Daily Dose

New Sleep Recommendations

1:30 to read

SLEEP! Who can get enough of it?  More and more studies point to the need for a good night’s sleep. But, as a new parent, you are sleep deprived, and then when your children get older they may sleep through the night,  but they want to wake up at the crack of dawn.  Once your children are adolescents their days and nights are totally up side down,  they often want to stay up too late and sleep half the day away.

Sleep is an important way to rest our brains and reset our bodies for another day.  Circadian rhythm helps to regulate sleep/wake cycles.  But trying to make sure that your children get enough sleep seems to be a never ending battle (at least in many houses). It is also one of the most frequent concerns of many of my patient’s parents.  

A recent study which was undertaken by the National Sleep Foundation reviewed over 300 articles published in peer reviewed journals between 2004-2014. Based upon their review here are the updated sleep recommendations:

Newborns (0- 3 months) 14 - 17 hours

Infants (4 -11 months) 12 - 15 hour

Toddlers (1- 2- years) 11 - 14 hours

Preschoolers (3 - 5) 10 - 13 hours

School aged children ( 6 - 13) 9 - 11 hours

Teens (14- 17)  8 - 10 hours

Young adults (18 - 25) 7 - 9 hours

So, how do your children stack up with their sleep?  Parents with newborns complain that their children may sleep 15 hours/ day, but not in the increments that they would like, while parents with children over the age of 13 rarely report that their children are getting  8 - 10 hours of sleep.

One mother recently was exasperated as her daughter age 7 would go to bed at 7:30 pm but woke up everyday at 6 am. I explained to her that her daughter was getting enough sleep, and that unfortunately her biological clock was set and that short of making her stay in her room until 6:45 when she wanted her to get up, there was not much to do.  The problem is that many parents cannot go to bed when their children do, (dishes, laundry, work emails, etc to get done while the children sleep.) So while their children may be getting enough sleep the parents are often sleep deprived!

While a good night’s sleep is important for mood and focus there is a lot of data suggesting that children who get enough sleep are less obese, are less likely to get into trouble and are certainly more pleasant to be around.

So, have a good nighttime routine beginning with a regular bedtime for your children. Commit to no electronics in their bedrooms and turn off any electronics at least an hour before bed.  We parents need to do the same!

Daily Dose

Wheezing Season is Here

1:30 to read

Have you ever heard your child wheeze?  With cough and cold season in full swing, I'm seeing more and more children and hearing many parents say, “I think my child is wheezing”.  Wheezing is a distinct sound that is heard during expiration and unfortunately is often not audible without a stethoscope. Many parents mistakenly hear the raspy upper airway noises from mucous in a child’s throat and think this is wheezing, which thankfully is not the case.

Wheezing is one of the most common reasons children are seen in the pediatric office during the winter months when RSV (respiratory syncitial virus), rhinovirus, and parainfluenza viruses all circulate...not to mention influenza.  Not all children who wheeze will go on to develop asthma but having a parent who wheezes and has allergies does put a child at greater risk for having asthma. 

Asthma is not a singular disease but rather a complex of symptoms which causes constriction of the airway smooth muscles, inflammation of the airway, mucous production and swelling that leads to air trapping.  This then results in coughing, wheezing, chest tightness,  prolonged exhalation and shortness of breath. For a young child the first symptoms of wheezing may be a persistent short, tight cough that occurs day and night without relief.

If you do think your child is wheezing you must always watch for ANY respiratory distress, or work of breathing!!!  You should never see your child’s ribs pulling in or out and they should always appear to be comfortable with breathing. You must look at their chest rather than just listen to their coughs.  Visual is just as important as the audible noise.

Like many things, there is not a specific test for diagnosing asthma. For a child who is initially found to be wheezing the first line of treatment is typically an inhaler or nebulizer with a bronchodilator to open up the tightened airways. For a young child it is often easier to use the nebulizer but once a child is older and a bit more cooperative an inhaler with a spacer is often less cumbersome and more convenient to use. When used appropriately the spacer/inhaler has been show to be equally effective.

If you are worried about your child’s breathing it is always a good idea to call your pediatrician to discuss. 

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

New parents often come in concerned about their baby spitting up.  They typically  ask, “does my baby have gastroesophageal reflux (GER)?”.  I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants.  Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time. 

GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”.  GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.  

For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.  

The best treatment for benign GER is lifestyle management.  Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas.  Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies.  It is always worth trying.

While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!

Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed.  Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.

For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary.  Talk to your doctor about options if lifestyle management does not seem to help. 

Daily Dose

Ebola in U.S.

1:30

It was only a matter of time before a case of Ebola virus was diagnosed in the United States. It just so happens to be at the hospital that I practice in which is also directly across the street from my office.  I can already tell you that there is a lot of concern from our patient families as well as from friends who were at the hospital today including my daughter in law. Concern is one word, but hysteria and misinformation are also words that come to mind.

When I first heard the news I too was skeptical that the person admitted to Presbyterian Hospital of Dallas would actually have Ebola virus. We have been on the “alert” for enterovirus D-68, which has also been making headlines, but Ebola was not on my “radar:.  The moment that the CDC announced that the patient had indeed tested positive for Ebola virus, the news helicopters started circling above the office (not quite a many as there were for George Clooney’s wedding), but a considerable number (and noisy!).

I have fielded emails, texts and phones calls beginning this afternoon and into the night from concerned parents.  The first thing to know is that Ebola virus is not transmitted as a respiratory pathogen like flu, or a cold or even enterovirus.  (My daughter in law did not have a mask on as she went to her appointment this morning and she too was a bit concerned until we spoke). 

The Ebola virus is transmitted when you come into contact with body fluids like saliva, blood, urines, or feces from the patient and then can enter your body through micro-abrasions or cuts.  It is not a virus that you will catch if you walked by the patient or passed the patient in the hallway or the airport.  Again, you must come into contact with body fluids to catch this virus.

This patient is in strict isolation within the hospital which means only certain medical personnel will even be in contact with him.  The area that I practice in and the babies that we see in that hospital are in no risk for exposure to the virus. There are always infection control procedures within the hospital and they will continue to be followed.  

So, there is no reason to panic.  I am not afraid or concerned about continuing to work within the hospital. We will continue our regular days in the office and reassure families that they are not at risk. We pediatricians are still more concerned about airborne viruses such as RSV and flu that will cause considerable illness, and will soon begin circulating.  Get your flu vaccines, wash your hands, get enough sleep, exercise and continue to have healthy family meals. Remember, keep your child ( or yourself) home from day care or school if they have a fever.  This is still the best prescription to stay healthy.

 

Daily Dose

RSV

1:30 to read

Flu season seems to be winding down but RSV (respiratory synctial virus) season is still here and actually arrived a bit later than usual this year. RSV is a common upper respiratory infection that causes cold symptoms with cough, runny nose, congestion and in some cases wheezing.  

But when new parents hear that there is RSV in their day care or school they often “freak out”. While RSV may cause cough, wheezing and respiratory distress in some young children (more commonly in those with underlying lung or cardiac disorders), thankfully for most it is just a really bad cold!

Statistically, 2% of infants less than 12 months of age are hospitalized for RSV each year.  But, that also means that 98% of infants do not require hospitalization!!  Much better odds that your child will be okay than if you play the lottery, right?

It really doesn’t make much of a difference as to which virus causes your child’s (or your) cold.  What is more important is how your child is breathing!!  Because a baby’s nostrils and airways are smaller, it is not uncommon for parents to be concerned that their child sounds noisy when they are breathing. I think it is more important to look at how your child is breathing rather than listening to their stuffy nose and coughing. This means that you need to take off their t-shirt or jammies and actually look at their chest, and make sure that you cannot see their ribs pulling in and out, or see their abdominal muscles doing work of breathing. You should also not see your baby’s nostrils flaring or see any change in their color...always pink, never dusky or blue!  The cough with RSV is horrendous and sounds terrible as well, but look at how they are breathing and their color when coughing.

It is also important that your child stays hydrated, even though they may not take their bottle or fluids as well as usual. You should always see “spit” in their mouths and tears when they cry and wet diapers (may not be sopping, but wet).  Remember, you probably don’t want to eat as much when you are sick yourself. Offer more frequent feedings. No schedules when your child is sick.

Best treatment, suck the mucous out of your baby’s nose and turn on a cool mist humidifier. They may also feel better when more upright, that is probably why there are many nights with a baby spent rocking on your shoulder when they are sick.

If you have any concerns about how your child is breathing you should always contact your doctor...better be safe. 

Daily Dose

Do Germs Make You Cringe?

1:30 to read

I see a lot of parents who are “germaphobic” and are constantly sanitizing anything and everything that may come into contact with their baby. I am not just talking about a newborn...but rather older infants and young children, especially as they start to creep and crawl around their environment.  Their mother’s purses have a bottle of hand sanitizer in easy reach and many have the bottle attached to the diaper bag or stroller as well. 

But now comes a new study which may help everyone relax a bit...and maybe stop constant disinfecting as well.  A recent study in The Journal of Allergy and Immunology found that children, under the age of 1, who shared a “dirty” home, with mouse and cat dander as well as cockroach droppings (I know you are all cringing now)  were less likely to develop allergies or wheezing by age 3.  

This idea has been called the “hygiene hypothesis”.  In other words, having children who are growing up in relatively sterile environments, may lead the immune system to “compensate” by reacting to pollen, dust and dander when there are fewer germs to ward off!  Now this doesn’t mean you have to stop keeping your house clean and never making a bed or vacuuming again ( novel idea), but the constant scrubbing and sanitizing may be a bit much. You don’t need anti bacterial soap in every room!

There have been other interesting studies done among children who live on farms.  They were taken into the barn as infants with hay, dander and animals all around them. They too were found to have fewer allergies than urban children.  So...playing on the dirty barn floor might not only be necessary for farm children, but also protective.

Should you run out and buy mice, a cat and try to breed roaches? I don’t think that is the recommendation.  Interestingly, this study did not show that having a dog was protective ....hmmmm when my kids were younger we did have a cat as well as a dog, not by choice but by my middle son’s insistence. Having always had dogs, somewhere in his early child hood years he “bargained” with us to adopt a black kitten that we all grew to love.  Maybe that was the best decision we made.  Fortunately none of my children have allergies or asthma. 

Lots of interesting studies on the horizon relating to this topic....stay tuned as I will keep you posted!

Daily Dose

Stop Cyberbullying Now!

1:30 to read

There have been a lot of recent stories about bullying occurring on social media sites. I have such mixed feelings about social media, and ironically I myself am writing a blog for our website and app.  The Kid’s Doctor is  active on Twitter (@TheKidsDoctor) and Facebook (TheKidsDoctor) as well.  So, I realize to stay current, social media is a must and it is usually quite beneficial and is a source of instant information and sharing. Maybe too instant?

But with that being said, why do some people feel they may use it as a “bully pulpit”.   Why do they feel compelled to be mean and even vulgar?  I spend a great deal of time discussing this topic with my adolescent patients and their parents but I am concerned that sometimes even parents are guilty of “cyber bullying”.

How do parents teach their children right from wrong, or how to behave appropriately in society....by modeling behavior themselves. Our children are watching us and looking to their mother and father to “show them the way”.  Leading by example is often difficult but absolutely imperative, and this includes social media and bullying.

For all of the years I have practiced I have seen that in most, maybe not all cases,  having parents who model appropriate behavior is one of the keys to raising healthy, compassionate, resilient and well balanced children.  It sounds simplistic but it works.

Curt Schilling recently wrote an interesting and compelling article discussing this very issue.  Right after he posted a congratulatory tweet announcing his daughter’s college acceptance his daughter received terribly inappropriate hateful and hurtful messages. He was able to “trace” the tweets to accounts and therefore knew exactly who had sent these messages. Unfortunately, there are often not consequences for cyberbullying or inappropriate behavior....at least for now.  Did the messengers get punished? Did their parents even know? I should hope so.

Social media is here to stay, but there has to be a way to teach our children (and adults) that there are consequences for behaving badly especially when the whole world is aware of your behavior.  It is time for the pendulum to swing back to morals, civility,manners....and as my mother would say to me, “Emily Post would not approve”. 

Daily Dose

Calming Parent's Fears About Night Terrors

1;30 to read

I received an e-mail from a viewer today about night terrors. Her concern was “my son is having what I think are nightmares, but he talks and makes no sense and seems to be afraid and I am not sure what is going on.”

Her description is perfect for night terrors, which typically occur in children during the pre-school and early elementary years. The peak age is between five and seven years, and night terrors usually resolve before adolescence. About three percent of children experience night terrors.

Night terrors are part of sleep disturbances known as parasomnias, and are characterized by partial arousal during non-REM sleep. Night terrors therefore typically occur during a child’s early hours of sleep, when non-REM sleep is deepest. Most children with night terrors will stay in their bed, but cry out and appear anxious and upset, but are also very confused. Some children may run down the hallway with heart racing and breathing fast as if they are being chased. Until you see a child having a night terror it is difficult to explain how anxiety provoking it is for a parent who doesn’t realize what is going on.

I speak from experience as our third child had classic night terrors, but the first time he appeared in a “semi” awake state screaming and sweating, I would have sworn he was in horrible pain. Not the case, as after about two to five minutes most children will calm down (on their own as you cannot awaken them or comfort them during the event) and return to sleep and have no recollection of the episode the following morning. It is a very helpless feeling until you realize that your child is really not awake at all.

The other big difference between night terrors and nightmares is that the child has no sense of dread or of being scared to sleep. They have no fear or anxiety about these events occurring, and while the sleep terror ends abruptly with rapid return to deep sleep there is complete amnesia to the event. The best treatment is in reassuring parents. It is also important to make sure that your child has a regular bedtime routine and that they are getting sufficient sleep. This sleep disturbance is really more disturbing to the family than the child and will resolve over time. Just remember to let babysitters know, as it may be quite unsettling for a new sitter who has just put precious children to bed!

That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Should your child get their MMR ahead of schedule?

1:30

Most of the discussion about the current measles outbreak revolves around those who choose NOT to vaccinate. But on the other side of the story anxious parents have called me and are wanting to make sure their children’s MMR vaccine is up to date. In fact some are so anxious they want to vaccinate their children “ahead of schedule”.  

One mother has an almost 4 year old, who had their first MMR on schedule when her son was 1 year.  She called and asked if she could bring him in 3 months before his 4th birthday, “just to make sure he is okay”. I assured here that there was not an indication to vaccinate him early and that I would see him later this spring for his routine check up.  She was relieved...as was he.  (he is not looking forward to that 4 year old visit!)

Several other parents have called and asked if they should bring their 6, 7 or 8 month old child in to have their MMR even before their 1 year check up. The current recommendations have not changed and the MMR vaccine is still being given at 12 months of age and then a “booster” dose at 4-6 years of age. There are recommendations to immunize children between 6-12 months of age who are traveling internationally. Many countries have far more measles cases than what we currently seeing in the United States.  For information on travel and measles vaccine go to www.cdc.gov.

I do remember being a young physician in the late 80’s when there was an epidemic of measles. The first time I saw a case of measles was in 1990 and I myself had a young baby at the time. There were over 55,000 cases of measles in the U.S. and over 120 deaths. Due to the extent of this measles “epidemic” a recommendation was then made to give any infant over 6 months of age a measles vaccine, knowing that they were not getting fabulous protection, but better than none. This group, including my now 25 year old son, then received MMR vaccine between 12-15 months, and again at 4-6 years.  

So...stay tuned, with new cases now cropping up in infants in a day care center in Chicago, and several more suspected cases in other areas...this story is unfortunately not over.

If you do NOT know you or child’s vaccination status.....it doesn’t “hurt” to get another MMR.  

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DR SUE'S DAILY DOSE

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