Sunscreen/Heat Safety

The use of sunscreen has been in the media lately due to new FDA regulations on the way these products are advertised and sold to us as consumers. There are also some misconceptions with the use of sunscreen in certain age groups that requires some clarification. Below is some general information about the use of sunscreen and sun/heat safety.

THE NEW FDA REGULATIONS
When choosing a sunscreen for you or your family members, the most effective products for skin protection are those that protect from both UVA and UVB rays now coined "broad spectrum" by the FDA. Historically, we had the tendency to purchase products with a certain SPF, but SPF is only reflective of the protection against UVB rays.  The current recommendation by the American Academy of Pediatrics for children is an SPF of 15 or greater. The higher the SPF the more protection from UVB rays you have.

With the changes from the FDA, there will be a new rating system for the UVA protection within sunscreen. The rating system is as follows:
1 star-lowest UVA protection
2 stars-medium UVA protection
3 stars-high UVA protection
4 starts-highest UVA protection

The new FDA regulations provides us the consumers with more information about the true reliability of the products we are purchasing. Don't forget to look at both of these elements when choosing products for your children.

THE USE OF SUNSCREEN IN INFANTS 6 MONTHS AND YOUNGER
The use of sunscreen in infants is a major point of misconception amongst the general public. There was a time in the 90's in which sunscreen was not recommended by the AAP in infants less than 6 months of age, however in 1999 the AAP changed its position statement to reflect the following:

Infants age 6 months or less do not handle heat effectively. Excessive heat in the this age group (and I would argue in older children as well) leads to "heat sickness" in which you might notice your child is flaccid or floppy in muscle tone, not as responsive as usual, high body temperature, all of which can lead to dehydration and death quickly in an infant. Therefore, it is not recommended that an infant 6 months or younger be in the heat or direct sunlight long enough to require sunscreen.

In the times when avoiding the direct sun or heat is unavoidable, the infant should be covered with loose clothing to as much of their bodies as possible, a hat with a wide brim should be worn, and sunglasses utilized to avoid damage the retina of their eyes. The remaining parts of their bodies which are exposed should be covered with a layer of sunscreen. No specific SPF is recommended for infants by the AAP, however most "baby" sunscreens come in at least 50 SPF.

It is also important to monitor your infant in the heat and sun. Breastfed babies need to nurse more frequently and bottle fed babies need to have additional bottles to prevent dehydration. Monitor how many wet diapers or urinations your child is having and take breaks frequently!

HOW TO USE SUNSCREEN
I know I know.....we all know how to rub sunscreen onto skin..... So bare with me here!
You should apply sunscreen AT LEAST 30 minutes prior to going into the sun in order for it to absorb to the layer of the skin where it is effective. In addition, it should be reapplied at least every 2 hours while out in the sun. The theory of less is more does not apply here......apply, reapply, and reapply, and reapply.  Always avoid contact with sunscreen to the eyes.

There is a great product on the market now that can help us parents avoid getting sunscreen in the eyes of our wiggly little ones. The sunscreen stick comes in both a "baby" and a "kids". Banana Boat and Neutrogena both make these products, as I am sure others do as well. It is essentially a cap stick consistency for the face and ears that is more easily applied.

Treating A Fever In Your Child

Fever is a very common issue that pops up with our kids.  When kids have fever they tend to be fussy, tend not to eat and drink well, and have a tendency to become dehydrated over time. As a parent, it can be scary but it is important for us to know how to effectively treat fever in order to help our kids feel better and avoid the complications of fever that can often times land us in the ER with our babies. 

Patients will ask me all the time "how high should the fever get before I call you".....NOW....I am not a numbers person.....so dont fixate on a number..... For instance, if your child has a fever of 103 but they are playful, eating, drinking, making urine and are responding to the use of tylenol and motrin to bring the fever down, then I would probably get to your Pediatrician/Nurse Practitioner at your earliest convenience in the next 24 hours.  Conversely, if your child has a fever of 101 but they are very fussy, are refusing to drink, are making less wet diapers or are not using the bathroom to urinate like they normally do, or are vomiting....then I would get to your provider as soon as possible. As the parent, look at the bigger picture not the number on the thermometer.  Unlike adults, children can often experience very high fevers when they are ill. So keep your cool if you kids got a high fever but seek treatment anytime you feel like things are not right. 

There is one MAJOR exception to the statement above: a newborn infant. From the day a baby is born until they get their first round of vaccines or typically 2 months of age (8 weeks), they are very susceptible to infection. If a baby younger then 2 months of age or unvaccinated gets a fever of 100.4 or greater when the temperature is taken rectally, the baby needs to be seen in the emergency room or by their health care provider immediately. In the event that your baby has a fever of 100.4 or more rectally they will likely undergo a batter of testing to ensure that there are no infections present. For example, a urine sample will probably be obtain by a catheter to test for a urinary tract infection, a chest xray will probably be obtained to check for a pneumonia, and a spinal tap might be done to check for meningitis. 

No matter what, a baby this age needs to be seen as soon a humanly possible even if they are eating, drinking and urinating like normal. So that means in the middle of night....you take them to the ER!  

TREATING A FEVER

There are two medications that you can use to treat fever: Acetaminophen (Tylenol) and Ibuprofen (Motrin).  Both of these medications are weight based, so if you do not give the correct dose it will not work the way it is suppose to. Also, always give the medication based on weight not age....

Acetaminophen (Tylenol) can be given every 4 hours for fever. Below is the dosing chart used for Tylenol. Acetaminophen is the generic name and can be used in the same manner. (I always buy generic products because they are cheaper and work just as effectively as their more expensive counterparts.)

Weight	Tylenol Milligram Dosage	Tylenol Infant drops 80mg/0.8ml	Tylenol Children’s liquid 160mg/5ml	Tylenol Chewables 80mg each	Tylenol Junior 160mg each
6 - 8 lbs	40 mg	½ dropper (0.4 ml)	¼ tsp (1.25 ml)	N/A	N/A
9 – 11 lbs	60 mg	¾ dropper (0.6 ml)	⅓ tsp (1.875 ml)	N/A	N/A
12 – 17 lbs	80 mg	1 dropper (0.8 ml)	½ tsp (2.5 ml)	N/A	N/A
18 – 23 lbs	120 mg	1 ½ dropper (1.2 ml)	3/4 tsp (3.75 ml)	N/A	N/A
24 – 35 lbs	160 mg	2 droppers (1.6 ml)	1 tsp (5 ml)	2 tablets	1 tablet
36 – 47 lbs	240 mg	3 droppers (2.4 ml)	1 ½ tsp (7.5 ml)	3 tablets	1 ½ tablet
48 – 59 lbs	320 mg	N/A	2 tsp (10 ml)	4 tablets	2 tablets
60 - 71 lbs	400 mg	N/A	2 ½ tsp (12.5 ml)	5 tablets	2 ½ tablets
72 – 95 lbs	500 mg	N/A	3 tsp (15 ml)	6 tablets	3 tablets

Ibuprofen (Motrin) can be given every 6-8 hours for fever. Ibuprofen (Motrin) is not recommended for children under the age of 6 months. Children who are younger than 6 months should only receive Acetaminophen (tylenol) if they are experiencing pain or fever. 

Weight (lbs)	Age (months)	Dose (mL)
	Under 6 months	Ask a doctor
12-17 lbs	6 to 11 months	1.25 mL
18-23 lbs	12-23 months	1.875 mL

Weight (lbs)	Age (years)	Dose (tsp or mL)
Under 24 lbs	Under 2 years	Ask a doctor
24-47 lbs	2 to 5 years	1 tsp or 5 mL
48-95 lbs	6 to 11 years	2 tsp or 10 mL

ALTERNATING TYLENOL AND MOTRIN 
Ever been told to alternate Tylenol and Motrin while your child has a fever? Here is why and how that works: 
Even though Tylenol and Motrin essentially execute the same actions, they are very different medications. For example, Motrin is metabolized by the kidneys and Tylenol is metabolized by the liver, therefore they can be given safely simultaneously. You might find that you have given Tylenol to your child and their fever continues....then you want to give Motrin. 


So here is how to do it.... 
Say you wake up in the middle of the night to a child who has a fever....(Always always always take your child's temperature....it is helpful to your health care provider to know how high the fever was and to you to know that the medications are working. I always recheck my daughter's temperature at her next diaper change after Tylenol or Motrin is given. It is the only way to measure the response of your intervention)....I would give Tylenol AND Motrin at the same time. Then I would start to alternate the medications every four hours starting with TYLENOL because Tylenol can be given every 4 hours whereas Motrin can be given every 6-8. Four hours after the dose of Tylenol I would give Motrin (which is now 8 hours after the original doses)....four hours later I would given Tylenol again and then Motrin four hours after that.....and so on and so on.... 


By alternating Tylenol and Motrin, you keep your child feeling better, less likely to dehydrate, and eating and drinking more than if their fever was high. 




WHAT IF THEY HAVE A SEIZURE FROM FEVER? 
Better known as a Febrile Seizure, a seizure in the presence of fever is most common in 6 months to 5 years of age. This is generally thought to be a result of a rise in body temperature, not how fast the temperature rises or how high the fever gets. A child can experience this phenomenon with a low fever, high fever, and even as the fever decreases with tylenol and Motrin. If this happens, place your child on the ground where he or she can be safe, do not place anything in their mouth, and roll them onto their side so that they do not block their airway with their tongue or  saliva. Call 911 immediately, I would not attempt to drive the child to the ER. You need to monitor their breathing as much as possible and attempting to drive them on your own is unsafe and should be avoided. 

Car Seats 101

Car Seats can be very confusing to parents...which one do you buy?....Is it properly installed?....When can you change the position? The truth is a car seat used in the proper manner can be the difference between life and death in a motor vehicle accident for our kids. According to the North Carolina Department of Transportation (NCDOT), Motor Vehicle Accidents (MVA) remains the #1 cause of accidental deaths of children including adolescents. When a car seat is improperly used the chance of serious injury and death in an MVA drastically increases and it doesn't take much for improper use to occur.

Just a few weeks ago a 10 month old baby girl was ejected from her car seat in a roll over MVA when her mother over corrected while driving on Lake Wheeler road in Raliegh. In this case, the child's straps were too loose and as a result she died at the scene of the accident from her injuries.

The straps of a car seat should be tight enough that you can only place two fingers between the child and the straps. In addition, the buckle should be at the level of the nipple line on the child. If either one of those two elements are incorrect, the child can come out of the car seat during a MVA.

The NCDOT has straight forward information about the use of car seats as well as the current NC laws. The link below provides access to the NCDOT's pocket card which is a great quick reference for this information.

http://www.ncdot.org/programs/GHSP/download/CPSPocketCard10.pdf

The other part to car seat safety is proper vehicle installation and every car is different. Follow the instructions for your vehicle and your seat. Another quick and easy thing to do to double check your car seat's installation is to utilize your local fire department. Fire department personel can have a specific training for car seat safety called Child Passenger Safety. Not all fire department personel have this certification so it is important to find someone in your area with this qualification. The link below provides the ability to search for CPS certified individuals and events. If you choose to utilize the fire department, typically all you have to do is go to a local station and ask for someone to check your seat. It is very easy and most of them are happy to help.

http://www.buckleupnc.org/contacts_local.cfm

On July 13th, the office I work in is hosting an event with our local fire department where they will be available to check anyone's car seat who is interested. The event is open to the public and if you would like more information please contact me directly.

One last element to this confusion is this year the American Academy of Pediatrics (AAP) changed its recommendations for the use of car seats in infants. Previously, they recommended that a child may change from a rear facing position to the forward facing position at the age of 1 year AND a weight of 20 lbs. The AAP changed their recommendation to keeping the child rear facing until the age of 2 years OR until the child exceeds to maximum weight for the rear facing seat. The reason for this change is related to the ability of the child to protect their head, neck, and spine during a MVA. Children who remain rear facing until 2 years have suffered less fatalities according to the AAP. The law however in NC remains that you may change your child to a forward facing position at 1 year AND 20 lbs. Most likely, the law will change in time with the AAP's recommendations and I encourage you to watch for those legislative changes from the NCDOT.