The Doctor is In...Archived Questions

Questions:

• A director has called to ask what she needs to know to serve a child with Hunter’s syndrome. What do I need focus my consultation efforts towards?
• How shall I advise a child care program serving a child with eczema? Sometimes the child scratches himself until he bleeds.
• A director has called to ask what she needs to know to serve a child with Hunter’s syndrome. What do I need focus my consultation efforts towards?
• During warm months some preschoolers were coming with VitaminWater or Monster Energy Drink. Is this okay?

1. Keep the skin clean and prevent blood exposure to the child’s classmates: The child’s pediatrician may recommend a gentle moisturizing soap. (Dove is an inexpensive choice). A non-stick gauze dressing with Vaseline or antibiotic cream should be used to cover the bleeding wounds as the sticky part of a Band-Aid can sometimes worsen the surrounding eczema.
   
   
2. Decrease the child’s itching: The child may have creams which need to be applied while in care. These include: a prescription-strength steroid cream stronger than the 1% hydrocortisone one can buy over the counter and moisturizing creams. Eucerin Crème is a good option, but if cost is a concern the pediatrician may suggest that Crisco shortening--used successfully for years--still works! In addition, diphenhydramine (Benadryl) may be prescribed to decrease the child's itching.
   
   
3. Decrease the trauma of the scratching: Be sure parents clip and file this child’s nails. In addition, try to keep light long sleeves or pants on to cover affected areas. Finally, keep those little hands busy doing something productive at the play table!

Dr. Thomas Ball

Question: “A director has called to ask what she needs to know to serve a child with Hunter’s syndrome. What do I need focus my consultation efforts towards?”

Answer: Hunter’s Syndrome is a genetic disorder that is the result of an enzyme deficiency. There is a mild and severe form of the disorder that is determined by the age of onset, degree of central nervous system involvement, and rapidity of deterioration. In the mild form no special care is required during the preschool years and survival into adulthood is expected. Unfortunately, for children with the severe form rapid deterioration of growth, hearing, mental capacity, and appearance occurs during the first 2-6 years of life.

Issues of importance for the CCHC are to first determine if the child has the mild or severe form of disease by asking the parents. They will usually know by their own family history, genetic studies, or from their child’s geneticist. For children with the severe form the child care provider can expect gradual loss of hearing during the preschool years and sometimes increased aggressive hyperactive behavior related to the declining mental capacity. It is common for the children to have partial contractures of the joints and spasticity during their decline; therefore, play options will gradually need to be limited. Coarsening of facial features, hair growth over the body, skin lesions and large head are common but mostly of cosmetic concern, while seizures and diarrhea are less common but a concern for caretakers. Since death is ultimately usually related to congestive heart failure or airway obstruction it is recommended to obtain information from the parents regarding recent pediatric cardiology and/or pediatric pulmonary medical opinions. Lastly, if you have the parent’s consent don’t hesitate to contact the nurse, social worker, or doctor where the child is receiving care as they will often be a good source of information regarding the specific child. All these children should be receiving care from a geneticist and/or Children’s Rehabilitative Clinics.

Dr. Thomas Ball


Question: "During warm months some preschoolers were coming with VitaminWater or Monster Energy Drink. Is this okay?"

Short answer: No! Teach children to reach for unsweetened beverages.

Long answer: While parents should be applauded for sending extra fluids with their children to keep them hydrated in Arizona’s hot summer months, Vitaminwater and Monster Energy drinks are unhealthy choices for young children.

Vitaminwater is a mixture of distilled water with added vitamins, herbs and flavors. On the surface this doesn’t sound so bad. What might not be as evident is that, Vitaminwater also contains a lot of sugar. A 20 ounce bottle of Vitaminwater contains nearly 8 teaspoons (125 calories and 32.5 grams) of sugar. That’s nearly as much as 12 ounces of Coca Cola. Parents, who are health conscious enough to seek out a beverage with added vitamins, usually don’t want their preschoolers consuming large amounts of sugar.

With childhood obesity at epidemic proportions all parents should monitor and restrict the use of sugar sweetened beverages by their children. Sugar sweetened beverages (SSBs) include not only Vitaminwater and Energy drinks, but sodas, fruit drinks, punches, horchata, and sports drinks. Consumption of sugar sweetened beverages has been linked to less healthy diets, obesity, and dental decay. Consuming SSBs can reduce a child’s intake of important nutrients from other sources. The Arizona Chapter of the American Academy of Pediatrics recommends that children consume zero or nearly zero sweetened drinks be each day.

One specific type of Vitaminwater, ‘Vitaminwater Energy,’ also contains caffeine and guarana. Guarana is from a plant grown in the Amazon and contains much higher levels of caffeine than the coffee bean. So this type of Vitaminwater has caffeine plus more caffeine- definitely a bad choice for children. The added sugar and calories, not to mention the possibility of caffeine and guarana offset any benefit from the vitamins that may be present in the Vitaminwater.

Monster Energy Drinks also contain sugar. They have about 13 teaspoons of sugar (54 grams per 16 oz can). This is a huge amount of sugar. Children have much smaller calorie needs than adults, so getting 160 calories from a drink that provides little or no nutrition is a major problem. Just 2 bottles a week above a child’s caloric needs is enough to pack on nearly 5 extra pounds in a year, contributing to an increased risk of obesity.

Monster Energy Drinks also contain caffeine AND guarana. Some Energy drinks contain ginseng, which may cause insomnia and increased blood pressure, and is not recommended for children. The manufacturer has included a warning label that says Monster Energy Drinks are not recommended for children under 10 years of age.

So what would be a better choice of drink? Water and low-fat or fat-free milk are the preferred drinks for children over 2 years of age. Water should be accessible to children throughout the day. Adults should encourage children to drink, especially in warm weather. The Arizona Department of Health requires child care providers participating in the Empower Program to offer children (not infants), water at least 4 times during the day. Training children early to reach for a non-sweetened beverage when they are thirsty may help them maintain healthy weights as they grow into adulthood. Children will often consume drinks better if the beverages are cold. One of the best strategies we may have to prevent childhood obesity and dental caries is to teach our children to reach for water rather than a sugar sweetened beverage when they are thirsty.

Diane Hiratsuka & Dorothy D. Johnson