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Daily Dose

The Truth About Antibiotics

1:30 to read

Despite warmer than normal temperatures in much of the country it is certainly already cough and cold season. Our office background music is already a lot of coughing coming from children of all ages…and a few of their parents too. In fact, a few of our nurses and docs are fighting a fall cold as well.

 

This makes it timely to discuss (once again) the difference between a cold which is a viral infection and a bacterial infection (example strep throat).  Viruses are NOT treated with antibiotics!! In other words, antibiotics are not useful when you have the common cold. Asking your doctor to put you on an antibiotic “just in case “ it might help is not advised, and doctors should be taking the time to explain the difference between a viral infection and a bacterial infection, rather than writing an unnecessary antibiotic prescription.  

 

While some people (fewer and fewer young parents) still think an antibiotic is necessary, the overuse of antibiotics has been called “one of the world’s most pressing public health problems”s, by the CDC. Not only does the overuse of antibiotics promote drug resistance, it may also cause other health concerns as well. While antibiotics kill many different bacteria, they may also kill “good bacteria” which in fact help the body to stay healthy. Sometimes, taking antibiotics may cause diarrhea and may even allow “bad bacteria” like clostridium difficile to take over and cause a serious secondary infection.  

 

At the same time that there are too many antibiotic prescriptions being written for routine viral upper respiratory infections, a new study in JAMA also found that bacterial infections (sinusitis, strep throat, community acquired pneumonias), are not being treated with appropriate “first line” antibiotics such as penicillin or amoxicillin.  Of the 44 million patients who received an antibiotic prescription for the treatment of sinusitis, strep throat, or ear infections, only 52% were given a prescription for the appropriate first line antibiotic. When a doctor prescribes a broader spectrum, often newer antibiotic, instead of the recommended first line drug, they too are responsible for increasing antibiotic resistance.

 

So, you should actually be happy when your pediatrician reassures you that your child does not need an antibiotic, and that fever control with an over the counter product, extra fluids and rest will actually do the trick to get them well.  I “brag” about my patients who have never taken an antibiotic…..as they have never had a bacterial illness, and tell their parents how smart they are for not asking for an antibiotic “just because”.

 

At the same time, if your child does have a bacterial infection, ask the doctor if they are using a “first line” drug and if not why…? It could be because your child has drug allergies to penicillins, or that your child has had a recent first line drug and has not improved or has had ‘back to back” infections necessitating the use of a broader spectrum antibiotic.  Whatever the reason, always good to ask.

 

Keep washing those hands, teach your child about good cough hygiene and run don’t walk to get your flu vaccines….November is here and flu usually won’t be too far behind.

 

 

  

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

Home From School

1:30 to watch

I continue to talk about it being  the “sick season” and thankfully it is now February!  Parents are all tired of having sick children and I can now at least assure them that we are halfway to the end of upper respiratory and flu season.

 

But, with that being said that means I am still seeing children with RSV, Flu and every other virus I can think of. Remember, the majority of the illness I see every day in my office is VIRAL.  It really doesn’t matter if you can put a name to the virus, as the treatment is the same. Rest, fluids, fever control and watch for any respiratory distress or symptoms of dehydration. As I told one young mother who said that her other child had been tested for RSV (by another doctor), testing the child I was now seeing will not make any difference in how we treat the illness. So, why make the child uncomfortable when doing the swab and also drive up health care costs, for no change in treatment recommendations.  I think people are confused about what the test actually does….it does not change how a child is treated, and it also causes a lot of “alarm” as the mother of one patient goes home to tell her friends that her child has RSV and then the school starts sending out emails and parents become more anxious and alarmed that they may have been exposed….as they are every day all over our city.

 

So…when do you know it is time to keep your child home from day care or school as we all know these viruses are spread at home, school and work as well.  

 

If your child has a fever over 100.5 degrees (by any method of taking their temperature) they should not go to day care or school for at least 24 hours after becoming fever free (without fever lowering medication).

 

If your child is vomiting, 2 or more times in the last 24 hours, they should stay home. Some young children may vomit after coughing as well, but if infrequent they may attend school. 

 

Diarrhea as defined by two or more loose, watery stools that are “out of the ordinary stool pattern” for your child. Any child having diarrhea that does not stay contained within a diaper should stay home. A child who has blood in their stool should not attend day care or school (and should see the doctor).

 

Children with strep throat may return to school after 24 hours if they are fever free and have received the appropriate antibiotic therapy.  (Newer article suggests 12 hours if they are feeling well).

 

Your child does not need to stay home due to a cold, cough, runny nose (of any color) or scratchy throat if they do not appear ill and do not have a fever. Look at how your child is behaving…some times a day of rest may be needed (even when you get sick, right?) 

 

Most importantly, it is not necessary to name the virus that your child might have, but to follow the guidelines for keeping them home (as well as out of stores, church, and after school activities) until they are feeling better. Wash hands, cover coughs and yes….still get the flu vaccine. It is not too late…the ground hog even said we still have a lot of winter left.

 

 

 

Daily Dose

What New Babies Need

1:30 to read

I have many friends whose own children are now having babies and they always ask, “what all do we need to have/buy for a new baby these days?”  While many things have changed since I had my own children, many have not,  and I still think “less is more” is a good adage to follow, especially for a newborn.  We all have a tendency to buy too much, or the “latest and greatest” only to find out that it is not necessary.

Carseat - a rear facing car seat is a must for your newborn!!!  Look at all of the reviews on line and pick which seat works best for you.  Do you want one with a base that you can also clip on to a stroller?  Remember your baby will sit in a rear facing car seat until 2 years. This is one item I would spend my money on!!

The baby needs a place to sleep so buy a crib and a good mattress.  If you are going to have more than one baby I would buy something that will last through several children. I like having a crib (rather than a toddler bed), as your baby will be in the crib for several years and then can move to a regular bed…no need for an “in between”.  Do not use an “old” crib that has drop sides, due to safety concerns. So that means the one that I had kept in the garage (from my kids) was a throw away! I usually move the first child to a bed when I need the crib for the next baby…no specific age. Bumpers are no longer recommended, so that saves money too!

Changing table or dresser for the millions of diaper changes.  It is so helpful to not have to bend over each time. I would also buy a diaper cream (Dr. Smiths, Destin or Butt paste) to have on hand….your baby will probably get a diaper rash at some time during their time in a diaper.

Baby bath tub: while you can bathe your baby in the sink, the newer bathtubs do make it easier for a newborn and you can use it in the tub as well until your baby can sit up alone. Remember, you will NEVER leave your child in the tub alone…even with all of the seats, rings and things  that they sell to support your baby!!  For bathing I like gentle bath wash like Cetaphil, Cerave, and Eucerin products….good for all skin types.  Pick one!

Swaddle blankets: WOW there are a million on the market and they all “claim” to help your baby to sleep better. I don’t think any of the products say “it will also takes weeks to months for your baby to sleep through the night” , no matter what you use.  I do like the thin swaddle blankets as they are useful for a number of things besides swaddling. Once you have your baby have the nurses show you how to swaddle (quick and easy).  The Miracle Blanket, Woombie and Halo also make it easy to swaddle as well. Pick one (or two) and stick with that.  Remember, your baby is going to be put in their crib on their back whether swaddled or not!! NO TUMMY SLEEPING.  

Diaper Bag: again their are a million out there in all shapes, sizes and price points. In the beginning you need to have a pad for changing (you will end up changing that baby all sorts of weird places), diapers, burp clothes, wipes…as your baby gets bigger you will have bottles, cups, toys all shoved in there too. All of my patients seem to have a travel size Purell strapped to the side of the bag as well. I would get a bag that you can wipe out as there will be spills of all sorts of stuff in that bag I assure you!  Somehow, over time you go back to “less is more” and the diapers end up in your purse!!  

So…that is a start. Will do another post on some other products in the future. 

 

 

Daily Dose

Teach Your Kids Good Manners

1.15 to read

Spring is always a busy time of year with end of school parties, proms, graduations, and lots of invitations.  These invitations are often sent not only to parents but many times they are sent to the kids as well. Some invitations have a reply card or say “please reply” or RSVP.   

Do your kids know what RSVP means?  Although it is French, surely everyone still knows it means “reply if you please”. Has RSVP been replaced by LOL and OMG? It is a common courtesy to respond to an invitation and one that all children need to learn (maybe some adults as well). 

Over the years I have had to explain this courtesy to my own children. Sometimes they just did not understand why I bugged them to reply in a timely matter.  After looking at the bulletin board where I would put check marks and dates by our response, I would often ask them if they had replied as well? This question was often answered with, “Not yet, trying to decide, or “ They know that I am coming ” or lastly “ I’ll do it later”.  Such answers did not seem to be exactly what I had hoped to hear. Of course, I couldn’t relent until we had closure on this issue and I knew that they had responded.  I was the bothersome mother after all!

For many years they seemed clueless as to head counts and party prep. I would re-iterate that by getting an idea of how many people are going to attend any event the hosts can make sure that there are enough seats for everyone coming, or enough food to eat and drinks for all. Otherwise, you either spend way too much over buying or end of scrounging as you didn’t plan on that many people. “Whatever”, right? 

Well, now that they are older, they were just complaining to me that they had not heard from guests for a party that they were planning. “How do I know how much food to order?”, “How do you rent tables and chairs if you don’t have a head count?”  “Why do people wait till the last minute to reply?”  “Didn’t their parents bug them about replying?”  And finally, music to my ears, “Mom you should write a blog about learning to reply to invitations”! 

So...here it is. Teach your kids (beginning at early ages) how to reply to a party. Have them pick up the phone to reply to the 5 year old birthday party, or learn to write an email response when they are accepting an invitation to attend an event. Teach them to reply in a timely manner, and if something does change, let the hosts know.  Lastly, I still don’t see any reply messages that say “text me if you are coming”, but I am sure that is just around the corner.  

Good manners are ageless and timeless.

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

Cold & Cough Relief!

1:30 to read

Although it is just getting really cold across the country, it feels as if we have been in full cold and cough season for awhile.  The office sounds like what I call “kennel cough” as every child seems to be coughing…. even those who are just coming for check ups.

Parents often ask, “what is the best way to keep from catching a cold?” and the answer continues to be, “wash your hands and try not to touch your hands to your eyes, nose and mouth”.  Easy enough for an adult (well maybe not), but trying to tell your toddler not to put their hands in their nose or mouth is nearly impossible! That is one reason that children get so many colds in the first several years of life. Toddlers typically get the most colds as they have just started having playmates with whom they share not only toys but their germs…all part of growing up.

I remind parents that coughs are there for a reason. While they are a huge nuisance, and cause a lot of sleepless nights for both the child and parent, a cough is there to keep the lungs clear, and a cough is actually protective. In other words, coughing helps you clear the lungs of mucus that comes with a cold and helps to prevent pneumonia and secondary infections.  But, with that being said, learning to cover your mouth when you cough is not only polite, but it is also protective for others. It is a big day when your children learn to cover their mouths with the crook of their arms (better than the hand). Who knew as a parent this would be a milestone for your child?

Whenever your child is sick and has a cough and cold it is important to not only listen to their cough but to actually observe how they are breathing.  Parents send me videos or voicemails of their child coughing, but I am usually more interested in seeing their chest and watching their breathing. Your child may have a huge productive cough and sound terrible, but have no respiratory distress. With that being said, your child may also have a tiny little non-productive cough and be struggling to breath. In most cases the visual is more important than the audible.

To help symptoms like stuffy noses, try irrigating your child’s nose with Little Remedies® Sterile Saline Nasal Mist and then suctioning his or her nose to clear the mucus and make it easier for him or her to breath, a warm bath or shower before bed to open up airways and a cool mist humidifier in the bedroom.

Don’t panic if your child gets sick, as each time they fight off a cold and cough they are actually boosting their immune system…small victories.  It is not unusual for a toddler to get 6 - 7 colds in one season (and their parents get half as many as that from them). Once your child turns about 3 you will see that he or she doesn't get a cold every other week and also seems to handle the viruses a bit more easily.

If your child has any difficulty breathing you need to call your pediatrician! For more information on these products visit www.littleremedies.com.

 

 

 

 

Daily Dose

Fever

1:30 to read

It’s starting….fever, fever, fever season and lots of concerned parents, so figured it was a good time to talk about fevers….AGAIN.  

 

Remember that fever is simply a symptom that your body’s immune system is working, and in most cases, in children, it is fighting a viral infection.  We docs call a fever a temperature above 100.4 degrees…but I do realize that day care and schools will send your child home when they have a temp above 99.5 degrees ( in some cases even lower). Some parents “explain” to me that their child’s body temperature is always lower than 98.6 degrees so a 99.9 degree temperature is abnormal for them….I’m just saying. 

 

The first thing to try and remember is that the thermometer is simply showing you a number and that the number should not scare you…it is only a number and a higher number does NOT necessarily mean that your child is any sicker.  Some children do tend to have a higher temperature with an illness than another, and even in the same family.  Again, the number should not make you concerned that one of your children is sicker than another…it is still just a fever.

 

Parents always ask…”what degree of fever is dangerous, and when do I go to the hospital?”  The number that registers on the thermometer should not be the deciding factor as to how sick your child is. They will look and feel worse with a higher temperature ( as do you when you are sick), but the important thing is to always look at their color (never dusky or blue), how they are breathing (you do breath faster and more shallow with a higher body temperature, but do not appear to be in any distress), and if they are hydrated (you do need more fluids when you are running a fever).  If all of this seems to be okay, the best thing to do is treat the fever with either acetaminophen or ibuprofen.  Once their temperature comes down a bit, and that may not be 98.6, look at your child again…children with lower temperatures typically “perk up” for a bit and may play or eat and drink for awhile, until their fever returns and they look pathetic again.  I would always check with my doctor before heading to the ER just because of a fever.

 

Parents also worry about their child having a seizure due to a fever…and this is true some children may have a febrile seizure. But, they can have a seizure with a temperature of 100.8 or 104.2…it does not seem to be the higher the temperature causes a febrile seizure. Febrile seizures do seem to “run in families” and they are also most common during the toddler years. (see another post on this).

 

So… as we are getting into sick season make sure you have an acetaminophen and ibuprofen dosing chart handy and always dose your child’s medications based on their weight and not age. I would also make sure to have a “working” thermometer, and I prefer a rectal thermometer for children under 12 months of age. Rectal temps are really easy to take and in my experience far more accurate (when I am really concerned if a child has a fever) than a tympanic or temporal thermometer. 

 

Be ready and relax….it is just a fever and having an anxious parent is not going to make your child feel better any faster.

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Daily Dose

Birthmarks

1:15 to read

Many years ago when children asked their parents “where did I come from?” they answered “the stork brought you”.  The picture of the stork’s beak holding on to the baby’s neck and flying to drop the baby on the new parent’s doorstep was known by all….but things change and that visual is not known by my newest parents.  In fact they look at me with completely blank stares when I discuss the birthmark on the nape of their child’s neck.

But the term “stork bite” comes from that old story, and the red birthmark seen on up to 50% of babies necks is also called nevus flammeus or nevus simplex. They are flat, pink and irregularly shaped and while they occur most commonly on the nape of the neck, they are common on the forehead, eyelids and above the upper lip as well. They are due to capillaries close to the skins surface. The stork bites on the face typically fade over time while the ones on the nape of the neck may continue to be present but are obscured and typically forgotten once the baby has hair. Many people are not even aware that they themselves have one.

When I am doing a newborn exam I see so many of these little “flat red patches” that I often to forget to bring them up as they are small and typically fade….but sometimes a parent will specifically ask about them. After I apologize for not bringing it up….as I know they are small and fade, but they are concerned,  I tell them that they are “stork bites” and get that blank look.  Then I launch into the etiology for the name etc. But, things are getting ready to change as STORKS a new animated movie is just bring released.  The old myth of the stork is making a come back!

So…if your baby has this small birthmark, no need to worry.  Be assured that most will fade but if they have not resolved by the age of 3 or 4 years, there are now lasers available to treat them.

In the meantime..take your family to see "STORKS" so they are aware of where “you used to come from”!  We can still tell our children the myth of the stork and then make sure to discuss the truth about “where did I come from?”. 

 

 

 

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