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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.

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Daily Dose

Update on Flu Season

1:30 to read

Flu vaccine is still available throughout the country and it is never too late to get a vaccine.  But, with that being said, our office has very few vaccines for children over the age of 3 years and there is no more vaccine being produced for this flu season.  Because the vaccine is “seasonal”, meaning that a new vaccine with different strains of flu is made each year, manufacturers stop producing vaccines in anticipation of flu season slowing down and ending….in fact, they will begin discussions about next years flu vaccine in the next several weeks.

 

I continue to have parents explain to me “why they don’t get fu vaccines”, yet they are concerned that their child has the flu. They tell me, “why should I get a shot, that hurts, if it doesn’t even work?”. Even though the vaccine effectiveness is less than had been hoped for, any protection is better than none!  There are studies every year that show that people who have been vaccinated have less severe illness, less secondary infections, fewer hospitalizations and lower mortality rates.  Knowing that, why would you “skip” the vaccine, while at the same time be anxious about your child’s illness being the flu?

 

I am also seeing many other viral illnesses right now that have very similar symptoms as the flu. Not every child who has a fever, runny nose, congestion, sore throat and cough has influenza. We have had kids test positive for all sorts of different viruses including coronavirus, adenovirus, parainfluenza virus, and rhinovirus.  This also means that all of these viruses are circulating in the community….and you are pretty much exposed to these viruses wherever you go.  Although a few schools in our area have closed due to Influenza, these kids are still exposing one another to viral infections as they head to the movies, the gym, swimming lessons, dance class and sports events. It is impossible to “hide” from the germs, even when you don’t go to school.

 

Lastly, several parents have told me that their child “did not feel well, but did not have a fever” so they went ahead and sent them to school or day care, only to be called a short time later that their child is at the nurse complaining of being sick and now have a fever. During this epidemic it would probably be better to err on the side of caution, and if your child is “under the weather”, keep them home for a day and make sure that they don’t develop a fever or become more ill. Remember, you are shedding virus and are contagious before you even get the fever.

 

So…get your vaccine if you have not yet gotten it. Wash hands, cover mouths when coughing or sneezing, and stay home if you or your children are sick!!!

 

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Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Daily Dose

Strep Throat

1:30 to read

During the “sick season” a common complaint among children (and their worried parents) is that a chid has a sore throat. While all children will at some point complain of a sore throat, most sore throats are due to a virus and are often the first sign of a cold.  

 

Many parents worry that their child may have strep throat which is a bacterial infection and requires treatment with antibiotics.  In fact, only about 10-20% of children with a sore throat will have strep.  More and more parents are bringing their children in to the office right after they “hear” that someone is their child’s class has strep (thank you social media).  In fact, their child may have not even complained about their throat until they were asked, “does your throat hurt”, or they may have only been sick for an hour or two.

 

How can you decide if your child might need to be seen at the pediatricians office if they have complained of a sore throat?

 

Strep throat is most common in school aged children 3-14 years of age.  It it typically not seen in young children (who cannot even tell you that they have a sore throat) or in adults over the age of 45.  With the advent of urgent care centers on every corner I am hearing more and more parents tell me “I have strep throat so I am worried about my child”, but when asked if they the parent are better on their medicine the majority say “not really”, and I am coughing and congested and not getting better. Their “strep throat” is more likely to have been the beginning of a cold. 

 

Children with strep throat typically do not have a cough, but do have swollen or tender lymph nodes in their neck (just under their jaw), have a temperature over 100.4 and have swollen inflamed tonsils that may or may not have exudate (white patches), and are between 3 - 14 years of age. 

 

By using these guidelines which are called the Centor Criteria your doctor is also deciding which patients should have a rapid (in office) strep test. Over testing (swabbing) with an in office rapid strep screen may lead to false positive results due to picking up the bacteria in a child’s (or adult’s) throat when they are simply carriers and do not have strep throat. Why is this important?   Over testing, may lead to over prescribing antibiotics and no one wants their child to be taking antibiotics unnecessarily. 

 

So, it is typically best to wait 24 hours or so after your child complains of a sore throat to take them to the pediatrician.  History of the illness and clinical findings are the two things that will determine if your child needs a “strep test” and should not be decided simply because “there is strep in their class”. In our office all children are examined by the physician prior to having a throat swab.

 

 

 

 

 

 

 

Daily Dose

CPR

1:00 to read

I was seeing a newborn the other day and the parents had a great idea. Their baby had spit up and they were concerned about how to clear his airway.  When we discussed how to hold the baby to clear the airway they had the great idea of having a CPR “teaching party” for a group of their friends who also had young babies!

 

I do encourage new parents (actually all parents and even grandparents) to take a CPR class. I am fortunate that we have yearly CPR class in our office which keeps us all up to date. 

 

It is fairly easy to find local CPR classes either through the YMCA, the American Heart Association and often through the hospital where you deliver your baby.  But, in these cases you have to take the class on “their schedule”. What a great idea to host a party with your friends and hire a certified CPR instructor to come to you!!

 

You know I do like to “isolate” my newborn patients from crowds (for 6-8 weeks), but it is fun to gather with other parents of newborns to get some social interaction. If everyone brought their baby, and a dish for dinner, it could be a mini dinner party followed by CPR training….ending with wine!

 

So…let’s start planning CPR parties, I may even do one for my friends who are becoming grandparents!

 

 

Daily Dose

Does the Color of Mucus Really Matter?

1.30 to read

It is that time of year and everyone seems to have a cold, including me!! I am actually “on” my second cold of the month, so I am feeling like a toddler who gets sick every two to three weeks.  

This is really a good time to talk about mucus. I wonder how many people will keep reading now? But I do get lots of questions and comments from parents who are worried about the color of their child’s mucus. Runny noses and mucus color are discussed as often as color of poop. And just like poop, the color of your nasal mucus is usually not terribly significant. 

If you happen to have a cold yourself, you probably notice that your nasal discharge changes throughout the day, that is unless you are a teenager, and they swear they never look at mucus or stool color!! I think we notice “green snotty noses” among children between the ages of six months and four years, when they typically don’t blow their noses and many times the mucus is either wiped off of their face or they wipe it themselves on their shirt sleeve, (which then leaves a telltale sign of the color of the mucus). Once a child can blow their nose and dispose of the Kleenex, the color of the mucus does not seem to be a hot topic of discussion.

So, what does color of mucus mean? When you have a cold, the nasal discharge associated with that viral infection typically begins as a clear discharge, that changes over several days into a thicker and more purulent (green) discharge. The color may be due to the white cells that are in the mucus that are producing antibodies to fight the cold. 

As a cold progresses the green mucus then changes back into a more clear discharge and eventually goes away, but that is usually after a seven to 10 day course. It is also common to see thicker “booggers” in the nose in the morning or after your child’s nap as the dry air they are breathing makes the mucus thicker and they are not wiping or blowing their noses so the mucus is thicker. Same for us, we also usually have thicker greener nasal discharge in the morning, while the “snot’ has been sitting overnight. The best way to clear out any color mucus is by using saline nasal irrigation. It works great for all ages. By clearing the nasal passages, it will prevent a secondary bacterial infection which and cause a sinus infection.   

Most doctors use length of time of nasal discharge as more indicative of an infection than color of mucus. Typically in a pediatric patient an antibiotic for a “presumed” sinus infection is not even considered until a child has had over 14 days of a “gunky” green nasal discharge. Remember too, that the nose can clear up and the cold can go away, only to be followed in another week or two by another cold. It is the season. With that being said I am off to blow my nose again and wash my hands! 

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

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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. 

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Daily Dose

Spoon-feeding Your Baby

1.15 to read

I continue to see a lot of new babies (so fun) and there seem to be a lot of questions and concerns around when to start feeding a baby solids and how to actually do it as well. 

The consensus about beginning solid foods has really not changed in the last 30 years. Infants do not need to begin solid foods until somewhere around 6 months of age, give or take a few weeks. 

It has also long been recommended to start feeding a baby rice cereal as their first solid food. Again, there is no real data on this and the AAP is at work on new feeding guidelines as I write this. We may be changing things around and starting protein before cereal? 

Never the less, I typically recommend starting a baby with some type of cereal as it is easy to make and easy to wipe up if your baby does not like it!!  One of the biggest things about beginning foods is it can tend to be messy, and this is an important part of a baby’s feeding experience as well. 

I start feeding a baby cereal from the spoon, typically as a breakfast meal, after the baby has had their morning breast or bottle feeding. I pick the mornings as most babies are happy in the morning, so you can pick the best time to feed your own baby. You don’t want to start a new project with a fussy baby. 

Put your baby in the Bumbo chair or high chair, so they are sitting up, and mix up the cereal (with either breast milk or formula) to the consistency that you can spoon feed it. Not so thick your child gags and not so thin it runs off the spoon.  Then you just do the airplane to the mouth game (somehow I always find myself also saying “yum, yum”) and see how your baby feels about eating cereal. Some babies love it and others will seal those lips and scream. There is no magic about beginning solid foods and don’t try to “make your baby open their mouth”, it is practice practice. 

After several days to weeks you will see that your baby is enjoying the high chair and is interested in spoon feeding and you can begin to feed other pureed foods. I also add more solid feedings to their day so that they are ultimately getting 3 solid meals (breakfast, lunch and dinner) as well as their bottle or breast feedings. Yes, that often means you are actually spending more time feeding than before. 

I usually begin veggies, then fruits then meats, but again there is no “perfect” way to add additional solid foods. Just feed your baby lots of different pureed foods with different tastes, as you will see they will eat almost anything at this age. Enjoy that as it all changes once they are a toddler! 

Spoon feeding is fun and is not the biggest source of a babies calories until they are older. It is just the beginning of getting your baby interested in the spoon and new textures in their mouths. Another new experience for both parent and baby. 

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

Daily Dose

Sleep & Your Baby

1:30 to read

Once a new baby joins a family one of the first questions I am often asked is, “when will my baby sleep thru the night?”.  SLEEP is one thing that all parents crave and for one reason or another many parents with infants over 6 months of age, complain that their baby is still not “sleeping through the night”. If your baby or child is not sleeping well, that typically means that parents are having disturbed sleep as well.   

By 6 months of age a baby should be able to self soothe and fall asleep on their own and the majority of babies are sleeping 10-12 hours thru the night as well.  After many years of practicing pediatrics and dealing with my own children’s sleep issues, I spend quite a bit of time with my patients discussing healthy sleep habits.  Like most things, it is easier to start off with good habits and bedtime routines.

So….when parents come in at the 6 month visit and are concerned about their baby’s sleep and awakenings I typically discuss “letting their baby cry it out”. This advice is met with varying responses.  Some parents are ready to get a good night’s sleep and will do “anything”, while others think I am “a mean doctor” and would “never let their baby cry”.  Like most things it is not always black and white and that is why we have chocolate and vanilla.  But, in my experience, the sooner you deal with sleep issues the faster they seem to resolve…

A recent article in Pediatrics should now reassure parents that they are not “harming their baby” by letting them “cry it out” which is called graduated extinction.  The study done in Australia found that infants whose parents let them “cry it out” fell asleep 13 minutes sooner than a control group and woke up less often during the night, and had no significant differences in stress levels (based upon salivary cortisol levels). The study also found no long term effects on parent-child attachment.  All good news for some sleepless parents who are considering this method to get their baby to sleep through the night. 

The researchers also looked at another behavioral sleep training intervention called “bedtime fading” which some feel is a “gentler” method of sleep training. In this case a baby’s bedtime is delayed with the thought that a sleepier child will fall asleep faster and may not cry as long.  This may be an easier method for some parents who continue to be anxious about “graduated extinction”.  This too showed that infants fell asleep sooner than controls but they showed no change in the number of nighttime awakenings.

Bottom line, sleep is important for the entire family ….all ages.  This article should hopefully go a long way in reassuring sleep deprived parents that a baby’s cries are not harmful and may actually get everyone to sleep faster, longer and more peacefully….you just have to believe the research and hang in there. 

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