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

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

Booster Shots

1:00 to read

Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

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

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?

 

Daily Dose

More Questions About Ebola

1:30 to read

The sky is falling!  That is what “some” people would like to think.....but the sky is NOT falling and Ebola Virus Disease (EVD) is not going to  be the disease that parents need to worry about this winter....rather it is other viral illnesses that we KNOW will cause numerous pediatric hospitalizations and unfortunately sometimes death. Influenza and RSV (respiratory syncitial virus) circulate every winter and they both are airborne illnesses. In otherwords, these viruses are easily transmitted when a person coughs, or sneezes or touches their hands to their nose and then touches a door knob or telephone ......do you get my jist?  Yes, you can get flu and RSV from just sitting next to another person....not so with EVD.

I have worked for the past 4 days trying to “talk parents off the ledge” about the possibility that they or their children have come into contact with EVD. Despite the fact that you can find any number of opinions on the internet about the chance of getting EVD, the brightest minds in the country continue to assure us that EVD is not going to be an epidemic in this country as it is in West Africa.  Instead of making yourself crazy about EVD and the one case in the United States, try to think about things that you can control and even prevent.  

That means vaccinating your children against ALL of the diseases that ARE preventable. I actually saw several parents who were so anxious about their child getting EVD, yet declined flu vaccination (which is routinely recommended for all children over 6 months of age).  I just cannot comprehend this reasoning.  The reality of flu killing thousands of people a year in the United States, including 105 children last year, yet declining a vaccine.....and wringing their hands over one case of EVD in Dallas.

The people who are truly in “harms way” are the courageous medical workers in West Africa who continue to try to control and treat the numerous cases of Ebola....they are heroes and deserve our prayers.

In the meantime..I will continue to ask all of my patients about any travel to West Africa, or direct exposure with body fluids of a patient who has been diagnosed with EVD....but all of those other viral illnesses are just a cough and a handshake away.

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Daily Dose

White Patches on the Skin

1.15 to read

I saw a 10 year old patient last week for her routine physical. One of her mother’s concerns was that her daughter had “white patches” under both of her arms.  Once I examined her I told her mother that the “white patches” were actually due to Vitiligo, which is an acquired disorder of pigment loss. 

Vitiligo is caused by a reduction in functional melanocytes, the cells that cause pigmentation in the skin. Vitiligo often develops before the age of 20 and there is no difference in predilection for male over female cases.  In children the hypopigmented areas are often first noted on sun exposed areas like the face (around the eyes and mouth) and well as on the hands.  The underarm area (axilla) is often involved, as are areas around the genitalia. In many cases the depigmentation is symmetrical (both arm pits, or hands or knees). 

Although the exact cause of Vitiligo is not clear, it is known that it has an immunogenetic basis, as there is a positive family history of others with vitiligo in 30 -40 % of patients. There are numerous theories as to different reasons that the melanocytes (pigment cells) are not working. The genetics of vitiligo is also being studied with changes seen on certain chromosomes. 

So why doctors are not clear as to how and why Vitiligo occurs, in most cases it does seem to be slowly progressive. There is spontaneous repigmentation in 10-20% of patients, especially in sun exposed areas of young patients. 

The problem with Vitiligo is that treatment is often lengthy and is frequently unrewarding. There is not “one way” to treat Vitiligo that will ensure repigmentation and resolution. Dermatologists have used phototherapy for treatment, but facial areas and small patches seem to be most responsive. A recent study showed that narrow band UVB therapy was superior to UVA therapy, but studies continue. 

Potent topical corticosteroids are also used to help promote re-pigmentation.  Topical immune modulators such as Tacrolimus have also been tried. 

With all of this being said, a referral to a dermatologist that is familiar with treating Vitiligo is of upmost importance. The sooner the treatment for these “white patches” the better. 

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

Daily Dose

Head Flattening on the Rise!

1.15 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Daily Dose

Ebola in U.S.

1:30

It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.

 

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DR SUE'S DAILY DOSE

Kids are too busy and it's curbing their development