Mental Health In America

I have many hobbies, one of them is reading. As with most working parents, I don't always put as much time into my hobbies as I used to.  That's probably why it took me almost two months to finish my recent book.  I highly recommend everyone reads Stephanie Giese's memoir, All I Never Knowed.  Since finishing her book, I want to reflect some more.

I'm a pediatrician. I have been called (yes I feel this is truly a vocation) to care for children and to be their advocate.  Some may think I mostly give shots, treat colds and ear infections, and make sure children are growing appropriately.  Those things are only a small part of my job.  Especially during the COVID pandemic, I feel more and more like a psychiatrist and therapist too.  I have families tell me, they've been waiting 3-4 months to see a therapist.  I have families tell me they took their child to the crisis center because their child's mental health deteriorated while waiting for therapy and they started performing self-harm.  I have families wait in the emergency room for days waiting for an inpatient psychiatric bed to open.  I have families tell me they agree they should see a psychiatrist but none accepts their insurance.  I have families tell me they found a therapist or psychiatrist, but they can't afford the self-pay rate.  Receiving treatment for mental illness shouldn't be this hard.

And now let's talk about the school system for a little.  These thoughts are not directed towards teachers.  I have not met a single teacher who doesn't want his or her students to succeed.  Tell me why our current educational model waits for students to fail before they investigate the need for special education?  Tell me why parents have to fight tooth and nail to get a child a 504 plan?  Tell me why schools receive funding based on standardized tests scores and not the social-emotional well being of the students?  And guess what!?!  Having a child fail in school, especially when it could be prevented with the proper accommodations and remediation, increases the rates of mental illness!!!

I honestly thought I had more to write, but I'm tired.  And I'm getting more angry as I think about the broken system, so that's it for now.  Go read Steph's book and keep fighting the good fight!

Happy Halloween!

It's been quite a while since I posted a "kids safety" topic, but with Halloween here, I think these tips from Healthy Children are perfect for today.

___________________

Halloween is an exciting time of year for kids. Here are some tips from the American Academy of Pediatrics (AAP) to help ensure they have a safe holiday.

All Dressed Up:

• Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
• Consider adding reflective tape or striping to costumes and Trick-or-Treat bags for greater visibility.
• Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes.
• When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
• If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.
• Obtain flashlights with fresh batteries for all children and their escorts.
• Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as “one size fits all,” or “no need to see an eye specialist,” obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
• Teach children how to call 9-1-1 (or their local emergency number) if they have an emergency or become lost.

Home Safe Home:

• To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations.
• Parents should check outdoor lights and replace burned-out bulbs.
• Wet leaves should be swept from sidewalks and steps.
• Restrain pets so they do not inadvertently jump on or bite a trick-or-treater.

On the Trick-or-Treat Trail:

• A parent or responsible adult should always accompany young children on their neighborhood rounds.
• If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
• Only go to homes with a porch light on and never enter a home or car for a treat.
• Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or Treaters:
• Stay in a group and communicate where they will be going.
• Carry a cell phone for quick communication.
• Remain on well-lit streets and always use the sidewalk.
• If no sidewalk is available, walk at the far edge of the roadway facing traffic.
• Never cut across yards or use alleys.
• Only cross the street as a group in established crosswalks (as recognized by local custom).
• Never cross between parked cars or out driveways.
• Don't assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn't mean others will!
• Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.

Healthy Halloween:

• A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats.
• Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
• Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items.
• Try to ration treats for the days following Halloween.

Love This! Allerbling

Can you tell I have off this weekend? I'm finally catching up on my google reader...

So, to the post. I'm training to be a pediatrician and ran across a great idea on Lyndsay and Jason's blog, Finding Our New Normal. I originally followed Lyndsay because I loved her photography, and then her life changed when her youngest son became sick and that's how they started the above blog. Somethings I understand, others I don't, but it's helping me keep my mind open as I go through my training. But, back to this post. Her middle child was just tested for allergies and Lyndsay found a great way to help tell everyone what allergies she has....Allerbling!
I'll have to remember this the next time I come across a patient with severe allergies. I love this idea. It's to the point and kid friendly!

Oh the Joys of Poo...

As a pediatrician I get paid to talk about poop. Yes, you read that correctly. For those who've never had a constipated kid, it's amazing how much discomfort and embarrassment constipation can cause children. I might need to find a new way to ask parents about their child's poop though. Today I asked a mom if her five-year-old's poop was pebble-like, snake-like, or pudding-like. Yeah, that 5 year old started cracking up. Mom knew what I meant though.

So, here's some information on constipation from one of my favorite sites, Healthy Children from the American Academy of Pediatrics.


How do I know if my child is constipated?

Bowel patterns vary in children just as they do in adults. Because of this, it is sometimes difficult to tell if your child is truly constipated. One child may go two or three days without a bowel movement and still not be constipated, while another might have relatively frequent bowel movements but have difficulty passing the stool. Or a child’s constipation may go unnoticed if he passes a small stool each day, while a buildup of stool develops in his colon. In general, it is best to watch for the following signals if you suspect constipation:

*In a newborn, firm stools less than once a day, though this can be normal in some exclusively breastfed infants
*In an older child, stools that are hard and compact, with three or four days between bowel movements
*At any age, stools that are large, hard and dry, and associated with painful bowel movements
*Episodes of abdominal pain relieved after having a large bowel movement
*Blood in or on the outside of the stools
*Soiling between bowel movements

Causes

Constipation generally occurs when the muscles at the end of the large intestine tighten, preventing the stool from passing normally. The longer the stool remains there, the firmer and drier it becomes, making it even more difficult to pass without discomfort. Then, because the bowel movement is painful, your child consciously may try to hold it in, making the problem still worse. (This is why it's important to catch it before pooping becomes too painful!)

The tendency toward constipation seems to run in families. It may start in infancy and remain as a lifetime pattern, becoming worse if the child does not establish regular bowel habits or withholds stool. Stool retention occurs most commonly between the ages of two and five, at a time when the child is coming to terms with independence, control, and toilet training. Older children may resist having bowel movements away from home because they don’t want to use an unfamiliar toilet. This, too, can cause constipation or make it worse.

If your child does withhold, he may produce such large stools that his rectum stretches. Then he may no longer feel the urge to defecate until the stool is too big to be passed without the help of an enema, laxative, or other treatment. In some of these cases, soiling occurs when liquid waste leaks around the solid stool. This looks like diarrhea or soiling on the child’s underpants or diaper. In these severe cases, the rectum must be emptied under a physician’s supervision, and the child must be retrained to establish normal bowel patterns. Consulting a pediatric gastroenterologist may be necessary.

Treatment

Mild or occasional episodes of constipation may be helped by the following suggestions.

Constipation due to breastmilk is unusual, but if your breastfed infant is constipated, it is probably due to a reason other than diet. Consult your doctor before substituting formula for breastmilk. (Keep in mind that the American Academy of Pediatrics recommends breastfeeding and avoiding cow’s milk for the first twelve months of life.)

For infants, ask your pediatrician about giving small amounts of water or prune juice. In addition, fruits (especially prunes and pears) can often help a constipated infant.

For a toddler or older child who is eating solid foods and has problems with constipation, you may need to add high-fiber foods to his daily diet.

These include prunes, apricots, plums, raisins, high-fiber vegetables (peas, beans, broccoli), and whole-grain cereals and bread products. At the same time, cut back on foods such as rice, bananas, and cereals or breads that are not high in fiber. Increasing the daily water intake also may help.

In more severe cases, your pediatrician—alone or in consultation with a pediatric gastroenterologist—may prescribe a mild laxative or enema. Follow such prescriptions exactly. Although some newer laxatives are over the counter and simpler to use than these products used to be, never give your child a laxative or other types of stool-loosening or -softening medications without first consulting with your doctor.

Prevention

Because each child's bowel patterns are different, become familiar with your child's normal bowel patterns. Make note of the usual size and consistency of her stools. This will help you and your pediatrician determine when constipation occurs and how severe the problem is. If your child doesn't have normal bowel movements every few days, or is uncomfortable when stools are passed, she may need help in developing proper bowel habits.

You can. . .

*Encourage your child to drink plenty of water and eat more high-fiber foods.
*Help your child set up a regular toilet routine. (Yes, you may need to schedule "toilet time." After meals is always easy to remember.)
*Encourage your child to be physically active. Exercise along with a balanced diet provides the foundation for a healthy, active life.

If you are concerned about your child's bowel movements, talk with your pediatrician. A simple change in diet and exercise may be the answer. If not, your pediatrician can suggest a plan that works best for your child.

Last Updated 6/11/2010
Source: Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

Babysitting

We haven't had any children yet, but having a child definitely can change a couple's priorities and lifestyle. However, I personally believe every couple should take some time to themselves and remember what it's like to be husband and wife, and not just mom and dad. To do that, you often need to hire a babysitter. Here are some reminders from the Academy of Pediatrics found on HealthyChildren.org.


The following list of information should always be left with a babysitter:

1. Parents phone numbers
2. Neighbors phone numbers
3. Doctor
4. Fire/Rescue
5. Police
6. Poison center
7. Home phone
8. Home address

Parents Should:

* Meet the sitter and check references and training in advance.
* Be certain the sitter has had first aid training and knows CPR.
* Be sure the babysitter is at least 13 years old and mature enough to handle common emergencies.
* Have the sitter spend time with you before babysitting to meet the children and learn their routines.
* Show the sitter around the house.
Point out fire escape routes and potential problem areas. Instruct the sitter to leave the house right away in case of fire and to call the fire department from a neighbor's house.
* Discuss feeding, bathing, and sleeping arrangements for your children.
* Tell your sitter of any allergies or specific needs your children have.
* Have emergency supplies available including a flashlight, first aid chart, and first aid supplies.
* Tell the sitter where you will be and when you will return.
* Be sure any guns are stored unloaded in locked cabinet.

Sitters Should:

* Be prepared for an emergency.
* Always phone for help if there are any problems or questions.
* Never open the door to strangers.
* Never leave the children alone in the house - even for a minute.
* Never give the children any medicine or food unless instructed to do so by the parents.
* Remember that their job is to care for the children.
* Tender loving care usually quiets an unhappy child.

Last Updated 6/10/2010

Source TIPP—The Injury Prevention Program (Copyright © 1994 American Academy of Pediatrics)

Help, my kid has a potty mouth!

I am amazed at how much some kids swear these days. While the American Academy of Pediatrics says it's a developmental transition, I still think kids swear more now than when I was a kid--but that could be because more parents swear in front of their kids nowadays too. Either way, here's what the American Academy of Pediatrics has to say to help deal.

Information taken from Healthy Children

-----------------------------------------------------------------------------------------

Swearing–the use of profanity or "dirty'' words–is almost a developmentally normal behavior for children during middle childhood and early adolescence. For these youngsters, swearing is often a sign of being worldly-wise and unafraid to be a little "bad." Profanity is used to impress friends and can become a part of peer relationships. Quite frequently, younger children do not know the meanings of the words they are using, but they will say them anyway simply because they have heard others use them.

Fortunately, this phenomenon of cursing seems to lose its attraction and abate as children become more mature. Until then, however, youngsters often delight in shocking their parents with the swear words they have learned away from home. (Bear in mind that parents who swear in the home are teaching their children to do the same and should not be surprised when their youngsters copy their behavior.)

Clearly, there is a smaller group of "incorrigible" children who swear. In addition to cursing, they have many other difficulties, personally and socially. These youngsters may be more prone to swear and rage at other people–a different phenomenon than using a few swear words during times of frustration. Profanity directed at another individual should never be tolerated.

What Parents Can Do

Here are some suggestions to help you manage the problem of swearing:

* If you feel it is appropriate, establish a rule that "no swearing will take place in our home." Do not under any circumstances tolerate swearing that is aimed at someone in anger. If this occurs, a child may be sent immediately to her room for a timeout.
* Minor swearing in frustration is almost a natural human behavior. Although perhaps inappropriate, it is commonplace in some families. If that is your own personal style, you will find it hard to teach your child something different.
* When your youngster swears, do not overreact with your own outbursts of rage and cursing. Also, washing a child's mouth out with soap is clearly improper, extreme and ineffective.
* On occasion, you may feel that your child is using profanity in an attempt to provoke a response from you. In these instances, ignoring her may be the most effective strategy.
* Reward your child for expressing her frustration appropriately without swearing. Star charts and money are helpful approaches. For example, use a jar of nickels that she can earn at the end of two weeks; for each day that she doesn't swear during this time, two additional nickels will be placed in the jar; but each time she swears, nickels will be removed. Your child will catch on quickly.

When To Seek Additional Help

In and of itself, swearing is not a sign of emotional disturbance. However, if there are other problems–chronic lying, chronic stealing, or difficulty with peers–than swearing may be just another symptom of a psychological or social disturbance. In this situation, talk to your pediatrician about counseling - either individual or family therapy.

Kids and Water Safety

Where in the heck have I been? Starting residency! Orientation started yesterday and between that and making our apartment a home, I've had little time. Hopefully I'll be able to keep up with this blog, but probably not as frequently. We'll see.

Now onto the post. It's summer time and the pools are open. Water can be an excellent source of summer fun, but let's not forget how dangerous it is too. The jury is still out as to when to start swimming lessons, but definitely not before the age of one. No matter the age, even if your child has had swimming lesson, water safety is essential. Here are some tips from the American Academy of Pediatrics.

____________________________________________________

If you do enroll a child under four years old in a swimming program, be sure the class you choose adheres to guidelines established by the national YMCA. Among other things, these guidelines forbid submersion of young children and encourage parents to participate in all activities. But remember that even a child who knows how to swim needs to be watched constantly. Whenever your child is near water, follow these safety rules:

1. Be aware of small bodies of water your child might encounter, such as bathtubs, fishponds, ditches, fountains, rain barrels, watering cans—even the bucket you use when you wash the car. Empty containers of water when you’re done using them. Children are drawn to places and things like these and need constant supervision to be sure they don’t fall in.

2. Children who are swimming—even in a shallow toddler’s pool—always should be watched by an adult, preferably one who knows CPR. The adult should be within arm’s length, providing “touch supervision” whenever infants, toddlers, or young children are in or around water. Empty and put away inflatable pools after each play session.

3. Enforce safety rules: No running near the pool and no pushing others underwater.

4. Don’t allow your child to use inflatable toys or mattresses in place of a life jacket. These toys may deflate suddenly, or your child may slip off them into water that is too deep for him.

5. Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive into the shallow end.

6. Backyard swimming pools, (including large, inflatable above-ground pools), should be completely surrounded with at least a 4-foot (1.2 meters) high fence that completely separates the pool from the house. The fence should have a self-closing and self-latching gate that opens away from the pool, with the latch at least 54 inches high. Check the gate frequently to be sure it is in good working order. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence. No opening under the fence or between uprights should be more than 4 inches (10 cm) wide. Keep toys out of the pool area when not in use so that children are not tempted to try to get through the fence.

7. If your pool has a cover, remove it completely before swimming. Also, never allow your child to walk on the pool cover; water may have accumulated on it, making it as dangerous as the pool itself. Your child also could fall through and become trapped underneath. Do not use a pool cover in place of a four-sided fence because it is not likely to be used appropriately and consistently.

8. Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.

9. Spas and hot tubs are dangerous for young children, who can easily drown or become overheated in them. Don’t allow young children to use these facilities.

10. Your child should always wear a life jacket when he swims or rides in a boat. A life jacket fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age five, particularly the non swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.

11. Adults should not drink alcohol when they are swimming. It presents a danger for them as well as for any children they might be supervising.

12. Be sure to eliminate distractions while children are in the water. Talking on the phone, working on the computer, and other tasks need to wait until children are out of the water.

Insect Repellent

As we packed up the truck today to make the final drive back to Baltimore, I received many mosquito bites. I hate these pesky insects! So, in that light, I thought it wise to discuss insect repellent and children. Once again, information taken from AAP's parenting site, Healthy Children. In summary, DEET is the best; however, it should only be applied once a day, so avoid buying the sunblock with DEET (because sunblock needs to be reapplied multiple times!). Visit here to learn more about sunblock and children.

______________________________________________________

There are so many insect repellents out there. What kind is best for my children?

Insect repellents come in many forms including aerosols, sprays, liquids, creams, and sticks. Some are made from chemicals and some have natural ingredients.

Keep in mind that insect repellents prevent bites from biting insects but not stinging insects. Biting insects include mosquitoes, ticks, fleas, chiggers, and biting flies. Stinging insects include bees, hornets, and wasps.


The following are types of repellents that are not effective:

*Wristbands soaked in chemical repellents
*Garlic or vitamin B1 taken by mouth
*Ultrasonic devices that give off sound waves designed to keep insects away
*Bird or bat houses
*Backyard bug zappers (Insects may actually be attracted to your yard.)

________________________________________

DEET

DEET is a chemical used in insect repellents. The amount of DEET in insect repellents varies from product to product, so it's important to read the label of any product you buy. The amount of DEET may range from less than 10% to more than 30%.

Studies show that products with higher amounts of DEET protect people longer. For example, products with amounts around 10% may repel pests for about 2 hours, while products with amounts of about 24% last an average of 5 hours. But studies also show that products with amounts of DEET greater than 30% don't offer any extra protection.

The American Academy of Pediatrics (AAP) recommends that repellents should contain no more than 30% DEET when used on children. Insect repellents also are not recommended for children younger than 2 months.

________________________________________

Tips for Using Repellents Safely

The following are guidelines on how to use insect repellents safely.

Dos

*Read the label and follow all directions and precautions.
*Only apply insect repellents on the outside of your child's clothing and on exposed skin.
*Spray repellents in open areas to avoid breathing them in.
*Use just enough repellent to cover your child's clothing and exposed skin. Using more doesn't make the repellent more effective. Avoid reapplying unless necessary.
*Assist young children when applying insect repellents on their own. Older children also should be supervised when using these products.
*Wash your children's skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

Don'ts

*Never apply insect repellent to children younger than 2 months.
*Repellents should not be sprayed directly onto your child's face. Instead, spray a little on your hands first and then rub it on your child's face. Avoid the eyes and mouth.
*Insect repellents should not be applied on cuts, wounds, or irritated skin.
*Don't buy products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.

Last Updated 3/30/2010

Source: A Parent's Guide to Insect Repellents (Copyright © 2005 American Academy of Pediatrics)

Babies with Reflux

Given that I just finished a pediatric gastro-intestinal rotation, I felt it was only appropriate to talk about reflux this week. Yes, I know I forgot last week.

Here's the bad news - reflux is a natural part of being a baby. There are many theories out there as to why, but unfortunately, some babies are just more spitty than others. More bad news, reflux tends to be the worst between 3-6 months of age. So, your 2 month baby's reflux is likely to get worse before it gets better. BUT IT WILL GET BETTER!

Here's the good news, most kids outgrow their reflux by one year of age!

I do not want to minimize the effects reflux can have on a family, however. Sometimes babies become fussy because of the reflux leaving acid in the stomach. That's when your pediatrician mAy prescribe an antacid. THIS DOES NOT STOP YOUR BABY FROM SPITTING UP. Your baby will continue to spit up, but there won't be as much acid from the reflux and hopefully that means your little one won't be as fussy. Other things you can try include the following:

• Keep your infant upright for at least 30 minutes after meals.
• Only put your baby in a car seat when driving in the car.
• Burp the baby frequently.
• Avoid tight diapers and elastic waistbands.
• Avoid exposure to tobacco smoke.
• Avoid overfeeding. Don’t feed the baby again after he or she spits up — wait until the next feeding.
• Your pediatrician may advise you to thicken the formula (or pumped breast milk) with rice cereal.
• For formula-fed infants, your pediatrician may recommend a special anti-reflux formula.
• For formula-fed infants, your pediatrician may advise you to try a formula created to be non-allergenic (hypoallergenic) for AT LEAST two weeks.

If your baby starts throwing up bile (greenish/yellow fluid) or blood, THIS IS NOT REFLUX! These could indicate something more serious is going on, so call your doctor!

Adapted from AAP's parent website, Healthy Children. Reflux More Reflux

Protect Your Kids from the Sun

While it's rainy, windy, and 43 degrees in Omaha as I post this, I know there are plenty of other places where people are welcoming spring and soaking up the rays. While we pediatricians definitely encourage outdoor activity, please be sure to protect your kids from the sun. Make it a routine each spring to check the expiration date on your sunscreen and toss the ones that have expired. Believe me, I know from personal experience that sunscreen can actually expire.

Again, topic copied from American Academy of Pediatric's Healthy Children.

What's the best way to protect my child in the sun?

Follow these simple rules to protect your family from sunburns now and from skin cancer later in life.

* Keep babies younger than 6 months out of direct sunlight. Find shade under a tree, umbrella, or the stroller canopy.
* When possible, dress yourself and your kids in cool, comfortable clothing that covers the body, like lightweight cotton pants, long-sleeved shirts, and hats.
* Select clothes made with a tight weave - they protect better than clothes with a looser weave. If you’re not sure how tight a fabric’s weave is, hold it up to see how much light shines through. The less light, the better.
* Wear a hat or cap with a brim that faces forward to shield the face.
* Limit your sun exposure between 10:00 am and 4:00 pm, when UV rays are strongest.
* Wear sunglasses with at least 99% UV protection (look for child-sized sunglasses with UV protection for your child). - UVB!
* Use sunscreen.
* Set a good example. You can be the best teacher by practicing sun protection yourself. Teach all members of your family how to protect their skin and eyes.

Sunscreen

Sunscreen can help protect the skin from sunburn and some skin cancers, but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer.

How to Pick Sunscreen

* Use a sunscreen that says “broad-spectrum” on the label - that means it will screen out both UVB and UVA rays.
* Use a sunscreen with an SPF (sun protection factor) of at least 15. The higher the SPF, the more UVB protection the sunscreen has.
* Look for the new UVA “star” rating system on the label. - this is news to me!
o One star is low UVA protection.
o Two stars is medium protection.
o Three stars is high protection.
o Four stars is the highest UVA protection available in an over-the-counter sunscreen product.
* For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and the shoulders, choose a sunscreen or sunblock with zinc oxide or titanium dioxide. While these products usually stay visible on the skin even after you rub them in, some now come in fun colors that kids enjoy.

Sunscreen for Babies

* For Babies younger than 6 months. Use sunscreen on small areas of the body, such as the face and the backs of the hands, if protective clothing and shade are not available.
* For babies older than 6 months. Apply to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into her eyes, wipe the eyes and hands clean with a damp cloth. If the sunscreen irritates her skin, try a different brand or try a sunscreen stick or sunscreen or sunblock with titanium dioxide or zinc oxide. If a rash develops, talk with your child’s doctor.

How to apply sunscreen

* Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, and hands and even the backs of the knees. Rub it in well.
* Put sunscreen on 30 minutes before going outdoors. It needs time to absorb into the skin.
* Use sunscreen any time you or your child might sunburn. Remember that you can get sunburn even on cloudy days. Also, UV rays can bounce back from water, sand, snow, and concrete so make sure you’re protected.
* Reapply sunscreen every 2 hours. Sunscreen wears off after swimming, sweating, or just from soaking into the skin.

The Right Size Bicycle

Here's the first kid safety post. With the warmer weather, your kids might be asking to ride their bikes more often. Here are some tips to keep in mind!

Choosing the Right Size Bicycle

A bicycle of the wrong size may cause your child to lose control and be injured. Any bike must be the correct size for the child for whom it is bought. To keep your child safe, the American Academy of Pediatrics recommends the following:

1. Do not push your child to ride a 2-wheeled bike until he or she is ready, at about age 5.

2. Take your child with you when you shop for the bike, so that he or she can try it out. The value of a properly fitting bike far outweighs the value of surprising your child with a new bike.

3. Buy a bike that is the right size, not one your child has to “grow into.” Oversized bikes are especially dangerous.

4. How to test any style of bike for proper fit

• Sitting on the seat with hands on the handlebar, your child must be able to place the balls of both feet on the ground.
• Straddling the center bar, your child should be able to stand with both feet flat on the ground with about a 1-inch clearance between the crotch and the bar.
• When buying a bike with hand brakes for an older child, make sure that the child can comfortably grasp the brakes and apply sufficient pressure to stop the bike.
  

5. A helmet should be standard equipment. Whenever buying a bike, be sure you have a Consumer Product Safety Commission (CPSC)-approved helmet for your child.

6. Consider the child’s coordination and desire to learn to ride. Stick with coaster brakes until your child is older and more experienced.

Last Updated 4/2/2010
Source TIPP—The Injury Prevention Program (Copyright © 1994 American Academy of Pediatrics)

Copied from AAP.

Kid Safety

As a future pediatrician, I'm going to try a new thing with my blog--kid safety. Once a week I'll try to post tips on here. A lot of them will be directly from the American Academy of Pediatrics Parenting Site, Healthy Children. I know not all of you have kids, but I'm a firm believer in education and it'll help anyone who's in contact with kids.