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Daily Dose

Elf on the Shelf

1:00 to read

“Tis the season”, and many of the families I care for have gotten out their “Elf on the Shelf” to help keep the season as merry and harmonious as possible. I think “TEOTS” is genius, as it is a fun way to use positive reinforcement during the holidays as behavior modification.  That elf needs to stay around a bit longer…but then it would lose the appeal.  The anticipation of the elf arriving plays a major role don’t you think?  

 

With the arrival of the elf I get to hear all of the cute family elf stories during the month of Dec. I also noticed that “TEOTS” has some new “gadgets” and outfits to add to the fun, such as a zip line to swing from and suctions boots so he/she can climb up walls. Ingenious right? Surely they will soon have an array of elf outfits so the elf can have some choices to wear during zip lining.

 

During the last year there was also a lot of discussion about what our children were hearing on the news and during presidential debates etc. It doesn’t matter your political affiliation, children were picking up on a lot of what was going on.  Even children whose parents were paying attention to all of the bullying during the debates and atrocious sound bites on the news by limiting TV and electronics told me that their children still overheard things. They were concerned about the messages that both candidates were sending…especially to children.  

 

So…when one of my families took out “TEOTS”  their son, who is almost 3, decided it was the year to name him. “Of course you can name your elf they said”.  The next day he announced that the was looking for the elf and asked his mother, “where is Donald Trump?”. She was a bit confused…until he returned holding the the elf and proudly announced, “ I found The Donald”!!

 

Out of the mouths of babes. More elf stories this month for sure!!

 

 

Daily Dose

Favorite Christmas Songs

1.00 to read

I have been taking a poll among my patients as to their favorite Christmas carols. This means I have asked patients from the ages of 3-22 years to weigh in. It is such fun to hear all of the different responses.  So this is “TKD” Christmas play list presented by my patients. 

When I asked a 3 year old what Christmas song he liked he quickly said, “Twinkle Twinkle Little Star”. I agree it does sound like a Christmas song...the star, right?  

The younger set likes “Frosty the Snowman”,  “Rudolph the Red Nose Reindeer”, “Santa Claus is Coming to Town”, as well as “Silent Night” which many of them are signing for their school Christmas programs.  I can still remember watching my own children perform these songs and “Silent Night” with elementary school voices could bring me to tears!!  Such sweet and innocent voices. 

Some of the other favorites have been “I Saw Mommy Kissing Santa Claus”, “Alvin and The Chipmunks”, “Rockin’ Around the Christmas Tree”, and “Jingle Bells”. 

The older kids like “All I Want for Christmas is You”, “Let it Snow, Let it Snow” (maybe wishing for a white Christmas here in Texas), and Santa Baby”. 

And for me.....I still love “Oh Holy Night” and “Ave Maria”, they just make the season. Christmas Eve always ends with the beautiful hymn “Joy to the World”. 

I can confess that by Christmas, my family is a bit over my continuous stream of carols......but I promise I will turn them back on again next year. 

 

Daily Dose

Happy New Year!

1:30 to read

Happy New Year!!  So here we go again with the New Years resolutions and the “to do” list.  I  try to figure out something each year that I am going to “resolve” to do….one of which continues to be to learn how to play bridge. Somehow I have had the same resolution for two years and yet I still cannot play…at least well. I start off with a bang and just as I can “kind of sort of” play a real game, I somehow get too busy to play and here we go again…back to beginner. I need a new plan!

 

I was having dinner with my “adult children” and they were talking about their New Yea'rs resolutions and it seems they have “categories” of resolutions. In other words they have several different resolutions…which they called personal, professional, social etc. Their thought is that they are more likely to succeed if they have more than one goal??  Maybe they are correct? New approach?

 

So…with that being said let’s think about several different areas that might be good for family resolutions. 

 

Family meals:  We all vowed to try to eat out less and cook at home more often. Not only is it less expensive, it is often healthier and an important time for families to come together to discuss their day. Whether your child is 2 ,10, or 20 yrs old,  just eating together as a family has been shown to improve moods, behavior, school performance and yes, reduces obesity.

 

Electronic media:  As I am on the computer typing I am reminded about how often we all have our faces engrossed in a screen. Some of my young patients know how to “Swipe” and “Refresh” before they can even walk!!  As the world becomes more electronic we are are becoming more isolated…and this is especially true of children. Making a family commitment to limit screen time for all ages may be difficult but is important for building language, social skills and even better sleep. Texting is not talking…who needs a study to confirm that?

 

Exercise: Who doesn’t vow to get more exercise every year…well maybe not young children who long to go outdoors regardless of the weather. But for everyone else, we are becoming more and more sedentary and that is probably somewhat related to the above issue (electronic media).  Make a family plan to exercise at least 3 -4 days a week, maybe after family dinner? Walking, bike riding  (helmet please), playing soccer in the yard, shooting hoops together, or even playing tag, make it easy. Getting our children to move continues to be important for overall health.   They will sleep better, snack less and exercise also gets those good endorphins flowing.  If you keep it up you actually do “feel better”. 

 

Smoking: If you are a parent that smokes…. resolve to “give it up for your children”.  Second hand smoke is REAL, and more and more data shows how it may contribute to SIDS, asthma and other lung problems in children. Model behavior you want to see in your children.  Teen smoking continues to be an issue and many teens are experimenting with electronic cigarettes which then often lead to smoking at a later age. Giving up smoking saves a lot of money towards a fun trip or night out!!

 

OK - let me know how your family does after a few months!! I am hopeful to stay on track for all of 2017. Happy Healthy New Year!!

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Daily Dose

It's the Sick Season

1:30 to read

Well, the New Year is starting off with a flood….of illness that is.  It is a typical winter in the pediatrician’s office with a bit of every virus you can name. RSV, flu, norovirus, just to start the list.  While so many parents want to name the virus, it is typically not necessary as you treat many viruses in the same manner, symptomatically.  

 

So, if your child is coughing and congested it may be due to any number of upper respiratory viruses, but the most important thing to remember…..how is your child breathing and is your child having any respiratory distress?? I sound like a broken record in my office as I remind our nurses to have parents take off ALL small children’s shirts, gowns, onesies and look at how they are breathing as you never want to miss a child who may be “working to breath”. In many cases, the visual of a child’s chest as they take breaths is more important than any cough they may have.  So remember this: “visual inspection and not just audible”.  Sending me a video of a child coughing is rarely helpful, but a video of their breathing is very important when trying to decide how to guide a parent.

 

Another tip: In most cases if your child is having respiratory distress they are quiet, as they are conserving their energy…which means they are not fighting with their sibling or running around the house, but are often sitting quietly. This also means that when they come to the doctor they are not screaming and yelling in anticipation of the doctor…again, they are usually sitting quietly in their parent’s lap. While a happy quiet child is a pleasure at my office, in a toddler it is not typical.

 

Lots of diarrhea and vomiting in our area as well. In this case, I am always trying to make sure that a child is not getting dehydrated. So, the things to look for include if your child has tears, saliva in their mouth and if they are urinating (having wet diapers).  If your child is vomiting you have to remember to wait about 30 minutes after they have vomited before giving them anything to drink….even if they are “begging for a drink”. Once they have not vomited you need to give them TINY sips of clear liquid and keep offering sips every 10 - 15 minutes. If you do this, in most cases you can keep the child from vomiting repeatedly.  Once they are keeping down sips you can go up in volume.  It is like the turtle and the hare….slow and steady wins!!  

 

With diarrhea alone it is more difficult for your child to become dehydrated, as you can have them keep drinking to keep up with the loss in their stool. Many parent “worry” as their child does not want to eat…and that is ok, the fluids are the most acute issue. You can go without food for quite some time…..don’t you ever skip a meal?

 

Keep washing those hands…and I hope you had your flu shot as I promise…it will come. 

 

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

Daily Dose

Hassle-Free Formula?

1:15 to read

I am certainly a big proponent of “hassle free” options for making parenting easier. ( is there such a thing)?   For many of the families I see with new babies, the latest “favorite” gizmo is an automatic baby formula maker. Yes, it is similar to the Keurig and Nespresso coffee machines  but in this case it “mixes the formula powder and water to perfect consistency”…according to one manufacturer label.

 

When I first saw one in use I agreed that it seemed to be “easy”, but at the same time, I was not sure it was any  faster than just putting a scoop of baby formula in a bottle and shaking it up?  It certainly took up more counter space….but whatever right?  I was told…” you don’t have to mix or measure and there are no air bubbles like shaking a bottle”. Old school vs new school - the end product is the same, correct??

 

Well, as with many things, “hassle free” may not always mean better.

 

I recently saw an infant who had been doing well and gaining weight while breastfeeding. Her mother returned to work and decided to start formula feeding and purchased one of the new “instant formula preparation machines”. She was making the baby’s bottles “hassle free” every feeding.  The baby was under 4 months of age, so she was only receiving formula for feedings.

 

When the baby came in for the next check up she had not been gaining weight and had actually fallen off of her growth curve.  When the mother was asked if the baby was eating well, pooping, sleeping etc. all sounded fine. The baby’s physical exam was also normal.  So….why is this baby not gaining weight? The differential diagnosis is fairly long, but includes some serious problems. Pediatricians do not like to see a baby that is not gaining weight - the term used is “failure to thrive”.

 

So, very long story short…the good news is that the baby is fine!!! It turns out that the baby does not have any underlying problems. The problem was the automatic formula maker that the mother was using to prepare the baby’s bottles. For some unknown reason ( technology ) it was not adding the correct amount of formula to mix and make the 6 ounce bottle.  In other words…machine error!  The baby was actually getting diluted formula….and no one knew.

 

Once she started measuring and mixing her bottles the “old fashioned way” - scoop, add water and shake…the baby started to gain weight again.  Mystery solved, healthy baby and no more worried parents…but the “hassle free machine” led to a lot of anxiety. All is well, but I hope they got their money and more counter space back!

Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

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