Daily Dose

Over The Top Birthday parties

1.15 to read

Birthday parties are getting to be quite a big deal...even for a one year old. I have had several parents in with their children for their 1 year old check up and they often bring along birthday party pictures. WOW!

Some of these bashes look like they could be a swee” sixteen or a wedding.  No kidding. I thought I had hit the jackpot when I started printing birthday invitations on my color printer....but these days some of the invitations are printed and delivered to other “1 year olds” who I assume cannot read yet. Thankfully their parents are also included as +2. 

These parents are very clever and most of the parties had themes....with the invitation, cake and party favors all coordinating. Looked like a ton of work for the parents to put this all together. If anything, this is not a “last minute” event...lots of planning and executing. I wonder if second or third children have such elaborate “bashes”.

I know I seemed to be able to throw together a birthday party at the last minute when necessary, but I am sure that was for child number 2 or 3. My husband did remind me of our first child’s 1st birthday when we had many friends and their toddlers over. He also reminded me that it was about 110 degrees in June, and that we had a plastic baby pool that we put a bunch of hot sweaty kids in, with parents who wished that they could have fit as well.  Not sure where those pictures are.

But it seems that petting zoos, bounce houses (maybe for the adults), magicians, and even super heroes arrive to celebrate this latest group of 1 year olds.  There are themed cakes with a miniature one for the birthday child too so that they may fully indulge in their “first sweet” A few of my moms had gluten free cakes made, just because. There are often tons of gifts as well, but many parents are opting to then donate them to one of our local children’s hospitals....a wonderful idea.

Lastly, with all of the fancy new apps and iPhone photos, many of the parties look like they have been professionally photographed (some of course had been).  Some of the precious 1 year old birthday children even had several wardrobe changes to celebrate the big day (yes, those were mostly little girls), I guess to get an early start on future occasions like the wedding.

What do you think about first birthday parties... I just think it might be worth waiting till your child can appreciate it as well?

Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?

 

Daily Dose

Leaving Your Child Home Alone

1.00 to read

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

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

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

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

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

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

 

Daily Dose

Booster Shots

1:00 to read

Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

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

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

Plate Size & Childhood Obesity

1.15 to read

While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

Insect Bites are Everywhere!

1.30 to read

We are definitely in the “dog days of summer” and despite temperatures above 100 degrees (not just here in Texas either), it seems that insects thrive in hot weather. The mosquitoes here are just horrible and I see at least 2-3 patients a day that come in because their children have been bitten by “some bug”, most of which I believe are mosquito bites. 

I have been surprised that so many of the parents who are bringing their children in to have their bites checked are not using any insect repellent.  They seem shocked that their child can be bitten just walking into day care, or while on the playground for just 10 minutes, or even while they are in the pool.  It only takes a second for that mosquito to swoop in and bite and you never even know it until you see that swollen bite later that day or even in the next morning. (It’s a mystery why children seem to have bigger reactions to the bite and plenty of of local swelling).  Many parents are convinced that there are bed bug bites, but I truly believe these are just pesky mosquitos.  I even got one the other morning while walking out my front door just to get the morning paper! 

The best way not to “worry” about bites is to prevent them. For infants who are usually in a stroller I would use mosquito netting to start.  It is easy to drape their carseat or stroller as you go outside.  But as a baby gets older and is now outside more, and for those toddlers and older children the most important thing is to pick a mosquito repellent and use it.  

If your children are going to camp or day care, use it in the morning before they are going outside.  Reapply in the evening as well if you are going to spend time outside as well. You do not reapply insect repellent throughout the day like you do sunscreen, so pick the strength of  repellent based on the amount of time you will be outside.  Products with DEET, picardin, and oil of eucalyptus may be used in children (age dependent).  See www.cdc.gov for a listing of insect repellents by brand.  

Fortunately, to date (through the end of July  2013) there have only been a total of 53 cases of West Nile virus disease in people, with 3 deaths in the U.S. (Compare to 2012 with 5,674 cases of disease and 286 deaths).   

While 35 states have reported WNV activity much of the middle of the country is not evening reporting activity (maybe we should all move for a few months). This is all great news. But we still have a lot of summer left, so keep using precautions and drain that standing water around your house as well ...this helps the entire community.

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.

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DR SUE'S DAILY DOSE

Why texture is important when introducing new food to your baby.