Daily Dose

Ear Infections Can Develop Quickly

1:15 to read

One of the things that I sometimes see in my practice, which is interesting to me as a pediatrician, and was equally interesting when I had young kids, is how quickly a child's ear exam can change.

You are taught that in medical school, but when you really see it happen it with your patients or your own child you become a real believer. As the saying goes, seeing is believing. I can remember checking one of my boy's ears for an ear infection early in the morning before heading out to work, and declaring, "his ears are perfectly clear". How could it be, my husband would inquire, "that they seem worse after we have been at work all day" and lo and behold, I would re-check their ears and a normal morning ear is an abnormal evening ear. What a difference 12 hours can make! Not a very good warranty on ears and infections.

I was reminded of this yesterday when a patient called and said that her little boy had developed "disgusting" eye drainage which was worsening since I had seen them in the office a few days ago. They had just returned from taking both of their young children to Disney World, and she "couldn't believe they came home sick!" That's a whole 'nother column. At any rate, seeing that they lived fairly close I told them to swing on by and let me look at him again. I think she was just hoping I would call in eye drops. The two precious boys arrived at my doorstep on Saturday night and lo and behold after looking in the youngest child's ears, both of his ears were so infected. So, once again I was a believer in ears changing, and he did not need eye drops he needed to have oral antibiotics to clear up his ears (and subsequently his eyes). There are several lessons from all of this. Ears can change quickly, eye drainage in a toddler with a cold may often really indicate that their ears are infected, and house calls are a good thing.

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

Daily Dose

Treating Swimmer's Ear

1:15 to read

Swimming is one of the best ways to beat the summer heat, but that may also mean that your child will develop a painful swimmer’s ear, also known as otitis externa. Swimmer’s ear is a common summer infection of the external auditory canal, in other words the part of the ear that connects the outer ear (where the Q–tip goes, but really shouldn’t) to the inner ear.

Swimmer’s ear often develops in school age children that spend much of their summer in the water, whether in a pool, lake or even the ocean. The ear canal just never gets a chance to dry out, and the constant moisture disrupts the skin’s natural barrier to infection. The skin may then develop micro abrasions, which allow bacteria to penetrate, and a painful infection develops.  The most common bacterial infection is due to the bacteria Pseudomonas aeruginosa.

A child with a swimmer’s ear usually complains when you touch their ear or tug on their ear lobe. They will often complain when they are lying down and roll over on that ear. Swimmer’s ear may be extremely painful and awaken your child from sleep. When you have an inner ear infection (otitis media) the ear itself is not painful to the touch. In severe cases the ear canal may be so swollen that it appears smaller than usual, and appears red and tender. At some times you may see discharge from the ear canal due to the infection and subsequent inflammatory response.

The treatment of swimmer’s ear is to use an antibiotic drop instilled into the ear canal. I often use an antibiotic drop in combination with a steroid to provide anti-inflammatory effects too which will help to reduce the local swelling and irritation. In severe cases it may be difficult to get the dropper into the ear due to the swelling so the doctor may place a “wick” into the ear that will open the ear canal and allow the drops to enter. A child may also need pain control with either acetaminophen or ibuprofen. At the same time you are using topical drops the child needs to keep water out of the ear!! This is the hard part as they are such water creatures at this age. This also means not to get the ear wet when bathing or showering. I usually say for four to five days before returning to the water.

To help prevent swimmer’s ear you can either buy a premixed solution called Swim Ear, at the pharmacy or mix up your own thrifty bottle made with 1/2 white vinegar and 1/2 alcohol. It is handy to keep this by the back door if you have a pool or in the beach bag. At the end of swimming apply a few drops to each ear and wiggle the ear around. This will help dry out the ear. Once your child is a “fish” and their heads are under water a good deal of the time, this a good time to start using this product. It is unusual to see a your-baby, toddler etc with swimmer’s ear, as they are just not under water all day. But prevention is the key, a painful ear is not fun and staying out of the pool just adds insult to injury! That’s your daily dose, we’ll chat again tomorrow.

Send your question to Dr. Sue!

Daily Dose

Early Talkers

1:30 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

Daily Dose

Bright Light & Sneezing

1:30 to read

What is the connection between bright light and sneezing? DId you know it was hereditary?I have always noticed that I frequently sneeze when I walk outside, and this was especially noticeable this summer with all of the bright sunny HOT days that we experienced. I thought I had remembered that my mother often did this too and when I asked her she confirmed this.

I was recently reminded of this again when I was with my youngest son moving him back to school. It seemed that every time we walked outside to get another load of boxes he sneezed! We both sounded like “Sneezy” one of the Seven Dwarfs.

Of course my son announced, “Mom are you just realizing this? I have always sneezed just like Ohma and you do”. Oh well, I am finally catching on.

This of course piqued my curiosity and then I remembered that I had read something about “the photic sneeze reflex”.  It has also been name ACHOO: Autosomal Cholinergic Helio-Opthalmic Outburst (and you thought ACHOO was the sound you made!)

It is estimated that this reflex affects about 1 in 4 people. It is inherited in the autosomal dominant manner (remember your days in biology and big B and little b?) If you have the “sneezy gene” your child has a 50-50 chance of also having it.

This reflex has been known for a long time but there wasn’t much science as to the cause. But a recent study (very small only 20 people) compared photic sneezers to controls and found that when shown a shifting pattern of images, the visual cortex of the sneezers showed higher activity than those of the control subjects.

There needs to be much more research done on this topic with larger groups of people studied to further confirm this finding.  But, nevertheless, it is interesting that scientists are now trying to elucidate the mystery of the photic sneeze.

In the meantime I realized that another one of my son’s also has the gene. Funny how you suddenly recognize a familial pattern to sneezing only to find out it is in the genes. It also reminds me I have a blue eyed and 2 brown eyed children, back to those genes again.  Just like they taught me in medical school, take a good family history!

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

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

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

What is Thrush?

1.15 to read

I get a lot of phone calls and questions from worried mothers who have noticed that their baby’s tongue has a bit of white coating and is this thrush?  Thrush is fungal infection of the mouth that is seen in babies (about 2-5% of babies), but thrush typically affects the sides of the inside of the baby’s mouth or under the lips and along the gum line. A white tongue alone is most likely residual milk. 

There are many cases of thrush that are mild enough that they may resolve on their own. On the other hand, a severe case of thrush may be painful and may make it difficult for a baby to feed, which then leads to a fussy, irritable baby. 

Thrush is caused by the fungus candida and despite everyone’s best efforts at cleanliness, candida like bread mold, can just happen.  Candida may be acquired at the time of delivery as the baby passes through the birth canal that is colonized with candida, or during nursing from the skin of the breast, or from a pacifier or the nipple of a bottle.  

Thrush is typically treated by wiping the inside of the mouth with a soft washcloth followed by an antifungal medication given as drops in the baby’s mouth after the baby has eaten. In a breast fed infant I treat the mother’s breast with a topical antifungal cream as well. 

Best way to look for thrush may be when you baby yawns and you get a good look at the inside of their mouths (bucal mucosa).  You don’t need to be a detective to find thrush, it is usually fairly evident and the biggest clue that it is not milk as it will not wipe off with a soft washcloth.

Daily Dose

Kids Need Vitamin D!

1.15 to read

During all of my check ups I discuss the importance of dairy products in a child’s diet to provide adequate calcium and vitamin D for bone growth and long term bone health.  It doesn’t seem that the little ones are difficult to get  to drink milk, eat string cheese, have a yogurt, but the older kids are definitely more challenging. 

Teenage girls seem to be one of the biggest problems when it comes to calcium intake. When I ask them if they drink milk, a typical response is “Uh, no”, then if I ask about other dairy they may say they drink the milk out of the cereal bowl, or they grab a frozen yogurt at lunch or have a slice of cheese on occasion.  When I ask them if they know how much calcium and viamin D they need during the tween and teen years I also get a blank look  but they do know how many texts they have on their cell phone plan!).  Answer is 1300 mg/day once you hit the teen years. 

With that being said, I am always encouraging more dairy products, milk and then a calcium/vitamin D supplement as well. Interestingly, they usually don’t balk at the idea of a vitamin, but the issue is getting them to stay on the supplement for more than a few days/weeks when they typically start to “forget”. 

So, I was seeing a family with two teenage daughters who had heard my calcium talk before. They were both non milk drinkers, competitive cheerleaders who needed strong bones and who by now could answer my calcium questions. When I asked if they were taking their calcium supplements the mother said, “they have access to calcium and vitamins” everyday......what a great line. Well put by a mom of teens! 

In fact, despite having “access” the girls readily admitted they “rarely” remembered to take them and might be more likely to up their dairy products everyday. 

Calcium and vitamin D metabolism is a hot topic and “banking calcium” during childhood is so important.....even with access to the supplement you have to swallow it to make a deposit. 

Daily Dose

Teens & Skincare

1.15 to read

I am seeing a lot of teens for their “routine” checkups and skin care is always part of our discussion. If you have a teen, you know how self-conscious they can be when it comes to their skin. Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is “nothing’. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone. The first thing that all adolescents need to do is to wash their face twice a day. You do not need “fancy” skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don’t scrub or buff, just wash. After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite. At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated. If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day. That's your daily dose. We'll chat tomorrow. Send your question to Dr. Sue!

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DR SUE'S DAILY DOSE

Don;t let swimmer's ear keep your kids out of the water!