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Daily Dose

Paddling in School

1:30 to read

I just finished reading an online post from a pediatrician in another state whose daughter has just started kindergarten. It seems that in her state, and her school, they may still “paddle” children for misbehaving. WHAT?!?!

In fact, the school sent a note home with her child that re-iterated the “school rules” surrounding paddling and asked that the parent sign the note that they agreed to paddling. Are you kidding me…what parent would sign a note agreeing to let someone HIT their child?  Parent’s have been arrested for spanking their children in a public place….but now you can let someone else paddle your child? 

I talk to parents about discipline even before their child turns one. Many a parent will tell you I am “the strict” doctor.  From the beginning, I discourage spanking (although I will admit to spanking my own children several times during their childhood - usually out of total frustration and never felt good about it) and begin with some simple strategies. For example when your 6-7 month old learns that they can make a new shrieking sound to get attention “ignore the behavior” and it will often go away.  Or, what about telling your child that you “will not pick the food up off the floor if they throw it” and then following through….they will not go hungry I assure you.

As children get older I discuss re-directing, time-out, taking away a toy.  For the older child it may be taking away screen time, missing a birthday party and for the teens taking away the cell phone,car or being grounded at home with parents.  But spanking and paddling is never part of the discipline/behavior modification discussion. And now I find out that there are still 19 states that allow paddling in their schools!! 

The mother of this child had not been aware of this rule. She could not believe that she was asked to sign a form to allow her child to be paddled. In this case we are also talking about 5-7 year olds who are just starting school where they will begin to learn school rules and expectations of kindergarten and 1st graders. Every teacher seems to have many strategies for discipline and behavior modification. Not one that I spoke with mentioned spanking or paddling. I am not sure that I even agree with taking away “recess” for misbehaving from this age group…(another conversation)  but certainly not corporal punishment.

The interesting part of this story is that the behavior issues were related to little boys “playing guns”  while they were on the playground. The school has a “zero tolerance for acting out play with guns”  but allows you to hit a child???  What kind of mixed message is that about violence? I know that while raising our three sons, despite our protests about violence and guns,  they seemed to turn anything we gave them into a “play gun” and that was long before they were ever even given a Nerf gun. 

Do your schools have policies regarding corporal punishment? I feel as if I have gone back in time 50 years - only all of this information came from that entity called the internet!!!

 

Daily Dose

Strep Throat

1:30 to read

It is still what I call “sick season” and strep throat is here and for some reason even seems to “flourish” during early spring.   Strep throat is a bacterial infection that is typically seen in school aged children between the ages of 4-16 years (but may be seen in younger children and adults on occasion).  Strep symptoms begin with a sore throat, often a fever, swollen lymph nodes in the neck, and some children may have a headache as well as abdominal symptoms with vomiting. 

Because strep throat is due to a bacterial infection it is treated with an antibiotic.  But in order to diagnose strep throat your child will need to have a rapid strep test which entails having a swabbed specimen taken from your child’s throat (tonsils and posterior pharynx).  The test is pretty easy and most children don’t mind a throat “swab” or specimen (we call it tickling your tonsils), although some children may gag and even vomit.  But rest assured, there is not a needle involved in a strep test!!  The rapid strep test takes about 5 - 10 minutes and will determine if your child needs an antibiotic. This test if really accurate, but in our office we also do a back up overnight culture (old school) on all negative rapid strep screens so as not to miss any false negative tests.

While strep is treated with an oral antibiotic (on occasion a shot for a vomiting child ), the rule of thumb was 24 hours at home after beginning antibiotics before returning to school or outside activities. An interesting study published in the Pediatric Infectious Disease Journal concluded that “children treated with amoxicillin (who are not allergic ) by 5 pm, and if fever free, could attend school the following day” and not put other children at risk.

Although this was a small study (only 111 children ), the authors found that 91% of the children who had received an appropriate initial dose of amoxicillin, had undetectable group A Strep on the rapid test and on a  throat culture on the second day. 

While this study is interesting, I also think that there are several important points to be made. A child with strep throat may no longer be contagious after 12 hours, but how are they actually feeling?   Did they sleep well that night? Do they still have a sore throat or maybe a headache? (despite being fever free) Is it better for that child to stay at home for a day rather than rushing back to school when “not at the top of their game”?

I do realize that it may be helpful for working parents as it would get them back to work more quickly as well, we still need to consider how their child is feeling.  Sometimes, while an antibiotic will “treat” the infection, a day of rest, fluids and no school may be just what the doctor ordered.  I still think we need to look at the individual child…and make a decision based on multiple factors. 

 

 

 

Daily Dose

Calming Parent's Fears About Night Terrors

1;30 to read

I received an e-mail from a viewer today about night terrors. Her concern was “my son is having what I think are nightmares, but he talks and makes no sense and seems to be afraid and I am not sure what is going on.”

Her description is perfect for night terrors, which typically occur in children during the pre-school and early elementary years. The peak age is between five and seven years, and night terrors usually resolve before adolescence. About three percent of children experience night terrors.

Night terrors are part of sleep disturbances known as parasomnias, and are characterized by partial arousal during non-REM sleep. Night terrors therefore typically occur during a child’s early hours of sleep, when non-REM sleep is deepest. Most children with night terrors will stay in their bed, but cry out and appear anxious and upset, but are also very confused. Some children may run down the hallway with heart racing and breathing fast as if they are being chased. Until you see a child having a night terror it is difficult to explain how anxiety provoking it is for a parent who doesn’t realize what is going on.

I speak from experience as our third child had classic night terrors, but the first time he appeared in a “semi” awake state screaming and sweating, I would have sworn he was in horrible pain. Not the case, as after about two to five minutes most children will calm down (on their own as you cannot awaken them or comfort them during the event) and return to sleep and have no recollection of the episode the following morning. It is a very helpless feeling until you realize that your child is really not awake at all.

The other big difference between night terrors and nightmares is that the child has no sense of dread or of being scared to sleep. They have no fear or anxiety about these events occurring, and while the sleep terror ends abruptly with rapid return to deep sleep there is complete amnesia to the event. The best treatment is in reassuring parents. It is also important to make sure that your child has a regular bedtime routine and that they are getting sufficient sleep. This sleep disturbance is really more disturbing to the family than the child and will resolve over time. Just remember to let babysitters know, as it may be quite unsettling for a new sitter who has just put precious children to bed!

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Zika Virus

1:30 to read

If you are pregnant or planning on becoming pregnant in the near future you need to be aware of the Zika virus.  This virus is spread via the Aedes mosquito (as is West Nile Virus, Dengue fever and Chikunguyna), and has been found in Africa, Southeast Asia, the Pacific Islands , South America and Mexico.  The Zika virus was also just confirmed in Puerto Rico and the Caribbean in December.  There are new countries confirming cases of Zika virus almost every day, as the Aedes mosquito is found throughout the world.  

When bitten by a mosquito that has the Zika virus, only about 1 in 5 people actually become ill.  The most common symptoms are similar to many other viral infections including fever, rash, joint pain and conjunctivitis.  For most people the illness is usually mild and lasts for several days to a week and their life returns to normal.  Many people may not even realize that they are infected. 

Unfortunately, if a pregnant mother is infected with the Zika virus, the virus may be transmitted to the baby.  It seems that babies who have been born to mothers who have been infected with the Zika virus may have serious birth defects including microcephaly (small head) and abnormal brain development. There have been more than 3,500 babies born with microcephaly in Brazil alone…and just recently a baby was born in Hawaii with microcephaly and confirmed Zika virus. In this case the mother had previously lived in Brazil and had relocated to Hawaii during her pregnancy.  The virus to date has not been confirmed in mosquitos in the United States.

Because of the association of the Zika virus and the possibility of serious birth defects, the CDC has announced a travel advisory stating, “until more is known and out of an abundance of caution, pregnant women in any trimester, or women trying to become pregnant, should consider postponing travel to the areas where Zika virus transmission is ongoing”.  

Should pregnant women have to travel to these area they should follow steps to prevent getting mosquito bites during their trip. This includes wearing long sleeves, staying indoors as much as possible, and using insect repellents that contain DEET.

Researchers are continuing to study the link between Zika virus and birth defects in hopes of understanding the full spectrum of outcomes that might be associated with infection during pregnancy. There will be more data forthcoming.

At this point the safest way to avoid being bitten is to stay away from the countries who have had confirmed cases of the Zika virus.  But as the weather warms up in the United States and mosquitos become more abundant there is concern for Zika virus to be found here.  It only takes one infected mosquito to bite one person who then contracts the virus….should that person be bitten by another mosquito, that mosquito may acquire the infection and so it spreads.  There is not known to be human to human transmission of the virus.

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Daily Dose

First Cold

1:30 to read

My office is hopping with a lot of little ones and their first colds. The worst cold that a parent experiences is not their own cold, but their child’s first  one.  Unfortunately, babies that are born in the fall and winter months often get their first cold earlier than a baby born during the spring and summer. 

It is such a helpless feeling for a new parent to see their baby with a runny nose, red rimmed eyes and a cough.  While newborns routinely experience nasal congestion, a cold is different. With a cold the baby’s nose will run and have clear to colored mucous,  and they will typically cough, just like all of us with a cold. They just look so pathetic...but you need to know what to watch for....as there will be more colds throughout the winter.

A baby (over the age of 2 months) may run a bit of a fever with their cold. A fever is defined as a temperature over 100.4 degrees. I am old school and still do rectal temperatures....just don’t think the temporal and ear thermometers are accurate.  The fever, if they even have one, should not last more than a day or two and should respond to the appropriate dose of acetaminophen for your child’s weight.

The biggest concern for a baby with a cold is how they are breathing. While they may look pitiful with that gunky nose, and have a loose junky cough, how your child is breathing is most important. You need to actually look at your child’s chest while they are breathing and coughing to make sure that they are not having any respiratory distress. Undo their onesie or take off the nightgown and look at their chest.  You do not want to see your child’s chest moving in and out (which is called retracting) or see that they are using their tummy (which is going up and down) to help them breathe.  The cough may sound horrible, but always look at their chest (visual more important than audible). They should also be nice and pink...even when they are coughing.  A cool mist humidifier in their room at night will also help.

Best thing for gunky nose is a nasal aspirator or nose Freda with some saline drops. Clearing the nostrils is often one of the best ways to help your child breathe, which will also help them to take the bottle or breast. A baby may not eat as well when they are sick (same as you and me) but they will take enough to stay hydrated and have wet diapers.  Being sick at any age typically effects your appetite and as your child is feeling better their appetite will improve as well.

Getting past that first cold is a milestone for baby and parents....but if you have any concerns about your child’s breathing, hydration or persistent fever, always call your doctor.

Daily Dose

Your Baby's Belly Button

What can you do if your baby has a lump n their belly button? I recently received a picture, via email of course, from a concerned parent who had noted a “growth” on their child’s belly button (umbilicus).  The father actually took the picture and he was the worried one,  as the growth had  appeared when the baby was about 10 weeks of age, and had seemed to be growing over the last several weeks.

The “belly button” is the scar tissue that remains after the umbilical cord drops off. The umbilical cord is made up of blood vessels that are attached to the mother’s placenta. Once a baby is delivered, the cord is cut close to the abdomen and clamped.  The umbilical cord is then typically cleaned with gentian violet to prevent infection. The dried umbilical stump typically falls off of a newborn somewhere around 2 -4 weeks of age.  There are varying opinions on how what to do about cleaning the cord prior to it falling off. There was an article written several years ago that recommended not cleaning the cord and letting it air dry, and this would shorten the time it took for the stump to drop off.   I still recommend cleaning the base of the cord as it is detaching. I use an alcohol swab to clean the base of the cord to get rid of the “goop” that develops and also the “stinky smell” associated with that. If you don’t, you may wonder why your baby does not have that delightful new baby “smell”.  Once the cord is off you can give your baby a real bath and get them really clean! If any tissue does not fully detach it can leave a small red, moist mass called an umbilical granuloma. These benign lesions are not apparent at birth, but usually appear shortly after the cord has separated and the extra granulation tissue remains.  In most cases these are easily treated by your pediatrician who will use a silver nitrate swab to cauterize the excess tissue. It usually only takes one or two applications and the issue is resolved. Some people have advocated having parents use twice daily application of table salt to the umbilical cord granuloma, and this may be easily tried at home. On occasion a larger umbilical granuloma or an umbilical polyp will remain that may require further evaluation and  treatment with the involvement of a pediatric surgeon. That's your daily dose.  We'll chat again soon.

Daily Dose

No Need for Stitches?

1.45 to read

OUCH!! I was just heading out to grab some lunch when a patient of mine, who happens to have 3 young sons (brings back memories) walked in with her youngest son who had been jumping on the bed and bumped his head!

As you can see by the picture, there was a nice little laceration right in the middle of his forehead. This was the perfect wound that would have previously required a stitch or two, but can now be closed with a liquid adhesive called Dermabond.

Fortunately, this experienced mother of 3 boys had already become a fan of Dermabond and instead of going to the ER; she came by the office for a fairly easy procedure to close the wound.  Smart Mom!

When Dermabond was released in the early 2000’s it took me awhile to get used to how easy this made wound closure.  Dermabond is a liquid skin adhesive that holds wound edges together. The best thing is that it is painless and can be used on small superficial lacerations. Even for a wiggly toddler in most cases the laceration can be closed even while the parent is holding a child still. This is certainly not the case when having to suture!

Dermabond forms a polymer which causes adhesion of the wound edges so it is perfect for “clean, straight, small” lacerations that I often see among my patients.  The classic ones are on the edge of the eye, the chin, the forehead or even the scalp. In studies the cosmetic outcome was comparable to suturing, and in my opinion for those small lacerations it is preferable.

So, we cleaned the wound up, laid him right down (he was perfectly still too) and within 5 minutes the head wound was closed and a happy 2 year waltzed out of the office. Not a tear to be found, but I did have a little residual glue on my finger!

The Dermabond will wear off on its own in 5 – 10 days. Once the adhesive comes off I always remind parents to use sunscreen on the area, which also helps to prevent scarring.

Happily this little guy left while singing “Dr. Sue said, no more little boys jumping on the bed!”

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

Daily Dose

New Fever Research

1:30 to read

I just read an interesting article in the Wall Street Journal “Your Health” section, about a new study being done by doctors at Boston Children’s Hospital looking at the definition of fever.  As you know from all of my previous posts, fever is a symptom rather than a disease….and fever causes a lot of anxiety for many parents as well as their physicians.

For my entire pediatric career I have been taught that the definition of fever is a temperature of 100.4 degrees or higher. Pediatricians have used this number to determine when a newborn has an elevated temperature and may have an underlying infection and need to be hospitalized. We have also used this number to decide when a child may return to school after an illness, and I can also remember several occasions when I was called to pick up a child from school due to a temperature of 99.9 degrees ( which I wanted to point out was not a fever).  Pediatricians also use this “magic” number to screen for systemic illness, especially in children who have “vague” symptoms of illness without other physical findings which may be seen in the early stages auto-immune disease.

While this has been the “gold standard” in medicine, doctors also know that our body temperature fluctuates throughout the day. There has been research to show that “temperatures varied about 0.9 degrees over the course of the day “ with the lowest being early a.m. and higher temps in the evening. This information has been used for a long time to chart “basal body temperatures” for those hoping to get pregnant. There is also wide variability in temperature depending on the instrument you use to take the temperature and where the temperature is taken (oral, rectal, tympanic, temporal ).  It is not an exact science….but we use the information all of the time to make medical decisions.

Knowing that there is variability in body temperature, Dr. Jonathon Hausmann, a pediatric rheumatologist , is now going to study over 10,000 people of all ages through a crowdsourcing app “Feverprints”. This app will enable the researchers to gather data looking at body temperatures for different age groups, gender, ethnicity, weights and body types. It will also gather data looking at the effect of medications we use to lower fevers, and will try to answer the question, “can you predict the cause of the fever by looking at temperature patterns?”. At the end of the day, these “feverprints” may end up helping to develop fever curves that will be used in different populations (somewhat like a growth curve). 

This is really an exciting and interesting study and will take a large number of people (10,000) enrolling via a free “app” and committing to downloading information for 6 months.  Wouldn’t you want to be involved….I think this would be a great way for a family to have a “science fair project” in their own home!!  I just downloaded the app myself…we might just find that the definition of fever will change…it only took 150 years and an iPhone! 

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