Hand-washing 101

When kids and adults alike come into contact with germs, they can become infected just by touching their eyes, nose or mouth. Washing your hands is one of the best ways to stop germs from spreading.

Don’t underestimate the power of hand-washing, says Dr. Reshmi Basu, a CHOC pediatrician.

Dr. Reshmi Basu, a CHOC pediatrician

“Besides getting an influenza vaccine, washing your hands is one of the best ways to protect yourself against  the seasonal flu,” said Dr. Basu.

Improper handwashing can also lead to food contamination and foodborne illnesses. But when, how long, and with what should we wash our hands? Dr. Basu offers tips for parents:

Hand wash rules

  • Use warm water and soap for best hand hygiene.
  • Scrub vigorously, and remember the backs of hands, between the fingers, under the nails and the wrists.
  • Wash your hands for at least 20 seconds — or the time it takes to sing “Happy birthday” twice.
  • Rinse and dry with a clean towel.

When to wash your hands

It’s important to wash your hands frequently throughout the day. However, a few times it’s especially needed:

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

Hand-washing FAQs

What kind of hand soap is best?

Using a moisturizing hand soap is best during winter months, when more frequent handwashing is necessary, Dr. Basu says. To avoid further drying out the skin, choose a soap labeled “moisturizing” or “conditioning,” she adds.

Are hand sanitizers OK?

The Centers for Disease Control recommends washing hands with soap and whatever whenever possible because handwashing reduces the amounts of all types of germs and chemicals on hands.

But if you’re on the go, and soap and water aren’t available, use a hand sanitizer with at least 60% alcohol that will kill at least 99% of germs.

This article was updated Oct. 15, 2020.

Breastfeeding during COVID-19

We understand how stressful it can be to navigate life as a new parent. With the added anxiety brought on by COVID-19, we want to share trusted information to breastfeeding mothers who are COVID-19 positive or suspected positive, on whether their milk is still safe and beneficial for their baby.

COVID-19 is a new disease and researchers are still studying how the disease spreads. However, breast milk remains the best source of nutrition for most infants.

Current guidance from the Centers for Disease Control states that a mother who has been confirmed or suspected to have COVID-19 should take all precautions to avoid spreading the virus to her infant. These steps include:

  • Washing hands with soap and water for 20 seconds before touching the infant, pumping equipment or feeding supplies.
  • Wear a face mask when breastfeeding, pumping or handling the baby.
  • If using a breast pump, washing hands before touching the pump and following CDC recommendations for cleaning the pump after each use.
  • Follow current CDC guidelines for proper breastmilk handling and storage.
  • If bottle feeding pumped breast milk, have someone who is well feed the baby, if possible.

“Although there’s limited research available on whether COVID-19 is transmitted via breastmilk, studies on similar viruses did not find the virus in the milk,” said Dr. Reshmi Basu, a CHOC pediatrician. “A mother’s milk does contain specially made antibodies, produced by the mother’s body to protect her and her child from various viruses. These antibodies are transferred in breastmilk.”

Cindy Baker-Fox, registered nurse and certified lactation consultant at CHOC, explains how these antibodies make breastmilk a good source of nutrition for infants.

“Lifesaving antibodies in breastmilk protect babies from many illnesses and are one of the many unique properties found in human breast milk, making it not only a good source of nutrition but also valuable medicine for newborns and infants.”

If you have specific questions about breastfeeding and your baby, contact your pediatrician.

This article was updated August 5, 2020.

7 Tips to Help your Child Sleep Better

By Dr. Reshmi Basu, a CHOC Children’s pediatrician

All parents have been there― it’s late at night, you’ve had a long day, and you’re struggling to get your child to go to sleep. I’m also a mom, and I’ve had plenty of those nights in my household too. Here’s my best advice as a pediatrician on getting your child to go to sleep.

  1. Know how much sleep your child should be getting

Sleep requirements change with age, so it is important to know what is appropriate as your child grows. However, remember these are ranges and each child is different. Talk to your pediatrician about how much sleep your child needs.

These are ranges for hours of sleep in a 24-hour period, including naps.

  • 0-2 months: 9-18 hours
  • 2-12 months: 12-13 hours
  • 12 months-3 years: 11-13 hours
  • 3-5 years: 11.5-12 hours
  • 6-12 years: 9-10 hours
  • 12-18 years: 8.5-9.5 hours

Behavioral problems can often be associated with inadequate sleep. And sleep can even affect weight. One study showed that putting preschoolers to bed early is associated with lower risk for adolescent obesity.

  1. Stick with a routine

A consistent routine is important no matter the age of your child. If possible, keep the same routine on weekdays and weekends, with a similar bedtime and wake time—even if they don’thave to get up early for school the next day. This may become a challenge in the teen years where teenagers will try to catch up on sleep on weekends, that can actually cause other problems such as insomnia.

In younger kids, naps are essential.However, it’s best to avoid naps late in the day that can interfere with bedtime. And although short naps, like a quick snooze in the car, can restore alertness for a short time, it is the longer naps that have a more long-term restorative function. Do your best to schedule naptime in the early afternoon even on busy weekends.

  1. Reduce stimulation prior to bedtime

Try to encourage calming and relaxing activities prior to bedtime. Limit very active play just prior to bed. Do your best to limit screen use before bedtime. This includes limiting screens in the evening and keeping all media devices out of the bedroom, especially after lights out. Never use electronics as a sleep aid.

  1. Be careful of sleep associations

As infants get older, avoid activities such as nursing or rocking to sleep because they may require the same during nighttime awakenings instead of being able to soothe themselves back to sleep. Studies have found that gradually delaying infant’s bedtime or parents’ response to infant’s crying improves sleep and is not associated with increased stress or emotional problems. School-aged children who require a parent to be present at sleep onset are more likely to wake up during the night. Some sleep associations, however, can be helpful and do not require parental intervention, such as a favorite teddy bear or blanket.

  1. Watch out for sleep disorders

Sleep disorders in children and adolescents include obstructive sleep apnea, sleepwalking, sleep talking, night terrors and insomnia. These may lead to excessive daytime sleepiness, irritability and even learning difficulties in school. If your school-aged child is napping, dozing off on short car rides or while watching TV, then tell her doctor. Loud snoring or restless sleep can also be a problem and should be discussed with your child’s doctor.

  1. Create an ideal sleep environment

Your child’s bedroom should be kept cool, dark and quiet. Consider blackout curtains to avoid direct light exposure in the bedroom during the night. A night light may help your school-aged child with nighttime fears. Remember crib safety for your infant and that it is not safe to continue swaddling after 4-6 months or earlier if the baby is trying to turn over. For teenagers, encourage them not to use their bed for activities other than sleeping (i.e. watching TV or using electronic devices).

  1. Remember good habits during the day

Healthy habits during the day will translate to healthy sleep at night. This includes adequate stimulation for infants and regular exercise for older children. Avoid skipping meals—especially breakfast―offer healthy snacks and avoid large meals just before bed.

Find a CHOC pediatrician near you

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Kids and throwing up: Should you worry?

Throwing up is no fun, for kids and parents alike. It can also be alarming. A CHOC  pediatrician explains what causes children to vomit and when to be concerned enough to call the doctor.

The most common cause of throwing up is a stomach virus, otherwise known as the stomach flu or acute gastroenteritis, according to Dr. Reshmi Basu. It is often accompanied by diarrhea. Vomiting could also be caused by reflux in babies, a toddler’s aversion to certain smells or foods, motion sickness, food allergies, food poisoning, urinary tract infection, appendicitis or other less common conditions.

“It’s also really common for a child to cough so hard that they throw up,” Dr. Basu says. “This can be scary, but should go away once the underlying cause of the cough is resolved.”

Treatment for vomiting varies depending on the cause. In some cases, anti-nausea medication may be prescribed to give your child some relief. A stomach virus should clear up on its own after a few days. When vomiting is caused by reflux, food allergies or motion sickness, the underlying issue can be treated.

A child who vomits one time and has no other symptoms should be fine, Dr. Basu says. They may just have an upset stomach or strong gag reflex.

When to Call the Doctor

Call the doctor if your child:

· Is throwing up for more than two days but has no other symptoms

· Has severe abdominal pain with vomiting

· Has severe headaches with vomiting

· Has a high-grade fever with vomiting

· Has unexplained weight loss with vomiting, or

· Has any signs of dehydration (see below)

“Also, if your child or teen is throwing up periodically over a prolonged period of time, without any obvious reason, I would want to investigate that,” Dr. Basu says.

Watch Out for Dehydration

Kids who have thrown up multiple times are at risk for dehydration, and that risk goes up the younger they are or if they also have diarrhea. Signs of dehydration include extreme fatigue, tired-looking sunken eyes, going several hours without urinating, dark urine, dry lips, dry mouth, dizziness, and, in babies, crying without tears or a sunken soft spot. Your child should see a doctor immediately if they have any of these symptoms.

To prevent dehydration, encourage your child to drink lots of fluids. Pedialyte is best, but if they refuse that then offer what they will take such as water or diluted juice, although it is better to avoid milk. Your child’s stomach may only be able to handle small amounts at first. Dr. Basu recommends starting with 1 tablespoon of fluid; wait 10 minutes, then try 2 tablespoons, and gradually increase as tolerated.

Your child should see a doctor if they cannot tolerate any liquids.

Meet Dr. Reshmi Basu

CHOC Children’s wants its medical staff and patients to get to know its growing team of physicians, including primary and specialty care providers. Today, meet one of our pediatricians Dr. Reshmi Basu. Following medical school at University of California, San Diego, she completed her residency at CHOC. She’s been a member of the CHOC medical staff for eight years.

Dr. Reshmi Basu, a CHOC Children’s pediatrician

What are your clinical interests?

I am especially interested in asthma, sleep issues in children (infants through adolescents), and helping new mothers breastfeed.

Are you involved in any research?

I am a physician leader for the American Academy of Pediatrics, Chapter Quality Network U.S. Immunization Project. Practices here in Orange County and across the nation are participating in the project to improve vaccination rates for children two years and younger.

What are your most common diagnoses?

In our practice, we see a lot of patients with viral respiratory illnesses, ear infections, abdominal pain, asthma, allergies, eczema and headaches. We also spend much of our time on routine well checks for infants, teens and young adults. These appointments are important for keeping children current on vaccinations, and making sure they are growing and developing normally. We work hard to address parents’ concerns during these visits, as well.

What inspires you most about the care being delivered at CHOC?

I am proud to be a CHOC Children’s provider because CHOC undoubtedly provides the highest quality of care for patients and families. One of my patients was being treated for cancer during the holidays. Not only did CHOC make sure she received the most advanced medical care, the hospital’s child life team did everything they could to bring the holidays to her. Her room was filled with inspirational banners, Christmas lights and even beautiful new bedding on her hospital bed.

When did you decide to become a pediatrician?

I decided to become a pediatrician after my pediatrics rotation in medical school. I had always liked working with children, and was already drawn to pediatrics after volunteering at CHOC Children’s at Mission Hospital. (I grew up in Mission Viejo.)  As a volunteer, I enjoyed spending time at the hospital, whether it was holding the babies or coloring with children. After my pediatrics rotation, though, I realized that children need advocates to fight for them, and that is something I wanted to do. My goal is to help all my patients grow and thrive to become healthy, successful adults.

If you weren’t a physician, what you be and why?

I pursued medicine and eventually pediatrics because of my interest in science and my love for children. If I wasn’t a pediatrician, then I think being a teacher would be another way for me to help children.

What are your hobbies and interests outside of medicine?

I enjoy spending time with my husband and children. I have a 5-year-old daughter and 3-year-old son who keep me very busy. We like being outdoors, whether it’s playing at the park or riding our bikes. We travel as often as we can. I also like to read, when I can find any free time.

What’s the funniest thing a patient said to you?

Several of my pre-school aged patients have told me I look like Doc McStuffins. This helps me to connect with them and put them more at ease during their visits. I dressed up as Doc McStuffins for Halloween a few years ago, and my younger patients were star struck!

Looking for a pediatrician? Find one near you.

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