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Daily Dose

Babies & Bow-Legs

1.15 to read

Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

TV Show "The Slap"

1:30 to watch

I was intrigued by one of the new “winter replacement shows” on TV, entitled “The Slap”. After watching numerous ads promoting the show, my interest was piqued and I did a bit of research on the background of the show.  Seems that this was a book that was the made into a series in Australia, and now is a new TV drama for the states. (It does have a lot of good actors).

 

If you have not heard/seen anything about the show it is based on the premise that a child is misbehaving (really awfully I might add) while at a party with several families and their children. When this child gets totally out of line and his parents seem to either be unaware of his behavior or ignore the behavior, another parent (also a Dad) slaps the child.  And so it goes....the real question, “is it ever appropriate to physically discipline someone else’s child?”.

So, resounding answer is NO!  But at the same time this has illicit a great deal of discussion about parenting.  While there is no “right way” to parent, most of the parents I asked agreed that they have been in the position when they felt that a friend’s child was behaving inappropriately, and the parents of said child did not seem to react or discipline their child.  What do you do then?

Some say that while the child “deserved a good spanking” by their own parent, they would never physically touch another person’s child. But, sometimes you do find your self either telling the child’s parent to do something, or at least reprimanding the ill behaved child. It is always a slippery slope.

While it seems more and more parents are taking the “I choose to ignore the behavior” approach, or tell me, “I don’t want to use the word NO with my child”, children do need to be disciplined.  Everyone who has been a parent for at least a year should understand this. Children are like “cavemen”, they do not come out of the womb and understand social mores and behavior. We are all innately ego centric, self centered and want our own way....but parents are there to teach children that the world does not revolve around them. We are all in this society together.  That is what parenting is about...while there is not one way to get there, discipline is a must.  

Limits, boundaries, redirection and a clear cut “NO” teaches children how to behave....whether from a parent, a teacher or a family friend. A “slap”....never in my book.

Daily Dose

Travel Healthy During The Holidays

1:30 to read

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 fear, 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

What Causes Circles Under a Baby's Eyes?

I received an email from a patient who had just weaned her your-baby from breast milk to formula. She was concerned because the your-baby sometimes looked as if she had circles under her eyes.I recently received an email from a patient who had just weaned her your-baby from breast milk to formula. She has a beautiful eight-month-old daughter and she was concerned because she thought the your-baby sometimes looked as if she had circles under her eyes. She felt like the your-baby was getting plenty of sleep, did not seem sick or tired but was concerned about the circles. She thought it might be allergies from changing from breast milk to formula. She was also concerned that she might have seasonal allergies.

In looking at her your-baby I really did not notice the circles, as you know mothers are the most critical about their own children. (Sorry Mom, I think my own Mother talks about my circles too!) At any rate, infants do not manifest symptoms of milk allergy with circles beneath their eyes. They have diarrhea, or vomiting or blood in their stools or failure to thrive. I do not think that the change in milk was the cause of the discoloration she described. Infants also do not develop seasonal airborne allergies until they are over the age of two or three and then they may present with the classic "allergic shiners" beneath their eyes, and the crease of the allergic salute across their nose, clear runny nose and often itchy eyes. I think this precious your-baby just had familial thin skin beneath her eyes with superficial veins that led to the appearance of circles. They were not always visible, and it would also depend on the position the your-baby slept in etc ...as to how much you might notice them. Will have to see if they bother her as she gets older, as there is always concealer and I use a lot of it when around my own Mom. That's your daily dose, we'll chat again tomorrow.

Daily Dose

The Right Way to Take A Temperature

1:15 to read

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

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

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

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

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

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

Daily Dose

Allergy Suffering Continues

Allergy suffering continues with itchy eyes, nasal congestion and sneezing. Dr. Sue explains how to treat season allergies.With pollen blowing across the country and “the worst spring allergy season in 10 years” in the headlines I thought I would follow up with a second blog on treating seasonal allergic rhinitis (SAR).

As discussed previously I typically begin seeing seasonal allergic symptoms of runny nose, sneezing, itchy eyes and cough in children after the age of 2, and more typically around 4 years of age.  Prior to that most physicians think that recurrent viral respiratory infections account for many similar symptoms in the toddler age group. Parents who are convinced that their 8 month old baby has allergies this spring are most likely facing their child’s first “cold” as allergic symptoms to pollens are brought on after repeated exposure, so we therefore see the symptoms later on.  Allergies do seem to be hereditary so a child who has two allergic parents has between a 50-80 % chance of developing those seasonal allergies. Seasonal allergies at this time of year are typically due to pollen from trees, and will then be followed by grass and weed allergies. By far the best way to prevent the misery associated with SAR is to begin a nasal steroid spray early in the spring in order to help prevent the histamine release that occurs when  microscopic pollen particles enter the nasal passages.  For children with known allergies I typically begin nasal steroids in mid March. The histamine release in the body following exposure to the offending pollens will cause all of the seasonal allergic rhinitis (SAR) symptoms.  On top of using a nasal steroid children who have classic allergic shiners (darkened areas beneath their lower eyelid), clear watery nasal discharge with frequent sniffing and/or blowing or throat clearing, cough and sneezing may benefit from taking a daily anti-histamine. (in other words to fight the histamine release that has already occurred).  There are both 1st and 2nd generation anti-histamines. The 1st generation antihistamines are the older drugs that often cause sedation or drowsiness but are still excellent antihistamines.  Examples of these are Benadryl (see recall info for this product), Tavist, Dimetapp, and Triaminic products that are all available over the counter.  I use Benadryl (see recall info for this product) most frequently as there are so many different choices as to dosing methods. Many allergists also feel that if one class of anti-histamine does not work to try another, so many people have their own favorite medication. The newer 2nd generation antihistamines such as Claritin, and Zyrtec (se recall info for this product) are now available OTC also and come in both liquid and chewable preparations.  There are also prescription products in this group such as Allegra, and Clarinex and Xyzal.  These antihistamines are labeled non-sedating and are usually given once a day.  Again, one child may prefer one brand over another and some do not have a chewable or liquid option so are used in older children and adolescents. There are also other drugs that are used to combat allergy symptoms and these drugs may be used in combination with antihistamines and nasal steroid sprays.  Decongestants help constrict blood vessels and shrink the nasal mucous membranes and may improve nasal congestion.  The most common medications are Sudafed which is pseudoephedrine (now found behind the medicine counter) and Sudafed-PE which contains the decongestant phenylephrine.  These decongestants may also be found in nasal sprays to use topically, but if used locally within the nose may cause actual rebound symptoms of more congestion so are not recommended for use as a nasal spray for more than 3-7 days. Therefore it is preferred to use systemically to avoid that problem.  Decongestants may also cause hyperactivity and insomnia so I rarely recommend them for use in the evening in children. Singulair which is a leukotriene inhibitor (anti –inflammatory) may help relieve nasal allergic symptoms as well as the allergic cough, especially in children who have frequent night time coughs during allergy season. It comes as both granules, chewables and pills and may be given to children down to 2 years of age, especially those that have asthma as well as nasal allergies. Lastly, there are antihistamine nasal sprays now available but they have the problem of “really tasting badly” and I find most children will not use them. There are also several good eye drops for those that get seasonal allergic conjunctivitis (SAC) several of which, Zaditor and Patanol are now available OTC and older children find them quite helpful. Despite this huge armamentarium of products, no one (or two or three) will totally prevent symptoms. So make sure that your child bathes or showers after playing outside, including washing their hair, to get the pollen off of their skin and hair.  It is also helpful to wipe off the dog or outside cat with a dryer sheet to get some of the pollen off of the pets. While I love to sleep with the windows open and ceiling fans going, if your children suffer from SAR you are better off keeping windows closed and the AC on. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Feeling Thankful

1:00 to read

What better week to think about how many blessings I have. One of the blessings is the many families I am privileged to take care of.  While the world seems to be struggling with so much violence in the recent weeks, the pediatric office is still a haven of “normalcy” as I watch families raise their children. 

I continue to believe that parents strive to raise healthy, educated and well adjusted children and have many hopes for their future.  At the same time, worrying about the future can cause a lot of anxiety. While I often talk about raising resilient, grateful, humble, appreciative, and thoughtful children, if there was a recipe for doing this we would all certainly follow it. But the longer I practice the more I realize that there is not one path to raising a child.  What works for one child in the family doesn’t always work for the other.  Different situations in life may also call for re-evaluating and “re-setting” family values or parenting practices….parenting is never stagnant, it is fluid and every changing.

 But with that being said,  maybe the whole idea of parenting is really to be mindful. Mindfulness is something I too am really trying to work on. The idea of living in the moment and paying attention to the present.   That means enjoying where you are and what you are doing and not being distracted by the the next task, event or dilemma which clutters the mind and the moment.  Maybe that is the virtue we should be trying to teach our children, which means we need to practice mindfulness ourselves.

So for this Thanksgiving I am going to practice mindfulness and enjoy family and friends being together for a day to count our blessings, whatever they are. I am not going to worry about the next event, or holiday or work commitment ….I am going to be mindful and practice taking a big breath and re-centering myself to the present and the day of Thanksgiving for which I am grateful. 

Daily Dose

Vomiting And Diarrhea

What can you do if your child is vomiting and had diarrhea?I received an iPhone App email, this one from Holly.  She writes “my son is on his 5th day of diarrhea. What can I do? Is this going around? Will my other kids get this? HELP!!!"

While most of the country is not currently experiencing flu (yet), we are seeing a large number of cases of vomiting and diarrhea.  Many people call this the “stomach flu” but in reality it is not related to influenza at all.  The medical term for the illness is gastroenteritis, and this illness is typically caused by a viral infection.  The problem with these viruses is just like colds, there are a lot of viruses that can cause vomiting and or diarrhea.  In other words, you may see your child get several of these viruses in a season, and often, because they are contagious, you the parent develop the dreaded illness too!   I have written about vomiting in an earlier blog, so we are going to cover diarrhea today. Rotavirus was previously one of the most prevalent fall and winter viral illnesses that caused vomiting and diarrhea in young children.  A vaccine against rotavirus was introduced more than 3 years ago,  and since that time there has been a greater than 50% reduction in childhood hospitalizations for dehydration secondary to rotavirus. This also means that fewer parents may be getting rotavirus from their children.  But other viruses like norovirus, adenovirus, or enteroviral infections can also lead to vomiting and diarrhea and dehydration. If your child has loose, frequent, watery stools (which often follows vomiting) the key is to make sure that you are giving them enough fluid to maintain hydration.   It is much easier to do this once the vomiting has stopped. (think about putting as much in as comes out the bottom).  Parents often want to “show me” the diarrheal stool, but honestly, unless there is blood in the stool,” diarrhea is diarrhea” and bringing in stool is usually not necessary. The best way to maintain hydration is by giving your infant frequent breast feedings or formula feedings and to make sure that they have tears when they cry and a moist mouth.  When you stick a finger in a baby’s mouth, the finger should never come out dry. A drooling infant is not dehydrated. It is difficult to tell if your child has urinated if they are in diapers, and are having diarrhea, as it is all watery together and the newer diapers “wick” the urine. Unless there is a large volume of urine you may not be able to tell that your child has urinated.  When in doubt, we actually either put a bag on a baby to see if they urinate or weigh the diaper, but this is not necessary at home. I see a lot of babies and toddlers whose parents are worried that they are dehydrated because “they have not urinated in 12 hours”. But while saying that,  the child is crawling or walking around the room drooling.  They just could not tell that they were wet as the diaper was not saturated. So much for advanced technology diapers, sometimes they are TOO good. For older infants and children, let them have frequent drinks of either Pedialyte or Gatorade and also let them eat solid foods.  When I was first in practice it was thought that the “gut” needed to rest and a BRAT diet was recommended. So, kids who had diarrhea were only given bananas, rice, applesauce and toast.  This was not only boring, but is was found to be too limiting and did not provide enough protein and nutrition to allow the gut to heal. It is now recommended to “feed a child through their diarrhea”, but to avoid fatty foods, and food high in simple sugars like apple juice.  Provide complex carbohydrates like cereal, potatoes and bread, along with lean meats, fruits and vegetables. In most cases of diarrhea a child can still tolerate dairy products, but if their diarrhea seems persistent or returns after your child drinks milk etc. you might limit their dairy for several days in order that the cells that produce lactase may regenerate. It is not uncommon for children to have 5 – 7 days of diarrhea with a viral gastroenteritis. There is some new data on using probiotics to shorten the course of diarrhea and in cases of prolonged diarrhea I have used some of these products (such as Florastor for kids) with success. This may help the gut by restoring good bacteria to promote intestinal health. We've all been there, haven't we?  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Puberty Chatter

1.15 to read

I was seeing an adolescent for her annual physical exam and this was the first time that she had asked that her mother not be in the room. This is not uncommon at all and many girls prefer their moms to be in the room. Everyone is different! 

At any rate, we were discussing puberty and I asked her if she had had her first menstrual period (which is called menarche).  She replied that she had had her first period about 3 months prior. I then asked her if she had had a subsequent period and her eyes got really wide and her face had this surprised expression and she said, “what do you mean?”  I almost wished that I had never asked her the question as I knew that I was about to “burst her bubble!” 

I told her that it was not uncommon to skip several months after having your first period, and it was not unusual to have irregular periods for the first 1-2 years after menarche. 

I explained that it took some time to have a regular monthly menstrual cycle.  She just looked at me dumbfounded as if I had told her there was no Santa Claus! Her reply to me verbatim was, “WHAT, you have another period!!  She really believed that this event was a one hit wonder and that you would never have another period again.  I think somehow she had suppressed the knowledge that she would continue to menstruate for many more years. Forget ever discussing menopause with this teen any time soon. 

The funniest thing was that I knew her mother fairly well, and felt certain that her mother had explained her pubertal changes, menarche and menses to her, probably more than once. She also attended a school that did a good job of discussing these issues as well. 

So this was just affirmation to me as both a parent and a doctor. Kids are really no different than we adults are. They sometimes hear what they want to hear and forget the parts that are unpleasant or difficult to deal with. My husband tells me that I am often guilty of this. 

This also reminded me that it does not hurt to discuss any topic with your adolescent more than once! Sometimes it takes several conversations to sink in and in my own experience as a parent, there are some subjects that need to be discussed over and over again.  I am still laughing as is her mother. Not sure about her. 

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

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