A Dose of Dr. Gwenn

(image) For those of us in New England, we live for season changes, especially winter. However, the last few years have been quite disappointing with very mild temperatures and modest snowfalls creating rather unimpressive ski conditions. We honestly didn’t know what to do when the snow started falling just days into December and the deep freeze came shortly thereafter. Out came all the winter gear, hardly used for the last few years, and high hopes were set for a season filled with much anticipated winter fun: sledding, snow shoeing, skiing, and just basic outdoor snow fun!

But, where cold and snow are concerned, “fun” takes on new challenges if we are not adequately prepared and it is all too easy to get injured from the elements and the activities so unique and special to a snowy winter. Anything can happen in snow from concussions due to sledding accidents to sprained ankles or broken arms from falling on icy sidewalks or getting checked during a hockey game. Even building a snow village can be treacherous with frostbite and frostnip risks and lacerations and contusions occurring from snowballs containing hidden objects such as pieces of trees or ice.

According to SafeKids USA more than a quarter million kids are injured in winter sports each year. They report that more than 49,000 children ages 5 to 14 were taken to emergency rooms in 2005 for winter sports juries. Of these, 29,000 were from skiing and snowboarding, 20,000 from sledding, and 660 from snowmobile accidents. If you add to these numbers the amount of kids injured that were treated at home or by their pediatricians, these numbers go much higher.

Proper equipment is essential in minimizing risk for all sports but especially important for winter sports with the added elements of snow, cold and ice. Make sure the equipment is the proper size for your child and consult and outdoor store if you have any doubt as to the integrity of used equipment. For all winter sports, including sledding, a ski helmet is mandatory for kids and adults and can cut down the risk of traumatic brain injury by over 50%.

Kids often have trouble understanding how dangerous the cold can be because we dress them like Eskimos but fail to explain to them why. It is crucial they understand starting very young that without all those thermal layers, they would be at risk for hypothermia, frostnip and frostbite – even while just walking to and from school or while waiting in line for a ski lift. How do you decide how cold is “too cold”? In general, the further below zero the wind-chill falls, the shorter the time it will take for any of these cold-related injuries to occur. Massachusetts schools all follow very strict guidelines for outdoor recess. Children must have snow suits and boots to play in the snow. And, children are kept indoors during cold weather advisories and when the temperature drops below zero. Encourage your family to follow these same guidelines for home and recreational activities. So, if it's too cold for outdoor recess, than it's too cold to build a snowman or hit the slopes.

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Cold-related injuries can be very serious and early identification and treatment is essential. Hypothermia develops when the body's core temperature drops below normal. The body essentially freezes and major systems stop functioning normally. Symptoms result from the body's attempt to warm up and conserve energy. Early symptoms include shivering, clumsiness, and slurred speech. If you become concerned your child may be developing hypothermia, get your child in a warm environment and seek medical attention right away.

Frostnip and frostbite are two extremes of the same problem and result from direct cooling and freezing of the skin and underlying structures. Early on the skin turns white and becomes numb and is referred to as frostnip. Frostbite is an actual freezing of the skin and outer tissues. Fingers, toes, ears and nose are the most susceptible. They may appear pale, gray or blistered and the child may complain that the skin burns or feels numb. Frostbitten areas need to be warmed up with warm water. Wrap your child in a warm blanket and give hot cocoa to warm up the inside temperature. If the symptoms do not resolve in a few minutes, call your doctor.

I know my family is looking forward to finally having a winter worthy of schlepping all the ski stuff north for! At the same time, I know as a parent I have no hope in getting my kids to dress like an Eskimo if I don’t do the same. So, “all for one, one for all” will be our motto for winter dressing and should be your family’s motto, too. And, that includes on the slopes. Believe it or not, ski helmets do come in adult sizes!!

It used to be so simple – get an over the counter medication and fix a symptoms, in ourselves and our kids. Nowadays, however, there is concern in over the counter medication use in children under 6 years of age and many of the products we were given as children and may have used in our teens and tweens as infants and toddlers with colds have now been pulled from the shelves.

Knowing what over the counter medications to have on hand and when to use them can come in very handy for those unexpected illnesses, when on vacation and for those middle of the night ails!! If you have any doubt at all about whether a medication is appropriate for your child, consult your pediatrician.

Here are some rules of thumb to help you decide what to stock in your medicine chest at home:

1. Other than ibuprofen (Advil and Motrin) and acetaminophen (Tylenol), most over the counter medications do not work well in children under the age of 2 and are thought to be unsafe in this age group. With this in mind:
a. Most over the counter (OTC) cold medications for kids under 2 years of age have been pulled from the shelves for this reason.
b. If you notice a product on a store shelf, do not purchase it.
c. If you have an OTC product at home that was once on a shelf, toss it.

2. Medications are dosed by age until approximately 12 years of age and 95 pounds at which point “adult” dosing kicks in.
a. Medication dosing for kids under 12 years of age are typically given in a range on over the counter packaging but this range is not very accurate on the extremes.
b. For an accurate dose for your child, consult your pediatrician for a weight-related dose.

3. Never give over any counter medication if your child appears very ill to you. Consult your doctor first or call 911 if your child appears
a. distressed in any way
b. has labored breathing
c. has altered mental status (inability to recognize you or act normally)

4. Fever is an elevation in body temperature and the cut off for what is considered fever varies by age. The younger the child, the lower the cut off for what we consider fever.
a. 100.4 rectally is considered a fever in infants. Infants under 1 month of age should be seen very quickly for a fever but older infants may not need to be seen right away. Consult your pediatrician right away in this age group for advice.
b. Fever in older infants, toddlers and school age children is generally considered 101.5 or higher taken any way – orally, by ear, rectally, under the arm. For older infants, consult your doctor’s on call group if a fever develops and it is after hours
c. For older children with fever, fever may be the only measurable sign of illness and it can last for a few days. You can usually wait for 1-2 days before seeing your doctor unless your child has any specific complaints (such as ear pain or abdominal pain).

5. I would not recommend using anti-diarrheal medication without consulting your doctor first.

In addition to over the counter medications, there are a number of other items that are useful to stock and have on hand:

1. First Aid Kit: band-aids of all sizes, wound cleaner, antibacterial ointment (Bacitracin or Neomycin), ace wraps, ice packs, tweezers for splinter removaA
2. bug spray and antiitch lotions such as aveeno, calamine or the first aid antiitch sprays
3. Benadryl for hives and allergic reactions (consult your pediatrician for a dose)
4. Fever reducer: acetaminophen and ibuprofen. Acetaminophen also comes in a rectal suppository – Feverall is the brand
5. Humidifier – cool works for most coughs and congestion
6. Pain reducer: Tylenol and Motrin/Advil as well as over the counter ear pain drops for middle of the night ear pain
7. For girls: Uristat is worth having for pain with urination to buy time while waiting to see your doctor. Hydrocortisome cream and antifungal creams are useful (such as Lotrimin)
8. Potty issues: stool softeners, Dulcolax suppositories, swipes
9. Rashes: mild soaps, hydrocortisone cream, lotrimin, lotions – Aveeno, Eucerin, Lubriderm are my favorites
10. Saline nose spray – great for kids of all ages, and bulb syringe for infants

You may end up needing other medications at home depending on your child’s symptoms. Your pediatrician’s office will guide you to these as your child’s symptoms evolve.

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