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. 

Daily Dose

Life Lessons

1.30 to read

I recently spoke to a group of mothers with sons who were in high school. I was discussing “boys to men....the high school years”.   As I was writing my remarks I was thinking about the many lessons I learned while parenting my sons through their high school years.  Funny how it sometimes seems like long ago, and at other times it seems as if it was just yesterday. 

I think one of the biggest lessons I learned while raising teens is something that my mother and father both told me.  There were so many occasions when I begged my parents for “something”. I can remember telling them, “it’s not fair, eryone else has a phone in their room!”  But, being the good parents that they were, they explained all of the reasons that I didn’t need to have my own phone.  I thought that my parents could afford to put a phone in my room, but they said that wasn’t the point.  Their reply was often “just because we can doesn’t mean we should”. 

That statement has probably been made by parents for hundreds of years. But I must say, it is often hard for some parents to follow this adage. We all want to give our children as much as we can, but sometimes by not giving, we are all being better parents. 

Just because you can give your toddler an iPad doesn’t mean that you should. Just because you can give your elementary school child and I-phone doesn’t mean you should.  The same for giving your child a TV in their room, or a car for turning 16.  I really admire the parents who can truly give their child “most anything”, but know that their children need to learn to wait.  

So, I spoke to the parents group about trying to follow my own parents statement when raising my sons. They would probably tell you that we were sometimes “mean and strict” and that they would get upset when we would say “just because we can doesn’t mean we should”.   I think it worked well for our family.....waiting is a hard but necessary lesson. It often makes you more appreciative as well.  

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

Treating Migraines in Children

What is the best way to treat a migraine in children?So, we have discussed migraines and looked at how to diagnose in the pediatric population. Now it’s time to decide how to treat the headache. Just like diagnosing the headaches, it is important to individualize treatment for each child, with the goal being fast relief, no rebound or re-occurrence, with minimal or no side effects to the medications.

When I see a patient who has a history compatible with migraines, I not only have the child and parents keep a headache log, but I spend a lot of time discussing early treatment of the headache. One of the first things you learn in medical school about treating pain is “get ahead of the pain”.  This means that you need to be aware of your symptoms and begin therapy earlier than later, as pain that has gone on for some time is much harder to treat.  I find that one of the best ways to explain this to a parent and also an older child is to talk about surgery. When you have a surgical procedure, the anesthesiologist does not wait for you to “wake up” and tell him that it hurts, they have already given you pain medication to “keep ahead of the pain” before they wake you up. If you have ever had surgery you know this to be true. The same pain principles apply to treating headaches, especially migraines. At the first sign of a migraine, with or without an aura, I usually prescribe an ibuprofen (Motrin, Advil) product.  In studies, ibuprofen was more effective for headache relief than acetaminophen. I use a “generous” (10mg/kg/dose) dose and repeat it once in 3 -4 hours if the headache has not resolved. You do not want to use ibuprofen more often than several times a week or you may find that your child actually gets rebound or overuse headaches.  Ibuprofen is available in liquid, chewable and pill form so can be used in a young child with suspected migraines.  I also like to use naprosyn (Aleve) in older children who can swallow pills.  It too is a non-steroidal anti-inflammatory  and is available over the counter. The most frequently used medications for childhood migraines are called triptans.  This class of drugs has been around for more than a decade now, but they are not FDA approved for use in children and adolescents because of the difficulty in designing a study (this is true of many different medications.)  Regardless, they are frequently used to treat childhood migraines with good results, tolerability and a good safety profile. There are many different drugs, with names like Imitrex, Zomig, Maxalt, Frova, and the newest drug Treximet (a combination of a triptan and a non steroidal drug), and all have a similar safety profile. Once a child has “failed” therapy with an over the counter non-steroidal drug, I typically use these drugs as “rescue” medications.  Just like many other medications, each person seems to respond differently, so it may be a bit of trying different medications to see which one works “best” for each migraine sufferer. When a patient seems to find the best triptan, it is important to start the medication at the earliest onset of a migraine. I also try to help adolescents distinguish between “different” types of headaches, so that they are not using this class of drugs too frequently (max 3 headaches a week).  Not every headache is a migraine! If these medications do not relieve the headaches within 48-72 hours more aggressive therapies need to be used, and preventative treatments and strategies should be considered.  There are many studies underway looking at the combined effects of biofeedback therapy and cognitive behavioral therapy in combination with medications. These are discussions that each parent/child should have with their own physician as it relates to their headache frequency and pain level. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Get Smart About Antibiotics

When your child is sick, do you know the best uses for antibiotics? Many parents do not, so here's how to stay in the know.It really is the time of year when “everyone” is getting sick, and fortunately most of these illnesses are due to common viruses that circulate during the Fall and Winter months.

I am already seeing so many parents bringing their young children with recurrent coughs and congestion and the strains of “can’t we just have an antibiotic” are being heard throughout the office. There isn’t a parent who doesn’t want to try and make their sick child better faster but antibiotics are usually not the answer. Antibiotics only work for infections that are caused by certain bacteria.  Unfortunately, antibiotics do not treat viruses!!  Viruses cause most of the seasonal cough, cold, congestion and flu viruses that we see throughout the year. These viruses do seem to be more prevalent in the Fall and Winter months as we all gather together in close quarters for holidays and to escape the cold days outside. Viruses are easily spread from person to person, typically via droplets that are aerosolized when a person coughs or sneezes. The other sneaky thing about viruses is that the virus may be shed by a person before they even feel sick. In other words, the person that is sitting next to you at church, or to your child at school may be innocently spreading a virus 12-24 hours before they even begin to feel badly. Knowing that, it is hard to point a finger at who “got your child sick” as we all come into contact with germs throughout the day. Many viral infections, such as a cold, may have symptoms that last for up to 2 weeks. This is not a “quick fix” type of illness. In fact,  the best medicine for a cold , viral sore throat or the flu is the age old fluids, rest, fever reducer and “tincture of time” .  An antibiotic given inappropriately may actually do more harm than good. By taking an antibiotic when they are not needed you may increase the risk of getting an infection later that is resistant to typical antibiotic treatment.  As you probably already have heard, antibiotic resistance is on the rise, and one reason may be the overuse of antibiotics when they are not needed. Taking an antibiotic is appropriate when needed for a bacterial sore throat, such as strep throat (which is documented by a strep test), or for ear infections in young children.  When your doctor prescribes an antibiotic you want to take it exactly as directed and always finish the entire prescription.  Even if your child is feeling better several days after starting an antibiotic finish the medication or the infection may return. Lastly, if you have any unused antibiotic throw it away and never save it for another use. Do not give an antibiotic for one child to another child in the family, as believe it or not, it is fairly common for one child to have a strep throat while a sibling may have a viral upper respiratory infection that does not need to be treated with an antibiotic.  Go figure, not everyone in the family gets the same illness at the same time. I tell my patients it is a good thing to “brag” that your child has never been on an antibiotic, almost like getting that straight A report card.  And remember, each viral illness is actually helping to make your child stronger by building antibody for future illness. Small victories with each cold! That’s your daily dose for today. We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Flu Cases Rising

1:30 to read

Flu season is definitely upon us and unfortunately it is hitting just in time for the holidays!  I have been on call for the last 2 weekends and I can assure you, flu is everywhere. You name the place and you are probably being exposed somewhere.  That includes the mall (where people are shopping whether sick or well), grocery stores, churches, synagogues, restaurants, day care, schools, airports...the list is endless.   I am saying this because patients continue to ask, “where do you think I got this?”.  

To compound the problem families are gathering for the holidays, so it makes it an even better time for the respiratory viruses to spread.  Those viruses just love this time of year.

Fortunately, despite the flu vaccine not being a “good match” for the Influenza A (H3N2) that is widely circulating, the children I am seeing with the flu (and yes, I myself have already seen 100’s) are not terribly sick.  They do have the typical fever, cough, sore throat, headache and body aches that typically comes with flu, but they are typically only running fever for 1-3 days and when the fever is down they are playing video games, watching TV and baking cookies. I have not seen anyone that has had a serious complication....I am hopeful that this continues.  

Many patients are wondering about using Tamiflu (which is advertising heavily right now). I am using Tamiflu for children who are high risk (under 2 years, have underlying illnesses, are immunocompromised, have significant asthma etc).  For most children the flu can be handled at home with the usual symptomatic treatment, fever control, fluids, rest and parental TLC (tender loving care).  I would always watch for any respiratory distress and make sure your child stays hydrated. In most cases I bet the fever is gone in a day or two and they are left with a nasty cough (same goes for the parents).  I always warn parents to watch for any re-occurence of fever later in the illness, which makes me worry about a secondary infection which would require a visit to the doctor.

Best prevention right now is to continue to get a flu vaccine....some protection is always better than none. Wash your hands, eat healthy, get plenty of sleep and if you are sick- please stay home!!  We’ve got several more months of flu....winter is just really starting.

 

 

 

Daily Dose

The Importance of Family Mealtime

I have believed in the importance of family mealtime for a long time, I think since my boys were in elementary school. The time that was spent together, even if only for 10 to 15 minutes a night grew to be one of the favorite times of the day, especially as the kids grew older. It was one of the few times that we were all able to enjoy one another's company, discuss what everyone had done that day ("what was the best part of your day") and to also try to teach table manners to three boys.

An added benefit was that the boys became fairly good "eaters" as my husband (who by the way is a good cook) and I also subscribed to the "same meal" for the entire family theory. I mean, who has time to cook multiple meals? Mow, that is not to say that they all ate the dinners that were made, and there were plenty of complaints too, but over the years they began to explore more foods and they even learned that pork is not chicken, what a breakthrough. No one starved when they didn't like a meal; they always seemed to find something on the table that they would eat. We also let everyone have their say in meal planning one night a week, when you could pick your favorite meal. A study from the April issue of Journal of Nutrition Education and Behavior also found that eating together as a family "has long term nutritional benefits." This study assessed the eating habits of 677 youths during their early teen years and then again five years later. Those who ate regular family meals at both points in their life had "better diet quality, and consumed more vegetable, calcium rich foods, dietary fiber and essential nutrients." So start up those family meals, it is never too late and it will improve your child's overall nutrition. As an aside, they will learn that a napkin goes in their lap! That's your daily dose, we'll chat again tomorrow.

Daily Dose

All About Tonsils

When it comes to tonsils, no two are the same. Over the span of my pediatric career, I literally have looked in thousands of throats and one thing that I do know: tonsils come in many shapes and sizes.  Scroll down and check out the photos I just took in my office.

Tonsillar tissue is considered a “secondary lymphoid organ” and is most active in children between the ages of 4–10 years.  As children go through puberty, the tonsils begin to shrink , as I like to say,” some things get bigger while tonsils get smaller” and by adulthood the tonsils are so small that they are often difficult to visualize. The most common complaint about tonsils relates to sore throats and pain with swallowing.  While many parents say their child was diagnosed with “tonsillitis” that does not really tell you what caused the inflammation of the tonsils, in other words it is not a diagnosis. Respiratory viruses are one of the most common causes of viral tonsillitis (and you know there are tons of those) with Group A strep being the most common cause of a bacterial tonsillitis.  Mononucleosis caused by Epstein Barr virus also causes a painful tonsillitis and is often seen in the teenage population (this is why mono is called the kissing disease), although mono is not exclusive to the teen age group. Recurrent “tonsillitis” associated with painful sore throats and large tonsils is often the reason parents ask about tonsillectomy for their child. While tonsillectomy was “almost routine” 30-40 years ago, the recommendations for tonsillectomy have continued to change since the 1970’s.  Even so there are still over a half a million tonsillectomies performed each year in the U.S.  The newest guidelines published in January by the American Academy of Otolaryngology, provide updated recommendations as to when tonsillectomy might be recommended. The new guidelines state that children should have at least seven episodes of throat infections in a year (both viral and/or bacterial) or at least five episodes each year for two years, or three episodes annually for three years before they are surgical candidates. All of these infections should be documented by a physician and not just by parental report.  The expert physicians who worked to draw up the new guidelines stress that “children who have fewer episodes really aren’t going to see a lot of benefit” and these new recommendations help to minimize the risks (infection and bleeding) and pain of the procedure in children. As with many things in medicine, things change, hopefully always to improve the outcome of the patient. These recommendations also included guidelines for tonsillectomy for sleep disordered breathing, more on that another day. That’s your daily dose for today.  We’ll chat again tomorrow. 

Daily Dose

Importance of Cholesterol Screening

Once again there is a lot of news about the appropriate time to screen children for lipid abnormalities.While we have been on the topic of screening, let's look at another area, cholesterol and triglycerides. Once again there is a lot of news about the appropriate time to screen children for lipid abnormalities. The medical community always likes a lively discussion with good scientific evidence, but the AAP, the American Heart Association, and the U.S. Preventative Services Task Force do not have a clear consensus on screening in children.

I think that the most important issue is knowing your patient's family history. We pediatricians should all be aware of the increase in cardiovascular disease in this country, and should continue to ask parents their cholesterol and lipid levels, if they take medication and their parent's history. In other words, we need to ask about grandparents too. I think this is fairly routine, but as a child gets older, they need to know their own family history so that they are informed (I learned this lesson from our eldest son when he told his "adult doctor" that he did not think he had any disease etc in his family, what did he think that cholesterol pill was that his Dad took everyday?) If there is a history of high lipids in the family it is probably worth screening your children somewhere between the ages of two - 10 years of age. Children with high BMI's should also be routinely screened. Which screening test your pediatrician decides to do may depend on your own physician. There continues to be data emerging about screening using total cholesterol alone, versus fractionated cholesterol. Next time you visit your pediatrician, discuss your family history and any changes in family history that may have occurred. Discuss the possibility of cholesterol screening for your children. Another number to pay attention too. That's your daily dose, we'll chat again soon!

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