Are Your Children At Risk for Dehydration This Summer?
Welcome to summer, the kids are out of school, summer camps are in full swing, family trips all over the country have begun and just in case you haven’t noticed, it’s hot outside. It is turning out to be one of the hottest summers on record with temperatures reaching triple digits in many parts of the country. As it heats up, summer safety becomes a serious issue. With all this fun and traveling going on please don’t forget to ask yourself one very important question, “are my children hydrated well enough to handle this heat?” the answer is most likely no.
Thousands of children each year are admitted to hospitals with heat-related illnesses and most go home, but there are the cases every year where children end up overheating and dying because they were not hydrated properly. As I write this, it’s a beautiful 94 degree Saturday here in Miami with all the humidity you can handle and that means one thing for us here at the fire department. A huge increase in the amount of heat illness related calls we are going to run and most of them will be on children.
As parents when we think of dehydration, we think of our children being sick and having a bout of diarrhea and or vomiting, and the doctor tells us to keep them hydrated with plenty of fluids. That is all well and good and as good parents we make sure our little campers get plenty of fluids and are back healthy A.S.A.P., But the kind of dehydration I am talking about is the kind we as parents tend to overlook in the rush of our day to day lives and that is the everyday dehydration of our very active children. By the time a child says he is thirsty, he is already dehydrated, and with studies finding that 50% of children participating in sports activities were already dehydrated we need to be hydrating our children before, during, and after physical activity as well as keeping an eye out for the signs of heat-related illnesses.
Recommendations for hydrating children ages 6 to 12 include:
- 4-8 ounces 1 to 2 hours before activity
- 5-9 ounces every 20 minutes of activity
- After activity, replace lost fluids within 2 hours
Recommendations for hydrating young athletes ages 13 to 18 include:
- 8-16 ounces 1 to 2 hours before activity
- 8-12 ounces 10-15 minutes before activity
- 5-10 ounces every 20 minutes of activity
Being able to recognize the signs of heat-related illnesses is critical and should be done by us the parents as well as the coaches. A basic awareness of the signs of heat-related illnesses could make all the difference, so here are some key points to be on the lookout for as recommended by Susan Yeargin, PhD, ATC.
Types of heat illnesses
Athletes who exercise in hot or humid weather are particularly at risk of heat illnesses:
- Heat cramps
- Heat exhaustion
- Heatstroke
Symptoms of impending heat illness
In addition to educating young athletes about both the importance of hydration and the dangers of heat-related illness, ensuring that they are drinking enough fluids, and taking precautions to reduce the risk of heat injury in children in hot and humid weather, you need to watch your child for symptoms of impending heat illness:
Weakness- Chills
- Goose pimples on the chest and upper arms
- Nausea
- Headache
- Faintness
- Disorientation
- Muscle cramping
- Reduced or cessation of sweating
A child continuing to exercise when experiencing any of these symptoms could suffer a heat illness.
Heat cramps
Symptoms:
- Thirst
- Chills
- Clammy skin
- Throbbing heart
- Muscle pain
- Spasms
- Nausea
Treatment:
- Move child to shade
- Remove excess clothing
- Have child drink 4 to 8 ounces of fluid with electrolytes (sports drinks) every 10 to 15 minutes
Heat Exhaustion
Symptoms:
- Nausea
- Extreme fatigue
- Reduced sweating
- Headache
- Shortness of breath
- Weak, rapid pulse
- Dry mouth
- Rectal temperature less than 104?F.
Treatment:
- Move child to cool place
- Have child drink 16 ounces of fluid containing electrolytes for every pound of weight lost
- Remove sweaty clothes
- Place ice behind child’s head
- Seek medical attention, if no improvement
Heat Stroke
Symptoms:
No sweating- Dry, hot skin
- Swollen tongue
- Visual disturbances
- Rapid pulse
- Unsteady gait
- Fainting
- Low blood pressure
- Vomiting
- Headache
- Loss of consciousness
- Shock
- Excessively high rectal temperature (over 105.8F.)
Treatment:
- Call 911
- Remove sweaty clothes
- Immediate and continual dousing with water (either from a hose or multiple water containers) combined with fanning and continually rotating cold, wet towels on head and neck until immersive cooling can occur.
As parents we tell our kids to study and do their homework so they will be prepared, well we as parents need to do our homework as well when it comes to recognizing the signs of heat-related illnesses and staying on top of hydration. Luckily for those parents who live and breathe on their iPhone there is help. iHydrate is an app that reminds you to hydrate yourself and your children before, during and after activities. App or no app, stay alert, keep those children hydrated and please remember, when in doubt call 911.
Is My Child’s “Barky Cough” CROUP and How Can I Help?
Croup, or laryngotracheobronchitis, is caused by many viral infections and falls into the category of upper respiratory infection along with the common cold. Croup tends to occur in the autumn and early winter months. In croup, the major areas affected are the ones referred to in the long name of this illness (above); the larynx, trachea and bronchi, which are all structures that convey air from the mouth and nose down toward the lungs. As with all colds or upper respiratory infections there is inflammation of the mucosa (most superficial covering) of the inside of the nose, mouth, throat and upper respiratory tract, leading to mucous production and irritation of those sites.
In croup, the area of the upper respiratory tract most prominently affected is the larynx, or the voice box area located very close to the firm lump in the front of your neck, the “adam’s apple”. When vocal cords are irritated and swollen, adults merely get hoarse or raspy talking and a “normal” sounding cough. Children have a much narrower windpipe and therefore with even the slightest swelling of their vocal cords, there is less room for air to get by and they also get hoarseness along with a cough and raspy breathing. There is also a characteristic barky (yes sounds like a animal barking) kind of cough and occasional difficulty breathing. All symptoms tend to be worse at night, a time when all illnesses seem to worsen.
For the most part this illness remains mild and the only treatment needed is a cool mist humidifier, fluid intake, elevated head at night and reassurance for the child and parents.
Rarely a child may progress to real difficulty breathing, with a characteristic whooping noise when taking a breath in versus a wheezing sound when breathing out found more commonly in those with asthma. So if your child exhibits difficulty breathing along with the above symptoms, call your doctor for further instructions.
Once a child has had croup, parents seldom forget what the barky cough sounds like and can make the diagnosis themselves. Usually, as with other upper respiratory viral infections there is a mild amount of fever and the child is not real sick.
If there is sudden high fever with the onset of “croup” and your child is drooling, cannot swallow or speak, and is very anxious, you must call your doctor immediately or call 911.
This symptom complex describes a rare but life threatening illness called epiglotitis which can be very dangerous. I stress that this is a rare illness which used to be far more common before we were able to vaccinate against the bacteria which causes this illness.
Study: ADHD Meds Given More Often to Youngest Kids in Class
“Youngest children in class more likely to get ADHD medication, study says,” The Guardian reports.
The results of an Australian study have caused concerns that, in some cases, immature behaviour may be misinterpreted as evidence of a behavioural disorder.
In a brief report, researchers found nearly 2% of 6-15-year-olds in Western Australia received a prescription for attention deficit hyperactivity disorder (ADHD) medication in 2013. Those born in the last months of the school year intake were more likely to have had a prescription than the oldest children in the year.
The gap between the oldest and youngest children in the class had a small, but significant, association with the increased use of ADHD medications. The researchers say their findings compare with those of other international studies.
It’s possible the youngest children in a school year may find it harder to keep up in lessons than children almost a year older than them, and may be more likely to have problems with concentration.
But it would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone.
The use of ADHD medication for under-16s in the UK is far lower than in many other developed nations – 0.4%, compared with Australia’s 1.9% or the US’ 4.4% – so the potential problem of inappropriate treatment may not be as much of an issue in this country.
Where did the story come from?
The report was authored by four researchers from Curtin University, Murdoch University and the University of Western Australia, all in Australia.
The study was published in the peer-reviewed Medical Journal of Australia, and the researchers declared no conflict of interest or study funding.
It’s available to read online on an open access basis, so you can download the study for free.
The UK media coverage was accurate, but does not point out the limitations of this brief report.
What kind of research was this?
In this brief one-page report, the researchers say four international studies found the youngest children in a school year are more likely to be receiving ADHD medication.
They aimed to see how Western Australia compares by analysing data from the Pharmaceutical Benefits Scheme – a scheme similar to the NHS, where the cost of medicine is subsidised by the Australian government – to see how many children were receiving ADHD medication.
This brief report provides very limited information about the authors’ methods, making it difficult to critique.
And we don’t know how the authors identified the four international studies they reported, so we don’t know whether this is a fully comprehensive look at the subject.
This means the report must largely be considered to be the opinion of its authors.
What did the researchers do?
The researchers compared the proportion of children born in the first and last months of a “recommended school year intake” who were recorded in the Pharmaceutical Benefits Scheme as receiving at least one prescription for ADHD medication in 2013.
The study included a total of 311,384 children, covering two age bands: those aged 6-10 (born July 2003 to June 2008) and those aged 11-15 (born July 1998 to June 2003).
The researchers looked at the number of children receiving medication and the patterns by time of birth.
What did they find?
The researchers found 1.9% of the full study sample (5,937 children) had received at least one prescription of ADHD medication, with more boys than girls being prescribed for (2.9% versus 0.8%).
In the 6-10-year-olds, they found those born in the last month of the school year intake (June) were nearly twice as likely to have been prescribed medication as those born in the first month (the previous July): relative risk (RR) 1.93 for boys (95% confidence interval [CI] 1.53 to 2.38) and RR 2.11 for girls (95% CI 1.57 to 2.53)
The same pattern was seen for 11-15-year-olds, but the risk increase was less, though still significant (RR 1.26, 95% CI 1.03 to 1.52 for boys; RR 1.43, 95% CI 1.15 to 1.76 for girls).
The authors say similar effects were also seen when comparing those in the first three to six months of intake with the last three to six months.
What did the researchers conclude?
The researchers say at 1.9%, their observed prescription rate is comparable to a recent Taiwanese study, and both this study and three North American studies observed the effects of birth month on prescription rates.
They describe a professional from the American Psychiatric Association who feels ADHD is overdiagnosed and overmedicated, saying that, “Developmental immaturity is mislabelled as a mental disorder and unnecessarily treated with stimulant medication.”
The authors say the findings indicate that, “Even at relatively low rates of prescribing, there are significant concerns about the validity of ADHD as a diagnosis.”
Conclusion
Overall, this study suggests that in Western Australia – and reportedly in other countries, too – the youngest children in a given school year are more likely to be diagnosed with and treated for ADHD than the eldest in the year.
However, it’s important not to draw too many conclusions from this brief report. The authors provide very limited information about their methods, so it’s not possible to critique how they conducted their study.
We don’t know why they selected the 2013 school year, for example. It was said to be recommended, but we don’t know why. It could be it was known there were an unusually high number of prescriptions noted in the Pharmaceutical Benefits Scheme that year, which means it might not be representative.
Also, this database can only tell us the number of children that filled out at least one prescription for ADHD medication. We don’t know how the children were diagnosed, how long they had been diagnosed or treated for, or whether they actually took the medication.
The authors also point out the possible limitation that they didn’t know how many children may have entered school outside of their recommended starting year – although this was thought to be few.
We also don’t know how the researchers identified the international studies, and we don’t know that these reported findings give a comprehensive look at ADHD diagnosis and treatment worldwide.
It would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone. And, as no UK studies were reported, we don’t know what the true situation is like in this country.
It’s possible the youngest children in a school year may find it harder to keep up with lessons than children almost a year older than them, and so could be more likely to be distracted – though this is clearly a big generalisation and is not always going to be the case.
However, it does perhaps highlight there is a need for children who are struggling or finding it difficult to concentrate at school to be recognised, and get the additional attention and support they need – something both teachers and parents of the youngest children in a school year may need to be aware of.
Analysis by Bazian. Edited by NHS Choices.
Links to the Headlines
- Youngest children in class more likely to get ADHD medication, study says. The Guardian, January 22 2017
- Children being diagnosed with ADHD and put on drugs when they are just ‘immature’. Mail Online, January 23 2017
Links to the Science
- Whitely M, Lester L, Phillmore J, Robinson S. Influence of birth month on the probability of Western Australian children being treated for ADHD (PDF, 163kb). Published online January 22 2017
Video: Is Your Child’s Rash Fifth Disease and Should You Worry?
In this video Dr. Rob Hicks, a general practitioner (GP) or family physician, briefly describes Fifth Disease or “Slapped Cheek Syndrome,” and how you can tell this rash apart from other more concerning illnesses.
https://youtu.be/vMHHYld7MK8
Editor’s Note: Video Highlights
Fifth Disease – or “slapped cheek syndrome” is a viral infection, caused by the virus, parvovirus B19- It is spread in the air when we cough or laugh, when we sneeze, or in saliva and air droplets when we’re in close contact
- It is most commonly children who get it – usually between the age of four and 12 – and can spread very rapidly throughout a classroom or school
- The symptoms to look out for are generally those of a common cold,so sneezing, runny nose, sore throat, headache, fever.
- But the characteristic of this infection is the rash – the blotchy red rash on one or both cheeks that gives the slapped cheek appearance
- The rash can remain on the face, but could spread to the rest of the body,including the palms of the hands and the soles of the feet
- Generally, it’s not painful but it might be irritating for some
- Unlike the worrying rash of meningitis, if you press this rash it will fade
- Symptoms are often mild and parents should follow the usual management of any viral infection,
- Plenty of rest and plenty of fluids
- For sore throats or a high temperature children’s paracetamol (acetaminophen) or ibuprofen is perfectly reasonable
- If you’re not sure have a word with a pharmacist or with your doctor
- The people who need to be concerned are pregnant women – if you get the infection in early pregnancy and you’ve not had it before it can increase the risk of miscarriage
Video: Kids and Cancer – What You Need to Know About ALL
Dr Victoria Grandage, Consultant Hematologist at the Children and Young People’s Cancer Service at University College London, describes the signs and symptoms of Acute Lymphoblastic Leukemia, also known as A.L.L. She and the mother of a young former patient, Josh, talk about the treatment and experience of ALL; a cancer that, thankfully, has a high cure rate in children. Click on the picture below to go to the NHS YouTube channel to watch the video.
Editor’s Note: Video Highlights
- Acute lymphoblastic leukaemia or ALL is a form of cancer of the blood
- For reasons we do not yet fully understand, immature cells in the bone marrow – lymphocytes or lymphoblasts – rapidly build up and crowd out the normal bone marrow cells
- Some of the symptoms of ALL include:
- Anemia: tiredness, shortness of breath, lethargy
- Infections, high fevers, maybe mouth ulcers
- Bleeding, bruising and rashes
- Enlargement of some lymph nodes around the neck or in the groin
- Enlargement of the liver and spleen
- Bone pain (a prominent symptom)
“When Josh was about two and a half, he went back to crawling rather than walking. He’d say his legs were too sore to walk and he’d crawl around for the first half hour or so (after getting up) and then start walking after that.” Josh’s Mom, Angela
Initial treatment, before a diagnosis has been confirmed, is supportive to address the above symptoms and can include fluids for hydration, antibiotics, and possibly a blood transfusion- Treatment of the leukemia itself involves chemotherapy, a broad term for many different drugs that may be given in tablet form, as injections, or directly into the blood stream as IV infusions
- Some ALL chemotherapy drugs are also given via a lumbar puncture
- Side effects of the chemotherapy include nausea, tiredness, and hair loss
- Treatment begins with acute therapy – for Josh this lasted 9 months – and is followed by maintenance treatment for a couple of years
- Josh’s total treatment lasted three years
- The majority of children with ALL go into remission – and 75%-80% of those are cured
- Further intensified treatment, including a stem cell transplant, may be required for children who do not go into remission
Which Complementary Therapies are Proven Effective for Asthma?
Most complementary therapies for asthma haven’t been shown to work. The exception is some types of breathing exercises, which do seem to improve symptoms and quality of life.
Research by Asthma UK shows that almost 1 in 10 people living with asthma use complementary medicine, and many would consider using it in the future.
According to Dr Mike Thomas from Asthma UK, there’s little evidence that complementary therapies in general improve asthma symptoms.
Specific remedies that are sometimes tried include homeopathy, acupuncture, air ionisers, the Alexander technique and Chinese herbal medicine, but the results have been disappointing. Read more about asthma treatment.
Breathing Exercises for Asthma
The exception is certain types of breathing exercises, which can help some people with asthma. These include breathing exercises taught by a lung (respiratory) physiotherapist, some types of yoga breathing exercises, and the Buteyko method of breathing.
People with asthma are taught slow, steady “diaphragmatic” breathing through the nose. This type of breathing is done by contracting the diaphragm, which is located between the chest and the stomach. This can result in fewer asthma symptoms and better quality of life. However, these exercises are not a cure, and people with asthma still need to use their regular inhalers.
The Buteyko Method
The Buteyko method, a system developed in Russia, teaches similar exercises and may improve asthma symptoms for some people. However, some find that the breathing exercises used during yoga also help their symptoms.
According to Leanne Male, Asthma UK’s assistant director of research, people with asthma who gain some relief from Buteyko and other types of breathing exercise should not rely on it so much that they stop their conventional medication.
“We know that some people with asthma use breathing techniques such as Buteyko but, while they may reduce symptoms, they will not reduce the sensitivity of the airway, and should not replace regular asthma medicine. Also, we don’t know what the long-term benefits are.”
Chinese and Other Herbal Medicines for Asthma
There isn’t enough clinical evidence to recommend the use of Chinese medicine, other herbal medicines, acupuncture, hypnosis and other complementary therapies.
