Daily Dose

First Cold

1:30 to read

My office is hopping with a lot of little ones and their first colds. The worst cold that a parent experiences is not their own cold, but their child’s first  one.  Unfortunately, babies that are born in the fall and winter months often get their first cold earlier than a baby born during the spring and summer. 

It is such a helpless feeling for a new parent to see their baby with a runny nose, red rimmed eyes and a cough.  While newborns routinely experience nasal congestion, a cold is different. With a cold the baby’s nose will run and have clear to colored mucous,  and they will typically cough, just like all of us with a cold. They just look so pathetic...but you need to know what to watch for....as there will be more colds throughout the winter.

A baby (over the age of 2 months) may run a bit of a fever with their cold. A fever is defined as a temperature over 100.4 degrees. I am old school and still do rectal temperatures....just don’t think the temporal and ear thermometers are accurate.  The fever, if they even have one, should not last more than a day or two and should respond to the appropriate dose of acetaminophen for your child’s weight.

The biggest concern for a baby with a cold is how they are breathing. While they may look pitiful with that gunky nose, and have a loose junky cough, how your child is breathing is most important. You need to actually look at your child’s chest while they are breathing and coughing to make sure that they are not having any respiratory distress. Undo their onesie or take off the nightgown and look at their chest.  You do not want to see your child’s chest moving in and out (which is called retracting) or see that they are using their tummy (which is going up and down) to help them breathe.  The cough may sound horrible, but always look at their chest (visual more important than audible). They should also be nice and pink...even when they are coughing.  A cool mist humidifier in their room at night will also help.

Best thing for gunky nose is a nasal aspirator or nose Freda with some saline drops. Clearing the nostrils is often one of the best ways to help your child breathe, which will also help them to take the bottle or breast. A baby may not eat as well when they are sick (same as you and me) but they will take enough to stay hydrated and have wet diapers.  Being sick at any age typically effects your appetite and as your child is feeling better their appetite will improve as well.

Getting past that first cold is a milestone for baby and parents....but if you have any concerns about your child’s breathing, hydration or persistent fever, always call your doctor.

Daily Dose

Middle Ear Issues

1:30 to read

I just read a really intriguing study on children who have persistent middle ear fluid (otitis media with effusion) in The Canadian Medical Association Journal. Persistent middle ear fluid is fairly common and is often a reason that children will undergo a day surgical procedure to insert tympanostomy tubes (ear tubes).  In fact, my 11 month old granddaughter just had tubes placed.

The treatment for middle ear fluid is often to just “watch and wait” and in many cases the fluid will resorb on its own and the problem is solved. But for persistent fluid surgery was often recommended. For older children I often would see if they could learn the “valsalva maneuver” which would increase the pressure in the nasopharynx and help open the eustachian tube. This is the same maneuver you use to “pop” your ears after an airplane flight.  The only problem is that some children don’t seem to be able to understand how to do this as there is not a way to really let them know how it feels when performed correctly.

In this study, 300 children aged 4 -11 years who had had recent ear symptoms and persistent fluid in one of both ears were randomized to “usual care” or were taught to use a nasal balloon.  The nasal balloon with auto inflation is a device which is inserted into one nostril while occluding the opposite nostril and the child blows up the balloon through their nose. By doing this they increase the pressure in their nasopharynx and open up the eustachian tubes and clear the fluid.  Genius…. the child can see that they are doing the maneuver properly as the balloon blows up….and it is both painless and fun!!

In the study the children, used the nasal balloon 3 times a day for up to 3 months and they were more likely to “achieve normal middle ear pressure” than the children who did not use the auto inflation balloon.  

This is certainly low cost and can be taught in the pediatrician’s office with minimal time and effort for both parent and child. Who wouldn’t want to try this rather than have a surgical procedure?

I am now going to look into where to purchase this product (wish I had thought this up) and try this on some of my own patients. I am sure there are plenty of kids that would love to blow up a balloon with their nose…perfect for a show and tell demonstration as well!

Daily Dose

Jaundice in Your Bbay

1.30 to read

Newborn infants will often experience an elevation in their bilirubin (one mother thought it was “belly robin”) levels in the first several days after birth. This makes the baby appear to be yellow or jaundiced.  

Parents may hear their nurses discussing a baby’s TcB (transcutaneous bilirubin) level, and some nurses may even show parents the nomogram which the hospital uses to chart bilirubin levels.  It seems there is now a lot of anxiety among new parents about what this all means and in most cases the levels are to be totally expected.  I continue to think, “too much information for a brand new parent may be harmful to their health”. I want parents to be informed, but only if there is a problem. Is a bili of 7.4 really any different than 8.2?  Do you need to be up at night worrying about that? The answer is no - I will be up at night if necessary and let you know.   Knowing your baby’s hourly or daily TcB is not necessary and in fact, in my experience they often do not correlate with actual serum bilirubin levels.  

Newborn jaundice is due to the fact that infants break down red blood cells in the first several days after birth which causes the release of bilirubin. Bilirubin excretion is also facilitated by the liver, and just like everything else in a new baby....it isn’t in full working mode quite yet. It takes a few days for everything to kick start. At the same time a breast fed baby may be more likely to  get jaundiced  due to the fact that they often don’t pee and poop as much a formula fed baby....that all corrects itself once the mother’s milk is “in”. Lots of recent articles about this...be reassured.

If your baby does have a problem with higher bilirubin levels, which typically occur somewhere between days 2 -7, then your doctor may recommend phototherapy with special lights that help to breakdown the bilirubin in the skin. This may be done in the hospital or even at home under a contraption called a “bili -blanket”.  Once the bilirubin levels drop the lights are turned off!

But, what did our mother’s say long ago, “don’t ask for trouble”. Ask your doctor before you start to worry and remember a little yellow is to be expected.  

Here is a picture of one of my newborns in their bili -blanket at home! Looks pretty comfy to me.

Daily Dose

The Heat is Taking a Toll on Many

1:15 to read

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

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

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

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

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

Daily Dose

How to Swallow a Pill

1:15 to read

I have always been a proponent of teaching children to swallow a pill.  In fact, I think I taught my boys to swallow a pill before they were 5 years old, mainly because I was tired of trying to find the measuring cup or syringe for the liquid medicine, which often didn’t go down “like spoon full of sugar”, even though we would sing the song during dosing. 

By the time one child had learned to swallow a pill the other two boys, as competitive as they were, decided that they too could do it, even the 2 year old.  So, based on that experience I have been encouraging young patients to swallow pills, and even teaching them in the office with my stash of mini M&M’s and Tic Tacs!  I also know that if you wait too long it becomes a huge ISSUE.

Well, who knew that someone would actually study “pediatric pill swallowing”?  In an article just published in the May issue of Pediatrics the authors looked at different pill swallowing interventions.  They found that up to 50 % of children were unable to swallow a pill.   Problems swallowing pills included a variety of reasons including fear, anxiety and intolerance to unpleasant flavors. 

The authors reviewed 5 articles published since 1987 which found that behavioral therapy, flavored throat sprays, specialized pill cups and verbal instruction with correct head and tongue positioning all helped children to swallow pills. They also found that pill swallowing training as “young as 2 years helped increase the likelihood of ease of pill swallowing”.

So, like many things....jump in with your young child and master the art of pill swallowing sooner than later. It will make everyone’s life easier.

Last caveat, I always tell my patients who are older “non-pill” swallowers, “you cannot possibly operate a motor vehicle if you can’t swallow a pill”! This is usually a huge motivator for the “late swallower” and they conquer the challenge. 

Daily Dose

Teaching A Child Boundaries & Limits

1.15 to read

"Boundaries" and "limits" are two words that every parent needs to have in their vocabulary, just the same way that every child knows the words "no" and "mine".

It comes naturally to a toddler to learn the word NO, and to shake their heads when they don't want to eat the peas or take a bath or go to bed. Right after NO, they somehow magically learn the word MINE, and life really changes for parents. Now that sweet, precious toddler is empowered and has the world on a string, or at least their string. Very soon after your toddler learns their important jargon, it is important that parents start enforcing age appropriate limits and boundaries. A toddler running off from their parent who is standing line at Starbucks looks very cute with that impish smile of "are they going to get me?" But a three or four year old who darts in and out of line, and not paying any attention to others around them is not as cute. Where are their parents who need to put them back in line with a firm, "NO", and stop them from tearing up the store? Boundaries and limits must begin at a young age, but should be age appropriate. You cannot expect a three year old to sit through a two-hour dinner at a fancy restaurant, or a six year old to sit still through an entire opera (despite the fact that their grandmother thinks they should) or even a 12 year old to go to five family holiday parties in a day (maybe two?) But without teaching your children the lessons of limits, boundaries and consequences when they first venture out into the real world, you cannot expect them to listen later on as they continue to test both their limits and yours. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Hot Car Deaths

1:30 to read

Did you know that heat stroke is the second leading cause of non-traffic fatalities among children, with the first being backover deaths.  As the summer temperatures are rising these tragic accidents become all too frequent.  

The state of Texas leads the country in child vehicular heat stroke deaths, followed by Florida and California.  But children who are trapped in vehicles have died in milder climates as well. The temperatures outside may be as low as 60 degrees, but the inside of a car heats up quickly, with 80% of the increase in temperature happening in the first 10 minutes. The reason for this is due to physics.....the sun’s short-wave radiation is absorbed by dark dashboards and seats...the heated objects including child seats then emit long wave radiation which heats a vehicle’s interior air.  All of this leads to tragedy.

A child’s thermoregulatory system is not the same as an adult’s, and their body temperatures will warm 3 -5 times faster.  When a child’s body temperature rises to about 107 degrees or greater, their internal organs begin to shut down.This scenario can then lead to death. If you see a child who has been left in a hot car call 911...every minute matters.

The greatest percentage of these tragic deaths are totally unintentional.  These parents are not “bad parents” or “child abusers”, they are loving, good parents who simply forgot that their child was in the car. On average there have been around 37 deaths per year due to vehicular heat stroke and in most cases this is not due to reckless behavior but simply to forgetfulness.  Parents and caregivers both admit to “just forgetting” a child was in the car.  It truly can happen to anyone.

So, how can you remember that your precious, quiet, sleeping child is in back seat. Make it a routine to always look in the back seat before you lock and leave the car.  Try putting your purse, briefcase, or cell phone in the back seat as a reminder to look for your child. Lastly, if your child is in childcare, have a plan that the childcare provider will call you if you have not notified them that your child will not be coming to school,  and they don’t show up.

Daily Dose

ATV Accidents

1:15 to read

I had just recently read an article about “all-terrain vehicles” and helmet use, when I received a call that a friend had been involved in a accident on an ATV while on vacation.  One of those “odd” coincidences.  My friend suffered a punctured lung and broken ribs…..very lucky, and he was not wearing a helmet!

The CDC recently conducted a survey to estimate the frequency of ATV riding among kids between the ages of 12-17 years.  They found that about 25% of youths responded that they had ridden an ATV in the last year. Males were found to ride more frequently than females.

(not a surprise).  Geographically, there were more riders in the South, lower in the Northeast, and rural areas had more riders than urban areas.

But…only 45% of riders reported always wearing a helmet!! Twenty percent of riders reported wear a helmet “sometimes”, while 10% reported that they seldom wore and helmet and 25% admitted to NEVER wearing a helmet.  Interestingly, riders who rode more frequently were more likely to wear a helmet.

ATV accidents are quite common.  The AAP has advocated prohibiting the use of ATV’s by children under 16 years of age.  Statistically, between 20-25% of injuries and deaths secondary to an ATV accident are in children under the age of 16, with deadly ATV accidents peaking between 14-15. Head injuries occur in at least 60% of ATV deaths. Helmet use is associated with reduced risk of traumatic brain injuries, but unfortunately the CDC survey shows that many teens continue to ride without helmets.

It seems that many vacation destinations worldwide will often offer ATV excursions or rentals. Parents need to be aware of the risks involved while riding an ATV with their children or having their children driving one alone. As my own children used to say, “everything we think is fun, you think is dangerous”, and I am sure I said that many times. They have also ridden ATV’s and as far as I am aware always with a helmet.  

Whatever your views, parental supervision and helmet use is one way to help prevent serious injuries.  Be safe, listen to the rules of the road and wear a helmet! My friend was truly fortunate.

Daily Dose

Do Essential Oils Boost Immune System?

1:30 to read

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

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

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

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

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

 

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