Baby Fall, Go Boom!

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

Bumps, scrapes, and bruises can be found on the scalp of any active child, some so much they look like a scuffed shoe.  Kids explore and lead with their big heads, so it comes with the territory. Usually it’s easy to know when a scalp bump can be cured with a mommy’s kiss.  These are the minor boo-boos from flying soccer balls or cups thrown by grumpy siblings.

It’s also not hard to know when a more traumatic blow requires an Emergency Room visit. It’s an easy decision if your child gets knocked out cold by a baseball bat, or is in a high-impact traffic collision. These obvious ones you bring to the hospital.

What about those in-between injuries:  the short falls on the head from a tree branch, the heavy tackles at football practice, the head-on sprints into an invisible glass door? Even if toddlers cry for a couple of minutes after a smack to the crown, or teens seem a little confused after a soccer ball to the head, they’re usually soon skipping around like nothing happened. However, every parent has heard stories from someone they know, or about a celebrity, who seemed fine after a head injury, didn’t go the hospital, and then didn’t wake up the next morning.  These tales will make any parent rush the kid in with the teensiest knock on the noggin.

Fortunately we now have scientifically valid criteria to evaluate those in-between cases, to decide who needs a brain scan and who doesn’t:

-Does your child complain of a really bad headache, or seem confused?

-Was he knocked out?

-Is she vomiting?

-Did he fall from over 5 feet up, or have another high-impact injury to the head (like a thrown baseball)?

These are the kids who need to get seen, but these criteria apply to kids 2 years-old and up.  What about the smaller fry?

Babies and toddlers fall a lot.  Even before babies can sit up, they will roll.  Off the bed. They tumble out of car seats and strollers.  Then when they first start walking, toddlers look like high-wire artists, weaving about with their arms out for balance, everyone around wondering, will he fall, won’t he?  Then the toddler learns to run, and is not deterred by walls or coffee tables.

Like minor head injuries in older kids from above, it’s usually easy to tell which baby or toddler is okay.  She bonks her head on the coffee table, cries for a minute, and then gets up and runs after the cat.  Baby flops out of the car seat that is on the floor, scrapes his forehead, then goes back to wiggling and cooing, and nurses fine.

So when do we worry?  Our high-risk criteria for older kids we discussed above don’t seem to apply to the littler ones.  How can you tell if baby has a bad headache, or is “confused?”  And many babies vomit daily, whether they hit their head or not.  For these reasons we have separate rules for head injuries involving kids under 2 years-old:

-Does baby have a large bump anywhere on the scalp, except the forehead?  Forehead bumps are allowed, since that is where the skull is hardest, designed for the most common, front-end impacts.

-Did the child lose consciousness for more than 5 seconds?  Many toddlers are temporarily dazed after smacking their heads, so we give them 5 seconds to recover their wits.

-Is the child acting normally, or is he more sluggish or more fussy?

-Did baby fall from more than 3 feet, or have a similarly traumatic blow?

Note that vomiting is not on the list for babies and toddlers.  Some toddlers will vomit when they cry really hard, and many babies spit up randomly.  Vomiting doesn’t correlate with bad head injuries in the littler ones- many toddlers who end up in Pediatric Intensive Care don’t vomit, and many babies who are fine vomit all day anyway.

So when baby falls and goes boom, you will initially freak out and want to rush to the doctor. Then take a breath, think about the above, and use your own noggin to decide!

A Tale Of Two Teenagers

Ben grew up with asthma, but at 15 he seemed to have outgrown it.  Then this fall he began to cough and feel tight.  His mom took him to a quick-care, where he was prescribed an inhaler. A few weeks later he caught another cold virus, began to cough and wheeze again, and started using the inhaler he had left in his school bag.

Ben was a busy teenager, and didn’t use his inhaler regularly.  He took puffs only when when he felt tight.  He began to get more tired and out of breath despite the inhaler, but he didn’t tell his mom.  He felt this was his business, and his mom nagged him enough as it was- about his grades, his phone use, his messy room.  He didn’t need more nagging about his medicine.

Then one evening he suddenly couldn’t breathe.  It was a struggle to pull in a breath, and he had to tell his mom.  When she saw that he couldn’t speak and was so air hungry, she called the ambulance. After an hour in the Emergency Department and lots more medicines, he was put in Intensive Care, still wheezing.

Ben’s story is common with teenage asthmatics.  Teenagers generally get poor health care, even those with chronic, potentially life-threatening conditions like asthma or depression.  Littler kids see the doctor a lot, given all the vaccines they need.  They get sick a lot more too, meaning more trips to the office.

When they get to be teens, there’s less reason for kids to go to the doctor.  The vaccines are fewer and far between.  Teens stay pretty well.  When they do get sick, rather than fight to get into their regular doctor, parents sometimes opt for more convenient walk-in clinics.

However, losing contact with your child’s doctor is a problem.  Sure the vaccines are fewer, but when you don’t go to your “medical home” to get seen, you don’t get reminded the important teen vaccines and may miss them: the meningococcal vaccine against meningitis, the tetanus booster, and the cancer-preventing HPV vaccine.  And a walk-in doctor is less likely to ask about your teen’s chronic conditions which need surveillance, like asthma, or depression.

Ashley, 14 years-old, was always a glum kid.  She kept to herself, rarely smiled, had few friends.  About a month ago she broke up with her first boyfriend.  This made her feel even more worthless than usual, and she lately has been thinking that the world would be better without her.  Today she told a friend that she was thinking of taking a lot of pills.

Ashley’s friend, burdened by this knowledge, stewed through several periods at school, and then told a counselor.  Though this made the friend feel like a tattle-tale, she actually saved Ashley’s life. The counselor called in Ashley and her parents, Ashley admitted her suicidal thoughts, and she was brought to the Emergency Department for evaluation.

Depression, like asthma, can be a chronic condition in teenagers.  Like our asthmatic teen from above, teens don’t like talking to parents about their condition.  They are embarrassed by it; they feel like freaks, with their asthma or depression making them different than others.  They also don’t like being nagged.  Throughout her childhood Ashley’s parents harped on her about her depression, and she had been to counseling several times.  She didn’t like counseling: who wants to talk about their feelings when their feelings are so negative?

Having a regular doctor is one way to keep tabs on depression.  At well visits, besides vaccines and school physicals, doctors should be asking teens about their feelings.  If kids seem depressed, their doctor isn’t afraid to ask the harder questions: do you want to kill yourself?  Why are things worse now: is it problems with your parents, your friends, your school?  The ”medical home” is all about prevention, unlike an Emergency Department or walk-in clinic, where it’s about fixing the kid’s immediate problem and moving on.

If you are worried that your teen is depressed and may be suicidal, fortunately Lafayette has the Jacob Crouch Foundation, a suicide awareness and support group.  You can visit their website at to learn suicide facts and myths, how to recognize signs, and how to get help.

Even better, get help earlier by sticking with your kid’s doctor!

Avoid a $100,000 Medical Bill

This week’s guest columnist is Dr. Michael Johnson, a Family Medicine resident at the University Hospital and Clinics here in Lafayette.

In the Sportsman’s Paradise, enjoying the great outdoors means most of us have encountered a snake.  I remember when my father and I were squirrel hunting one evening on a creek bank.  I was following, literally in his footsteps, when he suddenly stopped.  He turned to me and said firmly, “Son, back up now.”  I looked down and saw he was standing on a snake he had accidentally walked on, and he wouldn’t move until I was safely away.  He then pinned the snake behind the neck with a stick, stepped off, and let it slither away.  This was the start of my lifelong hatred of snakes.

Between snakes and mosquitoes, it’s sometimes hard to enjoy Louisiana outdoors. Every year about 8,000 people are bitten by poisonous snakes in the United States, with 10-12 deaths.  Louisiana is home to four species of poisonous snakes: the rattlesnake, water moccasin (a.k.a cottonmouth), copperhead, and coral snake.  Most bites happen during summer and fall.  How can we keep children safe during this time of year without confining them to the prison of “inside the house?”

Parents can start by keeping kids from playing in tall grass or around large rocks.  These are the preferred environment for snakes.  It’s another incentive to mow the lawn, besides keeping up with the Jones’s.  Children shouldn’t play in vacant lots.  Use extreme caution when moving firewood or stacked lumber.  When outdoors, examine and then designate safe areas before fishing in ponds or swimming in lakes or creeks.

Never teach your kids that it’s alright to handle snakes.  This includes not letting them see their crazy uncle (we all have one) catch a snake to remove it, or worse, play with it. Dr. Hamilton had one partner, a life-long swamp rat, who did just that after his son found a snake in the yard.  Instead of staying away, he decided to show his son how to “walk” a snake with a forked stick.  He led the snake just far enough to get himself bitten.

What if you or your child fall prey to a poisonous snake’s fangs? We’ve been educated by John Wayne, the Duke himself, on wrapping a belt around your arm, cutting the bite with your bowie knife, and sucking out the venom.  In the movies this always saved his life, yet it’s another case where Hollywood shows us exactly what NOT to do.  Here’s what we SHOULD do.

After being bitten, first remove the victim from the snake’s territory. Snakes don’t always bite and slither away; sometimes they stick around and bite again.  Next, don’t panic.  Up to 25% of poisonous snake bites are “dry” bites, where the snake bites but doesn’t inject venom.  If you do get injected, it’s still okay.  The chance of dying from a snakebite is nearly zero in the United States because of high-quality medical care.

After calming the victim (and yourself), keep him or her warm and quiet.  Immobilize the injured part with a splint and remove watches, rings, or tight clothing from the affected extremity.  Swelling around these might cut off circulation.  Do NOT apply tourniquets or tigtht dressings.  Loss of blood to the bitten part causes more damage than good. Clean the wound with water.

Attempt to identify the snake, as long as that doesn’t endanger anyone. Take a picture from a safe distance.  Don’t handle the snake even if it’s dead, since dead snakes can still bite reflexively.  Don’t try to kill the snake. Many snake bites are from non-poisonous snakes, and killing them gives the rats one less predator to worry about.  And if you try to kill it and get bitten yourself, that’s one more victim to worry about.  Most of all, don’t delay transport just to identify the snake.  Lay the patient down and get going!

How does this add up to a $100,000 medical bill?  If anti-venom is needed, treatment takes 6-10 vials, each vial costing about $7500.  Add that to the cost of a hospital stay. I’d rather spend that hundred grand on a yacht or a round-the-world trip.  So don’t be that person who plays with snakes; be the safer, more educated person with a yacht.

Guns or Dogs?

With the recent Grand theater shooting, I realized I hadn’t written about gun safety, so it’s overdue.  But I don’t like talking about gun tragedies since I spent a week on the trauma team in third year of medical school.  That week we had three incidents of children coming into the trauma room, dying of gunshot wounds.  The third child was the 5 year-old son of a DEA agent, who had come home from an overnight stake out.  Exhausted, he tossed his pistol on the kitchen table and crashed in bed.  The son woke up sometime later, and you can guess the rest.

I don’t like talking about guns and kids, but as my priest said this past Sunday, a real conversation on guns is overdue. Pediatric firearms deaths aren’t a single event like at the Grand either, but an ongoing problem.  Twice as many children and teens die from gunshots as die from cancer.

Preventing firearm tragedies begins at home, where most deaths occur.  In the past I have discussed how to best prevent your child from drowning in a pool- don’t have one.  Same with guns- it’s best just not to have one in the house.  I own a shotgun, but while my kids were growing up I kept it at my father-in-law’s.

If you must have a gun in the house (we’ll discuss the statistics of that further on), keep it locked in a gun safe, unloaded, with the ammunition locked separately. Regardless of your position on the National Rifle Association (NRA), they advocate this. The NRA has another good idea about safety- teach your kids about guns, to take away the mystery. Teach them to not touch, and even run away from, unattended guns (like at a friend’s house) and immediately tell an adult about unsecure guns.

The American Academy of Pediatrics advises doctors to discuss gun safety at office visits, just like above.  Except in Florida, where the legislature and governor passed a law forbidding pediatricians from doing just that.  You would think that that’s unconstitutional, given the right to free speech and a doctor’s duty to ensure child safety. Discussing gun safety is akin to discussing safely storing ant poison.  Inexplicably, two courts have ruled in favor of the law, which illustrates how far afield the gun debate has gone.

Fortunately we’re in Louisiana, so talking gun safety is okay.  As we discussed, it’s best not to have a gun in the house at all.  When my kids were little I kept my shotgun at my father-in-law’s.  When my son became curious about guns, his uncles and I took him hunting to teach him firearm safety.  Our favorite memory is of Uncle Tommy taking him on a squirrel hunt.  They rode the four-wheeler through the woods, zigzagging in the brush for so long that my son thought he was clear to Bunkie, though they ended up only 100 yards from the house.  My son never even touched the rifle, but he learned all about it.

If you have a gun in the house, keep it locked in a gun safe, unloaded, with the ammunition locked away separately.   But keeping it locked doesn’t make sense, some will say. What if someone breaks into my house- the gun won’t be ready!  The statistics are clear: violent home invasions are rare, and guns in the house are much more likely to kill the owner or a family member than an intruder.  Accidental deaths and suicides from home firearms are far more common than successful home defenses.  It’s better to get a dog with a deep, loud bark.

Finally, as any responsible gun owner will say, you must know the laws of ownership and use.  Particularly, as Seth Fontenot unfortunately found out, it’s illegal to use a firearm to stop a robbery.  One of my nurses who is an ex-marine and hunter puts it this way: if someone goes into your garage and starts walking away with your stuff right in front of you, you can’t use a gun to stop them.  You can call 911, and start taking stuff out of his car and putting it back in your garage, but no guns!

Again, better to have a big loud dog.

Bad News Bears

This week’s guest columnist is Dr. Claire Ronkartz, a family practice resident at University Hospital and Clinics here in Lafayette.

In the first week of medical school my class was split into groups of ten students with a professor.  The groups met weekly, between anatomy lessons and biochem lectures, to discuss doctor things like “how to use an otoscope,” and “how to scrub into a sterile OR.”  These were fun little breaks from the monotonous all-day lectures and hours spent studying.

One of these forums was a little different. It was on “Breaking Bad News,” how to tell patients something terrible, like that they had cancer.  We role-played scenarios acting as patients and doctors, nervously laughing, as we practiced giving each other bad news.  We learned tips like “before giving bad news to a patient, turn off your phone,” and “don’t sugar coat anything, tell the whole truth,” and “allow the patient ample time for questions.”  It was an important exercise, and one we would revisit throughout training.

Unfortunately there’s no handbook to prepare parents for receiving Bad News.  If only we were discharged from the hospital with our new baby in one hand and an indexed, tabbed, parenting handbook in the other.  I yearned for such a handbook when I was 20 weeks pregnant and on the parent side of Bad News.  My husband and I learned that our baby would be born with a complex heart defect that would require surgery.  Suddenly we were no longer researching car seats or deciding what color to paint the nursery.  We were talking about at which hospital to deliver this sick baby and planning for open heart surgery.

Thankfully, in the Pediatric Emergency Department, the bad news usually goes: “Gage did, in fact, break his arm,” or “Liza looks like she has Hand, Foot, and Mouth disease, so no daycare for a few days.”  Occasionally the bad news is more serious, and here are some tips I’ve learned in my own experience.

When presented with bad news, the most important thing to do is to select a “captain of the ship” for your child’s care.  You are wading into very unfamiliar and rocky waters, and you’ll want a doctor experienced in those seas.  When our baby was diagnosed with a heart defect, that doctor for my husband and me was our cardiologist, Dr. B, who could write a chapter on “breaking bad news.”

When Dr. B made the diagnosis he made sure we were the only family in the office.  He sat us down, took out a sheet of paper, and drew her defect.  Then he wrote down two lists: one with an explanation of the defect, and the second on “where to go from here.”  It was our plan to refer to when we were confused or stressed.  Finally, we scheduled an appointment in a month to discuss further questions.  No matter what, you will need a good, reliable captain for the journey ahead.

Another tip: resist the temptation to troll internet blogs; avoid late night Google searches.  My mom always told me in high school: “Nothing good comes from being out on the road after 10 pm.”  The same goes for Google!  Don’t get me wrong, there’s lots of good, useful information out there, but there’s a lot of bad information and horror stories too.  And while knowledge is power, I refer you to my first advice- ask your captain to give you good information and websites so you can properly educate yourself and advocate for your child.

Try to meet other families facing similar diagnoses.  These days, social media is a wonderful tool to find support groups and families who are walking your same path.  Meeting others and knowing that you are not alone is a huge help.  You’ll be surprised how many locals are in a similar situation.

Lastly, have a support system at home.  Lean on your spouse, family, and close friends.  If you live away from family, find a counselor, priest, or minister.  It’s imperative that you pay attention to your own needs in order to be able to take good care of your children.  And then when things go well like they did for us, you can celebrate good news!


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 This site has well written and detailed information for parents, to help you say the word.