Daily Dose

Is it Appendicitis?

1.15 to read

Last night, a patient called me and wondered if their daughter had appendicitis. I always thought it would be the easiest diagnosis, and that we would call the surgeon and whisk the patient off to the operating room for an appendectomy, just like Madeline (one of my favorite books as a child). Well, over the years have I been taught a few things. At times the diagnosis is easy. The patient has the classic symptoms of a "tummy ache" that starts around the belly button, they may vomit a few times and have a fever and the parent in all of us thinks, "yuk, another one of those tummy viruses". But over several hours the tummy aches worsens, and moves from around the belly button (peri-umbilical) to the right lower quadrant and the nausea and vomiting persist and your child just looks SICKER. At the same time you may notice that they have a funny walk, and won't stand up straight, as they try to get to the bathroom and when possible, they move very little at all, as any movement makes the pain worse. This is classic appendicitis. For a parent, that means a phone call to the pediatrician, day or night, as that child needs to be examined. On the other hand some children just forgot to read Nelson's text book of pediatrics. They don't vomit, they may not have a fever, they are a little nauseated, but when pressed could still eat, and it only hurts in their right lower quadrant, everything else is just okay. These are the difficult cases to diagnose. These children require a lot more history, repeat exams and lab tests and may even need a CAT scan to look at their appendix. But, you don't want to miss an appendicitis, as a perforated appendix is serious and requires a lengthy hospitalization. So as a parent and a doctor, if your child's tummy ache seems to be getting worse, it may be worth a trip to the doctor to feel that tummy, run a few tests and decide how to proceed. It is not always as easy as in a book or on TV. That's your daily dose, we'll chat tomorrow!

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

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

Daily Dose

What is a Fever?

1:30 to read

A child with a fever is one of the most frequent reasons a parent either calls their pediatrician or brings them to the office to be seen.  When I was a resident the term “fever phobia” came into use, and it referred to parents concerns about fever and its harmful consequences.  I must say, some 30 years later, fever phobia still persists and there is still a lot of inaccurate information floating around and even on the internet.

In fact, looking back at studies done in the 1980’s, 52% of parents thought that a fever of 104 degrees could cause serious neurological damage...and 20-30 years later 21% of parents still believe that brain damage is the primary harmful effect of fever and 14% even thought that fever alone could cause death.

So, here we go a fever update for all, especially for new parents to keep them from worrying unnecessarily.  Fever is just a symptom of an inflammatory response in the body, and may be due to many things including a viral infection, which is the most common reason for a child over 2 -3 months of age to develop a fever. Fever occurs when something in our bodies called “cytokines” are released and these increase the level of prostaglandins in the hypothalamus; and the hypothalamus is the body’s temperature regulator.  When this occurs the body’s thermostat elevates and raises the body’s internal temperature. There you go...lots of science...but trying to explain this in the middle of the night to an anxious parent....they really don’t care about cytokines!

Fever in and of itself does NOT cause brain damage and in fact may be beneficial to a child with a viral infection.  The most important thing for parents to watch is not the number on the thermometer (and many worried parents will take a temperature every 30 minutes to an hour), but rather how your child is behaving.  While your child may have 103.6 degree temperature are they still smiling on occasion and making good eye contact, are they still eating and drinking ( again maybe less than usual as they are sick), will they play with a toy off an on, or wake up from a nap and watch some TV?  (yes, you can still let your child watch TV when they are sick!). This is the hardest thing for me to help teach new parents....behavior is always far more important than any reading on a thermometer.

Parents of course want to do something to help their child’s fever. Treating your child’s fever with some acetaminophen or ibuprofen might make them more comfortable and therefore a bit happier as well. Make sure to use the appropriate dosages for weight and age and the correct dosing device as well when giving these medicines.

Getting through a few episodes of fever will also help...remember, “fever is your friend” and shows that your body is working to fight off that nasty virus....but if you are worried, always call your doctor!

Daily Dose

Your Baby's Poop

1.30 to read

I get so many questions about baby poop!!  It is interesting that most new parents (me included) are VERY interested in poop and a daily question is “did the baby poop?”  Pooping is very important in the initial newborn days as a baby begins to get milk and their stools change from the sticky dark meconium to “normal” baby poop. 

Once the meconium is passed baby stools can look much like diarrhea as they are often a bit watery, and are all sorts of different colors. If your baby is breast fed the stools are typically yellow, like mustard, and watery and have some “seedy bits” in the poop. I had a Dad who recently asked me, “what is the seedy part of the poop?” and I had to admit, no clue, that is just what they look like!  Formula fed babies have a bit less watery stools but they are still soft, like soft serve yogurt.  

Baby poop also comes in a myriad of colors with yellow, brown, green and orange all being normal.  A medical student once described it as “fall colors”.  Your baby’s poop should never have bright red blood, be tarry black or stark white. If you ever see that poop you need to save the diaper to show your doctor. 

Most babies will poop multiple times a day anywhere from 2-8 stools may be normal. But, with that being said, some babies are just efficient and only poop once every several days and are just fine. Everyone has a different poop schedule, right?!  As long as your baby is gaining weight, is comfortable and does not have a distended tummy and has soft stools it rarely matters how often they poop.  Many babies will grunt, groan, strain and turn bright red before they poop - but then out comes soft stool, so you don’t need to worry.

Parents will often keep track of how often a baby poops in the initial newborn period, but once you have seen your pediatrician and your baby is gaining weight it is not really important to write down every stool or feeding.  Take the time you would spend “charting” and either talk to your baby or take a quick nap. Both are more important than keeping a poop diary.

Just wait until your child is older.....then all you want to do is quit talking about poop and get them potty trained!

Daily Dose

Antibiotics May Boost Risk for Recurrent Ear Infection

1.15 to read

Did you know that repeated use of antibiotics to treat acute ear infections in young children increases the risk of recurrent ear infections by 20 percent? Researchers in the Netherlands found that 63 percent of children given the antibiotic amoxicillin had another ear infection within three years, compared with 43 percent of children given a placebo at the time of their initial infection. The results of the study are published online in the July edition of BMJ. Researchers looked at 168 children, aged six months to two years. In the group given amoxicillin, 47 out of 75 children had at least one recurrent ear infection, compared with 37 of 86 children in the placebo group. That equated to a 2.5 times higher risk of recurrent ear infection for the amoxicillin group. However, the study also found that 30 percent of children in the placebo group had ear, nose and throat surgery after their initial infection, compared with 21 percent in the amoxicillin group. The higher recurrence rate among children who took amoxicillin could be due to a weakening of their body's natural immune response as a result of taking an antibiotic at the initial stage of infection, the researchers said. Antibiotic use in such cases may cause an "unfavorable shift" toward the growth of resistant bacteria. Antibiotics may reduce the length and severity of the initial ear infection, but may also result in a higher number of recurrent infections and antibiotic resistance, the researchers stated. Because of this, they said, doctors need to be careful in their use of antibiotics in children with ear infections.

Daily Dose

Update on Autism

1:30 to read

Every parent watches for their baby’s first smile.  After the smiles are giggles and laughs and before you know it your baby is saying "dada" and "mama" and their vocabulary begins to explode. Suddenly you realize that your child is putting words together and may even start telling you what they want!  These developmental milestones all typically occur in the first 2 years of life.

Developmental screening is an important part of your visits to your pediatrician...especially for the first 2-3 years of life.  In many practices a parent fills out some sort of developmental screening questionnaire prior to their “well-baby” visit asking age appropriate questions....such as “does your child babble?”, “does your child point at objects?” “does your child play patty cake?”  “does your child put 2 words together?”.  During the check up your pediatrician is also watching how your child is interacting with their parents as well as with the doctor. I sometimes find that parents are “hard graders” and do not give their child credit for some milestones that I think they are actually doing when I am examining them.  Remember, there is a wide range of normal in the first several years of life. Not every baby does every thing at the same time!

Socialization and interaction is a very important part of early childhood development, but for some babies making eye contact and developing language skills is delayed. In fact,  for some children socialization and language seems to develop later and seems to be “different” than that of other children. These so called “red flags” in a baby’s development may be early signs of autism.  

The diagnosis of autism is typically not made until a child is between 18 months- 3 or 4 years of age.  The diagnosis of autism is based upon observation of a child’s communication and social interaction and for older children on their activities and interests. There is NOT a single test to diagnose autism.  In other words, your doctor cannot do a blood test to definitively diagnose autism spectrum disease (ASD). The diagnosis of ASD relies upon characteristic behaviors seen in a child, not on one milestone.

If you have concerns about your child’s development make sure you bring them up with your child’s pediatrician.  While it is hard for a parent to “wait and see” what happens over several months some babies will achieve their language and social skills later than others. Just like learning to read...some children do it earlier than others.

The most important thing is that you interact with your baby in those early years!! Talk, sing, read aloud and engage them in early play....as we know that every child needs that same stimulation.  

Daily Dose

Why Fever Is Your Child's Friend

Every parent is concerned about fever and why their child is running a fever.During the "sick season" I see 20 - 30 patients a day with a fever. Every parent is concerned about the fever and why their child is running a fever. Fever is one of the most common symptoms of childhood. Younger children run fevers quite frequently when they are sick. As we have talked about before, that may be four to eight times during the fall and winter season.

"Fever is our friend" has been one of my mantras for years. It is comforting for parents to understand that fever is a symptom that the body is fighting an infection. That is usually a viral infection that only lasts a few days, and lo and behold the fever is gone. The biggest myth is that fever, in and of itself, causes brain damage. Remember again, fever is simply a symptom.

The height of a fever does not correlate with severity of illness. Once again, higher fever does not necessarily mean you are sicker. Your child may feel awful with a fever of 101 or 104 degrees. Typically, once given either acetaminophen or ibuprofen for their fever, the temperature comes down a little and they symptomatically feel better for a while. Once the anti-pyretic (fever reducing) medications wear off, the fever will often return.

Children typically have more fever in the night, seems like darkness brings out the fever monster (that is the mother in me, but it was always true at my house) and those nights of fitful sleep, and hot little bodies seem very long. The other thing I have noticed, why do children who have had little sleep due to fever, coughs etc get up in the morning and do not long for a nap like their parents?

The other thing you need to keep in mind is that the higher the fever, the faster your child's heart will beat and the higher respiratory rate they will have. It is easy to climb into bed with your "hot" two year old and feel their heart pounding away, and know they have a high fever, even before the thermometer is out. This is the body's natural way of expending heat. Once the fever comes down you will notice that they are breathing less rapidly and their heart rate has come down too. Remember to offer plenty of fluids to a child with a fever, as they need extra fluids. They can eat too, but if not interested, a Popsicle or jell may be a good alternative. Just keep chanting, "fever is our friend." 

That's your daily dose, we'll chat again tomorrow.

Daily Dose

Leaving Your Child Home Alone

At what age can you leave your child home alone?

I get asked this question a lot "At what age can I leave my child home alone?"  There is no simple answer but a progressibe one.

I tend to think most children are ready to spend 20-30 minutes alone at home between the ages of 10-11, but every child is different.  It depends on a number of things including how your child feels about being alone, the length of time, and if you and your child have discussed how to handle emergencies and getting a hold of you or a neighbor in case there is an emergency or even just a question that needs to be answered.  

Well, this topic brought up an interesting question, what do you do when you leave your child alone and there is not a home phone?  I have never even given that a thought as I am “old school” and still have that landline in my house. It just gives me a “good feeling” to know that it is there, even if it rarely rings. (although the kids know to call the home number as I typically turn off the cell as soon as I hit the door from work).   

More and more families have given up a home phone and I think this brings up so many different topics for discussion, but for starts how does your child call you when you leave them alone?  Or how do they call the trusty neighbor if they need something.  Do you get them a cell phone? Do you have to have an extra cell phone to have at home?  It seems to me that a home phone is important for just that reason. In case of an emergency, your child can pick up the phone and call for help, assistance or just a friendly voice. I don’t think they need a cell phone!  

Also, landlines are relatively inexpensive. Cell phones for 8,10, 11 year olds?  Sounds inappropriate and expensive.  Wouldn’t it be easier to keep a home phone so children can learn to answer a phone, use good phone manners, and when you are ready to let them stay at home by themselves for a few minutes, there is always a phone available. I don’t know, just seems easy solution to me.    

What do you think? I would love to hear from you!

 
Daily Dose

Hand, Foot & Mouth Disease is Back

I have been seeing a lot of cases of "hand, foot and mouth disease" (HFM) in the office. This illness is usually caused by a Coxsackie virus A-16, a member of the enteroviral family. These viruses are typically seen in the summer and early fall. Don't worry, this illness is not related to "hoof and mouth" disease seen in animals.

Hand, foot and mouth disease is most common in younger children and often is seen in the toddler crowd. You can see "hand, foot and mouth" in older children, but most children have had it at younger ages and are immune as they get older. It is not unusual to have outbreaks of HFM in child-care centers or pre-schools. How is Coxsachie virus transmitted?  Person-to person contact as well as from contact with contaminated surfaces. The incubation period from time of exposure is about three to seven days. The typical child with HFM will present with fever, which is often fairly high. If seen early in the illness they may not have any other physical findings but over several days they will develop a sore throat with painful sores on the tongue and throat. Several days later they may develop the classic small, red, blister like lesions on their palms, soles of feet and often in the diaper area. When they have all of the symptoms it is an easy diagnosis, but not everyone who gets Coxsackie virus will have every symptom. Sometimes you see a child with the classic rash on palms and soles, but they have never had fever or even felt badly, lucky for them! One of the most common complaints may be drooling and irritability in a child with fever as the mouth and throat are sore, even before the classic lesions appear. Because this is yet ANOTHER viral infection, there is no specific treatment and antibiotics won't help. Keeping your child comfortable with Tylenol or Motrin/Advil will help with both fever and pain. This is a good time to try things that would help soothe a sore throat, things like ice cream, popsicles, pudding, Jell-O and even a Slurpee, especially in a child who is refusing fluids. The main concern is keeping your child hydrated during the illness. Once your child is fever free for 24 hours and feeling better they may return to child-care or school. The small lesions on the palms and soles will clear over the next five to seven days. The best way to prevent others from getting sick is with good old hand washing. That's your daily dose, we'll chat again soon.

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