Daily Dose

Treating Sunburn

1.15 to read

Is it hot enough for you and your kids?  I bet every day you look at the weather map and try to figure out the best ways to beat the heat. 

With kids taking the plunge to stay cool, many forget to re-apply sunscreen and end up with a bad sunburn.  Sunburn is no fun and can cause significant problems. 

Sunburns may cause first-degree burns and you know it when you see it…your child’s skin turns pink and red and is uncomfortable, and itchy. 

Sunburn may also cause second-degree burns where the burn actually penetrates the dermis and causes blistering and a deeper burn and more cell damage. With blistering may come scarring and also an increased risk of skin cancer and skin damage later in their lifetime. 

Repetitive sunburns are cumulative and can put your child at even more risk for melanoma. Recurrent sunburns are often seen on the nose, ears, chest, and shoulders. 

You may not notice symptoms until 2-4 hours after the damage has begun. You’ll see redness over the next 12 -24 hours with pain, swelling and blistering. Some children will even develop nausea, fever, vomiting or dizziness after a significant sunburn and are at risk for dehydration. 

The best way to treat sunburn begins by moisturizing the burned area to cool down the skin and reduce inflammation. Try a cool bath or apply cool, wet cloths.  I like a product called Domeboro.  It’s very soothing when added to a bath or to cloths that you can soak in the solution. 

Keep your kids hydrated to replace fluids.  You can also give your child a pain reliever like Tylenol or Motrin/Advil to help with discomfort.  Some children also respond to an oral antihistamine to help with itching. 

Do NOT let your child back in the sun until their symptoms are improved and even then they should wear sun protective clothing as well as sunscreen. Remember, you can even get a burn in the shade, under an umbrella or on a cloudy day. Most of us heard that from our own mother's but unfortunately did not believe it until we ourselves had experienced a sunburn.

 

 

Daily Dose

Getting Your Baby to Sleep!

1:30 to read

Did you know one of the biggest Google internet searches for parents revolves around “how do I get my baby to sleep?”  I guess that any new parent in the middle of the night is online searching for “THE ANSWER”, so of course you “Google it”!

Now that we are grandparents and the baby is about 6 weeks old (although technically she is a week old, as she was 5 weeks early) my son is also looking for answers on the internet to that same question....how to make her sleep, so I can too! He even asked me if their was “magic” to this?

If only there was an answer on Google or in any book. It just takes time and every baby is different.   I guess there are some babies that sleep through the night from the time they get home from the hospital, but I have never seen one.  I think some parents just forget that at some time or another they were up at night with a newborn.

A newborn baby does not understand circadian rhythm and they are really not “trying” to keep parents up at night.  It takes weeks for a newborn to even begin to have some “routine” to their day and I try never to use the word “schedule” when discussing a newborn.  A baby is not a robot, they do not eat every 3 hours and then sleep for 3 more before eating again. They are “little people” and their tummies sometimes need to eat in 2 hours and then later it may be 3 hours before another feeding.  Don’t you sometimes eat an early lunch one day and a later lunch the next? 

But by trying to awaken the baby throughout the day and offering a feeding every 2-3 hours you will hopefully notice after several weeks that your baby is eating more often during the day and suddenly may thrill you and sleep 4 hours at night. it just takes time....YOU cannot make it happen.  I tease new parents that awakening a newborn during the day and prayer is about all you can do....all babies do eventually sleep, but it may not be right after you get them home from the hospital...think several months (as in 2-4) and you will be happy if it happens sooner.

Lastly, with all of the tech in the room, don’t pick up your baby in the middle of the night if they are just “squirming” around. Babies are notoriously loud sleepers and if they are not crying let them be and you may be surprised that they arouse and went back to sleep. If your baby cries you absolutely go get them and console them and feed them too if it is time. An infant should not be left to cry. 

This too shall pass and sleep will come, but there will be new stages down the road that will keep parents up at night, of that you can be assured. Comes with the territory.

Daily Dose

"White Noise" and Babies

1.00 to read

I received an email from Meredith (via our iPhone app) because she had heard that “white noise” might cause a child to have speech/language delays. She used a sound machine in her children’s rooms at night, and was concerned about the possibility of “interfering with their speech”.

So, I did a little research and found an article from the journal Science in 2003.  A study from the University of CA at San Francisco (UCSF) actually looked at baby rats who listened to “white noise” for prolonged periods of time. The researchers found that the part of the auditory cortex (in rats) that is responsible for hearing, did not develop properly after listening to the “white noise”.   

Interestingly, when the “white noise” was taken away, the brain resumed normal development. Again, this study was in baby rats, and to my knowledge has not been duplicated.  But, these baby rats were exposed to hours on end of  "white noise” which may not be the same thing as sleeping with a “sound machine” at night. 

We might need to be more concerned about background “white noise”. We do know that babies learn language by listening and absorbing human speech. They need to hear their parent’s talking to them from the time they are born.  They listen to not only their parent’s speech, but also to siblings, grandparents etc. and from an early age respond to that language by making cooing sounds themselves, often imitating the sounds they have heard. They are also exposed to a great deal of “white noise” or background noise with the televisions being on, computers, telephones, vacuum cleaners, lawn mowers etc. going on all day.  The “white noise” that may be reduced by turning off televisions, videos, computers etc and replacing that background noise with human speech through reading, singing and just talking to your baby and child could only be beneficial. One might surmise that “white noise” in the form of a sound machine at night would not affect a child’s speech development, as this is not a time for language acquisition.

Having a good bedtime routine, reading to your child before bed, or singing them a lullaby will encourage language development, and the sound machine may ensure a good night’s sleep.  Just turn it off in the morning!

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

Daily Dose

Separation Anxiety

1.45 to read

I received an email from a mother who was concerned because her toddler son was crying when they left him at day care.  They were “alarmed” as he had not previously cried when they dropped him off and wondered if this was “normal” or a sign of a problem. Actually, this phenomenon should be quite reassuring to a parent as this is a sign that your child is developmentally on track, and has developed a healthy attachment to his parents. 

All children go through periods developmentally when they are more prone to separation anxiety.  As a new parent you are often concerned about “leaving” your child under the care of someone other than a parent. But, in actuality, it is far easier to leave a newborn or an infant than it is to leave a 8-9 month old.

By the time a child reaches this age they are beginning to show signs of stranger anxiety. In other words, they now recognize the faces and voices of their parents, routine caregivers, siblings etc.

But, when a new person (and face) reaches out for a 9 month old it is not uncommon for that child to suddenly panic and burst into tears. This is not because the “stranger” has done anything at all, but because the child now understands being separated from their parent and may fear that the parent is leaving forever. 

The bond between parent and child has been successfully established, which is quite healthy. This is the beginning of teaching a child that a parent may leave for work, school or even a trip, but that they will return.  Just because a parent leaves for awhile, they are not gone forever. 

This first stage of separation anxiety can provoke feelings of anxiousness in both child and parent, but it is an essential part of normal development. Separation anxiety, like almost all behaviors, varies from child to child. While some childen are more clingy than others, some may just be “wired” in a certain way and are more vulnerable to separating from a parent. Regardless, it is important for a child to begin to deal with healthy separation. 

During the ages of 12 – 24 months separation anxiety seems to peak, and the period of crying or anxiety when a parent drops a child at day care or Sunday school, or even at a grandparents house may escalate. 

While a child may cry after being dropped off, most children will then calm down and may be distracted and will begin playing soon after the parent has left. Again, some children just seem to take longer to adjust, so don’t be alarmed if  one child cries for 2 minutes, while another may take up to 20-30 minutes to settle down. 

Toddlers do not understand the concept of time, and therefore each one may react differently.  While happily playing while the parent is gone, it is not uncommon for the child to cry again upon seeing their parent when being picked up.  For the toddler, the return of the parent may remind them of how they felt when the parent left earlier in the day. 

For most children separation anxiety decreases between 2 -4 years of age as you can explain, and a child can understand, where you are going, how long you will be gone etc. 

For children who have rarely been left with others, it may be more difficult at this age.  Remember, healthy separations are important for both parent and child, and the idea that no one will “babysit” or care for your child other than a parent is not realistic nor does it teach your child to build trust in others. 

The more experience a child has had with earlier normal periods of separation the easier different transitions will be.  Remember, they will all be going to school one day and you want to prepare them for that separation.

Lastly, every child has good days and bad days and almost every child will have a phase when it is harder to separate than others. Just remember to hang in there, be re-assuring to your child when you leave them, do not prolong the departure, and be understanding about their anxiety. As with so many experiences in parenting, “this too shall pass”. 

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

Daily Dose

How is School Going?

1.15 to read

So with everyone back in school, I am already discussing “how is school going?” during my patients check ups. This question is great for kids from 5-18 years of age and you get various amounts of feedback depending on age and gender!  The elementary school set is usually talkative and goes into great detail about their teachers and classmates while most of my high school students just tell me their classes are “hard” and they are “busy and tired”.

The cutest comment came last week from an 8 year old little girl. She had only been in school a few days and when I asked her how it was going she said, “I am nervousited”.  What a great way to sum it all up! Of course she was both nervous and excited. A great way to sum up the start of school.

I think any of us at any age can understand being “nervousited”. The start of any new school year typically comes with excitement about the next grade, or a new school,  and a new teacher.  The start of school also makes many children, as well as their parents and teachers a bit nervous.  New friends to make, new expectations for the next grade level, new lockers....the list is very long for some.

But, I think we parents can help our kids to understand that being “nervousited” is normal and healthy.   Reassurance, good listening to our kids concerns and comments will make the new school year get off to a good start.

I must say I am still “nervousited” with the new TV show each week....but I am hopeful that it gets easier each week, right??  Stay tuned, will let you know if those butterflies go away in the next few months as I get used to this new gig...same as a new class. 

Daily Dose

Farmer's Marker: Family Fun!

1.15 to read

I was lucky to get a few weeks away and to travel this summer and came back with a renewed energy to cook even healthier meals.  If I could, I would plant a garden with a lot more than my few “scraggly” tomato plants, but Texas weather along with my less than green thumb seem to limit me. One of my new passions is going to one of my local farmer’s markets to buy local and fresh produce.  

What I have discovered is that the Farmer’s Market is a fun family excursion, it is free and what a great learning experience. Along the way you also get to buy fresh produce and commit to some healthier eating habits. Win, win, win!

During routine check ups I love to ask kids about their eating habits.  I usually ask “what is your favorite vegetable?”  I laugh at some of the responses, but I am impressed that some children really do love broccoli and spinach and I am convinced it is due to early exposure.  I also ask about favorite fruits and I also like to ask what they have for a favorite dinner and who cooks it.....a subtle way of getting some good information on family meals.

A trip to the market is a great teaching experience too - as children can learn what an eggplant looks like, or that there are so many different kinds of lettuce. Seeing the veggie in “real time” rather than on an I-pad is also important.  Who knew that there are round and long squash and that some looks like spaghetti on the inside?

So as you start back to school and hopefully cooler temperatures in the next month, let’s all try to be healthier.  More fruits, veggies and lots of color on the plate.....I may just try to plant a cucumber, I hear they are easy to grow?  I’ll keep you posted :)

Daily Dose

Head Flattening on the Rise!

1.15 to read

A recent study published in the online edition of Pediatrics confirms what I see in my practice. According to this study the  incidence of positional plagiocephaly (head flattening) has increased and is now estimated to occur in about 47% of babies between the ages of 7 and 12 weeks.  

The recommendation to have babies change from the tummy sleeping position to back sleeping was made in 1992. Since that time there has been a greater than a 50% decline in the incidence of SIDS. (see old posts).  But both doctors and parents have noticed that infants have sometimes developed flattened or misshapen heads from spending so much time being on their backs during those first few months of life.

This study was conducted in Canada among 440 healthy infants.  In 1999, Canada, like the U.S., began recommending  back sleeping for babies. Canadian doctors had also reported that they were seeing more plagiocephaly among infants.  

The authors found that 205 infants in the study had some form of plagiocephaly, with 78% being classsified as mild, 19% moderate and 3% severe.  Interestingly, there was a greater incidence (63%) of a baby having flattening on the right side of their heads.  

Flattening of the head, either on the back or sides is most often due to the fact that a baby is not getting enough “tummy time”.  Although ALL babies should sleep on their back, there are many opportunities throughout a day for a baby to be prone on a blanket while awake, or to spend time being snuggled upright over a parent’s shoulder or in their arms.  Limiting time spent in a car seat or a bouncy chair will also help prevent flattening.

Most importantly, I tell parents before discharging their baby from the hospital that tummy time needs to begin right away. It does seem that some babies have “in utero” positional preference for head turning and this needs to be addressed early on. Think of a baby being just like us, don’t you like to sleep on one side or another?  By rotating the direction the baby lies in the crib you can help promote head turning and prevent flattening.  

Lastly, most cases of plagiocephaly are reversible. Just put tummy time on your daily new parent  “to do list”.   

Daily Dose

Why Vitamin D is Important!

1:30 to read

As a follow up to the blog last week on children, calcium and vitamin D needs, a recent article in a Canadian Medical Journal reports that children who drink non-cow’s milk, such as soy, rice, almond and goat’s milk have lower serum vitamin D levels than those who are drinking vitamin D fortified cow’s milk.

This study looked at 2800 children between 1-6 year olds, and their consumption of either cow’s milk which is all vitamin D fortified and those who drank non-cow’s milk, in which case fortification is voluntary.  The researchers then looked at blood samples to measure vitamin D levels.

The researchers found that children who drank non-cow’s milk had nearly three times the risk for having low vitamin D levels.

So...bottom line...when I am discussing milk and dairy intake with families I am going to reiterate the need to drink cow’s milk, or children may need to continue vitamin D supplementation  and for most parents, including myself, it is hard to remember to give a vitamin or mineral supplement every day for a child’s entire life!).  A glass of vitamin D fortified milk at meals seems an easier choice in most cases.

Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

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