October 2, 2013

Vomiting and/or Diarrhea

Vomiting and diarrhea viruses are not fun for anyone. Doctors refer to the most common cause of these symptoms as "viral gastroenteritis". Some kids just vomit, some kids just have diarrhea, and the most unlucky have both. 

Most of these illnesses do not need to be treated with medications (antibiotics can make it worse, since they also kill the good bacteria in your tummy), and anti-diarrheal medicines (like Imodium) can be harmful to children. The most important thing is to keep your child HYDRATED (more on that below). If you suspect your child has vomiting or diarrhea from food poisoning or any other type of foreign ingestion, please call poison control 1-800-222-1222, who are free and staffed with physicians 24-7!

How can you tell if your child is starting to get dehydrated?
- their mouth/lips seem dry
- they are urinating (peeing) a little less than usual
- they are thirsty

Now what?
You need to keep your child hydrated!
- A baby can continue to breast feed or take infant formula, if they are just a little dehydrated. If they vomit after every feeding, or are refusing the breast/bottle, then try to hydrate them with an Oral Rehydration Solution, like Pedialyte. Warning: the plain ones taste like salt water, so I suggest getting a few flavored ones and trying them out, to see which ones they will take. If they refuse the bottle completely, you can try feeding them via a syringe or spoon, giving small amounts every 15 minutes.
- A child who is getting electrolytes from food (such as chicken soup, or crackers, even if it's just a little bit) can hydrate with water. If they are not taking in any food, or if they are throwing up the food, please hydrate them with an ELECTROLYTE solution (aka Oral Rehydration Solution, aka ORS). You can buy them at most USA markets (under brand name Pedialyte, or generic versions), you can make your own by mixing 1 liter (5 cups) clean water with 6 level teaspoons (=2 tablespoons) sugar and 1/2 teaspoon salt. You can add a little bit of orange juice or a banana for potassium. Common substitutions are rice water, congee, green coconut water, or mixing gatorade with water (although I do not recommend doing this, since it is hard to get the right balance of electrolytes this way). If your child does not want to drink, try giving them sips every 15-30 minutes, or giving them the ORS/Pedialyte in frozen popsicle form.
- For every age, and everybody in the house, WASH YOUR HANDS A LOT to prevent spread/transmission of the stuff that gets you sick. Teach everyone to wash their hands in warm water, scrubbing for at least 20 seconds (2 rounds of the Happy Birthday song). Try and use real soap and water, instead of no-rinse hand sanitizers, since they do a better job at killing the tummy microbes.

But what if they keep vomiting?
- Let their tummy rest.
- Call your pediatrician, or go to the hospital, if they have signs of dehydration (see more below).
- Ask your pediatrician if your child is old enough and healthy enough for a medication against nausea/vomiting.
- Start with no food, but still give an electrolyte fluid (aka ORS above), for the first 12 hours.
- When they are ready/want to eat, give bland foods (e.g. the popular rice, toast, soup) and avoid foods that are fried, acidic, oily, or contain lactose.

But what if they have icky diarrhea?
- Change the diaper or bring them to the toilet frequently. Use a LOT of diaper cream to keep the area from getting chapped/sore. Put on a zinc cream (like the purple desitin) as if you are icing a cake - this acts as a barrier layer, to prevent acidic poop from sitting on the skin.
- Feed them binding foods, like rice.
- Sometimes the microbes that cause diarrhea, also cause a temporary lactose (the sugar in cow's milk) intolerance, so avoid lactose-containing stuff, like cow's milk and cheese. You usually have to do this for 2-4 weeks after the onset of the illness, until their GI system is back to normal.
- Try a children's probiotic with lactobacillus once per day, such as children's culturelle.

When my patients get sick this way, I often refer them to the great patient resources at UpToDate, such as this one on nausea and vomiting in children:
or this one on diarrhea in children:

How can you tell if your child is dehydrated enough to warrant intervention (like an urgent care or ER), or at least a call to your pediatrician?
- they are not urinating (peeing)  often enough (every 4-6 hours for a baby, every 6-8 hours for a toddler/child, every 8-12 hours for an older child/adolescent)
- they are crying, but can not make tears
- they are an infant whose fontanel (soft spot on top of the head) is more sunken than usual
- eyes look very sunken

What are some other signs that I should call my pediatrician about, or head over to the local urgent care/ER?
- persistent high fever (above 102.5 F)
- any fever in an baby younger than 3 months old
- severe abdominal (tummy) pain
- abdominal pain that moves to the lower right side
- lethargy or decreased responsiveness
- bloody (red or black) or bright green (like pea soup) vomit or diarrhea
- diarrhea not improving after 1 week

Soon your baby will be back to enjoying (throwing) his food (c) 2013
The good news is that the gastroenteritis season is almost over, so hang in there. However, we are getting into cough and cold season, so see my August 2012 post for tips on that:

May 21, 2013

Fun in the Sun:

Sunscreen Tips and Links

Before going out to have fun in the sun, you should apply sunscreen to yourself and your child. Reapply sunscreen every 2 hours, and after every time you get wet or sandy (rubbing the sunscreen off). Harmful UV rays come through clouds, so a cloudy day is no excuse to skip the screen.

SPF 30-50 are best. SPFs that are higher than that do not add significantly more protection.

The safest sunscreens are barrier sunscreens. These are sunscreens that use zinc oxide or titanium dioxide as the active ingredient, which sit on the skin to provide a shield from the sun. Since they are not absorbed systemically, I recommend using only these types of sunscreens* on infants (in addition to shielding clothing and hats).

Chemical sunscreens are those that contain chemicals which are absorbed into the skin to provide protection. These are newer, but still safe when used correctly. Some of the active ingredients in chemical sunscreens include, but are not limited to, octinoxate, octocryleme, oxybenzone. Most sunscreens on the market today use these, and there are many more options that kids like with these formulations, such as sprays, colors, and different textures. The best sunscreen is the one you can actually get on your child everyday. The aerosol spray sunscreen versions should only be used outside, in well ventilated areas, and below the neck, because they are meant to be sprayed evenly on the skin (you should see a layer of sunscreen forming), and not breathed in. They are a quick way to reapply sunscreen on kids at the beach or park, but can be avoided at home.

A lot of people are wondering about vitamin D. Although our skin can make vitamin D by being exposed to UVB light from the sun, the amount of sun it takes is variable by region and skin type, and enough sun to make enough vitamin D will also increase skin aging/wrinkles and cancer risks, so I still recommend using sunscreen, then getting vitamin D in your diet. For more information, see

Do not use combination insect-repellent and sunscreen mixes. Insect repellents should not be applied more than once per day, and should not be applied to babies. For more information on insect repellents see here and here.

I used to link to the Environmental Working Group's sunscreen ratings, but their methodology has been ignoring science, and based on fear-mongering lately, so I stopped. For more information on that, see here and here.
EWG also warned against "nano particles" with no scientific basis. For information on them see this article from cancer.org.

*Here are some examples of sunscreens that use barrier (mineral) ingredients, in alphabetical order:
Aveeno Mineral Block
BabyGanics Cover-Up Baby Pure Mineral Sunscreen Stick
Banana Boat Natural Reflect Sunscreen
Burt's Bees Baby Bee Sunscreen
California Baby Sunscreen
Mustela Sun Cream and Sun Lotion
Neutrogena Baby Pure and Free

Here my son demonstrates proper beach attire with sunscreen (c) 2011

March 15, 2013

Immunization Information

There are a lot of great sites out in the world wide web that have information to help parents make an informed choice about vaccinations; however, unfortunately, there are also a lot of bogus sites that rely on anecdotes to promote myths, so I am including just a few links to help people find scientifically accurate information on vaccines:

My favorite book for vaccine information is "Vaccines and Your Child: Separating Fact from Fiction" by Paul Offit. It is short and covers all of the questions that parents frequently ask about immunizations. Here is the link to it on amazon:

The Children's Hospital of Philadelphia has a wonderful Vaccine Education Center, which covers the same material as in Dr Offit's book (above), as well as videos, FAQ pages, and more.
This is a great place to start if you want information on aluminum (which your child gets more of in breast milk than vaccines), formaldehyde (which our own bodies produce, and is also found naturally in things like pears), and other vaccine ingredients.

A great place to go once your child (or you) has gotten a vaccine and you have questions about it, or if you know of a specific vaccine that is coming up for your child, is the USA's Center for Disease Control. They put out "Vaccine Information Statements" on each vaccine that is routinely given in the USA:
They are also the best site to check out what vaccines you need for foreign travel:
Remember to check out the site and make an appointment at a travel clinic at least 6 months before traveling to areas which may have diseases that are not in your home country.
The USA government also has a general vaccination information site:

The U.S.A. has a vaccine adverse events reporting system (VAERS), but it allows anyone to "report" anything they likem without being the least bit accurate. Check out this great post on the subject:

If you have specific concerns about vaccines, or have heard some of the myths, please see the skeptcial raptor's blog, which covers each of the myths:
Especially this post:

If you want to see what happens when a child does NOT get vaccines, check out Shot By Shot's videos:

If you are a visual learner and only have 5 minutes, check out this beautiful infographic on vaccines:
If you have more than 5 minutes, Vaccinews's blog is also a good site to learn more about vaccines.

A cute and very short blog post about the chicken pox vaccine:
In addition to her wonderful points, I would add that you should give your child the varicella vaccine because you do not want your child to suffer from shingles when they're older, as it is very painful and can cause disability. Shingles is caused by the varicella (chicken pox virus) living inside you. If you never get the chicken pox (disease), then you can not get shingles.

Here are some other good web sites:
The American Academy of Pediatrics: www.aap.org
National Network for Immunization Information: www.immunizationinfo.org
Every Child By Two: www.ecbt.org

My pinterest immunization board: http://pinterest.com/motek42/immunizations/

This is just a small list, and I recommend that you discuss any concerns with your pediatrician. Also note that some people can not get certain (or any) vaccines, and therefore, rely on herd immunity (their community being vaccinated) to protect them.

My beautiful, fully immunized, son (c) 2012

Due to the high number of antivax trolls trying to post spam, I am disabling comments for this post. Sorry!