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Daily Dose

Life Jackets!

1:15 to read

Summer is here and that means many of my patients are taking off to the beach or the lake to escape the heat and enjoy some water activities.  I recently saw a patient who told me that had just gotten a new boat and were looking forward to getting the kids out on the water.  This brought up the subject of life vests. 

When taking your children on a boat it is important that you have life vests for everyone. It is a law that all children under 13 years of age wear a “coast guard approved” life vest when on a boat that is being operated. This designation is very important, as many of the “life vests” that parents buy are not approved for boating…this includes “water wings” and some of the “cute” wearable t-shirts with life preservers sewn into them. 

Once you have found “coast guard approved” life jackets you might let your child help pick out the one they like the best and that is comfortable. This is important as it will ensure that they are both safe and comfortable. Children’s life jackets are sized by weight, so you might always have a few extras in case a friend or two comes along at the last minute.

Infants life jackets are are a bit different and have a strap that runs between their legs and extra flotation behind the head which guarantees that the baby floats face up at all times. I can attest to this important safety feature as my husband took our son on a little boat one summer day at a friends lake house. The lake was small enough that I could actually see them from the house as they rowed out to try to catch a fish. It was two men and a toddler on the boat…and I watched in horror as our 14 month old (now 32 year old) son leaned over the side of the boat to look at the fish and fell right into the dark murky Texas lake!!  Fortunately, we had followed the boating RULES and he was wearing his bright orange coast guard certified life jacket and bobbed right up to the surface…with a huge scared look on his face!  We have many pictures of our boys in the life jackets every time they set foot on a boat...including this one!

Lastly, get in the habit of applying sunscreen before you even set off for the dock and then have the children put on their life jackets. Kids can just as easily fall off the dock into the water as you prepare to get on the boat.  I would also encourage them to wear a hat for additional sun protection.

A day of boating is a great family activity and there is a lot a child can learn on board as well…how to navigate with a boating chart or GPS coordinates, how to watch for buoys or other water markings and all of the boating jargon.

Bon Voyage! 

Daily Dose

Being a Dad

1:30 to read

Seeing that this is the week of Father’s Day (have you made your card or shopped yet?), I thought this was a good time to discuss some recent data that might be of interest to men….especially those who may be planning a family in the near future. 

For years research has shown that maternal age may contribute to birth defects and chromosomal abnormalities, including Down’s syndrome.. It has also been known that a pregnant woman’s health and habits may also affect their unborn baby’s health, therefore  woman are instructed to stop smoking and drinking alcohol while trying to get pregnant as well as throughout their pregnancy.

Dr. Joanna Kitlinska a researcher from Georgetown University has been studying how men’s age as well as their habits might also impact a child.  Her findings have shown a link between men who are over 40 years- “advanced paternal age”  and the incidence of autism as compared to fathers under 30 years of age.  Studies have also found that older fathers are more  likely to have children who develop schizophrenia.  Researchers wonder if this link may be due to changes in a father’s genes as they age….but to date this is unclear. “Biological clocks” and a woman’s decision to delay a pregnancy until their career is established (or for a myriad of reasons) may now be a decision that men will face as well.  Could both aging eggs and sperm play a role in genetic abnormalities? 

Smoking seems to be another habit that may somehow affect a man’s sperm and could potentially lead to genetic abnormalities in a child. 

While fetal alcohol spectrum disorders are known to be found in women who have consumed alcohol throughout their pregnancy,  researchers have also noted that 3 out of 4 children diagnosed with FAS also have alcoholic fathers.   Could their father’s excessive use of alcohol have also played a role in their developing brain?  This association has been found even if the mother did not drink alcohol during her pregnancy. Again, did the alcohol affect a father’s sperm and genes which was passed on to their child?

So…bottom line, it is important that “fathers to be” are equally invested in a healthy lifestyle when they are planning on having children.  It goes without saying that smoking, drinking, and even obesity and stress are not good choices for anyone …..but the fact that these choices may affect a future child are good reasons for both fathers, and mothers to be aware of this research when they are planning a family. 

 

Daily Dose

Ear Tugging & Your Child

1.15 to read

I see a lot of parents who bring their baby/toddler/child in to the pediatrician with concerns that their child might have an ear infection. One of the reasons for their concern is often that their baby is tugging on their ears.  

Babies find their ears, just like their hands and feet, around 4 -6 months of age.  I guess a baby must think “this ear tugging is fun and feels good” as maybe babies have “itchy” ears just like adults. It also seems to be a self soothing habit for other children who seem to pull on their ears when they get tired and cranky.  Maybe it is related to new molars coming in at the back of the jaw line?   

Whatever the cause, it often concerns parents who are told by their friends or relatives, “I am worried, this ear pulling probably means the child has an ear infection”.  So, being a good parent off you go to your pediatrician only to find out that the ears a beautiful and clear! 

Most babies and children do not get an ear infection without ANY other symptoms besides ear pulling.  In most cases infants and toddlers will get a secondary ear infection during cold and flu season. The multitudes of viral respiratory infections that children get in the first 3 years of life, often cause continuous runny noses and congestion. This congestion causes fluid to build up in the middle ear space which connects to the nasal passages via a small canal called the eustachian tube.   

Infants and children have so called “immature” eustachian tubes that are soft, and don’t drain well and the tube gets inflamed and swollen from the viral infection as well.  At times this fluid gets secondarily infected from bacteria that find their way to the middle ear.  Voila....an ear infection ensues. 

So, if a parent brings their child in for “pulling on their ears” and they are otherwise well (no cough, congestion, runny nose and sleeping well) I usually ask if they want to “wager” if their child has an ear infection.  That is really not fair, as this sweet parent is only concerned because typically someone else told them they should be.  But, in this case a quarter bet is usually made and I end up with a lot of quarters.  (they are good for all of the other bets I do lose with parents and kids about all sorts of things). Friendly betting at the pediatrician’s office, wonder if I am going to be investigated! 

Don’t worry about simple ear pulling especially when you see it happening all of the time.   

Lastly, with the new guidelines for prescribing antibiotics for an ear infection parent’s don’t need to worry as much about a prescription for antibiotics and a few days of waiting will not hurt.  

Daily Dose

Kids & Bedtimes

1.30 to read

As the summer winds down, my office is bust with back to school check-ups.  During these exams, I find myself asking a lot of questions related to a child’s sleep routines. Over the years I have always asked about sleep, and for so many  parents it is one of their main concerns.  

But what I have noticed is it seems children are going to bed later and later. I know the summer months are less scheduled for many families and children tend to get out of routines, but never the less, when I routinely ask, “during the school year what time does your child go to bed at night?” I am surprised by some of the answers.  And I am not talking about teens either, this is mainly the 5-13 year old set. (I do think teens need bedtime guidelines as well, that is a different discussion). 

As a working parent I totally understand and empathize with how busy the evenings are. I tell new parents that the evening hours between 6-9 pm are often the “witching hours” for newborns but I also see these same “crazy hours”  for most families once their children get to be school aged. (is this why cocktail hour was invented?)  It is the time of day for after school activities, homework to be done, dinners to be cooked and children to be bathed. Add in bedtime stories and/or reading by your child and it is CRAZY....but even so children need to have bedtimes appropriate for their ages.

Hearing that 5 year olds go to bed at 9 pm or that 10 year olds are up until 10 or 11 pm not only makes me tired but worries me as well that these children are not getting enough sleep. And the statement from frazzled parents, “they just won’t go to bed” makes me know just how important early good sleep habits are. Bedtime is a statement not a question!

While some children are just natural sleepers, others can be more difficult, but I am convinced that early good sleep habits help all children to be better and more independent sleepers.  Self soothing begins in infancy, but self calming and sleeping in your own bed is an important milestone as well. A child who awakens every night and ends up sleeping in their parents bed is disrupting both their sleep and their parents, which leads to irritable, unfocused and tired children and adults.

So, this seems to be a good time to re-look at bedtimes and adjust accordingly for your child’s age.  Once you get a good routine going, good habits are easy to continue.  

 

Daily Dose

How To Prevents SIDS

1:15 to read

A new study on swaddling and sudden infant death (SIDS) was just published this week in the journal Pediatrics. Not surprisingly, it found that infants who were swaddled and placed on their sides or stomach had a higher incidence of SIDS. It has been routinely recommended for more than 15 years that all babies sleep on their backs and since that time the incidence of SIDS has been dramatically reduced.  Unfortunately not everyone follows the AAP recommendation. 

While it has been known that tummy sleeping has been associated with SIDS this meta analysis looked at data which was gathered over two decades and from 3 different global sites. The review found that infants who were swaddled and placed on their sides were almost twice as likely to experience SIDS and the risk of SIDS did double in those babies who were swaddled and placed on their stomachs.  

I discuss swaddling with all of my patients as there are so many different swaddle blankets available.  Actually, one of the first things a newborn nurse seems to teach a new parent is how to swaddle their baby.  While swaddling has been promoted to aid in calming a newborn as well as to help their sleep, the recommendation that the baby be placed on their back in their crib continues..  Many a baby looks like a little burrito….. rolled up in the swaddle and then being placed on their back in the crib.

But is seems from this study that some babies were being swaddled and then placed on their side to sleep. Unfortunately, even a newborn may squirm enough that they then move from their side into the prone position.  Older infants who are swaddled may actually roll from their back to their tummies, even while swaddled. While the association between swaddling and SIDS remains unclear, I think this is a good reason to start getting a baby out of a swaddle once they are rolling. So around the 3 month mark I start having parents loosen the swaddle and try to just lay the baby on their back without being swaddled.

Let me re-iterate, this article does not confirm an association between swaddling and SIDS.  I do think it is a good reminder for putting a baby, “back to sleep” and once they are rolling “ditching” the swaddle seems to make even more sense. Once less thing to worry about, right?

 

Daily Dose

Summer Skin Infections

1:30 to read

I have been seeing a lot of skin infections and many of these are due to community acquired methicillin resistant staph areus (caMRSA). The typical patient may be a teen involved in sports, but I also see this infection in young children in day care, or summer camp. The typical history is “I think I have a spider bite” and that makes your ears perk up because that is one of the most common complaints with a staph infection, which is typically not due to a bite at all.

The poor spider keeps getting blamed, and how many spiders have you seen lurking around your house waiting to pounce? The caMRSA bacteria is ubiquitous and penetrates small micro abrasions in the skin without any of us every knowing it. The typical caMRSA infection presents with a boil or pustule that grows rapidly and is very tender, red and warm to the touch. The patient will often say that they “thought it was a bite” but the lesion gets angry and red and tender very quickly and typically has a pustular center.

For most of us pediatricians, you can see a lesion and you know that it is staph. It is most common to see these lesions in athletes on exposed skin surfaces such as arms and legs, but lesions are also common on the buttocks of children who are in diapers in day care. The area is angry looking and tender and the teenage boy I saw the other day would not sit on the chair, but laid on the table on his side as he was so uncomfortable. If the lesion is pustular the doctor should obtain a culture to determine which bacteria is causing the infection, but in most cases in my office the culture of these lesions comes back as caMRSA or in the jargon Mersa. When I say Mersa, I often cause widespread panic among my patients, but in most cases to date these infections may still be treated with an oral antibiotic that covers caMRSA, such as clindamycin or trimethoprim-sulfa. Many of the lesions improve dramatically once the site is drained and cultured. I will reiterate that if possible you want your doctor to obtain a culture to identify the bacteria that is causing the infection.

To prevent caMRSA remind your student athlete not to share towels, clothing or other items. Make sure that common areas are disinfected and once again encourage good hand washing. The closure of schools or disinfecting an entire football field or area with turf is not recommended. Lastly, this is a good reminder that you only want to take an antibiotic for a bacterial infection and that overuse of antibiotics leads to resistance. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Teen Driving

1:30 to read

 It’s funny that I often find myself reading articles in the newspaper or online, or even watching a TV segment, only to find that an “issue” that I have thought was important for years is “newsworthy” again.  The most recent example being on the topic of teenage drivers and the importance of parental involvement.

I feel like it was not too long ago that I was talking to my own sons about driving….and at that time Texas did not have a lot of rules around getting your driver’s license, besides being 16 an enrolled in school. (thankfully the laws in Texas have changed since then).  So after much discussion about the perils of teenage driving and knowing that the death rate due to an automobile accident topped the list for teens,  my husband and I  came up with a driving contract (which I have shared with too many to count), which clearly outlined the rules and expectations for our sons when they began to drive. I can also remember the oldest looking at the 3 page typed contract and announcing, “ I am not going to sign that!”.  If I remember correctly my husband’s calm reply was, “OK - then don’t drive”. He is a man of few words..but very convincing. 

Fortunately for us, all of our sons did sign the contract, knew the consequences and started off driving our family Suburban…and never had a serious accident (so many prayers as they pulled out of the driveway).  One son did back into a fence, and another hit a car in a parking lot….but I felt fortunate that that was the extent of their accident history.  

According to a recent article in the NY Times there is a time to be a helicopter parent, and that is when your “child” begins to drive.  “In 2013, just under a million teenage drivers were involved in police reported crashes, which resulted in 373,645 injuries and 2,927 deaths”.  These statistics are probably under-reported, and it is estimated that “one in four teens are going to be in a crash in their first six months of driving,” and one would hope that these would be minor “fender benders”, which as we told our sons, do count as an accident.

The biggest risk for a new teenage driver occurs when you add passengers to the car.  According to Dr. Nicole Morris at the University of Minnesota  “adding one non family passenger to a teenager’s car increased the rate of crashes by 44%, and that risk doubles with a second passenger and quadruples with 3 or more”. If your teen is not distracted by their passengers they are likely to be using their phones to stay in touch with their friends….either by text, talking or by checking their various social media sites….all while driving. Although teens state, “ I barely take my eyes off the road”, anything more than 2 seconds can be deadly. Better to turn off the phone and all notifications before your teen hits the road.

Teens should be reminded that driving is a privilege, and parents of teenage drivers need to have ongoing discussions surrounding expectations for obtaining the privilege of driving. Parents need to be knowledgable about teenage driving and their states’ laws - and enforce those, (too many parents of my patients seem to ignore some of the laws - such as limiting passengers in the car). Even if your state does not have laws regulating a step wise progression to full driving privileges (so called graduated driver’s licenses), parents may adopt their own to help ensure their teens safety. Earning more and more independence can be proven with time and a good driving record and the adage, “nothing good happens after midnight still stands”.  

If ever there is a time to be a hovering involved parent it when your child begins to drive - it has been proven to save lives.

 

     

Daily Dose

The Joy of Fun Summer Activities

1:15 to read

While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics like summer and all of the wonderful activities to do. We have talked about swimming and camps and staying abreast of academic work, but what about the basics of summer? The good, old-fashioned leisure time activities that we all used to do. While doing summer checkups and discussing everyone's summer plans I started thinking that I should really be asking about some of the basics.

So here are the things that come to my mind: Basic summer skills for all of us to remember and to teach. All of this is free, easy and are really akin to life skills that all children should probably master at some point in their childhood.

  • Jumping rope
  • Riding a bike (of course with a helmet)
  • Skipping a stone
  • Pumping a swing
  • Blowing bubbles
  • Catching a ball
  • Throwing a ball (don't think I have still mastered this, wonder if it is too late?)
  • Turning a somersault
  • Playing hopscotch
  • Playing four square
  • Learning how to float on your back
  • Fly a kite
  • Catching fire flies

Don't feel pressured to do this all at once, as childhood is a long time. But enjoy the time spent with your children accomplishing these simple pleasures. Why don't you let me know things that you think of and that you feel are essential skills of summer? I am sure I have missed many. That’s your daily dose, we’ll chat again tomorrow.

Send your question or comment to Dr. Sue!

Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

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