Daily Dose

Diagnosing Food Allergies

1.15 to read

Food allergies continue to be a problem in the pediatric population and I often get calls or see a patient for an office visit with a parent who has a concern that their child “may have” reacted to something they ate. Their question is, are they allergic?  

There is a great resource for physicians entitled “The Guidelines for the Diagnosis and Management of Food Allergy in the United States”.  Not all adverse reactions to foods are allergic and it sometimes takes a bit of “detective work”, which is a good history and physical exam, to begin to determine if a child has a food allergy.   

So, when a parent tells me that their child gets a rash on their chin or cheek after eating “xyz” food the questions begin.  Was it the first time they had ever been exposed to that food? Describe the rash and how the child was acting?  Did they have other symptoms with the rash? Was the rash just on a cheek or was it all over? Was it hives? This list of questions go on and on.   

The most common food allergens are egg, milk, peanut, tree nuts, wheat, shellfish and soy. I also ask if this was a one time occurrence, and  If they have tried the food again did it happen every time? Many times hard to tease out what a child has had to eat when they have a mish-mash of food on their plate and nothing is new!  

Is there a family history of allergy or asthma?  Does your child have eczema as well?  If so there is a greater chance of developing a food allergy.  

After a detailed history, and if I do think that the child has a good history for a food allergy, there are tests (skin prick and blood) that may help determine if an allergy may exist.  BUT, with that being said, there are several caveats.  Number one, your doctor should not test for “every” food allergen, only for the suspected food or foods, as there are many false positive tests when you just check all of the boxes for testing IGE levels for an allergy.  For example, if your child eats eggs and has had no problem but the IGE level comes back a bit high for egg allergy, what does that really mean?  In other words, I just test for the suspected culprit. So, I do not test for tree nuts if the parents only had concerns with a peanut product.   More to come on this topic. 

Daily Dose

Kids Need Vitamin D!

1.15 to read

During all of my check ups I discuss the importance of dairy products in a child’s diet to provide adequate calcium and vitamin D for bone growth and long term bone health.  It doesn’t seem that the little ones are difficult to get  to drink milk, eat string cheese, have a yogurt, but the older kids are definitely more challenging. 

Teenage girls seem to be one of the biggest problems when it comes to calcium intake. When I ask them if they drink milk, a typical response is “Uh, no”, then if I ask about other dairy they may say they drink the milk out of the cereal bowl, or they grab a frozen yogurt at lunch or have a slice of cheese on occasion.  When I ask them if they know how much calcium and viamin D they need during the tween and teen years I also get a blank look  but they do know how many texts they have on their cell phone plan!).  Answer is 1300 mg/day once you hit the teen years. 

With that being said, I am always encouraging more dairy products, milk and then a calcium/vitamin D supplement as well. Interestingly, they usually don’t balk at the idea of a vitamin, but the issue is getting them to stay on the supplement for more than a few days/weeks when they typically start to “forget”. 

So, I was seeing a family with two teenage daughters who had heard my calcium talk before. They were both non milk drinkers, competitive cheerleaders who needed strong bones and who by now could answer my calcium questions. When I asked if they were taking their calcium supplements the mother said, “they have access to calcium and vitamins” everyday......what a great line. Well put by a mom of teens! 

In fact, despite having “access” the girls readily admitted they “rarely” remembered to take them and might be more likely to up their dairy products everyday. 

Calcium and vitamin D metabolism is a hot topic and “banking calcium” during childhood is so important.....even with access to the supplement you have to swallow it to make a deposit. 

Daily Dose

Fruits & Veggies in a Pouch

1.15 to read

OK, I am back to the subject of “squeeze pouch foods” or as another cute 2 1/2 year old called it “squeegy fruit”.  I have written about this before as I was fascinated by these when they first hit the market. On the one hand, I get that they are convenient and are easy to use for those first months of pureed baby foods, but beyond that, I think they are given to older children.  

It seems that more and more kids are enjoying “squeegy fruit” and also “slurping” pureed vegetables. The issue is these pouches foods are being “masqueraded” as healthy foods.  Yes, they are fruits and vegetables often mixed together, but if you read the labels it gets a bit more complicated.

I see so many toddlers in my office who are happily “sucking down” a packet of apples and blueberries.  These parents are adamant that their kids don’t drink juice boxes or eat “junk food” but at the same time they are letting their children “suck down” several of these pouches a day.  This is also often in place of meals, as many of these children are described as “picky eaters”.  I saw a little boy today who had been vomiting, but was on the exam table with pouch to mouth as he “drank/ate” a combo of apples, peas and something else.  (note: not recommended when vomiting).

So....I decided to look up the nutritional value of these pouches....many of them although “all organic” or described as “healthy” do contain a lot of carbohydrate and sugars.  Actually, as much as two fruit roll ups!  Yes, I did a little comparison and 2 of the “dreaded” fruit rolls ups contain 23 grams of carbs and almost 11 grams of sugar.....while a 3.2 ounce pouch has somewhere between 19-24 grams of carbs and between 14-23 grams of sugar.  

The point of this is not to say that “squeeze pouches” are bad, or that a child should never have a fruit roll up.  Rather, it is to point out that even “healthy” snacks can be full of sugar.  Rather than a fruit roll up or a  squeeze pouch, what about a piece of fruit?  Sure, it may be a bit messier to cut up a piece of fruit, but those pouches are not teaching children about textures and chewing.

Pouches are great for travel, special occasions and babies. But, they are not for toddlers and certainly not for everyday consumption.  Oh lastly, they are bad for the teeth as well!  

Daily Dose

Baby Bling Can Be Dangerous!

1.15 to read

I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

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

Daily Dose

Breath-holding & Fainting

2.00 to read

Have you ever fainted?  I bet you may have not realized how common fainting is in the pediatric age group?  I know this from my own children (yes, I had 2 “fainters” and boys no less) as well as from many of my patients.

The medical term for fainting is syncope, and it really is common among children. It starts during the toddler years with breath-holding spells.  Many in this age group (up to 50%) will hold their breath when they are hurt or angry.

When a child holds their breath while crying (you can just see it happening in front of you) they will often turn a bit blue and “pass out”. This is a type of fainting. This can be very scary for parents who have never seen their precious child have such an attitude and then hold their breath over not getting the cookie? Yes, this is a normal part of being a toddler! They are very emotional and labile at this age (foreshadowing for teen years?) and most toddlers don’t have a lot of language yet, so when they get mad or frustrated they just SCREAM! But, while screaming, the child forgets to take a breath, and then the brain and autonomic nervous system takes over and the breath holding leads to fainting.

The breath holding spell, as scary as it is, is just a form of fainting. It will not hurt your child, but it may take your breath away!

My advice? Try not to pay attention to your child if they begin having breath-holding spells. It may be hard to “ignore” the first two or three, but these “spells” usually last for months (maybe years) and you do not need to rush to your child when they hold their breath. By calling attention to the event you may inadvertently reinforce the behavior. As a child gets older, the breath holding will stop (but not the tantrums?) and there will be new behaviors to conquer. Do you have a breath-holder? How do you cope? Let us know!

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

Daily Dose

Baby Bling Can Be Dangerous!

1:15 to read

I recently saw a TV segment on “blinging” your baby and toddler. It seems that the latest craze is decking out not only little girls, but also little boys. Being the mother of three sons I can understand wanting to “dress up” boys as well (little boy clothes can be a bit boring) but a few of the models on TV were wearing necklaces. 

Now, a boy wearing a necklace doesn’t bother me at all, but a baby or toddler with a necklace worries me!  This isn’t about gender, rather about safety.  

A necklace is a real choking and strangling danger for babies and young children. I know that many parents receive necklaces for their babies on the occasion of a baptism and in some cultures an infant is given a necklace made of string or beads to wear soon after birth. 

But, whenever a baby comes into my office with a necklace on I discuss the possibility, even if remote, of the child suffocating if the necklace gets caught or twisted around the child’s neck. There is no reason to even risk it! 

Baby bling is great if you want to put your child in cute shirts, hats, or even trendy jeans. Go for it!  But I would never put a necklace on a child. It is akin to the adage about peanuts...when should a child be allowed to eat peanuts?  When they can spell the word!  

We pediatricians are no longer worried about peanut allergies in the young child, it is the choking hazard that is the real concern. It’s the same for a necklace. Let your child wear it when they can spell the word, or put it on when your 3 year old plays dress up, but take it off once finished. There is no need to ever have a young child sleep in anything like a necklace, or anything that has a cord until they are much older. 

Children ages 4 and under, and especially those under the age of 1 year, are at the greatest risk for airway obstruction and suffocation.  So, put the necklace back in the jewelry box for awhile. You can re-wrap for re-gifting and re-wearing at a later date. Safety before bling! 

Daily Dose

Say No to Tanning Beds!

1.30 to read

I have previously discussed the importance of sunscreen but it is equally important to discuss the risk of artificial tanning and the use of tanning beds. I have emphasized that it is never too young to start using sunscreen, but for some reason teens think that tanning beds are a safe way to tan rather than going outside in the sun.

Not so.....tanning beds are using UVA radiation which can cause mutations in your DNA which can then lead to skin cancers. Dermatologists are seeing an increase in young women (who are more likely to use tanning booths) in their mid to late 20’s with  the deadliest form of skin cancer, malignant melanoma. Many of these women admit to frequent tanning during their teen age years.

Malignant melanoma is different than basal cell carcinoma and squamous cell carcinoma,  the other more common forms of skin cancer. Malignant melanoma may spread rapidly to internal organs and lymph nodes, and if not detected at an early stage,  may be fatal within months to years.

Young girls need to understand the risks of using a tanning bed and should be encourage to use a spray tan or a tan towel to achieve the “glow” that they are wanting. They need to understand the risks that are proven to be associated with tanning bed use. Many teens and young adults are using tanning beds that are provided at their dorms or apartments as well.

If there is a family history of melanoma or unusual moles then the risk may be greater to develop an atypical mole. Those young adults who have tanned need to be followed by a dermatologist who can examine their body head to toe and “map” their moles and identify any unusual moles. At the same time they may be educated as to how to follow their own moles and changes they should be aware of.  Do you know that melanomas may arise anywhere on the body, not only the sun exposed area!

Recent articles have shown that tanning beds may be associated with an increase in non melanoma skin cancers as well. While these lesions may take longer to develop, teens and young adults need to be aware of this risk as well.

The state of California has become quite progressive in advocating for the safety of children and their skin.  California recently passed a law that children under the age of 18 may no longer use tanning beds. Other states are looking at similar legislation. Makes sense to me!

So....... no suntanning and no tanning beds. Rub, wipe or spray on your tan or enjoy beautiful fair skin. Not only is it safer, you don’t have to worry about wrinkles later in life (trust me on this issue!)

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

Daily Dose

Enterovirus Continues to Spread

1.15 to read

Enterovirus infections are in the news and are causing a lot of parental anxiety. While enterovirus D-68 has caused some serious illness in children, especially in the midwest and now spreading to the northeastern states, you have to remember that there are many other children who handle this virus just like a bad cold.

Enteroviruses have been around for a long time...in fact polio is an enterovirus. But thankfully there is a vaccine for polio.  The hundreds of other enteroviral infections continue to cause upper respiratory symptoms, viral meningitis, as well as vomiting and diarrhea.  In most cases when you have many of these symptoms you don’t even think to “name the virus”.

Enterovirus D-68 was first reported in 1968 (so the name) but it was in 2008-2012 when it again began to be identified and was reported in the literature.  Enteroviruses typically peak in late summer and early fall, so this is the time of year that we expect to see a peak in these infections.

The typical symptoms with a  D-68 infection are upper respiratory with sore throat, runny nose, and a cough. Only about 25% of patients are even reporting a fever. In some cases, especially in children who have an underlying history of asthma or wheezing, there have been more severe symptoms with difficulty breathing, wheezing, and respiratory distress. In these instances the children have been admitted to the hospital for supportive care, which includes IV hydration, bronchodilator therapy, and supplemental oxygen.  In some cases a child may require intensive care. Fortunately, there have not been any deaths associated with enterovirus D-68. 

The bottom line? This is yet another respiratory illness that may cause more severe symptoms in some children. We also see this with other viruses such as RSV and flu which will be circulating later this fall and winter.  What parents do need to know is that if your child is sick and seems to be having ANY difficulty breathing you need to call your doctor or go to the ER. 

If your child is sick, keep them home from school. If you are sick don’t go to work or volunteer in the school cafeteria. To stay healthy over the ensuing “sick” season promote good hand washing and cough hygiene. Lastly, everyone over the age of 6 months needs a flu vaccine.

 

 

 

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