Friday, August 01, 2003
Pack well and don't medicate for convenience
By Darcy Lewis
You've undoubtedly spent hours planning where to go and what to see during the family vacation. But have you considered how to keep your children safe and healthy away from home?
Pack prepared First, think about the packing. This type of planning will help ensure a safe trip for all.
Dr. Richard Burnstine, a Northwestern Medical School pediatrician in private practice in Buffalo Grove, suggests that parents pack: • Sunscreen • Insect repellent with DEET (See Healthy Child, June 2003.) • Band-Aids • Acetaminophen • Antibiotic cream • Soap for washing cuts • Your pediatrician's phone number • A list of your child's regular medications, including dosage • Helmets and any other protective gear for any sports you intend to play during your trip. (See Healthy Child, May 2003.)
If you are flying, substitute round-tip scissors in any commercial first-aid kit because sharp-pointed scissors will most likely be confiscated.
Bone up on any health issues specific to your destination before you go. For example, Lyme disease is practically nonexistent in the Chicago area, but many common vacation spots, such as parts of Wisconsin, are hot spots for the tick-borne illness.
Of the 16,000 Lyme cases reported to the Centers for Disease Control and Prevention in 1999, 92 percent were from just nine states, most in the northeast. (For a national Lyme disease map, see www.cdc.gov/ncidod/dvbid/lyme/riskmap.htm.)
If you're traveling to an area at moderate- or high-risk for Lyme disease, familiarize yourself with, then follow, the suggestions from the CDC (www.cdc.gov): Dress children in light-colored long-sleeved shirts and pants (so any ticks will be visible), tuck pant legs into socks and apply a DEET-based insect repellent. Also, don't forget daily tick checks and prompt removal of ticks using fine-tipped tweezers. Watch for an unusual bulls-eye rash up to two weeks following a tick bite. Lyme disease is typically cured by a routine course of antibiotics and is rarely, if ever fatal, although joint pain can linger.
Antihistamine overload Imagine this scenario: During a multi-day car trip, two preschoolers get so agitated they scratch each other until they bleed. Their ensuing howls cause the panic-stricken family cat to plunge its claws into mom's legs, triggering tears from her, too. Dad is so distracted he barely averts a crash.
For some families, the antidote to overactivity on long trips is a dose of antihistamine in the hope of drugging the kids to sleep. But, in this case-a real example of a pediatrician dad (who wants to remain anonymous) who gave his otherwise healthy kids Benadryl to sedate them for the long trip-the drugs backfired.
"In some children, antihistamines will actually overstimulate them instead of sedating them," explains Dr. Charles Coté, a pediatrician and vice chair of anesthesiology at Children's Memorial Hospital in Chicago.
But there are dangers to unnecessary medication that go far beyond unpredictable behavior.
"Most sedating medications, including antihistamines, cause the throat tissues to relax involuntarily, which can affect children's abilities to keep their airways clear," Coté says. "And children's diaphragm and chest muscles don't mature until they turn 2, which also affects their ability to regulate their own breathing."
Coté says the children most at risk are those who must ride in car seats after being dosed. "A child might not be able to keep his own airway clear if he falls asleep with his head dangling forward," he says. "A normal child will arouse himself enough to change position if his airway is obstructed but a sedated child can't do that."
An article in the March 2003 issue of the Journal of Forensic Science details five infant deaths caused by Benadryl overdoses intended to make them sleep. This includes a notorious case in Florida in which a caregiver admitted lacing the baby's bottles with Benadryl. And Rosemont daycare workers were recently convicted of reckless conduct for giving Benadryl to toddlers to make them nap longer.
Some pediatricians reportedly endorse this "off-label" use of antihistamines, but others strongly urge parents never to use drugs for convenience.
"I see many babies on airplanes behaving perfectly well because they're being held, rocked and fed," says Northwestern's Burnstine.
Darcy Lewis lives in Riverside with her husband and two sons, ages 9 and 3. Find previous Healthy Child columns at www.chicagoparent.com.