Summer Bites, Bumps, Breaks and Bruises: How to Avoid or Treat Summertime Symptoms

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On May 20, 2014, Carolina Parent hosted a live Facebook chat with Chapel Hill Pediatrics and Adolescents. For those who missed this informative event, here’s a transcript of the conversation!

Carolina Parent Magazine Welcome to the Carolina Parent and Chapel Hill Pediatrics and Adolescents, P.A. “Summer Bites, Bumps, Breaks and Bruises” LIVE Facebook chat! Today we’ll be talking with Dr. Russell Homan and Dr. Walker Robinson about kids’ summertime health and wellness! READERS: Ask a question as a comment below this post and don’t forget to refresh your page! Welcome, Drs. Homan and Robinson! Onto the first question: What should be included in a family first-aid kit?
Chapel Hill Pediatrics and Adolescents, P.A. First, thank you Carolina Parent for having us on your Facebook chat. We think it would be helpful to have bandaids, soap, ACE bandage, Benadryl, tweezers, topical antibiotic, hand sanitizer, pain medicine, sunscreen, scissors, and gauze.

Carolina Parent Magazine We had a couple of mosquito questions from readers come in: “I read that drinking vinegar daily will keep the mosquitos away. That the mosquitos and smell it in your body and it keeps them away, is that true?” And another: “I read that by taking a daily Zyrtec, I’m less susceptible to get mosquitos bites. Is that true?” Could you please address both of these “tricks”?
Chapel Hill Pediatrics and Adolescents, P.A. We could not find any scientific studies to suggest that vinegar or Zyrtec consumption repels mosquitos. We suggest that kids NOT drink vinegar daily to prevent mosquito bites.
Lauren Isaacs I think I just won a bet between me and my husband!

bumps_001.jpgCarolina Parent Magazine Claire from Durham asks, “What are the 5 big things that send families to ER or Urgent Care?”
Chapel Hill Pediatrics and Adolescents, P.A. The 5 most common things that send people to the ER or Urgent Care are broken bones, cuts requiring stitches, asthma flares, prolonged fever, and severe abdominal pain. But we also want you to know that most of these issues are best evaluated by the child’s primary care physician, and many of these issues can be dealt with at your local clinic.
Carolina Parent Magazine What about bounce houses? Should those be avoided at parties?
Chapel Hill Pediatrics and Adolescents, P.A. There has been a recent study showing that bounce houses are roughly as dangerous as trampolines. But the primary injuries seem to happen when jumpers of different sizes and ages are jumping together. It is important to say that the American Academy of Pediatrics has a statement against trampoline use.

Lauren Isaacs What are the signs of babies with heat stroke? What should first-time moms look for?
Chapel Hill Pediatrics and Adolescents, P.A. First, we would emphasize that babies younger than 6 months should be out of direct sunlight for long periods of time. If concerned for heat stroke (which, by the way, is extremely uncommon), watch for extreme irritability and fatigue. You could also take the baby’s temperature, and if > 100, remove from the heat and bring them indoors.
Lauren Isaacs Thank you! My baby girl is almost 8 months and very pale! She minds the heat.
Chapel Hill Pediatrics and Adolescents, P.A. My wife (Dr. Homan) suggests letting babies play in a inflatable baby pool under an umbrella. This works great at the beach.
Carolina Parent Magazine Is there a maximum time that babies should be on the beach in bright sun on a hot day even if they are under an umbrella?
Chapel Hill Pediatrics and Adolescents, P.A. It’s definitely safer to keep the child out of the sun between 10am and 4pm, but if your baby is happy, laughing, and having a good time, then just keep playing in the sun.
Lauren Isaacs Thank you! All great information.

Lauren Isaacs We plan on going to the pool a lot this summer. Do I need to bathe my 8-month-old after a day at the pool? Also, do I need to bathe her at night after a regular day where she’s worn sunscreen? I’m just unsure about how long chlorine and sunscreen should be on my baby’s sensitive skin.
Chapel Hill Pediatrics and Adolescents, P.A. Lauren, it is a good idea to wash sunblock off because it can be absorbed into the skin. We are not aware of any health problems related to leaving chlorine on the skin–besides dryness. I would try giving her a bath after going to the pool, and make sure you apply moisturizer after the bath. If you notice her skin drying up, try cutting back on baths, or try a thick cream or ointment like Aquaphor or Eucerin.
Lauren Isaacs Ok so baths after a day of sunblock and the pool!

Megan Toth Haven Hi! It’s not a bite/bump/bruise question, just a summer question. What sunscreen do you recommend for a 3-year-old with super sensitive skin and horrible eczema? Everything we use tends to make his skin break out.
Chapel Hill Pediatrics and Adolescents, P.A. If sunscreen has caused a rash on your child in the past, consider avoiding Oxybenzone containing sunscreens. You may want to try titanium oxide or zinc oxide sunscreens.
Lauren Isaacs Megan, I have a baby with sensitive skin, too! Good question.

Myra Wright My oldest son ended up with Rocky Mountain Spotted Fever several years ago following a tick bite, so I’m very aware of the dangers some bug bites can pose. However, I’m also concerned about covering my kids in DEET every time they step outside. Are there any natural alternatives to keeping these pesky bugs away?
Chapel Hill Pediatrics and Adolescents, P.A. Hello Myra. DEET is very safe unless used at high concentrations (>30%) almost every day. A natural alternative is PMD from the oil of lemon eucalyptus. At least for mosquitos is almost as good as DEET, so it probably has some tick repellant qualities.
Regina Alston What does PMD mean? Can you buy lemon and eucalyptus oil and mix it to make your own mixture?
Chapel Hill Pediatrics and Adolescents, P.A. It is the active ingredient in the oil of lemon eucalyptus. Brand names include Repel Lemon Eucalyptus Insect Repellent Lotion and Spray Lotion and Survivor Lemor Eucalyptus Insect Repellant. Also a lower concentration is found in Off! Botanical Insect Repellant.
Regina Alston Thank you. This is helpful.

Carolina Parent Magazine Gary in Durham wrote in: “In the event that your child does suffer a sunburn, what do you do to soothe the burn and bring some relief? How do you know when a bad burn becomes sun poisoning and you need to consult a physician?”
Chapel Hill Pediatrics and Adolescents, P.A. If you notice that you or your child’s skin is appearing red, you can’t reverse the damage, but aloe vera-based gels, calamine lotion, or cool soaks may help with discomfort. Teens can try ibuprofen for pain control. Any ruptured blisters should be washed with gentle soap and water and can be covered with saline-soaked gauzes-don’t pop blisters! If you child’s skin is already burned, we recommend wearing a hat and a long-sleeve shirt for the remainder of the trip and if possible staying out of the sun.
Chapel Hill Pediatrics and Adolescents, P.A. If you child has severe sunburn and is acting cranky or very tired it would be good for him/her to see a physician, especially if much of the body is involved. Also, blisters can get infected, so watch for increasing redness, pain, or discharge.

Carolina Parent Magazine A Carolina Parent staff member would like to know: When you child is outside at camp all day, how much do they really need to be drinking in order to stay hydrated?
Chapel Hill Pediatrics and Adolescents, P.A. We think the child should have the opportunity to drink water at least 30 minutes. If water is readily available, the child’s thirst should keep him/her hydrated.

Carolina Parent Magazine Megan in Raleigh asks: How do you tell a tick bite from a regular bug bite?
Chapel Hill Pediatrics and Adolescents, P.A. Megan, there is no good way to tell bites apart once the tick has been removed. If you see a red round or oval-shaped rash develop around the bite, then you should assume tick bite and have your child seen by his/her pediatrician.

Carolina Parent Magazine Mark H. in Apex asks: What’s the best way to treat swimmer’s ears?
Chapel Hill Pediatrics and Adolescents, P.A. Specific preventive measures for those who engage in water sports include use of ear plugs, shaking the ear dry after swimming, and blow drying the ear after water exposure (placing the blow dryer on a low setting 12 inches away from the ears). Drops containing alcohol and/or acetic acid (vinegar) help to dry the ear, prevent skin breakdown, and re-acidify the ear canal, but it is unclear if any type of treatment prevents recurrence of swimmer’s ear. Persistent pain or discharge should be evaluated by a physician.

Carolina Parent Magazine Amy in North Raleigh would like to know: How do you know when cuts need stitches?
Chapel Hill Pediatrics and Adolescents, P.A. This is a challenging question. We would generally say that a cut is more likely to require stitches if the edges aren’t touching, the deeper the wound, wounds that cross over a joint, areas of skin that are under a lot of tension (i.e. on the face). If you have any concern that it might need stitches, please contact your primary care provider.

Carolina Parent Magazine Amy from Chapel Hill wrote in: “How do you know if your child is suffering from heat stroke or sun injuries?”
Chapel Hill Pediatrics and Adolescents, P.A. First, a quick primer on terminology. Heat stroke is an extreme heat injury where the body can’t regulate its own temperature and various organ systems (including the brain) stop working appropriately. Much more commonly, children have heat exhaustion. This can come from too much time out in the sun, and is usually characterized with more fatigue, fussiness, and thirst. Usually providing an ample supply of water will help those with heat exhaustion perk back up within 30 minutes.

Carolina Parent Magazine Roger from Apex asks: “What’s the best sunscreen to use? What degree of SPF?”
Chapel Hill Pediatrics and Adolescents, P.A. Remember to apply sunscreen at least 15 to 30 minutes before sun exposure and re-apply every 2 hrs. “Broad Spectrum” SPF 30 is good for playing outside. You don’t get much better protection above 30 SPF, though the sunscreen gets thicker. “Broad Spectrum” means the sunscreens protects against UVA1, UVA2, and UVB and should contain Avobenzone, Zinc Oxide, or Titanium Dioxide.

Beth Poland Shugg Here’s a question about teens: How safe is accutane? We struggled for a long time about whether to let our son take it but we finally decided to do it and his face is clearing up very nicely as he is entering the 4th month of treatment. I worry, though, about any long-term side effects he may incur. Can you offer your opinion this?
Chapel Hill Pediatrics and Adolescents, P.A. We think that Accutane is very effective and quite safe under the supervision of a dermatologist. Most importantly for teenage females of reproductive age, it is critical that they not get pregnant while on Accutane, as there are significant effects of Accutane on the growing fetus. Other long-term side effects are minimal and rare.

Beth Poland Shugg In 2000, I contracted Lyme’s Disease from a deer tick in Georgia, of all places. I came down with a fever, rash and other telling symptoms less than a week later, so I rushed to my doctor who wisely put me on two rounds of Doxycycline while we waited for the CDC results to come back. She initially thought it was Rocky Mt. Spotted Fever but it came back as Lyme’s. I think I caught it early enough to get rid of it but often wonder if it lingers in some way. Do you know if it’s possible to completely get rid of Lyme’s or will it always linger in some way? Of course now I worry that my kids will get it and stay on guard for the symptoms whenever we are in the woods or other forested areas.
Chapel Hill Pediatrics and Adolescents, P.A. Thanks for the question, Beth. Sorry to hear about your Lyme story. As far as we are aware, there are no Lyme disease contacts traceable to ticks in the Triangle area. But watching for signs of bulls-eye rash, fever, and headache. Also we strongly recommend using DEET at 30% as a tick repellant. In terms of chronic Lyme disease, this is a hotly debated topic. Data suggests that one round of doxycycline for Lyme treatment is ample for total course of treatment.
Beth Poland Shugg Very good to hear! Since I received 2 rounds I think I’m good to go.

Carolina Parent Magazine One last question if there is time for it! “My kids go to summer camp, what should I be worrying about?” A classic “Mom” question!
Chapel Hill Pediatrics and Adolescents, P.A. We suggest enjoying your time without your children, as long as you’ve communicated any special needs or chronic illnesses your children may have. Normal attention to hydration, sun protection, and daily tick checks are helpful.

Carolina Parent Magazine Thank you so much for your time, Dr. Homan and Dr. Robinson! This was a great chat just in time for the unofficial kick-off to summer this weekend. For more information about Chapel Hill Pediatrics and Adolescents, P.A., go to chapelhillpeds.com.
Chapel Hill Pediatrics and Adolescents, P.A. Thank you for hosting us! Thank you parents for your questions. We post to our Chapel Hill Pediatrics Facebook page a few times per week with similarly practical answers to common questions.
Carolina Parent Magazine Good to know there’s a resource out there for kids’ summertime health and wellness questions! Thank you,Chapel Hill Pediatrics and Adolescents, P.A.!
Brenda Larson Great information! Thank you Dr. Homan and Dr. Robinson and Chapel Hill Pediatrics and Adolescents, P.A.

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