Written by: Melissa Reffitt, CPNP

As the days gradually turn warmer, those of you spending days sitting on the bleachers supporting your young athlete may be watching those sweaty faces and wondering,

Is my child staying hydrated enough?

Do I need to stock up on that sports drink I saw on sale at the grocery store?

Would buying sports drinks provide better hydration after the game is over?

Marketing campaigns for sports and energy drinks have been successful in advertising to our adolescents and young athletes with the message that these drinks offer superior hydration and fuel for athletic performance. Sports drinks, such as Gatorade® or Powerade®, are flavored waters that contain carbohydrates (calories) in the form of sugar and may contain other vitamins or additives. Energy drinks, such as Monster Energy®, Red Bull®, or Rockstar®, contain stimulants like caffeine and guarana. They may also include vitamins, minerals, sugars or protein.

In truth, WATER is the best hydration for the vast majority of children’s sports activities. Here is a rule of thumb to keep in mind: for every 20 minutes of sports activity, 8 ounces (1 cup) of water is required to replace fluids lost. If your child is involved in a soccer game for 1 hour, he or she needs 24 ounces (3 cups) of water after the game is done. Sports drinks are not necessary for most sports activities. Only during times when elite players are playing for extended periods of time that do not allow for rest or eating would a sports drink potentially provide benefit. Carbohydrates, protein and vitamins are best obtained from eating healthy foods at meal times. To provide best ‘refueling’ for your athlete, make sure he or she is drinking water before, during, and after the game, and make sure a balanced meal is provided after the activity is completed. For more information on providing balanced nutrition go to www.choosemyplate.gov.

Your athlete may also claim a need to ‘boost’ their performance with an energy drink. Most of these drinks contain caffeine or guarana, a plant extract that contains caffeine. Caffeine can have dangerous side effects to an athlete’s body, including increasing heart rate and blood pressure, and loss of fluids (diuresis). Caffeine can also cause headaches and sleep disturbances. Caffeine is not appropriate to give to a child or teenager before, during or after sports participation.

Does your child seem to tire or fatigue more quickly than his or her peers when playing sports? Dehydration has been shown to cause a decline in sports performance. Make sure your child is well hydrated before the game. Can they keep a water bottle at their desk at school? Do they use the drinking fountain at school? Do they drink from their water bottle during the game? Have they eaten a balanced meal before the game (including fruit, vegetable, carbohydrate, and protein)?

Routine use of sports drinks can also be associated with excessive calorie consumption and risk for weight gain. If your child is overweight, sports drinks add additional unnecessary calories to their diet. After the game, a glass of low fat milk is actually a great choice for post-sports rehydration and protein replacement.

In summary, water is essential for hydration–before, during, and after children’s sports activities. Keep a water bottle handy for your young athlete!

Reference: Sports drinks and energy drinks for children and adolescents: are they appropriate? Pediatrics, 2011, (127), pp. 1182-1189.

One of your baby’s many “firsts” is their first tooth.  The age that teething starts can be hereditary; if you have a family history of early or late teethers, your child may follow the pattern. Teething can start as early as three months old (with the tooth cutting through days to months after symptoms start) to as late as thirteen months old. The general order for cutting teeth is:

1. Two bottom front teeth (central incisors)
2. Four upper front teeth (central incisors and lateral incisors)
3. Two lower lateral teeth (lateral incisors)
4. First four molars
5. Four canines or eye teeth (between lateral incisors and molars)
6. Remaining molars

The entire process of cutting all 20 primary teeth is normal complete by two and a half years old.  Permanent teeth start to show up when the child is in early elementary school.

Unfortunately, tooth decay is the most common chronic disease among children aged 5 to 17. It starts when teeth are exposed to any foods and liquids other than water for a long period of time.  Sugars in food and liquid are changed to acid by bacteria in the mouth. The acid eats away at the tooth enamel, the outer layer of the tooth, leading to cavities. Fortunately, it is preventable.

The most important thing you can do to prevent cavities is good oral hygiene. Even before any teeth have come through, get your baby used to having their mouth cleaned.  After feedings, gentle wipe your baby’s gums with water using a clean wash cloth or gauze. Or use a soft baby toothbrush. As baby grows and eats less frequently, develop a routine of brushing after meals or at least twice a day.  The easiest times are after breakfast and before bed.  Use a soft toothbrush designed for the age of your child with water or “baby” toothpaste that does not contain fluoride. Once your child is a toddler and wants to do everything his or herself, have the child brush first and then repeat the process yourself to be sure that each tooth is cleaned well.  Or you go first and let him or her finish. If any teeth are touching, start flossing once a day. Once your child is age 2 and can spit out the toothpaste, switch to a children’s toothpaste with fluoride.  Only use a pea-sized amount and get the toothpaste into the bristles so your child doesn’t just eat it. Take your child for a checkup with a dentist every 6 – 12 months.

In addition to brushing, there are things you can do to protect your child’s teeth:

• Don’t put your baby to bed with a bottle. Natural sugars in formula and milk will sit on the teeth over night and cause cavities.
• Teach your child to use a regular cup as young as possible.  A child using a regular cup is less likely to have liquid collect around their teeth compared to a bottle or sippy cup user. Start offering a cup with water at meals as soon as your child can sit up by his or herself. The only liquid offered in a sippy cup should be water. Other liquids should be in a regular cup with meals.
• Limit any juice, even diluted, to 4 to 6 ounces once a day and only serve it with a meal. Offer water between meals when your child gets thirsty.
• Avoid drinks that have sugar and acid like juice, sports drinks, soda pop and flavored drinks and teas. The sugar and acid promote cavity formation.
• Be careful with sweets and sticky foods. Fruit snacks and roll-ups, candy, and cookies, crackers and chips all have sugar in them and they can get stuck in molars, leading to cavities. Save them for mealtimes when you can brush as soon as you are finished eating. If your child is old enough to have gum, stick with sugar-free varieties or gum sweetened with xylitol.
• Brush teeth after giving medicine.  Many medicines contain acids and sugars that can lead to cavities.
• Be sure your child is getting the right amount of fluoride. Fluoride reduces cavities in children and adults and can even repair early stages of tooth decay before it becomes visible. If your community does not have fluoridated water or you use well water, talk to your dentist about using a supplement like bottled water with fluoride or a prescription tablet.

Nothing brightens up a day like a child’s smile. With proper care, that smile can last a lifetime. Remember, only brush the teeth you want to keep!

Author: Lisa Kanwischer PA-C, ProMed Pediatrics

Sources:

American Academy of Pediatrics
Consumer Guide to Dentistry
American Dental Association

Sleep is important to the health of children of all ages. Adequate rest helps to prevent illness, as well as improves mood and behavior. How much sleep does your child need?  How can you help your child get the best sleep possible?  How can you yourself get some sleep as well?  Read on for a better night’s sleep.

• Infants need 9 to 12 hours of sleep during the night and 2 to 5 hours of sleep during daytime hours (naps lasting from 20 minutes to 2 hours).
• Toddlers (1 to 3 years of age) need 12 to 14 hours of sleep over a 24 hour time period, usually a nap after lunch lasting 1 ½  to 3 hours.
• Preschoolers ( 3 to 5 years of age) need 11 to 13 hours of sleep; some need a day time nap and some outgrow the nap at 3 to 4 years old
• School age children (6 to 12 years of age) need 10 to 11 hours of sleep
• Teenagers need about 9 hours of sleep

Signs of sleep deprivation in a child can include:

• Mood.  Sleep deprivation may cause your child to be moody, irritable and cranky. In addition, he/she may have a difficult time regulating moods. Older children may become easily frustrated or be upset more easily. Infants and toddlers may be fussy or have more temper tantrums.
• Behavior. School-aged children who do not get enough sleep are more likely to have behavior problems, such as defiance and hyperactivity. Teenagers who are sleep deprived are more likely to engage in risk taking behaviors, such as drinking and driving fast.
• Cognitive Ability.  Inadequate sleep may result in problems with attention, memory, decision making, reaction time and creativity—all of which are important for school performance. Studies show that teenagers who get less sleep are more apt to get poor grades in school, have more tardiness/absences and fall asleep at school.

Here are some recommendations to help your child get the best sleep, to fall asleep easily, and maintain sleep.

• Sleep schedule. The bed time and wake time should be consistent from day to day, not more than an hour difference from school day to non school day.
• Bedtime routine.  A routine that last 20 to 30 minutes is best. Calm activities, books and reading are best. Avoid activities that require the parent’s presence, like rocking or holding to help the child get to sleep.
• Sleep environment.  Background noises, location, sleep partners, bedding, favorite toys, temperature of the room and lighting can all affect a child’s ability to fall asleep and maintain sleep.
• Sleep only zone.  Remove most toys, games, TVs, computers and video games from the bedroom.
• Caffeine.   Avoid drinks with caffeine after 3 p.m.
• Daytime routines.  Consistent schedules and regular mealtimes and playtimes also help to improve night time routines.
• Exercise.   Daily exercise also helps with initiating and maintaining sleep.
• Naps.  Nap times should be geared to your child’s age and needs. Long naps should be avoided.

Many children have nighttime fears at bedtime and most have these at some age. They are a normal part of development. Children have different fears at different stages of development, for example some young children are afraid of monsters. Young children have difficulty distinguishing the difference between real and imagined.  If your child is having difficulty with nighttime fears, your health care provider can help. Give us a call or come in for a visit.

Sleep or night terrors are common in children. They usually happen 1 to 2 hours after falling asleep and can last for a few minutes to an hour. Children who are having a sleep terror may have their eyes open, usually appear agitated, frightented, some may scream or cry or talk nonsense. Although difficult to watch, the sleep terror for the child is less traumatic than a typical nightmare or bad dream. Most children do not remember a sleep terror the next day.  Sleep terrors are not a sign of a traumatic event or psychological problem. Most children outgrow sleep terrors by adolescence, sleep terrors and sleep walking does often run in families. Stress, a full bladder, fever, illness, irregular sleep schedule, not getting enough sleep, some medications, sleeping in a different or noisy environment can all contribute to sleep terrors.

Contact your health care provider if you child has difficulty falling asleep, snores or experiences unusual awakenings or has sleep problems that are causing disruption during the day.

This blog was written by Genevieve Bastos, CPNP of Richland ProMed Peds. 269 552-2500.  For more information regarding sleep habits, bedtime routines or sleep problems, please call for an appointment.

Resources:  Mindell, JA & Owens JA (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Phildelphia: Lippencott Williams & Wilkins. 

Influenza, commonly known as the flu, is a contagious respiratory disease. Causing mild to severe illness (and sometimes even death), influenza is not “the stomach flu.”

In the U.S., more than 200,000 people every year are hospitalized with flu-related complications, and thousands die. While 90 percent of those who die from influenza are over 65, the flu still poses a serious health threat to kids. From September 2010 through August 2011, there were 115 deaths in children under age 18 due to confirmed influenza. Almost half of those kids were under the age of 5 and had no underlying illnesses or risk factors.

The flu season typically hits our area from November to March (peaking in January and February). The virus is spread mainly through tiny droplets (which become airborne when someone with the flu coughs, sneezes or talks). It’s possible to spread the flu before you know you’re sick. In fact, influenza is contagious one day before symptoms appear until five to seven days after becoming ill. Common symptoms of the flu include:

• Fever (unusually high) and chills
• Headache
• Sore throat
• Cough
• Runny or stuffy nose
• Extreme tiredness
• Nausea and vomiting (more likely in children)

Protection From Infection

Believe it or not, influenza has already been seen in Michigan—so put a flu shot on your to-do list today. The best way to protect yourself and your entire family from infection is to get the proper vaccination. The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6-months-old receives an annual flu vaccination. Getting vaccinated now will allow time for full immunity to develop before the flu season peaks. (Note: There is a small group of people who should not be vaccinated. Talk to your doctor before scheduling a flu shot to make sure you’re not in that group.)

This season’s vaccine protects against three flu strains: two influenza A (H1N1 and H3N2) and a strain of influenza B. There are three types of vaccines available:

• The traditional shot—approved for people 6 months and older. Containing killed viruses, the traditional shot sometimes causes soreness, redness or swelling (where the shot was given) and flu-like symptoms. Remember, these side effects are temporary and mild compared to suffering from a real bout with the flu. When given during pregnancy, the traditional vaccine protects the baby until 6 months of age, when the child can receive the shot.
• The nasal spray—approved for ages 2 to 49-years-old. While the nasal spray contains weakened viruses, it does not cause the flu. Mild and temporary side effects may include runny nose or nasal congestion, cough, fever, headache, muscle aches, abdominal pain and vomiting or diarrhea.
• The intradermal shot—approved for people 18 years and older. The intradermal flu vaccine is a shot that is injected into the skin instead of the muscle. A stronger dose is available for people over 65.

Along with vaccination, following these tips can also help you and those you love stay healthy throughout the flu season:

1. Sing “happy birthday” a lot. Washing your hands frequently with soap and water for at least 20 seconds (about the time it takes to sing “happy birthday”) reduces the spread of germs. 
2. Practice sneezing and coughing etiquette. To avoid spreading germs, cover your nose and mouth with a tissue or shirtsleeve when sneezing or coughing.
3. Keep it clean. Keep kitchen counters, bedside tables, bathroom surfaces and toys clean with a household disinfectant.
4. Schedule a sick day. If it’s at all possible, stay home from work (or school) if you have the flu.
5. You are what you eat. Eat a healthy, well-balanced diet rich in vitamins A, C and E. Foods that can boost the immune system include milk, eggs, citrus fruits, vegetables and nuts.
6. Get your z’s. Without proper sleep, you increase your odds of getting sick. Adults need at least seven hours of sleep per night (children need more).
7. Just relax. Find ways to reduce stress, including exercising, listening to music, practicing yoga, meditating or reading.
8. Kick the smoking habit. Smoking kills the fibers in your nose and lungs that help prevent mucus from clogging these airways. Breathing secondhand smoke is also unhealthy for those around you, particularly children.

About Medication

For the very ill or those at higher risk for complications, medications are available to relieve flu symptoms. Those who should seek treatment include:

• Children under 5 (especially under 2)
• People over 65
• Pregnant women and women who have recently given birth
• People with chronic conditions like asthma, or heart, lung or kidney disease
• People with weakened immune systems (such as those with cancer, diabetes, chronic infections and individuals on continued steroid therapy)
• People under 19-years-old who are on long-term aspirin therapy 

Medications, which work best if started within 48 hours of the start of symptoms, may shorten the time you are sick and can prevent complications. Side effects may include nausea and vomiting, and in children, confusion and abnormal behavior.

Lisa Kanwischer, P.A., is a certified physician assistant at ProMed Pediatrics.  For an appointment or more information, call ProMed Pediatrics in Richland at (269) 552.2500 or the Woodbridge location in Portage at (269)329-0944.

It may be nearing the end of summer in Michigan, but there’s still a great deal of discussion out there regarding sunscreen and its labeling.

In June of this year, the FDA modified its sunscreen labeling regulations. Unless they meet the FDA testing standards for protection against ultraviolet A (UVA) sunlight, sunscreens can no longer be labeled “broad spectrum.”

Protection against UVA is not included in the sun protection factor (SPF) number. While SPF has been the gold standard for conveying the strength of sunscreens, this number only looks at the sunscreen’s protection from UVB rays. However, overwhelming evidence shows that UVA radiation also contributes to early aging of the skin, as well as skin cancers like basal cell and squamous cell carcinoma, and melanoma. Only sunscreens that meet both UVA sun protection standards and have a UVB SPF of 15 or higher can be labeled as “broad spectrum,” and claim they protect against skin cancer and early skin aging.

Combined with these new standards, the FDA has banned the use of terms like “waterproof,” “sweat-proof” and “sunblock,” as sunscreen cannot actually provide these benefits. Instead, “water resistant” or “water resistance” can be used if the duration of the effect (either 40 or 80 minutes) is specified. Because their application differs from that of creams, oils and lotions, spray sunscreen formulations must also now provide additional information. These new regulations and labeling guidelines will begin in 2012 and 2013.

Physicians see these changes as long overdue, as they allow consumers to become better informed when making sunscreen choices. Regardless of the type chosen, it’s important to emphasize that sunscreens are effective for only two to three hours and must be reapplied often. Sunscreens should also be used with other protection measures, including wearing appropriate clothing and hats, limiting outdoor activities during peak hours of UV intensity, restricting activities to shaded areas, and wearing sunglasses.

Prevention Through Protection

Sun-protective practices for infants and children have been endorsed by the American Academy of Pediatrics (AAP) and American Academy of Dermatology (AAD). The skin of infants is thinner and more sensitive to the sun than the skin of older children. To protect your kids (no matter their age) from the sun, follow these recommendations:

• Remember, avoidance is the best way to protect your infant/children from the harmful effects of the sun. For babies under 6 months of age, try to keep them in the shade and out of direct sunlight. If they have to be in the sun, use sunscreens, longer clothing and a hat with a brim. When adequate clothing and shade are unavailable, a sunscreen with an SPF of 15 or higher should be applied to areas of skin (e.g., face, back of hands) of all children, including children younger than 12 months of age.
• Keep in mind, dermatologists recommend sunscreens with an SPF of 30 or higher. This is also the recommendation of the AAP and AAD, even though the FDA hasn’t approved sunscreen use for those under 6 months of age.
• There are no reported harmful side effects from today’s sunscreens. However, it’s a good idea to use sunscreens that don’t irritate the skin and/or eyes. Look for broad-spectrum, unscented brands with ingredients like zinc oxide and titanium dioxide, which tend to be less irritating and ideal for infants.
• Apply sunscreen early and often. You should apply sunscreen to your child 30 minutes before exposure to the sun, and then reapply the sunscreen every few hours. No sunscreen is waterproof, and must be reapplied at least every 90 minutes to two hours, particularly if your child spends a lot of time in the water.
• Protect your child’s lips, nose and eyes by applying a lip coating that contains sunscreen. If the nose (or some other area) has been repeatedly burned during the summer, cover it with zinc oxide or titanium oxide ointment. Protect your child’s eyes from the sun’s rays with good sunglasses.
• If your child has red or blonde hair, fair skin, and/or never tans, he/she is at higher risk for sunburn. These children need to use a sunscreen even for brief exposures and should avoid the sun whenever possible. Keep them out of the sun during the peak hours of 10 a.m. to 3 p.m., when the sun’s rays are the most intense.

Hazy or Bright, The Sun Harms Young and Old

Young or old, everyone is at risk for sunburn and its associated complications. The incidence of skin cancer continues to rise, occurring in younger and younger age groups. Since most skin damage happens in childhood, kids especially need to be protected from the sun’s burning rays. Sun exposure early in life increases the number of moles with genetic mutations (potentially leading to cancer). UV radiation exposure during the first year of life can have especially damaging long-term effects.

Think the sun is only dangerous when it’s bright out? Wrong. The harmful UV rays of the sun are invisible. Because he/she may feel cooler, and therefore, stay outside longer, your child may be exposed to more UV rays on foggy or hazy days. Exposure is also greater at higher altitudes. UV rays reflect off sand, water, snow and other surfaces, so even a big hat or an umbrella doesn’t offer absolute protection.

Relief for Sunburns

No matter how diligent we are about protection, most of us will suffer at least one sunburn during our lifetime. Leaving the skin pink/red, warm and painful, sunburns are typically first-degree burns. Prolonged sun exposure can cause blistering and a second-degree burn. In severe cases, sunburns can cause blistering, fever, chills, headache and a general feeling of illness.

If your child’s burn is minor (i.e., red, warm and painful), you can most likely treat it yourself using the following methods:

• Ibuprofen: Start ibuprofen (Motrin) or acetaminophen (Tylenol) for pain relief as soon as possible. Ibuprofen also treats the swelling from a sunburn. You may continue giving your child Motrin or Tylenol for two days.
• Steroid Cream: Apply 1-percent hydrocortisone cream as soon as possible. Use the cream three times a day for two to three days.
• Cool Baths: Apply cool compresses to the burned area several times a day to reduce pain and burning. To avoid a chill, limit cool baths (for larger sunburns) to 10 minutes. If possible, avoid using soap.
• Extra Fluids: To replace fluids lost and prevent dehydration, offer extra water during the first day of the sunburn.
• Blisters: Do not touch or attempt to treat blisters to prevent infection.
• Antibiotic Ointment: For large, open blisters, apply an antibiotic ointment.

Pain will usually stop after two or three days. Your child’s skin may peel at the site of the burn between day five and seven. If the pain becomes severe, the sunburn looks infected,  or your child develops a fever or becomes ill, call your doctor or seek medical attention.

A Seagull Named Sid

When it enlisted the help of a cartoon seagull named Sid, Australia created an effective public-health campaign. Sid encouraged Aussies to “Slip, Slop, Slap.” The message encouraged people of all ages to slip on a shirt, slop on the sunscreen and slap on a hat to protect themselves from the sun’s harmful rays. Today, the message now includes “Seek Shade” and “Slide on Some ‘Sunnies’” (an Australian term for sunglasses). The Slip, Slop, Slap, Seek, Slide message is a catchy way for you to teach your family how to stay safe from the sun.

Thomas Akland, DO, is a board-certified pediatrician. For an appointment or more information, call ProMed Physicians-Pediatrics in Portage at (269) 329.0944.