What is Swimmer's Ear?

While on vacation, my son started complaining about his ears hurting when I put on his shirt. At first I just thought it was him being a typical 4 year-old, but it caught my attention when it really seemed to bother him when I bumped his ear while brushing his hair and then later when giving him a hug. Turns out my son had developed swimmer’s ear after having spent several days in the pool.

Swimmer’s ear is a common summer occurrence, but can occur year round even in people who do not swim. It is also called otitis externa because it is inflammation of the external ear canal. The inflammation can be caused by a number of things, but is most commonly caused by water in the ear canal that causes skin breakdown. The loss of skin integrity allows bacteria or fungus to enter the skin and cause inflammation. Other things that can cause skin breakdown and lead to otitis externa are using Q-tips, a foreign body in the ear canal, hearing aid, a rash that extends into the canal or drainage from a perforated ear drum.

Children usually complain of itching or pain in the ear. Children may have drainage from the ear as well. It often hurts when either the tragus (the prominence in front of the external opening of the outer ear) or pinna (the largely cartilaginous projecting portion of the external ear) are moved.

Physicians diagnose otitis externa by looking in the ear with an otoscope and by the tenderness elicited with movement of the ear. It is often treated with prescription ear drops. Oral antibiotics are sometimes used if the infection is severe or spread beyond the ear canal. There are over-the-counter ear drops but these will not treat otitis externa that has already developed. The drops should be put in the ear with the child laying on his or her side and remaining there for 3-5 minutes for the medication to have contact with the skin of the canal. The ear canal should be kept as dry as possible during the healing process. Avoid swimming and bathing that would get the canal wet. A cool air blow-dryer can be used if the ear does become wet.

Once a child has had otitis externa, steps should be taken to prevent it in the future. Ear plugs are an option, but sometimes if they enter the canal, they can also cause irritation. Drying the ears after swimming and bathing is important. First dry with a towel. You can again use a cool air blow-dryer. Another option is a couple drops of 70% rubbing alcohol solution or a mixture of ½ alcohol plus ½ vinegar placed in the canal will help dry up any water in the canal.

Enjoy the warm weather while it lasts!

Dr. Dana Johnson
Pediatrician
Meriter McKee
607.417.8388
meriterkids.com

Getting the Okay to Play

Summer vacation has just started, but soon enough the annual mad dash to get those pre-participation sports physicals will begin. The state of WI requires that all students participating in organized sports have a physical examination by a qualified provider every two years to make sure they are healthy enough to participate in sports. These can be done as early as April first.

Keep in mind that the earlier the the exam is performed, the more time your doctor may have to investigate any problems that may be found. It is rare to find a condition such as a congenital heart disease or arrythmia that would completely disqualify an athlete. The pre-participation physical more often discloses issues that require follow up such as physical therapy, nutritional counseling, or referral for previous undiagnosed hypertension. It gives the opportunity for prevention of injury with effective conditioning programs. And it gives the opportunity to get certain conditions, such as asthma, better controlled before sports season begins. In addition, the sports physical is an opportunity for adolescents to develop a relationship with their physician who can also address issues not directly related to sports such as “high risk” behaviors (e.g. drug and alcohol use, use of sports enhancing substances, unsafe sexual practice).

Medical histoy is one of the most important parts of the sports physical and family history is a very good indicator of any potential conditions your child may be at risk for. Medical history questions are on the WIAA form that you can bring home. Please take the time to obtain your family’s medical history and answer the questions as well as you can.

Make a list of the following items:

• Chronic medical problems such as asthma, diabetes, seizures
• Previous hospitalizations and surgeries
• Past orthopedic problems/injuries/fractures
• Current medications
• Allergies
• Family history of any heart disorder (especially family members under 50) or any unexplained sudden death in the family history of concussions or head injuries (even if no one called it a concussion)
• Whether you’ve ever passed out, felt dizzy, had chest pain or significant trouble breathing during exercise/sports

Have fun, enjoy your summer. Don’t forget to schedule your sports physicals early!

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

What to Watch for: Hand, Foot and Mouth Disease

Summer is a time for children to play outside, be active, and enjoy freedom from the classroom. However, summer is also the season when some of the most common pediatric illnesses rear their ugly heads. One of these illnesses that is showing up recently in children in the Madison area is Hand, Foot and Mouth disease (HFMD).

HFMD is a viral illness that typically occurs during the summer months in children ages 10 years and younger. The usual symptoms include fever, mouth sores and a rash. The fever is often the first symptom to develop. This is typically followed by the development of blisters in the mouth, and sometimes on the hands and feet (hence the name!). Some children may also develop this blistery rash on their buttocks and genitals. As one can imagine, with these blisters, children may refuse to walk, eat or drink and may cry with urination.

Unfortunately, there is no specific treatment for HFMD. The most important steps a parent can take to help their child through this illness is to give acetaminophen or ibuprofen for comfort and fever reduction and to make sure that the child is getting plenty of fluids. Children with HFMD are at risk for dehydration because the mouth pain prevents them from drinking enough liquids. Offering popsicles or soup can help to soothe the throat while also providing fluids.

If you fear that your child may have become dehydrated or have other complications from HFMD, please contact your child’s primary care provider.

The best way to fight HFMD is through stopping the spread of the virus. Help children have a happy and healthy summer…teach them good hand washing!

Dr. Nicole Baumann-Blackmore
Medical Director, Pediatric Hospitalist Program
Meriter Hospital
meriterkids.com

Swimming Safety

Summer break is finally here and kids will soon be spending more time in and around water. Swimming is a great way for kids to get exercise and stay cool during the summer, but it is important to swim safely.

Remember to protect children from the sun. Sunburn is a risk factor for skin cancer. In 2003, a total of 45,625 new cases of melanoma were diagnosed in the U.S., and 7,818 people died from the disease. Check out Dr. Johnson’s Sun Safety blog (March 22, 2010).

Drowning is the second leading cause of unintentional injury deaths for children ages 1 to 14.

• Never – even for a moment – leave small children alone while in bathtubs, pools, spas or wading pools, or near standing water. With infants, toddlers and weak swimmers, an adult should be within an arm’s length.


• If you have a pool, install a four-sided fence. This includes inflatable and above ground pools.


• Children need to learn to swim. AAP supports swimming lessons for most children 4 years and older. New studies suggest classes may reduce the risk of drowning in younger children aged 1-4 as well.


• Parents, caregivers and pool owners should learn CPR.


• Do not use air-filled swimming aids (such as inflatable arm bands) in place of life jackets.


• Counsel teenagers about the increased risk of drowning when alcohol is involved.

Check out the American Academy of Pediatrics (AAP) updated guidelines on water safety and drowning prevention: http://www.aap.org/advocacy/releases/may2410studies.htm#drowning

Learn basic facts about recreational water illnesses.
The number of recreational water-associated outbreaks is increasing with a total of 78 outbreaks affecting 4,412 people reported for 2005-2006. The CDC recommends the following steps to prevent outbreaks:

• Never let your child swim when they’re not feeling well.


• Don’t let them swallow pool water.


• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers.


• Take your kids on bathroom breaks or check diapers often.

Public and pool users can test water at their local pool or hot tub. Free test strip kits can be ordered at: http://healthypools.org/freeteststrips/

You can check the quality of water at local lakes and beaches at the following sites:
http://www.wibeaches.us/apex/f?p=BEACH:HOME:620813377447211 and http://dnr.wi.gov/lakes/

Stay cool!

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Taking Time to Enjoy Summer

I remember that when I was a kid, summer seemed to last forever. I couldn't wait for the school year to end because I knew that those endless days were just around the corner. Those last few weeks of the school year were agony - the weather had already turned and we would sit in our desks perspiring (schools didn't have air conditioning in the stone age) and pretending that we were dutifully attending to our studies, but really we were dreaming of the summer's promise.

I recall afternoons spent shooting hoops on the Bauer's driveway or playing baseball with all the other neighborhood kids in the empty lot across the street - the ball diamond was a well worn path in the weedy grass. Sometimes we would cross the train tracks to go across the big highway (two lanes really, but to us it seemed tantamount to crossing a national border) to buy a few pieces of candy, some Zots, Pop Rocks, Root Beer Barrels, with the change we had managed to hoard from Dad's pockets. Aside from Little League and swimming lessons, my three brothers and I didn't really get a lot done over the summer. Or at least it seemed that way. I did manage to catch you-know-what from my Mom once when I went fishing all day and forgot about my piano lesson. But as I look back upon my childhood summers I do realize that they were a valuable component of my upbringing. I now appreciate that I was given the opportunity of free time, time that I could spend exploring, playing, engaging in what I found value in, even as a kid. I learned a lot about myself. And I learned a lot about how to occupy my free time without being told what to do.

I worry that we are depriving our children this same opportunity when we overschedule them. I hear ads on the radio offering academic day camps - so kids won't forget all the precious knowledge that has been pumped into them over the school year. (Not to disparage, but when's the last time you used the quadratic equation?) I think it's important to maintain a sense of balance in our childrens' summer schedules. They really do need some unscheduled time over the summer. Sometimes a kid just needs to be a kid.

So as summer approaches, I ask you to keep in mind, and think back to your own childhoods, what you remember most fondly about your summers growing up. And to give your kids some free time.

Dr. George Idarraga
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Get in Shape this Summer

Looking to run a road race this fall? Preparing your son or daughter to join the cross-country team? Just want to shed a few of those hibernation pounds? Nothing like a good jog on the Lakeshore Path or a run through the Arboretum to get yourself ready for the upcoming year! Experienced runner or novice jogger can “shape up” in a matter of 6-8 weeks by following a couple of simple rules.

• Train a minimum of four days a week. If you’ve never run before, start by using a combination of walking/jogging for a couple of miles every other day. If you’re an experienced runner start at a daily mileage you feel comfortable with.

• Increase your distance by about 10% a week. (i.e., if you just ran 25 miles, move up to 28, then 31, etc.) For variety, add in a short temp run by increasing your pace to the point where it just becomes difficult to converse. Once a week, try to go “long and slow.” A good mid-preseason schedule might have two easy runs, one tempo run, one long run and one medium distance run.

• Vary the scenery and the terrain. Madison has so many wonderful places to enjoy. And don’t forget to keep yourself well-hydrated!

• Go for a family run! Baby joggers (for children up to four) and bicycles can be a great way to get everyone involved in the outing!

Dr. Ron Grant
Pediatric Hospitalist
Meriter Hospital
meriterkids.com

Planting a garden with your child

Spring has sprung, and summer is on its way. This is a great time to plant something with your child. Flowers are fun, but vegetables can help a child learn that food doesn’t just come from the refrigerator. Even veggie-avoiding kids will sometimes try things that they grew themselves.

Many of the most delicious crops require full sun, but they don’t require a garden plot. Some can be grown in a pot! Every summer I grow five big tomato plants out in my main vegetable garden, but I also grow a cherry tomato in a half barrel that’s on our deck. I plant flowers all around the tomato and use a more decorative support structure since it’s visible right out the window. Last year my main task was trying to teach my two-year old that the tomatoes taste best if you wait until they are orange. (I planted Sun Gold, a very tasty variety that I highly recommend!)

Pole beans are green beans that grow on tall vines and taste delicious. If you have a sunny piece of ground, you can put up one 6 to 8 foot pole and bring strings down from a nail at the top to tent pegs in the ground in a circle that is 4 to 6 feet in diameter. Have the strings about a foot apart on the ground, and leave one area with at least two feet in-between strings for an opening. Then plant 4 beans at the base of each string. As the summer progresses, the vines will create a playhouse of leaves—a shady place with first flowers and then beans. If you have multiple poles available you can make a teepee of poles, tied together at the top. Then you could plant 6-8 seeds for each pole since they are further apart, as in this picture. Alternatively if there’s a window of your house with a southern or western exposure, you could set up strings in front of the window. By the hottest part of the summer, the beans will provide a nice leafy sun block.

Have fun with planting and add your suggestions as comments on our Meriter Facebook page. What have you grown with your kids in the past?

Dr. Julia Mason

Pediatric Hospitalist

Meriter Hospital

meriterkids.com

Bug Off!

It’s so exciting that spring is finally here after our long Wisconsin winter! Continuing on the summer theme, I’d like to talk about protecting kids from those pesky mosquitoes. Ordinarily, the bites of mosquitoes are just a nuisance. The bite may cause itching or swelling (a lot more swelling in some people than in others — and, yes mosquitoes definitely prefer some of us more than others).

Here are some tips to avoid mosquito bites when outdoors:
- Don't use scented soaps, perfumes or hair sprays on your child.
- Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
- Avoid times when mosquitoes bite. Generally, the peak biting periods occur just before and after sunset and again just before dawn.
- Wear appropriate clothing. Long-sleeved tops and long pants made of tightly woven materials keep mosquitoes away from the skin. Be sure, too, that your clothing is light colored. Keep trouser legs tucked into boots or socks.

You will also need to use an insect repellant. DEET-containing products are the most effective mosquito repellents available. DEET has been used for over fifty years with a very good safety profile. Other products have not necessarily been as thoroughly studied as DEET, and may not be safer for use on children. The American Academy of Pediatrics Committee on Environmental Health feels that products containing DEET up to concentrations of up to 30% are safe for use in children 2 months and above. In choosing the strength of DEET to use, keep in mind that the more DEET a product contains, the longer the repellant can protect against mosquito bites.

Products containing citronella, lavender, mineral oil and soybean oil generally do not last very long. Herbal products containing lemon eucalyptus oil as a repellant are the only ones found to have effectiveness similar to DEET containing products. Those are only recommended in children above the age of 3 years old.

When using DEET containing repellants in children, keep in mind the following safety tips:
- Select the lowest concentration effective for the amount of time spent outdoors. It is generally agreed that DEET should not be applied more than once a day.
- Apply the product to your own hands and then rub them on your child. Avoid children's eyes and mouth.
- Do not apply repellent to children's hands. (which often end up in their mouth)
- To make sure your child’s skin will not react to the repellent, apply the product to a small area of skin, arm or leg before general use.
- Use just enough repellent to cover exposed skin and/or clothing. Do not use under clothing.
- After returning indoors, wash treated skin with soap and water. Wash treated clothing before wearing again.
- Do not apply over cuts, wounds or irritated skin.
- Do not spray DEET-containing products in enclosed areas. DEET products will NOT repel stinging insects such as wasps and bees.

Questions or comments? Please post them on our Meriter Facebook Page.

Enjoy your time outdoors,

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Keeping Summer Fun

Whoever thought that age four would be the time to start worrying about extracurricular activities? The arrival of the YMCA and MSCR summer guides began my internal debate.

Perusing through the pages of both guides peaked my interest in many activities. I haven’t played tennis is over five years, and the adult tennis class sounds like fun. If only I was ten again, I could go to summer camp. . . Okay, back to my four-year-old. Up until this year, he was too young for many activities. Promoting a healthy lifestyle (including physical activity) at this age is very important for life-long health, but do I sign him up for karate or swimming or gymnastics or yoga or outdoor soccer or a soccer camp or a multi-sport camp or . . . The list goes on and on, and it will only get longer as he gets older.

As with all families, our time is limited, and I want to make the most of the time we are together. I also look forward to having trips to the library, zoo, park and many of the other amenities offered by living in Madison. We also want to take short weekend trips to explore new places and if I fill the summer with scheduled activities, when will we go exploring? My son has taught me that spontaneity can be the most fun. Children benefit from structure in some activities, but also need time to explore the world on their own and create their own adventures. My husband and I thought it was a great idea to go see the St. Patrick’s Day parade. My son enjoyed the parade, but had just as much fun running around the Capital lawn playing hide-and-go-seek. I don’t want to limit these opportunities to create his own fun (and mine, for that fact) by scheduling away all our free time.

The American Academy of Pediatrics has a good article to help guide parents: http://www.healthychildren.org/English/healthy-living/fitness/Pages/Physical-Activity-Make-the-Right-Choice-for-Your-Child.aspx.

So, I continue to have the internal debate, but for the time being, my son is only scheduled in 1-2 activities per week. I am planning to keep all weekends free in the summer for exploring and discovering what fun we can have on our own. The most important thing is for us to figure out what works for our family, stay active and have fun.

Dr. Dana Johnson
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriter.com/pediatrics