“He Bumped His Head And Went To Bed…”

Today’s guest columnist is Dr. Jesse Livingston, a family practice resident at the LSU-University Health Center here in Lafayette.  

Kids fall and hit their heads a lot.  Though most children with head injuries are fine, some need evaluation in the Emergency Department.  The parent can have difficult decisions to make, while at the same time dealing with a crying baby: Is the brain okay?  Does my child need a CT scan?  Can he nap?  We have all heard the nursery rhyme about the old man who bumped his head, went to bed, and couldn’t get up in the morning.  What about your two-year old, who despite every effort will “fall and go boom?”

The decision is easy for the worst falls.  If a child loses consciousness, has a seizure, vomits repeatedly, has a severe headache, is lethargic or confused, then she needs to be seen.  The doctor can decide if tests are needed, or if observation is enough.  We need to consider the “mechanism of injury,” meaning how it happened and what force was involved.  A child may seem fine after being struck in the head by a baseball, but such high-speed impacts need evaluation regardless of how well the kid is acting.

Here are more criteria for needing to get seen now: car wrecks where the child is thrown from the car, another passenger in the car dies, or the car rolls over.  If he is hit by a car while walking, or while riding a bike without a helmet, that’s concerning.  Kids under two years old need to be evaluated if they fall from over three feet; kids over two, falls higher than 5 feet.  If an infant or toddler under two gets a “goose egg” swelling anywhere but the forehead, that is worrisome.

However, most kids who hit their heads are okay and can stay home.  Kids who fall from their own, standing height, are usually fine.  Kids who hit their heads but are not knocked out and go back to playing are okay too.  Toddlers who run into walls also don’t generate enough force to hurt themselves badly.

Several times per week in the Emergency Department, we see a baby who rolls off the bed or falls from the stroller.   Mom is understandably freaked out- “I just left the room for a second, she has never rolled over before!”  Most falls occur at home and are usually either from falling off beds or other furniture, tumbling down stairs, or from being dropped. Interventions used only weeks ago to keep baby safe are now obsolete due to the child’s developing abilities.  Add to that the distractions of other children, pets, dinner on the stove, and the rest of the household confusion, and stuff will happen.

Like we said above, after most falls the child doesn’t need an Emergency Department visit.  If baby fell from a height less than three feet, then he is probably fine. Further, if he is acting normally, doesn’t have any “goose egg” swelling on his head (except for the forehead- a goose egg there is okay), doesn’t vomit, and is acting well, he is okay.  If you are unsure, call your doctor.  The doctor can help decide if baby can be observed at home or needs to come in.

Many parents believe they must keep their child awake after a fall to prevent coma. However, this is an “old wive’s tale.”  Naps after a minor fall can be restorative and comforting.  If there is a question about how bad the injury was, we do like an observation period where the child is watched for warning signs (severe headache, vomiting, changes in behavior, confusion).  During normal waking hours this is easy. However, if it is nap or bed time baby can go to sleep, but you should wake him up hourly for a few hours.  If the child is alert after waking (as alert as a child who’s just been awakened can be!), then okay.  If she seems overly groggy or lethargic, call your doctor or come in.

Unlike the old man in the nursery rhyme, most kids who bump their heads and go to bed are perfectly fine- they are not old men!  Someone needs to write a new nursery rhyme for kids who bump their heads.

Alternative Medicine?

The child had odd markings on his back.  He was three years old and being seen in the Emergency Department for coughing.  The resident first examined the boy and noted red streaks up and down his back.  The rash looked like it was drawn on by marker.  Or a branding iron.  Concerned that the child was being physically abused, the resident brought me in to look.

When I saw the marks, I breathed a sigh of relief.  “This isn’t abuse.  This is from ‘coining’,” I explained.  The family was vietnamese, and coining is an asian tradition of heating a coin and rubbing it on the back to draw out the “bad humours” causing the child’s cough.  They were not abusing their child, only trying to make him better.

We occasionally see or hear about alternative practices in the ED, what modern medicine now calls “Complementary and Alternative Medicine,” or CAM.  CAM includes traditional practices like herbology, acupuncture, chiropracty, and in Louisiana, the Traiteur. Surveys show that many more people are using CAM therapies on themselves and their kids than doctors hear about.  People are often uncomfortable telling their doctor about such practices, fearing they will be ridiculed for using what many physicians regard as quackery.

However, the line between “modern” medicine and CAM is starting to blur.  As certain non-medical therapies are shown by science to help patients get better, they have become adopted by modern medicine.  Such therapies include diet modification and probiotics, massage in kids with chronic pain, and play therapy for kids in the hospital.  The NIH now has a research section called the National Center for Complementary and Integrative Medicine, to study the validity of these practices.  The American Academy of Pediatrics also has a Section On Integrative Medicine with the same purpose.  In fact, some doctors get extra training in CAM therapies to ”integrate” CAM into their practice.

Now, some alternative medicine seems down right kooky.  Once in medical school, I was watching a woman in labor.  The Labor and Delivery nurse was an older, experienced, no-nonsense professional.  She took a clear history about the pregancy and competently assessed the contractions and cervical dilation.  But then this all-business nurse said to the woman, “We will need some more positive energy for this delivery,” and began to hover her hands up and down over the patient’s swollen belly, murmuring about boosting energy, acting like a wizard from the movies.  The nurse’s sudden change and what she was doing blew my mind.  Was this really happening, in a real hospital?  Was this Labor and Delivery, or the Psych Ward?

As I reflect on this memory now, I have more sympathy for that nurse.  I pray, go to church, and believe God gives me strength for the many stresses and occasional tragedies in pediatric emergencies.  But Christianity seems kooky to my sister-in-law, who is an athiest.  To her the universe is a machine, needing no diety to run it.  My belief in an unseen God and Holy Spirit is just as silly to her as the Labor nurse’s invoking positive energy with her hands.  However, this illustrates why many people use alternative medicine- it fits their belief systems, they are comfortable with it, and they feel it helps.

As we discussed above, scientific medicine is now researching alternative CAM therapies.  Science is powerful- it has given us antibiotics, cancer cures, anesthesia.  Science also realizes that belief is powerful too, and is testing the limits of what we believe will work and what actually will work.  Science has already revealed the danger of some alternative medicines- St. John’s Wort and chelation therapy in autism, for example. Science has also started to show that traditional practices like acupuncture, chiropracty, and massage may have real therapeutic benefits.

So don’t be afraid to talk about “alternative” therapy with your child’s doctor.  The doctor may already know more about these practices than you think.  Your kid’s doctor needs to know about these, to help counsel you about which practices are safe and which aren’t. However, if your doctor starts passing his hands over your child and murmuring incantations, maybe the doctor has gone too far.

 

 

 

 

 

 

 

Nutrition—For Life!

This week’s guest columnist is Dr. Allan Olson, a family practice resident at the University Health Center here in Lafayette.  Allan is 61 years old, yet is on the long and stressful road of residency that makes a doctor.  How does he do it?  For one, he takes care of himself with a healthy diet.  And there is no better time to learn to eat right than as a kid.  Read more:

How can parents have the biggest effect on their children’s health? Providing a safe environment and promoting physical activity top the list.  However, your guidance with the greatest potential involves something we do every day- eating.  Nutrition is a huge opportunity to help your kids feel good and be well prepared for their day. Furthermore, your food leadership will create habits to insure good health for their whole lives.

What foods are best?  Research is showing that whole food, plant-based nutrition provides the maximum benefits for children and adults.  This means a diet consisting of vegetables and fruits and less animal products (meat and dairy).  Avoiding fast food and processed food (any food that comes from a factory) is also important to eat well.  These contain too much fat, sugar, and salt for your body.

For many people this will be a major change in the foods they eat, and it is important to say that such changes need not happen overnight.  The key is to begin selecting foods which consist of plant products that have not been fried or processed, frozen or boxed. Start using these foods in your family’s diet, and eventually meet the majority of your meal needs with them.

Food choices can influence whether kids develop certain chronic diseases.  Childhood obesity has become much more common, as have diabetes, asthma, and constipation. Studies show most obese childen will become obese adults, and can expect to develop adult diseases early in life, like high blood pressure and heart disease.  In other words, obese kids will live shorter and more miserable lives.  While many factors lead to these diseases, food is among the most important causes, and the most effective cure!

Two examples of how diet can influence health and illness:  Many children with constipation are cured when milk is removed from their diet, and fruits and vegetables added.  Some studies show best results when all dairy is stopped.  Know that eating milk and cheese is a matter of choice, not necessity, for children and adults.  We do not absolutely need milk or other dairy in a healthful diet.

Asthma provides another example.  Asthma has become very common in children. Asthmatic airways become inflamed, breathing becomes difficult, and kids wheeze.  Often kids with asthma also have allergic runny noses and itchy skin.  These can be treated with medications, but we are finding that in many children they can be prevented with a plant-based diet.  Specifically, the antioxidants in plant foods seem to both prevent and treat the inflammation in allergy and asthma.

Now food companies have seized this idea and manufacture foods with added antioxidants, touting them as more healthy.  However, studies suggest that antioxidants in processed-food are much less effective than in whole foods.  It seems the whole food must be eaten to get the health benefits, and that natural foods contain other beneficial components besides the antioxidants.

Here are some more hints on diet.  Breakfast really is the most important meal.  Be sure your kids eat it every day, if only some fresh fruit.  Have your kids eat at home as much as possible, at the table with the whole family.  This is an important social time for families, and you can be sure your kids are eating right.

Avoid sugary drinks like soda and other canned or bottled drinks.  Even those which are sugar-free and artificially sweetened are not good.  Sugar-free drinks still do not keep off the pounds!  The best drink is water, though some sports drinks are okay for electrolyte replacement while exercising, or if your child is sick with vomiting and diarrhea.

Finally, eating should be fun!  Invite your kids to help you plan meals based on plants. Include their ideas in selection and preparation.  Make trying new foods an exciting challenge.  Your children may need to try a particular food a dozen or more times before they like it.  Your choices for their diet will help shape their choices- for life!

Kids As Infrastructure?

As I write this, elections just happened yesterday, with of course lots of talk about the economy.  Despite the political fighting, one thing Democrats and Republicans can agree on: government needs to provide infrastructure.  To have a humming economy, you need good roads and bridges, railroads and air transport, to move people and goods.  You need energy and communication.  So why is a pediatrician writing about railroads and the economy?  Because another key part of infrastructure is education, and that’s kids.

The coming generation of workers is as important to the future US economy as good roads and airports.  We will need skilled and educated workers for the high-tech communication, manufacturing, and engineering jobs of the future.  And right now we are on target to getting beat by foreign competition to supply those workers.  While India and China spend less per kid on education than the US, they do volume business.  With hundreds of millions of kids in their education pipelines, they will bring out plenty of crackerjack engineers and scientists.  In a generation, the leaders of innovation, manufacturing, and technology could very well be in Asia, with the United States left as an economic has-been.

Not enough US kids, particularly Louisiana kids, are getting the education they need.  Driving I-10 East towards Baton Rouge will tell you that Louisiana is not spending enough on roads.  Driving past Lafayette High and seeing its building will tell you that education is not getting enough money either. Then read about cuts to Louisiana’s college budgets. We must do better to get every child a good schooling; the US will need every kid, rich or poor, black or white, girl or boy, to stay ahead.

Good education is not just important to Louisiana’s and our nation’s economies.  It is even more important to the kids themselves.  Kids need good educations to get good jobs.  Kids need good educations to climb out of poverty and ignorance.  There are three pillars of happiness- having love, hope, and work.  The quality of hope and work start way back with the quality of one’s school.

At least once per week I see a bright-eyed kid who lives in poverty.  The child is alive with curiosity and intelligence.  As my mom would say, the kid has “a light bulb inside.”  Then I look at the child’s mom.  She is tired.  She has several children and two grinding, menial jobs.  She comes to the Emergency Department though she knows the child’s cough is not an emergency.  However, the doctor’s office was closed when she got off work, or was too busy to see them.  I can guess that this kid is headed for a below-average education in an unhappy neighborhood.  What will happen to that curiosity and intelligence?  It makes me despair.

The magic bullet to cure poverty is education.  Education starts with reading.  When I see a poor mom and child with potential, I take time to talk to mom about reading.  I tell her to read a book to him every night.  Talk to him a lot.  Fill his head with words.  Intelligence and happiness in kids is proportional to the amount and diversity of words they hear in infancy and early childhood.

The next step in education is pre-school and Head Start.  A good program with early reading and classroom socialization readies a kid for success in school.  Key words in that last sentence are “good program.”  Good pre-schools aren’t cheap.  It costs money to pay for the best pre-school teachers, decent books and toys, and a clean, bright, and safe place to have class.

The next steps in a kid’s education are elementary school, high school, and college.  Like in pre-school, good ones cost.  Society, through its government, must be willing to pay the bills.  Nothing good is free and when it comes to quality: you get what you pay for.

Good schools are the infrastructure kids need to succeed in life, and those kids will in turn be the infrastructure to make a healthy society and economy.  Now that the election is over, let’s encourage our new governments to make a better investment in those governments’ purpose- investing in the kids that will be our future citizens.

‘Tis The Season Of The Barking Cough

It was a case of Physician Heal Thyself, or in this pediatrician’s case, Heal Thine Own. One midnight in Baltimore, I was on duty in the Pediatric ED when my wife called: our son awoke struggling to breathe, such that he couldn’t even talk.  Miles away, I could only help over the phone.  I gave the standard pediatrician’s advice for croup : take him outside, keep him upright.  His breathing subsided, everyone calmed down, and I called in a prescription to the 24 hour pharmacy.  Croup can be scary, yet easily managed.  This week’s guest columnist, Dr. Leslie Sizemore, a family practice resident at the University Hospital and Clinics here in Lafayette, explains:

In the fall physicians prepare for the typical fall and winter illnesses. Everyone thinks of influenza virus (“the flu”) but we also worry about RSV, mycoplasma (“walking pneumonia”), common cold, and the ever recognizable croup.

What is croup?  Croup starts like any cold- dry cough, runny nose, hoarseness, and sometimes fever.  The characteristic “barking cough” comes about 12-48 hours later. The barking lasts about 3 days but the rest of the cold may take around 7 days to resolve. Sometimes croup comes on suddenly at night, with a previously well child awakening with the barking cough and shortness of breath.

Croup is caused by inflammation at the top of your windpipe, called the trachea, just below your vocal cords.  When these pipes get inflamed, they swell and the breathing space gets narrower.  The smaller space compresses the air during cough, making that strange cough like a barking seal.  If the swelling worsens, the child gets stridor, which is a high pitched whistling sound when breathing in.  When the airway is narrow enough to make stridor, kids really starting struggling to breathe.

We see croup mostly in the fall, October being the peak month.  This coincides with a peak in parainfluenza virus, the most common cause of croup.  Croup is mostly seen in kids age 6 months to 3 years, and is unusual beyond age 6.  Viruses that cause croup are spread by close contact, just like any cold.

Most cases of croup are mild with occasional barking cough, hoarseness, and maybe a little stridor when crying.  It is the more severe cases we worry about, when the swelling of the windpipe gets worse.  Then the child has that whistling stridor sound even at rest. These children need to get seen immediately.  If the airway gets too narrow the child may no longer be able to breath.  The good news is that less than 5% of kids with croup get put in the hospital, so these bad cases are rare.

How do we treat this nasty illness?  Since it is caused by a virus, we all know that antibiotics won’t help, since they don’t kill viruses.  We treat the symptoms while the child’s immune system gets rid of the virus.  We treat the airway inflammation with anti-inflammatory medicine- steroids.  This can be done in two ways: the child can be given a one-time shot, or be given three days of a liquid steroid by mouth. We all know which one the kid would prefer!

If the child is having stridor, we give them a breathing treatment with a medicine called epinephrine.  The breathing treatment, or nebulizer, is that pipe commonly used by asthmatics that turns medicine into a mist that is inhaled.  But instead of the albuterol that kids with asthma need, we put in epinephrine.

The epinephrine relaxes the muscles that line the windpipe.  We give this medicine only in the Emergency Department, not at home.  This is because the child needs to be watched for several hours after the treatment.  Sometimes kids who get the epinephrine treatment have “rebound,” where the stridor comes back within an hour, sometimes coming back worse.

For the other croup symptoms, you treat them like any other cold.  Give Tylenol or ibuprofen for fever and throat soreness.  Run a vaporizer by the bed for moist air to lubricate those inflamed airways.  Prop up the child’s head to help minimize gagging on secretions.  Give plenty of fluids, and in a few days your child should get better and go on about his business, no longer imitating a barking seal.

 

 

 

Rockabye Baby. Safely.

We see a lot of little babies in the Emergency Department when they get their first colds. They cough and are congested, have noisy breathing, gag and hack on mucus, and sleep miserably.  When I talk to the parents about what to do, I ask, “So where does baby sleep?”  I usually get a sheepish look and a guilty smile and mom admits, “with me.”

Then I take the opportunity to talk about sleep safety and Sudden Infant Death Syndrome (SIDS).  I talk about how baby should sleep on his back and be in his own crib or bassinet, how sleeping in bed with others is a smothering risk.  The parent often says that when baby is sick, they bring him in bed with them so they can watch that he is okay. Yes, I go on, that seems to make sense, but is the exact wrong thing to do with a sick baby.

October is SIDS Awareness Month.  The CDC, the American Academy of Pediatrics, and many other experts are getting the word out- keep baby safe!  SIDS happens when babies suffocate while sleeping.  They smother when they are face down in thick bed clothes or regular mattresses.  They smother when in parents’ bed by getting their faces stuck up against heavily sleeping adults, or when they slip between the mattress and a wall. Napping with babies on couches is dangerous too- there is even less room for the adult and a clear space for babies’ faces, and the cushions are even softer and easier to smother in.  Babies can also smother in their own cribs if there is too much soft stuff with them- thick blankets, sheep skins, stuffed animals, pillows, or bumper pads.

When babies gets their faces into something too soft to breathe through, they suffocate. And babies under 6 months old cannot rescue themselves.  They do not have enough arm control to push away from a smothering situation.  They can’t do a push-up when face down on a thick mattress, blanket, or pillow.  They can’t roll over purposefully yet. Their brains and nervous systems aren’t mature enough for such maneuvers.

What about our mom from above who brings her congested baby into her bed to watch him? If she is watching baby, doesn’t that protect him from smothering?  Unfortunately not. Too often “watching baby” becomes “sleeping with baby.” You’ve seen the old comedy routine in movies or on TV, where the character must stay awake to watch something, only to be overcome by sleep, and then be caught snoozing.  Well, this happens in real life when mom and baby are warm and snug in bed together.

This is one of those cases where what seems better is shown by science to actually be worse.  Statistics show that sharing the bed with babies is much more dangerous, particularly when they are sick.  So how do you watch baby without sharing the bed? Pull that bassinet up next to your bed!  That way baby is safe in his own crib, and you can watch him from your bed.

Here are the rules then, to prevent SIDS.  As above, baby sleeps in her own bassinet or crib. Baby sleeps on her back, face up.  Baby sleeps on a firm mattress that is specifically designed for babies.  Baby should sleep dressed in a onesie, so no pajamas shirts can ride up over her face.  If you must put a blanket in bed with baby, make it a thin one that is tucked in at the bottom of the bed, again to minimize the chance of it riding up over baby’s face.  And definitely no pillows, stuffed animals, or bumper pads. These things make baby’s bed cute, but they also are suffocation risks.

Some moms try to compromise on baby position by putting their babies on positioners or “boppy” pillows.  Unfortunately, the safety of these has not been established.  So play it safe with baby, keep baby in his own bed with minimal padding.  Put baby to sleep on his back.  You and baby may be more restless on a given night, but in the long run you both will sleep much more soundly.  And safely.

 

 

 

 

Whaddya Mean “It’s Just A Virus?”

Some parents are disappointed with the diagnosis “virus” and not getting antibiotics. The only two times in my career a parent has outright yelled in my face were when I didn’t prescribe antibiotics. Today’s guest columnist, Dr. Seth Koster, explains viruses and when antibiotics are needed.  Dr. Koster is a resident at the University Hospital and Clinics here in Lafayette.

A lot of parents aren’t sure what to expect with their first child.  Did he just cough?  He sneezed twice, is that bad?  Do I need to go to the doctor?  Some things are common, yet seem complicated.  Let’s talk about some common conditions that are usually a virus that get better with a little TLC, and some “red flags,” things that need to be checked right away.

I think my kid is wheezing, should I bring her in?  Many parents hear baby make funny sounds, and call it wheezing.  Sometimes the sound they are trying to describe is the rattling of nose congestion.  True wheezing that we worry about is a whistling, gaspy tone in the lungs.  Either way you would be safe calling your doctor for a next day appointment if the wheezing doesn’t get better.  But if your child seems to be breathing fast or is having to pull in breaths, then he needs to be seen right away.

The vast majority of colds and coughs are viral.  Even with true wheezing, this is usually a virus and not pneumonia, and antibiotics won’t help.  Hundreds of viruses cause coughs and runny noses and wheezing: adenoviruses, rhinoviruses, enteroviruses, and many more.  Antibiotics do not kill viruses.  What kids with these need is supportive care, meaning fluids and fever and pain medicine.  If they get really sick with wheezing and shortness of breath, they may need IV fluids, breathing treatments, and observation in the hospital.

My child is pulling at his ears.  Does she need antibiotics?  Most of the time “ear pulling” is not from ear infection.  Kids pull on their ears when they are stuffy from congestion, if they have a headache, or some kids just play with their ears.  If the child is not fussy and doesn’t have fever, they don’t have to see the doctor.

What if she has fever-rush her to the Emergency Department?  No.  Ear infections may hurt, but that can be controlled with ibuprofen or acetaminophen (Tylenol) for fever and pain.  Over 70% of ear infections are viral and don’t need antibiotics.  That being said, if your child is having ear pain and fever, see your doctor.  After an exam the doctor can decide if antibiotics or pain drops will help.  But ear pain is rarely an emergency that can’t wait until tomorrow.

My child is vomiting, what to do?  Whether vomiting needs to be checked out by the doctor depends on how much and how long.  Some kids are brought in to the ER when they vomit only once or twice, or only for a few hours. However, that is not enough time for a child to get dehydrated, and most will quit vomiting soon after.

A simple “stomach virus” is usually not serious and will resolve in 1-3 days.  If the child vomits, wait an hour for his stomach to settle, then start clear liquids (gatorade, dilute juice, pedialyte), sipping slowly.  After the child has stopped vomiting for about 6 hours, you can start bland foods.  No fast food.  If your child has a fever, ibuprofen or acetaminophen will help with that. For most stomach illnesses antibiotics will not help, and even make vomiting and diarrhea worse.

So when does your child need to be seen?  If she is having worsening belly pain, that is worrisome.  If your child is vomiting all day or is vomiting blood or dark green, bring them in.  If your kid is having diarrhea for more than a week, that is one of the few times an antibiotic may help, since that may be a bacterial illness and not a virus.

Your child will get sick, there’s no avoiding it.  You usually don’t need antibiotics to treat them.  Most of the time your kid just needs rest, fluids, ibuprofen, and TLC.

 

 

 

Teen Vaccines

This 16 year-old boy was slipping away.  He had come to the Emergency Department sleepy and feverish.  Mom noticed that he was covered with red freckles, and new freckles were coming out while we spoke.  As the nurses and I worked, he became more lethargic, an ominous sign in a kid with obvious overwhelming infection: meningococcus.  The second-to-last procedure I did was the spinal tap.

This is a procedure where a needle is put into the back to obtain fluid from the spinal cord.  This fluid comes from the brain and is used to diagnose meningitis.  Instead of a trickle of clear fluid we see in well kids, yellow pus-laden spinal fluid shot out of the needle onto my gowned chest. This definitely was meningitis. The last procedure I did was to sedate him and put him on life-support, and then I did my best to comfort his parents as he went to the ICU.

The year was 1995.  The episode above happens less often now, thanks to the meningococcus vaccine introduced in 2005.  This is one of the vaccines kids get at age 11-12.  Yet a large amount of teens aren’t getting this and some other life-saving vaccines.  One-in-ten adolescents don’t get a tetanus booster, almost 1 in 4 don’t get the meningococcus vaccine, and less than half of teens get the cancer-preventing HPV vaccine!

Why are so many teens not getting these crucial shots?  The main reason is many no longer go to their regular doctor- parents fall out of the habit of taking them there. This because older kids don’t get the flurry of vaccines that the younger ones need, and don’t get sick as often.  On the occasion that an older child does get sick, walk-in clinics are more convenient- no waiting for an appointment!  With no regular doctor visits, there is no one to remind the parents that their kid needs this one more vital set of shots. Most “quick-care” does not care about illness prevention, scoliosis, acne, and keeping up vaccines.

What are teen vaccines, and why are they so important?  The most dramatic infection they prevent is the meningococcus/meningitis bacteria that our teen above had (cliff-hanger resolution: he survived and walked out of the hospital six days later). Meningoccus is highly contagious, particularly in crowded living conditions that teens often go live in: college dorms and military barracks.  Remember the UL-Lafayette meningitis scare from a few years back?  And once a teen gets meningococcus, he or she can get deathly ill very quickly.  Fortunately this is becoming less common as successive years of kids get vaccinated.

The least given vaccine for teens is the cancer-preventing HPV vaccine.  This is partly because HPV (Human Papilloma Virus) causes a less dramatic infection than meningococcus- teens get some warts in sensitive spots.  Also HPV is a three-vaccine series rather than just one shot for meningococcus- you’ve got to go back two more times to complete the series. However, HPV causes deadly cervical cancer and anal cancer (actress Farrah Fawcett died from anal cancer).  The vaccine prevents this.  But cancer is also less dramatic than meningoccus in this way: what teen and parent are looking ahead to the “later in life” of cancer?  Worrying about cancer down the road is just not on many teens’ and parents’ radar.  Surviving Driver’s Ed and teen parties are drama enough.

Finally, teens need to get two other vaccines: influenza vaccine and the good ol’ tetanus booster “Tdap.”  Influenza season approaches, and influenza is a nasty virus causing a whole week of cough, fever, body aches, headaches, nausea, and sometimes worse. Get the “flu” shot every year to avoid this highly contagious misery. And tetanus is a deadly illness that can infect any dirty wound- not just rusty nail pokes. What kid doesn’t get dirty wounds?

So don’t lose touch with your child’s “regular” doctor as your kid becomes a teen.  Your regular doctor knows your child best and treats the whole kid, unlike a “quick-care” clinic that only cares about your child’s latest illness.  Your kid’s doctor knows what your child truly needs for things like scoliosis, sports and school physicals, and acne.  And when to get the Teen Vaccines.

The Flying Menace

This week’s guest columnist is Dr. John Giuffreda, a Family Practice resident at the University Hospital and Clinics here in Lafayette.  His column reminds me of when I was playing catch with my son.  When he went looking for a missed ball in some ivy, he stepped on a wasp nest.  Like a scene from the cartoons, he ran to the house trailing a cloud of wasps, yelling “Bees, bees, bees!!”  After we swatted them away and killed the ones that got inside, we counted 13 stings on his butt. We did everything Dr. Giuffreda talks about below, and my son did fine.

Bugs bites and stings are usually no worse than a homework assignment- annoying but basically harmless.  Some crying after a sting (wasps, bees, fire ants), but that’s it. Occasionally an insect bite can cause serious problems.  You should know when a simple ice pack can bring relief and when to visit your doctor, or the Emergency Department.

Bee and Wasp Stings:  For most kids bee stings are a minor nuisance.  The area may swell, turn red, and be somewhat painful, but that’s it. But bee and wasp stings can be real problems for people who are allergic.  A person can get a localized reaction (swelling, heat, or itching around the site) or a systemic allergic reaction, meaning that the venom affects the whole body.

In the case of a systemic reaction the person may break out in hives.  Other more serious symptoms include wheezing, shortness of breath, rapid heartbeat, and swelling of the face, lips, tongue, or throat. More subtle symptoms include weakness, nausea and vomiting, or a feeling of dread.  If a kid has any of these symptoms, call 911 immediately.  If an Epipen is available use it right away.  It’s rare, but severe allergic reactions to bee and wasp stings can be fatal if the person doesn’t get medical help.

Mosquito Bites: As you know, Louisiana is Mosquito Country, and mosquitoes hang out anywhere with still water.  Generally they are nothing to worry about.  They bite, you itch, end of story. But sometimes mosquitoes can give people diseases.  You have probably heard of West Nile Virus, which humans can get from mosquitoes.  The good news is that most kids, and any healthy person under age 50, who get West Nile virus get over it without symptoms and never know it.  Less than 1% of the people infected with West Nile become seriously ill.

What To Do: For most bug bites and stings, antihistamines like benadryl lessen itching and swelling.  Acetaminophen (Tylenol) and Ibuprofen can ease pain. Use 1% hydrocortisone cream (over-the-counter) for itching too.  If it’s a honeybee sting and you see the stinger, immediately scrape it out with your fingernail.  This lessens your kid’s dose of venom.

Wash the bite with soap and water and keep it clean. If it really bothers and you want more immediate relief than benadryl or Tylenol, ice can help.  Ice it for 10 minutes, every few hours or so.  If your child scratches and breaks the skin, you need to prevent infection.  Put on antibiotic ointment like Neosporin and again, keep the site clean and covered with a bandaid.

Preventing Bites and Stings: Kids don’t have to sit around and be a sample on the insect buffet.  Take some preventative steps:

Avoid mosquitoes by staying away from still pools and ponds where they breed, especially in hot weather.  Pour out standing water from bird baths, buckets, old tires, etc.  Stay inside when mosquitoes are most active (dusk, night, and dawn).

Use insect repellent when outdoors camping, hiking, or in the yard. DEET repellents on skin keep away mosquitoes and ticks.  Permethrin repellents are good to put on clothes. In wooded areas, tuck shirts into your pants and long pant legs into socks.  Make your kids wear shoes and socks outside, even if it’s just for a minute. Bees, wasps, and ants can sting unprotected feet.

Finally, don’t swat at buzzing insects.  It just swirls the mosquitoes around and can make the real stingers- wasps and bees- feel threatened so they will be more likely to sting.  Just keep away… from the Flying Menace.

Teens Behind The Wheel! Look out!

My three teens may not believe it, but I also once was a teen.  And one night I was bombing down a snowy road in our old iron Jeep Cherokee, the radio blasting my rock station, not a care in the world.  Then I topped a hill and headed down.  Now, four-wheel-drive is fine for getting you started on slippery ice and snow, but it’s no help slowing you down.  And down I went, at speed.

The hill had a turn and when I put on the brakes, I started sliding out of control towards some trees. So I pumped the brakes as best I could, made the turn, and headed for the intersection at the bottom.  Unable to stop, I hung on and hoped for the best.  Just before I crossed that road, a Honda Civic zipped by. Luckily that was it for traffic.  I skidded across and came bumping to a stop on a snow-covered lawn.  After a few minutes I was able to quit shaking and drive away.

My wintery adventure illustrates some safety issues with teen drivers.  Teens are inexperienced drivers.  They haven’t had enough time on the road to learn things like braking in time or driving slow enough for road conditions.  Teenagers also like speed. Speeding is fun, even though it’s not safe.  Teens don’t think about consequences. They’re temporary sociopaths- who cares about the future, I’m all about here and now. Though I had driven and jogged over that hill thousands of times, I didn’t foresee going over in a heavy car on snow.

Teens are also easily distracted behind the wheel. Like teen me, they listen to the radio too loud.  They drive with friends and have intensely important conversations, or a lot of laughs.  They talk on phones.  They text.  These things take a teen’s eyes and mind off what is out front.  Another car slams on the brakes, a red light is ignored, a turn is too tight, disaster ensues.

The above safety issues with teen drivers are why their car insurance is so expensive. Teenagers crash- they incur car repair bills and medical expenses.  So what can we do to keep our teens safer while they gain experience behind the wheel?  Fortunately Louisiana has Graduated Driver Licensing. This system allows teens to gain experience while keeping them, and those driving around them, safer.

The first rule in GDL is when a teen gets a permit at age 15, they must drive at least 50 hours before they get their license.  This means they should spend about one full hour per week driving with an adult, hopefully more.  15 of those hours should be gaining experience driving at night.  When a teen gets licensed at 16, there are more rules for that first year of solo driving.  By Louisiana law, no driving after 11 pm.  Teens can’t have passengers after 6 pm, except an adult over 21.  They can’t use cell phones.  And no texting. Ever. Even after 17.

Here are some ideas to keep your teen driver even safer. First, try to delay when they start driving.  The older teens get the more their brains mature, and they become safer drivers. Take advantage of teen procrastination.  Don’t drive them to the Office of Motor Vehicles on their 15th birthday- let them decide when to go in their own good time. Wait for them to badger you incessantly before you (eventually) get around to bringing them. Before you go, make them look up what they will need to bring to get their permit, and get those things themselves- this alone will buy you another few weeks of brain maturity.

Also, wait another year or two after 17 before you let them drive with friends or with a phone, or with the radio on.  More time driving with good concentration will help form better driving habits.  Finally, limit the time they drive in the rain, on the highway, at night, or at rush hour.  They do need to get experienced driving in adversity, but take it slow.

I’ve got three teens on the road myself and followed these rules and my wife and I still worry at night.  Look out!  Teens on the road!