Dr. Deb

November is Child Safety & Protection month. Many parents use safety gates and car seats but forget that a cell phone may pose one of the biggest safety threats.  Cell phones are no longer primarily for making calls but your child may be targeted for sexting, stalking, identity theft and bullying all through this portable device that is supposed to make parents feels safer. My poor 13 year olds are the “only kids in their class” without a cell phone but we are not ready for the risk or the expense when I know they are always under adult supervision.

Dr. Deb’s Cell Phone Safety Tips

1. Password Protect:

Place a password on all phones so another child won’t steal, take photos or send texts on their phone.  Many phones contain contact information, passwords and other critical information that you would not want to share. Most carriers will allow you to remotely block information so contact them as soon as a phone is missing. Remember to back up your phone on a home computer.

2. Turn Off Time:

Facts (from BeSmartWireless):

Boys typically send and receive 30 texts a day; girls typically send and receive 80 messages per day

26 percent have been bullied or harassed through text messages and phone calls.

25 percent of text messages sent by teens are sent during class

Teen’s who are considered “hyper-texters” (defined as texting 120 or more messages in a school day), are:

40% more likely to have tried cigarettes

43% more likely to be binge drinkers;

41% more likely to have used illicit drugs;

55% more likely to have been in a physical fight;

Nearly 3.5 times more likely to have had sex; and

90% more likely have four or more sexual partners.

Hold onto the phone until homework is finished and chores are completed. Phones are a privilege, not a right.

Collect phones at bedtime so kids can get a break from the constant texting.

When parent’s limit their child’s text messaging capabilities, they are less likely to be involved in “sexting”;  be a passenger in cars where the driver texted behind the wheel or used the phone in a dangerous manner while driving.

Data released today from American Public Health Association show 13% of high school students say they’ve received “sext” messages and one in 10 has either forwarded, sent or posted sexually suggestive, explicit or nude photos or videos of people they know by cellphone or online.

New controversial advice is to delete sexting messages and not to tell. Teachers are obligated to report to the police and sexting is still considered a felony in many areas under child pornography laws. Automatically deleting it does end it and prevent your child from being implicated but I personally I would consider contacting the parent of the child that sexted.

Children that sext reported twice the number of depressive symptoms, compared to teens who did not. 13% of teen involved in sexting reported a suicide attempt during that period compared with 3 percent of non-sexting teens, according to the researchers at the Education Development Center in Newton, MA.

3. Disable Geotagging & Use Parental Controls

2/3’s of teen frequently use a mobile device’s camera to take pictures “love it” and would “die without it.”

When Photos are posted online from a phone most of the time they are geotagged giving the exact longitude and latitude of where that photo was taken. This can give specific home address locations and show patterns of locations giving stalkers an exact map with timetable of your child whereabouts

Learn how to disable geotagging via IcanStalkU.

More than 37% of teens in the U.S. access the Web through their phones.

Parental controls can block content as well as limit accessibility during certain times of the day.  Contact your phone carrier for parental control options

Learn about Parental Block Options of popular phone carriers.

4. Don’t Download Apps

54% of text-using teens have received spam or other unwanted texts.

Children’s identities are being targeted more than ever and one of the easiest ways for scammers to access personal information is through malware on apps.  Children should never download an app without showing their parent but even reputable apps have been targeted with malware. Generally speaking limiting apps, limit hackers’ access.

Apps that pull information are also common on social networks sites and you should regular check what apps have access to your personal information.

Teach kids not to put their phone number on social networking sites. Don’t click on ads, contests, or texts for free prizes.

Learn how to delete an app from Facebook via Consumer Reports.

5. Pause before you Post

Anything you share on a social network, text or phone may become public knowledge so teach them never to post anything that would hurt or embarrass someone. Recently public comments made on Facebook have become accessible under Google searches.

Start talking about etiquette when they are first learning to use a computer. Constantly reinforce Pause before you Post.

Many parents are overwhelmed with technology just as they were learning to use a car seat. They must also learn the technology so they can keep their children safe.

Dr. Deb

New guidelines for cervical and prostate screens are actually recommending less screening as oppose to more and not everyone agrees, myself included. While I have done a lot of testing for cervical cancer and grant it, probably too much, I will never forget the patients that I diagnosed with cancer.  While some change is needed, many docs will not follow the new recommendations.

Who should NOT get a pap smear according to the new U.S. Preventive Services Task Force recommendations ?

U.S. Preventive Services Task Force recommends AGAINST Pap Smears

- Under age 21

- Older than 65

-Women that had a hysterectomy*

*(Unless they had a history of high-grade precancerous changes)

The task force did not recommend pap smears in women under 21 as the majority of sexually active young women will acquire some form of HPV,  (Human Papilloma Virus) or the virus that may cause many types of cervical and vulvar cancer, but will clear them without treatment.

The risk of cervical cancer in adolescents is about 1 in 1,000,000. Many painful and expensive procedures are used in this age group to treat precancerous lesions that are unlikely to progress to cancer according to the task force. These procedures have some risk of preterm labor however there is not a significant risk of NICU admissions or perinatal mortality.

It is important to remember that while a pap test is not recommended, an annual exam may still be needed.  A pap test is sampling of the cervix looking for precancerous cells. It does not check for other types of cancer such as the uterus or ovaries. It is also not checking for STDs or sexually transmitted diseases, which should be screened annually in sexually active teens and with new partners.  These years are critical in helping girls find self empowerment to enable them to stand up to sexualized media stereotypes and peer pressure. A strong doctor relationship can be of great benefit and I would hate for girls to think that just because they don’t need a pap, they shouldn’t see their doctor.

Women who have had a hysterectomy should talk to their doctor to see what type they had. Most of the time the cervix is removed but if it is left in then paps should be continued.

How are the USPSTF recommendations different than other organizations?

The USPSTF recommends a pap every 3 years for women ages 21-65. Currently other organizations such as ACOG (American College of Obstetrics and Gynecology) recommend testing with a pap smear every other year from age 21-29 and every 3 years in women over age 30 with a negative HPV  (Human Papilloma Virus) test in low risk women.  HPV is the virus that causes most cases of cervical cancer so a negative test is reassuring. Many women have HPV and never get cancer so testing HPV alone is not a specific enough test, meaning that too many women that don’t have cancer would need follow up. The USPSTF does not recommend using HPV testing at this time but many doctors will still use it to decide who should be followed more closely.

How frequently should women that have received 3 HPV vaccines have a pap smear?

Right now there have not been any changes to pap smear screening for vaccinated women. This may change with longer-term studies but the vaccine does not prevent all forms of cervical cancer.

Why was there a recommendation yesterday that all boys should be vaccinated?

HPV can cause warts and penile and anal cancer in men and obviously since most girls are getting HPV from boys it makes sense to vaccinate them too. There is new compelling evidence that other types of cancer including cancer of mouth, tonsils and throat are caused from HPV likely transmitted though oral sex. These types of cancers are increasing with over 7000 cases per year so boys should be vaccinated before they are exposed.

How important is USPSTF’s recommendation against PSA screening for prostate cancer?

The USPSTF recommended against PSA screening since prostate cancer is slow growing and most men diagnosed over 75 years old will die from something else The complications from the treatment including urinary problems and sexual dysfunction are often worse than the cancer itself in older men. The problem is we have no other screening test at this time and many people, including myself, know of men whose lives have been saved from the PSA test. Men with a family history of prostate cancer should consider getting the test even starting in their 40s. .

The bottom line is talk to your doctor about your risk factors to help decide what screening tests you should receive. For example, I will follow smokers much closer for cervical cancer as it is such a strong co factor than I would a non-smoker.  Any screening test has risks but many people are willing to undergo the risks of those tests to prevent what could be a fatal disease.

Dr. Deb

Every morning I make 6 neat little piles of vitamins for my family. A multivitamin with calcium, omega 3’s and CoQ10 for each of us. A new study showed that supplements increased death rates in older women.  With over 50% of American taking supplements like we do, does this mean we should we stop? I’ll explain.

Does this new study show that we should stop taking vitamins?

This study was very limited in that only white women with an average age of 62 recalling what vitamins they were taking were studied. The study did not a have  “cause and effect’” design. They did look at 40,000 women, ages 55-69, over 19 years and found a 2.4% increase in death in those taking multivitamins. The most significant increase was seen in those taking iron with a 3.9% increase risk of death. What we don’t know is if those taking these supplements had underlying medical problems that may have influenced taking supplements. Only Calcium showed a decrease risk of death by 3.8%.

Dr. Deb’s Tips in Taking Supplements

1. Never take Iron supplements unless you are Anemic

Extra iron intake has been linked to heart disease, liver disease, diabetes and most recently Parkinson’s disease.

As little as 200mg of iron can cause poisoning in children.

Hemochromotosis is an iron storage disease that affects 1 in 250 people of European descent. Complications from this common disease can be prevented by frequent blood donation. In medical school I tested high for iron stores without having hemochromotosis so I do give blood frequently.

Unless you have a blood test that proves you are anemic, then do not take an iron supplement.

2. Consider a Calcium Supplement

This study did show a decrease in death with calcium supplements ans most are not meeting the daily recommended dose. Teenage girls are most likely to be deficient in Calcium and would therefore benefit.  Take a supplement if you are not getting 1200 mg calcium per day with 600iu of Vitamin D.

3. Less is More

The most important thing this study shows is too much of a good thing may be bad. Don’t take extra iron unless you need it and don’t take megavitamin doses. A study published in JAMA yesterday showed that high doses of Vitamin E may actually increase prostate cancer. Vitamin D was seen as the wonder drug a few years ago but excess Vitamin D can cause problems too. Vitamins and supplement are not regulated by the FDA but can have major health consequences. What the company says is on the bottle may not be the case. Consumer reports found great disparity in what was actually in many supplements and also found many “natural” supplements” to have health risks.

4. Make half your plate fruit and vegetables

The food pyramid was recently replaced with the food plate as study after study has shown the most health benefit is found in a diet rich in vegetables and fruits which are still lacking in the American diet as only 3% of Americans are following the food plate. This one simple rule may be the most beneficial to your health. The old adage an apple a day keeps the doctor away has more and more data to back it up with apples showing a decrease in cancer, diabetes and asthma while helping with weight loss. You can track your nutrition on this link.

5. Talk to your Doctor

Many patients neglect to tell their doctor what supplement they are taking but it is critical as supplements may interfere with other medications. Supplements are drugs with consequences both good and bad and need to be discussed with your health professional.

This study will not change my supplement routine yet but does reinforce that no supplement can replace proper nutrition.

I always wanted twins until I actually HAD them. It took about 18 months before I actually LOVED mothering twins, which I do now with a passion. The early months were all about survival and I savored the exersaucer time in front of the TV. 20 minutes of Smart Baby gave me the least bit of sanity and I was making them smart, right? Turns out those videos don’t really make your baby smart and television, especially for young children, may lead to several health risks.

SpongeBob SquarePants is the most-watched TV show among kids between the ages of 2 to 11 but a recent study showed that 4 year olds who watched only 9 minutes of the show were significantly impaired on tests of executive function or the ability to focus and not get distracted compared to kids that watched a PBS show Caillou or drew with crayons.

Sponge Bob is considered a fast-paced show with complete scene changes every 11 seconds compared with 34 seconds for the slower-paced program. These fast paced shows may over stimulate the brain and lead to deficits.

This is not the first study to show problems with television. Television watching is associated with higher blood pressure and obesity, because not only is it sedentary and noninteractive, but there are an estimated 10,000 unhealthy food commercials per year being viewed each year.

Watching too much television is unhealthy for even active people. A recent study of the National Cancer Institute showed adults age 50-71 who watched more than 5 hours of TV a day were twice as likely to die sooner. Even those who exercised at high levels but also watched a lot of TV were still at risk for early death.

What is a sleep deprived mother to do?

Dr. Deb’s Television Watching Recommendations

1. Limit Screens to less than 2 hours a Day

The American Academy of Pediatrics discourages TV altogether for children under the age of 2 so forget Smart Baby like programs. It is important to be active and interactive and television does neither. When you do have the TV, keep closed caption on. This had been shown to be a far better reading aid than any video or smart program.

2. No Television in the Bedroom

32% of 2-7 year olds and 65% of 8-18 year olds have a television set in their bedroom. Television creates sleep problems for both children and adults. Even watching TV too close too bedtime caused sleeping problems in 28% of preschoolers who watch TV or played video game at least 30 minutes after seven.

Children need a quiet soothing winding down ritual time before bed and reading a book is a great habit to get children into at an early age.

3. Aim for Educational & Nonviolent Television

Children have trouble discriminating fantasy from reality. 37% of children who were exposed to one hour or more of violent media had sleep problems compared to those who watched less than an hour or none at all. Not only does more media violence promote real life violence but teens that watch sexualized shows tend have earlier and more frequent sexual experiences.  Make sure they are watching quality and diverse television. The FCC has V chip guidelines for every show with age recommendations.

4. Watch TV with your kids to Find Teaching Moments

I don’t think you should ban every violent or sexual show but make sure you are watching these shows together to have teaching moments about the choices the characters have made. You can help clarify the fantasy versus the reality of real life.

5.  Turn TV off during Meals

Mealtime should be sacred. Families that eat together and share their day are more successful in school and in life. It is too easy to have television as the background noise so make all television viewing with a purpose.  Those that eat while watching TV consume far more calories than those sitting at a table together.

Do my kids enjoy Sponge Bob? Absolutely! Keep him in his target audience of 6-11 year olds and out of the younger kids eyes. You don’t have to ban TV but don’t make it your babysitter either.  Think about what kind of modeling you are doing for your kids too.

Have a great week and don’t forget, the new fall season starts soon!

Dr. Deb

Preventing Annoying Back to School Infections

There’s peace in my house as all the kids are back to school but the return to school also means the return of annoying school infections such as pink eye and lice. I want to share my tips to keep those infections out of your house this year.

1. ABCs: Allergies, Bacteria and Colds

These three account for the most common infections in children and can all be prevented with hand washing, covering mouths while coughing and not sharing drinks and utensils.

Just one lesson on hand hygiene where students ages 5-15 learned to clean hands 3xs during the school day decreased 4 or more sick days by 66 percent according to the American Journal of Infection Control.

Most importantly have kids wash their hands when they come home from school to keep germs out of the house. They should also wash their noses with normal saline spray to prevent allergy outbreaks. If they do become ill then wash their toothbrush in the dishwasher or replace it to prevent reinfection.

2. Pink Eye

Pink eye is conjunctivitis or inflammation (swelling) of the conjunctiva—the thin layer that lines the inside of the eyelid and covers the white part of the eye.

The most common causes of conjunctivitis are viruses, bacteria, and allergens.

Symptoms include red eyes, crusty eyelids in the morning, itchy eyes, tearing and blurred vision.

Is typically mild, with symptoms being the worst on days 3–5 of infection. The condition usually clears up in 7-14 days without treatment but may take 2-3 weeks.

Many cases improve without treatment but topical antibiotics are often prescribed.

Prevention:

Wash your hands often with soap and warm water or an alcohol-based hand gel, especially after applying eye ointment.

Avoid touching or rubbing your eyes.

Wash any discharge from around the eyes several times a day but use different cloths on each eye.

Wash pillowcases, sheets, washcloths, and towels in hot water and detergent.

Don’t share tissues, towels, washcloths, eye makeup or eye drops with other people.

When treating allergic conjunctivitis dust and vacuum often to reduce allergens in your home and close windows when the pollen count is high.

3. Head Lice

6 to 12 million cases of head lice infestation occur each year in the United States in children ages, 3 to 11 years, according to the Centers for Disease Control and Prevention. They are tiny parasitic bugs that don’t spread disease and spread mainly by direct head-to-head contact with a person who already has head lice. Lice don’t fly or jump; they move by crawling.

Every parent should check regularly for lice by parting the hair in several spots. Lice can move fast so use a magnifying glass and a bright light. Nits can look like dandruff, but stay firmly attached to the hair if you pull your fingernail across the hair while dandruff will come off easily.

Most important for lice treatment is to use a fine-toothed comb or special “nit comb” to remove dead lice and nits that can be used with or without chemical treatment.

Prevention:

Don’t share hairbrushes, combs, hair ornaments, scarves, bandanas, towels, or helmets.  Girls with long hair should keep their hair braided and pulled back. Avoid head-to-head contact during play or slumber parties

When your child returns from a sleep over put everything in the dryer on high heat for 10 minutes. This treatment will also kill bedbugs.

Treatment:

Machine wash and dry clothing, bed linens, and other items using hot water (130°F) and dry on high heat. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks. Head lice survive less than one or two days if they fall off the scalp and cannot feed.

Vacuum the floor and furniture, particularly where the person with lice sat or lay.

Disinfest combs and brushes used by a person with head lice by soaking them in hot water (at least 130°F) for 5–10 minutes. After finishing treatment with lice medication, check everyone in your family for lice after one week.

4. Molluscum Contagiosum

MC are pink, white or flesh-colored bumps caused by a type of poxvirus. It is common in kids ages 1 to 10 but many parents have never heard of it. Molluscum contagiosum is very contagious, mainly through skin-to-skin contact or contact with contaminated objects, such as clothing, towels or toys.

Once someone has the virus, the bumps can spread to other parts of their body by touching or scratching a bump and then touching another part of the body. Molluscum can also be spread by sexual contact. There has been a relationship of catching molluscum by shared swimming pools, baths, saunas, or other wet and warm environments, this has not been proven. Most likely sharing towels and other items around a pool or sauna than through the water spread the virus.

Prevention: Hand hygiene and not sharing personal items, including towels are the best ways to avoid this skin infection, which typically clears up without treatment in 6 to 12 months. Do not shave or have electrolysis on areas with bumps. If you have bumps in the genital area, avoid sexual activities until you see a health care provider.

To prevent the spread of molluscum to other areas of your body or to other people, it is important to keep every blister or bump covered either with clothing or with a watertight bandage

Treatment

There are many treatment options including Cryotherapy (freezing), Curettage (removes the fluid inside the bumps), Lasers and Creams that include certain chemicals (i.e., salicylic acid, podophyllin, tretinoin, and cantharidin). There is also a newer cream (imiquimod) that helps strengthen the skin’s immune system.

Mollusscum is tough to treat when it spreads and I have used imiquimod on my own children with great success.  It needs to be used every night, is expensive, may cause irritation but is safe.

A home remedy that may be worth trying is apple cider vinegar or ACV. There are several options but one is to soak a cotton ball with ACV and tape it to the MC overnight. There can be some irritation and stinging. Some have reported just soaking in a bath nightly with ½ cup of ACV will work too. Others advocate popping the MC with a sterilized needle then applying the ACV that is very similar to the curettage that we do in the office. I do not recommend popping at home as you may spread the infection or cause a bacterial infection but I would try the ACV nightly bandage option.

Being a parent is never easy. Here is hoping for a Happy Healthy School Year!

Dr. Deb