Friday, October 28, 2022

Halloween Safety tips 2022

 


There are crunchy leaves on the sidewalk and fun decorations on houses. It is time for the Halloween post.


The last couple of years, with the pandemic swirling around us in full force, Halloween was a watered down affair for most families.

This year more people are trying to find a balance and do some safe celebrating.


Even though Halloween centers on scary things, as I list all of the accidents and things to be wary of, my intent is actually NOT to terrify you. Most of the things I mention are completely preventable!


Imagine that getting your children safely through this holiday is somewhat like walking through a minefield, but I am putting a warning flag on top of each mine so that you can avoid stepping on one!

 

Pumpkins

Carving a pumpkin can be a very fun tradition. Please make sure that your child's level of participation is consistent with their age and ability. Watch out for the sharp implements and make sure you assign your younger child to the safer tasks (young kids can draw on the pumpkin rather than carving.)

 

Clean up the mess. Pumpkin flesh is slippery and can cause falls and injuries when dropped on the floor. Layer newspaper or an old sheet under your carving work space and clean up spills right away so no one slips or trips. Skip the candles, which may cause fires. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick (available in many colors) or flameless candle to safely illuminate your jack-o'-lantern.

 

Choosing a costume

Children are more than twice as likely to be hit by a car on Halloween than on any other day of the year!

 

Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors. Have kids use glow sticks or flashlights to help them see and be seen by drivers. Is your dog going along with the trick or treaters? Have them wear a glow in the dark collar!

 

When selecting a costume make sure it is the right size to prevent trips and falls. Be sure to wear something that is flame-resistant. Even if you have complied, remind your child that they need to pay very close attention to their surroundings and avoid walking near any candles or flames, especially if they have loose flowy costumes.  If a sword, cane, or stick is a part of the costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if they stumble or trip.


Comfortable shoes! Anyone of you who has sacrificed comfort to wear their sexy high heels knows what I am talking about. 

 

Make sure that no part of the costume is covering the ears so thoroughly that hearing might be impacted.  Masks can sometimes obstruct a child's vision, so assess the fit. Non-toxic face paint and makeup are another option. In past years some face paint came under fire for containing toxic ingredients such as lead. Be familiar with the ingredients before you apply anything to your child’s skin. 

Avoid anything in the eye area. Always test the makeup in a small area first. Always completely remove it before bedtime to prevent possible skin and eye irritation.

 

Double check that your child doesn't have any latex sensitivity before you do too heavy of an exposure. Many Halloween masks are made of latex. I remember once that I actually had a patient who had an allergic reaction to the hair tinsel. You may want to do a test run of the costume and make-up a couple of days ahead of time to rule out any allergies. This dress rehearsal is also a great time to make sure the costume is comfortable and not tight or itchy.


My niece Lena is incredibly creative and for many years, when her son was younger, would put lots of time and energy into making fabulous costumes . More years than not, he would opt out at the last minute. The message here is not to get too invested. Take your photo ops early on while the getting is good.


Trick or treat rules


I was actually going to skip doing the Halloween post this year until I watched the news. Stories about Fentanyl that looks like candy caught my attention. Almost every year there are reports of pot laced candy, but Fentanyl kicks that up a notch and is much more serious. This drug is so dangerous that any contact with it can be extremely hazardous.


Make sure that your children know that after trick or treating, the grown up needs to pick through trick or treat bags and toss anything that looks suspicious. Anything that looks like it has been tampered with should get tossed. Ideally you only get candy from trusted sources in the first place.


Most parents automatically check through the candy of all of the younger kids (pocketing some of the good stuff for themselves.) But sadly, I think it is important to sort through the candy bounty from your older kids as well.


Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without you, remind them to stick to familiar areas that are well lit and trick-or-treat in groups. Never go into a strangers house unless they are accompanied by a trusted grownup.

 

Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so if you are out driving, be especially alert for the trick-or-treaters.

 

A good meal prior to parties and trick-or-treating may discourage youngsters from filling up on Halloween treats.

 

Bring plenty of water along when you go trick or treating. Just trust me on this one.

 

Some candies are real choking hazards. If you have a younger child in the house, make sure they don't have access to the stash.

 

If you have a child with nut allergies (I am sure this is NOT your favorite holiday) make sure that they turn over ALL the candy so that you can separate out anything that might cause trouble. Most of the time nuts may be just one of the ingredients, but as a general rule, kids who are allergic to nuts should also be able to identify the nuts that they are allergic to. If it is peanuts, make sure they know what an actual peanut looks like.


If your child has diabetes, make a plan with them to see how much candy they can safely eat without seriously impacting their glucose levels.

 

Expecting trick-or-treaters or party guests?

Consider purchasing non-food treats for those who visit your home, such as coloring books, stickers, tattoos or even hand sanitizer. Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks. (Okay, fine...maybe you don't want to be "that" house, but I had to put it on the list.) Be sure walking areas and stairs are well lit and free of obstacles that could result in falls. Keep candle-lit jack o'lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.

 

Covid tips


By no means is Covid the only game in town these days. Flu, RSV and all sorts of colds are also making the rounds. So how to we stay healthy and still have fun? As with all activities these days there is a risk/benefit analysis. Trick or treating outdoors with a small group should be pretty safe. Have some hand sanitizer spray that you can easily spritz if you are grabbing candy from a communal bowl. If you are going to be in a crowd, see if you have a costume that includes a nice protective mask as part of it.

 

Now what do we do with all this candy???

Make a plan about how much candy they can eat at one time. It is okay to be a little more liberal than usual for a day or two, but come to an agreement about a reasonable candy intake over the next few weeks. My daughter Lauren was about 6 when she caught on that mom and dad were pilfering through her trick or trick bag and stealing all the good stuff. After that she guarded her stash more carefully.

 

Remember that candy freezes (and some of it is actually better that way; frozen snickers bars, yum!) Some dentists and orthodontists have buy back programs, where they will give your child a reward for turning in their candy. Check with your dentist to see if they participate.

 

In any event, you may need to be extra vigilant with teeth brushing this season.


Tips from Oath’s developmental specialist Mona Singhal

www.Spark-wonder.com


Halloween with little ones 

Remember young children can’t always tell the difference between real and make believe. Give your kids a heads up that they may see some things like witches, pirates or ghosts that may look scary but it’s just friends playing dress up. Remind them that they will also see Elsas, Paw Patrol and their other favorite characters too! We want them to know there may be some scary moments but mostly some fun ones coming their way! 


Plan out the day with them. This will be a change in their routine so letting them know who you will be going trick or treating with and even talking about the path together will be helpful! “We are going trick or treating with your cousins and we will visit the pink house on peach street that we pass on the way to school!” A couple of highlights of the route is enough to help them feel like they know what to expect and this helps eliminate meltdowns. 


Wear comfortable clothing underneath their outfits! This way if the outfit gets uncomfortable (which it usually does) they can shed some layers while still sticking to the fun! Get your pictures in as soon as possible this way if dressing up isn’t going as planned you don’t have to stress it! A happy half pirate is better than a crying fully dressed one! 


Tips from an ER doctor.

I asked my friend Dr. Sheila, who has worked at pediatric emergency rooms for many years what ER visits spiked up around the holiday. She said that tummy aches and constipation from all the extra candy were very common. She also sees an uptick of little pieces of candy being stuck in places that they don’t belong (like the nose.)



Do you have wisdom to share?


Over the years of doing this post, parents have written in with their tips Do you have something to share that isn't on my list?



Bibi, one of my old patients' moms, instituted her own buyback program. Her kids could exchange candy for new lego pieces.

 

Glow sticks are a favorite, but sure enough one of my patients bent a stick in order to activate it and broke and squirted in her mouth. While you do want to avoid unnecessary contact with the insides of Glow sticks, they are generally non toxic. For the science nerds out there, this link is fun.

https://www.glowtopia.co.uk/news/how-glow-sticks-work/



Other resources


If you are on the Next Door app, they have a brilliant map so you can see which of your neighbors are participating in the action


Next Door Annual Halloween map


Here are some local Halloween activities for the 2022 season.

 

Bay Area Pumpkin Patch Guide


SF halloween events


And because everyone needs a good laugh…. 

Here are some brilliant suggestions from Oath Contributor, comedian and author Raquel D’Apice


Haven’t decided on a costume for your toddler for Halloween?


Let your toddler’s own personality be your guide Here are three last-minute suggestions that are tried and true, and by “tried-and-true I mean “I came up with them on a whim, but I think they seem feasible?”


For shy, overly clingy toddlers:


Consider dressing your toddler up as a moth and then you yourself can dress up as literally any light source. (old fashioned lantern, candle, the moon).  You won’t be upset that they spent literally the entire evening trying to get you to pick them up, you’ll just be thrilled that they committed to the costume so well.


For non-clingy toddlers:


Dress your toddler up as a gray sphere labeled “wrecking ball” and let them loose wherever the Halloween festivities are taking place. 


For Toddlers that like to explore, but lose their nerve after a few minutes and come back to you:


Boomerang or yo-yo costume is the way to go. If we’re being totally honest, the yo-yo costume is basically just a frisbee costume with a child leash attached to it, but it’s super practical if you’re worried about your toddler getting lost and it meets the requirement of “Can I throw this costume together frantically in an hour after the kid has gone to bed?”


Happy Halloween and best of luck!












Friday, October 21, 2022

Skin Fold irritations

 

SKIN FOLD IRRITATIONS



I began this blog back in 2013. It is almost 10 years old!

I started doing the weekly newsletter soon after.


One fun little feature that you can see if you visit the actual blog is that the ten posts that are getting the most activity will show up at the top. It is an easy way to see what is going around. You can always count on head lice and pinworms to make the top ten. One of the other ones that is almost always in the top is one of my oldest posts on skin fold irritations.


Most of the older posts are in dire need of editing (according to Sandy who took on this task several years ago.) This week alone, I have had multiple discussions about severe skinfold irritations; I decided it was time to freshen up the skinfold post.


We love pudgy babies. There is something about all of those chins and chubby thighs that is so delicious. But as your baby gets rounder and rounder, they develop all sorts of little creases. It is common for the skin in these areas to get irritated. This doesn't only affect babies of course. Many folks have enough skin and sagging parts that this can remain an issue throughout the lifespan.


The fancy medical term for this is intertrigo. Intertrigo is inflammation of the skin. It tends to occur in warm, moist creases of the body where two skin surfaces rub or press against each other. These troublesome spots can occur all over the body. Common areas are:


  • Upper thigh/ groin area, 
  • Butt creases
  • Under the breasts
  • In the armpits 
  • Behind the ears.
  • In the creases of the neck and chin 


Prevention is key!!! If you ignore the skinfolds, you may be caught by surprise by how red and stinky they can get.


When you are bathing your child make sure you get into all of those folds. I like to add a splash of apple cider vinegar to the bath water. I don’t have an exact amount, but roughly ¼ cup. This seems to prevent a good number of rashes


When you are toweling them off, make sure those creases get completely dry. 

 

Babies and children don't need to bathe every day, but they do need a bit of daily hygiene. It is important to be paying attention to all skin folds on a daily basis. Do a routine naked check. This includes separating all areas where the skin makes contact with itself, and making sure that there isn't trouble brewing in those creases. 


My favorite tools for both prevention and treatment are pretty simple. Use a gentle cleanser. There are many where you don’t even need water. Apply the cleanser and wipe off.

Some goods ones are Cetaphil and Mustela.


Then apply a protective ointment:


  • Aquaphor
  • Tummy Todd (Lauren’s favorite)
  • Emily’s soother
  • Cerave ointment
  • Calendula


See if there is an obvious cause. When your baby is teething and drooling up a storm, the creases in the neck can be quite challenging. 


Is there an irritation? In the upper thigh area, a poor fitting or new brand of diaper might be the culprit.


Is it fungal? Yeast loves warm, moist, dark areas. If the area has any odor or has red dots then this could be the culprit.


If you suspect yeast, I would go ahead and use a topical antifungal cream; lotrimin is fine. There is no such thing as a pediatric version. It is actually the same one that you would use for athlete's foot.


For really red areas adding over-the-counter hydrocortisone cream twice a day.


If the area is very raw, you can also add a dab of Neosporin (generic triple antibiotic ointment is fine) several times a day. 


It is okay to mix and match any of these. Always start with the cleanser, add medication and follow with protective ointment.

Dr. Ted sometimes uses a thicker diaper rash cream instead of ointment.


If you are not seeing improvement after a few days of treatment, call your doctor to have a look.


Some anti-fungal powders can be useful in creases, but the challenge is applying them without your child inhaling harmful particles. If you are someone who likes powders, sprinkle the powder into your hand away from the baby and gently apply it to the trouble area without causing the powder to get airborne.



Paying attention to your baby's skinfolds, head to toe, is something that I wish parents would put on their daily to do list. I know you are exhausted and don’t need more tasks, but in this case, two minutes a day can spare you and your baby from being caught by surprise by a nasty crease.


What's Going Around?



  • RSV is so prevalent that many pediatric ER's and ICUs are at capacity.



  • Croup



  • There are lots of colds and coughs that linger


  • There are lots of older kids with sore throats. They have all the classic symptoms of strep, but most of them are testing negative


  • There is still some covid going around. There is misery associated, but I haven't seen any serious cases.


  • Tummy bug. It is a combo, but perhaps more vomiting than diarrhea.



  • Hand Foot Mouth is not going anywhere, still very prevalent.


Make sure you get your flu shot if you haven't yet. Some states are starting to see the flu. It hasn't taken hold in the Bay Area yet.



Friday, October 14, 2022

Conjunctivitis/causes/ treatments/ eye drop administration tips

 

Conjunctivitis



There was just a new study that just came out about pink eye. It prompted me to dig out this old post and update it!


Let's start with some basics. The conjunctiva is the thin clear tissue that lies over the white part of the eye and then folds back and lines the inside of the eyelid.

 

Conjunctivitis is the term for when the conjunctiva has some inflammation. When this inflammation happens, the small blood vessels in the conjunctiva become more visible. This is what causes the whites of the eyes to appear reddish or pink. Common symptoms of conjunctivitis might include:

 

  • Redness in the white of the eye or inner eyelid
  • Increased amount of tears
  • Thick yellow discharge that crusts over the eyelashes, especially after sleep
  • Green or white discharge from the eye
  • Itchy eyes
  • Burning eyes
  • Blurred vision
  • Increased sensitivity to light

 

The white part of the eyeball isn’t always noticeably impacted. If you suspect conjunctivitis, see if the inner lining of the eye looks redder than normal. My favorite way to check is to put a finger on the upper part of the cheek and gently pull down. This will allow you to assess the color inside that lower lid. Check both eyes. It isn’t a bad idea to get a baseline and see what normal looks like before there are any symptoms.

 

Pink eye has a number of different causes, including:


  • Viruses
  • Bacteria
  • Allergies 
  • Irritants 

 

Viral: Many cases of pink eye come from the same viruses that cause a common cold. If there is discharge it is usually fairly thin. It is common to wake up with crusty eyes. Kids might complain that it feels like there is sand in their eyes.

Just as a cold must run its course, so must this form of pink eye, which usually lasts from four to seven days. 

Treatment is focused on relieving the symptoms; soothing eye drops are great. Also warm or cool compresses can ease the symptoms. Do you have access to breastmilk? You can apply some drops directly into the eye.

 

Bacterial conjunctivitis typically is redder and beefier looking with thicker discharge. Both bacterial and viral can start in one eye and then spread to the other. If there is a lot of green and yellow pus, it is more likely (but not absolute) that it is bacterial. 

 

Historically, pinkeye that is suspected to be bacterial has been treated with antibiotic eye drops. 


The new study out of Finland showed that many kids did just as well with lubricating eye drops instead of the prescription medication.


The groups using either kind of drops recovered much faster than the group who did nothing at all.

 

Perhaps this is one of the reasons that breastmilk is so effective (aside from the fact that it is magic). I have seen it help many an irritated eye.

 

If you don’t happen to have breastmilk, Similasan eye drops are a good choice

 

Simple conjunctivitis can clear up on its own, although as noted above, any kind of soothing eye drop can speed up the process. However, it is not uncommon for patients with goopy eyes to have something else going on. I am even more suspicious if kids are fussier than usual. Pinkeye is often part of a ‘package’ with an ear infection and/or sinus infection. Those kids may end up needing oral antibiotics.

 

Both viral and bacterial conjunctivitis can be highly contagious. Understandably, most schools and daycares will not want your child to attend if there is a suspicion that they might have conjunctivitis. The general rule is that kids can return to school once they have been treated for 24 hours. The problem with this is that many cases are actually viral in which case, antibiotic drops are useless; it does get a bit mucky. Lots of parents make the choice to start drops immediately so that they can get back to work sooner. In any case, if your kid's eyes are super goopy they shouldn't be around other kids.

 

I asked Dr Ted what he likes to use for a case that needs to be treated. His preference is a brand called Politrim. He added that he knows of other doctors and ophthalmologists who will often prescribe erythromycin ointments because the medication stays in the eye for longer, making it more effective, technically. However in his opinion ointments are very difficult to instill into a child’s eye. He would rather try to get clear liquids into the eye four times a day instead of a ribbon of thick goop twice a day.

 

The directions will often come with a range of time that you need to do the treatment; for example 3-7 days. I suggest that you continue to treat for an extra day or two after the eyes have cleared up. Don’t partially treat it or it is likely to come back - 3 to 5 days is usually standard. Your child is no longer considered contagious after they have completed a full day of the drops.

 

If there is no improvement after 3 days it is worth having them rechecked.

 

Allergic: If allergies are the culprit, both eyes will likely be affected. The eyes are usually watery and itchy, They are usually not crusty. Common causes can be dust, pollens or exposure to an animal.


Allergy eye drops can be used on an as needed basis. You don’t need to commit to doing a course. Some good choices are


  • Zaditor (3 years or older)
  • Pataday(2 years or older)
  • Similasan (2 years and older)

 

 

Irritation:

Common causes include harsh shampoo, dirt, smoke, chlorine from a pool, poor fitting, or dirty contact lenses, or a foreign body. 

 

The best treatment is flushing the eye out with sterile saline or an eye washKeeping an eyewash solution is a good addition to your medicine cabinet. Of course, do I even need to add that Breastmilk is an excellent flushing agent as well?

 

Dr. Ted’s Science:

When trying to tell the difference between bacterial, viral, and allergic conjunctivitis, there are a couple of key indicators. The discharge can be telling: your body sends lots of white blood cells to fight bacterial infections, which will lead to copious thick white discharge that needs to be wiped often (almost hourly). The eyes here will become deep red. Viral conjunctivitis doesn’t recruit as many white blood cells to fight, so there can still be discharge, but it tends to be thinner, less frequent, and more yellow. These eyes tend to be more pink. On average, bacterial conjunctivitis will impact one eye more than another (the site of inoculation) while viral pink eye tends to go to both eyes more quickly. Allergic conjunctivitis tends to be quite faint and mostly itchy without any pain, while both viral and bacterial can occasionally be painful. And finally, ear pain plus conjunctivitis should always raise suspicion for bacteria, specifically alongside ear infections. 

 

What’s the difference between pink eye and a stye?

A stye is a red and painful bump that forms on the eyelid, near the edge of the eyelashes. Conjunctivitis and styes have some overlapping symptoms, such as redness, light sensitivity and crusting along the eyelids. However, these are different conditions, with different causes. Styes are usually caused by an infection in the oil gland on your eyelid. Most of the time the treatment is warm compressing

Treating a stye with antibiotics is not indicated.

 

Eye Drop tips

I have some parents who claim that it is easier to give a bath to an angry cat than to administer eye drops to their kids. Getting those drops in can be somewhat of an art.

If you have the luxury of having a willing partner, It may indeed be a two person job. If your child is very uncooperative you may need to wrap them in a blanket so that they don’t have their arms to flail around. Gently pull down the lid. Even if they are clenching their eyes tightly shut, you should be able to find a little pocket in which to put the drops. Try not to touch the dropper tip to the eye. 

This is harder than you think.

For older kids, a little preparation before you go at them with the eye drops can go a long way. Let them do some playing. Have them give “drops” to 2 different dolls or stuffed animals. Make one cooperative. Give them lots of praise for being brave. Make the other one kick a fit. You get the idea.

 

 

If your baby is under 4 months, 

Crusty eyes may be from a blocked tear ductBlocked tear ducts mostly will be an issue when the babies wake up from a stretch of sleep with their eyes all gummy. If you are seeing more frequent goopiness, it is worth checking in with your doctor.

 

What makes me worried?

If the area around the eye looks very pink or red and swollen, that could be something called periorbital cellulitis and it can be quite serious if untreated. This would generally come with a fever and a child who looks ill.

 

Extra considerations

Frequent hand washing with soap and water is essential. To avoid spreading the infection, swap out pillow cases, and wash clothes or towels that might have been in contact with the goopy eyes.

 

Please don’t share drops between family members!

 

If you have a little one who is getting recurrent infections, little hands going from a snotty nose, up to the eyes could be the culprit. Beyond making sure the those hands are kept clean, make sure you scrub under the nails.


For the grownups - get rid of makeup that might have been used within several days of having conjunctivitis, especially mascara,

 

If you are a contact lens wearer, you might do better wearing your glasses for a few days.