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Daily Dose

Your Child's Blink Rate

1:15 to read

Here goes another one of my “you wouldn’t believe this“ moments from my office. A young mother had a list of questions out during her daughter’s 9 month check up. This was her first child, so of course there were lots of questions about feeding, crawling, childproofing the house, and socialization. But, at the end of her list was her “biggest” concern - “ her child did not blink enough?”. 

I must say, I have never given blinking much thought.  And watching your baby’s eyes and counting how often they blink.....really?   But, after reassuring her that I thought her precious baby, with those big blue eyes looking at me, seemed to be perfectly content blinking how ever often she did... I did a little research.

The average person blinks about 15-20 times a minute (I did not see any data specifically referencing infants) or 1,200 times/hour, or 26,000 times/day!  And to think that we don’t even realize we are doing this!  According to some research, blinking is a time for our brain to rest....and go “off line” for a second. If this is a time for brain rest...I am going to try and blink more often.

While stress and anxiety may cause an increase in the “blink rate”, intense concentration may cause a reduction in blinking. Maybe this little 9 month old is on to something...she is concentrating so hard on all of those developmental milestones like crawling and pulling to a stand that she has reduced her “blink rate”. Or maybe she will be a great poker player one day as she can keep those eyes on the cards and the other players and never blink!

You learn something new every day :)

Daily Dose

Babies & Bow-Legs

1.15 to read

Fact or fiction: if a young baby puts any weight on their legs they'll become bow legged? Dr. Sue weighs in.I’m sure you have noticed, babies like to stand up! With that being said, I still hear parents coming into my office who say, “I am scared to let my baby stand up as my mother (grandmother, father, uncle) tells me that letting a baby put weight on their legs will cause bow-legs!  How is it possible that this myth is still being passed on to the next generation?

If you look at a baby’s legs it is easy to see how they were “folded” so that they fit inside the uterus. Those little legs don’t get “unfolded” until after delivery. A newborn baby’s legs continue to stay bent for awhile and you can easily “re-fold” those legs to see how your baby was positioned in utero. Almost like doing origami. So, how do those little bent legs get straight?  From bearing weight. If you hold a 3-5 month old baby upright they will instinctively put their feet down and bear weight.  A 4 month old likes nothing more than to jump up and down while being held. They will play the “jumping game” until you become exhausted. That little exercise is the beginning of remolding the bones of the leg, while straightening the bones. If you look at most toddlers many do appear bow-legged as the bones have not had long enough to straighten. Over the next several years you will notice that most children no longer appear bow legged. For most children the bow legs have resolved by the age of 5 years. I child’s final gait and shape of their legs is really determined by about the age of 7 years. Next time you hear the adage about bow legs, you can politely correct the myth. Standing up is going to make that baby have straight legs! That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Teaching Kids How To Swallow A Pill

1.15 to read

I received a question via our iPhone App from 16 year old Steffi. She writes: “I take 4 pills a day and can not swallow them! When I try, my tongue pushed the pill to the roof of my mouth. HELP!”

 

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies!

 

So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

 

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned.

 

I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home).

 

We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down.

 

When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing).

 

For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!).

 

Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow!

 

I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger.

 

Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"!

 

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Study: Treatment for Colic

A new study looks a treatment for your baby's colic. Having had a baby who suffered with colic, I am always interested in reading any new studies that are related to new findings on treating colic.

Colic, which affects up to 25% of all infants, results in frequent and inconsolable crying throughout the day, and seems to have no "known" etiology. Parent's are at their wits end and are ready to do anything to help console their baby (yet alone get some rest themselves). I am convinced as both a parent and a doctor that the person or persons that discover the cure for colic will not only win the Nobel Prize, but will also win the hearts of every parent who has ever suffered "with" their colicky baby! A study in the March, 2011 issue of Pediatrics from researchers at the Peninsula Medical School in the UK, looked at 15 different studies of over 940 babies and different treatments for colic.  These studies included complimentary and alternative medicines that have been used including supplements, herbs, sugar water, probiotics, massage and reflexology. The review basically showed that none of the "treatments" were found to work consistently and the study design was even often flawed.  There were some "encouraging results" for fennel extract mixed herbal teas and sugar water, but all of these needed further study. So, once again it comes back to the basic tenet for treating colic, "Tincture of Time" and "TLC". I'll keep reading and for those of you looking for a "fix", I assure you I have felt your pain, and the only thing I can add is "this too shall pass".  None of these medicines is easy to swallow! Do you have a favorite treatment for colic? Let me know and we’ll share it.

Daily Dose

Swollen Lymph Nodes

1:30 to read

A parent’s concern over finding a swollen lymph node, which is known as lymphadenopathy, is quite common during childhood.  The most common place to notice your child’s lymph nodes are in the head and neck area.

Lymph nodes are easy to feel  around the jaw line, behind the ears and also at the base of the neck, and parents will often feel them when they are bathing their children.  Because young children get frequent viral upper respiratory infections (especially in the fall and winter months), the lymph nodes in the neck often enlarge as they send out white cells to help fight the infection. In most cases these nodes are the size of nickels, dimes or quarters and are freely mobile. The skin overlying the nodes should not appear to be red or warm to the touch. There are often several nodes of various sizes that may be noticed at the same time on either side of the neck.   It is not uncommon for the node to be more visible when a child turns their head to one side which makes the node “stick out” even more.

Besides the nodes in the head and neck area there are many other areas where a parent might notice lymph nodes.  They are sometimes noticed beneath the armpit (axilla) and also in the groin area.  It your child has a bug bite on their arm or a rash on their leg or even acne on their face the lymph nodes in that area might become slightly swollen as they provide an inflammatory response. In most cases if the lymph nodes are not growing in size and are not warm and red and your child does not appear to be ill you can watch the node or nodes for awhile.  The most typical scenario is that the node will decrease in size as your child gets over their cold or their bug bite.  If the node is getting larger or more tender you should see your pediatrician. 

Any node that continues to increase in size, or becomes more firm and fixed needs to be examined. As Adrienne noted in her iPhone App email, her child has had a prominent node for 7 months. Some children, especially if they are thin, have prominent and easily visible nodes.  They may remain that way for years and should not be of concern if your doctor has felt it before and it continues to remain the same size and is freely mobile.  Thankfully, benign lymphadenopathy is a frequent reason for an office visit to the pediatrician, and a parent can be easily reassured.

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

Daily Dose

Do Essential Oils Boost Immune System?

1.30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 

 

 

Daily Dose

The Facts About Mono

The chatter with moms at a recent school function revolved around a case of mono at school. The mothers were all concerned that their own child had been exposed to the girl with mono and when they were "all going to get mono". They were also concerned that the "index" case of mono was still attending school. "How could this be?"

So here is some accurate information about mono. Mononucleosis is a viral infection that is caused by the Epstein-Barr virus (EBV). Mono, also known as the kissing disease, is commonly thought of as a teenage illness. But, many younger children may be exposed to the virus and have very few symptoms, several days of fever and feeing badly, and develop life long antibodies to EBV. Older children and adolescents usually exhibit fairly classic symptoms including a horrible sore throat, fever, headache, puffy eyes, fatigue and just feel dreadful during the acute phase of the illness. The fever and sore throat are persistent and when you see the child's throat the tonsils are very large and covered in white (exudate is the medical term), and their cervical lymph nodes are huge and tender. In some cases the spleen enlarges, as do lymph nodes in the groin and under the arm. Occasionally there is a rash. Mono is diagnosed with a blood test, not a throat culture. The rapid mono test detects antibodies to EBV, so it takes several days of being symptomatic before the test is positive. Most people with mono never know when or where they were exposed to the virus. The virus is shed in saliva (hence, "the kissing disease"), and body fluids, and may be transmitted by drinking or eating after someone else. It is often four to seven weeks after exposure before you develop symptoms, so the girl in the class is not going to make you sick to tomorrow or the next day, and you can not get mono from her by sharing her books or sitting next to her at the movies. Good reason not to share drinks! The treatment for mono is entirely symptomatic as it is due to a virus. Rest is paramount as the fatigue from mono may last for several weeks. I give patients medication to control their fever, pain relievers for the sore throat and general aches, and good nutrition and rest as they feel better. The initial symptoms usually last for five to 10 days but the fatigue may last for several weeks. I limit physical activity and after school activity until the fatigue has improved and they have returned to normal school days etc. This is the hardest part, as your teen wants to go back full steam ahead, but slow and steady wins this race and within a month they are back to normal. That's your daily dose, we'll chat again soon.

Daily Dose

Antibiotics

1:30 to read

Fall is here and winter is just around the corner, which will usher in another “sick season”. I am already thinking about illness as I just finished reading a JAMA article about the overuse of antibiotics.  Did you know that the CDC estimates that “30% of antibiotic prescriptions in the U.S. are unnecessary”? 

The CDC reported that the majority of these misused antibiotics were prescribed for viral upper respiratory infections including the common cold, bronchitis and sinus and ear infections.  Which gets me back to “sick season” and the busy pediatric office.

Parents frequently bring their child in for one of the many viral upper respiratory infections that a child has, especially in the first 5 years of life, and “assume” that they will receive an antibiotic. In fact, I am still amazed that with all of the news about “superbugs” and emerging antibiotic resistance, some parents continue to “push” for a antibiotic because their child has had a fever, cough and runny nose for several days.  

The head of the CDC recently stated, “antibiotics are lifesaving drugs and if we continue down the road of inappropriate use, we will lose the most powerful tool we have to fight life threatening infections”.  In other words, we doctors need to be very judicious when deciding to prescribe an antibiotic and patients need to ask questions as to the necessity for taking an antibiotic.  It seems much too often I hear a parent say to me, “I am sick as well, so I went to the doctor who gave me an antibiotic for my cough and congestion, why aren’t you going to give an antibiotic to my child?”.  They often follow this statement with, “I felt so much better after being on an antibiotic for several days….”, but I actually think many of them felt better as they were getting better on their own and not due to the antibiotic.

In this JAMA article it was noted that “prescribing rates were highest in children age 2 years and younger. (who also get the most viral URI’s in a year) . There were also distinctions in prescribing practices by region of the country with the West having a lower rate of antibiotic prescribing than the South. 

So…looking forward to “sick season” I may be quoting this JAMA article when I once again explain to a parent, or a child….that their fever, cough and cold is due to a virus and that there is not the need for an antibiotic. In fact, a parent might want to boast, “my child has never been on an antibiotic”...which is a good thing. Save the prescription for a time when it is really warranted, and at the same time “pay it forward” by helping to prevent even more antibiotic resistance in this country.

Daily Dose

Kids Learn Tech Skills Before Life Skills

New study days that young children are learning how to use a an computer or Smartphone BEFORE they know how to ride a bike!Did you happen to see the new study which was just released by software maker AVG Technologies?  The company solicited 2,200 mothers to answer a survey looking at skills their children have; riding a bike or tying a shoe as well as those very important early childhood skills such as how to use an iPad or Smartphone!

While 21% of 4-5 year olds knew how to use a Smartphone or iPad application, only 14% of those same kids could tie their shoes. For children 2-5 years, 69% could operate a computer mouse, 58% could play a computer game but only 52% knew how to ride a bike (I am assuming that means pedaling a tricycle or a bike with training wheels for that age?). Seems incredible to me that more kids have computers than tricycles?  Also, 25% of 2-5 yr olds could open a Web browser, only 20% knew how to swim.  Technology is definitely changing the world, but is it all beneficial? The CEO of AVG Technologies commissioned the survey to show how young children are interacting with technology. He emphasized that parents need to be educating their young children about their online world and need to be promoting internet/online safety at very young ages. It used to be “when do I have the sex talk” now it is being replaced with ”how soon do I need to talk about online safety and technology?”. Obviously, if one looks at this study, the latter needs to come much sooner than one might think.   If you don’t teach children online safety early on, they might just find “the sex talk” online anyway, even before they can perform some very basic life skills like writing their own name. But the most disturbing aspect of this study is that it suggests that our children are way too wired and may be missing out on simple, yet important life skills. I myself have seen many a two year old open their parent’s iPad and turn on a movie while in the exam room.   They can recognize different icons and switch between applications but are not yet capable of talking in complete sentences. Some of these children are the same ones who at two years are not yet putting themselves to sleep at night, cannot sleep through the night and still have a bottle or pacifier!  Some parents are convinced that their child may not be capable of mastering these normal developmental milestones, while at the same time are thrilled about their child’s computer skills. Seems a little mixed up to me. Priorities sometimes get confused. As I have discussed many times before, it is important for children to have time to explore, create and use their imagination, without the benefit of constant technology.  I can remember when Velcro tennis shoes came out and our boys wanted those shoes. But, before succumbing to Velcro we felt it was important to learn to tie a shoe. Once that skill was mastered, Velcro shoes became a favorite, even if just for a while. Of course, as with many things, the Velcro lost its allure and they were back to tying shoes by middle school.  The basics have staying power. Technology is important and will continue to be so, but what if the computer is “down” and you need to write a story with pencil and paper, or draw a picture without the benefit of a computer screen. There are certainly many life skills to be mastered, the list is too long. What about pumping a swing, jumping rope, playing ball, and just being a kid.  The race to teach kids technology and to help them compete in our constantly “wired” world may be detrimental to a child’s physical and emotional health. We as parents need to remember to “turn off the technology” and get back to basics. There is time for both. What do you think? Leave your comments below.

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