Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two?There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

Daily Dose

Children & Thunderstorms

1:15 to read

It is not uncommon for young children to be afraid of thunder and lightening.We had big thunderstorms in our area last night. The skies were filled with lightening, huge claps of thunder, loud winds and torrential rain. While the storms only last for a short time it was enough to wake up the dog and I watched and listened as she ran for cover beneath our bed and curl up in the "dog" fetal position. She is really afraid of storms and didn't come out for hours.

This reminded me of the many times that our children would come running to our room during a thunderstorm and also curl up (great cuddle time) afraid of the lightening and thunder. It is not uncommon for young children to be afraid of thunder and lightening. It is usually loud and dark, two things that are both often scary to young kids. It often awakens them from sleep causing further disorientation. The blowing wind only makes it seem scarier as the tree limbs hit the roof and the rain seems like it will blow through the walls. Throw in a little hail and you have the makings for many scared children.

When your children are old enough, get some library books and read about thunderstorms. It is a great time to learn a little about the weather. They love understanding different types of clouds, why it hails and learning to count the time between the thunder and lightening. Having the knowledge of what is happening is empowering and often makes a thunderstorm less frightening. There are even storybooks for children in the toddler age, with characters that are afraid of storms too, which helps a child work through their own fears. Funny thing, as children get older they usually like the storms and want to watch the weather change. Before you know it they are teens and believe it or not, they sleep through anything.

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

Daily Dose

It’s The Season For Bug Bites & Stings

1:30 to read

Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss.It’s that time of year when insect bites and stings start showing up on your kids. Knowing how to prevent and treat common insect bites and stings, and knowing when to not overreact, can help keep your kids safe and healthy.

Babies and children may be more affected by bites or stings than adults. Let’s start with some common spring and summer insects. Spider bites Most spider bites do not actually penetrate the skin, and the majority of spiders found in the U.S are mostly harmless with the important exception of the black widow spider and the brown recluse spider, which are both dangerous to humans. Spider bites are fortunately uncommon. In many cases, presumed spider bites are actually due to another skin condition or an insect sting. The black widow spider is said to feel like a pin-prick, and some victims do not even realize they have been bitten. Sometimes you may notice double fang marks on the skin. The most common symptoms where the bite occurs are immediate pain, burning, swelling, and redness. Other symptoms may include chills, fever, nausea and vomiting, and severe abdominal pain. While black widow spider bites are hardly ever fatal, rare deaths have occurred from brown recluse spider bites and are more common in children than in adults. At first the bite of a brown recluse spider leads to a mild stinging, followed by local redness and severe pain that usually develops within eight hours but may occur later. Some reports of brown recluse bites describe a blue or purple area around the bite, surrounded by a whitish ring and large red outer ring in a "bull's eye" pattern. A fluid-filled blister forms at the site and then sloughs off to reveal a deep ulcer that may turn black. If bitten by a brown recluse or black widow spider - Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite. - Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg. - Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

Bee Stings In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. Most of the time the symptoms from a bee sting will be minor. Your child may experience a burning pain, a red welt, and slight swelling. Some children may have a stronger reaction with extreme redness and swelling that gets bigger over a couple of days. Children, adolescents, and adults who are allergic to bee stings may have a severe reaction called anaphylaxis. About 3% of people who are stung by bees quickly develop these anaphylaxis symptoms. - Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis) -  Difficulty breathing -  Swelling of the throat and tongue -  A weak and rapid pulse -  Nausea, vomiting or diarrhea -  Dizziness or fainting -  Loss of consciousness -  Convulsions -  Fever -  Shock may occur if the circulatory cannot get enough blood to vital organs. For most Bee stings you can apply an ice pack or cool compress, a meat tenderizer solution which can be made by mixing one part meat tenderizer and 4 parts water. Soak a cotton ball in the solution and apply to the bite for 15020 minutes. A baking soda paste works well or a topical anti-itch cream such as Calamine lotion. Talk to your pediatrician about ways to prevent bee stings and possible immunotherapy if your child is allergic. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems. If your child is allergic to bee stings always have an EpiPen available and use it right away as your pediatrician has directed. Wasps, hornets, and yellow jacket stings are similar to bee stings.

Fire Ants A bite that will get your child’s attention quickly belongs to the fire ant. Fire ants are so named because their venom induces a painful, fiery sensation. When disturbed, fire ants are very aggressive. To help children avoid fire ants, parents should regularly check their yards and their children's play areas for the presence of the ants and their mounds. Then they should either eliminate the ants or make sure children avoid them. If a child is stung, apply ice to the bite site for 10 to 15 minutes. Elevate the extremity where the child was bit. Clean and clip the child's fingernails to prevent any secondary infection that can result from scratching the bite. Check with the child's pediatrician for the correct dose of an oral antihistamine to reduce itching and inflammation A small percentage of children stung -- probably less than 0 .5 percent -- experience a severe (anaphylactic) reaction. These occur within minutes of a sting and vary in severity. A child who is stung and within minutes begins to experience hives, weakness, dizziness, wheezing, difficulty swallowing, shortness of breath or confusion should be taken immediately to the nearest emergency room. Watch the area for signs of infection over the next couple of days.

Ticks Ticks are common in grasses and wooded areas. If you have pets make sure they are tick free. Ticks are usually harmless but they can carry Lyme disease. To remove a tick begin by taking a cotton swab or cotton ball. Dip the swab or cotton ball in a small glass container that you will be throwing out after use. Place a small amount of rubbing alcohol in the bottom of your container. Use at least 2 tablespoons of alcohol. Dab on the site of the tick on the child or pet. Do not let it run, that is why you are dabbing it rather than pouring it on the site. If there is excess, dab it with another cotton swab or cotton ball. Let this cotton ball or swab sit on the tick for 3 minutes. This suffocates the tick and he will back out for retrieval with tweezers. If that method is unsuccessful, use the alcohol swab again and let the area dry. Then take a clean, unused cotton swab and glob a dollop of Vaseline petroleum jelly on the site where you see the tick. Let this stay on top of the tick for 3 minutes. You will then remove the tick and the Vaseline petroleum jelly.

Mosquitoes Probably the most common insect bite in the spring and summer come form mosquitoes. Ivillage.com has these tips for treating and preventing mosquito bites. The usual reaction is a local skin inflammation that is red, raised and very itchy. If your child scratches the bite, it may become infected as well. Here's what you can do for your children to help ease the itch and pain caused by mosquito bites. Treatments: Apply anti-itch creams like calamine as needed to help prevent scratching • Use anti-inflammatory creams like cortisone cream to help ease the inflammation and itching • If there is severe itching and multiple bug bites use antihistamines like Benedryl. Because they tend to make children drowsy, they work particularly well at night. •  Antihistamines like Claritin, Allegra, and Zyrtec tend to be much less sedating, buit check with your pediatrician about the correct dosage and whether these products are safe for children. Other Suggestions:
 Keep your child's fingernails cut short to prevent scratching • Apply cold wet compresses to the area to ease discomfort • Have your child wear long pants and long sleeves (if the temperature is bearable) • Make sure window screens are used if you keep windows open in your home • Use insect repellant to help prevent bites from occurring Choosing an Insect Repellant DEET is the best insect repellant in terms of effectiveness against flies, gnats, chiggers, ticks and other insects. The higher the DEET concentration the better it works. For children, however, the EPA recommends a concentration of 10 percent or less to prevent side effects and toxicity.

Scorpions Scorpion bites are painful but mostly harmless. The only dangerous scorpion in North America, probably the most venomous of all North American bugs is the bark scorpion. Bark scorpions are found in all of Arizona, extending west across the Colorado River in to California and east in to New Mexico. Scorpions are related to spiders, ticks and mites. Usually, they only sting to protect themselves or of they feel threatened. Scorpions can get caught up in bedding or crawl in to shoes so always check your child’s clothing and bed if you suspect scorpions may be around.  Scorpion stings without a serious reaction can be treated with ice on the sting and over-the-counter pain medication. Bark scorpion anti-venom is available only in Arizona. Any sting that shows signs of a bark scorpion needs to be treated at a hospital. Anti-venom has been shown to significantly reduce the effects of the sting. Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss. For pictures of several types of insects such as Black Widow and Brown Recluse spiders, check out http://www.webmd.com/allergies/slideshow-bad-bugs

Daily Dose

Head Flattening on the Rise!

1:30 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

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

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

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

Moles On A Child's Skin

1:30 to read

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.  So, not all moles are related to sun exposure.

Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood.

The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor.

Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life.

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Crib Deaths

1:15 to read

Crib bumpers may cause deaths and should never be used!  A recent study in The Journal Pediatrics looked at the incidence of crib bumper related deaths from 1985- 2012.  The authors reviewed data from the U.S. Consumer Product Safety Commission (CPSC) and found that there were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods that had been reviewed. Bumper pads caused 48 suffocations of which “ 67% were due to the bumper alone and not clutter in the crib, and 33% of the deaths were due to wedgings between a bumper and another object in the crib”.  An additional 146 infants had sustained injuries from the bumpers, which included choking on the bumper ties or near suffocation.  

The study also looked at the number of CPSC reported deaths compared with those from the National Center for the Review and Prevention of Child Deaths, 2008- 2011. When using that data the total number of deaths increased to 77. 

While bumpers had been marketed to prevent a baby from falling out of a crib or to keep a baby’s arms or legs from getting stuck between the crib rails, in reality they cause injury and death.  In 2012 a national standard was revised which required that crib bumpers must be 2 inches in thickness or less.  At that time the thought was that “thinner bumpers” would be less likely to cause suffocation. But the recent study found that 3 of the deaths occurred in cribs that had thinner bumpers.   

According to Dr. N.J. Scheers, the lead author in the study, “these deaths are entirely preventable” if bumpers were not used and were not widely available.  But when flipping through a baby store catalog, or even shopping for cribs, parents  and grandparents) see beautiful cribs that are adorned with bumper pads!!  So, if they cause death why are they being sold?  Mixed messages are very hard for parents to understand. Concrete recommendations and guidelines save lives.  

Several cities and states have already banned the sale of crib bumpers and the CPSC is currently in the process of publishing new recommendations on how crib bumpers should be regulated. 

I don’t see the need for any more studies to show that bumper pads may cause deaths and injuries.  Clear guidelines from the AAP state, “bare cribs are the best”  and “all infants should be put to sleep on their backs”.  Save your money and your baby’s life…no bumpers.


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