DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. The topic of this webcast is kids and hygiene. My little 3-year-old daughter's nickname is Piglet because she always is a mess. Joining us to talk about how much we should clean our kids, are two guests. First is Dr. Dan Neuspiel. He's associate chairman of pediatrics at Beth Israel Medical Center. Welcome.
DANIEL NEUSPIEL, MD: Thank you.
DAVID R. MARKS, MD: Next to him is Dr. Herschel Lessin. He's a pediatrician at the Children's Medical Group in Poughkeepsie, New York. Thanks for being here.
HERSCHEL LESSIN, MD: Thanks for having me.
DAVID R. MARKS, MD: All right, so how obsessed should I be with cleaning up my little Piglet?
DANIEL NEUSPIEL, MD: I've found in my practice, David, that there are many parents who feel that the more they bathe their children, the better. But in fact, there are many children who have sensitive skin and who may react badly to being bathed too often, by having irritated skin, something we call atopic dermatitis. It's probably better not to bathe kids, certainly, more than once a day, and many kids may only tolerate being bathed once or twice a week.
DAVID R. MARKS, MD: Tell me what atopic dermatitis is.
HERSCHEL LESSIN, MD: Atopic dermatitis is commonly known as eczema. It's sort of like hyper-irritable skin. It's skin that itches where normal skin wouldn't itch. And the kids scratch it, and then it gets more irritated, and then it itches more. It can be quite a problem. And it's very often aggravated by too frequent washing.
DAVID R. MARKS, MD: Are there any other conditions where it can be detrimental to the kid to try to wash them up too much?
HERSCHEL LESSIN, MD: If they hate it, and you're struggling all the time. When you have a kid who hates to be washed, and it's particularly a younger infant who isn't really rolling around in the dirt too much, younger than your Piglet. How dirty do little babies get, after all? You just have to bathe the diaper area, and you don't need to do a bath every night, unless something's there. So if they hate it, I don't think you have to bathe all the time.
DAVID R. MARKS, MD: What hygiene issues should we be concerned about, as parents?
DANIEL NEUSPIEL, MD: One of the most important things, David, is hand-washing. Hand washing is really the most important way to prevent transmission of infection, both at home and in school and in daycare centers. And it's important for children, parents and all people who work with children.
DAVID R. MARKS, MD: We often tell our kids to wash their hands before dinner and, of course, after going to the bathroom. Are there any other times when they should be washing up?
HERSCHEL LESSIN, MD: Certainly if they've gone outside to play. If they've played with other kids and have been all over them, as kids are wont to be. Those are times you ought to wash your hands. I think it's particularly important for adults to wash their hands if they have cold symptoms or are ill, if they're working in a daycare center or if they're around a lot of kids. Because that's really the best thing to prevent transmission of infectious disease, is good hand-washing.
DAVID R. MARKS, MD: Okay, I know as a parent it's easy to say: Wash your hands when you do this, wash your hands when you do that. But how do you really get them to do that because they're off doing their own things, usually?
DANIEL NEUSPIEL, MD: I think one thing is setting a good example by doing it yourself. And really just making it an expectation of kids, routinely. Particularly before meals, when using the bathroom.
DAVID R. MARKS, MD: Does it help setting a routine when they're younger? Trying to get them into a pattern?
HERSCHEL LESSIN, MD: Kids love routines. Despite what you might think, they like their lives to be orderly. And most of us don't live very orderly lives. So if you can establish a good routine early on, kids get security out of that, and you can help train them into good health habits by following the routine yourself, and kind of insisting that they do it also.
DAVID R. MARKS, MD: There's been a lot in the news over the last year about anti-bacterial soaps. Using them too much may be causing some resistance, maybe setting kids up for getting sick later on. Is there anything to that?
DANIEL NEUSPIEL, MD: There's really not a whole lot known, in terms of research in that area. But there's potential for anti-bacterial soaps to produce resistant organisms. And studies showing the protective nature of hand washing really show that it's the mechanical action of washing your hands, not what kind of soap you use.
HERSCHEL LESSIN, MD: It's the rubbing. You really need to rub. It's not whether you put on the latest germ killer, it's the rubbing and scrubbing when you do your hands. That's what kills the germs and prevents the transmission of illness.
DAVID R. MARKS, MD: But can, actually, that anti-bacterial ingredient cause resistant bacteria? I think that's the major concern from a lot of corners.
HERSCHEL LESSIN, MD: There's nothing known, as Dan said. Nobody's really done studies. But certainly in the area of antibiotic usage, we've found that overuse of antibiotics has bred a terrific number of resistant germs, which is causing us real problems now. And one can only speculate that the same process may go on by overuse of anti-bacterials when they really don't have a lot of benefit.
DAVID R. MARKS, MD: Does it help to actually cause kids to be immune by having them exposed to all these bacteria? Maybe it's beneficial?
DANIEL NEUSPIEL, MD: Could be. Certainly we see kids who actually have lots of colds at an earlier age, tend to have less minor infections later on. But whether that translates into what kind of soap is used, really isn't well known at this point.
HERSCHEL LESSIN, MD: The only way you can get immunity, unfortunately, is to catch something. Which is not to say you should go out and expose your child to everything, little Johnny down the block when he has a cold. But there's just some speculation that perhaps by killing off all these germs, that we're predisposing our kids to get more serious stuff later. But that's pure speculation, and there's been no data to support that. It's really just a thought, and it's really not been proven.
DAVID R. MARKS, MD: Okay, so just to wrap it up: What are the guidelines for parents? What should they be doing to keep their kids clean and healthy?
DANIEL NEUSPIEL, MD: Bathing as needed, at least once a week. And frequent hand-washing, particularly around meal time, bathroom usage, and if there's any illness in the home or in school.
HERSCHEL LESSIN, MD: I would add that if you're child's in daycare, which many children are, with both parents working, that when they decide to pick their daycares, they should really make it a point to be sure that there are good cleanliness habits going on in the daycare, between washing of hands, washing of shared toys, and things of that nature. That really should be a very important criterion in picking a daycare setting for your child.
DAVID R. MARKS, MD: Okay. Thank you both very much. Thank you for watching the webcast. And good luck keeping your child clean. I'm Dr. David Marks. Goodbye.