Daily Dose

How to Deal with Different Bed Times for Children

One of the questions I get from parents on an almost daily basis deals with sleep. So I thought I would spend the rest of the week answering some top sleep questions. Question #1: How do you get 2 younger kids to bed on good schedule when you have 2 older sibs too?

Having a bedtime schedule for both the younger and older kids helps. I would enjoy family dinnertime, and some activities together after dinner. Then separate the younger kids from the older ones. You might have older kids doing homework or independent reading (really dependents how much older they are) in a different area of the house while you take younger kids off for bathes and bedtime stories. Even if their bedtimes are only an hour apart, this will give you time alone with both sets of kids and age appropriate activities with each. Once the younger kids have had stories, prayers and are tucked in for the night you can now spend time with the older ones. I often found this a good time to do any review of spelling or homework they wanted me to look over etc and plan for the next day with them. Then we would enjoy “older version” of bedtime stories when they would read to me. Very relaxing, (must admit I sometimes found myself lulling to sleep while they read), and then I would read to them. It was a way to keep us both involved in reading aloud and I enjoyed most of Harry Potter books this way. They too liked saying prayers together, a hug and kiss and then to bed. Try to limit computer or TV for older kids prior to bed, as this seems to disrupt sleep. With that schedule I felt like both sets of kids had parent time, and you can also alternate Mom and Dad doing this routine depending on parent schedules etc. Divide and conquer seemed to work well in our home. That’s your daily dose on sleep for today; we’ll talk about it some more tomorrow.

Daily Dose

Cutting Down on Soft Drinks

The teen set seems to drink more soft drinks than any other group, and some of them drink three to four per day!!Do your children drink soft drinks? In talking with patients, especially the middle school and high school set, I ask about eating habits and the subject of what they drink always comes up. Of course I want them all to say they drink at least two glasses of milk a day, but I am often surprised. Many children drink water with their meals, some juices, and another group has a soft drink.

The teen set seems to drink more soft drinks than any other group, and some of them drink three to four per day!! They drink one for breakfast, followed by one at lunch and this is especially true for high schoolers who have off campus lunches. Then they will come home from school and have another with snack and then it's dinnertime and there is another. Wow!! I wouldn't believe it if I didn't hear it myself. The other surprising thing is that these are also not diet drinks and this information is often coming from teenage girls who are worried about their weight. Just think of how many calories per day they consume on liquids alone. They wouldn't have to eat a thing, as their Coke, Dr. Pepper or Sprite is keeping their weight up. The issue of caffeine also comes up depending on their beverage of choice. I am sure they are not meeting their calcium and vitamin D needs either and cola products contribute to decreased bone density later in life. What really amazes me is that parents continue to buy soft drinks. I found the easiest way to not have my kids drinking these beverages was just not to buy them! It took me a few years to figure this out, but it was so simple...we don't have them routinely. Now, if you are having a party or it is a special occasion of course you might have them. But after that, they disappear and the issue of drinking soft drinks at home is moot. How easy is that? Maybe we should have national "stop drinking soft drinks day". But I always love those kids that say, Dr. Sue " I don't like those fizzy drinks, I just drink milk." They are the easy ones. That's your daily dose, we'll chat tomorrow.

Daily Dose

Kids & Bedtimes

1.30 to read

As the summer winds down, my office is bust with back to school check-ups.  During these exams, I find myself asking a lot of questions related to a child’s sleep routines. Over the years I have always asked about sleep, and for so many  parents it is one of their main concerns.  

But what I have noticed is it seems children are going to bed later and later. I know the summer months are less scheduled for many families and children tend to get out of routines, but never the less, when I routinely ask, “during the school year what time does your child go to bed at night?” I am surprised by some of the answers.  And I am not talking about teens either, this is mainly the 5-13 year old set. (I do think teens need bedtime guidelines as well, that is a different discussion). 

As a working parent I totally understand and empathize with how busy the evenings are. I tell new parents that the evening hours between 6-9 pm are often the “witching hours” for newborns but I also see these same “crazy hours”  for most families once their children get to be school aged. (is this why cocktail hour was invented?)  It is the time of day for after school activities, homework to be done, dinners to be cooked and children to be bathed. Add in bedtime stories and/or reading by your child and it is CRAZY....but even so children need to have bedtimes appropriate for their ages.

Hearing that 5 year olds go to bed at 9 pm or that 10 year olds are up until 10 or 11 pm not only makes me tired but worries me as well that these children are not getting enough sleep. And the statement from frazzled parents, “they just won’t go to bed” makes me know just how important early good sleep habits are. Bedtime is a statement not a question!

While some children are just natural sleepers, others can be more difficult, but I am convinced that early good sleep habits help all children to be better and more independent sleepers.  Self soothing begins in infancy, but self calming and sleeping in your own bed is an important milestone as well. A child who awakens every night and ends up sleeping in their parents bed is disrupting both their sleep and their parents, which leads to irritable, unfocused and tired children and adults.

So, this seems to be a good time to re-look at bedtimes and adjust accordingly for your child’s age.  Once you get a good routine going, good habits are easy to continue.  

Daily Dose

A Rough Flu Season Ahead!

1.15 to read

As you know from previous posts, it is an early flu season and my office has been really busy with lots of flu cases.  With that being said it is never too late to get your flu vaccine (after all, this is National Influenza Immunization week).  Those of us who opted for flu vaccine earlier this fall are hopefully already protected and it looks like this years vaccine is a good match for the 3 types of flu that are already circulating. 

The flu vaccine contains 3 different types of flu strains, 2 Flu A, and 1 Flu B. We are seeing both types of flu right now, as is a great deal of the southern United States as well as the Midwest.  It will only be time before the rest of the United States will see rising flu activity as well, especially with holiday travel quickly approaching. 

For those of you who haven’t been immunized yet, I would put getting the flu vaccine for all children over 6 months of age at the top of my “to do list”. If you have been fortunate enough not to see your pediatrician this fall, you may not have had the opportunity to be reminded to get the vaccine. In fact, the last patient of the day yesterday was a 10 year old boy with classic flu symptoms: sudden onset of fever, chills, cough, scratchy throat and body aches.  His mother “thought” that she had been in and had gotten the vaccine but when I looked it was LAST fall and the time had just escaped her.  Not uncommon when you have healthy children who only see their pediatrician once a year. 

Even if you have been unlucky enough to already have had the flu, which really knocks you down for at least 5-7 days, you should go get the vaccine once you are over the acute illness. Believe it or not, you could actually contract one of the other strains of flu that will continue into the flu season. Some might say that it can’t happen, but it does! 

Lastly, if you do get the flu keep your child home from day care or school and all of their other activities. Flu is very contagious, and going to school just spreads the virus to others. This is also true for parents, who need to stay home from work with the flu as well.  

Keep washing those hands!  We have a long winter ahead.


Daily Dose

The Right Way to Take A Temperature

1:15 to read

 During flu season and really throughout the year, the questions surrounding how to take a temperature in a child and how to treat a fever seem never ending. So I thought let’s jump right in with a discussion on taking temperatures in all age children.

There are many different thermometers out there, and many different methods for taking a child’s temperature. The one way that I know that is not accurate is by “touch of hand”. Many parents report that their child had a fever, but have never taken their temperature. Neither your hand, nor mine is accurate in detecting a fever in a child. I am not a fanatic about taking temperatures all day long but it is important to document your child’s body temperature with a thermometer if you think they have a fever. Also, a fever to a parent may mean 99.6 degrees (I know your child has a different body temperature than others), but in terms of true fever most doctors use 100.4 degrees or higher as true fever. For everyone!

Body temperature in infants is very important and a fever in a child under two months of age is something that always needs to be documented. The easiest way to take a temperature in an infant is rectally and is actually quite easy. Lay your child down, like you would be changing their diaper, and hold their legs in one hand while you gently insert a digital thermometer (lubricate it with some Vaseline, makes it slide in more easily) into their rectum (bottom). It will not go too far, don’t worry, only about 1/2”. Keep the thermometer in their bottom for about a minute and by then you will be able to see if they have a fever. Again, over 100.4 degrees. I use rectal thermometers in children up to about two as they are usually pretty easy to hold and it is not painful at all. It is also accurate. Keep this digital thermometer labeled for rectal use.

Axillary temperatures are taken under the arm and can also be taken with a digital thermometer. It is often confusing if your child’s temperature is in the 99 – 100 degree range, so if in doubt take rectal or oral temperature. I am not a huge fan of axillary temperatures, and it actually requires more cooperation than a rectal temp. Oral digital thermometers, which are placed under a child’s tongues, are easy to use in a cooperative child. By the time your child is three or four, it is fun to teach them how to hold up their tongue and then hold the tip of the thermometer under their tongue and close their lips.  Especially with digital thermometers, elementary children like to read you what the thermometer says, and discuss their temperatures. My children always loved to show me they were REALLY sick when it said 103 degrees. It is then a “sick day activity” to take the acetaminophen and watch your temperature come down over the next several hours. They loved making charts of their body temps. It won’t win a science fair but does keep them busy. Also, if they can play this game they are not too sick. Lastly, do not let your child drink a hot or cold beverage right before taking an oral temp (note for parents of older kids, remember Ferris Bueller?), as the reading may not be accurate.

There are also fancy tympanic (ear) thermometers and temporal artery thermometers. I still prefer digital in my own house, and never purchased a “fancy” thermometer. You can buy tons of digital thermometers for every child to have their own, and still save money. We also often hear parents report that there was over a degree of difference between the same child’s ear. I also do not like ear thermometers in little ones, as their ear canals are too small to get accurate readings. Now that you know how to take a temperature I will discuss fever in another post.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

What to Look For in RSV

The office is just full of coughing and wheezing kids of all ages, much of which is RSV.Boy oh boy, RSV is really here and so more thoughts on that topic. The office is just full of coughing and wheezing kids of all ages, much of which is RSV. But the ones I am really concerned about are the infants and babies under the age of one year. They have a harder time with the virus and this infant age group is the group that statistically gets hospitalized more often. The buzz among moms about RSV continues (but at least less buzz about vaccines). They are all concerned and confused about when they need to come and see the pediatrician and also what "they" as parents need to watch for. Both of these concerns are important.

As we talked about before, almost all children get RSV by one year of age. In most cases it will just be a bad cold, but in some babies they will develop bronchiolitis (or airway inflammation of the lower respiratory tract) and they have a classic, frequent, non-productive cough, lots of secretions and often have a wheeze when listened to with the stethoscope. In most cases these babies are fairly "pathetic" and cough and awaken throughout the night, may not eat quite as well, and just feel "puny" and require a lot of parental care and TLC. Babies and therefore their parents don't get a lot of sleep when RSV is around. The babies I worry about are those that have true difficulty breathing. They not only cough frequently, they have signs of increased work of breathing which is evident by "pulling or retracting" while breathing. When you take off their shirts (which is what you should do at home too to look at how they breath), you see their ribs pulling or their abdomens working to help them breath. They look uncomfortable, not just while coughing, but also while just trying to get a breath. If this gets worse they may even grunt with each breath. I also worry about the your-baby that coughs and coughs and has "duskiness" with their cough. Most parents report that their your-baby gets bright red with cough, and eyes water and they may even vomit with cough. But a your-baby that turns even A LITTLE dusky needs to be seen immediately. Remember, red is good, blue is bad! Unfortunately RSV is here for a while. This is the peak season in most of the country and will be for weeks. Keep those young babies away from others and if your your-baby develops cold symptoms, look at how they breathe. If in doubt, take them in. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Booster Shots

1:00 to read

Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Daily Dose

Have Your Child's Blood Pressure Checked

1:00 to read

When you take your child in to the pediatrician for a check-up do they check their blood pressure? The American Academy of Pediatrics (AAP) recommends that children, beginning at the age of three years, should routinely have their blood pressure checked.  

In certain circumstances a younger child should have their blood pressure checked too. With the growing epidemic in obesity, pediatricians are seeing more children with abnormal blood pressure readings. It is important that the right sized blood pressure cuff is used for measuring a child’s blood pressure. There are standards for blood pressures for different age children. The standards are also based on a child’s height.

When a child’s blood pressure reading is greater than the 90th percentile for their age they are said to have pre-hypertension. The prevalence of childhood hypertension is thought to be between one and four percent and may even be as high as 10 percent in obese children. Obesity plays a role but, related to that is also inactivity among children, diet, and their genetic predisposition for developing high blood pressure. Then it is appropriate for further work up to be done to evaluate the reason for the elevation in blood pressure.

If I find a child with a high blood pressure reading during their physical exam, it is important to re-take their blood pressure in both arms. I also do not depend on automated blood pressure readings, as I find they are often inaccurate and I prefer to use the “old fashioned” cuff and stethoscope to listen for the blood pressure. If the blood pressure reading is abnormal, then I have the child/adolescent have their blood pressure taken over a week or two at different times of the day. They can have the school nurse take it and parents can also buy an inexpensive blood pressure machine to take it at home. I then look at the readings to confirm that they are consistently high. The “white coat” syndrome, when a doctor assumes that the elevated blood pressure is due to anxiety, may not actually be the case, so make sure that repeat blood pressures are taken. If your child does have elevated blood pressure readings it is important that further evaluation is undertaken, either by your pediatrician or by referral to a pediatric cardiologist.

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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


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