Daily Dose

Vapor Rubs: Do They Really Work?

1:15 to read

There was a great article recently published in the online journal of Pediatrics.  I had to read it as it was titled, “Vapor Rub, Petrolatum, or No Treatment for Nocturnal Cough”.  Having been a fan of both Vick’s Vapor Rub and Mentholatum since I was a child, I knew it was a MUST read article.

You can ask all of my family members, once we hit cough and cold season, the “vapor rub” jar goes next to my bed to help me during my frequent colds (see previous posts!).  I have such fond memories of being with my grandmother, Gaga, who at the first sign of a cold,  would rub Vicks all over my chest, which was then occluded by a warm damp CLEAN dishtowel, then followed by my flannel nightgown.  She would lovingly tuck me into bed, and shut the door and the whole room smelled like camphor, and menthol.   To me it was wonderful, my brother hated it!! As I grew older, my mother would hear me sniffle or blow my nose and down the hall she would come with the trusty Vick’s jar for self-application. Once I became a mother, in the family tradition, I too would rub a little Vick’s on my children’s chest, with no basis on medical fact, only what Gaga did. Funny thing, we all seemed to get better.

Two of my own children grew to despise the tradition, while one still asks for Vick’s or Mentholatum when he gets a cold.  There are old jars all over the house. I even bought several of the “plug ins” to use during cold season, which are the new fangled way to get that wonderful VR aroma into the room. They make a great stocking stuffer! So, with that history, what could be better than a study out of Penn State University that looked at the use of vapor rub (VR) to improve cold symptoms and nighttime cough.  With the recent FDA guidelines which limit the use of OTC cough and cold products in young children, many parents are at a loss as to what to do to help their child’s cold symptoms. The investigators looked at 138 children between the ages of 2 – 11 years. They were randomized to receive vapor rub (VR), petrolatum alone or no therapy.  Parents were then asked to grade their child’s symptoms and sleep on Day 1 when none of the children received therapy, and then again on Day 2 when they were randomized to therapy. 

The VR group scored best in improving cough, congestion and overall sleep for the children (and therefore their parents). This is the first evidence based therapeutic trial that I am aware of, for a remedy that is over a century old. As noted in the article, there were some irritant effects seen in the VR group with complaints of a stinging sensation to eyes, nose and or skin (I can hear my own children saying “it’s stingy”). Most of these complaints were transient in nature.  Despite older concerns about camphor when it was used as an oil that could cause possible toxicity if swallowed, skin exposure alone really has little systemic effect.   The FDA has approved camphor as an effective anti-cough preparation (anti-tusssive), but has limited concentrations to 11%. The concentration in VR is 4.8%. So, if parent’s are trying to improve nighttime cough and sleep disturbance in their children over the age of 2, there is a study to show it is time to go back to vapor rub preparations.  The mechanism for improved sleep is not really known, but whether it improves cold symptoms directly or through the aromatic effects, a better night’s sleep is good for everyone!!!  Could there be coupons to follow?

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

Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

RSV is Here

1:15 to read

RSV (respiratory syncytial virus) is here and seems to be hitting hard this year. RSV causes 64 million upper respiratory infections worldwide each year and some days it seems that every child in Dallas/Ft. Worth under the age of 2 has RSV. While there is has not been a lot of flu reported to date, RSV is being widely reported across the U.S. so I am sure your pediatrician’s office is busy as well. RSV season usually lasts until spring, so there are more weeks ahead.

RSV is a pesky virus and for most people causes symptoms of a “common cold”. Lots of congestion, runny nose, fever and a cough.  Bothersome, but not life threatening. But for some, especially those under 2 years of age, and for children with underlying medical conditions such as prematurity, heart disease, lung problems and other chronic medical issues, RSV may be more severe. While almost everyone under the age of 2 acquires RSV, 25-40 % may go on to develop wheezing and an illness known as bronchiolitis. In some cases RSV causes respiratory distress and a baby/child may need to be hospitalized for supportive care including oxygen…and in really severe cases an occasional child may require ventilatory support in the intensive care unit.

The local news in our area has been reporting that the ERs and hospitals are overwhelmed.  So what do you need to know about the course of RSV and when do you need to go to the doctor or ER? In a young child the illness starts off with a runny nose and congestion, but may progress to a frequent cough and wheezing.  While most children are uncomfortable and cranky, they handle the virus without any noticeable difficulty with their breathing. But, some children will develop signs of respiratory distress where their breathing is rapid, short and their chest wall pulls in and out (retractions) and their tummies move up and down with each breath. This is called “working to breath” and are signs of respiratory distress….which requires immediate medical care.

You also need to watch your child’s color…as some babies and children may turn dusky blue when coughing.  Most parents complain that their child turns bright red when they cough, but while some babies may only have a bit of a cough they may turn blue when they cough or even seem to gasp. Red is good, your child is oxygenating, but blue is bad! This is another reason to seek immediate care.

Lastly, make sure that your child stays hydrated….so if they have a good moist mouth, drool, tears and wet diapers (may not be soaking) you are keeping up with their fluid needs.  This is important as your baby/child will probably not nurse or take a bottle or fluids as well when they are sick .

Because RSV is a virus it is NOT treated with antibiotics. While there is a test to identify RSV it is not routinely recommended, as the treatment is symptomatic. The test may be run in certain situations when a child is hospitalized. Simple treatments such as suctioning your child’s nose, using a cool mist humidifier and treating fever with acetaminophen or ibuprofen (depending on their age) are all helpful As always, call your doctor if you have questions or concerns. 

What’s on the horizon…hopefully a vaccine one day!

Daily Dose

Kids And Headaches

1:30 to read

A recent study suggests teens and chronic headaches go together. This interesting study revealed about 1-2% of adolescents have chronic daily headaches, defined as more than 15 headache days per month for greater than 3 months.

When school begins, teens stress levels increase with each week of school, and with that come more complaints of  chronic headaches.  It is not unusual for me to see several teens a  week  who complain that they have headaches every day. Despite these persistent headaches, the majority of se adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches.  In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study, the authors followed adolescents ages 12–14 years who met criteria for chronic daily headaches. They followed the group after both 1 and 2 years, and then again after 8 years. The results showed that after 1 year, 40% of adolescents still complained of chronic headaches.

After 2 years, only 25% reported headaches.  After 8 years, only 12% reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the 8 year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years.  For the most part 75% of adolescents with chronic daily headaches improved over the 8 year period which is quite reassuring. This study just seemed to confirm that teens and headaches go together.  If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches.

I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches.  Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things!

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

The Science Behind Febrile Seizures

1:30 to read

As we head into “sick season" and I have been seeing many children with fevers, I thought it would be a good time to talk about febrile seizures.With the "sick season" upon us, I have been seeing many children with fevers so I thought it would be a good time to talk about febrile seizures.

A febrile seizure is defined as a seizure associated with fever in the absence of other known causes of seizures. About 5 percent of children between the ages of six months and six years will have a febrile seizure. That doesn’t sound like a lot of children but seeing that I have a son that had febrile seizures it is that statistic that really doesn’t mean much when you have a child that is part of that statistical equation. Did that make sense? Reassuring a parent that a febrile seizure is benign and will not cause any long-term problems is a “hard sell” while they are watching their child seize. I even felt scared and helpless and I knew what was happening! When my son had his first febrile seizure at about 18 months of age, I will never forget a nurse saying to me, “Didn’t you give him Tylenol or something, as he has a high fever?” She did not realize that I was a pediatrician, and I tell this story to other parents whose children have febrile seizures, as parents always feel guilty. (What is that with parental guilt?). I hope she did not have realized how guilty that might make a parent feel, for as I already thankfully knew, giving anti-pyretics (like Tylenol or ibuprofen) does not necessarily prevent a child from having a febrile seizure.

We know that febrile seizures may occur in some children with a fever of only 101 degrees, while another child may be running a much higher temperature and not have a seizure. About 30 percent of children that have a first febrile seizure will go on to have another. That is the concern of many parents who have children who experienced a febrile seizure. Parents will try to do anything they can to “ward off” another seizure when their child gets yet another fever. I was reminded of this again while I was reading an article from The Archives of Pediatric and Adolescent Medicine. The study, done in Japan, looked at giving children with a history of febrile seizures, extra doses of fever reducing medications. Despite this, fever-reducing medications did not appear to reduce the incidence of recurrences, even when children received an extra dose of medication. It seems that children who have febrile seizures may respond differently to fever reducing medications during a febrile event. There seems to be an innate difference in mechanism of fever in those children who have seizures and those that do not. We have known that there is often a history of other family members having febrile seizures, so this may be further evidence or metabolic differences in some individuals with fever? So, despite a parent’s best effort to lower a fever, especially in a child who has already had a febrile seizure, a seizure may still occur.

Take home message: Febrile seizures are scary, but benign and children outgrow these seizures. Never feel guilty, even if you are asked if you gave Tylenol, or something to lower the fever. Looking at this study it probably wouldn’t have changed a thing.

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

Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

That's your daily dose.  We'll chat again tomorrow.

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

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

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