Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

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

Daily Dose

Teens & Skincare

1.15 to read

I am seeing a lot of teens for their “routine” checkups and skin care is always part of our discussion. If you have a teen, you know how self-conscious they can be when it comes to their skin. Some teens are just blessed with good skin, and when you ask them what they do to their skin their reply is “nothing’. That is not the norm. Adolescence is the prime time for acne and whether the breakouts are mild or persistent, good skin care is the beginning for everyone. The first thing that all adolescents need to do is to wash their face twice a day. You do not need “fancy” skin potions or lotions either, the drugstore has more than enough choices to begin a good cleansing program. Using a mild soap- free cleanser may be enough to begin with , something like Purpose, Basis, Aquanil or Neutrogena. If the skin is more oily and acne prone try a cleanser that contains glycolic or salicylic acid , products like Neutrogena Acne wash, or Clean and Clear, you will need to read labels to look at the ingredients. These provide gentle exfoliation of the skin surface. Wash with a soft cloth but don’t scrub or buff, just wash. After washing your face in the morning, always apply a gentle non-comedogenic moisturizer WITH sunscreen. This will not cause acne, but will prevent sun damage that we all get on a daily basis. This is not the same as applying sunscreen for a day at the beach or lake. Again, I like Oil of Olay complete, or Neutrogena but there are many others out there, so find your favorite. At bedtime, after washing your face, if skin seems to be getting break outs begin using a 5% benzoyl peroxide lotion (you only need a dime size amount for the whole face) applied after your face has completely dried from the washing. If it is applied to a wet or damp face it may cause redness. Benzoyl peroxide products come in several strengths and may be titrated up in strength as tolerated. If this regimen is not working well it is probably time for a visit to the doctor to discuss some prescription products. More on that another day. That's your daily dose. We'll chat tomorrow. Send your question to Dr. Sue!

Daily Dose

Do Germs Make You Cringe?

1:30 to read

I see a lot of parents who are “germaphobic” and are constantly sanitizing anything and everything that may come into contact with their baby. I am not just talking about a newborn...but rather older infants and young children, especially as they start to creep and crawl around their environment.  Their mother’s purses have a bottle of hand sanitizer in easy reach and many have the bottle attached to the diaper bag or stroller as well. 

But now comes a new study which may help everyone relax a bit...and maybe stop constant disinfecting as well.  A recent study in The Journal of Allergy and Immunology found that children, under the age of 1, who shared a “dirty” home, with mouse and cat dander as well as cockroach droppings (I know you are all cringing now)  were less likely to develop allergies or wheezing by age 3.  

This idea has been called the “hygiene hypothesis”.  In other words, having children who are growing up in relatively sterile environments, may lead the immune system to “compensate” by reacting to pollen, dust and dander when there are fewer germs to ward off!  Now this doesn’t mean you have to stop keeping your house clean and never making a bed or vacuuming again ( novel idea), but the constant scrubbing and sanitizing may be a bit much. You don’t need anti bacterial soap in every room!

There have been other interesting studies done among children who live on farms.  They were taken into the barn as infants with hay, dander and animals all around them. They too were found to have fewer allergies than urban children.  So...playing on the dirty barn floor might not only be necessary for farm children, but also protective.

Should you run out and buy mice, a cat and try to breed roaches? I don’t think that is the recommendation.  Interestingly, this study did not show that having a dog was protective ....hmmmm when my kids were younger we did have a cat as well as a dog, not by choice but by my middle son’s insistence. Having always had dogs, somewhere in his early child hood years he “bargained” with us to adopt a black kitten that we all grew to love.  Maybe that was the best decision we made.  Fortunately none of my children have allergies or asthma. 

Lots of interesting studies on the horizon relating to this topic....stay tuned as I will keep you posted!

Daily Dose

Insect Bites are Everywhere!

1.30 to read

We are definitely in the “dog days of summer” and despite temperatures above 100 degrees (not just here in Texas either), it seems that insects thrive in hot weather. The mosquitoes here are just horrible and I see at least 2-3 patients a day that come in because their children have been bitten by “some bug”, most of which I believe are mosquito bites. 

I have been surprised that so many of the parents who are bringing their children in to have their bites checked are not using any insect repellent.  They seem shocked that their child can be bitten just walking into day care, or while on the playground for just 10 minutes, or even while they are in the pool.  It only takes a second for that mosquito to swoop in and bite and you never even know it until you see that swollen bite later that day or even in the next morning. (It’s a mystery why children seem to have bigger reactions to the bite and plenty of of local swelling).  Many parents are convinced that there are bed bug bites, but I truly believe these are just pesky mosquitos.  I even got one the other morning while walking out my front door just to get the morning paper! 

The best way not to “worry” about bites is to prevent them. For infants who are usually in a stroller I would use mosquito netting to start.  It is easy to drape their carseat or stroller as you go outside.  But as a baby gets older and is now outside more, and for those toddlers and older children the most important thing is to pick a mosquito repellent and use it.  

If your children are going to camp or day care, use it in the morning before they are going outside.  Reapply in the evening as well if you are going to spend time outside as well. You do not reapply insect repellent throughout the day like you do sunscreen, so pick the strength of  repellent based on the amount of time you will be outside.  Products with DEET, picardin, and oil of eucalyptus may be used in children (age dependent).  See www.cdc.gov for a listing of insect repellents by brand.  

Fortunately, to date (through the end of July  2013) there have only been a total of 53 cases of West Nile virus disease in people, with 3 deaths in the U.S. (Compare to 2012 with 5,674 cases of disease and 286 deaths).   

While 35 states have reported WNV activity much of the middle of the country is not evening reporting activity (maybe we should all move for a few months). This is all great news. But we still have a lot of summer left, so keep using precautions and drain that standing water around your house as well ...this helps the entire community.

Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Summer Series: Best Ways To Use Bug Spray

1.00 to read

Now that you know all about the options for bugs sprays this summer, let’s discuss the guidelines for using these products.

The American Academy of Pediatrics (AAP) and the Environmental Protection Agency (EPA) have issued recommendations for the application of insect repellents in children. These include the following: -Do not apply bug spray to children under 2 months of age -Use up to 30% DEET in children, depending on duration of outdoor activities. Avoid the use of higher concentrations in children. -Apply insect repellent only to exposed areas of skin and/or clothing. Do not use repellents under a child’s clothing.  Certain repellents may damage synthetics, leather or plastics. -Do not apply insect repellent to eyes or mouth, and apply sparingly around the ears. Do not spray directly on the face, spray on your hands first and then apply to the child’s face -Do not apply bug spray over cuts, eczema or breaks in the skin. -Have a parent or caregiver apply the bug spray as a child may inadvertently ingest the spray.  Do not allow children to handle the repellents without supervision. -Wash repellents off with soap and water at the end of the day. This is especially important when repellents are used repeatedly in a day or on consecutive days. Also wash treated clothing before wearing again. -Combination products containing DEET and sunscreen are not recommended, as sunscreen should be reapplied frequently (every 2 hours) and in contrast bug repellents should be applies as infrequently as possible.  It is also thought that DEET may decrease the effectiveness of sunscreen. -Do not use spray in enclosed areas or near food. Avoid breathing the repellent spray. -There are other ways to beat the bugs too.  Try to avoid go outside when the bugs are most active, dawn and dusk. - When your child does go out cover as much of the skin as you possibly can. Use lightweight, long sleeved clothing and pants.   Do not dress your child in bright colors or flowery clothing.  For young children use mosquito netting over their strollers etc. -The use of citronella candles or bug zappers have not been shown to help . -Eliminating standing water in yards and areas around the house and yard will help eliminate mosquito breeding. Fans do seem to help as mosquitoes have trouble maneuvering in the wind, so buying a fan to use around the picnic table may be useful. There are many ways to try and avoid the dreaded insect bites, the “battle” is just beginning. So, gather information and your favorite repellents and enjoy the outdoors. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue right now! Check the UV Index in your neighborhood here

Daily Dose

Selfies Cause Lice?

Daily Dose, infections, teens

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

Kids & Too Much TV

1.00 to read

Another new study has just been released which confirms that children are getting close to 4 hours of background TV noise each day. While many parents are aware of the need to limit their children’s active screen time (which includes TV, video game, telephone texting and computer screens) to no more than 2 hours per day, background TV time may be equally important. The American Academy of Pediatrics also discourages any TV viewing for children under age 2 years. 

The study from The University of Pennsylvania’s Annenberg School for Communication defines background TV as “TV that is on in the vicinity of the child that the child is not attending to”.  The research looked at TV exposure in 1,454 households with children aged 8 months-8 years. The study found that younger children and African-American kids were exposed to more background TV than other children.  Having background TV noise of any kind can disrupt mental tasks for all and may also interfere with language development in younger children. 

Those households that had the least background TV exposure were those that did not have a TV in the child’s room!! That doesn’t seem to be a surprising finding at all. Many parents leave the TV on in a child’s room to help them sleep, although there are numerous studies to show exactly the opposite effect, TV disrupts sleep. I now routinely ask every parent during their child’s check up if there is a TV in the child’s room. I also ask every older child the same question, and there are many teens who are not happy with me when I encourage their parents to take the TV out of the bedroom of their adolescent. There is just no need to have a TV in the bedroom of children of any age.  I have given up on this discussion with my college aged patients! 

While many parents are doing a good job of monitoring what their children are watching on TV, and how long they are watching, we may not be doing as well when it comes to background TV.  While older kids hear news stories or language that they needn’t be exposed to, a younger child’s language skills may be delayed due to background TV noise. 

So, the kitchen TV needn’t be on while you are making your children their breakfast before school or in the evening while eating dinner. Family dinner is one of the most important times of the day and conversation is the key. No one needs to try to talk over the TV, just turn it off! 

Lastly, keep reading those bedtime stories for children of all ages; this is key to language, and appropriate language at that. 

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

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

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