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Daily Dose

Bedtime!

1:30 to read

Bedtime….an important word for parents and for children. A new study in Pediatrics just reinforces how important bedtimes for children may be.  The research shows that preschool children who had an earlier bedtime were less likely to become obese in their teenage years. 

The study involved nearly 1,000 children who were born in 1991 and whose parents recorded their bedtimes when they were 4.5 years old.  The researchers then looked at the growth data (height/weight) for these children when they were 15 years of age.

Interestingly, the pre-school children who were in bed by 8:00 p.m. had half the risk of becoming obese as a teenager compared to those children who went to bed after 9 pm. Specifically, of the children who went to bed by 8 pm, only 10 percent were obese as teens, while 16 percent of those who went to bed between 8 and 9 pm developed obesity, and 23 percent of those children   who had bedtimes after 9 pm developed teenage obesity. 

While there has been much research surrounding sleep and obesity (as well as behavior), this study provides even more evidence to the possible “protective effect” of early bedtime and bedtime routines for young children.  If getting to bed on time and earlier can in some way help stem the obesity tide, it would seem like an easy recommendation for many parents to follow.  

As a mother I was always a “fan” of schedules and bedtimes…and actually putting your child to bed at night is such a wonderful time of day. The routine of a bath, snuggles, some books ( with wishes for just one more) and more hugs and kisses is such a wonderful memory I have of my own 3 boys. It just seemed that everyone was happier (and I guess healthier) when we had early bedtimes. I remember I had a friend who always had her 3 young children fed, bathed and in bed by 7:00 p.m. every night..and in those pre cell phone days we did not dare call her house after that time!!  

I also think bedtime routines are important for younger children year round. While it is more difficult to have regular bedtimes for older children during the summer months, children under elementary school age (and maybe even older) really do benefit from continuing on the same bedtime schedule during the summer months.  I think if you told your middle school or teenager this “rule” there  might be mutiny….but I know as well as a working parent, it is much easier to have a routine even when the kids are out of school…they would totally disagree!

I am excited about this study and using it as another resource when discussing sleep habits and bedtime routines with my patients.  This is especially important as we get ready to discuss back to school sleep routines….summer does fly by!

Daily Dose

A Better Night's Sleep

1:15 to read

What is it about sleep and parenting? Babies never sleep enough and teenagers sleep too much!! Why can’t “we” get this right? While sleep patterns definitely do change with the age of the child, good sleep habits can begin in infancy and continue throughout adolescence.

Even from the beginning,  you should try to teach your child to fall asleep on their own and to self-console by either sucking on their fingers or a pacifier. But remember, this sleep thing is new and babies really do have to learn how to do this.  Think of it as if you were teaching your child to read, it doesn’t happen overnight, but evolves with practice, patience and repetition. Sleep is the same way.

After the early years of teaching your child to fall asleep on their own, the toddler, preschool, and elementary years are usually fairly easy to establish good sleep patterns if you follow a routine, with a set bedtime, reading to your child before bed and hugs and kisses and lights out. This is the age for occasional nightmares, or fears, but also for regular nights of uninterrupted sleep.

With the tweens and teens and hormone changes of adolescence comes a new sleep clock that is set to stay up too late and not wake up in the morning. Even teens need a good nights rest, so a bedtime should be encouraged and enforced unless there is a test of special event. There is not a reason I can think of for teens to be up past 11 pm on a school night, homework should be finished, and all of the accessories such as cell phone, computer and all other electronic gear put up before bed. The older you get the more you understand a good night’s sleep , but someone has to teach the basics along the way and before you know it the whole house will be on that schedule too. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

Summer Viruses Are Gearing Up

1.15

Is it hot enough for you? Summer is here for a bit! Winter viruses are a distant memory (good bye flu and RSV), summer viruses which have been laying dormant are once again rearing their angry heads.

My office has been overflowing with really hot feverish kids of all ages.   I think the most likely culprit for much of the illness we are seeing right now is an enteroviral infection.  For some reason, it makes us parents feel better if we can “name that virus”, seems to help validate the illness.  

Enteroviral infections typically cause a non-specific febrile illness and with that you can see fairly high fever. In other words, just like the thermometer as summer heat arrives , 101-104 degrees of fever is not uncommon in these patients.  Remember the mantra, “fever is our friend”. I think it is almost worse to have a high fever in the summer as you are even more uncomfortable because it is already hot!

With that being said, if your child has a fever, don’t bundle them up with layers of clothes and blankets.  It is perfectly acceptable to have your younger child in a diaper and t-shirt, and older children can be in sundress or shorts rather than long sleeves and pants.  Bundling may increase the body temperature, even while you are driving to the doctor’s office. I often come into a room with a precious baby who is running a fever and they are wrapped in blankets, let them out! That hot body needs to breathe.

These summer enteroviruses may cause other symptoms as well as fever, so many kids right now seem to have sore throats and are also vomiting and having diarrhea. With this type of virus you also hear complaints of headaches and body aches (myalgias).  The kids I am seeing don’t look especially sick, but they do feel pretty yucky!  Just kind of wiped out, especially when their temps are up.

Besides treating their fevers, treat their other symptoms to make them comfortable.   If they are vomiting do not give them anything to eat and start giving them frequent sips of liquids such as Pedialyte (for the younger ones) and Gatorade or even Sprite or Ginger Ale. Small volumes are the key. 

I often use pieces of Popsicle or spoonfuls of a Slurpee to get fluids in kids. I always tried to pick drink colors for my own kids that were easier to clean up, in case they were going to vomit again, so no bright red!  The cold fluids may also help to soothe a sore throat. Once the vomiting has stopped, and it is usually no more than 12-24 hours, you can start feeding small amounts of food, but I would steer away from any dairy for a day or two. Again, nothing worse than thinking your child is over vomiting, fixing them I nice milkshake (comfort food) and seeing that thrown up!  Many a mother has come into my office wanting to strip after being vomited on, in a hot car no less.   I don’t think there is a car wash around that can fully get rid of that smell!

Most enteroviral infection last anywhere from 2-5 days. There are many different enteroviruses too, so you can get more than one infection during the season. This is not just a virus you see in children, so watch out parents you may succumb as well. Keep up good hand washing and your child should stay home from school, the pool, camp, day care etc. until they have been fever free for 24 hours. 

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

Daily Dose

Too Much Pressure to Play Sports?

1:30 to read

Does your child play a sport “after school”?  It seems children as young as 3-4 years of age are now involved in soccer and even football.  Some children are barely walking before they are signed up for a team.  Parents tell me various reasons for this including, “if they don’t start young they will be at a disadvantage athletically”, “if we don’t get on a team now, there will not be room for our child once they start kindergarten or first grade”,  and “our child wants to play and wear a uniform”. I just see lots of issues with burn out.

It seems awfully early to start “team sports” to me. I am a huge advocate of families and children playing together and learning all sorts of games and sporting skills. Kicking a soccer ball in the yard, or hitting the wiffle ball off of the tee, or having Dad throw a pass with the football all seems pretty “normal” to me. But organized sports with a 3 year old who is still in diapers….really?  Maybe one of the “guidelines” should be you have to be potty trained.  Yes, this is true, I see children in diapers who “will not pee or poop in the potty” according to their parents, but they go to soccer practice?  What is wrong with this picture?

So, while some of these well intentioned parents have told me that they are having fun being the coach, or attending games with other friends, their pre-school children “don’t have time to be potty trained”. They are too busy going to school, followed by organized activities that “it is just easier to let them stay in diapers”. I was even with a 4 year old at a football game and she was still in diapers?

At some point these children and parents will need to skip a practice or two and stay home long enough to get potty trained.  I am noticing that children are getting older and older before they are potty trained. I know there are books written on this topic with the philosophy that “the child will ultimately train themselves”, or “ how to potty train in 3 days, with a child who shows no interest”…or something along those lines.  But really, in my experience, if you watch your child’s cues, spend the time to “talk bathroom habits” and have the “time” to be home to potty train most children are potty trained between 24-36 months of age.  Yes, there are occasional children (none of my own) that just show interest earlier and say things like “I go potty now” and really do it on their own. There are also some who are more difficult to get interested and may be harder to potty train…but again, which is probably a more important life time skill…..getting out of a diaper or trying to figure out how to line up for a soccer game? I’m just saying.

Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

Daily Dose

Gold Medal Madison!

1:30 to read

I often write about choosing to be a pediatrician and realizing over the years that I picked the best field of medicine. What a privilege it is to care for a young family’s precious newborn and then to watch that child grow up. While there are many long days, and countless phone calls at night I can’t imagine practicing any other specialty. 

While I saw my own children grow up all too quickly, it seems that seeing your patients on a yearly basis somehow makes time go a bit slower.  In the beginning you see the newborn and toddler quite frequently, but then your patient turns 3 and you only see them yearly (barring illness) and each year you get to talk to them about their hopes and dreams.  How often have I asked, “what do you want to be when you get older?”.  Many times their aspirations change, but sometimes you hear the same thing over and over, from very early ages.

So….this is about one of those children, who is now a young adult, who is living her dream!  Although I am not her parent,aunt or godmother, as her pediatrician I have watched her grow up with a goal. Through ups and downs, highs and lows, exhausting days of school and practice followed by more practice and even long nights in the gym and unfortunately some injuries along the way,  she has always been persistent (and resilient) in her goal of being the best gymnast she could be…. and now she is an OLYMPIAN! (I just got goosebumps as I wrote this).

You know when someone just has “IT”, well, she did!! Her parents would come in each year with her for check ups and talk about her gymnastic ability…they “wondered where it even came from”.  She was a natural…no one that I saw pushed her, or begged her to become a world class gymnast…in fact, it was almost the opposite, she had the drive and the dream. I saw her parents provide the support (emotional as well as financial I am sure….how many carpools did they have to drive?) for this little girl who knew what she wanted and could flip and flop and swing from bars and land the stunt while having fun doing it. I remember being blown away when she showed up for her 12 year old check up with a signed picture of herself after being named to the National Gymnastic Team. (I think she was the youngest member).  Each year she would come in and I would have to “prod” her to not be so humble and tell me how she was doing in the gymnastics world. I suddenly found myself following her scores in the newspaper, reading about another competition around the world or sometimes with a text from her mother with updates.  With each win I too could see her….getting closer to the goal…. ultimately winning the world uneven bars competition.

But today, as I sit here  how I wish I had gone to Rio!) getting ready to watch her begin her quest for an Olympic medal…I have butterflies in my stomach, and I can barely stand to watch… (how does a parent go through this??).  I know her mother says she cannot sit in her  seat but wanders around the venue to find just the right spot to watch her daughter compete.  I now find myself trying to decide whether to even watch…or just wait for the results. Whatever happens….Madison Kocian has already won gold in my mind! 

…and now the world knows what I have always known….Madison is a gold medalist!!!  Way to go Maddie!!!

 

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

When Bug Bites Get Infected

1.00 to read

It is the season for bug bites and and I am seeing a lot of parents who are bringing their children in for me to look at all sorts of insect bites. I am not always sure if the bite is due to a mosquito, flea or biting flies, but some of them can cause fairly large reactions. 

The immediate reaction to an insect bite usually occurs in 10-15 minutes after bitten, with local swelling and itching and may disappear in an hour or less. A delayed reaction may appear in 12-24 hours with the development of an itchy red bump which may persist for days to weeks.  This is the reason that some people do not always remember being bitten while they were outside, but the following day may show up with bites all over their arms, legs or chest, depending on what part of the body had been exposed. 

Large local reactions to mosquito bites are very common in children. For some reason, it seems to me that “baby fat” reacts with larger reactions than those bites on older kids and adults. (no science, just anecdote). Toddlers often have itchy, red, warm swellings which occur within minutes of the bites. 

Some of these will go on to develop bruising and even spontaneous blistering 2-6 hours after being bitten. These bites may persist for days to weeks, so in theory, those little chubby legs may be affected for most of the summer. 

Severe local reactions are called “skeeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or an extremity. These are often misdiagnosed as cellulitis, but with a good history of the symptoms  (the rapidity with which the area developed redness, swelling, warmth to touch and tenderness) you can distinguish large local reactions from infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins, but are extremely rare. 

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion, Sarna lotion and Dommeboro soaks.  This may be supplemented by topical steroid creams (either over the counter of prescription) to help with itching and discomfort. 

An oral antihistamine (Benadryl) may also reduce some of the swelling and itching. Do not use topical antihistamines. Try to prevent secondary infection (from scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream (polysporin) to open bites. 

Due to an exceptionally warm winter throughout the country the mosquito population seems to be especially prolific. The best treatment is prevention!! Before going outside use a DEET preparation in children over the age of six months, and use the lowest concentration that is effective.  Mosquito netting may be used for infants in strollers.  Remember, do not reapply bug spray like you would sunscreen. 

Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

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