Every afternoon around Central Texas, the band kids are marking their halftime performances on the parking lot pavement. The football players are practicing downs on the field. The cross country runners are setting new paces on trails and sidewalks. And the elementary-schoolers are on the playground for recess.
And it’s 100+ degrees.
We asked Dr. Lisa Gaw, a pediatrician with Texas Children’s Urgent Care, to give us some tips on keeping kids cool, hydrated and not experiencing heat exhaustion or heat stroke.
How much and how often should you drink water?
If you’re out in the sun, she recommends that at least every 15 to 20 minutes you take a break and drink water. If you feel thirsty, you need to drink water. That’s a sign that your body is in the earliest stages of being too hot.
Rather than give you a ratio of how many ounces of water per hour, Dr. Gaw likes to tell parents and kids that your urine should be closer to a light lemonade-colored yellow rather than a yellow that looks more like apple juice.
If you no longer feel the need to go to the bathroom, that’s a warning sign.
Should it always be water?
Water is great, but if a kid is very active, think about a sports drink like Powerade or Gatorade to replace the electrolytes and salt rather than just water. What you don’t need is an energy drink like a Red Bull or a Monster drink. You don’t need the caffeine. The same is true for soda.
What are the warning signs of becoming overheated, having heat exhaustion or heat stroke?
The first warning sign is that you are thirsty. You might also have muscle cramps.
For heat exhaustion, you might feel hot, dizzy, light-headed, nauseated or weak.
With heat stroke, you’ll feel all of those things, but you’ll also feel confused, possibly become unresponsive. Your body won’t be able to regulate its temperature, and your body temperature could climb to 104 to 106 degrees. You’ll stop sweating because you cannot regulate your temperature.
What should you do if you or someone else is experiencing these symptoms?
If someone becomes unresponsive or is very confused, call 911.
For less-severe symptoms, go to a cool, shaded area, hopefully with some air circulation. The person should start sipping water. Add cool towels or cool compresses around their neck, in their groin area or under their armpits to cool down their core temperature.
46th in midwives and obstetrician/gynecologists per capita
36th in pediatricians and family doctors per capita
37th in parental leave policy
29th in hospital Cesarean-delivery charges
28th in hospital vaginal-delivery charges
19th in infant mortality rate
28th in low birth weight
10th in annual cost of early child care
26th in child-care centers per capita
What does all this mean to Texas moms? It means that they might have to travel farther to see a midwife or OB/GYN or go to a pediatrician or family doctor than people in other states.
The Economist also came up with another interesting statistic: delivering a baby in the U.S. costs about $10,808, part of the total of about $30,000 for before and after birth care. Most people with insurance pay about $3,000 in hospital delivery costs after insurance. Many women in Europe have birth and delivery available for free by their country’s medical care system. Then if they want an upgrade of a private room in a luxury hospital, they might pay an additional fee. Duchess Kate spent about $8,900 for her private room in the St. Mary’s Hospital in London.
The study looked at more than 24,000 children of more than 16,000 nurses enrolled in the Nurses Health Study II in the 1990s. The researchers specifically looked at children who were not obese before age 9 and where they were at age 14.
What they found was that 5.3 percent of those children became obese in those five years. The risk of becoming obese was lower in children whose mothers had a body mass index between 18.5 and and 24.9, engaged in at least 150 minutes a week of moderate to vigorous physical activity, did not smoke and consumed alcohol in moderation.
Here’s the big takeaway: Children of mothers who had those markers of health had a 75 percent less chance of becoming overweight than the children whose mothers did not.
Those researchers found that it wasn’t just about the children’s healthy lifestyle, it was about the mothers’ as well.
Dr. Kelly Thorstad, a pediatrician at St. David’s Children’s Hospital and Lone Star Pediatrics, says that what this study shows is it’s not just about genetics. While genetics is a factor, it’s also about lifestyle and creating an environment of healthy habits.
“I think children learn what they live,” she says. “Having parents that have a healthy lifestyle that have a healthy weight … it will be good for the family.”
Some of the things she recommends families start doing are:
Control how much TV kids and parents are watching, and no TV in the bedrooms.
Have family meal times together to share those healthy habits.
Avoid fried food. Instead of counting calories, worry about the amount of fat.
Focus on serving size. We have trouble remembering what a healthy serving is, especially at restaurants. “Look at your plate,” she says. “Cut everything in half and that would be a normal serving size.”
Get good protein throughout the day, but especially at breakfast. Think boiled eggs, a protein bar without a lot of sugar, whole-grain cereal with milk or, better yet, yogurt with fruit and some whole-grain cereal on top.
Trade chips and cookies for fruits and vegetables as a snack after school and on the weekends.
Control what you bring into the house. If you don’t bring in junk food, it’s not available for eating, at least when they are at home.
Thorstad, of course, would like families to do all of these things, but if they can only do one thing, cutting out sugary drinks would be her choice.
Thorstad often has to have conversations with parents when their children’s weight is not at a healthy level. She says she always asks them if it would be OK to talk about weight.
What time of day you eat could make a difference when it comes to cancer. A new study of from Spain that was done from 2008-2013 on 1,826 people who had either prostate cancer or breast cancer and 2,193 people who did not asked about how close to bedtime people ate meals. The study was published in the International Journal of Cancer in July.
What it found was that people who didn’t eat within two hours of their bedtime had a 20 percent decreased risk for prostate cancer and breast cancer. They also found a similar reduction in people who ate before 9 p.m. verses people who ate after 10 p.m.
Why would that timing matter? The study researchers seemed to think it had to do with the body’s circadian rhythms and their disruption. Dr. Vivian Cline, an oncologist at St. David’s Medical Center and Texas Oncology, says that like many studies, it brings up more questions than they answer, but this study had a large number of participants and it was asking participants to go back multiple years to look at their lifestyles.
We’ve already known that smoking is a risk factor, but studies are also looking at things like excess body weight and exercise, and like this one circadian rhythms. Other studies revealed that people who work nights have an increased cancer risk — again thought to be about the disruptions in circadian rhythms, Cline says.
We aren’t talking about eating late at night once or working an overnight shift once, she says. “We’re talking about habitual late-night eating.” With night-shift employees, doctors found it disrupted their glucose, cortisol and leptin levels. These workers also had a higher level of inflammation. All of this speaks to increases in cardiometabolic diseases and cancers.
“A lot of factors go into cancer,” Cline says, “It’s a dance between genetics and environment.”
While we can’t really do much about our genetics, “you can do something about your environment.”
So, why would eating less than two hours before going to bed mess with the circadian rhythms. “It’s intuitive,” she says. “When you eat a lot and go right to bed, you don’t sleep as well.”
For her patients with cancer already, Cline says if they are complaining about heartburn and not being able to sleep, she might recommend not eating within two or three hours of going to bed to see if that helps before adding another pill to their regimen.
For patients who are coming to her before they have cancer because of their heightened risk factors, she now might recommend not eating within two hours of going to bed in addition to talking to them about excess body fat, glucose levels and definitely smoking.
Smoking is still the No. 1 risk factor and the No. 1 thing she counsels against, followed by excess weight, increasing physical activity and healthier diet.
Sometimes that means having a nonjudgmental, yet tough conversation about weight. “Let’s look at your diet and reduce fat, salt and sugar and exercise regularly so you’re not in my office for a cancer diagnosis,” she says. “We need to try to make me obsolete.”
While eating late won’t move to the top of that list of risk factors, it is something that she says she’ll now talk to her patients about.
When your kid has a food allergy, diabetes or another life-threatening condition, back to school can be stressful. What will happen if your kid with a peanut allergy accidentally sits next to the kid with the peanut butter and jelly sandwich and gets exposed to peanut butter? What will happen if your kid with celiac disease is offered a birthday cupcake or is told something is gluten-free and it’s not? Or if your kids with diabetes has a low blood sugar moment?
Meet with school staff members: Set up meetings with principals, teachers, nurses and cafeteria staff. This ensures that everyone is informed and prepared and allows a parent to understand how a child’s school manages food allergies.
Create a written plan: Work with an allergist to develop an action plan that outlines all necessary information on your child’s allergy, including how to prevent accidental exposures and how to recognize and treat symptoms of an allergic reaction.
Post pictures: Tape pictures of your child to the classroom wall with information on their allergies to alert anyone that comes into the room. You can also post one on your child’s desk, which can serve as a secondary reminder when snacks are served.
Make safe snacks: Pack allergen-free snacks for your child in case someone brings in a treat for the class. Send the snacks to school with a label specifying that they are safe, or leave some with their teacher so your child won’t feel left out during classroom celebrations.
Have good communication with teachers and other parents. Be vocal about what your child’s food needs are and be proactive about finding solutions. However, don’t expect that the teacher or parent will change what they are planning to suit your child. It’s nice when it happens, but not realistic to depend on that.
Try to pre-plan with similar food alternates. Fothergill finds out ahead of time when there will be a party at school or what a birthday party host will be serving. If it’s not what her children can eat, she will make her children the gluten-free, dairy-free, egg-free equivalent if that is possible. A teacher even asked her to make the whole class gluten-free spaghetti for an event so that it wouldn’t be an issue.
Try to always have food on-hand. Fothergill keeps a freezer of food, especially baked goods for parties. She also sets up teachers with either pre-packaged cookies or frozen cupcakes they can keep in the freezer at school for when parties happen. Of course, on the occasion when her kids don’t have access to an alternative, they learn that “they can’t always get what the want,” she says. “Sometimes you have to wait.”
Eat before an event. If her kids are headed to a play date, she has them make a gluten-free sandwich beforehand. If there aren’t good choices at the event, they won’t be hungry.
Bring something with you. She also tries to have snacks on-hand wherever they go.
Learn where there could be cross-contamination. They stopped eating things like corn chips and fries because of the cross-contamination that happens when a restaurant fries the onion rings or the chicken nuggets in the same fryer as the chips or the fries. She’s also learned to always ask questions even if you would think something like a risotto would be gluten-free, but you find out that that particular chef puts flour in his risotto. She’s also learned to look at beauty products as well.
And again: Empower kids to be their own advocates. It gets easier with time, but her kids have learned how to talk to adults and their friends about their food needs. “It makes them independent,” she says.
Halloween, which is really only two months away can be a difficult time for kids with food allergies or intollerances.
Encourage neighbors to stock non-food items in their trick-or-treat basket, such as glow bracelets, stickers, tattoos, noise makers, bouncy balls.
Put a sticker on your child that says “non-food items only.” That way you don’t have to explain at every door why you can’t take the candy.
Place a sign on your door that reads “Non-food items available here.” Or paint a pumpkin teal. The Food Allergy Research & Education group created the Teal Pumpkin project to represent that you are food-allergy friendly by having non-food treats at your house. You can download a Teal Pumpkin sign here.
Take the candy if you don’t want to be impolite, but take it to an orthodontist participating in the Halloween Candy Buy Back program. I searched my ZIP code and found three locations nearby.
Don’t get caught missing a vaccine or without your paperwork. Find your children’s shot records and make sure they are in compliance with the 2018-2019 school vaccination schedule:
Diphtheria/Tetanus/Pertussis: four or five doses depending on which version your kid got.
Polio: four or three doses
Measles, Mumps and Rubella: two doses
Hepatitis B: three doses
Varicella: two doses
Hepatitus A: two doses
All of the above, plus
Diphtheria/Tetanus/Pertussis: three doses of the primary series plus a booster within the last five years
Meningococcal: one dose
Eighth- throught 12-graders
All of the above, but if the diptheria/tetanus/pertussis shot has not been given in the last 10 years, a booster is needed.
The Centers for Disease Control and Prevention also recommends these vaccines for the 11-year-old or 12-year-old check up:
Human papillomavirus (HPV) vaccine helps protect against HPV infections that cause cancer. For kids age 9-14, it’s two doses, one six months to a year after the first. For kids 15 or older, it’s three doses, the second one to two months after the first; the third, six months after the first.
Quadrivalent meningococcal conjugate vaccine
Quadrivalent meningococcal conjugate vaccine protects against some of the bacteria that can cause infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia). These illnesses can be very serious, even fatal. It recommends one dose at 11.
Tdap vaccine provides a booster to continue protection from childhood against three serious diseases: tetanus, diphtheria, and pertussis (also called whooping cough).
Preteens and teens should get a flu vaccine every year, by the end of October if possible. It is very important for preteens and teens with chronic health conditions like asthma or diabetes to get the flu shot, but the flu can be serious for even healthy kids.
Think your child doesn’t need to be vaccinated. Dr. Don Murphey, an infectious disease specialist at Dell Children’s Medical Center of Central Texas, who has been treating infectious disease in Texas children for almost a quarter of a century, explained to us last school why vaccines are so important.
Last year he saw seen mumps cases, like the ones at UT, come into Dell Children’s. Last year by August, Texas had more than 200 cases. “Before 2000, we had almost no cases of mumps,” he says.
He’s also seen in recent years more measles, whooping cough, pneumococcal meningitis and Haemophilus influenzae type b meningitis.
What’s going on here?
We’re seeing what doctors have been seeing in Europe, especially France and the United Kingdom, but on a smaller scale, Murphey says. The rates of mumps and measles in particular skyrocketed there after “The Lancet” medical journal published a 1998 study by Dr. Andrew Wakefield that it later had to retract. Wakefield lost his license because of it.
Wakefield’s study found a link to autism from the measles-mumps-rubella vaccine. Multiple studies including those funded by plantiff’s lawyers who were looking for a link found no-such link. What happens, though, is that the MMR vaccine is given around the same time — about 12 months to 15 months — as when many kids with autism start to show signs.
Yet, the misinformation and the fear of vaccines persisted. Parents in Europe stopped vaccinating and Europe no longer had the “herd” immunity that happens when at least 90 percent to 95 percent of the population are vaccinated against a disease.
Diseases like measles and mumps that we just didn’t see are happening again. We rely on the herd immunity to protect us. You see these vaccines are not fool-proof, and they have waning effects. In the case of the students at UT, even if college students have been vaccinated as children but are exposed to mumps now, they might not be fully immune and get it.
Murphey says the mumps vaccine we use “is a very safe one. It doesn’t cause any meningitis,” he says. “It works great for herd immunity, but it doesn’t work if you’re exposed.”
If you do get mumps, it isn’t the worst thing most of the time. You get a fever, you feel bad for a few days, he says. Boys can also get an infection in their testes and girls in their ovaries. What is scary is that mumps can lead to meningitis and deafness.
While mumps is not a terrible disease, we could avoid the whole thing, if people who can get immunized do get immunized, he says.
For parents who are considering or are using an alternative vaccine schedule and delaying vaccines, Murphey encourages them not to. “Alternative schedules have never been shown to be any safer,” he says.
By delaying vaccines, you’re not protecting the most vulnerable population, who can get the most sick from these disease — infants and small children. They end up in the hospital or worse.
“You want to start protecting those kids as soon as possible,” Murphey says.
Vaccinate, please, if not for your own child, but for the other children.
University of North Texas cheerleader Skyler Sanders, 21, was a junior at Hays High School when doctors discovered that she had a hole in her heart: officially an atrial septal defect.
She had started having heart palpitations in middle school. She would get short of breath and feel like she needed to sit down. At first she was having one episode every six months; then by high school, she was having about one a month. “They were very random,” Sanders says.
Sometimes palpitations would happen in cheerleading practice, but sometimes they happened when she wasn’t exercising.
She thought she was having anxiety, but her primary care doctor directed her to a cardiologist as soon as she mentioned the shortness of breath.
The cardiologist did an echocardiogram and ultrasound and saw the hole. The defect was enlarging her heart slightly, she says. She also had a leaky mitral valve.
Doctors told her that it wasn’t something she had to fix right away, but she says, she was told she needed to get it fixed before she turned 24 because that would be when problems would start arising. If left untreated, it could have caused a stroke or congestive heart failure.
Sanders decided to have surgery in May 2017 and was back cheering again two months later. Doctors were able to minimize scarring and shorten recovery time by making incisions in between her ribs instead of cracking her chest open.
Sanders’ heart problem is one of the problems that doctors can detect through screening. On Aug. 4, Heart Hospital of Austin will be offering free screenings for teens age 14-18. During the screening, technicians will do an echocardiogram and an EKG to look for heart defects such as atrial and ventricular septal defects and hypertrophic cardiomyopathy — that’s the one you sometimes hear about in seemingly healthy athletes. It can lead to a dangerous arrhythmia and sudden cardiac death.
The screenings are a great resource to the community, says Dr. Faraz Kerendi, surgical director of the Heart Valve Clinic at Heart Hospital of Austin and cardiothoracic surgeon at Cardiothoracic and Vascular Surgeons. “It allows young student athletes, young students in general, to find conditions that may otherwise be totally asymptomatic that could be life threatening. This allows them to get an echocardiogram, and an EKG, basically at no cost to them, to detect things that could otherwise show up in a bad way.”
The Heart Hospital does screenings two times a year, typically before school starts and in February. Out of those screenings, a few kids get diagnosed with one of these conditions. “For those few, it could be devastating if not discovered,” Kerendi says.
The screenings are for any teenager age 14-18, but it’s especially important for student athletes because of the exertion their hearts go through. Sometimes, if something is found, teenagers can continue doing their sport, like Sanders did. Sometimes, though, they might need to switch to a less-strenuous sport.
One of the people who will be doing a screening on Aug. 4 is Sanders’ sister Ryan, who plays volleyball. Even though Sanders’ condition is not genetic, Ryan still wanted to get screened and Sanders’ helped Ryan by signing her up.
Sanders wishes that she had taken advantage of the screening program when she was in high school. She might have chosen to do her surgery in high school instead of waiting. “That would have been easier,” she says.
Kerendi wants to remind teens and their parents that you don’t have to think something could be wrong to do a screening.
“There are conditions that are unknown and asymptomatic, and people shouldn’t assume that everything is fine,” he says. “You never know when one of these things could cause a problem until it does.”
It looked at 350 products in two grocery store chains in Calgary, Alberta, Canada. What it found was that 80 percent of the products had high sugar levels and 88 percent had poor nutritional quality because of high the levels of sugar, sodium and saturated fate. Many of them also had less protein. They had a similar percentage of calories from sugar as their gluten counterparts.
Gluten-free products are great for kids with a gluten intolerance or Celiac disease, but for your average kids, they won’t save anything by choosing the gluten-free alternative.
Dell Children’s Medical Center of Central Texas is the 11th children’s hospital in the country to be verified by the American College of Surgeons as a Level I Children’s Surgery Center. It earned the certification by meeting the highest criteria in the college’s new Children’s Surgery Verification Quality Improvement Program.
The program will help the hospital to continue to improve the quality of surgical care and ensure it is following the highest standards of care.
“I’m a mom,” said Dell Children’s chief surgeon Dr. Nilda Garcia. “One of the things I fear most is anything happening to my child. For me, being a mom, it means this hospital has gone above and beyond in their care of my child.”
Texas Children’s Hospital in Houston is the only other hospital in Texas to receive this verification.
Dell Children’s had to meet strict criteria and send a lot of data to the verification team over the course of about a year. Three doctors representing the college came to Austin in late April to verify Dell Children’s had met the criteria.
To meet this certification level, Dell Children’s had to make some changes. It joined the National Surgical Quality Improvement Program, which requires sending a lot of data about procedures, outcomes and complications to the college. The college gives feedback about how Dell Children’s compares to other hospitals in the country.
The hospital also created an office specifically to look at surgical quality, what kinds of criteria it should establish, why certain cases fell out of that criteria and how the hospital can improve.
Dave Golder, who is the director of the surgical quality program at Dell Children’s, says the hospital has reduced the number of CT scans it uses to diagnose things such as an appendicitis, instead relying on a physical exam by a doctor and an ultrasound by someone trained in detecting an appendicitis to diagnose one. This reduces radiation exposure to kids. Staff have reduced the number of Foley catheters used in surgeries, which reduces the risk of infections, and have reduced the amount of blood transfusions given.
Golder says he’s most proud of how the hospital outperformed other hospitals in preventable harm events such as sepsis, surgical infections and urinary tract infections following surgeries.
“Standardized care is a cultural thing and it has taken off (at Dell Children’s) in the last five or six years,” Garcia says. “The interest in adhering to (criteria) has been remarkable really.”
Going forward, the hospital is working on how it controls patients’ pain to reduce the amount of opioids given, as well as reducing the amount of unnecessary antibiotics given. It’s also working on how to implement Enhanced Recovery After Surgery programs that will do things such as give carbohydrates to patients before surgery, get patients moving quicker after surgery and shorten the length of stay after surgery.
Dell Children’s will continue to submit data every year to the college and will be reverified for the Level I certification every three years.
“We are maturing,” says Garcia, “and this is a step toward that.”