Daily Dose

A Baby Girl!

1.15 to read

Did you hear my big news?? I am officially a grandmother of a new “premature” but healthy baby girl!!! Yes a GIRL!!  After raising three sons I really thought I had mistaken the text announcing a baby girl.   As you probably know, all important information is now received via a text.....so as all four first time grandparents sat in the labor and delivery waiting room one of us got the text that read.....healthy but tiny baby girl...all good!! 

Now, if you have ever sat with a group of friends where everyone is awaiting the same information via text you know that despite the sender pushing send at the same time...the text may arrive on one person’s phone before another, even when sitting right next to each other. That was the case in the waiting room.....we all had phones, but one grandparent got the text first and read it and we all went, REALLY, for real a girl?? 

Despite the fact that our sweet grand daughter wanted to arrive 5 weeks early, she weighed in at 4’12” and only had to spend 8 days in the hospital.  She must have known how excited we all were and we wanted to be able to hold her sooner than later.  

After 2 nights in the neonatal ICU, where she had wonderful care and reassuring doctors and nurses, she was moved to the Special Care Nursery where we were allowed to hold her and feed her and gaze upon her in wonder.   Just think four doting grandparents who all wanted to hold her....we should have had quadruplets.  

After a few days of “feeding and growing”  she was discharged and I am happy to report she is now a whopping 5 lbs of pure joy. She is home with her parents and thriving.    

What a gift to watch your own children begin their parenting journey. I am doing the best I can to “keep quiet” and just enjoy being a grandmother...sometimes not easy but trying. Parenting never ends....especially when you are a mom. I can’t wait to take a grand daughter shopping, put bows in her hair and have tea parties, and all of the things my boys just didn’t want to do. We are tickled PINK!!!

Daily Dose

Update on Autism

1:30 to read

Every parent watches for their baby’s first smile.  After the smiles are giggles and laughs and before you know it your baby is saying "dada" and "mama" and their vocabulary begins to explode. Suddenly you realize that your child is putting words together and may even start telling you what they want!  These developmental milestones all typically occur in the first 2 years of life.

Developmental screening is an important part of your visits to your pediatrician...especially for the first 2-3 years of life.  In many practices a parent fills out some sort of developmental screening questionnaire prior to their “well-baby” visit asking age appropriate questions....such as “does your child babble?”, “does your child point at objects?” “does your child play patty cake?”  “does your child put 2 words together?”.  During the check up your pediatrician is also watching how your child is interacting with their parents as well as with the doctor. I sometimes find that parents are “hard graders” and do not give their child credit for some milestones that I think they are actually doing when I am examining them.  Remember, there is a wide range of normal in the first several years of life. Not every baby does every thing at the same time!

Socialization and interaction is a very important part of early childhood development, but for some babies making eye contact and developing language skills is delayed. In fact,  for some children socialization and language seems to develop later and seems to be “different” than that of other children. These so called “red flags” in a baby’s development may be early signs of autism.  

The diagnosis of autism is typically not made until a child is between 18 months- 3 or 4 years of age.  The diagnosis of autism is based upon observation of a child’s communication and social interaction and for older children on their activities and interests. There is NOT a single test to diagnose autism.  In other words, your doctor cannot do a blood test to definitively diagnose autism spectrum disease (ASD). The diagnosis of ASD relies upon characteristic behaviors seen in a child, not on one milestone.

If you have concerns about your child’s development make sure you bring them up with your child’s pediatrician.  While it is hard for a parent to “wait and see” what happens over several months some babies will achieve their language and social skills later than others. Just like learning to read...some children do it earlier than others.

The most important thing is that you interact with your baby in those early years!! Talk, sing, read aloud and engage them in early play....as we know that every child needs that same stimulation.  

Daily Dose

The Difference Between Cradle Cap And Dandruff

1.15 to read

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!

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

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!  

Daily Dose

Why Kids Hold Their Stool

Dr. Sue explains a very common bathroom issue and why it occurs.Poop and stool habits account for numerous discussions among parents, especially for those with newborn children or parents who are in the throes of potty training.  It's true, no topic is off limits when it comes to raising healthy, resilient kids!

A problem that is more common than many know (or not willing to admit to) affects children  who do not want to poop, in other words, stool holding. Stool holding is called encopresis and is often seen in children with a history of chronic constipation or who have had stool avoidance issues. Chronic constipation and encopresis may be related to a child having had pain with going to the bathroom. The normal response to the need to poop is to go the bathroom.  Seems very simple right?  While everyone may occasionally have a difficult or painful bowel movement, some children who have pain with pooping recall that it hurt “so, why would I continue to poop and have it hurt?”  In this case when a child feels the urge to poop they also feel they need to hold the poop in. The urge to poop is due to the fact that stool has entered and stretched the rectal vault, which in turn sends impulses to the brain that “I need to poop.” If this feeling is repressed (by a child who doesn’t want to poop), the pressure may lessen for awhile but stool continues to fill the rectum, which gets more stretch and even further distended with stool. As this scenario occurs multiple times a day, the stool becomes a larger mass filling the distended rectum, which can no longer be totally “held in”.  When the child inadvertently relaxes the rectal sphincter, the softer fecal material will escape from the rectum and causes an “accident” and soiling of a child’s underwear. Many times a child is totally unaware that soiling has even occurred, but this is only “the tip of the iceberg” as there is still a huge amount of stool that is being held in the rectum. This held-in stool is usually hard, and dry and painful to pass. The treatment of encopresis is multidisciplinary, with a combination of medicinal intervention, dietary changes and behavior modification. This must involve both parents and child and it may take as long as 4 – 12 months to adequately treat and resolve the issue. Explaining the mechanics of stooling to both parent and child is important. It is also important that both parent and child understand that encopresis is NOT a behavioral problem nor is it “all in a child’s mind”. It occurs because the colon is not working as it should. Unfortunately, there is not a “quick fix” for encopresis and patience is important. More on treating encopresis on Monday.

Daily Dose

Kids & Too Much TV

1:30 to read

Another recent study has just been released which confirms that children are getting close to 4 hours of background TV noise each day. While many parents are aware of the need to limit their children’s active screen time (which includes TV, video game, telephone texting and computer screens) to no more than 2 hours per day, background TV time may be equally important. The American Academy of Pediatrics also discourages any TV viewing for children under age 2 years. 

*The study from The University of Pennsylvania’s Annenberg School for Communication defines background TV as “TV that is on in the vicinity of the child that the child is not attending to”.  The research looked at TV exposure in 1,454 households with children aged 8 months-8 years. The study found that younger children and African-American kids were exposed to more background TV than other children.  Having background TV noise of any kind can disrupt mental tasks for all and may also interfere with language development in younger children. 

Those households that had the least background TV exposure were those that did not have a TV in the child’s room!! That doesn’t seem to be a surprising finding at all. Many parents leave the TV on in a child’s room to help them sleep, although there are numerous studies to show exactly the opposite effect, TV disrupts sleep. I now routinely ask every parent during their child’s check up if there is a TV in the child’s room. I also ask every older child the same question, and there are many teens who are not happy with me when I encourage their parents to take the TV out of the bedroom of their adolescent. There is just no need to have a TV in the bedroom of children of any age.  I have given up on this discussion with my college aged patients! 

While many parents are doing a good job of monitoring what their children are watching on TV, and how long they are watching, we may not be doing as well when it comes to background TV.  While older kids hear news stories or language that they needn’t be exposed to, a younger child’s language skills may be delayed due to background TV noise. 

So, the kitchen TV needn’t be on while you are making your children their breakfast before school or in the evening while eating dinner. Family dinner is one of the most important times of the day and conversation is the key. No one needs to try to talk over the TV, just turn it off! 

Lastly, keep reading those bedtime stories for children of all ages; this is key to language, and appropriate language at that. 

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

Daily Dose

Do Essential Oils Boost Immune System?

1.30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

 

Daily Dose

Treating Bee Stings

Bee stings are a right of passage during childhood, always memorable, but never fun.I was outside today and noticed that the bees are back, pollinating the flowers in my garden, but ready to sting too if they are crossed by bare feet or errant hands. Bee stings are a right of passage during childhood, always memorable, but never fun. Our office receives numerous calls about how to handle a bee sting. First thing is to get some ice or a cool compress on the sting, which relives both PAIN and swelling.

While the ice is working you can take a peek and see if the stinger is still in the skin, and if so do not go grab tweezers or your fingernails to try and remove the stinger. If you do that you will only make the sting worse. The best way to remove the stinger is by using the edge of a credit card to gently scrape the stinger out of the skin. Honey Bees leave behind their stinger while wasps and hornets do not. Unless the child is allergic to bee stings most people will only have a local reaction. If there are any symptoms associated with the sting such as swelling of face, mouth, lips, or difficulty swallowing or breathing, give an immediate dose of Benadryl (diphenhydramine) while calling 911. If the child has a known bee hypersensitivity and they have an epi pen you will need to use it and also call 911. For local reactions after the sting is cleaned you can apply calamine lotion or a topical steroid cream. For swelling and discomfort a dose of Benadryl is also recommended, as well as a pain reliever like ibuprofen which will also relieve local inflammation along with pain relief. The sting is usually not uncomfortable for more than 24 hours. Make sure to watch for signs of infection with increasing redness, streaking or pain at the site of the sting. If the area seems to be getting worse rather than better it is a good idea to let you pediatrician take a peek. That's your daily dose for today, we'll chat again tomorrow.

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Daily Dose

Calming Parent's Fears About Night Terrors

1;30 to read

I received an e-mail from a viewer today about night terrors. Her concern was “my son is having what I think are nightmares, but he talks and makes no sense and seems to be afraid and I am not sure what is going on.”

Her description is perfect for night terrors, which typically occur in children during the pre-school and early elementary years. The peak age is between five and seven years, and night terrors usually resolve before adolescence. About three percent of children experience night terrors.

Night terrors are part of sleep disturbances known as parasomnias, and are characterized by partial arousal during non-REM sleep. Night terrors therefore typically occur during a child’s early hours of sleep, when non-REM sleep is deepest. Most children with night terrors will stay in their bed, but cry out and appear anxious and upset, but are also very confused. Some children may run down the hallway with heart racing and breathing fast as if they are being chased. Until you see a child having a night terror it is difficult to explain how anxiety provoking it is for a parent who doesn’t realize what is going on.

I speak from experience as our third child had classic night terrors, but the first time he appeared in a “semi” awake state screaming and sweating, I would have sworn he was in horrible pain. Not the case, as after about two to five minutes most children will calm down (on their own as you cannot awaken them or comfort them during the event) and return to sleep and have no recollection of the episode the following morning. It is a very helpless feeling until you realize that your child is really not awake at all.

The other big difference between night terrors and nightmares is that the child has no sense of dread or of being scared to sleep. They have no fear or anxiety about these events occurring, and while the sleep terror ends abruptly with rapid return to deep sleep there is complete amnesia to the event. The best treatment is in reassuring parents. It is also important to make sure that your child has a regular bedtime routine and that they are getting sufficient sleep. This sleep disturbance is really more disturbing to the family than the child and will resolve over time. Just remember to let babysitters know, as it may be quite unsettling for a new sitter who has just put precious children to bed!

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

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