A few years ago, when my son was 2 years old, we held a pool party for my daughter’s fifth birthday. We invited an army of kids and parents. Our pool is an in-ground “sports” model, which is a nice way of saying it’s small. The deep end is only 5 feet, and the surface area is modest enough to give the water a crowded feel with anything more than a handful of swimmers. Still, as a doctor and nurse, my wife and I were aware of the inherent dangers of such an event, so we hired a lifeguard to keep an eye on the water. He wouldn’t be a substitute for parental supervision, but we figured his presence would ease minds and encourage more mingling among grown-ups than might otherwise occur. Plus, at the time, it seemed like a cool thing to do.

The lifeguard arrived, and the kids jumped into the pool. In the rush and hubbub we forgot to put my son in his swim belt. For those of you who haven’t heard of a swim belt, trust me–they’re great for little swimmers. Three flotation bricks hang from an adjustable belt, giving your child just enough buoyancy to keep his head up out of the water. As skills improve and he becomes more stable, you can remove a brick or two, thereby transferring more of the work to your new little swimmer. It’s not a substitute for a life vest. Think of it more as a training device.

Anyway, my swim-beltless son watched the other kids jump into the pool, and since he too was accustomed to jumping in, he went for it. Bad move. Without that belt, his tiny body sank right to the bottom.

From my perspective it was a Twilight Zone moment, all activity briefly freezing and then moving forward in super slow motion.

The lifeguard, still wearing street clothes over his swimsuit, jumped into the pool and saved my son. He was a hero, worthy in my mind of a medal of accomplishment from whatever body it is that certifies lifeguards. We didn’t have a medal to give him, but as I recall, we did add a substantial bonus to his hourly wage.

Accidents like this take only seconds to occur, and usually at a time when you least expect them. We were fortunate to have a lifeguard on duty. Many other children aren’t so lucky. In the United States, drowning is the second leading cause of accidental death in children between the ages of 1 and 14. Here are some tips to prevent your child from becoming the next victim:

Never leave your kids alone in or near a pool, even if they’re good swimmers, even if it’s for a minute. One minute is long enough for a slip on the deck, a crack in the skull, and a journey to the bottom.

Install a fence that’s at least four feet high, surrounding all four sides of your pool. Install a self-latching, spring-loaded gate whose latch is too high for little hands to reach.

You should not have access from your house directly into the pool area. Toddlers who wander out of the house and fall into the pool make up the largest number of accidental drownings.

Post and enforce pool rules such as NO RUNNING and NO DIVING.

Begin official swimming lessons at a young age. Check with your local YMCA, city pool, or swim club for ages and availability.

Rescue equipment, such a shepherd hooks and life preservers, should be located in a prominent location near the water.

Have a phone nearby, in case you need to make a quick call for help.

Do not rely on swimming aids as a substitute for constant observation. If you provide swimming aids, choose a solid material device and avoid plastic inflatables.

Any person responsible for supervising children in a pool should know how to perform CPR. Contact your local Red Cross to find training opportunities in your area.

When children are finished playing in the pool, put all toys away. This lessens the temptation of an unsupervised return to the pool area.

At the end of the swim season, be sure to cover your pool with a heavy-duty safety cover that meets the standards of the American Society for Testing and Materials (ASTM).

Swimming is a great form of recreation and exercise for people of all ages. Don’t fear the water, but be sure to respect it!

COPYRIGHT 2006 - MIKE PATRICK JR, MD

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The internet is full of buzz words these days. You have your blogs and tags and feeds. Then come the initials: RSS and XML. For busy parents, making sense of these trends can be confusing and difficult. But understanding them is an important skill for parents to master. Why? Because they’ll open a whole new world of useful content. The latest trend, still in its infancy, is podcasting. Many parents have heard of podcasts, but few understand exactly what they are or how to use them. Let’s take a closer look.Podcasts are audio shows. They range in length from 5 minutes to an hour or more, and while a few of them contain music, most are spoken programs–like radio talk-shows. Committed podcasters (the hosts) release new episodes of their show at least weekly. And they usually concentrate on a niched theme. So if you’re interested in gardening, listen to a gardening program. Want to plan a great vacation? Find a trip-planning podcast. Are you looking to lose weight or de-clutter your house or improve your parenting skills? You can find shows on these topics too. In fact, with an estimated 55,000 podcasts currently in production, you can find a show on just about anything.So what’s out there for parents? Lots. Here are a few examples:101 Uses For Baby Wipes - Billed as the DaddyCast, this program devotes only a slice of time to disposable cloths. The bulk of the program features news, commentary, interviews, and mixed-in music from up and coming artists.Dr Fitness and the Fat Guy - This program takes a look at fitness and weight loss. Despite the light-hearted tone, it offers sound advice and motivation.Tacoma Cat Hospital - If you like cats, you’ll love this program.The Radio Adventures of Dr Floyd - Listen with your kids! It’s like an old-time radio show, complete with funny voices and sound effects.Pediacast - Okay, shameless plug time–I’ll make it quick. Pediacast is the podcasting arm of Pediascribe. If you like our column, consider giving our podcast a try.There are many other podcasts out there. But how do you find them? Several directories, each arranged by category, will help you find the program that best matches your interest. iTunes has a great podcast directory. Even if you don’t own an iPod, you can download iTunes to use as a podcast search tool and player. Podcast Pickle has a huge online directory of podcasts. You’ll find support forums there as well. Other popular directories include Podcast Alley, Podcast.net, and Yahoo! Podcasts.Okay, so you’ve found a podcast that matches your interest. How do you listen? The easiest way is from your computer. You can listen right from the directory where you found the program or you can listen from the show’s homepage (directories usually provide a link to the program’s website). Of course, you can do other things while you listen–check email, surf the web, pay bills, cook, fold clothes, work on a project, or whatever else strikes your fancy.For a truly mobile experience, you’ll want to download the show to an MP3 player. If you have an iPod, iTunes makes this easy. For those of you with other players, it’s not that difficult. Simply download the program’s MP3 file and transfer it to your device. But keep this in mind: Podcasts are big files so if you have a dial-up connection, pack your patience and find something else to do while the program downloads.Keeping up with newly released episodes of your favorite podcast is another skill you need to master. This is done through an RSS (really simple syndication) feed. This isn’t as complicated as it sounds. The podcaster keep an XML file on the program’s site, which includes details about the show’s latest episodes. You simply “SUBSCRIBE” to the program from one of the podcast directories or from the show’s website. If you’re not using iTunes, you’ll also need an account with a podcatching service. Examples of these include Podnova, Newsgator, Netvibes, and Odeo.Once you have an account with a podcatcher, subscribe to any show you like. In your podcatcher, select the option to add a new podcast subscription. You’ll need to know the show’s RSS feed. To find this, look for a little orange square with a dot and two arcs on the show’s website. Click on it. Don’t worry if a page of foreign code appears. Look up at your browser’s address bar. That’s the address of the RSS feed. For example, the Pediacast feed is http://www.pediascribe.com/podcast/feed. Copy the feed address and past it into the appropriate box in your podcatcher. That’s all you have to do.The beauty of a subscription is that your podcatcher will periodically check your program’s RSS feed. When the podcaster releases a new episode, your podcatcher will catch it for you! And the next time you log into the podcatcher, the current episodes will be waiting for you.So how much will this cost? Well, that’s another beauty of podcasts–they’re free. Really, the only expense is a computer and internet connection. If you want the mobile option, you’ll also need an MP3 player. If you don’t already have one, consider an iPod—iTunes really does make this process simple. There is no charge for using iTunes or any other podcast directory. Podcatchers are free, and subscriptions are free. You can’t beat that!As a trend, podcasts are really catching on. Commuters can listen in their cars. Stay-at-home moms can listen while toddlers nap. You can listen while you exercise or walk the dog or fly in a plane. And that’s the advantage they have over radio. You can listen to the program you WANT to hear WHEN you want to hear it. So don’t be intimidated by terms like RSS and XML and feeds and podcatchers. It really is worth taking the time to learn. You’ll be amazed at the variety and quality of available shows. If you’d like to know more of the technical details, there’s a great guide called Feed 101 at FeedBurner.com.So what are you waiting for? Get on out there and give podcasting a try!COPYRIGHT 2006 - MIKE PATRICK JR, MD

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It’s funny how certain words elicit a predictable response on the part of listeners. Take the title of this column for example. Ringworm and scabies and lice, oh my! Ringworm and scabies and lice, oh my! Is your skin tingling yet? Do you feel an overwhelming urge to scratch? No? Okay, here’s a challenge for you. Read the entire text without scratching. Not even once. I’ll bet you can’t do it.

It’s equally funny how some diseases have earned an undeserved social stigma. Ringworm and scabies and lice fall into this category as well. Tell a mother her child has one of these conditions, and she’s sure to give you a horrified gaze that quickly turns into an indignant my-kid-is-not-dirty-there’s-no-way-he-has-ringworm-or-scabies-or-lice kind of stare. I’ve seen it many times. If you ever find yourself in this position, making this face, please remember to breathe. Relax. Don’t take it personally. Dirty conditions do not cause these disorders. They are spread by personal contact with the offending organism. Let’s take a closer look.

Despite it’s name, there’s no worm in ringworm. It’s actually a fungal infection of the skin, characterized by a ring-shaped pink patch that is mildly itchy. As it grows, the borders of the ring become raised and scaly, and the center clears. At least that’s the classic pattern. As with most disease, there is room for individual variation.

The spread of ringworm requires direct skin-to-skin contact, making it a common problem for wrestlers. Of course, little kids are rough and tumble, and since transmission doesn’t require prolonged skin-to-skin contact, ringworm spreads easily among them as well. If you haven’t seen it in your own child yet, don’t worry. It’ll visit soon enough.

Although it’s far less common, you can get ringworm from animals (especially kittens and puppies). The animal may not have a rash or any indication of a skin problem. So if ringworm is a persistent, recurring problem in your home, and if you have close contact with a kitten or puppy, consider making a trip to your veterinarian. Animal ringworm does not transmit from human to human. So if you get ringworm from your new kitten, don’t worry about passing it on to others.

We treat ringworm with anti-fungal creams and lotions. Some are available over-the-counter, while others require a prescription. After 48 hours of treatment, you won’t pass human ringworm to others. But you will have to use the cream a long time, usually 3-6 weeks. Stop treatment early and you run the risk of the rash returning. There is one place where treatment differs a bit–the scalp. Since the fungus penetrates deep into the hair root, an oral medication is required (prescription only).

Scabies is not a fungus. It’s a disease caused by tiny mites burrowing under the skin. They like skin folds best, so it’s common between fingers and toes and inside armpits. Scabies is extremely itchy and spreads easily. Like ringworm, most scabies comes from other humans. Animals get scabies too, but it’s a different type. Animal scabies can pass to humans, but it’s a very rare event.

Scabies has a 30-day incubation period (the time from contact to onset of symptoms), so you’ll have to treat everyone in the house to eliminate re-exposure. It’s important to tell your doctor about pregnant women and young infants living in your house because they require special consideration when choosing a treatment medication.

Scabies requires one application of medicine that’s left on the skin for several hours. The medicine kills mites, so the rash shouldn’t spread any more. But keep this in mind: The scabies rash is caused by the mere presence of mites in the skin. It doesn’t really matter if they are dead or alive. This means the rash will remain until your body replaces the infested skin with new layers, a process that may take several weeks. During this period, all you can do is treat the symptoms with steroid cream and antihistamines. Ask your doctor for details.

Scabies can live away from human contact for 3 days, so be sure to wash clothes and sheets in hot water and vacuum carpets and furniture to prevent reinfestation. Place unwashable objects (such as stuffed animals) in sealed plastic bags for a week. That way, when you remove the items, the mites will be dead.

Then there’s head lice. Like scabies, lice is an infestation of tiny bugs. They live on your head, suck blood from your scalp, and cement their little white eggs (nits) to your hair. Their favorite location is behind the ears and on the back of the neck. You’ll need a lice-killing shampoo to get rid of the critters. You’ll find some of these products, like Nix and Rid, available over-the-counter, while others require a prescription. These medications kill adult lice and their nits, but you still have to remove the nits by hand. It’s a tedious process best achieved with the help of a fine-tooth comb. If you’re having trouble removing the nits, try loosening them with a mixture of equal parts vinegar and water.

After killing the lice and removing nits, you’ll need to clean your house using the same process described for scabies. There is one important difference: With lice clean-up, you’ll need to keep unwashables in plastic bags for three weeks instead of one. Why? Because unhatched nits survive longer periods of time away from human contact.

Don’t mistake dandruff for nits. Dandruff is made up of little skin flakes that pull out easily.

There’s an old saying that goes, “Never share what goes in your hair.” This wisdom is based on the fact that lice spreads by direct contact. Combs, brushes, hats, and scrunchies–all of these things can spread lice from one person to another.

So how did you fare? Where you able to keep your fingers from scratching your skin? If not, you may want to inspect the itchy area for signs of ringworm or scabies or lice. Of course, plenty of other conditions cause itchy rashes as well, so if you find one, call your doctor and let him take a look.

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Interested in learning more about baby poop? Dr Mike discusses what’s normal and what’s not in episode 16 of PediaCast!

Newborn babies don’t do much. They cry and sleep. They gaze around some. They eat and spit-up. They pee and poop. Really, that’s about it. So it’s easy to see why new parents focus on their infant’s bowel habits. Of course, relatives are also responsible. Everyone has an Aunt Betty (or maybe it’s your Mother-in-law) whose goal in life it is to voice concern about everything. “He poops too much. She doesn’t go enough. It’s too hard. It’s too soft. Why’s he always grunting like that?” Often new parents aren’t concerned until someone convinces them of a so-called problem.

The trouble with baby poop is the wide-degree of variation. Some infants stool shortly after every feeding, while others go once a week. There’s also a wide-range of thickness–from thin liquid to clay patties. And then there’s color: yellows, greens, browns, reds, and blacks. Let’s take a quick look at each of these factors and discuss what’s normal and what’s not.

Stool frequency depends on how much stool your baby makes and how quickly the intestine moves it down the pike. The amount of stool is dependent upon two variables–how well your baby’s intestine absorbs food and how many bacteria live in the gut. Since a baby’s ability to absorb food changes over time, the amount of residue left over also changes. Typically there is more residue to stool out in the first few weeks of life. Then, as your baby’s intestine matures, absorption improves and the amount of residue decreases. Thus, babies who used to poop several times a day may slow production down to once every couple days.

On the other hand, bacteria may have the opposite result. As a baby matures, more and more bacteria populate the gut. They are important to the digestion process and are one of the reason baby stool changes in character over the first few months of life. But as their numbers increase, the body eliminates more and more of them in the stool. Stool bulk increases as the number of bacteria increases, and increased stool bulk leads to more frequent bowel movements.

Another factor affecting stool frequency is transit time. Some guts work faster than others. So what’s normal? Well, some newborns will have a stool every time they eat, while others will go every few days. If your infant’s stools are more than three or four days apart, it may still be alright, but you should give your child’s doctor a call and let him know.

Stool consistency is another important consideration. If your baby’s stools are always slimy like mucus or thin like water or thick like clay, talk to your doctor. The ideal consistency of newborn stool is like mustard, but some variation on this may be okay.

Also pay attention to color. Bright red usually means blood. Bring this to your doctor’s attention right away. Possible causes include milk allergy, a crack in the skin around the anus, or (rarely) a more serious internal problem of the intestinal tract. Black tar-like stool is normal during the first few days of life. But if it remains this way long or becomes this way again, talk to your doctor. It could be a sign of bleeding in the gut.

Other colors depend on diet and the make-up of intestinal bacteria. Normal colors can range from pale yellow to dark green and light tan to dark brown.

Putting this all together, normal baby poop should be the consistency of mustard. It may be yellow, green, tan, or brown and it may come several times a day or once every several days. Reasons to call your doctor include black tar-like stool, presence of blood, watery diarrhea, constant mucus, and thick or formed stool. Also let your doctor know if your baby routinely goes several days without passing stool.

A word about fussiness is in order. Many parents assume a fussy baby who has a bowel movement every few days is constipated. This may not be the case. Keep in mind that upset babies, whether they are upset from hunger or the pain of an ear infection or heart burn, will stiffen their bellies, draw up their legs, and pass gas as they bear down. You should not assume this behavior is from constipation, even if their bowels move irregularly. Instead, make an appointment with your child’s doctor for a thorough examination.

Okay, let’s say your infant is constipated. She has thick formed stool that is difficult to pass and she goes infrequently. Your doctor agrees your infant is constipated. What will he have you do? Here are some options:

RECTAL STIMULATION: Put a glob of lubricant on a rectal thermometer or Q-Tip. Insert the tip a quarter to half inch into the rectum, give a little twist, and pull back out. Often, this will stimulate a bowel movement within a minute or two.

GLYCERIN SUPPOSITORIES: These are available at most pharmacies. Use half a suppository to start, inserting it into the rectum. This works by increasing the water content in the stool through a process known as osmosis (think back to high school science class).

JUICE: Processed apple or prune juice from a grocery store (not fresh from a fruit stand) will also increase the water content of stool through osmosis. This works because undigested sugars make it all the way down to the large intestine and draw water into the bowel. Baby juice probably won’t work because it’s so dilute. Start with an ounce or two of full-strength processed juice. If it works, you may need to continue giving an ounce or two of juice once or twice a day to keep your baby regular.

ORAL MEDICATION: There are several of oral medications that work the same way as juice. Milk of Magnesia is available over the counter, while Lactulose and Miralax require a prescription. Oral medications are rarely necessary for young infants.

It’s important to consult your doctor before trying any of these methods. There are diseases, some of them serious, that mimic constipation–so don’t treat it without your doctor’s help.

Finally, a word is in order concerning some things you shouldn’t use to treat constipation. Kayro syrup and honey have the remote possibility of transmitting botulism to infants, so don’t use these products in children less than a year old. Likewise, unprocessed juice may contain harmful bacteria, such as E. Coli. Also, enemas are not recommended for infants–save those for the older kids and use them only under the guidance of your child’s doctor.

Baby poop is funny because it can be so different from one child to the next. And for some crazy reason, well-meaning relatives always seem to gravitate toward a newborn’s bowel habits. But don’t let Aunt Betty (or your Mother-in-law) get to you. Armed with the knowledge of what’s normal and what’s not, if she keeps pushing, feel free to teach her a thing or two.

COPYRIGHT 2006 MIKE PATRICK JR

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