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Daily Dose

Anemia

1:30 to read

Adolescent females are at greater risk for anemia than adolescent boys. This may due to several reasons including the fact that adolescent girls lose blood each month during their menstrual cycles and many teenage girls eat less red meat than adolescent boys.  

 

While some adolescents with anemia (low hemoglobin and hematocrit) complain of headaches, irritability or fatigue (which are very common teenage complaints), others are completely asymptomatic.  It is recommended that teens have a screening complete blood count around the age of 13 and then every 5 years or so thereafter. At the same time, the AAP recommends more frequent blood counts in those with risk factors for anemia, including diets low in iron rich foods (meat, eggs, fortified cereals) teens who have significant physical activity (especially female adolescent athletes) those with vegetarian or vegan diets and for any adolescent girl with excessive menstrual bleeding. Obese teens also have a higher incidence of anemia and should be screened. This list includes many of my patients.

 

Interestingly, you can have low iron stores without yet being anemic.  I have now started looking at the serum ferritin levels in teens with risk factors for anemia, as I am finding that some of my athletic patients have low ferritin levels, with a normal blood count. Some recent studies have shown that low ferritin may impact athletic performance including fatiguability. While fatigue during exercise is a subjective symptom,  maintaining iron stores is important for overall health.

 

Lastly, iron deficiency may impact cognitive function in adolescents. There have been several studies showing that girls who had higher serum ferritin levels had statistically significant improvement on cognitive tests of verbal learning and memory…so it may be worth looking at levels in a teen who is suddenly having difficulty in school, without previous issues. One blood test!

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

How to Treat Croup

1.15 to read

Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

Daily Dose

Should Children Lift Weights?

I am often asked by both young patients and their parents if children can participate in weight lifting and strengthening exercises.

I think the appropriate term is strength training and conditioning, rather than weight lifting, which connotes competition and the need for heavier and heavier weights. When done appropriately, strength training and conditioning is great for kids of all ages, and really encourages being physically fit. Weightlifting is not appropriate for a growing child as it can put too much strain on the tendons and cartilage. This is especially true when kids become competitive about lifting bigger and bigger weights at the risk of long-term injury. Allowing children to weight lift in hopes of “bulking up” or “building the biggest muscles” before pubertal development and their growth spurt is inappropriate. All of that can be deferred for the post pubertal athlete. On the other hand, an age appropriate strength training and conditioning program may actually be protective of a child’s joints by increasing their muscle strength and their endurance. By participating in supervised and structured strengthening programs, a child as young as eight may improve their endurance, body awareness and balance, all of which are beneficial. A strength-training program can be done without weights, as in resistance training, by simply using the child’s body weight. Examples of this would be abdominal crunches, push-ups and pull-ups. These are great ideas for the younger children. For older children free weights or resistance bands may be added. Parents or coaches who are familiar with the use of free weights should always supervise. Start out with lighter weights, and make sure that the child can do at least 10 repetitions with the weight, if not, drop to a lower free weight. Have the adult watch the child for form and technique and supervise any increase in weights or repetitions. There are also many programs through local gyms and YMCA’s tailored just for kids to participate in strength training. When beginning a conditioning program encourage your child to have a warm up period, with a little aerobic activity like walking or running as this his will help to warm the muscles and prevent injury. After the strength training it is equally important to have a cool down period with gentle stretching. Many children enjoy working out with their parents and this can become a family activity (we can all use the exercise) to promote coordination, healthy bones, joints, cholesterol and blood pressure. Most importantly make it fun! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Flat Feet

1:15 to read

Many parents come in concerned that their child has flat feet.  Early in life almost all babies have flat little chubby feet. if you look closely you can see the normal fat pad on the middle of the foot which overlies the arch of the foot. This fat pad will go away as your baby gets older.

 

As your child grows their foot goes through many changes and arch development continues until a child is about 8 years old.  The muscles and ligaments of the arch of the foot mature and tighten, just as do other muscles in a child’s body. 

 

About 14% of the population has flat-feet as adults and this condition often “runs in families”. Those with flat feet have normal variant in which the ligaments of the arch are lax and therefore the foot is flat when standing and weight bearing. 

 

During the physical exam your doctor can show you that your child’s foot is developing an arch. There are several maneuvers to look at a child’s foot. If they are sitting on the exam table look at the foot as it is hanging (non weight bearing) and see if you see an arch.  If you also push upward on the big toe you should be able to see the natural arch of your child’s foot.  Then have them stand and the arch will flatten out again. Now have them stand on their tip-toes and you should see an arch again.  Arches vary in size, like so many other things on different body types. There is not an “appropriate amount of arch” necessary.

 

It is rare for flat feet to cause any problems, especially in a younger child. In an older child that complains of pain, especially with running activities, you may buy over the counter arch supports. While arch supports and orthotics may provide comfort they do not stimulate the arch to grow and change.  

 

 

 

 

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

Daily Dose

Allergy Season

1:30 to read

Allergy season is here and if your child is known to have seasonal allergic rhinitis (nasal congestion, runny nose, itchy nose and sneezing) during the fall months, it is time to begin the use of their intra-nasal steroids and oral antihistamine on a daily basis.  It is also easy to begin therapy for suspected allergic rhinitis as both nasal steroid sprays and non-sedating antihistamines are available over the counter, and there are many choices as well (liquids, chewables, and pills).

 

Interestingly, I just read an article from a study done in India which looked at Vitamin D levels in children with allergic rhinitis.  It was a small study, only 42 children, between the ages of 5-15 years were followed. The authors looked at nasal symptom scores in children who were maintained on their allergic rhinitis protocol but one group received a Vitamin D supplement as well. 

 

Vitamin D is known to have effects on T and B cells which may link Vitamin D to immune related conditions and allergies. There are many interesting studies involving Vitamin D and the role it plays in our daily lives and there continues to be a lot of controversy on the topic as well. 

 

But, with that being said, in this study children who received Vitamin D supplementation (400-800 IU per day depending on age of the child) not only had higher Vitamin D levels, they also had lower nasal symptom scores. 

 

Of course in the study they looked at Vitamin D levels pre and post treatment. But it would seem to me (being an allergy sufferer myself) that adding a daily dose of Vitamin D to my allergy regimen couldn’t hurt.  

 

There continues to be an increase in allergic disease around the world and at the same time, more and more people are seeking protection from the sun (from which we make cutaneous Vitamin D). Sun protection continues to be a good idea too. Of course, this is only one study, and further research with greater study participants are necessary. But in the meantime, you might discuss adding a dose of Vitamin D to your child’s allergy regimen with your pediatrician. 

 

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DR SUE'S DAILY DOSE

Why young girls are at risk for anemia.

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