Sunscreen, Bug Spray, Impetigo – PediaCast 127
- Drug Warning Labels
- Hurricane Katrina Kids
- Childhood Obesity
- Insect Repellent
- FDA Proposes Major Revision Of Breastfeeding And Pregnancy Drug Labels
- Gulf Coast Children Who Lived In Trailer Units Are At Risk For Long-Term Illnesses
- Childhood Obesity Growth Appears To Have Leveled Off, But Racial Disparities Remain
- Article Abstract From JAMA Regarding Childhood Obesity
- DEET Information Sheet (Utah Poison Control Center)
Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For Every Child, For Every Reason.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, a pediatric podcast for moms and dads. It's Episode 127 for Monday, June 9th, 2008, "Sunscreen, Bug Spray, and Impetigo."
So definitely some seasonal topics today, which I think is appropriate because summer weather is finally here, at least in Central Ohio where we're located. I know in two or three months, I'll probably be complaining about the heat. But for now, 90 degrees and high humidity are definitely welcome here in Ohio.
I spent the last week opening the pool. And I have to say those of you who have pools, who live in climates that allow their pool to be opened year round; you really don't know how lucky you are. I mean, opening a pool in the spring is a chore. I mean, we have one of those solid stretched-out safety covers that's supposedly an elephant can walk on, although I'm not sure I would trust ours for that. It's ten years old. And even with that solid stretched-out cover, when you take that cover up in the spring, the water's green. You know, the bottom is full of sediment and worms and maybe a dead mammal or two. Yeah, thankfully, small ones like mice and chipmunks.
But still it's not pleasant business. And then, there's the constant addition of chlorine. I don't know how many pounds. Well, first, I know I put at least six gallons of liquid bleach and then, it's just pound after pound after pound of super shock, backwashing the filters, skimming, adjusting the PH. I mean, literally, it is a one to two-week process and the list goes on and on.
The end result is worth it, don't get me wrong. There's nothing like a cool dip when it's 90 degrees with high humidity. The problem though is, knowing Ohio weather, we have 90 degrees in high humidity now, but the pool's, it's still not ready. But you know, it will be soon. Of course, knowing Ohio, when it is ready, it will be 68 and breezy, you watch. But, see, I've lived here long enough to know.
Dr. Mike Patrick: All right, I want to give a shout out here really quick before we get started to my yard guy, Doug. We have a couple acres out in the country. We have trees and a fence road, that butts up to a field and flower beds and bushes. A lot of yard work to do, and honestly, if I had to do all of our yard work, there would be no PediaCast in the warm months. I mean, really, it's that much work. So, yeah, there's another cost I guess of doing a podcast, you got to pay for yard work. But it's OK, because I hate doing yard work and PediaCast keeps me from having to do it.
So I guess I should thank all of you and I forward all your emails of support to my wife to tell her how important this podcast is to each and every listener out there so that she will hopefully pony up the money for another season of yard work. So, thank you. And, of course, thanks to Doug, our yard guy because he does an outstanding job and it's fair price. So, thanks Doug. You are appreciated. And that's not only for me; it's from all listeners out there as well.
Oh, yeah, and thanks to Karen for agreeing to pony up the cash because that's important, too.
Dr. Mike Patrick: All right, so what are we talking about today? Actually, we have lots on the docket. Yes, this is not a swimming-pool-opening-talking-about-yard work podcast. This is actually a pediatric podcast for parents so I better get back on topic.
In the News department, we're going to talk about drug warning labels; also, hurricane Katrina kids and childhood obesity. And then, in our Listener Section, we have sunscreen, insect repellent and the question we're going to answer about impetigo. So that's all coming up a little bit later on in the show.
Don't forget if there's a topic you would like to hear and you would like us to discuss, it's really easy to get a hold of me. Just go to pediacast.org and click on the Contact link. You can also email firstname.lastname@example.org or call the voice line at 347-404-KIDS or 5437 for those who don't have letters on their keypad.
Don't forget, the information presented in every episode of this podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.
And with all that in mind, we will be back with News Parents Can Use right after this short break.
Dr. Mike Patrick: Our News Parents Can Use is brought to you in conjunction with news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.
The US Food and Drug Administration recently announced it's putting forward major revisions to the physician labelling of prescription drugs to better inform doctors how these products affect mothers and babies during pregnancy and breastfeeding, so that physicians can make better prescribing decisions and be in a better position to give advice to women who are pregnant or breastfeeding. This could also have an effect for moms and dads because as the FDA explained, the content of physician labelling information is often adapted for patient medication guides when the labelling is approved for a prescribed drug.
The FDA said physicians and pharmacists would have much better information about the effects of prescription drugs, and the proposed revision could have a huge impact on the well-being of women, babies and public health, in general.
Women take an average of five prescription drugs during the course of a pregnancy, which is in addition to medicine for ongoing medical conditions such as asthma and high blood pressure.
In preparation for the new labels, the FDA held a series of public meetings and focus groups to get comments from health professionals and consumers. The new revisions include a requirement to explain, based on available information, the potential benefits and risks for mothers and unborn children, as well as how these benefits and risks might change over the course of a pregnancy.
The current labels use a category system based on letters to show the risk of a drug during pregnancy. Comments from the focus group suggest that is misleading and results in health professionals and patients forming inaccurate and over-simplified views of the risks. Plus, it makes it difficult to update the labels in the light of new information.
The new rule proposes to replace the letter categories from the pregnancy section of the drug labels, and replace them with a new format based on written sub-sections. For example, there will be a "Fetal Risk Summary", which describes what is known about the effects of the drug on the unborn child. It will also indicate if those risks have been assessed from animal or human testing.
There will be a "Risk Conclusion" based on available evidence. For example, a risk conclusion might say, "Human data indicate that drug X increases the risk of cardiac abnormalities," followed by a summary of the main effects of the drug.
Next comes a "Clinical Considerations Section" which describes the effect of the drug if taken before a woman knows she is pregnant. This section will also look at the risk to the mother and baby if the drug is not taken. In other words, what complications arise from the disease you were treating in the first place?
A "Data Section" follows which would give more detail from human and animal studies on the evidence described in the "Fetal Summary".
Finally, "the Pregnancy Section" of the prescription drug label will reveal if there is a pregnancy exposure registry for the drug. Such registries keep records of reported side effects.
The "Breastfeeding" part of the label would be formatted in the same way and will include information regarding how much of the medicine gets into breast milk and how that medicine might affect the breastfed baby.
The FDA proposes to phase out the old label system over time. They'll use it first with all newly approved drugs and then move on to update established drug labels down the road. If you're interested in the ins and outs of the new labels or would like to make a comment to the FDA regarding them, you can go to the US Food and Drug Administration's website and I'll put a link to it for you in the Show Notes at pediacast.org.
Tens of thousands of Gulf Coast children, who lived in trailer units provided by the Federal Emergency Management Agency after Hurricane Katrina in 2005, might have increased risk for long-term health problems. The CDC in February announced that a study of the air quality in trailer units found toxic levels of formaldehyde, which can cause respiratory and other health problems. FEMA and the CDC did not begin efforts to relocate residents of the trailer units until after the release of the study, and federal lawmakers and health officials maintain that "the agencies' delay in recognizing the danger is being compounded by studies that will be virtually useless and the lack of a plan to treat children as they grow," and that's a quote.
In 2009, the CDC plans to begin a five-year study that will expand on a smaller study released in May. The new study, which will include as many as 5,000 children from Alabama, Mississippi and Texas who lived in the trailer units, will seek to determine whether a link exists between the units and their health problems.
However, some federal lawmakers and health officials maintain that the five-year study is inadequate because some health problems, such as cancer, can take ten years or longer to develop. Representative Bennie Thompson, Democrat from Mississippi, who has introduced a bill that would require FEMA and CDC to provide health screenings for Gulf Coast residents who lived in the trailer units, said, "Monitoring the health of a few thousand children over the course of a few years is a step in the right direction, but we need commitment."
Christopher De Rosa, assistant director for toxicology and risk assessment with the Agency for Toxic Substances and Disease Registry at the CDC, said, "It's tragic that when people most need protection, they go from a natural disaster to a health disaster which might end up being worse." He added given the longer-term implications of exposure that went on for a significant period of time, people should be followed through time for possible effects.
In a related story, the Washington Post recently examined how ineffective government contracting, sloppy private construction, a surge of low-quality wood imports from China and inconsistent regulation all contributed to the health problems of Gulf Coast residents who lived in the trailer units. According to the Post, "Each of the key players has pointed fingers at others for the health problems, a chain of blame with a cost that will not be known for years."
FEMA spent about $2.7 billion to purchase trailer units manufactured based on a one-page, 25-line list of standards that did not adequately address the safety of residents. Manufacturers produced the trailer units with unusual speed — because there were a lot of homeless people, that was my comment — and within months, some residents began complaining about sickness, breathing problems, burning eyes, noses and throats, and even deaths.
So for them, maybe it would have been better to be homeless. Not really, OK, I digress.
FEMA attributed the health problems to the manufacturers because in an effort to meet demand, they used low-quality, low-cost wood products that led to increased emissions of formaldehyde. However, the manufacturers maintain that FEMA did not provide consistent standards for the trailer units and that they relied on their suppliers to provide quality wood products. Meanwhile, the wood product suppliers blame cheap, high-formaldehyde-emitting plywood imports that flooded the US market during the recent housing boom.
The New York Times also recently examined the health problems and other social issues among residents of New Orleans left homeless since Hurricane Katrina. A survey of New Orleans residents at a city encampment conducted in February by the Unity of Greater New Orleans found 80% of respondents had at least one physical disability, 58% had some form of addiction, 40% had a mental illness and 19% had all three problems. Unity of Greater New Orleans has asked Congress to include a $76-million supplemental war appropriations bill to help fund rent subsidies and service for 3,000 homeless New Orleans residents with disabilities.
All right, I do have to make a couple of comments here. And I'm allowed to do that because I'm not really a newscaster, OK. So you get my opinion here. You know, this is just tragic. I mean, on the one hand, you really can understand the need to build these trailer units quickly, because I mean, you just have so many people whose homes were wiped out. And the alternative to living in stadiums is not a good long-term way to deal with this situation. So it's just a Band-Aid.
And the trailers are Band-Aids too. But there was this need to make them quickly. And at the same time, we've got this big housing boom, which is kind of scary if there's all this formaldehyde-laced plywood not just being made for the trailers. I mean, if it was made for a lot of houses, who's got formaldehyde in their homes now? I guess there will be testing for that.
So, anyway, this is tragic. Who do you blame? You blame Katrina, I guess. I don't know. It's a tough one. I mean, you want accountability but at the same time, you can only build with what you're given and if you need to make these things quickly, then maybe there should have been a longer list of standards. I don't know what the answer is there.
It's an interesting story, though. And one, we should all be aware of as good citizens.
All right, let's move on, some good news and some bad news with regard to childhood obesity. The good news, childhood obesity appears to be levelling off. The bad news, minority children continue to have some of the highest obesity rates. This information comes from a recent study published in The Journal of the American Medical Association. The study, conducted by Dr. Cynthia Ogden, an epidemiologist at CDC's National Center for Health Statistics analyzed data on 8,165 children between the ages of two and 19 from the 2003 through 2006 versions of the National Health and Nutrition Examination Survey.
Previous research showed the proportion of US children who are obese has tripled from about 5% to 15% since 1980. In the latest study, researchers found 15.6% of children were overweight, 16.3% were considered obese and of these kids, 11.3% were considered extremely obese. All combined, about 32% of US children, or 23 million kids are overweight or obese.
Obesity rates among minority children also appeared to have stopped growing, although there are still differences in obesity rates based on race. According to the study, among girls ages 12 to 19, about 27.7% of blacks and 19.9% of Mexican-Americans were obese, compared with 14.5% of whites. For boys ages six to 11, 27.5% of Mexican-Americans and 18.6% of blacks were considered extremely obese, compared with 15.5% of whites. Data on Asian-American children were not included in the study.
David Ludwig, a childhood obesity expert at Children's Hospital Boston who wrote an editorial accompanying the study, said, "Obesity is striking poor and minority children more severely than whites and wealthier populations." According to the New York Times, "It is not clear if the lull in childhood weight gain is permanent or even if it is the result of public anti-obesity efforts to limit junk food and increase physical activity in schools." In addition, there is a concern that the lull could represent a natural plateau that would have occurred regardless of public health efforts. Another worry is that as obesity rates stabilize, financing for childhood health efforts will wane.
Ogden said, "The study doesn't mean we've solved the childhood obesity problem, but maybe there is opportunity for some optimism here."
And an abstract of the study is available online, and as always, we'll have a link to it in the Show Notes at pediacast.org.
You got to love that, that a decline in childhood obesity may dry up the funding for research. What's wrong with that picture?
Dr. Mike Patrick: We want childhood obesity level off, we wanted to get better, but then, we don't get any more money.
All right, we'll be back and we're going to answer your questions about sunscreen and bug spray, and then, impetigo as well. That's all coming up right after this break.
Dr. Mike Patrick: OK, first up in our Listener Section today, we have Shannon from Seattle, Washington. Shannon says, "Hello, Dr. Mike. Just got on listening to the Rant and Rave Show and enjoyed it. Loved it when Karen is on. I had a comment about one of your questions that a listener had about her baby's sandy poop diaper. I know when my daughter has eaten too many Graham crackers with cinnamon and sugar; it is exactly as you described it – kind of sandy and not fun to get off the bottom. So that maybe another thought."
"I do have a question for you about sunscreen for kids. Do you need to get a kid's sunscreen or can you use an adult sunscreen on children? I always try to get the highest protection I can find for my daughter and myself, but really wondering, if I find one for myself, is it OK to use on her. Thanks, love the show. Shannon, from Seattle."
Shannon, thanks for your question. Thanks for your comment, too. Shannon is talking about, I believe that was… I can't remember if that was our first Rant and Rave Show or our second one, where we talked about grit in dirty diapers. So there's two Rant and Rave Shows, if you haven't listened to those. And I have gotten so many comments on love for Karen, so we're going to have to get her back on the show here sometime soon.
OK, so let's talk about sunscreen. Instead of just answering your question, Shannon, because there's a lot of other questions as well that goes along with sunscreen this time of the year, I think it's appropriate to go ahead and do a little bit of an expanded discussion instead of just answering your questions.
So let's talk about sunscreen. I think a good place to start would be how do sunscreen work? Most sunscreen products protect our skin from UV radiation in two ways. There are inorganic ingredients and organic ingredients. If you remember from chemistry class, the difference between the two is carbon, the atom, I guess you'd say, the element carbon as part of the molecule. I got to get my terminology correct or I'll have all the chemists in the audience writing me hate mail.
OK, inorganic ingredients, what are these? Zinc oxide, some use titanium oxide. Basically, this is what gives the lotion their sort of their whitish look and acts as a shield causing UV radiation to reflect or scatter away from the skin. So it's going to help you out that way with the lotions. Oils do not have this. And the sprays, I'm not sure if they have it or not. I bet they don't. I don't know, I have to look in the ingredients on it. You think I would have done that when I was researching for this discussion on sunscreen, but I just thought of it.
So that's a good question. I'm not sure if the spray ones do or not. OK, then the organic ingredients a couple of examples of these are Octyl methoxycinnamate and oxybenzone. So these are carbon-containing molecules and they absorb UV-radiation. So basically, a chemical reaction occurs in sun screen and so, it changes the make-up of the molecular of the sunscreen. It absorbs the UV-radiation, changes the chemical makeup and produces heat in the process.
So, you do feel a little warmer when you have the sunscreen on. It's not just from the sun itself, but the sunscreen is actually making heat as a by-product of a chemical reaction that is taking place in the sunscreen. But the other thing it means is that the sunscreen has a limited lifespan when it's applied. Because once the organic ingredient is used up it won't work anymore.
And this is where the concept of SPF or sun protection factor comes in. This number tells you how many times longer it takes your skin to burn with the product applied compared to the length of time without the product. So for example, if it normally takes your skin 10 minutes to burn, if you're real fair skin, you have Ohio winter skin, and it's the first part of the summer, you might even burn a little quicker than that.
But let's just say, for argument's sake that without any sunscreen on it, it takes your skin 10 minutes in the sun to burn. If you have a sunscreen with an SPF of two, it's going to take twice as long or 20 minutes to burn. If you have an SPF of 10, then it's ten times or 100 minutes. An SPF of 20 times or 200 minutes and if you have an SPF of 50, the highest that they really go at this point, then it's going to take about 500 minutes for you to burn with that on.
So the higher SPFs basically take longer for that chemical reaction to occur, so there's basically more of the organic ingredient, or the specific organic ingredient there just takes longer to completely convert. So it tells you how long the sunscreen's going to last based on its getting used up. Hopefully, that makes sense.
This also does assume that you put it on right, that you used enough of it, that you covered all exposed skin, and its durability that it stays on. So if you don't put enough on where the product comes off because you're swimming, your clothes are rubbing up against it, then you're not going to get the full length of protection. So that SPF just lets you know how long based on the ingredients in the sunscreen itself not on whether you applied it correctly or not, or whether you go swimming and some of it comes off.
OK, so what are the sunscreen rules then for kids? So, you want to use the highest SPF you can find. You want to apply it liberally. You want to re-apply it often and you want to monitor for signs of skin burning and you want to cover skin with clothing whenever possible. You know, use swimsuits and rash guards, the swim shirts that offer UV protection and that will help out as well.
OK, so great. But what problems can you have with sunscreen? Because otherwise, we'll just say use it on everybody. So what problems do we see with sunscreen? Well, the first and probably, the biggest one is going to be allergic reaction. And it's usually a result of the dyes and perfumes that are put into the sunscreen and not so much the inorganic or organic components that are actually doing the work.
To me, and this is very unscientific, not based on any studies at all. It's just me thinking about my practice. It seems to me that Water Babies have the fewest of these allergic reactions in my mind. Again, it's not science-based; I'm not getting any kickback from the Coppertone people who make Water Babies. But whenever I see an allergic reaction to sunscreen, I always ask, "What brand did you used?" And very seldom is it Water Babies. Now, again, that's not official endorsement. I can't promise Water Babies is allergic-reaction proof but it is the one I usually recommend at the office for kids and adults.
OK, another complication with sunscreen is over-reliance. So you missed an area, you don't use enough, you don't reapply often enough. You're not monitoring your child to see if they're starting to burn and the result is sunburn. This is really where the notion of don't use sunscreen in kids less than six months old comes in to play.
I mean, is sunscreen in and of itself dangerous to put on the skin of young infants? No, but it's possible that you're going to miss a spot or not put on enough or forget to reapply it and not be closely monitoring the baby. And those things are definitely possible. And sunburn in young infants can be life-threatening if enough skin area is involved. They can become dehydrated, overheating is a real possibility for babies left out in the sun.
So, from a liability standpoint, the safest thing for doctors in the companies who make sunscreen is to say, "Keep babies under six months of age out of the sun and don't use sunscreen on them." Why? Basically, you're trying to protect the baby from the stupidity of his or her parents and that's the reason. So sunscreen and babies under six months of age is fine if you must use it, but because of the risk and the ease with which complications can creep up in this age group, it's best use as a last resort. It's better to keep your babies out of the sun and not risk a problem.
OK, I would tell you again, and I talked about this a little bit in the beginning of the conversation, but I'm going to mention it again because I have some notes on it here. And I do think it's important. I think, personally, that lotions are your best bet. I think you're going to get the most barrier and UV reflection action from using a thick liberal amount of lotion. The solid rub-ons, it's more difficult to apply, enough of the product. And the sprays, I don't know, my brother is actually a lifeguard and he says the sprays don't work as well. I'm going to trust his opinion on that. So I would stick with the lotion, especially in kids. Again, my favorite Water Babies, SPF 50.
And I love the smell. The smell of sunscreen, that's just summer in a bottle, isn't it? I opened it up and take a sniff in February. It is great for adults, too, so actually, Shannon, instead of using your sunscreen on your daughter, how about using her sunscreen on you. That's what we did when head to Florida on vacation.
Of course, don't ask me if I've ever burned because I have, badly in fact. But it wasn't the sunscreen's fault. There was operator error. We'll leave it at that. It involved an inner tube in… OK, I won't leave it at that. It involves an inner tube and the sunshine in the Caribbean, Castaway Cay, Disney's private island, and floating on the inner tube, with my back facing the sun. And well, OK, I didn't get enough sun screen back there.
All right, Elizabeth in Carey, North Carolina says, "Dr. Mike, is it safe to put insect repellent on our kids? Are the DEE-free sprays that are worth buying? Can these sprays be put on skin or only on clothing. Thanks for your help, keep up the good work. Liz"
OK, so we're going to go from sunscreen to bug spray. OK, first off, DEET — products without DEET don't work well enough to trust. So you definitely want a product with DEET even in kids.
OK, so what is DEET? You've all seen it, DEET. It is Diethyl-meta-toluamide and it's a chemical that was developed by the US Army to protect soldiers from insects during jungle warfare at the end of World War II. How does it work?
This is interesting, I love how this works. Human sweat and breath contain a chemical called 1-octen-3-ol and insects are attracted to this chemical. It's one of the ways in which insects find you, the other being carbon dioxide emission. But it appears that this chemical in your sweat and in your breath, 1-octen-3-ol, it tells the insect not only that you're there, but that it should bite you.
And what DEET does is it blocks the insect's ability to sense the presence of 1-octen-3-ol. So you become either invisible to the insect, or if it's an insect like mosquitoes that will still be able to find you because you're breathing out carbon dioxide, they will find you but they won't want to suck your blood. So with DEET around, the insects either don't find you or they find you but they don't want to bite you. They don't think you are biteable.
So I think that's interesting, that's how DEET works. Now, let's talk about the potential harm from DEET, which is really at the heart of Elizabeth's question. Is it safe to use on kids? Well, DEET appears to have some toxic effects on the central nervous system. And I say appears because there had not been any formal studies looking at toxicity, only case reports.
The EPA maintains a registry of DEET-associated adverse effects and has close to 50 reports of seizures following DEET use and four of these cases led to death. Now, remember, these are case reports. We don't know if the DEET caused the seizures. Or if DEET used and the seizures were just a coincidence in timing. That's still a possibility. When you think about the thousands upon thousands, upon thousands of people who use DEET-containing insect sprays every year, 50 reports of seizure, I mean, how many people who didn't use DEET had seizures? Probably more than that.
So maybe you could make the argument that spraying yourself with DEET will protect you from seizures. OK, I'm not saying that. Please don't… I can see someone taking the sound bite and snipping it off right there. I'm not saying that. But I mean, you could make that argument, because I'm sure that if you took all of the non-DEET using people, there are more than 50 who've had seizures. Yeah, you could say, "OK, I did the DEET," and three hours later, they had the seizure. Again, 50 in a country of 250 million, I'd still think it's probably coincidence, but that's my opinion.
But let's say for the sake of argument that DEET can cause seizure and did cause seizures in this cases. Well, again, I think that you have to put this into perspective. Again, 50 cases out of millions of users. It's estimated actually that 30% of the US population regularly uses products with DEET. So that actually gives a seizure rate of one case per 100 million users. So even if it did, even if it wasn't a coincidence and the DEET really did lead to seizures, your chance is 1 case per 100 million users. So I mean, it's more likely that you're going to die in a car wreck on your way to buy the bug spray with DEET in it, OK?
Now, on the flipside, what are the benefits of using DEET? Well, as it turns out, insects can carry some nasty diseases. Let's name a few and since we have a global audience here on PediaCast, we'll include some that are seen inside and outside the United States. Mosquitoes can carry malaria, West Nile virus, yellow fever and viral encephalitis among other. Ticks carry Lyme Disease and Rocky Mountain spotted fever; also typhoid; and fleas can transmit plague. And that's just naming a few.
So, repelling insects is an important task and it can prevent disease and it can save lives. And we know that DEET has a very good job of doing this and I'm sure there are people who can't really get a number on this. But I'm sure there are people who would have died and don't even know it if they hadn't used an insect spray with DEET in it.
So, it boils down, like so many things do, to a risk versus benefit analysis, which is basically what I've done here. And the consensus on DEET, which makes sense now than you got the facts, the consensus on DEET from the CDC and the American Academy of Pediatrics is that the benefit of using DEET products outweighs the risk from DEET in adults and in children older than two months.
Now, why should you not use DEET in kids less than two months? It's a good question and I don't have any answer. It's arbitrary. Has there been more seizures and deaths associated with DEET use in this age group? No, but again, part of it is just protecting little two-month-olds from their parents. Just don't use it. Don't take them outside, OK.
Dr. Mike Patrick: So do we know for sure that DEET has any toxic effects on humans at all? No. I'm not going to go against the explicit advice from the CDC and the AAP here, folks. So don't use DEET on kids less than two months. Got it? OK, good.
Since there is this question mark on toxicity though, there are some additional caveats concerning DEET used in kids and adults. DEET is absorbed through the skin. So don't put it on under your clothes. I mean, don't put it on under clothes. You know what I mean.
Dr. Mike Patrick: I'm not saying don't put it on your underclothes. Don't put it under your clothes. I mean, if you put it on your underclothes, that would be pretty silly. What I'm saying is just don't put underneath the clothing. You don't need to. And plus, that would increase the absorption to the skin.
Don't apply at a broken-down skin or areas where you have sores because applying it to those areas will result in more of the DEET getting inside your body.
Also, after you go inside, it's recommended that you wash DEET off your skin with soap and water. So don't go to bed with it on. So, basically, let the DEET do its job and then get it off of your skin when you no longer need it.
Now, you're asking yourself, "Wait, you just said it was safe. One case of seizures out of a 100 million people, why are you saying that you have to get it off of your skin?" Well, it's again because no tests were done and we just don't know. So to be prudent, once you don't need it anymore, get it off of your skin.
If you're interested knowing more about DEET and what it does and all these stuff, and I know you are, I have a link for you in the Show Notes. There's an excellent, excellent handout from the folks at the Utah Poison Control Center and it contains lots of information and advice concerning DEET. For example, the handouts gives this advice, "Put DEET on your own hands and but not your kids' hands because they're going to eat it if you put it on their hands."
It is OK, Elizabeth, to use DEET on clothes and skin, but again, not broken-down or irritated skin, and wash your skin with soap and water before you go back indoors and wash the clothes before wearing them again. Use no higher concentration than 30% DEET for kids and adults — that's the recommendation.
And also, do not apply — again, this is all from this handout from the Utah Poison Control folks — don't use the combination product containing DEET and sunscreen. Why? Well, because sunscreen should be reapplied often and DEET should be used sparingly. So stay away from the combo products.
There's a lot more in this handout so check it out. Again, we'll have a link in the Show Notes for you at pediacast.org.
All right, we have time for one more question. This one comes from Angie in Redlands, California. Angie says, "Hi. Could you please discuss impetigo and staph infections. My son, two years old, had impetigo and then a few months later, my daughter – nine months got impetigo. Even after the antibiotics, my son has had a few sores which go away with topical Neosporin. Could something in my home or yard be infecting my children? How can I prevent my kids from contracting impetigo again?"
OK, good question. Let's talk about this, Angie. Impetigo, it's a bacterial skin infection. The sores are usually small less than an inch, but there may be more than one of them. They start out as small red bumps and then, they rapidly change to small cloudy blisters or pimples. Then, they break open, seep and form a soft yellow brown or golden scab.
So how does this happen? After all, our skin is covered in bacteria, right? We have bacteria all over our skin. So how does impetigo get started and why doesn't everyone have it all the time since we're covered with bacteria. OK, good questions, they're my questions but they're rhetorical. They're good because I'm going to answer them.
Well, first the type of bacteria makes the difference. There's good bacteria which is supposed to live on our skin. For example, there's one called staphylococcus epidermidis (or staph epi) or coagulase negative staph. That's the good stuff.
And then, there's the bad bacteria which shouldn't be there. And examples are staphylococcus aureus or coagulates positive staph and this includes a MRSA or methicillin-resistant staphylococcus aureus — you probably heard of that before. Streptococcus pyogenes, and this group includes group A strep which causes strep throat and rheumatic fever. These are all bad bacteria that shouldn't be on your skin.
So in the case of impetigo, you have bad bacteria that's not supposed to be there. Now, bad bacteria simply on the surface of your skin won't cause impetigo – won't cause impetigo without a toehold. And this is the second factor you need to get impetigo going. The bad bacteria need to be able to get into the skin so there has to be a disruption of the skin surface. Now, this disruption can be tiny. You might not see it — small scratch, dry skin, eczema, poison ivy rash, diaper rash. I mean, all of this can provide that toehold that the bad bacteria need to cause the infection.
So, basically, you got this toehold, you got the bad bacteria start to grow there and you get what we describe as the typical look of impetigo. So what do you do for it? Well, most cases only require a topical antibiotic. The infection is superficial. You pick off the soft golden scab – this is one case where you get to pick a scab, wash your hands first and afterward – apply the topical antibiotic after you pick the scab off, so it gets right down to where the bacteria is. And then, you want to probably cover it up, especially in young kids who are going to pick at it and mess with it.
Now, talk to your doctor. I'm not saying if your kid has impetigo, you should do this, OK? Because each case is different, it may be deeper. It may be a cellulitis, it may be an abscess underneath. Talk to your doctor, don't rely just on what I'm saying. I'm just saying most superficial, limited cases of impetigo, a triple antibiotic, ointments you get at the drugstores, is going to be fine for it.
Now, there are complications that can arise with impetigo and this is why you still need to talk to your doctor. If the infection goes deeper or spreads down around the surrounding skin or if it's a particular strain of the strep or staph that makes a chemical, then you can get some other complications. For example, there are some strains of bacteria that produce a chemical that causes large blisters in the skin. We call this Bullous impetigo. You can also have a type of staph that causes a scalded skin syndrome, where you get large peeling areas; a deeper generalized skin infection we call cellulitis and then, skin abscesses which becomes pus-filled. We see that a lot with MRSA.
And these kind of things are going to require something more than just a topical antibiotic. They're going to need an oral antibiotic or a shot or series of shots or IV-antibiotics. So again, you want to make sure you talk to your doctor. Also, these bacteria do have the potential to cause something called toxic shock syndrome which can be life-threatening. So impetigo has the potential to go south in a hurry, you don't want to ignore, you want to contact your doctor and take care of it while it's easy to take care of.
Now, in terms of prevention, which really gets to the heart of your question, Angie. In terms of prevention, and really you do hear especially like in school, people say, "Oh, if you have impetigo, you shouldn't go." The teachers will say, "You can't go to school if you have impetigo." But actually, it's not all that contagious once you start treating it. So really, a better way to sort of break the impetigo cycle is to actually prevent it in the first place.
So how do you do that? OK, so let's talk about that. First, you got to take good care of conditions that give the bad bacteria a toehold. So if you have a diaper rash or eczema or scrapes and scratches or poison ivy, you want to see your doctor and keep these issues under control as best as you can. So you want to try to keep the bacteria from being able to get a toehold or disruption in the surface of the skin. That's the first step at preventing reoccurrence and/or the first occurrence.
Number two, you want to eliminate colonization on your skin with bad bacteria. And here's when we get in to the problem of recurrence and in particular, in the spread of impetigo within the family or within the classroom. Why does it keep coming back and spreading back and forth if I just said it's not really all that contagious once you start treating it? Well, the answer to that usually lies in colonization. You have bad bacteria in the house or in the classroom and you keep getting it back.
So where is it hiding? Well, you'll be surprised. The answer may surprise you here. The most common hiding place is not on door knobs and toys and books. Actually, the most common hiding place for this, for the bacteria that cause impetigo is in your nose. So if you're a strep or you're staph, it's a nice place to hang out.
How do you keep your kids from getting impetigo then? I'm sorry, why do kids keep getting impetigo? We'll talk about how to keep them not getting it in a minute. Look, I'm not a professional here, folks. I'm just trying to share some knowledge with you. If I was professional educator, this would be much more streamlined, I know.
So, how do you keep kids from getting it? Or how do they keep getting it? Let's talk about that first. Well, they pick their nose and they scratch their skin. I know it sounds funny but it's true. Your kids got their fingers on their nose and they're scratching their skin. You got the bad bacteria from the nose, now it's on their finger, they're scratching their skin and now, it's got a toehold. So this is why kids get impetigo so easily.
So in order, to prevent your kids from getting it, you have to get rid of the bad bacteria that's in their nose. Or you have to stop them coming in to contact with the bad bacteria. You got to get them to stop picking their nose, stop scratching their skin.
So OK, let's talk about each of these, getting rid of the bad bacteria – good hygiene, you want to wash regularly with soap and water. And sometimes, if there's recurrence in the family, you need to put a topical antibiotic, a triple antibiotic, Neosporin kind of stuff up inside in the nose to kill the source.
Again, talk to your doctor about this. Don't do it based on my advice on this podcast. Some kids, where they keep getting impetigo, there's three or four kids in the house, they all keep getting, you keep treating it. You may even get to the point you're treating people with oral antibiotics. They keep getting it, and so what you do is you have everybody in the house put a little Neosporin up in their nose couple of times a day for seven to ten days and it breaks the cycle, because you're getting rid of the source.
And of course, also, you want to teach your kids to blow and not pick. You may get books and videos about germs that make it kind of fun for kids to learn to about that. And, of course, washing hands frequently helps as well.
They have itchy skin conditions like rashes, eczema and the like, treat those conditions, get the itching under control so your child doesn't have to scratch and that will help prevent it as well.
So, summing it all up, because it wasn't very streamlined, I know. There are teachers out there, I'm sure, that's just raising their eyebrows, rolling their eyes at my presentation sometime because they are a little tangential.
OK, so recurrent impetigo is a problem and with lots of community-acquired MRSA or methicillin-resistant staphylococcus aureus out there, it's becoming a bigger problem. But there are things you can do to stop the cycle and if you don't have a clear idea what those things are, rewind and listen again from the top.
Dr. Mike Patrick: It's OK to do that from time to time, there's lot of information here to absorb, I know.
All right, we're going to take a… I didn't really wrap that up. I said in summary, and I didn't even sum it up. OK, in summary, you got to get rid of the bad bacteria. You got to stop your kids from scratching. That will do it.
All right, let's take a quick break and we'll wrap up the show, which is probably a good thing at this point. We're going to wrap it up. See, part of the problem is, you get talking for an hour on science stuff and your brain does start to get a little loopy. All right, we're going to take a break; we'll wrap up the show right after this.
Dr. Mike Patrick: OK, a big, big thanks goes out to Nationwide Children's Hospital for providing the bandwidth for our show; also, Audiblekids.com for sponsoring this particular episode, Vlad Studio over at Vladstudio.com for providing the artwork for the site and Medical News Today, and of course, listeners like you, and definitely my family, and Doug the yard guy.
PediaScribe, that is the blogging arm of PediaCast, although, it's not really so much medical as it is parental. And Karen, my lovely wife takes care of the blog. My favorite recent post of hers was "Please Remove Me From Your Mailing List". If you ever felt inundate with junk mail in your mailbox — and I'm talking about your real-life physical mailbox here, folks, not cyber junk mail – if you ever felt inundated with junk snail mail, Karen has a great idea for you and it's one that really works.
I won't give away her secret here; you have to check it out. It's called "Please Remove Me From My Mailing List" over at the PediaScribe blog. And you can get there by heading to pediascribe.com or swing by the Show Notes at pediacast.org and click on the link there.
Reminders, iTunes reviews, they are really, really helpful. And this last week, there are several of you who wrote very nice reviews. And I appreciate that. I see every one of those, I read them and I know a lot of you read them because people who are looking for a podcast, and there's many of you out there who found PediaCast, the reason that you gave us a try is you saw how many good reviews we had. And I do think it's really important and it only takes 30 seconds to 60 seconds of your time to write a quick review. It's really appreciated.
Also, we have a Poster Page at the website, at pediacast.org – PDF files you can download and print out, hang on bulletin boards for us. And there's a Listener's survey at the website, as well.
I do want to make a comment here real quick. Well, actually two. Katie, my daughter Katie, she is almost 14 years old; is working on a teenage but safe, safe teenage because I'll be reading it, blog. It's called Baggachips.com. There's nothing quite up there yet. It's in the very initial early going stages. But stay tuned, because if you like a teenage blog for your teenagers that I think would be fun and definitely monitored and safe, you have to check that out, Baggachips.com. All that in a bag of chips. So that's coming up. OK, so there's the one announcement.
The other, please bear with me and my family. We have some potential life changes going on, which are exciting. Not catastrophic, but I can't talk about them quite yet. And no, we're not having a baby. I only mentioned this so you understand why there may be a show missing here and there. It's not laziness, there's just lots happening right now. Certainly, more than I had bargained for this summer. Yeah, but that's life, right? Change around every corner, you got to move with it.
So just keep that in mind, if there's some missing shows, you'll understand, we have some things going on which you will be privy to at some point, but not yet.
OK, so we are going to say goodbye for another week and until next time, this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids….
So long, everybody!