From the desk of Doc Smo: Sunscreen Essentials (Article)

As you send your children off to the wilds of summer camp, the pool, the lake, and other very sun-intense places, you should know some basic facts about young people and exposure to intense sunlight that includes ultraviolet rays. Young people are very susceptible to photo damage of their skin for number of reasons:
 
*Their skin is thinner than adults, and radiation presumably penetrates that much deeper

*They haven’t been out in the sun as much, and they therefore have less pigmentation to act as a natural sunscreen and to limit photo damage

*They are less aware of their surroundings and the danger intense sun exposure poses for them.

*They are therefore much less likely to protect themselves by getting out of the sunlight.

*Since sun damage may take more than 25 years to show itself, very young children are much more likely to live long enough for light-induced tumors actually to form.

*Finally, young children are more likely to expose more skin to the sun because they often lack inhibition to being naked or semi-naked.
 
If all that isn’t enough, consider the following data collected a number of years ago. People who had a severe BLISTERING sunburn in childhood have increased their chance of the deadliest type of skin cancer–melanoma skin cancer–tenfold! That’s right, they were TEN TIMES more likely to develop skin cancer than their peers who had not had severe skin damage as a child. The genetic injury to the skin cells that ultraviolet radiation causes is permanent and will be carried with your child for the rest of their days. I don’t think there is any doubt that a BLISTERING sunburn is really bad for you and your children.
 
Let’s review some things you need to consider at the beginning of the summer to make your next day in the sun as safe as possible:
 
*Use clothing with tight weaving or added sun protection to cover your children as much as possible. Hats, special swim clothes, and sunglasses with UV protection are great. Try to get clothes with a UPF (ultraviolet protection factor) of at least 25 or better.

*Try never to talk about a “healthy tan,” and make sure you set a good example by protecting your skin as well.

*Avoid prolonged outdoor activities at peak sun times: 10am to 2pm.

*Try to stay in shade whenever possible.

*In children six months or older, use a good sunscreen on areas most prone to sun damage (THE TOPS): top of nose, top ears, top of feet, and top of shoulders. I recommend sunscreens with either zinc oxide or titanium dioxide. Blue Lizard and Vanicream are two of my favorites. Put them on frequently and liberally!

*Early summer seems to be the time of year for the worst burns. Be especially careful in May/June.
 
Have fun, but be smart about it.

Parents, Enroll in “Camp Essential” June 13th-20th! (Article)

Last week we brought you a theme week revolving around potty training. Since summer is upon us and many children are heading off to some kind of camp, we thought you might enjoy learning some “Camp Essentials”. Learn some basics about swimmer ear, poison ivy, sunscreens, bug repellents, overuse injuries, and the importance of swimming instruction for your children. Kick back, read some short articles and download a few Pedcasts to listen to around the pool or lake. Your free pediatric education continues!

From the desk of Doc Smo: A Constipation Conversation (Article)

How many ways can constipated children come to the doctor?
I am totally amazed at the myriad of presentations that constipated children present to their doctors. I remember listening to MANY complex lectures in medical school and residency about recurrent abdominal pain and trying desperately to memorize the LONG list of conditions that present as recurrent abdominal pain in children. After all these years of clinical practice, common sense has finally taken precedence. Hold onto your seats for this DocSmo pearl: “Common things are uncommonly common.” In other words, don’t look for exotic illness when, most likely, everyday maladies are probably at work. Humans have two “common” reasons their stomachs hurt:

1. A lower intestine that is not completely emptying (Constipation)
2. An overly acidic stomach that doesn’t empty well and may actually reflux (send contents backwards) into the esophagus.

Let’s take a moment to talk about the first cause, constipation. Little kids—and even big ones—sometimes find pooping unpleasant. At some level they avoid it, and it catches up with them. When it does, they come to the doctor complaining of cramping pain (hollow organ trying to empty), feeling sick after eating (nowhere for food to go from the stomach), gas (excess fermentation in the colon), burping (slow gastric emptying), back pain (referred pain), vomiting (no room in the Inn), bloating, leaking stool, rectal pain, prolapse of the rectum… and the list continues. I am sure that another 30 years will bring many new variations on the same theme.

I really think we may have been better off when we lived outdoors, pooping wherever and whenever. I doubt children growing up in those conditions ever had stomachaches for the reasons we do now. Everything has to be so perfect for our children. They need to poop at the right time (when an adult says it’s ok), only in “approved” places, and quickly and cleanly: the so called Demand Poop. No wonder all the fuss!

 

*By reading this post, you are agreeing to Doc Smo’s terms and conditions.

 

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Potty Training- “Let’s get started right” (Pedcast)

Transcript:

For those new listeners, Pedcast are podcasts where we discuss parenting topics ranging from the basinet to the boardroom; they are informational in nature and not intended to give medical advice about a specific child.  For that, see your child’s doctor.

Play

 

In today’s Pedcast, we are going to discuss the burning parental questions “When can we stop buying diapers?”  “When should I potty train my child?”  “Are pull-ups useful?”  I’m going to give you the DocSmo view of potty training young children.  I think I am going to convince you that success with potty training is more about your child than about your parenting skills.  Hopefully I am going to give you an understanding of where a child needs to be developmentally to master potty training.  Finally, in this episode, learn from the experience of generations past.

 

Most parents start thinking about potty training when their toddler gets to be about 18 months old, when language starts to emerge.  Once it is clear that Johnny can talk, it is logical to think that he can be coerced into urinating in the toilet.  Physiologically speaking, he does have control of his sphincter muscles by this age; they are under his control!  So, if he can control his muscles and can talk, why not be potty trained?  Well, lets think it through.  What does he have to do in order to be trained?

 

 

  • Step One: notice that his bladder is full, stop what he is doing, and be motivated to take action.
  • Step Two: tell someone that he needs to go pee.
  • Step Three: have the physical skills to pull his pants down (undress)
  • Step Four: now he gets to control his sphincter muscles
  • Step five: resume play as before

 

I don’t know about you, but this doesn’t sound like many of the toddlers that I know or have lived with.  Developmentally this sounds more like a 2 to 3 year old.  I counted 7 things Johnny had to do to have success at the potty. Remember, most 18 month olds barely have any expressive language, very short attention spans, have great difficulty transitioning between activities, and are not concerned about the consequences of their actions…but they do have control of their sphincter muscles!

 

Let’s let history be our guide on this one.  There was a time when children were forced into potty training around 18 months.  Until the invention of the modern disposable diaper, children were expected to master the “potty thing” by 18 months.  Most actually did to some degree but many either couldn’t, refused, or rebelled.  These rebellious children used the potty for a while and then began refusing, much to their parent’s dismay.  Think about it: after using the potty for a while, these children just refused to take over responsibility for this function.  Their parents at this point knew they were capable but unwilling.  The child was mad at being made to do something they were not ready to take responsibility for, and the parent was mad that the child “could” but “wouldn’t!”  The perfect recipe for friction.  And boy was there friction.

 

I have been told that famous pediatrician Dr. Benjamin Spock (no, not the Star Trek character, but the most famous pediatrician of the 20th century) came to the conclusion that many children were simply not ready to potty train at 18 months.  He thought that too much training by 18 months in many children put too much stress on the parent child relationship.  I happen to agree.

 

Conclusions and advice: should parents wait until 2 to start?  Toddlers have the physical skill to control the muscles of pottying.  They often do not have the other “READINESS” things necessary to be successful at taking control of their bodily waste:

 

  • Awareness of the need and willingness to stop what they are doing when bathroom time is needed
  • Language to tell someone they need help
  • Physical agility to take off their clothes
  • Judgment to limit their toileting to the toilet
  • And the ability to transition back to play

 

Once your child has reached the proper developmental level as described, potty training is usually easy.

 

During the training process, remember:

  • Reward not punishment is best.
  • Praise any and all success…your attention and approval is the ultimate prize
  • Provide them with some cool underwear to get started
  • Once you have decided that they are ready and training has begun, don’t go back and forth between underwear and diapers….bad message.  Stick with the underwear even when they are having accidents.
  • Don’t force your child to sit on the toilet if they are fearful
    • Provide a low toilet if they prefer it …toilets are high for young children.  Let them play with it or sit on it and even pretend with it.
  • Potty should be their friend
  • Teach them the vocabulary of potty
  • Bath time is a great time to begin learning
    • Most bladders empty every 3 hours, so try every 2-3 hours to have your child visit the toilet during the daytime.
  • Don’t over-react to accidents no matter how much you love that oriental carpet.
  • I have to tell you, I am not a fan of pull ups…diapers with a different design.  Useful for overnight dryness but in my opinion, not for training.
  • Finally, relax: keep in mind that all developmentally normal children will eventually be trained…be patient.

Thanks for joining me today.  Feel free to check out any and all of the other Pedcasts on Docsmo.com.  It is my privilege to spend a few minutes with you today giving you my perspective on child health issues.  If you have insights or comments you would like to share, feel free to join the discussion at my blog, DocSmo.com.  This is Dr. Paul Smolen, your host, broadcasting from studio 1E in Charlotte, NC.  Hoping your child feels free… to have success controlling his or her  pee!

 

Until next time

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

 

© All Right’s Reserved.