Daily Dose

Chapped Cheeks

1.15 to read

Weather is crazy around the country and those cold temps continue. It was in the 80s this past weekend in Dallas but heading to the 20s this week!This really cold and dry winter has been hard on skin and I have seen more babies like this one who are coming in due to having “red cheeks”.  

These precious little red cheeks are just dry and chapped.  The toddler set seems be particularly affected as they are always getting their faces wiped!! Between those winter runny noses which parents are constantly having to wipe and the wiping of faces after finger foods have been “smeared” from cheek to cheek, a toddler’s face gets lots of wear and tear.

While it would seem that water on the face from lots of washing would be hydrating, it is actually not. At this time of year, a little less face washing is beneficial, but what toddler can go for more than an hour or so without having something washed off their face.

So to counteract all of the dryness requires lots of hydration with moisturizers. Right after washing, wiping your child’s face you need to use a thick moisturizer.  You cannot over moisturize your child during this time of year.   I am a fan of Cerave Cream and Aquaphor.  I often use Cerave (cream is thicker than the lotion) during the day and then lather on Aquaphor at bedtime!!  The thick moisturizer helps hold the water into the skin.   I was even known to rub Aquaphor on my own’s childrens’ faces once they were asleep, so they were not tempted to rub it off!!

Don’t worry, once the weather warms up, the heat is off and the humidity starts those rosy little cheeks will fade away....unless that is you don’t use sunscreen, but that is another blog!!

Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

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

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

Talking With Children About Sex Education

None of us wants our children to have bad memories of how they learned about their own bodies and sexuality.I have been helping teach a course to elementary students on their bodies and sexuality. It is really interesting as we teach both parents and their children, in separate rooms, so that parents are comfortable with discussing sexuality with their children as well as having doctors and nurses teach basic sex education to their children. It is a three-week series with different topics each week and really opens up the lines of discussion for parents and gives them information for further subjects and discussion as their child matures.

The most striking thing to me is how many parents admit to being "afraid or nervous" or feel ill-prepared for this discussion and many of those feelings come from their own experience learning about "the birds and the bees". If there is anything to learn from this, one would think, is that none of us wants our children to have bad memories of how they learned about their own bodies and sexuality. So, I recommend that starting from a young age you use the correct noun for body parts. No one has a problem saying this is your eye, or nose or ear, so when identifying other body parts stick with the correct words. By doing so you begin this journey of sex education with the correct words at hand. It is easier to discuss a subject with knowledge of the body part you are talking about than having to back track and re name things. Lastly, when your child asks a question, take the time to answer them truthfully, even if it is only a one-line answer, rather than saying "I can't talk to you about that yet" or something along those lines. Open the door slowly and it is easier to go in....remember it is a continuum of information which does not end for many years. That's your daily dose, we'll chat again tomorrow.

Daily Dose

When Parents Date

1.30 to read

I recently saw some patients of mine who are now teens. They were brought in for their check ups by their father who i had not seen in some time.  He has a boy and a girl about 16 and 14 years old.  I knew that there had been some “issues” within their family, but is had actually been several years since i had seen them.

As it turns out the parents had divorced, the mother had some problems with addiction and the father now had custody of the children. He was trying to get “everything back on track”, including visits to the pediatrician.  

After seeing each of the kids alone and talking to them, they actually seemed to be doing extremely well. They had seen a counselor during some of the more tumultuous times and were happy to be in a “stable” environment and had “less family stress” as they put it. They were both doing well in school, had lots of friends and were involved in different sports and school activities.  They said that their sad had been instrumental in getting things “back to normal”, or back to a “new normal”.  

I also visited with the dad and he told me he had a new concern.  He was really happy about how well his children were doing, all good.   It seems that he had just started dating agiain, and he was not quite sure how to handle the subject with his kids.  He told me that he had had several dates and his kids wanted to know....what’s next?

I had to laugh a bit, as we had just discussed his children dating and going to Homecoming. My response was,  “be honest with them”.  If you asked your teen after 2 dates “where is this going?”, they would probably reply, “dad, who knows, we’ve only had 2 dates...I’m not getting married!”.

I told him I would tell his children the same thing,  in a manner of speaking. I would acknowledge that I was enjoying dating, that I had no plans to get married any time soon, and did not even know if i was ready to be “exclusive” ( is that the adult version of Facebook official?) with anyone at this point.  

I would also make it clear that I would keep them updated if and when things changed, but in the meantime they did not need to worry. Their dad would be there everyday to get their breakfast, have dinner with them and continue their “new normal”. It was just such a good feeling seeing all of them happy!

Daily Dose

Kids Should Drink Milk, Even If It Is Chocolate

2.00 to read

I have always be a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.I have always been a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.

It is easy to have children drink milk when they are toddlers, but as children get older and decide that they “prefer” water or even juices or soft drinks it may be harder to get them to choose milk. Unfortunately, once a child enters the “real” world with school and sports, they realize that there are other beverages offered besides milk. So, what to do?  Well, I think it is preferable to have children and adolescents continue to drink milk, even if it means having chocolate or strawberry milk. There have actually been studies in the pediatric literature that have shown it is preferable to have a few extra calories from the sweetener in flavored milks, than to forgo drinking milk. Like many things, it is a trade off. It is difficult to provide a child’s daily calcium and vitamin requirements without having several glasses of milk a day as well as other dairy products. When looking at the calorie content for low fat chocolate milk compared to low fat milk we are only talking about 30 – 50 calorie difference per cup of milk (it seems to depend on the brand). I know that the calories may be cumulative, but if you take away a sugary cereal in the morning, or that after school fast food, the calorie difference would never be noticed. One could also argue that if we our children spent more time playing outside rather than on their play stations or computers, the extra calories from chocolate milk would never be noticed. Bottom line, it’s all about choices. Over the years I have also found that many children want to drink chocolate milk for the short-term and then will come back to regular white milk. If they continue to drink milk throughout their childhood they are also more likely to drink milk as young adults, which is still an important time for “banking calcium”. Bone health and many of the exciting new studies regarding vitamin D continue to outweigh the debate about calories. I really don’t think that my overweight patients are getting their extra calories from milk, but rather cookies, fast foods, and soft drinks. I wish milk was the culprit. Lastly, I did have chocolate milk in our house, but if you are really worried about the calories, I have been known to “dilute” chocolate milk with white milk and it is still chocolate. There are lots of little things like that we can do as parents and it seems to work well for everyone. I will have other Mommy secrets later; remind me about trying that with cereals. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

No More Fever Phobia!

1.30 to read

Parental concerns about children with fever continues to be the primary reason for phone calls to pediatricians offices, visits to the doctor and late night trips to the ER.  The term “fever phobia” is not new and one of the hardest things to “teach” parents is the mantra “fever is your friend”. What?  How can that be?  What if the thermometer reads 103.7 degrees?  Well, the latest report by the American Academy of Pediatrics reiterates that fever phobia is an unnecessary and unfounded worry, as the number on the thermometer is just that, a number, and is not indicative of degree of illness.  In other words, degrees Fahrenheit does not correlate with degree of illness. It is hard not to think that a thermometer that reads 103.7 degrees is not indicative of a life threatening illness. But fever in and of itself is a symptom and not an illness. The body’s reaction to fighting an infection is typically a febrile response, and fever may be a protective mechanism. I spend a lot of time with my patients and their parents discussing fever and what a fever means.  It is hard to discuss a fever in the abstract, and most parents say that they will not “fear a fever”. But, when the actual time arrives and their child has a fever, it is a whole different thing. Despite all of the education about “fever is your friend” the thermometer with 103.7 degrees flashing at you is a scary proposition. Of course it seems reasonable to think your child is” sicker” if their temperature is higher, and I know as a mother and pediatrician, your child does “look pathetic” with a high fever. The fever makes you feel yucky, and your heart rate goes up as does your child’s respiratory rate, this is a body’s normal response to a fever. When you have a higher temperature you don’t feel a lot like eating or playing, you are often happy to just lay on the bed or a couch and watch a movie and eat a popsicle or have a glass of Gatorade. But, taking fluids and watching a movie or quietly reading a book is a good sign that your child is not “too” sick. Young children with a fever are often whiny and pathetic, but they will have moments when they will play, or eat a cookie, and then become pathetic again soon thereafter. That up and down is a good sign. Treating a fever with either acetaminophen or ibuprofen is recommended only to make your child feel better. Treating a fever is not always necessary and some studies show that an illness may resolve sooner if the fever is left untreated. When and if you do decide to treat your child’s fever, make sure that you use the correct dosage of medication, which should be based on a child’s weight. I try to give each family a medication-dosing chart for acetaminophen and ibuprofen at their 2 month visit so that they may tape it inside the medicine cabinet and can refer to it when needed. I promise you there will be many nights of fever to face during the course of parenting!  As you learn to “relax” while reading a thermometer, each illness will become a little easier. Lastly, it is not necessary to awaken a child from a nap or during the night to take their temperature, or treat a fever. An uncomfortable child will wake up and demand your attention.  Fever does not cause “a scrambled brain” (term from a patient of mine), and you will not have caused brain damage if you let your child sleep with a fever. Sleep is usually one of the best treatments for illness, so let a feverish child rest and wait to take their temperature and treat the number on the thermometer. Chant with me “fever is your friend”!!! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Sick Child? Have Patience

1:30 to read

I just got off the phone from texting with the mother of a 3 year old patient of mine. It was late in the afternoon and her son had just started crying that his mouth hurt.  I was texting her from the back of a car en route to the airport..the wonders of technology!

She was concerned because the pain had come on so abruptly, but she text me that he did not have a fever, had not had a fall or trauma to hurt his mouth, and that when he opened his mouth she could not see anything that would cause “obvious pain”.  

I asked her a few more questions via text and recommended that she might try giving him a dose of ibuprofen and see if he calmed down and felt better, but I did not hear back from her for awhile.

It was then that I realized that pediatrics and parenting have quite a bit in common…one of the similarities being patience.  

While she was concerned that her child had suddenly started crying due to some sort of pain, much of pediatrics is about watching and waiting.  We parents all want to keep our children pain free, but sometimes things will hurt both physically, and as your child gets older, emotionally (which may be even worse to watch).  A parents first instinct is to find the cause of the pain and “fix it”.  Whether that means a band aid, a kiss on a boo-boo, or medicine.. “just make it better”.

But in many cases in pediatrics and actually all of medicine, it is about watching, following, and waiting, which is not as easy as it may sound. Doctors, parents and patients often have to “be patient” and see what evolves.  Not all tummy aches are cases of appendicitis, not all falls cause a concussion and not all boo-boos result in broken bones (thank goodness!).

But for a parent to hear “let’s see what happens in an hour or so” may sound like a lifetime and waiting just seems crazy when there is a “doc in the box” on every corner.  You may see where I am going with this.

So, by the time I heard back from this concerned mother, she was already at the nearby “doc in the box” waiting for a doctor to see her son, who by now had stopped crying.  She had already put him in the carseat for the drive to the clinic before she read my text, so he had not even had any ibuprofen.

According to the clinic doctor (or nurse), the child “had an ear infection causing his pain” and she was given a prescription for antibiotics.  Once the mother was home and I could talk to her I asked if they had prescribed medication for pain relief, such as ear drops and/or ibuprofen. She said she only had the antibiotic prescription which she had filled, but her child had stopped complaining of pain.

So, I was not there, and did not see her child, but I wonder if ibuprofen might have done the trick and alleviated his pain..and also kept him off of an antibiotic until he could be seen the following day in the office?

But in this age of “quick” medicine and a clinic on every corner,  a patient/parent may not need to wait and see what evolves. I wonder if this “quick” medicine may be one reason we see antibiotic overuse . I’m just saying….  


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