Daily Dose

Potty Questions Keep Coming

Potty training always gets lots of questions and one of the most common is having a child who will "tinkle" in the potty but is not yet "pooping". When potty training all three of my boys, they all pooped later than they tinkled. I know some people disagree, but I certainly think I hear of more people who have to work a little harder and longer to get to pooping on the potty. It may be due to a toddler's fear of letting their poop go, or the difference in sensation with stooling or any number of issues that toddlers are working through as they are potty trained.

Whatever the reason for children who arenot wanting to poop, you have to continue to be patient and praise their success on the potty with urination. Continue to discuss poop within the family, and let your child see you going to the bathroom. Talk about how animals, birds, fish and people all poop and they don't do it in a diaper or underpants but in the potty. During all of this conversation (and while you are frustrated), make sure that your child is not holding stool and becoming uncomfortable, which only adds to anxiety and fear and further withholding poop. You might want to try putting your child on a prune juice cocktail, milk of magnesia, or Miralax to soften the stool and ensure that they are having a soft stool every couple of days. A toddler will often hold their stool until bedtime when they are in their diaper and will then poop or may ask for a diaper to poop during the day. This is not uncommon and usually does not last terribly long. If they want to poop in their diaper I would have them sit on the potty with a diaper and poop and then put them back in their training pants. I also praise and rewardthem for sitting on the potty to poop, even if it is in a diaper, and use a sticker chart or M&Ms or both. Hopefully, over time they will realize that sitting on the potty to poop is perfectly normal and will give up the diaper. You can even cut a hole in the diaper to let the stool come out into the potty so that they may see that it is not painful, scary or difficult. Always remember to praise and not punish and to be patient and consistent with your messages about poop. Rewards seem to go a long way, and albeit small, they often work wonders. It may take several months of persistence to conquer the poop issue, so remain calm. If they continue to have problems have a further conversation with your doctor about the possibility of stool holding and encopresis. That's your daily dose, we'll chat again soon.

Daily Dose

Travel Healthy During The Holidays

Should you travel this holiday season if your child is sick?With all of the viruses and illnesses popping up, I am getting a lot of questions about travel plans. Many parents are asking "should I travel with a sick child?"

In my opinion, we all must continue our lives, even in the face of flu viruses, and a trip for a toddler to see his/her grandparents is important for everyone. We should all make our plans for trips to the visit family. While traveling, everyone needs to practice good hand washing and cough hygiene and be prepared to change plans if a family member is ill. Traveling while being acutely ill and running a fever is only exposing everyone else to you or your child’s illness and seems somewhat selfish. None of us should be traveling within 24 hours of having a fever (that means without the benefit of fever reducing medications), and isolating a child or parent for several days will be better for everyone, than traveling while sick. Think of the greater good! With that being said, I am not a proponent of a newborn under the age of 2 months traveling, unless out of necessity.  I have always been fairly conservative about exposing a baby to crowds and closed in spaces (malls, movies, restaurants) and airplanes certainly fit that description.  With the uncertainty of this year’s flu season it seems like a really good year to stay put. A newborn’s immune system is still fragile, and the more often a newborn is exposed to large groups of people,  the better chance they have of getting sick in the first 6 – 12 weeks of life. This must have been what was called “confinement” in the olden days. Staying home and enjoying the simplicity of life, with the excuse, “I have a newborn baby” gets you out of so many invitations and situations.  This is probably the only time that you can get away with that line, as after several months the realities of work, family commitments, and day to day living return and often that means with baby in tow. We all do what we have to do, but if you don’t have to take your newborn baby on a flight this holiday season, I would not. I also know that not everyone will abide by the “Do Not Travel While Sick” mantra, and exposure to illness is not uncommon during airline travel. There is not a way to sit 3 – 6 feet from another person on a plane! This is probably the time to have family come to you, and to make sure that they have all had their seasonal flu vaccines, and when available, the swine flu vaccine. I don’t have a crystal ball to see how this winter season is going to unfold, but I do know that a sick infant has a better chance of ending up in the hospital if they develop a flu like illness.  The holidays will be a happier for all, if infants stay close to home and leave the travel to those with older children. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Dealing With Runny Noses

With the combination of back to school germs and fall allergies, every child I see seems to have some sort of nose or throat symptom.

Cooler weather is here and with fall it seems runny noses begin to abound. With the combination of back to school germs and fall allergies, every child I see seems to have some sort of nose or throat symptom. Unfortunately there isn’t much to do for those first fall colds except to push fluids, encourage a good nights rest and lots of Kleenex.

Fortunately, fall viral respiratory infections don’t seem to be as miserable or last as long as the ones that are lurking around the corner for the winter. But, allergies are treatable and there are more and more over the counter medications available. Children under 2 typically don’t have a runny nose caused by allergies, but older kids may. It may be worth trying a product like Claritin or Zyrtec for several days to see if the itchy eyes, runny nose and intermittent sore throat improve. Benadryl is still an excellent antihistamine to use, although it may cause drowsiness, so try taking at bedtime. Nasal irrigation is also a good idea and there are many products available or make your own salt water solution at home (be thrifty). Lastly, although you can’t prevent the common cold, it is already time to be thinking about flu shots, so get yours scheduled. That’s your daily dose. We’ll chat tomorrow!

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Daily Dose

Life Lessons

1.30 to read

I recently spoke to a group of mothers with sons who were in high school. I was discussing “boys to men....the high school years”.   As I was writing my remarks I was thinking about the many lessons I learned while parenting my sons through their high school years.  Funny how it sometimes seems like long ago, and at other times it seems as if it was just yesterday. 

I think one of the biggest lessons I learned while raising teens is something that my mother and father both told me.  There were so many occasions when I begged my parents for “something”. I can remember telling them, “it’s not fair, eryone else has a phone in their room!”  But, being the good parents that they were, they explained all of the reasons that I didn’t need to have my own phone.  I thought that my parents could afford to put a phone in my room, but they said that wasn’t the point.  Their reply was often “just because we can doesn’t mean we should”. 

That statement has probably been made by parents for hundreds of years. But I must say, it is often hard for some parents to follow this adage. We all want to give our children as much as we can, but sometimes by not giving, we are all being better parents. 

Just because you can give your toddler an iPad doesn’t mean that you should. Just because you can give your elementary school child and I-phone doesn’t mean you should.  The same for giving your child a TV in their room, or a car for turning 16.  I really admire the parents who can truly give their child “most anything”, but know that their children need to learn to wait.  

So, I spoke to the parents group about trying to follow my own parents statement when raising my sons. They would probably tell you that we were sometimes “mean and strict” and that they would get upset when we would say “just because we can doesn’t mean we should”.   I think it worked well for our family.....waiting is a hard but necessary lesson. It often makes you more appreciative as well.  

Daily Dose

Teaching Kids How To Swallow A Pill

1.15 to read

I received a question via our iPhone App from 16 year old Steffi. She writes: “I take 4 pills a day and can not swallow them! When I try, my tongue pushed the pill to the roof of my mouth. HELP!”

 

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies!

 

So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

 

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned.

 

I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home).

 

We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down.

 

When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing).

 

For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!).

 

Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow!

 

I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger.

 

Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"!

 

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

Daily Dose

Fever & Your New Baby

Summer is here and many families are heading on vacation. I often get asked "can you trvael with a baby?"I have recently seen many babies coming in to the office for their first post hospital newborn check. The lovely thing about summer is that the office is not quite as busy as there just aren’t as many sick children.

Despite the decrease in sickness throughout the country during the summer, I still explain to new parents that it is important to try and limit their newborn’s exposure to illness. This is best accomplished by avoiding crowds.  This is especially important for the first 6–8 weeks of a baby’s life. We pediatricians get especially concerned if a newborn develops a fever during these first weeks. One of the first precepts of pediatrics is,” an infant under 8 weeks of age with a fever, is admitted to the hospital for a presumed bacterial infection until proven otherwise”.  This means a spinal tap, urine culture, and blood culture are performed and IV antibiotics are routinely started. In most cases the fever is secondary to a viral infection, but until all tests are negative, the baby spends 2-3 days in the hospital. Traumatic for everyone. But with the summer months here, many families are planning on travelling to the beach or mountains, or to go visit the grandparents etc. The travel issue came up as I had a patient that just had her 3rd baby (via C-section no less), and she came in with her precious newborn. While I was examining the baby, the mother casually mentioned that she was planning on going to Washington, DC in the next few weeks (baby would be about 3 ½ weeks old), for a family trip and sightseeing.  Her husband wanted the older children to see DC and they then planned to drive up to the battlefields in PA. UGH! I grew up in DC and there really is not a better place to take children for a combination of fun and learning.  But, the thought of travelling with a newborn, standing in lines to get through security at the airport (another post), and flying for over 3 hours only to stand in more lines to enjoy the sights of Washington with the older children, made me cringe.  Not just for the huge undertaking of travel, but because of this newborn’s possible exposure to infection.  Think of all of the germs that this newborn might come in contact with!! Now, you know I am not a “germaphobe” but I am wary of a newborn being exposed to this many people. Every time you stand next to someone who coughs or sneezes, they may unknowingly pass a virus on to you.  Many of the viral infections we so often discuss are airborne and enter our own eyes or noses via aerosolized droplets. Mother’s and father’s hands also touch many surfaces, and even with hand sanitizers there is no way to be sure that those travelling hands have not come into contact with germs that then may be spread to the newborn. No one wants to get a tiny baby sick, but there are a gazillion people out at airport check in counters, or in security lines, or sitting next to you on a plane that may be ill.  You don’t get to pick who you are with. Same thing goes for standing in a museum or shopping mall or hotel lobby.  So, that precious newborn may develop a fever from all of this exposure and they will end up in the hospital, wherever you are. So, if possible (I realize there are emergencies) stick close to home and plan that trip with your baby after they are 8 weeks of age. It will make it much easier on parent, infant and the pediatrician who hates to have to hospitalize a newborn. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Monitor Your Busy Teen for Depression

Now that we are into the second half of the school year, 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 e-mails 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!

Daily Dose

Using Foul Language Around Children

Watch your language around your children. They hang on to every word you say especially when using foul language.I really don’t watch much TV, but I am a big fan of the show Brothers and Sisters. I often tape and watch when I have a few free moments.  So, I was trying to catch up today and watch an episode from several weeks ago.

In one scene Kitty (Calista Flockhart) is holding her 3 year old son in her lap while she is on the computer trying to buy a purse during an online auction. When Kitty doesn’t succeed in getting the winning bid she blurts out  “Damn, Damn, Damn” right in front of her son!!!  Never even flinches or says Oops or anything. Now, I am not a television censor, but I mean REALLY??  Although the language that is on television is often disturbing to me, I realize that “we” can turn off the television and choose what to watch. I also think that is really important for parents to continue to monitor the television programs that their children watch, which includes the language that is used on the program. But in this case on Brothers and Sisters,  (I am not picking on that show I promise), not only did I think that the language was inappropriate, it was amazing that they would “show” a parent swearing in front of their child. Talk about bad parental modeling!  A 3 year old child is listening to every word that their parent says, and at that age they don’t know the difference between the word darn or damn. What they do know is that Mommy used that word so it must be okay. This was a good reminder that children are always listening to the language that we use. You can “get away with” using “bad” language when a child is an infant (not preferable), but as a child enters their second year of life, so after their first birthday, they are beginning to mimic language.  When a child hears any word they may repeat it, whether that word is appropriate or not. Many a parent has come into my office and asked “why is my child saying _________”. If their child is saying that forbidden word, it means that they have heard that word somewhere.  Maybe not from you, but from another caregiver, an older child, or yes, even on the television. It is especially important to keep language appropriate in the earliest years in order that a child will understand the difference between good words and bad words.  As a child is older and they are exposed to more situations and even more inappropriate language they have an understanding of words and what they should not be repeating. A little one does not get that. While I still love Brothers and Sisters, I think that a show about families,  would be prudent to forgo the bad language, especially while a mother is holding a child in her lap.  Even if I can’t get the writers to change, it is a good reminder to all of us that our children are listening! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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.  

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