All pediatric liquid acetaminophen for infant and children will be 160 milligrams per 5ml (or one teaspoon).  The hope is the single liquid concentration product will reduce dosing errors and create less confusion for parents and caregivers.

Acetaminophen, which is available both generically and under the brand name Tylenol, is a medication used to reduce fever and control pain.  Historically, it has been available as infant drops, 80milligram per 0.8ml, and for children 2 years and older as a liquid, 160milligrams per 5ml (or one teaspoon). 

Acetaminophen is generally safe when given in reasonable doses, however, each year children are treated at WakeMed Children’s Hospital for acetaminophen overdoses.   An overdose has the potential to cause liver toxicity and liver damage if taken over a long period of time or given at too high of a dose.    

The reason for changing to a single concentration is to help reduce and prevent medication errors.  The change was voluntarily agreed upon by the over-the-counter manufacturers.   Therefore, for a period of time both the concentrations will continue to be available in retail stores.   Parents and caregivers should be aware of the various products and to only use the dosing recommendations included with the purchased product.  

The new infant 160milligram per 5ml (or one teaspoon) product will now come with a dosing syringe rather than a dropper and for children the liquid acetaminophen will come with a dosing cup to assist with measuring doses.   Always contact a healthcare provider such as your pharmacist, nurse or physician if unsure of the appropriate dose.      

It is critically important for parents to fully understand any medication they are giving to their children and that they communicate clearly with their pharmacist or physician as to how much to administer and how often.  This way both caregiver and baby will feel better.

Interested in learning more about the change? 

otcsafety.org

NC Poison Center

Tylenol.com

Rhonda Zillmer is a WakeMed pediatric pharmacist.

Dr. Robert Howard

Having been an orthopaedic surgeon for the past 11 years specializing in trauma surgery, I have treated many different types of injuries – some of which still amaze me.  However, I have come to expect the cause of the many severe injuries.

The biggest injury offenders are:

Trampolines are notorious for causing injures, including fractures of the wrist and elbow. These injuries are mostly seen in children and rarely adults.  However, there is a great potential for serious neck and head injuries as well.  My recommendation: never have a trampoline at home, and if you do have one follow the safety rules closely.  Make sure it is on level ground with an intact safety net, supervise children at all times and make sure there is only one person on the trampoline at a time.   

Ladders are another pretty common cause of severe injury – primarily to the foot and ankle, and occasionally the spine.  Always follow safety recommendations for ladder use.  Do not exceed the maximum load for the ladder, ensure it is the proper size for the job, and always use the ladder on level ground with your body centered on it.  And, never step on the top – it really is not a step!

Table Saws cause severe injuries like amputations.  Always use safety precautions because it is not easy to reattach a finger – I guarantee that reattached finger will never work exactly the same. 

Playground Equipment is fun, but it is also a common cause of injury in children.  Both public and home playground equipment can be dangerous, however home playground swings are often the most dangerous because children are not as closely supervised and use them in unconventional ways.  Ensure that there is a soft landing surface, the equipment is well maintained and adults supervise play.

Bicycles: Last year alone, emergency departments across the U.S. treated more than 500,000 injuries that resulted from riding a bike.  Children are at a particularly high risk.  Always wear a helmet, check the brakes, make sure the bike is well maintained, don’t bike at night, and  always obey traffic laws

Skateboards or wheelie shoe accidents often cause injuries to the head, neck and upper extremities.  Make sure your child always wears a helmet when riding anything with wheels, understands the danger of vehicle collisions, never ride in the middle of the street, only have one person per skateboard and never hitch a ride on a car or bicycle.

Lawnmowers can cause serious injuries to feet – both the users and innocent bystanders like children.  Lawnmowers have also been known to cause cardiac arrest.   Be aware of where children are at all times and that they are a safe distance from the lawnmower.  Always wear ear and eye protection.  And, if you have cardiac disease let someone else do the mowing.  

Pets:  Dog and cat bites can cause infections usually in the hand.  Additionally, dogs or cats get caught up in feet and cause falls, which can be especially dangerous for folks who have difficulty walking or seeing.  Pools cause slips and falls and drowning accidents.  Exercise caution when in and around water all the time.

Area rugs and bath mats cause a surprising number of very bad falls, especially in the elderly where the fall often results in hip fractures.  Make sure all area rugs, including bath mats, are secured to the floor.  

Dr. Robert Howard is an orthopaedic surgeon with Wake Orthopaedics.

Some of our favorite Thanksgiving memories center around food and the time we spend together in the kitchen preparing our feast.  This year, don’t let your holiday dreams turn into kitchen nightmares because of a preventable cooking mishap with your kids. Here are a few tips for making merry (not misery) in the kitchen.

• Remind your child to always wash their hands before working in the kitchen. 
• Ask one of your non-cooking friends or relatives to watch the children in the kitchen. 
• Make your child feel special by assigning him/her kid-friendly food prep jobs in a specific area of the room, preferably away from appliances like ovens or the stove.
• If possible, use the back burners of your stove for cooking, and turn pot handles away from the edge of the stove. 
• If dishes are cooking in the oven, protect little hands with a child-proof oven lock.  They only cost about $5.00 and can prevent nasty burns.
• Make sure knives and other sharp appliances are secure and kept away from small children. 
• Do not allow small children to use the microwave unless they are old enough and even then make sure they can safely remove food without burning themselves.

 “Preventing kitchen accidents should be a high priority for parents,” says Siobhan Davis, WakeMed Injury Prevention representative and coalition coordinator for Safe Kids Wake County. Protect your family and your home by taking smart cooking precautions.  And while you’re at it, invest in a good fire extinguisher, and remember to change the batteries twice a year in your smoke detectors.

According to the American Diabetes Association in 2011 a total of 25.8 million children and adults in the United States—8.3% of the population—have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people
Prediabetes: 79 million people

What is type 1 diabetes?
People with type 1 diabetes do not make any insulin at all. They require insulin injections to provide the insulin they need to allow the sugar from the blood to enter the cells to produce energy (remember, insulin is the key that opens the cells and allows the glucose to enter). Only about 5% to 10% of people with diabetes have type 1.

What is type 2 diabetes?
In type 2 diabetes, the body does not make enough insulin, or the cells ignore the insulin that the body does make (insulin resistance).Therefore, all the sugar does not enter the cells, but stays in the blood. About 90% to 95% of people with diabetes have type 2.

What can I do if I have type 2 diabetes?
There is no cure for type 2 diabetes, but it can be managed by 7 self –care behaviors identified by the American Association of Diabetes educators,(AADE) that work together to influence your overall health.

The 7 self –care behaviors are:
1. Healthy Eating
2. Being Active
3. Monitoring
4. Taking Medication
5. Problem Solving
6. Reducing Risks
7.  Healthy Coping.

However, the most frequently asked question by a person with newly diagnosed diabetes is;

What can I eat now that I have diabetes?
The body’s primary source of energy is sugar (glucose). Sugar comes from breaking down carbohydrate foods such as fruit, milk and yogurt, sweets, and starches. Foods that contain carbohydrates contribute to increased blood sugar levels. We need to learn to recognize the foods that contain carbohydrates and limit the intake of these foods to maintain blood sugars within the target range set by your doctor. Remember meats, fish, and poultry do not contain carbohydrates. (If you have to kill it to eat it, it’s not a carbohydrate.)

Portion sizes also factor into the overall affect of carbohydrate intake on blood sugars. We have become accustomed to exaggerated portions when eating out and are frequently surprised at what a “true portion size” really is.

Learn about carbohydrates so you can be comfortable reading nutrition labels and knowing what they mean.

Next week we’ll cover the Truths and Myths of Diabetes.”

Carol V. White, BSN, RN-BC is a Patient Educator in the Adult Diabetes Management Program with WakeMed Health & Hospitals

For most people of normal activity level a general, supportive shoe that fits well will work just fine, regardless of whether they are biking, running, playing tennis or doing aerobics.

Specialized shoes really start to make a noticeable impact for individuals who are avid participants in a particular sport, have problems with their feet or who over- or under-pronate. These individuals often benefit from a specialized shoe. For over- or under-pronators (meaning you tend to land to the extreme outside or inside of your foot when walking or running), it is best to choose a shoe that offers more arch support and stabilization.

But, how do you know what shoe is best for you? The answer: It is really just a process of trial and error. Sales professionals at the shoe stores vary widely in their knowledge of shoes and of feet. Their time, experience and training may be able to help you identify a shoe that will be good for you, and they may be able to recognize certain types of issues by looking at the wear pattern on an old shoe.

Some shoe sales persons, however, specialize in making and fitting orthotics, or inserts in shoes, and they are knowledgeable and can be very helpful in helping you find a good athletic shoe to address specific issues.

But, honestly, for most individuals finding the right shoe for you is simply personal preference. The good news is that regardless if you choose the “wrong” shoe type for you, it is very unlikely to cause injury, although you may be disappointed by the hole left in your wallet.

Here are some suggestions for healthy items for your picnic or potluck. A good place to start is to bring a fresh fruit tray or fruit salad. This is always a healthy option and most people really enjoy having some fresh fruit to complement their meal. During this season of the year, many fresh fruits are available making it an easy option as well. Choose various colors and provide a light vanilla or plain yogurt dip.

Vegetables are a great healthy choices and there are so many options to choose from. A raw veggie tray with different colors and textures is always a hit. Hummus or a light dressing makes a great dip. A garden salad with mixed greens, various vegetables with a handful of nuts and berries makes a colorful tasty display.

Try to stay away from the starchy vegetables like corn and potatoes as the main focus in your dish as they are higher in calories. Sauteed vegetables, grilled vegetables and roasted vegetables make a great dish. There are so many vegetables that are great prepared this way including: peppers, eggplant, yellow squash, zucchini squash, onions, mushrooms, broccoli, asparagus and carrots. Many of these vegetables are in season right now and full of flavor so there is little need for seasoning. It is great to make a dish that includes a variety of these vegetables so there is something for everyone to try and taste. Many vegetables are also great as a cold salad, a great alternative to the traditional potato salad or macaroni salad. Cucumbers, tomatoes, green beans, carrots, broccoli and various peas and beans are delicious served as a cold salad.

Meat dishes can also be healthy options, but try to stick with grilled, baked or roasted meats. These preparation methods are healthier and add to the flavor of the meat as well. Stick to the leaner cuts of meat like skinless chicken or turkey breasts, pork tenderloin, London broil, sirloin and top round. Grilled fish is always a great healthy option that is sure to be a hit. Fish is a great source of protein, vitamins and healthy fats that can help protect us from certain cancers and heart disease.
So have some fun enjoying your picnics and potlucks and trying some new healthy dishes that your family and friends just may love. Here are some recipes that may give you a good jump start to trying some new things.  

Roasted Garlic Lemon Broccoli
• 2 heads broccoli, separated into florets
• 2 teaspoons extra-virgin olive oil
• 1 teaspoon sea salt
• 1/2 teaspoon ground black pepper
• 1 clove garlic, minced
• 1/2 teaspoon lemon juice
Directions
1. Preheat the oven to 400 degrees F (200 degrees C).
2. In a large bowl, toss broccoli florets with the extra virgin olive oil, sea salt, pepper and garlic. Spread the broccoli out in an even layer on a baking sheet.
3. Bake in the preheated oven until florets are tender enough to pierce the stems with a fork, 15 to 20 minutes. Remove and transfer to a serving platter. Squeeze lemon juice liberally over the broccoli before serving for a refreshing, tangy finish.

Fruit and Vegetable Salad
• 1 medium green pepper, chopped
• 1 cup chopped celery
• 1 cup shredded cabbage
• 3/4 cup chopped unpeeled red apple
• 1/2 cup seedless red grapes, halved
• 1/4 cup reduced-fat mayonnaise
• 1/4 teaspoon salt
• Lettuce Leaves
Directions
1. In a bowl, combine the first five ingredients. In a small bowl, combine the mayonnaise and salt. Stir into pepper mixture. Cover and refrigerate for at least 1 hour. Serve on lettuce leaves.

Grilled Sesame Chicken
• 1 cup olive oil or vegetable oil
• 1 cup white grape juice
• 1 cup soy sauce
• 1 cup chopped green onions
• 1/3 cup sesame seeds, toasted
• 2 tablespoons ground mustard
• 1 1/2 teaspoons ground ginger
• 2 teaspoons pepper
• 8 cloves garlic, minced
• 12 boneless, skinless chicken breast halves
Directions
1. In a large re sealable plastic bag, combine the first nine ingredients. Remove 1/2 cup for basting; cover and refrigerate. Add chicken to the bag; seal and turn to coat. Refrigerate for 6-8 hours.
2. Drain and discard marinade from chicken. Grill, covered, over medium heat for 6 minutes. Turn and cook 6-8 minutes longer or until meat juices run clear, basting occasionally with the reserved marinade.

Grilled Salmon
• 2 pounds salmon fillets
• 1/2 cup vegetable oil
• 1/2 cup lemon juice
• 4 green onions, thinly sliced
• 3 tablespoons minced fresh parsley
• 1 1/2 teaspoons minced fresh rosemary
• 1/2 teaspoon salt
• 1/8 teaspoon pepper
Directions
1. Place salmon in shallow dish. Combine remaining ingredients and mix well. Set aside 1/4 cup for basting; pour the rest over the salmon. Cover and refrigerate for 30 minutes. Drain, discarding marinade. Grill salmon over medium coals, skin side down, for 15-20 minutes or until fish flakes easily with a fork. Baste occasionally with reserved marinade.

**All of these recipes came from allrecipes.com, one of my favorite websites. 

Julie Paul is a registered dietitian with WakeMed ENERGIZE!, a program to help kids and teens who either have type 2 diabetes or who are at risk of developing type 2 diabetes learn to make healthy lifestyle changes.  Learn more by clicking here.

Don’t think it will happen to you? Each and every year WakeMed sees both adult and pediatric patients in our emergency departments with injuries from fireworks.  Fireworks ARE dangerous and should be treated as such.

This year, let’s prevent firework injuries this 4^th of July by:

• NEVER allowing children and adolescents around fireworks alone
• Making sure to use fireworks properly.  Many injuries are a result of improper use (such as holding the fireworks, etc.).  Always read the warning labels and instructions before use.
• Having a bucket of water close-by (for used fireworks and for emergencies)
• Ensuring that the firework is completely finished before getting near it
• Never using illegal fireworks—they are more likely to cause injury.  (This includes the fireworks your neighbor made the special trip to South Carolina to purchase.)
• Always protect your eyes— firework accidents can cause permanent burns and blindness

Although fireworks are often used as a fun finish to the 4th of July, just remember that they can have very serious, lasting consequences if used incorrectly or unsupervised.

Samy Saad is an emergency department physician with Wake Emergency Physicians, the physicians group that staffs all five WakeMed emergency departments.

Whooping cough is a highly contagious bacterial disease that causes uncontrollable violent coughing.  The disease is not very well known these days because widespread vaccinations virtually eradicated the disease in the United States years ago. However, whooping cough is making a comeback with 153 cases of confirmed in North Carolina in 2010. 

Most children receive the bordatella pertussis (commonly included in the D-Tap vaccine combination) vaccine at 2 months, 4 months, 6 months, and 18 months.  With each shot, children’s immunity builds to whooping cough, reducing their chances of contracting the disease and reducing the severity of the illness if they do happen to get it. 

Whooping cough boosters previously thought unnecessary are now recommended by physicians.

Up until a few years ago following the 18 month shot you were considered fully vaccinated. However, physicians and public health professionals have learned that the bordatella pertussis vaccine does wear off, and a booster shot between the ages of 10 and 64 is necessary to retain immunity.

A booster shot is especially recommended for teachers, parents, and grandparents – to protect both themselves and the newborn babies and young children who are at most risk of getting very sick and dying from whooping cough.  In fact, more than ½ of babies who get whooping cough will need to be hospitalized and 1 in 100 babies who get whooping cough will die.

Additionally, some parents are choosing to forgo vaccinations for whooping cough and many other diseases due to concerns with vaccine safety.  When parents make the decision not to vaccinate their children for whooping cough or other diseases, they are not only risking the health of their child but of the community at large.

Learn more about whooping cough and protecting you and your family from the disease by contacting your physician or by clicking here.

Robin Carver is the director of infection control and prevention on WakeMed Raleigh Campus.

WakeMed Children’s is dedicated to providing answers to common questions parents have about children’s health and wellbeing.   Learn more by subscribing to WakeMed’s Families First newsletter.  Have a specific question you would like answered?  Post a comment or email us directly.

As a result, the N.C. Division of Air Quality has issued a Code Orange Health Notice for Ozone for central North Carolina until 9 pm today. People in sensitive groups – young children, the elderly, anyone with respiratory ailments and people who work/exercise outdoors – should limit their time outdoors.

Many air filtration systems do filter out particulates, however they may not filter out the odor.  Therefore, it is best to try to stay indoors until the smoke clears.

For more information on this weather alert, please visit WRAL.

Make sure you know what to do if thunderstorms are predicted for your area with plans customized to where you are and what you are doing.  For example, if there is a high probability of severe thunderstorms, playing golf or going for a sail may not be a good idea.  If you are participating in these or any outdoor activities, make sure you have a contingency plan and be prepared to seek safe shelter if a storm does develop.  Hiding under a tree or umbrella until the storm passes is NOT considered a safe or smart contingency plan.

There are many resources available online to help you prepare for storms, including the Red Cross, NOAAs National Weather Service , and Ready.gov.

And, if you are looking for something to do this weekend, join us at StormFest, on Saturday, June 18 from 9 am to 5 pm at the Museum of Natural Sciences. Visitors can become Meteorologist for a Day, watch presentations on Storm Chasing, learn more about preparedness and tour emergency response vehicles and mobile hospital. 

Barb Bisset is the executive director of the WakeMed Emergency Services Insitute.