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

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

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!

Daily Dose

Curfews When Home For The Holidays

1:30 to read

I have learned that one of the hardest adjustments for both parent and child is that first winter vacation home from college. I woke up this week and realized that it's my youngest son's birthday. At this very hectic time of year I often ask myself, "why did I have a baby during the holidays?" I think the answer would be "we just wanted another baby", not thinking that I would have an almost Christmas baby. But, the point of this is not about trying to have birthday parties for your child when you have a million other things to do. Or about always thinking we would celebrate half birthdays in the summer, which never happened.  Or trying to shop for both birthday and Christmas gifts, and swearing never to "cheat" him, but still taking things from closet to tree each year trying to figure out which gift should be for which occasion. The real discussion is about curfews.

It is such an exciting time for parents. Welcoming your child back home after that first long semester away! I am always longing for family dinners, games by the fire and "adult" conversation about their favorite professor or class. Discussions about new friends, roommates, second semester and what they think they will major in. Instead, most of the conversations are about plans they have to visit friends or hang out or do something away from the house and parents. This is always followed by the parental, "what time will you be home?" (to play the fireside family game). The reply seems to be universal, "I am in college now, I don't have a curfew in college."

Several years ago a parent of a patient and I were discussing this issue and they agreed with the theory that curfews were no longer appropriate. One of the great things about my job is that parenting advice goes both ways, and over the years I have learned so much from both patients and their parents. But this time the experiment, which lasted for one night, only reinforced my belief that college kids should have curfews while home. This is especially important if you have younger kids at home who are in school, parents with jobs or anything that requires getting up in the morning and getting a good night's sleep. The "young adult" college student usually has a different clock, and my idea of reasonable time and theirs is not always in sync. I could be getting up when they think it is time to come home. I still subscribe to the "nothing good happens after midnight" theory.

So.... If you have a college freshman arriving home this week after finals, have the discussion about curfews. They always argue, "you don't know when I come home when I am at school." That does ring true, but when they are "home", parents just get a better night's sleep once their "baby" is also tucked into bed.

That's your daily dose, we'll chat again soon.

Daily Dose

Foods You Can Eat When Breast Feeding

1.30 to read

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

baby, breast feeding, Daily Dose, mom
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

Parenting is Not a Competitve Sport!

1:30 to read

When did parenting become the latest competitive sport?  I have heard all sorts of new parents, even on their baby’s first day of life... start off by saying that their baby is “not....insert what their friend’s baby is already doing.” Does that mean not breathing as fast, or having a lower heart rate...I mean what is there to be competitive about in the first 24-48 hours?

It has always been hard to be a parent, and self doubt is one of the biggest issues a parent faces....but to start off feeling like you are already “failing’ is totally crazy.  There are so many feelings that a new parent experiences, without having competition even enter their minds.

Babies sleeping longer, crawling earlier, talking more...that only seems to be the beginning. Soon it is about who’s reading first, is on the more competitive soccer team at the age of 6, or even has the biggest birthday party. Unfortunately, all of this is shared on social media....which means that you are feeling “competitive” or inadequate with not only your closest group of friends but with hundreds if not thousands of people, and many of whom you don’t even know. It is just too much!

At the same time you are also getting comments about your parenting....which I think only compounds all of the emotions and worries and questions parents experience. Instead, why not rely on your own circle of friends, family and maybe a book or two on raising children.  

So....I would resist the urge to share every moment of your baby’s life and milestones with the social media world, or to compare your baby with total strangers....there will always be someone who does something earlier and faster....and that does not always mean better. 

Parenting is definitely a marathon...but not a competitive one. 

Daily Dose

Learning to Crawl

1.15 to read

Back to more funny office stories - they really keep my job interesting and always a little bit of fun. 

Many of my “new” young parents worry (haven’t we all?) and one of the new comments I have started to hear is “why is my baby not crawling?” Well, for one reason, they are only 6 months old!  I know we are expecting children to achieve some milestones at younger and younger ages, an example of this is reading.  But while not all children are ready to read at 4-5 years, MOST children do not crawl until they are around 9 months of age. 

I am suddenly having moms and a few dads ask me how to “teach their baby to crawl”?   What???  This is new to me.  I wish I could remember   each of my own children as they learned to crawl. It is just a foggy memory now, but I do remember that suddenly they were mobile, and that changes everything! 

Babies instinctively want to move and explore their environment. For most babies, if you have been doing “tummy time”, which is followed by your baby learning to sit, they suddenly figure out how to go from the sitting position back to their tummy.   Why?  That maneuver is the precursor to learning to crawl.  They just do it!  You need to put them on the floor and let them figure it out. You DO NOT need to crawl around the house.  

While you will have to help “teach” your child to walk, in a manner of speaking, they WILL just crawl if given the opportunity.  That means putting them down and letting them figure out how to move. I had one mother who asked me if “her baby could sit in the grass?”  She was afraid to even let the child touch the ground. Other parents are worried that it is “too dirty” for their child to sit on the floor and crawl.  The world is full of dirt, grass and who knows what else, but children have to spend some time on the floor to learn to crawl.   

Take home message....no instructions for a baby to crawl, they just figure it out, and we parents figure out that some of the things our wonderful children accomplish are despite us!

Daily Dose

Why Parental Emotion Always Takes Over

1:30 to read

Why do parents let their emotions take over their child's diagnosis? Because we love out children and want the best for them. I was seeing patients in the office this week and noticed a young mother and her two daughters who had been in my office frequently in the last several months. Yes, it is the season for more visits to the pediatrician but she seemed to be in the office fairly often.   She was in this day with her 3 year old daughter who had complained of a “tummy” ache, and she was convinced that her daughter had appendicitis.

Here’s the scene: 3 year old little girl with long hair and a bright smile  prancing around the exam room in her leggings and UGG boots as if she is a rock star!  This (supposedly) sick little girl is putting on quite a show for both her 1 year old sister and her mother.  She looked adorable, but not sick!  While her mother and I chatted, I continued to watch her daughter out of the corner of my eye. According to her mother, the child had complained of a tummy ache earlier that day, and pointed to her side. She said she didn’t want lunch.  No fever, vomiting, or diarrhea. Nevertheless, her mother was worried that her daughter might have appendicitis.  She was convinced that the “tummy ache” must be something serious.

After examining this precious child, it was obvious that her “tummy ache” was not due appendicitis. So, her mother asked, “why do I always go to THE DARK SIDE”. When I asked her what that meant she said, “why does my brain always jump to the worst conclusion”. “Why am I here so often with my daughters? They have headaches that I am sure are brain tumors, or a tummy ache that must be appendicitis, or bruises that I am convinced are due to leukemia.” I don’t think it is actually a parent’s brain that takes them “to the DARK SIDE”, but rather it is the HEART! 

Sometimes we parents (and doctors who are parents too) know intellectually that the child’s complaint is probably nothing. It is most likely that the headache is just that (how often do you yourselves get one?) and the tummy ache could be due to gas or constipation rather than an “appendix ready to burst”.  But our emotional and sometimes irrational side takes over and suddenly we have “gone to the DARK SIDE” with fears of the worst possible diagnosis.  Truly, it happens to all of us at times. As a pediatrician and mother I do know this, bad things get worse and the child’s complaints get more frequent or new symptoms develop. The “bad” things do not just go away.

As they teach you early on in medical school,”when you hear galloping hooves, think of horses not zebras. “  In other words, think about common reasons for a symptom before jumping to the infrequent and life threatening diagnosis. We parents need to heed that advice too.   Sometimes a few hours to days of watching a child will keep you from going to “the dark side” as you realize your child has moved on from the tummy ache to wanting to go outside and play or to dancing around the room. Remember to try and stay on the “bright side” and see if the symptoms resolve.

That’s your daily dose for today. We’ll chat again tomorrow. Send your question or comment to Dr. Sue!


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