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August 8, 2020

Dr. Magryta: Summer

By Dr. Chris Magryta
Salisbury Pediatric Associates
It’s that time of year again and kids are starting to return to beaches. They are playing again with local friends outside within the framework of each states social distancing and contact avoidance rules. Flashlight tag, capture the flag, surfing, walking the beach and other great outdoor activities are back again to my pleasure. It is so awesome to see kids interacting verbally, socially and safely instead of interacting cyberly, restricted and suppressed as they were never meant to be for a prolonged time.
The beauty of this type of social interaction is that it allows for further growth of their understanding relationships, challenge-based tasks, team building and nature exposure which has been well studied for their health both mentally and physically.
With the increase in these activities, comes some mild risks that we must pay attention to:
• Jelly fish stings
• Insect bites
• Sunburns
• Swimmer’s ear
1. Jellyfish
What types are indigenous to the Carolinas?
Go to Google to see images of the different types:
• Cannonball — mild venom
• Mushroom — mild venom
• Southern Moon — mild venom
• Lion’s Mane — moderate venom
• Sea Nettle — moderate venom
• Sea Wasp — potent venom
• Man O War — potent venom
What to do if exposed?
First, assess the person for  signs of anaphylaxis. This is most important. Call 911 if you think that someone is reacting to a jellyfish sting with anaphylaxis symptoms like shortness of breath, vomiting, change in mental state or difficulty speaking. Use an injectible epinephrine pen if one is available. Get the person to a comfortable and flat position and raise their legs to preserve blood pressure. Administer CPR as needed based on basic life support guidelines. I highly encourage all parents to learn BLS.
For more local reactions:
1. Apply a compress of vinegar or sea water and sand paste for 30 minutes. Then scrape off stingers with a credit card followed by an application of a compress of vinegar for 30 minutes to stop the venom release.
2. Do not rinse with fresh water. It can activate the venom.
3. Calendula cream or cortisone cream can be used for itching and discomfort
2. Bug bites
Pesky bug bites are an issue that we deal with in our area frequently. As adults, it is easier for us to understand that we should not scratch and irritate these inflamed areas if we can possibly help it. Children however simply know that something itches and they are going to scratch it.
Prevention first:
  • Dress in loose-fitting clothing and long sleeves
  • Use safer bug spray products like All Terrain all over exposed skin. Stronger topical products with DEET like Off or Cutter can be placed directly on the clothing instead of the skin prior to wearing. This effectively decreases the toxic exposure to your child. Oil of lemon eucalyptus blend 30% is also effective to prevent mosquito and tick bites (not for kids under 3 years old). Apply all repellents by hand to avoid inhalation by your child.
  • Treat lesions with calendula or cortisone creams to prevent the itch scratch cycle. Also, rubbing a moist tea bag on bites can help with itching and swelling. The tannins act like an astringent. See Dr. Low Dog’s newsletter on herbal pastes.
  • Ice
  • Rub isopropyl alcohol three times a day on all lesions that have been excoriated open by scratching until healed. You can also use a diluted bleach solution of 1/8 teaspoon bleach in 16 ounces of water. Rub on topically and leave on for 15-30 minutes.
  • Keep nails cut short and filed down to remove hiding places for bacteria.
If you haven’t been successful at prevention and the bugs have won their war, then you have to try to keep nails trimmed and minimize scratching. If after treating the affected area it has developed a great red coloration, swelling and discharge then you child needs to be seen.
3. Sunburns
If you unfortunately get a sunburn, then apply aloe plant jelly directly to the burn. Commercial aloe products are available if necessary. As always, know your child’s burn threshold and avoid it. Almost all children can tolerate 20 minutes of direct sun without a risk of burn. Remember that the sun is very beneficial for Vitamin D production via your skin.
Use sun shirts and hats when possible. Use 30-block sunscreen from reputable sources like Aveeno, Blue Lizard, All Terrain, or see EWG.org’s sunblock list. No spray on suncreens, unless you fancy your lungs with chemicals in them. I know that I do not want that stuff sprayed near my kids.
4. Swimmers ear
To prevent this issue, I recommend using a tissue and rolling it into a needle to introduce into the ear canal at the end of the swimming day. This removes the water from the canal in a wicking fashion, thus, preventing the bacterial growth and an infection. This is simple and effective. Never place anything firm into the ear canal for risk of injuring the tympanic membrane, ear drum.
Treatment with topical antimicrobials is very effective when the first signs of swimmer’s ear develop. Infected children often complain of severe ear pain when the posterior ear is pushed forward.
Enjoy the beach this summer!

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Email him at newsletter@salisburypediatrics.com .

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