The Latest Newsletters from Dr. Joe Barber
Summer Safety Checkup
With the arrival of summer all parents need to perform a safety inspection of the house and all play areas inside and out. It is also the time for vacations, road trips, play dates, sporting events and summer camp. These new opportunities for exploration, experimentation and discovery make the arrival of summer the perfect time for a safety checkup.
A visit to the doctor is often the first step in this process. If your child has not had a yearly checkup, schedule a well-child visit with your pediatrician. Children grow and change so fast that a yearly checkup is essential. Immunizations can be given; vision and hearing screening performed and your child’s growth charts can be reviewed. Healthy lifestyle opportunities can be discussed and dietary, sleep and exercise opportunities can be reviewed.
The next step is to check out all outdoor play equipment. All outdoor playground equipment needs to be inspected and tested. All climbing structures must be inspected for soundness. Make sure rungs, stairs and guardrails are placed appropriately and attached correctly. All openings must be less than 3.5 inches and guardrails must be at least 29 inches tall for preschool children and 38 inches tall for school-aged children. Rope and climbing nets pose a strangulation and entrapment risk and must be inspected. Sliding boards must have at least a 4 inch side and closed slides are preferable.
Make sure all swings are well-attached and are made of soft and flexible materials such as a synthetic rubber or plastic. A full bucket seat is safest for small children and make sure all swings are separated by at least two feet to decrease the risk for collisions. Splinters, loose nuts and bolts and surface padding must all be checked. Having six inches of ground surface padding made out of shredded tires, pea gravel or bark is essential as is making sure the play area is away from trees and other objects that could become a hazard. Having the play area in a clear zone away from brush and trees also decreases the risk for tick bites and contracting Lyme disease.
Summer safety also includes teaching your child about playground safety and learning how to take turns with equipment. Learning how to climb a ladder, use monkey bars, avoid swings and moving away from the bottom of a slide are essential skills to review with your child. Some playground equipment can also become very hot if it is made out of metal and is in direct sunlight. Wooden equipment may also be a source of splinters if it is not well cared for.
During summer the rays of the sun are intense. Skin care is very important. The use of wide brimmed hats, clothing and sunscreen are important, as is making sure your child receives adequate hydration due to increased water intake requirements due to heat and increased activity levels and sweating. Clothing can also be a risk for your child if it can lead to entrapment or strangulation. Avoid drawstrings on all clothing.
Using mouth guards or eye protection while engaging in certain sporting activities is as important as it is to use sport-specific protection such as wrist, knee and elbow guards while rollerblading. For any “wheel” sport including bikes, skateboards and scooters a helmet must be used, and make sure the helmet fits your child correctly. The chin strap must be adjusted to allow only one finger to be placed between the strap and your child’s chin and the helmet must not be able to rock back from your child’s forehead.
Inspect all bicycles and perform yearly maintenance. Take your child’s bike to a bike dealer if you have any concerns about bike safety such as size, fit, brakes or steering. Children are becoming more adventurous with bicycle stunts, ramps and jumps. Discuss these activities with your child. Set boundaries for what is and is not acceptable and consistently enforce the rules you decide upon.
Do not allow your child to use a trampoline unless it is part of a supervised training program under the direct supervision of a coach or sport specific trainer. Backyard trampolines are dangerous and lead to over 100,000 injuries per year in the US.
Summer can be a time of concussions, broken bones and head and neck injuries. Your attention and preparation can eliminate most of the risk for these injuries and replace these severe injuries with minor sprains, strains, bruises, cuts and scrapes. With a little effort and attention you and your child can be ready for a fun and safe summer.
Sun Protection
The sun can be damaging to your skin. Sunlight contains both ultraviolet A (UVA) and ultraviolet B (UVB) rays that are damaging to your skin and increase your risk of skin cancer. UVA light causes premature aging and UVB light causes burning. Both types of ultraviolet light increase your risk of developing skin cancer. Throughout life the average person has a 1 in 5 chance of developing skin cancer and a 1 in 50 chance of developing the most dangerous skin cancer called malignant melanoma. Excess and unprotected sun exposure and ultraviolet light exposure from tanning parlors dramatically increase your risk of premature skin aging and developing skin cancer.
Unprotected exposure to the rays of the sun burns your skin. The effects often appear within hours of exposure but may not appear for 6-12 hours after the damage has occurred. Your skin becomes red and warm. Swelling often occurs and is accompanied by pain and in severe cases blistering. This skin damage often leads to peeling and further itching in the days following the injury.
If you are taking various medications including antibiotics (sulfa drugs, tetracycline and doxycycline), acne medication containing retinoic acid (Retin A) or a thiazide diuretic for blood pressure control, you have an increased risk for severe skin rashes and increased skin damage after sun exposure.
Sun exposure may also lead to a skin photosensitivity or so-called sun allergy. Such sensitivity may occur hours to days after sun exposure and can include redness, swelling and blistering of the skin. This type of eruption is called a polymorphous light eruption (PMLE).
The first step in sun protection is to protect yourself and be a model for safe sun exposure for your children. Always hunt for the shade and stay out of direct sun during the high sun periods between 10am and 4pm. Remember that sun rays do bounce off water, sand and concrete and always dress right. Wear a wide brimmed hat and clothes that are light in color and have a tight weave that prevents the UV rays from penetrating your clothing’s fabric. Some clothes have been treated with chemicals to prevent these dangerous rays from reaching your skin. A water or surf shirt that is tight fitting and has a high crew neck and long sleeves is also very helpful especially for those who are in the water where sunscreen is rapidly washed off. Sunglasses that offer 99% UV protection are also helpful and protect your eyes from sun damage.
Choose a sunscreen that provides broad spectrum protection for both UVA and UVB. A sunscreen with a sun protection factor (SPF) of 15 protects you from 93% of harmful UVB sun rays. A SPF of 30-35 is adequate to protect you from 97% of the rays. Higher SPF’s are often not needed and are more expensive. Apply the sunscreen 30 minutes before exposure and every 2 hours while you are in the sun. Some sunscreens are water resistant and need less frequent application. No sunscreen, however, is waterproof and the more sweating or water exposure the more rapidly the sunscreen is washed off your body. Everyone must pay extra attention to high exposure and hard to reach areas. Finally, directly applied lotions are better than spray on sunscreens, but spray on sunscreen is better than no sunscreen.
For young children and sensitive areas of your skin consider using a sunscreen that has zinc oxide or titanium dioxide as the active ingredient. These types of mineral based sunscreen are best for sensitive skin and do not carry the risk of chemical exposure that chemical sunscreens pose. Avoid sunscreens that contain oxybenzone or a class of chemicals called parabens that are included in many personal care cosmetic products as a preservative to decrease the growth of bacteria, mold and fungi. If you need to choose a chemical based sunscreen, choose one that list avobenzone or mexoryl as the active ingredient.
Lastly, when you or your child are are spending time in the sun always be on the watch for heatstroke especially if you are engaging in intense physical activity. Make sure you take frequent breaks and drink plenty of water. If you are not urinating frequently or your urine has a strong color or odor you need to rest, get out of the sun and increase your water intake.
Your Child Has Autism
“Are you sure?” She asked. “Yes, I am,” I answered. She and her husband leaned into my words. Unwavering and unbroken eyes filled with strength, vulnerability, confidence and dignity met mine. Without turning they reached out to one another and held hands. “Can you help us?” I nodded and took their hands in mine. “I believe in both my heart and my mind that your child is a perfect blessing. I can and will help you.”
The diagnosis of autism is given more often every year. The frequency of your newborn child being diagnosed with autism has increased 30% in two years. This is an estimated prevalence of one in 68 children and one in 42 boys. Although about one-third of children diagnosed with autism have an intellectual disability 23% have borderline intellectual disability and 46% score in the average or above average range of intellectual ability.
Children with an autism spectrum disorder (ASD) must be identified early if we are to ensure proper services for each child and every family. Early identification and intervention are the duty and responsibility of everyone. We must work together to deliver and coordinate the services every family deserves and requires. Each of us must find the time, energy and commitment to serve as thoughtful stewards to make this happen.
What can you do? First, you must believe. You must believe the diagnosis of autism is not a death sentence imposed on the weak, the less fortunate and the unwilling. This diagnosis is a blessing for us, the child and the family. Through understanding we can seek acceptance and allow the words autism spectrum disorder to fill our hearts and our minds with compassion, understanding and empathy.
When most people hear the word autism they see the words marginalization, limitation and grief rather than perfection, inclusion, opportunity and happiness. Children and adults with autism have been forged from love and designed for glory. Each of us has the responsibility to allow children and adults with autism to live a life not of perfection but rather of contribution. Every child and family who lives with this diagnosis blesses each of us with the opportunity to give more than to receive. They provide each of us the opportunities to learn to live life rather than manipulate life. They teach us to seek balance rather than success as well as the opportunity to create a life based on love and contribution rather than money, self-interest, praise and achievement.
Children and adults with autism provide each of us with the opportunity to discover and live a life filled with kindness, compassion and an understanding of both the perfection and equality found in life and death. The month of April is Autism Awareness Month. I challenge each of you to reach out to a family of a child, teen or adult with autism and share in this perfection.
Boiling Point
Have you ever wondered what your words sound like to your child?
“I am sorry,” The little girl said to her mom. “I can’t believe you did this again!” The mother screamed angrily. “You know those markers will not come off no matter how hard we scrub.” The child looked down at her feet. “I should make you scrub the walls instead of eating dinner! Wait until your father sees this! He told you what he would do if you did this again. You never seem to listen. Go to your room and don’t come out until your father comes home!”
Yelling can help in the short term but rarely in the long term. Parents who yell and shout at their children are teaching communication skills that can last a lifetime. These patterns often lead to long term problems with relationships and the ability to handle future negative emotions and failure. It many ways the anger, reactivity and demeaning comments that yelling represent teach your child behaviors you do not intend to teach and prevent the development of a healthy resiliency built on openness and optimism rather than shutting down and hopelessness.
Parents who are aware of the negative effects of physical or corporal punishment (spanking) are now resorting to yelling, screaming or shouting. More than 75% of all parents report yelling at their child at least once a month. Raising your voice in moderation to attract the attention of your child is reasonable if it is not associated with anger or threatening tones, words or intent.
The ability to recognize and respond to one’s own emotions is called emotional competency. It is one of the fundamental developmental skills a child needs to acquire during early childhood. The ability to respond to anger in a controlled way supports relationship building and problem solving.
Parents who take a child’s behavior personally are more prone to frustration and becoming overwhelmed to a point where yelling and screaming occur. Yelling not only disrupts a teaching moment but it also causes a downward spiral in the relationship you have with your child and fuels emotional reactions that prevent and hinder problem solving for both you and your child.
Be on the lookout for signs of a blow-up. Avoid situations where time constraints place added pressure on you or your child. This is when yelling is most likely to occur. Another cause is taking your child’s comments or behaviors personally. This often causes a parent to become overwhelmed, upset and even threatened by their child’s behavior. The end result is yelling and often a personal attack on the child where the child is belittled or blamed for the feelings the parent is experiencing.
Try some relaxation strategies and take a step back if you are reaching your boiling point. If issues of safety are not present then wait to respond or an emotional reaction called emotional flooding will take place. In this situation increasingly loud and negative verbal outbursts are exchanged between you and your child or teen as shouts and even insults elicit progressive negative thoughts, words and eventually can elicit negative actions.
Always express your feelings in a non-threatening and non-judgmental fashion and respect and recognize rather than trying to change your child’s feelings. Your child is the master of his or her own emotions and you do not have the right or ability to change them. Remember to seek calm approaches that foster mutual growth and problem solving and help prevent negative behaviors from occurring again.
A New Year’s Resolution
The eyes of so many parents tell the tale of fatigue, confusion and love. There is so much to do but so little time. Here is my resolution for this year. I hope it helps you.
The goal of every parent must be to encourage independence while discouraging both dependence and co-dependence. Dependence leads to low self-esteem, limited assertive communication, devalued feelings, poor boundary and limit setting behaviors and a lack of resilience. When independence is not supported problem solving, free expression, equality and healthy communication all suffer.
Signs of a healthy life balance include contentment, a zest for life, flexibility, resilience, a tolerance for stress, a sense of purpose and a healthy attitude at both work and play. When parents do not support the mutual sharing of feelings, thoughts and values, balance is difficult to achieve. The foundation of a healthy balance is an ability to discuss and accept your child’s feelings while also respecting your child’s boundaries. By nurturing resilience and setting reasonable rules a parent fosters independence, responsibility and decision making.
The first step in maintaining balance is to recognize, understand and respond to stress. Without this capability parents and children are prone to withdrawal, depression, anger and isolative behavior. When stress is managed effectively skills can be developed to allow both parent and child to trust their feelings and retain their own perspective while continuing to support one another.
The second step is to explore and clarify your own feelings. This allows you to respond to your own needs by understanding your own thoughts and actions. Once your personal needs have been met you are ready to support another. Focus on support that is kind, factual and optimistic. Non-judgmental support allows you to maintain your viewpoint while allowing the person you help to retain their own perspective and independence.
The final step to a healthy life balance is the ability to express gratitude and personal emotion while continuing to dream.
