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Daily Dose

Bathing Your Baby

The end of summer baby “boom” is still going on and new parents are coming in with all sorts of questions…including how do I bathe my baby?  As many mothers and their babies are being discharged from the hospital after 24 hours, they really don’t have the opportunity to “practice” new parent skills, including giving their baby a bath.

Bathing your baby is really fun and is a good bonding experience for parent and child.  The bath also keeps your baby clean and smelling “sweet”.  I was convinced that it would also help them to relax and to sleep longer (not scientific at all - but it works for us right?).  At any rate, you can bathe your baby every day or every 2-3 days, or even once a week. It is really personal preference…but that wonderful “after bath smell” makes me smile.

Many people buy infant bath tubs and there are tons to choose from. I like the the “Puj Tub” or the “Tummy Tub” as you can easily put them in the kitchen sink (grandparent friendly), but you want to make sure that there are no sharp edges or places where a baby might get bumped or injured when you put the tub in the sink.  Some people use a folding tub (be careful not to pinch the baby) or inflatable tub  these may collapse), because they are easier to store if you have limited space.

The number one rule for a bath - NEVER leave your baby alone in the tub, not even when they can start sitting up. A baby may drown in an inch or two of water…so never even turn around to check your phone or check an email.  You should also make sure that the water temperature is correct and every new parent should check the hot water heater and lower the temperature to 120 degrees F, so prevent burns. Regardless, always check the water temperature before you put the baby into the tub.

I am also a fan of using mild soaps..including Cetaphil, Cerave, Aveeno, and Aquaphor  baby wash. If your child tends to have sensitive skin it is best to avoid fragrances and harsh chemicals.  I also like to moisturize the infant after a bath with baby lotions from these same companies. New data is showing that frequent moisturizing (twice a day) may also be important in preventing allergies later in life…. so why not enjoy some baby massage…and keep watching for more information on this issue.

 

 

Daily Dose

Mumps Outbreak!

1:30 to read

The latest infectious disease outbreak is in the Boston area where several colleges have reported cases of mumps. Mumps is a viral illness that causes swelling of the salivary glands as well as other symptoms of fever, fatigue, muscle aches and headache.    Harvard University has been hit the hardest and has now documented over 40 cases this spring.  Boston is a city with numerous colleges all in close proximity, and there are documented mumps cases at Boston University, University of Massachusetts  and Tufts as well.  These Boston area colleges are all in close proximity and are merely a walk, bike or train ride away from one another, so these students, while attending different universities may all co-mingle at parties and athletic events.

Mumps is spread via saliva (think kissing), or from sharing food, as well as via respiratory droplets being spread after coughing or sneezing. It may also be spread via contaminated surfaces that will harbor the virus. People may already be spreading the virus for  2 days before symptoms appear and may be contagious for up to 5 days after their salivary glands appear swollen….so in other words there is a long period of contagion where the virus may inadvertently be spread. It may also take up to 2-3 weeks after exposure before you come down with mumps.

All of the students who have come down with mumps had been vaccinated with the MMR vaccine (mumps, measles, rubella).  Unfortunately, the mumps vaccine is only about 88% effective in preventing the disease. Despite the fact that children get two doses of vaccine at the age of 1 and again at 4 or 5 years….there may be some waning of protection over time. This  may also contribute to the virus’s predilection for young adults in close quarters on college campuses. Something like the perfect infectious disease storm!

In the meantime there are some studies being undertaken to see if adolescents should receive a 3rd dose of the vaccine, but the results of the study are over a year away.

In the meantime, be alert for symptoms compatible with mumps and make sure to isolate yourself from others if you are sick.  Harvard is isolating all of the patients with mumps for 5 days….which could mean that some students might even miss commencement.  Doctors at Harvard and other schools with cases of mumps are still on the watch for more cases …stay tuned.

 

 

 

 

Daily Dose

Spring Viruses

1.30 to read

While it is warming up here in Dallas, many parts of the country are still seeing freezing temperatures and even snow! Even so, I am beginning to see typical spring illnesses like Fifth’s disease. 

Fifth disease is a common viral illness seen in children, often in the late winter and spring. Many of these children look like they have gotten a little sun burn on their faces (just as your child starts playing outside) as they often show up in my office with the typical slapped cheek rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks.

Fifth’s is also called erythema infectiosum and is so named as it is the fifth of the six rash associated illnesses of childhood. Fifth disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa.  In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of not feeling well and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed. When I see a child with Fifth disease it is usually an easy diagnosis based on their few symptoms and the typical rash.

Although children with Fifth are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you never know where you got this virus. (the incubation period is somewhere between 4-20 days after exposure).  Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10-60% of students in a class may become infected.

Most adults have had Fifth disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a memorable event during childhood.

Fifth disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve. I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas. 

Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a warm spring day may work just as well too. Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth disease, so it is business as usual with school, spring days at the park and Easter parties.

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

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Daily Dose

New Concussion Guidelines

1:30 to read

A really interesting study was published in Pediatrics online entitled “Benefits of Strict Rest After Acute Concussion”.  The guidelines for treating a concussion continue to be debated and that is what makes this study thought provoking.  

This was a “randomized controlled study”  which followed 88 patients between the ages of 11 and 22 years who had been diagnosed with a concussion.  45 of the patients were given instructions for 5 days of strict rest at home with no school, no work and no physical activity.  They were then allowed to have a “stepwise return to activity”.  The other 43 patients were told to “rest” for 1-2 days after which time they could  return to school also follow a “stepwise return to activity”.

Interestingly, there was no clinically significant difference in the  neurocognitive or balance outcomes between the two groups.  In fact the group that was “advised to rest for 5 days” reported more daily post concussive symptoms and slower resolution of symptoms than those who were told to rest for 1-2 days.  

This was a small study and does not mean that everyone should be treated the same way. In fact, when seeing a patient who has sustained a concussion each person seems to be a bit different.....as one could expect when discussing a “brain injury”.  No two brains are exactly alike...at least for the time being...who knows what will happen one day with genetics

In my own limited practice I have found that “very few” tweens and teens subscribe to the complete rest theory...that is no school, but also no TV, no computer and no videos or smart phones....WHAT??? No social media for 5 days?  You would have to put most of them on an isolated “post concussion island” to ensure they disconnect.  

The study authors also wondered if patients reported more symptoms after having strict rest recommended.  It seems plausible that I too might notice a few more symptoms when just sitting there wondering if my head hurts or if I seem to be more fatigued.

Subjective symptoms are always difficult to quantify...which makes treating a concussion more problematic.  I think erring on the conservative side and restricting “return to play” for a longer period seems to be of more importance than any other recommendation, including “5 days of strict rest”. In the meantime this is an interesting study....with more data to surely follow. 

 

Daily Dose

Back to School

1:30 to read

Schools around the country have opened their doors and some will be starting soon. This is the first week of school for most students in my area and parents have been busy in the last few days attending “back to school” and “meet the teacher” nights in preparation for a new school yea

So…every school has different rules, expectations and strategies for helping their students evolve into their “best” selves and as you get older the “rules” often change in hopes of making students more independent and responsible. I other words, getting ready for the “real world ‘ one day.

Catholic High School for Boys in Little Rock, Arkansas has recently been highlighted in the news and on social media for the sign that is posted on the entrance to the school. It reads “If you are dropping off your son’s forgotten lunch, books, homework, equipment etc, please TURN AROUND and exit the building”  Your son will learn to problem solve in your absence.”  The school posted the same message on their Facebook page as well.

According to the principal of the school, this has been a Catholic High rule for quite some time…it was also a rule at the high school my boys attended.  While some feel that this is unjust and that the students should be allowed to “phone home” if they have forgotten something, the school’s explanation is really fairly simple…allowing your child to have some “soft failures” and to learn both problem solving skills and responsibility will ultimately mold them into functioning members of society as they reach adulthood.  Sounds reasonable to me.

I know that as my boys went from elementary school, on to middle school and then high school their father and I had greater expectations that they needed to be responsible for getting their “stuff” to school.  We started off the school year with a game of sorts where you were given 3 “hall passes” for the year. I guess this started from something at school where they were given a hall pass to go to the bathroom or the office, and some teachers would hand out homework passes that allowed you to “skip” an assignment. So, each child ( this probably started in about 3rd or 4th grade) had 3 passes/year  where they could call and have us “rescue” them if they forgot something. Once you used up your “hall passes” you had to suffer the consequences of no lunch or turning in an assignment late.  Interestingly, each child was a bit different….one would use them up pretty quickly, another would “hoard” them for late in the year.  One wanted to know if they could be accrued? 

By the time they reached high school it was not a SHOCK when they were told the school rule that they could not call their parents.  It seems they figured out how to borrow money for lunch, or share with a friend, how to borrow a tie or jacket for an assembly and that turning in assignments a day late usually meant 10 points off. Not only did it help them become more organized and responsible, it also made me a working Mom “feel less guilt” that I really was not available to rescue them sometimes, even if I wanted to.  Do you think you would appreciate waiting in your pediatrician’s office (any longer than you may already) while they tried to run a homework assignment to school??  

You might try starting off the school year with a few hall passes and see if it works for your family!  

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

College Drug Overdose

1:30 to read

Colleges are gearing up for a new school year and already there has just been a death reported at a fraternity house at Texas A&M University.  This news hit close to home as the adolescent who died was from a Dallas suburb and several of my patients attend Texas A&M and were even in the same fraternity.  

The misuse of opioid medications is a national epidemic and the drug scene on college campuses seems to be increasing. The misuse of opioid medications includes drugs which have been obtained both legally (by prescription for pain management) and illegally. Many of the college students that I take care of have recently told me that these drugs which include oxycodone, hydrocodone, codeine, morphine and fentanyl are relatively easy to obtain in dorms, frat houses, classrooms, and on line via social media sites.  All of these opioids are chemically related and interact with opioid receptors in the brain to produce pleasurable effects and relieve pain. Some students reported that friends often offered to “share” their unused pain relievers and would even offer them for free! Unfortunately, unintentional drug overdoses due to opioids also continues to rise and has more than quadrupled since 1999. Adolescents just don’t seem to realize the power of these drugs!

In the case of the recent death in our area, the teen was found unresponsive and not breathing in the early morning hours after a fraternity party. It was thought that he had combined alcohol (probably excessive) with an opioid. The toxicology reports are pending….but the police reported they found marijuana (which seems to be almost everywhere) and other drugs including not only opioids but also MDMA (Ecstasy), LSD and other drug paraphernalia. 

Just like alcohol poisoning following binge drinking, opioids also cause respiratory depression and loss of consciousness   The combination of the two may be even more deadly, which could occur even if this was the first time the teen had used opioids. There is an antidote to opioid overdose, Naloxone (Narcan) which may be injected (or given intranasally) to counter the effects of an opioid drug overdose.  It is now available over the counter and my be life saving if given soon enough, by helping to reverse the respiratory depression and allow the person to be transported to a hospital for life saving care.

If you are just sending your child off to college or back to college PLEASE talk to them about alcohol and drugs and reiterate that the combination may be even be more deadly!!  Even one time use could be the last time….so tragic.

 

 

 

 

 

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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