Daily Dose

Homework Help: The REAL Lesson

When you kids have homework to do, how much help do you give them? I can remember the first time a son of mine had homework and how exciting it was for “us” to all sit together and watch him do his homework and let him ask for help when he needed it. I can also remember the last time a child asked me for help with his homework, in Calculus, and I had no idea what he was doing.  So the full circle of homework has been completed in my house.

While I was so anxious to begin the whole homework thing as a first time parent (as we are for so many milestones), I was equally joyful when I no longer even thought about a child’s homework, and also knew I was no longer even competent to help. (Calculus, are you kidding me, it was a lifetime ago).  I think homework has a real purpose when a teacher gives an assignment to reinforce the day’s lesson, and the amount of homework is not unreasonable.  There were times as a parent that I felt that there may have been too much homework, or that the homework was really busy work, but be that as it may, it was an assignment from a teacher and therefore it was completed. I was fortunate that from the beginning we started having a good homework routine where our boys all gathered at the kitchen table to do homework in the afternoon. The routine was pick up carpool, come home and get a snack, have some down time, typically outside to get rid of excess boy energy, and then homework started.  The habit of doing homework at the kitchen table began with our oldest son and his brother’s followed suit. When our oldest son started school, the younger boys would “want” to have homework and we would make up things for them to do. As everyone got older the kitchen table suddenly had 3 boys doing homework and they would often help one another. The other thing about being a working mother was that I was often not at home to “supervise” homework, or to make sure that it was being done. I was fortunate I guess, it was just assumed that “homework is finished before Mom gets home”. By the time our boys were in middle school and high school, they had typically moved to a desk in their own rooms.  The benchmark of getting “your own desk” was somewhat of privilege and a ”right of passage”  in our house, and each child took great pride in the fact that they had a desk in their room and had moved out of the kitchen. Once our children had left the communal homework kitchen table I really never knew if and when they finished their homework.  They were responsible for knowing what they needed to do each night, and for getting it completed. Their father and I did not know when they had tests of what needed to be done, but we were there to support them if needed. What we did do is have dinner ready for them each evening and they had “a bedtime range” which was usually followed. They also had what we called “a homework pass”.  In other words each semester they would get a “ticket” that allowed them to call us from school to bring a forgotten assignment, or take them back to school to pick up a forgotten book. They got one each semester, beyond that, as difficult as it was, they had to figure out how to get that assignment or suffer the consequences. It was probably harder on me than them, but it was a lesson well learned. They did not forget many things at school or home and I think it made them the organized young adults they are today. The hardest thing for a parent is to watch your child struggle, or fail. But sometimes it is THE most important lesson that they will learn. Letting your child suffer the consequences of a paper not turned in on time, or a homework assignment not done, hurts every parent. But more importantly, it will prepare your son or daughter for college and their careers beyond. As much as we “want” to do the work, or bring them the project, that is not our job as parents.  Our job is to prepare them to be responsible, organized and independent adults who will go forward on their own, and not call home to talk to “the boss”. That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Shingles in Childhood?

1:30 to read

Is it possible for children to come down with shingles? I recently saw a 2 year old with a most interesting history who then developed a weird rash.   Funny thing, I read an article shortly after seeing this child that described his case perfectly, only wish I had seen this the week before.

So, this 2 year old complained that his leg hurt. Enough pain that he limped and woke up at night crying that his thigh hurt. He had no history of trauma and also was otherwise well, in other words no fever, vomiting, cold symptoms etc.

After several days of watching him without resolution of his pain the mother noticed 3 little spots on his thigh, which she thought might be a bite. The little boy was seen and the diagnosis of herpes zoster (shingles) was considered.  In children the differential diagnosis of localized leg pain in the absence of a rash would not normally include shingles.

According to the pedi dermatologist (that I consulted) shingles in children occurs more frequently on their lower extremities (not for adults) and may involve the back on the same side.   Unlike adults, most cases of zoster in children are only mildly painful and resolve fairly quickly.

Well, this little boy didn’t read the book and his rash continued to get worse and spread, and was quite painful for days. Prior to this, he was a perfectly healthy little boy and had received his first varicella vaccine when he was 1.  

Since the widespread use of the varicella vaccine (chickenpox vaccine, see old post), the incidence of chickenpox has decreased dramatically, and vaccination should also reduce the risk of developing shingles later in life. In otherwise healthy children shingles (zoster) tends to develop at a younger age among vaccinated children than in those who have had a “natural” chickenpox infection.  When shingles occurs after vaccination it represents either a new infection with wild-type virus (an exposure to chickenpox or shingles) or reactivation of the vaccine virus.

Once a child has received 2 doses of varicella vaccine as recommended, the immunity is “boosted” and should further reduce the risk of developing shingles. Varicella–zoster virus can be transmitted via contact with skin lesions of those who have either chickenpox or shingles.  Infection is less likely after exposure to shingles. Transmission of the virus occurs until all lesions have crusted over. In this case, the little boy was ultimately started on an oral anti-viral therapy with slow resolution of his rash and pain and a return to normal around his house.

Note to self: “weird” pain may precede the rash in herpes zoster by several days.  Even though unusual, herpes zoster may occur in a healthy child who no history of varicella exposure and who has received all or part of their chickenpox vaccine.

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

Daily Dose

Help: Bitten by a Tick

What should you do if you or someone you know has been bitten by a tick? Dear Dr. Sue: my daughter has a tick embedded on her back! EEK! I have removed it but I’m worried about Lyme disease.  Help! Signed: Tina

While many people worry about getting a disease after a tick bite, the actual risk of developing a tick-borne infection is really quite low. It also depends on the type of tick that bit you, the geographic area where you acquired the tick bite, and even how long the tick was attached to the skin.

First off, if you have been camping or in the woods etc., you should always check for ticks at the end of each day, this enables you to know that the tick has not been “feeding” for a lengthy period of time (which is important as longer attachment is required to pass infection). If you find a tick, you need to remove it promptly and properly by using tweezers to grip the tick as close to the skin as possible.  Gently and firmly use steady pressure to pull the tick off. Do not try to squeeze or crush the tick as that may cause the tick to release their fluid which may contain infection causing organisms. If you can identify some of the characteristics of the tick (size, color, flat or engorged) it will help determine if you need to be concerned about Lyme disease, which is not very common, even in endemic areas. After the tick is removed, it is only necessary to wash the area with soap and water and observe for any signs of infection. Remember, illness like Rocky Mountain Spotted fever, Lyme disease, and other tick born diseases are infrequent.  Specifically watch for symptoms over the next days including a rash that begins around the area of the bite, or the development of fever, joint pains, shortness of breath, vomiting, or a diffuse rash all over the body. If any of these symptoms occur after a tick bite, I recommend you seek medical attention immediately. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Breast-feeding is ‘On the Job Training’

So many of my mothers breast feed their babies and enjoy the experience. I think it is a little harder to breast feed in the early days after the your-baby is born, as your milk "comes in" and you deal with sore, full breasts as well as little sleep. Even with a well-prepared mom who has read all of the books, and practiced with dolls in different holds, real breast-feeding comes from "ON THE JOB TRAINING." But, over the next few weeks as the milk supply is established it will become much easier to breast feed and both mother and your-baby get the hang of nursing.

Saying this, it is not always possible for every mother to be successful at breast-feeding and not every mother wants to breast feed her your-baby. Although breast milk is ideal for an infant, formula works well too. The most important thing for your your-baby is for you to be a happy mother. Numerous studies have corroborated this fact, and if mother is happy, your-baby will thrive on breast milk or formula. When I discuss this with many mothers who are unhappy nursing, or are not making sufficient milk to provide enough calories for their your-baby to gain weight, there is such a sense of relief. Guilt is part of being a parent (seems especially so in us moms) but to start off your parenting feeling this way is not good for anyone. Do what is best for you and your child, and don't feel pressured by family, friends or coworkers. Lastly, there are all sorts of ways to successfully provide both breast milk and formula for your your-baby, so discuss your options with your doctor before feeling like a failure or stressing out. Just like babies, moms are all different too. That's your daily dose, we'll chat tomorrow.

Daily Dose

Teething Pain & Recalled OTC Products

Do OTC teething products really work? Which ones have been recalled? WHat parents need to know.I am getting a lot of questions from patients related to teething, pain, and the recall of over the counter teething products that contain benzocaine.

The FDA recently issued a warning to parents who use OTC products like Oragel and Anbesol on their infant’s gums for relief of teething pain. These products come as both liquids and gels, and benzocaine is the active pain reducing ingredient. It has now been found that excessive amounts of benzocaine may lead to a very rare, condition called methemoglobinemia. (Hemoglobin is the molecule in the red blood cell that carries oxygen). With methemoglobinemia there is a reduced amount of oxygen that is carried in the bloodstream which may lead to a bluish gray discoloration to the skin, shortness of breath, a rapid heart rate and fatigue and lethargy. Although the FDA did not withdraw these products from the market, they did recommend that they not be used in children under two, and then should be used “sparingly”. Unfortunately, the benzocaine containing products do not yet contain warning labels. I have never recommended using these products in the first place. I always wondered if they really helped a baby who was teething, as I am not sure you can tell when a baby is teething in the first place. If you watch any infant over the age of 4 months, their hands are always in their mouths, and they are constantly drooling!  Does that mean they are getting teeth? Unlikely, as most babies don’t even cut their first tooth until about 6 months, so they have been drooling and putting anything they can in their mouths for months prior. The drooling and “gnawing” on their hands (and sometimes feet too) is rather a developmental milestone and not always a sign of teething. My theory is let the baby chew on a teething ring, a frozen piece of a bagel (cut into quarters, good for gnawing and can throw out when used), or rub their gums with a cold washcloth if you think your child has discomfort. Babies will get teeth for many years to come and once the first several have broken the skin we don’t seem to pay as much attention anyway, right?  I mean, who is going to worry about a child cutting their 2 year old molars, there are way too many other issues to deal with (tantrums, climbing, throwing food) than if their molars are erupting. So, save your money and don’t buy teething products. Now the FDA even agrees! What do you think? I look forward to your feedback.

Daily Dose

Leaving Your Child Home Alone

At what age can you leave your child home alone?

I get asked the questions a lot "At what age can I leave my child home alone?"  There is no simple answer but a progressibe one.

I tend to think most children are ready to spend 20-30 minutes alone at home between the ages of 10-11, but every child is different.  It depends on a number of things including how your child feels about being alone, the length of time, and if you and your child have discussed how to handle emergencies and getting a hold of you or a neighbor in case there is an emergency or even just a question that needs to be answered.  

Well, this topic brought up an interesting question, what do you do when you leave your child alone and there is not a home phone?  I have never even given that a thought as I am “old school” and still have that landline in my house. It just gives me a “good feeling” to know that it is there, even if it rarely rings. (although the kids know to call the home number as I typically turn off the cell as soon as I hit the door from work).   

More and more families have given up a home phone and I think this brings up so many different topics for discussion, but for starts how does your child call you when you leave them alone?  Or how do they call the trusty neighbor if they need something.  Do you get them a cell phone? Do you have to have an extra cell phone to have at home?  It seems to me that a home phone is important for just that reason. In case of an emergency, your child can pick up the phone and call for help, assistance or just a friendly voice. I don’t think they need a cell phone!  

Also, landlines are relatively inexpensive. Cell phones for 8,10, 11 year olds?  Sounds inappropriate and expensive.  Wouldn’t it be easier to keep a home phone so children can learn to answer a phone, use good phone manners, and when you are ready to let them stay at home by themselves for a few minutes, there is always a phone available. I don’t know, just seems easy solution to me.    

What do you think? I would love to hear from you!

 
Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

Parenting is Hard Work!

1:30 to read

Being a mom (as well as a dad) is one of the hardest jobs in the world....and as many a person has pointed out, it pays a lot less than minimum wage.  But, it is also the best job in the world.

I have the privilege of seeing a lot of mothers everyday. From the time they come in with their brand new infant until their children have graduated from college....mothers worry about the “job” they are doing.  For a new mother who is already hearing that voice in her head...”am I doing this right?”, 

it is very reassuring for her to hear me say, “you can’t mess this up yet!” Your baby loves you unconditionally, just like you do them.

But as your child gets older it takes a great deal of self-esteem to sometimes feel as if you are “doing it right”.  Children of all ages can sometimes bring us to our knees...how can a small child know just the right thing to say, and that teenager...well, enough said.So, I like to tell them my own stories about raising children and my days of feeling like a failure, or at the least an inadequate mother....especially as your children point this out to you.

When my oldest and very verbal son was about 6, he was riding in the front seat with me (crazy huh) and I stopped the car in front of our neighbor’s house where our 4 year old son was heading to play. I rolled down the window to give the 4 year old some instructions when the eldest son leaned over and started telling his younger brother what to do. So. in my best “mommy voice” I tell the 6 year old that I am the mother and will handle this, to which he doesn’t miss a beat and responds ”if you were doing a better job of being a mommy I wouldn’t have to help you!”  Enough said.

It takes a lot of self esteem and true grit to be a mom. Hang in there.  We all have those days when we know we are doing our best and our kids disagree. 

Daily Dose

The Truth About Bedbugs

With everyone finishing out summer vacation and trips to near and far, and away from one’s own bed, I wondered if any one had been unfortunate enough to develop bites secondary to bed bugs? Bed bugs, also known as Cimex Lectularis have been a known human parasite (remember the lovely louse in hair) for centuries. It is only recently that there has been a resurgence of this blood-sucking insect in all parts of this country and the developed world. YUCK!

Bed bugs are flat, oval shaped and about 5mm long. They seek warmth and that helps them locate warm-blooded bodies. They usually avoid the light, and hide in mattresses, crevices of box springs, headboards, and even behind hanging pictures. Did you know that they can survive a year without feeding? No wonder we are loosing the bed bug fight. We humans also help to move them from location to location via clothing, suitcases, personal possessions and bedding. Now I am really thinking about moving my son into that dorm next week!! Looking at the literature (JAMA, April 2009) it seems that more than 40 diseases have been attributed to bed bugs, but there is little evidence that such transmission has ever occurred. It is the reaction to the bite that it most bothersome as well as the mental anguish associated with it. The usual response to a bed bug bite is to little to no reaction at the site of the bite. About 30 percent of people will develop more significant reactions with larger local reactions that are more bothersome. These bites may be treated with oral anti-histamines and topical steroid cream, and seem to resolve over several weeks. An antibacterial cream may be used if the bites become locally infected due to scratching. With all of that being said, there are currently no repellents that have been shown to be effective. Mosquito repellant and oil of lemon eucalyptus may be of some help, but wearing these to bed every night doesn’t sound wise. Pesticides for spraying mattresses are also a cause of health concerns and are not routinely recommended. Let’s just hope we are all in the 70 percent that don’t know if we have been exposed and leave it at that! That’s your daily dose, we’ll chat again tomorrow.

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DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?