Protecting against dry hands from frequent handwashing during COVID-19

Frequent and thorough handwashing remains a top method of protecting against COVID-19 and other viruses, but dry and cracked hands may be an unfortunate side effect in children and adults alike.

“Thorough handwashing is an absolute must during COVID-19, but it can lead to dry skin ,” says Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network. “There’s a lot we can do to help, while still ensuring proper handwashing is maintained.”

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Dr. Angela Dangvu, a CHOC pediatrician

Here, Dr. Dangvu offers tips to help protect tiny hands against dryness without compromising thorough hand washing that’s so critical during the pandemic.

Choose soap carefully

Start by choosing a moisturizing hand soap, Dr. Dangvu says. Pick soaps that look more like lotions than  a typical soap with words like “moisturizing” or “conditioning” on the packaging. Unless your child is already using these and is accustomed to them, try to skip antibacterial or deodorant soaps.

If they are available, use soap and water instead of hand sanitizer, Dr. Dangvu advises. The alcohol content in the hand sanitizer can sting hands that are already dry and cracked. If hand sanitizer is only available, be sure that it has at least 60 percent alcohol to ensure a thorough cleaning.

Timing is important

Parents should remind their children that when they are at home, they ought to be washing their hands at these times:

  • Before and after cooking or eating
  • After using the restroom
  • After cleaning around the house
  • After touching family pets
  • Before and after caring for a sick family member
  • After blowing their nose, coughing or sneezing
  • After changing a diaper
  • After being outside — playing, gardening, walking the dog, etc.

Beyond these instances, children do not need to continually wash their hands at home, Dr. Dangvu says.

“Children are such great learners and have been so incredibly adaptable during the pandemic, and many have really taken on to importance of handwashing,” she says. “Too frequent handwashing can worsen dry and cracked hands.”

Creams, not lotions

Applying moisturizer to a child’s hands after hand-washing or bath time can also help prevent dry hands. Select products described as creams rather than as lotions: The former are richer and have more staying power than thinner products like baby lotions, Dr. Dangvu says.

“They tend to stay on and be a better moisture barrier,” she says. “Parents should use them right after children wash their hands. If skin is still a little moist, the cream will trap that moisture. Apply it after bath time too.”

A three-step approach

If a child’s little hands still become dry, Dr. Dangvu recommends a three-step approach:

  1. Start by regularly applying cream to the hands.
  2. If dryness doesn’t improve after a few days, move on to a petroleum-based ointment. Parents can intensify the therapy by applying ointment to hands before bed, and asking children to wear cotton gloves or even socks over their hands to lock in moisture while they sleep.
  3. If the condition doesn’t change after a few more days, parents can try an over-the-counter hydrocortisone cream.

If these steps don’t yield improvement, it’s time to consult the child’s pediatrician to rule out a bacterial infection or other condition, Dr. Dangvu says.

Learn more about the CHOC Primary Care Network.

Why sports physicals are important – especially after a COVID-19 diagnosis

With league and school sports beginning to resume after a prolonged COVID-prompted off season, many young athletes are heading back to the field again.

Having a sports physical is an important step before getting back into the game – especially after a having COVID-19 symptoms or a diagnosis.

But what exactly is a sports physical and why are they needed? In this Q & A, Dr. Matthew Kornswiet, a sports medicine pediatrician in the CHOC Primary Care Network, answers these questions and more.

Coaches and parents should continue to follow safe return to sports guidelines from the Centers for Disease Control & Prevention and locally, the California Interscholastic Federation and California Department of Public Health.
Does having COVID-19 affect my child’s ability to play sports safely?

If your child had symptoms of or tested positive for COVID-19 at any point, it is important that they see their provider before returning to sports.

Research shows that sometimes after a COVID-19 infection, a patient has a small risk of developing myocarditis (inflammation of the heart) or multisystem inflammatory syndrome in children, also known as MIS-C, an inflammation of multiple areas of the body.

Even if your child had a sports physical recently, it is important that children have another physical exam after a COVID-19 infection before returning to sports.

In some cases, providers may recommend additional tests for your child’s heart or that they see a cardiologist, or heart doctor, for further evaluation. This is to ensure that children are safe to return to sports.

What is a sports physical and why are they important?

A sports physical helps determine whether it’s safe for a child to participate in a sports or athletics. They can also help uncover and treat health problems that might interfere with participation. The provider may also offer tips to help with training and injury prevention.

What should I expect at a sports physical?

A sports physical is divided into two halves: the medical history and the physical exam.

During the medical history portion, the provider will ask key questions about serious illnesses among family members; current or previous medical conditions, such as asthma, epilepsy or diabetes; past injuries; and more.

During the second half of the visit the provider will perform a physical exam. The physical exam will measure the athlete’s vital signs; check the athlete’s heart and lungs; evaluate strength and flexibility; vision; and more.

The provider will also ask questions about the athlete’s mental health, use of drugs, alcohol or dietary supplements, including steroids or other so-called “performance enhancers” and weight-loss supplements.

What happens after the physical?

When the exam is over, the provider will complete and sign a form indicating fitness to participate in the sport, if all is well. In some cases though, the provider may recommend a follow-up exam, additional tests, or specific treatment for medical problems.

Young athletes shouldn’t worry that additional follow-up care means being benched. A sports physical’s ultimate goal is to ensure athletes are safe while playing sports – not to stop them from playing.

Additional follow-up could be as simple as rechecking blood pressure in a few weeks. A referral to a specialist could ultimately help athletic performance, such as in the case of slight knee pain during running that an orthopedic or sports medicine specialist can demystify and treat.

If my child has a sports physical, do they still need a regular physical or well check?

It’s critical that patients of all ages undergo a regular physical every year, whether or not they also have a sports physical. Depending on when your child had their last physical, it can be done at the same visit as the sports physical.

While sports physicals focus on well-being as it relates to athletics, regular physicals are more comprehensive, addressing broader physical and mental health concerns, and helping to ensure patients are up-to-date on vaccinations.

Where can my child get a sports physical?

Families usually have many options for receiving sports physicals. Your child’s physician or a sports medicine physician can provide a sports physical exam.

Remember, your pediatrician knows your child’s medical history thoroughly, can make referrals if needed, and will play a critical role in any ongoing care plans – not to mention, is one of their biggest fans.

Is it OK to skip your child’s checkup if they’re healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why we recommend all well checkups for your child even if they’re healthy. During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

These checkups, also known as well child checks, are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions.

Under the current stay at home orders, it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are six reasons why it’s not OK to skip your child’s checkup, even if they’re feeling healthy.

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Dr. Katherine Williamson, a CHOC pediatrician

#1 Developmental screening

At every well checkup your pediatrician will be making sure that your child is meeting her or his developmental milestones, whether they are 4 months, 4 years, or 14 years old. For babies and toddlers, these milestones come rapidly as children’s brains are learning many new skills every day, from crawling to walking, and from first words to conversations. It is important to make sure your child is acquiring these necessary skills for brain development every step of the way. For older kids and teens, these milestones become less apparent, but are just as important, and are often reflected in a child’s ability to handle academics, relationship, and emotions. Your pediatrician is here to help at every stage of your child’s development.

#2 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When your child is a teenager, parents are often asked to leave the exam room so the pediatrician can speak to the teen in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life if their pediatrician has been a constant figure and steady resource since childhood.

#3 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

During well child checks amid the pandemic, mental health has been a bigger part of conversations during appointments than ever before. This is a chance for pediatricians to check on how the whole family is coping with stress related to COVID-19. They can share advice for how to talk to kids about COVID-19 and help them cope with COVID-19 anxiety as well as how to teach teens the importance of stay at home orders.

You can also talk to your pediatrician about how your child is coping with social distancing, or a lack of playdates and time with friends. They can offer advice on how to make this a positive time for your family.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

With children spending more time at home than ever, your pediatrician can be a resource on activity ideas for kids during COVID-19.

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask.

Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, academic concerns and anything in between.

#6 A fresh perspective on parenting

Pediatricians specialize in taking care of infants, children and teens – but they can be there for you as a parent, as well.

Right now, parents have been asked to take on more than ever – working from home, overseeing their child’s distance learning curriculum, keeping kids entertained and engaged around-the clock, and more – and they are understandably overwhelmed.

Having a fresh set of eyes on a family’s situation may help troubleshoot what they are trying to figure out. Many of my patients’ parents are struggling with a seemingly never-ending to-do list. Their child’s pediatrician is someone they trust and respect, and I validate that they are doing their best.

Parents should congratulate and forgive themselves. At the end of the day they may be hard on themselves and wish they had done more, and that feeling compounds by the end of the week or month. What parents are juggling right now is Herculean. I applaud each and every one of you.

This article was updated on May 18, 2020.

Meet Dr. Charles Golden

CHOC wants its patients and families to get to know its physicians. Today, meet Dr. Charles Golden, a board-certified pediatrician who serves as executve medical director of the CHOC Primary Care Network.

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Dr. Charles Golden, a board-certified pediatrician who serves as executive medical director of the CHOC Primary Care Network

Education and training

I earned a Bachelor of Science in Biology at University of California, Riverside. After completing my undergraduate studies, I attended Western University of Health Sciences College of Allied Health and earned a certificate as a physician assistant. I worked at Southern Orange County Pediatric Associates (SOCPA) as a physician assistant until I started medical school at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, in Pomona. I completed my internship and residency, including a year as chief resident, at Children’s Hospital Los Angeles.

Special clinical interests

I love all aspects of clinical medicine, but get energized when I have the opportunity to teach. I believe that every encounter with a patient is an opportunity to teach them something about the body and explain why we make the decisions that we do in medicine. I’m also passionate about teaching medical students and residents, as they continually challenge me to stay up to date with new research. I love the feeling I get from contributing to the development of their careers as physicians.

New programs and developments within CHOC’s Primary Care Network

In the near future, we plan to open an after-hours clinic for the entire community. By the end of this summer, we’re planning on implementing a single electronic health record (EHR) for all of our primary care offices so that all of our providers chart on patients in the same record, and a patient’s medical information can securely be available to whoever they see in our group. This will continue to improve communications within the practices.

We’re also growing our comprehensive adolescent medicine services. We will be hiring another adolescent medicine specialist to address this unique, complex patient population

We’re also working on the use of digital vision screening devices to look for problems with vision in children younger than 4 years old, who are often too young to read a visual acuity chart.

As a component of CHOC’s mental health initiative, we’re working closely with CHOC’s chief psychologist, Dr. Heather Huszti and her team to provide a mental health professional in each of our primary care offices to help the medical team screen for and address mental health issues.

What I want patients and families to know about CHOC’s Primary Care Network

For many people, bringing your child to seek medical care can be a stressful event. There are many sources of information out there regarding children’s health, and in some cases those sources may contribute to more confusion and anxiety. I would like patients and families to know that when they choose a CHOC pediatric provider, they can trust that the care being delivered is state of the art, up to date and based on clinical and scientific evidence, combined with years of expertise. They will be greeted by empathic staff who are skilled in making children feel comfortable, and providers who are not only skilled at diagnostics, but bring a warm and compassionate touch to the visit. Further, our pediatricians are partners with our specialists, and through this partnership they share knowledge, collaborate in patient care, and help to create a sense of calm for patients and their families.

What inspires me about the care being delivered at CHOC

Every day pediatricians, pediatric specialists, nursing staff, technicians and so many other professionals come to CHOC to make a difference in the lives of children in need. It’s a calling, and they’re passionate about it. You can feel it when you walk through the door, whether it’s from the smiles and greetings from the folks at the information desk, or when you see a security guard assist a family. Perhaps it’s when you see an associate go out of their way to offer hospitality to a random person in an elevator, or the cutting edge surgical and medical treatments that are happening every day. To try to answer what inspires me most about the care being delivered by CHOC would do a disservice to every little thing that occurs on our campus that makes CHOC a special place. I’m incredibly proud to be a part of it!

Why I decided to become a doctor

I fell in love with science as a teenager. Around the same time, my father had a heart attack. I remember going to the hospital and learning about his heart and how the medicine was working to provide care for him. I was fascinated by it all and never looked back.  If I wasn’t a doctor, I would probably be a general contractor. I’ve always enjoyed working with my hands.

Learn more about CHOC’s Primary Care Network

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