In the quest to avoid potentially harmful chemicals in commercial sunscreens; bloggers, parents, and marketers have be rekindling the notion of “natural sunscreens.” 

Coconut oil seems the natural option du jour. “Health” bloggers are touting coconut oil as a great way to get a “healthy tan” without the burn, and a great way to “safely” get a boost of vitamin D. 

Now, before you run to the kitchen cupboard to grab this edible elixir, you should recognize a HUGE credibility error in these claims.

No tan is a healthy tan. Any “expert” claiming the contrary is simply wrong. 

Coconut oil has no significant SPF (Sun Protection Factor) and is NOT a reliable choice for protection from UV sun damage.

Those claiming coconut oil’s ability to protect against the sun’s rays are often reviving narratives from the oil’s deep folk medicine roots. The oil’s long history in folk medicine includes treatment from everything from seizures, pancreatitis, and diabetes; to infertility, osteoporosis, and cancer. It has also been used for centuries as protection from sunburn for people native to tropical climates, including India and equatorial islands. 

The oil’s anecdotal ability to protect against sunburn has been fueled by a recent study claiming that the oil is able to block 20% of the sun’s UV rays. 

Even if this is true, the sun protection provided by coconut oil is still well below the AAD-recommendation of protecting our skin with a broad-spectrum (UVA/UVB), SPF 30 (blocking 97% of UV rays) product.

Interestingly, chicken oil (created by boiling a chicken carcass and skimming off the fat) had significantly better UV protection in the study. It seems the pale yellow color and chicken smell, however, has dampened its potential for commercial popularity. 

The good news there are some better options for broad-spectrum UV protection for parents looking for a natural sunscreen alternative. 

• Wear UPF-rated clothing and swim attire. I LOVE UPF-rating clothing on kids. The clothing covers large areas of skin; is very breathable, comfortable, and easy-care; and eliminates potential concerns of chemical exposure. Numerous companies have sun-blocking garments for the whole family. Some favorites are Coolibar,  REI , and LL Bean. Just don’t forget to apply mineral sunscreen to the few areas still exposed to the sun. 
• Use SPF-rated mineral sunscreens. Look for sunscreens with zinc oxide and titanium dioxide as the active ingredients. These are natural minerals that form a physical barrier between the sun’s UVA/UVB rays and your skin. The minerals “float” on the top of the skin, not being absorbed. Be sure to look for “water resistant” and SPF 30 on the label, as well. 
• Shield from the sun. Shade, wide-brimmed hats, and sunglasses are always in vogue.  This video demonstrates things to look for when choosing sunglasses for your children. 

Need more help?

• The Environmental Working Group, an American environmental health research organization, has published their favorite sunscreens for 2013. See if your favorite made the list.  
• Local dermatologists Dr. Molly Menser of Sunflower Dermatology and Dr. Amy Jo Nopper of Children’s Mercy Hospital recently discussed sun protection on Kansas City’s NPR affiliate, KCUR. I highly recommend this very informative and entertaining segment (5/22/13) for more credible sun protection information. 

We know that about 80% sun damage occurs before the age of 18. Make the choice to aggressively protect your child from the sun’s harmful rays. Then, get outside and have fun! 

When a child happens to get a common wart, families have 2 questions: How to prevent, and how to remove.

First, how to prevent. 

We know that warts are contagious, and are caused by a virus. Just like a virus that can cause a sore throat or a sore tummy, wart virus can spread by touching skin or surface that is contaminated. We prevent warts, therefore, by reducing the chance of coming into contact with the virus. 

Despite the age-old advice of protecting yourself against warts by wearing flip-flops into communal showers (memories of the college dorm, anyone?), few studies have examined how warts actually spread. A new study in Pediatrics looked at wart transmission in school aged children to get some better answers. Researchers found that warts are more commonly spread within household members and school classmates, rather than public areas. Sorry, shower shoes.

Based on this information, the best way to keep warts away is likely good personal hygiene. And if you do have a wart, keep it covered with a Band-Aid, especially at home and at school. 

Second, how to remove. 

Historically warts have been treated with all sorts of all interesting things. From Tom Sawyer’s “stump water” to Huck Finn’s graveyard cat , generations have tried to get rid of these bothersome bumps. 

Today, the good news is the vast majority of warts is able to be taken care of at home. Here is what I typically recommend for common warts on the hands and feet:

1. A good soak in the tub. 
2. Once the area is soft from the soak, rub the wart gently with a pumice stone or emory board to additionally soften and remove the hard calloused skin from the top of the wart.
3. Apply an over-the-counter salicylic acid product (liquid, like Compound W®; or solid, like WartStick®, as examples) to the wart, following the package directions. 
4. Cover the area with well-adhering Band-Aid or small piece of duct tape. 
5. Remove in 24 hours and repeat. 
6. No kissing toads. 

With patience and persistence, this routine will take care of most warts in about 2-4 weeks.

If home remedies don’t work, you may need the help of a professional. Warts can be frozen, injected, blistered, lasered, microwaved, or surgically removed. Call your health care provider/dermatologist if you have questions, or need help. 

Good luck!

I had the great pleasure of meeting Dr. Cara Natterson last October. She is a pediatrician from California with a unique pediatric consulting practice, and a passion for family education. 

(Now before you all hide your wallets and shield your daughters’ eyes… stay with me.)

Although American Girl is most well known for its dolls, boutiques, and cafes; American Girl is also known for one of the most popular books about growing up. The Care and Keeping of You (TKCY) has sold well over 3 million copies since its publication date in 1998; and has been a long-time, go-to recommendation for my female patients who are beginning body changes. 

Since its original publication, TKCY had been recommended for girls 8 years and older. The book’s challenge, however, was adequately covering biology for a wide age audience. Specifically, most parents and I agree some topics in the “old” TKCY were not necessary for a just-curious-8-year-old to discover. 

The great news is that Dr. Natterson has partnered with American Girl to author a new book, The Care and Keeping of You 2 (TKCY2). This new edition becomes the 2nd volume in what is now a 2-part set. The more “biologically-advanced” material originally available in TKCY has been moved to TKCY2; creating a slower, smoother transition in puberty topics within the series. TKCY is now more appropriately tailored for girls with initial curiosities about their body, while Dr. Natterson’s TKCY2 is more tailored to girls who have already entered puberty. 

In TKCY2, Dr. Natterson does an excellent job of providing a global approach to presenting puberty. Information about biology is presented with straight-forward diagrams and language, while maintaing age-appropriate grace. The greatest strength of TKCY2, however, is that anatomy is only one quarter of the book! 

The majority of TKCY2 is great information on growing up topics that many girls are eager to know. Sleep, mood changes, healthy food choices, body image and self esteem are just a few. Girls reading the book can relate to the well illustrated examples, and be reassured that their experience of body changes and emotional experiences are shared by many others.

Puberty and body changes can be difficult topics to discuss with our children. Finding strong resources to help with questions and answers can also be challenging. Dr. Natterson’s TCKY2 provides a solid solution for both parents and girls beginning these conversations. This book is a great reference to read with your daughter, or a book you can hand to your daughter with confidence to read on her own; allowing self-discovery and self-awareness about growing up. 

For more information on TCKY2, visit the American Girl website. And don’t miss this great list of conversation starters for girls of all ages. 

Good luck. 

Photo by gretchichi on Flickr, Creative Commons

“What do you think, Dr. Natasha? She really likes my new iPad mini. I’m thinking of buying her one for Christmas.”

 I curiously looked at the father standing in my office. His busy 9-month-old daughter was showing off her new crawling skills, independently roaming the exam room. 

“Buying one, for whom?” I asked. 

“For her!”, he exclaimed as he pointed to his little girl. 

The week of Thanksgiving traditionally marks the beginning of the Holiday shopping season. In some families, getting to stores on Black Friday at 6 AM holds as much tradition as grandma’s famous turkey stuffing. 

And on the top of Holiday wish lists? Technology!

From iPads and iTykes to LeapFrog and vTech, there seems to be a new gadget for every age. And in our adult world of bigger-newer-faster, it only makes sense that even our youngest children would be putting the latest tech on their wish list. 

But would they, really?

I think these shiny new boxes, dusted with the fragrance of fresh batteries, cloud our judgement. We get blinded by the blinking lights, overestimating toymaker-touted benefits. Meanwhile, we underestimate the learning and creative play our children are doing everyday. Naturally. Simply. Without intervention. 

I believe that just because we can buy the latest tech gadget for our children, does not always mean we should. 

As our toy technology advances, we limit their creative potential. Tech toys are given to children with predetermined boundaries and purpose. Simple toys, on the other hand, provide the raw materials of unlimited possibility.

Blocks, dolls, and trucks can be lifted and dropped, tasted and chewed, squeezed and thrown, cuddled and loved. These are the building blocks of self-directed learning, creative play, and intellectual development that we all want for our children.

Toys are also the building blocks of memories, more powerful than any LCD screen.

When it comes to toys for young children, I believe technology needs to be kept on the store shelf. So as I am shopping for my own family, nieces, nephews, friends, and neighbors; I have a simple rule:

No tech toys for tots. 

In exchange, I can offer some alternatives. Here are some classic, developmentally appropriate gift ideas for the little ones on your shopping list. 

0-6 months: Board books, Cloth books with large pictures, Rattles, Teething toys, Toys with various textures to grasp and chew, Activity mats

6-12 months: Simple picture books, Sorting cube, Push/pull toys, Bathtub toys, Stacking rings/blocks, Sensory balls, Soft blocks, Soft activity books

12-18 months: Picture books, Simple instruments, Dolls, Stuffed animals, Big dump trucks and tractors, Building blocks, Jumbo knob puzzles, Play workbench/kitchen

18-24 months: Lift-the-flap books, Simple shape puzzles, Large building blocks, “Helper” toys (broom, play vacuum, apron, play tools), Play animals, Play phone

Simple. Classic. Battery-free. 

Although these toys may never be on the “Hot 100” list for the Holiday season, they are classic toys for a reason. You may be pleasantly surprised just how long their joy will last. 

For more Holiday gift ideas, check out this post from Dr. Lai and Dr. Kardos of Two Peds in a Pod.

A special note: As Thanksgiving Thursday disappears as quickly as the pumpkin pie, I am hopeful that all of you will pause and be thankful for where you are. Thankful for the people that you are with. Thankful for the teachings and guidance from family members who came before you. Thankful for the person you have become, including your strengths and flaws. And, thankful for the next generation that we all have a part in guiding and loving until next Thanksgiving. 

Have a wonderful Holiday. 

Instead, you will likely find this:

A tangled mess of silver and plastic in no apparent order. 

I used to be bothered by a such a disorganized silverware drawer, but that was years ago. I have let go of the need for nestled stacks. Now, the upside down forks mixed with the oversized spoons just make me smile. 

Because my 2-year-old did it. 

The clean forks and spoons are always the last left in the dishwasher. It is my 2-year-old’s job to put them away. And, he does it. His way. His pace. His chore.

And the best part? The smile on his face when the last fork is dropped in the drawer. 

I believe chores are important, even for toddlers. As toddlers are learning their independence, and testing acceptable boundaries, they are developing their foundation of self-esteem and family belongingness. Chores are a way to promote responsibility and personal pride, while providing a routine opportunity for praise and love. 

So, after the second birthday, I suggest something to each of my patient families. 

A two-year old should have 2 chores. 

Giving a toddler a task, however, is very different than creating a chore list for an older child. Here are some tips on what to expect from the littlest members of your family. 

5 Tips for Toddler Chores:

1. Take advantage of a toddler’s natural tendency to mimic adult behavior. Turn an activity your toddler is modeling into a routine task. For example, is she following you around with a rag while you are dusting? If so, dusting may be a great first chore. Pushing laundry baskets? Putting clothes in the hamper? By routinely asking to repeat an activity your toddler is already showing interest in, you have successfully started chores! Need ideas? Look at this list some toddler-appropriate jobs.

2. Help your toddler understand that every member of the family has unique jobs to help one other. Use a consistent phrase to describe the essence of the task, and use the same phrase when talking about housework you are completing. For example, “Mommy is taking out the garbage to help the family. Can you put the napkins on the table to help the family?”  

3. Toddler chores are an opportunity for praise and acceptance. If a chore is not completed, a toddler should not be punished.

4. Help your toddler understand what is expected of him by breaking down larger tasks into little pieces. For example, instead of saying, “pick up your toys,” consider starting with, “put the truck in the box.” And, remember to show your child each step along the way. Praising your toddler as each step is completed will motivate more self-directed tasks in the future.

5. The goal of the chore is to complete the task to the best of your toddler’s ability. The goal is not perfection, efficiency, nor “correctness.” Expect your toddler to need some redirection and some extra time to get the task completed. 

And remember, if you come to my house and ask for a spoon, don’t expect to find it in a neatly organized location. Instead, expect to be rummaging through the silverware drawer, only to look up and see a smiling two-year old proudly saying, “I did it.”

I have a kindergardener this year. 

As much as she is adjusting to everyday school and to “no naps;” I am also adjusting to a set of new routines and obligations. 

One of these is the carpool lane.

After being in the drop-off and pick-up line for a solid month, I have noticed a problem. 

I am seeing too many elementary-aged kids hopping out of the front seat of vehicles in the morning, and hopping into the front seat after school. 

And what else? I have seen an alarming number younger siblings and friends jumping around the backseats of carpool vehicles without restraints at all. 

Kelsey Lueger, MD, a resident from the local children’s hospital, joined me in clinic through the month of September. She patiently listened to my carpool lane rants; and agreed that consistent proper use of seat belts and car seats should remain a priority whenever the wheels roll – even the carpool lane. 

I offered her a chance to add more of her thoughts. Enjoy her guest post.

Carpooling: Good for schedules. Bad for safety? 

Carpooling - What a great way to make life a little easier when it comes to getting your kids to and from school. Another bonus: you can feel good about helping the environment by cutting down on toxic fumes added by additional car trips. 

However, this efficient means of transportation for our children may not be the safest. 

The AAP published an article earlier this year, surveying parents about carpooling and booster seat use. It was concluded that proper car seat restraints are too inconsistently used.

Our children’s safety in any car should carry the utmost importance. The number one cause of death of US children is …You guessed it – motor vehicle injuries!

Think of the times you have had your child picked up or dropped off through a carpool, or seen other carpools bringing children to school. Have you noticed how many children less than 4 years old are no longer in a car seat; kids less than 8 years no longer in a booster; or how many children younger than 13 are riding in the front seat? 

And why? Inconvenience? 

None of us want a child to be at risk for becoming part of a statistic because someone didn’t take the time to make sure that they were properly restrained in a vehicle. 

The fact is, EVERY kid should be properly restrained, EVERY time.

So, what steps can we take to make sure our kids are safe?

1. Know the safety rules. Make sure anyone driving your kid knows them, too. Refer to Dr. Natasha’s “Car seat refresher course” and review the CDC guidelines for parents.

2. Spread the word. Tell your friends, your kid’s friend’s parents, and your kid’s teacher. Pass around the SafeKids USA Carpool Driver safety checklist for tips and reminders.

3. Problem solve. Having difficulty knowing what car seat or booster to buy, or knowing how to fit the recommended seats in your vehicle? Check out carpool solutions from The Car Seat Lady. 

 These tips will help every one arrive safely to their homes and after-school activities. Happy Fall! 

Dr. Lueger is a 2nd year resident physician at Children’s Mercy Hospital, and interested in general pediatrics.

Soon-to-be parents come to “interview” me almost every day. Typically, they come prepared with a long list of questions for a pediatrician. I answer them as best as I am able. 

For parents soon-to-be-expecting sons, I am frequently asked about circumcision. 

Most parents are just curious about how the procedure is technically done, when their baby can get the procedure, and how many of “these things” I have done. 

(Answer: A lot.) 

For some families, however, the decision to have a child circumcised is not that easy. These parents want to know the medical benefits of circumcision, the risks of the procedure, and the rates of circumcised boys in our community. They want to know if they will “look like” other boys when they grow older. And, what if they do/don’t “look like” dad?

All of these families just want to make the best decision for their son. 

In some areas of the world, circumcision is performed nearly universally. And in some areas, it is rarely desired. The vast differences in circumcision rates are largely attributed to regional cultural, ethnic, and social values around our world. 

What is also interesting is that regional rates of circumcision seem to be varied based on the need for parents to pay for it. Meaning, if the cost of circumcision is not covered by insurance plans, parents are less likely to have it performed. This is noted by the decreased rates of newborn circumcision performed in the US in states where Medicaid does not cover the procedure. 

In turn, the number of circumcisions being performed has dropped slowly over the years. Currently, in the US, it is reported that 55% of men are circumcised. This is well below the 80% of men circumcised in the 1980s.

This cost-factor for this elective procedure is at the center of a recently released Statement on circumcision from the American Academy of Pediatrics (AAP). The Statement emphasizes the health benefits of the procedure in order to adequately justify circumcision being covered by a family’s insurance policy.

Ultimately, the AAP is advocating for a parent’s personal choice to circumcise their child without the cost of the procedure being a factor. 

The new report details the medical benefits from circumcision. For infants, circumcision decreases the rate of urinary tract infections in the first year of life by 3-10 fold. As he grows up, studies have shown that circumcised men have a lower rate of certain sexually transmitted infections (STIs).* These studies have focused on certain STIs with significant long-term health detriments including HIV, HPV (human papilloma virus), HSV (herpes), and syphilis. Maintaining higher circumcision rates in a community may, in turn, decrease complications and suffering from long-term consequences of these infections; including penile cancer in men, and cervical cancer in women of infected partners.   

The most common risks of circumcision include blood loss, infection, pain, poor cosmetic outcome, and penile adhesions. Rarely can damage to the penis occur. All of these complications can be reasonably avoided by having boys circumcised by trained health care providers, and with adequate pain control. Parents should be educated on appropriate care after the procedure. 

As with all medical procedures, I believe that each individual family should be able to ultimately decide what is best for their sons based upon their unique family history, traditions, and expectations. Every family should have the opportunity to ask questions, and discuss the benefits and risks of this elective procedure, with the qualified health care provider who is able to perform their child’s circumcision.  

Like most pediatricians, I am equally comfortable performing a circumcision, as I am educating parents on how to care for an uncircumcised penis. 

So, blend your knowledge of this procedure with the history and experience of your unique family. Then allow yourself – whether you do or don’t – to be confident that it was the best decision you could make for your child.

For more information about circumcision, I recommend the following patient education article from UpToDate. 

*Of note, circumcision is not the only way to protect against STIs. Regardless of circumcision status, STI transmission can be reduced by avoiding sexual activity or practicing safer sex.