Getting Ready for the H1N1 Virus Fall 2009

The World Health Organization(WHO) has raised the pandemic alert to Phase 6 in response to the global spread of H1N1. This just means it has spread all over but the severity of the disease remains the same. In order to prevent this from spreading the CDC recommends some of this practical guidelines.

• cover your nose and mouth with a tissue when you cough and sneeze
• instruct children to cough on their sleeves and not on their hands to decrease transfer of the virus
• do not leave used tissue all over the place, instruct minors to throw this in the trash can
• wash hands after coughing or sneezing with soap or water or any available hand sanitizers
• avoid touching your eyes, nose and mouth
• if you are sick try to say home from work or school and limit contact with others. Make sure you stay at home till you are fever free for 24 hours without any fever-reducing .

If you suspect your child has influenza. Call your pediatrician.

Persons diagnosed with swine influenza are contagious for up to 7 days following the onset of the illness and this could be longer if the symptoms are persistent or has not resolved.

Heat Exhaustion and Heat Stroke

In the sweltering heat of Arizona were the temperatures outside have been climbing in the 110-118F it is no surprise that the incidence of heat exhaustion and heat stroke is on the rise. There comes a time when the body will be unable to maintain normal temperature when exposed to excessive heat. We have normal mechanisms that prevent this from happening. We become very thirsty and we start to sweat to help bring our core temperature down. Sometime people do not notice this especially children because they are having so much fun under the sun.

Signs and Symptoms of Heat Exhaustion

• mild dehydration


• core temperature from 100.4 to 104F


• profuse sweating


• thirst, nausea, vomiting


• confusion


• headaches


• feels faint or has collapsed

Signs and Symptoms of Heat Stroke

• usually with severe dehydration


• core temperature greater than 104F


• flushed with hot dry skin


• dizziness, vertigo, fainting, confusion, delirium


• loss of consciousness


• may be in shock

First Aid for Heat Exhaustion and Heat Stroke

• bring child/adult indoors


• undress


• have them lie down and elevate the feet slightly


• put the child is awake place cool bath water or sponge bath the child immediately if outside spray with mist from a garden hose


• if the child is alert give frequent sips of cool, clear fluids


• if child is vomiting turn to side to prevent aspiration


• monitor the child's temperature


• call the doctor if this is not resolving

Prevention is the best medicine

• teach children to drink lots of fluids before and after playing outside even it they are not thirsty


• make sure they wear light-colored loose fitting clothes


• hats , eye wear for protection


• only participate in heavy activity before 10 am in the morning and after 6pm


• tell children to come indoors immediately if they feel overheated

Sunburn

The most common photosensitive reaction in children is acute sunburn and the best treatment for sunburn is prevention.

The sun is one of the most important things that keep our planet alive. We get our vitamin D from the sun from its conversion of cholesterol in our body, this helps absorb calcium for healthier teeth and bones. As we say too much of a good thing is not too good either, it does not take long of sun exposure to cause damage. This can cause skin damage, eye damage, immunosuppression and cancer.

The invisible ultraviolet rays of the sun can cause tanning, burning and other skin damage.

• Ultraviolet A causes skin aging, wrinkling and skin cancer such as melanoma


• Ultraviolet B causes sunburns, cataracts and immune system damage, they contribute to cancer


• Ultraviolet C are most dangerous but fortunately it is totally blocked by the ozone layer

Melanin: Our protection from the Sun

Melanin is our defense from the sun because it absorbs the dangerous UV light before it can cause serious damage resulting in a darker color or a tan but with constant exposure this can still result in a sunburn. Children vary in susceptibility to UV light depending upon their skin tone the lighter they are the less melanin they have.

Sun-reactive Skin Types

Type Demographics Sunburn, Tanning History

I red hair, freckles and Celtic origin Always burns easily with no tanning

II fair skin, fair-haired, blue-eyed and white usually burns with minimal tanning

III darker skinned white sometimes burns, gradual light

brown tan

IV Mediterranean backgrounds minimal to no burning, always tans

V Middle eastern white, Mexican rarely burns, tans profusely dark

Oriental brown

VI Black Never burns, pigmented black

Avoidance is the best Prevention

Avoid the most intense heat of the sun between 10:00am to 4:00pm. Make sure to apply sunscreen if they are exposed to sunlight. Try to avoid exposure of infants to the sun because they burn more easily because of their thinner skins. Make sure you cover-up infants and you may put sunblock on the exposed areas. Make sure you have umbrellas to cover everyone from the sun exposure from time to time.

Sunscreen

Select a sunscreen with at least a SPF(Sun protection factor) of 15 or higher to prevent sunburn and tanning. Select one that is broad-spectrum that protects from UVA and UVB rays. If your child have sensitive skin avoid sunscreens with PABA and instead look for one with titanium dioxide as an active ingredient.

• do not skimp on sunscreen make sure you got good coverage, experts suggest to start of on a lotion as a base and you can use the spray for reapplication every 2-3 hours


• apply sunscreen 30 minutes before sun exposure


• apply a waterproof sunscreen and do not forget the eyelids, back of the neck, lips, hands,ears, feet and shoulders


• need to wear sun-glasses with both UVA and UVB protection

First Aid for Sunburn

• keep away from the sun into a cool shaded area, additional sun exposure will aggravate the burn


• have your child take a cool bath


• apply pure aloe vera gel to any sunburned areas


• pain reliever (acetaminophen or ibuprofen) do not give aspirin to children and teens this can result in liver problems


• apply 1% hydrocortisone to inflammed areas (do not use topical benzocaine, this can cause skin irritation or petroleum-based products, they prevent excess heat and sweat from escaping)

Call your pediatrician if:

• Sunburn is severe resulting in blisters


• child has unexplained fever of higher than 102F


• the skin looks infected


• trouble looking at the light(sunburn in the cornea)


• fever or chills after sunburn


• signs of dehydration (increased thirst or dry eyes and mouth)


• sunburn covering a large area


• facial swelling from sunburn

Newborn Care 101

Feeding and Nutrition
Breastmilk or formula should be your baby's major source of nutrition for the first year of life. We usually introduce solids around 4-6 months of age. There will be a period of time that your baby will undergo growth spurts. They will start to nurse and eat more often than usual and they seem to be hungry all the time. Do not worry this just occurs in spurts and they go back to their normal routine. You know you are overfeeding your baby because they will be spitting-up a whole lot. Make sure you burp them often in between feedings.

You are underfeeding your baby if:

• he has less than 4 wet diapers a day
• not nursing at least 10 minutes at the breast
• appears hungry looking for the breast
• appears more yellow
• does not seem to be gaining weight

(for the first few weeks of like we expect the babies to be gaining at least 1/2 ounce a day)

Bowel Movement

The initial bowel movement of babies are called the meconium stools . They start of as black and tarry then we see the transition stools which are greenish yellow and the normal seedy mustard looking stools that is slightly watery. Formula fed babies have more formed stools. They can move their bowels everytime they eat to once a week there is a wide variation of normal. They are considered constipated if the stools are rock hard and come out as pellets.

Wet Diapers

We need to know the number of wet diapers a baby has to ensure the baby is taking enough breastmilk or formula. This is usually between 6-8 diapers a day.

Crying

Babies can not express themselves very well and they tend to cry for everything. It will take you a few weeks to learn what cry is for what. You can not spoil a baby by carrying and hugging them. Make sure the baby is not hungry or wet. Sometimes they just need cuddling.

According to Dr. Karp think of the 4S

S - swaddle the baby this helps them feel comfortable, remember they were inside the uterus in a tight spot which is a comfort for them

S - Stomach try to lay them across your arms on their stomach they seem to quiet down with this position

S - Shh... silence or darkness can calm them, overstimulated babies are cranky babies

S - swinging not to much just gently, they like monotonous noises like the sound of the blow dryer, the vacuum cleaner

Burping

If you do not burp your baby they will become fussy and inconsolable. Try burping in between feeding. you can burp them over your shoulders, across your lap or sitting-up, make sure you pat their backs gently

Hiccups

This is totally normal in newborns. Try to feed them before they get too hungry when they start gulpin the milk down they tend to swallow a lot of air. make sure the nipple airflow is not too fast.

You can never spoil your baby during the first few months of life. This is the perfect time to attend to their needs closely and you will realize that they can communicate to you what they need and want very effectively.

Starting Solid Foods

Newborns up to 4 months of age are fed on breastmilk and/or formula. They are ready for solids if they manifest the following:

• drinks more than 35-40 ounces of formula a day
• seem to be nursing all the time and does not seem to be satisfied
• when propped up make sure that the baby's neck is stable and not very wobbly
• make sure the baby does not have a lot of tongue-thrusting (tongue reflex that seems to push the food outwards)
• they will be drooling a lot

Once they are ready and able you can start them with 1 tablespoon of rice cereal to 5 tbsp of breastmilk or formula. Make sure you try to sit them up so they do not choke. Give the cereal in a spoon if your baby does not seem to like it try again another time. Try to add less of the milk and more of the cereal until the consistency is thicker. Try a new food for 3-4 days before introducing a new one. Make sure your baby is not allergic to the food. Reactions result in diarrhea, vomiting or a hive like rash all over the body.

• cereals(rice, barley and oats)
• vegetables (yellow/orange veggies before green) the yellow vegetables is more easily digestible than the green
• fruits
• meats (not until 8-9 months of age)
• give eggs around 1 year of age
• stay away from any shellfish(shrimps and crabs) for possible allergic reactions
• do not give baby anything that can choke(nuts, grapes,apple skins...)

Once solid foods has started you will notice that the consistency and odor of the stools will changed. If the food is not strained you will see bits and pieces of food in the stool. Feed the baby solid foods before giving their milk. you will notice that the amount of milk will markedly decrease.

Juice is not needed for infants less than 6 months of age. You can give up to 4 ounces of juice once a day during mealtimes for babies 6 months and older. Juice is not needed.

Introducing new foods should be an enjoyable process. Talk and interact with your child while feeding them.

Fun in the Sun

Summer is here and finally everyone wants to go outside, smell the breath of fresh air and swim in the cool waters of your swimming pool. It is very important to protect yourself from the intense heat of the sun. Here are a few reminders from the American Academy of Pediatrics.

First things first, since we live in Arizona and the temperatures really go up, up and up to 120F. We should not get outside. The less exposure to the sun the better for our skin. If you can not help it, sunglasses, hats and clothes are good to protect yourself. Avoid the intense heat of the sun from 10am in the morning to 4pm in the afternoon.

• Infants less than 6 months should be protected from the sunlight. put them under an umbrella or under a shade. You can apply some sunscreen to small areas of their body such as the hands, face and feet.
• Make sure to put on sunblock on children with sun exposure, hats and sunglasses are a must.
• Get a sunblock which reads "broad-spectrum" this means it is good coverage for ultraviolet A and ultraviolet B with at least an SPF(sun protection factor) of 15.
• Make sure to reapply the sunblock every hour, especially when they swim or they sweat a lot
• Minimize sun exposure by swimming before 10am and after 4pm,
• Cloudy days only reduce the UV rays by only 20%-40% of the time, kids still need to wear sunblock.

Start the kids with good habits and they will grow up to be adults with good habits. enjoy your summer and be safe!

Birth of you Newborn

Once your baby is born the umbilical cord will still be attached to the placenta and the doctor will put a clamp to it. He may cut it or let Dad cut the cord, if he is not too squeamish.The clamp is kept for 24-48 hours till it has dried and upon discharge they take it off. The umbilical stump usually falls off with 1-3 weeks. They will then bring the baby to the warmer to dry and stimulate your baby till he/she cries. Vital signs will be checked to make sure baby is stable. An eye ointment will be applied to the baby to prevent infections that he/she might be exposed in transit through the birth canal. Since babies have low vitamin K level which results in clotting. Your baby will be given a shot of Vitamin K to prevent baby from bleeding. If everything is good and mother is awake they give the baby to mother so she can try to nurse.

Another more important thing they will do is to put some matching bracelets on the baby and the mom. Making sure that it is the right baby for the right mom.They also would get some baby footprints for documentation. They will then call the pediatrician who will then check the baby within 24 hours of birth. They then would check the baby everyday that the mom will still be in the hospital. An alarm will be applied either to the baby's umbilical clamp or the ankles. This is what you call a "baby low-jack". if somebody attempts to get your baby without permission the elevators would not close or the alarms on the doors will be set off. This is a great way of protecting your babies from abductions.

You have the nurses in the hospital for support. Ask a lot of questions because they are very knowledgeable. Get their help as much as you can then you can go home more confident.