Daily Dose

A Baby Girl!

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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

The Difference Between Cradle Cap And Dandruff

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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

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

Ebola in U.S.

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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.

 

Daily Dose

Diaper Dermatitis

1:30 to read

Newborn babies have the softest little bottoms and they also have a lot of poop! The combination often leads to a raw red bottom and a diaper rash. A newborn often poops every time they eat and sometimes in between....and you don’t even realize they have pooped again.

Even with the constant diaper changing (would you have believed you would use 8-12 diapers a day) it is very common for that newborn to develop their first diaper rash.  Not only will the skin be red and raw....it may even sometimes be so chapped that it may bleed a bit.  This diaper rash is causes a lot of parental concern and will often result in the new parent’s first of many calls to their pediatrician.

A new baby is supposed to poop a lot, so you can’t change that fact,  but you can try all sorts of things to protect that precious bottom and treat the diaper rash.  After using a diaper wipe ( non perfumed, hypo-allergenic) I sometimes bring out the blow dryer and turn it to cool and dry the baby’s bottom a bit. Then I apply a mixture of a zinc based diaper cream (examples:  Desitin, Dr. Smith’s, Triple Paste cream), which I mix in the palm of my hand with a tiny bit of liquid over the counter antacid.  (I don’t measure it:  just a lot of diaper cream and small amount of antacid so it won’t be runny).  I put a really heavy layer of this on the baby’s bottom.

If after several days rash is still not improving it may have become secondarily infected with yeast so I add a yeast cream (Lotrimin AF, Triple Paste AF) to the concoction. If it has yeast this should do the trick to treat all of the problems.

I will also sometimes alternate using Aquaphor on the bottom with the above diaper cream concoction.  It will take some time for it to totally go away but you are trying to get a barrier between the poop and the skin on the baby’s bottom. She keep something on there after each diaper change.

After a few weeks of constant pooping the number of stools do slow down and bit and that will help heal that new baby’s bottom as well. 

Daily Dose

Is it Appendicitis?

1.15 to read

Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!

Daily Dose

The Dangers of 'Sexting'

If you are a parent of a teen, or even a 'tween, have you heard of "sexting"? If you haven't, you should know about this phenomenon that is happening coast to coast. "Sexting" is a form of text messaging, where racy or explicit sexual images are being sent from cell phone to cell phone. Teens say this is just a form of flirting. Most people would think otherwise.

When you view some of the suggestive and provocative pictures that are being "sexted", it is often embarrassing and some would argue these "sexts" are a form of pornography. A simple picture sent in a suggestive bikini may seem innocent enough until it is sent around an entire school. Unfortunately, many of the pictures are taken without the bikini, showing breasts and nudity. While a young teen may think this picture is only for one set of eyes, many of the pictures are then passed around to classmates, and even beyond that. A recent survey showed that one in five teens have sent or posted provocative photos of themselves. So many teens "sext" before they think and then must face the consequences. The consequences of "sexting" include legal issues about trafficking in child pornography, which most teens haven't even heard of. They are not aware that this is a criminal offense. At the same time, the emotional turmoil that a teen faces after her nude picture has now been passed around her school, may lead to humiliation, depression and even suicide in the case of one teen in Ohio. "Sexting" and cyberbullying are both discussions that every parent needs to have with their child. The dangers of technology can be very real when the technology is not used appropriately. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Warts: A Common Virus

I see so many kids with warts. Warts are caused by viruses and can be a real nuisance. Because warts are due to viruses they are contagious and may be acquired without a person even knowing where they contracted the virus.

It is funny that some people seem to be susceptible to the virus and may get warts recurrently, while other people have never had a wart. I typically see warts in children after the age of three all of the way to adults. The most common areas to see warts on children are on the fingers and hands, arms, knees, and on the feet. Because they are contagious and could bleed when traumatized and may cause spreading, it is important to not pick at a wart or try to clip them with scissors or nail clippers. Avoid friction, and rubbing, even with lotions or while shaving as this may spread the warts. For many children the best treatment is no treatment at all as the wart may go away by itself, but it may take months to years for that to happen. In some cases if the wart is becoming bigger or spreading you may use an over-the-counter (OTC) wart treatment that contains salicylic acid. According to Dr. Margaret Lemak, a practicing dermatologist in Houston, it is important to be consistent when using these preparations. For warts on the bottom of the feet (plantar warts), you can use a stronger salicylic acid (40 percent plasters) and may take several weeks to months for the wart to go away. The OTC liquid nitrogen freezing canisters that have been on the market for several years may be successful in treating a small wart, but at the same time I have seen this cause painful blistering and may be uncomfortable for 24 to 48 hours. I usually do not recommend these and have had little success using them myself. If these treatments are unsuccessful or the warts are becoming unsightly, it is probably time to take your child to the dermatologist for further treatment. According to Dr. Lemak the dermatologist may freeze and scrape the wart or prescribe a cream that can be used at home. Warts often recur in the same area so after treatment it is important to continue to be observant for two to three months looking for a recurrence. Earlier treatment in this case is typically more successful. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Upper Respiratory Viruses

Why does it seem that our kids continue to get sick this time of year.I have been on call over the last weekend and I am beyond sounding like a broken record as I explain to parent after parent, “we are at the height of upper respiratory season”.

When you take weekend call in our practice you see patients in the office, you make hospital rounds at several hospitals and you also are taking phone calls from the answering service.  With that being said, parents are having a hard time understanding “how is it possible that my child is sick AGAIN?”  Said child was sick 2-3 weeks ago with something that seemed like the SAME thing, and here we are AGAIN.  You don’t even have to see their faces, you can hear the concern, disbelief and exhaustion in their voices! So, after finishing up hospital rounds and seeing all sorts of sick kids (these were not the hundreds seen in the office mind you, but the few that were sick enough to be hospitalized) it seemed like a great time to review respiratory illnesses. There are literally hundreds if not thousands of upper respiratory viruses that cause many similar symptoms, which are typically congestion, cough, scratchy throat, fever and just feeling “cruddy”.  A typical young child (under the age of 5 yrs) will get 7–10 of these viruses during a season which means at least one a month.  Unfortunately, this often means that parents with young children are also sick and it is even harder to take care of your child when you are sick and feeling terribly yourself.  Double whammy for sure! When discussing the frequency of upper respiratory infections parents wants to know “which virus is causing this?”  Surely you can name the virus, or do a test to confirm the virus or SOMETHING!!   Well, we can often name the viruses that are in the community, but again, naming the virus often does little good in diminishing the symptoms or expediting the length of the illness. Today was a good example of that as I was seeing our hospitalized patients. I saw a 6 month old with parainfluenza virus (this has nothing to do with flu either, so confusing), who had been admitted with croup and cough and needed oxygen.  Both of her parents are sick with colds too (probably due to the same parainfluenza virus). The next room was a 18 month old with wheezing who needed oxygen and bronchodilator treatments,  and he was found to have metapneumovirus.  Yet again, his 3 year old sibling and mother were coughing away and blowing their noses, somehow the father was yet to be sick and he felt quite smug! Several more rooms and 2 more children who had RSV and they too were coughing, having a hard time breathing and needed oxygen. Lastly was a child with rhinovirus who had developed a viral pneumonia and also required oxygen.  The point of this is that despite the fact that we “named” their viruses it really did not help very much in their overall care. All of these patients were under the age of 4 years, were otherwise healthy children and needed to be admitted to the hospital for a viral upper respiratory infection which required supportive care in order to maintain their oxygen levels.  In just one morning, I saw 4 documented different viruses, all causing similar symptoms and definitely lots of concern, exhaustion and frustration for their parents.  The best news is that they were all improving and would be going home over the next several days. Unfortunately, there will be new cases to fill their rooms. The list of respiratory illnesses seems just endless and by this time of year everyone, including children, parents and their doctors are “over it”.  In other words, when is this going to end?  We probably have 6 - 8 more weeks of this and then the viruses will diminish as the weather gets warmer and more humid. Viruses like cold dry temperatures like we have during the winter months .With warmer temperatures we will all spend a l more time outdoors and germs are not so easily spread. I too am hopeful for the end of upper respiratory season, as I was innocently sneezed on today by the little 6 month old with croup, and her mother said, “Dr. Sue, guess you will be the next one to be sick.”  Washing hands, and praying that I am immune. That’s your daily dose. We’ll chat again tomorrow.

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