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Daily Dose

New Test for Baby

1.30 to read

If you recently had a baby (or are getting ready to) you may have noticed another “test” being performed on your newborn before they leave the hospital. Earlier this year the American Academy of Pediatrics endorsed the routine use of pulse oximetry to enhance detection of critical congenital heart disease.  

Critical congenital heart defects (CCHD) are serious structural heart defects that are often associated with decreased oxygen levels in infants in the newborn period. These heart defects account for about 17-31% of all congenital heart disease (or about 4,800 babies born each year in the U.S.)  

While some of these defects are found on pre-natal ultrasounds, and some may be evident immediately after birth when the pediatrician hears a murmur or the baby has difference in their pulses, others may not present until a baby is several hours - days of age.  Using pulse oximetry to measure a baby’s oxygen levels before they are discharged is just another method of screening a child, and if there are abnormalities a baby would undergo further evaluation with an echocardiogram and would see a pediatric cardiologist. 

Pulse oximetry is routinely used in all aspects of medicine these days and requires a simple non-invasive device that is placed on a babies finger or toe to measure the level of oxygen in the blood. (looks a little like ET device to light up a finger). It works by comparing the differences in red light, which is absorbed by oxygenated blood, and infrared light, which is absorbed by deoxygenated blood.  

In a large study just published in the journal Lancet (looking at over 230,000 newborns), simple pulse oximetry detected 76% of congenital heart defects, with only a rate of 0.14% false positive results. The risk of false positives was even lower than that when pulse ox was performed when the baby was over 24 hours of age. Pretty impressive! 

It has been estimated that about 280 infants with unrecognized CCHD are discharged from newborn nurseries each year. Congenital heart disease also accounts for somewhere between 3-  % of infant deaths. With early intervention and surgery the chance of survival from CCHD is greatly improved. 

So ask your pediatrician or obstetrician if they are doing routine pulse oximetry in your hospital nursery.

 

 

Daily Dose

Happy Thanksgiving

Wishing each of you a healthy and happy holiday with your family. I am thankful for the many blessings of friends and family. A special prayer and thank you for those men and women who are not with their families today as they are overseas protecting our values and freedom. Happy Thanksgiving from Dr. Sue and everyone at The Kid's Doctor!

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Daily Dose

Parenting is Hard Work!

1:30 to read

Being a mom (as well as a dad) is one of the hardest jobs in the world....and as many a person has pointed out, it pays a lot less than minimum wage.  But, it is also the best job in the world.

I have the privilege of seeing a lot of mothers everyday. From the time they come in with their brand new infant until their children have graduated from college....mothers worry about the “job” they are doing.  For a new mother who is already hearing that voice in her head...”am I doing this right?”, 

it is very reassuring for her to hear me say, “you can’t mess this up yet!” Your baby loves you unconditionally, just like you do them.

But as your child gets older it takes a great deal of self-esteem to sometimes feel as if you are “doing it right”.  Children of all ages can sometimes bring us to our knees...how can a small child know just the right thing to say, and that teenager...well, enough said.So, I like to tell them my own stories about raising children and my days of feeling like a failure, or at the least an inadequate mother....especially as your children point this out to you.

When my oldest and very verbal son was about 6, he was riding in the front seat with me (crazy huh) and I stopped the car in front of our neighbor’s house where our 4 year old son was heading to play. I rolled down the window to give the 4 year old some instructions when the eldest son leaned over and started telling his younger brother what to do. So. in my best “mommy voice” I tell the 6 year old that I am the mother and will handle this, to which he doesn’t miss a beat and responds ”if you were doing a better job of being a mommy I wouldn’t have to help you!”  Enough said.

It takes a lot of self esteem and true grit to be a mom. Hang in there.  We all have those days when we know we are doing our best and our kids disagree. 

Daily Dose

Umbilical Cord Hernia

1:15 to read

It is not uncommon for me to see a newborn baby in the first few weeks of life with an umbilical hernia.  Once the umbilical cord detaches and is healed, some babies have an “outy” belly button.  While this causes a bit of parental concern, the bulge is typically due to the fact that the abdominal muscles around the belly button have not fully closed.  

In some cases the hernia may be tiny and barely noticeable, but in other cases the “bulge” may be as big as a quarter or half dollar.  The bulge is often bluish in color and “squishy” as the hernia allows a small bit of the intestine to push through he defect.

While the hernia is disconcerting for parents...who often wonder if their baby’s belly button will always be an “outy” or if they will need surgery...in most cases the muscles usually come together and the hernia will close on its own over months...sometimes several years.

When I was first in practice it was not uncommon for me to see a baby come in who had their tummy “bound” with an Ace bandage and maybe a quarter or half dollar “pushing” the belly button back in. But over the years I guess the word is out that this really does not help and like many things in parenting if you just leave it alone...it will get better.

Lastly, you may notice that the hernia gets bigger when your baby cries or pushes to poop. Don’t worry that is totally normal...it is just the increased pressure on their abs...and when the baby relaxes the hernia is not as apparent and should easily be pushed back into the tiny defect.  

If you have any concerns make sure to talk to your doctor.

Daily Dose

The Facts About Mono

The chatter with moms at a recent school function revolved around a case of mono at school. The mothers were all concerned that their own child had been exposed to the girl with mono and when they were "all going to get mono". They were also concerned that the "index" case of mono was still attending school. "How could this be?"

So here is some accurate information about mono. Mononucleosis is a viral infection that is caused by the Epstein-Barr virus (EBV). Mono, also known as the kissing disease, is commonly thought of as a teenage illness. But, many younger children may be exposed to the virus and have very few symptoms, several days of fever and feeing badly, and develop life long antibodies to EBV. Older children and adolescents usually exhibit fairly classic symptoms including a horrible sore throat, fever, headache, puffy eyes, fatigue and just feel dreadful during the acute phase of the illness. The fever and sore throat are persistent and when you see the child's throat the tonsils are very large and covered in white (exudate is the medical term), and their cervical lymph nodes are huge and tender. In some cases the spleen enlarges, as do lymph nodes in the groin and under the arm. Occasionally there is a rash. Mono is diagnosed with a blood test, not a throat culture. The rapid mono test detects antibodies to EBV, so it takes several days of being symptomatic before the test is positive. Most people with mono never know when or where they were exposed to the virus. The virus is shed in saliva (hence, "the kissing disease"), and body fluids, and may be transmitted by drinking or eating after someone else. It is often four to seven weeks after exposure before you develop symptoms, so the girl in the class is not going to make you sick to tomorrow or the next day, and you can not get mono from her by sharing her books or sitting next to her at the movies. Good reason not to share drinks! The treatment for mono is entirely symptomatic as it is due to a virus. Rest is paramount as the fatigue from mono may last for several weeks. I give patients medication to control their fever, pain relievers for the sore throat and general aches, and good nutrition and rest as they feel better. The initial symptoms usually last for five to 10 days but the fatigue may last for several weeks. I limit physical activity and after school activity until the fatigue has improved and they have returned to normal school days etc. This is the hardest part, as your teen wants to go back full steam ahead, but slow and steady wins this race and within a month they are back to normal. That's your daily dose, we'll chat again soon.

Daily Dose

Parents Need 'Me' Time

1.15 to read

Do you ever feel TOO connected?  I have been talking with many of my young parents about being a bit too connected to their little ones.  Now don’t get me wrong, good parents are connected to their children, but it cannot and maybe should not be 24/7, day in and out. 

It is important for parents and children to learn independence from one another, and it begins shortly after a baby is born when you realize that as new parents you need a break for an hour or two, maybe to go to dinner, a movie or the book store to pick up the latest parenting book. (so stay tuned from The Kid’s Doctor). 

But while you go out and the baby is either with the other parent,  grandparent or babysitter, you do not need to be in constant communication to check in 15 minutes after you leave. In that case there really is no break.  If you get a phone call, or text 10 minutes after leaving because the baby is crying or spit up or won’t go to sleep, which in turn makes you anxious, so you turn around to come right home, then the whole point of a break is moot. 

This came up again the other day when a young mother told me that she was so exhausted and had a 6 week old baby at home.  Her sweet husband treated her to a mani/pedi which she anxiously looked forward to. She left her husband with a bottle of pumped breast milk and headed out the door for an hour and half break and maybe a nap in the spa chair. But, shortly after she settled in, she kept getting texts about the baby.  The more texts she got the more anxious she got and then wished that I had never even left.  I just “knew I had to be there!” 

When I brought up the fact that life seemed a bit simpler and maybe even more relaxed prior to constant cell phone communication she and her husband both paused for a moment. What? No way! But after realizing that an hour break while their baby was in the care of another responsible adult might be just what the doctor ordered. 

In the olden days a trip to the grocery store ALONE was a treat, and I knew that the baby would still be there when I returned. Daddy could not call to say that our sweet baby boy had cried for 10 minutes, they just muddled through together.  While I was in a sleep deprived stupor at the grocery store, I was also enjoying languishing in the produce department trying to decide whether to buy iceberg or romaine lettuce. It was a break of sorts! 

So, maybe try an hour away from your baby without a phone call or text! Make a pact with your spouse or sitter and take a break. It does wonders for everyone to figure out that baby, mother and father can all survive. 

Try it and let me know how it goes. 

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

Daily Dose

What Are Breast Buds?

1.15 to read

I received a phone call today from a mother who was worried about the “bump” beneath her 12 year old daughter’s nipple. I do get this phone call quite often and even see mothers and daughters in the office who are concerned about this lump?  First thought is often, “is this breast cancer?”  The answer is a resounding “NO” but rather a breast bud.  While all mothers developed their own breast buds in years past, many have either forgotten or suppressed the memory of early puberty and breast budding.

Breast buds are small lumps the size of a blueberry or marble that “erupt” directly beneath a young girl’s areola and nipple. Most girls experience breast budding somewhere around 10-12 years of age although it may happen a bit sooner or even later. It is one of the early signs of puberty and estrogen effects.

Many girls will complain that the nipple area is sore and tender and that they are lopsided!! It is not unusual for one side to “sprout” before the other. Sometimes one breast will bud and the other is months behind. All of this is normal. 

While a lump in the breast is concerning in women reassure your daughter that this is not breast cancer (happy that they are so aware) but a normal part of body changes that happen to all girls as they enter adolescence.   Breast budding does not mean that their period is around the corner either, and periods usually start at least 2 years after breast budding (often longer).

Breast buds have also been known to come and go, again not to worry. But at some point the budding will actually progress to breast development and the continuing changes of the breast during puberty.

Reassurance is really all you need and if your daughter is self-conscious this is a good time to start them wearing a light camisole of “sports bra.”  

Daily Dose

It's Croup Season!

1.45 to read

It is definitely fall and all around the country, the temperatures are cooling off and the chill is in the air at night. With the cooler temperatures more of those pesky viruses come out and once again I am seeing croup.

Croup is a viral upper respiratory infection that causes swelling of the trachea and larynx (voice box) which causes young children to cough and at times to bark like a seal. This hoarse raspy cough is most problematic in younger children who have smaller airways.  

Children often go to bed at night with nothing more than a little runny nose, and then suddenly awaken with this barking cough. Many times the noise emanating from the child’s room sounds more like a sick animal than your previously healthy toddler and may be alarming to both parents and the child.  

Whenever you awaken to a croupy child, the first thing to do is turn on the hot shower and shut the bathroom door as you head down the hall to your child’s room.  After getting your child, grab several of their favorite books and head back to the steamy bathroom. Sit in the bathroom and try to calm your child down and let the steam work.

Typically in several minutes (or until the hot water runs out) their coughing should improve and they will relax. Remember, they have suddenly awakened and are trying to figure out what is going on as well so they may appear to be tired and anxious as well.

In most cases the steam and humidity will help to relax the airway. If the steam doesn’t seem to be working after 5– 10 minutes try going outside into the cool night air. Many times a frantic parent will put their child into the car for a trip to the ER, only to find the child perfectly calm and no longer coughing on arrival to the hospital. The reason being, the cool air has also helped to calm the coughing.

If your child is having stridor (a high pitched squeal) when they breath in and appears to be having any respiratory distress with pulling of their ribs when they are breathing (called retractions), then you need to call your doctor. If they are coughing and turning bright red while coughing be reassured that they are still moving air well. You should not see any duskiness or blue color and if you do call 911. (Remember the adage blue is bad, and red is good).

If by morning your child is having continued symptoms you may want to see your doctor as steroids (given orally or by injection) may be used to help shrink the airway swelling. Most cases of croup do not require hospitalization. After several days of croup your child will probably be well.  

Lastly, older children and adults may also get the virus that causes croup, but with larger airways will simply show signs of laryngitis and being hoarse.

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

Daily Dose

Does Your Child Have A Crooked Finger?

What Can You Do For A Crooked Finger?I received an email via our iPhone App from a mom who was worried that her daughter had a “crooked” finger.  She did not give any more specifics, but the most common finding in children is a curvature of the 5th or “pinky” finger called clinodactyly.

The word clinodactyly is derived from the Greek words kliner “ to bend” and dactylos, “a finger”.  Clinodactyly is typically caused by abnormal growth and development of the small bones of the finger resulting in the curvature of the finger in the same plane as the palm.

Clinodactyly may occur in up to 10% of the population, but occurs to different degrees.  It is typically a benign condition but has been associated with numerous syndromes where it occurs in combination with other abnormalities. There are several common characteristics seen with clinodactyly. It  is more common in males and is often bilateral (occurs on both hands). It is frequently seen in families as an inherited “condition” and is thought to be autosomal dominant,  so when you go to a family reunion look at everyone’s fingers as you probably have a lot of siblings or cousins who have the same bent finger. When clinodactyly is minimal and does not cause any problem the best treatment is simply watchful waiting.  If the “deformity” becomes progressive as a child grows, then xrays may be obtained to further delineate the abnormality and surgical treatment may be undertaken.  A board certified hand surgeon would be the preferred choice to do this surgery. Send your question to Dr. Sue!

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