Category: Blog

Sunburn Art & Sunscreen

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Recently social media has been filled with trending “Sunburn Art” photos – people strategically applying sunscreen in extravagant patterns then getting intensely sunburned to display the masterpiece. Although it may be tempting to show off artistic talents for the Instagram likes and retweets, sunburns can have long term consequences on your skin health, including risk for skin cancer and premature aging. As you enjoy the outdoors this summer here are a few tips for sunscreen use:

What kind of sunscreen should I buy? Do I really need the SPF 100+? The best option is to find one that you are willing to wear regularly! The American Academy of Dermatology recommends that sunscreen should be broad spectrum with protection against both UVA and UVB. This should be at least SPF 30 and water resistant. Many dermatologists recommend a higher SPF, even SPF 100. This is due to recent research showing that many people do not apply sunscreen as thick as how the SPF number was established. Often, people use as little as 25-50%! Using a higher SPF may partially compensate for putting on too little. Using a moisturizer containing sunscreen on exposed skin can be nice for daily use when you know you won’t have extended time outside. Usually the SPF in makeup is an added bonus but is not applied thick enough to rely on.

What is the safest way to apply sunscreen? It is best to apply sunscreen 15-20 minutes before going outdoors. It takes this long to fully absorb. Make sure to apply it to all exposed skin, getting help for hard to reach places like the middle of the back. To get the true SPF value on the bottle, sunscreen amount should be based on the “teaspoon rule” – 1 teaspoon to the face/neck/scalp, 1 teaspoon for each arm, 1 teaspoon to the chest and abdomen, 1 teaspoon to the back, and 2 teaspoons for each leg. Please be sure to re-apply every two hours while outside because the sunscreen will lose effectiveness over time. The re-application rule is also important after swimming or heavy sweating. Many people who wore sunscreen at the beginning of long day outside get burned because of not reapplying. Keep up the good work!

But I hate the feel and smell of sunscreen. What are my alternatives? Physical blockage from the sun by clothing is an alternative to sunscreen. There are many marketplace options for UPF (ultraviolet protection factor) clothing with UVA and UVB protection based on weave and thickness of the fabric. This should be taken with caution because bleaching or stretching the fabric can decrease the effectiveness. A broad brim hat can be helpful but this has been documented to only show SPF protection less than 10 (and a baseball hat has a SPF 1.5 for the nose at best!). These are best used in combination with other forms of sun protection.

Do the sunscreen recommendations change for my kids? Sun protection for kids and teenagers is super important! It is well documented that sun exposure in childhood is a risk factor for developing skin cancer as an adult. Per the American Academy of Pediatrics, it is best to use other sun protective methods first (shade, sun protective clothing, hats) with broad spectrum sunscreen applied on skin that is still exposed. Sunscreens with UV blocking active ingredients titanium dioxide and zinc oxide are recommended for children under two years old.

If you are interested in having a skin cancer screening or would like to have a concerning lesion evaluated, our board-certified and experienced dermatologists at IHA Dermatology are always happy to help in any way that we can. Just call us at 734-667-DERM (3376) to schedule an appointment.

Sleep tips for children and teens

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Sleep has a number of key health benefits for children and is important for their growth and overall development. Sleep is important for muscle growth, tissue repair and growth hormone release. Sleep is also critical for learning and memory consolidation, making sleep important for children to perform their best in school. Sleep is necessary for maintaining the overall health of our immune system and our metabolism.

The amount of sleep a child needs really depends on the age of the child. Newborns typically require the most sleep, which can be up to 14-17 hours per day. As children get older, their sleep requirements decrease so that by adolescence their sleep needs are similar to adults.

The National Sleep Foundation recommends that toddlers get 12-15 hours of sleep and preschoolers 10-13 hours of sleep per day, including their daytime nap. The National Sleep Foundation recommends 9-11 hours of sleep per night for school-aged children, 8-10 hours of sleep for teenagers and 7-9 hours of sleep per night for adults between 18 and 64. Adults aged 65+ need 7-8 hours of sleep.

Unfortunately, we know that many children and adults do not get the recommended amount of sleep each night. A 2004 National Sleep Foundation poll found that children of all ages got less than the recommended amount of sleep. Our sleep deprivation gets worse as children get older, with teenagers usually being the most sleep deprived age group.

A 2006 National Sleep Foundation poll found that 45% of adolescents got less than 8 hours of sleep per night, with high school seniors averaging only 6.9 hours of sleep on school nights. Adults do not usually fare much better, with about 40% of adults getting less than 7 hours of sleep each night.

Insufficient sleep is associated with daytime consequences, in which children can be very different than in adults. Most adults will present with symptoms of sleepiness such as falling asleep at work, while reading or watching TV. Children, on the other hand, can present with increased energy (hyperactivity) or problems with focus/concentration. They can sometimes look very similar to children with ADHD. In fact, children are sometimes misdiagnosed with ADHD when in the symptoms are really due to poor sleep.

Children can also present with more behavior problems or poorer school performance. Daytime sleepiness is also seen in children. For example, children may have a harder time getting up in the morning and may even be late for school as a result. They can also be more likely to fall asleep in the car or on the bus ride to school. Or, they can even fall asleep in the classroom, which can affect their ability to learn.

The National Sleep Foundation estimates that about 25% of teens fall asleep in the classroom at least once per week. Some children who are chronically sleep deprived will try to catch up on their sleep at home either through an after school nap or “sleeping in” on the weekends. If your child takes regular naps, especially if they are 45 minutes or longer, or if they “sleep in” more than 2 hours on the weekends, then your child may not be getting enough sleep.

If you have any concerns about your child’s sleep patterns, particularly if your child snores, pauses in their breathing during sleep, gasps for air, has mouth breathing, has frequent night awakenings or restless/sweaty sleep it is important that you talk to your child’s doctor as these could all be signs of obstructive sleep apnea. Difficulty falling asleep or staying asleep could also be signs of other sleep problems that you should discuss with your child’s doctor.

Question about Base Tans

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Question: I’m getting married this summer and want to be tan in my wedding photos and on my honeymoon. Will visiting the tanning salon a few times decrease my chances of getting a sunburn if I get a base tan? Also, aren’t tanning salons safer than laying out in the sun?

Answer: You’d be surprised how often these questions are asked! The short answer is NO and NO! Any type of tan is a sign of skin damage. A tan is the skin’s response to UV damage to the skin’s DNA. The skin darkens to prevent more damage, but your risk of skin cancer is already increased. There is no such thing as a “safe” or “healthy” tan.

Tanning beds deliver concentrated levels of UVA and UVB radiation, both of which cause cell damage that can lead to skin cancer. UVA radiation also penetrates deeper into the skin and causes irreversible skin aging like loss of elasticity, wrinkles and brown spots.

If you want to look tan in your wedding photos, try a sunless tanning cream or lotion. You can still get the glow you want without any of the skin damage.

As far as your honeymoon, take plenty of sunscreen with you. Look for a sunscreen that is SPF 30 or higher, broad spectrum (blocking both UVA and UVB), and water-resistant. Be sure to apply sunscreen at least 15 minutes before going outdoors, and to reapply sunscreen at least every 2 hours or immediately after getting wet (for example, after getting out of a pool). Forgetting to reapply sunscreen throughout the day is the one step that most people forget during vacation and that leads to sunburns. Sunscreen only maintains its listed SPF for approximately 90 minutes, after which point the SPF starts to decrease and the sunscreen starts to lose its ability to block ultraviolet light. Shade and clothing can also help protect you from UV rays. Wear protective UV-blocking sunglasses, broad-brimmed hats and tightly-woven clothes and seek shade when possible. Getting into the habit of protecting yourself from UV rays is as simple as the steps above and will allow you to enjoy the outdoors without damaging your skin.

This article was originally published on May 18, 2015, and was updated on April 12, 2017.

Seasonal Allergies

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It’s that time of the year when runny noses, itchy eyes, and scratchy throats start. It is allergy season. For many people, when spring starts and trees and grass grow they start getting allergy symptoms. Allergies can happen all year, though.

Common environmental allergies can be due to dust mites, animals, pollen, grass and trees, just to name a few. Each of these allergies can happen more often in different times of the year. Grass and trees are often bothersome to people in spring, whereas pollens are in the late summer. Dust mite allergies can be found all year round.

When symptoms are bad, many people turn to medications for help. There are some things you can try prior to using medications. For example, for dust mite allergies you can try using dust mite covers on your pillow and bed. Staying in air conditioning may help symptoms when the pollen count is high. You can also flush out the allergens by using a netti pot or saline eye drops.

Medications that can be helpful include decongestants and antihistamines. Decongestants help relieve nasal congestion symptoms once they have started. Antihistamines block the histamine reaction and help prevent symptoms from happening. They often have to be taken several days to weeks prior to exposure to the allergens. Nasal steroids can also help decrease nasal congestion symptoms and work right at the source of the congestion. There are allergy eye drops that help with itchy, watery eyes too.

If you are having allergy symptoms that are not improving with over the counter medication, it is time to see your primary care doctor to discuss your symptoms. There may be another reason for your symptoms or other medication or treatments to consider. Allergy testing may also be needed to figure out what specifically you are allergic to so that you can avoid the allergen.

This article was originally published on March 20, 2015, and was updated on April 10, 2017.

Break Free from Pelvic Floor Disorders

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Did you know that 1 in 3 women suffer from or will develop a pelvic floor disorder during their lifetime?

Pelvic floor disorders are problems related to bladder, bowel and sexual function. They include different types of urine leakage (incontinence) or bladder control problems like going frequently, getting up at night to urinate, or getting strong, uncontrollable urges to urinate. Pelvic floor disorders also include problems related to the bowels such as accidental loss of gas or stool. Finally, a condition known as prolapse, which is a feeling that the pelvic organs (bladder, uterus, vagina or rectum) are bulging or falling out, is also a pelvic floor disorder.

The risk for pelvic floor disorders increases with age. While these conditions are often linked to having children, there are other reasons they can develop. There are also many conditions that make pelvic floor disorders worse that can be managed with relative ease. Many women suffer silently from these conditions. They assume that these conditions are a normal part of the aging process. They also assume that because their mother or sister had it, then they are destined to get it too.

Fortunately pelvic floor disorder are not life threatening. They primarily affect a woman’s quality of life. That means that they do not have to be treated right away. Depending on how bothersome the condition is, a watch and wait approach is often acceptable. However, a thorough evaluation is needed first to ensure it is safe to wait.

Once a pelvic floor disorder affects a woman’s quality of life, there are a number of treatment options available. Many of these options are conservative and non-invasive like lifestyle, behavior, or diet changes. Other treatments include medications, physical therapy and surgery in some cases. Each woman is different; therefore each woman’s treatment plan will be different.

Be open with your doctor about your symptoms and ask about treatment options. You can also ask about seeing a specialist and request a referral if needed. There are qualified specialists in your area that are willing to help you break free from pelvic floor disorders.

This article was originally published on October 20, 2014, and was updated on March 30, 2017.

Vaccinations for Expectant Parents

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Question: My wife and I are expecting our first child. My primary care physician suggested we get our vaccinations updated prior to the baby arriving and make sure our families are vaccinated as well. We were both vaccinated as kids. What type of immunizations should we be planning for?

Answer: Congratulations on your first baby! There are a few vaccinations that are important for your wife to get during pregnancy, because they will also protect your child before he can get his own vaccines. The vaccines are important for you and any close family members who will be frequently around the baby to get as well. Even if you were immunized as a child, you may be due for a booster because immunities can fade over time, or if a vaccination wasn’t available when you were young.

These are the vaccinations that the U.S. Centers for Disease Control and Prevention (CDC) recommend for both parents and other family members.

THE FLU VACCINE

The flu vaccine protects against three strains of influenza virus. The CDC recommends that everyone, every year, get a flu vaccine. It’s especially important for pregnant women to get because the immunity can be passed through to the fetus, helping protect the baby when it’s less than 6 months and too young to get the vaccine. It’s also important that anyone who lives with or cares for babies less than 6 months gets the vaccine.

THE CHICKEN POX VACCINE

Chicken pox tends to be a more serious illness in adults than in children. If a woman catches chicken pox while pregnant, she could get really sick. There’s also a small chance it could affect the fetus. The vaccine is the best way to prevent chicken pox. If you’re not immune (if you’ve never had it or been vaccinated), you should get the vaccine. Pregnant women who are unsure of their immunity should be tested and will be given the first dose right after giving birth.

THE TDAP VACCINE

The CDC recommends the Tdap (tetanus, diphtheria and pertussis) for all adults; women should get it during each pregnancy. Anyone with regular contact with babies under a year of age should get a Tdap shot as soon as possible (at least two weeks prior to contact is recommended). Pertussis can be life-threatening for babies, and they’re most likely to catch it from a family member. It’s highly contagious and causes severe coughing attacks that can last for months.

THE HEPATITIS A VACCINE

Hepatitis A is prevalent in many parts of the world. It causes jaundice, diarrhea and flu-like symptoms that can be severe. The CDC recommends anyone adopting or caring for a child from a country outside of the US, Western Europe, New Zealand, Australia, Canada or Japan should be vaccinated.

THE MMR VACCINE

The MMR vaccine protects against measles, mumps and rubella (German measles). Anyone born after 1956 that hasn’t gotten the vaccine, or hasn’t had a positive result on a blood test for rubella immunity should be vaccinated. If you’re pregnant, you’ll have to wait until after the baby is born to get the shot. Some adults, not all, are immune to German measles. However, if it is contracted during pregnancy, you could miscarry or give birth to a child with serious birth defects.

If you have questions about these vaccines, please contact your primary care physician. They should have your immunization records and will work with you and your wife on your specific needs and testing for immunities.

This article was originally published on September 22, 2014, and was updated on March 28, 2017.

The importance of yearly physicals

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As pediatricians, we are frequently asked why a child needs a yearly physical, even if they seem perfectly healthy. At each well visit, your provider will ask questions, examine your child and discuss any recommended vaccines. At each age milestone, different screening tools and tests may be recommended in addition to the traditional physical exam.

Children are constantly growing and a lot can change in a year. We measure height and weight to ensure adequate growth. We plot these measurements on a growth curve which shows projected growth patterns. Variations in this curve can indicate nutritional deficiencies, hormone deficiencies, as well as other major medical problems.

Between two and six-years-old, children grow at a faster rate than almost any other time during their development. During this time, we can monitor their growth rate, size, weight and blood pressure to help determine if early action is needed to combat issues that may arise later in adolescence. Children who are overweight at age five have a much higher percentage of being obese in adolescence and later in life.

When your child hits the “tween” age, around eight to 12-years-old, growth patterns and timelines for development can vary. Because your child is starting toward puberty, getting a yearly physical can help us prepare them (and you!) for hormonal changes as well as other physical and emotional changes that occur during these times.

These yearly physicals allow us an opportunity to address important topics such as ways to ensure your child’s safety, healthy sleep habits, goals for adequate nutrition and more. Through these visits, we work to identify any physical, emotional, developmental or social concerns and begin to address them. The “sick visit” is a time to address an acute illness or check in on an ongoing specific condition. In contrast, the well visit (or physical) is a time for the provider to do a more thorough evaluation. It also gives the patient, family and provider an opportunity to work together to ensure quality overall health.

Additionally, if your child plays a sport, the state of Michigan (MHSAA) requires that students receive a physical AFTER April 15, 2017 in order to play sports in the 2017-2018 school year. Act now to schedule your child’s physical for this spring/summer. You can schedule online or by calling your child’s office. We look forward to seeing you!

The importance of colon cancer screenings

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For most adults, screening for colon cancer starts soon after turning 50. This because the chances of getting colon cancer increase as you get older. According to the CDC, 90% of cases occur in people 50 years or older. However, this doesn’t mean that adults younger than 50 can’t develop colon cancer and it’s important to know if you are at risk.

A history of colon cancer in the family means it could be genetic. If a close relative, generally your parent, sibling or child, has had colorectal polyps or colon cancer it is important to get screenings at a younger age. This risk is even higher if that family member was younger than 45-years-old when they were diagnosed with cancer, or if more than one close relative is affected. Additionally, if you have inflammatory bowel disease, your risk of colon cancer is increased.

Colon cancer forms when abnormal growths, called polyps, form in the colon or rectum. These polyps can mutate into cancer and spread throughout the colon. Thankfully, screening tests like a colonoscopy can find the polyps and your physician can remove them during a colonoscopy before they turn into cancer.

Colon cancer is one of the most treatable forms of cancer and there are a number of lifestyle factors that you can be aware of to actively reduce the risk of getting colon cancer. These include getting the recommended amount of physical activity, eating a healthy diet with fruits and vegetables, maintaining a healthy body weight and watching your consumption of alcohol and tobacco.

Even without inflammatory bowel disease or a family history of colon cancer, it is vital to listen to your body. If you think something is wrong, make an appointment with your doctor.

Fun with fiber!

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Fiber has many wonderful characteristics! Fiber can lower blood sugar, cut cholesterol and may even help prevent colon cancer. But few people are getting enough! Women should get about 25 grams each day, and men at least 35-40 grams. However, the average person only gets about 15 grams per day.

Many people rely on whole grains and salads to provide their daily fiber intake, which is definitely a good start. But, lettuce alone isn’t enough. In fact, iceberg lettuce only has about 0.5g per cup! Try adding some artichokes, which provide about 10.3g, or avocado, which provide 6.7g per half, to your salad. Additionally, adding beans to your meals also helps increase your fiber intake. One cup of white beans is about 12g of fiber, while one cup of black beans is about 15g.

If you’d rather get your fiber from a dessert, try black bean brownies. It may sound odd, but you can’t taste the beans, and the brownies contain more than 22g of fiber total.

You can also try incorporating flaxseed into your diet, by adding this to your oatmeal, smoothies or yogurt. A two-tablespoon serving of flaxseed contains 3.8g of fiber, and also gives you a dose of omega-3 fatty acids! Chia seeds offer 5.5g of fiber per tablespoon and are great for thickening smoothies or puddings, and for replacing eggs in most baked good recipies!

Some other high fiber foods include corn (2g per ear), brown rice (3.5g per cup), lentils (15.6g per cup), pears (skin intact, 5.5g per pear), and broccoli (5g per cup).

Eating your recommended daily amount of fiber can be fun! Push the limits and try some new fiber filled recipes! Your colon will thank you!

Sleep training your baby

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Typically, when your baby is about six-months-old, their circadian rhythms stabilize and they start to wake up less and less during the night. This is a great time to work on sleep-training, or trying to get them to learn to fall asleep on their own and stay asleep during the night. There are a variety of commonly used methods, however, one that worked for your friend or coworker may not work for your baby.

 

The most common are:

Pick-up-put-down: this is a gentle technique that is exactly what it sounds like. When a baby is fussy and it’s time to go to sleep, pick them up and comfort them until they’re calm and drowsy, but not yet asleep. Put them back in their crib to sleep, and repeat until they’re finally asleep. This requires a lot of patience, and not every baby will like this method. For some, it’s overstimulating and can make them fussier, rather than coax them to sleep.

Fading sleep: this method consists of helping your baby fall asleep by rocking or feeding, but shortening the amount of time you rock/feed each night, which allows your baby to do more to get themselves to fall asleep. This also requires a lot of patience, but this works very well for families who want to minimize crying.

Chair method: This method doesn’t involve picking up your baby at all. Begin with your normal bedtime routine and put a chair very close to the crib while your baby falls asleep. The goal is to reassure baby that you’re nearby, but you don’t help them calm down or give them any attention after you’ve put them to bed. Each night, you move your chair farther and farther away until you’re right outside the door and no longer need the chair at all. This method can be very difficult on parents and baby, but for some, it can work well.

Ferberizing (check and console): This technique allows you to check the baby at timed intervals while allowing them to learn to console themselves. Your goal is to reassure baby that you’re nearby while reassuring yourself that they’re ok. When you check on baby, don’t pick them up, simply tell them that they’re ok and pat or rub their back for two-three minutes before leaving. Over time, increase the amount of time between checks. Start with 10 minutes between checks and increase by five minutes each night. This method helps baby learn to fall back asleep in the same environment they wake up in each night.

Cry it out (sleep extinction): This is the most commonly known method. The idea is you do your normal bedtime routine and put the baby to bed, but do not check on them again, instead of letting them fall asleep on their own. This can be hard for parents to not console their child when they’re crying, but the idea is that if you go in after a certain amount of time, your child will expect you to do that every night.

There is no “one-size-fits-all” method of sleep training. You may find a hybrid of these methods works best for you, or something that’s not listed here at all. If you need help finding a way to sleep train your baby, or talking through some of the ideas listed here, talk to your pediatrician. They can offer some helpful suggestions about what to try and what might work for you and your baby.