A Dose of Dr. Gwenn

The time between Thanksgiving and New Year’s Eve are typically filled with all sorts of extra and unique celebrations from school events to family meals. While these are the times that tend to make our most special and unique family memories, for our kids the holidays can be a hectic time and the very aspects that make the holidays so out of this world also carry some health and safety risks we need to be aware of.

The American Academy of Pediatrics has some holiday tips they always circulate this time of year that they encourage us to circulate around. These cover the lion’s share of issues that tend to pop up during the holidays that can turn a magical moment into a nightmare but there are a few others that I’ve thought of that I’ll share with you at the end.

The 2007 American Academy of Pediatrics Tips for Safe Holidays:

Trees
• When purchasing an artificial tree, look for the label "Fire Resistant."
• When purchasing a live tree, check for freshness. A fresh tree is green, needles are hard to pull from branches and when bent between your fingers, needles do not break. The trunk butt of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.
• When setting up a tree at home, place it away from fireplaces, radiators or portable heaters. Place the tree out of the way of traffic and do not block doorways.
• Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help to keep your tree from drying out and becoming a fire hazard.
• Be sure to keep the stand filled with water, because heated rooms can dry live trees out rapidly.

Lights
• Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted.
• Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them.
• Check all tree lights-even if you've just purchased them-before hanging them on your tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections.
• Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.
• Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.

Decorations
• Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.
• Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked down.
• In homes with small children, take special care to avoid decorations that are sharp or breakable, keep trimmings with small removable parts out of the reach of children to avoid them from swallowing or inhaling small pieces, and avoid trimmings that resemble candy or food that may tempt a young child to eat them.
• Wear gloves to avoid eye and skin irritation while decorating with spun glass "angel hair." Follow container directions carefully to avoid lung irritation while decorating with artificial snow sprays.
• Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame.

Toy Safety
• Select toys to suit the age, abilities, skills and interest level of the intended child. Toys too advanced may pose safety hazards for younger children.
• Before buying a toy or allowing your child to play with a toy that he has received as a gift, read the instructions carefully.
• To prevent both burns and electrical shocks, don't give young children (under age ten) a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
• Children under age three can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.
• Children under age 8 can choke or suffocate on uninflated or broken balloons. Remove strings and ribbons from toys before giving them to young children.
• Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.

Food Safety
• Bacteria are often present in raw foods. Fully cook meats and poultry, and thoroughly wash raw vegetables and fruits.
• Be sure to keep hot liquids and foods away from the edges of counters and tables, where they can be easily knocked over by a young child's exploring hands.
• Wash your hands frequently, and make sure your children do the same.
• Never put a spoon used to taste food back into food without washing it.
• Always keep raw foods and cooked foods separate, and use separate utensils when preparing them.
• Always thaw meat in the refrigerator, never on the countertop.
• Foods that require refrigeration should never be left at room temperature for more than two hours.

Happy Visiting
• Clean up immediately after a holiday party. A toddler could rise early and choke on leftover food or come in contact with alcohol or tobacco.
• Remember that the homes you visit may not be childproofed. Keep an eye out for danger spots.
• Keep a laminated list with all of the important phone numbers you or a baby-sitter are likely to need in case of an emergency. Include the police and fire department, your pediatrician and the national Poison Help Line, 1-800-222-1222.
• Traveling, visiting family members, getting presents, shopping, etc., can all increase your child's stress levels. Trying to stick to your child's usual routines, including sleep schedules and timing of naps, can help you and your child enjoy the holidays and reduce stress.

Fireplaces
• Before lighting any fire, remove all greens, boughs, papers, and other decorations from fireplace area. Check to see that the flue is open.
• Use care with "fire salts," which produce colored flames when thrown on wood fires. They contain heavy metals that can cause intense gastrointestinal irritation and vomiting if eaten. Keep them away from children.
• Do not burn wrapping papers in the fireplace. A flash fire may result as wrappings ignite suddenly and burn intensely.

The three issues the AAP’s holiday safety tips do not delve into are toy safety given the recent recall barrage, travel issues, and health concerns.

Toys and Recalls
Do be sure to double check the updated recall lists before you purchase any toys for your kids. And, if you receive any toys as gifts you are unsure about, don’t open the toy. Look into the toy online and on the CPSC recall list.

Travel
Holiday travel can be one of the trickiest moments for a family given most people travel to snowy areas! The key to sanity is planning ahead, being flexible for changes and remembering that kids are not small adults. Bring distraction toys and once through security buy drinks and food since airlines on longer have those on board as readily. The other issue is time. Kids don’t do well harried. Give yourself plenty of time checking in and consider checking your bags to make life easier and more convenient.

Health Concerns
Expect someone to get sick during the holidays. Keep in mind that December is the official start of cold and flu season. Make sure everyone in your family who needs a flu shot receives one. If a member of your family has an illness, consider staying home from an event. This is very important because these events are filled with infants, small kids and older adults whose immune systems are not as robust as ours. And, there may be people in the group battling health issues that weaken their immune systems such as cancers. So, we owe it to the health of others to play it safe if our kids or other adult members are sick. We can’t control what others so but we can control excluding our family members when appropriate. What’s the rule? Fever free for 24 hours or on antibiotics for 24 hours if given one. And, the sick person must be ok to visit – no vomiting, diarrhea, coughing that would make it difficult for the person or those around him or her.

Here’s to a safe, happy and healthy holiday season.

With all the talk of the flu shot this time of year and how “best” to combat the flu, it can be confusing to figure out who in your family should get the flu shot each year. The bottom line boils down to this: if you are a household with kids under 5, every grown up and child over 6 months of age should get the flu shot annually unless a person has an allergy to a component of the flu shot such as egg. And, even if you don’t technically fall into this list, you likely come into contact enough with someone who would be at high risk if they contracted the flu, so getting the flu shot is a good idea still.

The flu is a very strong virus and we know from clinical experience that it hits the extremes of ages hardest: the kids and the elderly. Among the kids, the youngest of the kids and kids with chronic conditions are at most risk but just being a kid is a risk for the flu because their immune systems are still developing.

As for kids, there are two flu vaccines available: FluMist nasal spray and the traditional flu shot. Both work just as well in kids over 2 years of age and cost the same. So, for parents wanting to avoid another shot, the nasal mist is the way to go and is very well tolerated.

One question that comes up every year is why do encourage everyone to get a flu shot yearly. The flu virus changes yearly so our vaccine changes yearly. Luckily, most changes in the virus are not huge so the vaccine, although based on last year’s flu season, still work fine.

Here are the official CDC recommendations for who should get the flu shot each year:

1. People at high risk for complications from the flu, including:
o Children aged 6 months until their 5th birthday,
o Pregnant women
o People 50 years of age and older
o People of any age with certain chronic medical conditions (primarily chronic heart and lung conditions such as congenital heart disease, respiratory conditions, and those people on immunosuppressive treatment)
o People who live in nursing homes and other long term care facilities

2. People who live with or care for those at high risk for complications from flu, including:
o Household contacts of persons at high risk for complications from the flu (see above) – i.e. parents of kids under 5!!
o Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
o Healthcare workers

Your pediatrician can help you figure out if your child would benefit from the flu shot and help answer any other questions you might have. For more information, the CDC website is a great resources, and I post frequent updates on Pediatrics Now as the flu season progresses.

Finally, talk to your kids about some simple flu-avoidance measures that can keep all of you as healthy as possible this winter:

1. Wash hands frequently
2. Stay away from sick people – cancel playdates if you have to, don’t go to school, work or activities if feeling sick. This self-exclusion is very important to control the spread of illness.
3. If you have to cough or sneeze, use the crook of your arm – and wash your hands if you cough/sneeze in your hands.

So, be wise, immunize…and when in doubt, wash your hands!