Daily Dose

Why Vitamin D is Important!

1:30 to read

As a follow up to the blog last week on children, calcium and vitamin D needs, a recent article in a Canadian Medical Journal reports that children who drink non-cow’s milk, such as soy, rice, almond and goat’s milk have lower serum vitamin D levels than those who are drinking vitamin D fortified cow’s milk.

This study looked at 2800 children between 1-6 year olds, and their consumption of either cow’s milk which is all vitamin D fortified and those who drank non-cow’s milk, in which case fortification is voluntary.  The researchers then looked at blood samples to measure vitamin D levels.

The researchers found that children who drank non-cow’s milk had nearly three times the risk for having low vitamin D levels.

So...bottom line...when I am discussing milk and dairy intake with families I am going to reiterate the need to drink cow’s milk, or children may need to continue vitamin D supplementation  and for most parents, including myself, it is hard to remember to give a vitamin or mineral supplement every day for a child’s entire life!).  A glass of vitamin D fortified milk at meals seems an easier choice in most cases.

Daily Dose

Selfies Cause Lice?

1.30 to read

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

Picky Eating: Magic Words Offer Food for Thought

1:15 to read

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting. An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits.

She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together.

There has been a lot of data substantiating the many positive side effects that stem from family meals.  Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners. Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent.

Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life. I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults.  I think my boys are less “picky” than I am! (No sushi for me).

Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time. That’s your daily dose, we’ll chat again tomorrow.

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

Keep Your Athletes Hydrated On and Off the Field

1:30 to read

With summer heat all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 129 deaths while playing sports due to heat and exposure to elevated temperatures.

Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.)

The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used.

Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

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

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

Lice is Tough to Treat

1:15 to read

School is just back in session and we will start to see lice heading back to school as well!!  The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

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