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News to Use -- The Great Outdoors: What most parents don't know and doctors may not have told them

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Now, Bobby's 5-year-old sister, Jo, thinks baseball is neat.
Squire recommends that parents can help prevent muscle injuries
to a child's shoulders and elbows by limiting baseball pitching
to age- appropriate levels. When a pitch is completed, the
pitcher's palm should be facing the ground to prevent
"side-arming," she says. And even professional
baseball-pitching coaches agree that young pitchers shouldn't
be throwing curve balls or sliders before the collegiate
level.

But the real question for Jo or any child that age is
whether they really want to compete in team sports. "The
competitive spirit only arises in children about 5, 6 or even
older," says Squire. She points to organized soccer for 3- and
4-years-old as "psychologically wrong. They not only don't want
to compete, it's hard for them to stay focused. The grass and
birds may hold more interest to them," she says. "It has to be
the child's choice to compete, not the parents' decision."

Two-year-old Susie doesn't care about football or baseball.
She just wants to be a fish -- a mermaid, to be precise. But,
says Squire, she may have to wait before wriggling about
underwater. Children younger than 3 may enroll in infant and
toddler swim programs to begin enjoying the water with their
parents. But they should not be taught to swim or hold their
breath or learn other such skills. Classes that encourage
infants and toddlers to be submerged underwater are dangerous
and are discouraged by the American Academy of Pediatrics.
Squire says most children are ready to begin swimming lessons
by 3 or 4. These lessons help them become comfortable in the
water while learning basic skills.

What's a parent to do?

Bobby and Jo, being kids, get injured anyway just playing
around the yard. That's typical, Squire says: "We see more
acute injuries from backyard accidents than from organized
sports"-- big spills from skate-boarding, playing on a
trampoline, falling off fences and trees. To help them, never
apply heat to an injury unless directed by a physician. Using a
tea towel or pillowcase, apply real ice or a frozen gel
compress for no more than 20 minutes at a time to prevent nerve
damage. The ideal cold compress? A bag of frozen peas, which
conforms well to the joint. Now the kids seem OK, but how's a
parent to know? Take a child to the doctor anytime a complaint
seems to be affecting a child's play, like a limp or an arm,
hand or leg the child nurses, trying not to use, Squire says.
Also seek attention if a problem recurs over time, like once a
week for six weeks.

Safe, not sorry, for those who like the great outdoors

The area where you live has experienced an outbreak in rabid
animals. And your house is tucked into the woods. You may want
to consider preventive rabies vaccinations for your children,
if not yourself, says Dr. Dennis Clements, medical director of
Duke Children's Primary Care. The problem with taking rabies
shots after exposure to an animal is that some people do not
know if they have been bitten by an infected animal, and become
deathly ill with an unrecognized case of rabies. Symptoms from
the virus can show up in as little as two weeks or not for
several years. He recommends a course of three to five shots,
followed periodically by a booster shot, only for those people
most likely to be in contact with rabid animals. Clements adds
that rabies shots are not the horrifying jab to the stomach
they once were. They are now simply administered as shots in
the arm and are no more painful than any such needle prick
would be.

Allergies widespread in children and may change over
time

Some parents of sparkling, fresh children can't believe
their youngsters can become allergic to the world -- so soon!
But allergies affect 25 percent of Caucasians. They can show up
as a skin rash within a year of birth, if the child is allergic
to a food. Allergies to the environment are usually discovered
when children start wheezing at 3 to 6 years old, after several
seasons have sensitized them, according to Dr. Larry Williams,
a Duke specialist in pediatric allergies. A kid's allergic
reaction can be highly variable -- some children outgrow them,
others grow into them as a teenager. Allergies can also produce
asthma, atopic dermatitis and eczema. What isn't known is the
source of the allergic reaction -- a person's genetic makeup is
crucial, but it also has to do with aging and hormonal changes.
Williams doesn't recommend testing for children with only mild
symptoms, but those who haven't responded to first-line
therapies and children with frequent wheezing need to be
tested. Allergy shots are usually avoided in smaller children
because the allergens to which they react may change over
time.

No sunscreen on babies?

Every doctor agrees that sun exposure boosts the risk of
skin cancer. But there's less consensus on how to protect your
child from that risk. Pediatricians, for the most part, advise
using sunscreen whenever a baby is in the sun. But
dermatologists say to avoid sunscreen on infants under 1 year
old . Why the seemingly contradictory advice, and who's right?
Duke pediatric dermatologist Dr. Neil Prose says the confusion
stems from yet-unproven concern over babies' skin, which is
thinner, more sensitive to allergens and more plentiful in
ratio to their body weight than adults' skin. "Babies' skin has
a lot of surface area, so there is the potential for more
absorption of sunscreen per pound of skin," Prose said.
Theoretically, the chemicals in sunscreen could, if absorbed,
travel via the bloodstream to the developing brain, he said.
Until the matter is cleared up, Prose recommends avoiding the
risk altogether by keeping your infant out of the sun: "Your
baby won't end up in the sun unless you put him there."

Ear aches in the air

If you're worried about Johnny's ear infection causing him
pain while you're flying to see Grandma, consider this: the
common cold is more likely to cause discomfort on an airplane
than an ear infection, says Duke pediatrician Dr. Chip Walter.
While it sounds contradictory, the reason is simple. Ear
infections result in fluid build-up behind the eardrum, which
prevents the ear drum from moving. With the common cold, there
is no fluid build up, and the added pressure from head
congestion can "pull in" the eardrum. As the plane descends,
the air pressure pushes the ear drum in even further, a
sensation that's responsible for the pain people often
experience when flying. Walter recommends giving the child a
decongestant to relieve the pressure of the cold and hence
reduce the chance of pain upon descent.

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