and clipped.

Another of nature’s blood suckers is a hitchhiker, grabbing onto unwitting passersby.  This vampire doesn’t have pale skin, slick hair, and pointy canines, or get rides with it’s thumb out (who’d pick up that guy anyway?).  This horror movie happens on a tinier scale: the tick.

To get out of the home, get some exercise, and get kids away from their electronic heroin, we’re heading outdoors to woods and parks.  In spring, ticks are also hitting these places, clinging to bushes and grasses that we walk past.  As we brush by, the tick latches on to our clothes with hooks on it’s legs.  It’s swooped up and crawls to a hidey hole on the skin.

Until recently, we didn’t know how ticks actually sucked blood.  It certainly wasn’t the lightning fast stab-and-run of the mosquito.  Ticks take hours before they get their “blood meal.”  Then, in 2013, German scientists filmed the event.  Dr. Dania Richter of the Technische Universitat of Braunschweig is a researcher on how ticks transmit Lyme disease to humans. One day, as I imagine it, her team was lounging around the lab when she said, “Hey Franz (the actual name of one of her collaborators), let’s film some ticks sucking blood!”  They got some high speed, high res cameras and mouse “volunteers,” and made bug research history.

Instead of the quick stab of the mosquito, it’s a time-consuming process for ticks. They first cut into your skin with two tiny saws at the front of their heads.  Then they stick a fat harpoon between the saws.  Alternating thrusts of the saws and harpoon, they claw their way deeper until blood flows back into the mouth.  See it on Youtube!

Ticks occasionally transmit diseases like Rocky Mountain Spotted Fever, Erhlichiosis, and Tularemia.  But mainly, they’re just gross.  Prevent bites just like with mosquitoes: spray repellent on your skin and clothes, wear long sleeves and pants (if you can stand the heat), and keep yard grass short.  After hiking, when you shower off the dirt and sweat, check all your skin for ticks.  If you see one, pull it off with tweezers by the head, as close into your skin as possible.  You don’t have to turn your skin into hamburger getting all those saws and harpoons out- they don’t transmit disease themselves.

 

 

Bouncing Babies

This past Thursday, on my monthly morning spot on KLFY TV, I wanted to demonstrate the forces that apply to babies and children in car accidents.  To simulate the effect of a 10 mph car crash on an unsecured infant, I dropped a life-sized baby doll from a 6-foot ladder, face down.  The doll went smack, to a collective gasp from the morning team.  For my own curiosity, the day before, I simulated this in my own car.  I revved up to 10 mph with the unbuckled doll in the back seat and stomped the brake. That baby flew! 

Some people neglect to buckle their infants into car seats, or fail to secure the seat to the car.  Older kids and teens sometimes don’t wear seatbelts. They just don’t understand the danger of sudden decelerations to their bodies. Looking for ways to demonstrate this for TV, I went to the internet.  I found myriad physics lessons that would be confusing to anyone not willing to brush up on higher math. The best I could find: A 30 mph crash into a solid object, like a tree or another car, would be like driving your car off of a 30 foot high building, landing nose first.  Sure, your seatbelt, airbag, and car crumple zones would protect you, but wanna try it?  How about without your belt on?

Humans (and animals) have a much better understanding of falling from heights.  Our ancient ancestors needed to have a fear of heights to survive: don’t jump off that cliff or you’ll die, or at least it’ll really hurt.  We’ve lived with heights for eons and fear of falls is baked into our DNA.  Cars have only been with us for a few generations, so understanding the dangers is an intellectual matter, not a visceral one.  And some people don’t use their intellect.

Thus food for thought: we’ve seen lots of unbelted kids and teens in the past few weeks in car wrecks.  Some had broken bones, including broken hips and femurs, which takes lots of energy.  Like driving your car off of a 3 storey building.  So when your kids get in the car, have them visualize you plunging off that building, the ground rushing up in the windshield.  Buckle up!

In the 1930s, the Boeing Corporation was developing a new, “heavy” bomber for the military.  It was far more complex than any airplane to date: it had four engines, with lots of controls and dials for each. The flaps and rudder were so large that they had to be locked when the plane was just sitting there, lest gusts of wind make them flop around and get damaged.  One day the test pilots took this “B-17″ for a flight, forgot to unlock the controls, and crashed.  Thus Boeing invented the first “checklist,” so pilots wouldn’t have to remember all the important steps it took to fly such a complicated machine.

We discussed above the human perceptions and misunderstandings about the danger of riding in a car without a seatbelt.  It’s not easy to foresee the forces that would slam your body around in a car crash, as opposed to knowing how it will hurt if you fall off a roof.  Though cars are more simple to operate than airplanes, there’s safety considerations that are often forgotten by parents, kids, and especially teens.  Here’s the checklist:

First of course, make sure your kids are buckled properly, in seatbelts or car seats.  Some parents “short-circuit” this step in certain situations. I’ve been told, when talking to parents after a crash, that “we were only going down the street,” to the store or grandmas.  However, the majority of car crashes happen close to home.  Sometimes they let their kids continue trying to buckle up, while starting driving in a parking lot.  Then the crash.  Sure it’s a low speed “fender bender,” but remember our story from above, where a 10 mph crash is like falling from a 10 foot ladder, baby making a horrifying smack.

Some parents just expect their kids to listen.  They say, “buckle up,” and then don’t double check that the belts are on, the doors are closed, or the car seat is properly strapped to the car.  Thus I propose a checklist, taped to the steering wheel (I’ve done this myself!), to remind them that the car should not move an inch until they visually inspect that all is secure in the back.  Boeing Corporation would be proud.

Skin and Bones

Dealing with ailing bodies and human foibles all day long, it’s no wonder doctors have a sick sense of humor, me included.  When people show me their kids’ rashes in public, I play it straight and happily consult.  However, occasionally adults will haul up their shirts at parties to show me the latest blemish on their bellies or backs and ask, “Hey Doc, what the heck is this?” I nod confidently: “It’s definitely cancer,” I say. Then I give them a wry smile that says, hey, only kidding!

Given the warm winter we’ve had, the early spring, and the early school closings, I predict a rough summer for rashes.  Children meet the outside world with their skin.  When falling off bikes or monkey bars, not “sticking the landing” as they say in gymnastics, they get scrapes and cuts and bruises.  When they plow through vegetation exploring or searching for stray balls, their skin gets irritated by thorns or poison ivy. Mosquitoes enjoy a blood meal from our children, and later, when the bite itches, they tear at themselves with ragged, dirty fingernails.  Sun cooks hot, exposed skin too.

We’re all learning new habits from Coronavirus concerns, like washing our hands more often and extra carefully, wiping down potentially contaminated surfaces, and trying not to touch our faces.  It’s also a good time to improve skin-care habits for children.  That’s the best prevention for skin injuries and infections that we’ll see in the Emergency Department in the coming months.  Paradoxically, skin is hardest to hurt when it’s soft and pliable.  It bounces back, and heals better.  Hard dry skin cracks under pressure and itches worse when insulted.

Kids should use moisturizing soap. Buy brands like Dove and Caress, which are easy on skin, rather than harsh drying soaps like Ivory, Zest, Dial, or Irish Spring.  Washclothes and vigorous toweling also can irritate, so kids should use only their hands and the soap, and pat dry with towels. Advanced Parenting involves using white lotion to moisturize kids’ skin, putting on sunscreen, and applying bug spray.  When a kid gets a cut or scrape, “rub dirt on it” is just a joke!  Wash broken skin with soap and water, and dress it with neosporin and bandages.  Please keep those grubby ragged fingernails clean and short.

In 2008, New York City mom Lenore Skenazy was shopping with her 9 year-old son.  They had ridden the subway, and that day he begged Ms. Skenazy to let him ride home by himself.  Having taught him how to read subway maps and distinguish between uptown and downtown trains, she decided to let him go.  He got home safely and was ecstatic with his feat.  But when Ms. Skenazy wrote about his adventure in a newspaper column, she set off a storm of controversy.

Some called her the “world’s worst mom.” Child Protection paid her a visit.  Others praised her for giving her child freedoms not allowed by “helicopter parents,” so-called because they hover over their kids’ every move. Ms. Skenazy then briefly had a reality TV series where she coached such parents on letting their kids ride bikes or slice vegetables.  The show’s title: World’s Worst Mom.

Fortunately, we in Acadiana needn’t worry about children navigating crowded cities. But they will be having adventures on bikes and trampolines, or dirt bikes and ATVs.  Most emergencies we’re seeing now are injuries from these. If your child falls off a bike or monkeybars, check the head first.  Head injuries are the most common serious injury in pediatrics.  If the kid has been knocked out or is acting confused, get them into us right away.  Please put helmets on bike-riders before this happens!

If the head checks out okay, limbs are next.  Broken bones are obvious: the child cries and points to the dinged wing.  Sometimes it’s bent in an unnatural way.  The best care for an injured arm or leg is to immobilize it. Preventing the hurt part from moving is the best pain control.  Tape it to a rolled up newspaper or magazine, or a handy board. Give your child some pain medicine, like ibuprofen or tylenol.  DON’T give your child anything to eat or drink.  They’ll need an empty stomach if anesthesia is necessary.

If your child crashes a motorized bike or ATV, you’ll feel like the World’s Worst Mom- these vehicles’ power and speed are too dangerous for little bodies.  Bikes are good enough, and better exercise for their skin and bones.

Happiness In The Age of COVID

The Advocate newspaper carries a column on parenting by child psychologist John Rosemond. I’ll herald the latest installment to my wife: “Hey Honey, cranky ol’ Dr. Rosemond is at it again!”  He’s old-school, wherein children-should-be-seen-and-not-heard, hard-work-is-its-own-reward, etc.  While not exactly advocating that kids work 14 hour-shifts in textile mills, he likes to cast doubt on such “modern” diagnoses as ADHD.

He sometimes makes good points. His column “Why Some People Believe That They Are Entitled,” speaks to the erosion of happiness in the age of COVID.  Entitlement is the idea that you deserve happiness, wealth, and success, whether you’ve earned it or not.  According to Rosemond, recent generations have raised kids to think like European Royalty, that they’re more special than everyone else, and thus Entitled.  Even cheating to get what you want is okay, since you’re above the rules meant for commoners.

Many argue that instilling a sense of Entitlement, and generally spoiling children, has led to the rise in depression and suicidality in kids and teens.  When kids don’t get their way in the real world, in school, with other kids or adults, they’re profoundly disappointed, their world-revolves-around-me view shattered.  Now with social distancing, travelling restricted to grocery shopping, and economic free-fall, few adults are getting their way anymore either.

With loss of work and freedom, people are bored, depressed about a life without purpose, and full of anxiety that they or their loved ones will get seriously ill. Many raised in the land of plenty are, like spoiled toddlers, now profoundly disappointed with life.  However, many others, in the search for meaning in this new age, have taken action. They’ve started life-affirming tasks- learning new skills like a new language or cooking; spending more time with their kids (and parents!), making masks and delivering food to health care workers and shut-ins, donating blood.

John Rosemond is right, at least about this aspect of parenting. Kids should learn that being useful, being moral, and working hard, are more important than striving to be happy and successful.  Then strangely enough, the pursuit of character begats happiness anyway.. Especially in the Age of COVID.

Another pillar of happiness is being connected with others.  While we just discussed that hard work and a meaningful life lead to happiness, social interaction helps too.  Before the invention of telephones in 1876, people communicated from afar by written letter. Also in those days, early death was a constant.  About one quarter of infants died before their first birthday, and almost half of children died before puberty.  The average adult was lucky to live past 40.  Thus letters between distant family members often started with “I hope this letter finds you well,” followed by a summary of the health of those at home.

That was the snail pace of life, death, and communication in the Age of Enlightenment. Thanks to the internet, with email, twitter, instagram, and facebook, the above sentiments are transmitted instantly.  I’ve gotten scads of electronic messages from near and far asking me if I’m okay on the “front lines” in the Emergency Department. At home we’ve been spending lots of facetime with my daughter in Seattle and my son in New Orleans, COVID hot spots.

Though it’s a good time for the internet, with it keeping us connected and informed, the net’s also a two-edged sword in these respects. Hateful and divisive posts on facebook or twitter come at us instantly as well. Nothing gets people fired up, and not in a good way, like a skewed political post claiming the other side is criminal or incompetent.

Misinformation spreads quickly too, For example, there’s many posts about how influenza, the plain old flu, has caused many more deaths than COVID, and yet we never tanked the economy by closing schools and businesses during flu season. What they don’t mention is that COVID threatens to cause even more deaths than influenza, since it’s more deadly to individual patients, may be even more contagious, and has no vaccine or anti-viral medication to check its spread. The only way to stop it and save lives- closures and social distancing.

So for information on keeping you and your kids safe, and your futures, please use expert sources without political or social agendas: the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP.org). These places will give you the straight scoop as it becomes known, without an extra helping of anger to dampen your happiness.

School’s Out For….Spring?

This week’s guest columnists are Drs. Mark Carreras and Jacob Sellers, Family Practice residents at the University Hospital and Clinics here in Lafayette.

When I was a kid, the last day of class would end with a final bell, and we’d blast Alice Cooper’s “School’s Out For Summer.”  We were free, thrilled we’d “survived” another year, as if we’d reached high ground just ahead of a tsunami. With schools closed probably for the rest of the year, many kids celebrated pretty early.

For parents this is NOT a fun, exciting time (their lyrics: “Well I tried to make it Sunday, but I got so damn depressed”).  School’s definitely not out yet for summer, and while parents are used to kids’ summers off, this is very different.  There’s no more family vacation, with many household budgets taking a hit and vacation spots closed. Working parents must find babysitting and activities for their kids way before they were ready.  And there’s school work still to be done. At home.

Unless you’re a professional educator, schooling and teaching are tough. Who remembers what they learned in history, much less technical subjects like trigonometry?  While schools are transitioning to on-line teaching and assignments, parents must do their share to keep their kids from falling behind.  More on this below.

Doctoring must be done at home too. Offices and clinics have shortened hours, and visits are more time-consuming.  Many practices have parents wait in their cars, and staff call them when it’s their turn to come in.  Emergency Departments are COVID war zones, with really sick and contagious patients; not places you want to be with your child.

This blog’s a place to go for advice if your kid is sick.  If you’re reading this in the Advocate, note the blog address below.  Stock up on ibuprofen, tylenol, and benadryl. Make sure asthma medicine is refilled, as COVID can make trouble for wheezers. And don’t panic. Many kids are still getting cold and fever viruses, and parents worry it’s COVID.  Rest assured that in most kids, COVID is benign, and soon gotten over.  Only go to the ER if kids are short of breath, too sleepy to drink enough, or vomiting continually.

As a new parent, one of the most shocking realizations for me has been the power of the screen.  My 2 year-old is typically unreserved, energetic, and sociable. All at once.  He’ll hold a conversation with you while leaping from couch to chair.  However, a flip of the television switch turns him into an expressionless, drooling zombie.  I wouldn’t be surprised if he started moaning “..brains….brains….”

Limiting screen time may be the biggest challenge for parents during this extended school break, or school-at-home-for-the-rest-of-the-year.  But this battle is worth fighting, as increased screen time is linked with worse childhood obesity, depression, poor diet and constipation, and worse sleep.  In other words, an overall tanking of quality of life.  As Dean Wormer said in the movie Animal House, “Fat, drunk, and stupid is no way to go through life, son.”

One recipe for success during this COVID outbreak is maintaining a routine.  Filling kids’ days, making them adhere to school work and stay off the computer/phone/tablet/TV sounds tortuous.  However, mapping out a daily schedule can actually save time and make things easier.  Start with wake-up time, three meals, snacks, and bedtime. Then insert school work, indoor play time, outdoor playtime, chores, and family activity. There can be some fluidity in that schedule, but keep in mind that kids are happier and better behaved when kept to a routine. The wake-up, mealtimes, and lights-out should be reasonably enforced.

One daily activity that can’t be discounted is reading.  Study after study shows that reading with children improves brain development, social-emotional skills, language, and of course literacy.  Your schedule should absolutely include reading to your child, or them reading independently.  When they read on their own, make time to discuss with them what they’ve read.  One of the best opportunities to read to your child is bed-time. This should ALWAYS be part of the nightly ritual.

How you manage this challenging time will make a difference about how your children grow up.  Do you want them to be successful and happy?  Kids thrive on structure and reading.  Reinforcing these makes the difference between your kid being strong and independent, or being a screen-addicted zombie, depending on others for…..their brains!

Don’t Touch Your Face?

When we visited my 89 year-old mother-in-law last week, we met on the patio. Staying on the swings far from her chair, we couldn’t pass her the COVID virus if we were carriers.  My wife brought her own bottle of wine.  Later Nana went into the kitchen to refill her glass, and through the window we saw her pick up my wife’s bottle, examining the label, while we both slapped our foreheads: “Nana, go wash your hands!”

Staying safe from the COVID-19 virus, aka Coronavirus, is like playing “invisible force field,” where any surface (counters, door knobs, wine bottles) is potentially contaminated, and you need to wash your hands before you touch your face or food.  That’s how COVID, or any cold/flu virus, gets into your system.  You inhale it when someone coughs or sneezes near you, or you put it in your mouth, nose, or eyes with your fingers.

The good news is that so far, COVID doesn’t seem bad for children.  They get a cough, runny nose, and maybe fever, but many fewer kids are hospitalized for breathing trouble than adults. Like any other cold and fever virus, kids get by with ibuprofen or Tylenol for fever and pain, and plenty of fluids.

The bad news, and the main reason why schools and daycares close, is that kids spread infection around.  They cough and sneeze without covering their mouths, letting fly with virus-laden droplets.  They wipe their nose and mouths with their hands, and smear infectious drool onto every thing they touch.  Kids shed virus into the environment worse than adults, because they’re, well, gross.  So we close schools so kids don’t pass the virus from family to family, sending it into households with vulnerable family members- the elderly, cancer patients, or those with certain medical conditions.

Some kids get seriously sick from COVID.  The Chinese experienced some pediatric hospitalizations, with some critically ill. Kids with asthma might get it worse, or kids with heart conditions, or infants.  If your child has a potentially dangerous condition, be extra vigilant about who they contact, where they go, and what they touch.  And don’t touch your face!  More on that below.

Three weeks ago my wife and I were on vacation.  We weren’t in China or Italy; we were in the snowy woods of Quebec, away from crowds, cross-country skiing.  However, we flew home through Newark airport, part of New York City’s transportation network, with lots of international travelers milling about.  In the Customs line a kid next to us kept sneezing without covering his mouth, his parents oblivious. Great.

We haven’t gotten sick, so the little turkey apparently hasn’t given us COVID, but it’s  now revealing itself in Acadiana.  As you keep hearing, the best defense against catching the virus is good hygiene. Cough and sneeze into your elbow to avoid spreading the virus.  Don’t get close to anyone since they might be shedding it.  Wash hands frequently, in case you’ve inadvertently touched a contaminated surface. And don’t touch your face?

As we mentioned above, the virus gets into you through your mouth, eyes, and nose.  You can pick up the virus from a doorknob, a handshake, a handrail, and then when you touch your face, you pass it into those portals.  It’s remarkable how many times people touch their faces- on average several times per hour.  After all, faces are sensitive, and need scratching.  Noses need picking, thumbs need licking..

Telling people to stop touching their faces is like telling them to lose weight or stop smoking.  Eating badly, smoking, and rubbing your nose are all near-impossible habits to break.  Hence the draconian steps of closing schools, restaurants, and anywhere else people mingle. The virus spreads too easily, and people pick it up too easily as well.  And try teaching kids not to touch their faces!

That’s also why we’re advised to wash hands so much.  When we do touch our faces, we’re safer with clean hands.  Frequent hand-washing is easy for me, washing them over forty times per day at work anyway, before and after touching each patient.  But not everyone has that habit.

The CDC has warned that wearing a face mask doesn’t really stop the spread of infectious droplets. But maybe wearing the mask will keep you from getting your fingers into your mouth, nose, or eyes.  Maybe people should wear mittens instead.  And definitely, for the next few months, stay away from Nana.

Elbow Woes

This week’s guest columnist is Dr. Tasia Bradley, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I was two years-old.  “Pick me up! Pick me up!” I yell to my sister. She grabs my hands, begins whirling me around, and up into the sky I go.  “Faster! Faster!”  Suddenly a pain in my left elbow.  I begin to shriek as my sister lets me down, a puzzled look on her face, what did she do?  Now Mom’s worried, she doesn’t know what happened either.  On my first trip to the Emergency Department, the staff’s all smiles, no big deal, just a dislocation.  1…2..3.. back in place.  Soon I’m running around again, but no more flying in the sky.

“Nursemaid’s Elbow” is an occasional event in toddlers, where a bone in the elbow gets dislocated. The forearm has two side-by-side bones, the radius and the ulna.  Their ends near the elbow are held together by a rubber-band called the annular ligament. In some kids that ligament is weak, and the radial end can be pulled out of that loop by traction. Traction like being whirled around like me above, or having the hand jerked to hurry a slow toddler along.  Sometimes it happens when a parent is trying to get a shirt off, tugging away at that long sleeve, and pop!

When children dislocate their radius, they cry at first, but then settle down.  It looks benign- no swelling like with a broken bone, and kids often start playing again.  Except that they’ve stopped using that elbow, letting it hang by their side, and do everything with the other arm.  When parents bring them in, no x-rays necessary.  If the story’s right (“Pulled on the wrist, eh?”), it’s a simple maneuver to put it in place. The elbow clicks like you’ve cracked a knuckle, a brief squawk from the child, and in a few minutes she’ll give you a high-five. Fixed!

To avoid this injury, of course, no tugging on hands and wrists. Pick up infants and toddlers under their armpits.  But kids like being swung around, and they also can dislocate when wrestling or falling just so. When they pop that elbow, bring ‘em in. The good news: kids prone to Nursemaid’s Elbows develop stronger annular ligaments and stop dislocating by age 5.

Fast forward from 2 year-old Tasia above, to 1994. I’m on the playground at Boudreaux Elementary in Gretna, climbing the ladder to the monkey bars. Grab one bar, swing to  the next, and the next, and….I’m falling through the air and land on my right arm.  I’m crying, my elbow hurts so much. I went to my teacher, who wasn’t worried because there wasn’t any swelling, and by the end of the day I was using it again.  No Emergency Department visit this time, but I’ve never been on monkey bars since. Just looking at them makes me break out in a sweat.

Sometimes though, kids end this scenario with a swollen elbow that just won’t stop hurting. Besides being vulnerable to dislocations as we discussed above, kids’ elbows are susceptible to fractures.  The bone at the elbow end of the humerus (the upper arm bone) is thin.  When kids land on their elbow, or impact on their outstretched hand, that bone end can crack.  In fact, 70% of these fractures occur when the child falls and puts his hand out to brace himself. The force is transmitted through the forearm and snaps that vulnerable spot.

These injuries are more obviously bad than the Nursemaid’s elbow from above. The elbow is swollen and sometimes blue from internal bruising, and it really hurts.  These need to be seen in the ER for x-rays, pain medicine, and treatment.  Sometimes all that’s needed is a cast to hold the broken elbow still and protect it while it heals, usually 4-6 weeks. In some unlucky kids, however, the end of the humerus is cracked all the way through and shifted. These need surgery to pin that thin bone end back in place.

Finally, let’s briefly talk about the word “fracture.”  Occasionally, a parent will be discussing their kid’s bone injury, and ask “is it broken or is it fractured?”  This question puzzles us, since a fractured bone IS broken. It’s like asking “is the sky blue, or is it azure?”  Fracture is just a fancy word for broken, and either way, it needs treatment, usually a cast, but sometimes surgery.  Hopefully when your kid hurts their elbow, it will just be sprained like mine was, and get better in a matter of hours.  But if it’s swollen and really painful, come on in!