Childproofing Checklist

• first things first get all the poisonous substances(detergent, bathroom cleaners...) and put on higher ground (so children can not reach)
• make sure the sharp edges of the tables and corners are protected by edge bumpers
• door stops and door holders are essential
• do not put the cribs close to the blinds with the strings hanging, babies can get strangulated on these cords
• smoke detectors (make sure you have one at each level of the house)
• all swimming pools at home should be gated accordingly adhering to the federal standards
• safety latches and locks (especially for the kitchen and the bathroom cabinets and drawers)
• safety gates (preferably the ones that screws on the walls)
• window guards(bars in guard should not be more than 4 inches apart)-make sure you have a window that can be used as a fire escape
• outlet covers (make sure you get the ones that the child can not remove)
• carbon monoxide detectors
• when you visit someone or when you have visitors, make sure all the purses are out of reach (they can have a different kinds of medications in their purse that you do not want your child to get into)

Once everything is in place the last thing you need to do is get down on your knees and crawl all over the house to see what else your child might be interested in to get to it and do something to make your house safe. Try to do the childproofing of your house as early as 4-6 months of age and re-evaluate every few months to see if it is still effective protection according to your child's developmental stage. Remember children can outgrow the way you childproof your house. Re-evaluate from time to time.

Head Injury

Once your child turns 6 month to 5 years of age you need to be very careful about minor head injuries. Babies' heads are a little bit big compared to their bodies so basically they are top heavy. Their coordination is not very good but they are very brave and go were no adult would boldly go because they do not know better. Most minor head injury in infants and young children are preventable and close adult supervision can not replace any state-of-the-art childproofing equipment that you might use.

What are the signs and symptoms of a mild head injury?

• child crying but consolable
• minor scalp swelling
• minor cut or laceration of the scalp
• mild headaches
• vomiting 2 to 3 times

What are signs and symptoms of a potential serious injury?

• crying non-stop and inconsolable
• on feeling the scalp area you might feel a cracking sound there might be a fracture
• blood or clear fluid coming from the nose or ears
• obvious serious wound i.e. a big laceration or swelling
• seizures
• loss of consciousness
• vomiting more than 2-3 times after the injury
• changes in behavior such as increased sleepiness, agitation, confusion or sluggishness
• headaches are getting worse

Call you doctor or 911 if you see any of the signs and symptoms of a potential serious injury.

Prevention is the Key:

• avoid letting your baby sleep on the bed (they tend to roll over and fall), I can not but emphasize this so many times but still a lot of the parents are letting toddlers/infants sleep with them.
• do not use walkers (they become a little more mobile than what their development can handle so they tend to pull on things resulting in furniture falling on them), they tend to fall on steps (it is actually a good thing here in Arizona that we mostly have 1 story houses with no basements)
• childproof the house
• can not emphasize more the need for close adult supervision ( the most important tool is prevention) but sometimes those babies are pretty quick just a few seconds that you do not look at them, accidents happen.

Teething

Teething is a process by which the first set of teeth pushes through the gum line. Some babies do not seem to mind this at all but other babies can be very fussy every time a tooth comes through. They refuse to eat and sometimes may just take the bottle or nurse. They will be waking-up several times at night because of discomfort.They can also be grabbing at their ears because of referred pain, same nerve fibers innervate the gum and the ears.This may be associated with low grade fever but once the temperature is more than 101.5F this is most likely not secondary to teething. Teething is not associated with diarrhea or congestion. Most mother's believe that it is the case. Studies have not shown a correlation between this two symptoms. Teething happens from 3 months to 3 years of age. They should have their first set of teeth, 20 in all, by 3 years of age. What to do if your baby is teething? You will notice some swelling in the gum line with the white teeth coming through, this process can occur for several weeks.

• you can use your clean fingers to massage the area of the gum that is swollen
• give your baby something to chew on, a wet washcloth that has been put in the freezer for 30 minutes should soothe him, teething rings are good too, just make sure it is not hard as ice because this can cause bruising in the gums
• acetaminophen is good to help at night when they go to sleep and should last for 4 hours
• sometimes we can try some baby Oragel or Anbesol only if the baby is very irritable this does not usually last long and I rarely recommend it because it is a topical anesthetic
• lots of hugs and kisses should work great

I always tell my parents that this is a "rite of passage" and this too shall pass before you know it (after a few sleepless nights).

What is the scaly lesion on my child's scalp?

Patient is a 2 year old female who was noticed to have a scaly round patch on the left side of her scalp. She was prescribed several shampoos and was given steroid creams to put on the area but mother noticed that this seem to be persistent for 1 year now and not getting any better. She was then prescribed some Nizoral shampoo which she can buy over the counter and told to follow-up in 1 month. On follow-up apparently the lesion seem to have gotten a lot better but still persistent. Otherwise, she has been a healthy young girl with no other problems. She was them prescribed some Griseofulvin to follow-up in 2 months.

She has "ringworm of the scalp" known as tinea capitis. This is from a group of fungi which invades the layer of the skin, hair and nails. This can be transmitted from animals such as cats or dogs directly or indirectly. This can also be transferred from person to person. The treatment takes a long time because this is a slow growing microorganism. The first line of treatment is Griseofulvin by mouth with Nizoral shampoo twice a week. If we encounter resistance Ketoconazole is another alternative for treatment. Most patients respond well to the medications.
We usually tell parents to make sure child does not share combs, towels with any one, because this can be contagious.

Is it a common cold or allergies?

The most common infection in children in the common cold but the significance of this is attributed to the possible complications that it can cause. Children usually have 5-8 infections a year and this is more common in children younger than 2 years of age. 1/3 of the common colds is caused by the rhinovirus but there are 200 different strains of viruses that can also cause this infection. Colds is usually more severe in younger children because it can result is some fever. They can have ear infections with this and if the discharge is more purulent they can have a sinus infection with this. This is very contagious so it is really hard to quarantine children with this illness. Period of infectivity starts a few hours prior to the appearance of symptoms to 1-2 days after the illness appeared.

Babies younger than 3 months of age start with fever, irritability, restlessness and sneezing. Nasal discharge start which can lead to nasal obstuction. They will then have a hard time breathing or eating so it is very important that we help clear their airway by applying some normal saline to the area with some suctioning. In older children, they feel dryness in their throat some nasal discharge with coughing and some fever. They may complain of some muscle aches too. In most cases, the acute phase lasts for 2-4 days.

Allergic rhinitis can be differentiated from the common cold because it is not usually accompanied by a fever and the nasal discharge is usually clear. They have persistent sneezing and itchy eyes.

How your Baby Develops? (3 years old)

3 year old

They are pretty much ready for pre-school. They should be talking in sentences and can start to tell stories. They can draw a line and pretty much a circle. They know some of their numbers and letters and they can identify 2-3 colors. The temper tantrums still might persist but has markedly gotten better at this age. They can climb, kick a ball, remove their clothes and most toddlers are pretty much toilet trained at this age.

To Vaccinate or Not to Vaccinate your Child with the H1N1

The H1N1 is a new mutation that emerged last August 2009 and the flu vaccine was already in production when the new mutation occurred so they have to make it separately from the rest of the flu vaccine , hopefully next year they would incorporate this in the seasonal flu vaccine. Many parents are worried because this is something new. Remember the H1N1 vaccine is produced exactly the way the regular flu vaccine is produced. Exactly the same manufacturing steps and the same companies who produce the flu vaccine produce the H1N1 vaccine. Since this is a new strain most the young population do not have any antibody to the virus. We do not really know the full extent of what this new virus can do but preliminary results show that this can cause significant morbidity especially to the pediatric population. I urge all the parents to have their children vaccinated. I had all my 4 boys vaccinated too and of course myself and so far everyone is fine.