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Daily Dose

Selfies Cause Lice?

Daily Dose, infections, teens

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

RSV is Going Around

RSV is here and can be one of the scariest illnesses for parents of young babies. Dr. Sue tells you what this virus is and the best ways to treat it. Whew, this is a  busy week! Busy for you too, I'm sure. I've seen many coughs, colds and another baby with RSV.  RSV is the acronym for respiratory synctial virus, which is a winter-time upper respiratory infection that causes colds and coughs, but also an illness known as bronchiolitis.

Bronchiolitis is an inflammation of the lower respiratory tract that is seen in infants and young children, often due to a viral infection. At this time of year, throughout the country,  the most common cause of bronchiolitis is RSV.  RSV is seasonal virus, and is  typically seen from November until April, but in recent days and weeks, the number of  young children coming to my office with coughs and wheezing just sky rocketed. Once you hear the frequent, tight, wheezing coughs in the hallways, and listen to a few wheezy babies, you know that RSV has arrived. Unfortunately, in my area it looks like it is going to be a busy RSV season. RSV is a viral infection, and like so many other viruses, including influenza, some years the virus just seems worse than others.  In the last few days I have already admitted several babies who had RSV bronchiolitis, and have required hospitalization for supportive care with oxygen supplementation. Fortunately, they are doing well and no one required intensive care. At this time of year, every parent I see who has brought in their sick, coughing, wheezing baby hears basically the same thing. “Your baby probably has RSV which is a viral infection, somewhat like a cold .” When you say RSV, they all cringe, but you need to understand what you are looking for. When older children and adults get this infection, we get a nasty cough, lots of congestion and have a dreaded winter cold.  But, when a baby gets this infection the virus may cause inflammation and constriction of the lower respiratory tract which results in wheezing and in some cases difficulty breathing. The key point is “difficulty breathing”. Babies who are having difficulty breathing will not only have a frequent tight cough, but they will also exhibit signs of “increased work of breathing”.  This means that you may notice that the infant is retracting, which means that they are using their rib muscles or abdominal muscles to help them breath.  This is a visible sign of respiratory distress, and you will see their chest cage move in and out as they work to breath. Babies may also grunt with each breath, or cough so hard that they turn dusky or blue. All of these symptoms are significant and are need for concern and a visit to the pediatrician.   With that being said, most babies handle the virus and will cough and wheeze and have a lot of mucus and secretions, but will not exhibit signs of respiratory distress. They may appear “pathetic” and cough a lot and be up and down at night due to cough and congestion, but they will not show signs of retracting or increased work of breathing. When your baby has a cold and cough it is imperative that you look at their chests. That means turn on the lights, lift up their jammies or unzip their onesie and look at how they are breathing. Is their chest sinking in with each breath?  Can you see their ribs moving in and out as they are retracting?  Are the using their abdominal muscles to help them breath?  Can you hear a wheeze or grunting or are they just congested and coughing? Lastly, look at their color. A baby who is coughing and turning red in the face is good, a baby with a  dusky or blue face or lips or mouth is bad. It is basic:  red is good, blue is bad! For infants who are showing signs of respiratory distress, they may need to be hospitalized for supportive care, and supplemental oxygen. (there is are recent study about using hypertonic saline treatments for hospitalized babies. It looks interesting).  Because RSV is a virus, antibiotics won’t help.  There are no medications to “fix” the problem.  It is once again “tincture of time” for the illness to run its course. That may mean several days to a week in the hospital for some babies. That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue.

Daily Dose

Treating the Common Cold

Having a cold myself is a sobering reminder that the average cold lasts seven - 10 days and the cough may last up to two to three weeks.I have had this nasty fall cold for the last week, and I gotta say, " I am sick of it!" I am not really surprised that I finally succumbed to my first cold of the season. While I am seeing 20 -30 kids a day with colds, it's not hard to figure out why my own body just waved the white flag and joined the ranks of cold sufferers. But having a cold myself is a sobering reminder that the average cold lasts seven - 10 days and the cough may last up to two to three weeks. That being said, I still have a week to go and I just want to hibernate until it is gone. Unfortunately, that is not reality for most of us.

My sweet patients are always concerned about my health, and then wonder, "What do you do for your cold, Dr. Sue?" That just makes me giggle, as I know they have heard me say a million times, "there is really not much to do for a cold except rest, fluids, throat lozenges, and tincture of time." I wish I had been hiding the secret potion that only doctors can take to make their colds go away in a day. So for the last week I have sucked on any lozenge that people hand me (I personally think lemon helps the most), have had enough hot tea to float a boat, and really tried to get to bed at a reasonable hour, right after that warm bath with eucalyptus oil. Guess what? My cold is still here. If anyone else has the recipe for that "secret cold potion" I am open to suggestions, but figure at least I am half way through it and hope it will stay away until the spring? In the meantime, I am still washing my hands. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Daily Dose

Concussion The Movie

1:30 to read

As the end of football season is upon us, with bowl games for colleges and play offs for the NFL, a week does not go by that we don’t hear about a player who has been diagnosed with a concussion.   The debate surrounding football players and concussions will only get louder after the movie “Concussion” debuts over the Christmas weekend. The movie starring Will Smith will have broad appeal for kids and adults as it is a “sports thriller as well as a medical drama”.  “Concussion” is the story of the doctor, Bennet Omalu, and his discovery that concussions cause long term neurological consequences and his persistence in fighting the NFL. He forced the NFL to admit to the problem and his groundbreaking research has led to ongoing changes in the treatment of concussions both on and off the field. 

As a parent of 3 sons (full disclosure here), I must admit that  our youngest son played football. We had somehow managed to “dodge the football bullet” until the third boy came along. He was the most athletic ( is brothers would tell you that is because they taught him to play “up” with them in any sport”), and starting playing football while in elementary school. ( we are from Texas where football is king). Fortunately or unfortunately, he was good, as was his team, and they all went on to play through middle school where they won the league championship, and then into high school.  He loved the sport, begged us to keep letting him play and despite numerous conversations and our dismay that he wanted to continue to play football, he did play.  Of course we “bought him the best helmets” (not knowing then that studies would show that that is not enough) and we prayed every time he took the field that he would not get hurt.  He did get hurt. During his senior year he suffered a shoulder injury, had major surgery  taking a tendon from his knee to put into his shoulder,  and vowed never to play again!  He also figured out , “that he was not the best player on the team” which does not mean you can’t get hurt.

But, with all of the new studies and good data on CTE (chronic traumatic encephalopathy)  related to head injuries and concussions I called and asked him if he thought he had ever had a concussion???  Certainly, we never noted anything, but again this was 8-10 years ago. But to my surprise and in retrospect he thinks he probably did “have a couple of concussive like events” but he never told anyone about his symptoms…not his parents, coach or trainer…he only missed the end of his senior year due to his shoulder injury, not a concussion.  Thankfully he seems to be okay and is currently getting his MBA and does not even play recreational football.

So after reviewing all of the new data and the guidelines for return to play (RTP) and the the kids I have screened for concussions and kept out of games, I am not sure what I would do today if our child wanted to play football. That is the biggest question that parents are now facing….do you LET your child play football knowing about the risk of head injuries and the possibility of long term injury to a still developing brain??   Injury that may not be reversible?

Th AAP has recently come out with a zero tolerance policy for headfirst hits in football and the Council on Sports Medicine and Fitness has written the policy on tackling in youth football (Pediatrics. 2015 Oct 25) which includes seven recommendations to help make football safer. As Dr. Gregory Landry one of the lead authors states, “participants in football must decide whether the potential health risks of sustaining injuries are out-weighed by the recreational benefits”, and who is to decide, the parent, the under age child or both????

Good questions, but many differing opinions on the answers.

Daily Dose

It's the Sick Season

1:30 to read

Well, the New Year is starting off with a flood….of illness that is.  It is a typical winter in the pediatrician’s office with a bit of every virus you can name. RSV, flu, norovirus, just to start the list.  While so many parents want to name the virus, it is typically not necessary as you treat many viruses in the same manner, symptomatically.  

 

So, if your child is coughing and congested it may be due to any number of upper respiratory viruses, but the most important thing to remember…..how is your child breathing and is your child having any respiratory distress?? I sound like a broken record in my office as I remind our nurses to have parents take off ALL small children’s shirts, gowns, onesies and look at how they are breathing as you never want to miss a child who may be “working to breath”. In many cases, the visual of a child’s chest as they take breaths is more important than any cough they may have.  So remember this: “visual inspection and not just audible”.  Sending me a video of a child coughing is rarely helpful, but a video of their breathing is very important when trying to decide how to guide a parent.

 

Another tip: In most cases if your child is having respiratory distress they are quiet, as they are conserving their energy…which means they are not fighting with their sibling or running around the house, but are often sitting quietly. This also means that when they come to the doctor they are not screaming and yelling in anticipation of the doctor…again, they are usually sitting quietly in their parent’s lap. While a happy quiet child is a pleasure at my office, in a toddler it is not typical.

 

Lots of diarrhea and vomiting in our area as well. In this case, I am always trying to make sure that a child is not getting dehydrated. So, the things to look for include if your child has tears, saliva in their mouth and if they are urinating (having wet diapers).  If your child is vomiting you have to remember to wait about 30 minutes after they have vomited before giving them anything to drink….even if they are “begging for a drink”. Once they have not vomited you need to give them TINY sips of clear liquid and keep offering sips every 10 - 15 minutes. If you do this, in most cases you can keep the child from vomiting repeatedly.  Once they are keeping down sips you can go up in volume.  It is like the turtle and the hare….slow and steady wins!!  

 

With diarrhea alone it is more difficult for your child to become dehydrated, as you can have them keep drinking to keep up with the loss in their stool. Many parent “worry” as their child does not want to eat…and that is ok, the fluids are the most acute issue. You can go without food for quite some time…..don’t you ever skip a meal?

 

Keep washing those hands…and I hope you had your flu shot as I promise…it will come. 

 

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

All About Naps

1.00 to read

Just how many naps should your baby be taking and how long? When you are an adult, there is nothing better than taking a nap. Shouldn’t it be the same for children?  I get lots of questions from parents who ask when their children should take naps; how many times a day they should be napping and when do children stop napping?

Many new parents expect their newborn infants to take regular naps throughout the day (and then to sleep all night) even when they are only 4-10 weeks old. Unfortunately, a newborn’s sleep cycle is not ready for 2 hour naps in both the morning and afternoon followed by a 10 -12 hour extended sleep at night. But, by the time your child is 6-9 months of age (and sooner for some great sleepers); they should be on a good schedule with a morning and afternoon nap.  Naps are usually anywhere from 45 min – 2.5 hours.  I think naps serve a dual purpose, as they provide rest and rejuvenation for both child and parent. Nap time, just like bedtime should be scheduled, typically mid morning and mid afternoon and a child should be able to put themselves to sleep after a book or a story. Naptime routines can be bit shorter than the bedtime routine. You will be able to tell when your child is ready for a nap as they may rub their eyes, or get fussy, or some may just lay their heads down or point to bed as they know they are tired. By the time a toddler is somewhere between 12months – 2 years of age they will usually drop a morning nap and continue to have their midafternoon nap. This is usually right after lunch. Transitioning from 2 naps to 1 nap a day is a little “dicey” at first, as your child may get quite cranky in the morning as you drop that nap, while at the same time their afternoon nap may become longer. This adjustment period usually only lasts several days to a week and then you will find that they are back on a good nap/nighttime schedule. I get asked about stopping a child’s nap. I think naps are important (and as we adults know a privilege) for children until they are in elementary school. Most kindergartens continue to have “rest” time after lunch and many children will fall asleep for 20-30 min while the teacher reads them a book or music is played and the children lay on their mats. Even if your 4 – 5 year old child doesn’t “want” to nap in the afternoon, they need to have quiet time.  This may be for an hour or so in the afternoon, and is time for them to lay in their bed and read, color, play with dolls etc.  I do not think is the time for video games, or computer time etc. Many a child will fall asleep once they are in bed reading and will continue to take a good nap, they just didn’t know that they needed it! Moms, Dads, babysitters etc all need this quiet time too, to get much needed work done around the house, or dinner started etc. It was just a rule at our house that naps didn’t stop until you were in “big boy” school.  A quiet house for an hour each afternoon seemed to make the rest of the day and evening a happier time for everyone! That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Breastfed Babies & Diaper Rash

1:30 to read

I was shopping at Target just the other day and happened to be in the “baby aisle” looking for one of those snack cups with the lids to let little fingers get in and not let the puffs fall out.  I needed it as part of a baby gift basket.  Useful for sure!!

So…while I am browsing, I see a young mother and her mother looking at diaper creams and obviously trying to decide which one to buy. I could’t resist offering help (always worry about being intrusive). When I asked what they were trying to treat the mother said, “ my new baby has this raw and red diaper rash right around his bottom”.  “He is just 12 days old and I change his diaper all of the time….how could he possibly get a diaper rash? What am I doing wrong?”

As we say in Texas, “bless her heart”!!! I asked if she was breast feeding,  and she was,  then I immediately knew what she meant. A breast fed infant will poop ALL OF THE TIME.  Many times you change a new diaper and as soon as the next diaper is put on the baby stools again. There are many times when your infant may poop a bit of stool during sleep and when you get them up they have a dirty diaper…all normal. No new mother guilt!!

The good news is that a newborn who is stooling a lot is probably getting plenty of breast milk as well…and that means they are gaining weight too!  The flip side is that it is not uncommon for a newborn to get that raw red bottom during the first month or so of breast feeding.  After that time, the stools do slow down a bit and diaper rash is less common.

The best remedy I have found for treating that tender new bottom is a combination of a diaper cream that contains zinc (Destin, Dr. Smith’s, or Boudreaux’s Butt Paste) and a bit of a liquid antacid (Mylanta, Maalox, Gaviscon). I put  a blob of diaper cream in my palm and then pour a bit of the antacid into it and mix….you can’t use too much of the liquid or it will run off.  Then I take that combo and coat the baby’s bottom. You can’t over do it. Use it with each diaper change.   It seems to do the trick and is easy. Several years ago I told a mother about the concoction (she had 4 children and was very sleep deprived) and I  just said use some antacid if you have some. She called later in the day and said she had tried to crush up the tablets and mix it with diaper cream and it wasn’t working.  I have since learned to be a bit more specific about a LIQUID antacid.  

 

 

 

 

 

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