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Daily Dose

Dealing With A Baby's First Cold

1:15 to read

With the "sick season" upon us, I'm starting to see more babies with cold symptoms and their concerned parents wondering "what can I do to help their precious bundle of joy?"

In pediatrics, we often say “children are not little adults” but in the case of the common cold, they really are. They have the same symptoms, runny nose, red-rimmed eyes, cough and they just FEEL YUCKY! With those symptoms most babies are fussier than usual and don’t sleep well at night, which is just like an adult with a cold (or maybe just me). One of the main differences is that an adult cannot wake up off and on all night and have someone really “care” that you can’t sleep because you are so congested, or your throat hurts. As much as your spouse loves you, the most common response is “just deal with it” and go back to sleep. Not so for an infant, they are usually up and down all night, don’t feed as well, and just want to be held a little more. We the parents are also up and down with the baby with a cold and so it goes as a parent. When an infant get’s a cold it is not uncommon for them to run a fever along with the cold symptoms. This usually only lasts a day or two and then resolves, but the other common cold symptoms may last from seven to 10 days.

The first several days of a cold usually begin with a runny or congested nose and a cough. With a cold they may not want to nurse or drink their bottle as well as they have a hard time breathing and sucking. These leads to a cranky baby, who may take less with each feeding, but will need to eat more often. It is important to make sure that they stay hydrated. Contrary to popular myth, drinking formula or breast milk does not make a cold worse, and fluids are the most important thing. If your baby is having difficulty taking the bottle or latching on due to the congestion, you may use the “bulb syringe” that is sent home with the baby after birth. Place the tip of the bulb syringe inside the baby’s nostril to remove mucous and help them breath and eat. You may also use a little salt water nose drops to squirt up their nose to help the mucous come out. It also helps to get a cool mist humidifier to place in the room at night to help put some moisture in the air while the heat is running and the air is dry. The cool mist will also help alleviate some of the thicker mucous and also help the cough that accompanies the cold.

The most important thing to watch for is any sign of respiratory distress. A child’s breathing may “sound noisy” but it is important once again to look at their chest to make sure that they are not using those muscles between the ribs and “pulling” when they are breathing. They may also have a congested cough and it can sound “junky” but they should still not be showing any signs of difficulty with breathing. Coughs are also protective in that they help move mucous and keep the airway clear to prevent pneumonia. Lastly, your child should look a little better after the first several days of their cold. They should not develop fever later in the cold, and if they do it would be worth a pediatrician visit to check their ears. Not every baby with a cold gets and ear infection and they usually develop after they have had several days of cold symptoms, and not on the first day of a cold.

The only way to diagnose an ear infection is for the doctor to visualize your child’s eardrum, even with email, and phones, you just can’t get a picture down the ear canal! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Toddlers: Tantrums, Time Out & Hoarding

Toddlers & tantrums go hand in hand. Here's how to make time out work for you!When I see my toddler patients, lots of words come to mind.  Busy, active, inquisitive, climbers, impulsive, biters, but never before did the word “hoarding” make me think of a toddler.

During an 18 month old well child visit the biggest discussion I have with parents is related to toddlers behaviors.  While a toddler may do the cutest thing one minute, the next minute they may be laying on the floor kicking and screaming and having a tantrum. Toddlers are truly like Dr. Jekyll and Mr. Hyde.  Parenting a toddler requires a great deal of energy, patience, and consistency.  While many people talk about “the terrible twos” I really think that one of the most difficult stages, as a parent, is from 15 months – 30 months. In other words a long time!! The reason I bring up hoarding stems from a remark from a parent during their child’s 18 month old check up. We had discussed so many topics related to their child and concerns that they had. We discussed how to ignore a tantrum and try to redirect the child after several minutes. We talked about how to begin time out.  I start using time out at around this age when a child has been overtly defiant (yes, it does happen to all of us).  In that case, when the behavior cannot be ignored, I use a small chair in the house and have a kitchen timer handy. I tell the child that they have “misbehaved by ----------------“ (fill in the blank) and that must sit in the time out chair for 1 minute. I typically recommend 1 minute per year of age.  If your toddler will not sit in the chair, then you go behind the chair and wrap your arms around the child (like a piece of human rope).  This way there is no eye contact, and you can restrain the child in the chair.  Of course, the child will be crying while this is going on as they are not happy about being held in a chair. Once the minute is over, go back around to the front of the chair, get down on your child’s level and explain again why they had to sit in time out. Over time (sometimes days, even months) your child will begin to understand that they sit in time our when they have misbehaved and they will learn to sit in the chair alone.  The concept of time out is useful throughout childhood, as you will see when you “send your teen to their room one day”, which is another variation on the same theme. So, at the end of this fairly lengthy visit the father says, “I have one more question Dr. Sue”. “Our toddler puts all of her stuffed animals in her crib. She plays with them and then just adds them to the crib so that by the end of the day the crib is covered with her stuffed animals and dolls.”  He paused for a minute and then said, “Is this a sign that she will be a hoarder?”   I thought I had heard it all but this was a new one!!  I started to laugh as I thought of those reality TV shows I had heard about with hoarders. I reassured the Dad that it is quite normal for a toddler to “hoard” all of their toys in one place. Their crib, or a favorite old cardboard box, or under the bed etc.  They like to “have control” over their toys, and this may be a way that their child “knows where her animals are”. I could not stop laughing the rest of the day as I thought about this. I just hope that the behavior modification discussions did not make him think he needed to “redirect” her toddler hoarding. This behavior sounds perfectly normal to me. I am still giggling about hoarding, very cute. That's your dialy dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

MRSA & Your Family

1.15 to read

I continue to see cases of community acquired methicillin resistant staph (caMRSA) in my practice. So, I just read an interesting article in this month’s Archives of Pediatrics about households contacts of children who had been diagnosed with caMRSA. 

It is well known that there outbreaks of caMRSA among members of a family, and this is thought to be due to close contact. It seems that some members of a household may not develop an infection, but may be asymptomatic carriers. 

Traditionally staph aureus colonization has been reported to occur most frequently in the nose. But this study looked at other areas of the body that might also be colonized with staph. 

Interestingly, 21% of household contacts of pediatric patients with a caMRSA infection were colonized with staph. In addition, parents of the patient were more likely to be staph carriers than other family members. It was also found that there was a high rate of staph carriage in the groin as well as beneath the arms. In the study nearly 1/4 of the study participants were colonized in the groin and not the nose.  

So.....the fact that household members might be have staph in other areas outside of the nose is clinically important.I often have all family members and household contacts use an antibiotic cream placed into the anterior portion of the nose to reduce staph carriage.  If indeed  there are other areas that are “guilty” of staph then those areas need to be targeted.  This might mean that dilute bleach baths are important for not only the child who has the staph infection but also for family members. 

Stay tuned for more, but after reading this article I think I may add another step for families who are dealing with caMRSA infections.  Get out the bleach!

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

Daily Dose

Early Talkers

1.15 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

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

Wear Sunscreen During Spring Break!

1.30 to read

Spring break season has begun and many families will be heading to the mountains for skiing or to the beach for some warmer weather.  Either destination requires sun protection, especially for the face. 

I have just returned from skiing with my best friend from medical school days, who is a dermatologist. Whenever we travel together I know that one of her big focuses will be if I am wearing sunscreen and enough of it!!  She was teaching (reprimanding) the teens and young adults on the trip as well, as they needed some sunscreen “re-education”. 

The sun was shining for our entire trip and we had lots of snow, so perfect conditions for great skiing but also for a sunburn. On top of the direct sun, the reflection of the sun off the snow (or the sand at the beach) just adds to the risk for sun damage to the face.   

The best way to protect your face (and this goes for other areas too) is to apply a GENEROUS amount of sunscreen to the face and neck at least 30 minutes before heading outside.  She advocates layering sunscreen as well. By that I mean put on a base of sunscreen and really rub it into the skin. 

If you are using a spray on sunscreen you need to rub it in as well.  I used an SPF of 60 for my face.  Then wait for 10-15 minutes and get those ski clothes on (that takes awhile).  After letting the sunscreen absorb I reapplied another GENEROUS (maybe an ounce) of sunscreen to my face and neck.  What my derm friend told me is that layering a 60 SPF plus a 60 SPF does not make the protection 120 SPF, but it does make it more likely that you are getting better sun protection than one layer alone. Make sure that you are also applying sunscreen to the lips followed by Chapstick or lip balm that also contains sunscreen. 

Now, throw a small tube of sunscreen and lip balm in your pocket so that you can re-apply later on, as you know that you should continue to re-apply if you are spending the day outside. There are also some good sunscreen sticks that are convenient with an SPF of 50 or more. These are great for a parent to use on children off and on during the day. I am a fan of the Neutrogena and Cerave products, as they are hypoallergenic as well. 

Enjoy the break....but be sun smart too. 

 

 

 

 

Daily Dose

Babies Rolling Around in Their Crib

Many babies roll around in their crib, but should parents worry they will spend too much time on their tummy and not be able to roll on their back?I received an email from the parents of a 3½ month old daughter who has recently learned how to roll from her back to her tummy.  Their “conundrum”, as they put it, was twofold.  They were concerned about her sleeping on her tummy, as well as the fact that she would get upset after she rolled from her back to tummy and would then “scream loudly” So,what to do?

Most babies learn to roll around 4 months of age and like everything else there is variability in this milestone.  Many babies learn to roll tummy to back first, typically while they are having tummy time. Suddenly you realize that the baby has used their arms to push up and then over onto their back.  Watching them do this is fun, as they will often look up with big startled eyes almost as saying, “Wow, this is like an amusement park ride!”, while other babies will let out a shriek and start to cry as they were scared by the whole event.  Remember we are all different and some of us (me) like roller coasters that go upside down and backwards and others (one of my children) would still rather give up a week’s allowance than get on a ride like that. There are also babies, like the one in question, who learn to roll from their back to tummy first.  This often occurs at night and causes a lot of concern, as all parents hear from the beginning, put your baby “back to sleep”.  But, even when sleep positioners were being used (they are no longer recommended), many an infant would figure out how to roll from their back to get all cozy and sleep on their tummy. Once your baby has achieved this milestone on their own, you cannot keep them from becoming a tummy sleeper. It is important that you still put the baby to bed on their back, but after that your baby will begin to find their own sleep position which many times is at the opposite end of the crib and may be on their tummy. Trying to be a vigilant parent who turns the baby back over is an exercise in futility as they have a mind of their own and will just flip over again, which is not as cute at 3 am. . You do not  need a video monitor or check on your baby every 10 minutes to see if they have rolled during the night.  As an infant has learned to roll it is also assumed that they will turn their head to clear their nose and mouth and the risk of SIDS decreases. Now, in the case of the baby in the email, she loved to flip from back to tummy, but then it would make her upset and she would scream.  Every time the parents went in there and turned her over and settled her again on her back, she would flip over to her tummy again, and the screaming would re-start.  In this case, I think you have to let your baby fuss (scream loudly) for a few minutes to see if they will either roll back over or fall to sleep again. It is so hard to hear your baby so upset, but she got herself in this mess (first of many) and so it is the beginning of figuring out how to handle it. She will either cry or roll, and you can flip a coin to see which comes first. After she has cried for 5 – 10 minutes I would go back in the room, try to soothe her while she is on her tummy (remember she rolled there) and then see if she will calm down and go back to sleep.  This is going to take patience and time and some sleep deprivation (which you had hoped was past I am sure), as she learns to self-console again after rolling over.  The good news is that she has achieved an important developmental milestone with rolling over. Lastly, once your baby is rolling remember never to leave them unattended on the bed, changing table, couch etc.  I call this 4–6 month old a “floor baby” as it is best to leave them on the floor on a blanket while you run to get a diaper or answer the phone etc.  Many a baby, including my own, has rolled right off that bed to the floor, usually without sustaining any injury but causing a lot of parental worry and guilt.  That experience must be like a free fall ride at Six Flags! That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Spider Bite or MRSA

Is it a spider bite or staph infection?While walking down the hallway in my office, I keep hearing more and more patients concerned about a “spider bite”.  Think about this: how many spiders could there be out there, especially in the winter and early spring months? Also, these “spider bites” occur on really weird places; a baby’s bottom, the inner thigh, or even on the palm of the hand.

The poor spiders are being maligned when in fact they have nothing to do with these random skin lesions at all. In most cases, a patient had never even seen the offending spider! In reality, all of those “spider bites” are often due to a community acquired MRSA (methicillin resistant Staph Areus) infection of the skin and soft tissue. The frequency of these infections continues and parents should be aware of the fact that an unusual “bite” that is becoming more tender, has surrounding redness (erythema), feels warm to the touch and may have the appearance of a large pimple or boil needs, to be examined. In some cases that I have seen, a parent has tried to open the lesion with a needle. DO NOT take needles, pins, finger nails or anything else to open the lesion!! I tell the older kids, “if your mom or dad comes at you with a needle run Toto run!!” Once a “spider bite” has been correctly diagnosed as a MRSA infection, it is appropriate to try and drain some of the purulent material for a culture. This is usually easily done in the pediatrician’s office. By obtaining some of the purulent discharge the correct diagnosis may be made, and an antibiotic that treats community acquired MRSA may be prescribed. For larger lesions it is appropriate to drain them, and this may be done under sterile conditions (no home needles). There are certain times a pediatric surgeon may need to actually drain these larger lesions. There have been numerous journal articles debating the pros and cons of drainage versus antibiotic use. In most cases in my office, we culture the drainage, and prescribe an oral antibiotic.  There are some articles that advocate drainage only without the use of antibiotics. There is not a definitive opinion on this and I would defer to your doctor to decide the appropriate individual treatment. So… if you think the spiders have invaded your home, think MRSA instead. That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Introducing New Foods To Your Child

When to introduce new foods to your child's diet.There are so many questions (including Megan's via our iPhone App) about “when” you can feed a child different foods.  More and more information is being published on this subject and the “older” recommendations around withholding certain foods from children have recently changed.  Actually, they have changed about 360 degrees!

Like so many things in medicine and life in general, “nothing stays the same”.  When I was beginning foods with my own young children we always started with them eating rice cereal and added vegetables, fruits and then meats.  The recommendations ( I don’t know if they were actually via the doctor or my friends) were to try a new food every 2 – 3 days.  We were not very “sophisticated” then either and there were only about 7 vegetables in the Gerber section and about the same number of fruits. I don’t think “organic” was even a word.

Over the years, as food allergies seemed to become more common,  there were newer guidelines which recommended restricting certain foods from a child’s diet.  In  theory it was thought that by delaying a child’s exposure to a food group,  they would have a more mature GI tract and immune system and therefore might not develop food allergies. There were even some doctors recommending that pregnant and breast feeding women avoid certain foods too.   At the time, this seemed very restrictive to me, and by now my own children were living on peanut butter and fish sticks (both newly forbidden foods).  I don’t think many of the children born in the late 90’s ever saw a jar of Skippy. In the past 2 years the theories regarding delayed introduction of foods have been “de-bunked” and we the pediatricians are returning to a more relaxed approach to feeding infants.  It seems that keeping children away from peanut butter and fish and eggs really did nothing to slow down the development of food allergies.  What it seemed to do was to make new parents quite uneasy about introducing new foods and many children were eating “less healthy” foods by avoiding some food groups. Currently, I recommend that parents begin feeding their infants solid foods at about 5 – 6 months of age. It seems logical to me to start cereal, as a baby is usually happy in the morning at breakfast time, and that is a good time to begin spoon feeding. In reality it does not have to be cereal. There is some data that we should start protein first (meat, hmmm….breakfast sausage for babies?). I then begin vegetables, simply because of taste, again with the thoughts that a baby will not eat carrots when given sweet pears first, but I really don’t think there is any study to substantiate that belief.  Then we just “plow” ahead with almost any food that can be pureed or mushed to spoon feed a baby.  So many mothers are making their own baby food, and that is really quite easy for certain foods.  There are now many more selections in the baby food aisle and babies are happily eating avocado, mango, beets, lentils and so on. There is not a “FORBIDDEN” food, except for CHOKING issues.  So, peanut butter, cashew butter and almond butter are great sources of protein.  So too are bits of flaky fish such as salmon and tilapia.  By the time a baby is 8 -9 months old they are ready to explore some mushy finger foods too, and this does not have to be limited to cheerios, goldfish and puffs.  Pieces of overripe fruits (any kind) cut into small bits are great.  So too are noodles and sauce (tomato is fine) as well as eggs. Unless you have another child with definite food allergies I would try everything.  The more foods your baby is exposed to the broader range of tastes and textures they will have tried.  Just remember to cut everything into tiny pieces and offer a little bit at a time.  The risk of choking seems to be greater than the risk of food allergies. That's your daily dose.  We'll chat again tomorrow.

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