What Parents Need to Know About Dry Drowning

Dr. Christian Wright is an Assistant Professor of Pediatrics at the University of Maryland School of Medicine and specializes in pediatric emergency medicine at the University of Maryland Children’s Hospital. Below he answers everything parents need to know about “dry drowning.”

What is dry drowning?

“Dry drowning” is actually an outdated term. These days, research and health organizations prefer to simply define drowning as a process where being submerged or immersed in liquid leads to respiratory impairment—that is, difficulty breathing. Drowning can be fatal or nonfatal. Sometimes a person can develop difficulty breathing after they have left the water, sometimes even hours later, and sadly there have been cases when children have died of drowning hours after being exposed to water.

In the media, a distinction is often made between “dry drowning” and “secondary drowning.” Again, these are outdated terms, but they do attempt to explain two physiological processes that occur in drowning.

When water is inhaled, it causes a spasm of the airways which causes them to close, which makes it difficult to breathe. This usually happens right after the water has been inhaled, so the person could still be in the water or they could have just left it. In the past, it was thought that in this way a person could drown without water entering the lungs, so this was called “dry drowning.” In reality, though, water enters the lungs in almost every drowning death.

When water gets into the lungs, it interferes with our lungs’ ability to exchange oxygen and carbon dioxide, so oxygen levels in the body drop. Water also washes out surfactant, which is a substance in our lungs that prevents the small air sacs (alveoli) from collapsing when we exhale. This leads to pulmonary edema, or a buildup of fluid in the lungs, and difficulty breathing. A child could develop these symptoms up to 24 hours after exposure to water, and in rare cases this results in death. This has been referred to as “secondary drowning,” though it is really just the culmination of the drowning that started when the child was in the water.

How common is it?

“Secondary drowning” is rare, so there aren’t good statistics about how frequently it happens.

What are the symptoms?

Any time water enters our airway, our body has reflexes that kick in to clear the water. So a child could have coughing, gagging or difficulty breathing. Usually, this is sufficient to clear the airway. However, if water got into the lungs, the child could develop symptoms hours later. These include coughing, difficulty breathing, chest pain, vomiting, irritability or fatigue.

How does someone become a victim of dry drowning?

Any time water is inhaled, it could cause delayed symptoms. This could be after swimming or bathing or even after a short exposure to water like being dunked or the face being submerged in a puddle.

How’s it treated?

Drownings are treated by monitoring lung function and treating as necessary. A patient without symptoms may only need to be monitored. Patients with symptoms will need to have their lung functions monitored and supported. They might need supplemental oxygen, noninvasive forms of ventilation like CPAP, or a breathing tube may need to be placed. These patients will need to be monitored until their symptoms go away and their lungs are working normally again.

What’s the best way to prevent dry drowning?

The best way to prevent “dry drowning” is to exercise good water safety principles, including the following:

  • All children should be closely watched whenever they are are in or near water. Never leave children unattended near water.
  • Swim where there is a lifeguard, but don’t rely on the lifeguard alone to watch your child—continue to closely monitor your child.
  • Make sure pools are properly fenced and guarded. Fences should completely surround the pool area, be at least 4 feet tall, and gates should be self-closing and self-latching.
  • Teach teenagers the dangers of drinking alcohol while engaging in water activities.
  • Teach children to not roughhouse in the water
  • Enroll children in swimming lessons as early as possible
  • Have young or inexperienced swimmers wear U.S. Coast Guard-approved life jackets
  • Learn CPR

To learn more about Pediatric Emergency Medicine at the Universtiy of Maryland Children’s Hospital, please click here.

Summer Safety: How to Treat Your Child’s Cuts and Scrapes

More outdoor playtime usually brings more cuts and scrapes for kids. Here are some tips from the experts at the University of Maryland Children’s Hospital on the best way to treat your child.

What’s the best way to treat a small cut or scrape?

If the wound is bleeding, keep the area elevated and apply pressure to the site with a clean cloth or gauze. Most minor wounds will stop bleeding in about 5 to 10 minutes. Continue to hold pressure until the bleeding stops.

After the bleeding stops, wash the wound with lots of water. Soaking the wound in water can be helpful if there is dirt or other debris in the wound. You can use mild soap to clean the wound but don’t use rubbing alcohol or hydrogen peroxide —they irritate the tissue in the wound, which causes pain.

After cleaning the wound, apply antibacterial ointment and cover it with a clean dressing.

How do I know if my child needs stitches?

Here are some examples of wounds that probably require stitches:

  • Cuts that go all the way through the skin
  • Cuts with visible fat (yellow) or muscle (dark red)
  • Cuts that are gaping open
  • Cuts longer than half an inch. Note that smaller cuts can often benefit from butterfly closures or skin glue

Your doctor can examine the wound and help decide the best way to close it.

What is the process for getting stitches?

Getting stitches can be scary for children, but there are many ways to make the experience easier. These include numbing the area, distracting and coaching the child, and giving medications to decrease the child’s anxiety or even help them sleep through the procedure.

There are two options for stitches: absorbable and non-absorbable sutures. Absorbable sutures don’t need to be removed. Non-absorbable sutures need to be removed; how long they stay in depends on where the wound is, so your doctor will tell you when to come back to have them taken out.

What other options will a doctor use to close a cut?

  • Skin glue is helpful for minor cuts. It is applied to the cut while the cut is held closed and allowed to dry. Skin glue is not as strong as stitches, so it is not good for cuts that are under tension from a nearby muscle. But when the cut can be appropriately closed with skin glue, the cosmetic result can be just as good as with stitches.
  • Butterfly closures are narrow adhesive strips that are placed across a cut to keep it closed. They are helpful for small cuts or areas over joints. They aren’t as strong as stitches and can fall off early. Stitches provide a strong closure for wounds and almost always stay in place until they are removed.
  • Staples are a fast way to close certain wounds. In children, they are used most often to close cuts on the scalp.

How soon does my child need to see their doctor for stitches?

While it’s ideal to close the wound as soon as possible after an injury, wounds up to 8 hours old can still be closed. Some wounds can be closed up to 24 hours after the injury.

How can I make my child’s scar less visible?

While your child’s skin won’t look exactly the same as it did before the injury, there are some steps you can take to make the scar less visible. Sunlight can make the scar turn dark, so protect the scar from the sun by covering it with a hat, clothing or sunscreen. You can also massage the scar or apply silicone scar sheets.

For more information, visit umm.edu/childrens.

To make an appointment at one of our locations, call 410-328-6749.

Summer Safety: How to Treat Your Child’s Sunburn

Pool time and outdoor play may increase your child’s chance for developing sunburn. Here are some tips from the experts at the University of Maryland Children’s Hospital on the best way to treat your child.

What causes sunburn?

Sunburn appears within 6 to 12 hours after the skin is exposed to ultraviolet (UV) rays from the sun. Artificial light sources like sun lamps and tanning beds can also cause sunburns. The skin becomes red and painful, and swelling of the skin, tenderness and blisters can develop. Severe sunburn can also cause nausea, chills and malaise (“feeling sick”). The burned area remains red and painful for a few days. Later, peeling may occur as the skin heals.

What are the risks of sunburn?

Exposure to the sun can harm children even when they don’t get sunburn. Over the years, the effects of sun exposure build up and can lead to wrinkles, freckles, tough skin and even skin cancer later in life. Some medications and medical conditions can also make people more sensitive to sunlight. Since people get most of their sun exposure as children, it’s important to teach children sun safety early on so they can be protected from these problems in the future.

Sunlight contains both UVA and UVB rays. UVB rays cause sunburn. However, UVA rays also cause damage in the long run, including skin cancer. Since tanning beds use UVA light, they aren’t healthy and should be avoided.

How is sunburn treated?

If your child has sunburn, he or she should stay out of the sun until the burn has healed completely. Once it’s healed, be sure your child is wearing sun protection, including sunscreen, before going out in the sun again.

You can control pain from sunburn by applying cool washcloths to the area. Over-the-counter sunburn sprays that contain numbing medications like benzocaine or lidocaine can help, although they may also cause irritation to the skin. You can give anti-inflammatory medications like ibuprofen by mouth to help with the pain. As the burn heals, apply a moisturizing lotion. Products that contain aloe vera can be helpful in soothing the skin.

How is sunburn prevented?

The sun doesn’t need to be shining brightly to be dangerous. Children can be exposed to UV rays even on foggy or hazy days, and exposure is greater at higher altitudes or when UV rays are reflected off of water, snow, sand, or other surfaces. UV rays are strongest when the sun is the most intense, so try to keep your child out of the sun between 10 am and 4 pm. Infants and young children can quickly develop serious sunburns.

Dermatologists recommend using a sunscreen with a sun protection factor (SPF) of at least 30. Check the label to make sure the sunscreen blocks both UVA and UVB rays. Apply sunscreen 15-30 minutes before going outside. Reapply sunscreen every 2 hours. Since no sunscreen is waterproof, you may need to reapply sunscreen more frequently if your child is spending lots of time in the water.

Appropriate clothing is also important for sun protection, such as wide-brimmed hats and lightweight cotton clothes with long sleeves and pants.

Keep babies under six months of age out of the sun and in the shade as much as possible. Avoid sunscreen in babies less than six months old.

For more information, visit umm.edu/childrens.

To make an appointment at one of our locations, call 410-328-6749.

 

3 Things to Know about Mother-Child Relationships

By Sarah Edwards, DO

  1. Healthy moms = healthy children and families. Healthy moms are essential to building children’s healthy brains and helping everyone in the family grow well and love well. Maternal depression, anxiety and stress can affect how a mother interacts and develops a relationship with her baby. Babies need a safe and stable connection with a caregiver for social, emotional and cognitive development. If this attachment is not strong, it can have lasting effects on a child’s brain, and puts children at risk for behavior and emotional problems.
  2. Family bonding is key to a healthy family. The good news is that there are effective ways to help caregivers bond with their children and promote a healthy relationship for the whole family. Finding joy in themselves and each other helps everyone feel loved and part of something important: their family.
  3. Help is available. If you have concerns about your relationship with your young child, contact the University of Maryland Medical Center’s Secure Starts Clinic at 410-328-3522 to make an appointment.

Dr. Edwards is the medical director of child and adolescent psychiatry services at University of Maryland Medical Center and an assistant professor of psychiatry with the University of Maryland School of Medicine. For a consultation, call 410-328-3522.

Child Life Month

How Play is Helping UMMC’s Youngest Patients

By: Colleen Schmidt, System Communications Intern

As many parents know, the hospital can be a scary and unfamiliar place for a child. To help relax these fears, UMMC’s team of child life specialists and assistants use a variety of techniques to help children adjust to the hospital setting. Child life specialists, or CLS, aim to provide a positive and non-traumatic hospital experience for all patients at the University of Maryland Children’s Hospital.  UMMC’s Child Life team consists of six CLS and two assistants. They work in the Pediatric Progressive Care Unit (PPCU), Pediatric Intensive Care Unit (PICU) and the Pediatric ER.

Members of the Child Life Team

 

Play is one technique often used by child life team to help normalize the child’s hospital experience.  Various types of play are thoughtfully used to help children meet developmental milestones, express emotions, and understand their medical situation.  For example, during a practice called medical play, a CLS will provide their patient with a “hospital buddy” or small doll that the child can decorate. Next, with the guidance of a CLS, the child is introduced to medical equipment that they can explore and use on their new hospital buddy.  According to Aubrey Donley, a CLS at the pediatric ER, medical play is helpful in addressing misconceptions the child has about medical equipment.

“It gives them a sense of control and mastery over their hospital experience and over what they’ve been through,” she explains. Medical play empowers patients and allows them to have an active role in their hospitalization. Helping the children understand their environment lessens the chances of confusing or traumatizing them.

In addition to medical play, the child life team uses therapeutic play to help children work through a variety of issues that may accompany hospitalization. Sometimes, children who are hospitalized have experienced severe trauma. Unlike adults, children may not be able to verbalize their feelings. Play is how they express themselves and work through their experiences. For instance, one of Donley’s young patients survived a house fire and used play to understand what happened to him. “He was running around in a fireman costume pretending to put out a fire. For an onlooker, it might seem like he was just playing but we understand he is trying to make sense of the chaos and trauma that he had witnessed,” she explained. Therapeutic play can also help children who are at the hospital for long periods of time meet their physical and cognitive milestones.

With backgrounds in child development, the child life team is able to make individual plans for each child that matches their medical, physical, and emotional needs.  The team advocates for the children they support, and work with an interdisciplinary team of medical professionals to provide a comprehensive plan for that child. Child life specialists also provide educational and emotional support for families. All services provided by the child life team come at no charge to families.


For more information on our child life services please visit: http://umm.edu/programs/childrens/services/inpatient/child-life

Winter Wives’ Tale

The University of Maryland Children’s Hospital sets the record straight…

Put on your hat since you lose most of your body heat through your head.”
This is not necessarily true! Your body heat escapes from any exposed area- so if you had on snow pants and a T-shirt and you forget your hat and jacket, the most amount of heat would escape through your arms- since that would be the largest exposed part of your body. Putting on winter accessories such as hats, mittens and scarves is still a very good idea to avoid the outside dangers of frostbite and hypothermia.

You will get sick if you go outside with wet hair.”
This is another winter wives’ tale. While your kids may be cold, they won’t actually catch a cold by venturing outdoors with a wet head. Germs are spread by people, and temperature simply doesn’t play a part.

 

Setting the Table for Celiacs: Q&A with Celiac Disease Program’s Nutritionist

University of Maryland Medical Center nutritionist Pam Cureton answers questions about celiac disease and gluten-free diets.

pam-cureton-rdQ: What is gluten?

A: Gluten is a protein found in wheat, rye and barley. These grains in any form must be avoided. Foods labeled gluten free are safe to eat but if a food item is not labeled gluten free look for these six words in the ingredient list to see if it contains a gluten containing ingredient: Wheat, Rye, Barley, Malt, Brewer’s yeast and Oat (only use oats that are labeled gluten free).

Q: What exactly is wrong with gluten?

A: The problem with gluten is that it is not completely broken down into smaller amino acids that can be easily absorbed by the intestine. For the majority of people this presents no problem at all but in individuals with celiac disease, the body sees this protein as a toxin and this sets off a string of reactions leading to intestinal villous damage.

Q: What cross contamination problems should I look for in the kitchen?

A: Preventing gluten free foods from coming in contact with gluten containing foods make the difference in your guest enjoying a wonderful holiday meal or becoming ill and leaving early. Guest with celiac disease cannot simply take the croutons out of a salad or eat the meat from the wheat bread sandwich. Gluten free foods can be contaminated by using the same spoon to mix or serve foods, putting wheat products next to the gluten free dips, “double dipping” the knife into a condiment then gluten containing product then back into the condiments or using the same toaster.

Q: Can you taste the difference between gluten-free foods and their gluten counterparts?

A: Gluten free foods have come a long way in their taste and texture to be very close to their gluten containing counterpart. There are so many great tasting gluten free products on the market today that no one should be eating something they do not like.

Q: What are the symptoms of Celiac Disease:

A: Celiac disease can present itself in many different forms. Untreated, celiac disease causes multi-system complications such as diarrhea, constipation, gas, bloating, iron deficiency anemia, decreased bone density, failure to thrive, short stature, and behavior problems. If you have any concerns, please check with your primary care provider before you start a gluten free diet.

Q: I have severe reactions when I eat bread, such as stomach bloating and pain in my joints. Does this mean I could have celiac or gluten sensitivity?

A: We recommend that you see your primary care provider and ask to be tested for celiac disease. However, do not start a gluten free diet before this testing is done. The first step is a simple blood test for screening. If all the tests are complete and you do not have celiac disease, then try a gluten free diet to see if you improve as it may be non-celiac gluten sensitivity.

Q: How common is late-onset celiac disease and is there any way to know if other family members are at risk of developing it later in life?

A: It is possible to develop celiac disease at any age. You may have had celiac disease for many years before being diagnosed because symptoms may have been attributed to other conditions or you may not have had any symptoms with the active disease. We recommend that all first degree relatives be screened for celiac disease after the relative had been diagnosed and if negative at that time, repeat the screening labs every 2-3 years or if symptoms appear.

Q: Is there a cure for Celiac Disease?

A: Currently the only treatment for celiac disease is the gluten free diet. In most cases, this treatment works very well but it can be expensive, socially isolating and, at times, difficult to follow. Also, there are people that do not respond completely to the diet or take up to 2 years to heal after diagnosis. For these people, additional therapies are need to prevent additional complications of celiac disease.

 

Learn more about the Celiac Disease Program or call 410-328-6749 to make an appointment.

vegetables

 

“No Screens Under 2” Q&A with Dr. Brenda Hussey-Gardner

brenda-hussey-gardnerHi, my name is Dr. Brenda Hussey-Gardner. I am a developmental specialist who works with the Department of Pediatrics at the University of Maryland Children’s Hospital. I attended the American Academy of Pediatrics conference in San Francisco to share the results of research that I have done with colleagues here at the University of Maryland and to learn what other researchers are doing across the nation in order to bring this new knowledge back to the hospital to better serve our children and their families. At this conference, the American Academy of Pediatrics released their new guidelines regarding screen time and children.

Please see the Q&A here for more information on these guidelines.

Q: What is the “No Screens Under 2” rule and in what ways is it changing?

A: The American Academy of Pediatrics (AAP) previously recommended no screen time for children under 2 years of age. In its new guidelines, the AAP offers slightly different recommendations for children less than 18 months and those 18 to 24 months of age.

Children less than 18 months

The AAP discourages parents from using digital media with one exception: video-chatting (e.g., Skype, FaceTime). This form of interactive media can be used, with parent support, to foster social relationships with distant relatives.

Children 18 to 24 months

The AAP recommends that parents, who want to introduce their child to digital media, do the following:

  1. Only use high-quality educational content.
  2. Always watch shows or use apps with your child. Talking about what the child sees helps foster learning.
  3. Never allow your child to use media alone.
  4.  Limit media to a maximum of 1 hour per day.
  5. Avoid all screen time during meals, parent-child playtime and an hour before bedtime.

Q: Can you provide some insight into how the decision was made? What research was taken into account?

A: The AAP Council on Communications and Media reviewed research on child development, television, videos and mobile/interactive technologies to develop their current recommendations. Research shows that children under the age of 2 years need two things to develop their thinking, language, motor and social-emotional skills: (1) they need to interact with their parents and other loving caregivers, and (2) they need hands-on experiences with the real world. In fact, researchers have demonstrated that infants and toddlers don’t yet have the symbolic, memory and attention skills needed to learn from digital media. Importantly, research also shows evidence of harm (e.g., delayed thinking, language and social-emotional development; poorer executive functioning) from excessive media use with young children.

Q: Why do these new guidelines matter to parents, and should they affect the ways parents and their young children interact with technology?

A: AAP guidelines matter because parents want their children to be well adjusted and smart, and they don’t want to do anything that may harm their child’s development. As such, parents should try their best to avoid screens with their children who are less than 18 months of age and realize that it is their interactions with their child that are the most important. Then, from 18 to 24 months of age, parents should strive to use only the highest quality educational technology with their child. As hard as it is, parents should try to avoid using technology as a babysitter and try to understand the negative impact that it can have on their child’s development.

Q: What is your biggest take-away from the session?

A: A parent’s lap is always better than any app!

Q: What is your opinion on the new guidelines and do you think it will affect your clinical practice? If so, how?

A: I believe that the new AAP guidelines, while a little more flexible, may still be difficult for parents to adhere to, as screen time is so pervasive in our society. However, it is very important for parents to make smart choices about digital media and screen time if they want to help their infant and toddler develop into a child who is healthy and ready for success in preschool. It is my goal to develop a pamphlet summarizing the research findings and AAP guidelines to help parents make the best choices for their child and family.

 

For more information about media, screen time, and child development, parents are encouraged to read the AAP recommendations located within the publication “Media and Young Minds,” and to read the “Early Learning and Educational Technology Brief” published by the U.S. Department of Education and the U.S. Department of Health and Human Services.

Signs of Bullying

This information is provided by University of Maryland Children’s Hospital, the Center for Infant and Child Loss and the Maryland Department of Health and Mental Hygiene.

As a parent, there are many things you need to diligently watch for in your child. One of them is to look for signs of bullying.

There are health risks related to depression for the victim, bully, and those who witness bullying, which may include:

  • Irritability or angerdoctor-consoling-patient-126648704
  • Nightmares
  • Headaches
  • Stomachaches
  • Inability to concentrate
  • Multiple joint and muscle pains
  • Weight gain or loss
  • Depression
  • Difficulties in falling and/or staying asleep
  • Self-injury (i.e., cutting)
  • Impulsivity
  • Suicide attempts
  • Homicidal thoughts

If your child is experiencing any of the above, talk with them, and contact their pediatrician or teacher. For more information call 800-808-7437.

 

 

8 Tips to Confront Bullying in School

This information is provided by University of Maryland Children’s Hospital, the Center for Infant and Child Loss and the Maryland Department of Health and Mental Hygiene.

bullyingBullying is a behavior that is both repeated and intended to hurt someone either physically, emotionally, or both. It can take many forms like teasing, name calling, making threats, physical assaults, and cyber-bullying.

If your child is being bullied and is attending one of Maryland’s public schools, you and your child have the right to report your concerns. The school also has the responsibility to investigate those concerns. Here are eight tips to stop bullying and report the problem:

  • Ask your child’s teacher, counselor, or administrator if you can speak privately about a personal problem. Talk about what is happening or making you (or your child) uncomfortable, and how long it’s been going on.
  • Ask for a Bullying, Harassment or Intimidation Reporting Form; or download at GracesLawMaryland.com. Complete the form, return one copy to the administrator, and keep a copy for yourself.
  • Feel free to call the Maryland State Department of Education if you have additional questions regarding the completion of the Bullying Form. You can reach them at 410-767-0031.
  • If an incident occurs in an unstructured area, ask what the school will do to make you (or your child) feel safe.
  • Ask the administrator to investigate allegations, develop a plan of support and schedule a meeting.
  • If your child is being bullied on a social media site, take a screen shot and save the content to share with parents, police, and the school administration. Fill out a report as often as you need to.
  • Change your password, use privacy settings, and block people on social media who send negative messages, texts, tweets or photos.
  • Ask friends not to share negative social media or pass along to others.

For more information call 800-808-7437.