By Dr. Lauren Lucas
-Children should always be supervised by a responsible adult when around a pool or other body of water, even when it is not time to swim.
-The responsible adult should not be distracted and should not be under the influence. It is important for swimmers to take scheduled breaks from the pool so that the responsible adult can also get breaks or switch with another adult. Discuss the plan for breaks before swim time starts.
-Responsible adults and caregivers who monitor children swimming should be trained in CPR.
-Set the rule early and remind children often that they should never get in the water without getting an adult’s permission immediately prior to stepping into the water. It is never too early to start discussing this rule!
-Teach children to yell for help immediately if they see another child struggling or staying under the water for too long.
-Ensure pools are surrounded by 4-sided fences and keep doors that access pool areas locked. The recommended height for these fences is at least 4 feet tall. Consider installing alarms on the doors so that adults are easily alerted when they open.
-Children should always have a life jacket on at all times on while on a boat, including while docked or on a dock. These life jackets should be Coast Guard Approved.
Check out the following websites for more tips!
Insect Repellant Tips:
-The AAP recommends using bug sprays with DEET as the repellant.
-For infants and children older than 2 months, DEET with concentrations between 10-30% should be used.
-The percentage of DEET is related to duration and not strength - 10% provides protection for 2 hours while 30% can provide protection for 5-8 hours.
-Children should not use DEET with higher concentrations than 30%.
-Avoid using combo sunscreens and insect repellants - sunscreens will need to be reapplied much more frequently than insect repellant.
-Insect repellant should ideally only be applied once a day to children.
-Skin should be washed when outdoor time is over to remove the repellant.
-For babies, use netting or mesh screens over strollers for extra protection, especially for infants less than 2 months who should not have insect repellant applied on their skin.
-Avoid applying anything with strong scents – perfumes, body washes, etc. that may attract bugs before going outside.
-Insect repellants with alternate repellants like picardin or IR3535 are less effective than DEET.
Check out the following websites for more tips!
By Dr. Lauren Lucas
Sun Safety Tips:
-Stay in the shade and have kids wear sunshirts, hats and sunglasses as much as possible when outdoors.
-Plan outdoor activities for early morning and late afternoon/evening when you are able (before 10am and after 4pm).
-Apply mineral-based (titanium oxide, zinc oxide) sunscreen to babies and toddlers. These are safe to apply to babies less than 6 months if outside for extended periods, but these infants should really be kept out of the sun and in shade completely.
-For older kids, use sunscreen that is at least SPF 15 and includes both UVA and UVB protection.
-Reapply sunscreen every 2 hours, or more frequently if swimming or sweating.
-Make sure kids have a water bottle readily available throughout the day and encourage them to stay hydrated.
-Never leave infants or kids in the car, even with the windows cracked for short periods.
Check out the following websites for more tips!
By: Lauren Lucas. MD
In early April, the CDC released the first data set describing children who have tested positive for COVID-19 in the United States. This included about 2500 children less than 18 years old. Strikingly, kids only made up 1.7% of known cases (where age was reported) though they comprise 22% of our population.
The authors only had information on about 300 of those children’s symptoms, which demonstrated that 73% of these kids had the classic symptoms of fever, cough and/or shortness of breath versus 93% of adults. Breaking down each individual symptom, 56% had fever, 54% had cough, and 13% reported shortness of breath.
The hospitalization rate was estimated at 5.7-20% of pediatrics cases where hospitalization status was known, and the ICU admission rate was between 0.58-2% where status was known. Both of these numbers are lower than those for adults, out of whom up to 10-33% require hospitalization and 1.4-4.5% require ICU admission. These are all very rough estimates given the limitations in testing and the smaller portion of COVID patients whose hospitalization status was known.
Out of the children included, 345 cases reported presence or absence of underlying conditions. These cases demonstrated that a quarter of kids who tested positive for COVID had at least one underlying health problem, with the most common being asthma, cardiovascular disease and immunosuppression. This is actually lower than I expected, as I would anticipate these kids to be tested more frequently than kids with no medical problems.
Overall, these numbers coincide with those out of China last month. Kids are less likely than adults to have the classic symptoms, especially the triad of fever, cough and shortness of breath all together. About a quarter of children may have atypical or no symptoms. Kids are still at risk for hospitalization and ICU admission from COVID-19 complications, but they do seem to be at lower risk than adults.
We still have so much to learn about COVID-19 and kids, especially as we have the ability to test many more people. However, I hope this sheds a little bit more light on how our kids could be and have been affected.
By Dr. Lauren Lucas
We still have a lot to learn about COVID19, but the trends in children so far have put many of our minds at ease. Initial reports from China were encouraging, and now we actually have some early numbers to give us a better feel for how kids fare with this scary virus. If you have been in for a well check with me recently, you’ve probably heard me ramble off many of these numbers.
A few weeks ago, Pediatricians in China released an observational study before finalization to share their findings with other countries, and it was published in Pediatrics, one of our main sources of evidence-based medicine. This study included 2,143 children up to age 18 with a mean age of 7. One of the downfalls of the study is that 1/3 of the children included had positive testing and the other 2/3 were suspected due to exposure but not confirmed cases.
This study found that the vast majority of these kids (94%) had none, mild symptoms (though mild symptoms were flu-like with fever, runny nose, cough, muscle soreness, and in some cases nausea, vomiting and diarrhea) or moderate symptoms (including pneumonia but not requiring oxygen therapy or hospitalization). About half of patients in each age group were classified as mild. One third of kids between ages 6-15 were asymptomatic.
As Pediatricians, some of the early data from China did give us pause about our littlest patients. Infants and toddlers may be more susceptible to COVID19 than initially suspected. They may be more at risk for difficulty breathing, drops in their oxygen levels, and therefore hospitalization. 10% of the infant age group and 7% of the toddler age group had severe (difficulty breathing and changes in oxygen requiring hospitalization) to critical cases (Acute Respiratory Distress Syndrome requiring intensive interventions). We still have a lot to learn about infants born to pregnant mothers infected with COVID19 as well, and whether transmission occurs across the placenta (studies are inconclusive so far).
One child in the 10-20 year old age range passed away in this group of Chinese children, and thankfully none less than 10 passed away. In the preliminary data from Italy (according to article in JAMA March 23, 2020), no children less than age 20 had died in Italy at that time. Unfortunately in the US we have lost one infant who tested positive for COVID, but the cause of death has not been released.
What does this all mean? Thankfully, children are most likely to have no symptoms to mild symptoms. While this is very reassuring as a parent, this data reinforces the need for kids to social distance. Do not let children play with other children outside your home, even in the neighborhood or nearby park. Children can be shedding the virus with little to no symptoms. There is still risk to children, especially younger infants and children with co-morbidities, and even “mild” symptoms can be as severe as flu.
Dong Y, et al. Epidemiological Characteristics of 2143 Pediatric Patients with 2019 Coronavirus in China. Pediatrics. 2020; doi: 10.1542/peds.
Go for walks and bike rides as a family. Trips outside are safe as long as you maintain social distance from neighbors. It is best at this time to avoid playdates and neighborhood parks. Teenagers are especially having a difficult time with social distancing from friends. This is a great opportunity to go for a walk with them and check in.
Cook a new recipe together as a family.
Have a picnic outside for a meal.
Write letters and draw pictures to mail to family members.
Schedule a virtual family reunion on platforms like Zoom or Google Hangout.
Check artist websites for fun ideas – many are offering coloring pages and even art classes. South Carolinian Dorothy Shain is hosting weekly art classes for kids with a different featured artist each week.
Take virtual tours or lessons of museums or zoos. Our own South Carolina Aquarium has regular updates on their Facebook page. Many Zoos and Aquariums are offering virtual tours and live streams.
Check out the many educational Podcasts for kids.
For preschoolers, check out PBS Kids (https://www.pbs.org/parents), which is sending out a daily newsletter with show and activity ideas.
Overall, maintaining some routine and structure will be helpful for children, but allow for some flexibility and grace. Create a schedule together distinguishing work hours and play hours. Kids might need more breaks than normal from their school work as well. Allow for frequent 5-10 minute breaks during their school time as able. For school time, try to have a quiet work area with minimal distractions.
More Tips from the American Academy of Pediatrics:
Mount Pleasant parents have spoken and the votes are in! Coastal Pediatric Associates has been named the Best of Mt. Pleasant from the readers of Mount Pleasant Magazine. Says the magazine, "Parents desire nothing but the most exceptional treatment when it comes to the health and well-being of their children and Coastal Pediatric Associates pride themselves on being compassionate, relentless advocates for all patients and their families.”
There are several reasons parents choose Coastal Pediatric Associates. The team has been caring for Charleston children for more than 20 years, and provides the most current, compassionate, and comprehensive care in the Charleston area. Coastal Pediatric Associates' team of skilled physicians, nurse practitioners, and staff are committed to delivering clinical excellence in an environment that is fun, kid-friendly, and sensitive to the unique needs of each child.
Our #CPAkid families benefit from:
Coastal Pediatric Associates is a designated Level 3 Patient Centered Medical Home with five convenient locations across the area. In addition, they provide research opportunities through Coastal Pediatric Research and newborn and breastfeeding care through the Breastfeeding Center of Charleston. To learn more about our team, https://www.cpakids.com/questions.php.
It is a common myth that cold weather causes colds, but it does not. Colds are caused mainly by viruses that we are exposed to more often in the winter months. These viruses are spread even more easily when children are in school and in close contact with each other, usually through respiratory droplets in the air and on hands. Coach your kiddos to cover their mouths and noses when they cough and sneeze, and to also wash their hands often with soap and water. These are the best ways to help reduce spread of infection.
If you have a cold here are a few tips:
As for outdoor time, children should dress in layers for the school day. We have wide variations in daily temperatures in this area, so having the ability to put on, or take off, extra layers can help. Dress babies and young children in one more layer of clothing than an adult would be wearing in the same conditions. If your child suffers from minor winter nosebleeds, use a cold-air humidifier in their room. Saline nose drops can help keep their nose moist. Don’t forget to use sunscreen. Children and adults can still get sunburned, even in the winter.
Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. It can cause mild to severe illness, and in some serious cases, can lead to death. The best way to prevent flu is by getting a flu vaccine each year. A recent study by the CDC found that children 0-18 years old are the most likely target to get sick from flu.
Flu can be very dangerous for children. CDC estimates that between 6,000 and 26,000 children younger than 5 years of age have been hospitalized each year in the United States because of influenza. The flu vaccine is safe and helps protect children from the flu.
Coastal Pediatric Associates’ (CPA) recently announced that they will host flu clinics at all five locations starting in September, and it could not come at a better time! School is back in session, and the germs are spreading. A flu vaccine can help to keep your child healthy and flu free this school year.
Coastal Pediatric Associates' team of skilled physicians, nurse practitioners, and staff are committed to delivering clinical excellence in an environment that is fun, kid-friendly, and sensitive to the unique needs of each child. Dr. Steven Stripling highlights some important flu tips for parents.
CPA’s Top 10 Flu Tips:
1. Schedule your child’s vaccine! Flu shot clinics will be held at all CPA locations.
2. Look for symptoms: High fever, sore throat, headache and body aches. Dr. Stripling says, “The younger child should be seen quickly with a high fever.”
3. Avoid touching the face as hands often hold the germs!
4. There are several flu strains. It’s possible to get more than one strain in a season. Dr. Stripling explains, “Over the years there are several strains each season. It is possible to get two different strains. Vaccinate even if the child has had the active flu at the beginning of the season.”
5. See a physician when flu symptoms begin so that they can establish a treatment protocol for the patient.
6. Rest and fluids if diagnosed.
7. Ibuprofen helps with body aches.
8. Take care of the cough. Older children can take cough syrup as prescribed by physician.
9. Keep an eye out for complications: Fever after day six warrants another trip to the doctor. “If you have been in and diagnosed, doing supportive care, and still do not feel better after a week, we need to look out for secondary bacterial diseases,” Dr. Stripling explains.
10. Remember CPA is here to help! We offer 5 convenient locations as well as extended hours and availability seven days week.
CPA provides the most current, compassionate, and comprehensive medical care. CPA is a designated Level 3 Patient Centered Medical Home, recognized for providing the highest level of care in the three-tiered quality grading system. To schedule a flu vaccine appointment, please call the location closest to you. For more information: https://www.cpakids.com/contact.php.