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Daily Dose

Best Baby Age?

1.15 to read

How much fun is a 4-6 month old baby?  I just love this age, and if you have a baby of your own, you probably know what I mean.  I call this age a “chia baby”!  They are just perfect and “low maintenance” like the “chia pet”. 

Think about it, this precious aged baby only requires “watering”, i.e. they just drink - no real food yet, so no meal planning or mess to clean up.  They don’t move , so you know where they are at all times, no looking for them under foot, or worrying if they will be home on time. They sleep for at least 6-8 hours at night (those early months were much more exhausting) and typically wake up with a smile on their face.  

When you talk to this age baby they smile, babble and laugh at whatever you say.  They think you are funny and clever (not always the case during their teen years), even when you might not be.  A 4 month old baby packs up easily and can travel, just like moving a “chia pet” from one window sill to another.  (wait till toddlerhood and trying to convince the same child to sit still on a plane).   

I am always ready to take a 4 month old baby home with me for a few days.  I tell the parents at the 4 month check up that I will gladly babysit . I just wish I could keep a 4-6 month old baby around at all times.  I do believe that this stage of infancy is “God’s gift to parenting”.   

Don’t worry, there are many different stages in a child’s life that are also special and “perfect”, but this is just the first one. This stage is well worth the first months of sleep deprivation and exhaustion!  If you have a younger baby, hang in there, it’s getting ready to get really fun!

Daily Dose

Pool or Trampoline? The Safety Debate

1.00 to read

Both pools and trampolines are fun for children, and both do pose dangers.I saw a patient today who asked me my opinion of trampolines. It seems that she and a friend, both of whom have elementary school age children, are having a discussion about trampolines. My patient is totally against having a trampoline in her yard, although she has a pool. Her friend says that it is safer to have a trampoline than a pool. And so their debate continues.

Both pools and trampolines are fun for children, and both do pose dangers. But as my own children often told me "according to you Mom, everything that is really fun, is dangerous!" The biggest issue surrounding children playing in pools and jumping on trampolines is parental supervision. When children are taught safety and are given rules to follow that are then enforced, they may have fun and be safe at the same time. Pools are fenced, and gated. Parents watch their children swim. This is usually the party line. But trampolines also require the same amount of supervision and many parents don't realize this. Most trampoline injuries occur when children are unsupervised. Many serious trampoline accidents occur when children of disproportionate weights are doubling jumping and the smaller child becomes a missile and is thrown from the trampoline when serious neck injuries may occur. Trampolines are also safest when they are buried in the ground or have safety nets on the side. Letting children jump unsupervised is as dangerous as swimming alone. So, I can't resolve this friendly discussion, but I do know that both pools and trampolines require parental supervision and strict safety rules to ensure the safest possible experience. And yes, they are both fun! That's your daily dose, we'll chat again soon.

Daily Dose

4th of July Celebrations!

1:30 to read

The 4th of July weekend is right around the corner, which means many families will celebrate with a long weekend with other families and friends. Let’s remember the importance of making it a safe holiday!   

Of course the celebration includes fireworks which are definitely fun to watch, but at the same time, when they are used by consumers (many of whom are children and teens) rather than by trained professionals, there are many associated risks.  Being on call in the ER as a new doctor was one of the scariest and longest nights in my life...and I can remember seeing children with burns...several which were disfiguring. Burns remain one of my biggest fears.

In 2013 there were an estimated 11,400 people treated in emergency rooms for fireworks related injuries, and the risk of fireworks injury was highest for children ages 0- years, followed by children 10-14 years. I know that having fireworks in your backyard or on the beach is fun, but also dangerous. Although I was used to my boys saying, “ Mom, you tell us that everything that is fun is too dangerous...which not only included fireworks, but trampolines, and motorcycles.”  I am sticking to that.

The majority of fireworks related injuries were to the extremities followed by those to the head (eyes, ears, face).  The greatest number of injuries were caused by small firecrackers, sparklers, and bottle rockets. Did you know that a sparkler burns as hot as 1200 degrees F, while water boils at 212 degrees F and wood burns at 575 degrees F!! Even a left over sparkler may cause a significant burn to little hands.

Fireworks are best left to the “hands” of the experts. Fireworks are dangerous and can be unpredictable, especially in the hands of amateurs (including parents).  Public firework displays are equally enjoyable and are carefully planned and executed. Especially with drought conditions and fires already raging in parts of the U.S. it is especially important to be aware of the risk of inadvertently setting a small fire from a misguided bottle rocket.  That small fire may lead to an even bigger fire which destroys acres of land as well as puts firefighters themselves at risk. No one wishes for that scenario but there were over 17,500 fires caused by fireworks in previous years. 

Start planning your holiday fireworks viewing now....from a safe venue! Happy 4th!

Daily Dose

Timeout!

1.30 to read

When I am seeing toddlers for their check ups, the topic of behavior is usually at the top of both the parent’s and my list for discussion.  Once a child is walking and beginning to talk, all sorts of new behaviors seem to occur! 

Parents ask, “how do I stop my child from hitting or biting?”  “What about misbehaving and not listening?”  The toddler years are challenging for behavior as a child is gaining independence, and testing as well.  Toddler and teens have some of the same attributes and it is important to begin behavior modification during the toddler years. 

Time out is the most commonly used behavior modification and not only will parents use this method at home, but preschool and day care teachers begin using this technique as well. This is the age that children begin to understand rules and consequences. 

So how do you “do” time out and when?  I usually start using time out when a child is between 15 -18 months of age. While I try to ignore and distract tantrums, I use time out for biting, hitting and those age appropriate yet inappropriate behaviors. 

I pick a chair in the house (we had a small set of table and chairs which seemed perfect) and every parent needs a kitchen timer to use for time out.   It is important to get at your child’s level when disciplining them as well. Tell them why they are going to time out and then have them sit in the chair for 1 minute per year of age.  (Trust me a minute sometimes feels like forever!)  

Here is the trick, if your child will not just sit in the chair (and many won’t), go behind them and hold them in the chair as if you were a human rope.  In most cases the child will be crying and trying to get up out of the chair, but you calmly hold them in the chair from behind. No eye contact!  Once the timer goes off, you let go of them, go back around so that you make eye contact again, get down to their level, and explain once again that they had to sit in the chair because they (fill in the blank).  

Time out takes time and patience.  If you are consistent about using time out for misbehaving, your child will learn to sit in the chair.  For some it may only take 1 time and others are more head-strong and it may take months of “human rope” before they decide to sit alone. 

Don’t give up!!!  This is a very important lesson for children to learn and you will use time out many times, not only in that little chair, but in other venues as your child gets older.    

Daily Dose

Dealing with Warts

1.30 to read

Warts are one of the most common skin lesions seen in pediatric practices. Warts also drive parents and some kids crazy!  According to one study up to about 1/3 of school children have warts.  

Warts are viral infections of the skin which are caused by human papilloma viruses (HPV).  There are more than 100 types of HPV and different types of HPV cause different types of warts. The most common warts on hands and knees are caused by HPV types 1,4, 27, 57.  These are not the HPV types that cause sexually transmitted infections 

Some people seem to be more prone to getting warts than others, and it is not uncommon to see several children in one family dealing with warts. The HPV virus is spread through skin to skin contact or through contaminated objects or surfaces. In other words, they are hard to prevent.  HPV can also have a long incubation period, so when parents ask, “Where and when did my child get this wart virus?”, my answer is typically, “not even the CIA will be able to tell you that”.  

I many cases if the warts are left alone they may resolve on their own in months to years (one study showed two thirds remission in 2 years) ......but with that being said, most teens (especially girls) want those warts to “be gone!” 

There are several different ways to treat warts and one of the most effective is with over the counter (OTC) products that contain salicylic acid.  Salicylic acid acts as an irritant that activates an immune response against HPV.  There are tons of different OTC products and in many studies there was not one product that proved superiority over another, so I would buy an “on sale” salicylic acid for starters. I know from using these on my own children that you have to be consistent and persistent in their use....but it did work. 

If OTC products don’t seem to be working the next step for those who are determined to try and get rid of the wart,  is to head to the doctor who may try freezing the wart with liquid nitrogen or using cantharidin.  Unfortunately, there is typically a little pain involved with these products. 

Like so many other things, sometimes it may pay to just to wait it out and see if the virus just gives up and goes away!

Daily Dose

Kids Say Some Funny Things!

1.15 to read

Parents, you know you can say all sorts of funny things and now here come cute, clever kids comments.  This has been a week of “kids say the darndest things”.

A verbal little 3 year old came in this week and while I was getting his chart opened on the computer, I asked him “what’s the matter?”. He is the third child in the family and is quite comfortable coming to the doctor and is always chatty. His response was, “I have the God bless you’s”. Now I admit that I was not quite sure what he meant? Then it hit me!  He was sneezing a lot and that was what the “God bless you’s” meant.  How smart is that!

He then proceeded to tell me that he had been sneezing and coughing. He also happens to have asthma, so I asked him if he had been wheezing as well.  His response to all of these questions was equally bright.  He said , “I haven’t had to use my puffer, my “breaving” is okay”.  

I examined him (by this time he is watching a cartoon on his iPad) and he was spot on. His lungs were clear as a bell, he had a clear watery runny nose and his nasal mucosa was swollen. He also had allergic eyes.  He was using an antihistamine but not his steroid nose spray. 

So I “tweaked” his allergy medicines a bit and reminded his mom to have him bathe or shower after he had been playing outside. I also suggested that they use a nasal saline rinse on him as well, as this would help to get the pollens out of his nose after he had been outside, and may be one of the best “cures” for the “God bless you’s”. 

Who says children can’t give a good history? I often find that the young patient is a great communicator and may open a doctor’s eyes to different ways of relaying a new symptom. Whether is from a 3 year old, a tween or a teen, having a patient that you know and that is comfortable talking to the doctor is the key to a good history.  This is was a great reminder!

Daily Dose

The Mommy Voice

1.15 to read

I get a lot of questions from parents about when to start behavior modification. I think in the “old days” this was called discipline! It is a great question and my answer is “younger is better”. This means that a child of about 9 months can start to be re-directed as they start to get into things that are not appropriate, or throw food, or any number of behaviors that are not desirable. 

The interesting thing about starting to let a child know that you do not “like” or approve of what they are doing is how you approach it. So many new parents tell me that they are not going to use the word NO??? Now I guess there must be new words to use like...”stop that” or “please don’t do that” or even this noise that one of my parents used which sounded like ehehehe? I don’t understand why NO has become a forbidden word, but for some parents it seems to be right up there with four letter words. To each his own. 

Well, I am still using the word NO and redirecting children of all ages. But whatever word you want to use to connote disapproval, it also needs to be used with voice inflection. In other words you cannot use a sing song happy voice when trying to discipline your child. 

This does not mean that you need to scream or yell, on the contrary. But it does mean that it is important to change the tone of your voice to let the baby, child, tween or teen know that you mean what you are saying. My kids named this “the mean Mommy voice”. 

I cannot lie and say that I never screamed at my own children as I know that I did (not proud to admit that either). But I really tried to change my voice when I disciplined them, even when toddlers, so that they would understand that this was not Mommy’s happy voice and I did not like what they were doing at that moment. 

This became really important as they got a bit older and tried to “push” a bit harder. After several times of asking them to “quit hitting your brother” or to “please stop yelling in the house” or “to share your toy with your brother”, I would really change my voice inflection and they knew i meant business. They understand that they were on the brink and it was only going to get worse once the “mean Mommy voice” came out. For the most part it really seemed to help and kept things from escalating even more!!
The funniest thing is that when they were older they would tell their friends, “she is using the mean Mommy voice and that means she is really angry, we better stop...” 

When all else failed I resorted to tears...more on that another time. 

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

Daily Dose

Why Is Your Baby Not Sleeping?

1.15 to read

I recently received an email from a mother who was beginning to have new sleep problems with her 6 month old. Whenever I get questions about a 6-9 month old and new sleep issues, most parents relate the problem to either teething and or not getting enough cereal/solids before bed time. 

In fact, new sleep issues often arise around this age as your baby is beginning to think and use those frontal lobes. Many babies had been sleeping for 6-10 hours a night by now and then suddenly begin to awake and they are crying.  This must be pain from teething, right?  So in response to that, many parents start giving their baby a pain reliever, such as acetaminophen nightly, but the sleep problems do not go away and still no teeth! 

At the same time, most babies are eating solid foods beginning around 6 months, and parents were convinced that starting solids would also cure the sleeping issues.  The baby is eating cereal and  waking up in the middle of the night. What gives? 

I think the most important milestone for this age baby to ensure good sleep:  the baby must put themselves to sleep. Many of the babies who are having awakenings are being rocked to sleep, or having the pacifier put back in their mouth all night long.  They are routinely rocked every night and then put down, so when they have arousals (as we all do all night long) they want to be rocked back to sleep, they are smart now and know what they want!   Similar to wanting a back rub every time you wake up, sounds good right? 

While all of this is going on in your baby’s mind your parent mind is telling you it has to be teething pain or lack of food or something worse, and not just a new phase of baby sleep!  Suddenly habits are started, the baby is getting fed in the middle of the night again, or you are giving acetaminophen every night, and typically the arousals continue.  

Sleep is precious for both baby and parent and a baby between 6-8 months of age should be able to not only put themselves to sleep at bedtime, but self console to go back to sleep in the middle of the night. Makes sense but takes a bit of work. This usually requires letting your baby cry for awhile. I am not a propionate of letting an infant cry it out or (CIO as this cute mom emailed), but I do see the need in this age baby. They have to learn to self-console and it is easier to break a bad habit sooner than later. Some babies have more stamina too, so each baby is going to be different in how long they can CIO. 

Practice putting the baby down awake and going back into the room to let them know you are present but not active in getting them to sleep.  Lengthen the time between each visit to their room. Repetition and consistency are the key.  It takes a while but most babies will then get back into even better and longer sleep at night, and you can stop all of that acetaminophen. They get teeth forever (well, at least for 12 years) and that is usually not the reason for waking up. Ask them when they are 5 and getting molars and sleeping well! 

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

Daily Dose

Alternative "Medicines" to Fight a Cold

What are some ways you can fight a cold using alternative medicines?I am still fighting (that is really a descriptive term) my latest cold and the office is engulfed in a cold virus epidemic. Children of every age have runny noses, are blowing noses, and there’s a cacophony of coughs.  So I thought I would finish discussing more alternatives for preventing the common cold and possible treatments.

A mother told me today about something called “boogie wipes” which are supposed to be far superior to a Kleenex.   Now you know that I am frugal but I do buy “fancy tissues with aloe vera etc. According to this Mom you can’t beat these new “boogie wipes” for keeping your nose clean as well as not chapped.  Best hint of the day!! Recently, I discussed the use of vitamins and minerals and their use to combat the common cold, but now want to look at some other interesting options.  Some herbs have been studied as well.  A. paniculata (king of berries) is a popular herb that is used to treat fever, sore throat and respiratory infections. In two different studies in children, one studying Russian children and another Chilean students, both found that those receiving this herb had a shorter duration of symptoms of their colds.  The Chilean study also showed that those who took A. paniculata had a 70% reduction in the number of upper respiratory infections than those given placebo. I found this very interesting!  I think I am going to head to store tomorrow to buy this herb which I had never heard of!  It certainly can’t hurt and I can just add it to all of the other stuff I am taking. What about probiotics (dietary supplements containing potentially beneficial bacteria or yeast)? Probiotics are being used in formulas and foods, to help prevent gastrointestinal issues as well as in the treatment of post viral gastroenteritis (vomiting and diarrhea).  How about to prevent or treat the common cold? A Finnish showed no difference in the symptoms of respiratory infection among those using probiotics as compared to placebo. Another study out of Israel also showed that those who consumed probitoics had no effect on the duration or frequency of respiratory illnesses. Honey has received a lot notoriety lately and is thought to have anti-inflammatory effects in general. Several years ago, a study with parent support reported honey was better for a nighttime cough than cough syrup containing dextromethorphan.  Buckwheat honey is considered safe for use to control cough in children who are over 1 year of age. The most interesting report I found was out of Australia.  This study  which looked at the effectiveness of mind-body therapies in combating cold symptoms. Children received stress management to deal with generalized anxiety and to promote positive self-esteem. Another group received guided imagery and relaxation therapy. The children who received either of these therapies had a shorter duration of upper respiratory symptoms than the control groups.  Many studies have looked at white cell function during times of stress and also So it looks to me like the use of elderberry and stress reduction may hold some value in combating common colds. I know there is much more data to come, but in the meantime it looks like another herb and a nap may help more than my current vitamin/herbal regimen. It certainly can’t hurt. I am also going to get my FLU SHOT tomorrow in hopes of keeping that virus at bay all winter long! That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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