Daily Dose

Breast Feeding Woes

1:30 to read

I recently read an editorial in The New York Times entitled “Overselling Breast Feeding”. It was written by Courtney Jung who is a professor of political science at the University of Toronto.  It was quite interesting to me as she stated “the moral fervor surrounding breast feeding continues unabated, with a steady stream of advocacy and education campaigns”.  The WHO (World Health Organization) developed “ten steps to successful breast feeding” in hopes of increasing breast feeding initiation and duration around the world. Hospitals have been designated “Baby-Friendly”  (aren’t they all supposed to be?)  if they adhere to these steps as well. But the United States has done well with breast feeding rates as 79% of mothers initiate breast feeding.

Most, if not all of the new mothers I make rounds on are proponents of breast feeding. They have read the books, gone to classes and are determined to be successful at breast feeding. But, in my experience over the last several years, I have actually seen more and more new mothers becoming over-wrought and wary of breast feeding fueled by the “rules” that they are being required to follow. With that being said, having someone “tell you that you must breast feed your baby in the first hour after birth”, and that “your baby must remain in your room 24 hours a day“, and that they “may not have a pacifier”, “and should “breast feed on demand” is actually anxiety promoting and leaves many a new mother exhausted and tearful within a day or two of having a baby. 

While breast feeding is “natural” it also requires some practice and the only practice is really “on the job” training.  Some babies just latch on quickly and are pros immediately, but not all babies will become proficient at breast feeding in the first day or two. The mothers are told to “let the baby nurse on demand” and some mothers have had their babies at the breast for hours on end and are exhausted, with sore and bleeding nipples. I have walked in to too many hospital rooms with a mother in tears and a fretful baby, and a “helpless” new father.  Some feel as if “they are failures” as mothers before they even are discharged, and at the same time are having serious doubts about continuing to breast feed.  They are sure that their baby will catch serious illnesses and have a lower IQ if they don’t breast feed, but how can they maintain this constant breast feeding and no sleep and never put a pacifier in their baby’s mouth??? Is there only one way to be successful at breast feeding?

I loved breast feeding but it was a long time ago and we were instructed by caring nurses “to just go home and put the baby to the breast every 2-3 hours”. While that may not have been the best education has the pendulum swung too far?  Will giving the baby one bottle when a mother is having postpartum anxiety and sleeplessness really harm the baby?  Should a mother have to sign an order allowing her baby to have a pacifier??   While guidelines for breast feeding are helpful should they be so rigid that a mother “gives up” on breast-feeding because she can’t follow 10 steps in the first 24-48 hours?   

The New York Times article was quite interesting and I had to agree with many of the author’s  points. Supporting a woman’s choice to breast feed is admirable and “policy changes promoting maternity leave, and flexibility” are definitely needed to encourage women to continue to breast feed. But as she states “is all of this breast feeding advocacy crossing the line?”   A mother should choose to breast feed because she wants to, and that does not mean if her baby does not breast feed in the first hour that she will never bond with her baby or be successful at breast feeding.  Some woman are unable to breast feed for a multitude of reasons and that decision should not label her as a “bad mother”.  Again, breast feeding, like a woman’s breast, is not “one size fits all”. 


Daily Dose

Skin Lesion: Staph or Pimple?

1:30 to read

I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them.  BRAVO!!

So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck.  She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better.  She said that friends told her that it could be scabies, or possibly staph.  Leave it to friends to make you more apprehensive about the mystery bump. Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection. Many times just washing the “zit” and leaving it alone, it will go away.  When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. 

In many cases this may be due to staph or strep from your hands.  This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone. There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size. Many times there will be drainage from the bump which now resembles a boil.  In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are.  They have a fairly classic appearance (see old post on Staph).

MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected. In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital.  MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.

This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object. If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face. For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members). I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members. Lastly, this is certainly not scabies, but we have an older post on that too with pictures!

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

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

Daily Dose

Food Myths & Your Baby

1.15 to read

I really enjoy talking to my young parents about feeding their baby and toddler new foods. But what about food allergies they say?   I believe that healthy nutrition and good eating habits begin early on, actually just as a child starts to eat solid foods. The more foods a child is exposed to initially, the better chance a parent has of having a child who eats a variety of foods when they are older.  This means no making yucky faces if you (parent) don’t like spinach - fake it! 

But, with that being said, so many new parents are still under the impression that there is a “list” of forbidden foods. As I talk to them about finger foods and letting their baby explore new foods and textures they are amazed when I say things like, “let them try scrambled eggs” or “what about trying almond butter or peanut butter?”, “try ripping up pancake pieces”. 

I also like to let a 9-15 month old try all sorts of different fruit, veggies and proteins. In fact, “there are really no forbidden fruits” as long as the food you offer is mushy (we adults might say a bit over cooked at times) and broken/or cut into very small pieces. I am most concerned about the size and texture of the piece and protecting the airway than I am about the food itself.  

Over the last 5-10 years studies have shown that restricting foods and delaying introduction of certain food groups did not prevent the development of food allergies.  So, the idea that delaying the introduction of peanut butter until after a child is 2 yrs old, or waiting to give a child fish until they are older, or not letting your 9 month old child taste scrambled eggs, did not prevent food allergies. Some researchers would say it may actually be the converse, earlier introduction may be preventative.  

But the funniest thing to me, it is like old wives’ tales....these ideas have somehow been perpetuated.  The new group of parents that I am now seeing were often still in college and dancing at parties when it was the recommendation to wait to introduce some foods (egg, peanut , fish etc).  How do they hear these old ideas?  Maybe grandparents or friends with older children. Who knows? 

So, for the record, the rates for most common food allergies are still low at 2.5% for milk, 1.3% for eggs and 1% for peanut and less than that for tree nuts.  Don’t limit what you give your child unless you have seen them have a reaction when a food is initially introduced, and if you are concerned, talk to your doctor.  Most people who report having food allergy actually turn out not to have true food allergies after a good history and further testing. 

More about true food allergies to come.  Stay tuned! 

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

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

Are Kids Too Connected?

1:30 to read

We are living in a digital world which is ever changing. In light of this, the American Academy of Pediatrics (AAP) has been reviewing their recommendations regarding screen time. While there has been much written on the subject, the newest data from many families regarding their digital experience shows just how “connected” we really are.

The AAP has not yet published a new policy statement on this matter (due in 2016), but their Growing Up Digital working group has just released new guidelines in the hopes of giving parents some practical guidance. While the AAP has previously recommended limiting screen time to “2 hours/day”, the one size fits all does not seem to work (which is true of many things).  We are all living in an “online” world, and it appears it is only getting more “connected” via screens, so how do you really deal with this? 

I personally still think it is very important to try and limit screen time for children under the age of two. This is the basis of parenting….be aware of the importance of modeling behavior even beginning at the earliest ages. Which means you too have to limit your screen time when you are with your baby and toddler,and spend more time talking or reading to your child (which is still shown to be important in early brain development) without your phone/computer distracting you. This does not mean that your toddler never has the chance to watch Daniel Tiger or Sesame Street, but be aware of how much they are watching.  As a parent, I know too well myself that sometimes an 18 month old is safest in front of a screen watching a “healthy” program, while you shower or cook a meal and parents shouldn't feel “guilty” about this. Once done…turn off the screen…these are good habits to begin with.

As your child gets older it is equally important to “parent” their screen time, and to teach them the appropriate use and behaviors of their “on line” lives.  While so many kids are now on a screen during the school day,  as well as for homework and out of school assignments, remind your children that face to face interaction is very important.  While the world is totally available digitally, socialization “off-line” teaches other skills that cannot be found when engaging solely on a screen - even with Skype and FaceTime.  Like many things moderation seems to be the key. Another recommendation, have “tech-free” zones. This is especially important at meal time and bedtime.

I also think it is important to enforce no screen before school and while in the car on the way to school.  Conversation during mealtimes is so important!  (whether at home or in a restaurant). It is often one of the few times in the day that a family is all together. Carpooling to school is another great opportunity to talk and listen to the kids, rather than having a movie playing on the DVD player.  I remember driving our teenagers and their friends to school or sporting events and listening while they just talked to one another.  It was one of the best times to hear what was going on in their lives. Save that DVD player for long trips and special occasions. 

Lastly, parents need to know and be aware of what their kids are doing on line….this is true for children of all ages.  Begin with solid family rules and expectations for appropriate use of social media and the digital world…and just like many things the boundaries and limits will change as your child gets older.  But if you find your child is using technology inappropriately there need to be consequences.  We all make mistakes, but use mistakes as teachable moments.  

Digital life is here to stay, and the technology changes in a nano-second, so watch for more and more information on this topic.




Daily Dose

Why Babies Get "Goop" In Their Eyes

1:15 to read

If you have recently had a baby you may already know about “clogged tear ducts”. This is also named nasal lacrimal duct obstruction and is fairly common in newborn infants in the first weeks to months of life.

A baby’ s tear duct, the tiny little hole in the inner corner of the eye, is very small and narrow and may often get obstructed. If that is the case the tears that an infant makes gets backed up and may form a thickened “goopy” discharge in the eye. At times when this occurs the baby’s eye will seem to be “glued” shut as the goop gets in the eyelashes and almost seems to cement those little eyes shut. Occasionally the eye will look a little puffy due to the debris in the eye. The best thing to do for this problem is to use a warm compress or cotton ball dampened with warm water to wipe the eyelashes and remove the discharge from the eye.

Once the “goop” is removed and your baby opens their eye, look at the whites (conjuctiva) of the eye. The conjunctiva should not appear to be red or inflamed. The goop will re-accumulate over time, but the eye itself should continue to look clear. Babies with clogged tear ducts do not appear to be ill and continue to eat well. The only problem should be the goopy eye. In order to help open the clogged duct you can try to massage the inner lower corner of the baby’s eye (beneath the tear duct itself), several times a day. Gently apply pressure to the area and do this several times a day. The eye “goop” always seems to be worse after the baby has been sleeping. It is also not uncommon for one eye to clear up only to have the other eye develop “goop”.  Most of these obstructions resolve on its own by four to six months of age. If the tear duct continues to be obstructed, talk to your pediatrician about a possible referral to the pediatric ophthalmologist.

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

Daily Dose

Your Child's Sitter

1:30 to read

Do you ever leave your child with a babysitter or caregiver? Weird question right? But some parents never want to leave their child with someone else....and I am not sure that is healthy for either parent or child.   

I recently had this discussion with parents of a 3 year old child who was having a terrible time with separation anxiety. While many children go through stages of separation anxiety, by the time a child is 3-4 years they are typically past this stage. When I was talking with this family they told me their child had never been left with anyone.  

I guess as a working mother I was incredulous. What? Had the parents never gone out to dinner or to a party, a concert, lecture  or even on a night away for some much needed “couple” time?  They told me that they would occasionally call in grandparents but typically took their child everywhere with them.  (I think there are many places such as movies, adult restaurants, and other venues that might not want the 2 year old in tow).   I suppose some would say the child was fortunate, but I really believe that as a child reaches age 2ish they need to begin learning to separate from their parent. Not for days or weeks, but for either a play group, a pre school program, the gym nursery or something where the child is learning a bit of independence.   

While some parents are quite fortunate that they don’t have to leave their child to go to work every day, the concept of leaving your child for any hour or two with a trusted babysitter should not cause anxiety for the parent and ultimately not the child. Separation is an important milestone, as your child learns that while you may leave for an hour or two, you always return. There is security in that knowledge. They will also learn how to interact with  other adults and children, which is often different than they do with their own parents.  (Ask any teacher about that phenomena). 

Autonomy and independence are typically traits that parents desire for their children.  Parents also need to have some autonomy as well.....I think this makes for a better parent child relationship in the long run.  Little steps in separating become bigger steps as a child grows older....starting with a babysitter or nursery for an hour or two on occasion is often the beginning. 


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