How to Help Your Children Avoid Insect Bites

Anyone who has spent a second in DC during the Summer knows that the mosquitos can be especially brutal (we are on a swamp after all). Don’t let these pesky bugs keep you and your family from enjoying time outside with these tips from Dr. Jessica Long.

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My kids are loving these long, sunny summer days and begging for some outdoor adventures.  However, if you are a true city girl like I am, the thought of leaving your concrete jungle and venturing into the grass and the trees may fill you with trepidation.  I do not like bugs and it greatly detracts from the nature time the rest of my family craves.  Plus, a new alert that West Nile positive mosquitos have been found in Ward 3 does little to calm my neurotic nature.  Obviously, I cannot prevent any and all insect encounters but there are many safe and effective ways to minimize my family’s exposure.

While complete avoidance of insects is not a realistic goal, we can be mindful of where we spend our time and what we wear.  Avoid areas with tall grass that ticks love to cling to as well as stagnant water that is a breeding ground for mosquitos.  When outside in the evenings when mosquitoes love to munch, choose long sleeves and pants that are light and breathable.  The same goes for hikes in the woods or tall grass to prevent ticks from attaching to your skin.  Be sure to do a “tick check” in the evenings when you’ve been outdoors (even your own backyard counts).  They especially like to hide in armpits, in and around ears, inside the belly button, back of the knees and between the legs, around the waist, and in your hair.

It is also a good idea to apply insect repellant to exposed skin and clothing. However, hitting the bug spray aisle of the store can be overwhelming.  There are so many options and ingredients!  Lotions, sprays, wipes, DEET, picardin – what should you choose?

The American Academy of Pediatrics and the Centers for Disease Control both give the thumbs up for 10-30% DEET in children as young as 2 months (keep the under 2 month babies away from insects completely). DEET has also been shown to be safe in pregnant and breastfeeding moms.  Another option is Picardin, a synthetic compound approved in the US in 2005 and protects about as well as 10% DEET.  There are also many repellants that contain essential oils such as citronella, cedar, soybean, and eucalyptus (the latter should be avoided in children under 3 years old).  While these are considered safe, they have to be reapplied frequently and long-term follow up studies are lacking.

Similar to sunscreen, whichever insect repellant you choose must be reapplied frequently.  10% DEET and products that function like it last about 2 hours while 30% DEET keeps you covered for up to 5 hours.  Choose the lowest concentration you need for adequate coverage; no need to go with 30% DEET if you are planning on playing in your backyard for an hour.

So now that you’re armed and ready to fight those insect bites, get out there and enjoy this gorgeous DC summer!  My family might even convince me to get out there, too.

How To Handle Immunization Anxiety

As parents we all know that immunizations, although necessary, can be a source of anxiety for little ones (and for us!). Here are  Dr. Jessica Long‘s tips on how to keep our children calm during immunization visits.

I always hoped that, since I’m a pediatrician, my children would have no qualms about anything that happens at the doctor’s office. I was wrong. My children get as upset about shots, as fearful of a blood draw, and as manic about opening their mouths for a strep swab as the next kid. But shots don’t have to be a horrible experience for kids and parents alike. There are simple things we can do to calm our child, no matter her age, to make everything go a bit smoother.

Leading up to the doctor’s visit, your toddler or school-aged child may ask if it will hurt. Honesty is the best policy. Let him know that yes, it will hurt for a second, but it won’t be bad and you’re right there with him. Some kids like to role play beforehand, pretending to be the doctor giving shots to their parent or stuffed animal, which can make them more confident for the real thing.

At the doctor’s office, the first step in calming your child is checking in on your own mood. If you are relaxed that will rub off on your little one; if you’re stressed, that will too. How would you feel about getting a shot yourself? Probably not exactly excited about it, but also not too worried or afraid. You should feel that way about your child getting a shot. And your child will notice how you feel, and will tend to feel that way herself. Children are perceptive – pretending won’t help.

At the time of the shot, distraction can be very helpful. An infant may want to nurse, suck on a pacifier, or be skin to skin on a parent, all of which have been shown to reduce the stress of painful procedures in babies. An older child may want to hugged or cuddled, read a book, or even watch a favorite video on your phone. Encouraging your child to cough loudly right before and right after the shot has also been shown to reduce painful reactions in school aged kids and even middle schoolers (yes, they get scared, too).

Congratulate your child on being cooperative and brave, but don’t make too big a deal out of it Give her a high five, a hug or a cuddle to let her know you’re proud of her and then head out for a small reward. In our house we go for cake pops, and knowing there is a special treat waiting for my girls (and me!) at the end of a tough doctor’s visit puts everyone a little more at ease.

Strep Throat

We made it through flu season (fingers crossed), but what about the dreaded strep? Read on for advice from Dr. Jessica Long on how to handle this often painful infection.

Now that flu is leaving the D.C. area, it seems like strep throat has happily filled the void. If you have a school-aged child, chances are you have had at least one experience with strep throat. It’s almost a parenting rite of passage to get the “There is strep in the classroom” letter home from the teacher! Even though you hear about it all the time, what exactly is strep throat and why are pediatricians so quick to treat it with antibiotics?

Strep, short for streptococcus, comes in different forms but Group A Strep (aka streptococcus pyogenes or GAS for short) is the one that tends to infect the tonsils. The tonsils are a pair of soft tissue masses that are in the back of the throat. When they get infected, by either a virus or a bacteria, they can get larger, red, painful and sometimes even have pus on them. Though viruses are the main culprit of sore throats in kids, if your child continues to complain throughout the day of throat pain or has fever, belly pain, or a rash, it’s a good idea to see the pediatrician.

If your pediatrician wants to check if your child has strep throat, she will order a rapid strep test that can be done right there in the office. After a quick q-tip “tickle” of the tonsils, your doctor will have an answer in just a few minutes. The rapid strep test is good at checking to see if your child is infected but it misses a few people (it catches between 90-95% of people who have strep throat). Therefore, most physicians will also do a culture to see if strep grows from the swab over 24-48 hours. This extra test will make your pediatrician that much more confident that if the test is negative your child truly does not have strep throat.

We treat strep throat for a few reasons. First off, it makes kids feel better faster and who doesn’t want that? Also, after 24 hours of antibiotics your child is no longer contagious and can safely go back to school and activities without infecting friends and family. Plus, strep throat that goes untreated can lead to more serious infections such as an abscess of the tonsils, kidney problems, and even rheumatic heart disease. That’s why it’s important to take the full course of antibiotics if they are prescribed even though your child will feel back to normal in just a few days.

The biggest question on every parent’s mind is how to prevent this in the future? Unfortunately, that can be tough since strep throat can be spread a few days before a child has any symptoms. Throat infections are passed through the air by sneezing, coughing, or touching someone who has it, so remind your child to be vigilant about hand washing, to cough or sneeze into her elbow (not her hands!), not to share drinks and food, and to stay home from school when she doesn’t feel well.

Baby Proofing 101

Once your baby is mobile, it’s time to start making some changes around the house to protect your curious little one. Read on for tips from Dr. Jessica Long on best practices for baby-proofing.

There are a lot of ways parenthood changes us but one I did not expect was how drastically different our house would look. Never mind the scooters on the front porch, the chalk drawings on the sidewalk, or the toys strewn everywhere inside and out. There are more subtle differences I never would have guessed like covers on the outlets, gates on the stairs, and not a loose coin to be found. Baby-proofing your home is a huge but important endeavor and it involves changing habits and routines you never really knew you had.

How do you even start making your home safe for your little one who, at a very young age, can (and will) start reaching for things and sticking them in her mouth? Suddenly a benign water bottle lid becomes a potential choking hazard. The dog food bowl becomes your child’s most desired possession. And don’t get me started on how every electric cord in the house suddenly becomes a beacon of fun.

As you prepare to baby-proof, I recommend looking in each room in your house, ideally from the much lower viewpoint of your child, to see what potential dangers there are. There are obvious things like installing baby gates at the top and bottom of all stairs but also more subtle hazards like window blind cords that should be tucked out of reach. In bedrooms and living rooms, make sure furniture is secured to the wall so that your curious child does not accidentally topple it over when trying to pull up on it. The same goes for TVs, which are notorious for causing injuries to young children.

In kitchens and bathrooms, invest in strong cabinet and drawer locks so that curious hands do not find medications or cleaners. When possible, store toxic or poisonous substances up high as well as locked away to minimize the chances of your little one accidentally getting ahold of them. Outlets should be covered and electrical cords should be taped down or hidden behind furniture so as not tempt curious babies.

One of the big changes that needs to be made, and maintained over time, is keeping choking hazards out of your child’s reach. Gone are the days where you can toss loose change on the table without thinking or absent-mindedly leave batteries on the counter – both pose serious threats to your child. When ridding your space of choking hazards, use the toilet paper roll rule. If an item is small enough to fit through the cardboard tube, it should be placed out of reach of your child. While this is a routine that can take time to master, it will soon become second nature and ensures your child can crawl, walk, climb and explore in a safe space.

Once you’ve seemingly covered your house in bubble wrap, the next step is seeing what your child gets into. All the baby-proofing in the world doesn’t replace good adult supervision, and watching your child will reveal new hazards to abate Plus, every child is different, so while your first may never have looked at an outlet, your second may be found licking one (true story). You will likely continue to update and change your safety precautions as needed and as your child grows.

 

THE DREADED VIRUS – HAND FOOT AND MOUTH DISEASE

Now that school is back in session, germs are spreading and your children are bringing home all types of illnesses, one in particular you should watch out for is Hand Foot and Mouth disease, a viral illness that results in fever and a painful rashes. Dr. Jessica Long gives us the lowdown on this dreaded illness.

When we signed up for parenthood, none of us really knew what we were getting into. Which is probably a good thing because if we were warned about dealing with a sick child who had Hand, Foot, and Mouth disease we may have made a different decision (just kidding, sweet kids!).

If you haven’t been plagued by this viral illness yet, your time will eventually come. Nearly every child is struck by this rash during their early childhood. It is typically harmless and lasts about a week but boy does it make for sleepless nights and lots of phone calls and office visits from uncomfortable families.

Hand, Foot, and Mouth is most common during the summer and early Fall though enteroviruses, which cause it, can infect at any time of year – our practice is seeing a lot of it right now. Your child may feel run down and a bit unwell for a few days, perhaps with fever or less of an appetite. Then the rash will start popping up on their – you guessed it! – hands, feet, and in and around the mouth. Not all three areas will necessarily be affected and other spots, especially their buttocks, can be plagued with these tiny red blistery spots.

There is no quick fix for Hand, Foot, and Mouth disease. Keeping your little one hydrated is the main goal since kids often avoid eating and drinking due to the uncomfortable spots in their mouth. Giving some acetaminophen or ibuprofen may make them more willing to drink. Pedialyte popsicles are also lifesavers to soothe an aching mouth and get fluid in your sick child. If your child still doesn’t want to drink anything, chat with your pediatrician as there are prescription mouth washes that can be used to help combat the pain.

Even though your child may continue to shed the virus for weeks in respiratory droplets (like a runny nose or cough), most kids are no longer contagious once the red spots have crusted over, which takes about seven days. Your pediatrician will likely recommend that your child stay home until that happens and she is feeling better. To help prevent spreading Hand, Foot, and Mouth to others, wash hands frequently, clean and disinfect touched surfaces including toys, and avoid close contact such as kissing, hugging or sharing utensils and cups.

Most importantly, this too will pass. Just like lice, sleep regression, and that really annoying biting stage, Hand, Foot, and Mouth disease is another badge of honor we earn as parents. We really are super heroes.

TEENAGERS AND VACCINES

Most parents, even brand new ones, expect a lot of vaccines in their children’s first few years of life. There are many diseases that we can protect children from – including whooping cough (pertussis), chicken pox (varicella), and the flu – and most well-child visits include at least one shot. But as our kids grow, the shots are fewer and further between until it seems like they’re only getting a flu vaccine each year (speaking of – now’s the time to get yours!).

However, there are many important vaccines that teenagers should get as well. The Centers for Disease Control (CDC) recommends that children between 11-12 get a Tdap booster and a meningitis vaccine, as well as start the HPV series. When your high schooler is 16 years old, a meningitis booster is needed and many pediatricians also start the Meningitis B vaccine series at that age as well.

What in the world are all these diseases and acronyms? Let’s break it down so that you and your child know what to expect and understand the importance of each of these vaccines.

Tdap vaccine

In the first four years of your child’s life, she likely received 5 DTaP shots that protected her from diphtheria, tetanus and pertussis (whooping cough). However, over time the protection the vaccines provide slowly decreases so when kids are 11 years old we give them a booster, confusingly called Tdap instead of DTaP, which provides further immunity against the same diseases. All of these diseases are caused by bacteria. Diphtheria, which causes a very serious throat infection, and pertussis can both spread person to person through sneezing or coughing; we see pertussis outbreaks even in local schools in DC. Tetanus is caused by a toxin made by bacteria in soil and enters the body through cuts, scrapes or puncture wounds to the skin. It can cause muscle spasms and even breathing problems or paralysis. All good reasons to make sure you are up to date with your booster shot!

Meningococcal Vaccines

Most parents have heard of meningitis or seen the very emotional commercials on TV encouraging them to vaccinate their children. This vaccine protects children from any illness caused by a bacteria called Neisseria meningitides, which can lead to an infection of the fluid and lining around the brain and spinal cord or an infection in the blood. Meningococcal disease passes from person to person through saliva – through things like kissing or sharing a drink – and easily spreads when people live in close quarters such as college dorms. This is why we make sure children are fully vaccinated against this disease before they head off to college. Infections caused by Neisseria meningitides are very serious – the CDC estimates that even with treatment about 10 to 15 out of 100 people will die from it.

The meningitis vaccine that children get at 11 years old protects against four types of the bacteria – A, C, W, and Y. In recent years there have been outbreaks of a fifth kind, Meningitis B, on college campuses with some deaths attributed to it. Therefore, the CDC recommends that teenagers also receive a vaccination against Meningitis B. There are two forms of the vaccine available (one is a three shot series and one is a two shot series) so talk with your pediatrician to see if this is a good choice for your teenager.

HPV Vaccine

Infection with the Human Papilloma Virus (HPV) causes 31,000 cases of cancer in women and men a year according to the CDC. While there are over 150 different strains of HPV, they do not all cause cancer. Thankfully we now have a vaccine that protects against the nine strains of HPV that are most likely to cause cancer.

With the HPV vaccine, starting early is best! Studies have shown that kids 11-15 years who complete the HPV vaccine series show such a good response that only two vaccines total are needed. For older teens who are unvaccinated against HPV, three shots total are needed. Therefore your pediatrician will likely recommend your child receive his or her first HPV vaccine at the 11-year old appointment.   Hopefully more cancer preventing vaccines, like the HPV vaccine, are in our future!

NEW YEAR’S RESOLUTIONS FOR YOUR FAMILY FROM SPRING VALLEY PEDIATRICS

The New Year is a time for us to reflect on how to improve our lives and family lives. Read on for tips from Dr. Jessica Long on how to set realistic goals for your family in 2018…

Somehow 2018 has snuck up on us. Between the fun chaos of winter break and the holidays with small children, my family neglected to figure out new years resolutions ahead of time. Now that we are settling back into our routine – and it’s too cold to do anything else – I finally sat down to think of ways we could come together even more as a family in 2018.

Top of the list is screen time. Though as a pediatrician I am all too aware of the negative consequences of my children being glued to a screen, I far too often give myself a pass. Which is not entirely fair. When our phones are down, we speak 5 times as many words to our babies and toddlers who are acquiring language skills, we engage more meaningfully with our children who thrive on individualized attention from us, and we model appropriate behavior for our adolescents who are starting out in the electronic world. So starting in 2018, my phone will be hidden at meal time, it will be far from me when we do family movie or game night, and I will leave my Instagram stalking to after my children are asleep.

Before I had children, volunteering was a big part of my life – I loved participating in weekend service projects and spent summers doing medical volunteering abroad. Sadly, volunteering has taken a way far back seat since having children, partially because I felt it was too hard to include my kids. This year we are changing that! Turns out there are lots of ways even small children can meaningfully participate in community service and – no surprise – they love it. Our family resolution is to do a minimum of one family service outing a season. First up will be delivering meals to home bound seniors through Food and Friends and after that we’ll try a Sunday morning at The DC Diaper Bank. Your kids will be most excited if you initially tap into their interests – take your animal lover to spend time at the Humane Rescue Alliance or have your budding artist make get well cards for hospitalized children. Once you see how fun and easy it is to volunteer as a family, I have no doubt this will be an easy resolution to keep.

Last up will probably be the hardest – introducing new foods to everyone! Like all families with young children, dinner often feels like a constant rotation of “kid food”. My girls are not adventurous eaters at all but 2018 is the year to change it! To expand their palate, we are going to put them to work. Involving your kids in the shopping and cooking process makes them more likely to at least give the spoon a lick at dinner time. Once it gets warm, I am determined that we will finally successfully grow vegetables in our garden which will hopefully pique their interest in eating something they helped to cultivate. Will my children start requesting wheatgrass smoothies and lamb vindaloo? Unlikely, but at least it’s a step in the right direction.

Cheers to a healthy and fun 2018 with your loved ones. What resolutions will you make with your family?

HOW TO KEEP YOUR SLEEPING BABY SAFE

The first few months at home with a newborn can be especially stressful, especially when it comes to sleep. Here are Dr. Jessica Long‘s  tips on how to keep your sleeping baby safe.

I am expecting my third daughter in the Spring and the thought of going back to sleepless nights is sort of terrifying. Nothing plagues parents of small children like sleep – or lack thereof – and you would be hard pressed to find a new parent who can get through a conversation without mentioning their baby’s horrible sleep patterns. While I worry about the late night awakenings, I at least do not have to stress about how I put my baby down at night to keep her as safe as possible. With these simple tips you don’t have to either.

Back in the day when we were all babies, most parents placed their little ones on their bellies to sleep. In the 1990s, as studies showed that belly sleeping increased baby’s risks of Sudden Infant Death Syndrome (SIDS), the Back To Sleep Campaign championed a safer sleep position. Since then, the number of SIDS deaths has dropped precipitously – by more than 40% – and we now know of other simple steps you can take to keep your child safe at night.

Babies should sleep in their own space – not in the bed with their parents but ideally in the same room. The American Academy of Pediatrics (AAP) recommends keeping your child in a crib or bassinet in your room for ideally the first year but definitely the first six months. Your little one should have a flat, firm mattress with no pillows, blankets, bumper pads or stuffed animals. Instead of loose blankets that can be wiggled around to accidentally cover a child’s face, you can place your baby in a sleep sack. While they are adorable, baby crib bumpers should be avoided due to cases of babies smothering in them. Yes, a bare crib looks boring but boring is safe when it comes to a baby who cannot move to protect her breathing.

There are many products out there that promise to provide further protection against SIDS. Everything from heart monitors that link to your smart phone to bassinets with build in fans is available for purchase. The AAP does not endorse any of these devices as they have not been shown to actually reduce the risk of SIDS. Unless your child was sent home from the hospital with additional medical monitoring of breathing or heart rate, save your money and your sanity and skip these unnecessary gimmicks.

While following the ABCs (Alone, on her Back, in a bare Crib) of baby sleep positions may not get you any additional hours of sleep, it will at least let you rest easy that your child is as safe as possible while you both catch some hard earned zzz’s. Happy dreaming!

Spring Break Safety Tips

March is finally here, and many of us are planning and prepping for our Spring Break getaways. Read on for tips from Dr. Jessica Long on how to keep your little ones safe while on vacation.

February, the shortest and yet the slowest month of the year, is finally over which means one thing – it’s almost Spring Break! I love exploring new places with my children but traveling with kids takes a lot more planning than the days you could throw a bathing suit in a bag and be ready to jet off to Mexico. Whether your family is going somewhere within the US or traveling abroad, make sure you check these things off your to-do list to ensure a safe and healthy vacation.

First off, plan ahead. At least 6 weeks before an international trip you should arrange a travel consultation with your pediatrician to ensure your child is up to date on vaccines, check to see if any additional shots are recommended based on your itinerary, and discuss other health concerns related to your locale. The Centers for Disease Control has a great online resource that highlights health-related travel recommendations based on your country of travel. Physicians like to see you far in advance of international travel to ensure that any vaccines given will be protecting you in full force by the time you travel and to allow enough time to order any shots we may not routinely keep in stock.

Next up is the never-ending packing list. Things you’ll want to throw into your bag are sunscreen (SPF 30 or above) for all that fun in the sun, DEET (30-50%) for deterring those pesky mosquitos, and antibacterial wipes or hand sanitizer. I never travel without children’s acetaminophen and ibuprofen for fevers and aches, antihistamines for any allergy symptoms, and nasal saline for those inevitable stuffy noses. It might be helpful to throw in hydrocortisone cream for itchy rashes and antibacterial cream for skinned knees.

Unfortunately accidents still happen when you’re on vacation, so the same precautions you take at home should be taken on your trip. That means dragging along (or renting) car seats or booster seats so your child is safely secured for car travel. No classic spring break trip is complete without a dip in the ocean, and no child swimming in the ocean should be without a life vest, protective footwear, and a vigilant pair of adult eyes on her – the CDC notes that drowning is the second cause of death in young travelers. It’s also worth the effort to research ahead of time what medical care is available at your destination. That way, if an emergency does come up, you won’t have to waste valuable time figuring out where you child can get help. Depending on the age and health condition of your child, it may make sense to consider the availability and level of local health care when choosing a destination in the first place.

This may seem like a no-brainer but don’t forget your child’s normal medications. Countless times I have received a frantic phone call from a parent who left an asthma inhaler or other important medication at home by accident. No one wants to take time out of a fun vacation to hunt down a pharmacy for a new prescription so double-check that any daily, or even occasional, medication your child takes is packed in your carry on.

Happy travels and here’s hoping you get at least a little bit of R&R on your family trip!

 

Have a safe and happy Halloween