Daily Dose

Crooked & Toes Fingers?

1:15 to read

 I get a lot of questions from parents during their child’s first months of life about fingers. ( and sometimes toes as well).  Because, if you look closely you may see that your child’s finger  seems to be a bit “crooked”.

The term used for bending or curvature of the finger is clinodactyly, which describes a bending  or curvature of the finger in the plain of the palm.  It is a fairly common and occurs in about 10% of people. Upon close inspection i actually think that I may have a bit of it myself . It is more common in males and typically affects the small “pinky” finger.  It is unusual to have it on both hands, but possible ( Would be a great show and tell!)

It seems that clinodactyly run in families and may be inherited. When parents are concerned about a bit of bending of the 5th finger, I usually say, “ go to your family reunion and have everyone hold out their hands”. You may find that your favorite aunt or uncle has the same thing!

The very mild curving of the finger that often concerns parents ( especially in the first few months when “we” examine everything), rarely causes any problems. There is no associated pain and you will see that your child uses their fingers without a problem. Often by the time your child is older you have forgotten about it altogether, and are now more concerned that they don’t break those fingers getting it slammed in a door.

For severe curvature of the finger make sure you talk to your doctor and watch the growth of the finger as abnormalities of the growth plate may contribute to clinodactyly. In severe cases where curvature progresses and interferes with hand function a hand surgeon may be consulted to correct the deformity.   

Daily Dose

Toddler Behavior

1.30 to read

Do you have a toddler? If so you are in the throes of some difficult, albeit sometimes funny, yet inappropriate behavior. It happens to every parent...suddenly their precious child turns into Dr. Jekyll and Mr. Hyde.  Somewhere around 15-18 months, you will most likely see this change in behavior. Although most books refer to the “terrible twos” I really think it is the “me no wanna” 18-30 month old. 

“Me no wanna” is the phrase we often used around our house, and it was coined when the boys were toddlers. It just seemed like the best line when our sweet toddler would rather have a tantrum than do the simple task that we wanted him to do. Example: please put your toy back in the box. “Me no wanna”, I would prefer to fall to the floor and scream.   

How is it that your typically sweet 20 month old child can be in middle of playing nicely and then suddenly seems possessed as they fling themselves to the floor kicking and screaming?  What is the matter?  Are they having a seizure? Or is it that “something” just didn’t seem right to them and they are angry and frustrated???  How can they change behavior so quickly.?   (hint, foreshadowing for those teen years). 

You never know with a toddler what kind of answer you will get when you say something as easy as “let’s get on your shoes to go outside”. Sometimes they happily run get the shoes, bring them to you, sit down and the shoes go on licitly split.  The next time they get the shoes, throw them across the room, lay on the floor and look at you like “me no wanna”. 

Trust me, you are not a “bad” parent, you are just living through some really challenging parenting. It is exhausting at times, but while this age is typically difficult it is some of your most important parenting. This is really the beginning of behavior modification.  Your brilliant toddler is testing you, this may be the first time you the parents understand why everyone talks about boundaries and consequences. 

Some children also express their “me no wanna” by acting out with hitting, biting and kicking. Again, very inappropriate behavior. Your job is to change that behavior by using time out, or taking away a toy or even putting the child to bed early.. There are so many ways to start letting your toddler know that there are consequences for misbehaving, and that tantrums don’t work. 

I am in throes of “me no wanna” again, only this time it is with a puppy! Seems very similar to me.

Daily Dose

Why Babies Get "Goop" In Their Eyes

1:15 to read

If you have recently had a baby you may already know about “clogged tear ducts”. This is also named nasal lacrimal duct obstruction and is fairly common in newborn infants in the first weeks to months of life.

A baby’ s tear duct, the tiny little hole in the inner corner of the eye, is very small and narrow and may often get obstructed. If that is the case the tears that an infant makes gets backed up and may form a thickened “goopy” discharge in the eye. At times when this occurs the baby’s eye will seem to be “glued” shut as the goop gets in the eyelashes and almost seems to cement those little eyes shut. Occasionally the eye will look a little puffy due to the debris in the eye. The best thing to do for this problem is to use a warm compress or cotton ball dampened with warm water to wipe the eyelashes and remove the discharge from the eye.

Once the “goop” is removed and your baby opens their eye, look at the whites (conjuctiva) of the eye. The conjunctiva should not appear to be red or inflamed. The goop will re-accumulate over time, but the eye itself should continue to look clear. Babies with clogged tear ducts do not appear to be ill and continue to eat well. The only problem should be the goopy eye. In order to help open the clogged duct you can try to massage the inner lower corner of the baby’s eye (beneath the tear duct itself), several times a day. Gently apply pressure to the area and do this several times a day. The eye “goop” always seems to be worse after the baby has been sleeping. It is also not uncommon for one eye to clear up only to have the other eye develop “goop”.  Most of these obstructions resolve on its own by four to six months of age. If the tear duct continues to be obstructed, talk to your pediatrician about a possible referral to the pediatric ophthalmologist.

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

Daily Dose

The Heat is Taking a Toll on Many

1:15 to read

This is a follow up last week’s Daily Dose on the toddler who burned his feet after playing outside on a very hot day. He has been being treated with daily dressing changes and debridement of the skin from the blistering on his feet. HIs mother called to tell me that the first few days were “BRUTAL” and extremely painful as the doctors popped the blisters and removed dead skin and then would scrub the area to prevent infection. His mother was also doing bandage changes at home.

But after those first horrible days, he is no longer having to go for “burn therapy” and she is managing the dressing changes on her own. She is fortunate to be a nurse, but having to change your own child’s dressings is a daunting task for any parent, even one who has done dressing changes before.

Her son is also now off all pain medication except for over the counter acetaminophen and ibuprofen, and is smiling and playing with his older brother. He is still not walking and is being “carried to and fro”, it seems that he realizes his feet have tender new skin.  The doctors also feel as is he will not have any significant scarring over the long term.  

The triple digit heat is continuing in many parts of the country and I just read about another child in Texas who died after being left in a car.  Remember, put something in the front seat to remind yourself that your child is in the car with you. A sleeping quiet baby can be momentarily forgotten when a parent is distracted….and even minutes in a hot car may be deadly.

Be aware of the many risks associated with these extreme temperatures, and make sure that your children have shoes on whenever they are going to be outside!!  Hoping that these extreme temperatures will moderate over the next few weeks…especially as children are heading back to school!

Daily Dose

Potty Questions Keep Coming

1.15 to read

Potty training always gets lots of questions and one of the most common is having a child who will "tinkle" in the potty but is not yet "pooping". When potty training all three of my boys, they all pooped later than they tinkled. I know some people disagree, but I certainly think I hear of more people who have to work a little harder and longer to get to pooping on the potty. It may be due to a toddler's fear of letting their poop go, or the difference in sensation with stooling or any number of issues that toddlers are working through as they are potty trained.

Whatever the reason for children who arenot wanting to poop, you have to continue to be patient and praise their success on the potty with urination. Continue to discuss poop within the family, and let your child see you going to the bathroom. Talk about how animals, birds, fish and people all poop and they don't do it in a diaper or underpants but in the potty. During all of this conversation (and while you are frustrated), make sure that your child is not holding stool and becoming uncomfortable, which only adds to anxiety and fear and further withholding poop. You might want to try putting your child on a prune juice cocktail, milk of magnesia, or Miralax to soften the stool and ensure that they are having a soft stool every couple of days. A toddler will often hold their stool until bedtime when they are in their diaper and will then poop or may ask for a diaper to poop during the day. This is not uncommon and usually does not last terribly long. If they want to poop in their diaper I would have them sit on the potty with a diaper and poop and then put them back in their training pants. I also praise and rewardthem for sitting on the potty to poop, even if it is in a diaper, and use a sticker chart or M&Ms or both. Hopefully, over time they will realize that sitting on the potty to poop is perfectly normal and will give up the diaper. You can even cut a hole in the diaper to let the stool come out into the potty so that they may see that it is not painful, scary or difficult. Always remember to praise and not punish and to be patient and consistent with your messages about poop. Rewards seem to go a long way, and albeit small, they often work wonders. It may take several months of persistence to conquer the poop issue, so remain calm. If they continue to have problems have a further conversation with your doctor about the possibility of stool holding and encopresis. That's your daily dose, we'll chat again soon.

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

Rashes in Newborns

Newborn rashes are quite concerning to new parents, but are very common and usually innocuous. In the first several days after birth a your-baby will often have a blotchy red rash on their trunk and legs. This rash is called erythema toxicum, and doctors are not sure what causes this in the first days after birth. This red blotchy rash will resolve over the first week of life.

The next thing that parents will notice is that a newborn's skin will seem dry and the newborn will even peel over their feet and ankles and hands. This is common in a term newborn and will resolve, and leave behind beautiful your-baby skin. Moisturizing their skin will also help maintain skin hydration. Over the next month a newborn may develop neonatal acne and have a pimply rash on their face and even shoulders. This is a hormonal reaction, and again doesn't require medication or special soap. Just continue to wash your your-baby's face with warm water and a mild soap. No need for acne wash, or scrubs, and don't be tempted to "pick" them and magically the skin usually clears by two months. All of these issues are frequent worries for new parents and like many things, resolve on their own. It just helps to know how to "name that tune!" That's your daily dose, we'll chat again tomorrow.

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Daily Dose

Do Essential Oils Boost Immune System?

1:30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

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.

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