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Pediatric Tips for Summertime and Every Month: From the Dangers of DEET to the Joy of a Late Bedtime

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The dangers of DEET

Don't assume the fragrant smell wafting from that bottle of insect repellant means it's safe and non-toxic. Most brands contain the insecticide DEET - a chemical which is generally safe when used in small amounts and by itself. But when combined with other chemicals or medications, DEET can have toxic effects on the brain and body, cautions Duke pharmacologist Mohammed Abou Donia, who has tested the effect of numerous chemicals found in the environment on chickens, which have a nervous system similar to humans. An expert in studying the origins of Gulf War Syndrome as well as the effects of pesticides, Abou Donia says that following a few simple rules should minimize safety concerns.

First, never use insect repellents on an infant. Their skin is too thin to provide an adequate barrier against absorption, and their systems cannot metabolize drugs and chemicals as well as an older child or an adult.

Second, never combine insecticides with medications. Even so simple a drug as an antihistamine can combine with DEET to cause toxic and long-term side effects, says Abou Donia.

While few scientific studies exist on the dangers of combining chemicals with medications, Abou Donia says the potential for danger always exists. "Don't spray your yard for bugs and then go in the house and take medications," he says. "Until we have more data on potential interactions, safe is better than sorry."

Watching the real world

Don't feel guilty if you're cleaning the house instead of plying our baby's intellect with the latest designer toy. Duke psychologist Amy Needham has shown that babies derive a great deal of information about how objects work from simply watching them move about - not just by manipulating them.

Babies as young as four-and-a-half months can figure out that two separate objects stuck together are still two separate objects with definite boundaries. By eight months, babies understand the laws of gravity - that an unsupported object is supposed to fall. How does Needham arrive at these conclusions when her subjects can't walk, talk or grab objects? By devising a precise system of measuring a baby's eye movements and the length of time they stare at an object.

"Babies tend to look at things longer that surprise them," says Needham, whose research has called into question long-held theories that babies understand objects only by manipulating them.

"Our position is that infants are not likely born with their brains pre-wired with basic ideas of object support or other rules of physics, but rather they acquire these skills based on visually interacting with the environment around them."

What is the bottom line for parents? Babies benefit most from experiencing the real world. In the normal visual environment, there's a very healthy diet of angles and colors and shadings and movements that can help babies learn about objects. "Just letting your baby watch you vacuum or chop wood provides a lot of interesting sights to help both their visual and cognitive development," Needham says. (Remember, put safety goggles on the infant when demonstrating your prowess in chopping wood in case any splinters fly.)

Testing the first treatment for a deadly disorder

This summer will be the first to offer hope to children born with Pompe disease, an inherited glycogen storage disease that is invariably lethal when it strikes in infancy. Duke pediatric medical geneticist Y.T. Chen will begin treating a handful of children with an enzyme replacement therapy he developed.

Pompe disease, caused by the lack of an enzyme that breaks down glycogen into a form of sugar glucose, is rare, affecting approximately one child in 100,000. In patients with the disease, glycogen accumulates, destroying skeletal, heart and lung muscles. The enzyme replacement therapy, to be administered intravenously, is intended to restore glycogen levels in muscle tissue to normal and has proven to work in experimental animals. If successful in humans, patients will need the treatment for the rest of their lives.

Chen's team at Duke spent more than five years developing the recombinant enzyme. "This is something we have been working toward for quite some time," he said.

Has anyone seen my ring?

Duke pediatric radiologists have seen it all: paperclips, watch batteries, pieces of board games, earrings, needles, nuts, bolts, even a from a hook from a Christmas tree bulb. Kids will swallow anything.

"Coins are by far the most commonly swallowed non-food item," says Dr. Sara O'Hara, who has researched the items which pass through toddler tummies - or which can kill them before the item ever reaches the stomach. "The danger from any of these items varies by whether it is truly 'swallowed' or aspirated into the airway or lungs," she says. Things such as pieces of balloons, peanuts, grapes, hard candy and plastic bags can completely obstruct the airway and kill more than 1,500 infants a year, as many as are killed in motor vehicle accidents, according to a recent study by the National Institute of Child Health and Human Development.

Toys with small, removable parts can be swallowed or become lodged in a child's windpipe. A parent's best defense is prevention, O'Hara says. Supervise your child's play, and keep small objects out of your child's reach. Keep an eye peeled for small items like pins, staples, buttons, and coins. If it is on the floor, kids will find it.

"Amazingly, most swallowing items will pass through the digestive tract without incident," says O'Hara. "If your child swallows a foreign object and is having intestinal pain, bring him or her to a doctor for an abdominal X-ray."

Most times the object will pass into the stool without incident, but in some cases, items can become lodged. Doctors can often remove the object quickly with an endoscope (a thin tube with a surgical tool inserted from the mouth into the stomach), without requiring surgery if the object is lodged in the esophagus or stomach.

Summertime, and the living is easy

It's summer and your kids are lobbying to stay up late. Should you do it? And if so, night after night? It's OK to show some flexibility in their bedtimes, says Duke nurse clinician Nancy Murray, but she stresses that parents need to be reasonable. "It's fine if they stay up an hour later, but depending on your child, that may mean they need to sleep that extra hour the following morning." And if a child participates in a sleepover, which usually means late nights, have them nap the next day.

Murray says it is surprising how often parents don't monitor their children's sleep habits - and then they wonder why their darlings are cranky and ill-behaved. "Children vary in their need for sleep, so it's not easy to recommend a fixed number of hours, but they generally should have a lot," she says. "If you aren't sure, the best way to tell if your children are not getting enough sleep is to look at how they act. Being irritable and getting sick more often are classic signs that a child is sleep deprived."

Murray also suggests that parents set ground rules at the beginning of the summer for behaviors and expectations, and she adds that this is a perfect time to "start incorporating chores into their routine. Many parents put this off during the school year, thinking the children already have enough to do, so now is the time to establish those behaviors."

To cough or not to cough: that is the question

Tom is three years old and has been coughing for a while. Most parents would be concerned about a cold, but it is possible that Tom is one of 6,000 children who get pertussis, otherwise known as whooping cough, each year.

The reason children like Tom are getting sick with a disease that most people think is long gone is because they're not properly vaccinated. Polio, diphtheria and pertussis no longer strike fear in the hearts of parents today, as they did many years ago and doctors say some parents have become complacent when dealing with vaccinations necessary to protect their children from these serious diseases.

According to Dr. Samuel Katz, Wiburt C. Davison professor of pediatrics emeritus, a small but surprising number of parents are deciding to not vaccinate their children, even though these diseases of the past can still be deadly. The viruses and bacteria are still circulating in this country and in other parts of the world.

"What happens is that some people tend to focus on the rare adverse effects of the immunization instead of the adverse effects of the disease," Katz explained. Some other reasons that children aren't being properly vaccinated are that parents simply don't know the vaccination timetables and some parents, about one percent, choose not to vaccinate due to religious and philosophical reasons.

This type of complacency towards vaccinations has led to children dying from diseases that parents thought were a thing of the past. For example, in 1989, 150 children died from measles and each year, 90-100 children die from chicken pox and its complications. A vaccine for chicken pox has been widely available for several years.

"Now that we have entered an era of molecular biology, vaccines seem commonplace to most American households," Katz said. "But vaccines don't protect children unless they actually receive them."

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