Nationwide Children's Hospital Sports Medicine Update

     Now that the Nationwide Children's Hospital Hilliard Close To Home is open with expanded services, including an Urgent Care, other services are being added. The Sports Medicine department, which we have found very helpful for our parents. is going to be adding 2 half day sessions in Hilliard at the Close To Home. In addition, Jessica Buschmann, Clinical Dietician with the Sports Medicine Department, is offering one-on-one, group, and team services with patients. We can refer, upon your request, to Sports Medicine physicians or the Dietician. You may also call yourself to their clinic at #355-6000.

New FDA sunscreen recommendations.

     It is well known that sun exposure leads to skin damage. The skin damage raises the risk of skin cancer and premature aging. Sadly, despite this knowledge, the rate of skin cancer is growing rapidly. Melanoma, the most serious (dangerous) type of skin cancer, has had it's incidence (the number of cases in a given year in the group of people studied) increase. In fact, the number of cases are doubling every 10 years. Melanoma is the most common cancer in the U.S. It is thought 1 in 5 persons will be diagnosed with a skin cancer in their lifetime.
     Protecting everyone with sunscreen when they are sun exposed is an excellent way to help prevent skin damage. Reading labels on sunscreen can be difficult. The SPF on the label stands for sun protection factor. Originally, we were all informed that an SPF of 16 was twice as protective as an 8 -- it turns out this was not true. In fact, these are the new regulations:
1. The highest SPF you should see will be "50+".
2. There is no evidence that says that an SPF greater than 50 is more sun protective.
3. Sunscreens with SPF greater than 15 are more sun protective than those with an SPF of less than 15.
4. "Broad Spectrum" sun screens will need to have both UVA protection (against skin cancer and premature skin aging) and UVB protection (against sunburn).
5. The terms "waterproof" and "sweatproof" will no longer be allowed.
     My recommendations:
1. Use sunscreen with both UVA and UVB protection whenever you are being exposed to the sun.
2. Look for products with an SPF of 30 or above. But realize it is not likely you are getting more (or much more) sun protection if the SPF is over 30. If the higher-than-SPF-30 sunscreen is more expensive, consider purchasing the SPF 30 sunscreen instead.
3. Reapply sunscreen every 2 hours. Reapply more often if sweating or in and out of water.
4. Covering up with sunglasses, hat, and covering exposed skin helps limit sun damage.
5. Limit sun exposure from 10 a.m. to 2 p.m. when the ultraviolet rays are the strongest.
6. For infants less than 6 months of age: a. avoid sun exposure, b. dress infants with a hat and long clothing if out in the sun, c. if adequate clothing and shade are not possible, apply a small amount of SPF 15-30 sunscreen to small areas (exposed areas on the face, arms, or legs).
Resources used: FDA report and 'FDA's Sunscreen Recommendations' in October 2014 Contemporary Pediatrics by Mary Beth Nierengarten, MA.

Pediatric Psychiatrists

     We know many of our families battle mental health issues and have a need for the services of pediatric psychiatrists. There is a need for more mental health professionals in many communities in the U.S., including here in Central Ohio. Here is our list of mental health professionals we frequently refer to on our website.
     I just became aware of two pediatric psychiatrists that are accepting new patients. They are Drs. Nathaniel Johns, MD and Walter Stearns, MD. They are with UMCH Family Services at 1033 High Street, Worthington, Ohio. The office requests that we fax them a referral with the necessary information. If you are interested in a referral, contact our office during routine office hours Monday through Friday.

Chapped Lips and Rashes Around the Mouth

     We have entered the chapped lips time of year Fall and Winter. When the weather gets cooler and everyone turns their heat on in their home, our skin and lips naturally get more dry. Many young children lick their lips more often in reaction to the dryness. The excessively licking the lips results in even more dryness once the saliva dries on the lips and the skin around the mouth. Not drinking enough causes increased dryness. So try increase the child's water intake. Although there are many, many products that help dry lips, you will frequently hear us recommend Aquaphor Healing Ointment or the new Aquaphor Lip Repair by Biersdorf. More information is available on these over the counter items here. It is important to have the proper expectations about these products: you will likely have to apply them multiple times per day, remind your child to not lick (instead, ask for more lip ointment!), and do this for many days until the Spring season arrives. The peak years for this licking/chapped/licking/chapped cycle is 2-8 years of age.
     Being outside in the cold weather often makes lips chapped. In the coming months, when your children are out on cold weather adventures such as making a snowman, skiing, snowboarding, and sledding, putting on Aquaphor or another similar product ahead of time sure can help prevent chapped lips. Applying it again when your child arrives inside will also help. Older kids can put a stick of ChapStick or Blistex in their pocket of their coat so they can reapply when they need it.
     Thumb sucking and pacifier use increase the chances of having not just dry lips but a rash around the mouth. The rashes often look chapped and irritated. It is not likely, unless things have gotten more complicated (read below), that it will look scabbed, very red, or show much peeling. I personally do not think you should stress about this rash because it is so difficult to get it to look much better until your child cuts back or stops sucking their thumb or using their pacifier. It is fine to apply some Aquaphor Healing Ointment to this area. The small amount that your child might get into their mouth after you do this is not worrisome.
     There are times when just coating the dryness will not help. If the above measures do not help, especially if the rash around the lips is quite painful, itchy, peeling, blistered, or scabbed, we should see your child at walk-ins or a scheduled appointment to better assess what is going on and how to help. There are cases of yeast (or ringworm or fungal -- all mean the same thing here), bacterial (impetigo, others), or viral (herpes simplex virus) infections that will need further treatment. We also see some children who have eczema (atopic dermatitis) who have rashes around the mouth that need something besides just moisturizing the area.

Staying Safe in an Electronically Connected World

     I recently discovered a very helpful resource called "OnGuard Online" to help all of us stay safe in this electronically connected world that we live in. It has terrific information about many topics. Near and dear to a pediatrician's heart are the sections on Keeping Kids Safe Online. The full site is available at OnGuard Online. I hope you find it helpful.

Ebola Virus

     I have hoped to find an excellent resource for parents and families about the Ebola virus. I have found one here at the Healthy Children website, which is affiliated with the American Academy of Pediatrics. The information is excellent and accurate. In addition, here is a link to the Centers For Disease Control webpage about Ebola.
     As I said on Facebook earlier this week, there will very likely be more deaths this year in the U.S. from influenza than there will have ever been cases of Ebola. Although the chance of dying from Ebola is much greater (about 40-50% so far), there will be many more cases of influenza in this country.
     To limit the spread of the virus, it is very, very important to limit the contact someone with possible Ebola viral infection has with others. If someone has travelled to West Africa or had a known exposure to someone with Ebola virus AND has symptoms of fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, or unexplained bleeding or bruising, walking into a doctor's office, urgent care, or emergency room without letting them know ahead of time may needlessly expose many people to the virus. If your child or yourself have the symptoms and the possible exposure, CALL your doctor's office for advice. Because of the severity of the symptoms, children and adults with Ebola will need to be evaluated and cared for at the hospital.
     Remember that we are in the midst of the Fall cold and flu season (although we have not yet seen cases of influenza this Fall as of mid-October). Many people with no direct contact with Ebola will have the same symptoms of Ebola -- just not as severe -- this illness season in the U.S. Many of these are routine illnesses that will pass with routine care. Do your best to lessen your risk of becoming sick this illness season with wise, routine measures: 1. have you and your family receive the influenza vaccine, 2. make sure yourself and your children are up to date on other vaccines, 3. eat healthy, 4. get plenty of sleep, 5. stay active, 6. wash your hands with soap and water or use hand sanitizer regularly, and 7. avoid as best you can people how are sick.
     

NCH Hilliard Close To Home Center Moving to New Location, Adding Services

     On October 20th, 2014, the Nationwide Children's Hospital Hilliard Close To Home Center is moving from Brown Park Drive to 4363 All Seasons Drive, off Britton Parkway. This is just North of Cemetery Road in the same development as the new Giant Eagle and Rusty Bucket. Previously, lab services, x-ray services, as well as speech, occupational, and physical therapy services were available. These are still going to be available. The big news is that this location will offer urgent care services. Their hours for urgent care will be Monday-Friday 3-10 p.m. and Saturday-Sunday noon-8 p.m. Other services are available from 9 a.m. to 5:30 p.m. Monday through Friday. During the weekend, the lab and x-rays will be available during urgent care hours. In addition, sports medicine services will also be at this location.
     If your child needs an urgent care, we strongly recommend the Nationwide Children's Close To Home urgent care centers.

Calcium and vitamin-D for children.

     The national recommendations are changing about calcium and vitamin-D intake for children. Intake of these are not just important for strong bones for growing children but to prevent osteoporosis in elderly adults. Osteoporosis is a disease of the bones that causes the bones to be more fragile and to break easily. A healthy intake of calcium and vitamin-D in childhood helps build healthy bones ("bone mass"). Childhood and the teenage years are the best years to build these strong bones: by 18 years of age, about 90% of bone mass has already been made.
     Daily Calcium Needs:
1-3 Years of Age: 700 milligrams
4-8 Years of Age: 1000 milligrams
9-18 Years of Age: 1300 milligrams
     Note that there is about 300-400 milligrams of calcium in a serving of dairy products. A serving of dairy is considered to be 8 ounces of milk, 8 ounces of yogurt, and 1.5 ounces of cheese. Other foods rich in calcium: salmon, tofu, orange juice supplemented with calcium, broccoli, spinach, baked or white beans, sesame seeds, peas, almonds, and Brussel sprouts. See a link here for more info on good sources of calcium. So if your child only gets calcium from milk, a 1-3 year old needs 16 ounces a day, a 4-8 year old needs 24 ounces per day, and a 9-18 year old needs 3-4 servings per day. Note that you would need 4-6 cheese slices or sticks to get 700 milligrams a day (that is quite a bit!). Most cheese sticks are 1 ounces of cheese and the average slice of cheese has 0.6 ounces.
     Daily vitamin-D Needs:
Birth-1st Birthday: 400 IU
1-18 Years of Age: 600 IU
     Note that infants who are exclusively breast-fed or who take less than 16 ounces of formula per day should take a daily dose of vitamin-D. Formula fed infants do not need a supplement as the formula has vitamin-D. Baby ddrops(r) have 400 IU of vitamin-D in one drop. See more information here. Enfamil D-Vi-Sol(r) has 400 IU in 1 milliliter with more information here. There are other over the counter options.
     For older children who are allergic to dairy, struggle to get it in, or who otherwise need a supplement, it is the Viactiv(r) chews that we recommend. These over the counter chews have 500 IU of vitamin-D and 500mg of calcium. Therefore the dose would be 1-2 chewables per day, depending on age and other sources of vitamin-D or calcium.

Great information resource for information about influenza.

     The website Flu.gov is an excellent website with accurate, up to date information about influenza and the flu vaccine. If you want specific information about the illness, more information about the vaccine, and should receive the vaccine (almost anyone 6 months and above), and who should not (very few persons -- the most common is if someone has anaphylaxis to eggs (not just hives or vomiting)).