Daily Dose

Say No to Tanning Beds!

1.30 to read

I have previously discussed the importance of sunscreen but it is equally important to discuss the risk of artificial tanning and the use of tanning beds. I have emphasized that it is never too young to start using sunscreen, but for some reason teens think that tanning beds are a safe way to tan rather than going outside in the sun.

Not so.....tanning beds are using UVA radiation which can cause mutations in your DNA which can then lead to skin cancers. Dermatologists are seeing an increase in young women (who are more likely to use tanning booths) in their mid to late 20’s with  the deadliest form of skin cancer, malignant melanoma. Many of these women admit to frequent tanning during their teen age years.

Malignant melanoma is different than basal cell carcinoma and squamous cell carcinoma,  the other more common forms of skin cancer. Malignant melanoma may spread rapidly to internal organs and lymph nodes, and if not detected at an early stage,  may be fatal within months to years.

Young girls need to understand the risks of using a tanning bed and should be encourage to use a spray tan or a tan towel to achieve the “glow” that they are wanting. They need to understand the risks that are proven to be associated with tanning bed use. Many teens and young adults are using tanning beds that are provided at their dorms or apartments as well.

If there is a family history of melanoma or unusual moles then the risk may be greater to develop an atypical mole. Those young adults who have tanned need to be followed by a dermatologist who can examine their body head to toe and “map” their moles and identify any unusual moles. At the same time they may be educated as to how to follow their own moles and changes they should be aware of.  Do you know that melanomas may arise anywhere on the body, not only the sun exposed area!

Recent articles have shown that tanning beds may be associated with an increase in non melanoma skin cancers as well. While these lesions may take longer to develop, teens and young adults need to be aware of this risk as well.

The state of California has become quite progressive in advocating for the safety of children and their skin.  California recently passed a law that children under the age of 18 may no longer use tanning beds. Other states are looking at similar legislation. Makes sense to me!

So....... no suntanning and no tanning beds. Rub, wipe or spray on your tan or enjoy beautiful fair skin. Not only is it safer, you don’t have to worry about wrinkles later in life (trust me on this issue!)

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

Daily Dose

Bright Light & Sneezing

1:30 to read

What is the connection between bright light and sneezing? DId you know it was hereditary?I have always noticed that I frequently sneeze when I walk outside, and this was especially noticeable this summer with all of the bright sunny HOT days that we experienced. I thought I had remembered that my mother often did this too and when I asked her she confirmed this.

I was recently reminded of this again when I was with my youngest son moving him back to school. It seemed that every time we walked outside to get another load of boxes he sneezed! We both sounded like “Sneezy” one of the Seven Dwarfs.

Of course my son announced, “Mom are you just realizing this? I have always sneezed just like Ohma and you do”. Oh well, I am finally catching on.

This of course piqued my curiosity and then I remembered that I had read something about “the photic sneeze reflex”.  It has also been name ACHOO: Autosomal Cholinergic Helio-Opthalmic Outburst (and you thought ACHOO was the sound you made!)

It is estimated that this reflex affects about 1 in 4 people. It is inherited in the autosomal dominant manner (remember your days in biology and big B and little b?) If you have the “sneezy gene” your child has a 50-50 chance of also having it.

This reflex has been known for a long time but there wasn’t much science as to the cause. But a recent study (very small only 20 people) compared photic sneezers to controls and found that when shown a shifting pattern of images, the visual cortex of the sneezers showed higher activity than those of the control subjects.

There needs to be much more research done on this topic with larger groups of people studied to further confirm this finding.  But, nevertheless, it is interesting that scientists are now trying to elucidate the mystery of the photic sneeze.

In the meantime I realized that another one of my son’s also has the gene. Funny how you suddenly recognize a familial pattern to sneezing only to find out it is in the genes. It also reminds me I have a blue eyed and 2 brown eyed children, back to those genes again.  Just like they taught me in medical school, take a good family history!

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

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Daily Dose

Teens Are Stressed Out

1.30 to read

If you have a teen it is hard to not hear the words,  “I am just stressed out!” on a regular basis.  I don’t remember ever saying that as a teen but I am sure there must of been some version of that saying, although there just wasn’t that much stress when I was growing up.  

Our society as a whole is so much more stressful (I think both real and perceived) and parents often utter the same words. But while the teenage years are sometimes difficult, and may be stressful at times, these years should also be filled with friends, fun and downtime.  There should be “lazy” days to fill with just “whatever”. 

But when I talk to my adolescent patients they tell me quite the contrary.  They are always worried about grades and start discussing SAT and ACT tests long before high school.  They have almost every precious waking hour filled with school (with crazy competitive class schedules), after school activities and homework after that.  Far too many teens are getting too little sleep (do you have a teen that gets the recommended 8 hours/night?), poor nutrition, and too much time on the internet. 

Stressed teens report difficulty falling asleep, or staying asleep which may lead to further problems with concentration and mood.  I see many high school students who think they “have ADHD”, who have never had issues before, but suddenly say they cannot focus or concentrate, which may be exacerbated by lack of sleep.  Trying to get them to believe that is not always easy!  Poor nutrition is also a problem as well, but again a teen does not always see “eating junk food” as poor nutrition. Their brains need protein and vegetable and fruits to keep functioning at warp speed, but skipping meals is quite common. 

Stress can often be reduced by parental involvement in daily schedules. I don’t mean that you tell your teen what to do all of the time. But the security that comes from knowing that there is breakfast daily, and that there is a family meal for dinner and that there is a “bedtime” when the computer and phone go dark actually helps make a teens life less stressful. Having parents who sit down to help a teenager see their way through a stressful event or provide wisdom or perspective may also help to alleviate stress. There needs to be a balance of “not being involved” but “being available”.  That is sometimes easier said than done. 

Stress is always going to be a part of life, but teenagers should not perceive that their life is constant stress and anxiety. They have plenty of time for that once they are parents, right?

Daily Dose

New Trend: Placenta Capsules?

1.30 to read

Okay, have you heard of placental encapsulation?  I recently had a new mother tell me about dissecting her placenta and putting it in capsules - which she swallows. I must say, I was gagging a bit while she explained this to me.  So like everyone else I went on line and looked up any data on this “new” trend. 

There is not much science on this subject, but plenty of sites that advertise people who are “placental encapsulators”. The practice of consuming the placenta is actually called placentaphagy - still sounds gross to me.  I know other species consume their placentas - but rarely is it done by humans.  

According to my patient’s mother (who also happened to be a patient of mine when she was a child), the placenta is supposed to help mother’s breast milk and provide hormonal “balance” post partum and thereby also reduce the incidence of post partum blues and depression.  (As a side note - I saw this young mother on day #4 post partum and she was teary and tired - just like most new mothers, despite the placenta pills).

The father of the new baby explained that he was given the placenta, in a “bio hazard” container after his wife’s delivery. He took it home and kept it in the refrigerator until the local placenta encapsulator person arrived at his house to begin the process. 

She “dried” the placenta in an apparatus (kind of like making your own beef jerky in a dissicator) and then 24 hours later crushed the dried placenta in her “Cuisinart” after which the mixture was placed in capsules.  My patient’s mother is now taking 2 tablets 4x/day and will do this until the capsules are gone. The number of days that you take the placenta depends on how much “dried placenta” is obtained - not a very precise science.

So.....I continue to learn new trends everyday.  This one is a bit tough for me to “swallow”.  I am awaiting science to have data that this is safe and worthwhile.  In the meantime, I have my study of one to gather data from.

 

Daily Dose

Lactose Intolerance

1.30 to read

A parent emailed me via our iPhone App and asked if her child’s constipation, which started as he was transitioning from formula to whole milk, could be a sign of lactose intolerance. She is concerned because her son is now having very hard stools.

Actually, lactose intolerance does not typically cause constipation, but conversely causes abdominal pain and often loose stools or diarrhea.  In the case of this 1 year old child who suddenly is having hard stools, it may seem to be “caused” by the switch from formula to whole milk, but is probably coincidental.

It is routinely recommended that parents stop giving a child a bottle and formula at 1 year, which often results in a toddler drinking less milk (recommended amount is about 16 ounces /day) and therefore they are getting less fluid which may result in harder stools. This is also the age that children’s diets are changing as they are self feeding and often eat a lot of carbohydrates (breads, noodles, rice etc) and fewer fruits and vegetables, even when offered as they become “pickier” eaters.

All told this often leads to bouts of constipation that can be managed with the addition of more fluids as well as clever ideas such as apple prune juice, bite sized prunes (often can be “sold” as raisins to a young child) and even with milk of magnesia if necessary. (see older posts on constipation)

Lactose intolerance is defined as the inability to digest lactose which is a sugar found in milk and milk products.  It is due to a deficiency in the enzyme lactase, which is produced by cells lining the small intestine.  Lactose intolerance is uncommon in young children and is typically not seen before the age of 2 -3 years.  It is more common in older children and teens who may complain of abdominal pain, cramping, gas, bloating and diarrhea after ingesting dairy products. In most cases lactose intolerance is diagnosed on clinical history alone, and if suspected is managed by eliminating dairy products to see if the symptoms improve. 

In many cases even children with a lactase deficiency may tolerate some lactose in their diet such as a scoop of ice cream, or milk on their cereal, but only experience symptoms when they have “too much milk”. Fortunately, there are products, such as lactose free milk, which will provide a child with the necessary vitamin D and calcium which is so important during childhood. Dietary supplements should also be used in children who do not drink milk in order that they meet their daily calcium and vitamin D requirements. Lastly, lactose intolerance is different than a milk allergy which is fairly uncommon and is due to an allergy to the proteins in milk, not the lactose.  True milk allergy usually presents in early infancy.

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

Daily Dose

Foods You Can Eat When Breast Feeding

1.30

Should breast feeding moms avoid certain foods?I was making hospital rounds today and talking to all of the new moms (and dads) about their newborns.  I love talking to new parents about the importance of having healthy meals to support breast feeding! I even had a young dad asking “what foods should I avoid cooking for my wife while breast feeding?”  How cute is that! Can we clone him?!

After breast feeding my 3 children, I have decided that you can really eat whatever you want!  I know some people swear that certain foods you eat will cause a breast fed baby to have gas. But think about it, bottle fed babies and breast fed infants all have GAS!  None of the formulas contain broccoli, or cauliflower or beans or tomatoes and bottle fed babies have gas too. It is just a fact, newborn babies are gassy for the first several months as their digestive tracts mature. And yes, it is stinky too! So… I told this dad, “good for you for cooking for your wife.  Make her healthy, well balanced meals and throw in a few of her favorite foods.”  I would not change anything unless you can definitely correlate that a food ALWAYS makes your baby more uncomfortable (and that is so hard to keep track of). Eat what you want (in moderation) to be healthy and happy.  I have no data but feel certain that happier mothers must in some way have an effect on a  baby, so at least enjoy mealtime. When I had a colicky baby (previous post), I tried eating only broth and bland foods, and with me equally miserable and starving…this stressful situation only got worse. Final words, if I was going to try eliminating anything from my diet while breastfeeding to try and help “relieve “a gassy baby, it would be excessive dairy, as there has been some data on this. Remember, everything in moderation. I’m willing to bet that by the time your baby is 4 months old (the magic age) you are not even worried about what you are eating, as you are having too much fun laughing with your baby! What foods (if any) bothered your baby while breast feeding? I would love your comments.  Leave them below. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Stop Bullying Now!

1.30 to read

October is National Bullying Prevention Month.  This is one topic that should be discussed with our children, and not only during the month of October.

Bullying is defined by an American Academy of Pediatrics (AAP) policy statement  as “a form of aggression in which one or more children repeatedly and intentionally intimidate, harass, or physically harm a victim who is perceived as unable to defend himself or herself”.  

Unfortunately, study after study shows that the incidence of bullying is on the rise with the most prevalent bullying occurring during the middle school years.  One study I read stated that “160,000 students skip school everyday to avoid being bullied”.  Another study stated that somewhere between 10-40% of middle school students report being bullied. 

Where does bullying begin?  Sadly, some of the bully behavior is modeled from parent to child, and parents can be part of the problem.  Good behavior and acceptance of others needs to begin in the home with parents discussing hurt feelings and mean language in the toddler years. How many times have you heard yourself saying to your own child, “when you say that it hurts my feelings”, or “did that person hurt your feelings?”  These lessons are taught early on, beginning in the sandbox. The discussions really continue throughout childhood but are obviously age appropriate.

When talking to my patients during middle school years about bullying and the “mean girls”  phenomena (verbal and cyber bullying is more common among girls, while physical bullying is more common among boys) I ask about their friendships and how they perceive themselves as friends. Many middle school patients of mine report feeling excluded from some groups, or events, but at the same time are learning how to decide who are their “real” friends. The discussion often comes back to the basic, “if you are nice to everyone, you will find that you are not very interesting to bully or gossip about”. Sounds easy, but it is really hard to always be nice. It is a good place to start.

Bullying not only causes emotional effects it is often linked to physical effects as well. Anxiety, depression, substance abuse, physical complaints  (head and tummy aches)  and even suicidal ideas may all arise due to bullying. These are all problems that I see in my own practice.  

Take some time to engage in a bit of dinner conversation and talk to your children about the various types of bullying and how to prevent it. 

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