Daily Dose

Happy Thanksgiving From The Kid's Doctor

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I just wanted to take this opportunity to wish everyone a happy Thanksgiving. I hope that you have the opportunity to gather around the family table with many generations and enjoy this special day of thanksgiving.I just wanted to take this opportunity to wish everyone a Happy Thanksgiving. I hope that you have the opportunity to gather around the family table with many generations and enjoy this special day of thanksgiving.

I am thankful for my family, for our many friends who we will gather with and for all of the many blessings that we have. I am also so appreciative of those who are serving our country in Iraq, and Afghanistan and other places around the world, and for their many sacrifices that enables each of us to live in freedom. I wish that I could hug their family members who will be without them this Thanksgiving and pray that their loved ones will return home safely. Have a blessed Thanksgiving.

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Daily Dose

Make Sure Your Playground is Safe

This is the best time of year for children playing on playgrounds and in the front yard.I was outside with the neighbors and their children on this beautiful evening and realized that the longer days of spring are here. This is the best time of year for children playing on playgrounds and in the front yard. With those outside activities come concerns about safety for children of all ages. From falling off the slide to running into the street to chase a ball and being hit by a car, accidents and injuries are far too common.

Approximately 20 children under the age of 14 die each year from injuries sustained on playgrounds. Many of these deaths occurred on backyard playgrounds. Thousands of other kids will make trips to the E.R. for fractures and sprains, cuts that need stitching, and head and neck injuries. The best way to ensure safe play is to ensure that the equipment they are playing on is safe, and that there is good parental supervision. Swings may pose a choking and hanging hazard, so check out that home made rope swing. Check out the slide for sharp edges or hooks that may cause lacerations. Burns may occur from slides that heat up in the heat of the midday sun (that may only be a southern experience!) Another source of injury is due to inappropriate surfaces beneath the playground equipment. Look into installing a protective shock-absorbing surface beneath your swing set or fort. Make sure that the surface extends far enough in all directions to cover jumps from swings and slides. Playing outside is a rite of passage, and a great way for a both family and friends to have fun, and get exercise. Just make the experience as safe as possible. That's your daily dose, we'll chat again tomorrow.

Daily Dose

How to Treat Stool Holding

Stool holding part 2: how to treat this common ailment.On Friday, we discussed stool holding and encopresis: what it is and why kids have trouble going to the bathroom.   Now it’s time to discuss treatment.

The medicinal component of treatment begins with  cleaning out the rectum. This is typically done by using enemas (Fleets) to get rid of the large amount of old stool that has distended the rectum.  Mineral oil given orally may also help the stool to be evacuated (it is tasteless but a child can see the oil, so get a soft drink or juice and put a top on it and mix in the mineral oil and serve with a straw), you can also mix into oatmeal. I typically use an enema to start and then keep up daily mineral oil for awhile until the stools are routinely soft and not painful.  Enemas are not well liked by anyone.  A daily laxative is also important. Milk of Magnesia and Miralax are my favorites.  The dose may be titrated but you want to ensure that your child is having a stool every day. The laxatives are not habit forming, but are serving a purpose to help the colon begin to work correctly again. Once your child is having regular bowel movements without pain, or avoidance you can slowly wean the laxative too, but do this over several months. Dietary therapy is also important to help soften stools and decrease the transit time of stool in the colon. Healthy eating habits which incorporate high fiber foods are helpful. The formula for fiber intake is the child’s age in years + 6 = number of grams of fiber /day. You would be surprised at fiber content of foods and they are all listed on the food packages. Benefiber is also a good source of fiber and can be used daily.  I like  to use Metamucil cookies too and if necessary put a little icing on top.  Adding more fluid to a child’s diet is equally important , and a “prune juice cocktail” made with prune juice and seven up or ginger ale is a great way to get in some more fluid with additional laxative benefit. (you taste it not bad at all!) Lastly, behavior modification.  Begin by establishing a regular toileting schedule. This is typically after each meal (to take advantage of the gastro-colic reflex which occurs after eating and causes intestines to contract) and at bedtime.  I sometimes use a timer as a game to try and have the child “beat the clock” in pushing out their poop, and then they receive a “prize” (Dollar store is adequate, does not need to be expensive etc.). A child needs lots of positive reinforcement with charts, stickers to show their progress and even larger reward (maybe trip to bookstore, or ice cream store etc) for a week of good work. Remember, this is not an overnight resolution but typically takes weeks to months of work, so be creative as to positive reinforcement. If your child does not stool every day, try using a suppository and increasing the laxative.  They can also practice doing the Valsava maneuver (where you hold your breath and bear down to have a bowel movement) which will also help them push out the stool which should be soft. If your child is in school you need to discuss these strategies with the teacher so that the child has adequate bathroom time when needed. By working on all 3 areas encopresis can be treated and successfully cured while saving the child embarrassment and anxiety that often comes with it. No one wants to have “poopy pants” they just need the tools to fix the problem. For very difficult cases you may need to ask your pediatrician about using a behaviorally trained pediatric psychologist for assistance. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

How to Treat Croup

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Now that the weather seems to change daily, croup season is here. Have you heard the sounds of raspy, throaty voices in your house lately? This "noise" is ushering in croup season! Croup is an infection that causes swelling of the larynx (vocal box) and trachea (windpipe) that in turn makes the airway just beneath the vocal cords become swollen and narrow. When you have swelling and narrowing of the airway breathing becomes more difficult and noisy and the sound that is made, almost like that of a seal barking, is called being “croupy”. Croup is quite common in young children, but the sound the emanates from that child when they cough, can be scary and concerning for both parent and child. Children are most likely to get croup between the ages of six months and three years. As a child gets older croup is not as common as the trachea gets larger with age and therefore the swelling does not cause as much compromise. When you awaken in the middle of the night to hear your child “barking” in the next room you need to know what to do. Most croup is caused by a common virus, so croup is not treated with antibiotics. The mainstay for the treatment of croup is try and calm you child, as they may be scared both from the tight feeling in their chest, as well as the sound that is made when they are breathing and coughing. The best treatment for croup seems to be taking your child into the bathroom and turning the shower on hot. Let the steam from the hot water fill the room and sit in there and read a book or two to your child. Typically within five to 10 minutes (before the hot water runs out) the moist hot air should help your child’s breathing. They may still have the barking, croupy cough, but they should be more comfortable and will not look like they are having trouble breathing. If the moist steam does not work, and it is a cool fall night, go outside. That is right, taking your “croupy” child from the moist heat in the bathroom, outside to cool night air may also help open their airways. If your child is showing signs of respiratory distress, with color change with coughing (turning blue while coughing, red is always good), is retracting (using their chest muscles between the ribs to help them breath), is grunting with each breath, or seems quite anxious and having trouble breathing you should call for emergency help. If a child is having real difficulty breathing they may be admitted to the hospital to have supplemental oxygen or breathing treatments. Steroids have also been helpful when used for the correct patient population. Steroids may be used in both an outpatient and inpatient setting. Steroids help to reduce inflammation in the trachea and the symptoms lessen over several days. Steroids used in a short burst are not harmful to your child, and are indicated in a child who may have mild respiratory distress due their croup symptoms. Your child may have symptoms of croup for several days, and for some reason they always seem to be worse at night. Put your child to bed with a cool mist humidifier in their room for the next several nights, this will also help to provide moisture to their airway. It is not uncommon for some children to seem more “prone to croup” and may get it recurrently all fall and winter. Have the humidifier handy and in working order! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

The Homework Battle

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Homework is one of the least favorite exercises for both parent and child.

Homework is one of the least favorite exercises for both parent and child. I was reminded of this while helping my five and seven-year-old nephew and niece with their homework recently. It seems like yesterday since I was helping our own sons with homework, when in actuality it was many years ago. It is easy to forget the complaining, cajoling and pleading to get homework finished. But it is also an important exercise in helping your children get an organized workplace at home, to having family rules about computer and TV time before homework is finished and to teach independent study skills as a child matures.

So... trying to get my niece and nephew to settle down for homework with out getting up, trying to "sneak" back to the computer andto focus on the letter ‘N’, was a real test of forgotten parenting skills. I am not sure I was a total success. They did not want to do their homework, gave me 10 reasons it wasn’t necessary and told me "Aunt Sue you are the meanest aunt we have", which I am sure was not a compliment.

After much stalling, begging and promising "we" finished one worksheet for first grade and a Pre-K sheet glued with picture of ‘N’ words cut from catalogs (while he searched for Christmas presents for me to buy him). It was organized chaos to say the least, but it was finished! The short story is, have a set time for homework and a place for your young children to work, where they are within your sight, but also without a lot of distraction.

Try to get homework done earlier than later; it’s always harder when both parents and children are tired. Make their homework their responsibility, even from early elementary years, as it sets the stage for the rest of their years of homework. Lastly, don't ask Aunt Sue the pediatrician to help; she has "way too many rules".

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

Daily Dose

Talking to Your Baby

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An interesting study on how mothers and fathers converse with their infants is being published on line today in the journal Pediatrics. I found it fascinating since I am once again “oohing and gooing” with a baby: my precious granddaughter. I was just feeding her yesterday and remembered talking to my own children years ago and gazing into that baby’s eyes in amazement.

The study entitled, “Gender Differences in Adult-Infant Communication in the First Months of Life”, looked at 33 babies and audio recordings which were made from birth to 7 months of age.  They found that infants were exposed to more speech from mothers than fathers (are you surprised, we do have more words, right?). Interestingly they also found that infants preferred mother’s speech and language over fathers. Do you think it is the timbre of the voice or the number of words that we mothers use when talking and soothing an infant? I am not sure that it is purposeful, but men do use less words than women.....at least in my house which was full of boys...who turned into men of few words as well.

The study also showed that mothers responded more frequently to girls and there were trends for fathers to respond to boys at birth and during the first month of life.  Do you think it may be that new mothers and fathers are not yet sure what they should be discussing with these new babies that may be of the opposite gender? It takes a while to figure out that a baby boy is just as happy hearing his mother discuss how to bake cookies, as a baby girl may be to hear her father discuss the latest sports scores.

Interestingly, overall language exposure increased over time for all of the infants as they matured. 

Bottom line? Start talking to your baby the minute they are born....about anything.  Babies just love hearing their mothers’ and fathers’ voices and parent talk is always beneficial for a child’s language development.

Daily Dose

Ebola in U.S.

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It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.

 

Daily Dose

Reading Nursery Rhymes

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What has happened to nursery rhymes?  Have they been lost in translation? I saw a cute 4 year old patient the other day who had fallen at pre-school and gotten a really “nice” bump on the middle of her forehead. Fortunately she was just fine, except for the goose egg.  When I told her she was just like Humpty Dumpty she looked at me with big wide unknowing eyes and said, “Who?” 

Her mother and I proceeded to tell her the nursery rhyme about Humpty’s great fall. I think she was amazed that her mom and I knew the same rhyme! Her mother told me she had never thought about reading her children nursery rhymes, but at the same time she agreed that nursery rhymes needed to be passed along to each generation.  I think she was on Amazon ordering a Mother Goose book while we were talking! 

Seeing that I am Dr. Hubbard, I remember being teased for years about being a child who lived in a shoe. As I got out of college and medical school, I found that it was convenient to have the last name of Hubbard, so when I was being introduced as Dr. Hubbard or calling in a prescription, I would say “Hubbard, like Old Mother”.  It has only been in the last 5 years or so that people would say, “Who?” Now I have to spell my last name. 

I often talk about going back to the basics. I think nursery rhymes may fall into that category as well.  These rhymes, although often nonsensical and whimsical, should not be forgotten.  The Cow that Jumped Over the Moon, or Little Miss Muffet and her friend Jack Horner are too treasured to be forgotten. It is such fun to hear a young child recite a rhyme that they have heard over and over again, even if it takes years for them to understand their meaning. 

I have saved my own childhood book of nursery rhymes that my parents read to me, and I read them to my own children, now I have to wait for grandchildren. I can’t wait to enjoy reading them aloud to the next generation. Is this a hint?

 

 

 

Daily Dose

The Right Way to Take A Temperature

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 During flu season and really throughout the year, the questions surrounding how to take a temperature in a child and how to treat a fever seem never ending. So I thought let’s jump right in with a discussion on taking temperatures in all age children.

There are many different thermometers out there, and many different methods for taking a child’s temperature. The one way that I know that is not accurate is by “touch of hand”. Many parents report that their child had a fever, but have never taken their temperature. Neither your hand, nor mine is accurate in detecting a fever in a child. I am not a fanatic about taking temperatures all day long but it is important to document your child’s body temperature with a thermometer if you think they have a fever. Also, a fever to a parent may mean 99.6 degrees (I know your child has a different body temperature than others), but in terms of true fever most doctors use 100.4 degrees or higher as true fever. For everyone!

Body temperature in infants is very important and a fever in a child under two months of age is something that always needs to be documented. The easiest way to take a temperature in an infant is rectally and is actually quite easy. Lay your child down, like you would be changing their diaper, and hold their legs in one hand while you gently insert a digital thermometer (lubricate it with some Vaseline, makes it slide in more easily) into their rectum (bottom). It will not go too far, don’t worry, only about 1/2”. Keep the thermometer in their bottom for about a minute and by then you will be able to see if they have a fever. Again, over 100.4 degrees. I use rectal thermometers in children up to about two as they are usually pretty easy to hold and it is not painful at all. It is also accurate. Keep this digital thermometer labeled for rectal use.

Axillary temperatures are taken under the arm and can also be taken with a digital thermometer. It is often confusing if your child’s temperature is in the 99 – 100 degree range, so if in doubt take rectal or oral temperature. I am not a huge fan of axillary temperatures, and it actually requires more cooperation than a rectal temp. Oral digital thermometers, which are placed under a child’s tongues, are easy to use in a cooperative child. By the time your child is three or four, it is fun to teach them how to hold up their tongue and then hold the tip of the thermometer under their tongue and close their lips.  Especially with digital thermometers, elementary children like to read you what the thermometer says, and discuss their temperatures. My children always loved to show me they were REALLY sick when it said 103 degrees. It is then a “sick day activity” to take the acetaminophen and watch your temperature come down over the next several hours. They loved making charts of their body temps. It won’t win a science fair but does keep them busy. Also, if they can play this game they are not too sick. Lastly, do not let your child drink a hot or cold beverage right before taking an oral temp (note for parents of older kids, remember Ferris Bueller?), as the reading may not be accurate.

There are also fancy tympanic (ear) thermometers and temporal artery thermometers. I still prefer digital in my own house, and never purchased a “fancy” thermometer. You can buy tons of digital thermometers for every child to have their own, and still save money. We also often hear parents report that there was over a degree of difference between the same child’s ear. I also do not like ear thermometers in little ones, as their ear canals are too small to get accurate readings. Now that you know how to take a temperature I will discuss fever in another post.

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

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