Dairy Products: the most disgusting food safety scandal, by far, involved the contaminated infant formula in 2008 which killed 6 children and sickened 300,000 others, many with permanent kidney disease. Unfortunately, since then, this melamine chemical has been rediscovered in a few dairy products, and thus all of China remains justifiably wary of the entire dairy industry.

If you have a newborn baby, the healthiest milk in any country remains breast milk, so it would be wonderful to breast feed for as long as possible. Otherwise, most doctors I know in Beijing would recommend only buying infant formulas imported from other countries, from the most reputable brands, as well as from the most famous stores. I would definitely not recommend getting formula or anything of consequence from taobao.com, as the counterfeit industry is very large. As for regular milk products, again the trust issue is key. I think the American-owned Wondermilk brand of milks and yogurts is a good choice, as are the Green Yard brand and other local organic milks or imported boxes of milk. But don’t forget another option — soy milk! Making your own soy milk at home with a machine is a healthy, fun and fragrant way to start a family’s day. The best company is called Joyoung, and their machines can be found at almost all electronics stores for 300-400RMB. You can also buy simple machines to make your own yogurt, which is a very healthy food.

Fruits and Vegetables: Again, the main issue is trust: do you know exactly where this green veggie is from, and how it was made? If it’s from one of the handful of organic farms around Beijing and you’re comfortable with the farm’s practices, then that’s great. For most of us, this is an impractical or expensive option, so I prefer to buy organics as often as possible from the large internationally-run hypermarkets such as Carrefour, Metro, Walmart, Tesco and Auchan. I prefer organics not so much for the taste and quality, but more for their quality chain of ​production, traceability, and oversight by multiple governmental and organic agencies. In other words, you have a much better chance of getting healthy and safe produce from a heavily monitored farm than you would from a Shunyi corner market or farm. And make no mistake, you should be wary of getting produce from small farms in China, where pesticide, growth hormone and other chemical rates are enormous, not to mention very high rates of water pollution runoff.

No matter where you buy your produce, it remains crucial to wash them all very well, especially the leafy greens. If your ayi prepares your foods, it’s important that she is educated by you not only on proper food washing but also simple hygiene such as correct hand washing or not mixing raw meats and veggies on the same cutting tables. Take nothing for granted with your ayi! There are some food safety handouts online in Chinese and English from the World Health Organization which you can print out and show her; you can find them online at my blog here.

Meats and Fish: A diet rich in fish is beneficial at all ages, as fatty fishes are filled with nutritious omega 3, a crucial element for a child’s brain as well as for an adult’s heart. But finding any safe fish in China is a serious issue, as many local rivers and waterways are seriously polluted. I’m very happy with my recent discovery of Metro’s frozen food section, which has a large selection of fish from other countries, and whose quality (and price) is quite reasonable. As for meats, again I like organic meats at larger international markets, mostly again because they have their own, independent supply chains and traceability.

To sum up, we all need to be more careful here in order to ensure safe food for our families. But with a little extra knowledge, we can thrive just fine.

You can read more about food safety in my food safety archives. 

(This article first was published in my monthly “The Doc Is In” column in Beijing Kid’s November 2011 issue. You can read my previous columns here.)

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How many parents have brought their child to acupuncture treatments? You may be interested in a big new research study last week which looked at all the best data — and found a 12% rate of “mild” adverse events from acupuncture. This systematic review, published in Pediatrics magazine, concluded that “that acupuncture is safe when performed by appropriately trained practitioners”. I actually don’t agree so much with that; on one hand, there’s still a 1% risk of severe adverse events such as a punctured lung. But I also think a 12% rate of mild events is still unacceptable when the benefits of treatments for acupuncture are so unclear. Where is the risk & benefit analysis here? And why would a parent subject their child to a poorly understood treatment when there’s even a small risk of serious adverse effects? You can hear more about this issue at my podcast at the above links.

More Podcast Information

You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

You can listen to all my previous podcasts at the podcast archive.

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The first step parents should take is to find out where your child fits on a Body Mass Index (BMI) chart. Your doctor should be doing this at the well-child exams, but you can easily find childhood BMI calculators online (such as this one) and find out yourself. A child above 85% is considered overweight, and above 95% is obese. Many parents are surprised at finding their child is officially overweight or obese, which is why these objective BMI standards are important for tracking, as well as assessing progress.

There are quite a few weight loss approaches that most doctors can agree on; one major agreement is that diets almost never help, at any age. Any diet plan designed for quick weight loss is almost guaranteed to long-term failure, and many people frequently end up even heavier than before. The healthiest option is always slow and steady weight loss. One pound a week of weight loss for many children, from very conscious changes in diet and exercise routines, is appropriate.

Another major approach involves cutting back on TV time. The American Academy of Pediatrics just published a major policy statement stating that “the evidence linking excessive TV viewing and obesity is persuasive”. They specifically recommend a ban on junk- and fast-food advertising in all children’s TV programs, and they set specific limits of TV time for age groups. They also detail multiple studies showing how having a TV in the bedroom is another independent risk factor for obesity, both as a child and later as adults. They also recommended that “pediatricians need to ask 2 questions about media use at every visit: 1. How much screen time is being spent per day? and 2. Is there a TV set or Internet connection in the child’s bedroom?”

One approach I mentioned before was to have a good breakfast. Many studies have shown that eating a nutritious breakfast is crucial for a child’s physical growth and school performance, and that breakfast-skippers actually end up more overweight, both in childhood and later as adults.

Of course, the main treatments for obesity are the obvious: more exercise and eating proper foods in moderate amounts. It’s important that there be a family effort to help your overweight child lose weight. Parents also need to lead by example; it’s much harder for a child to lose weight if their parents are also overweight and don’t exercise. As for diet recommendations, the most obvious choices to eliminate are sodas and fruit drinks. Sodas truly have almost no redeeming value, especially for children. Any child drinking a daily soda is adding extra pounds of fat each year, and they are also increasing their risk for diabetes as well as teeth problems. Most fruit juices are also quite poor substitutes for natural fruits and should be used at a minimum. For exercise, most kids should be getting 60 minutes a day, but this can be broken up into multiple sessions. The key is finding something they love to do. And don’t forget that any exercise is better than nothing!

Another effort involves reviewing the foods at school. I recently heard the great news that milk producers in America this fall are all reformulating their flavoredmilk to have 1/3 less sugars and calories. Many (but not all) nutritionists consider this a positive step, as schools that totally eliminated flavored milk encountered a large drop in milk drinking, which raises the risk of kids not getting enough nutrients such as calcium. What does your school do?

Parents who want to learn more about childhood obesity and how to fight it can find excellent resources at the website healthychildren.org, which is officially run by the American Academy of Pediatrics. And at familydoctor.org, the American Academy of Family Medicine also offers many tips on weight loss for all ages.
This article was originally published in the October 2011 edition of BeijingKids magazine. You can read my monthly BeijingKids “The Doc Is In” archives here.

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In my never-ending quest of researching air pollution, I’ve collected a good library of my favorite articles which I’d now like to share with you below. As I have said multiple times, I think air pollution is a serious public health issue all over China which is obvious to all — and yet precious little actual intervention, treatments or warnings are provided to our community, at least officially. I personally think that we doctors, especially family medicine and pediatrics, have a moral and professional responsibility to do more to help our Beijing population with this issue. Indeed, the American Academy of Pediatrics, in their official position paper on air pollution, specifically mention:

in communities with poor air quality, pediatricians can play a role in educating children with asthma or other chronic respiratory tract disease and their families about the harmful effects of air pollution. Patients and families can be counseled on following the AQI to determine when local air-pollution levels pose a health concern… Pediatricians who serve as physicians for schools or for team sports should be aware of the health implications of pollution alerts to provide appropriate guidance to school and sports officials, particularly in communities with high levels of ozone.

So here are my top articles on air pollution, especially in regards to kids’ health:

• World Health Organization Air Quality Guidelines – this is the essential report, from 2005, which is the official guide for most countries
• The Effect of Air pollution on Lung Development from 10 to 18 Years of Age – one of the scariest studies, in NEJM, a prospective study showing decreased lung function in Los Angeles kids — at levels much, much lower than what we experience here every day
• “Seeing Through The Smog” — a big PDF file discussing air pollution. It’s a great review, from the Wilson Institute. They have a great collection of PDF articles from their China Environment Series.
• Air Pollution Threatens The Health of Children in China – a review from Pediatrics, 2008
• The World Bank: Cost Of Pollution in China – The very important 2007 report; a large PDF file to download. Read chapter 2, starting page 42, Health Impacts of Ambient Air Pollution
• Ambient Air Pollution: Hazards to Children — again from AAP Committee on Environmental Health, 2004
• Air Pollution and Children’s Health — another review article from the AAP, in 2004
• Ambient Air Pollution and Childrens Lung Function in China — a 2009 review showing decreased lung functions in Chinese children
• Children’s Response to Air Pollutants — a review from 2008
• Pollution & Life Expectancy in the US – an excellent, free New England Journal article (PDF file) from January 2009, plus the editorial and a fascinating interactive map – Pollution & Life Expectancy in US Cities
• Beneficial Cardiovascular Effects of Reducing exposure to Particulate Air Pollution With A Simple Facemask — this research (in Beijing!) offers very practical evidence on the use of N95 masks. 

OK, that’s enough to keep everyone busy for a few days. I don’t expect us to work miracles here; I just hope to share the evidence and continue the discussion, and at the very least have us Beijingers take proper precautions for our own families — and lead by example.

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The Scenario:  A 5-year old expat girl gets scratched on the leg by the new family cat. The cat was bought at a local pound which claims she was born there, to a stray cat, and has her rabies vaccine documented. Mom brings her to the ER and it’s decided, after a long consult with our local vet experts, that we simply cannot rely on this pound’s vaccination records nor their rabies vaccine quality, and we must assume she could potentially have exposure to rabies.

Outcome 1. This 5 year old already has her 3 rabies pre-exposure vaccines, so she now only needs one booster vaccine, and another in a week. She gets a Spongebob sticker afterwards and merrily goes home.

Outcome 2. The girl had no pre-exposure rabies vaccines because the parents had decided the risk was low and didn’t vaccinate the family earlier. She now starts a 5-vaccine series, today getting one in each shoulder, plus an extremely painful and expensive immunoglobulin injection (fortunately in stock) at the site of the scratch. Mom and dad cajole, bribe and eventually straddle her down onto the table as the doctor tries to inject the medicine into her wildly kicking leg. Afterwards, she gets my entire sheet of Spongebob stickers as well as a set of panda stickers for extra comfort.

Outcome 3. The girl gets scratched by her cat and doesn’t tell her parents about it. Why would she? Kids get cat scratches all the time. Half a year later, she develops symptoms of rabies, and is dead within another month.

So which outcome would parents prefer? Because the scary truth is that if your children are infected with rabies, they are certain to die — rabies is 100% fatal with no cure. In China, thousands of people die every year of rabies, and a large percentage of deaths are in children. This is something we simply don’t have to think about in places like the US, where maybe 1-3 people die every year of rabies, usually not from dogs but from wildlife like bats.

So, please, parents, please consider getting the 3-shot rabies vaccine now, before it’s too late. Outcome 2 above is an all-too-real scenario that we see very often in clinic, and it’s so much less traumatic to deal with animal bites if the child is already pre-vaccinated (as well as the animal, of course — from a reputable center).

And yes, expats have died from rabies, as Beijing’s International Center for Veterinary Services co-founder Mary Peng mentions in her extremely useful slideshow below, which I highly recommend you all view. In fact, Mary mentions an expat that died from his pet dog who didn’t even have symptoms; and the man wasn’t even bitten! He probably got infected from normal playing (who doesn’t occasionally have their dog lick their face?).

For more information, you can see Mary’s slide show below, plus the entire FAQ from Mary and her ICVS group:

Rabies Awareness and Prevention in China

It is very important for all individuals to understand the seriousness and prevalence of rabies in China and to understand how testing for rabies is handled locally. Rabies pre-exposure and post-exposure vaccinations are considered essential for anyone living and traveling in China:

• Rabies is a virus that is transmitted from the saliva of an infected animal to a human or other mammal through bites or by licking a cut or open wound on the body or the mucous membranes (e.g., lips, nostrils, eyes, etc.). Rabies is one of the leading fatal, infectious diseases among humans in China today. According to the Ministry of Health, more than 3,380 persons in China died of confirmed rabies infections in 2007. Dogs accounted for more than 95% of these rabies cases in China
• Rabies testing is strictly controlled in the PRC. Doctors and hospitals and pet owners cannot send animal remains or saliva samples to laboratories for rabies testing as may be done in other countries. Rabies is an extremely dangerous zoonotic disease that is uniformly fatal once symptoms develop. Zoonotic diseases are diseases that can be transmitted from animals to humans. Every suspected case of rabies must be reported in line with legal regulations and handled by the China Centers for Animal Disease Control and Prevention (CCADC)
• Only the CCADC is authorized to send animal remains or saliva samples for rabies testing at government designated laboratories. An individual must first report the suspected animal to a legally registered animal hospital that must then go through the official channels to report and work with the CCADC on these suspected cases.

The time that it takes to report the case and to have the animal tested at the official government designated facilities may take several weeks or longer. A delay of this length may jeopardize the health of the human patient especially in cases where the vaccination or health history of the animal is unknown or unclear.

In line with WHO, USA CDC and China CADC recommendations, it is strongly advised that vaccine therapy with human rabies immunoglobulin (HRIG) be given to rabies-exposed patients that have never been previously vaccinated against rabies. The incidence of rabies vaccinations among dogs in China is less than 10% and is nearly zero in cats and other small companion animals. Compounding this situation is the risk that the animal may have been improperly vaccinated at an unauthorized facility. Unauthorized facilities are not permitted to purchase legally registered, imported vaccines that are only distributed through the Agricultural Bureau, and so are likely to procure vaccines through unsecured illegal channels. Vaccines from unsecured illegal channels may be counterfeit, expired or improperly stored (e.g., non-refrigerated) and therefore ineffective. Unauthorized facilities include pet shops, animal markets, grooming salons, kennels, breeders, small animal clinics and even large animal hospitals that are not officially designated as animal rabies vaccination hospitals.

The International Center for Veterinary Services (ICVS) is a legally registered full-service animal hospital and officially designated animal vaccination hospital in the PRC. Please see this link below for more information on officially designated animal vaccination facilities:

http://www.icvsasia.com/index.php?option=com_content&view=article&id=51&Itemid=72&lang=en

The pre-exposure rabies vaccinations are recommended for all travelers and residents in China, especially children. Children are most likely to engage in provocative behavior with animals and to not tell their parents or other adults about an exposure. The pre-exposure rabies vaccine is a course of 3 vaccinations given over the course of 21- or 28-days (e.g., on days 0, 7 and 21 or 28). The pre-exposure rabies vaccination protocol DOES NOT REQUIRE THE ADMINISTRATION OF THE HUMAN RABIES IMMUNOGLOBULIN. The post-exposure rabies vaccination protocol most widely adopted in China requires the administration of 5 rabies vaccinations over the course of 28-days (e.g., on days 0, 3, 7, 14 and 28) with the human rabies immunoglobulin given on the same day as the first rabies vaccination. This is the protocol for persons that have NEVER been previously vaccinated for rabies and have been exposed to a potentially infected animal.

If you were already rabies vaccinated and then found yourself exposed to a potentially infected animal (e.g., bitten, scratched, licked on wounds or mucous membranes, etc.), you should then receive another 2 injections of the rabies vaccination (e.g., on days 0 and 3) with the first injection scheduled as soon as possible after the exposure. You are unlikely to need the human rabies immunoglobulin if you were previously rabies vaccinated. This is an extremely important point as human rabies immunoglobulin is in short supply worldwide and is expensive. If you are traveling outside of the major cities in China, it is UNLIKELY THAT THE LOCAL CLINICS AND HOSPITALS WILL HAVE IMMUNOGLOBULIN IN STOCK.

In all cases of exposure (e.g., bites, licks on cut/broken skin or scratches, etc.), the wound areas should be washed and flushed thoroughly with soap and water for at least 15-minutes and then disinfected with iodine or ethanol. Medical treatment and post-exposure rabies vaccinations should be sought immediately.

Rabies vaccinations are considered to be effective for at least 2-years or more. While it may be common to test for rabies antibody titres in other countries, this test is not a standard test offered at most medical facilities in China. Please consult with your medical doctor about rabies vaccinations for all members of your family.

You are welcome to contact the International Center for Veterinary Services (ICVS) with any questions:

International Center for Veterinary Services
No. 29 Liang Ma Qiao Lu, An Jia Lou
Chaoyang District, Beijing, PRC 100125
Tel: (8610) 8456-1939/1940/1941
Fax: (8610) 6433-2301
E-mail: ICVS_CHINA@yahoo.com
Web site: www.ICVSASIA.com
Open Daily: Monday to Saturday, 8AM-8PM; Sunday, 10AM-7PM

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We doctors now always need be on alert to counter the many anti-vaccine arguments, and now we have a major reinforcement in a new evidence-based  review of the 8 most common vaccines. This very important report is from the US Institute of Medicine, which is considered the gold-standard of objective, evidence-based reviews upon which many countries base their medical care. Or to put it another way — many lawsuits regarding vaccines would use IOM reports as their top evidence. (Here is the link to the IOM report, called “Adverse Effects of Vaccines: Evidence and Causality”.)

The most important take-home message from this study was that “the M.M.R. vaccine doesn’t cause autism, and the evidence is overwhelming that it doesn’t,” according to Dr. Ellen Wright Clayton, the chairwoman of the IOM panel. To put it more dryly, the IOM states, “evidence favors rejection of five vaccine-adverse event relationships, including MMR vaccine and autism and inactivated influenza vaccine and asthma episodes.” This certainly isn’t the first time scientists have found no link, but hopefully this IOM report can be the final nail in the coffin of the MMR-autism allegations.

So that’s the good news; the less good news is that there are some adverse reactions, sometimes severe, which vaccines can cause. The most concise review of the report’s pros and cons is from a Medscape report:

The IOM group decided that the evidence “convincingly” supports a link between

• anaphylaxis and MMR, varicella, influenza, hepatitis B, meningococcal, and tetanus toxoid vaccines;
• febrile seizures and MMR vaccine (such seizures almost always have no long-term consequences);
• syncope and the injection of any vaccine;
• deltoid bursitis and the injection of any vaccine;
• disseminated Oka-strain varicella zoster virus, along with Oka-strain varicella zoster virus viral reactivation (both with and without other organ involvement) and varicella vaccine; and
• measles inclusion body encephalitis and MMR vaccine in individuals with severe immune system deficiencies.

According to another set of committee conclusions with a lower certainty level, scientific evidence favorsaccepting a causal relationship between

• anaphylaxis and HPV vaccine,
• transient arthralgia in adult women and MMR vaccine,
• transient arthralgia in children and MMR vaccine, and
• a mild and temporary oculorespiratory syndrome and certain trivalent influenza vaccines in Canada.

Conversely, the committee stated that the evidence favors rejecting a causal relationship between

• type 1 diabetes and MMR vaccine;
• type 1 diabetes and diphtheria, tetanus, and pertussis vaccine;
• Bell’s palsy and inactivated influenza vaccine;
• asthma exacerbation or reactive airway disease episodes and inactivated influenza vaccine; and
• autism and MMR vaccine.

In its deliberation on MMR vaccine and autism, the committee stated that it reviewed 22 studies for epidemiologic evidence but relied only on 5 that, unlike the others, were “reasonably valid” overall. Each of the 5 studies asserted that there is no causal relationship between the vaccine and autism.

The committee also reviewed 4 articles and weighed evidence for the biological mechanisms by which MMR vaccine could possibly trigger autism. Its report noted that one of those articles, authored by the controversial Andrew Wakefield, was retracted last year by its publisher, The Lancet. Earlier this year, a series of articles and editorials in the British Medical Journal called Wakefield’s article an “elaborate fraud.”

“The committee assesses the mechanistic evidence regarding an association between MMR vaccine and autism as lacking,” the report stated.

There was also a good review of this important research by the The New York Times, which mentioned how the chicken pox (varicella) vaccine can sometimes cause problems as adults:

The panel did conclude, however, that there are risks to getting the chickenpox vaccine that can arise years after vaccination. People who have had the vaccine can develop pneumonia, meningitis or hepatitis years later if the virus used in the vaccine reawakens because an unrelated health problem, like cancer, has compromised their immune systems.

The same problems are far more likely in patients who are infected naturally at some point in their lives with chickenpox, since varicella zoster, the virus that causes chickenpox, can live dormant in nerve cells for decades. Shingles, a painful eruption of skin blisters that usually affects the aged, is generally caused by this Lazarus-like ability of varicella zoster.

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My top resource is an essential read for all parents: the newly updated 2011 guidelines for car seat safety, from the American Academy of Pediatrics:

The AAP recommends that all infants should ride rear-facing starting with their first ride home from the hospital. All infants and toddlers should ride in a Rear-Facing Car Safety Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer

Types of rear-facing car safety seats
There are 3 types of rear-facing car safety seats: infant-only seats, convertible seats, and 3-in-1 seats. When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat or 3-in-1 seat.

Types of Car Safety Seats at a Glance

And here’s a video which provides a useful, shocking reminder as to why seat belts are so important. If you cannot see the video below, please click here:

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The simple answer is: usually not nearly as much as you may think. Let’s take the common cold for example. The common cold symptoms of a low fever, wet cough and runny nose are usually caused by a family of viruses and not bacteria. The typical course is 3-4 days of these symptoms, with the cough usually the last to resolve many days later. The commonly assumed “warning sign” of colored or greenish runny nose does not mean this infection is bacterial; it only means your body’s white cells are fighting an infection, which again most likely is viral. So in most of these cases, the antibiotic doesn’t help fight this infection at all.

Antibiotic overuse is a serious problem not only because the medicine isn’t properly treating your child; it also could cause common side effects such as diarrhea and rash, or more serious allergic reactions such as allergic shock or even death. Plus, your child’s body may become resistant to this antibiotic in the future, when they may actually need the medicine to fight a real bacterial infection. This issue is also a major problem here in China’s hospitals and clinics, where antibiotic use, especially for intravenous drips, is many times higher than in most countries.

The American Academy of Pediatrics and the American Academy of Family Medicine both agree that antibiotic overuse is a serious problem with children’s illnesses, and they are dangerously over-prescribed for simple illnesses — but especially for ear infections. Many times in this scenario, the infection again is caused by a virus, and thus a week of antibiotics is not helpful at all. Fortunately, thanks to these Academies’ public education campaigns, doctors have been much more aggressive these last few years in cutting back on prescribing antibiotics for ear infections.

So what can we all do about this? I think one major fault lies with the doctors; we really need to do a much better job convincing our patients or their parents that antibiotics are only for serious bacterial infections. Perhaps doctors should even rename “antibiotics” to “antibacterials” to help patients distinguish the difference; after all, there is a class of “antivirals” for specific viruses such as HIV, influenza or hepatitis. Another technique is to prescribe the antibiotic but to have the parents wait before buying the medicine; after 24 to 48 hours, if the child is clearly worsening, then the parents can choose to fill the prescription. This can be a nice win-win for doctor and patient, as it gives the parents a bit more control, and it also gives the child time to recover without antibiotics.

Parents and teachers can find helpful information about this important issue at http://www.dobugsneeddrugs.org/, including handouts in Chinese.

(This article was originally printed in BeijingKids magazine, in my monthly “The Doc Is In” column)

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The second half discusses a new decree in Shanghai that sets up a free medical review board for patients who are disputing care with their hospitals. Apparently, many disgruntled patients hire people or agencies to act on their behalf by disrupting the hospitals, even falsely posing as angry family members. Hopefully, this free government agency will bring some order to this system.

Click on the arrow below to listen to the 5-minute podcast:

.

You can always listen to the Beijing Hour on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the CRI Radio network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

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First, skin cancer is by far the most serious long-term problem from all of the above maladies. Unfortunately, new research has shown that frequent sunburns during childhood are a major risk factor for future cases of melanomas, which are the most deadly form of skin cancers. Therefore, it’s crucial for parents to keep their children protected at all times from serious exposure. Proper clothing, hats and sunglasses help, as well as avoiding the peak sun times of 10am-4pm. Sunscreens are also crucial, and a broad-spectrum sunscreen of at least 15 SPF should be an essential tool for all days. Even in winter, everyone should consider using a facial moisturizer that also includes sunscreen of at least 15 SPF. My personal favorite is Neutrogena Men’s Triple Protect, but you can find many options at Watsons and other local pharmacies.

For children, a sunscreen of at least 15 SPF is best, although I personally always use 30 or 45. I don’t see much extra benefit for any SPF over 45.

Insect bites are very common during summertime, mostly from mosquitos, bees and ticks. A bee sting usually isn’t too serious and can be easily treated with ice, calamine lotion, pain medicines and sometimes antihistamine creams. The most common antihistamine cream is diphenhydramine, also called Benadryl in the U.S. A low-dose steroid cream such as hydrocortisone, available over the counter from your local pharmacy, can also provide relief from itching and swelling. Severe allergic reactions to bee stings are rare but can be very serious, and your local doctor may need to quickly provide emergency medicine if needed. Those of you with a history of severe allergic reactions should always carry around self-injectable epinephrine (usually called an EpiPen) for emergency use.

Mosquito bites are usually a minor annoyance but sometimes can cause illness from viruses or parasites which are carried by these insects. A typical bite can cause similar skin reactions as the bee stings above, and most of the above treatments also work well for the itching and swelling of mosquito bites. The most serious diseases include malaria, and anyone traveling to malaria areas should talk to your doctor about possible use of prescription medicines to take as prevention. But in all cases, a proper mosquito spray is crucial. The American Academy of Pediatrics recommends two medicines for children after 2 months of age; these are DEET in 10-30% concentrations, as well as picaridin 5-10%. Other medicines such as citronella and other herbal sprays aren’t nearly as effective or long-lasting as these two approved medicines.

One of my favorite summertime activities as a child involved picking blackberries from my backyard, but I often ended up with itchy welts all over my forearms from touching the leaves of poison oak and ivy vines. These itchy rashes (also called contact dermatitis) often can last for days but are usually easily treated with lots of soothing calamine lotion as well as topical antihistamine creams. If the itchy rash is driving you crazy and preventing sleeping, your family doctor can help by prescribing stronger anti-itch creams as well as the last resort — steroids, via injection or pills for a few days.

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

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