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Daily Dose

When Is The Best Time To Potty Train?

1.30 to read

Every parent wants to know, when is my child ready to potty train? A study that was recently published in an issue of The Journal of Pediatric Urology is one of the first to show that timing of potty training children seems to be more important than the technique.

I found this quite interesting as the lead author, Dr. Joseph Barone stated, this is the first study “that gives parents an idea of when it’s a good time to toilet-train”. The best time to potty train has typically been thought to be somewhere between the second and third birthday, but that is a wide range.

This study suggests that age 27-32 months is the appropriate time to move a child out of diapers. In the study, children who were toilet trained after 32 months were more likely to have urge incontinence, and problems with daytime wetting and bedwetting when they were between the ages of 4 and 12 years.

This data was gathered from a retrospective study of children who were being seen by pediatric urologists for problems with urge incontinence (daytime wetting episodes) and their answers to a questionnaire on when they started potty training and what method they used, was compared with children who did not have urge incontinence. The results showed that the mean age for children with the wetting problems to have been trained was 31.7 months while those children who did not have problems were toilet trained at 28.7 months.

Potty training continues to be at the top of the question list for parents with toddlers. I still believe and this study tends to support that children who are potty trained younger seem to have “less issues” than those that are older. That is not meant to say that your child will be potty trained by 28.7 months, but in most cases if you begin discussing the potty and following a child’s cues and follow through with reinforcement and consistency that the majority of toddlers may be potty trained by age 2 ½ (which would be 30 months).

In my experience as both a mother and pediatrician, those toddlers who are put in pull ups and never asked about going to the potty or are not taken to the potty seem to be the ones that I see at 3 year old check ups still wearing their pull-ups. By this time if you ask them if they want to go potty they all say, “NO”. I believe this is termed “the child directed approach” which seems analogous to me as saying “what time do you want to go to bed?”

In most cases, if a toddler is introduced to the toilet, goes with their parent to “sit or practice or watch Mommy and Daddy potty” during the early 2’s, and given some incentive to perform, whether that be a sticker or M & M or both, they will become interested in the potty and then they will become ready to potty train. I guess this is a combination of both the parent directed and child directed approach.

Once you see your child is interested you have to “go for it” and put them in good ‘ole cotton training pants and go to the bathroom frequently. You can’t ask if they want to go, again it is a statement, “time to go potty” and most will be trained by the “magical” 27-32 months of age.

To me potty training is somewhat like a space shuttle launch. “The window is not that wide” and you have to potty train during that magical window or the launch window may not come around again for a long time!

That's your daily dose. We'll chat again soon.

Daily Dose

Dog Flu Is Going Around

1:15 to read

Funny time of year for me to be blogging about flu?  Well, now it is “dog flu” that has been spreading across the United States.  Dog flu is caused by an influenza virus and is a contagious respiratory disease in dogs. There have not been any reported human infections with either of the viruses that cause dog flu.  The viruses are also of the Influenza A variety and cause symptoms similar to those seen in humans including cough, runny nose, fever, lethargy and at times severe respiratory symptoms including pneumonia. Sadly, there have been dog deaths reported due to this infection. 

Because dog flu is a fairly new virus now being seen in the United States, most dogs have never been exposed to this virus.  Due to this, just like new influenza types in humans, most dogs that are exposed (about 80%) may develop dog flu but remember most will have mild symptoms and just require supportive care including extra fluids and rest.

If you are concerned that your dog may be showing signs of dog flu there is a test that your vet may administer ( just like we do flu tests for kids!). Extremely ill dogs, especially young puppies or pregnant dogs may have a harder time handing the virus ( again, does this sound familiar?).

But, the main thing to know is that this flu is not being seen in humans.  There is a vaccine for one of the types of dog flu and the veterinary community it working on other vaccines.

So, no need to worry about the kids and their pet dog!!  Just like your children make sure your dog is up to date on their vaccines, gets a healthy diet, exercises daily, has enough sleep and enjoys lots of family time too. But,  this is a good time to remember that human flu vaccine will begin to be available by the end of the summer. But don’t worry, I will remind you! 

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 



Daily Dose

Uber & Teens

1:30 to read

Do you have Uber cars in your area?  I first found out about Uber (and I am only using them as an example) when my son lived in NYC and often used the car service. Later on I heard about college kids using Uber as well.  In that case, many college kids did not have cars and/or they were being “responsible” after being at a party.

But recently, in conversations with my adolescent patients, I have heard that high school kids are using Uber to come home after a party, or other social activities. In otherwords, their parents are not picking them up from the dance, concert, or party but are letting their children (often young girls) call Uber.  Where are their parents and what are they thinking?

I realize that once your child heads off to college you hope and pray that they are making good choices and are being safe. You don’t really plan on picking them up after an event or talk to them that same night about what they have been doing and with whom.  But when we had high school age children, my expectations were that we, the parents, were responsible for taking our teens to the party and to pick them up. Once they were driving the “rules” changed a bit in that they were then often driving themselves to an event and then would drive home and we would be up waiting for them to get home.  They always knew that we would be there when they got home and also that if there were any “issues” we were also available to pick them up. We talked a lot about underage drinking as well as driving and responsibility.  Never did I think they would call a cab or car service, nor was that idea ever broached, they were to call their parents.

So now that these “app” car services are available around the clock, are parents abrogating their responsibilities for parenting teens?  By allowing their teens to call a car service for their ride home, are parents seemingly not interested in where their child has been or who they have been with or what they have been doing before they get home?  You certainly can drop your child at a concert or party and tell them to text Uber to get a ride home, but does this parental non-participation quietly help to condone inappropriate, risky, teen behavior?

Although picking your child up at the end of the evening or checking on them when they pull in the driveway will never ensure that your teen does not get into trouble, I think it does help them think a bit more about having to interact with their parents at curfew time. This “worry” might help lead them to make a better decision about drugs, alcohol or whom they are hanging out with. Putting teens into the “hands” (cars) of strangers as their ride home just seems wrong. Parents be aware. 

Daily Dose

Summer Series: How to Treat Common Insect Bites

From May/June until fall I consistently see children who are brought to my office for me to look at their insect bites.As we continue our summer series, it’s time to talk about pesky insect bites.  From May/June until Fall, I consistently see children who are brought to my office for me to look at their insect bites.  Just last week a mother brought in a 7 year old that she thought had chickenpox, but in reality it was numerous bug bites, which were located on the child’s arms and legs (exposed skin) rather than on the trunk which is seen with early chickenpox.  

In many cases, the offending biting insect is not accurately identified, as it could be the ubiquitous mosquito, or biting flies, gnats or fleas. Systemic reactions from insect bites are much less common that systemic reactions to insect stings. The immediate reaction to the insect bite usually occurs in 10–15 minutes with local swelling and itching, and may disappear in an hour or less.  The delayed reaction may appear in 12–24 hours with the development of an itchy red papule (bump) which may persist for days to even weeks. This is the reason that some people do not remember being bitten while they were outside, but the following day may present with the bites all over their arms and legs or chest, depending on what part of the body was exposed. Large local reactions to mosquito bites are common in children. For some reason it seems to me that “baby fat”  reacts more to the bite of the mosquito. (No science here).  The toddler set will often have itchy, red, are warm swellings appearing within minutes of the bites and they may even go on to develop bruising, and spontaneous blistering in 2–6 hours after being bitten. These bites then may persist for days or weeks, so in theory their little legs will be affected for most of the summer.  Severe local reactions are called “sweeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or extremity.  These are often misdiagnosed as cellulitis, but with a good history, the rapidity with which the area developed redness, swelling, warmth to touch and tenderness,  would be uncommon for a bacterial infection. Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins but are extremely rare. The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion,  Sarna lotion, Dommeboro soaks etc.  This may be supplemented by topical steroid creams (either over the counter or prescription) which may be used several times a day for a week or so to minimize scarring. An oral antihistamine (Benadryl)  may also reduce some of the swelling and itching.  Do not use topical antihistamines.  It is also important to try and prevent secondary infection (by scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream like Polysporin to open bites. The best treatment is actually prevention. Using a DEET preparation before going outside (lowest concentration that is effective) may be used in children over the age of 6 months.  Mosquito netting may be used for infants. Try to avoid going outside at dawn and dusk and make sure that you check pots etc for standing water that may be breeding areas for mosquitoes. Wearing long sleeves and long pants will also help (can’t imagine when it is 105 degrees !) That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now!

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

The Best Cold Treatment

1.30 to read

Alright, enough is enough! How could I possible have another cold?  I routinely tell patients with children that it is not unusual for kids to get 8-10 colds a year which seems like once a month from September through April!

If you also think that the average cold lasts anywhere from 7–14 days, then it seems like a child has a cold that lasts most of the year. That is how I am feeling right now.

A cold usually starts off with a little “sniffles” and maybe a sore throat, and you pray that it is just your imagination, and then over several days you  realize that you now feel “yucky”, have more congestion, the sore throat is still there and you are coughing. That is a cold!!!! That is not allergies, nor is it flu. It is that pesky cold virus of which there are an infinitesimal number, and you have succumbed once again. That is my story!

So, with those symptoms AGAIN, and a day in the media research office, I went back to the literature to see if I could find ANYTHING that might lead me to preventing  a cold, curing a cold or making this nasty thing go away any faster. I mean, I am a busy woman and like everyone else, “I really don’t have time for this!” There have been thousands of studies done over the years looking at cold symptoms and their prevention. Studies on Vitamin C from the days of Linus Pauling, to more recent studies for prevention and treatment of upper respiratory infections have really found no benefits to taking vitamin C.

There was one study that showed taking vitamin C might reduce the duration of cold symptoms if taken before a cold begins.  My question is, how do you know that you need to start Vitamin C in anticipation of a cold?  Also, too much vitamin C may cause an upset stomach and diarrhea.

How about Echinacea?  I have been taking Echinacea for years in hopes of “warding off colds”, but the review of the data  showed that Echinacea had no effect in preventing the common cold, studies did show that it might reduce cold symptoms in adults, but studies in children did not produce the same results.  It was also found to increase rashes in those who had eczema (atopy), and allergies to ragweed. I am still taking it, but personally “can’t tell a difference”. You do realize that my opinion alone is not statistically significant. Then there was the whole zinc movement and there are numerous studies that show conflicting results. Some studies did show that those who took 15 mg of zinc daily had a lower mean number of colds and also a shorter duration of cold symptoms.

Other studies did not find a statistical significance for either reducing the number of colds or decreasing symptoms. I have tried all sorts of zinc preparations over the years (even when it was such a hot item I had to order lozenges off of QVC-should I admit that?) and besides tasting horribly I think my cold lasted the same number of days.  Another study of one (not significant), and most would say that the data is still inconclusive.

The hottest new topic is vitamin D.  A study published in the Archives of Internal Medicine in early 2009, analyzed information on vitamin D levels in adult and adolescents.  The results showed that those people with the lowest vitamin D levels (less than 10 ng/ml) were 36% more likely to report having upper respiratory infections that those with higher vitamin D levels (above 30 ng/ml).

Vitamin D is also important for bone and general health, so it is a good idea to be making sure that you are getting adequate vitamin D. The AAP increased the recommended daily intake of vitamin D to 400 IU. I am currently taking a vitamin D supplement in hopes of boosting my immunity as well as keeping my bones healthy.

If you have any ideas or PROVEN remedies, potions, concoctions please send them my way. In the meantime, I continue to drink lots of herbal tea, take hot showers and baths to help the congestion, go to bed earlier than usual, suck on my honey throat lozenges and pray. I also wash  my hands incessantly and even resorted to wearing a mask over the last several days in hopes of warding off germs. My patients think I am playing dress up!

That's your daily dose for today.  We'll chat again tomorrow (cough)! 

Daily Dose

It's Croup Season!

1.45 to read

It is definitely fall and all around the country, the temperatures are cooling off and the chill is in the air at night. With the cooler temperatures more of those pesky viruses come out and once again I am seeing croup.

Croup is a viral upper respiratory infection that causes swelling of the trachea and larynx (voice box) which causes young children to cough and at times to bark like a seal. This hoarse raspy cough is most problematic in younger children who have smaller airways.  

Children often go to bed at night with nothing more than a little runny nose, and then suddenly awaken with this barking cough. Many times the noise emanating from the child’s room sounds more like a sick animal than your previously healthy toddler and may be alarming to both parents and the child.  

Whenever you awaken to a croupy child, the first thing to do is turn on the hot shower and shut the bathroom door as you head down the hall to your child’s room.  After getting your child, grab several of their favorite books and head back to the steamy bathroom. Sit in the bathroom and try to calm your child down and let the steam work.

Typically in several minutes (or until the hot water runs out) their coughing should improve and they will relax. Remember, they have suddenly awakened and are trying to figure out what is going on as well so they may appear to be tired and anxious as well.

In most cases the steam and humidity will help to relax the airway. If the steam doesn’t seem to be working after 5– 10 minutes try going outside into the cool night air. Many times a frantic parent will put their child into the car for a trip to the ER, only to find the child perfectly calm and no longer coughing on arrival to the hospital. The reason being, the cool air has also helped to calm the coughing.

If your child is having stridor (a high pitched squeal) when they breath in and appears to be having any respiratory distress with pulling of their ribs when they are breathing (called retractions), then you need to call your doctor. If they are coughing and turning bright red while coughing be reassured that they are still moving air well. You should not see any duskiness or blue color and if you do call 911. (Remember the adage blue is bad, and red is good).

If by morning your child is having continued symptoms you may want to see your doctor as steroids (given orally or by injection) may be used to help shrink the airway swelling. Most cases of croup do not require hospitalization. After several days of croup your child will probably be well.  

Lastly, older children and adults may also get the virus that causes croup, but with larger airways will simply show signs of laryngitis and being hoarse.

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

Daily Dose

Afraid Of The Dark?

Dr. Sue has advice on ways to help your child get over their fear of the dark.Just about every child goes through a phase when they become afraid of the dark.  It is interesting to see a toddler who happily goes to bed in their crib in complete darkness, turn into a 2 year old who is afraid of shadows and monsters in a dark room. How does that happen, seemingly overnight?

Actually fear is a normal part of development, and is usually  seen  in children around 2 -3 years of age. Fears develop when a child is old enough to have an imagination, but is not yet old enough to distinguish fantasy from reality.  Try telling your 3 year old “that ghosts aren’t real” and to “just go to sleep”, and I guarantee you will lose that discussion.

Fear of the dark is called “nyctophobia” and is amazingly common.  Even as an adult,  my worries and anxieties seem to be worse in the middle of the night in the darkness, than the same issues are during daylight hours.  A toddler has a very active imagination, which is also influenced by things that they see and hear  throughout the day.  Television shows and videos that they have watched or books that they have read may seem innocent enough during the day but may be a scary memory  at night. When a child goes to bed, even after a lovely, calming bedtime routine, there are few distractions to keep their minds occupied and their young brains go into high gear in a dark room. The shadows are definitely a witch that they saw in a movie, or the noise in the hallway is a “bad guy”.  They are very real and VERY SCARY. The best way to conquer fear is to discuss a child’s fears with them.  Talk about things that seem to make them afraid and turn off the TVs and stimulating videos.  Draw pictures of the scary thoughts and then have a party to throw them away.  By empowering them to talk about their fears will often help children feel better.  Teach them about positive self talk, with phrases such as” I am not afraid, it is just dark” or “I am not alone, Mommy and Daddy are in the other room”. Another strategy that worked in our house was the “bedtime box”.  We decorated a shoe box and filled it with things to help make our boys feel safe and able to handle their fears. In the box was a flashlight, extra batteries ( for the “what if the batteries go out” discussion), a magic wand and monster dust to sprinkle in the room (glitter), and their favorite books.  They knew this box was there every night if they needed it.  Children will also often want a night light and some may even want the lights on for a while, but let them feel like they are in control. Lastly, there are lots of books to read with your children about being afraid of the dark. Take a trip to the library, ask the librarian for suggestions. A few of our favorites were  “The Dark, Dark Night” and “Can’t You Sleep Little Bear”. Children’s fear of the dark usually resolves around 4 -5 years of age as their magical thinking matures. That's your daily dose for today.  We'll chat again soon.


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