What you need to know about Juuling (and other electronic cigarettes)!

Juuling has quickly become very popular in our high schools, colleges, and even middle schools.  While electronic cigarettes were created to help people quit smoking, in young people they are actually becoming the introduction to tobacco use.  Here are some key things to know:

Safer does not equal safe.  Yes there are no studies linking e-cigarettes to cancer.  Just because e-cigarettes are safer than traditional cigarettes does not mean they are safe.  They still contain many chemicals that we know are airway irritants and carcinogens.  They contain nicotine.   We have no long term studies of the safety of e-cigarettes.

Nicotine is addictive. The Juul pods contain the same amount of nicotine as a pack of cigarettes.    Some e-cigarettes juice is even stronger.  Studies have shown e-cigarette fluid that claims to be nicotine free often contains nicotine.  We also know nicotine affects the developing brain leading to difficulties with attention, learning, impulse control, and mood.

Teens are the target of advertisement. Juul, the most common e-cigarette used among teenagers, began advertising on Youtube, Instagram, and Twitter.  There is a huge social media presence of Juul and Juul is starting to show up in TV shows and movies.  #doitforJuul is a common hashtag that people use to show them using a Juul.  This affects teens, even if they do not realize.

People vape a variety of substances. On youtube you can find videos of people using a variety of fluids including caffeine, alcohol, and Marijuana. Anytime someone is breathing in a substance, it is likely to irritate the airwyas.  There have even been cases of people dying after vaping synthetic cannabinoid.

Juul use is increasing tobacco use among teens. Starting in the 1990s there was a steady decline in tobacco use among teenagers, reaching as low as 12% of all teenagers ever using tobacco.  With the advent of Juul, as many as 35% of teenagers admit to using nicotine containing products.  Unfortunately, many of these Juul users go on to smoke traditional cigarettes.

Juul and other ecigarette companies create fruit flavored fluids that appeal to young users.  Juul can be easily concealed and has become a trend among high school students.  Our teens are getting addicted to nicotine and we must do our best to prevent this!

By Dr. Ashlee Mickelson

Parenting Through Puberty

I know when my oldest let me know about the changes, I wasn’t ready.  I had prepared my child with what to expect, gotten her some nice books about it that we read together. But, when the time arrived, I thought, “already?”

The changes of puberty are different for every child, but there are some points that help know what’s ahead, just around the corner.

Physical Changes

 

For girls, the changes of puberty start between 8 and 13 years old.  Usually the first sign is breast development.  It commonly takes about two years to get from there to the first menses, or period.  Along the way, development of pubertal hair and a growth spurt usually ensue as well.  When girls start menses, it can be irregular in the first year, but it tends to become more regular with time.

For boys, the changes of puberty start between 9 and 14 years of age.  This starts with genitals enlarging, followed by pubertal hair.  Then they will develop increased muscle mass and voice changes, with the start of these averaging at 13 ½ years old. The peak height for boys is usually reached by 17 years old, 2 years past that for girls.

Both girls and boys will have other changes as well, including hair growth, acne, and body odor.  If you have questions or concerns about whether your child’s patterns are normal, it’s important to ask your healthcare provider.

Emotional Changes

 

Along with the physical changes, there are many emotional changes with puberty as well. Adolescent youth begin to become more independent and less interested in having the attention of their parents.  Some will lose their temper more easily and have more mood swings.  It’s important to keep the conversation open with these changes, both physical and emotional.  Being positively and proactively involved in your child life, even when it’s not invited, helps them know you support them when they need it.

Puberty is Starting Earlier

 

Despite the normal ranges of puberty described above, the onset of puberty has gotten earlier over the years. The cause is unclear, but we know several factors can lead to an earlier start.  Trends from lifestyle factors include an earlier start for girls with more sugar intake (independent of weight), also an earlier start for girls with obesity.  There are differences in the start of puberty with different racial background as well, with puberty often occurring earlier in African-American children.


Booklist

 

Some books that may help open the conversation with you and your child include “The Care and Keeping of You: A Body Book for Girls” by Valerie Lee Schafer and “Guy Stuff: the Body Book” by Dr. Cara Natterson.  These are appropriate for kids 8 years old and up according to Common Sense Media, a website with recommendations on books and movies for kids that are age appropriate.


Are My Child’s Changes Normal?

 

If your girl starts showing signs of puberty before 8 years old or your boy before 9, it’s worth bringing up with your provider to discuss further.  Similarly, if your girl has not started these changes by the time she reaches 13 or your boy by 14, that’s a good reason to discuss as well. Your annual well-child visits are a great opportunity for providers to evaluate these development milestones and make sure things are on track. Please make sure to keep up-to-date on these important visits.

Entering into the next stage can be an intimidating phase for parents and kids alike, but it’s all about being there for your child in an open and honest way.

By Dr. Deborah Wiser, Chief Medical Officer

Skin Protection in the Winter

We all know that the skin is the largest organ of the body.  But sometimes we forget how important healthy skin is for a healthy body. Your skin does many jobs like helping your body control its temperature and protecting you from germs like bacteria that might make you sick.  A way to think of your skin is like a strong concrete wall.  Skin cells form a good barrier when they have strong connections to each other, just like concrete blocks need cement to keep them stuck together.  And just like any good wall, if we don’t care for it the wall might start to crack and fail – with our skin that might mean infection or inflammation.

So, let’s review skin health, which is especially important during the winter when the air doesn’t hold as much moisture and dry weather makes it easier for our “strong wall” of skin cells to crack and weaken.

Signs that our skin might be starting to weaken:

  • Chapped lips
  • Dry, itchy arms and legs
  • Cracked hands and feet
  • Small white patches on the cheeks

Skin Moisture – Our goal is to combat the dry air.  Here are a few tips:

  • Use a moisturizer
    • Find a moisturizer that you like – the best moisturizers are thick and do not have fragrances or other additives, especially for those of us with sensitive skin.
    • Some options that I like to use: CeraVe, Cetaphil, coconut oil, or even ointments like petroleum jelly (as long as we can keep it from staining your clothes!)
    • If a lotion has a pump it might mean that water was added to the lotion, which can actually dry the skin.
      • Better to find a tub or squeeze tube.
    • Apply 1-2 times every day, especially after baths or showers when the water washes away natural skin oils
      • Overuse of hand soap can also remove natural oils
    • Moisture comes from the inside too!
      • Drink water throughout the day whenever you are thirsty and more often when you are exercising, spending time outside or sick.

Skin care can be quick and simple! Even if you do not have obvious signs of skin dryness, having a daily routine will keep your skin happy and healthy.

What’s a good present that we can all give to ourselves this winter season? Answer: A big tub of moisturizing skin cream!

by Dr. Marcus Baca

Winter Weather Safety

Winter is here and kids are excited to get outside and play in the snow. Parents know that the cold temperatures can also bring potential dangers. Fortunately, there are several steps you can take to keep your family safe this time of year.

 

Dress for the Weather:

-Dress children in layers when they go outside to help them stay warm and dry. This should include a hat, gloves or mittens, warm socks and waterproof boots. Make sure to remove and replace any wet clothes right away.

– Remember that sun sunscreen and sunglasses are important this time of year because the snow reflects the sun’s UV rays.

-Give your child a snack before they go outside. It’s also a good idea to have children come inside about once every hour to warm up and drink fluids.

 

Use Caution when Participating in Winter Sports:

-Children and teens should wear a properly fitted helmet for skiing, snowboarding and sledding.

-Avoid sledding on steep hills or areas where there are trees, large rocks, or busy streets nearby.

-The American Academy of Pediatrics advises that teens younger than 16 should not operate snowmobiles and children younger than 6 should not ride on them.

 

Be Aware of Signs of Danger:

-Signs of frostbite are pale, grey or blistered skin. Frostbite most commonly occurs on the ears, nose, fingers, and toes. If you think your child has frostbite, seek medical care.

-Signs of hypothermia are shivering, slurred speech, clumsiness and confusion. If you suspect your child has hypothermia, call 911 immediately.

 

Keep Your Family Safe Inside the Home:

-Make sure that smoke and carbon monoxide alarms are installed and in working order on every level of the home and in all sleeping areas.

-Be careful around fires. Put a protective gate around the fireplace if there are small children in the house.

-Keep an emergency kit at home and in the car. Stock the kit with extra blankets and clothes, flashlights, batteries, matches, a first aid kit, bottled water, and non-perishable food.

 

Washing hands frequently and keeping your family’s immunizations up to date are also important ways to stay healthy this winter.

Let’s Talk About Teeth!

Healthy teeth are an important part of a healthy body.  Spending a few minutes each day taking care of your teeth keeps your smile beautiful and your body happy.

Did you know?

Children who visit the dentist before they are four years old are less likely to need dental procedures (crown placement, restorations, tooth removal) compared with children who start seeing the dentist at a later age.

 

Keep Those Pearly Whites Shining Bright

  • Clean teeth twice daily with a soft toothbrush
  • Brush for two minutes each time (sing the ABCs in your head three times!)
  • Start flossing once per day as soon as teeth begin to touch
  • Parents should supervise brushing until at least kids are able to tie their shoes

A word about fluoride:

  • Use fluoride-containing toothpaste for all children with teeth – For children less than three years, use an amount the size of a grain of rice. For children over three, use an amount the size of a pea!
  • Most of the water in the Spokane area is non-fluoridated, consider a fluoride supplement – ask your doctor!
  • Have fluoride painted on your teeth as often as recommended by your dentist or doctor

Watch What You Eat – Your Teeth Are Counting On It!

  • Frequent snacking and sugary beverages during the day may increase the risk of dental decay
    • If you plan on snacking on sugar-containing drink (soda/juice/sports drink), drink it within a limited time instead of slowly sipping during the day
    • Try to give your mouth a three hour break between sugary foods/drinks
  • After sugary foods and beverages try rinsing your mouth with water or chewing sugarless gum
  • Watch out for: hard candy, gummy candy/vitamins, cough drops, fruit leathers

A Moment for the Young Ones:

  • The first tooth usually appears around six months of age
  • Think about scheduling the first dental visit at the one year birthday
  • Start a training cup (sippy cup) at six months. Plan to ditch all bottles by one year

Factors that increase the risk of developing dental decay:

  • Bottle use beyond 12 months of age
  • Using a sippy cup throughout the day (especially for juice/sugary drinks)
  • Exposure to secondhand smoke
  • Using a bottle at bed time
  • Breastfeeding past 12 months if nursing overnight

By Dr. Baca, MD

Tips for summertime fun!

Go outside! The warmer months are a wonderful opportunity to explore, play and learn outdoors.

Here are a few tips to stay safe in the sun:

Bright Sun and Healthy Skin
• Keep your skin protected from sun damage to prevent sunburns, skin cancers and wrinkles later in life. Remember that small amounts of sun exposure over time causes most sun damage – It is important to protect yourself every day, not just on long pool days.
• Use sunscreen that is at least SPF 30 or higher, protects from UVA and UVB rays, and is water resistant if you will be spending time in the water. Re-apply every 2 hours and after getting out of the pool!
• Fight heat exhaustion! It can start slowly but become serious quickly.
– Drink plenty of fluids on hot days, especially during time in the sun.
– Be careful about moderate to heavy exercise at midday.
– If overheating, have your child lie down in the shade and seek medical care immediately if concerned.

 

Hiking and Camping
• There is Poison Ivy all around in Eastern Washington and North Idaho. Don’t forget: “leaves of three, let them be”.
• Check for ticks! Lyme disease, which ticks can carry, is not common in Washington. It is still important to examine for ticks and remove them quickly if they are found. Be sure to check behind the ears, scalp, under the arms and groin.
• DEET-containing insect repellent is safe for children older than 2 months old. Use 10-30% and apply one time per day. Do not apply to the face, or to the hands of young children.

 

Water Activities
• Learn about water safety. Swimming is fun and can be a lifelong healthy activity, but it is very important to know how to stay safe around the water. Nearly 1,000 kids drown each year – most in swimming pools.
• Plan to enroll in swimming lessons after the child turns four years old. Even if a child knows how to swim, all children deserve close observation when around water.
• Life vests are very important for kids to wear whenever they are near water.
• Install a fence around a pool if there is one in the home.
• If there is concern for drowning, pull the child out of the water, call for help/911, and if child is not breathing start CPR if you have been trained.

Learn more by asking your pediatrician!

by Marcus Baca, MD – Pediatrician at Valley Clinic

Autism, what is it?

Autism spectrum disorder (ASD) is a complex developmental disability; signs typically appear during early childhood and affect a person’s ability to communicate, and interact with others. Your Pediatrician can start to recognize these symptoms between 1-2 years old and should be testing for concerns. ASD is defined by a certain set of behaviors and there is a wide spectrum as to how it impacts each child’s life.

There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes.

Many of the early signs of Autism deal with difficulties with social interaction. 

The range and severity of symptoms can vary widely. Common symptoms include:

  • difficulty with communication
  • difficulty with social interactions
  • obsessive interests
  • repetitive behaviors
  • difficulty making eye contact
  • poor motor skills’ and sensory sensitivities (overly sensitive to the feel of clothing or texture of foods).

A person with ASD may follow many of these behaviors or just a few, or many others as well. The diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity and how they impact that child life and learning.

Autism is treatable.

Children do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. For more information on developmental milestones, visit the CDC’s “Know the Signs. Act Early” site.

  • Lack of or delay in spoken language
  • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
  • Little or no eye contact
  • Lack of interest in peer relationships
  • Lack of spontaneous or make-believe play
  • Persistent fixation on parts of objects

Early recognition, as well as behavioral, educational, and family therapies may reduce symptoms and support development and learning.

Cold or Allergies?

Spring is here and we are all looking forward to longer days and warmer weather. However, this time of year can also bring seasonal allergies for many.

There are two types of allergies, year round and seasonal. Allergy symptoms that last throughout the year are often caused by indoor allergens such as pet dander or dust mites. Seasonal allergies, or allergic rhinitis, occur when the immune system reacts to harmless substances including mold, dust mites, pet dander and pollen. In response, the body releases histamine, which can cause nasal drainage, sneezing, coughing, throat irritation, and itchy watery eyes.

Seasonal allergies are usually related to pollen from weeds, grass and trees. You may also notice that allergy symptoms are worse at certain times of day. Someone allergic to dust may have symptoms when they first wake up in the morning while someone who has a grass allergy may experience symptoms after being outside.

Because the symptoms of allergic rhinitis are similar to the common cold, it can sometimes be difficult to determine what is causing symptoms.


Questions to Consider:

  • Length of symptoms. The common cold typically resolves within 2 weeks. If symptoms last longer than this, it may be time to look at allergies as a possible cause.
  • Do you have a fever? Allergies do not cause a fever, so if your symptoms are accompanied by an elevated temperature, it is safe to believe you have virus.
  • Do you have eye symptoms? Allergy symptoms usually include itchy, watery and irritated eyes, while the common cold does not.

 


To diagnose allergies, your provider may order allergy testing through a blood or skin test. Many medications and lifestyle modifications can help control allergy symptoms. See your healthcare provider if you suspect allergies or have any questions or concerns about your symptoms or condition.

Is it a Cold or Seasonal Allergies?

Spring is around the corner and we are all looking forward to longer days and warmer weather. However, this time of year can also bring seasonal allergies for many families and children.

Seasonal allergies, or allergic rhinitis, occur when the immune system reacts to harmless substances including mold, dust mites, pet dander and pollen. In response, the body releases histamine, which can cause nasal drainage, sneezing, coughing, throat irritation, and itchy watery eyes.

 

Allergy symptoms that last throughout the year are often caused by indoor allergens such as pet dander or dust mites. Seasonal allergies are usually related to pollen from weeds, grass and trees. Parents may also notice that their child’s allergy symptoms are worse at certain times of day. A child that is allergic to dust may have symptoms when they first wake up in the morning while a child that has a grass allergy may experience symptoms after they have been playing outside.

 

Because the symptoms of allergic rhinitis are similar to the common cold, it can sometimes be difficult to determine what is causing a child’s symptoms.

 

Questions to Consider:

  • How long has your child had symptoms? The common cold typically resolve within 2 weeks, so if your child has symptoms that last longer than this it may be time to look at allergies as a possible cause.
  • Does your child have a fever? Allergies do not cause a fever, so if your child’s symptoms are accompanied by an elevated temperature it is safe to assume that they have a virus.
  • Does your child have eye symptoms? Allergy symptoms usually include itchy, watery and irritated eyes while the common cold does not. Dark circles under the eyes are also a common sign of allergies in children.
  • Do any of your child’s playmates or siblings have similar symptoms? If you have noticed that other children that your child has been in close contact with have similar symptoms, a virus is the most likely cause.
  • Is there a family history of allergies? Allergies are more common in families with a history of allergies.

 

To diagnose allergies, your child’s provider may order allergy testing through a blood or skin test. Many medications and lifestyle modifications can help control allergy symptoms. See your child’s healthcare provider if you suspect allergies or have any questions or concerns about your child’s symptoms or condition.

Heart Pearls – Statins

In honor of February being American Heart Month, I’m sharing pearls from my conversations with family members about cardiovascular disease. Even though I am an Ivy-League trained nurse practitioner with nearly two decades of experience of keeping patients healthy, I’ve found that even my loved ones doubt my perspective until it is validated by their own medical providers, the CDC, or even (shudder) a celebrity interview.

 

“Ask for a statin,” I said to my husband.  His cholesterol had been climbing on his annual work health screening and starting a regular exercise program hadn’t done anything to bring it down.  Long-term research about statins not only shows that they are proven to reduce incidents of heart attacks and strokes, but that they also reduce the incidence of certain types of cancers.  They are not for everybody (especially women at risk of pregnancy), but my experience has shown that very few people have side effects while on statins. Those that do can usually reduce their side effects by taking a daily CoQ10 supplement  along with the statin.

 

Even small amounts of extra cholesterol can accumulate in the blood vessels over the years and lead to hardening of the arteries, so treat slight elevations just as aggressively as very high elevations. When it comes to cholesterol management, it is worth investing in your long-term health.

 

As for my husband, he eventually had a conversation with his own provider, and I had a happy-dance when he came home with a Pravachol prescription.

 

By Ginger Blake, ARNP at North County Clinic