Lice Removal Tips in Time for Back to School Season

By Katie Bui, clinical pharmacist at CHOC Children’s

Head lice can be a pest. But don’t panic! There are many effective ways to prevent your child from getting these critters, and treat them should your child come home with lice. There’s even ways to get rid of the “super lice” that have received media attention recently for being resistant to some existing treatments.

Prevention is the First Defense

First things first- prevention is key. Be vigilant in monitoring your child’s head for lice before the infestation and symptoms start, usually when there are reported incidences at your child’s school or daycare. Teach them not to share hair ties, combs, hats, scarfs, and pillows at school or during sleepovers. Surprisingly, even taking selfies might increase the risk of getting head lice, since an affected child’s hair could touch another child’s healthy hair—the new way that older children and teenagers are being affected.

Lice Removal Tips

When treating head lice, both the eggs (also known as nits) and adult lice must be killed. To kill eggs, use nit combs and brush your child’s head from the hair shaft (the part that sticks out from the skin) for at least three days in a row. Then to kill the adult lice, there are medicines and other measures. Lice medicine can be purchased over-the-counter at your local pharmacy.

Pediculicides (medicines that kill lice) have active ingredients such as pyrethins and permethrin lotion/shampoo. If over-the-counter medicines fail, parents should seek advice from a doctor. In some cases, prescription medicines may help, including benzyl alcohol, Ivermectin lotion and malathion lotion. These medicines are safe and effective when used as directed by the label and by your doctor or pharmacist.

Non-medicine measures include washing and drying clothes, bed sheets, pillow cases and other linens in hot water to kill lice and eggs. Items that cannot be washed should be sealed in a plastic bag for two weeks or be dry-cleaned. Vacuuming furniture and floors can also remove nits.

September is National Head Lice Prevention month so be sure to share these tips- but not lice- with friends and family.

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CHOC Experts to Share Parenting, Safety Tips at Festival of Children

Parents and families can join the team of community education experts from CHOC Children’s at Festival of Children, to be held every weekend in September at South Coast Plaza, Costa Mesa. CHOC will host an informational booth offering health tips for families and an opportunity to meet CHOC’s beloved pet therapy dogs. Every Friday in September at 11 a.m. on the Carousel Court Stage, free Mommy & Me Classes will be offered, including coffee and tea. Hear first-hand from CHOC experts on the following topics:

Sept. 2 – Child Passenger Safety

Sept. 9 – Water Safety

Sept. 16 – Home Safety  

Sept. 23 – When to Take Your Child to the ER, offered by a registered nurse and manager of the trauma program

Festival of Children highlights all children charities serving our community for National Child Awareness Month in September. The event at South Coast Plaza will also feature other activities and crafts for children. Learn more about the Festival of Children event.

Learn more about upcoming events at CHOC.

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Oncology Patient Returns to CHOC as Oncology Nurse

In honor of Childhood Cancer Awareness Month, we share a poem written by Kim, a registered nurse in the hematology/oncology unit at CHOC Children’s, at the time she finished her training. Kim is a cancer survivor and former CHOC patient.

Serendipity

I had no idea what this was going to bring up

All these memories and feelings I have folded so neatly in a cup

Tucked away never again to be touched

Walking back into CHOC, oh how I have forgotten so much

You see, I once had cancer too

I came back as a nurse to see what I could do

I once told my own nurses, now peers, I will be back. Something I am sure they heard before

10 years later I walk through CHOC’s door

As a registered nurse I am proud to be

But I never underestimate the patient that is still inside of me

People have told me it takes certain strength to face it again

“Doesn’t it remind you of all your pain?”

My pain?, I think, I am one of the lucky ones.

I get to come to work and I have fun

I am allowed to make funny faces

I make kids laugh and participate in car chases

I am able to share in life’s precious moments daily

Except for the need of possibly doing a Foley

Even when I am running around like a chicken with no head

I will always take time for that scared kiddo sitting in the bed

There are times when I step back and remember

When that was once me waiting for a cure

This hasn’t been easy, seeing the chemo’s and procedures

And sitting through those late effects lectures

Sometimes when the day has been hard I ask myself, “Why did I pick THIS? What else could I have been?”

But I quickly remind myself I didn’t pick this- it picked me way back when.

I am surrounded by hope, a side people do not see

For I am a proud survivor and now registered nurse of pediatric oncology.

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Home Safety Tips for the Whole Family

Kids have more freedom as they get older, which teaches them independence and nurtures their curiosity, but they can often overestimate what they’re capable of doing. Most injuries for kids up to five years old occur in or around the home, so keep in mind these home safety tips for older children, to protect kids of all ages in your home.

“Older children tend to take more risks, so we as parents must walk a fine line between bubble-wrapping our kids and protecting them,” says Amy Frias, community educator at CHOC Children’s and Safe Kids Orange County coordinator.

  • Batteries. Keep batteries and battery-operated devices out of sight and out of reach. If your child ingests a battery, seek emergency medical attention or call the National Battery Ingestion Hotline, 202-625-3333.
  • Burns. Getting kids involved in cooking your family’s meals can be a great way to encourage healthy eating habits later in life, but should be done under careful supervision. Don’t hold a small child when using the stove, and always keep sharp and hot objects out of reach.
  • Carbon monoxide. In addition to a working smoke alarm, ensure your home has a carbon monoxide detector and check its batteries regularly.
  • Choking. Even when kids are old enough to start learning how to use utensils themselves, make sure food is cut into bite-size pieces. When purchasing a toy or game, take into account the size of its pieces. Keep small items such as magnets, makeup or batteries out of reach, as they could be confused for a toy or candy. Cords and strings from window blinds should also be kept out of reach to prevent choking. Move furniture away from windows to prevent choking on cords, or falls.
  • Falls. Install window locks that prevent openings greater than four inches, yet could still be easily removed by an adult in the event of an emergency. Children under 10 years old should not be on a top bunk of a bunk bed. Use liners underneath rugs and in the bathtub to prevent falls. Secure-top heavy furniture to the wall.
  • Fire. Make a fire escape plan. Establish a place to meet in the event of a fire in your home, and remind children that getting out safely should be their first priority.
  • Medicine. Remind children that medicine is not candy. Medication should be stored out of reach and out of sight, and in a locked location. Keep in mind that medicine is usually stored in more places than just a medicine cabinet, and can usually also be found in a purse, nightstand, etc.

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Contact Lenses: Is Your Child Ready?

You might think your child’s glasses are adorable, but she could very well disagree. Is your child ready for contact lenses though? In honor of Children’s Eye Health and Safety Month, we chatted with Dr. Sidney Weiss, a CHOC Children’s ophthalmologist, about how parents can find out.

 With the advent of low-maintenance contact lenses that are replaced daily, children as young as 8 might be able to wear lenses, Dr. Weiss says. Children ages 12 and older are better equipped to wear and maintain contact lenses designed to last for two weeks or a month, though he still recommends one-day lenses for children this age.

contact lenses
Dr. Sidney Weiss

But age isn’t the first criteria for knowing a child is ready for contacts. Most importantly, the child needs to show enthusiasm for wearing them, Dr. Weiss says.  Along with that, children must understand that contact lenses require responsibility and rigorous hygiene.

“Children must have the cognitive ability to understand that wearing contact lenses imposes a serious responsibility to protect the health of the eye,” Dr. Weiss says.

Hygiene is Key

Parents must be able to judge a child’s ability to maintain good personal hygiene, which is key to ensuring safe contact use. Users must be vigilant about washing hands before inserting, removing or simply adjusting contact lenses.

Poor hygiene and improper lens handling pose several risks to users, Dr. Weiss says.

“Corneal infections are the prominent threat to children wearing contact lenses,” he says. “Even with proper hygiene and technique, infections can and do occur. Far less common are fungal and even more exotic sources of infections.”

A scratch on the cornea can result during insertion or removal; if a foreign object gets between the lens and the cornea; or if a child too vigorously rubs his or her eye, Dr. Weiss says.

“The most common signs of trouble are the presence of a red eye or the observation of a white spot on the affected cornea,” he says. “Symptoms of pain, light sensitivity, and decreased vision are common. These should alert the child and family to seek professional help.”

Proper Materials

In addition to frequent hand washing, contact lens wearers must use proper materials to clean and store the lenses. Never use water or saliva to clean a lens. If the child uses eye drops, only use clear drops rather than any product that appears milky. Swimming in contact lenses is discouraged, but if undertaken, lenses should be removed and thrown out afterward. Don’t share lenses with others and don’t sleep in lenses.

In addition to good hygiene, children must have basic small motor skills to wear contacts. Though Dr. Weiss says parents can assist children in inserting the lenses, the child must be able to remove them in case of an emergency.

Parents should supervise insertion and removal for at least several months after a child begins to wear contacts. Following hand washing, a basic insertion technique requires the child to look up, pull the lower eye lid down and forward, and place the lens onto the eye with the other hand. Removal also begins with hand washing, and essentially requires a pinching motion to pluck the lens from the eye.

Astigmatism’s Effect

Even with enthusiasm and good hygiene and motor skills, some children may still not be ready for contacts, especially if they have astigmatism. Astigmatism is a defect in the curve of the eye that creates a football-like shape and can be harder to fit for contacts.

“The common spherical contact lenses available do not correct astigmatism,” Dr. Weiss says. “This circumstance may lead to disappointing vision in these children as opposed to their vision when wearing glasses, and consequent failure. Astigmatism-correcting contact lenses are more expensive and hard to fit well, and are best fit on older children and adults.”

Astigmatism or not, proper fit is crucial for contacts. That’s why all appointments with ophthalmologists or optometrists must be kept and repeated on a timely basis, and children should not procure lenses from non-professionals, Dr. Weiss says.

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CHOC Children’s Expands Plastic Surgery Services

A pediatric plastic surgeon specializing in reconstructive plastic surgery has joined CHOC Children’s. Dr. Raj Vyas sees patients with a variety of complex conditions including clefts and craniofacial anomalies.

plastic surgery
Dr. Raj Vyas

“Care at CHOC is delivered in such a multidisciplinary fashion, allowing for complex higher-level discussions and nuanced treatment planning in both standard and exceptional circumstances. There is also an emphasis on safety and process improvement, both critical for a state-of-the-art facility serving a complex and diverse patient population,”Dr. Vyas says.

During his third year of medical school at UCLA David Geffen School of Medicine, the  Southern California native discovered that plastic surgery was his newfound passion.

“I unexpectedly fell in love with plastic surgery, particularly craniofacial surgery,” Dr. Vyas explains.  “My appreciation for the depth and breath of plastic surgery grew from my experiences during this rotation in medical school. I remember seeing a child with hypertelorism undergo a facial bipartition and I was fascinated.”

Following medical school, he completed a plastic surgery residency in Boston at the Harvard Combined Plastic Surgery Residency Program. He then completed a craniofacial surgery fellowship at New York University Medical Center, where he treated children and adults undergoing facial reconstruction for congenital anomalies or after suffering trauma and cancer. He also gained expertise in microvascular surgery and virtual surgical planning.

Dr. Vyas is working with the team at CHOC to build a multidisciplinary program in facial reanimation. By combining craniofacial surgery with microsurgery, he hopes to restore facial form and function in children and teens with facial paralysis.

“We have a great team at CHOC. Dr. Daniel Jaffurs has been an incredible mentor,” Dr. Vyas says. “My goal is to help make the program the best in Southern California and beyond.”

Dr. Vyas enjoys working with virtual scanning and 3D modeling technology available at CHOC, as it helps him plan and ensure optimal safety and precision before a procedure.

“Today, we are able to use cone beam CTs to significantly minimize radiation exposure while still obtaining high quality 3D imaging. This allows for virtual surgical planning that is both precise and extremely effective in reducing uncertainty in the OR,” Dr. Vyas explains. “In neonates with upper airway obstruction, for instance, who are scheduled to undergo mandibular distraction, we are able to customize bony osteotomies in a way that prevents injury to dental structures and nerves, while optimizing distraction vectors that improve the airway and maintain cosmetic considerations. We can also virtually anticipate the extent of facial movements and design custom splints that facilitate orthognathic (upper and lower jaw) surgery. The benefit of these types of pre-planned procedures are expanding as surgeons utilize this technology in a variety of craniofacial reconstructions.”

When this dedicated physician is not busy helping patients at the hospital, he volunteers with Global Smile Foundation, a nonprofit organization that treats children with facial congenital deformities in underserved countries. Most recently he went to Trujillo, Peru, where he helped over 100 patients.

“It’s so rewarding to work with children,” he says. “Their reconstructions have a long-life impact.”

Dr.Vyas is board certified in plastic surgery and a member of the American Society of Plastic Surgeons, American Society of Craniofacial Surgery, American Cleft Palate-Craniofacial Association and International Cleft Lip and Palate Foundation, among other professional organizations.

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Is Your Teen Sweating Too Much?

Sweating is a natural part of puberty, a time when sweat glands become more active and the body produces more hormones. It’s also how the body cools off in response to heat, exercise or emotional distress. Given the fact that sweating is something everyone experiences, perhaps even more so during adolescence, how would you know if your teen is having problems with it?

Teens experiencing excessive and/or unpredictable sweating may suffer from a condition called hyperhidrosis. While fairly common, the condition can be embarrassing and impact everyday activities, from holding a pen to turning a doorknob. Emotional problems, including social isolation and decreased confidence, can occur. And some teens may face painful and irritating skin problems as a result of excess sweat. These symptoms warrant a trip to the pediatrician, who can provide more information and treatment options.

The cause of hyperhidrosis is not known, although some experts believe it may be tied to overactive sweat glands or genetics. Diagnosing the condition involves a physical exam, including a starch iodine test. Iodine is applied to the sweaty areas (armpits, hands or feet), followed by the application of starch. The combination turns blue in response to excess sweat. A paper test may also be performed. Special paper is placed on the affected area(s) and subsequently weighed to calculate the rate of sweat production. Blood tests may be done to rule out underlying medical conditions, based on the symptoms.

There are various treatment options for hyperhidrosis:

  • Prescription strength antiperspirant creams are often the first line of treatment because they are the least invasive. When applied to the affected areas, the antiperspirant is dissolved by sweat and pulled into the pores, forming “plugs” that can stay in place for at least 24 hours.
  • Iontopheresis is a treatment that involves using a medical device to pass a mild electrical current through water (shallow pans large enough for hands or feet) and through the skin’s surface. There’s been no significant or serious side effects reported, but patients must adhere to a maintenance schedule.
  • Botox has been approved by the FDA for use in treating underarm sweating. The botox is injected into the armpit, just below the surface of the skin, to temporarily block the secretion of the chemical responsible for activating the sweat glands.
  • When no other treatments work, surgery to cut the nerve that signals excess sweating or remove the sweat glands may be considered.

In addition to treating the physical symptoms associated with hyperhidrosis, it’s important to address the emotional impact the condition may have on your teen. Be sure to ask your child’s medical doctor about available mental health resources in your community, including possible support groups.

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Children and Tics: What Parents Should Know

People of all ages can experience repeated involuntary movements called tics, but they are most prevalent in children. Nearly one quarter of all children experience this genetic disorder that becomes most visible in school-aged children.

Common motor and vocal tics include:

  • Blinking
  • Shoulder shrugs
  • Neck twitches
  • Throat clearing or sniffling
  • Coprolalia, involuntary and repetitively utters obscene words

All tics tend to wax and wane in severity and frequency. The tics themselves can also change over time, says Dr. Mary Zupanc, chair of neurology and the director of CHOC Children’s pediatric comprehensive epilepsy program. This means that a child with simple childhood tic disorder can have repetitive eye blinking during one point in time, and during another phase, can have irregular but repetitive shoulder shrugging, and later, intermittent head twitching.

children tics
Dr. Mary Zupanc

Childhood tic disorders are very common in young children. It is a “spectrum disorder,”  with some children having only intermittent, isolated tics, and having multiple motor and vocal tics. If these tics last greater than one year, the diagnosis is Tourette’s syndrome, which is simply a more severe form of childhood tic disorder.

Preserving Self Esteem

“Tics alone will not hurt a child, but we certainly want to preserve a child’s self-esteem, and not allow them to be embarrassed by their tics. Vocals tics can be especially problematic in the school setting,” says Dr. Zupanc. “Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. Family and child counseling are often important, so that the child maintains his or her self-confidence.”

Treatment Options

Medication may be recommended in some severe cases. Pediatric psychologists who have training in behavioral modification can help children learn to suppress a specific tic.

Tics often disappear around the time of adolescence in many cases of childhood tic disorders and Tourette’s syndrome, although there may be concurrent co-occurring health challenges that are more problematic, Dr. Zupanc says. Learning disabilities, attention deficit hyperactivity disorder, obsessive compulsive disorder, and oppositional defiant disorder frequently appear in tandem with either childhood tic disorder or Tourette’s syndrome.  These co-morbidities may require medications for effective treatment.

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Tips for Minimizing Scarring After Surgery

A child’s skin is much different than an adult’s skin, and has the potential to react to scarring much different than the way their parents’ might. In this episode of CHOC Radio, Dr. David Gibbs, a pediatric surgeon and the director of trauma services at CHOC, discusses tips for minimizing scarring after surgery, including:

  • Which children are more predisposed to scarring
  • What pediatric surgeons at CHOC do during surgery to help minimize scarring
  • What parents can do in the year after surgery to help mitigate scarring
  • Other advice for parents whose child is preparing for surgery

CHOC Radio theme music by Pat Jacobs.

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Know the Risks of Sunken Chest

Pectus excavatum, or sunken chest, is the most common congenital chest wall abnormality in children. Although some may think of the abnormality as purely a cosmetic problem, the limited chest cavity space can displace the heart as well as limit lung capacity, says Dr. Mustafa Kabeer, a pediatric surgeon at CHOC Children’s. Fifteen percent of patients can experience arrhythmia (an abnormal heart rhythm) or mitral valve regurgitation, wherein the heart valves allow blood to leak back into the heart, as a result of the inward compression from the sternum.

sunken chest
Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s

Surgery to expand the chest wall can eliminate many symptoms. The pediatric surgeons at CHOC perform a minimally invasive procedure that dramatically reduces the appearance of incisions and the time spent in the operating room. A small incision is made on either side of the chest, and a small camera is inserted for observation as the surgeon passes a thin, curved metal bar through the chest cavity below the sternum. When the bar is flipped, the sunken chest is instantaneously repaired. The bar remains in place for two years, and is periodically monitored by a pediatric surgeon. A historical approach to these surgeries involved a large incision across the chest, and up to six hours in the operating room as the chest wall was taken apart and then reconstructed.

The pectus excavatum team at CHOC is comprised of experts in pediatric pulmonology, cardiology and surgery. The multidisciplinary team performs various tests to examine heart and lung function, before and after surgery. By using the latest techniques in minimally invasive surgery, along with recent improvements in pain management, patients are able to return home and get back to their daily activities sooner than ever before.

Although the cause is unknown, 40 percent of patients report a family history of pectus excavatum, and 40 percent of cases occur in tandem with scoliosis, says Kabeer.

Parents may notice an indentation in their child’s chest wall either when they are first born, or closer to puberty, when changes in the chest wall can become more pronounced.

“When pectus excavatum presents itself closer to puberty, it may be difficult for parents to notice, since teens or pre-teens are more clothed than they were as babies, so their parents might not see the change in their chest wall right away,” says Kabeer.

Warning signs tend to be subtle, but if your child experiences frequent shortness of breath, difficulty breathing during exercise, chest pain or light- headedness, or otherwise is not able to keep up with their peers, consult your child’s primary care physician, who may refer you to a pediatric surgeon or pectus excavatum specialist.

Learn more about CHOC’s surgical services.

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