On-Call with Dr. Nyiri Grigorian, LCSW, Phd

"Can I Have One More Book Mom?” and other bedtime issues!

Nyiri has been in private practice for twenty-five years treating children, adolescents, and adults, as well as families and couples. Dr. Grigorian not only specializes in anxiety and depression, but has treated couples in Parent Guidance for decades. She supervises a wide range of therapists professionally who are in the mental health field. Dr. Grigorian has lectured and conducted workshops on a wide range of topics, including sibling therapy, early intervention in childhood development, and prevention in mental health. She has also served as a consultant to many school districts and non-profit organizations identifying high-risk children and families. She has contributed to the body of research on treating siblings together as an alternative to traditional individual treatment. She has been part of long-term research group studying trauma.

As a relationship specialist for the Bedtime Network (bedtimenetwork.com) Nyiri contributes weekly stories providing advice on a variety of sleep topics. Pedimedica found the following published article to be beneficial to their readers and wanted to share her perspective on dealing with the difficulties of getting their youngsters to bed!

“One of the most frequently asked questions in clinical practice with parents of young children revolve around BEDTIME strategies and difficulties. Sleep and how to get more of it is the number one question on parents’ minds! It can be at the root of parent fatigue, guilt, anger, and marital strife. Very often, for example, when treating couples in marital therapy, the theme of putting children to bed at night comes to the fore as a central focus. In some families, there is the dread over the impending bedtime and, it is often viewed as another chore at the end of a long day.

In the same way adults frequently feel it is never a good time to get married, get pregnant, buy a house, move, change jobs, or go back to school, they feel too, that there is never a good time to tackle a child’s bedtime issues. In a like manner to adult concerns, children are teething, sick, having separation anxiety, coping with the birth of a sibling; starting nursery school coping with a new babysitter etc…There never seems to be a good time.

One of the things most helpful to acknowledge before tackling bedtime problems is: always REMEMBER that when you are putting your child to sleep at the end of the day, you are at your most fatigued and vulnerable. Your mind could still be on the toys that are all over the floor downstairs, laundry that is undone, and…bills. Although it sounds simplistic, one of the most dramatic things a parent can do (if married or with a partner) is to be in AGREEMENT about the bedtime approach. For example, that means that one parent isn’t angry at the other while they are playing airplane and wrestling 20 minutes prior to bed or resentful that their partner jumps at every whimper, sound and move their child makes.

How can we create a stress-free bedtime? How young children sleep at night very often is connected inextricably to what goes on during the day. We need to remember that toddlers, preschoolers, and latency age children sleep dramatically better when they are tuckered out from plenty of exercise, fresh air, and activity during the day. Since children are consuming many hours of television a day and are involved with electronics at a VERY young age, they are exercising less and less. Passive activities have replaced playing at the park and playground, running and playing in the fresh air.

Napping can also be a major culprit when identifying difficulties at bedtime with young children. Parents can be reluctant to shorten naps or eliminate them altogether thereby enabling them to have more time to themselves. After all, who wants a cranky child on their hands? Phasing out naps slowly and shortening them can have a major impact on how easily and what time your child goes to sleep. One must work hard, for example, keeping your child awake in the car in the later afternoon so that he doesn’t go to sleep.

Consistent bedtime routines are KEY to a smooth transition at bedtime. Setting the same time every night is the single most helpful bedtime ritual and the addition of a soothing bath, brushing teeth with a special toothbrush, a small stack of books to choose from, or a short song can all make the pleasure and safety of bedtime better for children.

Since bedtime for children can summon up separation issues and fears, it is crucial for them to feel in CONTROL. For example, one can give them a choice of books to read, which stuffed animal to sleep next to and which “night-night” song to sing.

If children are frightened to be alone, one can sit in the room with them and leave for brief intervals, checking in every five, ten and fifteen minutes. Let them know you’ll be back to check on them. Don’t attempt any long-winded explanations of why they have to sleep. Keep everything loving, comforting, simple and short. Don’t forget to verbally and physically reward your child when for several nights in a row, they have gone to bed well. Three nights become one week, and one week becomes two weeks. Simple rewards and treats, for example, even a new colourful pack of markers or stickers, can show your appreciation. Before you know it, your child will be in the land of Nod.”

Dr. Nyiri Grigorian, LCSW, Phd.

Bedtimenetwork.com   published 10/1/11 issue

On Call with Dr. Lori Rosenberg

Dr. Rosenberg has all the answers to the questions you may have on what to expect when your newborn arrives and will provide you with prenatal advice as well, in her BABY PREP 101 seminar!
Are you having a baby?  Are you excited? Nervous?  Scared?  Have no idea what to expect?  Getting advice from your mother, mother-in-law, father, even father-in-law and from every friend who’s been pregnant?    Don’t know which book to buy, which friend to listen to and which side to sleep on (when you’re not waking up to use the bathroom every three hours)? 
To find the answers to all of your questions, come to BABY PREP 101.  Some of the questions that will be discussed are….

Q:  How do I choose a Pediatrician?

A:  Choosing the right pediatrician for your baby is very important.  You want to find a doctor that you can trust and feel comfortable with because for the first few years, the relationship will be between you and the doctor.  Most doctor practices will allow expectant parents to set up prenatal consults to find out more about the practice, hospital affiliations, on call hours, how appointments are scheduled and phone calls are handled, etc. 

Q:  What do I need to bring with me to the hospital for the baby?

A:  Not much initially.  All hospitals put your baby in diapers and t-shirts.  Some hospitals even provide pacifiers.  You can bring a pacifier from home if you desire.  Anything that you forget to bring, you will have at least a day or two to retrieve.  On the day of discharge, the baby will certainly need a fully assembled car seat and clothes to travel home (bring a few outfits, as one might get soiled prior to departure).

Q:  When does my baby get his or her first shot?

A:  Hepatitis B is offered in the hospital; however, it is not given without parental consent.  Some pediatricians choose to have the hospital administer it, others opt to self-administer at the first office visit.

Q:  How soon after birth will the pediatrician see my baby?

A:  Pediatricians come within twenty four hours to make rounds.  They typically arrive in the morning prior to office hours.  If there is a complicated delivery or emergency, there will always be a pediatrician at the scene (some hospitals have residents, some have house doctors and others will call in the private pediatrician).  Regardless whether the baby is seen at delivery or not, the pediatrician makes rounds daily as long as mom and the baby are in the hospital.
 
Q:  What can I do in my last trimester to prepare for my baby?

A:  Sleep as much as you can!  It might be difficult to do so with a newborn at home.  There are no books to buy or magic tricks to learn that can teach you as much as ‘on the job’ training will.

AND …come to my class:  Baby Prep 101, where you can find out the answers to all of your pre and postnatal questions.

Rid Your Teen of Acne Scars!

On Call with… special guest contributor and friend of Pedimedica William K. Boss, MD, FACS

Rid Your Teen of Acne Scars!

Adolescent acne, while not a threat to the health of young people, has always been a source of stress and psychological discomfort to teenagers in their formative years. Acne hits kids when they are most vulnerable to concerns over appearance and attractiveness. And both boys and girls are susceptible to these stresses. In some cases teens can suffer from significant acne scaring but fortunately, there are many options to treat scaring and Dr. Bill Boss has a takes a very unique approach…simple and easily available treatments for acne and other skin ailments.

A Unique and Highly Successful Approach to Acne Therapy

As a board certified reconstructive and cosmetic surgeon Dr. Boss focuses his efforts in treating acne scars with a very unique and individualized approach that yields excellent results in his patients. Dr. Boss works closely with many dermatologists in different geographical regions, so the treatment is an available option for many prospective patients.

 At the first visit, Dr, Boss needs to determine if the patient is a good candidate for reconstruction. The most important determinant is if the active acne has been under control for the past 6-12 months.  There is no point to treat scarring in patients with active acne because new scars will continually form and the patient will have wasted time, effort, and money.

 The treatment begins with a careful medical history and examination to determine the most effective and least invasive procedures possible.  As a plastic surgeon Dr. Boss can employ the largest variety of techniques possible to treat the scarring. For example, ice pick, deep contracted scars require excision and as a micro surgeon Dr. Boss uses magnification to excise the scars and build up the skin layers to minimize the scar.

Other scars require subcision followed by fractionated lasers or simply lasers alone.  There are also lasers that can treat discolorations and tiny blood vessels around the scars.

In some cases Dr. Boss will utilize long acting fillers when indicated, such as Restalyne, Perlane, Juvaderm, Sculptra and Radiesse.  There is also a new and exciting development in cell therapy that is currently undergoing FDA trials for treatment of acne scars and was recently approved by the FDA for correction of smile lines.  This treatment was invented by Dr. Boss and involves growing the patient’s own collagen producing skin cells known as fibroblasts in a certified laboratory. These cells are then re-injected into the dermis of the skin to help correct the problem.

Often times, the skin that has been ravaged by acne is loose and the face has lost volume; that is when more invasive treatments such as stem cell fat transfers and mini facelifts might be helpful. Fortunately there are many treatment options that are available and can produce tremendous results. However, it is important for the patient to make an appointment for a consult and go over the options with the doctor to determine which treatment is best for the individual.

William K. Boss, MD, FACS is certified by the American Board of Plastic Surgery. He is distinguished among his colleagues, patients and hospital staff for his professional skills, extensive experience and excellent results in cosmetic plastic surgery. Dr. Boss was the former Chief of Plastic Surgery at Hackensack University Medical Center and Assistant Clinical Professor at New Jersey School of Medicine and Yale University School of Medicine. Dr. Boss maintains memberships with various medical societies such as the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Cosmetic Surgery & Rejuvenation Center

385 Prospect Ave., Hackensack, NJ 07601

Tel. 201.488.1035 Fax 201.488.2264

info@drbossmd.com

On Call… with Dr. Mary Thomas

HPV Vaccine: A Pediatricians Argument to Vaccinate Your Daughters AND Sons !

Although millions of dollars and man-hours have proven again and again that our vaccines are safe, many parents are still afraid.  Each day that I am in my office I find myself making pleas to parents to vaccinate their children with routine vaccines recommended by the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) and that are also required by New Jersey schools.  Imagine, then, how challenged I feel when faced with the task of vaccinating young girls, and even young boys with a vaccine that has garnered as much controversy as the HPV vaccine. 

 As a pediatrician, and a mom of three young kids I feel that one of my most important purposes in life is to protect children from illness and disease.  My vaccines are my most powerful tool in doing so.  I might even argue that the HPV vaccine is the sharpest tool in my belt because it is the only one that can protect our children from something that we all fear may sneak up on us – cancer. 

If this article has caught your attention you must have wondered about the HPV vaccine once or twice.  What is it and why is it so important?  HPV (Human Papilloma Virus) is a sexually transmitted virus that infects more that half of sexually active people at one time or another.  Usually it is a benign wart that may even be asymptomatic and will in many cases resolve without treatment.  However, in the US, 15,000 women will develop cervical cancer from that virus; and of those 15,000 women, 4,000 will die. 

Those statistics are very frightening, but for the first time in history, we can change them.  The HPV vaccine prevents most cervical cancer if the vaccine is received before first sexual contact.  This is why the optimal time to vaccinate is at age 11 or 12.  This is also the time when the body is primed to create the best immunity.

The schedule is simple.  The first dose is given and then the second will follow 1 to 2 months later.  A third dose is indicated 6 months after the first dose was received.  It seems easy, but we need to do better.  At present, only 32 percent of girls receive all three vaccines and only 1% of boys.

Yes, boys.  I guess you are thinking “Why should I vaccinate my son, who does NOT have a cervix?”  It is a good question.  On October 26^th the CDC recommended the vaccine for all males ages 11 to 12.  For them it can prevent both genital warts and anal cancer.  There is also evidence that it may prevent some types of head and neck cancer transmitted through oral sex by men who have sex with men.  Don’t write me off at this point, this is not just an STD that affects homosexuals.  At some point we all hope that our sons will find the perfect girl and marry.  This vaccine protects her and helps prevent your son from caring for a wife with a cancer that can be potentially fatal. 

These are things that are hard to think about as parents.  They are even harder to talk about with our children.  A recent study in pediatrics showed that daughters of women who have talked to their mothers about the risks of unprotected sex and the benefits of vaccination were more likely to elect for the vaccine.  Talk to your kids.  Protect them before sexual contact.  You may be saving their life! 

On Call with Dr. Basil Bruno

This month Pedimedica asks Dr. Bruno for his insight and recommendations on how to ease your child’s back to school anxiety.

How to Overcome School Anxiety

Going to school offers a wide range of emotions for parents as well as children. Whether it's dread or excitement, fear or euphoria, all of these feelings can be bottled up inside our kids. Remember that any one symptom of distress does not cement a child's fate or mean that their school year will be a failure. All kids, at some point in their academic career, will struggle, so try hard not to view their setbacks or anxiety as a permanent threat to their school career. Every year that your child goes through school will be filled with highs and lows, good moments and devastating ones. The emotions your child experiences before the start of school can also lead to a general sense of anxiety-a feeling most children won't be able to articulate.
As parents, we have to realize that our children rarely will open up to us if they are experiencing any problems or anxiety, whether at home or at school.  This can be due to embarrassment, fears of being punished, or retribution from siblings or classmates.   And sometimes they just can’t figure out what is bothering them, a common sign of anxiety. Sometimes there are signs that we can pick up on that may help us decide if there is a problem.  Significant changes in behavior sleep patterns, homework or grade patterns, and friendships may be signs that your child is experiencing school issues or anxiety. As parents, it’s our instinct to want to jump right in to protect and help our children.  Although it’s fine to initially address the situation with your child, it’s important to not be overbearing and to back off if you are met with resistance.  It might be helpful to talk to your pediatrician if this occurs.

It's important to remember that when placed in any new situation, all children (and parents, too) are going to need to take time to adjust. Realize that your child will require a period of time to figure out their comfort zone and what's required for them to fit in to their new environment. Fortunately, there are steps you can take as a parent to make the prospect less daunting-the key is to prepare your child both emotionally and physically so that they can have the best start possible this school year.

Proactive parents can help their kids overcome school anxiety. Dr. Bruno lists several tips for parents to employ:

• Identify and address anxieties you have about your struggling child.
• Set a time and place to discuss the issue when your child is most relaxed.
• Start the discussion with hopeful empathy.
• Help your child remember past successes.
• Form a plan.
• Familiarize your child with the school.
• Talk to your pediatrician if you notice any significant changes in behavior.

For Learn more about Pedimedica Hackensack Office, Please visit, www.pedimedica.com

On Call with Dr. Lona Yegen, Pedimedica, Closter Office

Understanding ADD and ADHD and their treatment options from a medical and behavioral approach.

Q.What is ADD and ADHD?
A. Attention Deficit (Hyperactivity) Disorder is a condition in which the child has the following symptoms that may or not be accompanied by hyperactivity:
1. Difficulty in paying attention and focusing.
2. Difficulty with impulsivity.
3. A lack of organizational skills.

Q.How do we diagnose ADD?
A.This is a clinical diagnosis.  It is usually diagnosed after a child enters school and because he/she is having difficulties there.  A child should have a complete physical exam with a Pediatrician to confirm that there are no medical problems that could be causing these symptoms including testing a child's vision and hearing.  There should be an evaluation by the child's' teachers and parents using guidelines to evaluate behavior. The child may be evaluated by a Neurologist, developmental Pediatrician, or a Psychiatrist to make certain the child fits the categories for ADD/ADHD and make sure there are no other concerns e.g. learning disabilities.

Q.How do we treat ADD/ADHD?
A.The medical therapies fall into three categories:
1. Stimulant medication e.g. Ritalin, Concerta, Focalin, Daytrana
2. Non stimulant medication e.g. Straterra
3. Anti-depressants e.g. Wellbutrin
Stimulant medications are the most commonly used medications.  There are side effects to all three classes of medication.  For example, stimulant medications can suppress appetite and growth and can cause difficulty with falling asleep. Therefore, they must be used with supervision by a medical professional to make sure they are well tolerated. The medical therapies will be managed by your pediatrician, neurologist, or psychologist so let us talks about behavioral therapies.

Behavioral therapies are multiple.
1. In managing behaviors there are technologies to improve memory and focus.  For example, while riding in a car, tell the child you are going to play a game.  You are going to name three things and you are going to ask the child to name them later. So, at the beginning of the ride, name three items, e.g. ice cream, bicycle, mountain and at the end of the ride, ask the child to list them.  If the child can name three things consistently, then go to five things.  There is also a board game called Memory which works on the same skills.

2. We also want to teach the child organizational skills.  Organizational skills can start at the beginning of the day.  Ask the child to list “what do I need for the day in school?” and make a check list of all items and assemble books, assignments, clothes e.g. gym clothes, lunch so that he/she is ready for the day.  If the morning is too hectic this can be done at night.  Organizational skills should be done throughout the day.  Give the child a notepad so he/she can write down assignments and a check list for all books so the child is prepared when he/she gets home.  Organizational skill should continue after school.Teach the child to make a schedule for what homework and chores need to be done that day and allot specific times for each subject and task with scheduled breaks for sports, play dates, and hobbies like music lessons.

3. School strategies include placing the child with ADD/ADHD in the front of the class so it is easier to focus on the teacher.  Also, the teacher and child can have a special signal that they choose to remind the child to stay on task.  For example, the teacher can raise her right thumb up as a sign so the child needs to look and listen to her.  No one else will know this special signal.

4. Homework should be done in a quiet place without distractions.

5. Goal setting should be clear and concise.  When a goal or assignment is completed there should be verbal rewards or approval with extra time for a pleasurable activity.

6. There are Psychologists and social skills courses for children who need help with their behavior or relationships.

Q.When should we use medication?

A.Consider the following indicators:

• When all the behavioral and psychological therapies are not working.
• When the child's school performance is below expectations due to his/her inability to concentrate on set skills.
• When the child is not able to control impulsive behaviors leading to relationship problems or when the child is disruptive to others in class.
• When there are concerns that poor academic performance is leading to low self esteem.

Q.When should we not use medication?

A.Consider the following indicators:

• The child is doing well academically in school.
• The child's behavior is not disruptive in class.
• The child's peer and family relationships are good.
• When the parents are concerned about long term use of medication.

On Call with Dr. Kolsky

It’s summer and we all love to be outside and enjoy the great outdoors, but take precaution with your children’s delicate skin.

Infants through teens must be careful when it comes to sun exposure. Dr. Kolsky has researched and posted an extremely informative article from Healthykids.org on this topic and has even included a sun burn instruction sheet that you should print out and keep handy during the lazy, hazy days of summer. Also, remember to check back on this site next week to hear Dr. Suldane’s radio show on this very relevant topic!

So as you slather in the suntan lotion make sure to read these important guidelines:

“We all need some sun exposure; it's our primary source of vitamin D, which helps us absorb calciufor stronger, healthier bones. But it doesn't take much time in the sun for most people to get the vitamin D they need, and repeated unprotected exposure to the sun's ultraviolet rays can cause skin damage, eye damage, immune system suppression, and skin cancer. Even people in their twenties can develop skin cancer.

Most kids rack up between 50% and 80% of their lifetime sun exposure before age 18, so it's important that parents teach their children how to enjoy fun in the sun safely. With the right precautions, you can greatly reduce your child's chance of developing skin cancer.

Facts About Sun Exposure

The sun radiates light to the earth, and part of that light consists of invisible ultraviolet (UV) rays. When these rays reach the skin, they cause tanning, burning, and other skin damage.

Sunlight contains three types of ultraviolet rays: UVA, UVB, and UVC.

1.    UVA rays cause skin aging and wrinkling and contribute to skin cancer, such as melanoma. Because UVA rays pass effortlessly through the ozone layer (the protective layer of atmosphere, or shield, surrounding the earth), they make up the majority of our sun exposure. Beware of tanning beds because they use UVA rays as well as UVB rays. A UVA tan does not help protect the skin from further sun damage; it merely produces color and a false sense of protection from the sun.

2.    UVB rays are also dangerous, causing sunburns, cataracts (clouding of the eye lens), and effects on the immune system. They also contribute to skin cancer. Melanoma, the most dangerous form of skin cancer, is thought to be associated with severe UVB sunburns that occur before the age of 20. Most UVB rays are absorbed by the ozone layer, but enough of these rays pass through to cause serious damage.

3.    UVC rays are the most dangerous, but fortunately, these rays are blocked by the ozone layer and don't reach the earth.

Melanin: The Body's First Line of Defense

UV rays react with a chemical called melanin that's found in skin. Melanin is the first defense against the sun because it absorbs dangerous UV rays before they do serious skin damage. Melanin is found in different concentrations and colors, resulting in different skin colors. The lighter someone's natural skin color, the less melanin it has to absorb UV rays and protect itself. The darker a person's natural skin color, the more melanin it has to protect itself. (But both dark- and light-skinned kids need protection from UV rays because any tanning or burning causes skin damage.)

Also, anyone with a fair complexion — lighter skin and eye color — is more likely to have freckles because there's less melanin in the skin. Although freckles are harmless, being outside in the sun may help cause them or make them darker.

As the melanin increases in response to sun exposure, the skin tans. But even that "healthy" tan may be a sign of sun damage. The risk of damage increases with the amount and intensity of exposure. Those who are chronically exposed to the sun, such as farmers, boaters, and sunbathers, are at much greater risk. A sunburn develops when the amount of UV exposure is greater than what can be protected against by the skin's melanin.

Unprotected sun exposure is even more dangerous for kids with:  

• moles on their skin (or whose parents have a tendency to develop moles)
• very fair skin and hair
• a family history of skin cancer, including melanoma

You should be especially careful about sun protection if your child has one or more of these high-risk characteristics.

Also, not all sunlight is "equal" in UV concentration. The intensity of the sun's rays depends upon the time of year, as well as the altitude and latitude of your location. UV rays are strongest during summer. Remember that the timing of this season varies by location; if you travel to a foreign country during its summer season, you'll need to pack the strongest sun protection you can find.

Extra protection is also required near the equator, where the sun is strongest, and at high altitudes, where the air and cloud cover are thinner, allowing more damaging UV rays to get through the atmosphere. Even during winter months, if your family goes skiing in the mountains, be sure to apply plenty of sunscreen; UV rays reflect off both snow and water, increasing the probability of sunburn What's important is to protect your family from exposure to UVA and UVB, the rays that cause skin damage.

With the right precautions, kids can safely play in the sun. Here are the most effective strategies:

Avoid the Strongest Rays of the Day

First, seek shade when the sun is at its highest overhead and therefore strongest (usually 10 a.m. until 4 p.m. in the northern hemisphere). If kids must be in the sun between these hours, be sure to apply and reapply protective sunscreen — even if they're just playing in the backyard. Most sun damage occurs as a result of incidental exposure during day-to-day activities, not at the beach.

Even on cloudy, cool, or overcast days, UV rays travel through the clouds and reflect off sand, water, and even concrete. Clouds and pollution don't filter out UV rays, and they can give a false sense of protection. This "invisible sun" can cause unexpected sunburn and skin damage. Often, kids are unaware that they're developing a sunburn on cooler or windy days because the temperature or breeze keeps skin feeling cool on the surface.

Make sure your kids don't use tanning beds at any time, even to "prepare" for a trip to a warm climate. Both UVA and UVA/UVB tanning beds produce sunburn. And there is an increase in the risk of melanoma in people who have used tanning beds before the age of 35.

Cover Up

One of the best ways to protect your family from the sun is to cover up and shield skin from UV rays. Ensure that clothes will screen out harmful UV rays by placing your hand inside the garments and making sure you can't see it through them.
Because infants have thinner skin and underdeveloped melanin, their skin burns more easily than that of older kids. But sunscreen should not be applied to babies under 6 months of age, so they absolutely must be kept out of the sun whenever possible. If your infant must be in the sun, dress him or her in clothing that covers the body, including hats with wide brims to shadow the face. Use an umbrella to create shade.

Even older kids need to escape the sun. For all-day outdoor affairs, bring along a wide umbrella or a pop-up tent to play in. If it's not too hot outside and won't make kids even more uncomfortable, have them wear light long-sleeved shirts and/or long pants. Before heading to the beach or park, call ahead to find out if certain areas offer rentals of umbrellas, tents, and other sun-protective gear.

With the right precautions, kids can safely play in the sun. Here are the most effective strategies:

Avoid the Strongest Rays of the Day

First, seek shade when the sun is at its highest overhead and therefore strongest (usually 10 a.m. until 4 p.m. in the northern hemisphere). If kids must be in the sun between these hours, be sure to apply and reapply protective sunscreen — even if they're just playing in the backyard. Most sun damage occurs as a result of incidental exposure during day-to-day activities, not at the beach.

Even on cloudy, cool, or overcast days, UV rays travel through the clouds and reflect off sand, water, and even concrete. Clouds and pollution don't filter out UV rays, and they can give a false sense of protection. This "invisible sun" can cause unexpected sunburn and skin damage. Often, kids are unaware that they're developing a sunburn on cooler or windy days because the temperature or breeze keeps skin feeling cool on the surface.

Make sure your kids don't use tanning beds at any time, even to "prepare" for a trip to a warm climate. Both UVA and UVA/UVB tanning beds produce sunburn. And there is an increase in the risk of melanoma in people who have used tanning beds before the age of 35.

Use Protective Eyewear for Kids

Sun exposure damages the eyes as well as the skin. Even 1 day in the sun can result in a burned cornea (the outermost, clear membrane layer of the eye). Cumulative exposure can lead to cataracts (clouding of the eye lens, which leads to blurred vision) later in life. The best way to protect eyes is to wear sunglasses.

Not all sunglasses provide the same level of ultraviolet protection; darkened plastic or glass lenses without special UV filters just trick the eyes into a false sense of safety. Purchase sunglasses with labels ensuring that they provide 100% UV protection.

But not all kids enjoy wearing sunglasses, especially the first few times. To encourage them to wear them, let kids select a style they like — many manufacturers make fun, multicolored frames or ones embossed with cartoon characters. And don't forget that kids want to be like grown-ups. If you wear sunglasses regularly, your kids may be willing to follow your example. Providing sunglasses early in childhood will encourage the habit of wearing them in the future.

Double-Check Medications

Some medications increase the skin's sensitivity to UV rays. As a result, even kids with skin that tends not to burn easily can develop a severe sunburn in just minutes when taking certain medications. Fair-skinned kids, of course, are even more vulnerable.

Ask your doctor or pharmacist if any prescription (especially antibiotics and acne medications) and over-the-counter medications your child is taking can increase sun sensitivity. If so, always take extra sun precautions. The best protection is simply covering up or staying indoors; even sunscreen can't always protect skin from sun sensitivity caused by medications.

If Your Child Gets a Sunburn

A sunburn can sneak up on kids, especially after a long day at the beach or park. Often, they seem fine during the day but then gradually develop an "after-burn" later that evening that can be painful and hot and even make them feel sick.

When kids get sunburned, they usually experience pain and a sensation of heat — symptoms that tend to become more severe several hours after sun exposure. Some also develop chills. Because the sun has dried their skin, it can become itchy and tight. Sunburned skin begins to peel about a week after the sunburn. Encourage your child not to scratch or peel off loose skin because skin underneath the sunburn is vulnerable to infection.

If your child does get a sunburn, these tips may help:

• Have your child take a cool (not cold) bath, or gently apply cool, wet compresses to the skin to help alleviate pain and heat.
• To ease discomfort, apply pure aloe vera gel (available in most pharmacies) to any sunburned areas.
• Give your child an anti-inflammatory medication like ibuprofen or use acetaminophen to lessen the pain and itching. (Do not, however, give aspirin to children or teens.) Over-the-counter diphenhydramine may also help reduce itching and swelling.
• Apply topical moisturizing cream to rehydrate the skin and treat itching. For the more seriously sunburned areas, apply a thin layer of 1% hydrocortisone cream to help with pain. (Do not use petroleum-based products, because they prevent excess heat and sweat from escaping. Also, avoid first-aid products that contain benzocaine, which may cause skin irritation or allergy.)

If the sunburn is severe and blisters develop, call your doctor. Until you can see your doctor, tell your child not to scratch, pop, or squeeze the blisters, which can become easily infected and can result in scarring. Keep your child in the shade until the sunburn is healed. Any additional sun exposure will only increase the severity of the burn and increase pain.

Be Sun Safe Yourself
Don't forget: Be a good role model by consistently wearing sunscreen with SPF 30 or greater, using sunglasses, and limiting your time in the sun. These preventive behaviors not only reduce your risk of sun damage, but teach your kids good sun sense.

Reviewed by: Kate M. Cronan, MD

Date reviewed: August 2010