Daily Dose

Traveling With an Infant

A common concern among new parents traveling is "what do we need to take for the your-baby in case they get sick?"Today really marks the last few days of frenzy in my office before the Christmas holiday. School has been out for several days and now begins the familiar pilgrimage of family travel to be together for the holidays. Packing up the kids, pets, gifts etc can be daunting, but a common concern among new parents is "what do we need to take for the your-baby in case they get sick." The combination of air travel and the germs one is exposed to while sitting with 200 of your closest friends, combined with family gatherings with children of all ages, definitely promises to promote colds. But, that being said, unless you have a newborn, the holidays are about family and traditions, so a cold is worth it!

When taking a your-baby their first trip you should be prepared. That was not the case when we flew with our son to L.A. for his first Christmas. What did I know, I was a new doctor and mother and inexperienced in both. Of course we packed gifts (very important for a six-month-old), special toys, clothes for all types of weather etc. What I did not prepare for was illness. So at 2:00 a.m. on day three of the visit (airplane germs have incubated) the your-baby awakens crying and hot. That would be my assessment, as I have brought nothing to take a temp or treat a fever for that matter. Off we go to the 24-hour 7/11 store to buy a thermometer, Tylenol and Pedialyte. Over the course of the next three days he continues to run a fever so we end up in a random E.R. in order that he may be examined by a "real doctor" or at least one that is more prepared than I was. Of course, after sitting for hours and numerous tests he is pronounced to have a VIRUS and we are sent home with more Tylenol. He then develops a viral rash just in time for returning home. It was an epiphany as a mother and doctor. Be prepared! When packing for that first trip, I would recommend taking fewer clothes (your-baby clothes are easy to wash) and scale down with toys, but DO PACK: a thermometer, Tylenol and ibuprofen drops with appropriate dosing charts, a bulb syringe for nasal suction and saline nose drops. A good gift for grandparents to own is a cool mist humidifier if there are numerous young grandchildren visiting each year. Families, holidays and unfortunately viral infections often come together, but they are usually short lived and an inconvenience. Having your few medical items at hand makes it even easier to deal with, and I am now a believer in the adage, "if I take it I won't need it". That's your daily dose, we'll chat again tomorrow.

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Daily Dose

Time for Report Cards

It seems that it is report card time and many parents are looking at their children's grades.It seems that it is report card time and middle of the semester so many parents are looking at their children's grades. Hopefully, there were no surprises at your house and your child is doing well in all areas, which includes academics as well as socialization and peer relationships in the younger grades. But, if you were not thrilled with your child's report card it may be time to sit down with both your child and their teacher for a conference.

The most important thing is to determine if your child is trying their hardest and working to their capabilities. If not, that area can be addressed with some goal setting and maybe a little more supervision of homework and what your child is doing with their "extra time". On the other hand, it may be that your child is working as hard as they can but not achieving the results that you would expect. In that case it may be worth discussing if there might be any learning disabilities that need to be addressed. Most of these learning differences show up in elementary school, but occasionally they are missed and will still need to be addressed in the upper grades. Discuss your child's learning style with their teacher and see if educational testing might be warranted to evaluate their learning. This may be done within in the school district or through private educational diagnosticians. Looking at your child's report card from the aspect of how they may improve and how you their parent might help them figure it out may be the path to future success. That's your daily dose, we'll chat tomorrow.

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Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Bright Light & Sneezing

1:30 to read

What is the connection between bright light and sneezing? DId you know it was hereditary?I have always noticed that I frequently sneeze when I walk outside, and this was especially noticeable this summer with all of the bright sunny HOT days that we experienced. I thought I had remembered that my mother often did this too and when I asked her she confirmed this.

I was recently reminded of this again when I was with my youngest son moving him back to school. It seemed that every time we walked outside to get another load of boxes he sneezed! We both sounded like “Sneezy” one of the Seven Dwarfs.

Of course my son announced, “Mom are you just realizing this? I have always sneezed just like Ohma and you do”. Oh well, I am finally catching on.

This of course piqued my curiosity and then I remembered that I had read something about “the photic sneeze reflex”.  It has also been name ACHOO: Autosomal Cholinergic Helio-Opthalmic Outburst (and you thought ACHOO was the sound you made!)

It is estimated that this reflex affects about 1 in 4 people. It is inherited in the autosomal dominant manner (remember your days in biology and big B and little b?) If you have the “sneezy gene” your child has a 50-50 chance of also having it.

This reflex has been known for a long time but there wasn’t much science as to the cause. But a recent study (very small only 20 people) compared photic sneezers to controls and found that when shown a shifting pattern of images, the visual cortex of the sneezers showed higher activity than those of the control subjects.

There needs to be much more research done on this topic with larger groups of people studied to further confirm this finding.  But, nevertheless, it is interesting that scientists are now trying to elucidate the mystery of the photic sneeze.

In the meantime I realized that another one of my son’s also has the gene. Funny how you suddenly recognize a familial pattern to sneezing only to find out it is in the genes. It also reminds me I have a blue eyed and 2 brown eyed children, back to those genes again.  Just like they taught me in medical school, take a good family history!

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

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

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

Feeding Baby Solid Foods

1.15 to read

I still get a lot of questions about starting solid foods in a baby.  The recommendation from the American Academy of Pediatrics is somewhat confusing as the latest recommendation is that mother’s should exclusively breast feed for the first 6 months of life...which means you do not start solid foods until 6 months.  But, the recommendation for formula fed infants is to begin introduction of solid foods between 4-6 months of age.

I recommend that parents routinely wait until their baby (whether breast or bottle fed) is about 5 1/2 months old to begin solid foods.. For a first baby, parents are really anxious to start cereal as they think it will, “make them sleep all night”, or want to try out all of those spoons people gave them as gifts. Those cute grand parents perpetuate the idea that cereal=sleep. Again, a myth, the majority of children are sleeping by 4 months of age whether breast or bottle fed, and no cereal.  Cereal is less calorie dense than milk! If we all drank breast milk or formula all day long we would definitely have weight problems, but for the first 4-6 months of life milk is all the baby needs.  

Whether you start your baby on solid foods at 4 or 6 months, it is important that you do give your child infant cereal. Whether you want to use rice cereal, oatmeal or mixed grains, baby cereal is iron and zinc fortified. The amount of iron and zinc in fruits, vegetables and even baby food meats is actually very low.  Baby cereals also provide vitamin B and other vitamins that are important for a baby’s nutrition. 

So, for parents who want to make their own baby food fruits, vegies and meats I am all for that. Did you know that there is more iron in pureed cooked meats than in infant prepared jar meats? But not all parents cook and some are uncomfortable in pureeing food at home. 

 At the same time, I encourage families to continue baby cereals for as long as they can.  For first children that may be until they are even 15-18 months of age. They don’t “know” that there are other cereals out there.   Mixing in some fruit will make that baby cereal just taste great as well as increase the absorption of iron.  Those toddlers will learn that we have Cheerios and Corn Flakes, and if it is your 2nd, 3 rd or even 4th child, they know about Cocoa Puffs and Fruit Loops by the age of one and are reaching for their siblings Captain Crunch. 

Birth order does play a role in foods introduction!

Daily Dose

Anti-Vaccine Movement

1.30 to read

It seems that the “anti-vaccine” movement is still alive and well and has been a hot topic on Twitter and Facebook again. Unfortunately, much of what I have read on these sites seems to be inaccurate and based on a lot of emotion and very little science.  But, emotional posts can be quite persuasive, especially to a new parent who wants to do EVERYTHING for their new child.  I would think that would include protecting them from deadly diseases that have NOT been totally eradicated.

One of the first things you learn during your early medical school days is the mantra that doctors should “first do no harm”.  I have continued my daily pediatric practice with that in mind.....so how could I not vaccinate my precious patients?  Vaccines have been well studied ( and continue to be studied) and absolutely DO protect children (and adults) from numerous diseases....including polio, bacterial meningitis, whooping cough and measles.  Vaccines are also safe.....how many different studies does it take to assure parents of this? 

Choosing to not vaccinate your child unfortunately can “cause harm”.  Do parents not realize that we are all exposed to diseases unknowingly?   I know that there isn’t a parent out there that would purposely expose their child to a disease....especially one that could cause death. But with that being said, the bacteria ( h. flu and pneumococcus) that cause meningitis are often harbored in a person’s nose and are just a sneeze away from an unprotected baby.  When I used to do spinal taps on a regular basis on very ill children, some of whom indeed had bacterial meningitis, every parent would ask, “how did my child get this?”  The answer at that time was, “we don’t know where they were exposed”.  Not a very good answer to give parent’s of a critically ill child, some of whom would die. 

Since the vaccines against meningitis have been released I have not seen a case of H.flu or Pneumococcal meningitis in my practice. I can’t remember the last time I did a spinal tap.  Those are memories I don’t need to experience again.  My office was also involved in the studies for the HIB meningitis vaccine and I saw first hand how labor intensive and difficult vaccine studies are. There were a lot of parents at that time that allowed us to stick their infants for blood samples on (many times, on a regular basis) to prove that the vaccine provided antibody and protection for their baby.  Thank you to all of those parents!

So.... I continue to be alarmed that there are parents (often clustered in certain areas) that want to deny their child vaccines.  I wonder what their baby would say, if they had the chance to choose to get vaccinated. Unfortunately, they don’t.

Daily Dose

Is It A Viral Sore Throat Or Strep Throat?

1.30 to read

It only takes the winter season to usher in an array of illnesses in the pediatrician's office. As you know, we are smack in the middle of flu season, with cases and deaths being reported daily. To review (again), flu like symptoms for all influenza strains are typically similar with fever, sore throat, cough, congestion, headaches and body aches. Occasionally there may be some nausea or vomiting but that is not seen as often. Flu like symptoms seem to begin with general malaise and then develop over the next 12–24 hours and you just feel miserable. Some of the confusion now is about sore throats and the difference between a sore throat with the flu, which is due to a viral infection, and strep throat, which is a bacterial infection. As for most things in life, nothing is 100 percent and the same goes for viral and bacterial sore throats. But, with that being said, there are certain things that might make a parent think more about a viral sore throat than strep throat and vice versa. Viral sore throats, which we are seeing a ton of with the flu right now, are typically associated with other viral symptoms which include cough, and upper respiratory symptoms like congestion or runny nose. A viral sore throat may or may not be accompanied by a fever. In the case of flu, there is usually a fever over 100 degrees. With a viral sore throat you often do not see swollen lymph nodes in the neck (feel along the jaw line) and it doesn’t hurt to palpate the neck. If you can get your child to open their mouth and say “AHHH” you can see the back of their throat and their tonsils, and despite your child having pain, the tonsils do not really look red, inflamed or “pussy”. Even though it hurts every time you swallow, to look at the throat really is not very impressive. Strep throat on the other hand, typically occurs in winter and spring (that is when we see widespread strep), but there are always some strep throats lurking in the community, so it is not unusual to hear that “so and so” has strep, but you don’t hear a lot of that right now. Over the next 2 months, there will be a lot more strep throat. Strep throat most often affects the school-aged child from five to 15 years. Children get a sudden sore throat, usually have fever, and do not typically have other upper respiratory symptoms (cough, congestion). This is another opportunity to feel your child’s neck and see if their lymph nodes are swollen, as strep usually gives you large tender nodes along the jaw line. When you look at the throats of kids with strep they usually have big, red, beefy tonsils (looks like raw meat) and may have red dots (called petechia) on the roof of the mouth. The throat just looks “angry”. Sometimes a child will complain of headache and abdominal pain with strep throat. Some children vomit with strep throat. The only way to confirm strep throat, again, a bacterial infection, is to do a swab of the back of the throat to detect the presence of the bacteria. There are both rapid strep tests and overnight cultures for strep. Most doctors use the rapid strep test in their offices. If your child is found to have strep throat they will be treated with an antibiotic that they will take for 10 days. Again, antibiotics are not useful for a viral sore throat and that is why strep tests are performed. I’m sure we’ll talk more about sore throats, but in the meantime, get those flashlights out and start asking your kids to say "ahhh". That's your daily dose for today. We'll chat again tomorrow.

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