Bicycle Safety for your Child

 I've been a big bike fan ever since I saw BMX Bandits with Nicole Kidman back in 1983. Actually, I was already a big BMX fan before I saw BMX Bandits, but I couldn't find a 1980 reference.

Back then, as many of you know, parents didn't put too much thought into bikes. And safety wasn't that much of a concern. As long as you weren't riding on the freeway, you were OK. 

Times of changed, that's for sure. So for this post, I wanted to highlight a few tips to keep your kids safe this summer.   

Wearing a helmet ought to be a priority 

Although many parents don't believe in wearing helmets (because they didn't wear one when they were kids and nothing happened to them), here at the practice we see at least 2 or 3 concussions every summer due to children falling from their bikes. 

A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

Remember that a helmet should be work so that it is level on the head and not tipped forward or backwards. Also, the straps ought to be snugged and fastened. If needed, you can always use helmet sizing pads to improve fit. 

The Right Size

Buy a bike that is the right size for your child. I know, I know, it is tempting to buy a bike and let the child "grow into" it, but the reality is that oversized bikes are especially dangerous. Especially if the child is just learning how to ride a bike. 

The Right Bike

Nothing worse than buying a bike for your child and then your child not riding because she didn't like it. 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 one.

Don't Push It

I'll be honest. I wanted my kids to ride a bike as soon as they were two years old. But I had to hold my horses so to speak. It is best not to push your child to ride a 2-wheeled bike until he or she is ready. Usually this happens at around 5 to 6 years of age. Of course, just like anything else, some kids are ready earlier, while others take their sweet time. 

The important thing is to have in mind yours chid's coordination and desire to lear to ride. 

Written by Brandon Betancourt, BMX extraordinaire  

Photo Credit: TredzTalk

Summer Safety Series - Pool Safety

An average of 3880 adults and children in the US die each year due to fatal drowning, according to federal health officials. 

CDC researchers analyzed death certificate data from the National Vital Statistics System and injury data from the National Electronic Injury Surveillance System -- All Injury Program for 2005 to 2009 and found drowning was the leading cause of injury death among children ages 1-4.

Alarming statistics no doubt. The truth is, I hate to put statistics up like this but I feel they must be reported in an effort to make us all aware that water safety should not be taken lightly. 

Here are a few guidelines drawn from the AAP concerning pool safety that I'd like to share: 

• If you have a pool, or are going to be visiting a place where there is a pool, make sure there is a fence installed on all sides of the pool. The fence should be at least four-feet high. Also, the fence should not have any openings or protrusions that a young child could use to get over, under or through. 
• Ensure that pool gates open from the inside of the pool and self-close and self latch. Also, make sure that the latch is not easy to reach. 
• Under no circumstances should you leave your child unattended or alone in a pool. Even for a moment.  
• As soon as you can, consider putting your child in swimming lessons. Keep in mind that children may not be developmentally ready for swim lessons until after their fourth birthday. However, check around. In many places they allow swimming lessons to be conducted with a parent. 

My husband and I put our kids in swiming lessons at a very early age. Even though they weren't ready to swim on their own, they learned basic skills that helped them be more comfortable in the water once they got older. 

One important thing I want to mention regarding swimming lessons. Swim programs for children under 4 should not be seen as a way to decrease the risk of drowning.

• Lastly, but certainly not least, whenever infants or toddlers are in or around water, an adult should be within arm's length, providing "touch supervision." If you are a parent of a toddler you know how fast they can be. Don't take chances. 

To read more about pool safety, check out this AAP link. http://www.aap.org/family/tipppool.htm You may also want to check out the resources on the healthychildren.org  site for more great info. 

Written by Joanna E. Betancourt MD FAAP

What Type Of Life Jacket Should My Child Wear?

My family loves a day at the water park or time on the boat. And always I remember important rules such as “Do not leave your child unattended by the water.”“Keep young children at arms length,” “never allow your child to run around the pool area.”  

These are all important safety tips in and around water, but can you say you feel safe with your child by the water?  As a parent of four, I find myself counting heads every few seconds; and trust me when I say it only takes seconds for pool accidents to happen.  

For this reason, when my children are near any body of water they, must wear their life jacket.   

Did you know it is a state law for “all children under 13 to wear a personal flotation device on vessels <26 ft when underway unless below deck or enclosed in a cabin?” www.ilga.gov.  

Following the Law is important to me, but the most important message I want to send home is your child’s safety.  So here are some helpful hints from www.healthychildren.org.

1. Children should wear life jackets at all times when on boats or near bodies of water.
2. Make sure the life jacket is the right size for your child. The jacket should not be loose. It should always be worn as instructed with all straps belted. 
3. Blow-up water wings, toys, rafts and air mattresses should not be used as life jackets or personal flotation devices.
4. Teach your child how to put on his or her own life jacket.
5.  Make sure your child is comfortable wearing a life jacket and knows how to use it.

So how do you know what life jacket is right for your child?  

I spent a little time gathering some information on different types of life jackets.  All life jackets warn on boats must be have a (UL) clearly labeled and be US coast guard approved.  So my recommendation is to look for those labels when shopping around.

Also, it is important to know what type of activity your children will be doing in water. For example, 

Type I  

• Best for all waters, open ocean, rough seas, or remote water, where rescue may be slow coming. 
• Abandon-ship lifejacket for commercial vessels and all vessels carrying passengers for hire. 
• These life jackets are typically used when aboard a cruise ship.

Type II

• For general boating activities. 
• Good for calm, inland waters, or where there is a good chance for fast rescue.
• These jackets are most frequently used on family boats and pool side, note the bottom strap, for the children that do not know  how to swim or are not strong swimmers.

Type III

• For general boating or the specialized activity that is marked on the device such as water skiing, hunting, fishing, canoeing, kayaking and others. 
• Good for calm, inland waters, or where there is a good chance for fast rescue. Designed so that wearing it will complement your boating activities. 
• These jackets are for the more advanced swimmers. 
• You may see a person wearing this life jacket while water skiing, note the bottom strap is not present.

Type IV

• A life preserver is a cushion or ring and is not worn.
• It is designed to be used in two ways.
• It can be grasped and held until the person is rescued, or it can be thrown to someone in the water until he or she is rescued.
• It is not a toy and should only be used in a rescue situation. 

I hope this sheds some light on life jackets and always remember SAFETY FIRST.  We love to see all of our families, but we prefer to see you for well visits!

The information provided was obtained at http://www.uscg.mil/hq/cg5/cg5214/pfdselection.asp#recreational.

Written by Marciann Bock, APN

Summer Safety Series - Sun Safety

As the summer months are starting to creep in, it is important to start thinking about sun safety, heat stress related conditions, pool safety, bug safety and playground safety. 

 In the next few blog post, I'm going to be addressing these topics with the hope that you all get a basic overview of what to watch out for. 

 Although I suspect that many of things I'm going to be talking about you already know, I think there is value in being reminded. Sometimes, we forget. Especially those of us that spend half of the year hibernating (except during this past crazy winter season). 

 For this post, I'd like to begin with "sun safety." 

 Depending on your child's age, you will want to consider different things. For example, babies under 6-months old will require different tactics to avoid sunburn that children that are older. Naturally, older children are far more active and have the liberty to play out in the sun for longer period of time. So you'll want to keep that into consideration.

So let's look at the American Academy of Pediatrics recommendations for each age group: 

Babies under 6 months:

The two main recommendations from the AAP to prevent sunburn are to avoid sun exposure, and dress infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck to prevent sunburn. 

However when adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen with at least 15 SPF (sun protection factor) to small areas, such as the infant's face and the back of the hands. 

If an infant gets sunburn, apply cold compresses to the affected area.

For Young Children:

Apply sunscreen at least 30 minutes before going outside, and use sunscreen even on cloudy days. The SPF should be at least 15 and protect against UVA and UVB rays. 

Wearing adequate clothing and a hat or cap ( I know, sometimes it is hard to keep them on; littles ones especially don't like things on their heads, but at least try) goes a lot way in protecting your child from the sun. 

For Older Children:

The first, and best, line of defense against the sun is covering up. Make sure your child wears a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99-100% of ultraviolet rays), and cotton clothing with a tight weave.

As many of you know, the hours of between 10 am and 4 pm are the most intense, thus during that time, it is best to stay in the shade whenever possible and minimize exposure during those times. 

For my children, I don't use anything less than 50 SPF, but the recommendations from the AAP is to use a sunscreen with an SPF of 15 or greater. 

Be sure to apply enough sunscreen - about one ounce per sitting for a young adult and reapply sunscreen every two hours, or after swimming or sweating.

Lastly, use extra caution near water and sand as they reflect UV rays and may result in sunburn more quickly. Just because you are in the shade, doesn't mean your child won't' get sun burned. The reflection of the water and sand can cause sunburn as well. 

Written by Joanna E. Betancourt MD, FAAP

Are Diaper Rashes in Babies Serious?

This is a questions that we get asked often. So we wanted to take a moment and give you a little bit of background on diaper rashes and hopefully give you some good insight about this condition that many babies have. 

What is diaper rash?

A diaper rash is any rash that develops inside the diaper area. In mild cases, the skin might be red. In more severe cases, there may be painful open sores. It is usually seen around the groin and inside the folds of the upper thighs and buttocks. Miles cases clear up within 3 to 4 days with treatment. 

What causes diaper rash?

Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:

• Too much moisture
• Chafing or rubbing
• When urine, stools, or both touch the skin for long period of time 
• Yeast infections
• Bacterial infection
• Allergic reaction to diaper material

When skin stays wet for too long, it starts to bread down. When wet skin is rubbed, it also damages more easily. Moisture from the soiled diaper can harm you baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop. 

More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often when:

• Babies get older-mostly between 8 to 10 months of age.
• Babies are not kept clean and dry.
• Babies have frequent  stools, especially when the stool stay in their diaper overnight. 
• Babies have diarrhea
• Babies begin to eat solid foods
• Babies are taking antibiotics or in nursing babies whose mothers are taking antibiotics. 

When to call the pediatrician?

Sometimes a diaper rashes need medical attention. Talk with your pediatrician if:

• The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
• The rash includes blisters or pus-filled sores. 
• Your baby is taking antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
• Your baby has a fever along with a rash.
• The rash is very painful. Your baby might have a skin condition called cellulitis. 

What can I do if my baby gets diaper rash?

If your baby has a diaper rash (and to prevent future diaper rashes) it’s important to keep the area as clean and dry as possible. Change wet or soiled diaper right away. This helps cut down how much moisture is on the skin.

• Gently clean the diaper with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing. 
• Pat dry; do not rub. Allow the area to air-dry fully. 
• Apply a thick layer of protective ointment or cream (such as on that contains zinc a oxide or petroleum jelly). These ointments are usually are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or burring will only damage the skin more. 
• Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled part does not rub against the skin as much.
• Use cream with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful. 
• Check with your pediatrician if the rash a) has blisters or pus-filled sores; does not go away within 2 to 3 days; Gets worse.  

Many parents ask me if a cloth diaper is better than disposable diapers. Research suggests that diaper rashes are less common with the use of disposable diapers. 

However, what is more important than the type of diaper is how often it is changed. Whether you use cloth diapers, disposables, or both, always change diapers as needed to keep your baby clean, dry, and healthy. 

Written by Joanna Betancourt MD., FAAP.