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Daily Dose

How to Treat Poison Ivy

1.15 to read

With the long weekend here, many families are enjoying the outdoors. But with outdoor activity, your children may develop summer rashes like poison ivy, poison oak or poison sumac. Each plant is endemic to different areas of the country, but unfortunately all 50 states have one of these pesky plants. Teach your children the adage “leaves of three, let it be”, so they come to recognize the typical leaves of the poison ivy.

The rash of poison ivy (we will use this as the prototype) is caused by exposure of the skin to the plant sap urushiol, and the subsequent allergic reaction. Like most allergies, this reaction requires previous exposure to the plant, and upon re-exposure your child will develop an allergic contact dermatitis. This reaction may occur anywhere from hours to days after exposure, but typically occurs one to three days after the sap has come into contact with your child’s skin and they may then develop the typical linear rash with vesicles and papules that are itchy, red and swollen. Poison ivy is most common in people ages four to 30. During the spring and summer months I often see children who have a history of playing in the yard, down by a creek, exploring in the woods etc, who then develop a rash. I love the kids playing outside, but the rash of poison ivy may be extremely painful especially if it is on multiple surface areas, as in children who are in shorts and sleeveless clothes at this time of year. The typical fluid filled vesicles (blisters) of poison ivy will rupture (after scratching), ooze and will ultimately crust over and dry up, although this may take days to weeks. The fluid from the vesicles is NOT contagious and you cannot give the poison ivy to others once you have bathed and washed off the sap. You can get poison ivy from contact with your pet, toys, or your clothes etc. that came in contact with the sap, and have not have been washed off. If you know your child has come into contact with poison ivy try to bath them immediately and wash vigorously with soap and water within 5

Daily Dose

Migraines in Children

1.15 to read

I received an email via our iPhone App inquiring about migraines in children. Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches which include migraine headaches. 

Migraine headaches are best diagnosed by obtaining a detailed history and then a thorough neurological exam. There are several characteristics of childhood migraines that are quite different than adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population. 

Childhood migraines often are shorter in duration than an adult migraine and are less often unilateral (one sided) than in adults. Only 25-60% of children will describe a unilateral headache while 75-90% of adults have unilateral pain.  Children do not typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise or loss of appetite proceeding the headache.  About 18% of children describe migraine with an aura and another 13% may have migraines with and without auras at different times. When taking a history it is also important to ask about family history of migraines as migraine headaches seem to “run in families”. 

Children who develop migraines were also often noted to be “fussy” infants, and they also have an increased incidence of sleep disorders including night terrors and nightmares. Many parents and children also report a history of motion sickness. When children discuss their headaches they will often complain of feeling dizzy (but actually sounds more like being light headed than vertigo on further questioning). 

They may also complain of associated blurred vision, abdominal pain, nausea and vomiting, chills, sweating or even feeling feverish. A child with a migraine appears ill, uncomfortable and pale and will often have dark circles around their eyes. It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep as wells as stress. But stress for a child may be positive like being excited as well as typical negative stressors. 

Children will also tell you that their headaches are aggravated by physical activity (including going up and down stairs, carrying their backpack, or even just bending over). They also complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms. 

Children with migraines do not watch TV or play video games during their headaches. They are quiet, and may not want to eat, and may just want to rest.  Nothing active typically “sounds” like fun. To meet the diagnostic criteria for childhood migraine, a child needs to have at least 5 of these “attacks” and a headache log is helpful as these headaches may occur randomly and it is difficult to remember what the headache was like or how long it lasted, without keeping a log. 

There are many new drugs that are available for treating child hood migraines and we will discuss that in another daily dose.  Stay tuned! 

Daily Dose

Ear Infections

1:30 to read

Musings from the very busy pre-holiday pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button….surely it is coming…maybe Santa will bring it!

 

 

   

Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

 

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

Daily Dose

Kids Who Snore

1.30 to read

Does your child snore?  If so, have you discussed their snoring with your pediatrician.  A recent study published in Pediatrics supported the routine screening and tracking of snoring among preschoolers.  Pediatricians should routinely be inquiring about your child’s sleep habits, as well as any snoring that occurs on a regular basis, during your child’s routine visits.  

Snoring may be a sign of obstructive sleep apnea and/or sleep disordered breathing (SDB), and habitual snoring has been associated with both learning and behavioral problems in older children. But this study was the first to look at preschool children between the ages of 2-3 years.

The study looked at 249 children from birth until 3 years of age, and parents were asked report how often their child snored on a weekly basis at both 2 and 3 years of age.  Persistent snorers were defined as those children who snored more than 2x/week at both ages 2 and 3.  Persistent loud snoring occurred in 9% of the children who were studied.

The study then looked at behavior and as had been expected persistent snorers had significantly worse overall behavioral scores.  This was noted as hyperactivity, depression and attentional difficulties.  Motor development did not seem to be impacted by snoring.

So, intermittent snoring is  common in the 2 to 3 year old set and does not seem to be associated with any long term behavioral issues. It is quite common for a young child to snore during an upper respiratory illness as well .  But persistent snoring needs to be evaluated and may need to be treated with the removal of a child’s adenoids and tonsils.

If you are worried about snoring, talk to your doctor. More studies are being done on this subject as well, so stay tuned.

Daily Dose

Get Your Flu Shot!

1:30 to read

I just had my flu vaccine!  Guess what - my arm didn’t even hurt this year.  I have also been reminding all of the pregnant mothers that I see to get their flu vaccines as well.  The current recommendation is that pregnant women receive influenza vaccine as soon as possible beginning after their 28th week of pregnancy (3rd trimester). 

When a pregnant woman receives her flu vaccine she is not only protecting herself, but also her baby.  Infants cannot receive a flu vaccine until they are 6 months of age…and for babies born during the fall and winter season, that means they will not be vaccinated until the following year. But when a mother has received a flu vaccine the infant is also getting protection via antibody that the mother passes to her baby across the placenta. 

In a 2014 study, the authors reported that “immunization of pregnant women with trivalent inactivated influenza vaccine (IIV3) was safe, immunogenic, and partially protected the women with a vaccine efficacy of 50% and their infants with a vaccine efficacy of 49% against laboratory-confirmed influenza illness during a 6-month follow-up post delivery ”. In other words, the infants in the study had just as much protection as the mother.

In a more recent study the authors now looked at how long the immunity lasted in the infants born to the flu vaccinated mothers. Surprisingly, the immunity was not as long lived as had been thought. The infants involved in the study were born an average of 81 days after their mothers were vaccinated with flu vaccine, and were monitored for influenza infection for about 172 days after birth.

Infants born to mothers who had a longer interval between vaccination and delivery had higher antibody titers. The infants’ antibody levels did drop off after birth and by 8 weeks of age the babies did not have significant antibody. Ideally, In order for babies to have better protection a mother would be vaccinated even earlier in her pregnancy, and studies are being done to look at this possibility.

Infants are especially susceptible to influenza and have a higher rate of complications as well as hospitalizations.  While the current recommendations for vaccinating pregnant women may not confer as much immunity to the newborn as was previously thought , there is very high protection for the first 8 weeks after birth. Any protection is preferable to none!.

Get your flu vaccine and if you are pregnant ask your doctor to give it to you as soon as you are in your 28th week.  The longer the baby is getting placental antibody the better!!

 

 

 

 

 

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

Daily Dose

Monitor Your Busy Teen for Depression

1:30 to read

THis is hard fo rme to admit, but I am beginning to see a fair amount of adolescent kids (way too many!) who are feeling overwhelmed with school and all of the other things thing have going on in their lives.

For many of my patients the day begins before dawn as they head out the door (frequently without breakfast) to begin their very long day. Many have before school practice for drill team, band or even an off-season sport that involves an early workout. These teens then get finished with their early morning commitments just in time to shower and head to class. Still, no time to eat or even down a smoothie or granola bar, or so they say. Next comes a full day of classes, often with honors and AP classes (up to five in one semester) with a 30 minute break for lunch, if they choose to eat. For those that do eat, it is not a well-balanced lunch, but rather pizza, hamburgers, or a bagel and Gatorade. Remember this is the first food they have had since the previous night (when I am sure they went to bed far too late).

As the end of the school day approaches many of these teens will head to after-school jobs, or extracurricular activities such as yearbook staff, newspaper staff, debate team or a different athletic team than their morning workout. If they remember, they might eat a Power Bar, or grab a Red Bull or Starbucks to keep them going until they eventually head home. For many they will not get home from their school day until long after dark with a lot more still to do. Hopefully, these kids will manage to sit down for dinner (can we say well-balanced) with some family member (many may have already eaten earlier), but they jump right up after gobbling down their food, to head off to do homework.

For many high school students, especially those carrying a heavy pre-college load, there may be several hours of homework, which won’t be finished until 11 p.m. or later if they are lucky. Somewhere they will also fit in on-line computer time to catch up on FaceBook, or emails and texts, while doing a multitude of other things like watching their favorite TV show that has been recorded to fit their schedule. Many report that they have difficulty falling asleep. DUH – their brains are on overload and can’t stop, and then they only get about five to six hours of sleep a night. With all of that being said I can totally understand how stressed out our adolescents are. They want to succeed, they want to be involved, and they constantly worry about what lies ahead. There are actually seventh and eighth graders already talking about SAT prep, and college resumes as if they were already high school juniors. How is this happening? How can we stop this out of control pressure? I certainly don’t know how to solve all of the issues surrounding adolescent stress, but I do know that parents can play an active role in helping their teens manage their time.

While we don’t want to be overly involved or helicopter parents, parents do need to discuss the issues of stress and over commitment when they see their child struggling. Sometimes it is appropriate to step in and say, “I see you need some help with this” and work together on time management. The days will come all too soon when you are not there to help lead the way or ensure that your son or daughter eats breakfast and dinner, or gets enough sleep. For many teens just helping them see the “big picture” and re-adjusting their schedule a bit, will be all they need to feel a little less pressure. Sometimes, they just need to talk about it and will move on. But if your adolescent seems to be overwhelmed, and is getting more anxious or depressed, make sure to talk to their doctor about getting some professional help. There are many people ready to help our teens, we parents just have to recognize when it is needed.

That’s your daily dose, we’ll chat again tomorrow. What do you think?  I welcome your comments and thoughts below!

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DR SUE'S DAILY DOSE

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