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Daily Dose

Let's Talk Flu

1:30 to read

Summer is not even officially over, but it is time to discuss flu vaccines.  This years flu vaccine is now being shipped and our office has already started giving the vaccine.  If you somehow missed the biggest news you need to know that there is not an intranasal flu vaccine (Flumist) available this year…in other words, everyone gets a shot!

The flu vaccine is recommended for everyone over the age of 6 months. Because circulating flu strains change, the flu vaccine is “new” every other words, the flu shot you may have received last year is not the same shot that will be given this year.  I have had several adults  (friends) already say to me, “  got my flu vaccine in January….so I don’t need one now, right?” WRONG..that was “last years vaccine”…put your arm out for the new one.

While many children had gotten used to “sniffing” their flu vaccine and were thrilled not to have a shot, recent studies found that the intranasal flu vaccine was not as effective as the injectable flu vaccine.  In fact, for the 2015-2016 flu season the intranasal vaccine effectiveness among children 2 through 17 years was 3 percent as compared with 63 percent for the injected vaccine (quite a significant difference).

Actually, the fact that studies are done to look at flu vaccine effectiveness each year should be reassuring. By having the data available adjustments and new recommendations can be made, providing children with the best possible protection from getting the flu, and this year that means a shot.

The flu vaccines available this year may be either a trivalent vaccine ( containing 2 influenza A strains and 1 B )  or a quadrivalent vaccine (2 influenza A strains and 2 B).  I would ask my doctor which vaccine they are offering and if given a choice I would pick the quadrivalent…but most importantly just get your vaccine, sooner rather than later.

While I am already seeing sad little faces when they hear they will have a “shot rather than a mist”,  the good news that should bring smiles to their faces (and their parents) is that they will have better protection against the flu.  

Even though temperatures may still be on the warm side without any hint of flu “in the air”, it is time to get your vaccine…and yes, the protection will last throughout the flu season. It is best to be vaccinated and protected ahead of flu season.


Daily Dose

Cold & Cough Relief!

1:30 to read

Although it is just getting really cold across the country, it feels as if we have been in full cold and cough season for awhile.  The office sounds like what I call “kennel cough” as every child seems to be coughing…. even those who are just coming for check ups.

Parents often ask, “what is the best way to keep from catching a cold?” and the answer continues to be, “wash your hands and try not to touch your hands to your eyes, nose and mouth”.  Easy enough for an adult (well maybe not), but trying to tell your toddler not to put their hands in their nose or mouth is nearly impossible! That is one reason that children get so many colds in the first several years of life. Toddlers typically get the most colds as they have just started having playmates with whom they share not only toys but their germs…all part of growing up.

I remind parents that coughs are there for a reason. While they are a huge nuisance, and cause a lot of sleepless nights for both the child and parent, a cough is there to keep the lungs clear, and a cough is actually protective. In other words, coughing helps you clear the lungs of mucus that comes with a cold and helps to prevent pneumonia and secondary infections.  But, with that being said, learning to cover your mouth when you cough is not only polite, but it is also protective for others. It is a big day when your children learn to cover their mouths with the crook of their arms (better than the hand). Who knew as a parent this would be a milestone for your child?

Whenever your child is sick and has a cough and cold it is important to not only listen to their cough but to actually observe how they are breathing.  Parents send me videos or voicemails of their child coughing, but I am usually more interested in seeing their chest and watching their breathing. Your child may have a huge productive cough and sound terrible, but have no respiratory distress. With that being said, your child may also have a tiny little non-productive cough and be struggling to breath. In most cases the visual is more important than the audible.

To help symptoms like stuffy noses, try irrigating your child’s nose with Little Remedies® Sterile Saline Nasal Mist and then suctioning his or her nose to clear the mucus and make it easier for him or her to breath, a warm bath or shower before bed to open up airways and a cool mist humidifier in the bedroom.

Don’t panic if your child gets sick, as each time they fight off a cold and cough they are actually boosting their immune system…small victories.  It is not unusual for a toddler to get 6 - 7 colds in one season (and their parents get half as many as that from them). Once your child turns about 3 you will see that he or she doesn't get a cold every other week and also seems to handle the viruses a bit more easily.

If your child has any difficulty breathing you need to call your pediatrician! For more information on these products visit





Daily Dose

No Screen Summer!

1:30 to read

Kicking off the summer and I have had a few parents announce that they have decided to have a “screen free” summer. When I asked them what this meant they said NO “ipads, phones, computers” for the summer and they have vowed that they will spend more time outside playing, reading, going on “field trips” and enjoying more family time.


I am thrilled that I have seen more than one family who has decided to adapt this summer rule and this means that the parents are also going to forgo a lot of unnecessary screen time. That is a difficult summer for parents as well.


Now…with that being said, there are some exceptions….namely car trips and travel. For those trips the I-pad or phone will be allowed but once the destination has been reached…they are going to be back on the “do not use” feature.


So far …week one…these families have already been enjoying the screen free decision and they have explored the library, the Arboretum and even the art museum. But, even if you don’t Iive in a big city you can find all sorts of things to do…start your own book club, go fishing, plan a lemonade stand or go visit a nursing home to brighten a elderly person’s day.  There are so many different opportunities, some of which your child can do on their own, and others which will involve the family.


It also doesn’t have to be “all or nothing”!! Especially if you have older kids. Maybe small steps with “screen free” days on alternate days. Or certain parts of the day devoted to family time and being screen free. There are many ways to approach a “screen free” summer without making it miserable and a constant struggle. Any commitment to taking some time away from the screen will be beneficial for everyone.


Let me know know how it goes….Be creative!

Daily Dose

When Tests Should Be Ordered

1:30 to read

The American Academy of Pediatrics has been involved in a series of articles entitled “Choosing Wisely”, as it relates to when and why some tests should be ordered. The latest is related to endocrinology and the myriad of laboratory tests that are often ordered unnecessarily and are overused.


The AAP states that it is important to, “avoid ordering Vitamin D concentrations routinely in otherwise healthy children, which includes children who are overweight or obese”.  While a Vitamin D level is the correct screening lab to monitor for Vitamin D deficiency, it should only be ordered in patients with disorders associated with low bone mass (like rickets), some children with liver disease, or in those children who have recurrent low-trauma fractures (not one broken arm).


I have seen many patients who have had lab work done by another physician in which they “have a low Vitamin D level” and they are concerned that this is the reason their child is “fatigued”, “depressed”, “not doing well in school”….just to name a few of the statements. Vitamin D levels have not been correlated with any of the above. 


Due to the variability of tests available, and unclear cutoffs for deficiency, many children could be misclassified as having Vitamin D deficiency.  The uncertainty around “ normal levels” may lead to over diagnosis, with no clear benefit and may cause undue anxiety. 


More important than a Vitamin D level is the assurance that parents are routinely offering their children milk and dairy products high in Vitamin D. Vitamin D is necessary to help the body use calcium, which is the building block for strong bones and teeth.  As many parents have stopped giving their children milk, but are offering more water, the daily recommended intake of Vitamin D and calcium may be difficult to reach.


Other foods high in Vitamin D include canned tuna, salmon and some fortified cereals.


If you have questions about Vitamin D intake talk to your pediatrician.  



Daily Dose

No More Food Battles

1.30 to read

Seems that I spend several times a day discussing “food battles” with my patients and their families.  I guess the longer I practice the more I don’t think we should even have to discuss how often parents “battle” with their kids about eating.  

From the early days of parenting when a baby is first offered either breast or formula, they are not asked “do you like this?”.  It is taken for granted that an infant will eat and grow and  there you have it.  The easiest days of parenting, correct? (except for a few months of sleep deprivation).  But once that baby begins to eat the discussions start about “he makes a face when he eats spinach”, or “she will only eat chicken tenders from Chik-fil-a”, or “he only likes pasta and won’t eat meat”, or even “I make 3 diferent meals for my 3 kids”.  If you have a child older than 9 months you understand what I am talking about. 

Food is necessary to nutrition, growth and health. But, with that being said, parents have to trust that a child WILL EAT when they are hungry.  Really, hunger drives us all to eat, eventually.  That bowl or cereal, or the steamed vegetables or even the dreaded chicken breast will get eaten if your child gets hungry enough. I remember reading somewhere that , “ a parent’s job is to provide food for their children at appropriate meal times, and child’s job is to decide if they will eat it.”  In other words, make the meal whether for your toddler or teen and “forget about it”.  Meal time needn’t be a battle but more a gathering to enjoy being together eating is just a bonus.  

As an adult, when you go to a dinner party, you don’t ask what they are serving before you accept, nor do you tell the host/hostess, I hate lamb!!  (my example).  You just smile and find something to eat and there is not a battle.  We all need to approach family meals as a dinner party. Our children are our guests, and sometimes they like what we fix and other times they push some food around their plate and choose not to eat.  The good news for most children is that there is another meal to follow. 

So, think about it and don’t let certain food likes and dislikes dictate mealtime. The more foods young children are exposed to the better chance they have of EVENTUALLY becoming a well rounded eater.  Children’s taste buds change with time as well, so you will find some foods that a 3 year old loved is no longer the favorite at 13 years of age.   

Well balanced, nutritious, colorful meals are the family goal and “food battles” can be left out of the vocabulary.   

Daily Dose

When To Worry About Stuttering

1.15 to read

I received an e-mail today from a mother who is concerned about her 2 1/2 year old daughter who has started stuttering in the last week. She asked ”is this something to be worried about or just watch it and see?”

This is a common question from parents with preschool aged children, and is typically most frequent between 18 months and five years of age. Stuttering at this age is called disfluency or pseudo stuttering and is quite common as children learn to speak and develop more complex speech patterns.

In many cases the stuttering occurs out of the blue, and may last for several weeks, and resolve, but may return off and on during the preschool years as a child is learning more and more language. In a preschooler who is stuttering the parents usually note that the child repeats an initial sound such as l-li-like or s-st-star or may have frequent pauses with “um” and “er”. It is not uncommon to see this happen when a child is excited, or anxious or tired.

They may stumble or words or sounds and after a good night’s rest you may see an improvement. They often don’t seem to realize that they are even stuttering as their brains and mouth try to keep up with one another. Remember they have a lot to say!

The best medicine for stuttering is for a parent to reassure their child that it is okay to slow down as sometimes it is hard to make the words correctly. A hug from Mom or Dad while they are reassuring their child is also helpful. Practice slow and relaxed speech when you are talking to your child and try not to rush them when they are talking, even if the stuttering is bothering you. When your child asks you a question, pause before answering to also model behaviors with speaking. Reading aloud with your child in a slow and normal manner is also beneficial (I remember nights of trying to rush through those early books to try and get everyone in bed!).

The best person to emulate is Mr. Rogers, think of how relaxed he always was when speaking. He never seemed as if he was hurrying for anything! In most cases a child’s stuttering will not last more than weeks to several months and will resolve on its own.

If you think the problem is increasing in severity or is causing stress and anxiety for your child it may be time for a discussion with your pediatrician.

Do you have any tips?  Feel free to share them with us!

Daily Dose

Time-Out for Toddlers!

1.15 to read

I love talking to parents about behavior modification and that includes beginning to discipline their children. I really think this is one of the most important jobs for parents and it is hard to believe that your most “precious, perfect” child will at times misbehave.  It happens to all of us!

I would recommend to start using time out as a means of behavior modification when a child is somewhere between 15-18 months of age.  For those of you who watch Super Nanny, she coined the word “the naughty step” which is her version of time-out chair.

When you begin time out, pick a small chair in the house which you can use consistently for time-out. Never use a child’s crib or bed, as you do not want them to think that “bed is for misbehaving”.  After a child gets used to doing time out you can use all sorts of chairs and do time out anywhere. Like many things it just takes practice.

When putting your child in time out get down to their eye level, explain why they must sit in the chair, and hold them from behind (with your arms wrapped around them like you are a rope). I use a timer even at this young age so your child begins to understand how long they will be sitting in time out.  Time out is typically one minute per year of age.

After time out is “finished”, get back to eye level and explain that the next time you ask them to mind you, “they may choose” to listen and they will not have to go to time out.  These are such important words for a child’s entire life, as they need to understand that they are making choices for their behavior.  In other words, taking ownership of making a bad choice and knowing that there will be consequences.  You will use these words over and over, “you made a bad choice therefore....the consequence is....for a young child it is time out, for older children it may be no TV, or no going to a party, or even no driving. All versions of time-out.

One of my patients is a cute family of 5 and the mother has her version or time-out. She says “nose and toes in the corner” for a minute----her kids started doing that at 12 months! Impressive.

Daily Dose

Selfies Cause Lice?

1.30 to read

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 


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Count your blessings this Thanksgiving!

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