Daily Dose

Warts: A Common Virus

I see so many kids with warts. Warts are caused by viruses and can be a real nuisance. Because warts are due to viruses they are contagious and may be acquired without a person even knowing where they contracted the virus.

It is funny that some people seem to be susceptible to the virus and may get warts recurrently, while other people have never had a wart. I typically see warts in children after the age of three all of the way to adults. The most common areas to see warts on children are on the fingers and hands, arms, knees, and on the feet. Because they are contagious and could bleed when traumatized and may cause spreading, it is important to not pick at a wart or try to clip them with scissors or nail clippers. Avoid friction, and rubbing, even with lotions or while shaving as this may spread the warts. For many children the best treatment is no treatment at all as the wart may go away by itself, but it may take months to years for that to happen. In some cases if the wart is becoming bigger or spreading you may use an over-the-counter (OTC) wart treatment that contains salicylic acid. According to Dr. Margaret Lemak, a practicing dermatologist in Houston, it is important to be consistent when using these preparations. For warts on the bottom of the feet (plantar warts), you can use a stronger salicylic acid (40 percent plasters) and may take several weeks to months for the wart to go away. The OTC liquid nitrogen freezing canisters that have been on the market for several years may be successful in treating a small wart, but at the same time I have seen this cause painful blistering and may be uncomfortable for 24 to 48 hours. I usually do not recommend these and have had little success using them myself. If these treatments are unsuccessful or the warts are becoming unsightly, it is probably time to take your child to the dermatologist for further treatment. According to Dr. Lemak the dermatologist may freeze and scrape the wart or prescribe a cream that can be used at home. Warts often recur in the same area so after treatment it is important to continue to be observant for two to three months looking for a recurrence. Earlier treatment in this case is typically more successful. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Use Nasal Saline to Combat Spring Allergies

Spring allergy season is in full swing around the country and we probably have four to six more weeks ahead of us. So many people are having a hard time with allergies this year, and many people are being affected that have never even experienced allergies previously. Check the pollen counts in your area, but ours in the Dallas-Fort Worth area have been sky high and tremendous amount of wind continuing to spread the pollens.

I know I have emphasized the use of steroid nasal sprays in the prevention of allergic symptoms. These need to be taken on a regular basis to provide maximum benefit. But nasal saline irrigation is being shown to be more and more helpful in controlling allergic symptoms. The use of nasal saline has been around for years, originating in India, and allergists have long promoted its use. With endorsements this year by Oprah, the use of the Netti pot has soared and many patients are feeling relief from clogged nasal passages and sinuses that irrigation may provide. Pediatricians have used a form of nasal irrigation for years in infants and young children when they have a cold. The bulb syringe that every parent receives on discharge from the hospital is a mini-Netti pot. By using a small amount of salt-water solution placed into the nostril of an infant, the parent can suction mucous out of an infants nose that they are unable to blow. Young children seem reticent to learn how to blow their nose (although I am convinced that girls acquire this ability before boys who find it perfectly appropriate to wipe it on their sleeve), and many children may be in elementary school before they are capable of effectively blowing their noses. So during this allergy season, you might consider adding a Netti pot (or competitors product, there are many out there) to facilitate removing pollens and other allergens from the nose and sinus cavity. Once you have tried using it, children are even surprised at how much better they feel. I told a little boy today, using the warm water in the nose is a leap of faith, just try it once, the same way you tried riding a bike, and you may find relief from that allergic nose wiping. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Update: Back-to-School Vaccines

Which vaccines do your kids need as they head back to school? Dr. Sue fills you in. With only a few days or weeks to go (for some) before school resumes, it's important to know August happens to be National Immunization Month.  For every age child that is getting ready for school there are, immunizations that are necessary and for any child who has missed or lapsed immunizations it is a good time to update and “catch-up”.

Children entering kindergarten (ages 4-6) will need to have had a  DTaP (diphtheria, tetanus and acellular pertussis), an IPV (inactivated polio), MMR (mumps, measles, rubella) and Varivax (chickenpox) vaccines.  (These are all booster doses). It has also been recommended that children over the age of 1 year (who have completed their 4 dose Prevnar series with Prenvar 7) and who are under the age of 6, receive a booster dose of the newer Prevnar 13 . (see previous blog from Spring 2010). For those children between the ages of 11-12 years there are also booster doses (for older children and adults too) of the tetanus, diphtheria and pertussis vaccine (TdaP) as well as the meningococcal vaccine.  These shots are typically given before entering 7th grade. If your child is over the age of 11 years and has not yet received the meningococcal vaccine I would go ahead and get it, even if they are still in later elementary school and it may not be “required”.  (The names of the vaccine are Menactra or Menveo). This vaccine prevents a devastating form of meningitis and bacterial blood infection that often leads to a rather rapid death in the adolescent and young adult age group. There is also the recommendation that all adolescents who “missed” receiving a meningococcal meningitis vaccine during their high school years receive a dose prior to entering college. In fact, in the state of Texas, this is the first year that ALL college freshmen must show proof of immunization prior to moving into their dormitory.  This is due to the fact that meningococcal meningitis has a higher attack rate for adolescents and young adults, especially those living in close living quarters, such as a dormitory. Once you get the vaccine it takes awhile for your body to develop antibodies and therefore immunity, so college students who get vaccinated once arriving at school, will also have to wait 10 days before they are allowed to move into their dorm.  If you son or daughter is heading to college in the next several weeks, go get the vaccine now, so that you will have a 10 day window to show proof of vaccination. With outbreaks of pertussis on the west coast, and actually clusters throughout the United States, this is a good time to reiterate that all adults should have a tetanus, pertussis and diphtheria vaccine too!! That means every 8–10 years and you want to make sure you have gotten the vaccine containing acellular pertussis, which prevents the adult population from spreading whooping cough to infants who have not yet been immunized or who are just getting their own 3 dose series. Even adults need to continue getting vaccinated and the TdaP vaccine is recommended for adults until 65 years of age. What can you expect from me over the next few weeks? Updates about flu vaccine once again. How time flies! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?


Daily Dose

Tongue Tied Babies

1.30 to read

Here’s a great Scrabble word (too long for Words with Friends): Ankyloglossia. It is the term for being tongue tied. 

During my years as a practicing pediatrician being “tongue tied” was thought to have little consequence. Being tongue tied refers to the problem which occurs when the anterior (tip) of the tongue is attached too closely to the lingual frenulum (the piece of tissue that attaches the underside of the tongue to the floor of the mouth).   This tightness may impair movement and function of the tongue and occurs in about 4 -5 % of newborns.  

While it is not life threatening to be sure, and is really not associated with any long term speech problems, new data is showing that being tongue tied may interfere with early breast feeding. 

Several recent articles in different pediatric journals have now looked at Ankyloglossia and breast feeding success. One of the most difficult times for a new mother is when she is first attempting breast feeding. I can attest to that myself. 

While I was a pediatrician, and could perform life saving procedures on newborn infants, I was ill prepared for breast feeding. Not only did I not have any clue as to what I was doing, I was also exhausted, anxious and only knew that nursing sometimes brought tears to my eyes as the baby latched on and who even knew if they were getting any milk?  Many mother stop nursing in the first several weeks after their baby is born due to a combination of the above factors. 

Now if you add in a tongue tied newborn, who may have an ineffective or awkward latch, there may be even more pain associated with nursing. 

For some mothers the bottle seems easier and surely less painful, and they may abandon breast feeding in the first weeks.  But in these two recent studies, infants who were noted to be tongue tied and were exhibiting feeding issues, who then had their frenulum clipped (frenectomy) in the early neonatal period, had more long term success in breast feeding. Both studies demonstrated an improvement in infant latch and diminishment in maternal pain, which led to overall feeding improvement for both baby and mother. With this came more successful and longer breast feeding. 

Many young (and not so young) pediatricians have not been trained in how to perform this simple procedure. When being “tongue tied” is noted on a baby’s initial exam a frenectomy may easily be done in the first few days of an infant’s life. Because the frenulum has a poor blood supply and heals rapidly, the baby may be put to the breast soon after the procedure. There is typically no more blood loss than when a child loses their first tooth. I think it is less invasive than circumcision, but that is my opinion of one. 

With recent studies to document improvement in nursing it may be time for me to re-visit this procedure.Surely is it like riding a bike, you never forget how to do it!  

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

Daily Dose

No Screen Time for a Week!

Kids are spending over 7 hours a day in front a screen: TV, watching video, playing games event texting. How much is too much?So, how much screen time does your child have?  You know what I mean, TV time, computer time, playing video games, using a cell phone (including texting). The list goes on and on!

The average American child spends 7 hours a day involved with some type of media, which is more than any other activity besides SLEEP! With that being said, this is National Turn Off Week!  My colleagues at the American Academy of Pediatrics are supporting an effort to encourage parents to implement a “screen free week” in their home. If the average child spends over 1000 hours a year involved in some type of media but only 900 hours a year in school it seems obvious that we are doing something wrong. The solution is to start limiting screen time beginning at the earliest ages. With so many parents believing that Baby Einstein videos will make their infant smarter (there is no proof), and parents who are teaching their children to use a computer or I-phone or I-pad by the age of two, early guidelines regarding time spend “on screen” are exceedingly important. The AAP endorses a “no TV for children under the age of two” rule and limiting TV/media time to 2 hours per day for children and teens.  Unfortunately, many parents may know that their children are home, but are not clear about what they are doing while at home, which often involves screen time in the “privacy” of their own rooms. I ask every patient and or parent about media time and if there is a TV or computer in the child’s room. I am continually amazed at how often the answer is yes, even for the elementary school set. Parents often view putting a TV in their child’s room as a “right of passage” despite the fact that there are really good studies to show that having a TV in a child’s room contributes to poor sleep habits which may impact children in many negative ways. I must say, there isn’t a teenager that I take care of that is “happy” that we are discussing media time, but just like other subjects that need to be addressed during a pediatric visit, this one may be more important than previously thought. For all of this interactive screen time may actually be becoming new “peer group” for a child, rather than having face to face time with their peers. So by turning off the “screens” and spending some time enjoying one another, a new normal could be started.  Families cooking together after the homework is finished, or going outside for a family walk or quick game, or reading together, or even playing board games, the list seems endless.  What a treat to get back 2, 3 or even 4 hours a day with your child.  Think about the  benefits that come from decreasing screen time, which include better academics, better sleep, less depression and anxiety and even an impact on obesity. I know it is challenging for all of us, but this is a “do-able” task for a week. While all of the screen are in the “OFF” mode, talk about new guidelines for when the screens go back on.  In this case the adage “less is more” seems appropriate. That's your daily dsoe for today.  We'll chat again tomorrow. Send your question or comment to  Dr. Sue!

Daily Dose

Teething Questions Never End

I saw a lot of nine to 15-month-old babies yesterday and there were many questions related to teething.  Your child may get their first tooth as early as three to four months of age on up to 18-20 months of age.

The average age for a baby to cut their first tooth is usually around six months of age, and typically the lower central incisors are the first teeth to erupt. There have been many articles written on teething, but the longer I practice the less I believe that parents, or doctors for that matter, can tell if there is a lot of pain associated with teething. It seems if any baby or toddler is fussy, whiny, clingy or not sleeping, it is often attributed to teething. But children will cut 20 teeth in the first two to three years of life and the majority of the time they do so without a lot of fuss or even suspicion until a tooth is suddenly there. If they have pain related to teething it is probably only for a day or two prior to the actual eruption of the tooth. It is certainly not days and nights on end. As parents we want to be able to blame these difficult your-baby moods on something so why not teeth as a new one is always somewhere in the gums. Children will also lose all of these baby teeth beginning around 5 years of age and here we go again with new teeth erupting. But, no one is blaming poor grades at school, or inappropriate manners, or fighting with your sibling on teething pain! It just doesn't make sense that it hurts when younger than older, a tooth is a tooth. So...that being said, I am not a big fan of oral topical analgesics for teething. They just make the mouth numb and the tongue too as the child spreads the "goop" all over their mouth. I do think you can give an infant a dose of Tylenol if you see a tooth erupting, but only for a day or two. Many of the mothers and dads I talked to today had been giving daily and nightly doses of medication as they thought their child's awakening must be teeth. I am afraid it is probably more a habit of awakening and that needs to be addressed but not with nightly Tylenol or Advil. Wish I could ask the tooth fairy for a comment. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

All About Naps

1.00 to read

Just how many naps should your baby be taking and how long? When you are an adult, there is nothing better than taking a nap. Shouldn’t it be the same for children?  I get lots of questions from parents who ask when their children should take naps; how many times a day they should be napping and when do children stop napping?

Many new parents expect their newborn infants to take regular naps throughout the day (and then to sleep all night) even when they are only 4-10 weeks old. Unfortunately, a newborn’s sleep cycle is not ready for 2 hour naps in both the morning and afternoon followed by a 10 -12 hour extended sleep at night. But, by the time your child is 6-9 months of age (and sooner for some great sleepers); they should be on a good schedule with a morning and afternoon nap.  Naps are usually anywhere from 45 min – 2.5 hours.  I think naps serve a dual purpose, as they provide rest and rejuvenation for both child and parent. Nap time, just like bedtime should be scheduled, typically mid morning and mid afternoon and a child should be able to put themselves to sleep after a book or a story. Naptime routines can be bit shorter than the bedtime routine. You will be able to tell when your child is ready for a nap as they may rub their eyes, or get fussy, or some may just lay their heads down or point to bed as they know they are tired. By the time a toddler is somewhere between 12months – 2 years of age they will usually drop a morning nap and continue to have their midafternoon nap. This is usually right after lunch. Transitioning from 2 naps to 1 nap a day is a little “dicey” at first, as your child may get quite cranky in the morning as you drop that nap, while at the same time their afternoon nap may become longer. This adjustment period usually only lasts several days to a week and then you will find that they are back on a good nap/nighttime schedule. I get asked about stopping a child’s nap. I think naps are important (and as we adults know a privilege) for children until they are in elementary school. Most kindergartens continue to have “rest” time after lunch and many children will fall asleep for 20-30 min while the teacher reads them a book or music is played and the children lay on their mats. Even if your 4 – 5 year old child doesn’t “want” to nap in the afternoon, they need to have quiet time.  This may be for an hour or so in the afternoon, and is time for them to lay in their bed and read, color, play with dolls etc.  I do not think is the time for video games, or computer time etc. Many a child will fall asleep once they are in bed reading and will continue to take a good nap, they just didn’t know that they needed it! Moms, Dads, babysitters etc all need this quiet time too, to get much needed work done around the house, or dinner started etc. It was just a rule at our house that naps didn’t stop until you were in “big boy” school.  A quiet house for an hour each afternoon seemed to make the rest of the day and evening a happier time for everyone! That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Mommy Guilt

1.15 to read

I spent part of my Mother’s Day reading the Time magazine article on attachment parenting.  The cover is obviously quite provocative and has stirred a lot of discussion in and of itself.  Even SNL spoofed it! But the greater discussion seems to me to be on how women mother and parent. What constitutes a good enough mother? (wonder if there is going to be a follow up article on fathers just in time for Father’s Day - what would that cover look like?) 

I guess my first thought about the article is that mother’s often feel like they are not good enough. I don’t think that is necessarily influenced by how long you breast feed, or if you let your child sleep in your bed, or if you ever yelled at your child. It is something about the female brain and we feel guilty about so many issues as they relate to mothering.  I have now practiced for over 25 years and the topic of maternal guilt has always been an issue for so many of the mothers I see on a daily basis, it doesn’t seem to change.  Me included! 

For some reason, the female hormones estrogen, progesterone, and prolactin that surge at the time of a baby’s delivery must also turn on some deep area of the brain related to guilt.  I often joke that “with the final push” comes enough guilt to last a mother’s lifetime. (seems to happen with a c-section as well).  The attachment to that baby is so deep that any little thing can cause maternal anxiety and it often starts with whether or not to breastfeed your baby. So let’s start with that subject. 

As a pediatrician I am a huge advocate for breast feeding, but with that being said I have also seen many a mother who is unable to breastfeed. There are any number of reasons (including breast reduction surgery and no let down, maternal medications which might affect the baby, and a mother who was diagnosed with breast cancer while pregnant who started chemo immediately after delivery.) 

There are also some mother’s who just don’t want to breastfeed. Should they be judged inadequate right out of the gate? I don’t think that is my role as a pediatrician to make that mother feel guilty. I think I need to discuss the options and the benefits of breastfeeding but at the same time realize that one size does not fit all. Is it worth having a depressed, sad and anxious mother who is unhappily breastfeeding, over a bottle fed baby with a happy mother? I think maternal well-being and feeling bonded to that newborn is what is important, whether that be with a breast or bottle. You can be attached to that baby without out actually having a latch. 

So...I digress. What about guilt and motherhood? I just don’t know how to fix it but I don’t think that the front of Time magazine really helped, but did provoke lots of conversation. 

What do you think?  I would love your thoughts! Leave them below.


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