Ask Dr. Lowe

It is the recommendation of the American Academy of Pediatrics that trampolines not be used as home playground equipment.  However, if your child already has access to a trampoline, a recent article suggested that adherence to three safety rules might help in preventing injuries. They are:  one user at a time, the use of a safety net and adult supervision.  The most important aspect of adult supervision is to enforce safety rules and help children get on and off the trampoline safely.  Despite the safety recommendations of that particular article, these safety recommendations will not be supported by many experts as being "enough" to ensure children's safety.  Trampolines are enticing and as a fun activity for children, it is difficult to say "no" to letting your children participate.

With an unlimited number of activities that children can take part in (outdoor recreation, games, sports, etc.) it is not a good idea to let children take part in an activity that has such a high potential for injury and devastating or life-threatening injuries.  

All sports and play activities have some risks.  Parents should be aware of what children are doing and set rules and limits.  More information about these issues can be obtained from your pediatrician, the American Academy of Pediatrics and other national organizations concerned with children's play, playground equipment and physical activities. 

Here are several key points parents can use in teaching their children good manners.

• It is imperative that parents set an example.  If children see their parents displaying kind, courteous and polite behavior and respecting others, they will tend to imitate this.  The old adage of “do as I say, not as I do” will not result in positive manners.
• Start early. Even 2-year-olds can understand the concept of “please” and “thank you.”  Manners must begin at home and in a family context.  It’s most important that children have respect for their parents and siblings. They must learn to respect their siblings’ privacy and have some concept of sharing.  They must respect parental authority. Once these concepts are well-developed at home, it becomes simple to transpose good manners in the child’s progressive relationships with friends, on the playground, in the classroom and later in the work place. 
• Manners must be used and reinforced daily. Tell children ahead of time what you expect.  For example, when you go out to dinner you can explain the etiquette of good manners such as “Don’t talk with your mouth full”, “Don’t reach for food in front of someone,” etc. Parents also need to explain expected behavior with extended family members.  “We are going to Aunt Ellen’s house for Christmas, be sure and thank her for your gift.” 
• Parents must be consistent.  If you tell your children that it’s impolite to answer the phone in a negative manner and then ask the child to tell a caller that you’re not home, you essentially have destroyed the value of that particular example of manners.  If a child displays unacceptable behavior (manners), it is never a good idea to use punishment. It is much better to explain the situation and reinforce what the parent expects.

A short list of manners, including verbal responses and behavior, might include the following:

• Always say “please” when asking for something, and always say “thank you”;
• If someone thanks you, say “you’re welcome” in return;
• Greet people and look them in the eye when you talk to them;
• Don’t interrupt when others are talking;
• Be polite during meals;
• Don’t talk on the cell phone or play games while at the dinner table; and
• Show your respect for others by being courteous and polite; not only to your peers but also to people of authority such as teachers, etc.

There are a number of good books that outline specific manners such as table manners, being a guest in someone else’s home, and proper use of a telephone. Your pediatrician can also offer good guidance and support.

The two most important components of teaching good manners are the constant role model parents display, and making sure that manners within the family group are consistent.  If parents do not practice good manners, it’s unreasonable to expect that of their children.  The “golden rule” of “treat others as you would like to be treated yourself” is clearly an important concept. Good manners are a reflection of parental teaching and are truly essential in a child’s positive social development.  Manners help children develop good personal relationships and are a good foundation for helping children be accepted and respected by others.

Treatment

Ear pain, particularly when there is movement of the ear lobe, may be so severe that a physician needs to be consulted. However, swimmer's ear should generally be seen by a physician because it is important to assess the extent of the infection and to determine the proper therapy. Generally, simple external otitis media, or swimmer's ear, can be treated with ear drops, usually containing antibiotics and ingredients to decrease moisture and change acidity. Some cases of swimmer's ear are severe enough that oral antibiotics also may be prescribed.  If the ear canal is closed from swelling, physicians may use an ear wick and this also reduces pain.   

During the first few days of an ear infection, the pain may be severe enough that pain medication is needed. Generally, acetaminophen is adequate.  It is recommended that children do not swim as long as the ear is infected and this may very well mean 7 to 10 days out of the water. 

Prevention

Some children seem to have more trouble with swimmers' ear than others and they may have recurrent problems throughout the season. Since water left in the ear canal is the precipitating cause of external otitis, one can use ear drops that specifically evaporate water and change the acidity of the ear canal after swimming, showers, etc. This often will help prevent or eliminate swimmer's ear and may be a good therapy once the initial episode of external otitis has subsided.  These ear drops are relatively inexpensive and your pharmacist can recommend an effective over-the-counter brand. In addition, children should make sure they dry their ears after being in the water. Swimming caps and shower caps can be used to help keep water out of the ears, and parents may consult their child's physician about the possibility of using ear plugs.

It is important to avoid trauma to the ear canal. Children should not clean their own ears with anything but a wash cloth and should be taught to never put objects in their ears, including cotton-tipped applicators.

Although swimmer's ear can be painful it does respond to therapy and rarely leads to serious problems. However, left untreated, external otitis can become a long-term problem that necessitates much more extensive therapy.  Early symptoms should lead to prompt examination of your child's ear so treatment can be started early. Occasionally, children can have persistent pain or develop a persistent problem such as chronic ear drainage.  If so, the child should again be examined because there may be an underlying problem such as the presence of a foreign body.

Swimming is such a fun activity and an integral part of our "summer time," that we should make every effort to keep a child's ears healthy. Reasonable preventive measures can help your child avoid swimmer's ear and prompt attention to early symptoms usually brings a quick recovery.

• Consult the student health program or college that he's going to attend for guidelines on what medical information and vaccines are required for incoming students.  At the same time, find out as much as you can about the student health program. Schedule an office visit with your child's physician for a pre-college, comprehensive evaluation.  Make sure required medical forms are prepared and that immunizations are current. 
• Immunizations are no longer the province of the younger child and it's important that your college student has certain immunizations.  Follow the guidelines of his college, but the Centers for Disease Control (CDC) recommends that teens and college students have current tetanus, diphtheria, pertussis vaccine; hepatitis B series, polio; measles, mumps, rubella; varicella (a booster is now recommended); hepatitis A series.  In addition, pneumococcal vaccine may be recommended and influenza vaccine probably should be given, particularly with the current concerns about swine flu.  Two vaccines that are particularly important to incoming college freshman are Human Papilloma Virus (HPV) vaccine (helps prevent cervical cancer, genital warts, etc.) and meningococcal vaccine if they have not received either of these as a teenager.  Meningococcal meningitis is not an uncommon occurrence in college students, particularly those living in dormitories.  This is a serious, rapid, sometimes fatal disease.  Immunization with the current meningitis vaccine can prevent this catastrophe at least 70 to 80 percent of the time.
• Make sure your child understands his health insurance coverage and that he has an insurance ID card.
• Make up a first aid kit that includes things such as thermometer, over-the-counter pain medication, bandages, etc.
• If your student takes any prescription medication, make sure you've discussed how the medication will be refilled.  Will the teen take care of this or will you send the refills to him? Strongly encourage him to continue any current medications. He should understand why the medication is being given and consequences of not taking it. 
• Discuss your student's use of the campus medical care facility and encourage him to utilize this service on his own.  This is particularly important if your student has a chronic disease.   

The most important point to make to your college freshman is to take care of himself.  He should stick to his principles and not get involved in unsafe behavior.  Discuss his usual health status so he understands the importance of nutrition, sleep and exercise.  Encourage him to make healthy decisions about alcohol, drugs, sex, etc.

Parents are obviously giving up a lot of responsibility, but your college student will be able to manage this and with encouragement from home, should do well.  Sooner or later he will call home with a complaint about a given illness; do not try to diagnose this over the phone but encourage him to use the campus health facilities on his own. 

As you talk with your student throughout the college years, inquire about and discuss his health to judge how well he's assuming responsibility.  Parents will be surprised how well their student can and will assume responsibility for their self. 

These guidelines are recommended by the AAP and further info can be obtained from AAP and CDC, particularly regarding standard immunization requirements for the college aged student. 

Arkansas Children's Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States serving children from birth to age 21. The campus spans 29 city blocks and houses 316 beds, a staff of approximately 500 physicians, 80 residents in pediatrics and pediatric specialties and more than 4,200 employees. The private, nonprofit healthcare facility boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking medical research - all dedicated to fulfilling our mission of enhancing, sustaining and restoring children's health and development. ACH has  ranked twice on FORTUNE 100 Best Companies to Work For®, most recently at No. 85.

Are children well supervised?

What is the camp’s staff ratio to campers?  What sort of experience and qualifications does the staff have?  Is the camp staff knowledgeable about various developmental needs in various age groups? 

How are minor medical emergencies handled? 

What is the camp’s policy about medical situations, emergency and non-emergency? Is there a nurse on duty part time, full time?  What kind of connections with local health institutions such as nearby hospitals, emergency rooms and physicians are in place?  Who helps with a child’s medication if needed?  (A designated member of the camp staff should be responsible for campers’ medication supervision. The primary purpose is to ensure that medicine is properly distributed and there is no chance for repeated doses, skipped doses or overdose.) How will the camp handle an ongoing medical problem your child might have, such as asthma?  (This should be a point of discussion with camp personnel.) What is the camp’s policy about food allergies? (Camp staff will usually be diligent in helping children with allergies but children should take some responsibility themselves.) 

What happens in case of injury or trauma?

Injuries are frequent at camp. Fortunately they are mostly minor, but the camp should have guidelines in place which outline how injuries are handled.  In addition, the camp should have safety requirements and someone with medical experience to reinforce the safety plan. (Do staffers who supervise the pool know pediatric cardiac resuscitation? Are children required to wear helmets when they ride horses?  Is there an agreement in place by the camp to obtain help from an Emergency Medical Service (EMS), local hospital, etc. if needed?)

Are infection control measures in place? 

Infection control is a big issue at camps since children are in close proximity to each other. This can trigger poor hygiene if modest boys or girls refuse to take a shower or bath in fear of being seen nude, or possibly refuse to remove a wet swimsuit.

Activities and Playtime

Are activities and play supervised and structured in a way your child will enjoy his camp time?  

A national accreditation association, the American Camping Association (ACA) www.acacamps.org , is a good place to start in selecting a camp. The association accredits camps based on nationally recognized safety standards. Many day and resident camps in the United States are accredited. If a camp is not accredited, parents may want to ask about the deficiencies or reasons.

In addition to the above considerations, parents should sit down with their child and make camp selection a family decision. Remember, the child is the one attending summer camp. Just because mom or dad went to a particular camp doesn’t mean it is the best choice for their son or daughter. Climate can also be an important factor.  Children who attend camp in western states should know something about hydration. There is also a great deal of interest in the ‘specialty sport camp’ but these camps can sometimes be too structured and kids have little time for interaction with other campers or just good, solid fun.

Ticks emerge in the late spring and early summer, and remain until the first frost or freeze in the winter.  They cling to tall grass and bushes and are quite common in campgrounds, playgrounds and your own backyard.  Ticks cling to upper levels of vegetation and easily brush onto people and pets as they pass by.  Ticks move around a bit on their "host," but most attach to the skin.  Only 3 percent of tick bites are associated with illness, but tick-borne illnesses are common enough in Arkansas to be of concern.

The most common diseases in Arkansas are Rocky Mountain spotted fever and tularemia.  Tularemia occurs more frequently in adults, and two-thirds of the cases of Rocky Mountain spotted fever occur in children younger than 15 years of age, particularly those 5 to 9 years of age.  Lyme disease is much more prevalent in the Eastern and Northern states.   

Both tularemia and Rocky Mountain spotted fever are associated with common symptoms such as fever, malaise, general discomfort, aching muscles and joints.  Laboratory tests cannot be used to diagnose these diseases in the early weeks because positive results depend on the development of anti-bodies after the disease has started.  Rocky Mountain spotted fever is characterized by a fever that persists beyond the usual three or four days of the common summer illnesses.  After the first four or five days, a rash may appear.  Rocky Mountain spotted fever is a progressive disease that affects more organ systems as time goes by, so it's important to treat the disease early with antibiotics.  The history of a tick bite is important, but the tick bite itself may not be red or swollen.  

Tularemia is the most common tick-borne illness in Arkansas.  It is caused by a bacterium that is transmitted during a tick bite or from handling meat of an animal that is infected, most commonly rabbits, but also squirrel.  If contraction of the disease is due to handling infected animals, there will be a prominent, tender, red lesion where the bacteria entered the body, usually through a pre-existing cut or lesion.  Lymph nodes in the area will be swollen and tender. 

The best approach is avoidance of ticks in the first place.  Prompt removal of any attached ticks is quite important since the tick generally has to be attached for more than 36 to 48 hours before they transmit disease.  The following tips can help you and your family avoid these pests: 

• Avoid common tick-infested areas such as high grass, brush, wooded areas, and groundcovers such as blackberry bushes, muscadine vines, etc.  
• Wear closed-toe shoes, long sleeves, long pants - with pants tucked into socks.  Long hair should be pulled up, and preferably tucked under a hat, when playing or working in grassy or wooded areas.   
• Insect repellants that include DEET are helpful and can be used on children older than 2 months of age.  DEET can be obtained in different percentages, and at 30 percent an application will generally last four or five hours.  Insect repellant should be applied only to exposed surfaces, being careful not to get near eyes, nose or mouth.  They also can be sprayed on clothing.  If children's exposure to the outdoors extends beyond three-to-four hours, a second application of insect repellant may need to be applied.  New insect repellants are available almost yearly and your pediatrician, pharmacist, or pest control expert can advise you of the best bug repellant to use.
• After children have been outside, they should be thoroughly examined from head to toe, including hair.  They also should have a thorough bath at the end of the day and parents should examine children closely for any sign of ticks. 
• The family pet, particularly dogs, can be readily infested with ticks.  Veterinarians can advise you on shampoo for your pets and other products to ward off ticks. 

If a tick is found, it should be removed immediately.  The best practice is to use tweezers or fingers protected by tissue.  The tick should be grasped as close to the person's skin as possible and pulled straight out.  This lessens the chance of leaving in the head, which must be removed because its presence can lead to secondary infection.  Folklore remedies such as hot matches, kerosene or petroleum jelly do not work and should not be used.   After tick removal, cleanse the area well with soap and water and wash your hands thoroughly. 

Prompt medical attention should be sought for any fever that lasts more than three or four days - as in a common cold, the presence of a rash, or if your child appears to be more ill than usual.  The longer a tick-borne illness persists, the more likely complications and death can occur. 

Arkansas has tremendous outdoors and outdoor activities are a major pastime throughout spring, summer and fall for everyone.  It's important to be aware of the potential problem with ticks and other insects so families can have a fun and healthy summer. 

We now know that the teenage sleep issue has some scientific merit.  Two things occur during adolescence and both directly impact the teenager's sleep. First of all, teens go through a rapid growth spurt during puberty and their biological clocks are changing. The reality is that these teenagers need at least nine hours of sleep a night to cope with their physiological changes. The second issue is an increased demand on a teenager's time.  Not only is he faced with more homework, he also may be involved in extracurricular activities such as sports, music, socialization with friends, etc. As a result of these two factors, almost no teenager gets enough sleep. Throughout the week, they are busy with activities or homework and tend to go to bed later, which means it will be harder to wake them in the morning.  Lack of sleep has a cumulative effect, so by the weekend they essentially can "sleep all day". 

When teens don't get enough sleep they certainly may be irritable, unable to concentrate, have a decrease in short-term memory or school performance, and even be delayed in their response times. Some of those characteristics can be dangerous, especially if your teen drives.  A recent report in Kids Health indicated that more than half of vehicle accidents resulting from drivers falling asleep at the wheel are caused by teenagers.

Another result of sleep deprivation is the increasing consumption of power drinks by teenagers for quick energy, to enhance sports performance or to stay more alert to study for tests, etc.  In addition, more than 30 percent of teenagers now drink coffee. This is not healthy, and to reduce the use of these stimulants we will have to address the most common underlying cause which is lack of sleep. 

An approach to help your teenager get the nine to ten hours of sleep they need is to look at their overall activities.  You can help them develop a routine so they can manage more time for activities but at the same time have a consistent bedtime, particularly during the week. On weekends, if they do stay up late for social activities, sporting events, etc., one should acknowledge their need for sleep and let them sleep late the following day. If your teenager is aware that drowsiness, lack of concentration in the classroom and sluggishness on the sports field can be due to lack of sleep, they will be more interested in structuring their own activities to solve this problem.

Perhaps a point to make with your teen is that the human body can tolerate only a certain amount of stress without having a comparable period of rest or down time.  Use of power beverages, etc. does not solve this problem, but in reality just adds to physical stress. 

Keep in mind that your teenager's need for sleep, changing moods and demanding schedule are all typical for adolescents in this stage of life.  When they can't get the sleep their growing bodies require, allow them to catch up when possible. If you are able to help your teenager come up with a schedule that allows for adequate sleep, you will also see and enjoy the benefits of a well-rested adolescent. 

Here are several key points parents can use in teaching their children good manners.

• It is imperative that parents set an example.  If children see their parents displaying kind, courteous and polite behavior and respecting others, they will tend to imitate this.  The old adage of “do as I say, not as I do” will not result in positive manners.
• Start early. Even 2-year-olds can understand the concept of “please” and “thank you.”  Manners must begin at home and in a family context.  It’s most important that children have respect for their parents and siblings. They must learn to respect their siblings’ privacy and have some concept of sharing.  They must respect parental authority. Once these concepts are well-developed at home, it becomes simple to transpose good manners in the child’s progressive relationships with friends, on the playground, in the classroom and later in the work place. 
• Manners must be used and reinforced daily. Tell children ahead of time what you expect.  For example, when you go out to dinner you can explain the etiquette of good manners such as “Don’t talk with your mouth full”, “Don’t reach for food in front of someone,” etc. Parents also need to explain expected behavior with extended family members.  “We are going to Aunt Ellen’s house for Christmas, be sure and thank her for your gift.” 
• Parents must be consistent.  If you tell your children that it’s impolite to answer the phone in a negative manner and then ask the child to tell a caller that you’re not home, you essentially have destroyed the value of that particular example of manners.  If a child displays unacceptable behavior (manners), it is never a good idea to use punishment. It is much better to explain the situation and reinforce what the parent expects.

A short list of manners, including verbal responses and behavior, might include the following:

• Always say “please” when asking for something, and always say “thank you”;
• If someone thanks you, say “you’re welcome” in return;
• Greet people and look them in the eye when you talk to them;
• Don’t interrupt when others are talking;
• Be polite during meals;
• Don’t talk on the cell phone or play games while at the dinner table; and
• Show your respect for others by being courteous and polite; not only to your peers but also to people of authority such as teachers, etc.

There are a number of good books that outline specific manners such as table manners, being a guest in someone else’s home, and proper use of a telephone. Your pediatrician can also offer good guidance and support.

The two most important components of teaching good manners are the constant role model parents display, and making sure that manners within the family group are consistent.  If parents do not practice good manners, it’s unreasonable to expect that of their children.  The “golden rule” of “treat others as you would like to be treated yourself” is clearly an important concept. Good manners are a reflection of parental teaching and are truly essential in a child’s positive social development.  Manners help children develop good personal relationships and are a good foundation for helping children be accepted and respected by others.

Over the years children have become enamored with Valentine's Day, including the exchange of whimsical Valentine's Day cards and candy.  Since Valentine's Day focuses on personal relationships, it presents a good opportunity for parents to evaluate their child's ability to establish friendships.   

Valentines typically are most enjoyed by children between the ages of 5 and 12, the years when children are developing friendships. Friendship allows children to communicate their feelings and ideas with their peers and develop close companions. Parents should educate their children as to what friendship is and what makes a good friend. Several factors can determine how your youngster selects her friends: 

• If your child feels good about herself and is respected and loved within the family group, she is much more likely to make good choices with friends. 

• If parents relate well to each other and the children within the family also have caring, supportive relationships, children will have positive examples of how people can relate, and they will rely on these impressions when making friends outside the family group.  

• Teach your child about the meaning of friendship.  Take time to understand why she chooses the friends she does. This discussion can include your child's feelings, values and behaviors. Your child needs to learn that good friends respect others, follow the rules and help those in need.

• A healthy friendship is when both children are on equal footing.  They should be willing to share, make an effort to please each other, and plan activities they can do together. 

Two concerns parents may have over their child's friendships are a "best friend" and an "unacceptable friend."  Some youngsters seem to concentrate on a single best friend and make little or no attempt to develop others. This is not detrimental but parents should make sure these "best friends" continue to participate in a broad range of experiences and social activities involving other children. 

Dealing with a friend whom parents think is a bad influence is more difficult.  It's usually not a good idea to tell a child to stop a relationship. Parents can explain the values that are important to their home such as positive language, respect for others and fair play. They can then point out how some of the child's friends do not display those behaviors.  This lets parents discuss why they object to a certain friend based on the friend's behavior, not the child herself. Discussing these issues with your child can help them make their own decision and most of the time, hopefully, the right one. 

Although Valentine's Day can be a special time for children, some youngsters can be quite apprehensive about not receiving cards from friends, especially a particular friend. Parents can provide support and guidance, not only by helping their children prepare their Valentines to send, but by taking an interest in Valentines received.  This will help parents identify any hurt feelings and discuss how their child can lessen the disappointment and move forward.  Evaluation of your child's friendships at this time fits well with their Valentine's Day since the exchange of Valentines will be more of an expression of friendships rather than the adult interpretation of love and romance."