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Havilah Brodhead FNP-BC, Family Nurse Practitioner, Hearthside Medicine Family Care/Owner

QSunscreen options have really expanded and gotten expensive in recent years. What are the differences between the cheap stuff, the pricier options and the ones marketed as kid's sunscreen?

ASunscreens essentially come with three varieties of "UV filters": chemical, mineral, or chemical + mineral.

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Sun products marketed for babies or children tend (key word) to be mineral-based, as mineral UV blockers are considered much safer for children than chemical UV filters.

I strongly recommend mineral-only (zinc oxide and/or titanium dioxide).

Most commonly known sunscreens such as Banana Boat and Coppertone (yes, even the "kid versions") contain chemical filters, may be less expensive, and typically include a combination of these active chemicals: oxybenzone, avobenzone, octisalate, octocrylene, homosalate and octinoxate.

Lab studies indicate that some chemical UV filters may mimic hormones (increasing risk for hormone-related cancers) or cause skin allergies and reactions.

Oxybenzone and other filters have been detected in mothers' milk (also blood and urine), indicating that the developing fetus and newborns may be exposed to these substances. A 2010 study from the University of Zurich found at least one sunscreen chemical in 85 percent of breast milk samples. I encourage mineral-based sunscreens for the whole family, not just kiddos.

Avoid spray sunscreens — some studies indicate inhalation may be harmful to the lungs.

Avoid skin products containing pre-formed vitamin A (retinyl palmitate, retinol, retinyl acetate, retinyl linoleate and retinoic acid). About 12 percent of sunscreens contain vitamin A and may actually trigger development of skin tumors in the presence of sunlight. More studies are needed to determine safety.

I appreciate the Environmental Working Group's "Guide to Sunscreens," which rates hundreds of sunscreens on a scale of 1-10, with 1 being safest and 10 being least safe.

Top ranking kid's sunscreens include All Good Kid's Sunscreen, Adorable Baby Sunscreen, Aveeno Baby, Badger Kids (among others).

Worst ranking include Banana Boat Kids, Neutrogena Pure & Free Baby, Coppertone Kids, Panama Jack, and Australian Gold.

We recommend sunscreen after 6 months of age, broad-spectrum (UVA/UVB protection), spf 30-50, re-apply at least every two hours, and dispose if expired, change in color or consistency or exposed to high heat as this can render the product unsafe and ineffective.

QMy daughter loves soccer, but she's stressed about the amount of pressure put on her by coaches, teammates and society in general. I don't want her to quit. How can I help her set healthy boundaries around competition and encourage sports as part of a healthy lifestyle?

AWe are living in a world with unprecedented rates of youth depression, anxiety and suicide, so I truly appreciate this question.

Many theories exist to explain the skyrocketing mental health crisis. Some propose over-stimulation, insufficient sleep, excessive activities, performance pressure and not enough down time may contribute.

Consider your child's unique strengths and personality. Some children thrive in team sports while others are more cut out for individual sports.

Competition absolutely has its value as well, such as the ability to learn to play in a team dynamic and persevere through challenges; however, some children have a personality better suited for non-competitive exercise and may tolerate competition when they are a little older.

I encourage parents to allow their children to try different sports until they find one that "clicks." Weigh the pros and cons and include your child in this conversation.

Is your sport worth the anxiety it is causing? What do you enjoy most about it? Least? Are your goals aligning with your child's? Does your child just want to play for fun and not for competition?

If your child's motivation is to continue in a group sport or competitive sport, help them identify the particular stressors and capitalize on their strengths for overcoming them.

Maybe try out a different team with a coach that can better support your child.

Primarily, keep sports fun to establish a healthy, life-long love of exercise!

QHow important is nap time for young children? I have four children under the age of 6. Between working part-time, shopping and play dates, we don't have much downtime. My kids end up dozing in the car between errands. They are super cranky when I wake them and often make the afternoons miserable.

AAs a full-time working mom of a 3-year-old and almost 2-year-old, I feel your pain! We live in a "Go! Go! Go!" society. Sleep often gets "squeezed in" and not prioritized.

Insufficient sleep can disrupt critical hormones, such as growth hormone, thyroid hormone and even leptin and ghrelin, hormones that tell us when we are full versus hungry. Lack of sleep increases risk for diabetes and obesity and increases stress hormones cortisol and adrenaline, which lower our immune system.

Studies on toddlers have shown that missing one 90-minute nap a day can cause a child to have more anxiety, irritability, difficulty concentrating and struggle more with learning and problem solving.

"But my child does not want to nap," you may say. That's ok. We cannot make our children sleep, but we can prioritize and cultivate rest by providing a "rest routine." Rest is essential for the brain. This means no screen or stimulating toys or sound—just a few books or quiet activities such as puzzles or coloring in a quiet room.

Naps serve as a way to add more sleep to the "sleep bank" to reach the total needed hours of sleep in a 24-hour period. As a general rule for sleep requirements, most 2-3 year-olds require 12-13 hours and most 4-5 year-olds require 11-12 hours.

Regarding our children's mental and physical health, sleep and rest is one of the most important things we can give our children to set them up for success (and let's be honest, to save our sanity sometimes too, as parents).

The reality is, we won't always be able to provide our children with a dedicated nap time, especially while traveling. Thankfully, children are adaptable. If you find that naps are not realistic, consider eliminating some extracurricular activities and/or moving your child's bedtime up to compensate for the loss of daytime sleep.

QIs there an advantage to exposing my child to chicken pox and going through the sickness over getting him vaccinated? I've heard arguments on both sides. I don't actually know of anyone whose kids have had the chicken pox.

AChickenpox is a highly contagious infection caused by the varicella virus hallmarked by a painful rash. 300-500 blisters can occur during a single infection and result in permanent scarring for some children. A person can be infectious 48 hours before the rash appears.

An infected person may recover without consequence but can spread the disease without knowing they are infectious to those who may suffer serious consequences, such as infants, non-immune pregnant persons, and those who are immune-compromised.

Chickenpox "typically" resolves without complications. However, approximately one of every 1,000 children will develop severe pneumonia or encephalitis (infection of the brain).

Before routine vaccination started in 1995, about 4 million children were infected annually, resulting in around 10,000 hospitalizations and 100 deaths a year —mostly occurring in previously healthy young children.

On the other hand, the varicella vaccine rarely has serious side effects. Here is a breakdown from CHOP:

Chickenpox risks

• Painful Rash (300 -500 blisters) with possible scarring

• Pneumonia or brain infection (1 out of 1,000)

• Birth defects (1 of 50 infants born to women infected during pregnancy)

• Secondary bacterial co-infections

• Dehydration

• Death

• Rarely rash can spread to the eye and result in emergent infections called uveitis and keratitis

Most Commonly Reported Vaccine Risks

• Pain and tenderness at the injection site

• Low-grade fever

• Rash around injection site (four of 100 recipients) or rash more distant to site of injection (usually around 10 to 30 blisters that are not contagious to other people)

I remind my patients that there are often risks of getting an intervention and risks of not getting an intervention.

Not everyone can get the varicella vaccine, such as those with a life-threatening allergy to gelatin or neomycin, infants, those who are pregnant, or those with suppressed immune systems.

For parents with questions regarding vaccines, I enjoy discussing ingredients, benefits, risks, side effects, schedule, adverse effects, weighing pros and cons and discussing each disease. I believe caregiver concerns are valid and should be addressed with openness and respect.

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