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Author: Charish Barry, MD

Insect Bites and Stings

Posted on by Charish Barry, MD in

Your child’s reaction to a bite or sting will depend on her sensitivity to the particular insect’s venom. While most children have only mild reactions, those who are allergic to certain insect venom can have severe symptoms that require emergency treatment.

In general, bites are usually not a serious problem, but in some cases, stings may be. While it is true that most stings (from yellow jackets, wasps, and fire ants, for example) may cause pain and localized swelling, severe anaphylactic reactions are possible, although uncommon.

If your child is having a severe reaction to an insect bite or sting, call for medical help immediately.  If your child is experiencing moderate pain or itching for a prolonged period of time, call (805) 845-1221 to schedule an appointment at Petite Pediatrics today. Our highly trained pediatrician, Dr. Charish Barry, can treat the bite or sting and test for allergies if deemed necessary.

Treatment

Although insect bites can be irritating, they usually begin to disappear by the next day and do not require a doctor’s treatment. To relieve the itchiness that accompanies bites by mosquitoes, flies, fleas, and bedbugs, apply a cool compress and/or calamine lotion freely on any part of your child’s body except the areas around her eyes and genitals. If your child is stung by a wasp or bee, soak a cloth in cold water and press it over the area of the sting to reduce pain and swelling. Call your pediatrician before using any other treatment, including creams or lotions containing antihistamines or home remedies. If the itching is severe, the doctor may prescribe oral antihistamines.

If your child disturbs a beehive, get him away from it as quickly as possible. The base of a honeybee’s sting emits an alarm pheromone (hormone) that makes other bees more likely to sting as well.

It is very important to remove a bee stinger quickly and completely from the skin. The quick removal of a bee stinger will prevent a large amount of venom from being pumped into the skin. If the stinger is visible, remove it by gently scraping it off horizontally with a credit card or your fingernail. Avoid squeezing the stinger with a pair of tweezers; doing this may release more venom into the skin. The skin may be more swollen on the second or third day after a bee sting or mosquito bite.

Keep your child’s fingernails short and clean to minimize the risk of infection from scratching. If infection does occur, the bite will become redder, larger, and more swollen. In some cases you may notice red streaks or yellowish fluid near the bite or your child may get a fever. Have your pediatrician examine any infected bite right away, because it may need to be treated with antibiotics.

Call for medical help immediately if your child has any of these other symptoms after being bitten or stung:

  • Sudden difficulty in breathing
  • Weakness, collapse, or unconsciousness
  • Hives or itching all over the body
  • Extreme swelling near the eyes, lips, or penis that makes it difficult for the child to see, eat, or urinate
  • Prevention
  • Some children with no other known allergies may have severe reactions to insect stings. But if you suspect that your child is allergy-prone, discuss the situation with your doctor. He may recommend a series of shots (hyposensitization injections) to decrease your child’s reaction to future insect stings (but not bites). In addition, he will prescribe a special auto-injection kit containing epinephrine for you to keep on hand for use if your child is stung.

It is impossible to prevent all insect bites, but you can minimize the number your child receives by following these guidelines.

Avoid areas where insects nest or congregate, such as garbage cans, stagnant pools of water, uncovered foods and sweets, and orchards and gardens where flowers are in bloom.
When you know your child will be exposed to insects, dress her in long pants and a lightweight longsleeved shirt.
Avoid dressing your child in clothing with bright colors or flowery prints, because they seem to attract insects.
Don’t use scented soaps, perfumes, or hair sprays on your child, because they also are inviting to insects.
Insect repellents are generally available without a prescription, but they should be used sparingly on infants and young children. In fact, the most common insecticides include DEET (N, N-diethyl-m-toluamide), which is a chemical not recommended for use in children under two months of age. Do not apply DEET-containing repellents more than once a day on older children.

The concentrations of DEET vary significantly from product to product—ranging from less than 10 percent to over 30 percent—so read the label of any product you purchase. Some products have concentrations much higher than 30 percent, and the higher the concentration of DEET, the longer the duration of action. Its effectiveness peaks at a concentration of 30 percent, however, which is also the maximum concentration currently recommended for children. The safety of DEET does not appear to be related to its level of concentration; therefore, a prudent approach is to select the lowest effective concentration for the amount of time your child spends outdoors. You should avoid products that include DEET plus a sunscreen, because sunscreen needs to be applied frequently while DEET should be applied only once a day. If you apply DEET more frequently, it may be associated with toxicity. Also be sure to wash off the DEET with soap and water at the end of the day.

An alternative to DEET is a product called picaridin (KBR 3023). While it has had wider use in Europe, picaridin has more recently become available in the US. It is a generally pleasant- smelling product without the oil residue associated with DEET, and is available in concentrations of 5 to 10 percent.

The American Academy of Pediatrics recommends that repellents used in children over six months of age have 30 percent DEET or 5 to 10 percent picaridin repellent, applied once before going outdoors. These repellents are effective in preventing bites by mosquitoes, ticks, fleas, chiggers, and biting flies, but have virtually no effect on stinging insects such as bees, hornets, and wasps. Contrary to popular belief, giving antihistamines continuously throughout the insect season does not appear to prevent reactions to bites.

Insect Bites and Stings

Mosquitoes
Water (pools, lakes, birdbaths)
Stinging sensation followed by small, red, itchy mound with tiny puncture mark at center.
Mosquitoes are attracted by bright colors and sweat.

Flies
Food, garbage, animal waste
Painful, itchy bumps; may turn into small blisters.
Bites often disappear in a day but may last longer.

Fleas
Cracks in floor, rugs, pet fur
Multiple small bumps clustered together; often where clothes fit tightly (waist, buttocks).
Fleas are most likely to be a problem in homes with pets.

Bedbugs
Cracks of walls, floors, crevices of furniture, bedding
Itchy red bumps occasionally topped by a blister; usually 2–3 in a row.
Bedbugs are most likely to bite at night and are less active in cold weather.

Fire ants
Mounds in pastures, meadows, lawns, and parks in southern states
Immediate pain and burning; swelling up to 1⁄2 inch (1.2 cm); cloudy fluid in area of bite.
Fire ants usually attack intruders.

Bees and wasps
Flowers, shrubs, picnic areas, beaches
Immediate pain and rapid swelling.
A few children have severe reactions, such as difficulty breathing and hives/swelling all over the body.

Ticks
Wooded areas
May not be noticeable; hidden on hair or on skin.
Don’t remove ticks with matches, lighted cigarettes, or nail polish remover; grasp the tick firmly with tweezers near the head; gently pull the tick straight out.

 

Introducing CloudVisit Telemedicine at Petite Pediatrics

Posted on by Charish Barry, MD in ,

 

We are excited to offer our patients the option of a telemedicine visit.

Telemedicine is a secure way to communicate with Dr. Barry via electronic devices such as smart phones, tablet and lap/desktop computers. For families that may be traveling outside of the Santa Barbara area, this enables us to maintain continuity of care by discussing and evaluating non-emergent medical concerns.

The American Academy of Pediatrics has endorsed the use of telemedicine for children’s healthcare and recommends that telemedicine services be delivered in the context of a medical home, because this model of health care provides continuity and efficiency.

You can register with our telemedicine service CloudVisit Connect by linking to the icon above.

This is a service that is billable to insurance and  is based upon the duration of time for the telemedicine appointment.

Newborn Eye Color

Posted on by Charish Barry, MD in

https://www.healthychildren.org/English/ages-stages/baby/Pages/Newborn-Eye-Color.aspx

Newborn Eye Color

New parents often ask what color I think the baby’s eyes are going to be. I never answer this question until the child is at least 1 year old; I mean, what if the parents believe me and use my answer to make major life decisions? When we talk about eye color, we’re really talking about the appearance of the iris, the muscular ring around the pupil that controls how much light enters the eye. After all, the pupil will always be black, except in flash photos, and the whites (sclera) should stay pretty much white, although jaundice may turn them yellow and inflammation may make them look pink or red.

Gray or Blue Eyes at Birth
Iris color, just like hair and skin color, depends on a protein called melanin. We have specialized cells in our bodies called melanocytes whose job it is to go around secreting melanin where it’s needed, including in the iris. When your baby is born his eyes will be gray or blue, as melanocytes respond to light, and he has spent his whole life in the dark.

Eye Color Changes Over Time
Over time, if melanocytes only secrete a little melanin, your baby will have blue eyes. If they secrete a bit more, his eyes will look green or hazel. When melanocytes get really busy, eyes look brown (the most common eye color), and in some cases they may appear very dark indeed. Because it takes about a year for melanocytes to finish their work it can be a dicey business calling eye color before the baby’s first birthday. The color change does slow down some after the first 6 months of life, but there can be plenty of change left at that point.

Eye color is a genetic property, but it’s not quite as cut-and-dried as you might have learned in biology class.

  • Two blue-eyed parents are very likely to have a blue-eyed child, but it won’t happen every single time.
    Two brown-eyed parents are likely (but not guaranteed) to have a child with brown eyes.
    If you notice one of the grandparents has blue eyes, the chances of having a blue-eyed baby go up a bit.
    If one parent has brown eyes and the other has blue eyes, odds are about even on eye color.
    If your child has one brown eye and one blue eye, bring it to your doctor’s attention; he probably has a rare genetic condition called Waardenburg syndrome.

Cross-Eyed?
Parents also often note that their newborns’ eyes appear to cross from time to time. For the first 6 months of life this can be normal. To begin with, to look at something the brain has to know where to point the eyes. For the first 2 to 4 weeks of life vision is not accurate enough for the baby’s eyes to find a target a lot of the time. Parents often feel like their newborns are looking past them rather than at them, because they are. By the fourth week of life, however, your baby will focus on your face if you’re cradling him.

Most visual development occurs in the brain, not in the eyes themselves. One of the greatest challenges for the developing brain is to coordinate visual signals from one side to the other. Nerve signals from the eyes travel through optic nerves and split off to both sides of the brain. To make sense of those signals, the 2 sides of the brain have to cooperate, comparing information and coordinating eye movement in the desired direction. Until age 2 months you may notice your infant will follow your face or a toy a little way, then lose it as it crosses from one side to the other. By 2 months, however, he should be able to track from right to left and back again.

The next big visual milestone occurs at 6 months of age. By this time the 2 sides of the brain are on good terms with each other. Until this point the eyes track together as long as they both have something to look at, but if one is deprived of input (from being covered by a hat, for example), it might drift off in its own direction. By 6 months of age the eyes should continue looking the same direction even if one of them is covered temporarily. We test this in the clinic by covering 1 eye for 3 seconds, then suddenly uncovering it and looking to see if it’s still tracking with the opposite eye. We call this test the cover-uncover test.

Sometimes the shape of a child’s face makes it look as though the eyes are crossed even when they are not. A child with a broad nasal bridge may appear to have an inward-looking eye, when in fact he’s just looking off to the side. You can check this by watching the light reflection in your child’s eyes from a window or lamp; if it falls in the same place on each eye, the eyes are working together.

Even with office screening, however, we don’t always catch an eye that tends to deviate. Deviations occur more often when the child is tired. If you ever notice that your 6-month-old or older child has an eye that doesn’t always look the same way as its partner, alert his doctor. It’s critical that an eye specialist (ophthalmologist)examine the child. What some people call a lazy eye (amblyopia) may be a sign that one eye doesn’t see as clearly as the other. When the brain is forced to make 1 picture from 2 very different inputs, it starts to ignore the signals from the worse eye. Over time this process becomes irreversible, leading to partial blindness in the weaker eye. In most cases, you should address the problem before the child turns 3 to ensure he’ll grow up with normal depth perception. Treatments for amblyopia vary based on the cause and severity of the condition. Some children require glasses or patches that force the brain to pay attention to signals from the weaker eye. Other kids need surgery to shorten or lengthen certain muscles that control eye movement.
Author
David L. Hill, MD, FAAP
Last Updated
5/6/2015
Source
Dad to Dad: Parenting Like a Pro (Copyright © American Academy of Pediatrics 2012)

Tips on Physical Activity for School-Aged Children

Posted on by Charish Barry, MD in

https://www.healthychildren.org/English/healthy-living/fitness/Pages/Energy-Out-Daily-Physical-Activity-Recommendations.aspx

Energy Out: Daily Physical Activity Recommendations

​Physical activity in children and adolescents improves strength and endurance, builds healthy bones and lean muscles, develops ​motor skills and coordination, reduces fat, and promotes emotional well-being (reduces feelings of depression and anxiety). Activities should be appropriate for their age and fun, as well as offer variety.

The daily recommendation for physical activity for children 6 years and older is at least 60 minutes per day. Active play is the best exercise for younger children.
The types of physical activity should be moderate to vigorous. Vigorous activity is activity that makes you breathe hard and sweat. During vigorous activity, it would be difficult to have a talk with someone. Some activities, such as bicycling, can be of moderate or vigorous intensity, depending upon level of effort.

The 60 minutes does not need to be done all at once. Physical activity can be broken down into shorter blocks of time. For example, 20 minutes walking to and from school, 10 minutes jumping rope, and 30 minutes at the playground all add up to 60 minutes of physical activity. If your child is not active, start from where you are and build from there.

Types of Sports and Activities for Children and Teens (and Parents, Too!)

Aerobic Exercises

Use body’s large muscle groups
Strengthen the heart and lungs
Examples of moderate-intensity aerobic exercises include:
Brisk walking
Bicycle riding
Dancing
Hiking
Rollerblading
Skateboarding
Martial arts such as karate or tae kwon do (can be vigorous too)

Examples of vigorous-intensity aerobic activities include:
Basketball
Bicycle riding
Games such as tag
Ice or field hockey
Jumping rope
Martial arts
Running
Soccer
Swimming
Tennis

Muscle-Strengthening (or Resistance) Activities
Work major muscle groups of the body (legs, hips, back, abdomen, chest, shoulder, arms)

Examples of muscle-strengthening activities include:
Games such as tug-of-war
Push-ups or modified push-ups (with knees on the floor)
Resistance exercises using body weight or resistance bands
Rope or tree climbing
Sit-ups (curl-ups or crunches)
Swinging on playground equipment/bars
Bone-Strengthening (Weight-Bearing) Activities
Tone and build muscles and bone mass
Can be aerobic exercises and muscle-strengthening activities

Examples of bone-strengthening activities include:
Basketball
Hopping, skipping, jumping
Gymnastics
Jumping rope
Running
Tennis
Volleyball
Push-ups

Resistance exercises using body weight or resistance bands

About Strength Training
Strength training(or resistance training) uses a resistance to increase an individual’s ability to exert force. It involves the use of weight machines, free weights, bands or tubing, or the individual’s own body weight. This is not the same as Olympic lifting, power lifting, or body building, which are not recommended for children. Check with your child’s doctor before starting any strength training exercises.

Last Updated
5/5/2015
Source
Energy In Energy Out: Finding the Right Balance for Your Children (Copyright © 2014 American Academy of Pediatrics)

Play Time for Preschoolers

Posted on by Charish Barry, MD in

Let’s Play: Study Finds Preschoolers Need More Opportunities for Active Play

​​​​Physical activity is important for young children’s health and development, yet most 3- to 5-year-olds are not getting the two hours per day of recommended physical activity.

A study in the June 2015 Pediatrics, “Active Play Opportunities at Child Care​,” published online May 18, finds kids simply are not given enough opportunities for active play.

For the study, researchers observed 98 children from 10 child care centers in the Seattle area. All of the centers had scheduled at least 60 minutes per day of outdoorplay time, and they all had outdoor play areas as well as indoor space for physical activity. Researchers categorized children’s activity levels throughout the day, and the children wore accelerometers. In the study, children averaged 48 minutes per day of active play opportunities and only 33 minutes per day of actual outdoor time. Children had less than 10 minutes per day of teacher-led physical activities. For 88 percent of the time children were in the center, they were not given opportunities for active play, which explains the finding that children were sedentary for 70 percent of their time. Children were more likely to be active when outdoors and engaged in free play, rather than in teacher-led activities indoors or outdoors.

Study authors conclude that children should have more opportunities for active play during preschool. Possible strategies include increasing outdoor time, more child-initiated and teacher-led active play, and flexibility in naptime for older preschoolers.

Published
5/18/2015 12:00 AM

 

The Milestone of Riding a Bicycle…Tips to Get Started

Posted on by Charish Barry, MD in

https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Choosing-the-Right-Size-Bicycle.aspx

Choosing the Right Size Bicycle

A bicycle of the wrong size may cause your child to lose control and be injured. Any bike must be the correct size for the child for whom it is bought. To keep your child safe, the American Academy of Pediatrics recommends the following:

Do not push your child to ride a 2-wheeled bike until he or she is ready, at about age 5.
Take your child with you when you shop for the bike, so that he or she can try it out. The value of a properly fitting bike far outweighs the value of surprising your child with a new bike.
Buy a bike that is the right size, not one your child has to “grow into.” Oversized bikes are especially dangerous.
How to test any style of bike for proper fit
Sitting on the seat with hands on the handlebar, your child must be able to place the balls of both feet on the ground.
Straddling the center bar, your child should be able to stand with both feet flat on the ground with about a 1-inch clearance between the crotch and the bar.
When buying a bike with hand brakes for an older child, make sure that the child can comfortably grasp the brakes and apply sufficient pressure to stop the bike.
A helmet should be standard equipment. Whenever buying a bike, be sure you have a Consumer Product Safety Commission (CPSC)-approved helmet for your child.
Consider the child’s coordination and desire to learn to ride. Stick with coaster brakes until your child is older and more experienced.
Last Updated
5/11/2015
Source
TIPP: The Injury Prevention Program (Copyright © 1994 American Academy of Pediatrics, Updated 9/2005)

Sun Safety to Enjoy a Healthy and Fun Summer

Posted on by Charish Barry, MD in

https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Sun-Safety.aspx

Sun Safety: Information for Parents

About Sunburn & Sunscreen

It’s good for children and adults to spend time playing and exercising outdoors, and it’s important to do so safely.

Simple Rules to Protect your Family from Sunburns
Keep babies younger than 6 months out of direct sunlight. Find shade under a tree, an umbrella, or the stroller canopy.
When possible, dress yourself and your children in cool, comfortable clothing that covers the body, such as lightweight cotton pants, long-sleeved shirts, and hats.
Select clothes made with a tight weave; they protect better than clothes with a looser weave. If you’re not sure how tight a fabric’s weave is, hold it up to see how much light shines through. The less light, the better. Or you can look for protective clothing labeled with an Ultraviolet Protection Factor (UPF).
Wear a hat with an all-around 3-inch brim to shield the face, ears, and back of the neck.
Limit your sun exposure between 10:00 am and 4:00 pm when UV rays are strongest.
Wear sunglasses with at least 99% UV protection. Look for child-sized sunglasses with UV protection for your child.
Use sunscreen.
Make sure everyone in your family knows how to protect his or her skin and eyes. Remember to set a good example by practicing sun safety yourself.
Sunscreen
Sunscreen can help protect the skin from sunburn and some skin cancers but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer.

How to Pick Sunscreen
Use a sunscreen that says “broad-spectrum” on the label; that means it will screen out both UVB and UVA rays.
Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 (up to SPF 50). An SPF of 15 or 30 should be fine for most people. More research studies are needed to test if sunscreen with more than SPF 50 offers any extra protection.
If possible, avoid the sunscreen ingredient oxybenzone because of concerns about mild hormonal properties. Remember, though, that it’s important to take steps to prevent sunburn, so using any sunscreen is better than not using sunscreen at all.
For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and shoulders, choose a sunscreen with zinc oxide or titanium dioxide. These products may stay visible on the skin even after you rub them in, and some come in fun colors that children enjoy.
How to Apply Sunscreen
Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, hands, and even backs of the knees. Rub it in well.
Put sunscreen on 15 to 30 minutes before going outdoors. It needs time to absorb into the skin.
Use sunscreen any time you or your child spend time outdoors. Remember that you can get sunburn even on cloudy days because up to 80% of the sun’s UV rays can get through the clouds. Also, UV rays can bounce back from water, sand, snow, and concrete, so make sure you’re protected.
Reapply sunscreen every 2 hours and after swimming, sweating, or drying off with a towel. Because most people use too little sunscreen, make sure to apply a generous amount.
Sunscreen for Babies
For babies younger than 6 months: Use sunscreen on small areas of the body, such as the face, if protective clothing and shade are not available.
For babies older than 6 months: Apply to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into her eyes, wipe her eyes and hands clean with a damp cloth. If the sunscreen irritates her skin, try a different brand or sunscreen with titanium dioxide or zinc oxide. If a rash develops, talk with your child’s doctor.
Sunburns
When to Call the Doctor
If your baby is younger than 1 year and gets sunburn, call your baby’s doctor right away. For older children, call your child’s doctor if there is blistering, pain, or fever.

How to Soothe Sunburn
Here are 5 ways to relieve discomfort from mild sunburn:

Give your child water or 100% fruit juice to replace lost fluids.
Use cool water to help your child’s skin feel better.
Give your child pain medicine to relieve painful sunburns. (For a baby 6 months or younger, give acetaminophen. For a child older than 6 months, give either acetaminophen or ibuprofen.)
Only use medicated lotions if your child’s doctor says it is OK.
Keep your child out of the sun until the sunburn is fully healed.​

Last Updated 5/11/2015
Source Fun in the Sun: Keep Your Family Safe (Copyright ? 2008 American Academy of Pediatrics, Updated 4/2014)

A Vitamin a Day…

Posted on by Charish Barry, MD in , ,

 

It has been estimated that just over half of all preschoolers are given multivitamins. We’re pretty sure that’s a good bit more than are served broccoli on any given day. And we’re quite sure we can relate to the reasons why. When the going gets tough, it is often a whole lot easier to reach for a quick fix in a bottle of Flintstones vitamins and forget the fight. The fact that there are so many parents who do just that isn’t so much a food fight, per se, but a reflection on the parental feelings that so many share that what we’re feeding our children is nutritionally inadequate. While we can definitely understand the sentiment, it compels us to address the fundamental question: What role should multivitamins play in your child’s diet, and is it you or your child that stands to benefit from them more?

Who Needs ‘Em, Anyway?

We’ll come right out and say what most nutrition experts have been saying all along: Most children don’t need vitamin supplements at all! Yes, we realize that the perfect, vegetable-loving, cooperative eater we all long for doesn’t exist. But even taking all food fights into consideration, there are nevertheless very few instances in which a child’s diet is likely to leave him truly deficient.

If you need further convincing, we suggest you consider the following facts:

  • The amount your child needs to eat to get enough vitamins and minerals from his food alone is probably much smaller than you think. Even for the pickiest of eaters, it doesn’t take more than a very few picks from each of the basic food groups for children to get their recommended daily dose.
  • Many vitamins can be stored in the body. This means that your child doesn’t have to eat each and every one every day—affording you the option of spreading your efforts at achieving a balanced diet out over the course of a week or two without spreading the vitamins too thin.
  • Ironically enough, parents who are most likely to give multivitamins are also those who are most likely to be feeding their children healthy diets in the first place.
  • Vitamins can be found in some unlikely sources. Calcium doesn’t just have to come from cows, since it is contained in both supplements and many nondairy foods ranging from salmon, tofu, spinach, and sardines to rhubarb, baked beans, bok choy, and almonds—admittedly not all of which are an easy sell at the dinner table, but at least you have plenty to choose from!
  • And finally, many foods these days are fortified. That means that even if your child favors foods that do not come naturally loaded with all of the necessary nutrients, all hope is not lost; it’s entirely possible that food manufacturers have added them in for you. Classic examples include the vitamin D fortification of milk, margarine, and pudding, and the calcium contained in kid-friendly foods such as orange juice, cereals, breads, and even Eggo waffles.

Schedule an Appointment at Petite Pediatrics

Dr. Charish Barry offers concierge-style care that is designed to provide highly personalized care to infants, children, and teens throughout the Santa Barbara area. She and her team of highly trained nurse practitioners will take the time to answer any questions you may have. Schedule an appointment at Petite Pediatrics today! Call our Santa Barbara office at (805) 845-1221.

A Vitamin a Day?

Posted on by Charish Barry, MD in , ,

Do toddlers need vitamins to make up for their picky eating?    You may be surprised at the answer!

It has been estimated that just over half of all preschoolers are given multivitamins. We’re pretty sure that’s a good bit more than are served broccoli on any given day. And we’re quite sure we can relate to the reasons why. When the going gets tough, it is often a whole lot easier to reach for a quick fix in a bottle of Flintstones vitamins and forget the fight. The fact that there are so many parents who do just that isn’t so much a food fight, per se, but a reflection on the parental feelings that so many share that what we’re feeding our children is nutritionally inadequate. While we can definitely understand the sentiment, it compels us to address the fundamental question: What role should multivitamins play in your child’s diet, and is it you or your child that stands to benefit from them more?

Who Needs ‘Em, Anyway?

We’ll come right out and say what most nutrition experts have been saying all along: Most children don’t need vitamin supplements at all! Yes, we realize that the perfect, vegetable-loving, cooperative eater we all long for doesn’t exist. But even taking all food fights into consideration, there are nevertheless very few instances in which a child’s diet is likely to leave him truly deficient.

If you need further convincing, we suggest you consider the following facts:

  • The amount your child needs to eat to get enough vitamins and minerals from his food alone is probably much smaller than you think. Even for the pickiest of eaters, it doesn’t take more than a very few picks from each of the basic food groups for children to get their recommended daily dose.
  • Many vitamins can be stored in the body. This means that your child doesn’t have to eat each and every one every day—affording you the option of spreading your efforts at achieving a balanced diet out over the course of a week or two without spreading the vitamins too thin.
  • Ironically enough, parents who are most likely to give multivitamins are also those who are most likely to be feeding their children healthy diets in the first place.
  • Vitamins can be found in some unlikely sources. Calcium doesn’t just have to come from cows, since it is contained in both supplements and many nondairy foods ranging from salmon, tofu, spinach, and sardines to rhubarb, baked beans, bok choy, and almonds—admittedly not all of which are an easy sell at the dinner table, but at least you have plenty to choose from!
  • And finally, many foods these days are fortified. That means that even if your child favors foods that do not come naturally loaded with all of the necessary nutrients, all hope is not lost; it’s entirely possible that food manufacturers have added them in for you. Classic examples include the vitamin D fortification of milk, margarine, and pudding, and the calcium contained in kid-friendly foods such as orange juice, cereals, breads, and even Eggo waffles.

Head Lice… what to know

Posted on by Charish Barry, MD in ,

No denying… Head lice is a nuisance, but they don’t cause serious illness or diseases ~

Also, head lice can be treated at home.

The following information from the American Academy of Pediatrics (AAP) will help you check for, treat, and prevent the spread of head lice.

What are head lice?

Head lice are tiny insects. They are about the size of a sesame seed (2–3 mm long). Their bodies are usually pale and gray, but color may vary. One “lice” is called a louse.

Head lice feed on tiny amounts of blood from the scalp. They usually survive less than a day if not on a person’s scalp. Lice lay and attach their eggs to hair close to the scalp.

The eggs and their shell casings are called nits. They are oval (about 0.8 x 0.3 mm) and usually yellow to white. Nits are attached with a sticky substance that holds them firmly in place. After the eggs hatch, the empty nits remain attached to the hair shaft.

Head lice live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Who gets head lice?

Anyone can get head lice. Head lice are most common in preschool– and elementary school–aged children. It doesn’t matter how clean your hair or home may be. It doesn’t matter where children and families live, play, or work.

How are head lice spread?

Head lice are crawling insects. They cannot jump, hop, or fly. The main way head lice spread is from close, prolonged head-to-head contact. There is a very small chance that head lice will spread because of sharing items such as combs, brushes, and hats.

What are symptoms of head lice?

The most common symptom of head lice is itching. It may take up to 4 weeks after lice get on the scalp for the itching to begin. Most of the itching happens behind the ears or at the back of the neck. Also, itching caused by head lice can last for weeks, even after the lice are gone. However, an itchy scalp also may be caused by eczema, dandruff, or an allergy to hair products.

How do you check for head lice?

Regular checks for head lice are a good way to spot head lice before they have time to multiply and infest your child’s head.

  • Seat your child in a brightly lit room.
  • Part the hair and look at your child’s scalp.
  • Look for crawling lice and for nits.
    • Live lice are hard to find. They avoid light and move quickly.
    • Nits will look like small white or yellow-brown specks and be firmly attached to the hair near the scalp. The easiest place to find them is at the hairline at the back of the neck or behind the ears. Nits can be confused with many other things, such as dandruff, dirt particles, or hair spray droplets. The way to tell the difference is that nits are attached while dandruff, dirt, or other particles are not.
  • Wet the hair. Use a fine-toothed comb to help comb out the lice or nits. Comb through your child’s hair in small sections. After each comb-through, wipe the comb on a wet paper towel. Examine the scalp, comb, and paper towel carefully.

How do you treat head lice?

Check with your child’s doctor first before beginning any head lice treatment. The most effective way to treat head lice is with head lice medicine. Head lice medicine should only be used when it is certain that your child has head lice.

When head lice medicines are used, it is important to use them safely. Here are some safety guidelines.

  • Follow the directions on the package.
  • Never let children apply the medicine. Medicine should be applied by an adult.
  • Check with your child’s doctor before beginning a second or third treatment. A second treatment is usually needed 10 days after the first treatment. In some cases a third treatment 10 days after the second treatment is needed.
  • Do not use medicine on a child 2 years or younger without first checking with your child’s doctor.
  • Do not use or apply medicine to children if you are pregnant or nursing without first checking with your doctor.
  • Store medicine in a locked cabinet, out of sight and reach of children.
  • Ask your child’s doctor if you have any questions.

Note: The comb-out method (removing head lice without medicine from damp hair with a fine-toothed comb) often fails. Also, home remedies, like using petroleum jelly, mayonnaise, tub margarine, herbal oils, or olive oil, have not been scientifically proven to work. Never use dangerous products like gasoline or kerosene or medicines made for use on animals!

What head lice medicines are available?

Here is a list of head lice medicines approved by the US Food and Drug Administration. Check with your child’s doctor before beginning any treatment.

Head Lice Medicines
TreatmentDescription
Permethrin cream (1%)Available without a prescription

Applied to shampooed and towel dried hair, then rinsed off after 10 minutes

Approved for use in children 2 months and older

Pyrethrin-based product (shampoo or hair mousse)Available without a prescription

Applied to dry hair and rinsed off after 10 minutes

Should not be used in people who are allergic to chrysanthemums

Malathion lotion (0.5%)Prescription needed

Applied to dry hair and rinsed off after 8 to 12 hours

Approved for use in children 6 years or older

Flammable; may cause chemical burns

Benzyl alcohol lotion (0.5%)Prescription needed.

Applied to dry hair and rinsed off after 10 minutes. Repeat in 7 days.

Contains no neurotoxic pesticide.

Approved for use in children 6 months and older. Not recommended for infants younger than 6 months.

Spinosad topical suspension (9%)Prescription needed.

Applied to dry hair and rinsed off after 10 minutes.

Approved for use in children 4 years and older. Not recommended for infants younger than 6 months.

Made from a naturally occurring soil bacterium that causes lice to become paralyzed and then die. Also contains benzyl alcohol.

Ivermectin lotion (0.5%)Prescription needed.

Applied to dry hair and rinsed off after 10 minutes.

Approved as a one-time-use, topical treatment of head lice in children 6 months and older. If there is leftover medicine, it needs to be thrown out, not reused.

Lindane shampoo (1%)Prescription needed

No longer recommended by most experts

What else do I need to know about treating head lice?

You do not need to throw away any items belonging to your child. However, you may want to wash your child’s clothes, towels, hats, and bed linens in hot water and dry on high heat if they were used within 3 days before head lice were found and treated. Items that cannot be washed may be dry-cleaned or sealed in a plastic bag for 2 weeks.

Do not spray pesticides in your home; they can expose your family to dangerous chemicals and are not necessary when you treat your child’s scalp and hair properly.

If your child has head lice, all household members and close contacts should also be checked and treated if necessary.

About “no-nit” policies

Some schools have “no-nit” policies stating that students who still have nits in their hair cannot return to school. The AAP and the National Association of School Nurses discourage such policies and believe a child should not miss school because of head lice.

Remember

Head lice don’t put your child at risk for any serious health problems. If your child has head lice, work quickly to treat your child to prevent the head lice from spreading.

Additional Information

  • Managing Infectious Diseases in Child Care and Schools, 3rd Edition – Completely revised and updated, the new 3rd edition of this award-winning quick reference guide provides the latest information on preventing and managing infectious diseases in child care and school settings. (AAP Bookstore)
  • Head Lice (AAP Clinical Report)
  • National Association of School Nurses

Schedule an Appointment at Petite Pediatrics

Dr. Charish Barry offers concierge-style care that is designed to provide highly personalized care to infants, children, and teens throughout the Santa Barbara area. She and her team of highly trained nurse practitioners will take the time to answer any questions you may have. Schedule an appointment at Petite Pediatrics today! Call our Santa Barbara office at (805) 845-1221.

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