Daily Dose

Booster Shots

1:30 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.  

Daily Dose

It's Cold Season!

1:30 to read

It is already starting....fall and colds and parents are already wondering why their toddler or young child may have already had 2 colds and it is not even winter!  It is incredible how often a toddler can get sick....I even had a hard time believing there were so many viruses for one child to get.

But, I do know that there does not seem to be any way “around” the frequent runny noses, coughs, mystery fevers, and episodes of vomiting and diarrhea that a parent has to get through!! There is not a short cut to get through this desert of illness...you have to walk the walk.

Yes, it takes a lot of little viral illnesses to help build a child’s immune system. We can give vaccinations to prevent meningitis, whooping cough, polio, mumps, measles and rubella.  But there are hundreds of viruses that cause colds and coughs....and there is not a vaccine for any of these viruses.  

So, once your child reaches the age where they are walking and touching a million things a day (even though you wash their hands), you should not be surprised or alarmed that they seem to have a new illness every few weeks. Parents ask me everyday, “what vitamin works to prevent colds?”, “do probiotics prevent those fever viruses?”. If I had the “secret” potion, trust me I would tell them, but I would also bottle it and sell it on the internet and retire to an island , after receiving the Nobel Prize in medicine for finding the “secret”.  But in the meantime, I will continue to reassure parents that they will get through these early illnesses.....everyone does. 

Daily Dose

Leaving Your Child Home Alone

1.00 to read

I get asked the questions a lot "At what age can I leave my child home alone?"  There is no simple answer but a progressibe one.

I tend to think most children are ready to spend 20-30 minutes alone at home between the ages of 10-11, but every child is different.  It depends on a number of things including how your child feels about being alone, the length of time, and if you and your child have discussed how to handle emergencies and getting a hold of you or a neighbor in case there is an emergency or even just a question that needs to be answered.  

Well, this topic brought up an interesting question, what do you do when you leave your child alone and there is not a home phone?  I have never even given that a thought as I am “old school” and still have that landline in my house. It just gives me a “good feeling” to know that it is there, even if it rarely rings. (although the kids know to call the home number as I typically turn off the cell as soon as I hit the door from work).   

More and more families have given up a home phone and I think this brings up so many different topics for discussion, but for starts how does your child call you when you leave them alone?  Or how do they call the trusty neighbor if they need something.  Do you get them a cell phone? Do you have to have an extra cell phone to have at home?  It seems to me that a home phone is important for just that reason. In case of an emergency, your child can pick up the phone and call for help, assistance or just a friendly voice. I don’t think they need a cell phone!  

Also, landlines are relatively inexpensive. Cell phones for 8,10, 11 year olds?  Sounds inappropriate and expensive.  Wouldn’t it be easier to keep a home phone so children can learn to answer a phone, use good phone manners, and when you are ready to let them stay at home by themselves for a few minutes, there is always a phone available. I don’t know, just seems easy solution to me.    

What do you think? I would love to hear from you!


Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?


Daily Dose

Button battery Dangers

1.15 to read

I saw a patient the other night who was having difficulty swallowing and her parent’s thought that she had swallowed something. She was a toddler and had been playing with her sister and then suddenly started coughing and having a hard time swallowing. When  saw her she seemed to be “ok” but looked like she was having a hard time swallowing and wouldn’t eat or drink.  Fortunately she was not having any respiratory distress. 

Her parents were not sure of what she might have swallowed, but the first thing that comes to mind is that she might have swallowed a button battery.  Button battery ingestions are on the rise as more and more devices like remote controls, games and other household objects use the 3 volt 20 millimeter lithium batteries.  

An article in the May issue of Pediatrics reported that there were nearly 66,000 battery related ER visits by children under the age of 18 during a 20 year span. More than 75% of all battery related hospital visits involved children 5 or younger. 

Because of the article and her presentation I immediately sent her to the ER for an x-ray to look for a possible ingestion of a foreign body.  Ingestion of a button battery is considered a medical emergency so it is important that the diagnosis is made quickly. In most cases the battery will pass into the stomach and then be “pooped” out. 

There are reports of parents finding a battery in the stool and never knowing that the child had ingested a foreign body. But, if the battery lodges in the esophagus it may result in alkaline burns and corrosion and perforation of the esophagus. The longer the battery remains in the esophagus and GI tract the greater the chance for complications. 

Good news is that this little girl had swallowed a foreign object, but it was not a battery but a barrette used for her sister’s hair.  The pediatric ENT doctors were able to scope her and remove the barrette without problems and she is as good as new! 

But, if you ever think your child may have swallowed “something” make sure to consider those button batteries. Better yet, childproof all of those devices in the house by taping them shut and keep all batteries up and out of reach of children.   You know a toddler, they will put anything in their mouths, just not the foods that you are trying to get them to eat! 

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

Protecting Your New Bundle of Joy

When I see newborns in my office this fall I am already thinking into the winter season ahead.

As I see new parents in my office this fall, bringing in that most precious newborn for their first pediatric visit, I am already thinking into the winter season ahead. Infants born during fall and winter are exposed to more upper respiratory viruses and flu in their first six months of life. Infants under six months of age are at more risk of complications from viruses like RSV and flu. Unfortunately, infants under six months cannot receive flu vaccine.

But a recent study showed that mothers who received a flu vaccine during pregnancy reduced influenza illness in their newborns. That study is important in reminding pregnant mothers of the importance of receiving flu vaccine during their pregnancy. Unfortunately, in my practice, I do not see this information being given to pregnant mothers while they are in for their OB visits. It is also important that new parents are vaccinated against whooping cough with a newer vaccine which is given to adults called a TDaP. If you are pregnant or thinking about becoming pregnant this winter discuss these vaccines with your obstetrician. If they do not have the vaccines in their office, your local health department has them. The best way to protect that new bundle of joy is by immunizing those around them. This would also apply to grandparents, aunts, uncles and cousins. Spread the word about flu vaccine and TDaP and not the germs. That's your daily dose, we'll chat tomorrow!

Daily Dose

Changing the Clock

1:30 to read

How are you and your children doing with the change in time??  While we all enjoyed an “extra” hour of sleep over the last weekend, it is also difficult to adjust to it being dark at an earlier hour. This change to Standard Time and dark evenings makes our brains want to go to sleep a little earlier too.  This same thing happens to your child, but the problem is if you put them to bed earlier, they may still wake up at their same time in the morning.

I had been talking to parents about their children waking up at early hours and reminded them that a 6 am awakening a week ago was now going to be 5 am and REALLY DARK...no one wants to wake up with their 2 or 3 year old at that hour.  But it takes several weeks for our brains to adjust to this sudden “fake clock” that happens twice each year. 

Resist the urge to let your child go to sleep earlier this week...try to keep them up until their regular bedtime, even if that means you have cranky, tired children by 6:30 pm.....hang in there with baths and story time. If you have to let them go to bed earlier, make it 10-15 minutes rather than an hour.

If your child awakens at an early hour, go in and reassure them that it is not yet time to get up....it is still dark and children get up when “ Mr. Sun” rises. Do you know that song? We used to sing it to our children when they were little and even as teens I drove them crazy walking into their room on school days singing, “Mr. Sun, Sun, Mr. Golden Sun....time to get out of the bed”. Sort of always made up my own lyrics when I sang that song. 

Parents have also taught me that there are these new clocks that even have a moon on the face that lights up at night and the sun shines when the day begins....very clever way to let your child know when they can get up and out of bed for breakfast. Don’t even have to tell time....pictures do the trick.

Hang in there...in a few weeks all of our brains, both big and little will have adjusted to the time change, until the spring when we do it all over again in reverse.

Daily Dose

Do Germs Make You Cringe?

1:30 to read

I see a lot of parents who are “germaphobic” and are constantly sanitizing anything and everything that may come into contact with their baby. I am not just talking about a newborn...but rather older infants and young children, especially as they start to creep and crawl around their environment.  Their mother’s purses have a bottle of hand sanitizer in easy reach and many have the bottle attached to the diaper bag or stroller as well. 

But now comes a new study which may help everyone relax a bit...and maybe stop constant disinfecting as well.  A recent study in The Journal of Allergy and Immunology found that children, under the age of 1, who shared a “dirty” home, with mouse and cat dander as well as cockroach droppings (I know you are all cringing now)  were less likely to develop allergies or wheezing by age 3.  

This idea has been called the “hygiene hypothesis”.  In other words, having children who are growing up in relatively sterile environments, may lead the immune system to “compensate” by reacting to pollen, dust and dander when there are fewer germs to ward off!  Now this doesn’t mean you have to stop keeping your house clean and never making a bed or vacuuming again ( novel idea), but the constant scrubbing and sanitizing may be a bit much. You don’t need anti bacterial soap in every room!

There have been other interesting studies done among children who live on farms.  They were taken into the barn as infants with hay, dander and animals all around them. They too were found to have fewer allergies than urban children.  So...playing on the dirty barn floor might not only be necessary for farm children, but also protective.

Should you run out and buy mice, a cat and try to breed roaches? I don’t think that is the recommendation.  Interestingly, this study did not show that having a dog was protective ....hmmmm when my kids were younger we did have a cat as well as a dog, not by choice but by my middle son’s insistence. Having always had dogs, somewhere in his early child hood years he “bargained” with us to adopt a black kitten that we all grew to love.  Maybe that was the best decision we made.  Fortunately none of my children have allergies or asthma. 

Lots of interesting studies on the horizon relating to this topic....stay tuned as I will keep you posted!


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