The Kid's Doctor: Take Charge.

Traveling with a Toddler

dina — Wed, 19 Jun 2013 10:00:00 +0000

Summer is upon us and that means travel and family vacations. I think the hardest time to travel with your child is when they are a toddler. While a 1-2 year old child is adorable, they are also like a teenager. What do I mean by that? A toddler is moody and temperamental, just like a teen. One minute they love you the next minute, not so much. They are prone to tantrums, meltdowns, and “going to the dark side” as we called it.

If you are heading for a plane trip with a toddler, you just never know what to expect. A lengthy plane ride is somewhat challenging for sure. While driving to the airport all I can think about is security lines with a toddler. The lines are longer in the summer and trying to keep your child entertained while standing in a long line is akin to climbing Mt. Everest. It is even worse than sitting in the pediatrician’s office, at least we have toys!

So, once you get through security you still have to wait to board, get settled into your seats (holding a lap child is not easy) and then pray that your flight is not delayed on the tarmac. I was fortunate as when my boys were little you could still get up and walk up and down the aisles with a child to entertain them. Even then it was difficult to keep your toddler’s hands to themselves. You cannot walk those precious toddlers up and down the aisles anymore, and sitting in that seat for hours is just not what a toddler wants to do. They want to MOVE!

One of my patients’ is getting ready for a move to Australia. This couple has a adorable 16 month old and they are getting ready for a 17 hour trip and asked my advice. I wish you could “Fed Ex” your child ahead.

This cute little boy has a lot of words and during his check up in my office he kept pointing to the door and saying “OUT”. Stuck inside a plane is not going to be his idea of fun...he would rather be at the park.

But parents do what they have to do......so I advised them to look for new toys and try to bring out something different throughout the flight. They are great young parents and have not yet introduced their child to the I-pad, so they can now “pull out” this new gadget to help entertain their toddler. I also told the mother to pack a ton of snacks and even “forbidden snacks like cookies and candy might be used to coerce the child to sit in his seat. I have a hard time sitting still, so it is reasonable for a toddler to be antsy as well.

I just hope they have wonderful seat mates (on this journey) who want to help entertain a little boy who just wants “out”. They hope to have another baby while in Australia. The return trip could even be more fun.

Family Routines Can Reduce Childhood Obesity

drsue — Tue, 18 Jun 2013 10:00:00 +0000

I just read an article published in the journal Pediatrics which once again validated the importance of family routines. In this study researchers from Ohio State University looked at household routines as they related to childhood obesity, an ever escalating problem.

The research, conducted in 2005, but published this year, analyzed over 8,500 four year old children. 18% of the children were identified as obese. Families were then asked if they regularly ate evening meals together, did their children have a bedtime and receive adequate sleep, and was television time limited within the home? When looked at more closely a little more than half of the children reported having family dinners 6 or 7 evenings a week.

There were 57% of the children who were reported to have 10.5 hours of sleep per weeknight. Only about 40% of the studied children were reported to watch less than 2 hours of television or movie viewing per weekday. When looked at in terms of those children who were exposed to all 3 routines, the prevalence of obesity was 14%, while those children not exposed to any of the 3 routines had a prevalence rate for obesity of 24.5%. The research also found that the number of household routines was a predicator of obesity and that by adding a routine, there was a 17% reduction in odds for obesity as a new routine was added.

These household routines seem to be fairly easy to initiate in that they may be accomplished without any cost etc. Establishing good routines for family meals has repeatedly been shown to improve a child’s academic success, attention, risk of using alcohol and drugs and overall well being. If it could also reduce the incidence of obesity what a win!! Just one more reason to plan for a family to eat dinner together. This study did not even discuss healthy food choices, which might make the statistics even more compelling, and what about adding eating breakfast together? Bedtime routines are important for all children and the lack of sleep has been documented to cause numerous issues.

We as parents all know that our children are “cranky” when they are sleepy, and as they get older lack of sleep impacts a child’s school performance, alertness and focus and may even be a factor in a teens driving safety. I think all children need to have a “bedtime”, and even teens need to know when to go to bed! Lastly, the AAP has recommended that children under 2 years of age not watch TV, and for those older than 2 years there is no more than 2 hours of television/DVD/movie/computer time per day. I would also add that children should not watch TV prior to their school day, and that includes watching movies in the car while en route to school! I just don’t get that.

So, 3 simple household routines may make a huge difference in a child’s over all well being, including reducing their risk of obesity. Start with one of these routines and as they become “routine” add another. See what you think! Send your question or comment to Dr. Sue right now!

Recall: Baby Recliners Linked to 5 Infant Deaths

Del — Mon, 17 Jun 2013 15:00:00 +0000

Baby Matters LLC is voluntarily recalling its foam rubber Nap Nanny and Nap Nanny Chill infant recliners and their covers, in exchange for the U.S. Consumer Product Safety Commission (CPSC) dropping an administrative complaint that it filed in December 2012.

From 2009 to the present, the Commission staff has received at least 92 incident reports involving the Nap Nanny and Nap Nanny Chill products, including five infant deaths. CPSC is aware of four infants who died in Nap Nanny Generation Two recliners and a fifth death involved in the Chill model. In the incident reports received by CPSC, there were 92 reports of infants hanging or falling over the side of the products, including some infants who were restrained in the product’s harness.

In December 2012, four major retailers—Amazon.com, Buy Buy Baby, Diapers.com, and Toys R Us/Babies R Us—announced a voluntary recall of Nap Nanny and Chill models sold in their stores. Consumers who purchased a Nap Nanny from one of these retailers should contact the retailer for instructions on how to obtain a refund for the product.

About 165,000 of the Nap Nanny and Chill products were sold between 2009 and 2012 for about $130. The recalled products were sold at toy and children's retail stores nationwide and online, including at www.napnanny.com.

Baby Matters LLC is no longer in business and is not accepting returns. CPSC urges consumers to immediately dispose of the products to ensure that they are not used again.

Consumer contact:

- Amazon.com: http://www.amazon.com

- Buy Buy Baby: Toll-free at (877) 328-9222, http://www.buybuybaby.com/productRecalls.asp

- Diapers.com: (800) 342-7377, http://www.diapers.com

- Toys R Us/Babies R Us: (800) 869-7787,  http://www.toysrusinc.com/safety/recalls

Source: http://www.cpsc.gov/Recalls/2013/Four-Retailers-Agree-to-Stop-Sale-and-Voluntarily-Recall-Nap-Nanny-Recliners-Due-to-Five-Infant-Deaths/

HPV Vaccine & Teens

dina — Mon, 17 Jun 2013 10:00:00 +0000

Summertime in the pediatrician's office means lots of check ups, and often this includes those tweens/teens/and college students who were “too busy” to schedule their doctor’s appointments during the school year. The next three months will be busy indeed.

With HPV back in the news after Michael Douglas revealed that his throat cancer was due to HPV, what better time to remind parents and young adults of the need for the HPV vaccine. The HPV vaccine has been available in the U.S. for over seven years, but statistics from the CDC continue to show that the HPV vaccine is still not being given at the same rate as other recommended vaccines. In other words, we doctors need to ensure that every person between the ages of 11-26 who we see is offered the vaccine, this also means we need to educate.

HPV causes CANCER! This is truly the first anti-cancer vaccine, and I am hopeful that I will see more vaccines to prevent cancer while I continue to practice. I am sure that there will be more anti-cancer vaccines in our children’s lifetime. This is exciting news as research continues on ways to combat cancer.

But.....for some reason (that is difficult for me to understand both as a parent and a physician), some parents are refusing to have their children vaccinated despite ongoing evidence that HPV is widely prevalent and causes numerous cancers. The fact that this virus is transmitted sexually seems to be the root cause of parental concern. Do parents not assume that their own children will become parents one day as well? Don’t they want to be grandparents one day? Well, that means having sex with a partner. At some point in time, our children do become “sexually active” and shouldn’t they all be protected as much as possible?

Giving adolescents the HPV vaccine does not promote sexual activity. In fact, I think that by having a discussion about sexually transmitted diseases in an open and frank manner adolescents are more aware of the risks associated with pre-marital sex and multiple partners.

My adult sons gave me a huge compliment the other day when HPV was back in the news - they said “Mom, remember when you gave us that vaccine “off label”? We thought you were crazy but you were really smart!” I will take any praise I can get....I just smiled.

Summer Viruses Are Gearing Up

dina — Sun, 16 Jun 2013 10:00:00 +0000

Not only does it already feel like summer where I live in Texas, summer is really here for everyone. With winter viruses long gone (good bye flu and RSV), those summer viruses which have been laying dormant are once again rearing their angry heads.

My office has been overflowing with really hot feverish kids of all ages. I think the most likely culprit for much of the illness we are seeing right now is an enteroviral infection. For some reason, it makes us parents feel better if we can “name that virus”, seems to help validate the illness.

Enteroviral infections typically cause a non-specific febrile illness and with that you can see fairly high fever. In other words, just like the thermometer as summer heat arrives , 101-104 degrees of fever is not uncommon in these patients. Remember the mantra, “fever is our friend”. I think it is almost worse to have a high fever in the summer as you are even more uncomfortable because it is already hot!

With that being said, if your child has a fever, don’t bundle them up with layers of clothes and blankets. It is perfectly acceptable to have your younger child in a diaper and t-shirt, and older children can be in sundress or shorts rather than long sleeves and pants. Bundling may increase the body temperature, even while you are driving to the doctor’s office. I often come into a room with a precious baby who is running a fever and they are wrapped in blankets, let them out! That hot body needs to breathe.

These summer enteroviruses may cause other symptoms as well as fever, so many kids right now seem to have sore throats and are also vomiting and having diarrhea. With this type of virus you also hear complaints of headaches and body aches (myalgias). The kids I am seeing don’t look especially sick, but they do feel pretty yucky! Just kind of wiped out, especially when their temps are up.

Besides treating their fevers, treat their other symptoms to make them comfortable. If they are vomiting do not give them anything to eat and start giving them frequent sips of liquids such as Pedialyte (for the younger ones) and Gatorade or even Sprite or Ginger Ale. Small volumes are the key.

I often use pieces of Popsicle or spoonfuls of a Slurpee to get fluids in kids. I always tried to pick drink colors for my own kids that were easier to clean up, in case they were going to vomit again, so no bright red! The cold fluids may also help to soothe a sore throat. Once the vomiting has stopped, and it is usually no more than 12-24 hours, you can start feeding small amounts of food, but I would steer away from any dairy for a day or two. Again, nothing worse than thinking your child is over vomiting, fixing them I nice milkshake (comfort food) and seeing that thrown up! Many a mother has come into my office wanting to strip after being vomited on, in a hot car no less. I don’t think there is a car wash around that can fully get rid of that smell!

Most enteroviral infection last anywhere from 2-5 days. There are many different enteroviruses too, so you can get more than one infection during the season. This is not just a virus you see in children, so watch out parents you may succumb as well. Keep up good hand washing and your child should stay home from school, the pool, camp, day care etc. until they have been fever free for 24 hours.

That’s your daily dose for today. We’ll chat again tomorrow.

When a Child Looks Yellow

dina — Sat, 15 Jun 2013 10:00:00 +0000

I saw a toddler the other day with the mom’s chief complaint of “my child looks yellow”. On first glance I too noticed the child’s “glowing” yellow skin, but it was quickly evident that this child was not jaundiced, but rather was carotenemic.

Carotenemia is a clinical condition caused by an increased level of carotene in the blood. It is commonly seen in infants and toddlers who eat excessive amounts of baby food carrots, sweet potatoes, squash and peaches. Children actually metabolize carotene more slowly than adults, which is why it is more commonly seen in children.

Many of the commercially prepared baby foods, especially vegetables and fruits, have a high carotene content as carrot and carrot rich ingredients may routinely be added to strained baby foods.

Carotenes are present in all pigmented vegetables and fruits, and the carotene may be masked by the green color of chlorophyll in these foods as well. Foods with a high carotene content include not only carrots and squash, but apricots, beans, peas, spinach, sweet potatoes, mangoes, oranges, tomatoes, and papaya.

In general, vegetables that are deeper green or yellow contain the most carotene. Human milk may also be a source of carotene if the maternal serum carotene is high.

Upon further questioning, the child’s mother told me that her daughter was otherwise healthy. She did not have any fever, was not vomiting and did not have any change in the color of her urine. She was a happy baby and was just starting to walk.

Her daughter was beginning to drink whole milk and was still eating baby foods. On the child’s exam her eyes were not yellow in appearance and she did not have an enlarged liver. The mother was happily relieved to hear that the problem was actually not jaundice, as several of her relatives had suggested. The mother and I discussed the diagnosis of carotenemia, and also discussed transitioning her daughter from pureed foods to table foods. Not only was it important and age appropriate for her child to begin feeding herself mushy table foods, there is an inverse relationship to carotene levels in smaller particle foods rather than table foods.

The mother left relieved and her daughter just looked a bit too golden but healthy!

That’s your daily dose for today. We’ll chat again tomorrow.

Father's Day

dina — Fri, 14 Jun 2013 10:00:00 +0000

With Father’s Day approaching, I always have frequent thoughts of my own father. He has been deceased for quite some time and I am saddened (especially at this time of year) that he did not get to see his grandsons become young adults. He would have been so proud of them and in many ways they are like him.

One of the many exceptional attributes that my dad possessed was the ability to FIX ANYTHING! I grew up not knowing about the Maytag Man, the plumber or the electrician as my dad fixed the washer, the electrical socket or the garbage disposal. Of course, like most homes, there was always a running list of things to be fixed.

Because my dad was often gone for long periods of time (he worked for the government in intelligence) my mother would say we would “have to wait for your father to return” to fix whatever it was, and when dad returned he would get right to work. If he didn’t know how to fix something he somehow figured it out and that was before you could “GOOGLE IT”! I remember him painting the house, building our downstairs rec room and taking apart an early computer just to see how it worked.

Being able to “fix” things must somehow be a genetic link as I now see this trait in several of my own children (you know who you are). When I was a newlywed I was shocked to learn that not all men had this gene. When something broke in the house I would automatically tell my husband and he would lovingly attempt to “fix it”. But, what I quickly learned was that while my husband has many wonderful traits he did not inherit the “fix it gene”. Many a repair man has been called to our home to “fix” the problem created by my loving husband who attempted home repairs.

But several of my boys loved to watch their grandfather fix things and take things apart. As they got older, they would come to the rescue to help around our house with the laundry list of issues and repairs.

Many of the issues these days revolve around technology and they all inherited their grandfather’s technology “fix it gene” as well. Unfortunately, they are not in the next room any more to call upon when I have no idea why my computer is frozen or when I cannot even turn on my iPod to play music in all of the rooms of the house.

So as we approach this Father’s Day I am thankful for all of the lessons learned from my own father, and for his “fix it gene”. But, with all of the boys out of the house, I now have a handyman on speed dial.

Happy Father’s Day!

A Healthy and Happy Father's Day

Del — Fri, 14 Jun 2013 06:55:59 +0000

Dads are known to give their all when it comes to supporting their family and friends, but in doing so they often neglect their own health. Maybe it’s just a stubborn streak or not wanting to take the time to visit their doctor – but men are notorious for not getting even a basic checkup.

Let’s face it, who likes to get a physical or blood tests or take a stress test or see the dentist or optometrist? No one I know.

But some dads may need a little extra prodding and a reminder that these medical visits are important. We want dad around for a long time.

There’s not a long list of tests that every man should have – but there are some very important ones that can help provide valuable health information. Not every man will need to have an annual exam, but as they age there are certain conditions they should keep an eye on. Family and personal history can also dictate which tests are must haves and maybes.

When many of these conditions are caught early and treated they can either be managed or cured. It’s when they are left unattended and have time to progress and damage the body that they can become life altering or even fatal.

Here’s a list of medical tests every man should have performed routinely.

Blood Pressure - High blood pressure can cause serious organ damage or death. But screening for it is easy and reliable. It’s typically part of every exam when you see your doctor. Testing at home should also become part of a weekly routine.
Cholesterol – Checking the cholesterol level is a simple blood test taken after fasting for 8 hours and is recommended for all men 35 and older. If a man has a family history of heart disease or is at risk for developing heart disease, starting at age 20 is recommended for testing.
Colorectal cancer - Colon cancer kills more than 56,000 people every year. But the CDC says that nearly 60% of those deaths could be prevented if everyone was screened properly and treated appropriately. All men and women 50 and older should be screened for colorectal cancer. People at higher risk may need to be screened at a younger age. This includes people who have a close relative who had colorectal polyps or cancer or who have inflammatory bowel disease. There are several techniques for screening. Each has its own set of advantages and disadvantages for individual patients. The ideal interval between screenings depends on the test. But CDC data from 2005 suggest that nearly 42 million Americans over 50 have not yet been screened appropriately.
Immunizations - Immunity can fade over time, and vaccine recommendations change over the years. For men over 50, a tetanus booster is recommended every 10 years. Flu shots are suggested every year for this age group. And a pneumococcal vaccine is recommended once at age 65.

There’s also a list of tests that a man may or may not need depending on his individual health. His doctor will be a guiding factor in determining need.

These tests are:

Prostate Cancer. Prostate cancer when caught early is very treatable. Tests for prostate cancer are somewhat controversial. Screenings are either a prostate specific antigen test (PSA) or digital rectal examination. While the PSA can detect prostate cancer in its early stages, it can also return many false positives. However, men should talk to their doctor about the relation between prostate cancer, age and family history. The PSA is most likely to benefit men aged 50 to 70. It can also be beneficial if you are over 45 and are at increased risk.
Diabetes – If you have a family history of diabetes are overweight or have a high risk life style for developing diabetes most doctors will want to test you for it. Adult type-2 diabetes has increased over the last couple of generations. It can often be managed through lifestyle changes and medication.
Skin cancer – Some doctors recommend a yearly exam by a dermatologist to check for changes in moles or for new moles that develop. Skin cancer is another condition that when caught early is typically treatable. Melanoma is the most dangerous form of skin cancer but once again, if it is caught early it is almost always curable. If it is not it can spread to other parts of the body and can be fatal. It’s good to keep on top of any changes in the skin.
Testicular cancer. Testicular cancer mainly affects young men, ages 20 to 39. Though testicular cancer is rare, it is curable if detected early. the American Cancer Society recommends a testicular exam “as part of a routine cancer-related checkup.”

Many a reluctant man has gone to the doctor because his wife or loved one pushed him to do it and has been grateful that he did. Early detection is the key to a good outcome.

So this June 16^th, perhaps a gentle reminder in your card to dad about how much you want him healthy and around to celebrate many more Father’s Days isn’t a bad idea.

Happy Father’s Day from The Kid’s Dr.!

Source: Richard Sine, http://men.webmd.com/features/mens-health-tuneup-schedule-medical-tests

Bright Light & Sneezing

drsue — Thu, 13 Jun 2013 10:00:00 +0000

What is the connection between bright light and sneezing? DId you know it was hereditary?I have always noticed that I frequently sneeze when I walk outside, and this was especially noticeable this summer with all of the bright sunny HOT days that we experienced. I thought I had remembered that my mother often did this too and when I asked her she confirmed this. I was recently reminded of this again when I was with my youngest son moving him back to school. It seemed that every time we walked outside to get another load of boxes he sneezed! We both sounded like “Sneezy” one of the Seven Dwarfs. Of course my son announced, “Mom are you just realizing this? I have always sneezed just like Ohma and you do”. Oh well, I am finally catching on. This of course piqued my curiosity and then I remembered that I had read something about “the photic sneeze reflex”. It has also been name ACHOO: Autosomal Cholinergic Helio-Opthalmic Outburst (and you thought ACHOO was the sound you made!) It is estimated that this reflex affects about 1 in 4 people. It is inherited in the autosomal dominant manner (remember your days in biology and big B and little b?) If you have the “sneezy gene” your child has a 50-50 chance of also having it. This reflex has been known for a long time but there wasn’t much science as to the cause. But a recent study (very small only 20 people) compared photic sneezers to controls and found that when shown a shifting pattern of images, the visual cortex of the sneezers showed higher activity than those of the control subjects. There needs to be much more research done on this topic with larger groups of people studied to further confirm this finding. But, nevertheless, it is interesting that scientists are now trying to elucidate the mystery of the photic sneeze. In the meantime I realized that another one of my son’s also has the gene. Funny how you suddenly recognize a familial pattern to sneezing only to find out it is in the genes. It also reminds me I have a blue eyed and 2 brown eyed children, back to those genes again. Just like they taught me in medical school, take a good family history! That’s your daily dose for today. We’ll chat again tomorrow.

Five Facts About Dads and Kids

Del — Wed, 12 Jun 2013 15:00:00 +0000

The esteemed Pew Research Center, a non-partisan think tank that conducts public opinion polls and demographic research and analysis, came up with five facts about fathers that are interesting.

Over the last thirty years, the roles fathers play in the lives of their children have changed. Some might say for the better.

While there are still way too many children growing up without a father, many dads are making a dedicated and heartfelt effort to be more involved in their child’s life.

So, in keeping with dad appreciation week as we build up to Father’s Day next Sunday, here are five facts you may not know about dear old dad.

1. The Census Bureau estimates that last year there were about 189,000 stay-at-home dads, defined as married fathers with children younger than 15 who stayed out of the labor force for at least one year primarily to care for the family while their wife works outside the home. Those dads cared for an estimated 369,000 children.

2. In 2009 there were about 2.4 million custodial fathers (that is, raising their children while the mother was living elsewhere), versus 11.2 million custodial mothers, according to a Census Bureau report. About 619,000 custodial fathers were due child support; collectively, they received about $1.9 billion.

3. Fathers have nearly tripled the amount of time they spend with their children, from 2.5 hours in 1965 to 7.3 hours per week in 2011, according to a Pew Research report that analyzed years of time-use data. Despite that increase, 46% of fathers said they spent too little time with their children, compared with 23% of mothers who said the same; half of dads said they spent the right amount of time.

4. More than three-quarters of new fathers took one week or less off from work after the birth or adoption of their most recent child, according to a 2011 Boston College study of fathers at four large companies; 16% didn’t take any time off at all. Most new mothers at the same companies took anywhere from six to 12 weeks off. Of those who took time off, 92% of fathers said they had a positive experience being with their child during that time.

5. Forget the ties, “World’s Best Dad” T-shirts and other clothing clichés: According to a 2012 poll from market-research firm Ipsos, most dads would prefer to either spend quality time with their families on Father’s Day (40%) or receive no gift at all (22%). Gift cards were a distant third, at 13%.

Dads are more involved in their children’s lives than ever and enjoying the benefits that come with building a close relationship with their kids. Some are choosing to be stay-ay-home dads while others are beginning to take time off from work when their child is born and more dads are making family time a priority. It’s all good news!

Source: Drew DeSilver, http://www.pewresearch.org/fact-tank/2013/06/11/5-facts-about-fathers/

Time-Out for Toddlers!

dina — Wed, 12 Jun 2013 10:00:00 +0000

I love talking to parents about behavior modification and that includes beginning to discipline their children. I really think this is one of the most important jobs for parents and it is hard to believe that your most “precious, perfect” child will at times misbehave. It happens to all of us!

I would recommend to start using time out as a means of behavior modification when a child is somewhere between 15-18 months of age. For those of you who watch Super Nanny, she coined the word “the naughty step” which is her version of time-out chair.

When you begin time out, pick a small chair in the house which you can use consistently for time-out. Never use a child’s crib or bed, as you do not want them to think that “bed is for misbehaving”. After a child gets used to doing time out you can use all sorts of chairs and do time out anywhere. Like many things it just takes practice.

When putting your child in time out get down to their eye level, explain why they must sit in the chair, and hold them from behind (with your arms wrapped around them like you are a rope). I use a timer even at this young age so your child begins to understand how long they will be sitting in time out. Time out is typically one minute per year of age.

After time out is “finished”, get back to eye level and explain that the next time you ask them to mind you, “they may choose” to listen and they will not have to go to time out. These are such important words for a child’s entire life, as they need to understand that they are making choices for their behavior. In other words, taking ownership of making a bad choice and knowing that there will be consequences. You will use these words over and over, “you made a bad choice therefore....the consequence is....for a young child it is time out, for older children it may be no TV, or no going to a party, or even no driving. All versions of time-out.

One of my patients is a cute family of 5 and the mother has her version or time-out. She says “nose and toes in the corner” for a minute----her kids started doing that at 12 months! Impressive.

Lactose Intolerance

drsue — Tue, 11 Jun 2013 10:00:00 +0000

A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea. In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental.

It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters.

All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation)

Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products. It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine. Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years. It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve.

In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose. True milk allergy usually presents in early infancy.

That's your daily dose. We'll chat again tomorrow!

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dina — Mon, 10 Jun 2013 19:41:02 +0000

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Fathers Are Very Important!

Del — Mon, 10 Jun 2013 15:00:00 +0000

There is a lot of well-deserved attention paid to mothers and kids. Study after study looks at the impact that mothers have on their child from birth to adulthood. Fathers on the other hand – not as much.

That’s a shame because fathers have a huge impact on the emotional, intellectual and social life of a child. Fatherhood is important whether it’s a biological dad, a step-dad, an adoptive dad or a male friend that substitutes in a father’s role.

The role that fathers play in the life of their children is a relatively new area of research, but more and more articles are beginning to surface by scientists, sociologists, psychologists and psychiatrists.

Interestingly, one of the more comprehensive looks at the impact of fathers on children comes from the U.S. Department of Health & Human Services. In preparation for a manual to help social workers protect children at risk, the agency looked at studies on the importance of fathers in the healthy development of children. Too often caseworkers didn’t work effectively with fathers when they were asked to investigate a family. It became a particular challenge when the father was the abuser in the case. But the authors looked at the positive impact a father can have in the family and noted that how well a caseworker understands the father’s reactions and feelings and how effectively the caseworker can address them will make a major difference when trying to either help an abusing father become a protecting father or engaging a father as an ally in addressing the family dynamics that made the situation unsafe for the child.

It seemed particularly poignant when looking at both sides of the fatherhood coin – abuser or loving father. A dad’s influence is enormous.

A number of studies looked at the impact of an involved father on their child’s education. The results show that:

- Children with involved, caring fathers have better educational outcomes.

- Fathers who are involved, nurturing, and playful with their infants have children with higher IQs, as well as better linguistic and cognitive capacities.

- Toddlers with involved fathers go on to start school with higher levels of academic readiness. They are more patient and can handle the stresses and frustrations associated with schooling more readily than children with less involved fathers.

- An active and nurturing style of fathering is associated with better verbal skills, intellectual functioning, and academic achievement among adolescents.

Other studies looked at the effects of fathers on the psychological wellbeing and social behavior of children. Findings show that the effects are impressive:

- Starting at birth, children who have an involved father are more likely to be emotionally secure, be confident to explore their surroundings, and, as they grow older, have better social connections with peers.

- Fathers often push achievement while mothers stress nurturing, both of which are important to healthy development. As a result, children who grow up with involved fathers are more comfortable exploring the world around them and more likely to exhibit self-control and pro-social behavior.

- One study of school-aged children found that children with good relationships with their fathers were less likely to experience depression, to exhibit disruptive behavior, or to lie and were more likely to exhibit pro-social behavior. This same study found that boys with involved fathers had fewer school behavior problems and that girls had stronger self-esteem. In addition, numerous studies have found that children who live with their fathers are more likely to have good physical and emotional health, to achieve academically, and to avoid drugs, violence, and delinquent behavior.

- Fathers also have an indirect impact on their children’s lives. One of the most powerful is the relationship they share with the mother in a family. A father who has a good relationship with the mother of their children is more likely to be involved and to spend time with their children and to have children who are psychologically and emotionally healthier. Similarly, a mother who feels affirmed by her children's father and who enjoys the benefits of a happy relationship is more likely to be a better mother. Indeed, the quality of the relationship affects the parenting behavior of both parents. They are more responsive, affectionate, and confident with their infants; more self-controlled in dealing with defiant toddlers; and better confidants for teenagers seeking advice and emotional support.

- Fathers who treat mothers with respect and handle conflict in a thoughtful and patient way are more likely to have boys who are less aggressive towards girls and when they are older, women. Girls who have involved and respectful fathers are more likely to look for those qualities in the boys they choose to date and marry.

Being a parent, whether it’s a mother or father is probably the most important and difficult role you’ll ever have. There is no perfection in parenthood. Every child responds with his or her own interpretation of the meanings behind their parent’s words and actions. Try as you might, you’ll never get it right 100% of the time.

As Father’s Day approaches, the jokes about the presents and cards received start to circulate. Another new tie or tool typically gets a chuckle. But just like Mother’s Day, Father’s Day often makes us stop and reflect on the role our parents have played in our lives particularly when one or both of them are not around anymore.

To all the fathers who will be receiving an extra bit of acknowledgement this June 16^th, and to all the dads who are no longer with us – Happy Father’s Day. You are now and will forever be very important.

Source: Jeffrey Rosenberg, Bradford W. Wilcox, https://www.childwelfare.gov/pubs/usermanuals/fatherhood/chaptertwo.cfm

West Nile Virus

dina — Mon, 10 Jun 2013 10:00:00 +0000

The temperatures are warming up around the country and “summer” iis only a few weeks away. But the bugs are already coming out in full force and that includes those pesky mosquitos. In Texas with warmer temperatures than other areas, I am already seeing lots of mosquito bites, which is already causing some anxiety due to the risk of West Nile Virus.

West Nile Virus (WNV) was first detected in the United States in 1999 and 2012 was the second worst outbreak of WNV disease (the worst was in 2003). WNV disease is a seasonal illness which typically is seen during summer and early fall, when mosquitos are at their peak.

In 2012 there were a total of 5,674 cases of WNV in the U.S. reported to CDC and there were 286 deaths. WNV has been reported in all 48 contiguous states as well as DC and Puerto Rico ( we can all head to Hawaii??). 75% of human WNV cases were reported from just 10 states, with Texas having the highest number. (1,868 cases and 89 deaths)

So....what do you need to know. Number 1: WNV as the name states is a VIRUS, which means there is not an antibiotic used to treat the infection!!

Secondly, about 80% of people (or 4/5) who are infected with WNV will NEVER show any symptoms of illness. Up to 20% of people who are infected will show symptoms of fever, headache, body aches , nausea or vomiting and some may also have swollen lymph nodes and a rash. These symptoms mimic many other viral illnesses so trying to decide if your child who has a fever and “the feel bads” has WNV or an enterovirus (like coxsackie) or and adenoviral infection is really not important.

What do you do for all of these viral infections but treat the symptoms, right? Give it a few days to see how your child is doing, treat the fever, keep them comfortable and hydrated and in a few days the illness will typically resolve and will be another unnamed nuisance viral illness.

About 1/150 people infected with WNV will develop severe illness with neurological problems including seizures, meningitis, and encephalitis. Those are the people who are at greatest risk of requiring medical care, which includes hospitalization and life support, which is most often seen in older people and in people who have other medical problems.

The best thing to do is to keep yourself protected from mosquito bites by using bug spray, closing windows and doors, draining standing water and avoiding peak exposure during the early morning and evening hours. When you can wear long sleeves and long pants and socks to cover up from bites. For infants I would head out now to get some mosquito netting to cover strollers when a baby is outside (buy it now while available).

Lastly, don’t panic!!! Some parents are already telling me they aren’t letting their children go outside!? We have a long summer ahead and everyone needs fresh air and exercise. Start shopping for bug spray....i am looking for buy one get one free deals!

More on WNV as we get into the thick of the season although my zipcode in TX is already reporting WNV positive mosquitos.....maybe Hawaii?

Why Doctors Fire Patients

dina — Sun, 09 Jun 2013 10:00:00 +0000

There was a recent article in the WSJ entitled “more doctors dismissing patients who refuse vaccines for their children”. It was interesting to me as I too now only accept new patients who are going to vaccinate their children. This was not an easy decision on my part, and prior to the decision I had several families who refused vaccines completely, and another group that followed “an alternative” vaccine schedule. Even so, I was never comfortable with their decision and it always gave me pause and sleepless nights when their children would get sick.

During the height of the debate over vaccine safety and the possible link to autism it seemed like much of my day was spent “debunking” vaccine myths. I spent a great deal of time discussing the reasons behind the AAP/ACIP (American Academy of Pediatrics and the Advisory Committee on Immunization Practices) recommended vaccine schedule and also explaining how vaccinations had saved lives, actually millions of lives.

As more and more data was gathered, and the Wakefield papers were discredited, it became apparent that there was not a link between vaccines and autism. The arguments about thimerasol in vaccines were also moot as thimerasol is no longer the preservative used in vaccines (except for flu vaccine). With all of this being said I decided to take a stand and vaccinate all of my new patients, according to AAP guidelines.

I discuss this decision with families even before their child is born. I tell them that it is important to pick a pediatrician that shares their beliefs as the doctor patient relationship is a long one in pediatrics. (hopefully cradle to college) It is analogous to dating; why would you pick a date on a match site if you held opposite beliefs to begin with?

The same goes with picking a pediatrician, you need to start off the relationship on common ground. Even if there may be some other disagreements on subjects down the road, I think you need to begin the relationship holding similar beliefs.

I have practiced long enough that I remember doing spinal taps in my office and treating children with meningitis or bacterial sepsis. There were long nights spent in the ICU with families and unfortunately a few patients died, while other survived but are deaf or have other residual effects from their disease. It was devastating to me and I can’t even imagine for those families. I also bet that those families would have given anything to have a meningitis vaccine or a chickenpox vaccine for their now deceased children.

I understand that every parent has to make their own decision for their children. At the same time I believe that it is also “my practice” and I get to choose how I practice pediatrics. With that being said, my parents choose to vaccinate their children and we happily start off the parenting/doctoring partnership together. I also sleep better at night not worrying that their child will contract a vaccine preventable disease.

That’s your daily dose for today. We’ll chat again tomorrow.

Why Posture is Important

dina — Sat, 08 Jun 2013 10:00:00 +0000

Whenever I am doing a child’s physical exam I always spend some time looking at their backs. Why? It’s important to look at a child’s spine to assess any irregularities or disease that may be present like scoliosis. I also check the skin around their neck and back (really everywhere) for moles that need to be noted and watched. This is all part of a child’s yearly physical.

But as children get older I often note that when I ask them to stand up to look at their backs, they are slouching or slumping! I can just hear my own mother’s voice, “Susan, stand up straight, put your shoulders back”. I am suddenly, noticeably, sitting up straighter even while typing this!

Posture is so important and at times a parent will even ask me to discuss the importance of good posture with their child. It typically isn’t the 3-10 year old set, they really seem to stand up fairly straight, but the tween and teen group is often guilty of poor posture. It is interesting as most patients that age talk about wanting to be taller, but regardless they don’t even stand up straight.

Then there is the “tall” group who for many teenage reasons, feel as if they are “too tall” and try to hide their height by slumping. In either case, slouching and slumping not only looks bad, but it’s not good for the back.

Poor posture can lead to neck and shoulder pain, which is a common complaint of adolescents. Not only do they have poor posture while standing but have you watched them as they hunch over their computers?

Adolescents are often spending in excess of 8 hours a day online and are not paying any attention to how they are sitting. I see many a teen with neck pain that radiates down their back and scapula, often secondary to their posture while “computing” on their many electronic devices. This poor posture leads to lots of muscle spasms as well.

My advice? Have your child start practicing standing up straight. Have them try good old-fashioned time with their back and shoulders up against the wall and see if you they can step away from the wall and maintain that erect posture.What about the ‘ole book on the head trick as well? A younger child will find balancing a book on their heads to be a fun exercise, but this exercise may not be as much fun for the older set.

Everything just works better with good posture don’t you think? You can breath better, your tummy muscles get tighter as you stand up straight, and that takes pressure off of your back as well. You will have less neck and shoulder pain and lastly, you just look better! (boy would my mother be proud of me for agreeing with her.)

That’s your daily dose for today. We’ll chat again tomorrow.

Kid’s Water Safety Tips

Del — Fri, 07 Jun 2013 16:05:28 +0000

Kids and water: They may not want to drink a lot of it, but they sure love to play in it. Now that the magical season of summer is almost here, there will be a lot of children doing just that. While you may think you already know everything there is to know on water safety, it’s still a good idea for parents, guardians and babysitters to freshen-up on ways to help keep kids safe when around or in water.

The good news, according to a study published by the Bloomberg School of Public Health at John Hopkins University in 2012, is that more parents ARE paying attention to water safety. Children dying from drowning–related incidents have declined dramatically since the early 1990s.

Unfortunately, more than 1,000 U.S. children still die from drowning and another 5,000 are injured every year. Dying from drowning isn’t the only serious outcome that can occur. Nonfatal drowning can also result in brain damage and long-term disability.

Children less than 4 years old are most likely to die in drowning incidents, usually in bathtubs or after falling into water. Older children are more likely to drown while swimming, according to research cited in the study, with the risk rising in warmer regions of the South and West that have longer swimming seasons.

Let’s review a few water safety tips, provided by kidshealth.org, and USA Today News that may help your little one from becoming one of the heart-breaking statistics listed above.

Supervision: The number one rule for water safety and children is that an adult, preferably one who knows CPR, is overseeing any child or group of children in water - whether the water is in a bathtub, a wading pool, an ornamental fish pond, a swimming pool, a spa, the beach, or a lake. If you don’t know how to swim, learn. A parent or guardian who can actually enter the water and retrieve a child is able to respond faster, when a child is in trouble, than someone who has to wait for help to arrive.

Floatation Devices: Invest in proper fitting, Coast Guard-approved flotation devices (life vests) and use them whenever a child is near water. Check the weight and size recommendations on the label, then have your child try it on to make sure it fits snugly. For kids younger than 5 years old, choose a vest with a strap between the legs and head support — the collar will keep the child's head up and face out of the water. Inflatable vests and arm devices such as water wings are not effective protection against drowning.

Pool Safety: If you have a pool on your property, you also have a huge responsibility when it comes to water safety. Unfenced or poorly fenced pools are magnets for small children, especially curious toddlers. A small child can slip out of the house and be in a pool in a matter of minutes. Check your fence thoroughly on a regular basis. The Consumer Product Safety Commission (CPSC) has pool fencing standards listed on their website at www.cpsc.gov.

Water Wisdom: Kids are not the best judges of safe play in and around water. They need guidance. Teach your child proper pool, lake and spa behavior. Let them know they should contact a pool guard or an adult if they witness an emergency.

Pushing, shoving, running around the perimeters of a pool and diving in without checking to see if someone else is in your line of projection are some examples of dangerous play. I know… it’s hard to keep kids from doing what they are most inclined to do, but that’s where being a responsible parent or guardian comes in. Just do it. Kids can still have a ton of fun without endangering everyone around them and themselves.

Lightening and bad weather: Get everyone out of the pool or lake and into a safe building immediately. Enough said.

Safety Equipment: Make sure you have a charged cell phone with you. You don’t want to have to find your phone when seconds count. It’s a good idea to have 9-1-1 programmed into your quick dial feature. If you have a call while you’re watching your kids – make it brief. You can always call them back once the kids are safely out of the water.

Have a long pole or a rope with a floatable device at the end, near the pool. These types of simple objects might be just the thing that saves a child's life. Pool cleaning poles are great – they are usually pretty sturdy and can expand when needed.

Swimming lessons: If your child is going to be playing in or around water, make sure they know how to swim. The American Academy of Pediatrics (AAP) used to recommend that you not begin formal swimming lessons until kids are at least 4 years old but they are no longer against aquatic programs and swimming lessons for younger toddlers and preschoolers between the ages of one to four years old.

While it’s great that your child knows how to swim, don’t let a false sense of security lesson your diligence when overseeing kids in the water. Many an adult and child have drowned that knew how to swim.

Water safety reminders: These facts aren’t listed to scare you so much that you deny your child the experience of playing in a pool or lake, but to remind you that things can change quickly and that’s why it’s so important to always be a diligent supervisor when little ones are in or around water.

- In 2006, 1100 children under age 20 died from drowning, and for every child who drowns, three or four receive emergency department care for near-drowning or non-fatal submersion injuries, some of which lead to serious injuries including brain damage.

- Most young children who drown do so in a home pool.

- Most of these children were left unsupervised for less than 5 minutes.

- Drowning usually occur in the summer months, from May to August.

- Drowning rates are highest on the weekends (Friday to Sunday) and at noon and 6pm.

If you own a pool and your child is missing- check there first. Go to the edge of the pool and scan the entire pool, bottom and surface, as well as the area around the pool.

Remove any toys that are left in the pool after the children get out. Toys floating in the water or sitting at the bottom of a pool are just too much of a temptation for toddlers and small children.

There are more in depth articles on the web that give more specifics regarding as pool fencing and water safety equipment. They are very helpful in explaining what works and what doesn’t.

So, enjoy the summer and the water – it’s refreshing and fun. And don’t forget the sunscreen!

Sources: http://kidshealth.org/parent/firstaid_safe/outdoor/water_safety.html

Ellin Holohan, http://usatoday30.usatoday.com/news/health/story/health/story/2012-01-17/Study-Childrens-drowning-injuries-deaths-decline/52610662/1

No More Food Battles

dina — Fri, 07 Jun 2013 10:00:00 +0000

Seems that I spend several times a day discussing “food battles” with my patients and their families. I guess the longer I practice the more I don’t think we should even have to discuss how often parents “battle” with their kids about eating.

From the early days of parenting when a baby is first offered either breast or formula, they are not asked “do you like this?”. It is taken for granted that an infant will eat and grow and there you have it. The easiest days of parenting, correct? (except for a few months of sleep deprivation). But once that baby begins to eat the discussions start about “he makes a face when he eats spinach”, or “she will only eat chicken tenders from Chik-fil-a”, or “he only likes pasta and won’t eat meat”, or even “I make 3 diferent meals for my 3 kids”. If you have a child older than 9 months you understand what I am talking about.

Food is necessary to nutrition, growth and health. But, with that being said, parents have to trust that a child WILL EAT when they are hungry. Really, hunger drives us all to eat, eventually. That bowl or cereal, or the steamed vegetables or even the dreaded chicken breast will get eaten if your child gets hungry enough. I remember reading somewhere that , “ a parent’s job is to provide food for their children at appropriate meal times, and child’s job is to decide if they will eat it.” In other words, make the meal whether for your toddler or teen and “forget about it”. Meal time needn’t be a battle but more a gathering to enjoy being together eating is just a bonus.

As an adult, when you go to a dinner party, you don’t ask what they are serving before you accept, nor do you tell the host/hostess, I hate lamb!! (my example). You just smile and find something to eat and there is not a battle. We all need to approach family meals as a dinner party. Our children are our guests, and sometimes they like what we fix and other times they push some food around their plate and choose not to eat. The good news for most children is that there is another meal to follow.

So, think about it and don’t let certain food likes and dislikes dictate mealtime. The more foods young children are exposed to the better chance they have of EVENTUALLY becoming a well rounded eater. Children’s taste buds change with time as well, so you will find some foods that a 3 year old loved is no longer the favorite at 13 years of age.

Well balanced, nutritious, colorful meals are the family goal and “food battles” can be left out of the vocabulary.

Screen Time & Vision Problems?

dina — Thu, 06 Jun 2013 10:00:00 +0000

I received a question via our iPhone App from a Dad who was concerned about all of the new electronics his children are using and whether all these gadgets might harm his child’s vision? Good question.

After doing a bunch of research, there is not a lot of data to support the idea that all of this new technology can cause actual visual problems. But the constant use of computers, electronic games, and smartphones for messaging as well as good old fashioned TV watching may cause eye fatigue. The number of hours kids spend on these activities continues to grow, and even for a diligent parent who is watching their child’s screen time, the hours a child is on line at school must be factored in. It seems that 97% of all classrooms in the US have a computer or computers.

A study done in 2009 showed that the number of people with nearsightedness has been increasing in the last 30 years, and whether this is due to the amount of time we all spend doing “near work” is unclear.

The most important fact: limit your child’s screen time and count time on their phone texting, as well as on line on the computer or in front of the TV. It is cumulative. Encourage your child to take a break from the screen every 20 -30 minutes to let their eyes rest and to also adjust to some far away vision.

Smaller screens with smaller print also require more work for the eye muscles, which much contract to allow the eyes to focus. So, having your child read articles and lengthy papers on a bigger screen would be preferable to long reading tasks on their smartphone.

I see a lot of kids with tired necks and backs from leaning over their computers. They rarely associate their “screen time posture” with other aches and pains. Kids should be encouraged to sit up in a chair at a desk with their feet on the floor while working on the computer.

The computer or game screen should be at least 20 – 28 inches away from their eyes. Have your child move around and change positions when possible if they playing games etc and not at a desk.

Lastly, and most importantly, limit your child’s total screen time to no more than 2 hours /day. That may be more challenging than seeing the screen!

That’s your daily dose for today. We’ll chat again tomorrow.

Got Dip? Pass the Veggies!

Del — Wed, 05 Jun 2013 15:00:00 +0000

Time and time again headlines declare that vegetables are absolutely necessary to a healthy lifestyle. As parents, we get it. But what if your little one doesn’t like broccoli, green beans, squash, cucumbers, carrots, beets -ok, I’ll pass on that one too- corn, cauliflower, spinach or tomatoes? What if every time you attempt to smuggle a vegetable into your child’s meal world war three breaks out?

Well...there may be hope. Try a little dip (and tenderness). According to a small but optimistic study, kids that don’t normally like veggies messing up their perfectly good meal, will reevaluate that outlook and give vegetables a taste if they are presented with a bit of flavored dip.

The fact that the dip used during the study was low in fat, calories and sodium didn’t seem to matter.

The study was conducted at the Center for Childhood Obesity Research at Pennsylvania State University.

Thirty-four preschoolers were asked to do a taste test of vegetables with and without the low-fat dip.

Not surprisingly, the kids liked the veggies better when they were served with dip. When the dip was flavored, kids liked the vegetables even more compared to plain dip or no dip at all.

What I find amazing is that thirty one percent of the little tykes liked the vegetables as is – nothing added. When the researchers added the dip though, a whopping sixty-four percent were thumbs up on the vegetables. There were of course, those children who wouldn’t budge even while others were smiling, dipping and exclaiming how tasty cauliflower can actually be. Six percent said no thanks to the dip and the vegetables while eighteen percent said absolutely no to the vegetables with no dip.

To see just how far kids were willing to go with the veggie and dip combo researchers did another study. This time they offered 27 preschoolers’ celery or squash – both notorious for being leaders in a preschooler’s yuck category. The kids basically picked at the unadorned squash or chopped celery. I suspect, knowing preschoolers, they spit it out - but there's nothing in the study about that.

When the flavored dip was added to the mix, the little ones ate a little more – about a quarter cup of the chopped celery and about 15 grams of squash. Once again, the dip won although it didn't make a huge difference.

Some people might say that if you were able to get preschoolers to eat chopped celery or squash at all, the test was a huge success.

Vegetables have a tough time competing with french-fries and fast foods particularly if they are rarely served. Sometimes you just have to get creative.

"It is a good idea to try to pair less preferred foods, like vegetables, particularly those that your child doesn't like so much, with something to give it a little more flavor," said Marlene Schwartz, of the Rudd Center for Food Policy and Obesity at Yale University, who was not involved in the study.

Experts note that the amount of the vegetables a preschooler eats is not as important, at this stage, as whether or not they are willing to try new foods and flavors and be open to liking them.

"If you can get preschoolers to see themselves as people who try a bunch of different vegetables and try them in different ways and like vegetables, then you can really reinforce that way of seeing themselves and that's going to help you in the long run," she said.

On the other hand, Schwartz said, if a child comes to identify himself as someone who doesn't like vegetables, "then you're really fighting an uphill battle."

Amen to that.

There are a couple of other veggie introduction tricks that have been somewhat successful. Pizza is usually a hit with kids (and adults) so many parents will add vegetables as a topping. You have a lot more control over the sodium and fat content and you can get your child involved by asking them which veggies they would like to put on the pizza. Then let them place the vegetables on the top of the pizza.

Letting children be participants in growing vegetable gardens seems to also get them excited about picking and eating what they have grown.

Some parents put vegetables in a blender and then add the smooth concoction to assorted foods they know their kids like, such as the infamous mac and cheese. Personally, I like vegetables to look like vegetables and for children to know that they are eating vegetables. It just seems more honest.

I like dip. So, perhaps I’ll give it a try and see if my little one will keep the broccoli in his mouth this time.

Source: Kerry Grens, http://news.yahoo.com/adding-dip-veggies-gets-kids-eat-more-174841524.html

Dog Bites & Kids

dina — Wed, 05 Jun 2013 10:00:00 +0000

I saw a young boy (this week) who was bitten by a dog. Very sad as I began to think this is the time of the year that I will start seeing more bites. Why? Warmer weather brings families outdoors and I’ve noticed more dog parks popping up. I have experience with dog bites as a pediatrician and mom.

We are a dog family and my husband and I had our first dog, Mrs. Brown, before our oldest son was born. She was the “perfect” dog, a mutt that my brother (who is a vet) had found and gave yo us.

When the boys came along she was wonderful and would follow them around the yard and to the closest neighbors, I would always know where the kids were as Mrs. Brown would be waiting on the porch for them.

Our next dog was a golden retriever, Maddie, that our middle son wanted, and she too was a member of our family for 12 years. Sweet (but a bit lazy), she was so sad as each of our sons left for college. She was suddenly the only child left at home. It broke our hearts when she died and the boys had not gotten a chance to get home to see her.

Thinking we didn’t need a dog in a “empty” house was a mistake. The youngest son felt like he should have a dog (even though he was away at college) and I thought a little dog might be nice. No way, according to the youngest son, we “are a big dog family”, and so we now have 4 year old Maggie, a yellow lab. Sweet, smart and spoiled is all I can say.

Now, back to dog bites. I think it is important for children to be around dogs (and other pets as well) but to have a respect for them. Just like we teach children, “stranger danger”, the same goes for dogs. Teach your children not to approach strange dogs, or reach through a fence to pat a dog. Always ask the owner before trying to pet a dog.

I would not recommend buying your child a dog until they are around 4 years of age. But, if you already have a dog, bringing that new baby into the home gives the dog some time to get adjusted before they are having a toddler around. You as a pet owner should also know the temperament of your dog and if you sense any issues with your pet and aggression it may be best to find another home for the dog before your child is mobile. It doesn’t matter how careful one is, toddlers like to explore and that may mean that they are touching and petting the dog as well.

I know about dog bites from experience as our youngest son was bitten in the face by a friends dog. The bite was not provoked, but the dog came over while he was laying on the floor eating popcorn and watching a movie and went right for his face. A late night phone call, trip to ER and plastic surgeon and 20 stitches later my son still wanted to play at that friends house!! He loved dogs before, and still does. Just a freak “accident” but I can still see the scars. But, you know I am the mom!

Stop Debate Over HPV Vaccine

dina — Tue, 04 Jun 2013 10:00:00 +0000

I have been receiving a lot of calls, emails and questions on twitter regarding Michael Douglas' admission that his oral cancer was caused by HPV.

If you have an adolescent, I am hopeful that your own doctor has already discussed the prevalence of STD’s among the adolescent and young adult population with both you and your tween/teen/young adult. If not, you need to know that HPV infection is one of the most common sexually transmitted diseases, with over 6,200,000 new cases annually with the peak rates of infection occurring in women 25 years and younger.

HPV is what doctors would call, “a bad player”. There are over 100 serotypes of this virus, and you often don’t even know you have it before you have passed it on to someone else.

Some HPV serotypes also cause cancer, and researchers are realizing that it doesn’t just cause cervical cancer, but vaginal, vulvar, penile, rectal and oral-pharyngeal cancers (mouth, tongue, tonsils).

When Harald Zur Hausen was awarded the 2008 Nobel Prize in medicine it was for the research he had done in the 1970’s and 1980’s that identified HPV (specifically types 16 and 18) as the most common cause of cervical cancer. (side note: read “The Immortal Life of Henrietta Lacks”). Hausen’s discovery enabled other brilliant scientists to develop the FIRST anti-cancer vaccine against HPV. The first HPV vaccine was released in the United States in 2005.

With all of this background , I cannot comprehend why there is any debate surrounding the HPV vaccine. The comment that the HPV vaccine is dangerous and can cause mental retardation is unfounded.

As stated in a press release by the AAP, “there is no scientific validity to this statement.” Since the vaccine has been introduced worldwide there have been more that 35 million doses given with an excellent safety record. Anyone can go to the CDC website to look up safety information on any given vaccine, so do some research. You should also know that doctors, as well as patients are reporting any adverse events related to a vaccine and this ongoing monitoring (post-marketing surveillance) continues to ensure the safety of a vaccine even after it has been approved.

Lastly, the reason that the vaccine is given at age 11-12 (approved down to age 9) is two- fold. You want to give the vaccine PRIOR to exposure to the virus, and unfortunately studies continue to show that some teens are engaging in sexual activity, which is not only sexual intercourse, at very young ages.

The vaccine prevents infection with certain HPV serotypes, but it does NOT treat HPV. Secondly, the vaccine produces a robust immune response in this age group to provide excellent protection. In other words, more bang for your buck!

More and more studies are being done on HPV, with exciting new data about disease reduction being shown in other countries where the vaccine has been given even longer. There couldn’t be better news, the vaccine is working if we give it!

Keep talking to your adolescent about STD’s. Discuss abstinence, condoms, teen pregnancy, and any other information they need to be well informed so that they make good choices as they go through their adolescent and young adult years. At the same time, get both girls and boys their HPV vaccines, it might just save their life.

Has your daughter or son received their HPV vaccine? I would love to hear from you!

Kid’s ATV Safety Tips

Del — Mon, 03 Jun 2013 16:20:00 +0000

With the end of another school year and summer knocking at the front door lots of kids will be outside doing what kids do- playing. These are the months when a child's boredom level has a short fuse and they can easily be persuaded to ramp up a little danger and excitement when playing with friends.

ATVs (all terrain vehicles) can offer just such a challenge, along with dirt bikes, regular bikes and skateboards. All of the transportation apparatuses listed here can offer a lot of fun and excitement on long summer days. But, as a parent, you already know that they can also be quite dangerous when adults aren’t around to supervise activities. Of course, having an adult nearby is no guarantee that safety will prevail if they themselves aren’t acting responsibly. But let’s assume they are and they want their child to have fun and be safe.

Of all the activities listed above, ATVs bring their own particular set of safety concerns. While you most likely won’t be present the entire time your child is riding his or her bike through the neighborhood, you should be present if your child is on a dirt bike or an ATV. The U.S. Consumer Product Safety Commission (CPSC) reports that ATVs continue to be the fourth most deadly product the CPSC oversees, with more than 700 ATV-related deaths per year.

CPSC notes that in 2011, ATV –related deaths decreased. However, the number of estimated injuries per year remains at more than 107,000, with an increase in estimated injuries to children younger than 16 years of age to 29,000. More than half of these injuries were suffered by children younger than 12.

There are some basic guidelines on ATV safety that every parent of a child who is going to be riding one of these vehicles needs to insist upon. This list is a compilation from CPSC’s website on ATV safety and ClassBrain.com.

- Do not allow children younger than 16 to drive or ride on adult ATVs. The American Academy of Pediatrics strongly recommends that children under the age of 16 should not operate an ATV. This is especially important, since younger children are usually injured on ATVs due to their size or inexperience with operating vehicles. Even once a child is 16 and able to operate an ATV, adult supervision should be present at all times.

- Never allow a child younger than 6 on an ATV. ATVs are simply too dangerous for children under the age of six. Allowing a child under the age of six to operate an ATV is illegal in some states.

- Choose an appropriate ATV size for your child. Your child may be larger than some other children his or her age, but that doesn’t mean they are more capable of controlling a larger than recommended ATV. Riding an ATV safely is not only a matter of size – but skill and strength as well as coordination and maturity. Kids, especially those with little or no prior experience, can easily panic if they find themselves engaged in an unfamiliar situation. A typical situation might be if they accidently open the throttle too much and the ATV takes off quickly. The heavier and more powerful the ATV- the more likely a serious or even fatal accident can occur.

- Most ATVs are designed for only one person. Do not ride on a single-rider ATV as a passenger or carry a passenger if you are the driver. ATVs are designed for only one rider at a time. Since you have to manipulate your weight in order to control the vehicle, two riders on a vehicle is incredibly dangerous. Also, the ATV may be unable to successfully hold the combined weight of two riders, making it less stable and more apt to roll over. Finally, having an additional rider can distract the driver from the task of properly operating the vehicle.

- Always wear a helmet and protective gear when riding ATVs. Just like operating a motorcycle or bike, riding an ATV requires you use proper protective gear. ALWAYS wear a helmet. Most serious or fatal accidents occur when the rider is not wearing a helmet and falls on his or her head. A helmet may not be the most stylish accessory, but it can literally save your life. Also, since most riders operate ATVs in wooded environments, be sure to wear proper eye protection, as a rock, branch, or even a bug can fly into your eye and cause damage. Furthermore, be sure to wear boots and gloves to protect your hands and feet while operating the ATV.

- Do not drive ATVs on paved roads. When it comes to where to ride your ATV, ensure you choose a proper setting. Avoid roads and streets, since ATVs are not designed nor intended to be driven on concrete or asphalt with larger cars and trucks. Also, avoid improper terrain that may encourage the ATV to roll over due to instability in the ground.

- Take a hands-on safety-training course. This is especially important for young or first-time riders. Before you drive a car, you take a safety course, so why should driving an ATV be any different? Safety courses educate riders of the correct way to operate and ride an ATV to ensure he or she knows how to handle the vehicle. Also, safety courses will teach riders of all ages the appropriate behavior when riding an ATV, making it critical for teens and adults to attend.

- Avoid tricks and stunts on ATVs. There are thousands of YouTube videos showing kids and young adults using their ATVs as if they were performing in a circus. What they don’t show are the funerals and life-altering results of children who have lost control of their ATVs. These are heavy machines that can crush a head or a back in an instant. Young boys are particularly fond of showing off their skills and feel they are invincible. They are not.

There’s no turning back the sales of ATVs for young kids, that horse has left the barn. Most of the time, kids will be ok and have a good time. As parents, you make the decision on whether your child will be riding one of these machines or not. Make sure your child is prepared as best they can be before he or she hops on board and turns the key.

Sources: http://www.cpsc.gov

Donna Somerkin, http://www.classbrain.com/artteenah/publish/atv_safety_tips.shtml

Coxsackie Virus is Going Around

dina — Mon, 03 Jun 2013 10:00:00 +0000

Coxsackie virus is rampant once again! I have seen too many kids to count (TMKTC) with symptoms of coxsackie virus and the classic skin rash associated with “hand, foot and mouth disease”. Many parents are telling me that their day care centers are having outbreaks which is what typically happens at this time of year.

Like many viruses, coxsackie can make some children quite miserable, while others have very few symptoms but never the less are contagious and shed the virus to others. Viruses are just plain ‘ole contagious, even with the best precautions to help prevent spreading the illness. Best prevention continues to be hand washing!

The classic symptoms of “hand, foot and mouth disease” are a fever, sore throat, and a rash which looks like small red spots or even a bit of a blister, occurring on a child’s palms, soles and often in their throats causing pain. We are also seeing many children who have a rash on their buttocks, and legs as well. The rash is often confused for a diaper rash if there are no other associated symptoms.

Coxsackie virus typically lasts from 3 -7 days. While some children are terribly cranky and uncomfortable and will even drool rather than “swallow their own spit”, other seem to not even notice the rash on their hands or feet. The treatment is totally symptomatic, which means acetaminophen or ibuprofen for fever and discomfort and keeping your child hydrated.

Most kids don’t have a great appetite when they have a sore throat (do you?), so I am a big believer in popsicles, Slurpees, ice cream, fozen yogurt, shaved ice.....the list is long. You just want to make sure your child is hydrated during the illness so “food rules” get thrown out for a few days. If they have a fever they need to stay home until they have been fever free for 24 hours, and they may then return to school, day care, and other activities.

Thankfully, adults rarely get this illness, as we have developed some immunity over the years. Interestingly, there was just an article about a trial of coxsackie virus vaccine given to children in China which proved to be quite successful in preventing serious coxsackie disease......stay tuned for more about this in the coming years.

Say No to Tanning Beds!

dina — Sun, 02 Jun 2013 10:00:00 +0000

I have previously discussed the importance of sunscreen but it is equally important to discuss the risk of artificial tanning and the use of tanning beds. I have emphasized that it is never too young to start using sunscreen, but for some reason teens think that tanning beds are a safe way to tan rather than going outside in the sun.

Not so.....tanning beds are using UVA radiation which can cause mutations in your DNA which can then lead to skin cancers. Dermatologists are seeing an increase in young women (who are more likely to use tanning booths) in their mid to late 20’s with the deadliest form of skin cancer, malignant melanoma. Many of these women admit to frequent tanning during their teen age years.

Malignant melanoma is different than basal cell carcinoma and squamous cell carcinoma, the other more common forms of skin cancer. Malignant melanoma may spread rapidly to internal organs and lymph nodes, and if not detected at an early stage, may be fatal within months to years.

Young girls need to understand the risks of using a tanning bed and should be encourage to use a spray tan or a tan towel to achieve the “glow” that they are wanting. They need to understand the risks that are proven to be associated with tanning bed use. Many teens and young adults are using tanning beds that are provided at their dorms or apartments as well.

If there is a family history of melanoma or unusual moles then the risk may be greater to develop an atypical mole. Those young adults who have tanned need to be followed by a dermatologist who can examine their body head to toe and “map” their moles and identify any unusual moles. At the same time they may be educated as to how to follow their own moles and changes they should be aware of. Do you know that melanomas may arise anywhere on the body, not only the sun exposed area!

Recent articles have shown that tanning beds may be associated with an increase in non melanoma skin cancers as well. While these lesions may take longer to develop, teens and young adults need to be aware of this risk as well.

The state of California has become quite progressive in advocating for the safety of children and their skin. California recently passed a law that children under the age of 18 may no longer use tanning beds. Other states are looking at similar legislation. Makes sense to me!

So....... no suntanning and no tanning beds. Rub, wipe or spray on your tan or enjoy beautiful fair skin. Not only is it safer, you don’t have to worry about wrinkles later in life (trust me on this issue!)

That's your daily dose for today. We'll chat again tomorrow.

Moving From the Crib to a Bed!

dina — Sat, 01 Jun 2013 10:00:00 +0000

I am often asked, “when should I take my child out of their crib and put them in a bed?” I really think that there are several reasons to transition a child from their crib to a “big boy or girl bed”.

The first and foremost reason seems to be when your child is climbing out of their crib. I have had many a patient (and a few of my own children) who will attempt to climb out their cribs one time and then if seems as if they were frightened by the experience and that was the end of it.

On the other hand there are some children who are adept climbers and they will routinely climb out of their cribs. In this case, due to safety concerns, I think it is necessary to put the child (typically a toddler 12 - 18 months), into their own beds. Now some of my patient’s parents have purchased a crib tent rather than even think about going to the “big bed”! They don’t even want to discuss beds!

I think another compelling reason to transition a child to a “big bed” is when you need the crib for the next baby. Call me frugal, but it seems crazy to purchase another crib when you really won’t need it for long. It is possible to put a 15 -18 month old to bed in their “big boy” bed and they will stay put! With that being said it is also possible that the child will decide they just want to get out of bed on their own, but this problem can occur at any age, and requires behavior modification.

I remember putting our first born son in a twin sized bed that he helped “pick out” when he was not yet 2 as I was expecting another baby. We also let him pick out his sheets for the new bed (I think they had Big Bird on them) and he easily transitioned to the bed. But, when he turned 3 years old he decided he wanted to get out of bed and “rejoin” the parents and he was difficult to break of this habit!

The last reason to transition to the “big bed” is when the child is either just too big for the crib (or breaks your back trying to get them in there), or when you as a parent are ready for the next step. For most of my patients this occurs when their child is around 3 years old, and the crib goes away and the big boy/girl room starts.

I do have patients that are over 4 years old and still in a crib, but that is the usually the exception. One cute mother comes to mind who has twin girls (her youngest). When I asked why they were still in their cribs she replied, “I just can’t find the right bedroom furniture” which made me laugh. We all have our reasons! Those cute girls are now 6 and she finally found the “perfect” beds and they are happily tucked in each night.

That’s your daily dose for today. We’ll chat again tomorrow.

Mom’s Obesity Surgery May Impact Future Child’s Health

Del — Fri, 31 May 2013 15:00:00 +0000

Many obese men and women are turning to surgery to help them lose the extra weight. But for women who are planning a pregnancy, is it a good idea?

A new study suggests that for obese women who choose weight-loss surgery to bring their weight under control, having the procedure may also benefit their future children.

A Canadian study found that children born after their mother had lost considerable weight from gastric bypass surgery were slimmer than their pre-surgery siblings and had fewer risk factors for diabetes or heart disease later in life.

The findings showed that numerous genes linked to obesity-related health problems worked differently in the younger siblings than in their older brothers and sisters.

The researchers looked at the genes of 50 children who were born to 20 mothers before or after they had gastric bypass surgery. The children were on average about 15 years old.

The moms were between the ages of 35 to 51 and were all classified as obese before they had the procedures. They all lost almost 100 pounds after the surgery.

The type of gastric bypass surgery performed on the mothers who participated in the study is called a biliopancreatic diversion with duodenal switch procedure. It is not used as often as the more common Roux-en-Y gastric bypass procedure. In the biliopancreatic diversion with duodenal switch procedure, a larger part of the stomach is left intact while bypassing most of the intestine.

In the children born after their mother’s surgery and weight loss, researchers found 5,698 genes were expressed differently than their older siblings. What that means is that the mothers didn’t pass on different genes to their children, but how those genes operated in the children’s bodies were different in the pre and post surgery children. The reason may be that factors inside the womb seem to affect the dimmer switches that develop on a fetus' genes — chemical changes that make genes speed up or slow down or switch on and off. That in turn can greatly influence health.

The Canadian study’s findings may offer new information on how a mother’s weight and health impacts her fetus. Overweight mothers have higher levels of sugar and fat in the bloodstream, which in turn makes it to the womb. That combination may do more than just produce a large baby: it may also affect certain genes clustered in pathways known to affect blood sugar metabolism and heart disease risk.

The mother’s weight loss surgery may not be the only important factor in her child’s health. Diet and exercise plays an important role in how fit children are and will continue to be. Mothers who are making an effort to keep their weight under control typically prepare or offer their kids healthier meals and participate in more family exercise.

Whether having gastric bypass surgery by overweight mothers-to-be will have a life-long impact on their child’s health is still unknown. What is known is that experts agree that women who are planning a pregnancy should talk with their doctor about their weight before they conceive. Carrying too many extra pounds during pregnancy can produce its own set of complications such as premature delivery, birth defects, hypertension, gestational diabetes and blood clots. Women who are obese while carrying are more likely to require a cesarean section.

The takeaway from this study is that if you are obese - can’t lose the weight you need to by more traditional methods -and want to become pregnant, perhaps gastric bypass surgery will not only help you shed the extra pounds but may also pass along added benefits to your future child.

Talk with your OB/GYN first before you make a decision to try any weight-loss surgery.

The study was published in the journal Proceedings of the National Academy of Sciences.

Sources: Michelle Castillo, http://www.cbsnews.com/8301-204_162-57586480/moms-who-had-weight-loss-surgery-may-pass-on-healthier-genes

Lauran Neergaard, http://news.yahoo.com/moms-obesity-surgery-may-help-break-cycle-kids-192322482.html

Fruits & Veggies in a Pouch

dina — Fri, 31 May 2013 14:36:01 +0000

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”. I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods. Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries. These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day. This is also often in place of meals, as many of these children are described as “picky eaters”. I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else. (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars. Actually, as much as two fruit roll ups! Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up. Rather, it is to point out that even “healthy” snacks can be full of sugar. Rather than a fruit roll up or a squeeze pouch, what about a piece of fruit? Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption. Oh lastly, they are bad for the teeth as well!

Good Grades Pill

dina — Thu, 30 May 2013 10:00:00 +0000

There is a lot of pressure placed on students to succeed and many of them are turning to what teens call the “good grade pill”. What is it? Prescription stimulants that are commonly used to treat children with ADHD. Teens that have not been diagnosed with ADHD have figured out that with the help of these drugs, they can focus and improve their grades.

I see a lot of kids who have attentional issues and I evaluate and treat children for ADHD. With that being said, I also spend a great deal of time with each family looking at their child’s history, report cards, teacher comments, educational testing and subjective ADHD rating scales.

While many families would like it if I just “wrote a script for a stimulant”, I feel it is my job to try and determine to the best of my ability, which children really fit the diagnosis of ADHD. (There are specific criteria for diagnosing ADHD).

But in the last 3-5 years I personally have seen more and more teenage patients coming to me with complaints of “having ADHD”. These are successful teens who are now in competitive schools.

In most of the cases there have never been any previous complaints of difficulty with focusing or inattentiveness. All are typically A and B students but are now having to work harder to keep their grades up, and to also keep up all of their extracurricular activities. They too all want to go to “great colleges” and their parents expect that of them as well.

When I see these teens, I point out to them that there has never been mention of school difficulties throughout their elementary and middle school years. I also tell them that ADHD symptoms by definition are typically evident by the time a child is 7 years of age, and often earlier. So what do you do? I don’t take out the script pad.

I believe that stimulant medications are useful when used appropriately. I am also well aware that these drugs are overprescribed and are also being abused. I have had parents (and teens) be quite upset with me when I decline to write a script for stimulant medication for their teen.

I think that this problem is growing and (we) parents need to stop pressuring our children and (we) doctors need to be vigilant in deciding when stimulant medications are appropriate.

It is a slippery slope, but the number of teens obtaining stimulants illegally is on the rise. Why? They hear that this is a quick fix to getting good grades. It may help their grades for the short term, but what does their long term future look like?

That's your daily dose for today. We'll chat again tomorrow.

Preventing Baby’s Whooping Cough Before Pregnancy

Del — Wed, 29 May 2013 15:00:00 +0000

If you’re planning on adding another child to your family-or thinking about starting a family-you might want to consider getting the whooping cough vaccine before you get pregnant.

Why would you do that? According to a new study from Australia, babies who are born to women that are vaccinated with the whooping cough (also known as Pertussis) vaccine before they become pregnant have a 50% lower risk of developing the disease.

Whooping cough is an infection of the respiratory system. It mainly affects infants younger than 6 months old before they are immunized, and kids 11 to 18 years old whose immunity has started to decrease. Pertussis is characterized by severe coughing spells that may produce a whooping sound when the child breathes in.

It is highly contagious and before the Pertussis vaccine was available it killed 5,000 to 10,000 people in the U.S. each year. Now that there is a vaccine, the annual number of deaths is less than 30. But in recent years, the number of cases has started to rise. By 2004, the number of whooping cough cases spiked past 25,000, the highest level it's been since the 1950s.

The researchers looked at 217 babies ages 4 months and younger who had whooping cough. They compared them with 585 healthy infants born at the same time in the same area.

They discovered that a similar percentage of mothers - in both groups - received the whooping cough vaccine. However, 41 percent of the moms of healthy babies had been vaccinated at least four weeks before their infant became sick. However, of the mothers whose babies had whooping cough, only 27 percent of mothers had been vaccinated at least four weeks earlier.

Also in the healthy baby group, 26 percent of the mothers said they had been vaccinated before their baby was born, while only 14 percent of mothers whose babies had whooping cough said they had been vaccinated before delivery.

In this program, "there was no vaccination during pregnancy, so if a woman said they had it before birth, this meant before pregnancy," said Dr. Helen Quinn, a researcher at the National Centre for Immunisation Research & Surveillance of Vaccine Preventable Disease in Australia.

Quinn told MyHealthNewsDaily.com that in the study, vaccination before pregnancy lowered a baby's risk of developing whooping cough by a whopping 52 percent.

Another study has shown that a woman’s body doesn’t typically start to produce the anti-bodies needed to fight whooping cough until about 2 weeks after she receives the vaccine.

Researchers noted in the new study that babies who were part of large families and those who were less well off were more likely to get whooping cough. They also pointed out that babies who were breastfed were less likely to get sick.

Quinn said the findings "suggests that vaccination as part of pre-pregnancy planning would have the greatest impact on whooping cough infection."

Last year, an advisory board for The Centers for Disease Control and Prevention (CDC) recommended that women receive the whooping cough vaccination each time they become pregnant.

This study suggest that getting vaccinated before you become pregnant may actually offer your newborn an even better chance of being protected against whooping cough.

Sources: Karen Rowan, http://news.yahoo.com/moms-whooping-cough-vaccine-pregnancy-cuts-babies-risk-120834863.html

http://kidshealth.org/parent/infections/bacterial_viral/whooping_cough.html#

Kids Say Some Funny Things!

dina — Wed, 29 May 2013 10:00:00 +0000

Parents, you know you can say all sorts of funny things and now here come cute, clever kids comments. This has been a week of “kids say the darndest things”.

A verbal little 3 year old came in this week and while I was getting his chart opened on the computer, I asked him “what’s the matter?”. He is the third child in the family and is quite comfortable coming to the doctor and is always chatty. His response was, “I have the God bless you’s”. Now I admit that I was not quite sure what he meant? Then it hit me! He was sneezing a lot and that was what the “God bless you’s” meant. How smart is that!

He then proceeded to tell me that he had been sneezing and coughing. He also happens to have asthma, so I asked him if he had been wheezing as well. His response to all of these questions was equally bright. He said , “I haven’t had to use my puffer, my “breaving” is okay”.

I examined him (by this time he is watching a cartoon on his iPad) and he was spot on. His lungs were clear as a bell, he had a clear watery runny nose and his nasal mucosa was swollen. He also had allergic eyes. He was using an antihistamine but not his steroid nose spray.

So I “tweaked” his allergy medicines a bit and reminded his mom to have him bathe or shower after he had been playing outside. I also suggested that they use a nasal saline rinse on him as well, as this would help to get the pollens out of his nose after he had been outside, and may be one of the best “cures” for the “God bless you’s”.

Who says children can’t give a good history? I often find that the young patient is a great communicator and may open a doctor’s eyes to different ways of relaying a new symptom. Whether is from a 3 year old, a tween or a teen, having a patient that you know and that is comfortable talking to the doctor is the key to a good history. This is was a great reminder!

The Kid's Doctor TV

dina — Tue, 28 May 2013 20:17:19 +0000

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Ready for Summer Camp!

dina — Tue, 28 May 2013 09:59:00 +0000

Summer camp season is upon us, I can tell from the number of forms I am signing each day!! Many parents ask me when their child is ready for an overnight camp experience? While you and I know that every child is different and some may be “camp ready” sooner than others, here are a few tips to show readiness for “sleep away” camp.

Most children are ready to spend a week or two away from their parents between the ages of 8 - 10. Older children may even want to spend a month or 2 at camp (certainly was the case for one of mine and not the others). But, age is not the only factor involved in deciding camp readiness. A child who has siblings going to camp may even be ready to join their brother or sister when they are as young as 7 years old. They might miss their sibs more than their parents!

For starters, has your child asked about going to camp, or have you asked them how they feel about going “away” to camp? Does your child like to spend the night at a friend’s house or spend the night with relatives? Or, are they the type of child who always calls to get picked up because they want to “sleep in their own house”. If you can’t spend one night away, I would not suggest leaping to 2 weeks of overnight camp.

Has your child gone to a day camp before, made new friends easily and asked to go back for more? Do they like certain types of camps that fit specialized interests, or are they just there to “do everything!”. These should be questions to answer when deciding about an overnight camping experience as well.

Research camps with friends and neighbors. Do you want your child to be “far away” in different environment? (both culturally and seasonally). What about accessibility and travel arrangements to and from camp? These decisions might also help you to choose camps either in or out of state. Some children would much prefer an overnight camp where you take them and pick them up rather than arriving at a new camp via bus or plane.

Lastly, remember like so many other parenting decisions, this is a camp for your child. Just because you went to “Camp --------” does not mean that it is necessarily the right camp for your child. Be open- minded and take some time to visit a few camps this summer while they are open. Just like colleges, best time to visit is when they are in session!

That’s your daily dose for today. We’ll chat again tomorrow.

Lea Children’s Bed Collection Recall

Del — Mon, 27 May 2013 15:00:00 +0000

Lea Industries, a leading manufacturer of children’s furniture, is voluntarily recalling over 59,000 beds in the U.S. and 4,200 in Canada. The recall involves the side rails on 34 different Lea children’s bed collections, including loft, bunk and panel styles in twin, full and queen sizes. The wooden beds were sold in various wood finishes and paint colors, including black or white. The beds have two side mattress support rails connecting the headboard to the footboard and slats or a Bunkie board to support the mattress.

The bed’s side mattress support rails can break, posing a fall hazard.

There have been 22 reports of incidents involving the recalled beds in the U.S. since 2009 and one in Canada. Two injuries were reported. In a 2009 incident in Madison, Wisconsin, an 11-year-old girl was placing a fitted sheet on the top bunk when the child, mattress and bed supports collapsed on her 6-year-old sister in the bed below. The 6 year old was treated at a hospital emergency department for a head injury involving a cut to her face.

The beds were sold at furniture stores and direct buy stores nationwide and online through Amazon, and other websites from August 2008 through March 2013. Prices ranged from between $400.00 and $3,000.00.

Consumers should immediately stop using the beds and contact Lea Industries to receive free replacement side rails for the beds.

The date code, rail item number and purchase order numbers are located on a white label on the inside of one of the side rails.

Date codes between August 2008 and March 2013, shown as 8-2008 through 3-2013, are included in this recall. Platform beds manufactured since 2010 are not included in this recall. Recalled bed names, item numbers and purchase order numbers can be found at http://www.cpsc.gov/en/Recalls/2013/Lea-Industries-Recalls-Childrens-Beds/#Remedy

Pictures of the beds can be found at www.leaindustries.com. For more information you can call Lea Industries at their toll-free number (888)770-7116. You can reach them Monday thru Friday from 8:00 am to 7:00 pm Eastern Standard Time.

A Funny Exam Room Story

dina — Mon, 27 May 2013 13:27:17 +0000

Here is another one of the “can’t believe what I hear at the office”! I was on call the other night and it was around “bedtime” when I walked in the exam room to see 2 little girls (actually they are part of a triplet set but their brother was home). Their dad had brought them in because they had rashes and bug bites. Nothing too serious. They are adorable 2 years old and very well behaved.

So, after examining the rashes and bites and determining that they could be dealt with a bit of cortisone cream, the dad and I were discussing a few more things. Of course the girls got bored, and as you know a bored 2 year old typically doesn’t sit still, especially when it is time for bed. So as the girls jumped up and down off the table and picked out more stickers their Dad was getting tired as well. By the way, he is a great father and he and has wife have handled having triplets with such “ease”. They were meant to have “multiples”.

Well, before we could finish up the appointment the girls had gotten into the diaper bag, pulled out snacks and were enjoying themselves. As much as he was ready to go, they were not ready to pack up and leave and he was having a hard time getting them to listen.

Here comes the line of the night! He turns to the girls in a moment of “what to do next” and says, “if you don’t behave and listen to me, Dr. Sue is going to make you sick!” LOL! I have heard a lot of “Dr. Sue will give you a shot if you don’t behave”, but I have never heard this one. While I don’t believe in threatening kids with shots at the doctors, this was a new one.

After I stopped laughing I told the girls that this was not true, doctors would and could not make them sick, but they did need to listen to their dad!!

I know that we all say things out of desperation, but please don’t use the lines “the doctor will give you a shot” to try and change a child’s behavior. We docs seem to give enough shots when needed and not for bad behavior. This also includes “the doctor will make you sick!” there’s always a new one.

All About Ear Infections

dina — Mon, 27 May 2013 10:00:00 +0000

One of the most frequent reasons for a visit to the pediatrician continues to be ear infections (otitis). In fact, I think my otoscope (device used to look into the ear) is getting worn out!

Over the years there have been literally thousands of articles published on the diagnosis and treatment of ear infections. Parents continue to ask, “how do I know if my child has an ear infection?” and the answer to that question has yet to change, the only way to diagnose otitis is by looking in the ear and visualizing the ear drum.

There is not a symptom, or a combination of symptoms that will lead to the diagnosis of an ear infection without looking at the ear drum itself. So, babies that pull on their ears, or awaken at night, or children with a fever and cough, or even those who say their ears hurt, do not always have an ear infection.

There are many days that a 2-4 year old child will have said, “my ear hurts” and are therefore brought to my office. When I visualize their ear drum it looks perfectly normal, so ear pain (otalgia) does not always mean infection. The pain may be due to pressure behind the ear drum, or referred pain from a sore throat, or tooth, or even just a passing feeling in the ear after putting their finger in their ear canal. You have to look, and therefore the diagnosis may not be made over the phone (maybe one day there will be an App for visualizing the ear drum remotely?).

When the doctor looks down your child’s ear canal, they are looking for an ear drum that is either bulging, or red (if the child is not crying or does not have high fever as this may cause redness of the ear drum), or for fluid behind the ear drum (called an effusion). In most cases it is a combination of findings that one sees when looking at the ear drum. For a practicing pediatrician, visualizing an ear drum in a squirming, screaming, toddler who has waxy ears, is an art. Yes, ears can be full of wax and you don’t even realize it. (don’t use a Qtip it just makes it worse!)

Cleaning out a child’s ear is necessary and not always fun for the child or the doctor. One of the hardest skills to learn in early pediatric training is how to look at an ear drum. I remember it taking months and months of practice and instruction before really believing that I was getting better and better with the otoscope.

Many parents ask if they can look in their child’s ears at home with an otoscope that they bought on line? “Sure”, I reply, if you want to spend a year in the ER looking in thousands of ears!! Just like I am sure I could learn how to “tune up my car” if I went and worked in a garage for months, or tried to learn to speak a language by immersion, the skill of using an otoscope is based upon repetition and practice. (like most things in life I guess). Parents tell me that there are even some “swanky” otoscopes that purportedly talk to you and tell you if the ear is infected, but none of these devices are accurate, you have to rely on the old fashioned otoscope and know what you are looking for.

So, ear pain and ear infections are not synonymous and the “gold standard” of visualizing the ear drum is the only accurate way to diagnose an ear infection.

Relief During Allergy Season

drsue — Sun, 26 May 2013 10:00:00 +0000

The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind. The perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa. The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines. Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms too. The problem is getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it everyday" (it must take all of 15 seconds to use on yourself!) They have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect. There are many different brands available and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season. That's your daily dose, we'll chat again tomorrow. Oh, God Bless You! Send your question to Dr. Sue!

The Difference Between Cradle Cap And Dandruff

drsue — Sat, 25 May 2013 10:00:00 +0000

I recently received a question from a Twitter follower related to cradle cap and dandruff. She wanted to know if there was a difference in the two. You know there really isn’t as they are both due to seborrheic dermatitis, an inflammatory condition of the skin in which the skin overproduces skin cells and sebum (the skins natural oil). Cradle cap is the term used for the scaly dermatitis seen on the scalp in infants. It is also seen on the eyelids, eyebrows, and behind the ears. It is typically seen after about three months of age and will often resolve on its own by the time a baby is eight to 12 months old. It is usually simply a “cosmetic” problem for a baby as it looks like a yellowish plaque on a baby’s scalp and is often not even noticed by anyone other than the parents. Unlike seborrheic dermatitis in adults, cradle cap typically doesn’t itch. It is thought that cradle cap may occur in infancy due to hormonal influences from the mother that were passed across the placenta to the baby. These hormones cause the sebaceous glands to become over active. In some severe cases an infant’s scalp becomes really scaly and inflamed and causes even more parental concern, as it appears that the infant is uncomfortable and may be trying to scratch their head by rubbing it on surfaces. The treatment for cradle cap is to wash the baby’s scalp daily with a mild shampoo and then to use a soft comb or brush to help remove the scales once they have been loosened with washing. When washing the head make sure to get the shampoo behind the ears and in the brows (keeping the soap out of baby’s eyes). This is usually sufficient treatment for most cradle cap. In situations where the greasy scales seem to be worsening it may help to put a small amount of mineral oil or olive oil on the baby’s head and let it sit (I left a small amount on my children’s heads overnight) and then to shampoo the following day. The oil will help the scales to loosen up and come off more easily. For babies that have very inflamed irritated cradle cap a visit to your pediatrician may be warranted to confirm the diagnosis. In persistent cases I often recommend shampooing several times a week with a dandruff shampoo that has either selenium (Selsun) or zinc pyrithione (Head and Shoulders) making sure not to get any in the infant’s eyes. I may then also use a hydrocortisone cream or foam on the scalp that will lessen the inflammation and itching. In these cases it may take several weeks to totally clear up the problem. As children get older, especially during puberty, you may see a return of seborrhea as dandruff. Again you can use dandruff shampoos. It also seems that with the overproduction of sebum there is an overgrowth of a fungus called “malessizia” so using a shampoo for dandruff as well as a antifungal shampoo (Nizoral) often works. I have teens alternate different shampoos, as sometimes it seems to work better than always using the same shampoo for months on end. Teens don’t like white flakes falling from their scalp and unlike a baby, a teen is worried about the cosmetic issues of seborrhea! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Avoiding Tragic Hot-Car Deaths

Del — Fri, 24 May 2013 15:00:00 +0000

You can count on it. As spring turns to summer and temperatures outside start climbing, a child will die after being left in a hot car.

It happened recently in Dallas. A mother arrived at work, parked her car, grabbed her purse, locked the car and went into her workplace. She didn’t see her baby asleep in the backseat.

When officers arrived about 6 hours later, they said she seemed truly surprised when they confronted her. She asked if her husband was ok or if something had happened to her baby at daycare. She was sure she had delivered her baby to daycare that morning up until the moment she was told her baby had died in her car.

Variations of this story play out across the country every year and children die because they are either intentionally or accidently left in a hot car.

Many people are shocked when they hear or read about something like this happening especially when a parent or caregiver simply forgot the child was with them or thought they had left the child with someone else. They wonder how could that possibly happen?

While there is no excuse for negligence, experts say that parents who are otherwise loving and attentive to their kids can forget that their child is in the car when they are super-focused on getting somewhere, distracted while driving, under tremendous strain or when taking their child to daycare is not part of their daily routine.

Another factor that may contribute to a parent’s forgetfulness is rear-facing car seats. Originally intended to save lives, when the car seat is placed behind the driver’s seat a parent may miss the visual cue of a child when glancing in the rear-view mirror. Children are usually pretty noisy when they are in the car, unless they fall asleep. The silence doesn’t offer the sound cue that someone else is in the car.

Then there are the parents or caregivers who deliberately leave their child in the car when they run an errand. They often think that it’s easier and faster to leave them there, particularly if their child is asleep, get what they came for and get back to the car. They may even crack a window thinking that’s enough to keep the car from getting too hot. It’s not.

Heat coming into the car from a window is absorbed by the interior and the glass acts as an insulator. According to the National Highway Traffic Safety Administration, 'a locked car sitting in the summer sun quickly turns into an oven,' and 'temperatures can climb from 78 degrees to 100 degrees in just three minutes, to 125 degrees in 6-8 minutes.'

But it doesn’t have to be boiling outside for a car to heat up to a life threatening temperature; it just takes a few minutes longer.

While you may think you could never forget that your child is in the car it’s still an excellent idea to get in the habit of setting visual cues as well as considering some of the new technology driven gadgets that can give you that extra peace of mind.

- First and foremost, always put your cell phone, purse, or briefcase, and anything else you'll need that day, on the floor of the backseat. When you retrieve it at the end of the ride, you'll notice your child.

- Keep a teddy bear or other stuffed animal in the car seat when it's empty. When you put your child in the seat, move the animal to the front passenger seat, to remind you that your baby's on board.

- Put the car seat on the passenger side of the back seat.

- Ask your child's babysitter or daycare provider to always phone you promptly if your child isn't dropped off as scheduled.

- Make a habit of always opening the back door of your car after you park, to check that there's no kid back there.

- Never assume someone else, such as a spouse or an older child, has taken a young kid out of her seat. Such miscommunication has led to more than a few hot-car deaths.

- Check online about child safety gadgets that can warn parents when they’ve left a child in a car. There are even phone apps that will send you an alert.

- Put visual cues in your office and home. There are decals you can buy (or make yourself) that remind you to check the car seat.

- Never leave your child unattended in a car. Weather isn’t the only factor when it comes to keeping your child safe from a dangerous outcome. A child left unattended in a parked car is vulnerable and easy prey for someone intent on doing harm.

If you see a child left unattended in a car- call 9-1-1. Don’t worry about offending someone or anything other than making sure that the child is rescued - whether it’s hot or not.

These types of articles and warnings go out every summer and yet children still die from being left in parked cars. More than any generation before, we are living in a multi-task, fast paced and distracting world. A lot of us are a little more forgetful than we used to be and anything you can do to slow yourself down and focus on your little one in the back seat of the car is a thing worth doing.

Source: Melissa Balmain, http://www.parenting.com/article/tragedy-in-the-backseat-hot-car-deaths

Teens Not Getting Enough Sleep

dina — Fri, 24 May 2013 10:00:00 +0000

If you're the parent of a teen, this does not surprise you at all: teens do not get enough sleep!

An online study released by the Center for Disease Control and Prevention says, “70 percent of high school students are not getting the recommended hours of sleep on school nights”. I could have done that study in my office on any given day of the week!

Having raised 3 teenagers as well as thousands of teens in my practice, I know this to be true, first hand. The problem is this age group is least likely to believe or convince that lack of sleep causes a plethora of physical as well as psychological problems.

According to the CDC study, which was just published online in Preventive Medicine, insufficient sleep is associated with numerous “risky” behaviors including drinking alcohol, smoking cigarettes, fighting, lack of physical activity and being sexually active. The data on sleep was accumulated from the 2007 National Youth Risk Behavior Survey where students were asked, “on an average school night, how many hours of sleep do you get?” Insufficient sleep was defined as less than 8 hours, while sufficient sleep was 8 or more hours per night. On an average school night, almost 70% of responders reported insufficient sleep.

In my practice I ask every child/adolescent about their sleep habits and routinely find teens are averaging between 5–7 hours of sleep per night. They also come in everyday with a chief complaint of FATIGUE!

I used to tell my own sons throughout their high school years that they needed to be in bed at 10:30p.m. They could not understand why I was up “prowling around their rooms” in the dark of night demanding, that they go to bed. “No one else has a bedtime in high school” was the common complaint.

But I also told them that I made my living out of telling teens (and their parents) that the reason their child “felt badly” was not mono, or a dreaded disease, but lack of sleep.

Those teens who did not have adequate sleep also drank more soft drinks (did not include diet), used computers for 3 or more hours every day, admitted to current alcohol, cigarette and marijuana use, were sexually active, and also expressed more feelings of being sad or hopeless or even of having suicidal thoughts.

If we could improve these statistics and reduce so many teenage “health risk behaviors” by just having parents enforce bedtimes, it sure seems like an easy sell.

Set a time, turn off the electronics and “put your teen to bed”. I know they have homework and tests and papers to write, but they also must be healthy, and rested to make good choices in both school and outside the home.

Oh, the study also found that watching 3 or more hours of television each day was not related to insufficient sleep. You might leave that part out!

Spring Sports Injuries

dina — Thu, 23 May 2013 14:15:00 +0000

With the advent of spring the sport season heralds in baseball, softball, track and field. This also means that kids need to be prepared to play.

Professional ball players spend 4-6 weeks in spring training, preparing for the season, but for many kids the spring ball season starts without any real spring training. Some kids have been less active during the winter, others may have been playing indoor sports, but with spring kids of all ages head outside to “play ball”. Their bodies may not be quite ready for “full steam ahead” play.

I am already starting to see both boys and girls coming in complaining of early muscle strains and sprains. Kids need to get into shape with throwing, hitting, pitching and fielding increasing over time. But no one seems to understand “gradual” these days.

Kids want to play ball and they may want to impress their coaches as well. They are being watched to determine who plays which position, batting line up etc. which may make some athletes try to throw too much or too hard as they first start back.

Parents (and coaches) need to encourage daily pre-activity warm up and stretching followed by light throwing to prepare the body to increase the activity and intensity over several weeks rather than days.

Kids need to learn proper throwing mechanics which will not only improve efficiency but will control stress on the body. The shoulder joint is held together almost entirely by muscles. Developing strength and endurance in the key muscle groups that keep the shoulder stable will help to prevent fatigue.

The same goes for pitching. Strict adherence to pitch counts, and well as following the recommended rest period between pitching will help to prevent overuse injuries as well. I have already seen a high school baseball player with elbow pain who admitted to me that he was pitching curve balls and fast balls, far over the number that he is supposed to. He does not realize the stress that he is placing on his body, and it is still very early in the season. He was not thrilled that I told him he need a week off to rest before he started back and then much less aggressively. He has a few more years of high school ball before he even thinks about college baseball and needs to stay healthy.

Remember to use ice as an anti-inflammatory as well as ibuprofen. And if shoulder or elbows already hurting, try a slower spring re-entry into throwing and pitching.

There is an American Academy of Pediatrics policy statement on Baseball and Softball with some practical information for parents and coaches and officials. Check it out at: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2011-3593

The Kid's Doctor TV

dina — Wed, 22 May 2013 17:04:19 +0000

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Kid’s Tummy Ache Most-Likely Constipation

Del — Wed, 22 May 2013 15:00:00 +0000

It’s a common ailment – particularly around the time your little one is supposed to get ready for school – the illusive tummy ache. Is it real or just a made up reason to avoid going to school? Knowing your child very well is probably the only way you’re going to know for sure, but you should also take into account how severe the pain appears to be.

Turns out that a recent study found that constipation is the most common reason for abdominal pain among children going to the emergency room.

Appendicitis is always a concern when someone complains of bad stomach pains but researchers noted that only about 4 percent of the children, who went to the ER with a tummy ache, were diagnosed with appendicitis.

The study, led by Kerry Caperell, MD, of the Department of Pediatrics at the University of Louisville in Kentucky, looked at the outcomes of children who went to the emergency room for abdominal pain.

The researchers investigated the medical records of 9,424 children, aged 1 to 18, who went to the Children's Hospital of Pittsburgh emergency department for abdominal pain during a two-year period.

They found that more than half of the children received multiple diagnoses for their complaints. Appendicitis was less common among younger children, but constipation was commonly diagnosed for all ages.

More than 20 percent of the children were diagnosed with constipation and for kids, ages 5-12 years of age; the diagnosis went up to 25 percent.

Diagnosing causes of abdominal pain in children can often be difficult, especially the younger they are," said Chris Galloway, MD, a dailyRx expert who specializes in emergency medicine.

"Fortunately common causes are still common and constipation is a frequent diagnosis we make in the ER, and can be quite distressing for your child," Dr. Galloway said. "Consult your pediatrician if your child has abdominal pain."

Older children seem to have more serious ailments and were more likely to remain in the hospital and have an operation related to the reason they went to the ER.

The study was published in the journal Pediatrics.

What causes constipation in children? Constipation is common in children and typically is not an indicator of bowel problems late in life, but can be very uncomfortable. If your child has had a painful bowel movement because the stool was hard and difficult to pass, he or she may try to hold their stools. This creates a viscous cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes more pain when it finally does pass. Many parents mistake the behaviors that children develop to hold in stool as straining to have a bowel movement, but they are usually stiffening their muscles or fidgeting as an attempt to hold their stool in and avoid a painful bowel movement.

Children with special needs, such as spina bifida, Down syndrome, mental retardation and cerebral palsy, often experience constipation that may be related to certain medications.

Infants that are constipated should be evaluated by their pediatrician.

Making changes in your child’s diet can often treat constipation. Fiber is important for good bowel movements in children as well as adults. The usual recommendation is that children should have 5-6 grams of fiber plus their age in years each day. So a 4 year old should have 9-10 grams of fiber each day.

Sometimes dairy products can cause constipation. Cow’s milk, yogurt and cheese can cause constipation and how much is too much is something that parents have to experiment with. Some children can drink a lot of milk and never get constipated, while others don’t have to drink much at all before they end up with a bad tummy ache. For children that drink a lot of milk, soy milk is a good alternative, as it is usually much less constipating than cow's milk.

Vegetables that are high in fiber include beans, especially baked, kidney, navy, pinto and lima beans, sweet potatoes, peas, turnip greens and raw tomatoes. Other foods that are good for children with constipation include vegetable soups (lots of fiber and added fluid), and popcorn. Extra bran can also be helpful, including bran cereals, bran muffins, shredded wheat, graham crackers, and whole wheat bread.

It takes awhile for dietary changes to help manage constipation; in the meantime there are some common medications that can be administered. Be sure and only give the recommended pediatric doses. A child’s age can play a role in which medications your pediatrician will recommend so check with him or her first before trying any over-the counter medicines.

Sources: http://www.dailyrx.com/abdominal-pain-children-emergency-room-was-most-commonly-constipation

http://pediatrics.about.com/cs/conditions/l/aa081200.htm

Teens Are Stressed Out

dina — Wed, 22 May 2013 10:00:00 +0000

If you have a teen it is hard to not hear the words, “ I am just stressed out!” on a regular basis. I don’t remember ever saying that as a teen but I am sure there must of been some version of that saying, although there just wasn’t that much stress when I was growing up.

Our society as a whole is so much more stressful (I think both real and perceived) and parents often utter the same words. But while the teenage years are sometimes difficult, and may be stressful at times, these years should also be filled with friends, fun and downtime. There should be “lazy” days to fill with just “whatever”.

But when I talk to my adolescent patients they tell me quite the contrary. They are always worried about grades and start discussing SAT and ACT tests long before high school. They have almost every precious waking hour filled with school (with crazy competitive class schedules), after school activities and homework after that. Far too many teens are getting too little sleep (do you have a teen that gets the recommended 8 hours/night?), poor nutrition, and too much time on the internet.

Stressed teens report difficulty falling asleep, or staying asleep which may lead to further problems with concentration and mood. I see many high school students who think they “have ADHD”, who have never had issues before, but suddenly say they cannot focus or concentrate, which may be exacerbated by lack of sleep. Trying to get them to believe that is not always easy! Poor nutrition is also a problem as well, but again a teen does not always see “eating junk food” as poor nutrition. Their brains need protein and vegetable and fruits to keep functioning at warp speed, but skipping meals is quite common.

Stress can often be reduced by parental involvement in daily schedules. I don’t mean that you tell your teen what to do all of the time. But the security that comes from knowing that there is breakfast daily, and that there is a family meal for dinner and that there is a “bedtime” when the computer and phone go dark actually helps make a teens life less stressful. Having parents who sit down to help a teenager see their way through a stressful event or provide wisdom or perspective may also help to alleviate stress. There needs to be a balance of “not being involved” but “being available”. That is sometimes easier said than done.

Stress is always going to be a part of life, but teenagers should not perceive that their life is constant stress and anxiety. They have plenty of time for that once they are parents, right?

Tragedy & Children

dina — Tue, 21 May 2013 13:00:00 +0000

We are all saddened by the tragic devastation in Oklahoma and surrounding communites leveled by yesterday's tornadoes. There are numerous tragic and traumatic events which occur across our country (and around the world) and at times, children may be witnesses to these events. With that being said, how do you discuss these tragedies with a child?

I think the most important thing to remember when talking to a child about a trauma or tragedy is to use words that are appropriate for the child’s age and vocabulary and to acknowledge your own feelings as well. They need to know that you too were scared, sad, upset or anxious about the event. Ask them how they felt and listen to the words that they use as you may use those words again when talking to your child.

While every child is different you can often follow their cues as to how much and how detailed a discussion to have, and when and how to bring the topic up again. Some children are talkers and want to discuss things at length, while others may be quieter and take some time to absorb the information. Don’t force the discussion. A parent knows their children and the discussion may/will be different for each child and will be further impacted by their ages.

For young children, it is also important to let them know that “Mommy and Daddy” are there and will take care of them and protect them, but at the same time bad things sometimes happen. That is why parents take precautions and are responsible (like holding hands when crossing the street, or wearing a helmet etc).But, if something does happen it is so important to validate your child’s feelings while at the same time teaching your child coping skills and resilience.

If your child does view a traumatic event it is not unusual for them go through a period when they are afraid of separation, or have nightmares etc. They sometimes develop somatic complaints like tummy aches, headaches, and non specific complaints of “I just don’t feel well”. This is normal, but you should watch for a child who seems to “be stuck” with symptoms long after the event. In some cases a professional therapist may be helpful.

Lastly, don’t let them revisit the event. By that I mean keep the TV off for awhile, and monitor the internet so they are not watching constant images of the same event. With so many amateur videos of traumatic events being shown “on screen” 24/7 if your child sees these images over and over, it is as if they are reliving the experience each time. It sometimes may feel as if we become addicted to watching it. It was nice “in the olden days” when there were not constant images on screen to remind us of a picture that often fades in our own minds.

New Guidelines for Treating Acne

Del — Mon, 20 May 2013 15:00:00 +0000

I recently ran into a friend I hadn’t seen in about 5 years. We were catching up on each other’s lives when her teenage son joined us. The last time I saw “John” he was about 11 years old and full of pre-teen energy and curiosity. This time however, he was quiet and kept his head down when he said hello. When he finally looked up, I saw why he had been avoiding full-face eye contact. “John” had a pretty severe case of acne. Not a few pimples, but entire areas on his face that were red and dotted with large pustules and cysts. It looked painful.

Typically, acne isn’t a serious medical condition. It comes and goes throughout life and is more of an annoyance than anything else. For some though, acne can cause emotional distress and lead to scarring of the skin and psyche.

Fortunately, there are many over-the-counter (OTC) medications that when combined with a consistent face cleaning routine, keep breakouts to a minimum.

But for some people, teens in particular, acne can progress to the point where OTC medications don’t control the problem. Pediatricians are often called upon to help teens come up with a plan of treatment.

There is a range of medications that can clear up even severe cases of acne, according to the American Academy of Pediatrics (AAP). Writing in the May issue of its journal Pediatrics, the group throws its support behind new guidelines from the American Acne and Rosacea Society that detail how to treat acne in children and teens of all ages.

That "all ages" part is important because acne is becoming more and more common in pre-teens, too, said Dr. Lawrence Eichenfield, the lead author of the AAP report. One study of 9- and 10-year-old girls found that more than three-quarters had pimples.

A possible reason for why kids are experiencing breakouts at a younger age is that, on an average, boys and girls are starting puberty earlier than in past generations says Eichenfield.

According to the AAP, milder cases of acne can be managed with OTC soaps, washes, lotions or gels containing benzoyl peroxide. Another common ingredient used to battle acne is salicylic acid. Department stores now have sections of aisles filled with these types of products making them easy to find.

But what if the OTC medications do not help clear up your teen’s acne? The AAP recommends going to the next step of trying a topical retinoid. Retin-A, Avita and Differin are the most commonly prescribed treatments. They are vitamin A derivatives and work by speeding up skin cell turnover, which helps unclog pores.

The main side effects of all the topical treatments are skin irritation and dryness, the AAP said.

If the acne is considered moderate to severe and other treatments have failed to work, the next step may be oral antibiotics. When pores become clogged with oil and skin cells, bacteria can grow in the pore and cause inflammation. Antibiotics help by killing bacteria and soothing inflammation.

But, Eichenfield said, "it's important to use antibiotics appropriately."

Antibiotics can have their own set of problems and should be used with caution. The overuse of antibiotics has made some acne causing bacteria more resistant. Other side effects can be stomach upset, dizziness and, in girls - yeast infections.

When all else fails and acne is severe, the prescription drug isotretinoin may be an option. Brand names include Roaccutane (formerly known as Accutane) and Claravis.

The drug is very effective, but it can cause birth defects, so girls and women have to use birth control and get regular pregnancy tests if they go on the medication. Isotretinoin also has been linked to inflammatory bowel disease, depression and suicidal thoughts in some users, although it's not clear the drug is to blame, the AAP said. (Severe acne itself can cause depression and suicidal thoughts, for example.) Other side effects can include sun-sensitivity, dry eyes, mouth, lips nose and skin as well as itching, nosebleeds and muscle aches.

Why do we get acne?

Acne occurs when hair follicles become plugged with oil secretions, dead skin cells and sometimes bacteria. The most common areas on the body where acne erupts are the face, neck, chest, back and shoulders. It takes time for acne lesions to heal and quite often another breakout will appear as one is finally clearing up.

Hormones and certain medications can play a role in triggering acne. Whether diet is a factor is still up for debate. "The idea that food plays a role became relegated to myth," Eichenfield said. But recently, he added, some researchers have been revisiting the issue. There is some evidence that a sugary diet may promote acne, for example. But for now, it's not clear whether any diet changes will actually help keep kids' skin clear, Eichenfield said.

Stress may not cause acne but it can aggravate it.

Keeping skin pores open and unclogged is the key ingredient to preventing acne. While it may seems that scrubbing your face, using astringents and drying masks would help do that, they aren’t generally recommended. Too much washing and scrubbing can irritate the skin.

It's best to wash your face gently twice a day, with a soap-free pH-balanced cleanser, the AAP said. Facial toners -- which commonly come in pre-packaged acne regimens -- can help clear away oil. But the group suggested going easy on toners, since they can irritate the skin.

One myth that seems to never go away is that tanning and more time in the sun is good for acne. A sunburned face may look better to you because your whole face is red instead of just certain areas. Too much sun can actually make acne worse for some people. It also ages your skin and can cause skin cancer. Certain medications (including some for acne treatment) can make your skin very sensitive to the sun’s rays. Always use a “face-friendly” sunscreen that doesn’t clog the pores.

I really felt bad for my friend’s son when I saw how miserable he was. To me he’s still handsome and has a bright and interesting future ahead of him. I’m not so sure that he thinks that, at least not until his acne is under control.

The bottom line, Eichenfield says, is that many treatment options are available. "There's no reason that children have to live with acne that is severe and troubling to them.”

Sources: Amy Norton, http://www.webmd.com/skin-problems-and-treatments/acne/news/20130506/pediatricians-endorse-new-acne-treatment-guidelines

http://www.mayoclinic.com/health/acne/DS00169

Strong Moms Empower

dina — Mon, 20 May 2013 10:00:00 +0000

I just participated in the StrongMoms Empower™ program sponsored by Similac® in New York. I had the privilege of speaking to a group of mothers (along with my new best friend Dr. Michele Borba) about the judgement that mothers feel they face every day. This campaign urges moms to create a more supportive and less judgemental environment with the goal to empower moms to feel confident in their parenting decisions.

I know first hand that mothers are feeling stressed and anxious and this was affirmed by a study, “The National Motherhood Decision Survey”. Whether this feeling of being judged and graded on their mothering is real or perceived, it is causing a lot of emotions. Mothers admitted to both physical and emotional effects. Stress, anxiety, insecurity and inadequacy are common complaints of today’s mothers.

But this stress on mothers is also causing a “trickle down effect” on their children. A study done by the American Psychological Association on Stress in America revealed that 4 in 10 children reported feeling sad when their parent is stressed or worried. Young children pick up on their parents stress, I see this is my practice every day. Even that cute 4-5 month old child who smiles when you smile, can be brought to tears by a sad, frowning face.

Increased family stress, and specifically maternal stress may have a negative impact on the health and well being of our children as well. This may present as behavior problems, self esteem and confidence issues and physical complaints. Children have headaches, tummy aches and sleep problems, just like adults.

But there seems to be a “stress disconnect” as well. Parents don’t realize the impact that their own emotions play in their children’s sense of well being. Almost 70% of parents said that their stress had only a slight or no impact on their children, yet 91% of children reported that their parent is stressed. STRESS is not a word that young children should even understand!

So...what can mothers do? Moms do a better job raising their children when they feel supported. They feel more confident, more relaxed, happier and fulfilled. in other words, “when mom is happy, everyone is happier”.

Mothers need layers of support and this should come from their most trusted inner circle of friends and family and not anonymous mothers who weigh in from social media, friends of friends etc. Trust your instincts and try not to “second” guess every decision. Don’t judge others either without knowing their circumstances. Remember, “people in glass houses shouldn’t throw stones”.

Use your pediatrician as your partner in parenting and look for advice from experts and professionals when you are facing tough questions and decisions.

Lastly, be confidant and trust your “momtuition”. Share your ideas and values in a positive manner and support one another.

The StrongMoms Empower™ Mission is to keep doing what works best for your and your family. All moms want to raise confident, capable and caring children. We are all in this together! For more information go to www.strongmomsempower.com

Talk To Your Child At Every Opportunity

drsue — Sat, 18 May 2013 10:00:00 +0000

A frequent subject among us “older moms “ is the observation that parents with young children are not talking to their children. Now, what do I mean by that? It seems that the parents are busy talking on their cell phones, or texting or replying to e-mails on their iPhones or Blackberry’s. I often see young mothers strolling their children around the neighborhood, but the child is in their stroller and the mother is talking away on her cell phone, or listening to her iPod oblivious that this is a perfect opportunity to be talking with her child. There are so many subjects to talk about while strolling an infant or young child. The sun, wind, flowers, trees, squirrels, lawnmower noises, different colors of flowers, the list is endless. All of these conversations are important to developing language for infants and toddlers. As you probably know, it is not as important what you are talking about with an infant, but that you are talking, all of the time. As your child is a little older it is important to talk to children about things around them, describing objects and events, and telling them stories. What better place to discuss how squirrels find acorns that might one day become a tall oak tree. Now that we are the “wired” generation the opportunities to just have idle chatter and conversation with your child seem to be limited. I have even noticed this in my office as parents and their children are waiting for the doctor (I apologize for running late!). In years gone by (now I really sound old) I would walk into an examining room and the mother or father and their child would be playing hangman on the exam table paper, or they might be playing “I spy” in the room, or even playing patty cake or “where’s your eyes, where’s your nose” with a one-year-old. There was interaction and conversation. Now it is not uncommon for the parent to be answering the phone and texting while the child is “hooked up” to a DVD player watching anything from Baby Einstein, to a Disney movie. I understand that waiting for the doctor is boring and nerve wracking, so that may not be the best example, but the point is the same, interact with your child at every opportunity. The importance of talking to your children to encourage language acquisition was supported by a recent study in Pediatrics. Dr. Zimmerman, the lead author, looked at not only the importance of reading, and talking to your child to promote language skills, but actually showed that conversing with children is important in acquisition of language. Not surprisingly, they found that children who had increased exposure to adult speech had higher preschool language scores than children who had greater amounts of television viewing. Interestingly, they also found that preschool language scores significantly improved the more an adult and child conversed back and forth. By using dialogue rather than just talking to children, parents could better foster their children’s developing language skills. Zimmerman showed the importance of getting back to the basics. Not only is it important for parents to read to their children, or to tell stories and limit television viewing, it is also important to engage their children in discussions, on just about subject. It doesn’t have to be rocket science. So, the next time you have the opportunity to talk with your child , turn off the hardware and have a conversation, whether it is through babble or a lengthy discussion. We don’t want the next generation to forget that language is an inherent tool for engagement with others. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Protecting Your Family From The West Nile Virus

Del — Fri, 17 May 2013 15:10:10 +0000

On Monday, The Centers for Disease Control and Prevention (CDC) released a report saying that, in the United States, 2012 was the deadliest year on record for deaths attributed to the West Nile virus.

Texas led the nation, compromising 33 percent of all reported cases with 1,868 infections and 89 deaths. That was far above California, which had the second most reported cases at 479 and 20 deaths.

In the majority of West Nile virus cases, most people experience only minor symptoms such as fever and a mild headache. However, some people who become infected with the virus develop a life-threatening illness that includes inflammation of the brain.

Serious symptoms can include:

- High fever

- Severe headache

- Stiff neck

- Disorientation or confusion

- Stupor or coma

- Tremors or muscle jerking

- Lack of coordination

- Convulsions

- Pain

- Partial paralysis or sudden muscle weakness

Signs and symptoms of West Nile fever usually last a few days, but signs and symptoms of encephalitis or meningitis can linger for weeks, and certain neurological effects, such as muscle weakness, may be permanent.

If you or a family member experience any of these more severe symptoms see a physician immediately.

The CDC's Dr. Lyle Petersen says it's impossible to know what West Nile will do this summer. "It is very hard to predict," he said in a telephone interview with NBC News. "I can't tell you what the weather is going to be like this summer, for example." The virus is driven by weather; it's worse during hot, wet summers in temperate climates.

"What last summer's outbreak tells us is that West Nile is not going to go away," Petersen said. "Most places in the United States are at risk of having outbreaks."

Currently, there is no vaccine against the virus for people. Most infections occur in the warmer months when mosquitoes are active.

Adults over 50 are at the highest risk for serious infection, but if any family member is suspected of being infected with the virus he or she should be tested.

While children are typically at a much lower risk for infection (about 3 percent of cases reported) they are the most likely to be playing outside during the warmer months and should be protected against mosquito bites.

Some steps you can take to protect your children (and yourself) from mosquito bites are:

- Making sure to keep as much of their skin covered with clothing as possible, including a long sleeve shirt, long pants, socks, and a hat.

- Wearing light colored clothing, so as not to attract bugs.

- Avoiding using any scented soaps or other products on your children, since the fragrances can also attract insects.

- Using an insect repellent regularly. Commonly used insect repellents that can usually be safely used in children include those with less than 10% DEET, or others with citronella or soybean oil. New reports suggest that an insect repellent with 30% DEET is safe for kids too.

- Using window and door screens to prevent insects from getting inside your house.

- Empty standing water around your house where mosquitoes can breed.

- Avoid outdoor activities during peak mosquito biting times, from dusk (early evening) to dawn (early morning).

Parents shouldn’t be so fearful of their child getting the West Nile Virus that they don’t allow their children to play outside during the warm spring and summer months. However, taking extra precautions to protect your child from mosquito bites just makes good sense.

Sources: Maggie Fox, http://vitals.nbcnews.com/_news/2013/05/13/18232095-2012-was-deadliest-year-for-west-nile-in-us-cdc-says

Vincent Iannelli, M.D.

http://pediatrics.about.com/cs/commoninfections/a/west_nile_virus.htm

http://www.mayoclinic.com/health/west-nile-virus/DS00438/DSECTION=symptoms

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