Daily Dose

Update on Autism

1:30 to read

Every parent watches for their baby’s first smile.  After the smiles are giggles and laughs and before you know it your baby is saying "dada" and "mama" and their vocabulary begins to explode. Suddenly you realize that your child is putting words together and may even start telling you what they want!  These developmental milestones all typically occur in the first 2 years of life.

Developmental screening is an important part of your visits to your pediatrician...especially for the first 2-3 years of life.  In many practices a parent fills out some sort of developmental screening questionnaire prior to their “well-baby” visit asking age appropriate questions....such as “does your child babble?”, “does your child point at objects?” “does your child play patty cake?”  “does your child put 2 words together?”.  During the check up your pediatrician is also watching how your child is interacting with their parents as well as with the doctor. I sometimes find that parents are “hard graders” and do not give their child credit for some milestones that I think they are actually doing when I am examining them.  Remember, there is a wide range of normal in the first several years of life. Not every baby does every thing at the same time!

Socialization and interaction is a very important part of early childhood development, but for some babies making eye contact and developing language skills is delayed. In fact,  for some children socialization and language seems to develop later and seems to be “different” than that of other children. These so called “red flags” in a baby’s development may be early signs of autism.  

The diagnosis of autism is typically not made until a child is between 18 months- 3 or 4 years of age.  The diagnosis of autism is based upon observation of a child’s communication and social interaction and for older children on their activities and interests. There is NOT a single test to diagnose autism.  In other words, your doctor cannot do a blood test to definitively diagnose autism spectrum disease (ASD). The diagnosis of ASD relies upon characteristic behaviors seen in a child, not on one milestone.

If you have concerns about your child’s development make sure you bring them up with your child’s pediatrician.  While it is hard for a parent to “wait and see” what happens over several months some babies will achieve their language and social skills later than others. Just like learning to read...some children do it earlier than others.

The most important thing is that you interact with your baby in those early years!! Talk, sing, read aloud and engage them in early play....as we know that every child needs that same stimulation.  

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

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

Earaches Are Painful

1:30 to read

I just managed to catch yet another cold from my cute, little patients who felt that they could “squeeze in” one more cold before officially closing out the sick season of 2014-2015!  Parents are so SICK of their children being SICK and I must agree...it is time for everyone to stop coughing and sniffling and get well, and that means fewer ear infections as well.

Ear infections are one of the most common reasons that a parent brings a child to their pediatrician.  But, not every child that has a runny nose, cough, fever, or pulls on their ear will have an ear infection. In fact, most will not.  

Several important facts about an ear infection: a child’s ears typically do not get infected on the first day of a viral upper respiratory infection, most ear infections occur between day 3-7 of a cold. Most children who will develop an ear infection will have a runny nose, congestion, cough and often develop a fever.  It is not unusual for a child to have a fever for the first few days of a cold, but a fever that develops 3, 5, 7 days after the beginning of a cold may be a red flag for an acute ear infection.

The newest guidelines on ear infections are quite clear and state that the pediatrician needs to distinguish between an acute otitis media (AOM), with a bulging and opaque ear drum versus those children who simply have serous otitis media (fluid behind the ear drum).  Antibiotics are only recommended for those children with and acute ear infection who are symptomatic.   

For children under the age of two years, especially those in day care or school situations who have a first AOM, amoxicillin is still the recommended drug of choice. It is inexpensive and well tolerated (and tastes good too). For children with recurrent ear infections second line drugs will be used.

For a child over the age of two years who is not running a high fever or in exquisite pain, the newer guidelines advise “watchful waiting” with treatment beginning with topical ear drops for pain and acetaminophen or ibuprofen.  In the older child the infection is less likely to be bacterial and more likely viral and therefore will not respond to antibiotics.  I will give the parents a prescription for an antibiotic with instructions to begin it if the child seems to be worsening over several days, and to call me to let me know they started the antibiotic. In over 75% of my patients, they never begin antibiotics and the symptoms improve and the ear infection resolves on its own.

Discuss options for treatment with your own pediatrician and remember, judicious use of antibiotics is very important.  Not every child who pulls on their ear or who has a “bad night” of sleep will require an antibiotic. All children must be seen to decide who has an ear infection. it is not a telephone diagnosis!

 

Daily Dose

ADHD Medication

1:30 to read

If your child takes medications for ADHD you may be noticing that your insurance company may be denying coverage for these prescriptions, or they are wanting to use a generic version of the medication your child may be taking.  It seems that this is becoming more and more prevalent and I get phone calls from patients asking what they should do?

Medications for ADHD have never been inexpensive and for some families, especially without insurance coverage, they are cost prohibitive.  For a child who has been diagnosed with ADHD, it is known that a combination of medication and behavior modification provides the best outcome.

When I begin a child on medication for ADHD I typically start with a brand name drug and do not use any generics.  I explain to parents that although I am a believer in generic drugs, and use them frequently, I want to make sure that any effects of the drug (positive or negative) are indeed due to medication and are not influenced by a difference in a generic drug.  Once a patient has been on medication and is doing well, if there is a generic available, I will often prescribe it in order to be more cost effective.

Over the years patients have commented to me that they do not feel as if the generic version of their given ADHD medication is working well. While these are anecdotal reports, they have not been uncommon. In that case some of my patients have opted to pay for the more expensive brand name medication.

The FDA just released an interesting article that states just that....studies have recently found that generic versions of the drug Concerta (by 2 different manufacturers) “may not provide the same therapeutic benefits for some patients” as does the branded medication.  While Concerta has a “drug releasing system” that provides 10 -12 hours of extended effectiveness, it seems that the generic drugs may relase more slowly, and the diminished release rate may not provide the same effect for the patient.

So, if your child is on these medications and you have tried a generic version and were concerned about their effectiveness, now is the time to discuss with you doctor.  This may not be the case for all, but it is certainly worth knowing there is now data on this subject.

Daily Dose

Dry Skin in Winter

1:30 to read

As the weather is getting a lot colder our skin gets a lot drier. We all recognize this with our own skin, but what about a baby? I am already seeing babies with chapped cheeks and dry patches on their bodies...and it will get worse as the weather continues to get colder.  

Eczema, also know as atopic dermatitis, has been on the rise and effects about 10-20 % of children. I see babies and toddlers with eczema almost daily.  Eczema also typically flares, with the skin getting dry and red and itchy, during the winter months. 

In several recent studies it seems that babies who had 2-3 baths a week, rather than everyday, and who were moisturized on a daily basis had a decreased chance of developing eczema.  I always liked to give my own babies a bath everyday because they smelled so good afterwards, but it may be best to back up on those baths during the winter months.  

In another study out of the UK doctors randomized children who were at risk for eczema (due to positive family history) into 2 groups.  The first group used a fragrance free moisturizer everyday and in the other group the parents were instructed not to use a moisturizer.  After 6 months the babies who received moisturizer had almost 50% less chance of developing eczema. It seems that it is possible to protect the skin barrier with moisturizer.

The American Academy of Pediatrics (AAP) also recommends that a baby be bathed 3x/week or less and to apply a daily moisturizer. I like hypoallergenic, fragrance free moisturizers like Cetaphil, Cerave and Aveeno. The creams are going to be even more moisturizing than the lotions and contain ceramides as well. 

We don’t understand all of the genetics that play into eczema, but it is seems that some people seem to have a gene variation that reduces the protein filagrin which helps the skin barrier retain moisture.  If parents have eczema I would really get busy with moisturizing my baby’s skin this winter.

Daily Dose

Meningitis Outbreak

1:30 to read

There has been another outbreak of the meningococcal disease among college students at The University of Oregon.  If you remember a year or so ago, there was an outbreak at Princeton University as well as one at UC Santa Barbara.  The meningococcal bacteria may cause a serious blood infection, meningitis or in some cases both diseases and may even be fatal.  

Meningococcal disease seems to cluster in adolescents who come into close contact with one another...such as on college campuses with students living in dorms and other residence halls.  The bacteria is spread via respiratory droplets which may occur when coming into close direct contact with an infected person...in other words even a roommate, or suite-mate.  

The latest cases of meningococcal disease in Oregon have been due to Serogroup B infection, which caused the outbreaks at the other universities as well.  Most colleges have required that students receive a meningococcal vaccine against Serogroups A, C, W, and Y (Menactra, Menveo) ...but until recently there had not been a vaccine against Type B disease.  The FDA recently approved two vaccines against serogroup B, and they are Trumenba and Bexsero.  These vaccines were given to thousands of students at Princeton and UCSB during the previous outbreaks, even before they were approved by the FDA, as they have been well studied and were already being given in Europe. 

Although these vaccines are not yet routinely recommended in the United States, in certain situations, such as people who are immunocompromised, or during an outbreak such as that at the University of Oregon, the vaccine may be recommended. You can see the guidelines for vaccine recommendations on the CDC website as well.

The early symptoms of the disease often mimics the flu with fever, body aches, headache, nausea.....but quickly progress to have far more serious symptoms.  As a pediatrician that takes care of a lot of college students (and who saw a case of Serogroup B disease several years ago), I am always on the alert.

Daily Dose

Colds & Suctioning Your Child's Nose

1:30 to read

I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

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

Daily Dose

HPV Vaccine

1:30 to read

I recently read an interesting article in JAMA in which a study was done suggesting that “HPV vaccine does not lead to risky behaviors in teen girls”. This seemed to be a timely study as Merck has just recently received FDA approval for their new Gardasil vaccine which will now protect against 9 serotypes of HPV (human papilloma virus) which causes the majority of cervical cancer ( as well as other genital cancers) and genital warts.

Since the vaccines against HPV were released in this country about 8-9 years ago, the uptake of the vaccine among tween/teen girls and boys has been less than hoped for.  Like many vaccines, there were those parents who were “worried or skeptical” about giving their children a new vaccine - despite the fact that it is the first vaccine against a virus that was known to cause cancer..actually a great deal of cancers.  The CDC reports that about 57% of preteen/teen girls have received one dose of HPV vaccine, while only 35% of boys in the same age group. The completion rate for completing all 3 vaccines is only 37% for girls and 14% for boys. 

But while many parents believe in the benefit of the vaccine a common concern has been, “giving the vaccine to a pre-teen may lead girls to engage in sexual activity at younger ages”.  In my personal experience I have not found that to be at all true. In fact, educating these tweens and teens about the risk of infection and cancer is “scary enough” for some to be even more wary.  I am pretty direct with this group as they get into their true teen years and are experimenting in all sorts of ways...not only sexually. I truly do not think that a vaccine does “promotes” becoming sexually active....hormones do a good job in that area. 

So, the study looked at 21,000 vaccinated girls who were matched with more than 186,000 non vaccinated girls. Researchers then compared rates of sexually transmitted infections (STI) including herpes, chlamydia, gonorrhea, syphilis and HIV. They found that the “rate of STI’s overall were equal among the vaccinated and unvaccinated groups”, which suggests that the HPV vaccine does not impact sexual behaviors. 

With an even more protective HPV vaccine now available I encourage you to read the literature and talk to your own doctor about getting your adolescent vaccinated.  The vaccine is protective but does not treat HPV if you have already been exposed....there will be 14 million new cases of HPV in the U.S. this year...and that statistic is not one you want your adolescent to be among.

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.