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Daily Dose

Prevent Common Injuries

1.00 to read

This week, I saw two of my little patients who sustained very common injuries which served as good safety reminders to parents especially new ones. 

A 4 month old little girl was sitting in her Bumbo chair after her dad placed the chair on the counter while he was unloading groceries. Somehow the baby managed to squirm and tip the Bumbo chair off the counter.  She cried for a minute but then seemed to be fine so the parents felt as if they were lucky and no major injury had occurred. 

The following day they noted that she would not bear weight on one of her legs when she was being held to stand. They also thought the leg looked a bit swollen. The little girl was still happy and playful if you left her leg alone.  After being examined I sent her for an x-ray which showed that her tibia had a small fracture. 

Because the fracture was tiny and not displaced, the pediatric orthopedist did not need to cast the baby. I just saw her again and she is already bearing weight on her leg and all is well.  The mother’s comment was the side of the Bumbo chair clearly says “do not place on counter, but I guess Daddy did not read that!”  Reminder to all, put the chair on the floor and not up on something where it might tip off! 

Another toddler was in for a head injury which he sustained after a TV fell over on him.  He had climbed up to grab the remote from the top of the TV which then tipped over. Luckily he was not trapped under the TV, but he did have a big knot on his forehead.

The CDC reports that an estimated 13,700 children were treated in ER’s between 20008 - 2010 due to being “struck by a television”. With newer front heavy TV’s, it seems as if these injuries are on the rise. 

The American Academy of Pediatrics recommends that televisions are placed on low stands and push the TV back on the furniture as far as possible.  Ideally the TV and stand should be secured to the wall with appropriate anchoring devices as well. 

Two cute patients, worried yet relieved parents and no major injuries made for a good week.

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

Daily Dose

K2: New Legal "Drug" For Teens?

1.30 to read

I was seeing patients the other day when I saw a teenage boy that I have taken care of since he was born (one of the perks of being a pediatrician).  He came in over lunch with his mother, as she had called me earlier that morning, and she wanted him to have a drug screen. She had found a “pipe” in some pants of his and she was concerned that he was smoking marijuana.  I am often asked to perform drug screens on kids, and I really think it is important to sit down with the child and parents to discuss their concern, rather than ruin the trust of the teen, and blindside them with the results of a drug screen obtained under false pretenses. So…the point of this is that the adolescent told me that he had been smoking K2.  He told me that it was a “legal” substance that you could buy over the internet or in smoke shops. K2 is a mixture of herbal and spice products that are then sprayed with a psychotropic drug.  When asked why he would smoke it, he told me that it had similar effects as marijuana with an overall feeling of feeling good, sleepy, and relaxed.   Seeing that I did not know anything about this new substance, I got my computer, brought it into the exam room and “googled” K2, only to see many different articles. The most interesting was an article in LiveScience written earlier this year, that explained how K2 had been developed by a research scientist who was studying cannabinoid receptors in the brain.  He had published articles about this substance (which when first discovered went by his initials, JWH-018),  and had found that that K2 binds to the same receptors in the brain as marijuana, and that it is actually much more potent than marijuana. K2 may be 10 times more active than THC (marijuana) and while it may have many of the same effects as the high with marijuana, it  has also been found to cause hallucinations, and seizures. Upon further investigation, I found that it is becoming a problem in many states with plenty of information on the internet. K2 has already been declared illegal in the state of Kansas.  There are concerns that this drug has caused adverse effects and ER visits due to hallucinations, vomiting, elevated blood pressure and heart rate, which are not typical symptoms seen with marijuana.  K2 does not show up on routine drug screens.  There is a researcher in St. Louis who is studying K2 and is seeking urine samples obtained from teens who have used the substance.  I called several private labs in my area and they did not have the capability of testing for it. The good news in my patient’s case is that he told me about K2, had not smoked it in the last several weeks, and his urine drug screen was negative for marijuana and other drugs. Oh the things we must learn to keep up with adolescents! How someone discovered the article written in scientific journals in the late 1990’s and extrapolated that this compound, which binds to the same receptors in the brain as marijuana, could be used “legally” for a high similar to “weed”  is beyond me.  But kids are really “smart and clever” and will do almost anything for a “high” especially in this case with a product that is easily obtained and is legal.  After a lengthy discussion with this boy and his mother I understand that K2 use is quite prevalent in his high school, even among the “non-drug” crowd. I am going to continue researching this topic and will keep you posted. But if you have an adolescent who you think exhibits odd behavior and may even require a visit to the ER for a suspected overdose, and the drug screen turns out to be negative, be aware of K2. Lastly, talk to your teens, they are probably already in the know. That's your daily dose.  We'll chat again tomorrow.

Daily Dose

Babies and Jog Strollers

I seem to get a lot of questions from new parents that are runners about using the jogging stroller with their newborn or baby. I have researched this issue in the pediatric literature and I cannot find a consensus statement discussing when it is safe and appropriate to use a baby jogger with a newborn. (Could this be a double blind controlled study waiting to happen?)

Intuitively, it seems that using a your-baby jogger to walk or run with your newborn would be safe if you are covering the same terrain that you would with a regular stroller, i.e. not climbing Mt. Everest or running down the side of a mountain, over rugged terrain or over pot-holes which seem to be the most common problem in our neighborhood. All of these activities would also seem detrimental to the mother in the post-partum period, and despite being avid joggers it is important that a new mother not overexert herself. Most OB's recommend that a postpartum mother limit her physical activity for the first four to six weeks and I agree. It may be important for a new mother's sanity to get some light exercise, like a walk around the block, but not a 5-mile jog until they have been given the go ahead by their OB. If you push yourself too quickly you will see that it does take a toll both on your breast milk production and overall energy level. Just give it a few weeks to catch up with you as your euphoria and the hormones involved fade and you realize that you really are exhausted. Use the first few weeks after have a your baby to lounge around in your nightgown, take a catnap and enjoy just staring at your newborn!! It is really the only time you will get that opportunity and the run will be there in a few weeks. This being said, the issue is really with the baby, and making sure that an infant's neck is supported while they are in the jogger. The manufacturers of many of the most popular baby joggers have come out with a car seat apparatus that fits into the jogger, for use with younger babies. This has head and neck support with cushioning and may be used until your your-baby develops more neck support at around 4 months of age. I have had many parents of infants who have started taking their baby on walks/runs at around four to six weeks of age gradually increasing the length of their exercise, while the baby seems to be quite happy snuggled in the jogger. Some parents say this is their  baby's best sleep and can always be assured that their infant will calm down once they get moving. Much more economical than driving the your-baby around in the car too, which also seems to be a good calming maneuver. The only other issue is weather related. Make sure that your infant is well hydrated in the summer, wears a hat and sunscreen and is also shaded with an awning. Sun can penetrate the stroller awning so do not assume that your your-baby is not getting sun exposure. If bugs are a problem use mosquito netting too. The rule of thumb is if you are hot (or cold, during the winter months) so is your baby, so dress them appropriately and don't overdue it. That's your daily dose, we'll chat again tomorrow. 

Daily Dose

Skin Rash: Fifth's Disease

Even though it already feels like summer across many parts of the nation, I’m still seeing typical spring illnesses like Fifth’s disease.  Fifth’s disease is a common viral illness seen in children, often in the late winter and spring.

Many of these children look like they have gotten a little “sunburn” on their faces as they often show up with the typical “slapped cheek” rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks. Fifth’s is also called erythema infectiosum and is so named as it is the fifth of six rash associated illness of childhood. Fifth’s disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa. In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of “not feeling well’ and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed. When I see a child with Fifth’s disease it is usually an easy diagnosis based on their few symptoms and the typical rash. Although children with Fifth’s are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you “never know” where you got this virus. (the incubation period is somewhere between 4-20 days after exposure). Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10 – 60% of students in a class may become infected. Most adults have had Fifth’s disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a “memorable” event during childhood. Fifth’s disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve. I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas.  Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a hot spring/summer day may work just as well too. Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth’s disease, so it is business as usual with school, end of year parties, and summer play dates! That’s your daily dose for today.  We’ll chat again tomorrow!

Daily Dose

Surviving Picky Eating

It's been a busy day in the office and a lot of parents have had questions about picky eaters.It was a busy week in my pediatric office (always is!) and one of the hot topics surrounded picky eating.  The issue of picky eating seems to be on every parent's list from one to 18 years. Actually, picky eating is not as much of a subject in the older kids, seems that there are bigger issues and also hopefully the picky eating resolved when the child was younger.

I think that food is important for nutrition, nurturing, time spent together over a meal, etc....but it is not a big issue if you are relaxed about feeding your child. If you begin preparing your child healthy meals from the age of one year, provide them with many opportunities to experience different foods, and realize that most toddlers are picky regardless of what you feed them, they will eventually become good eaters. Parents worry that "they will starve" if I don't fix their favorite food every night. Children are SMART and they are smarter than we are, they self regulate and eat when they are actually hungry. If you provide a well-balanced meal three times a day, most younger kids will eat one fairly well and may pick at two. That does not mean that they need a different meal when they pick or refuse to eat, it just means they are not hungry at that time and should nicely be reminded that they might be hungry later, but not forced to eat. Along those same lines, when it is snack time later in the day, they should be given something healthy (even that sandwich or fruit that they refused at lunch) and not crackers and goldfish. Again, let them decide whether to eat it. IF you take the high road on this issue, hang in there for a LONG time, you will be pleasantly surprised that they become "good eaters", eat a wide variety of foods and know that you are not the short order cook at home. Those picky toddlers continue to gain weight, learn their colors and alphabet and grow into children that enjoy mealtime together. That's your daily dose, we'll chat tomorrow.

Daily Dose

RSV is Going Around

RSV is here and can be one of the scariest illnesses for parents of young babies. Dr. Sue tells you what this virus is and the best ways to treat it. Whew, this is a  busy week! Busy for you too, I'm sure. I've seen many coughs, colds and another baby with RSV.  RSV is the acronym for respiratory synctial virus, which is a winter-time upper respiratory infection that causes colds and coughs, but also an illness known as bronchiolitis.

Bronchiolitis is an inflammation of the lower respiratory tract that is seen in infants and young children, often due to a viral infection. At this time of year, throughout the country,  the most common cause of bronchiolitis is RSV.  RSV is seasonal virus, and is  typically seen from November until April, but in recent days and weeks, the number of  young children coming to my office with coughs and wheezing just sky rocketed. Once you hear the frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, you know that RSV has arrived. Unfortunately, in my area it looks like it is going to be a busy RSV season. RSV is a viral infection, and like so many other viruses, including influenza, some years the virus just seems worse than others.  In the last few days I have already admitted several babies who had RSV bronchiolitis, and have required hospitalization for supportive care with oxygen supplementation. Fortunately, they are doing well and no one required intensive care. At this time of year, every parent I see who has brought in their sick, coughing, wheezing baby hears basically the same thing. “Your baby probably has RSV which is a viral infection, somewhat like a cold .” When you say RSV, they all cringe, but you need to understand what you are looking for. When older children and adults get this infection, we get a nasty cough, lots of congestion and have a dreaded winter cold.  But, when a baby gets this infection the virus may cause inflammation and constriction of the lower respiratory tract which results in wheezing and in some cases difficulty breathing. The key point is “difficulty breathing”. Babies who are having difficulty breathing will not only have a frequent tight cough, but they will also exhibit signs of “increased work of breathing”.  This means that you may notice that the infant is retracting, which means that they are using their rib muscles or abdominal muscles to help them breath.  This is a visible sign of respiratory distress, and you will see their chest cage move in and out as they work to breath. Babies may also grunt with each breath, or cough so hard that they turn dusky or blue. All of these symptoms are significant and are need for concern and a visit to the pediatrician.   With that being said, most babies handle the virus and will cough and wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear “pathetic” and cough a lot and be up and down at night due to cough and congestion, but they will not show signs of retracting or increased work of breathing. When your baby has a cold and cough it is imperative that you look at their chests. That means turn on the lights, lift up their jammies or unzip their onesie and look at how they are breathing. Is their chest sinking in with each breath?  Can you see their ribs moving in and out as they are retracting?  Are the using their abdominal muscles to help them breath?  Can you hear a wheeze or grunting or are they just congested and coughing? Lastly, look at their color. A baby who is coughing and turning red in the face is good, a baby with a  dusky or blue face or lips or mouth is bad. It is basic:  red is good, blue is bad! For infants who are showing signs of respiratory distress, they may need to be hospitalized for supportive care, and supplemental oxygen. (there is are recent study about using hypertonic saline treatments for hospitalized babies. It looks interesting).  Because RSV is a virus, antibiotics won’t help.  There are no medications to “fix” the problem.  It is once again “tincture of time” for the illness to run its course. That may mean several days to a week in the hospital for some babies. That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue.

Daily Dose

Family Movie Night!

Gather your family for Family Movie Night! It's much more than just watching a movie.Well, the weather here turned cold with a combination of rain, sleet and snow and bulletins of more to come, so we are all homebound and what better time to have a family movie night!  We started the tradition of Friday night family movie night when our boys were young.  We watched  “Homeward Bound”, “Land Before Time”, “ET”, “Mary Poppins”, “The Lion King”, the list goes on and on!

It was a Friday night treat to come home from work and  order a pizza (which I think we must have done every Friday for at least 10 years, using one of those mailer coupons ). The kids would gather their favorite blankets and pillows and all cuddle up for the Friday night movie. If on occasion a friend was asked to spend the night we would explain movie night to their parents, to ensure that their family also okayed the movie choice. Movie choices in the early years were fairly easy, the issues surrounding picking age appropriate movies became a little more “tricky” as the oldest son became 13 and resisted watching G movies. He insisted that he watch a PG-13 movie once of age, even though he really still enjoyed the old family favorites.  This is when we began to have negotiations and pre-parental movie watching to screen movies. I found that not all PG-13 movies had what I would deem inappropriate subject matter for a 10 or 11 year old.  The rating system in and of itself, was not always as good a predictor of content as I expected.  I do remember that there were several PG-13 movies that seemed to have a better message than a G movie.  Nothing is 100%, right?  There were also times that mid way through a movie we would decide to “turn it off for whatever reason,” which led to many a discussion as to language and innuendo etc. As our sons grew older the family movie night continued although we would often grab a quick dinner and head to a movie theater rather than have pizza.  There were lengthy discussions over movie reviews, “guy vs. girl” movies and we all took turns in making suggestions. If someone picked dinner, then another person got to pick the movie. We did see some” bad” movies together, but the important part was that we were all together!!!  Even now, when we have the privilege of having everyone home for a holiday, we enjoy going to movies as a family.   We talk about our memories of where we saw “Home Alone” or “Finding Nemo”.  The guys still insist on having Milk Duds or Sour Patch Kids for movie watching, and now that they are older they don’t even have to “share their drink”.  As so many things change over time, the movie theater experience remains pretty much the same, just more expensive. Movie night is a great way to stay connected as a family. Pick a night once a week or once a month and commit to enjoy a movie with your children. It is a great way to launch discussion and interaction and make memories while doing it. Try it and let me know how it goes!

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

Talking To Children About Sex

With the recent news that teenage pregnancy rates are on the rise for the first time in over 20 years, it seems to be a good time to discuss the importance of talking to your children about sex.With the teenage pregnancy rates on the rise over the past 2 years, it seems to be a good time to discuss the importance of talking to your children about sex. The “birds and the bees” talk is a sentinel moment and should be a required prerequisite before your child enters middle school. For some parents this “talk” is easy and does not intimidate them, but for others they get sweaty palms, and feel sick to their stomachs.

I am sure there is also a group in between. Wherever you fall in the spectrum really doesn’t matter, but this is one of the most important discussions parents will have with their children.  Many parents start discussing the differences between boys and girls as young as age 4 or 5. I myself have given this talk countless times and teach a class at our church as well. But, when it was time to discuss this with our first son, I too felt ill prepared. The discussion was necessitated as he was about eight-years-old and kept singing a song with the words “sex you up” in it. Obviously, I had let him listen to some inappropriate song on the radio. Nevertheless, this prompted my husband and myself to head to the bookstore to look for the appropriate book/books to begin the initial discussion and I know that book has been well worn over the years. It was not detailed, but explained in fairly simple terms how a “mommy and a daddy” each had “special parts, (which were identified correctly) that “connected” and that a sperm and an egg came together to make a baby. It was very basic, with simple cartoonish type pictures. We read the book and had a discussion together and answered any questions that he had. It went fairly well, he took in the information and went outside to play. That is just the beginning. The time came up again for further discussion when he announced at about age nine that his pet hamster, Sally, “was going to have babies.” Immaculate conception alone in her cage. Discussion number two was just around the corner. I myself do not think that any one discussion about human reproduction and sex is enough. It also depends when you begin these discussions. Some inquisitive children will ask hundreds of questions, while others won’t say a word, either way the talks must go on. Keep the information age appropriate no matter where you begin. Don’t be embarrassed as if you are they will be too. That is why it is called: The Facts of Life. But as children enter their teen years I think the discussions should be explicit and open. If you think they cannot find any information they would like by just surfing the web, then wake up, as it is all there. I would much rather sit down with my own children and discuss every detail they would like to know and at the same type impart factual information as well as our family values. The more information you give them the better decisions they may make. I believe that they should be taught abstinence, but also what to do if they are going to engage in pre-marital sex, which by the way does include oral sex. Let them know about condoms, birth control and other methods to prevent STD’s and pregnancy. We are failing our children if we do not empower them to make thoughtful, well informed choices with as much guidance as we can give them. Seeing the teen birth rate on the rise should never be due to lack of information and family discussions. That’s your daily dose, we’ll chat again tomorrow. Send Dr. Sue your question now!

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