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Daily Dose

Vaccine Pain

1.00 to read

I am often reminded of the adage, “this is going to hurt me more than it hurts you” before beginning infant vaccinations. I can remember my own parents saying that to me before a spanking (the preferred discipline of my childhood) and that statement never made any sense to me until I too became a parent. 

As I discuss infant vaccinations with new parents, I somehow know that they are wishing they could “take the needles” for their own child. I really do believe that those first vaccines at 2 months of age “hurt the new parent, more than the infant”. It is an early parenting hurdle to get through those first immunizations and realize that your baby handled the vaccines without much ado and somehow the next set of vaccines at 4 and 6 months are a bit easier. Pain is not anything that a parent wants their child to endure, and if there is any way to mitigate the pain associated with immunizations I am all for it. 

Many parents come to my office prepared with sucrose to let their baby suck on during the immunizations.  I recently read an article in Pediatrics that showed the 5 S’s - swaddling, side/stomach positioning, shushing, swinging and sucking on a pacifier significantly reduced the pain associated with vaccines in 2 and 4 month old infants. In fact the 5S’s worked “substantially better to reduce post vaccination pain than sucrose alone”. 

So, if you are concerned about the pain associated with your infant’s vaccines, come ready to swaddle, shush, swing and let your baby have a pacifier as well. A little tummy time after the immunizations might be good medicine too. 

But more importantly, remember that by vaccinating your baby you are protecting them from disease for their entire childhood and into adolescence (when I am not sure the immunizations are any easier). 

The 5S’s seem like an easy solution for parent and baby, and a lollipop or ice cream cone goes a long way for pain relief in the 4-11 year old set as well. Vaccines are a moment of pain for a lifetime of gain for sure!

Daily Dose

It’s The Season For Bug Bites & Stings

1:30 to read

Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss.It’s that time of year when insect bites and stings start showing up on your kids. Knowing how to prevent and treat common insect bites and stings, and knowing when to not overreact, can help keep your kids safe and healthy.

Babies and children may be more affected by bites or stings than adults. Let’s start with some common spring and summer insects. Spider bites Most spider bites do not actually penetrate the skin, and the majority of spiders found in the U.S are mostly harmless with the important exception of the black widow spider and the brown recluse spider, which are both dangerous to humans. Spider bites are fortunately uncommon. In many cases, presumed spider bites are actually due to another skin condition or an insect sting. The black widow spider is said to feel like a pin-prick, and some victims do not even realize they have been bitten. Sometimes you may notice double fang marks on the skin. The most common symptoms where the bite occurs are immediate pain, burning, swelling, and redness. Other symptoms may include chills, fever, nausea and vomiting, and severe abdominal pain. While black widow spider bites are hardly ever fatal, rare deaths have occurred from brown recluse spider bites and are more common in children than in adults. At first the bite of a brown recluse spider leads to a mild stinging, followed by local redness and severe pain that usually develops within eight hours but may occur later. Some reports of brown recluse bites describe a blue or purple area around the bite, surrounded by a whitish ring and large red outer ring in a "bull's eye" pattern. A fluid-filled blister forms at the site and then sloughs off to reveal a deep ulcer that may turn black. If bitten by a brown recluse or black widow spider - Cleanse the wound. Use soap and water to clean the wound and skin around the spider bite. - Slow the venom's spread. If the spider bite is on an arm or a leg, tie a snug bandage above the bite and elevate the limb to help slow or halt the venom's spread. Ensure that the bandage is not so tight that it cuts off circulation in your arm or leg. - Use a cold cloth at the spider bite location. Apply a cloth dampened with cold water or filled with ice. Seek immediate medical attention. Treatment for the bite of a black widow may require an anti-venom medication. Doctors may treat a brown recluse spider bite with various medications.

Bee Stings In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. Most of the time the symptoms from a bee sting will be minor. Your child may experience a burning pain, a red welt, and slight swelling. Some children may have a stronger reaction with extreme redness and swelling that gets bigger over a couple of days. Children, adolescents, and adults who are allergic to bee stings may have a severe reaction called anaphylaxis. About 3% of people who are stung by bees quickly develop these anaphylaxis symptoms. - Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis) -  Difficulty breathing -  Swelling of the throat and tongue -  A weak and rapid pulse -  Nausea, vomiting or diarrhea -  Dizziness or fainting -  Loss of consciousness -  Convulsions -  Fever -  Shock may occur if the circulatory cannot get enough blood to vital organs. For most Bee stings you can apply an ice pack or cool compress, a meat tenderizer solution which can be made by mixing one part meat tenderizer and 4 parts water. Soak a cotton ball in the solution and apply to the bite for 15020 minutes. A baking soda paste works well or a topical anti-itch cream such as Calamine lotion. Talk to your pediatrician about ways to prevent bee stings and possible immunotherapy if your child is allergic. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems. If your child is allergic to bee stings always have an EpiPen available and use it right away as your pediatrician has directed. Wasps, hornets, and yellow jacket stings are similar to bee stings.

Fire Ants A bite that will get your child’s attention quickly belongs to the fire ant. Fire ants are so named because their venom induces a painful, fiery sensation. When disturbed, fire ants are very aggressive. To help children avoid fire ants, parents should regularly check their yards and their children's play areas for the presence of the ants and their mounds. Then they should either eliminate the ants or make sure children avoid them. If a child is stung, apply ice to the bite site for 10 to 15 minutes. Elevate the extremity where the child was bit. Clean and clip the child's fingernails to prevent any secondary infection that can result from scratching the bite. Check with the child's pediatrician for the correct dose of an oral antihistamine to reduce itching and inflammation A small percentage of children stung -- probably less than 0 .5 percent -- experience a severe (anaphylactic) reaction. These occur within minutes of a sting and vary in severity. A child who is stung and within minutes begins to experience hives, weakness, dizziness, wheezing, difficulty swallowing, shortness of breath or confusion should be taken immediately to the nearest emergency room. Watch the area for signs of infection over the next couple of days.

Ticks Ticks are common in grasses and wooded areas. If you have pets make sure they are tick free. Ticks are usually harmless but they can carry Lyme disease. To remove a tick begin by taking a cotton swab or cotton ball. Dip the swab or cotton ball in a small glass container that you will be throwing out after use. Place a small amount of rubbing alcohol in the bottom of your container. Use at least 2 tablespoons of alcohol. Dab on the site of the tick on the child or pet. Do not let it run, that is why you are dabbing it rather than pouring it on the site. If there is excess, dab it with another cotton swab or cotton ball. Let this cotton ball or swab sit on the tick for 3 minutes. This suffocates the tick and he will back out for retrieval with tweezers. If that method is unsuccessful, use the alcohol swab again and let the area dry. Then take a clean, unused cotton swab and glob a dollop of Vaseline petroleum jelly on the site where you see the tick. Let this stay on top of the tick for 3 minutes. You will then remove the tick and the Vaseline petroleum jelly.

Mosquitoes Probably the most common insect bite in the spring and summer come form mosquitoes. Ivillage.com has these tips for treating and preventing mosquito bites. The usual reaction is a local skin inflammation that is red, raised and very itchy. If your child scratches the bite, it may become infected as well. Here's what you can do for your children to help ease the itch and pain caused by mosquito bites. Treatments: Apply anti-itch creams like calamine as needed to help prevent scratching • Use anti-inflammatory creams like cortisone cream to help ease the inflammation and itching • If there is severe itching and multiple bug bites use antihistamines like Benedryl. Because they tend to make children drowsy, they work particularly well at night. •  Antihistamines like Claritin, Allegra, and Zyrtec tend to be much less sedating, buit check with your pediatrician about the correct dosage and whether these products are safe for children. Other Suggestions:
 Keep your child's fingernails cut short to prevent scratching • Apply cold wet compresses to the area to ease discomfort • Have your child wear long pants and long sleeves (if the temperature is bearable) • Make sure window screens are used if you keep windows open in your home • Use insect repellant to help prevent bites from occurring Choosing an Insect Repellant DEET is the best insect repellant in terms of effectiveness against flies, gnats, chiggers, ticks and other insects. The higher the DEET concentration the better it works. For children, however, the EPA recommends a concentration of 10 percent or less to prevent side effects and toxicity.

Scorpions Scorpion bites are painful but mostly harmless. The only dangerous scorpion in North America, probably the most venomous of all North American bugs is the bark scorpion. Bark scorpions are found in all of Arizona, extending west across the Colorado River in to California and east in to New Mexico. Scorpions are related to spiders, ticks and mites. Usually, they only sting to protect themselves or of they feel threatened. Scorpions can get caught up in bedding or crawl in to shoes so always check your child’s clothing and bed if you suspect scorpions may be around.  Scorpion stings without a serious reaction can be treated with ice on the sting and over-the-counter pain medication. Bark scorpion anti-venom is available only in Arizona. Any sting that shows signs of a bark scorpion needs to be treated at a hospital. Anti-venom has been shown to significantly reduce the effects of the sting. Children love to be outside in the spring and summer when the daylight is longer and the backyard, playground, or campsite can become a magical play space. Insect bites are bound to happen. Most are just an annoyance, but make sure you know which ones to be concerned about and which ones may just require a hug and a kiss. For pictures of several types of insects such as Black Widow and Brown Recluse spiders, check out http://www.webmd.com/allergies/slideshow-bad-bugs

Daily Dose

Pool or Trampoline? The Safety Debate

1:15 to read

Do you have a pool or trampoline in your yard? Both pools and trampolines are fun for children, and both pose dangers as well. I saw a patient today who asked me my opinion of trampolines. It seems that she and a friend, both of whom have elementary school age children, are having a "discussion" about trampolines. My patient is totally against having a trampoline in her yard, although she has a pool. Her friend says that it is safer to have a trampoline than a pool. And so their debate continues.

Both pools and trampolines are fun for children, and both do pose dangers. But as my own children often told me "according to you Mom, everything that is really fun, is dangerous!" The biggest issue surrounding children playing in pools and jumping on trampolines is parental supervision. When children are taught safety and are given rules to follow that are then enforced, they may have fun and be safe at the same time. Pools are fenced, and gated. Parents watch their children swim. This is usually the party line. But trampolines also require the same amount of supervision and many parents don't realize this.

Most trampoline injuries occur when children are unsupervised. Many serious trampoline accidents occur when children of disproportionate weights are doubling jumping and the smaller child becomes a missile and is thrown from the trampoline when serious neck injuries may occur. Trampolines are also safest when they are buried in the ground or have safety nets on the side. Letting children jump unsupervised is as dangerous as swimming alone.

So, I can't resolve this friendly discussion, but I do know that both pools and trampolines require parental supervision and strict safety rules to ensure the safest possible experience. And yes, they are both fun! That's your daily dose, we'll chat again soon.

Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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

Daily Dose

Who Knows Their Phone Number?

1.15 to read

Can you recite your spouse and your children’s cell phone numbers? Trying to remember 7 digits used to be easy but now I think our brains are losing the ability. I am finding more and more children who do not know their own home phone numbers (many don’t have a “home phone” to remember, there are just numerous cell phones at the house ).  One of the first things children used to memorize was their home phone number, it was a proud accomplishment for a 4-6 year old.  

Now that we have “smart phones” I think memorizing addresses and phone numbers is becoming a lost art.  Our brains are just not absorbing the numbers when all we have to do is push a name or say a command and the number is dialed.  Maybe not as smart as we think?

I guess the first question is: do you even have a home phone or do your kids call your cell phones?  Do they know your phone numbers by memory? Can they recite them to a teacher or a police officer if necessary?   I posed this question to several young parents this week, and they all kind of laughed and said, “you know I had not really thought about it”.

I see kids as young as 1-2 years using the iPad, also know as “my pad” and they use words such as “refresh”, “swipe”, “password” and “app”  so easily.  They can call their parents when they are just 12-18 months old by pushing the picture on the screen.....but do they ever know the number they are calling?  Do children still know about calling 911, or do they look for the icon of the police?

Keep teaching your children their phone numbers...they may need to call you at some time without having an “app for that”!

Daily Dose

Cough Medicine Alert

Should the FDA limit cough medicines for kids?With cough and cold season already here and only getting worse as winter arrives, many parents are asking whether they should use over-the-counter (OTC) cough and cold preparations. There are many studies that show that these products really do not help treat the common cold. On top of that they may actually have adverse effects when used in children and there have even been deaths reported due to inappropriate dosing of these medications.

The American Academy of Pediatrics does not recommend using OTC cold remedies in children under six and the FDA says not to use in children under two. There are so many products out there and most contain the same ingredients causing even more confusion for parents. The longer I practice, as well as taking care of my own children, I agree that these medicines really don't do much of anything for a cold. The best medicine still seems to be the tried and true remedies of rest, fluids, nasal saline irrigation and a box of kleenex. So....throw away any leftover cough and cold preps and get ready for winter with your latest recipe for chicken noodle soup. That's your daily dose. We'll chat tomorrow.

Daily Dose

Does Your Child Have A Crooked Finger?

What Can You Do For A Crooked Finger?I received an email via our iPhone App from a mom who was worried that her daughter had a “crooked” finger.  She did not give any more specifics, but the most common finding in children is a curvature of the 5th or “pinky” finger called clinodactyly.

The word clinodactyly is derived from the Greek words kliner “ to bend” and dactylos, “a finger”.  Clinodactyly is typically caused by abnormal growth and development of the small bones of the finger resulting in the curvature of the finger in the same plane as the palm.

Clinodactyly may occur in up to 10% of the population, but occurs to different degrees.  It is typically a benign condition but has been associated with numerous syndromes where it occurs in combination with other abnormalities. There are several common characteristics seen with clinodactyly. It  is more common in males and is often bilateral (occurs on both hands). It is frequently seen in families as an inherited “condition” and is thought to be autosomal dominant,  so when you go to a family reunion look at everyone’s fingers as you probably have a lot of siblings or cousins who have the same bent finger. When clinodactyly is minimal and does not cause any problem the best treatment is simply watchful waiting.  If the “deformity” becomes progressive as a child grows, then xrays may be obtained to further delineate the abnormality and surgical treatment may be undertaken.  A board certified hand surgeon would be the preferred choice to do this surgery. Send your question to Dr. Sue!

Daily Dose

Your Child's Sitter

1:30 to read

Do you ever leave your child with a babysitter or caregiver? Weird question right? But some parents never want to leave their child with someone else....and I am not sure that is healthy for either parent or child.   

I recently had this discussion with parents of a 3 year old child who was having a terrible time with separation anxiety. While many children go through stages of separation anxiety, by the time a child is 3-4 years they are typically past this stage. When I was talking with this family they told me their child had never been left with anyone.  

I guess as a working mother I was incredulous. What? Had the parents never gone out to dinner or to a party, a concert, lecture  or even on a night away for some much needed “couple” time?  They told me that they would occasionally call in grandparents but typically took their child everywhere with them.  (I think there are many places such as movies, adult restaurants, and other venues that might not want the 2 year old in tow).   I suppose some would say the child was fortunate, but I really believe that as a child reaches age 2ish they need to begin learning to separate from their parent. Not for days or weeks, but for either a play group, a pre school program, the gym nursery or something where the child is learning a bit of independence.   

While some parents are quite fortunate that they don’t have to leave their child to go to work every day, the concept of leaving your child for any hour or two with a trusted babysitter should not cause anxiety for the parent and ultimately not the child. Separation is an important milestone, as your child learns that while you may leave for an hour or two, you always return. There is security in that knowledge. They will also learn how to interact with  other adults and children, which is often different than they do with their own parents.  (Ask any teacher about that phenomena). 

Autonomy and independence are typically traits that parents desire for their children.  Parents also need to have some autonomy as well.....I think this makes for a better parent child relationship in the long run.  Little steps in separating become bigger steps as a child grows older....starting with a babysitter or nursery for an hour or two on occasion is often the beginning. 

Daily Dose

Dog Bites & Kids

1.15 to read

I saw a young boy (this week) who was bitten by a dog.  Very sad as I began to think this is the time of the year that I will start seeing more bites. Why? Warmer weather brings families outdoors and I’ve noticed more dog parks popping up. I have experience with dog bites as a pediatrician and mom.

We are a dog family and my husband and I had our first dog, Mrs. Brown, before our oldest son was born. She was the “perfect” dog, a mutt that my brother (who is a vet) had found and gave yo us.

 When the boys came along she was wonderful and would follow them around the yard and to the closest neighbors, I would always know where the kids were as  Mrs. Brown would be waiting on the porch for them.

Our next dog was a golden retriever, Maddie, that our middle son wanted, and she too was a member of our family for 12 years.  Sweet (but a bit lazy), she was so sad as each of our sons left for college. She was suddenly the only child left at home. It broke our hearts when she died and the boys had not gotten a chance to get home to see her. 

Thinking we didn’t need a dog in a “empty” house was a mistake.  The youngest son felt like he should have a dog (even though he was away at college) and I thought a little dog might be nice.  No way, according to the youngest son, we “are a big dog family”, and so we now have 4 year old Maggie, a yellow lab. Sweet, smart and spoiled is all I can say.

Now, back to dog bites. I think it is important for children to be around dogs (and other pets as well) but to have a respect for them. Just like we teach children, “stranger danger”, the same goes for dogs. Teach your children not to approach strange dogs, or reach through a fence to pat a dog. Always ask the owner before trying to pet a dog.  

I would not recommend buying your child a dog until they are around 4 years of age. But, if you already have a dog, bringing that new baby into the home gives the dog some time to get adjusted before they are having a toddler around.  You as a pet owner should also know the temperament of your dog and if you sense any issues with your pet and aggression it may be best to find another home for the dog before your child is mobile. It doesn’t matter how careful one is, toddlers like to explore and that may mean that they are touching and petting the dog as well.

I know about dog bites from experience as our youngest son was bitten in the face by a friends dog. The bite was not provoked, but the dog came over while he was laying on the floor eating popcorn and watching a movie  and went right for his face. A late night phone call, trip to ER and plastic surgeon and 20 stitches later my son still wanted to play at that friends house!!  He loved dogs before, and still does.  Just a freak “accident” but I can still see the scars.  But, you know I am the mom!

 

 

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