Never Start a Habit That Someday You Will Want To Quit

Knowing a habit is dangerous and quitting a dangerous habit are two different things. Empower your teens and their friends with the tips below. My adolescent patients could repeat my quip, "Never start a habit that someday you will want to quit."

E-Cigarettes and Vaping: What Parents Need to Know

E-cigarettes have become very popular. These devices (also called

e-cigs, vape pens, e-hookah, e-cigars, mechanical mods, and pod

systems) are not a safe alternative to cigarette smoking. The

American Academy of Pediatrics (AAP) supports actions to

prevent children and youth from using or being exposed to the

vapor from e-cigarettes. This fact sheet offers facts and tips for

parents to help address e-cigarette use and exposure.

Common types of e-cigarettes

Health Harms

• The solution and vapor from e-cigarettes contain harmful chemicals, some of which cause cancer

• The nicotine in e-cigarettes is addictive and can harm brain development

• E-cigarettes are not recommended as a way to quit smoking

• In some cases, e-cigarettes have exploded, causing burns or fires

• Exposure to secondhand vapor from e-cigarettes is harmful to growing lungs

• Long-term health effects on users and bystanders are still unknown

• E-cigarettes can be used to smoke or “vape” marijuana, herbs, waxes, and oils

Dangers to Youth

• E-cigarettes are the most commonly-used tobacco product among teens: in 2018, over 20% of high

school students reported having used e-cigarettes in the last 30 days

• Youth are uniquely vulnerable to the nicotine in e-cigarettes because their brains are still developing

• Youth who use e-cigarettes are more likely to smoke traditional cigarettes in the future

• Children are exposed to e-cigarette advertising in the media, online, and in magazines and billboards

• E-cigarettes appeal to children because they come in fun flavors like fruit, bubble-gum and candy

• Although it is illegal for e-cigarettes to be sold to youth under age 18, they can be ordered online

Risk of Poisoning

• E-cigarette solutions can poison children and adults through swallowing or skin contact

• A young child can be killed by very small amounts of nicotine: less than half a teaspoon. Because of

this, liquid nicotine is required to be sold in childproof packaging

• Symptoms of nicotine poisoning include sweating, dizziness, vomiting, and increased heart rate.

• Calls to poison control centers related to e-cigarettes have skyrocketed in the last 5 years

• If exposure to liquid nicotine occurs, call the local poison center at 1-800-222-1222

Recommendations for Parents

• The best way to protect your children is to never smoke or vape in the house, in the car, or in places

that children spend time. Talk with your doctor about ways to help you quit tobacco products

• Talk to your children about the dangers of e-cigarettes, and make sure you can identify them

• If you are an e-cigarette user, always keep e-cigarettes and liquid nicotine locked and out of the

reach of children. Protect your skin if handling e-liquid

For more information about these devices, including statistics and citations, please visit

http://www2.aap.org/richmondcenter/ENDS.html

Visit the AAP Richmond Center online at: www.richmondcenter.org

The Lousiest House Guest This Summer

The Lousiest House Guest

When a member of the Pediculus Humanus Capitus family decides to visit during the summer, no one is happy. While this family has been around for close to two million years, and really doesn’t take up much room, they are not a welcome beach or summer camp guest. These visitors, otherwise known as head lice, have sent many families into sheer panic and when one is panic stricken one doesn’t think straight. In the United States, the stress and stigma around a child’s case of head lice is worse than the actual head lice. So, let’s get the facts straight.

• Head lice cannot fly or jump. They find a new home from direct head-to-head contact with a friend.

• Head lice are not spread by animals. Humans are the one and only lucky hosts. Our scalps are their sole source of food where they anchor to hair shafts and experience their entire life cycle.

• Anyone can acquire head lice. It is not associated with poor hygiene or the level of cleanliness of a home, camp or class room.

• Head lice do not spread disease.

• Lice cannot not live on inanimate objects like bed linens and stuffed animals for more than 48 hours. Eggs cannot hatch at temperatures lower than the scalp, therefore, less than 2% of transmission occurs through shared combs, brushes and hats.

• The presence of nits (empty egg casings) does not signify active infestation and children should not be banned from school because of the presence of nits.

What is that white stuff in your hair?

Dandruff, sand, dry shampoo and dried hair spray can be lice egg and nit impostors. Your suspicion of head lice should be heightened if the white things attached to the hair are the size of sesame seeds, close to the scalp and stuck to individual hair strands like glue. Due to impostors, it is wise to get a confirmed diagnosis prior to treatment.

What do we do now?

After confirming the diagnosis, there are several “Over the Counter” treatments and home remedies to get rid of these pesky houseguests. While local resistance to various products exists, often unsuccessful treatment is related to not repeating the “Over the Counter” treatment at the recommended interval. Your pediatrician should know about local resistance.

Several home remedies and occlusive products are available. Since they are not regulated by the FDA, there are minimal studies about their effectiveness. One uncontrolled, nonrandomized study reported a 96% cure rate with Cetaphil Cleanser applied to the hair, dried on with a hair dryer, left on overnight and then washed out in the morning with weekly repeats for 3 weeks.

Manual removal of live lice and nits is inherently the least toxic and most likely the most threatening treatment for the parent-child relationship. While removal of nits (egg casings) is esthetically beneficial, nits do not represent infestation.

The following steps will help prevent re-infestation by lice that have reached clothing or furniture in the 48 hours prior to treatment.

• Machine wash and dry clothing, bed linens, and other items that the infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry–cleaned.

• Vacuum the floor and furniture, particularly where the infested person sat or lay.

• Soak combs and brushes in hot water (at least 130°F) for 5–10 minutes.

• Remind yourself that head lice survive less than 2 days once they fall off a person and cannot feed; eggs cannot hatch and usually die within a week if they are not kept at the same temperature as that found close to the human scalp.

What about school, camp, practice?

A child who is determined to have head lice in school or other location may remain there with strict avoidance of head-to-head contact with others. A parent should be notified and prompt, proper treatment should be started upon reunion with the caregiver.

Children who are complaining of scalp discomfort or who have had direct head-to-head contact with a child with lice should be evaluated. Because of the lack of good evidence of efficacy, routine classroom or school wide screening should be discouraged. It is more effective to have parents be on the lookout at home.

Since nits are not a sign of active infestation, “no-nit” policies that exclude children from school until all nits are gone are discouraged by the American Academy of Pediatrics. Non-viable nits may remain after treatment and will not cause transmission to another child. Some schools still practice “no-nit” policies resulting in torturous and unnecessary comb outs at home and missed days of school. In fact, because head lice have low contagion within classrooms, where head-to-head contact does not often occur, having children with active lice stay in the classroom could be considered.

Bicycle Safety – Helmets and Beyond

There seems to be a false sense of safety that we embrace when on vacation. Vacations spots like the Jersey Shore are happy places where we leave our worries behind. Families let down their hair and often let down their guard.  While homework rules may not apply in the summer and definitely not at the shore, bicycling rules apply all year around at both home and on the lovely sand blown streets of the shore. I am struck by the number of bicyclists I see at the shore not wearing bike helmets.  In the case of a crash or fall, bike helmets are known to reduce head and facial injury by 80%.  Most notable, they reduce injury in the population that falls the most – children. New Jersey’s law states that young people under the age of 17 are required to wear an approved helmet when cycling, roller skating, in-line skating, or skateboarding. The proper position of a helmet is flat on top of the head to ensure coverage of the forehead with a snugly, fastened strap to prevent wiggling. Wearing a bike helmet is a safety feature which should be adopted by bicyclists of all ages, however, it should not give riders a false sense of security and increase risky riding behavior.

Additional safety habits to employ when taking off to explore are to:

• Ensure that the brakes work, tires are filled, the seat is positioned so that your toes just touch the ground when seated, a bell is present, reflectors are secure and headlights and taillights work, if riding at dusk or at night.
• Tie shoelaces and avoid wearing flowing pant legs or skirts which can get caught in a pedal or wheel.
• Always ride with traffic and not against oncoming traffic.
• Act like a car and always obey all traffic rules, ride in single file and use proper hand signals when turning.
• Never wear headphones or use a phone while riding.
• Wear bright or fluorescent colored clothing, which are more visible than white clothing, especially when biking at night.

According to the NJ Bicycle and Pedestrian Resource Center, “While riding a bicycle on a sidewalk is not prohibited by New Jersey statutes, some municipalities have passed ordinances prohibiting bicycle traffic on certain sidewalks. This prohibition is usually posted. It should be noted, that sidewalks are for pedestrians. Riding on sidewalks can cause conflicts with pedestrians and, like wrong way riding, can lead to crashes since it places bicyclists in situations where others do not expect them. Except for very young cyclists under parental supervision, sidewalks are not for bicycling.” Bikers, pedestrians and car drivers play a part in keeping everyone safe on the road.  As more people choose to bike, drivers and pedestrians alike will know to be on the lookout for bikers and to share the road making it safer for everyone. So, tie your shoes, grab your helmets, your bikes, your family and head off for some frozen yogurt.

By Barbara Klock, MD appearing in “The Roasted Beat” publication

Water Fun - Friend or Foe

It is time for fun in the sun and fun in the sun involves water.  While enjoying the summer months with friends and family, it is important to remain alert to water safety every day and every time you are around water. Children ages 1-4 have the highest drowning rates and most drownings in this age group occur in home swimming pools. Except for birth defects, drowning is responsible for more deaths among children ages 1-4 years than any other cause. Drownings in natural water settings and boating related accidents increase with age.  In 2010, almost three quarters of boating deaths were caused by drowning with close to 90% of victims not wearing life jackets. Alcohol use is involved with up to 70% of deaths associated with water recreation in adolescents and adults. Half of swimmers who experience a non fatal drowning event require hospitalization. Drowning injuries can result in long term disabilities such as memory loss, learning disabilities and loss of basic functions.

Tips for a summer of safe play in the water:

• Designate an adult to watch children in or around water at all times. Drowning occurs quickly and quietly with no shouting or splashing.  Someone who is drowning can often look like they are being playful with their head in the water as they struggle to stay afloat, therefore, the supervising adult should not be distracted by reading, phone use, food preparation, lawn mowing or any other activity.
• Partake in formal swimming lessons but don’t assume that swimmers cannot drown. Often good swimmers will take more risks especially in natural water settings and also risk swimming alone.
• Always swim with a buddy and select swimming sites where a lifeguard is present. Do not depend solely on the lifeguard to supervise children
• Learn Cardiopulmonary Resuscitation (CPR).
• Avoid alcohol before or during swimming, boating or water sports and especially when supervising children.   
• Educate children in avoiding participation in underwater breath holding games.  This can cause a swimmer to blackout under water and drown.
• Isolate pools with a four-sided fence.  Four sided fences reduce a young child’s risk of drowning by 83%.
• Wear U.S. Coast Guard approved life jackets when boating. Do not depend on air filled or foam toys like water wings and “noodles” to keep swimmers safe.
• Know the weather conditions and rip current risk before heading out.

Swimming, boating and enjoying natural settings are fabulous ways to enjoy the summer and each other when attention to safety accompanies the fun. Enjoy!

An Important Reminder - NO ASPIRIN for Children or Teens

Have you noticed that the fever and pain reducers recommended for your child are Tylenol (acetaminophen) or Motrin (ibuprofen)? Never ever is aspirin mentioned.

Why is that?

Back when current parents were children themselves, it was discovered that children who had flu symptoms, chicken pox or other viral illnesses and took aspirin for relief of these symptoms were at greater risk of developing a rare but serious condition called Reye’s Syndrome.

Reye’s syndrome causes liver degeneration and brain swelling in children younger than 18 years old.  The cause is unknown; however, the taking of aspirin by a child at the time of a viral illness has been implicated as a possible causative agent.

In 1978, the CDC was informed that several children developed Reye’s syndrome during an influenza outbreak, and by 1980, the CDC demonstrated a link between those patients and the administration of aspirin-containing medications. In 1980, 555 cases of Reye’s syndrome were reported in the United States.  In response, the CDC, American Academy of Pediatrics and the Surgeon General published educational statements and added a “Black Box” warning not to give aspirin to children and teenagers with influenza or chicken pox.  By the mid-1980s, baby aspirin was removed for use of all routine fevers because one might not know if the fever was related to influenza, chicken pox or other viral illnesses. Large warning signs educating parents about the complete avoidance of aspirin for fever were visible in pharmacies and elsewhere for the following decade.

These educational signs are now gone but aspirin remains in households for appropriate use by adults.

I write this post to educate both parents, grandparents and “older” caretakers who may recall giving their children baby aspirin for febrile illnesses. The very same dosage is now used by many adults as part of their daily regimen.  I can envision a scenario where a well intentioned person uses the aspirin in place of Tylenol or Motrin until either of these medications is acquired.  Please educate your caregivers about complete avoidance of aspirin for your child.

One more thing - there are many other products that contain salicylate, the ingredient in aspirin that children should avoid.  These include Pepto-Bismol, Kaopectate, Alka Seltzer, Excedrin, Ecotrin and others. For a complete list, please refer to:

http://www.reyessyndrome.org/pdfs/nonrxprintable.pdf

The National Reye's Syndrome Foundation, the U.S. Surgeon General, the FDA, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics recommend that aspirin and combination products containing aspirin not be taken by anyone younger than 19 years during fever-causing illnesses.

Please note: Children with cardiac issues, rheumatoid arthritis or other chronic issues may be appropriately prescribed aspirin as part of their regimen.