Primary Care, Coatesville

Clinical Corner

FDA Approves New Rules for Labeling Sunscreen — July 2013

The Food and Drug Administration has approved new rules designed to reduce confusion about sunscreen labels.

Sunscreens protect against two forms of sun radiation: UVB, which causes sunburn, and UVA, which causes skin wrinkles. Both UVB and UVA cause cancer.

Only products with SPF > 15 will be allowed to claim they prevent sunburn, early skin wrinkling, and cancer. If the product protects against both UVB and UVA, it will be designated “broad spectrum” protection.

Manufacturers no longer will be able to claim their products are “waterproof” or “sweatproof", since these terms are misleading. Instead, they are permitted to claim the number of minutes the product is water resistant (based on test results).

What does this mean for consumers? With the new rules, the consumer will have to pick an SPF number (we recommend 30 or above) and make sure it is a “broad spectrum” product.

It is not clear if there are people who might benefit from products having an SPF >50. It is possible that sunscreens with SPF>50 might be more irritating to the skin.

The FDA is currently investigating the safety of sunscreen sprays. The concern is what might be the adverse effect if they are accidentally sprayed in the face and inhaled.

No sunscreen will work if it is not applied! Please keep your children protected this summer.

Preventing Swimmer's Ear — June 2013

Swimmer’s ear is a painful infection of the ear canal associated with exposure to water. Usually caused by bacteria, it is a very common condition, responsible for 2.4 million U.S. healthcare office visits per year. It occurs in adults as well as children.

Symptoms of swimmer’s ear include ear pain when tugging on the ear lobe (or when trying to sleep the affected side), redness and swelling of the ear canal, and sometimes drainage of whitish or yellow material.

The simple steps can help prevent this illness:.

  1. After your child finishes swimming, use a towel to dry the ears well and have the child tilt her head to hold each ear facing down to allow water to escape from the ear canal.
  2. Pull the earlobe gently in different directions while the ear is facing down to help water drain out.
  3. If water remains in the ear canal use a hair dryer on lowest heat to move air within the canal. Hold the hair dryer several inches from the ear.
  4. Do not put objects in your child’s ears (including cotton-tip swabs, paper clips, pencils, or fingers).
  5. Do not try to remove ear wax. If you think your child’s ear is blocked with wax and the child cannot hear well , call the office to have us gently remove it.
  6. Use 4-5 drops of a 1:1 mixture of rubbing alcohol and white vinegar placed in your child’s ears after he is done swimming. This will help dry the ears and prevent bacterial growth. Do not use this mixture if your child has ear tubes, ear drainage, or damaged ear drums. Swimmer’s ear prevention drops are also available commercially.
  7. If you own the pool, make sure the disinfectant levels and pH are adjusted properly to make the spread of germs less likely.

Raising awareness of infant car seat dermatitis — June 2013

As the warmer months approach and infants begin to wear short-sleeved onesies, it is important to keep “car seat dermatitis” in mind as a newly recognized form of contact dermatitis. Online parenting blogs dating back to 2008 have testimonials from clever parents who had noticed an itchy rash on their children that was worse in areas on skin that was in direct contact with the car seat. This rash was found to be more commonly associated with car seats lined with a shiny, nylon-like material and was more prevalent in warmer months. The areas of involvement included the posterior legs, elbows, and the occipital scalp. Ingredients that are being investigated include a flame retardant, a preservative used as a mold inhibitor known as dimethylfumurate, or another yet unknown agent. Given that many cases are associated with excessive sweating, some experts have theorized that this reaction could represent an irritant rather than allergic contact dermatitis.

Once this diagnosis is suspected, patients benefit from replacement of the car seat along with topical steroids. As heat, sweat and short summer clothing are felt to play a role in facilitating this contact dermatitis, keeping cool and applying a barrier between the child and the car seat lining could be helpful in cases where buying a new car seat is not feasible.

Source: www.chop.edu/childrensdoctor

Risks of Indoor Tanning — May 2013

With over 19,000 indoor tanning salons in America, getting an indoor tan has become very popular among both adults and teenagers. National surveys indicate that over 25 percent of high school girls used an indoor tanning device in the previous 12 months.

Tanning devices emit primarily UV-A radiation. UV-A causes tanning but usually not sunburn. Tanning occurs almost immediately. The doses of radiation emitted by tanning units may exceed 10 times that of the sun at mid-day. Indoor tanners may increase their annual UV-A exposure up to five times the usual amount from natural sunlight.

In addition, some of the new tanning lamps also emit UV-B, which results in greater tanning.

Tanning is the skin’s response to skin damage by radiation. It is associated with DNA damage to skin cells. Any wavelength of UV light, whether UV-A or UV-B, is capable of inducing tanning. Recent studies have strengthened the concern that indoor tanning increases skin cancer risk. It is estimated that indoor tanning increases the risk of melanoma (a serious type of skin cancer) by 20 percent.

In contrast, many teens — and many tanning salon employees — believe that indoor tanning has no health consequences. But the International Agency for Research on Cancer has stated that UV radiation-emitting tanning devices are carcinogenic. The World Health Organization, American Academy of Pediatrics, and American Academy of Dermatology have all recommended that minors not use tanning devices. Thirty-three states have laws restricting tanning salon use by teenagers. In Pennsylvania, a newly approved state Senate bill would require teenagers between 14 and 18 to have parental consent, and teens under 14 would be prohibited from using the services without a written physician’s note.

We encourage parents to discuss the dangers and perceived benefits of indoor tanning with their teenagers. If you have further questions, our office staff would be happy to discuss this with you further.

Health Hazard Alert - Laundry Detergent Pods — November 2012

Children’s Hospital of Philadelphia (CHOP) recently has received reports of children with vomiting, mental changes and breathing problems after ingesting laundry detergent pods.

The pods are designed for single wash loads; the capsules, which contain concentrated liquid detergent, dissolve when in contact with moisture. During the period May to June 2012 poison centers around the country reported 1008 laundry detergent exposures, almost half of which involved detergent pods. Ninety-four percent of such exposures occurred in children younger than five years of age.

At CHOP the Poison Center was notified of a boy aged 17 months who had bitten into a laundry pod and developed vomiting, lethargy and breathing problems. He required mechanical ventilation in the ICU. Even after his recovery he had ongoing problems with swallowing. It appears that symptoms are worse following pod laundry detergent exposure compared to non-pod exposure.

To children, laundry pods may look like candy. As with other household chemicals, they should be kept out of reach and out of sight of children.

Mosquitoes and the West Nile Virus  — September 2012

The chance of contracting the West Nile Virus (WNV) from an infected mosquito is small and chances of becoming seriously ill are even smaller. However, the Chester County Health Department recommends that individuals take personal precautions to minimize the possibility of being bitten by infected mosquitoes.

The Health Department also recommends the following precautions to help eliminate mosquito-breeding areas:

For more information about WNV, visit www.chesco.org/heath or call 610-344-6752.

Televisions — June 2012

Televisions need to be anchored to the wall to prevent tipping. Front-heavy televisions can topple over onto a child who is trying to reach for a toy or remote control that is sitting on top of the TV.

There were 169 children who died between 2000 and 2010 due to televisions tipping over, according to the U.S. Consumer Product Safety Commission. Deaths are usually caused when a television crushes or suffocates a child.

An estimated 13,700 children were treated in ER’s between 2008 and 2010 because they were struck by a television. Those younger than 5 years old were injured most frequently, and the most common injuries were to the head.

To protect your child from such injuries, follow these tips from the American Academy of Pediatrics:

Seasonal Allergies — March 2012

The symptoms of allergies can be very similar to the symptoms of the common cold, but there are some important differences.

Both may cause nasal congestion, runny nose, post nasal drip and sneezing. Itching –especially of the eyes, nose, and sometimes the ears and throat - is a common feature of allergies, but is not usually present with a cold. Body aches, fever and sore throat, commonly occur with a cold and are not present with allergies.

Allergy symptoms may last for as long as the trigger is present. For example, pollen allergies may last for an entire season and pet allergies last for the entire time the person is exposed to the particular animal.

Children with allergies often have a difficult time expressing what they are feeling. They could exhibit certain behaviors that are ultimately the result of allergies such as; not sleeping well, poor school experience and missed school days.

Some signs that your child may have allergies include:

Helpful hints in managing allergies:

Preventing SIDS — April 2011

Here are important guidelines to prevent SIDS according to the American Academy of Pediatrics:

For more information: The American Academy of Pediatrics: www.aap.org and The American Sudden Infant Death Syndrome Institute: www.sids.org.

Dangers of High Energy Drinks — January 2011

Evidence has been mounting that high energy drinks, alone or mixed with alcohol, pose a significant public health risk. Since in recent years high energy drinks are increasingly used by teenagers, we would like to inform our patients and their families of the inherent dangers posed by these beverages. Unfortunately the marketing strategy of high energy drinks makes it look “cool” or “hip” to carry around a can of their product. Anyone can buy these beverages. It is estimated that 31 percent of 12-17 year olds, and 34 percent of 18-24 year olds consume high energy drinks. Sales of these drinks increased 67-fold between 2002 and 2008.

Energy drinks have caffeine concentrations up to 35 mg per oz, compared with 4 mg per oz in cola and 15 mg per oz in coffee. In contrast, energy “shots” are much more potent: they may contain 170mg/oz, with one “shot” being only 1-2 oz. Being a hot beverage, coffee is generally sipped slowly, whereas energy “shots” are drunk in one gulp. Caffeine levels after drinking energy beverages are often much higher because of the speed with which they are consumed.

Adverse reactions noted in persons who drink energy drinks without alcohol include: elevated blood pressure, sleep disturbances, miscarriages in pregnant women, and small birth size in infants. Also, individuals with heart problems may experience rapid heart rate, palpitations, and irregular heart rhythm after drinking high-caffeine beverages.

If the energy drink is consumed with alcohol, a person may become “wide awake drunk,” meaning the person has impaired judgment and reflexes, but is wide awake. The person may not realize he or she is drunk because they feel so alert. This awake state may allow the person to continue drinking for a longer time, resulting in even higher alcohol levels in the body.

People who combine alcohol and energy drinks are three times more likely to binge drink than drinker who do not mix alcohol with energy drinks. In 2009, Donte Stallworth, a wide receiver for the Cleveland Browns, struck and killed a pedestrian after drinking alcoholic beverages and a high energy drink. He testified that he did not feel drunk at the time. People who drink alcohol and energy drinks are more likely to be victimized by sexual assault.

Recent evidence also indicates that using energy drinks with alcohol also may increase the risk of alcohol dependency. Clearly more research is needed to study these issues, but it is prudent to warn teenagers of the potential dangers of energy drinks. We encourage parents to talk to their teens about this topic.

More information can be obtained on many websites, including:

Reviewed by: Bruce Tilton, DO, FAAP

Whooping Cough — November 2010

Since April 2010, the Pennsylvania Department of Health has reported increases in whooping cough cases. The outbreak began in Philadelphia and its surrounding suburban counties, but by November 2010 the disease has been detected in other areas of the state as well. We have seen several cases in the Coatesville area this fall.

Whooping cough (or pertussis) is a highly contagious disease caused by a bacteria. It is spread from person to person through air droplets from an infected person sneezing and coughing. Most whooping cough cases occur in adults and teens, in whom it causes mild to severe coughing spasms lasting weeks or months. For babies who catch the infection, however, pertussis can be life threatening. It causes such severe coughing in infants that they can have seizures, bleeding into the brain, pneumonia, and lack of oxygen – all of which potentially may have a fatal result.

The term “whooping” cough comes from the noise that affected infants sometimes make during a coughing spasm: a whooping sound the end of the cough is a classic symptom of this disease. But many infants and children may not have this “whoop.”

We may suspect whooping cough when:

Our suspicions for whooping cough are raised when there are public health reports of a current outbreak, as there is in 2010.

Immunization greatly reduces the risk of getting whooping cough. Unfortunately, infants are not protected until they have had their third whooping cough vaccine at around six months of age. Until then, infants must rely on their family members being vaccinated for their protection. Children should receive booster doses at certain intervals, so by the age of seven years, they should have had five doses.

The CDC recommends all adults and teens be up to date on their pertussis vaccination, to protect the most vulnerable among us – newborns and infants. In recent years the numbers of whooping cough cases have been on the increase among all ages, but especially in adults and teens. We urge everyone to become up to date by receiving the Tdap booster vaccine. That is the best way to protect infants, who are not old enough to be fully immunized.

Poison Ivy — August 2010

What causes a poison ivy rash?

A poison ivy rash is caused when the oil from any part of the plant touches your skin. This could include touching the leaves, stem, vine, root or its flower and berries. The oil from the poison ivy plant could also be transferred to you by handling clothing, shoes, sports equipment or outdoor tools that have oil on them, including pet fur.

Signs and symptoms

The rash from poison ivy develops within 12 -72 hours after the oil comes in with the skin. It appears to be red and itchy with blisters that appear in thick patches or as thin lines where the edge of the plant rubbed against the skin. The rash might appear all at once or you continue have new lesions daily for 4-5 days. The first 5 days of the rash is usually the most uncomfortable and will take 1-2 weeks for the rash to resolve.

Am I contagious?

The fluid inside the blisters from poison ivy does not contain the oil from the plant; therefore your rash can not spread to other parts of your body or to someone else. Another person could develop the rash if you still have the oil on your skin that was not washed off, or they touch any clothing or shoes that have poison ivy oil.

What to do when exposed

Rinse your skin with cool water then wash well with soap, and rinse the skin well. Do not use hot water because it may cause the poison ivy oil on the skin to spread, and be harder rubbing off then skin. Also scrub under your fingernails to remove any poison ivy oil that may have lodged there. Cut fingernails short to keep the child from breaking the skin when scratching. Short, clean finger nails also help to prevent a secondary skin infection from germs that hide under long nails.

How to care for the rash

Oatmeal baths (Aveeno) are soothing to the skin and may help stop itching. The warmer the water the more the child will itch, so avoid hot baths or showers. If the child is outside playing and is hot and sweating, apply a cool compress to the face to help control itching.

Give one following over the counter anti-itch medications:

When does the child with poison ivy need to be seen by a doctor?

Call and make an appointment if:

Reviewed by: Doris J. Wenger, CPNP

Soda and Sweetened Drinks — July 2010

Reviewed by: Jordan Spivack MD, PhD

Fruit Juice and Your Child — June 2010

For a product to be sold as a fruit juice, the Food and Drug Administration (FDA) requires that it contain 100 percent fruit juice. If there is less than 100 percent juice, then you will find terms such as fruit “drink,” “beverage,” “cocktail," or “punch” in the description, and these products may contain added sugar, flavors, or other ingredients. Please avoid these products.

The AAP makes the following recommendations:

Reviewed by: Jordan Spivack MD, PhD

Warning about Baby Slings — April 2010

You are probably aware of the recommendations to place infants on their backs, or supine, for sleeping. Part of this knowledge stems from education you received both before and after your baby was born. Loose bedding and blankets in the crib can also affect a fragile infant’s breathing. Did you know that baby slings can suffocate your infant? As it turns out, neither did the experts. Thanks to proper reporting, it was discovered that there were 14 infant deaths in babies that were in sling type infant carriers. Twelve of those were in infants less than 4 months of age. In 2009, 3 babies died as a result of suffocation from slings. This prompted the U.S. Consumer Product Safety Commission to raise awareness of this issue.

Baby slings have become more popular over the past 10 years. They are useful to allow a fussy baby to be in close contact with the caregiver, allow the caregiver to have use of his/her arms, and gives privacy for breastfeeding a baby in public. The U.S. Consumer Product Safety Commission acknowledges the benefits of slings, but warns against them for infants younger than 4 months of age.

The message for parents is that you can still use your baby sling, but with modifications. Wait until your baby is over 4 months of age before using it! Make sure your baby’s face isn’t covered and is visible at all times. Since the baby can shift in the sling, frequent repositioning and careful monitoring is vital.

For more information, visit www.CPSC.gov.

Rear-Facing Car Seats are Safer for Children Under Age 2

Thanks to a study stemming from the US National Highway Traffic Safety vehicle crash database, it was recently determined that children less than 2 years of age are five times safer when in a rear-facing car seat. Researchers looked at car accidents from 1988-2003 that involved children less than 2 years of age. The children that were rear facing were 75 percent less likely to die or experience a devastating injury. The explanation for why it is safer is that when rear-facing, the force of the crash is distributed evenly over the back, neck, head and pelvis. In forward-facing car seats, the force of the injury is concentrated in the head, neck, and seat belt pressure points. Children under 2 have relatively larger heads and weaker necks that make them at risk for serious head injuries.

The most common reason why parents turn their child forward-facing is that the child’s feet are hitting the back seat. After analyzing injuries, it was found that lower leg injuries were rare! The conclusion made from this study is that the risk of a head and neck injury is far greater than the risk of a lower leg injury. We urge you to check the height and weight limits for your convertible car seat and do not convert your child forward until s/he has reached those limits. The take home message is that you should keep your child rear-facing until their second birthday or at least until those height and weight limits have been reached!

For more information, visit http://www.aap.org/healthtopics/carseatsafety.cfm.

Striving for Earlier Detection of Autism — March 2010

In the last decade there has been increasing awareness that autism may not be detected early enough by traditional developmental questions such as, “When did your child start to roll over? Crawl? Say ‘dada’”? and so forth. That is because often the first signs of autism are more subtle delays in social, emotional, or communication skills – characteristics not noted by asking questions about motor and speech development alone.

Exploring your child’s social and communication abilities at well visits will give us a more complete picture and help us identify problems at an earlier age.

Parents can help with early detection of developmental disorders by becoming familiar with the social, emotional and communication milestones children should achieve at certain ages. To that end, listed below are key observations parents should make for children up to 3 years. Please refer to these age-specific lists to see if your child is achieving the expected abilities or behaviors at the right time.

First is a list of “red flags” - delays of special concern that may require timely, detailed evaluation. Also listed are questions you should ask yourself as your child reaches a certain age. If you feel your child is not meeting expectations, please talk with us to discuss further.

Red flags

Social, emotional and communication milestones

At 4 months

At 6 months

At 9 months

At 12 months

At 15 months

At 18 months

At 24 months

At 36 months

Reviewed by: Bruce Tilton, DO, FAAP

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