Sunblock at School and Betwetting in the Older Child.

Hi Everyone!

Here's some random readers questions that I have been getting lately.

Sunblock at School?

Dear Dr. Cason-

My 7 y/o daughter came home with a bit of a tan after playing in her school's playground. She was outside for about 30 minutes at 3pm. I am thinking about sending her to school with a hat and some sunblock. What do you think? - AT

Dear AT,
Sounds good to me. Kudos for being so proactive. Most of the skin damage people suffer from were from exposure as a child. Blistering sunburns are the worst. Make sure you apply the sunscreen at least 20 minutes before they are exposed to the sun.


Bedwetting in the Older Child

Dear Dr. Cason,

What can help when the child is no longer a child but a teen that still wets the bed. A friend of mine has a 14 year old daughter whom still wets the bed. The Dr says there is no medical reason that it must be a habit situation. Can you offer any advise on how to help this young lady. From what I understand this occurs almost every night. - JH

Dear JH-

The most important thing when you get a child persistently wetting the bed is to visit a Urologist that specialized in bedwetting (AKA Nocturnal Enuresis). I treat the older child the same as the younger child but I'd be more apt to put them on medication if warrented. Here are some other tips.

1. Limit caffeine and Juices in the evening. They are bladder irritants.
2. Limit fluids 2 hours before bedtime.
3. Practice timed voids- Urinate every two hours during the day. The bladder is a muscle and if your child tends to hold their urine during the day, then it is fatigued at night when it really needs to "work".
4. Purchase an alarm that wakes then up when urine is felt. This trains the brain to feel the bladder and hold the urine. This has been shown to be very effective.
5. Look for constipation. This is linked to enuresis in children and it's necessary to solve this problem BEFORE you solve the bedwetting issue.
6. Avoid scolding or repriminding your child. If they could help it, they would.
7. If your doctor approves then consider DDAVP administration. DDAVP is secreted by the brain and helps to concentrate urine. The bodies of some kids that wet the bed don't secrete this until they are older and may benefit from adminstration.
8. Don't ignore the problem. Years ago we used to say it was no problem and don't treat it because they will eventually outgrow the issue. But now we know that if the child is bothered by it, then the psychological effects of bedwetting can be lifelong. Therefore if you feel your child or teen is bothered by the bedwetting, then seek medical attention and a solution sooner rather then later.

Sheila Cason MD

Medicine Mondays:Essential Fatty Acids and Children,

Hi Everyone,

Welcome back to Medicine Mondays.

Each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

Dear Dr. Cason,

For toddlers, is there a given amount of fatty acids they should have for good brain development? Are supplements available and ever necessary?With my daughters dairy, egg, and nut allergies, the fatty acids she can intake are limited. She eats a lot of avocados. What are other good sources?- Anonymous


Dear Anonymous,

When people talk about consuming fatty acids they are most likely referring to essential fatty acids (EFAs) They are called essential fatty acids because they cannot be made in the body from other substrates and must be supplied in food. These fatty acids are called Linoleic Acid (Omega -6) and Alpha-Linolenic Acid (Omega - 3).

In the body, essential fatty acids are primarily used to produce hormone-like substances that regulate a wide range of functions, including blood pressure, blood clotting, blood lipid levels, the immune response, and the inflammation response to injury infection.

You can get these EFA in supplements but since they are nutritional supplements and therefore not regulated by the FDA, there is no specific guidelines about what a safe amount is. I generally recommend that parents feeds their kids good healthy foods that will supply the EFA and don't worry about additional supplementation found in capsule form.

Most people forget that while eating Omega- 6 and Omega- 3 EFA are important what is more important is eating the right ratio of Omega -6 and Omega-3. Marion Nestle in Her Book, "What to Eat" points out that

Although these two essential fatty acids differ, the enzymes that work on them are exactly the same. This means that when you eat a lot of linoleic acid, Omega- 6, it can compete with the alpha-linolenic acid, Omega-3, for the enzymes that turn the alpha-linolenic acid into EPA and DHA, the two longer omega-3 fatty acids that seem especially good for health.

This means that it's important to eat the Omega -6 and Omega -3 EFA in the right ratio to prevent this competition. Nestle suggests eating balance of 6:1. Oils that have a good balance of Omega-6 to Omega- 3 are Flaxseed oil at 1:4, Canola at 2:4, Soy at 7:1 and a fairly good balance of these two EFAs can be found in Olive Oil at 9:1.

Most people get enough Omega- 6 without even trying. Examples are- Safflower oil,walnut oil, grass fed cow milk, olive oil, palm oil, sunflower oil, soybean, peanut oil and sesame oil to name a few. What they need to focus on is increasing their Omega- 3 intake.

Examples of food that have a good amount of Omega- 3 are oily fish, walnuts, flax seeds, pumpkin seeds, canola oil and soy. Omega eggs are also a good source of Omega-3 fatty acids and you can find them in your grocery store. The hens that lay these eggs are fed on healthier feeds, which results in eggs that contain omega-3 fatty acids. For a child that is allergic to nuts and eggs, I would focus on taking in a balance of salmon, flax seeds and canola and soy oil.