What? What?

The rock band Pink Floyd was known in its day for being loud.  Legend was that at a concert in 1971, the noise was so bad that it killed the fish in a pond next to the stage. Probably more truthfully, the fish went belly up due to fans dancing in the pond, smoke bombs, and the giant inflatable octopus on the water (Pink Floyd was also known for eccentric decorations).  But fish dying because of loudness is a better story.

Many rock stars have hearing loss due to the chronic and loud sound of their profession. Phil Collins, Neil Young, Eric Clapton, and Pete Townsend of the Who are just some of the victims of their own success.  The listening apparatus inside our ears is delicate, and can be injured or permanently damaged. We’ve all come home from rock concerts to lie down and hear ringing in our ears. That ringing is the sound of acoustic injury.  Usually the ringing goes away, the hearing organ heals up.  Sometimes the ringing doesn’t go away.

William Shatner, who played Captain Kirk on Star Trek, has permanent ringing in his ears. This condition, called Tinnitis, started when a special effects explosion went off too close to his head.  Since then he has been tormented by what he calls a “hiss-static,” night and day. Many military veterans also have Tinnitis from rifles, grenades, naval guns, and rocket launches.  Besides pounding targets, these explosions also pound the ear drum, the delicate bones behind the drum that transmit sound, and the fragile nerves that receive the bones’ signals.

Kids are vulnerable to hearing loss too.  Remember when the Saints won the Super Bowl? Remember Drew Brees holding his infant son, Baylen, and Baylen’s earphones?  Baylen had them to protect his hearing from the roar of the crowd.  Your kids need to be wearing those too, when they are hunting, mowing lawns, or going to rock concerts.  Well, no kid who wants to be cool is wearing those to a show, but consider other protection: fewer concerts, more subtle ear plugs, quieter venues.

I married into a loud family, and they laughingly admit it.  Thanksgiving can be deafening , with 50-plus Fournets packed into a house.  It’s like the movie My Big Fat Greek Wedding, except with pork roast instead of lamb, and conversation sprinkled with french instead of greek.

Part of the noise is due to hearing loss in my in-laws.  They have to shout to be heard.  My father-in-law ran a service station, flew airplanes, and hunted.  His sons worked in the station and also hunted.  And the sons went to plenty of rock concerts. All those roaring engines, shotguns, and guitars while growing up took a toll.

When considering hearing injury, we think of the really loud noises mentioned above- guns, explosions, amplifiers.  But sustained moderate noise can cause hearing loss too. Just like too much running can lead to overuse injuries in knees and feet, chronic intense sounds can also hurt ears.  Mowers, blenders, hair dryers, TV, car radios, and ipods all contribute to hearing loss.  Even cell phones glued to your kids’ ears can be too much.

Some people are more susceptible to hearing loss than others.  The Fournets have a family history of hearing loss, and the youngest son had some warning to start wearing headphones while hunting, woodworking, and mowing the lawn.

Are you worried about your child losing his hearing?  Parents usually worry about hearing loss when their kid seems not to hear them: they shout and shout and get no answer. Fortunately this deafness is usually due to them tuning you out rather than true hearing loss.  Kids get lots of hearing screening at school.  Lafayette Parish schools screen in kindergarten, first grade, and every other year after that to eleventh grade.  But if you are worried, your doctor can recommend testing at audiology and ENT offices.

Better still, worry about your kids hearing ahead of time and take action.  Keep the phones, car radios, and MP3 players dialed down.  Turn down (heck, turn off) the TV. Set limits on the number and intensity of concerts, and get them headphones for chronic noise makers.  Then maybe they’ll hear you when you call them to do the dishes.  Or not.

The Heat Is On!

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

It’s summer time, and the heat is on…on your child’s skin!  With the sun out, her soft and beautiful skin is at risk for sunburn.  Sunburn is very common, with more than 30% of adults and 70% of children and adolescents getting at least one sunburn per year.  Although most aren’t severe, a lifetime of sun exposure significantly increases the risk of skin cancer, and wrinkles.  And it hurts!  When kids hurt, they whine, and no one wants that on vacation.

Sunburn can be sneaky.  Unlike other types of burns, sunburn may not show immediately, because it takes three to five hours for redness to develop after being out.  Redness peaks at about 12 to 24 hours after sun exposure and fades over 72 hours.

What increases your risk of sunburn?  One factor is the amount of pigment in your skin, called melanin.  Melanin protects from burns, so really pale kids burn easier than their darker skinned friends.  Also, where you are in the World counts.  The close you are to the equator and the higher your altitude, the more rays you get and risk increases.  So if you’re heading to Central America or the Caribbean with the kiddos, or hiking in the Rockies, pack the sunblock!

Another thing we often forget is that certain medications make skin more sensitive to burning.  These include certain antibiotics, some blood pressure medications, and even something as simple as ibuprofen.  So before you go the beach, make sure your 15-year-old on Doxycycline for his acne is okay with having a red face for a few days. Better still, put on the block!

If your child does get sunburn, there are treatments.  First, stay out of the sun until the redness and pain resolve.  Ibuprofen (Motrin, Advil, or generic) or acetaminophen (Tylenol) can relieve the pain.  These should be started as soon as the burn is noticed, since the benefits tend to decrease after 24 hours.  Cool compresses, aloe-based lotions, and lotions with local anesthetic may help too.

A friend of mine once went on a misson trip to the Philippines.  He schlepped his snorkeling gear half way around the world because he had heard about the beautiful coral reefs there.  When his day at the beach came, he forgot about sunblock or wearing a sunshirt.  While snorkeling the cool water kept him from realizing what the near-equatorial sun was doing to his skin.  The next morning he had sunburn so bad it blistered his back and shoulders- a second degree sunburn!  Sleeping was tough, but fortunately aloe was handy and he smeared that on generously.

Lesson to be learned: when in the beam, use the ‘screen!  Here are some tips to using sunscreen most effectively.  Put it on 15 minutes before going out in the sun: the better it dries, the harder it is to rub or sweat off.  Be sure to cover all surfaces, including ears. I remember an old OB/GYN attending, an avid sailor, who had notches in his ears where pre-cancerous growths had had to be cut out.

Applying sunscreen just once isn’t enough.  Sunscreen is washed off by water, rubbed off by towels and sand, and sweat off when your kids run around in the heat. You need to re-apply at least every 2 hours during peak burning times (roughly 10 am to 5pm) to properly protect your kids.  Apply more often for the very active swimming and running and toweling kids.

Another strategy is to avoid sun exposure in the first place.  Shade is your kid’s friend- umbrellas, beach tents, leafy trees, shaded porches.  Some fair-skinned kids just can’t get enough sunblock, they burn so easily.  These kids benefit from protective clothing- long sleeve shirts, long pants, big brimmed hats, and sunglasses. They now make shirts and pants that are light enough to be cool and have SPF (Sun Protective Factor) ratings just like sunscreen.

Fun in the sun is something that even the littlest ones look forward to, but be prepared for the damage that can be done.   Remember: cover that beautiful baby skin with protective clothing and high SPF sunblock to keep the fun, in the sun!

Heat And Light

If you think pediatricians don’t make mistakes raising their own kids, think again!.  My wife and I had just had our first baby.  When our girl was 6 weeks old, my wife was getting cabin fever, stuck home breast feeding around the clock.  We lived in eastern Maryland then, and decided to take a weekend at the beach for some fresh air and sunshine.  Being a pediatrician and a pediatric nurse, we were careful about the sun- big hat, sun tent, plenty of fluids.

We didn’t put sunscreen on baby and unfortunately, didn’t count on sunlight reflected off the sand and off the water.  Baby was lit up from below where her hat and tent didn’t protect and when we brought her home, she was the color of a cooked lobster.  Some experts!

Now it’s summer and kids should be outdoors swimming and playing, having fun and using their brains in healthier ways than with a phone, computer, or TV.  However, kids need protection from too much heat and light from the summer sun.  The most dangerous problem is children and teens overheating.

The heat-related tragedies are already making the news.  The story typically goes like this: the parent is in a rush, goes into a store and leaves the child in the car.  The parent is detained somehow and by the time he/she gets back to the car, the child is dead.  They always say, “I was only going in for a few minutes,” but unfortunately anything longer than a few minutes is all it takes.

Consider this: How long could you sit in a parked car in the sun, engine and A/C off?  Five minutes?  Ten, if you’re strong?  It takes about 40 minutes to bake a cake, about 20 minutes to bake a cupcake.  Now if you’re the cake and can only stand five minutes in the car before you are drenched with sweat and gasping and overheated, how long do you think your cupcake toddler can last?  The lesson is clear: don’t leave kids in a car in the summer at all, for any length of time!

Fortunately, these episodes of kids dying in hot cars is rare.  Much more common is heat injury with older kids during summer sports practice.  August is coming and with it, football practice.  I can count on seeing some kids in the Emergency Department with heat cramps, heat exhaustion or worse, heat stroke.

Heat cramps are the mildest of the sports heat injuries, where the kid athlete is working out hard, not stretching enough, not drinking enough, and not resting enough between bursts of activity.  He begins to get painful muscle cramps, and this means it’s time to stop, recover, stretch, and hydrate.

The next level of injury is heat exhaustion.  In addition to cramps, these kids begin to have dizziness, headache, and weakness from dehydration and over-heating.  If the child-athlete doesn’t take a break at this point, the next, worst, stage is heat stroke: the child becomes confused, lethargic, may stop sweating, and then is at risk for muscle and kidney and brain injury, and death.

To prevent heat injury, coaches and team captains should take these precautions: First, athletes need to adapt to the heat.  Start with work-outs of lighter intensity and shorter duration.  Football players should spend the first weeks of summer practice in shorts and t-shirts only; then progressively add intensity, duration, and equipment.

The second strategy is adequate hydration and recovery.  Athletes should drink before, during, and after practices.  There should never be limits on access to drink; coaches who restrict fluids are only hurting their kids, hurting their kids’ performance, and should be fired.

Finally, direct sun exposure should be minimized.  Teams should have a shady spot to rehydrate between work-outs.  Practices should be scheduled for earlier morning, like for 7am to 10 am instead of 8 to 11.  Afternoon practice should start at 4 or 6 pm instead of 2 pm.

Finally, coaches should have an action plan to handle heat injury.  Like surveillance for concussions, coaches should be watching players for signs of cramping, sleepiness, and headaches.

We all make mistakes, like when my wife and I accidentally sunburned our new baby at the beach.  Just please don’t make bigger mistakes by not taking heat seriously.

 

My Kid Has A Fever…Help!!!

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

As a resident working in the Pediatric Emergency Department, I’ve noticed that “fever phobia” is pretty common.  Many parents rush into the ER when their child has a fever.  They’re afraid that fever is a sign of serious infection, and that a higher fever means it’s even more serious.  They’re afraid of the fever itself, that it will hurt their kid’s brain or cause seizures.  Fever can be scary for parents, but is actually harmless.  Yes, it’s harmless!  It feels bad, but doesn’t injure your child.

Here’s the good news: fever is an important part of the body’s defense against infection.  Most infections that cause fever are minor and are “self limited,” meaning kids get over them on their own.  Most fevers go away within 72 hours.

When your kid does have a fever, start by treating it at home.  Have her drink plenty of fluids.  If giving fruit juices, dilute with half water and half juice.  Children can eat and drink milk with a fever, but don’t force them.  Bland foods are better, such as breads, crackers, oatmeal, or pastas.

Use acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) to make your child feel better.  Dress him or her in lightweight clothing and light blankets.  You can use lukewarm baths to help your kid feel better too, though a bath may not bring down the temp.  Don’t use ice baths or alcohol baths- these won’t help either, and can be dangerous.

When giving medicine for fever, use the correct dosage.  A lot of parents are afraid to give too much, and end up not giving near enough to work.  The correct dose is based on the child’s weight and is on the medicine’s box, or on the internet.  Tylenol can be used every 4 hours and ibuprofen every 6 hours- more than that will not work any better.

A common myth is that if your child feels warm, they must have a fever!  Children can feel warm for many reasons such as playing hard, crying, or hot weather.  Overdressing infants can make them seem warmer too.  If your child feels warm, check the temperature before calling your doctor or rushing to the Emergency Department.  If the child’s temperature is less than 100, that’s not a fever, no matter how warm she feels.  However, some parents are so afraid of fever that a thermometer won’t convince them- “98.6, no way!  He definitely has a fever- feel him!”

Again, fevers are not bad for children.  Fever is a protective mechanism, helping fight infections.  If the fever does not come down or you cannot “break” the fever, this doesn’t mean it’s more serious.  Height of the fever doesn’t correlate with how sick the kid is either.  In other words, if a child has a temperature of 104, she isn’t necessarily sicker than a kid with a temp of 101.  How your child looks is what’s important, not the height of the temperature.

So, when do you call your doctor or go to the ER?  Again, it’s how your child looks.  If a child has a fever, but is playful and drinking, then just treat the fever.  Your child may sleep more, not eat so well, and act miserable, but this can be okay too.  As long as he feels better after fever medicine (at a decent dose!), is drinking,  and is breathing comfortably, then things are fine.

Talk to your child’s doctor or go the ER if your child is not alert after the fever is treated.  If your child is not drinking and urinating as much, this can be worrisome too.  If your child has trouble walking, cannot be easily awakened, seems confused, has difficulty breathing, has a bad headache, or has new rashes with bruising, get seen.  Infants under 3 months old with fever need to see the doctor too, as do kids with certain conditions like sickle cell disease.

Yes, fevers are scary to parents, but they are usually not an emergency.  Of course, if you are worried call your doctor.  He or she can help you sort through your child’s symptoms and nip ”fever phobia” in the bud.

Cancer- There, I Said It!

Cancer.  It’s a diagnosis so feared that many are unable to even say the word. If someone does says it, they feel compelled to knock on wood, to ward cancer off like an evil spirit. In the Pediatric Emergency Department, the fear often becomes real when a child has a headache.  Kids get headaches just like adults, but with a kid parents worry if this could be the worst: is this a brain tumor?

Fortunately, brain tumors are rare. When a child comes in with a headache, part of the pediatrician’s job is to acknowledge the parent’s fear so that we can alleviate the anxiety. The vast majority of child headaches are benign- viruses, stress, and migraines.  We discuss with the parents why their child does not have a brain tumor, so that they can smile, have a chuckle at their fear, and go “whew!”

How we think about cancer has evolved dramatically over the past two generations.  40 years ago, cancer in a child was hard to talk about because it was a death sentence. The most common childhood cancers are leukemia and brain tumors.  When children were diagnosed with one of these, almost none survived.  It was not a “nice” death either, with bleeding, pain, bad smells, and slow deterioration.

Then in the 1950s, doctor-scientists began to figure out how to treat the incurable disease. These doctors were brilliant, dedicated, and desperate.  They despaired of their small, suffering patients and were willing to try anything, hoping to learn how to win some lives back.  The experimental treatments were painful, seldom worked, and would be impossible to try today in our medical-legal climate.  But through years of agonizing trial-and-error, they did begin to learn, and begin to win.

By the time I started training in 1989, treatment of leukemia was a tremendous success story.  The cure rate of these cancers had gone from 0% to over 90%.  There began new thinking about cancer. First, we had to begin to talk about it openly and honestly, so that we could diagnosis and begin to treat it.  Second, if the cancer couldn’t be cured, the task was to help the child and family accept death, and make that death as painless and “nice” as possible.

Now we need to overcome our fear in order to learn about cancer.  The first cancer to discuss is the most common- leukemia. Leukemia is bone marrow cancer.  Bone marrow manufactures the blood cells: white blood cells to fight infection, red blood cells to carry life-giving oxyen throughout the body, and platelets that help make clots and stop bleeding.  Leukemia is bone marrow cells gone amok.  The cancerous marrow cells overgrow and crowd out good cells.  Instead of making the crucial blood products, the marrow cranks out tons of useless “blasts,” dummy white blood cells.  Leukemia has been called “liquid cancer,” as opposed to brain tumors and other “solid” tumors.

The signs of leukemia relate to the lack of blood cells.  Without enough red blood cells, the patient becomes pale and fatigued.  Without platelets, he bruises easily and the bruises heal slowly.  Without working white blood cells, the child is easily infected and runs fevers. Fortunately, leukemia is easy to detect with a simple blood test: the CBC (Complete Blood Count of the three kinds of blood cells).

The next most common childhood cancer is brain tumors.  Most headaches can be diagnosed as benign by history and a neurologic exam, without a CT scan.  CT scan can see tumors, but uses a lot of radiation and thus can cause cancer itself.  We don’t use it unless we must.  Benign headaches come and go, are easily treated with ibuprofen and tylenol, and are easily attributed to other causes.

“Red flags” for brain cancer are headaches that wake the child at night and early morning, vomiting with headache, and headaches that are steady and don’t come and go.  Brain cancer is much harder to treat than leukemia, often requiring surgery, chemotherapy, and radiation, and the cure rates are less optimistic.

So If you want to face your fear and learn even more about childhood cancer, go to Kidshealth.org. This site has well written and detailed information for parents, to help you say the word.

Old Wive’s Tales: Are They Really True?

Today’s guest columnist is Dr. Asma Khan, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Whenever any couple has a newborn, their world changes completely!  Suddenly every decision is colored with thoughts of the child’s well-being.  It’s unavoidable and it’s beautiful.  But as the couple embarks on raising this new child, something less magical happens.  Meemaw, Nana, and Auntie Gertrude all have something to say about how he should be raised.  Much of the advice is good, but some is Old Wive’s Tales.

I heard some Old Wive’s Tales this past month in the Pediatric Emergency Department. One baby had fever for a few days, and mom was feeding only pedialyte.  When I asked why, mom said that her doctor told her you shouldn’t give feverish babies formula because it curdles in their stomach and they vomit.  Now, this doctor is one of my colleagues in the Family Practice residency, so I emailed her.  The doctor in question swore up and down that she never says this, so mom probably got the advice from some other revered source (grandmother, perhaps???) and grafted it onto her doctor!

This idea of milk curdling in children’s stomachs is a myth.  The thought is that when the child has fever, milk curdles because of the heat, just like milk curdles when heated on the stove.  The child then has indigestion and vomits.  In fact, there’s no reason to deny a fevered child milk.  If the child tolerates milk, by all means feed it!  Milk is a better fluid to give a sick child than water if she is refusing to eat, so she gets some nutrition.

Now, your child may vomit when ill.  This is because of the illness itself, not because of milk.  Some infections cause vomiting, just like they cause fever or cough or diarrhea.  If your child vomits, then we stop milk.  Milk can be more difficult to hold down on an upset stomach.  With vomiting we advise to switch to clear liquids like pedialyte or sports drinks for 6 to 8 hours.  When the vomiting has stopped you can go right back to the milk.

Do you know why kids hate to wear coats?  It’s because parents and grandparents insist that they wear one out in the cold.  ”You’ll catch a cold if you don’t bundle up, sweetie!” is a line we have all heard when we were kids. But to kids, coats are a pain to put on and encumbering when they play.  Also, some kids love to defy authority, so being told to put on a coat becomes the exact opposite of what they want to do!

However, kids don’t “catch colds” because they didn’t wear a coat.  Winter viruses are not from the weather.  Coughs and runny noses are caused by viruses that you catch from another person, and a coat doesn’t prevent that. Periodic hand-washing is much better prevention for the common cold.  Having a coat on in the winter keeps you comfy, but your child running around the backyard is already pretty warmed up.  Let him run free for a bit and then make sure he cleans up before sitting down to that stew.

“Feed a cold, starve a fever” is another Old Wive’s Tale, that dates back to the 1500s. The belief was that eating warmed up the body, while not eating cooled it down.  Thus “starving” was felt to be a way to control fever.  Likewise if baby had a “cold,” you wanted to feed baby to warm it up.  This is all a myth and the saying should be “feed your child,” period.  Fever is not the main ailment, it’s one of the body’s natural responses to fight infection.  When your child has fever, it’s a message to you to feed him as much (or as little!) as he wants, so he has the strength to get healthy.

These are a few tips as you go along the beautiful and scary journey of parenthood.  If other family member’s advice sounds dubious, check with a professional source when it comes to your child’s health.  If it’s the best chocolate cake recipe you’re after, always listen to Meemaw or Nana or Auntie Gertrude!

 

 

The Running Of The Bulls

I was checking out The Running of the Bulls on the internet yesterday.  If you haven’t heard, that’s a festival in Pamplona, Spain where they set bulls loose in the streets of the city. Thrill-seekers get chased by the bulls, and every year the news shows someone getting gored by a bull’s horns and/or stomped on.  I found one site titled, “Running of the Bulls with Families,” and did a double-take.  They let kids run with the bulls too??!!

Fortunately, that website said children aren’t allowed in the streets when the bulls run, and discussed how families can reserve a balcony to see the fun.  It reminded me of our own Louisiana version of Running of The Bulls with Families which I call “Letting Kids Drive ATVs.”

ATVs (or 4-wheelers) and bulls have lots in common.  They are both over-powered.  Like bulls, ATVs are designed to go off road and pull farm wagons.  That requires a lot of power, too much for young children to handle.  Also like bulls, ATVs are difficult to control.  ATVs have high centers of gravity and go fast, making them easy to roll over.  They require hand-eye coordination and anticipation of hazards that children don’t have, which is why we don’t let kids drive cars before age 15.

And yet many parents put their children on ATVs anyway.  They even make 4-wheelers for kids!  I have treated ATV drivers as young as 5 years old in the Emergency Department.  It boggles the mind that these parents don’t see the potential for injuries.  Kids fly off them and hit their heads, sometimes sustaining severe brain injuries.  Kids roll the things, the heavy machine tumbling over the child, maybe causing organ rupture and internal bleeding.  Kids zip past trees and posts, smashing hands and ankles, knees and elbows.  Children who lose control sometimes run over their friends.

I have seen all these injuries in all degrees of severity. I have seen ATVs put children in the Operating Room and in Intensive Care.  I have warned in this blog, in the newspaper, and on TV about letting kids drive them.  Yet some parents can’t stop from indulging their children with 4-wheelers, no matter what experts say.

In fact, Federal Consumer Product Safety Commission (CPSC) seems to have given up cautioning against putting kids on ATVs, and instead has posted recommendations for “safe” ATV operation for kids.  As I list these recommendations, it feels like giving children safety instructions on smoking cigarettes (“Hey kids, be sure to smoke only filter tips!”).

The first tip on the CPSC fact sheet is to stay off paved roads.  ATVs are for off-road.  They go too fast, get harder to control, and are easier to roll over on pavement.  Also, roads are where the cars and truck are, and I’ve seen too many kids crash into the bigger, faster moving vehicles.  Another tip: never allow children younger than 16 on adult ATVs.  The CPSC states that more than 90% of child ATV injuries happen when they drive adult machines, given kids’ lack of size and developmental skills.  Thus companies make ”age-appropriate youth models.”  (Maybe It’s time cigarette companies come out with age-appropriate youth models too).  To be fair, the kid models have adjustable speed limiters, making it harder to go unsafe speeds.  Please keep the adjuster to a safe setting!

Kids (and adults) should wear helmets, goggles, gloves, long pants and sleeves, and over-the-ankle boots.  Going off road means tree branches, fence posts, and rocks, so wearing that stuff makes good sense.  Allow only one rider on single-rider ATVs.  Safe operation of ATVs requires the driver to be able to shift weight freely and a passsenger gets in the way, increasing the risk of roll-over or other crashes. Finally, if you must let your child drive an ATV, get them training!  Deaths and injuries happen when inexperienced drivers lose control, get thrown, roll over, or run into things.  Hands-on training can help your kid avoid bad situations.  FInd a course at the ATV Safety Institute, the ATV dealer, or the National 4-H Council.

Even better, save lots of money and heartache by getting your kid a really good bicycle instead.

Let’s Go For A Swim!

This week’s guest columnists are Dr. Kevin Morris and Dr. Richard Pearson, Family Practice residents at the University Health Center here in Lafayette.  Dr. Morris is a former paramedic, and knows of what he speaks:

It’s warming up and sunny, let’s go swimming!  ”Rescue 51, respond to the swimming pool in the Sunset neighborhood, 3 year-old drowning.”  This request no paramedic likes to hear.  Upon arrival, the girl is found lying next to the pool, having been pulled out by her parents.  She is unresponsive and has no pulse.  We work frantically to save her.  The family tells us they were having a reunion, with twelve children and thirty adults.  No one saw her go into the pool.  This potentially tragic event is avoidable, with simple steps.

As temperatures rise, we begin to think about staying cool and having fun.  Both needs are met by jumping in the pool and we’re all for it!  It’s great exercise and play, and gets the kids outside.  And they certainly can’t bring a phone or video game in with them!  However, we all need to be aware of the danger.

According to the Centers for Disease Control (CDC), every day two children in the US die from drowning, and another ten go to the Emergency Department for non-fatal submersion.  Drowning is the second leading cause of death in ages 1 to 14 years, only behind car crashes.  There are many, easy ways to dramatically improve safety.

One of the most common reasons drownings occur is a lapse in supervision.  We all enjoy the poolside- barbequing, drinking, visiting, swimming, and making big splashes. All this distracts from the young non-swimmers.  When children are there, it’s important for one supervising adult to be distraction-free to watch the kids. The American Academy of Pediatrics recommends “touch supervision,” meaning that children are always within touching distance at the pool.

When it’s a party at the pool with adults and kids milling around, it’s impossible for any adult to stay 100% vigilant.  That’s how tragedies like our child above happen, even with a designated watcher.  Therefore life jackets are great for non-swimmers in the group. They are easy to use and really help.  Air-filled toys and “floaties” are adorable and fun, but just aren’t safe enough.

The girl from above had been at a pool that was fenced, but went through the gate unnoticed.  It’s not unusual to accidentally leave a gate open, so a self-closing and self-latching gate may save a life.  Sometimes children impress us with their craftiness and do things we never thought possible, like opening “child-proof” locks. Thus the gate latch should be at the top of the fence where small children can’t reach.  Also, pool fences should be on all four sides of the pool: having the pool open to a patio door invites disaster.  To see what your pool fence and gate should look like, check out hotel pools- many have great fence systems.

One of the best ways to protect children from drowning is teaching them to swim. Kids who have formal swimming lessons are safer from drowning.  Lessons are recommended for age 5 and up, but can be started earlier depending on the child’s maturity. The Boy Scouts have one of the best swimming programs, because it drills kids in pool and water safety as it teaches the actual swimming.

A word about another big group at risk for drowning: teenagers.  Teens, like toddlers, are natural risk takers.  They don’t think ahead, and spend time with their friends at bayous and lakes.  They may be drinking, jumping into unknown bodies of water, boating, and yet not know how to swim.  No teen should be at a pool, lake, bayou, or any body of water without being able to swim.  Talk to your teens about safety- not drinking, wearing life jackets, and not diving into shallow water, or water where you can’t see the bottom. Here in Louisiana everyone has a tragic story about water and a careless teen.

With these simple steps, playing in the water can be much safer for the kids and less stressful for parents.  Get out, stay active, enjoy the weather, and laissez les bon temps rouler!

Music and Medicine

Medical school applications require an essay and most pre-meds write about “why I want to be a doctor.”  All those missives begin to sound the same and can really bore the med school admissions committee.  When I applied back in 1984 I wanted my essay to be different, so I wrote how being a violinist would make me a better doctor.  I was proud of that little composition and wish I still had a copy.  Needless to say, I got in.

The gist of my essay was that learning and playing an instrument requires hard work and concentration akin to learning medicine.  However, while medical practice can drain one’s energy and soul, playing music can restore these, and help the practitoner cope with a career that often involves despair, tragedy, and death.

Music has health benefits for the patient as well as the doctor.  Music and our lives are already intertwined.  We listen to music while we work, in our cars, while we exercise, and then when we go out.  Movies, television shows, plays, and video games all have music accompaniments.  It’s no surprise that there are myriad interactions between music and health.

The health benefit of music starts with babies, even premature ones.  Infants in the Neonatal Intensive Care Unit are born to a noisy place- the hiss and whir of machines, the babble of doctors and nurses and therapists, the beeping of alarms.  These noises are stressful to babies that should otherwise be hearing a mother’s voice and lullabies. Indeed, researchers have found that playing music to premature infants soothes their vital signs and improves their eating and sleeping patterns. The music also soothes the stressed parents huddling around the isolette.

Beyond infancy, music has many other health benefits.  Science has shown that music can help treat depression (though probably not with “death metal”), reduce anxiety in patients before surgery or in the emergency department, and even improve the body’s immune function.  Music sometimes works better than medication to relieve anxiety or chronic pain.

Learning music also improves concentration.  Just look at the faces of kids learning a new instrument and you’ll see.  When I was first learning the violin, I used to play with my mouth wide open, partly from concentration, partly so my jaw would hold the instrument under my chin.  I looked like I was being constantly surprised.  My teacher at the time did me one better- she told me she used to drool on her violin, so busy was she with the notes and the fingers and the bow!

Music-improved learning starts, like with our premature baby from above, in infancy. Researchers have found that hearing music enhances a baby’s language acquisition.  It seems that infants hear people speaking like they hear music- they listen to patterns and tone rather than listen for meaning.  Only later does the meaning of words and inflection get attached to the sound.  And the more sounds, music or talk, that a baby hears, the faster their brain gets at interpreting the sound.

When kids get to school, music remains an important aid to learning.  The National Association for Music Education lists 20 benefits of having music education in school. Here are the ones important to me as an Emergency Department doctor:

1.  Stress Relief- whether the stress is in me, or in the many patients I see with anxiety and depression; music soothes, and playing music soothes even more.

2.  Playing music improves coordination- I was a klutz as a kid and was always getting hurt.  Learning an instrument teaches a kid to concentrate on coordinating his body as much as learning a sport.  Better coordination and fewer accidents mean fewer broken bones and lacerations in the ER.

3.  Playing in a band or orchestra leads to success in society- playing together requires teamwork, and band members learn to get along and belong while making music. Students in band or orchestra are more likely to be successful in life, and less likely to abuse drugs or alcohol.

So let’s keep music education strong in schools.  Not every kid can afford private lessons, and learning music helps kids be smarter, healthier, happier, less stressed, and more capable.  That’s certainly as important as math, US history, and football.

Feeding New Babies New Foods

This week’s guest columnist is Dr. Nichole Miller, a family practice resident at the University Health Center here in Lafayette.  Dr. Miller has a four-month old baby, and know of what she speaks:

Brandon’s mom was excited, her baby is 6 months-old, sits up without much assistance, and is now interested in food.  Great!  What a big step in little guy’s development.  But now: “Which foods should I start with?  Is he really ready to eat foods?  What if he has food allergies?  Sheesh, why is it so complicated?”

Every parent’s journey includes the exciting time of feeding foods for the first time.  This new adventure comes with those questions.  According to the American Academy of Pediatrics (AAP), babies are ready for solids when they can hold their heads up, sit with minimal support, and open their mouths to food.  Easy enough, right?  But again, what foods to start?  Start with simple puree foods, like baby cereals.  Vegetables should come before fruits.  No highly allergic foods, like foods containing peanuts or egg.

Give one new food at a time and wait three days before introducing another new food.  This helps identify any food allergies your child may have- if baby starts with a bad rash, vomiting, or diarrhea after eating that new food, stop serving it.  If you give new foods too close together, you can’t know which one caused the rash.

Let’s fast-forward: Brandon is now one year and his mom is at the next hurdle, the picky eater stage.  Every parent worries about picky eaters.  The AAP reminds parents that toddlers sometimes just aren’t hungry.  Brandon may eat all his breakfast and not touch lunch or dinner.  Instead of fighting about food, offer a variety of foods and let your toddler choose.  Whatever he doesn’t eat, offer it at the next meal.  Remember the four main food groups: meat, dairy, fruits and vegetables, and breads and cereals.  Offer items from each group.  Avoid highly processed foods, which means foods which are highly packaged and have ingredients you can’t pronounce.

That covers the “do’s” of feeding toddlers food, let’s talk about the “don’ts.”  Say Brandon still won’t eat any foods, only drinks milk.  Milk is good for a kid, right?  So mom feeds him all the milk he wants- four 8-ounce bottles per day.  Since he won’t eat meals, she lets him snack all day.  This is common with new parents and toddlers, and reveals three don’ts.  First, no bottles after one year- kids should drink from sippy cups.  Second, toddlers shouldn’t drink more than three 4-ounce cups of milk per day- more than that kills their appetite for foods, and filling up on milk robs a kid of important food nutrients.  Finally, snacking also kills appetites for meals, and snack-grazing behavior contributes to obesity.

However, Brandons’ parents read our blog and he is eating a variety of foods and is doing great.  Now Brandon’s dad offers him grapes.  He eats one and begins to choke.  Mom panics, pounds him on the back, and he coughs up a barely-chewed grape.  Many small firm foods are choking hazards for toddlers because they don’t know how to grind their food while chewing.  The AAP recommends the following foods be avoided: un-cut hot dogs, hard candies, nuts, peanut butter chunks, popcorn, seeds, whole grapes, and the like.  Parents should take a CPR class to learn choking management like the Heimlich maneuver.

Another food concern is eating things that aren’t food.  Say Brandon is now 7 years-old and in T-ball.  He just finished a game and is enjoying some sunflower seeds like real baseball players.  However, unlike the guys on TV, he is swallowing the shells with the seeds instead of spitting them out.  The next day, Brandon has terrible pain when pooping.  The pain gets so bad he’s brought to the Emergency Department.  On x-ray, we see the shells stacking up and forming an impaction in Brandon’s rectum.  Also, the shells’ sharp edges hurt like broken glass.  Brandon has to go the Operating Room to get the horrible impaction out.

Parents, never let your kids eat sunflower seed shells- just the seeds please!  Leave the shell eating-and-spitting to the pros, who get paid to do that on TV.