‘toddlers’

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More Data That Laundry “Pods” Carry Risk

pod photo croppedLaundry detergent pods continue to cause trouble — increasing convenience yet posing risks to young children. New data out today confirms what we’ve seen since their introduction. These cute, colorful and entirely convenient laundry packets (typically called “pods”) were introduced in the U.S. in 2012 and quickly made measuring out laundry detergent a thing of the past. Unfortunately we’ve also seen that these pods grab the attention of young children. Beautiful design gone wrong. As you’ve likely heard, or witnessed yourself, young children can be drawn to the pods (often these packets of detergent look like a preschooler’s toy or a piece of candy) and because of young children’s unique method of exploration (infants/toddlers/preschools use their mouths as much as their eyes & hands to explore) they may be at risk for injuries if the detergent pods are in arm’s reach. New research out today from Pediatrics documents an ongoing onslaught of children exposed to laundry pods, more than 17,000 children in less than two years. Some in the media have translated the volume of calls to poison control — a call every hour in this country — secondary to exposures to these packets of concentrated detergent.

Single-Dose Detergent Concerns

The first warnings about the dangers of laundry pods came out in May of 2012.  The American Association of Poison Control Centers (AAPCC) started getting calls about children getting in to the capsules and ABC news did a subsequent story warning parents about the risks. Several factors make the pods a serious risk for young children: they’re appealing to the eye (look how fun and colorful the Tide pods look in the photo above) and small in size.  They also have a thin membrane (built to dissolve quickly in the wash) and are full of highly concentrated soap. It’s unclear exactly why this concentrated liquid causing so many new symptoms (vomiting, coughing, or rarely severe breathing problems and severe symptoms like changes in level of alertness or seizures). Dr. Suzan Mazor, an emergency physician at Seattle Children’s, adds she’s seen several eye abrasions, which happen when children accidentally squirt the pod contents in their eyes. She adds, “These ultimately heal just fine but can be painful and distressing to the children and parents.” The ingestions have been serious enough at times to send children to the ICU and need mechanical ventilation. With the beautiful curiosity of a toddler coupled to the lack of judgement, you have a recipe for this “pod” problem. Here’s a look at it by the recent study numbers:

  • 17,230 – Children under the age of 6 exposed to laundry pods (between Feb. 2012 – Dec. 2013), the majority being ingestions. The AAPCC reports that 8,915 exposures have already been reported in 2014 (data through end of September, 2014)
  • 645% -The increase in exposures to laundry packets between March 2012 – April 2013
  • 74% – The percentage of children exposed to detergent packets who are under age 3 years. Clearly toddlers are the most vulnerable group when it comes to these packets of detergent
  • 80% - The percentage of ingestion for the reported cases. This translates out that 8 of 10 children who have an exposure put these pods in their mouths. About 7% of children have injuries to their eyes, and the remaining 3% are a combination of skin injuries and damage caused by inhalation into the lungs
  • #1 – #1 household product ingested in Italy. This isn’t just a US problem. In Italy, where detergent pods have been available since 2010, the product is the number one most commonly ingested household product
  • 56% – More than 1/3 of kids vomit after an ingestion. For overall exposures, 48% percent of children exposed to pods vomited, making it the most common side effect. After vomiting comes coughing  or choking (13%), eye irritation or pain (11%), drowsiness or lethargy (7%), and eye redness (6%)

pod poison timeline

What Parents Need to Know:

Read full post »

Why Broad Spectrum Sunscreen?

I’ve written about sunscreen before (Protecting Children From The Sun, 10 Tips on Tanning, & the video on Protecting Infants included below). More important and than any granular, scientific detail about a sunscreen ingredient, UVA/UVB radiation, or it’s vehicle– a spray or a lotion or an ointment–is how you use it. The best sunscreen is the one that is used early and often on children. No sunscreen is waterproof and no sunscreen is play proof. For infants and toddlers, I’ve found the best trick for easy application is to put it on while they are strapped into the car seat on your way to the beach! There’s no controversy that it’s best to apply sunscreen 20 minutes before sun exposure and repeat the application head to toe every 1-2 hours during active play/swim.

Don’t be fooled– sunscreens marketed for children may not provide any increased safety or protection. You’ll see and hear conflicting reports on ingredient safety, particularly as differing groups discuss concerns about chemical ingredients versus physical/mineral ingredients. Trouble is, groups now warn about the physical/mineral ingredients (previously felt to be the safest) due to their particle size. And although the FDA warns against using spray sunscreen with children (concerns about inhalation of the fumes) most families love the convenience. Here’s a comprehensive, current review on ingredients & safety.

Good thing is, most everyone agrees that the ingredients in sunscreen are less risky than any significant sun exposure or burn in childhood.

The video above explains the need for broad spectrum protection. You’ll need to look for a sunscreen that has 2 or 3 ingredients to cover all the range of UVA and UVB rays that damage our skin. Here’s the American Academy of Dermatology’s tips.

A Little Science About UVA/UVB Light & Sunscreen:

  • UVA radiation causes Aging and deeper skin damage. To protect against the entire spectrum of UVA rays, you’ll likely need two ingredients in the sunscreen–most commonly you will see oxybenzone or avobenzone coupled with another (zinc oxide, titanium dioxide, for example) to cover the entire UVA spectrum of light. Although some people report concerns about oxybenzone’s irritation to sensitive skin, recent research finds when it’s only at typical 1-6% concentrations, skin reactions are unlikely. If using a sunscreen for the first time, apply a small patch of sunscreen to your child’s leg as a test before using it elsewhere. UVA radiation is constant throughout the year, regardless of season or heat index. Read full post »

5 Ways To Avoid Cavities And Still Feel Like A Celebrity

Dental caries (cavities) are preventable for most children. To keep those pearly whites pearly it takes being thoughtful about eating habits, brushing habits, drinking habits, and being knowledgeable about your child’s water supply. Although physicians are making robots to perform surgery and putting tiny cameras in our bodies to explore the inside, we may sometimes lose sight of easy, affordable ways to improve the lives of millions. Maybe we simply retreat from those prevention efforts…or maybe it’s something else.

The CDC reported this spring that for the first time in 40 years, preschoolers have more cavities than they did 5 years ago. And many children have so many cavities that they show up at the dentist with double-digit numbers requiring general anesthesia for repair. In one month alone, I’ve done a number of pre-op visits for dental anesthesia for patients in my clinic.

Many national headlines have covered this data over the last few months. And I would suggest there is one thing to stress here. Part of this increase in cavities may be a cultural issue, a parent-culture issue. That is, many parents may not be brushing their children’s teeth because of push-back from their children and a goal to maintain harmony at home. And many parents believe bottled water is safer than that from the tap. When it comes to teeth, that isn’t the case.

Sometimes we really have to act like adults and do the flossing.

I think this bump in cavity numbers is a parenting issue more than anything else. Read full post »

Idaho: Vaccine Safety, A Desert, And A Networked Community

I’ve just returned from a week in Idaho where I had the privilege to do a series of talks for the Idaho Department of Health (DOH) about using social media to communicate about vaccines. The best part of the week was all of the education I received. I traveled around the state (see those photos!), witnessed the DOH at work, connected with Idaho physicians & politicians & advocates & volunteers, and talked with many Idahoans about changing the understanding of vaccine science. Three times I heard Dr Melinda Wharton from the CDC present on vaccine safety. And more, in a matter of 4 days we talked with a clinician, nurse, or medical assistant from every single office in the state that provides vaccines to children. I mean, that’s a wow–a sincerely networked community circa 2012.

If all states had the opportunity to convene like they do in Idaho we’d really improve understanding, communication, and opportunities in health care surrounding vaccine safety and decision-making.

After arriving home to my boys, I’m compelled to share 3 things I learned in Idaho:

ONE:

I think it’s essential that we talk about the risks associated with vaccines when we give them–each and every time. Dr Wharton discussed known risks to vaccines and the science to support those risks. She also talked about inferred risks that aren’t backed up with science (autism, for example).

Take fainting: we know teens faint after shots sometimes. Read full post »

Concerns About Autism: Reasons To See The Pediatrician

When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.

Read more about the science of autism from Autism Science Foundation.

We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.

When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…

Signs of Autism In Infants & Toddlers:

There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,

  • You should observe your infant demonstrating curiosity.
  • You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.
  • Your child should show you they know their name by 1 year of age.
  • You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.

Here’s a list of specific Autism Warning SignsRead full post »

How Do Doctors Screen For Autism?

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.

However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »

Toddler Sleep: Early Morning Awakenings

Every week in clinic families ask me about strategies to help with children who awake before the sun is up. We all thrive with improved, uninterupted, prolonged periods of sleep at night. Particularly on those Saturdays where an extra hour or two of sleep can be life-sustaining for exhausted parents to toddlers and preschoolers. Because of our boys’ early schedules, late last year Santa conveniently dropped off an incredible tool: a toddler teaching clock. The clock has helped our 3 year old know when 7 o’clock rolls around. And we’ve made a deal with boys for 2012: no leaving their bedroom until 7 appears on the screen. And so far, it’s working–we’re batting about .900. Learning to play quietly on their own in the early morning has been a great benefit, too.

Toddlers and preschoolers between 1 and 3 years of age need about 11 to 13 hours of total sleep within 24 hours (night time and nap combined). Sometimes no matter what time bedtime starts, early morning awakenings continue to happen. As many parents learn, moving bedtime later doesn’t always shift the time a child awakens in the morning. But with time, shifts in schedules sometimes improve that Saturday morning sleep…

Dr Craig Canapari, a pediatric pulmonologist and sleep expert in Boston helps explain some reasons for these uber-early wake-ups and what we can do about it:

Why does my toddler get up so early in the morning?

Read full post »

Toddler Sleep: 4 Reasons Toddlers Wake Up At Night

There is a lot of writing online about how to get your baby to sleep through the night during infancy but not as much expertise to help those of us with toddlers and preschoolers who wake a number of times. Between age 2 and 3 when O was released from crib jail and moved to a big bed, he’d come to find me a couple of times a night. I’d often awake (and startle) to find him standing next to my bed! I tried many things to improve his opportunity for a full night’s sleep yet for those kids who never quite figure out that sleeping through the night starts around 7 or 8pm and ends with the sun coming up around 7am, we want to help. Recent data shows that 1 in 5 infants who have trouble sleeping may continue to have challenges during the toddler years. Clearly challenges with sleep that span multiple years affect many of us.

I turned to a pediatric sleep expert for help. Dr Craig Canapari is a doctor I met on Twitter (of all places) who answered questions surrounding sleep challenges for toddlers. Dr Canapari is a father to 2, a pediatric pulmonologist & sleep expert, and is thinking of starting a blog! He told me that when he was a kid he, “definitely did have problems falling asleep sometimes,” so not only is he an expert, he’s experienced! Check out his responses here and leave comments and questions — I’ll get him back on the blog to respond as needed.

Why does my toddler wake up at night?

Every parents has experienced the dreaded 2 AM call. You hear your little one stirring on the monitor. Either you wait, fingers crossed, to see if they go back to sleep and they don’t, or you run in there as fast as you can to stuff the pacifier in their mouth before they really wake up. Most babies are capable of sustained sleep (6-8 hours in a row) at night by age six months. If you are nursing your child, it may take them a bit longer to achieve this. I think that it is reasonable that every child should sleep through the night most nights by 9-12 months of age. Now, every child wakes up sometimes at night. I view the awakenings as a problem if they are more than a few minutes in duration, occurring multiple times at night, or resulting in significant daytime irritability for either the child or the parents.

If your child is having problematic nocturnal awakenings, there are a few possible causes: Read full post »

Reading A Growth Chart: Mama Doc 101

Parents, pediatricians, and nurses have been using growth charts since the late 1970’s to track growth in their infants and children. The charts were revised back in the year 2000 as the data for the first charts (from a small study in Ohio) that didn’t accurately reflect the cultural and ethnic diversity of our communities.

The hallmark of a well child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, and/or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.

Watch the video to learn more about interpreting growth charts.

If your doc doesn’t have a computer in the room, ask to see the chart (on paper) or on a computer in their office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time they have been seen.

The human body really is a fine-tuned machine and growth is simply astounding if you really stop to think of it.

If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s okay if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask for the doctor or nurse practitioner to explain it.

Revisions to the growth charts in 2000

Understanding growth charts

Half & Half

I had a great trip to the grocery store today with the boys. Life has been so hectic these past few weeks, we haven’t had weekend time for a leisurely trip to the aisles of fruit and fondue. Today, we had the luxury of time, a list, and a proper plan. They weren’t hungry (and neither was I) so our stomachs didn’t drive the cart and the boys were uniquely engaged. We perused the produce area. We made peanut butter in the machine that crushes raw peanuts. We talked about some of the beginnings of the food we bought (the avocado came from Mexico, the mini-oranges from California). But I thought most about how pleased I am when I end up at checkout with more fresh food in the cart than food stuffed into packages. Today I think I came close.

And that’s the lesson. One thing I say over and over again in clinic is, “If at all possible, for every single meal you offer your child at home, make sure 1/2 the plate is covered in fresh fruit and veggies.”

So if that’s the goal, the cart should always look the very same way.