Daily Dose

RSV

1:30 to read

Flu season seems to be winding down but RSV (respiratory synctial virus) season is still here and actually arrived a bit later than usual this year. RSV is a common upper respiratory infection that causes cold symptoms with cough, runny nose, congestion and in some cases wheezing.  

But when new parents hear that there is RSV in their day care or school they often “freak out”. While RSV may cause cough, wheezing and respiratory distress in some young children (more commonly in those with underlying lung or cardiac disorders), thankfully for most it is just a really bad cold!

Statistically, 2% of infants less than 12 months of age are hospitalized for RSV each year.  But, that also means that 98% of infants do not require hospitalization!!  Much better odds that your child will be okay than if you play the lottery, right?

It really doesn’t make much of a difference as to which virus causes your child’s (or your) cold.  What is more important is how your child is breathing!!  Because a baby’s nostrils and airways are smaller, it is not uncommon for parents to be concerned that their child sounds noisy when they are breathing. I think it is more important to look at how your child is breathing rather than listening to their stuffy nose and coughing. This means that you need to take off their t-shirt or jammies and actually look at their chest, and make sure that you cannot see their ribs pulling in and out, or see their abdominal muscles doing work of breathing. You should also not see your baby’s nostrils flaring or see any change in their color...always pink, never dusky or blue!  The cough with RSV is horrendous and sounds terrible as well, but look at how they are breathing and their color when coughing.

It is also important that your child stays hydrated, even though they may not take their bottle or fluids as well as usual. You should always see “spit” in their mouths and tears when they cry and wet diapers (may not be sopping, but wet).  Remember, you probably don’t want to eat as much when you are sick yourself. Offer more frequent feedings. No schedules when your child is sick.

Best treatment, suck the mucous out of your baby’s nose and turn on a cool mist humidifier. They may also feel better when more upright, that is probably why there are many nights with a baby spent rocking on your shoulder when they are sick.

If you have any concerns about how your child is breathing you should always contact your doctor...better be safe. 

Daily Dose

College & Alcohol: A Dangerous Mix

1:30 to read

I have been reading and watching news reports surrounding the University of Virginia article in Rolling Stone and the recent trial of several Vanderbilt University football players charged with rape. I guess it has weighed heavily on my mind as I have had three sons in a fraternity at a large state school, as well as taking care of more than several young women (patients) who have said they were sexually abused while away at college.

To begin with, and I have said this before, my husband and I began talking to our sons, at rather young ages, about how you “treat” girls. This began with explaining to them that there is a “difference between boys and girls”, and I say this as a woman, wife , mother, physician, and now grandmother to a little girl.  

So...we taught our sons that when a girl says “NO” it always means “NO”, no matter the circumstance.  This conversation became even more direct as they got older and started dating.  Now that they are adults, I can only hope and assume that they listened!

I believe in gender equality, but i do think there is a difference between boys/girls, young men/young women and that difference comes when both genders begin drinking alcohol and getting drunk.  My patients will tell you that I discuss this with each of them as they leave for college. While boys get drunk and do some very scary, inappropriate and dangerous things...they do no get raped by a drunk girl. 

In all of the girls I have taken care of, and also in the case of so many other college women in the news, there was excessive alcohol when a sexual assault took place.  Binge drinking on college campuses is one the the biggest problems being tackled by many universities across the country.  But sexual assault and abuse is another university problem that continues to exist.

Back to differences....a girl/young woman who is drunk cannot protect herself, often cannot recall “he said/she said” and sometimes awakens from a drunken stupor without her clothes on. It distresses me to write this. Whether it was consensual, or rape...it is often unclear when the girl was drunk.

Talk to your sons and daughters about this epidemic.  I tell my female patients, and I will tell my grand daughter one day "it is your body and the only way to protect yourself is to be of clear mind...if you drink you need to be able to take care of yourself and always be aware of what is happening". It cannot be a “blurry” memory.

Daily Dose

Diagnosing Eczema

After examining her cute daughter, who scratched her skin throughout our discussion, it was pretty clear that she had "nummular eczema".I saw a child in the office today whose mother was concerned that she had "ringworm gone wild". She told me that her daughter had numerous places "including several obvious ones on her face and eyelid". They seemed to be spreading, and she was using antifungal medication from another doctor. Despite this they were "overtaking her body".

The first thing I thought is this is probably NOT ringworm with so many areas involved. It is fairly uncommon to see that many areas of involvement with the "dreaded ringworm" which is a fungal infection on the skin. She also made me laugh when she said she had considered leprosy in her diagnosis, but didn't think the Google description matched. Gotta love the Internet. After examining her cute daughter, who scratched her skin throughout our discussion, it was pretty clear that she had "nummular eczema". These coin shaped dry, scaly, inflamed and itchy lesions are just another form of eczematous dry skin and are often confused with ringworm. They are usually in scattered areas chest, legs, arms, and in this case had become secondarily infected due to the persistent scratching, so they looked even nastier than usual eczema. Much relief by all that we could clear these up with several medications and not ship her off to the leper or ringworm colony. So before jumping to ringworm gone wild, consider eczema and particularly nummular (coin shaped) eczema. That's your daily dose, we'll chat again tomorrow!

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

Booster Shots

1:00 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

Peanut Allergies

1:30 to read

Did you see the New England Journal of Medicine article which was recently published regarding peanut allergy? Interestingly, the study out of the UK seemed to confirm what some of us “old school pediatricians” had thought... the previous recommendation that babies and toddlers avoid peanut products in the first year of life may actually lead to more peanut allergies in children who are already at risk for developing food allergies.

In the late 1990’s allergists were concerned about the rise in peanut allergies and recommendations were made to delay introduction of peanuts (as well as some other foods).  At the time it did seem strange seeing that children born prior to this were raised on peanut butter...but like many things, nothing stays the same, right?

But over the years, the increase in peanut allergies continued, despite the fact that mothers were not eating peanut products during their pregnancy or while breast feeding and parents were delaying the introduction of peanut products until their child was 2 years of age. When the data from this period was analyzed, instead of seeing a decrease in children with peanut allergies... the incidence of peanut allergies continued to increase.

So, in 2008 the AAP changed their recommendations and again encouraged parents to let their children eat peanut products in the first year of life just NO peanuts due to the choking hazard.  But many parents continued to be wary...in fact some, who had no history suggesting allergies ( eczema, wheezing, family history of food allergies), would actually bring peanut butter to my office for a trial. One mother came for a quick “house call” one day and I handed her child (who was 20 months at the time) a peanut butter cracker I was eating and her mother “freaked out”.  Fortunately, the child loved the cracker and no issues with peanut butter either. She was thrilled when she left with another cracker in hand 

This article was just the first of many studies being undertaken to “help solve the puzzle of food allergies”. There is so much about this topic on the horizon but in the meantime, if your child does not have a  history to suggest allergies I would try introducing peanut butter, almond butter, as well as eggs and dairy to your child. If you have a family history of food allergies, or concerns talk to your doctor about beginning these foods earlier than later even if that is in a controlled situation in the pediatrician’s or allergist’s office.

I can’t wait to give baby granddaughter some of these foods as well (she just started to get some veggies) and peanut butter is not far behind.  I did “sneak” her a morsel of pancake the other morning...you should have seen that smile.

Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Do Your Kids Drink Milk?

1:30 to read

I have noticed over my years in practice that fewer and fewer patients  drink milk every day. You may wonder why I ask the question, “does your child drink milk?”.  Calcium is an important nutrient which in necessary for healthy bones. But you have to put that calcium into your bones when you are a child and adolescent which means milk at meals. By age 18 years about 90% of your peak bone mass has been laid down.

Most children that I see are not drinking many soft drinks...in fact, many tell me they don’t like “fizzy drinks” at all...even on special occasions they would prefer “fancy waters”.  But, when I ask them what they drink at dinner they often say, “water”. I then ask their parents if they even pour milk for their children and they too say their child prefers water.

I am not sure how water became the preferred drink among many of my patients. When and how did parents and children decide that children need to drink a certain amount of water a day. I have never found any recommendations about water consumption in healthy children.  But there are recommendations regarding calcium and Vitamin D intake.

Children between 1-3 years of age need 700 mg/day of calcium, while 4-8 year olds need 1,000mg/day and 9-18 year olds need 1,300mg/day.  It is also recommended that all children between ages 1-18 years receive 600IU of vitamin D a day.  The best way to meet calcium and vitamin D needs is through food sources, including milk.  

With statistics showing that less than 15% of adolescent girls in the United States meet the recommended dietary allowance for calcium, many young girls may be setting themselves up for osteopenia and osteoporosis in their adult years. 

Exercise is equally important for maintaining bone health...which means more time outside or in the gym, rather than in front of a screen!

Change your habits and start pouring milk with your child’s meals and then go outside and get some vitamin D and exercise.

Daily Dose

Jaundice in Your Bbay

1.30 to read

Newborn infants will often experience an elevation in their bilirubin (one mother thought it was “belly robin”) levels in the first several days after birth. This makes the baby appear to be yellow or jaundiced.  

Parents may hear their nurses discussing a baby’s TcB (transcutaneous bilirubin) level, and some nurses may even show parents the nomogram which the hospital uses to chart bilirubin levels.  It seems there is now a lot of anxiety among new parents about what this all means and in most cases the levels are to be totally expected.  I continue to think, “too much information for a brand new parent may be harmful to their health”. I want parents to be informed, but only if there is a problem. Is a bili of 7.4 really any different than 8.2?  Do you need to be up at night worrying about that? The answer is no - I will be up at night if necessary and let you know.   Knowing your baby’s hourly or daily TcB is not necessary and in fact, in my experience they often do not correlate with actual serum bilirubin levels.  

Newborn jaundice is due to the fact that infants break down red blood cells in the first several days after birth which causes the release of bilirubin. Bilirubin excretion is also facilitated by the liver, and just like everything else in a new baby....it isn’t in full working mode quite yet. It takes a few days for everything to kick start. At the same time a breast fed baby may be more likely to  get jaundiced  due to the fact that they often don’t pee and poop as much a formula fed baby....that all corrects itself once the mother’s milk is “in”. Lots of recent articles about this...be reassured.

If your baby does have a problem with higher bilirubin levels, which typically occur somewhere between days 2 -7, then your doctor may recommend phototherapy with special lights that help to breakdown the bilirubin in the skin. This may be done in the hospital or even at home under a contraption called a “bili -blanket”.  Once the bilirubin levels drop the lights are turned off!

But, what did our mother’s say long ago, “don’t ask for trouble”. Ask your doctor before you start to worry and remember a little yellow is to be expected.  

Here is a picture of one of my newborns in their bili -blanket at home! Looks pretty comfy to me.

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