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Daily Dose

Prebiotics and Probiotics

1:30 to read

There has been plenty of discussions about using prebiotics and probiotics in your child's diet. What is the difference between the two?There has been a lot of discussion lately (in both medical and lay literature) surrounding the use of prebiotics and probiotics.  The first question patients/parents often ask is what is the difference between the two “biotics”? Prebiotics are non-digestible nutrients that are found in foods such as legumes, fruits, and whole grains. They are also found in breast milk.  Prebiotics have also been called fermentable fiber. Once ingested, prebiotics may be used as an energy source for the good bacteria that live in the intestines. Probiotics are beneficial live bacteria that you actually ingest. These bacteria then pass from the stomach into the intestine to promote “gut health”. The gut is full of bacteria and these are the “good bacteria”.  

There are currently hundreds of different probiotics being marketed. The research on the value of using prebiotics and probiotics has been ongoing, but there are actually very few randomized, double blind, controlled studies to document that pre and pro-biotics provide any true benefit to treat many of the diseases that they are marketed to treat. There are several areas where probiotics have been shown to be beneficial. By beginning probiotics early in the course of a viral “tummy infection” in children the length of diarrhea may be reduced by one day. Probiotics have also been shown to be moderately effective in helping to prevent antibiotic associated diarrhea, but not for treatment of that diarrhea.

There are also studies that are looking at giving very low birth weight premies probitoics to help prevent a serious intestinal infection called necrotizing enterocolitis. To date there seems to be evidence to support this and there are currently more ongoing studies. Studies are also being done to look at the use of probiotics as an adjunct to the treatment of irritable bowel syndrome, infantile colic, and chronic ulcerative colitis as well as to possibly prevent eczema.  While preliminary results are “encouraging” there is not enough evidence to date to support their widespread use. In the meantime, there are so many different products available.  Prebiotics and probiotics are now often found in dietary supplements as well as in yogurts, drink mixes and meal replacement bars. It is important to read the label to see if these products are making claims that are not proven such as, “protects from common colds”,  or “good bacteria helps heal body”.  Many of the statements seem too good to be true!

Until further studies are done there is no evidence that these products will harm otherwise healthy children, but at the same time there is not a lot of data to recommend them. They should never be used in children who are immunocompromised,  or who have indwelling catheters as they may cause infection. This is a good topic to discuss with your doctor as well.

Daily Dose

New Fever Research

1:30 to read

I just read an interesting article in the Wall Street Journal “Your Health” section, about a new study being done by doctors at Boston Children’s Hospital looking at the definition of fever.  As you know from all of my previous posts, fever is a symptom rather than a disease….and fever causes a lot of anxiety for many parents as well as their physicians.

For my entire pediatric career I have been taught that the definition of fever is a temperature of 100.4 degrees or higher. Pediatricians have used this number to determine when a newborn has an elevated temperature and may have an underlying infection and need to be hospitalized. We have also used this number to decide when a child may return to school after an illness, and I can also remember several occasions when I was called to pick up a child from school due to a temperature of 99.9 degrees ( which I wanted to point out was not a fever).  Pediatricians also use this “magic” number to screen for systemic illness, especially in children who have “vague” symptoms of illness without other physical findings which may be seen in the early stages auto-immune disease.

While this has been the “gold standard” in medicine, doctors also know that our body temperature fluctuates throughout the day. There has been research to show that “temperatures varied about 0.9 degrees over the course of the day “ with the lowest being early a.m. and higher temps in the evening. This information has been used for a long time to chart “basal body temperatures” for those hoping to get pregnant. There is also wide variability in temperature depending on the instrument you use to take the temperature and where the temperature is taken (oral, rectal, tympanic, temporal ).  It is not an exact science….but we use the information all of the time to make medical decisions.

Knowing that there is variability in body temperature, Dr. Jonathon Hausmann, a pediatric rheumatologist , is now going to study over 10,000 people of all ages through a crowdsourcing app “Feverprints”. This app will enable the researchers to gather data looking at body temperatures for different age groups, gender, ethnicity, weights and body types. It will also gather data looking at the effect of medications we use to lower fevers, and will try to answer the question, “can you predict the cause of the fever by looking at temperature patterns?”. At the end of the day, these “feverprints” may end up helping to develop fever curves that will be used in different populations (somewhat like a growth curve). 

This is really an exciting and interesting study and will take a large number of people (10,000) enrolling via a free “app” and committing to downloading information for 6 months.  Wouldn’t you want to be involved….I think this would be a great way for a family to have a “science fair project” in their own home!!  I just downloaded the app myself…we might just find that the definition of fever will change…it only took 150 years and an iPhone! 

Daily Dose

Breastfeeding Needs Patience & Practice

It is not uncommon for many new mothers to be concerned and breastfeeding and also finding it to be a little more challenging than the books would say.Those first several days home with a newborn can be very difficult and not exactly like the Gerber your-baby on TV. I typically see a newborn in my office several days after they are discharged from the hospital, so day four to six of life. That gives parents several days to have been home alone with their your-baby and then the questions begin.

It is not uncommon for many new mothers to be concerned and breastfeeding and also finding it to be a little more challenging than the books would say. The first thing I tell them is that there is not a book that will provide the same information as on the job experience (kind of like the rest of parenting!) Breast feeding may take a bit for both your-baby and mother to get used to, new job for both, and don't let that discourage you. I found the person who was most helpful getting me comfortable with breastfeeding was a friend who had done it before and who was a cheerleader for me. The adage practice, practice, practice is important here, and you will make breast milk (trust me on this one) and your your-baby will get the hang of it, but be patient. It can bring even a CEO new mother to tears but this is not like running a business, the your-baby has their own agenda, and despite your best intellectual efforts this event is based on patience and persistence, not IQ. By day four to six a mother should have breast milk and you should see that your your-baby is having wet diapers and that their stools are changing from dark, sticky meconium to yellow, seedy stools. There are usually numerous stools and wet diapers as the your-baby picks up their nursing and "gets the hang of it". Don't be alarmed if every feeding does not go as smoothly as the next, the your-baby is just like you, eats more some times than others. The important things are to get the your-baby to the breast every two to three hours, for the nursing mother to drink lots of fluids and to eat well. Lastly, both your-baby and mother need rest, so hop back in bed between feedings. That's your daily dose, we'll chat again tomorrow.

Daily Dose

It's Allergy Season!

1:30 to read

WOW!  A busy week in the office and while I was on call in the evening,  the biggest problem right now seems to be allergies!  While some parts of the country may still be experiencing cold and a few snow flake, many states are warming up and the trees and grasses are starting to spread their pollens. In fact, my backyard is covered in yellow oak tree pollen, and some of it is so thick it looks like tumbleweeds. This cannot be good for anyone.

While I am finally seeing fewer and fewer children with the multitude of winter upper respiratory infections I see every year, the allergy season is looking “wicked” this year.  Seasonal allergies due to pollens from grasses and trees are typically not seen in children until they are over 24 months of age.  At times it is difficult to distinguish the last of the cold viruses from early allergy symptoms. But at this time of year, a good history is important (always) as well as a family history of allergies.

The good news is, there are a lot of medications available to help relieve the symptoms of itchy eyes, scratchy throat, cough, and drippy nose.  While the non-sedating antihistamines like Claritin, Zyrtec, and Allegra have been available over the counter for quite some time, intra-nasal steroids are now available as well. 

Intra-nasal steroids are one of the mainstays of allergy treatment, as they are a preventative medication. When used on a daily basis they help to prevent the “allergic cascade” that occurs when you inhale all of those pollens blowing in the wind.  They work best when used every day for the duration of allergy season which is really dependent on where you live. Allergy sufferers in the northeast will typically have symptoms later in the spring/summer than those in the “sunbelt”.

So you can now pick up Flonase and Nasacort over the counter and use them daily, even in children.  Make sure you try to aim the spray toward the outer side of the nostril and not toward the nasal septum (middle). This will allow the steroid spray more coverage as well as to try and help nosebleeds which may be a side effect of a nasal steroid spray. 

Lastly, with all of the kids playing outside in the “yellow mist” of pollen, make sure to bath/shower them and wash their hair when they come in.  This will help to reduce some of the itching and rubbing of their eyes and nose as well!

Daily Dose

Hand, Foot & Mouth Disease

1.15 to read

They say a picture is worth a thousand words and I believe it, especially as it pertains to rashes and pediatric illnesses. My iPhone has become a wonderful educational tool for my patients in the office, online and via social media.

It seems rather late in the season for Coxsackie virus to be occurring (typically more late summer early fall) but I am seeing so many little patients with the classic skin findings of “hand-foot and mouth” disease (HFM).  Some of the cases have been so classic that I took pictures of the rash, as once you see HFM you tend to know it!  Unfortunately, you may see this rash and think you won’t see it again, but you can get HFM more than once, so you will definitely know what you are dealing with once you have seen it.

HFM disease is a viral illness which typically occurs in younger children, although I occasionally see a miserable teenager who has classic Coxsackie virus findings.  In most cases the rash is preceded by a few days of fever and malaise and then the viral papules appear on the hands and soles of the feet. At the same time those papules and vesicles are often in the child’s throat, so you may see a toddler who is drooling more as it hurts to even swallow their spit!

Most kids with HFM don’t feel well and are irritable and fussy.  Occasionally you will see a child who appears totally happy, never had a fever and only has the classic Coxsackie rash on the hands, feet. The rash often occurs on the buttocks as well and may be equally as uncomfortable for those in diapers.

Because HFM is a viral illness there is no treatment per se.  This is where the TLC becomes important. You can use acetaminophen or ibuprofen for the fever or even for the throat discomfort. I am also a fan of things like popsicles, pudding, ice cream and Slurpees to help with the throat pain. Just make sure your child stays hydrated during the illness, they will eat their meals once they are feeling better.

The virus is contracted from person to person as well as from contaminated surfaces. This means that it is not uncommon to see “outbreaks” in daycare and preschools as the toddler set shares their germs better than their toys. The incubation period after exposure is about 3–7 days.

Once your child is fever free for 24 hours they may return to school as the rash may last anywhere from 5 – 7 days. Best prevention is still good hand washing.

Thanks to all of my little patients who were so helpful in letting me take pictures of their rash! I am getting better with the iPhone camera all of the time.

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

 

Daily Dose

Late Teether?

1:30 to read

Time for another of those moments in my office when I just turn my head and say “what?”.  The latest...during a 9 month old check up the child’s mother expressed concern that her daughter did not yet have any teeth.  

When I explained to her that this was totally within the range of normal, and in fact, I myself loved babies without hair or teeth in the first year of life!!! Why? They are “low maintenance”.  Don’t have to worry about washing dirty hair or brushing those first teeth...plenty of time to deal with that later on right?

But her concern was real...she was very worried about her daughter’s lack of teeth.  I reassured her that it was not uncommon, there are a lot of babies that will not get a tooth until around 1 year of age and late teething often runs in families.  I wondered if she knew when she or her husband had gotten their first tooth?

Upon further questioning her real concern was that she had been “told”  “if your child is a late teether they will also be a late reader?”  Was this something her friends told her on Facebook or on their Instagram post? I thought I had heard all sorts of concerns about teeth erupting...things like my child is fussy, doesn’t sleep well, drools a lot, chews on everything, has runny poop.....but won’t be able to read?  There is just too much information or rather “mis-information” out there.

So, it was such a relief for me to be able to tell her that I was not aware that there was any relationship between teething and reading. In fact...one of my own children had his first tooth erupt at 6 months (which is about average) and he ending up being dyslexic (which is another blog on successful ways to help children with learning differences).   My middle son did not get a tooth until about 18 months (which did worry my mother, she was ready to put money into savings for baby dentures), and he was reading before kindergarten ( which had nothing to do with us...we were focused on trying to teach his older brother how to read).

See why I love my job....something new everyday.... thankfully some of the concerns have no basis in fact....and I get to reassure parents.  

Daily Dose

New Baby Questions!

1:30 to read

Lots of new baby questions this week in my office, so I that I thought I would cover a few of the most frequently asked by parents within days of bringing that precious newborn home from the hospital. So, here we go:

My baby has blue hands and feet…should I go to the ER?  The medical term for this is acrocyanosis.   It is not uncommon for a baby to have a bluish/purple discoloration to their hands and feet. This often occurs if the baby gets chilled or cold, whether that is after a bath or sometimes even after they are unswaddled to wake them up a bit to get them to eat.  If your baby has pink lips and tongue and seems otherwise fine this is the normal adjustment of a baby’s circulation and may last for a few weeks to months.  When parents are concerned about this and make a trip to the ER where they are discharged with the diagnosis of “worried well”.

What temperature do I need to have my thermostat set?  This question always makes me laugh a bit because some of it is truly dependent on the climate where you live. Many parents think they need to “crank up the heat” for a newborn, but actually a cooler room temperature has been shown to correlate with a reduction in sudden infant death (SIDS).  The “ideal” temperature that has been recommended is around 68 - 70 degrees, but for those of us who live in the south during the dead of summer, it is almost impossible to keep your house this cool and very expensive. At the same time, some parents are uncomfortable during the winter with the thermostat at 68 degrees…so I would recommend keeping your house comfortable and on the cooler side rather than too warm. You also do not need to bundle your baby when it is blazing hot outside, less is more if the house is hot.

What about a pacifier?  Mother’s come in and say, “I was told that I shouldn’t use a pacifier because it will cause “nipple confusion”.  While I am a huge proponent of breast feeding I think that a pacifier is also helpful for a breast feeding mother so that she does not use her own breast as a “human pacifier”. Many new moms come in to see me at the 2 week check up crying, exhausted and with bleeding nipples. They are putting their baby on the breast for hours at a time as “it seems the only way my baby is content”.  Although they were told that they could put their finger in their baby’s mouth as a way to help console their baby, that too does not provide much of a distance from the baby…even to go to the bathroom, take a shower or eat!! A baby has the reflex to suck which is termed, “non-nutritive sucking”.  This is one way that your baby will calm themselves.  So, once your baby is getting on the breast, I would buy a pacifier and “teach” your partner how to hold your baby in the position as if they were going to be fed,  but with a pacifier to suck on rather than the breast. Once situated you can try walking around, gentle bouncing or swaying while your baby is happily sucking on their pacifier. Mother gets a bit of a rest between feedings and infant is happy with a pacifier ( rather than a finger). We will discuss taking away a pacifier at another time! 

 

Daily Dose

Teen Drivers

1:30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website www.youngdriverparenting.org was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

Daily Dose

Keep Your Athletes Hydrated On and Off the Field

With summer heat in full swing all across the country and kids heading back to school athletics, band practice, drill team and the like it is a good time to discuss heat related illnesses and their prevention.

It is always at this time of year that I begin worrying about heat exhaustion and heat stroke and I find myself re-emphasizing the importance of maintaining hydration, even before you start back to outside activities. The Centers for Disease Control and Prevention reported 3,442 deaths between 1999-2003 due to heat and exposure to elevated temperatures, while children under 15 years of age accounted for approximately 7% of the total deaths. Among high school athletes, exertional heat stroke is the third leading cause of death and is often related to lack of acclimation to the heat and dehydration. You can’t just head out to run three miles in the heat or work out in pads or march in the band on the hot field without preparing ahead of time. Heat exhaustion occurs when the core body temperature is elevated between 100.4 and 104 degrees. This is different than having a fever secondary to illness. Symptoms are typically non-specific but include muscle cramps, fatigue, thirst, nausea, vomiting and headaches. The skin is usually cool and moist from sweating and is indicative that the body’s cooling mechanism is working. The pulse rate is rapid and weak and breathing is fast and shallow. Coaches, athletes and others should all be aware of these symptoms. This is the body saying, “I am overheated” and don’t keep going! (You would not drive your car when overheated; you pull over, and at least add water.) The mainstay of treatment is to prevent progression to heat stroke by moving to a cooler place, in the shade, air conditioning etc. Remove as much clothing as possible (uniforms, pads, helmets etc) to help heat dissipation. Water misting fans may be helpful. Begin rehydration with appropriate oral electrolyte solutions and water. When treated quickly and appropriately, symptoms usually resolve in 20 -30 minutes. The child should not return to activities that day, and should avoid heat stress for several days. Heat stroke is a MEDICAL EMERGENCY and will require transportation to the ER for aggressive treatment. In this case the previous symptoms have been missed and the core body temperature rises to 104 degrees or greater. The skin is flushed, hot and dry from lack of sweating. The athlete is confused, or even unconscious. The heart rate is fast and there is hyperventilation. The blood pools away from vital organs and can result in encephalopathy, liver, kidney and multiple organ failure. While awaiting transportation to the ER the athlete should be moved to a shaded area, clothing removed and ice packs may be applied to surface areas overlying major vessels, (i.e. the neck, beneath the arm pits, and the groin). Cooling and misting fans may also be used. Continue to educate your children about the need for hydrating the evening prior to events, and for continuous hydration while exercising in the heat. They should know to drink fluids even when not thirsty, as once you become thirsty you are already behind in your fluid intake. With good education, and recognition of early signs over overheating heat related illnesses are preventable. That’s your daily dose, we’ll chat again soon! Send your question to Dr. Sue!

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DR SUE'S DAILY DOSE

Wouldn't it be great if your child did not have to get stitches to close a wound?

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Wouldn't it be great if your child did not have to get stitches to close a wound?

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