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Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

Daily Dose

Brown Spots on Your Baby?

1:30 to read

I was examining a 4 month old baby the other day when I noticed that she had several light brown spots on her skin. When I asked the mother how long they had been there, she noted that she had started seeing them in the last month or so, or maybe a couple even before that.  She then started to point a few out to me on both her infant’s arm, leg and on her back.

These “caramel colored” flat spots are called cafe au lait macules, (CALMs) and are relatively common. They occur in up to 3% of infants and about 25% of children.  They occur in both males and females and are more common in children of color.  While children may have a few CALMs, more than 3 CALMS are found in only 0.2 to 0.3% of children who otherwise do not have any evidence of an underlying disorder.  

Of course this mother had googled brown spots in a baby and was worried that her baby had neurofibromatosis (NF).  She started pointing out every little speckle or spot on her precious blue eyed daughter’s skin, some of which I couldn’t even see with my glasses on. I knew she was concerned and I had to quickly remember some of the findings of NF type 1.

Cafe au lait spots in NF-1 occur randomly on the body and are anywhere from 5mm to 30 mm in diameter. They are brown in color and have a smooth border, referred to as “the coast of California”. In order to make the suspected diagnosis of NF-1 a child needs to have 6 or more cafe au lait spots before puberty, and most will present by 6 -8 years of age.

For children who present for a routine exam with several CALMs ( like this infant), the recommendation is simply to follow and look for the development of more cafe au lait macules. That is a hard prescription for a parents…watch and wait, but unfortunately that is often what parenting is about.

Neurofibromatosis - 1 is an autosomal disorder which involves a mutation on chromosome 17 and may affect numerous organ systems including not only skin, but eyes, bones, blood vessels and the nervous system. Half of patients inherit the mutation while another half have no known family history.  NF-1 may also be associated with neurocognitive deficits and of course this causes a great deal of parental concern. About 40% of children with NF-1 will have a learning disability ( some minor, others more severe).

For a child who has multiple CALMs it is recommended that they be seen by an ophthalmologist and a dermatologist yearly,  as well as being followed by their pediatrician.  If criteria for NF-1 is not met by the time a child is 10 years of age,  it is less likely that they will be affected, despite having more than 6 CALMs.

The biggest issue is truly the parental anxiety of watching for more cafe au lait spots and trying to remain CALM…easier said than done for anyone who is a parent. 

Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

Daily Dose

Drowning Is Silent!

1:15 to read

Summer is coming to an end, and many families will create memories this holiday weekend at the beach, lake, or pool. The first thing that comes to my mind (when I think of water) is safety!!  

Knowing that over 900 children between the ages of 1–14 die each year from drowning, the discussion of water safety is a necessary part of summer routines. Astoundingly, reports show that 9 out of 10 of those children who drowned were “under supervision”. The American Academy of Pediatrics has endorsed allowing children between the ages of 1-4 to take swimming lessons. It was previously thought that encouraging swimming lessons for children under the age of 4 years might actually contribute to increased drowning.   In fact, recent studies have suggested that children ages 1–4 may be less likely to drown if they have had formal swimming instruction. The AAP has not gone so far as to routinely recommend mandatory swimming lessons for this age group, but does endorse swimming lessons in younger children who are frequently exposed to water and are emotionally and physically able to participate.  

The AAP does not recommend formal “infant survival swimming lessons” for children under the age of 1 year. When I discuss water safety with my patients, I emphasize that drowning continues to be the second leading cause of death for children ages 1–19.  I often have interesting discussions with parents who have a backyard pool who do not believe that it is necessary to have a barrier around the pool. They will say, “we never let our child outside alone” or “he or she is always being supervised by an adult”.

As you might expect, these are usually first time parents who have yet to experience the cunningness of a toddler.  Just as our children watch us and learn how to feed themselves, or drink from a cup or climb out of a bed, they too watch us open a door, or take a stool out to reach something. A toddler is more than capable or figuring out how to reach a door handle even with a lock, or climb out a window to go outside and head straight for the pool. Drowning is SILENT!!  It is not like the movies with screaming and yelling. The child quietly goes beneath the water and sinks.  It only takes minutes and the consequences of drowning are devastating.  Even for a child who is found and resuscitated there may be a life-long brain injury and the worst case scenario, death.

All families with a pool should install a 4 sided fence that is at least 4 feet high to limit pool access. It must be difficult to climb and have a self-latching, self-closing gate. The arguments I hear about “landscape aesthetics” fall on deaf ears.  Every family should also know CPR. Sign your child up for swimming lessons, and have fun practicing flutter kicks and arm strokes. Just do it with an adult within arm’s reach of all new and novice swimmers and a fence around the pool!

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

Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Daily Dose

Sans the Screen

1:30 to read

A bit of fall weather has finally arrived and with it “we” Texans can finally go back outside and enjoy some fresh air rather than the artificial (necessary luxury) air conditioning that we have lived in for the last several months. Texas has brutal summers!

So….with the cooler weather and the opening of Shake Shack in Dallas I thought it was the perfect time for a field trip (and a hamburger). My husband and I headed out for lunch only to find a long line but decided that we had time to “kill” so we decided to just hang out and wait our turn. While standing in line and then waiting for our double cheeseburgers (sometimes you just go for it! , I started looking around and noticed once again that most people were all looking down at some sort of phone screen.

There were people of all ages waiting in line and and on the lawn area but I would have to guess that greater than 80% were not engaged with anyone other than their own screen. This included children who had an iPad to pass the time, or teens and their friends, to millennials and then the “older” folks as well.  I suddenly realized that everyone is so busy scrolling through their phones and seeing what the rest of the world (or their hundreds of Facebook friends) are doing that they are not experiencing their own lives. We are living other people’s lives via a phone screen rather than being in the moment (even a boring one) of our own life.  

I was equally guilty (before I had this revelation) as I was taking a picture of the Shake Shack line to send to my children who had lived in NYC and loved the SS burgers.  I am not sure they really “cared” about the line at SS, although one replied to the text and picture with a picture of his own showing a  tray with burgers and fries…and the text, “ we have already been”. 

The whole discussion about how much time the world now spends looking at a screen or socializing via a text or email rather than a conversation continues to evolve, but experts in child development are concerned. Their concerns surround things like language development and social skills and the ability to carry on a conversation whether at home, or school or eventually at work,  as well as how to understand body language. The number of children that I now see with issues surrounding social skills and how to interact on a playground or in a class room seems to be growing and I wonder if any of this relates to electronics….call me crazy, but I really think there is a correlation.

So…at that moment as I watched those around me, I vowed to put down my own screen, record less of where I was or what I was doing (which is not necessary ) and to live in my moment…and not worry about what everyone else is doing.  My husband and I spent the next hour enjoying the weather, the hamburgers and each other’s company…sans the phone!  

Of note, I did watch one young mother corral her two precious toddlers and play hide and go seek while waiting….kuddos to her, they looked like they were having a ball.

Daily Dose

Screen Time Warning

1:30 to read

While new guidelines are being discussed as to the amount of screen time our children should be having in our digital world, an interesting study from CNN broadens the conversation. It seems that our kids are actually “online” using social media even more than expected.

CNN partnered with child development experts who analyzed the social media feeds of 200 eighth graders from across the country.  As anyone with children knows….most teens are dependent on their phones, one girl saying she would “rather not eat for a week than have her phone taken aways”.  Some teens even admitted to checking their social media feeds over 100 times/day. 

Addiction may be the word to describe how teens feel about their on line lives and use of social media. But like many addictions, excess is not healthy.  The study analyzed over 150,000 social media posts of these 13 year olds, and were collected over a 6 month period. The researchers looked at their Instagram, Facebook and Twitter posts.

 Social media is a great way for teens to connect with their friends and is a way for them to see what people are doing, not only with their close friends, but also with “their online world”.  But the tween/teen years are often about “fitting in” and peer pressure is rampant and unfortunately, not all of their online experience is positive. The study found that the more teens look at their social media, “the more distressed and anxious they may become”.  Too connected?

The study showed that while teens are checking their posts for “likes” and comments” they are seeking approval from the masses, but are also having a hard time separating their online life from their “real” day to day lives. They admitted to posting comments that they would never say in person and to some people that they barely know. Many of the comments also contained profanity, explicit language, pornography and even comments about drug use.  They seem to forget that these posts may be used against them at a later time. An inappropriate picture sent to one person may be forwarded and forwarded…. Remember these were 13 year olds!

The parents of the participating teens were also studied and 94% of them underestimated the amount of fighting and negativity which happened online.  On a positive note the parents that tried to monitor their children’s social media use and posts did have an effect, a positive one, on their child’s well-being.  According to the authors,  parental monitoring and involvement “helped to erase the negative effects of online conflicts”.

While teens may feel hurt, excluded and pained by some of the social media they see, they also find affirmation, and support from their online lives.  It is about finding a balance and using social media responsibly and appropriately.  

Bottom line - I think the longer you can delay your child’s use of social media is for the best. I admire the parents of my patients who have opted to “hold out” on giving their children a phone or allowing them on social media sites. But, I also have 7, 8 year old patients talking to me about their Instagram and Facebook accounts. Even with parental monitoring it seems that these young children could inadvertently be exposed to inappropriate posts.  Once you do give your children the privilege of a phone and the use of social media there should be plenty of  conversation about the pros and cons of the online world….and start off slowly, somewhat like a “learner’s permit” and graduated privileges.

Daily Dose

Early Talkers

1.15 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

Daily Dose

Read To Your Kids

1:30 to read

I know that there seems to be a “national” day for almost everything these days…we just celebrated National Dog Day! (who doesn’t love a dog…but not all families want, have space or  extra income to care for a dog). But there is one thing all parents can do and celebrate very day regardless of socioeconomic background, ethnicity, or geographic location…they can read to their child in the first 5 years of life (and maybe even longer!) 

Try reading to your child 15 minutes a day. The benefits are endless!  Seems like an easy enough “to do” and something that all parents can start from the time their baby is an infant. Newborns need to hear their parents voices and  language early on as a baby’s brain grows exponentially and will actually double in size in the first year of life alone.

A recent study conducted by You.Gov for the Read Aloud Campaign found that only about 46% of parents read aloud with their child every day and only 34% do so for the recommended 15 minutes.

The American Academy of Pediatrics (AAP) has also recommended that all children, beginning at birth, are read to every day. In another survey while six in 10 ( 62%) of parents admit to receiving advice to read aloud to their child only 8% actually followed through.  When asked why they have not read to their child parents site “I can’t find the time in the day”, while over half of the parents surveyed say “their child watches TV or uses a tablet at home rather than being read to”. Some parents say, “their child won’t sit still” to be read aloud to.  But if you realized the head start you are giving your child….could you find the time?

Scientists know that a baby’s and toddler’s brain is making huge connections among the 100 billion neurons they are born with.  By the age 3 there will be about 1,000 trillion connections between those neurons.  These are also the critical years in the development of a child’s language skills.   A child will quadruple the number of words they know between the ages of 1 and 2 years.  Yes, they will mimic everything….even words you wished they had not heard so be careful.

Reading aloud is one of the single most important things a parent or caregiver can do to help a child prepare for learning.  Children who have been exposed to books while listening and reading daily with a parent get a head start in language and literacy skills.  Unfortunately,  more than one in three children begin kindergarten without the necessary skills of listening and learning.  Some are at such a disadvantage that they may not be able to “catch up”.

So, I find myself giving books as baby gifts more and more these days - as who doesn’t have a favorite book or two that make timeless gifts (that may even be passed on to the next generation).  Nursery rhymes, Good Night Moon, Pat the Bunny are a few of my favorites as well as all books by Dr. Seuss and Eric Carle. 

So make it a new habit whether your child is 1 day, 1 month, 1 year or older….read aloud 15 minutes a day and before you know it your child will be reading to you!!!

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